Jason: April 9, 2022, 2:12pm
30 year old male
CC: Sequelae of stroke: paralysis, spasticity, near total aphasia
Patient suffered a sudden heart attack two years ago, followed immediately by a debilitating stroke. He lived in a
rehab facility with minimal outside contact due to COVID protocols until December 2021. His mother has been my
patient for years, and I began treating him about a week after he came home.
His limbs and trunk are almost completely immobile, although he can move them a little with a lot of effort and
support, e.g. with a team of PT’s encouraging him. His hands are contracted inward to his upper chest, and locked
in a “claw” formation very rigidly. His mouth is often locked in the maximum open position, but not always. He
leans right in his bed, and his head is turned about halfway to the right. His ankles are locked in an extremely
inverted position. He cannot talk at all, except for an occasional “uh-huh,” but usually nothing.
He will frequently moan loudly in pain or other distress for long periods of time.
I also treated him a couple of times in 2018, when he was 25. At that time, he was somewhat reluctant and
skeptical, and had been convinced by his mother to try it. He was charming, a little aggressive, not forthcoming.
“Just do the treatment,” kind of attitude. He had had a history of depression, collapsed left lung 1 year prior, achy
joints, heavy achy body, fatigue, difficulty walking, chronic bloating. He was a daily pot smoker. My diagnosis was
yangming damp-heat. His parents had divorced around 2015, and his mother has since told me that around that
time, and right up until the cardiac event and stroke, he was angry every day. I know they were also fighting about
him going to college and finding direction. When I first saw him he was in the middle of an all-consuming break
up. He generally seemed robust, with a pot belly, and a likable “cool guy” vibe.
LV-SJ: His eyes are striking. I couldn’t say if they were bright, but he seems to want to communicate everything
with them. They often appear terrified and confused. I was told he was likely having hallucinations, an expected
part of brain healing. I supplemented liver. Hallucinations and night terrors have been markedly reduced since then.
PC-GB: I’ve mentioned anger a few times already. He also tends to be awake most of the night (although that is
somewhat improved). On the other hand, his whole upper chest is locked tight. I don’t think the shoulders are
obviously hunched in, but he is supine, so maybe they are. I’ve supplemented PC twice. One difficulty with this
case is that assessing the response is like reading tea leaves. It didn’t seem to help, and may have correlated with
more pain.
LU-ST: He is borderline emaciated, and is fed through a port to his stomach implanted in the middle of his
abdomen. The abdomen itself is rigid. It’s as if it has contracted around the port so that there is nothing left to
palpate. His skin is often wet, especially around his neck. I couldn’t find any dryness anywhere. When I
supplemented lung, he relaxed more deeply than with other treatments. That was a couple of weeks ago. This
week, they told me he had been having a lot of phlegm in his chest and they were putting him on albuterol. His
nurse believes it’s just phlegm breaking up and it’s a good thing. I can’t tell, but there didn’t seem to be any clear
benefits to this treatment.08/01/2024, 13:31Paralysis, aphasia – Qiological Community
https://forum.qiological.com/t/paralysis-aphasia/1820/print2/6
LI-SP: I can’t see any clear indication for either of these, except that if his skin is wet and LU+ was injurious,
maybe there is some pocket of internal damp pathology despite the emaciation. Seems doubtful.
HT-UB: The hypofunction is obvious, and obviously TGTITR. The abdomen is rigid, and he is prone to apparent
terror at night and when hallucinating. Also, Toby’s case study on paralysis suggests heart supplementation. I’m
considering it, but there’s some heat. When he gets angry, he sweats. Sometimes his pulse is rapid. Considering his
likely poor response to PC, I’m reluctant to needle LV 1 again. Does the extreme hypofunction override that
concern? Heat has reduced somewhat since starting beta-blockers, but by no means gone.
SI-KD: They believe he is prone to painful back spasms, headaches, pain in his right hand for unknown reason, and
generally pain everywhere. SI+ may have helped, but not enough to be sure. I followed it with KD+, because of the
life-threatening nature of his injuries. I can’t say that helped either. On the Kidney excess side, the one thing that
always makes him grin madly, is any reference to his romantic prowess, especially the fact that he obviously
prefers therapy from petite blonde women. (Last week, his speech therapists were in the next room plotting to get
his cooperation by including pictures of pretty ladies in the exercise materials. He was giddy about it.)
Liver has been the best, and I’ve only treated it twice in 3 months, so maybe it’s still indicated. Mainly I feel at a
loss as to how to assess this patient or the effects of treatment. It seems that every channel pair can be argued both
ways. The last few weeks I’ve shied away from Sa’am, until I can get a better read. I can help him relax and relieve
acute pain, but of course I would like to do more.
They’ve consented to share a video of him, if anyone thinks that would be useful. DM me and I’ll set up a
temporary link so you can see it.
I’m grateful for any help anyone can offer.
Tobydaly1: April 11, 2022, 7:38pm
Jason:
Does the extreme hypofunction override that concern?
Yes.
Have you taken the Saam 3 class yet?
T
Jason: April 11, 2022, 8:11pm
I’m still working through it. I’ll review that case again. Thanks for responding!08/01/2024, 13:31Paralysis, aphasia – Qiological Community
https://forum.qiological.com/t/paralysis-aphasia/1820/print3/6
Jason: April 11, 2022, 9:06pm
@Tobydaly1 Do you have any thoughts on why LU+ was not successful here? I thought with the emaciation and
wet skin it would be a home run.
Tobydaly1: April 12, 2022, 5:57pm
In difficult cases you sometimes have to supplement one particular channel to “unlock” other channels to have
them function like you’d expect.
George_Mandler: April 12, 2022, 7:52pm
Hi Jason
You have a challenging case with many layers. I have had a few of these where it is challenging to make headway
and can take some diligence to finally crack the case so to speak. And some where I can not help.
Jason:
Do you have any thoughts on why LU+ was not successful here?
We don’t really know it was not successful unless the phlegm started right after the session or next day. Also
maybe he needs supplement LU+ but he needs something else first.I find that the challenging part, where a
different treatment has to happen first before another treatment can take effect. We sometimes need to layer
treatments. LU/ST is more on the physical level and perhaps more on the emotional level first. Did he grow up well
resourced? I like HT+ and observe him closely – sounds like heartbreak over his parent’s divorce?
Jason: April 13, 2022, 2:48pm
Hi George,
I like that framing of heartbreak, whereas I had focused on the anger. I’m planning to supplement heart on
Saturday, without LV 1.
George_Mandler #8April 13, 2022, 4:28pm08/01/2024, 13:31Paralysis, aphasia – Qiological Community
https://forum.qiological.com/t/paralysis-aphasia/1820/print4/6
Jason:
…without LV 1.
You have to needle all 4 points else it is not a supplement HT treatment. Why are you reluctant to needle LR1?
Jason: April 13, 2022, 5:14pm
From the notes to the deconstructing class. “Liv 1: Consider leaving off point combinations with extreme heat
signs.” He has insomnia and sweats when angry, and sometimes a strong, rapid pulse. Looking for the sweet spot
between careful and timid here. What do you think?
George_Mandler #10April 13, 2022, 8:24pm
I asked Toby and his response: “My heuristic is to start off with the four point combinations and only modify if the
patient’s reaction forces me to. There are some heat signs in this case but there’s massive cold (hypo-functioning)
signs. I’d recommend unmodified Ht supplementation for a case like this.”
So I would suggest staying with the patient and watching him. Do you see his face getting red, any agitation
increase etc.
Keep us posted.
Jason: April 13, 2022, 11:28pm
Awesome, thank you for that clarification. I hadn’t thought of hypofunction as equivalent to cold. Makes sense. I’ll
let you know how it goes.
Jason: April 21, 2022, 5:08pm
Supplemented HT on left side on Saturday. He immediately showed increased mobility in his right arm. The report
today is that he has been free of episodes of bad spasms, pain, fear, confusion, and he is sleeping better. He has also
been more communicative, eg shrugging his shoulders to respond.
I’m honestly amazed, and very grateful to Toby, George, and the Saam lineage.
Today I decided to supplement DU in the hope that it will help close his jaw and correct the tendency for his eyes
to roll back. He’s sleeping soundly.08/01/2024, 13:31Paralysis, aphasia – Qiological Community
https://forum.qiological.com/t/paralysis-aphasia/1820/print5/6
This is about my 10th visit to this house and it’s never been so peaceful. His mom looks like she caught up on a
year of sleep.
Pending new info, I’m expecting to follow up next week with HT+ on the right.
Tobydaly1: April 21, 2022, 5:59pm
Sounds like a great case to write up and publish in one of our CM journals:
Book
Writing Acupuncture Case Reports: Theory and Practice Writing Acupuncture Case
Reports: Theory and Practice discusses the importance of writing acupuncture case reports
for education, research, and practice. In addition to providing a step-by-step…
George_Mandler #14April 23, 2022, 9:50pm
Jason:
I’m honestly amazed
Sa’am leaves me amazed every week in clinic. It is fantastic that your patient responded so well to the HT+
supplementation. Keep us posted on progression and results of the Du+ supplementation.
Jason: April 29, 2022, 12:34am
Last week I supplemented DU only. It seems like his eyes are less prone to pulling upward, but they’re still doing it
somewhat. He did have a couple of bad nights 2 and 3 days afterward, possibly due to his mother being away.
Overall another ambiguous result. But The general improvement in his overall comfort and mobility remains. This
morning he told her “I love you,” so that’s positive.
Today I supplemented HT on tHe left. No instant benefit this time, but we’ll see how it develops. Right now he’s
coughing a lot with phlegm. I’m not sure how to address it, given his body type. Some ideas are:08/01/2024, 13:31Paralysis, aphasia – Qiological Community
https://forum.qiological.com/t/paralysis-aphasia/1820/print6/6
LI: His skin isn’t dry, so with the chest phlegm, maybe double dry is an option. There’s also still some heat on his
pulse. But I think he’s really too thin for this.
ST: he may have had a bad response to LU+, so I have to consider it, but again the body type. Is this a case of
channel not quality?
GB: Thinking of the muscular tightness in his chest, and previous unclear response to PC+ , I wonder about this
possibility. He is prone to frustration and anger, but I can’t say it’s not appropriate to his situation. Still, this seems
like an outlier.
SJ: He’s had LV+ 3 times in 3 months, and he’s a bit reticent toward me. His eyes are dark colored. They shine
when there is something he wants, but today they looked a bit shielded.
@Tobydaly1 I’ll think about writing it up. Hopefully I’ll have more measurable results before too long.
George_Mandler: May 1, 2022, 7:22pm
It sounds like you may have gotten some traction with the DU supplementation.
He does have some KD excess signs…what about going back to supplementing SI+? Does he have stagnant blood
signs? What was the cause of his stroke?