AJSClaussen: October 1, 2019, 6:14pm
LS is a 56 yo female I have been treating for about 6 weeks. All three of her complaints, listed below, have
improved. What has not improved is the tingling, numbness, and cold toes associated with her neuropathy. Am I
missing something or am I expecting results too quickly?
CC: Neuropathy in bilateral feet onset during chemo for breast cancer in 2/18. From ball of foot to toes has
constant tingling and numbness. Her feet feel swollen and heavy which can sometimes make her trip. Feet always
feel cold to the patient but are not always cold to the touch. Supportive shoes can help with decrease symptoms.
2C: Hot flashes with sweat, onset 2017, before cancer dx though increased frequency after chemo, 1-2xdy. W/w
alcohol, possibly stress. They don’t disrupt sleep.
3C: Allergies in spring and fall. Sinus congestion with clear, watery drainage, itchy eyes, occ red and watery eyes.
Appearance: average height, apple shaped, dusky skin tone, very friendly and thoughtful +8, cheerful, does not
complain
Lifestyle: patient divorced, lives alone, visits with grown children and grandchildren often, works in IT
Skin: dry, sweats with exertion, dusky tone
Temperature: warm with cold feet (subjective), aversion to heat & humidity
Dig: poor appetite upon waking, stress eater (crunchy foods),
Thirst: poor sense of thirst, prefers tepid to warm water
Resp: prone to strep
Sleep: WNL, hx of snoring which improved with tx
Urine: urgency since menopause, nocturia 0-1x a night
BM: hx of loose which improved with tx
Menses: last cycle 12/17
Tongue: swollen pink-red body with thin yellow coat and scallops
1st tx – LI+ right (numbness, heavy feet, soft abdomen, soft stools)
feet more mobile and less stiff
decreased sense of swelling
no change in tingling numbness or cold toes
decreased intensity of hot flashes
decreased allergy sx25/01/2024, 11:43Chemo Induced Neuropathy – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/chemo-induced-neuropathy/646/print2/7
2nd tx – SI+ right (dusky skin, pain)
decrease loose stools
decrease frequency of hot flashes
no change in tingling, numbness or cold toes
3rd tx – LU+ right (numbness, right LU 10 deflated, feet better with support)
no change in tingling, numbness, or cold toes
Thank you for your time and brain power.
KristinWisgirda: October 1, 2019, 7:03pm
@AJSClaussen Great job! Getting significant relief in 2 out of 3 chief complaints in 2 visits is a good response.
By chance have you seen this?
Case Study Format
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…
A couple of tools contained there-in can help everyone see your patient more clearly through the lens of Saam.
Namely, rating the patient’s symptoms and assigning all of the signs and symptoms to possible channel excesses. In
the process you go through all of the channels with an eye to your patient. It also asks you to point out the grossest
thing in the room-what really stands out to you about this patient’s presentation?
If you add those case history elements, we can give you more constructive feedback about your case.
One thing that stands out based on the info above:
AJSClaussen:
LU+ right (numbness, right LU 10 deflated, feet better with support)
It is interesting that you chose to Lung+ when her skin (dry) and morphology (apple shaped) point more toward
Lung excess. I wouldn’t assign “better with support” to Stomach excess, especially if it only applies to the feet.
The deflated thenar is a weaker sign of St excess when compared to the above signs of Lung excess. ST+ would
likely also help her appetite.
You might want to ask about trauma to the right thumb. In another thread I wrote about a case where both thenars
were very deflated but the patient’s overall presentation was Lung excess. Time and time again she responded
really well to St+ treatments. In her case the thenars were not an accurate reflection of her overall environment.25/01/2024, 11:43Chemo Induced Neuropathy – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/chemo-induced-neuropathy/646/print3/7
Toby called them “shattered mirrors” for that reason. Now I ask all of my patients with deflated thenars about their
thumb/wrist trauma history.
AJSClaussen: October 1, 2019, 9:23pm
I have re-posted the entire case below with the requested additions of the Sa’am channels and Grossest Thing in the
Room.
KristinWisgirda:
It is interesting that you chose to Lung+ when her skin (dry) and morphology (apple shaped) point more toward
Lung excess. I wouldn’t assign “better with support” to Stomach excess, especially if it only applies to the feet.
I chose LU+ due to associating the numbness/tingling in the feet with dampness on the exterior. It seems I may
have been focusing on the trees and missed the forest.
Chemo Induced Neuropathy
LS is a 56 yo female I have been treating for about 6 weeks. All three of her complaints, listed below, have
improved. What has not improved is the tingling, numbness, and cold toes associated with her neuropathy. Am I
missing something or am I expecting results to quickly?
CC: Neuropathy in bilateral feet onset during chemo for breast cancer in 2/18. From ball of foot to toes has
constant tingling and numbness. Her feet feel swollen and heavy which can sometimes make her trip. Feet always
feel cold to the patient but are not cold to the touch. Supportive shoes can help with decrease symptoms.
2C: Hot flashes with sweat, onset 2017, before cancer dx though increased frequency after chemo, 1-2xdy. W/w
alcohol, possibly stress. They don’t disrupt sleep.
3C: Allergies in spring and fall. Sinus congestion with clear, watery drainage, itchy eyes, occ red and watery eyes.
Appearance: average height, apple shaped +6, dusky skin tone, very friendly, reliably turns conversation away
from herself+8, cheerful, does not complain
Lifestyle: patient divorced, lives alone, visits with grown children and grandchildren often, works in IT
Skin: dry (pt uses lotion so unable to tell severity), sweats with exertion, dusky tone
Temperature: warm with cold feet (subjective), aversion to heat & humidity
Dig: poor appetite upon waking, stress eater (crunchy foods),
Thirst: poor sense of thirst +5, prefers tepid to warm water
Resp: prone to strep
Sleep: WNL, hx of snoring which improved with tx25/01/2024, 11:43Chemo Induced Neuropathy – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/chemo-induced-neuropathy/646/print4/7
Urine: urgency since menopause, nocturia 0-1x a night
BM: hx of loose which improved with tx
Menses: last cycle 12/17
Tongue: swollen pink-red body with thin yellow coat and scallops
Sa’am
HT: very friendly+8, family oriented, aversion to heat, hot flashes, warm soft midline
UB: urinary urgency, cold toes
SI: nocturia (?)+2, mixed warm & cold, dusky skin tone+7 (?)
KD: mixed warm & cold
GB: snoring (?)
PC:
SJ: warm body with cold feet, hot flashes +4
LR: poor night vision
ST: aversion to humidity (?), numb & tingling feet +9, LU10 deflated on right, feet feel heavy & swollen +6,
allergic rhinitis +4
LU: dry skin, apple shape +6, lack of thirst+5 (?), swollen tongue (?)
LI: dry skin
SP: numb & tingling feet +9, feet feel heavy & swollen+6, lack of thirst+5 (?), swollen tongue (?)
Grossest thing in the room
neuropathy in feet
tingling
numbness
subjectively cold toes
friendliness
1st tx – LI+ right (numbness, heavy feet, soft abdomen, soft stools)
feet more mobile and less stiff
decreased sense of swelling
no change in tingling numbness or cold toes
decreased intensity of hot flashes
decreased allergy sx
2nd tx – SI+ right (dusky skin, pain)
decrease loose stools25/01/2024, 11:43Chemo Induced Neuropathy – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/chemo-induced-neuropathy/646/print5/7
decrease frequency of hot flashes
no change in tingling, numbness or cold toes
3rd tx – LU+ right (numbness, right LU 10 deflated, feet better with support)
no change in tingling, numbness, or cold toes
heavy and swollen feeling in feet less but present
KristinWisgirda: October 2, 2019, 4:18pm
Thanks for taking the time @AJSClaussen
Just to be picky: You can put poor appetite (too full) under Lung excess/Spleen excess. Not sure about where to to
put snoring (swelling or flabbiness in the nasopharynx).
Since the CC is on the bottom of the foot you should include that under K excess and SI excess as possibilities.
Can’t forget the channel trajectory!
To stimulate observation and Saam thinking based off your above analysis, here are some considerations:
Seeing that you have entries in SI/K, you might take a look the next time to see if she has any varicosities,
congested sublingual veins, other signs of blood stasis. How pretty/symmetrical is she? She has a history of cancer
which is a form of Kidney excess.
Seeing you have entries in SJ/Liver- how bright are her eyes? Any light sensitivity? How polite is she?
Based on what you have shared, her response to treatment, and the presence of dampness as part of the chief
complaint, I would consider supplementing LI, SI, St. Damp is a sticky and tenacious pathogen. When dampness is
a prominent part of the picture, T recommends adding SI+ to LI+ or ST+ in the same treatment. The movement SI+
provides helps resolve the damp more quickly.
AJSClaussen:
am I expecting results too quickly?
Damp and cold can be slower to resolve.
For neuropathy, I like to carefully test how sensitive the area is to heat, comparing that sensitivity to an adjacent
normal area of skin. Even though she has some H excess signs, if the feet can’t feel heat, and aren’t responsive to
your other treatments and you have reduced her overall aversion to heat (which might be coming from dampness),
you could carefully consider H+.
Keep a close eye on how her body is changing during treatment and reassess frequently.
Let us know how it goes.
AJSClaussen: October 3, 2019, 6:16pm
25/01/2024, 11:43Chemo Induced Neuropathy – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/chemo-induced-neuropathy/646/print6/7
Thank you @KristinWisgirda for your very detailed evaluation.
Is numbness/tingling always considered a damp manifestation? Does the hot and dry nature of chem play into the
etiology of the neuropathy? Though I am guessing the swelling and heavy sensations corroborate a damp dx.
I have been using Sa’am for only a couple of months. Since Toby strongly encourages newbies to stick with single
channel treatments I am assuming that I would alternate SI+ with ST+/LI+.
How do you test for heat sensitivity? I was thinking of using a TDP lamp or heating pad.
Your time and energy spent on this forum is much appreciated 25/01/2024, 11:43Chemo Induced Neuropathy – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/chemo-induced-neuropathy/646/print7/7
KristinWisgirda: October 5, 2019, 1:37pm
AJSClaussen:
Is numbness/tingling always considered a damp manifestation?
It is important to differentiate between numbness and tingling. Toby teaches that frank numbness is strongly
associated with dampness. I don’t have the experience to confidently say that numbness=dampness. Tingling has
many more potential etiologies. There are a number of neuropathy case studies on this forum to consider.
AJSClaussen:
Though I am guessing the swelling and heavy sensations corroborate a damp dx.
Yes.
AJSClaussen:
Since Toby strongly encourages newbies to stick with single channel treatments I am assuming that I would
alternate SI+ with ST+/LI+.
Given that you have conscientiously treated LI+ and SI+ with positive responses to both and with LI+ clearly
helping the feet somewhat, you have permission to use LI+ and SI+ at the same. I am confident that this won’t
get me in trouble with T.
AJSClaussen:
How do you test for heat sensitivity?
I use a tiger warmer because it is fast. Faster is safer when testing for heat sensitivity. I wouldn’t want to leave a
heat source on a potentially insensate area for any length of time.
AJSClaussen: October 9, 2019, 4:31pm
@KristinWisgirda thank you for the feedback and clarification. I am seeing this patient on Friday and am eager to
apply your suggestions.