adambroder: August 16, 2021, 11:59pm
52 year-old female
Chief complaint: uncomfortable numbness and stiffness in right leg and foot; symptoms began in December as
intense 10/10 pain down entire right leg, cause unknown; five days later the pain subsided and she was left with the
numbness; she also had some lingering “sciatic” pain in her right lateral hip/glute
Appearance and demeanor: average facial symmetry; neatly but casually dressed; friendly but not warm; polite;
makes eye contact but eyes are in between dull and bright; face can be red at times
Lifestyle: married with a son, works as an office manager which she likes but can be stressful, likes to
run/hike/ski/snowshoe, recently went on a road trip which included swimming, hiking and some camping
Body morphology and flesh quality: average frame, pretty good muscle tone, warm abdomen, water sounds in
abdomen during fukushin exam (though that may have just been hunger sounds)
Skin Quality: has had psoriasis which comes and goes; sun and salt water make it better; when it flares it is very
irritated, burning, itching; skin is dry upon palpation with light red spots all over; patient reports that the psoriasis
is leftover from a flare she had when she got COVID a year and a half ago
Body Temp: tends to run warm, enjoys outside sports in the winter time
GI: often skips meals, doesn’t tend to eat much at once, suspected glomus
Respiratory: sometimes gets allergy symptoms with congestion and watery eyes/nose, sneezing, frontal headache
Sleep: no issues reported
Emotions: says she is not the type of person to get stressed easily and her demeanor reflects this
Urination: no issues reported
Tongue: purple, slightly puffy, peeled/geographic coat, lots of movement (+8)
Excess Presentations:
Heart: runs warm, warm abdomen, burning quality to psoriasis, prefers cold weather, red face
UB:
GB: outward flaring quality to psoriasis
P:
SJ: flaring psoriasis, red face, upper body warmth and flushing with stress or when drinking red wine04/01/2024, 12:06Numbness and tingling in foot – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/numbness-and-tingling-in-foot/1610/print2/5
Liver:
Lung: well-resourced, dry skin, internal damp symptoms (runny nose, watery eyes, abdomen)
Stomach: numbness
LI: likes to be active, says she doesn’t get bored easily
Spleen: numbness, internal damp symptoms
SI:
K: numbness, skin issues
The Grossest Thing(s) in the Room: lingering radiculopathy symptoms with no known cause
Main treatment ideas: LR+, UB+, SI+
Other treatment ideas: ST+, LI+
I have seen this patient 7 times. The channels supplemented were as follows (all on left side except when I did a
BL tx):
1st tx: SI+
2nd tx: UB+
3rd tx: LR+
4th tx: ST+
5th tx: LR+/SI+
6th tx: ST+ (ST36 mod)
7th tx: LI+
We’ve been making some progress on each treatment. Symptoms began in the leg and foot and are now just in the
foot. The sciatic hip pain has gone away and as her allergy symptoms come up they go away after a treatment until
a couple weeks later. The foot symptoms change a little each time too, sometimes presenting with quick, sharp
pains at the tips of the 2nd-4th toes, sometimes the foot is described as very stiff, sometimes it feels like she’s
stepping on a big ball. I will palpate and move the foot around and I don’t feel anything unusual. She will tell me
that she feels my pressure but the numbness fees very deep. After the 5th treatment she went on a road trip from
New Mexico to Texas. I was interested to see how humid weather might affect it since New Mexico is very dry. On
the trip she went swimming in warm salty water and got out in the sun, the combination of which helped her
psoriasis. She also ate a lot of seafood which she normally doesn’t do. For some reason her foot got really swollen
on the trip. Upon returning it was back to normal. After the 6th treatment. there was pretty much no change. I
wanted to try something new so I went with LI+ based on SP excess presenting as numbness, along with internal
damp symptoms and that weird foot swelling. I texted her to follow up (treatment was Wednesday, follow up text
was Saturday, today is Monday, I see her again on Wednesday); she said it’s still numb but the stiffness is a little
better, mobility is good, felt cramping in the toes the past couple days but that’s feeling better today.04/01/2024, 12:06Numbness and tingling in foot – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/numbness-and-tingling-in-foot/1610/print3/5
Please let me know of any recommendations you have. She will see me again in two days along with someone else
in the practice who does passive stretching. I’m thinking about writing her a prescription to get an MRI as well.
This issue could potentially be due to a herniated disc. If so, I wonder how much more Sa’am can help with it.
George_Mandler: August 22, 2021, 3:43pm
Adam
Sorry for the late reply I see you wrote this last week and have already seen this patient again. You have done due
diligence for your patient IMO.
Getting an MRI seems reasonable.
adambroder:
patient reports that the psoriasis is leftover from a flare she had when she got COVID a year and a half ago
This has me pause considering all the crazy post-covid symptoms we’ve seen. I’m asking for Michael Max – have
you done herbs with her? With that purple tongue and lack of sensation and given you’ve supplemented SI+ a
couple of times…ya know.
A couple of things…
adambroder:
SJ: flaring psoriasis, red face, upper body warmth and flushing with stress or when drinking red wine
What are you thinking in putting the ‘flaring psoriasis’ in SJ excess category?
Also for completeness SJ excess is more red cheeks rather than just red face – cold feet and bright eyes are the
arbiter.
Skin, external dryness – Maybe HT excess or LU/LI excess given her other characteristics.
I am curious how she responded to the different sessions. I’d look at maybe which was the biggest responses and
do that again. Maybe have some fresh eyes and pretend you never saw her before to choose your channel.
adambroder: August 23, 2021, 4:49pm
Thank you for your response George. I am in the GMP for the first time so I am not currently doing herbs for
patients. Her psoriasis has been an ongoing thing throughout her life. I don’t know if I’d consider it a long-COVID
type of thing, if that’s what you’re getting at, since any stronger illness might have had a similar effect. For SJ
excess I think of upward and outward flaring heat, but in a more contained way, such as red cheeks instead of a red
face (my mistake above for putting red face under SJ excess). I think I heard Toby say that redness at the elbows
could be considered SJ excess. So because the psoriasis has a patchy/spotty quality I put it there.04/01/2024, 12:06Numbness and tingling in foot – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/numbness-and-tingling-in-foot/1610/print4/5
I have done ST+ a couple of times but not SP+. I know ST and SP excess both present as numbness but I don’t
know how much the rest of the presentation should be taken into consideration when numbness presents.
LI+ helped a bit. Last time I saw her I did GB+. She is a calm person, reports never getting very stressed or
expressive with her emotions, and has an intellectual quality to her that never really stood out to me until I thought
more about the PC/GB dynamic. And because the numbness is described as being very deep it seemed to me to be
concave in a way.
I can look back again at which treatments had the best responses. We seemed to have a lot of progress at first as the
symptoms moved from the leg and foot to just the foot and it’s really been stagnant since then. Sometimes there
will be more cramping and less stiffness, sometimes the opposite, sometimes minor shooting pains. It’s hard to tell
which of these different presentations are indicative of progress and which aren’t.
adambroder: August 25, 2021, 5:29pm
Another update: like most of the treatments recently, GB+ provided relief for a day or two followed by a return to
normal. She is in the treatment room as I type this with a bilateral treatment: SI+/UB+. I looked back at my notes. I
did UB+ one other time, for the second treatment, and it looks like that was the best result so far though I wonder if
that’s partly because it was so early on and we were getting things more in balance then. Looking at the patient
with fresh eyes, I noticed more redness to some of the psoriasis. Her entire face is red and not just her cheeks. And
the stiffness perhaps could be considered a dry symptom, in need of cool water. The SI+ was added based on
everything that was stated above. I took another look at her tongue after several treatments of not looking at it and
the dark purple is still there and quite striking. The tongue is peeled: the lower 2/3 has a thick white coat and the
upper 1/3 has no coat at all. These areas are separated by a distinct diagonal line. Also there is an unusual amount
of movement to the tongue.
Some other things I noted this time:
-The patient often has allergy symptoms characterized by congestion in the face; she frequently sniffles while
receiving treatment.
-She reports swelling in the foot; I asked if that’s a sensation of swelling or if it’s visible and she said it can be
visible though upon inspection both feet appeared identical. I pressed some points in both feet at once and she
reported feeling swelling at KD3 on the problem foot. I saw the slightest swelling there compared to the left. I also
noticed her skin from the knees down on both sides to be sort of sagging/sort of pitting, just loose in general. She
said she feels like her right shoes fit differently from the left. I asked if there are problems taking them off and
putting them on and she said no. I think this swelling is a subjective thing though she did say that on her trip to
Texas last month her foot swelled up a lot, “from the humidity”. I have never observed the swelling.
-I asked her to go this next week only drinking water when her body tells her she’s thirsty. The fluid balance is
confusing to me. Without a doubt her skin is dry. But with the swelling, numbness and congestion from allergies,
how else to look at the inside except being damp? That being said, ST+ on two separate occasions didn’t
accomplish much. Her body morphology and personality both say more LI excess than SP excess to me though.
-I asked about her light sensitivity and vision. She said her vision has been getting blurry recently, and she doesn’t
like to drive at night anymore. This would add to her LR excess symptoms though the flushing that she reports
when stressed or when drinking red wine gives me pause to do SJ+.04/01/2024, 12:06Numbness and tingling in foot – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/numbness-and-tingling-in-foot/1610/print5/5
Thanks in advance for your input. I am very impressed with this patient’s commitment and I want to do all I can for
her. I wrote a referral for a clinic that can prescribe an MRI so hopefully that happens soon.