martine: October 22, 2019, 7:07pm
Hi all, I would love some input on this. I joined Toby’s webinar in august and have been experimenting with Sa’am
since then in my practice. Still a beginner!
This case is about my son, 16 yo. I find it very hard to find the right diagnosis. And since he’s really very very
scared of needles, I really want to choose the right points!
His main complaint is stubborn acne on his face (mainly cheeks and forehead -ST-meridian and some on the
temples -GB). His facial skin is undernourished according to a beauty therapist, although it feels rather a bit greasy
with red, slightly raised papules and blackheads, cheeks have a bit of a purplish hue.
The skin of his arms and legs are neither dry nor wet.
He is tall and skinny, but with good muscle tone (likes sports), pale, small boned, very symmetrical (a well-known
agency scouted him as a fashionmodel, so his skin is really an important issue to him now). (In herbal terms, he
would totally fit into dr Huang Huang’s ‘guizhi-bodytype’)
He used to crave for sweet food, but has changed his eating habits since a few months now. He has a very good
appetite, can eat a lot and doesn’t get fatter.
Does not sweat easily, rather difficult.
Stool: normal
Sleep: normal, likes to sleep, although moves a lot in his sleep, no nightsweating
thirsty: yes, likes tea and water
no fear of cold
He’s very social, easily makes friends even with total strangers, his behaviour is rather quiet than loud. He is lazy:
whether it’s school, or projects or work: minimum efforts and always believes that ‘everything will come right’.
Has a cyst at his left testicle since 2 years.
Since childhood he easily catches cold, usually at least every autumn he’s coughing for 2 weeks, dry lips.
tongue: light red with cracks
My first idea was: ST excess: dry inside, wet outside (because of the acne), but thinking it over I’m more tending
to LI-excess: dry in and out + KID-excess because I suspect some bloodstasis due to the purple hue on his face +
cyst. But he’s certainly not the LI-‘always busy’-type!
He’s so afraid of needles, but wants to try everything to get his skin better, so I’ll problably can get four needles in.
I would really appreciate some help here.
Thanks!
Martine
KristinWisgirda: October 22, 2019, 8:23pm
Thanks for the case.
Have you seen our case study format?
Case Study Format 25/01/2024, 11:24Acne case question – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/acne-case-question/701/print2/11
Here is a proposal for case a case study format for our forum. I welcome any and all feedback. The goals are to
help you sharpen your Saam diagnostic skills, help your readers see your patient and stimulate conversation
that will helps us grow as Saam practitioners. When presented with the idea of a case study format/intake sheet,
this was Toby’s response: Great idea, basically the Saam diagnosis is interested in everything. I think the Shen
Kuo quote from the lecture is a good starting framew…
It has includes tools that will help you and your readers see your patient better in Saam terms. I know it already
took effort to write up the case but it will be a helpful exercise to go through all of your son’s signs and symptoms
and assign them to the appropriate channels. Rating the signs and symptoms will help you/us see what is really
prominent about him, aka the grossest thing in the room. Give special attention to rating the qualities of the acne-
how red, how greasy, how purple, how prominent are the blackheads.
Since he isn’t a fan of needles, we all want him to get great results fast!
martine: October 23, 2019, 10:56am
Thanks Kristin!
I’ll write the case again in the format.
martine: October 23, 2019, 12:02pm
Chief Complaint: stubborn acne on his face. Location: mainly cheeks and forehead -ST-meridian and some on the
temples -GB. Facial skin is undernourished according to a beauty therapist, although it feels rather a bit greasy +6
acne: red 7+, slightly raised : 5+, small red spots 7+, blackheads: 5+, purple hue on his cheeks around SI-18/ST-3:
6+
Second complaint: (but says he doesn’t want to be treated for that with acu): cyst at his left testicle since 2 years.
Appearance and demeanor: friendly +8, easily makes new friends +9, polite +7, doesn’t talk a lot 4+, Can be
very bored if there’s no screen around. Eyes: +5. Likes expensive clothes. Intelligent 7+, lazy and lack of initiative
+8, doesn’t like hard work
Lifestyle: Student. Sports 3x/week. Likes travelling
Body Morphology and flesh quality: tall and skinny, but with good muscle tone (likes sports), pale skin, small
boned, very symmetrical (is scouted as a fashionmodel). In herbal terms, he would totally fit into dr Huang
Huang’s ‘guizhi-bodytype’.
Skin quality: : skin on his arms and legs are neither dry nor wet. Facial skin: little bit greasy 6+, but also
‘undernourished’ according to beautyspecialist. Does not sweat easily.
Body temp: neutral, neither hot or cold25/01/2024, 11:24Acne case question – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/acne-case-question/701/print3/11
GI: very good appetite, can eat a lot and all the time. Likes fruit. Used to crave for sweet food, but has changed his
eating habits since a few months now. Stool daily, normal shape
Sleep: good sleep, although moves a lot in his sleep, no nightsweating. Late bedtime because he likes gaming
Emotions: positive 7+, easy-going 8+, likes to make jokes 6+, sensitive 8+
respiratory: easily catches cold, usually at least every autumn he’s coughing for 2 weeks, dry lips.
tongue: red 6+, swollen, dry, cracks, thin white peeled coat
Excess presentations:
ST: dry inside, wet outside (greasy skin face + acne)
LI: overall dryness. dry lips. Although he is certainly not the ‘always busy LI-type!’
KID: cyst left-testicle + purple hue on his face
The grossest thing in the room: handsome, little bit shy, very scared of needles!
Main treatment ideas: tonify LU, tonify SI
Hope this will make it easier to help me out. Thanks in advance!
Martine
Ryan_Gallagher: October 23, 2019, 1:39pm
Hi @martine
Thanks for the case. The 3 excesses that pop up for me are:
ST excess (exterior damp, interior dry; acne along ST channel)
KD excess (symmetry, handsomeness, accumulation in the form of cyst and acne)
GB excess (acne = protrusions; acne along GB channel)
So, supplementing LU, SI, and PC makes sense to me. Hope he summons the courage to experience a few needles!
martine: October 23, 2019, 5:59pm
Thanks Ryan!
I wouldn’t have thought GB-excess, as he is definitely not aggressive, but you’re right, the location and protrusions
might be sufficient to point to GBexcess. I’m going to try it!
michaelmax #7October 23, 2019, 7:09pm
Hello @martine
There are two things that stand out for me.
Wet on the outside25/01/2024, 11:24Acne case question – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/acne-case-question/701/print4/11
Blood stasis
Given his symmetry and the purplish color of the cheeks, considering SI makes sense.
Also that he’s dry on the inside and wet on the outside, supplementing LU would be another avenue.
As to the beauty therapist saying the “skin is undernourished” just what the heck does that mean?
martine: October 23, 2019, 7:28pm
Hi Michael,
thanks for your reply. Well, she said that his skin is actually dehydrated, and that’s why blackheads etc become
stuck in the skin and create small inflammations. So her advice was: drink lots of smoothies and more water =
hydration from inside out.
Now that I’m thinking about her explanation from Sa’am perspective, in his case there is dryness inside, so no
moistening from the inside outwards. And when there is no fluid, things become stuck, right? So dryness inside
can’t provide healthy fluids on the outside. His skin is slightly greasy on the outside, but that is not healthy fluids.
Does that sound right?
KristinWisgirda: October 23, 2019, 10:46pm
Thanks for doing the rewrite.
martine:
Excess presentations:
ST: dry inside, wet outside (greasy skin face + acne)
LI: overall dryness. dry lips. Although he is certainly not the ‘always busy LI-type!’
KID: cyst left-testicle + purple hue on his face
I am more interested in sharpening your Saam sight than giving you my opinion based on what you have written.
The excess presentation list will help you do that if you list all 12 channels and put *every single symptom in the
category/categories it could possibly belong to. This will help clarify the patient’s big picture and give you more
confidence in your diagnosis. Or if things go south, you can refer back and figure out what happened. We don’t
want to get fixated on certain symptoms and lose sight of other possibilities. See what emerges when you analyze
the whole case.
For instance, this is my analysis of a couple of channels based on what you wrote:
Spleen excess: greasy skin +6, lazy and lack of initiative +8, easily bored
LI excess: dry lips, doesn’t sweat easily, skinny
Kidney excess: interested in being a model, likes expensive clothes, symmetrical (+?), purple face 6+, testicle cyst;
acne on SI channel
SJ excess: polite+7, left testicle problem (liver channel + left)25/01/2024, 11:24Acne case question – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/acne-case-question/701/print5/11
SJ excess would be corroborated by a face with blotchy redness or a flush of redness on the cheeks besides the
papules. Acne with this kind of presentation is SJ excess “heat above”.
Definitely list channels where symptoms present and their counterbalancers
so acne on the GB channel can be listed under GB excess and P excess.
For precision’s sake I wouldn’t put acne under wet outside. Acne isn’t always a wet surface problem. It is more
helpful to focus on the qualities of the acne. It is appropriate to say acne on St channel could be Stomach excess.
martine:
Eyes: +5.
I’m not sure what this means. Are his eyes bright, dull? If eyes are bright, add that to SJ excess.
I am interested in his dry, cracked tongue. There are a few tongue presentations that are really relevant to Saam.
Send along a picture if possible so that we can see if his tongue gives us more clues.
KristinWisgirda: October 23, 2019, 10:45pm
Ryan_Gallagher:
KD excess (symmetry, handsomeness, accumulation in the form of cyst and acne)
I wouldn’t assign “accumulation in the form of … acne” under K excess. The cyst in the testicle yes. Purpleness in
the skin, yes.
martine: October 24, 2019, 12:31pm
Thanks so much Kristin! I really appreciate your time and effort to help me getting better in Sa’am diagnosis!
Here are some pictures of his tongue + also of his acne. As you can see there’s a horizontal crack in the back of his
tongue, but that comes from his dental braces.
Looking at his cheeks, is this what you mean by ‘blotchy redness on the cheeks / SJ excess’?
About his eyes: he has big blue eyes which stand out because of their alomond-shape, but because he can be so
bored, they can look dull, so I don ‘t know how to put that in a number according to the format.
Thanks again!25/01/2024, 11:24Acne case question – Sa’am Clinical Questions – Qiological Community
KristinWisgirda: October 24, 2019, 4:41pm
Thanks for the pictures.
When you said the tongue was cracked, I wondered if it was deeply fissured, like cracks in drying mud… A deeply
fissured tongue indicates a kind of fluid deficiency in Saam that is treated with Taiyang (UB+ or SI+) especially
when the tongue is red. Patients with such tongues have also benefitted from SP+, in my experience.
I see that he does not have that kind of deeply fissured tongue. But he has plenty of other K excess signs for you to
consider SI+.
martine:
they can look dull
Dull eyes, even if beautiful, are a Liver excess sign.
martine:
Looking at his cheeks, is this what you mean by ‘blotchy redness on the cheeks / SJ excess’?25/01/2024, 11:24Acne case question – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/acne-case-question/701/print11/11
His redness looks like a possible SJ excess sign- redness floating over a pale background. The red papules by
themselves could be considered a blotchy redness. So with the eyes, his politeness and shyness he has a mixed
Liver/SJ excess picture. That adds more to the mix. The Liver/SJ axis doesn’t appear to be the most prominent or
interesting imbalance with him but it is good to flesh it out anyway and keep looking at him with fresh eyes as he
changes.
The redness in the face could be considered a heat sign by itself and contribute to a mixed hot and cold picture of
SI+, though he sounds like mixed hot and neutral. It doesn’t look like the full face redness of Heart excess.
michaelmax: November 7, 2019, 2:11pm
martine:
Well, she said that his skin is actually dehydrated, and that’s why blackheads etc become stuck in the skin and
create small inflammations. So her advice was: drink lots of smoothies and more water = hydration from inside
out.
Hi @martine, sorry for the delay in response, I’ve been traveling and on the go.
this sounds like the common “advice” from a skin care or “alternative” health person. This is why it is so important
to look for ourselves and see if we see what they claim to see.
This guy looks thin, the skin does not look dry… at least from these pictures. I’m seeing heat in the ST channel, so
counter-balancing with LU could be an option to explore.
And as @KristinWisgirda, the SI for moving, especially in those with a tendency to KD excess
KristinWisgirda: November 7, 2019, 3:26pm
michaelmax:
this sounds like the common “advice” from a skin care or “alternative” health person. This is why it is so
important to look for ourselves and see if we see what they claim to see.
I agree…