philipsuger: September 20, 2020, 6:44pm
I have been seeing a patient with HS recently. First time ever dealing with this type of patient, very intense
condition where boils grow in certain areas of the body which are very painful and itchy. This gentlemen is in his
early 40s and had been dealing with this condition for a year and a half. It has gotten worse in the past 6 months.
His boils manifest around the groin area, has been on a number of meds with little benefit. When I first saw him he
was very cold, wore a lot of clothing in the middle of a hot Texas summer. Appeared tired and in lots of pain. He
also has a condition where water is accumulating in his testicles.
I started with some channel based treatments and herbs. We got some good results but I wanted to try out Sa’am to
see what could be accomplished. I supplemented LI two times with good result. The boils are more under control
and haven’t been spreading. He has some good weeks and bad weeks. Upon the 3rd tx I was considering either
supplementing SJ or HT. SJ because he is quite dense and uncaring when it comes to social interaction, the grown-
ass man plays games on his phone while we do the intake it was quite unbelievable. I was thinking HT because his
sensations of cold, though with tx his feelings of cold had reduced by this time. So I went with SJ also figuring that
m. fire/ fire could maybe warm up the exterior and get rid of these boils.
He seemed OK with the needles, he did have some bad pain after the tx though, not sure if this was because of
choosing the wrong channel. He explained that he often has one bad day after tx but then sees it improvement, I am
seeing tomorrow again. Wondering if anyone has any other ideas as to how to approach this patient.
KristinWisgirda: September 20, 2020, 8:09pm
Thanks for the case @philipsuger.
Writing up the case more fully would help us see your patient more clearly.
Here is the preferred case study format. Case Study Format
Sometimes just using the format will help you see more possibilities for your patient.
michaelmax: September 21, 2020, 3:06am
[quote=“philipsuger, post:1, topic:1286”]
SJ because he is quite dense and uncaring when it comes to social interaction, the grown-ass man plays games on
his phone while we do the intake it was quite unbelievable.
[/quote]he
@philipsuger what a great image for a Liver Excess person. And given that the LV channels runs through the
groin and he has lots of boils there, I think tonifying SJ makes good sense on a constitutional level. You might19/01/2024, 11:17Hidradenitis Suppurativa – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/hidradenitis-suppurativa/1286/print2/3
however ruin his enjoyment of computer games.
I thought about tonifying LI as well to dry.
It seems like there is an aspect of heat and toxin here as well. I hear that he feels cold. What about if you palpate to
see if his abdomen is cold? are the hands and fee cold as well?
Sometimes there is a lot of cold on the interior and displaces the yang qi out to the surface (sorry, thinking herbally
here) But it does give some weight to tonifying the HT to see that helps. If it is displaced heat, then he should both
warm up and the boils should become less red.
I would also consider the SI just to create some circulation in the system. He seems pretty stagnated.
Interesting case. Keep us posted.
KristinWisgirda: September 21, 2020, 6:54pm
michaelmax:
It seems like there is an aspect of heat
Phil hasn’t included any descriptors that say heat to me, unless I skipped over them. I want to see redness or feel
heat to say heat. All we know about the boils is that they are an itchy and painful condition manifesting at the
surface of the groin. I want to hear about the color, if and how much they protrude above the surface of the skin
(how convex) and how hard they are. Knowing about the general state of his skin and flesh would help lots too.
lauramcgraw: September 21, 2020, 7:09pm
Hi There,
I am very curious about the surface of this patients body. Does he sweat easy or not at all, there is a lot of cold and
in a pivot area(groin) so wondering about his surface would be helpful in diagnosis.
philipsuger: September 22, 2020, 1:41am
He came back today and had a good week. Felt much less pn after the SJ+ tx. When I came into the room he also
put away his phone this time So I decided to tonify SJ again since he did well last time.
So this makes 2x LI+ and 2x SJ+
He had originally sent me pictures of his boils but they were hard to make out, he is also African American so the
darker skin tone also makes it difficult to discern. I asked him to send me some new pictures. He seemed much
better today. Before beginning tx he said his pn was 10/10 now he says it is 7/10. But I don’t believe him I think he19/01/2024, 11:17Hidradenitis Suppurativa – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/hidradenitis-suppurativa/1286/print3/3
has gotten more relief than that. His bad days are really bad. When things are going bad he feels pus filling up in
the boils. Since we have begun tx no new boils have formed and he feels like the boils are receding.
Which makes me think about the use of SJ for skin diseases, normally the territory of LU/ST SP/LI but with the
idea of SJ addressing the exterior makes sense.
I palpated the abdomen it was not hard and cold, it was actually pretty warm and moist today.
He used to sweat a lot and felt cold, but that is more under control now.
KristinWisgirda: September 22, 2020, 1:24pm
Thanks for the update. Glad to hear that he is making progress.
philipsuger:
the idea of SJ addressing the exterior makes sense.
I would frame this differently. SJ+ brought warmth and light to an area that it has particular affinity to (the Liver
channel) and improved the function of the exterior in that location.
philipsuger:
skin diseases, normally the territory of LU/ST SP/LI
Yes, you definitely want to consider the balance of Taiyin/Yangming, damp and dry, with skin diseases. Other
channels commonly used for skin in my practice are UB+, SI+, Liv+. However, it is important to remember that all
of the channels can affect the function of the exterior whether through their affinity for location or by bringing their
particular qualities. Skin needs the right balance of damp/dry, heat/cold, density and openness, convexity and
concavity, dynamic movement of blood and consolidation.
You have to love the patients with extreme qualities even when they are rude! They show us how the body works
and the genius of Saam.