maeveodon: February 10, 2020, 10:10pm
Hi everyone, I’ve been on this forum since the start and it has been invaluable to me, so thank you to everyone who
shares their knowledge. This is my first time to post a case, so apologies that it is very longwinded and probably
missing info!
75 year old male.
CC Depression, anger/anxiety and neck pain. Also has frequent urination issue from diagnosed benign prostatic
hyperplasia about 18 months ago. Had a stroke 6 years ago. Depression started about 1 year ago and he has been
hospitalised for it and is on medication. I know its a common side effect post-stroke and can occur up to 5 years
afterwards. According to him and daughter there was no other trigger for it 1 year ago (but maybe the prostate
issue?). For him feels like apathy, no interest in anything, just wants to lay in bed. No appetite or interest in food.
Daughter is the person pushing him to try acupuncture as feels medication is not helping at all. She told me on
booking that he has angry outbursts at his family, especially if he wants something to be done and it is not done
immediately. His anxiety seems to be very linked to the frequent urination issue as he finds it embarrassing. The
neck pain started shortly before he had a stroke 6 years ago but after the stroke it went away, has had it
intermittantly and now it has for a couple of months. Its an achy pain, worse on movement, has to rest when it gets
bad. Points specifically to C7 and Bl ch both sides, also feels it up to about C3.
The other post-stroke effects have been memory loss and weakness of legs, feels they could give at any time. Not
his knees, more the front of thighs, couldn’t pinpoint it to a particular channel.
Mentioned irregular heartbeat but no pacemaker or medication for that.
Both hips replaced about 15 years ago. Thyroid removed about 10 years ago with benign tumors.
Medication: anti-coagulent, type 2 diabetes med, eltroxin, antidepressants, med for prostate.
Appearance: Neatly dressed, polite, very early for appointments. Stooped over a bit…with neck pain says difficult
to hold head up. Bright eyes +5. Small reddish sores on lower eyelids. Thin (has lost a lot of weight in recent
months due to lack of appetite)
Said he feels on the colder side, wraps up with heavy coat but it is winter time here
Bowel movements normal, sometimes on the dryer side
Lots of varicosities around ankles, but also very dry cracked skin all around heel
LU10 area looks normal, not inflated or deflated. Did not ask about finances as had a feeling he would find it
intrusive for now.
Hands cold to the touch but feet quite warm (can this be LIV XS as well as SI/Kid? I remember SJ XS is more
likely to be opposite of this)24/01/2024, 11:51Depression post-stroke – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/depression-post-stroke/888/print2/5
On palpation, stomach soft and flaccid with some extra flesh. No tightness or tenderness under ribs on either side.
No hard masses either. Sternum to umbilicus soft, not particularly warm.
Skin some dry patches and callouses on hands and feet but overall not very dry or moist. Sweating normal.
Frequent urination but no burning or hot symptoms with that.
Tongue: Reddish tongue with extremely red tip. Lots of deep cracks but also quite wet. Slightly swollen on left
side. Slightly distended purple sublinguals.
Liver XS:
Depression +10, Cold hands/warm feet +6, Weakness on front of legs (Liv Ch), guarded +6
SJ XS:
Weakness on front of legs (Liv Ch), Bright eyes +5, Red sores around lids +5, anxiety in public about urination +8,
sometimes sees bright flashes in his vision +6, prefers bright days +6, controlling behaviour…needs everything
done now +8
GB XS: Anger outbursts at family +8, red tongue tip +9, irritated on questioning +7
PC XS:
HT XS: Reddish tongue +5, neck pain on BL ch, irregular heartbeat?
BL XS: Possibly frequent urination but more likely to be related to enlarged prostate +4, Feels on the colder side
+5, Neck pain on Bl ch +4, Sensed some fear around his health, but he said he does not worry about it, deep cracks
on tongue +4
SI XS: age +9, cracked medial heel +6, frequent urination possibly needs consolidation +5, Pain worse on
movement +8
Kid XS: History of stroke +10, past tumor on thyroid +5, varicosities +7, deep cracks on tongue, distended purple
sublinguals +6
SP XS: Enlarged prostate +9, Apathy +10 (read a comment from Kristin about this but maybe depression is too
extreme a form of apathy to consider this?), lack of appetite +8, fleshy abdomen +5. Had loose mucosy cough at
2nd appointment +5
LI XS: Quite thin now +5, tends towards constipation +3
LU XS: Weak legs on ST ch +7 (does it have to be weak knees for this axis to be involved?), lack of appetite +8,
fleshy abdomen +5, enlarged prostate +9, Had loose mucosy cough at 2nd appointment +5
ST XS: Weak legs St channel +7, constipation +3
From the classes and case histories on here, I know depression is mostly linked with Liv/SJ and SI/Kid pairs. But
because all 4 seem to be in excess I was nervous to start on these in case of making anything worse for
him.Unfortunately I’m not sure if he is going to come back now but I would like to have your thoughts on it.24/01/2024, 11:51Depression post-stroke – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/depression-post-stroke/888/print3/5
Treatment 1: +PC – As it was his daughter made the appointment and mentioned a few times the angry outbursts,
plus the irritation after a while of questioning, and the very red tongue tip, I thought this was the biggest thing that
day. He had not been feeling as down for a number of days before the treatment. He completely relaxed during the
treatment. His daughter reported on the phone 3 days later that there was an improvement with the outbursts but on
next appointment he himself reported no change in anything.
Treatment 2: +LI – As SP XS seems very prominent, I chose this to see if it could help with the frequent urination,
the apathy and in case the excess damp is affecting his appetite as well. I put the needles in and he closed his eyes
and said he felt good. His face looked good to me and he seemed very calm. But 10 minutes later he started moving
around and said he needed to use the toilet immediately. So I took the needles out. He used the toilet but did not
want any further treatment. He had to wait for his daughter and was very chatty during that time but then started to
get a bit agitated again and asked me to call her. So I take it that this was not the correct treatment. I called the next
day and his daughter said he was the same as usual that evening but the morning after he said the pain in his neck
felt better.
In hindsight I think +Kid may have been the best option for the first treatment because of his age and his body has
been through a lot medically in last few years, and the pain which is worse on movement. But with the history of
stroke is this risky?
+SI also needs to be considered but could this make his neck pain worse? Maybe +Kid first and then +SI later?
Also aware of +SJ for deep depression but read a recent comment on +SJ making depression and anxiety worse
and he seems to have a lot of SJ XS.
Thanks,
Maeve
amyjenner: February 11, 2020, 1:38am
Just thought I’d share how I approach the resources question which can be a bit strange meeting someone for the
1st time. I just ask “How do you feel you are doing with resources?” They usually respond with “like Money?”.
And I say “yeah, money, time, friends, family support. Do you feel like you have what you need in life?” Then
whatever comes after that generally gives me a good sense of things in the resource department.
KristinWisgirda: February 11, 2020, 5:56pm
Hi Maeve,
Thanks very much for the case. This poor fellow needs help on many fronts but also needs careful consideration
because of mixed excesses as well as an overall picture of frailty.
For future cases, paring the words to the essential really you see your patient better on paper. It also helps your
readers too :).
maeveodon:24/01/2024, 11:51Depression post-stroke – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/depression-post-stroke/888/print4/5
I know depression is mostly linked with Liv/SJ and SI/Kid pairs.
Depression is an umbrella term that can describe lots of qualities of experience including darkness, cold
disconnectedness, heaviness and lack of motivation. Some people might include irritibilty too.
In Saam, the first thoughts for depression are SJ+ to bring bright clear light and H+ to bring warmth and
connection to counter ice cold-disconnectedness, fear and despair. LI+ can be used when there is a damp apathetic
aspect. K+ can be used when there are suicidal tendencies because of low self worth and when the person is just
falling apart. There may be other elements to consider but these are the more common.
It is helpful to know what makes the patient really feel better but your patient sounds like he might not be able to
provide that information. Asking yourself “which quality does this patient need to help his depression?” might help
you differentiate- – warmth and love, bright sunlight, drying off a damp burden, consolidating a fractured self, etc.
For this patient my sense is that the hypofunctioning of UB excess is an element of his depression. Along with the
depression, his easy anger could be seen as a lack of warm love for others. There are enough pointers to consider
H+ as a treatment. Winter is a safer time to use H+ as well.
maeveodon:
prefers bright days +6,
belongs under Liver excess, not SJ excess. You can add “polite” to his SJ excess profile too. The anxiety around
urination isn’t a for sure SJ excess sign, unless you think it is clearly from feeling overexposed. He has enough of
mix of Sj and Liv excess signs to give me pause before treating with SJ+. I might consider using Liv+ and H+
together but would double check to be sure that I am reading his SJ excess signs correctly, eg bright eyes,
controlling.
About your Spleen excess entry: “lack of appetite” doesn’t belong here. LI+ is used for reducing sweet cravings
and appetite. For lack of appetite, your first Saam thought is to supplement Stomach to help open the GI tube to
downward movement- so that means a diagnosis of Lung excess. Though there are cases of extreme dry interior
with poor appetite and diarrhea, where you would look to supplementing the Spleen.
maeveodon:
As SP XS seems very prominent,
I have to question this. You say he is “quite thin now 5+” with poor appetite and dry constipation and the deep
cracks on the tongue (a dryness sign, most often treated with Taiyang UB+/SI+ but also SP+). Yes, he has some
internal damp signs but these don’t seem to be the grossest part of his presentation. Damp can be part of depression
but there is enough dryness in his picture that I am not surprised that he was agitated after the LI+ treatment
beyond just the sudden need to urinate.
maeveodon:
LU XS: Weak legs on ST ch +7 (does it have to be weak knees for this axis to be involved?),24/01/2024, 11:51Depression post-stroke – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/depression-post-stroke/888/print5/5
Stomach channel involvement can theoretically point you to Lung excess but weak knees which makes the patient
want to sit down especially after losing money is the classic pointer to Stomach excess. Lung excess has easy
access to external resources – so quality-wise weakness is not a match for a Lung excess presentation.
maeveodon:
I think +Kid may have been the best option for the first treatment
Toby has mentioned that he seldom if ever has used K+ for the first treatment.
maeveodon:
+SI also needs to be considered but could this make his neck pain worse?
The leg weakness and difficulty holding his head up, along with the other SI excess signs, would make me very
cautious about using SI+. It sounds like he is having a hard time holding himself together.
Clinic is hard! Best wishes to this gentleman and yourself as you figure out how to care for him.
maeveodon: February 11, 2020, 11:43pm
Thank you Amy for that advice, a nice soft approach that should work for everyone. I will use that in future.
Kristin, thanks so much for your very detailed response, it is all so helpful. I hadn’t thought of HT for depression at
all but it makes a lot of sense in the way you explained it, and I had a lot listed under BL XS so i should have
questioned it more. And I can see that I need to do more reading up on the SP/LI and ST/LU. Lots to think about.
Thanks again.