KristinWisgirda: July 19, 2019, 4:35pm
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 framework, then add abdominal palpation, face observation, chief complaint, etc…
“When the ancients treated patients, they became familiar with the cycles of yin
and yang and of time, and with the exhalations of qi from mountain, forest, river
and marsh. They discerned the patient’s age, body weight, social status, style of
life, disposition, likes, feelings, and vigor. In accordance with what was appropriate
to these characteristics, and avoiding what was not, they determined which
medicine was appropriate.”
Shen Kuo, Su Shen Liangfang , 12th century (Rosenberg)
Toby emphasizes that can’t always believe our patients words and we really need observe our patients closely.
Please include your impressions. What does this patient look like walking through the door? How does the story
they tell about themselves mesh with your impressions?
Please indicate the patient’s chief complaint and 1-2 other secondary complaints since these should be strongly
guiding your treatment. What is the most troubling to the patient?
Help your readers by reducing the number of words and organize your findings by
· listing symptoms and qualities under functional headings
· summarizing complicated histories but do include precipitating factors relating to their chief problems such as
illnesses, accidents, childbirth, major stressors
· distill emotional states into themes
Grading symptoms and qualities on a scale of +1 to +10 will help us know how much clinical weight to place.
· For instance, bright eyes +1=mildly bright, +5=moderately bright and piercing, +10=diamond eyes.
Please organize your findings into the appropriate Saam channel categories, even if it is to say that there aren’t any
stand-out findings. This will help you to start observing patients in a Saam way. Some qualities/symptoms may not
have a clear slot. You can put a question mark if you think it might belong in that category but aren’t sure. See the
case below for examples.26/01/2024, 11:43Case Study Format – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-study-format/387/print2/7
60 year old woman
Chief complaint : vision changes R>L from macular degeneration (rare dry type with abnormally large drusen
overgrowth); eye chart lines look wavy, black colors seen as gray; light sensitivity +9 (wears sunglasses in her
house)
Second complaint: left knee pain-Liver/ Spleen channels, daily intermittent 5/10, pain during activities, cam throb
at rest
· worse with: sitting in odd positions for long hours researching her many projects, carrying grandkids up and
down stairs, walking hills
· started after taking Levaquin for sinus infection, 9 months ago; made worse by knee strengthening exercise
with a physical therapist
Appearance and demeanor : average facial symmetry; neatly but casually dressed, warm and friendly +5; polite
+5, animated talker+5 but doesn’t overtalk, points her index finger at you in stabbing motions for emphasis; bright
eyes +8; slight malar flush +1; brings homemade cookies and/or flowers to every visit +10 J; drives a Prius
Lifestyle: Former social worker who retired because of major burn out and recurrent debilitating respiratory
infections. Has many projects (+8) involving creative activities along with caretaking for adult children,
grandchildren and husband; exercises regularly; self critical with a spiritual bent +8
Body morphology and flesh quality: Average frame, overweight +3; soft droopy flesh over good muscle tone
Skin Quality: “needs” to moisturize daily so assuming dry
Body Temp: runs warm +4, occasional hotflash+1; cool feet +2
GI: fine currently, gas and loose stools when eats too much veg; heartburn with tomatoes or overeating(rare)
Respiratory: rhinitis controlled by claritin; recurrent sinus infections in the winter
Sleep: late bedtime because of many projects, 6 hours, wakes unrested, diagnosed with mild apnea that is worse
when she stops taking Claritin (will get cpap)
Emotions: positive attitude that feels a bit forced +9; tends to neglect her own needs so that others can be cared for
+7 (getting better); lack of self assertivenesss +4
Urination: stress and urge incontinence +5 since pregnancies
** Gyn: 2 csections, menopause 7 years ago
Other Body: very few varicosities; average recurrent right SI joint pain (not currently)+1; whole back is jumpy to
palpation +7
Tongue: small body +5, coat peeled in patches, sl thick coat in rear
Excess Presentations:
Heart: warm friendly +5
UB: fear of mortality +3, incontinence+5(?)26/01/2024, 11:43Case Study Format – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-study-format/387/print3/7
GB: pointy index finger
P: lack of self assertiveness ; loves researching?
SJ: bright eyes +8, light sensitive +9, self critical and spiritual +8, black seen as grey (?): malar flush +1; warmer
above with cool feet (?); Liver channel knee pain on the left
Liver: none, Liver channel knee pain on the left
Lung: damp inside/dry outside?; good resources; rhinitis(?)
Stomach: none
LI: hyperactively project oriented +8; Spleen channel knee pain
Spleen: Spleen channel pain
SI:puts others needs before her own+7; mixed warm and cool(generally warm with cool feet)
K: mixed warm and cool, pain
The Grossest Thing(s) in the Room: light sensitivity, bright eyes, hyperactive projected oriented doer
Main treatment ideas: Liv+ on right, Sp+ on right,
Other treatment ideas: SI+, K+; ST+(damp inside, dry outside)
Treatments 1+2: Liver+ on right
· noticed improvement in light sensitivity, no change in wavy lines, no change in knee pain
Treatment #3: Wanted to focus on knee, Spleen + on right
· Eliminated knee pain. Patient noted that she was no longer jumping up to take care of others at the concerts she
attends weekly. Instead she was able to enjoy the music. The lack of motivation to be constantly doing and tending
to other people made her wonder if she was depressed!
8 Likes
Stubborn migraine case
14yo skinny dry boy with exhaustion and body pain
Acne case question
Some clarification
Calling on the Brain Trust_Ramsey Hunt in 30F
Adverse reaction case and question
Case study: PTSD26/01/2024, 11:43Case Study Format – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-study-format/387/print4/7
Hidradenitis Suppurativa
Heat signs, internal or external
TaiYang Stage illness
Studying Saam step by step?
Vertigo poss brought on by PC+? (help!)
Ulcerative Colitis and Infertility
Chronic low-grade fever case
Macular degeneration case update
Patient with Schizophrenia
Case where H+ and Liv+ did not work well at all
Chronic diarrhoea up to 30 times/day and complex presentation
Frequent Urination in elderly man
Facial pain post trauma
Need Help with a Diarrhea – Hot Cheek Seesaw
Chemo Induced Neuropathy
Kxs looking for a way out
Gallbladder deficiency, or
Help with case of double vision
Tachycardia and Heartburn plus
Interesting Case with success but need more clarity
Dry / Damp Signs and Symptoms . .
chels: July 19, 2019, 5:40pm
This is really helpful and clear. Categorizing Excess Presentations like you’ve listed is a great way to help retrain
our brains to think in that manner. I can already see myself editing my charting to reflect this.26/01/2024, 11:43Case Study Format – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-study-format/387/print5/7
michaelmax: July 19, 2019, 8:16pm
Well it’s just like Toby start with a quote like this
Thanks @KristinWisgirda, this is really helpful and in my own clinical work I’ve been moving in the direction of
something like this. I especially find the way of charting the clinical weight of the various things that stand out to
be very helpful. It’s a helpful blend of objective measures and the intuitive “feel” of clinic.
I find it helpful too to have something that helps me stay “on track” with Saam thinking.
thanks for you contribution with this
Tobydaly1: July 19, 2019, 8:18pm
Perfect. Thank you Kristen. Really appreciate all your hard work.
Donley #5July 19, 2019, 11:19pm
Thank you @KristinWisgirda. That is a really great format.
Donley: July 19, 2019, 11:37pm
Hi @michaelmax,
Is there a way we could pin this post to the top so it can be found easily?
michaelmax made this a banner . It will appear at the top of every page until it is dismissed by the user.
#7July 20, 2019, 1:25am
michaelmax: July 20, 2019, 1:28am
yes @Donley. I’ve got it set to that now
1 Like
amyjenner #9July 20, 2019, 9:26pm26/01/2024, 11:43Case Study Format – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-study-format/387/print6/7
What is the best way to get a printed copy?
I really appreciate the clear, concise format. I think it will be very helpful. Thanks for taking the time to put it
together.
amyjenner: July 20, 2019, 9:45pm
I cut and pasted the format into a word doc, and took out the particulars of this case to make myself a kind of
worksheet to go through. Under the “other body” heading, this example had some varicosities, I’d like to put a list
there of the other for sure signs we have like the dry cracked medial heel, and the deflated thenar eminence, the
diffuse tongue cracks, red tipped or dots on tongue, left side or right side rib tightness, midline cold and tight vs
warm and slack. What else goes on that list? I want to remember to check all these things when I’m with the
patient at the intake.
sweiz: July 21, 2019, 10:47am
Thanks Kristin! This is so helpful!
KristinWisgirda: July 22, 2019, 5:47pm
There could be 2 lists- physical findings and subjective indications such as light sensitivity, demeanor, etc.
Anybody want to have a go at organizing all the channel indications from class, observing Toby and podcasts? Use
slides from class as your base.
One of my next projects will be to reorganize my intake form to make the Saam indications pop out at me.
Over the weekend, I questioned if it was clear to grade symptoms and put them in under channels. For instance my
patient was warm and friendly +5, meaning that she was warm and friendly in an average way. This really
shouldn’t have gone under Heart excess because her behavior was pretty normal. My mistake. So don’t place a
symptom under the excess category unless it is really an excess presentation.
My goals are clarity and ease, not fussiness. We will all just do the best we can and ask questions as we go along.
I really have to give our wonderful @sweiz a shoutout here for some of the pieces going into the case study
format. The teachings in her Graduate Mentorship Program help one develop a grounding in our medicine through
observation, organization and critical thinking that really cranks up the clinical efficacy. All of this easily translates
to Saam work- what do we know for sure about our patients if we forget their story and look at them through the
lens of Saam? Thanks Sharon!
2 Likes26/01/2024, 11:43Case Study Format – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/case-study-format/387/print7/7
amyjenner: July 22, 2019, 6:22pm
Thats a good way to think about it. I was thinking channels but i like subjective/objective better. I’ll take a crack at
it as a first pass then folks can add in whatever i missed
amyjenner: July 23, 2019, 12:42am
I put it all into a word doc table but when I cut and paste it here, it loses its chart-ness. not seeing a way to do an
attachment. Suggestions?