Jeffrey: September 12, 2019, 7:52pm
70 year old male
F: good bone structure,symmetry, ruddy red complexion (works outside)
CC: heat flushing in face> dizzy> discombobulated, incident lasts apx 2-3 min. 6x over 8mos.
CC#2: Left nasal intermittent blockage due to seasonal allergy>sx. causing dizziness.
Appearance/demeanor: “wants to do stuff” “lots of energy” he gets things done and is meticulous.” I feel like I’m a
little low on vitality lately”. First incident of cc happened after news of his daughter being diagnosed with
melanoma, which he refers to as a shock. very fit and trim, on no meds, strong, smart, good looking, fleshy medial
heel, (sl.)sunken thenar eminence, night vision not so good, likes light. some anxiety since for last year.
lifestyle: Retired forester, still consults, gentleman farmer/builder ,tinkerer, loving husband and father. active, been
doing yoga since the 70s, lives in rural area.
Digestion: usually good, sx. sl. bloat
Temp: no issues subjectively, objectively sl. cool hands and feet. patient has “white coat syndrome” and says h/f
temp changes too. Objectively I perceive heat due to fire in R&L guan
sleep: good
emotions: even keeled, loves wife and kids, recent anxiety, concerned about mortality. interested, polite,
appreciates details.
urine: noc. 2x+, flow is better daytime (pulse indicates BPH)
BM: 1x pday normal
respiration: good though affected by pollen
skin: dry out/in, face sl moist
tx ideas: +SI,+LU,+UB,+P, (+LV?)
tx#1: +SI to move qi & blood, thin dizzyperson
very appreciative after tx., “felt a shift” looking forward to next visit
still v new at this so always interested in feedback, critique, suggestions25/01/2024, 12:02Kxs looking for a way out – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/kxs-looking-for-a-way-out/603/print2/5
KristinWisgirda: September 12, 2019, 9:07pm
Thanks for the cases Jeffrey. I know they take time to write up. Looks like you have really been loving the Saam!
Here is a link to a case study format I made up. Your cases come pretty close to my suggested format but there are
a couple of suggestions that would help us all see your patient better. One is the grading system which helps us
know the intensity or level of the symptom or sign. Is your patient’s handsomeness a +10 Hollywood type or +3
pretty good looking for an average guy. Another is pointing out the grossest thing in the room. What really stands
out to you about your patient?
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…
No need to rewrite your current case.
On to your current case:
Sounds like a good response to SI+ in the room.
Jeffrey:
+SI to move qi & blood, thin dizzyperson
Just to play devil’s advocate here: Writing it up this way makes it look like this was your thinking for choosing
SI+. Were you not also thinking “He’s so symmetrical and good looking, with a plump heel and dizzy to boot?
Strong signs for SI+” I’m not seeing signs of qi and blood stasis, though blood stasis is enough to tx SI+.
Thinness is not a sign to SI+. I wonder if you are thinking of the special presentation for SI+ of thin + small-boned
+ dizzy. You have to have all 3. I must ask Toby about this because I have only heard about this being used for thin
small boned dizzy women. I am not sure if this can apply to a man.
Jeffrey:
dry out/in,
Not sure what this means. Maybe dry interior/exterior?
Jeffrey:
h/f temp changes
Not sure what this means.
I would be interested in a description of his tongue. There are a few tongue findings that are important in Saam.25/01/2024, 12:02Kxs looking for a way out – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/kxs-looking-for-a-way-out/603/print3/5
Jeffrey:
+LU,+UB,+P, (+LV?)
Let me know what leads you to consider these treatments and we can discuss.
Thanks again for your efforts, curiosity, and keeping the forum discussions going.
Jeffrey: September 12, 2019, 10:32pm
sorry, was trying to follow suggested format. Though, I didn’t comply with the rating of each S&S.I see the value
thereof.
+SI to move qi and blood (just acknowledging the obvious action of +SI) and yes, chosen due to so many Kxs
properties.
Thin/dizzy, did not know it was for women specifically
dry out/in…yes, dry interior/exterior (i figured, same same)
Jeffrey:
Temp: no issues subjectively, objectively sl. cool hands and feet. patient has “white coat syndrome” and says
h/f temp changes too. Objectively I perceive heat due to fire in R&L guan
h/f= hands and feet. suggesting that his hands and feet change temp as does his BP due to “white coat syndrome”
+LU > sunken thenar eminence, a bit of hard luck story, needing some interior moisture, some drying on moist
face/exterior, to boost qi
+UB> ruddy red face, fire in both R&L guan, overt affection/love for family,
+P> lv fire/st fire(pulse dx),expansive heat,(admittedly, +P perhaps needed ?)
+LV> detail oriented,perfectionist,self blaming(further hard luck story about daughter),meticulous,anxious, very
externally oriented(likely more clinical weight here than +P. I likely confused the two)25/01/2024, 12:02Kxs looking for a way out – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/kxs-looking-for-a-way-out/603/print4/5
Ryan_Gallagher: September 14, 2019, 1:29pm
KristinWisgirda:
There are a few tongue findings that are important in Saam.
Kristin, would you mind elaborating here? Which tongue findings should we be on the lookout for?
KristinWisgirda: September 16, 2019, 1:52pm
Congested, dark, tortuous sublingual veins are a sign of Kidney excess. If it is only on side side, you can SI+
contralaterally.
Red tip, especially when it doesn’t match the rest of the tongue suggests GB excess and P+.
Fissured tongue- it looks like it has been sliced with a razor blade- indicates a need for Taiyang water- UB+ or SI+,
especially if it is red, dark red with no coat. In my experience these patients have also done well with SP+ at times.
Jeffrey, I’ll get back to your case soon.
KristinWisgirda: September 16, 2019, 7:23pm
Thanks for the clarifications @Jeffrey. It would be good to grade symptoms, match all of the symptoms with
potential channels, as I suggested in your 8 year old cough case.
You are missing a couple of channels in your consideration, namely
SJ+ (Liver excess):
Jeffrey:
night vision not so good, likes light.
Sp+(LI excess):
Jeffrey:
dry out/in…
Jeffrey:25/01/2024, 12:02Kxs looking for a way out – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/kxs-looking-for-a-way-out/603/print5/5
“wants to do stuff” “lots of energy” he gets things done
On to the rest of your post:
Jeffrey:
+LU > sunken thenar eminence, a bit of hard luck story, needing some interior moisture, some drying on moist
face/exterior, to boost qi
He is dry out/in as you mentioned before with only slight moisture on his face, so his morphology/skin isn’t
strongly Stomach excess and sounds more like LI excess… For the hard luck story to be Stomach excess, it has to
have a strong theme of significant recurring loss of resources. I wonder you are mentioning boosting qi, because he
says he is low on vitality lately. But he also says he has lots of energy. I wonder if he is an LI excess who just burns
himself out and has unrealistic expactations of what he should be able to do. To use Lung+ to boost qi, you really
want to see a deflated presentation. Toby said that he tried using Lung+ to boost qi with less discrimation and it just
didn’t work.
A side note: visiting Toby recently we saw a case with atrophied thenar eminences with a recovering Lung excess
morphology (skin relatively moist that day). She presented with a nodule on the stomach channel of her neck. Toby
LI+ without improvement. At the next treatment he asked about her thenars. Ends up she broke both of thumbs
badly at one point. He ST+ and the nodule shrunk on the table. Toby said that after the break, the thenars are like a
broken mirror- no longer able to give a good reflection of Lung energy. It pays to ask.
Jeffrey:
+UB> ruddy red face, fire in both R&L guan, overt affection/love for family,
+P> lv fire/st fire(pulse dx),expansive heat,(admittedly, +P perhaps needed ?)
+LV> detail oriented,perfectionist,self blaming(further hard luck story about daughter),meticulous,anxious,
very externally oriented(likely more clinical weight here than +P. I likely confused the two)
When practicing Saam, you have to put aside using other systems including pulse, even if you really, really have
lots of confidence in it. Sorry. Have fun noticing correlations while you learn and use Saam but don’t use them in
your diagnosis.
“Anxiety” can be from an excess of any channel. To use Liver+ for anxiety, you want to be sure that the theme is
the patient feels overexposed, overwhelmed by outside forces.
Under P+ you put expansive heat. GB excess is slightly warm, if you have to give it a temperature, but not
characteristically hot. You can consider P+ because his chief complaint is paroxysmal and windy.
Take it from there.