Adina_Kletzel: January 5, 2021, 10:40am
HI,
I could use some guidance on the following acne case
22 year old male, has had acne since age 15.
Born at 36 and a half weeks and has a history of asthma, eczema, stool incontinence until age 6, bed wetting until
age 8, and developed and anaphylactic allergy to nuts at age 3.
CHief complaint
The acnes is on his face, neck , shoulders, and ears.
Big red swollen pimples that look more like lesions than pimple.
They feel tight and he picks at them to relieve the pressure inside.
Yellow puss and blood ooze out when he breaks it open.
Pimples take at least 3 weeks to heal, some even take months.
His face is oily and he also has a lot of black heads.
Lifestyle: university student and pressured part time job. Always working or studying. has alot of friends but
doesnt have much time to hang out with them since starting university.
Always pushing himself to study. Hard on himself if doesnt do well.
Appearance and demeanor: He is thin, small boned, low energy, slightly stooped over.
symmetrical: 4. Puts himself together and wears clean clothes but is not into appearance or fashion at all. Likes
simple plain clothing that are comfortable.
dull eyes 6 sallow complexion 7 when stressed he is quiet and withdrawn and tense. When not stressed he joins in
conversation and can be playful and funny
very hard to get information out of him. Difficult to reach him.
Energy level: 5. He is a student and has a demanding part time job. Stays up late studying. He always feels low
energy
Digestion: gets very tired after big meals. low appetite. Skips breakfast, eats a small lunch and some dinner.
Lactose intolerant.
Sweat: hands and feel always sweaty
Temp.: not too cold or too hot but likes to be covered – likes to wear long sleeves with hoods. Feet always cold.
Thirst: moderately thirsty – rates his thirst as a 5. drinks room temp water
mouth is dry
Urin.: Pees once every 2 hours
bowel: skips 1-2 days a week
Emotions: tight and tense when stressed (which is most of the time since starting university). feels anxiety by CV
14 area – says its just there 10/01/2024, 13:03Difficult acne case – Qiological Community
https://forum.qiological.com/t/difficult-acne-case/1452/print2/7
feels a little down also because of hard work. Pushes himself hard to succeed.
He keeps everything inside. Rarely ever gets angry and if does get angry argues intellectually.
respiratory: gets a dry cough at every change of season
Tongue
Reddish, white coating in MW and LW. thicker in LW
long crack down the middle from LW up to but not including UW. Some horizontal cracks extending out from
main crack to LW area.
Red dots on liv/gb area and on tip
Slightly distended purple sublingual veins
Pulse
whole pulse is strong , tight and wiry and floating up
except for right cun – that is weaker
and right chi is a bit weaker on deeper level
Abdomen
it is all tight and hard
hard CV line
Excess presentations
GB: convex lesions 8+
PC: slow and deliberate movements 7+, argues intellectually 7+ not confrontational 8+
Liv: dull eyes 6+, emotionally down (since starting univ.) 6+ very difficult to reach and get info out of him 7+
closed and guarded 7+
SJ: criticizes self 8+
St: dry on inside wet on outside 8+ low energy 8+
Lu: very poor appetite 8+
SI: not very symmetrical 6+ not into appearance 6+ hard on self 7+ born a bit premature 6+
Kid: tight and hard lesions on skin 8+ young 8+
Bl: anxiety sits under heart 8+ lesions are red 7+
Ht: anxiety sits under heart 8+ sternum to umbilicus hard and tight 7+
Treatments I have done (not in order)
I have used LU + a bunch of times and ti gives him some energy for a couple of days and slightly improves the
skin but nothing very significant.
I am also concerned to overuse LU because of his very low appetite.
SJ+ helped with his mood and appetite a bit but caused a bit more of a breakout on his skin.
Kid + made skin worse
SI + he said he was so so tired that week
UB+ was so tired after and skin got worse
Ht+ more energy, no change in skin
PC+ skin on face a bit better but worse breakout on arms and shoulders
Liv+ helped skin on face but still felt tired and heavy
St+ a bit of improvement in appetite but no change on skin
I did GB+ once and he seemed to have a bit more energy but no change in skin.10/01/2024, 13:03Difficult acne case – Qiological Community
https://forum.qiological.com/t/difficult-acne-case/1452/print3/7
I am just not sure where to go from here.
He seems to have a strong constitutional weakness but there must be something more that I can offer him.
Any suggestions?
Also – he seems to have a constitutional weakness of LU but since he was born a bit early does that also mean that
he has a constitutional weakness of Kidney? Enough to say that I should try to tonify Kid again?
Thanks so much!
KristinWisgirda: January 5, 2021, 12:17pm
Yellow pus and oily skin. My first choice is LI+.
michaelmax: January 5, 2021, 4:05pm
This is a tough one @Adina_Kletzel
What stands out to me are some issues with Kidney Jing, and the heat and dampness at the exterior. It also sounds
like this fellow pushes himself which is a kind of Yang Ming excess.
I can see how you d be drawn to tonifying the LU for him. @KristinWisgirda s idea of tonifying the LI would
also bring some cooling.
This case reminds me that mixed patterns are tricky. If I put on my herbal hat I m thinking of harmonizing, of
bringing balance to the entire system. With Saam I suspect
(this is not from Toby, this is my own working hypothesis, not even a rock, more like a clump of dirt, but it s
something think about)
that we either need to attentively toggle between the aspects we want to harmonize or use a bilateral treatment that
addresses two aspects. For example, K to nourish the Jing and LU to dry the exterior and moisten the interior.
When I think of harmonizing with herbs we are usually using herbs that work quite differently from each other.
One to go up and another to go down, or one to cool above and another to warm below. When I think of applying
that principle in Saam I m NOT looking to treat both ends of a counter balance, but to ask the body to do two
things at the same.
Again working hypothesis. Does that help at all?
Adina_Kletzel: January 5, 2021, 5:44pm
I tried it too – even though he is dry on inside. It did not help either. He got more tired and acne got worse.
I don t think in this case yellow pus and oily skin = LI
I don t think this damp is coming from damp on the inside. Something else is at play and I just haven t figured it
out yet.10/01/2024, 13:03Difficult acne case – Qiological Community
https://forum.qiological.com/t/difficult-acne-case/1452/print4/7
I think his up and out mechanism is lacking and the moisture is just hanging out on his surface.
He also is so low energy and closed emotionally. I feel like we need to get his energy up and out in many senses.
It s just that clinic has not supported this hypoethesis
Adina_Kletzel: January 5, 2021, 5:47pm
Yes thank -you. But he is low energy and his case is so confusing that I am nervous that if I do both sides I won t
be able to really know what helped. I am also not sure he can handle both sides.
I also feel that I have used almost all of the channels and have not had movement so his system had many
opportunities to harmonize even if it wasn t all at once.
Which leads to my question about being born at 36 and a half weeks – could the constitutional weakness be greater
than my quest to harmonize?
Would it be okay to ask you if you have a specific herbal formula that may help? I have been trying so hard on that
front too.
George_Mandler: January 5, 2021, 9:34pm
Adina
I read this case and it seems he seems pretty closed off and a significant emotional component. I want to question
the reporting after a session – such as skin got worse, skin better – do you think this is accurate? IMO slight changes
in skin as things wax and wane are common – how much change is there during treatments vs before you started
treatment.
I have seen treatments not work and then work – sometimes I question if my point location were precise enough.
Also when he was wiped after a treatment how long did you leave the needles in him?
Gosh there is so much here – the hx of asthma, eczema, bed wetting where is all this skin damp heat coming
from. You may have to choose channels that feels right for him and not let the acne cause you to lose focus. It is
not an easy one and will take time if he is up for this – it may be about bringing a channel up, then choosing a
different channel. I see Michaels said this better than I did.
And even though he is thin I would consider LI+ as Kristin mentioned – he shows heat and damp. This is not an
easy Sa am only case IMO. Sure would make a good herbal writeup though.
KristinWisgirda: January 5, 2021, 11:56pm
Adina_Kletzel:
I am also concerned to overuse LU because of his very low appetite10/01/2024, 13:03Difficult acne case – Qiological Community
https://forum.qiological.com/t/difficult-acne-case/1452/print5/7
I asked Toby about using Lung+ for a patient with low appetite. He said not to worry about it if the St excess is
clear. Using Lung + really helped the patient s chief complaint and her appetite might have even improved a bit.
This is a tough case. It makes it more complicated when he is not forthcoming with information. Do you trust his
reporting? Taking pictures and comparing pics at each visit can be helpful. You can also make a checklist of
parameters like new pimples, healing time of old lesions, presence of pus when scratching, etc. so you have more
data to evaluate than his general impression. How is he with hygiene? The picking should be discouraged
especially as it sets him up for secondary infections.
His energy is low after so many treatments. Is it really lower as a response to treatment or is it a function of staying
up late studying? If a patient chooses not to get a decent amount of sleep, there is only so much you can do,
especially if his constitution is weak. It can be helpful to tell patients that they have weak constitutions so they can
understand that they need to take extra care. I am cautious about doing this but this fellow really seems depleted. If
he has deflated thenars and medial heels, you can even show him some of the physical signs that you are looking
at.
Did he settle with all of these treatments?
You may also want to look at order of the treatments for clues to how effective a treatment was. For instance, if you
treated H+ after UB+ which aggravated his skin and energy, you have to consider that the H+ was just
counterbalancing the adverse reaction to the UB+. H+ might have more potential.
According to the tradition, bilateral treatments are not recommended when there is constitutional deficiency. As
well, I still think you need more clarity on whch treatments are really beneficial to him.
amyjenner: January 6, 2021, 12:42am
Sounds like STxs body morphology skinny, damp skin, greasy oozing lesions How about LU+. Would make
sense as he has skin issues
Adina_Kletzel: January 6, 2021, 11:34am
That is the channel I treat most often. It gives a small shove in the right direction which from what everybody
wrote above should be considered progress.
Adina_Kletzel: January 6, 2021, 12:17pm
THank-you so much for your response. I think you are right about not necessarily trusting his reporting. Good
point. I will make a check list of parameters.
His hygiene is good, his thenars are actually inflated- which makes things a bit more confusing 10/01/2024, 13:03Difficult acne case – Qiological Community
https://forum.qiological.com/t/difficult-acne-case/1452/print6/7
KristinWisgirda:
Did he settle with all of these treatments?
He falls asleep with all of them – except LI+ took him some time to settle but he did toward the middle.
Adina_Kletzel:
Also – he seems to have a constitutional weakness of LU but since he was born a bit early does that also mean
that he has a constitutional weakness of Kidney? Enough to say that I should try to tonify Kid again?
would you be able to respond to this specific question?
Thank-you so much for all of your help.
KristinWisgirda: January 6, 2021, 1:07pm
Adina_Kletzel:
Also – he seems to have a constitutional weakness of LU but since he was born a bit early does that also mean
that he has a constitutional weakness of Kidney? Enough to say that I should try to tonify Kid again?
I don t think that this talk about specific constitutional deficiencies is very helpful because they are theoretical. His
lifestyle demanding work and probably not enough sleep are reason enough for his weakened condition and major
contributors to the lack of resources that responds to Lung+.
Adina_Kletzel:
He falls asleep with all of them
That he falls asleep with treatments that haven t really benefited him significantly or at all tells me that he is just so
wiped out. He must get more sleep.
In all of my Saam notes, I don t see that being a preemie is an indication for SI excess. For this reason I wouldn t
try K+ again solely based on this idea.
The exhaustion and the reporting seem to be the 2 major obstacles in this case. SJ+ might be helpful to make him
more aware of his body s need to sleep.
Adina_Kletzel: January 6, 2021, 1:23pm
10/01/2024, 13:03Difficult acne case – Qiological Community
https://forum.qiological.com/t/difficult-acne-case/1452/print7/7
Ok thanks so much. You have been very helpful.
One last question – in your experience is there anything I can suggest to him to put topically on the lesions? He
picks at them because they are so tight and painful and getting them to open and emit pus and blood brings him
some relief.
jedwardian: January 6, 2021, 6:20pm
This is less a suggestion for Adina and more a question for everyone: couldn t a worsening of acne in a case like
this actually be part of a resolution process? I know I m mixing in some foreign-to-Sa am (and even foreign to
TEAM) ideas here, but with breakouts the body is pushing toxins out through the skin, at least that s one thing that
could be happening, and it seems possible that that process may need to become more intense before it resolves. It
could be worth considering that treatments that were positive except for an increase in breakouts are actually
moving things in the right direction. In particular, I wonder about more SJ+ for him, and about trying GB+ again to
help move things out while giving him more oomph to his PC excess self. Definitely a tough case.
cassiopeia: January 8, 2021, 11:41pm
Hi Adina,
I don t have anything to add re: Saam, but I have been using Saam in conjunction with herbal methods learned
from Mazin, and the combo is fantastic for skin issues – they are progressing at least 2x as quickly as before, when
I used herbs alone. Are you using herbs with this person? It sounds like he has a combination of damp heat/phlegm
nodulation, toxic heat, and (depending on the degree of redness) blood heat + seborrhea.
Re: topicals, Mazin s line Dermatology M has a few products that benefit most acne cases: spot treatments using
Fei zi shui for daytime use, and Dian dao shui gao for night (it s brown in color); if oily skin, Jin yin hua xi
ji/honeysuckle wash works great.
Adina_Kletzel: January 9, 2021, 10:15pm
THank-you so much!! I will look into those products.
I have been using herbs as well which also need to be reevaluated.
THanks again!