Case from 15 November Clinic Case discussion

kellykd: November 15, 2020, 11:38pm
I presented a case today of the woman who wakes every night parched. I am going to see her tomorrow and I am
excited to try UB+ with her.
In the presentation it came up that I did Lu+ and some of you wondered why. I mentioned her symptoms that I had
in the St XS column (acid reflux was the main one) and now I realize that I might have an error in my notes. I
know that the Lung channel ascends (a little) and Stomach descends, as Kristin reminded me (thanks!), but for
some reason I have ‘burps a lot and ascending digestive sx” under St XS / Lu+. Not correct, I now understand.
Should be under Lu XS. Glad to get that straight!!!
The other reason I chose Lu+ was that I looking at Yangming for her and I was thinking LI XS and St XS (but Sp+
didn t work and Lu+ wasn t great) but now I am realizing that it is likely Yangming xu not XS. So it makes sense
So, here comes the question, do you see Yangming issues, such as constipation, do well with LI+ in someone who
isn t particularly Sp XS? I think I was stuck thinking constipation = Yangming XS, but Yangming xu makes sense,
too, now that I think about it. I am definitely doing UB+ next, and maybe that will help everything, but thinking
about follow-ups, and whether LI+ would be something to consider. I am curious what you all think about this.
and possibly St+ as a potential next time she might be having ascending digestive sx.
I am also looking at Jueyin for her, and P+ is on the short list, too.

Jeffrey: November 17, 2020, 10:34pm
Hi Kelly,
not remembering all the details of this case nor the exterior quality of this person, ST sounds like a more
appropriate choice for digestive issues and constipation with someone who s gaining weight but not a SPxs. At
least when you use ST, you have the direction going for you. Also you mentioned that LU didn t work so well so
there is that. Also, we were reminded that with the earth and the metal element, morphology is something to pay
attention to more. That was a really good reminder for me. ( I would be careful with too cold herbs due to her
likely weak spleen and stomach issues. if I remember correctly, this patient sounded like she had a bit of deficient
heat.?
The tongue sounded like it had a little bit of heart fire and blood stagnation. if she is around menopause age,(?)
there could be kidney fire that contributes to these tongue signs/ symptoms. you may want to check her left chi
pulse for that. when I see constipation and headache together, I always look to see if there s deficient heat)
UB should be a good teacher for us

George_Mandler: November 18, 2020, 4:32pm

18/01/2024, 11:17Case from 15 November Clinic Case discussion – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-from-15-november-clinic-case-discussion/1395/print2/10
kellykd:
So, here comes the question, do you see Yangming issues, such as constipation, do well with LI+ in someone
who isn t particularly Sp XS?
I have had reported constipation improve with SI+, LI+, SP+, BL+, ST+. I d consider supplementing LI+ when
constipation is more of the soft type and they show some damp. (I show patients a Bristol stool chart – that is an
easy way to talk about poop). However my results for constipation with Sa am alone don t feel consistent.
Your patient is waking up with a parched mouth but that doesn t tell us if the dryness is inside or outside. I don t
remember the details you shared but if there seems to be some damp inside then I d consider supplementing ST+.
I m interested to hear how supplementing BL+ went
kellykd:
I was stuck thinking constipation
If that was an intended pun I like it

kellykd: November 29, 2020, 4:58pm
I have seen this patient twice since last writing so here s an update. I will include a summary of her case at the end,
too.
after Lu+ 11/9 she initially reported her main sx of being parched at night was the same or slightly better, had a
headache that evening (which she attributed to a blood draw that same day). She reported a blip in interstitial
cystitis – urgency and not much urine comes out. they found bacteria in her urine and she ended up on antibiotics.
She had a biopsy of her salivary gland to test for Sjogren s and had a bruised, numb lip and couldn t eat. By the
time she came in 11/16 she was super parched at night like it was a month ago (we had made some progress) and
she was quite constipated.
11/16 I did UB+ and it helped her urinary sx but not her chief complaint. (she was also on antibiotics) She later
reported that had bad reflux all week. She received the diagnosis of Sjogren s.
11/23 When she came in she also had pain at about SI14 on the R, which has come and gone in the past.
I did St+ and she emailed me yesterday to say that she had some improvement – the reflux is down and she is less
dry at night.
I will see her again tomorrow and my top ideas are SI+ (which Kristin suggested when I presented, and maybe I
should have done that last week) esp if she still has that pain around SI 14.
Maybe Liv+/SI+ since she has done very well with Liv+ (constitutionally at least) in the past.
P+ is still on the short list, mainly because she is woken at night parched, and has red tip tongue. Maybe Liv+/P+
St+ again is also definitely on the list.18/01/2024, 11:17Case from 15 November Clinic Case discussion – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-from-15-november-clinic-case-discussion/1395/print3/10
Here s the summary of her case:
female age 48
CC: Waking 2-3 am with dry mouth at night, no saliva, not hot.
Dry eye, interstitial cystitis (intermittent).
Heat sensitivity since traveling in Greece where she had heat exhaustion.
Dizzy/lightheaded/head pressure initially starting with sunny winter day, triggered by sun.
Thin/fit, slightly petite, focused attorney, more on introverted side, pretty +4, bright eyes +2, redness left cheek,
polite, exercises a lot.
Hates heat and humidity, not bothered by VT cold weather, cold hands and feet (feet colder to touch), likes cool
mist of forest. Wears sunglassses AND visor in sun.
Thirsty, more thirsty at night, not quenched by drinking, if drinks too much water gets bloated. Constipation – hard
bound, reflux, big burning painful canker sores front of tongue 10x yearly, nausea sometimes.
Floaters occasionally with sunshine.
hx occular migraines sunray treated with OBC.
Great skin (not dry at all).
No problem getting pregnant (once by choice – colicky baby), periods ok (on OBC) cramps and PMS Not bad.
signs: fleshy heel, Lu 10 is not sunken.
Hara: weak low belly, slightly taut upper belly, ticklish R hypochondriac adn St 25.
P: R guan is stronger, L guan is weak and thin and sometimes taut.
I previously took: Liv+, Sp+, K+, then Liv+ and P+ with teishin.
10/9 Liv+ no change in CC but felt good after tx. 3 days later woke nausea and blip of lightheadedness,
constipation cleared out and stool wasn t dry. some reflux/indigestion upper ab.
10/14 Sp+ nausea for1 1/2 days, but less dry, lightheaded on and off, reflux ok, taking miralax for constipation.
10/23 K+ mostly the same, no nausea or lightheadedness, good energy in day. Then 4 days post treatment SO
dehydrated even in daytime, thirsty, constipated, had blip with interstitial cystitis, felt like UTI – feels like has to
go, but not much urine.
10/30 Liv+ R and P+ with teishin – felt good, more balanced than previous. a little less dehydrated starting 4 days
later. 15% less intense. Started taking herbs the day after the treatment. IC calmed down some, bladder hurts,
muscular pain and tight. bloated after eating sometimes, and after drinking.
Discussion and thoughts on this case:
I didn t go to UB+ initially because she isn t hot when she wakes parched. The results were not remarkable, but I
may consider it again down the line.
I was honing in on the 6 Conformations here, maybe too much.The Yangming and Taiyin, as well as Jueyin, was
what I saw for her. I was seeing the Yangming as blocked so I wanted to unblock the Yangming and give her Taiyin
fluids. But even though I wrote Yangming xu for her diagnosis, I got stuck on Yangming block as being XS (yes
George, on purpose this time). Her fluid balance is off and she is clearly not absorbing fluids. After re-watching the
Advanced class this week, I have been able to absorb (on purpose, George) more of Toby s wise words and
discussion about thin people with constipation and not absorbing fluids.
I clearly was off with my Taiyin choices Sp+ and Lu+ from her response. I took Sp+ even though she was having
nausea (doh!). Maybe Sp+ would be ok if my timing was better, as she did have some less dryness that week. Lu+18/01/2024, 11:17Case from 15 November Clinic Case discussion – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-from-15-november-clinic-case-discussion/1395/print4/10
was wrong for her (the direction!) and St+ was so much better – even though she seems to be dry inside (dry
constipation, parched?) and her lovely skin is not dry (not greasy). She seems to be either dry inside damp outside,
or double dry. And she has some retention of not absorbed/pathological fluids inside, which may be partly why she
did well with St+. Maybe she could be considered double damp Sp XS while she has the pathological fluids inside
(nausea, hates humidity, bloated if drinks too much) but it s a bit of a stretch.
George_Mandler:
Your patient is waking up with a parched mouth but that doesn t tell us if the dryness is inside or outside.
I was leaning towards the parched mouth as inside dry since she is not absorbing fluids. But maybe since St+
helped it shows that it is outside dry. UB+ didn t help – since it s Taiyang I would have thought UB+ would be
helping fluids on the outside, but I recall Toby saying it is the whole body.
It seems like she has dry and damp inside!
So thinking 6 conformations, maybe she needs Yangming supplementation with St+ and LI+ to improve/strengthen
her digestive functioning/constipation and clear pathological fluids before potentially hitting her again with Taiyin
fluids Sp+.
What do you think? Sorry so long-winded

KristinWisgirda: November 29, 2020, 9:57pm
Hi Kelly,
Frankly your presentation is all over the place. Even with effort I don t really feel like I see your patient. It would
be helpful to list all the channel excesses and the symptoms that belong with them. This will help you and us better
sort things out.
kellykd:
P+ is still on the short list, mainly because she is woken at night parched, and has red tip tongue.
For instance, this rationale for P+ is weak as these symptoms have lower clinical weight for Gb excess. The
insomnia is caused by being parched at night. It would be different if the dynamic of her insomnia is too much
impetuous up and out that needs P+ to ground. I don t see her P/GB balance. She is an attorney but is she
aggressive and ungrounded or more bookish?
kellykd:
I will see her again tomorrow and my top ideas are SI+ (which Kristin suggested when I presented, and maybe
I should have done that last week) esp if she still has that pain around SI 14.
Maybe Liv+/SI+ since she has done very well with Liv+ (constitutionally at least) in the past.
P+ is still on the short list, mainly because she is woken at night parched, and has red tip tongue. Maybe18/01/2024, 11:17Case from 15 November Clinic Case discussion – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-from-15-november-clinic-case-discussion/1395/print5/10
Liv+/P+
St+ again is also definitely on the list.
Since she hasn t gotten a great deal of relief yet and she has lots going on, you really want clarity when treating
her. This means doing once channel at a time. If you are going to use SI+, use it alone so you can maximize the
clarity of her response.
Liv+ didn t help her chief complaint so why go there right now?
Stomach+ helped somewhat but I would still hesitate to use it twice in a row unless the response was really
outstanding AND she clearly has a strong constitution and she is more grossly a Lung excess. I m not seeing any of
these criteria being clearly met. If she has a weaker constitution, repeating a treatment is almost always a bad idea.

kellykd: November 29, 2020, 10:59pm
KristinWisgirda:
Frankly your presentation is all over the place. Even with effort I don t really feel like I see your patient. It
would be helpful to list all the channel excesses and the symptoms that belong with them. This will help you
and us better sort things out.
Oh geesh. In my efforts to keep it to a short summary I made it even less clear. I can organize that better.

kellykd: November 30, 2020, 12:56am
female age 48 (full case format)
CC: Waking 2-3 am parched with dry mouth at night, no saliva, does not feel hot. This got noticeably bad starting
in September. Dry eye is worse along with parched at night.
Secondary complaints:
1. Interstitial cystitis (intermittent). Urgency and not much comes out, bladder hurts/feels tight.
2. Dizzy/head pressure or lightheadedness. Hx: Heat sensitivity since traveling in Greece 8 years ago where
she had heat exhaustion. After her trip to Greece, while driving on a sunny January day she had an episode
of dizzy/head pressure for a month. Pressure in forehead and zygoma area and dizzy – unstable feeling and
had to pull over (not vertigo/no room spinining). After vacation to Brazil, it lightened up. Acupuncture
helped. She still has blips of this dizzy/head pressure or lightheadedness often triggered by sun.
Appearance and Demeanor:
Thin/fit, slightly petite and proportional, pretty +4, average bone structure, moderately thin hair, bright eyes +2,
slight redness left cheek +1, polite +7, aware +7.18/01/2024, 11:17Case from 15 November Clinic Case discussion – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-from-15-november-clinic-case-discussion/1395/print6/10
Morphology and Flesh: Fit body, Flesh is light/soft.
Skin: Skin not dry.
Lifestyle: focused attorney (commercial real estate law – not stressful work, esp working from home), more on
introverted side, exercises a lot, loves traveling, reading. Not/rarely bored. More librarian type, but she can get
reactive with her daughter (in college but at home because of COVID). More on soft spoken side but not shy.
Resourced.
Perspiration: Very little sweating even with exercise, will sweat if runs over an hour, doesn t get red in face.
Body temp: Hates heat and humidity, not bothered by VT cold weather, cold hands and feet (feet colder to touch),
likes cool mist of forest. Wears sunglassses AND visor in sun. Feels like she needs to be sheltered from the sun as
it triggers Sx. Used to be ok with sun grew up in FL.
Dream environment = 50 s fall
Thirst: thirsty, not excessively in day time, more thirsty at night, not always quenched by drinking, if drinks too
much water gets bloated.
Urination: normal/smooth, except with IC when there is urgency, discomfort and not much comes out.
GI: Constipation usually hard bound stools, every 2-3 days, uses Miralax as needed.
Reflux since COVID, feeling of indigestion in epigastrium.
Appetite is ok, doesn t eat big meals, bloated in upper belly lately.
Doesn t feel good with sugar, hates fruit, drinks wine.
Big burning painful canker sores front of tongue 10x yearly.
Nausea sometimes.
Sleep: Falls asleep fine, wakes 2-3 am parched, falls back asleep then wakes constantly/every half hour. Energy not
good since she hasn t been sleeping well. Was fine before September.
Other body: Dry eye for 2 years, uses drops in morning and night. Worse with this issue of being parched at night.
Floaters occasionally with sunshine.
hx of occular migraines sunray treated with OBC
GYN: No problem getting pregnant (once by choice – colicky baby), periods ok (on OBC) cramps and PMS Not
bad.
Emotions: Frustrated with her health, as she is good at taking care of herself. Wakes frustrated in morning.
Signs: fleshy heel, Lu 10 is not sunken.
Hara: weak low belly, slightly taut upper belly, ticklish R hypochondriac and St 25.
P: R guan is stronger, L guan is weak and thin and sometimes taut.
T: Red tip, pale purple with pale sides
Excess presentations:
GB: red tip tongue, sleep issues/hyperactivity at night, can be reactive18/01/2024, 11:17Case from 15 November Clinic Case discussion – Sa’am Clinical Questions – Qiological Community
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P: intelligent, attorney, introverted, focused
SJ: polite, aware, light open flesh, dizzy/lightheaded worse with sun/bright, wears sunglasses and visor, (likes cool
mist forest), cold hands and feet (feet colder), focused, bright eyes +2, sl red left cheek, floaters?
Liver:
Heart: Hates heat, cold doesn t bother her, thirsty and not quenched?, hyperfunction?
UB: female, urinary issues?, dry eye?
K: fleshy medial heel, pale purple tongue, dizzy, symmetrical/pretty +4 , easy to get pregnant, pain at SI 14, pale
purple tongue
SI: weak low belly, thin hair
Lung: reflux, nausea, bloated, hates humidity?, bloated if drinks too much?
Stomach: thin, moist/not dry skin?, constipation?
LI: dry constipation, never bored, thin
Spleen: Hates humidity, bloated if drinks too much
*I thought some sx could be more than one channel, so I put those in both with a ? for my second choice. Is this an
ok way to do this? I also put a question mark by a couple I wasn t sure about.
GTITR: Lack of available fluids esp at night. Wakes parched at night, thirsty at night and dry eye worse.
Main Tx ideas: Liv+, UB+, SI+, St+ (all taken except SI+)
Other Tx ideas: P+, Sp+ (Sp+ wasn t good, but maybe in future after dealing with dampness)
Treatments:
10/9 Liv+ no change in CC but felt good after tx. 3 days later woke nausea and blip of lightheadedness,
constipation cleared out and stool wasn t dry. some reflux/indigestion upper ab.
10/14 Sp+ nausea for1 1/2 days, but less dry, lightheaded on and off, reflux ok, taking miralax for constipation.
10/23 K+ mostly the same, no nausea or lightheadedness, good energy in day. Then 4 days post treatment SO
dehydrated even in daytime, thirsty, constipated, had blip with interstitial cystitis, felt like UTI – feels like has to
go, but not much urine.
10/30 Liv+ R and P+ with teishin – felt good, more balanced than previous. a little less dehydrated starting 4 days
later. 15% less intense. Started taking herbs the day after the treatment. IC calmed down some, bladder hurts,
muscular pain and tight. bloated after eating sometimes, and after drinking.
11/9 Lu+ she initially reported her main sx of being parched at night was the same or slightly better, had a
headache that evening (which she attributed to a blood draw that same day). She reported a blip in interstitial
cystitis – urgency and not much urine comes out. they found bacteria in her urine and she ended up on antibiotics.
She had a biopsy of her salivary gland to test for Sjogren s and had a bruised, numb lip and couldn t eat. By the18/01/2024, 11:17Case from 15 November Clinic Case discussion – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-from-15-november-clinic-case-discussion/1395/print8/10
time she came in 11/16 she was super parched at night like it was a month ago (we had made some progress) and
she was quite constipated.
11/16 UB+ and it helped her urinary sx but not her chief complaint. (she was also on antibiotics) She later reported
that had bad reflux all week. She received the diagnosis of Sjogren s.
11/23 St+
When she came in she also had pain at about SI14 on the R, which has come and gone in the past.
She emailed me yesterday to say that she had some improvement – the reflux is down and she is less dry at night.
I will see her again tomorrow and my top ideas are SI+ (which Kristin suggested when I presented, and maybe I
should have done that last week) esp if she still has that pain around SI 14.
Maybe Liv+/SI+ since she has done very well with Liv+ (constitutionally at least) in the past.
P+ is still on the short list, mainly because she is woken at night parched, and has red tip tongue. Maybe Liv+/P+
St+ again is also definitely on the list.
Discussion and thoughts on this case:
I didn t go to UB+ initially because she isn t hot when she wakes parched. The results were not remarkable, but I
may consider it again down the line.
I was honing in on the 6 Conformations here, maybe too much.The Yangming and Taiyin, as well as Jueyin, was
what I saw for her. I was seeing the Yangming as blocked so I wanted to unblock the Yangming and give her Taiyin
fluids. But even though I wrote Yangming xu for her diagnosis, I got stuck on Yangming block as being XS (yes
George, on purpose this time). Her fluid balance is off and she is clearly not absorbing fluids. After re-watching the
Advanced class this week, I have been able to absorb (on purpose, George) more of Toby s wise words and
discussion about thin people with constipation and not absorbing fluids.
I clearly was off with my Taiyin choices Sp+ and Lu+ from her response. I took Sp+ even though she was having
nausea (doh!). Maybe Sp+ would be ok if my timing was better, as she did have some less dryness that week. Lu+
was wrong for her (the direction!) and St+ was so much better – even though she seems to be dry inside (dry
constipation, parched?) and her lovely skin is not dry (not greasy). She seems to be either dry inside damp outside,
or double dry. And she has some retention of not absorbed/pathological fluids inside, which may be partly why she
did well with St+. Maybe she could be considered double damp Sp XS while she has the pathological fluids inside
(nausea, hates humidity, bloated if drinks too much) but it s a bit of a stretch.
I was leaning towards the parched mouth as inside dry since she is not absorbing fluids. But maybe since St+
helped it shows that it is outside dry. UB+ didn t help – since it s Taiyang I would have thought UB+ would be
helping fluids on the outside, but I recall Toby saying it is the whole body.
It seems like she has dry and damp inside!
So thinking 6 conformations, maybe she needs Yangming supplementation with St+ and LI+ to improve/strengthen
her digestive functioning/constipation and clear pathological fluids before potentially hitting her again with Taiyin
fluids Sp+.

kellykd: November 30, 2020, 12:57am

KristinWisgirda: November 30, 2020, 12:48pm
kellykd:
I hope this is much more clear.
It makes a HUGE difference. Thank you! The formatting makes all of your excellent details easily accessible.
kellykd:
*I thought some sx could be more than one channel, so I put those in both with a ? for my second choice. Is
this an ok way to do this? I also put a
question mark by a couple I wasn t sure about.
Perfect!
The Kidney excess signs are enough to make SI+ my first choice still.For double extra confirmation you can look
at the following:
You say she exercises a lot. Do you have a sense what it does for her? Do her clothes/makeup point to her being
into herself? These days with people working from home, I give extra Kidney excess points to women who wear
makeup or jewelry to treatment. Does she have varicosities?
kellykd:
GB: red tip tongue, sleep issues/hyperactivity at night, can be reactive
P: intelligent, attorney, introverted, focused
Can you imagine her being really snippy or even explosive? Her idea of reactive may or may not be that reactive at
all.
The attorney and introverted aren t necessarily P excess. I know plenty of attorneys and introverted people who are
ungrounded. For P excess you want to see calm, grounded, with slow deliberate movements, a shrinking back
presence.
I stand by my analysis of your treatment ideas, with more confidence now. Do one channel only, ideally SI+.
1 Like18/01/2024, 11:17Case from 15 November Clinic Case discussion – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-from-15-november-clinic-case-discussion/1395/print10/10

kellykd: December 5, 2020, 8:54pm
Update after SI+ treatment on 11/30, her words:
12/3 1:00 pm My bladder pain is better (although I went back on the antibiotic thinking maybe the infection was
not fully cured). The acid reflux is not an issue right now. My back pain has been much improved. Unfortunately
the dryness at night is even worse. I am having trouble staying asleep more than an hour or two at a time.
12/3 6:50 pm I actually am feeling a bit under the weather though (which may explain things being a bit worse?)
KristinWisgirda:
Do her clothes/makeup point to her being into herself? These days with people working from home, I give
extra Kidney excess points to women who wear makeup or jewelry to treatment. Does she have varicosities?
She does not wear makeup to her appointments but does wear makeup generally, though she said much less during
COVID – no extra KXS there.
She exercises daily for an hour – long walk and yoga – and feels better when she does. When she doesn t exercise,
she had a hard time saying how she didn t feel as good, I suggested irritable or pent up, and she said a bit pent up.
I also asked her about being reactive and she said she doesn t argue with her husband – she may get frustrated but
not engage about it. With her daughter, the same but if something is really bugging her, she will occasionally yell
or be irritable. When she is not feeling well she will not engage, even if she is bothered by something.
She repeats that she is frustrated with this health issue.
So overall she is not explosive and may be barely snippy – she seems to keep her emotions in.
Notes: She drives a BMW and wears yoga pants (her acu pair have a hole) and often a cashmere sweater to her
appointment. She is quite pretty but not overly so, more in a plane jane way, her face is a bit narrow, without strong
facial features such as cheekbones, but her forehead is rather large +5 with hairline is being rather back and her
hair is shoulder length, not dry, but thin +5.