Brightraven: July 8, 2019, 8:28pm
Hello friends…wondering if anyone has some further insight into the following case?
My patient is a 21 year-old male who is suffering from symptoms of Lyme disease and PANDAS (Pediatric
Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections), diagnoses given to him by his
doctors. Upon first inspection, he is tall, thin, and very rigid in his movements. His musculature is quite well
developed in the upper half of his body but very thin in the lower half. He has an extremely strong smell, sweats
quite easily, and is prone to lots of acne throughout his face and back. He has no phlegm expectoration or sinus
issues, but seems to be rather bound up, tight, and dry (despite the acne). Upon palpation, he is extremely ticklish
and holds back laughter upon the lightest touch of his abdomen, which is very tight and bound up. He complains of
not feeling oriented in space, where he feels most properly aligned when his neck is off to the side rather than
facing forward, and that even though his arms hang down by his sides, they sometimes feel like they are behind
him. He likes to work out at the gym but this makes it very difficult for him because he can’t tell where his limbs
are. He also cannot do yoga because of his inability to feel properly aligned in space. (He is, however, able to touch
his nose with his eyes closed, so there is some proprioception that is working). He also suffers from severe tics
(which he struggles to hold in), where his body and head will flail around violently, and at one point was so intense
that he sustained a head injury. He also has a history of auditory and visual hallucinations that have come and gone
over the last year and a half, but interestingly, he seems to be quite psychologically intact and his demeanor is very
friendly with appropriate eye contact, smiles, and normal conversations. He is extremely polite. He talks about how
his brain is all over the place and can feel extremely foggy and discombobulated sometimes, but that he can get
ahead of it much of the time and not be debilitated if he focuses his willpower. However, he has no job and lives
with his parents because of his symptoms. Though he appears rather relaxed, his body is very rigid, and his energy
is incredibly restless, he says, and he spends most of his day outside where he is constantly running, walking, or
working out in order to discharge the excess energy within him. He is on no medication and does not drink any
alcohol or take any drugs. He eats only natural whole foods, mostly vegetables and fruit which help to cool him
down and settle his symptomology, and anything packaged or unnatural exacerbate his symptoms dramatically. His
sleep is erratic and sometimes he will be awake the entire night, while other nights he will sleep soundly. His
bowels are normal, well-formed, with no odor (so he says, although his body odor is out of this world) and his
urination is normal and semi frequent because he drinks so much water all day long. His pulse is extremely wiry.
His tongue is slightly quivering, slightly swollen and pale with a pronounced white coat with some red spots off to
the sides coming through, and a red tip that is notched. There are slight visible veins under the tongue.
The ticklish abdomen, wiry pulse, polite demeanor, and wind symptomology make me want to tonify Liver, and
perhaps this would cool him down as well. I wonder if UB would be too cold for him given his pale tongue? I also
wonder if there is some hidden phlegm here. Any thoughts or insights would be much appreciated. Many thanks!
KristinWisgirda: July 8, 2019, 11:18pm
26/01/2024, 11:32Proprioception Issues, Tics, and Discombobulated Thoughts – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/proprioception-issues-tics-and-discombobulated-thoughts/360/print2/4
How bright and focused are his eyes?
Do his proprioception issues make him clumsy at all? Does he bump into things or knock things over?
Brightraven: July 9, 2019, 12:12am
Hi Kristin,
His eyes don’t seem that bright, and maybe even a little dull…however, he does have a focused expression much of
the time…he’s quite a serious guy with a gruff sounding voice but totally pleasant to interact with. He expresses his
gratitude constantly. I have not noticed him bumping into anything, so he seems to be in control of his limbs, but in
his mind he senses that they are in different places. It is difficult for him to explain it (and perhaps for me to
understand it, but that’s what I got…)
Many thanks!
KristinWisgirda: July 9, 2019, 12:46am
Brightraven:
His eyes don’t seem that bright, and maybe even a little dull…
I’m not quite sure of what to make of his SJ/Liver balance. With the proprioceptive issues how much is a SJ excess
hyperfocused picky perception versus a Liver excess dense lack of the ability to feel properly. Or something else.
The “foggy”, discombobulated brain can be from too much dampness, too much density, or too much brightness or
agitating heat.
Brightraven:
The ticklish abdomen, wiry pulse, polite demeanor, and wind symptomology make me want to tonify Liver,
The only for sure Saam SJ excess sign in your list is the politeness. Pulse is not diagnostic in Saam except for rapid
pulse pointing to Heart excess.
The violent tics along with the red tipped tongue are diagnostic for GB excess. Consider P+ treatment.
@Brightraven What is the grossest aspect of his presentation to you? I’m reading that his agitation level is fairly
high. If this is true, throwing a bucket of ice water on him via UB+ treatment seems like an option. In the absence
of any real cold signs, I wouldn’t worry about his pale tongue.
MollyB: July 9, 2019, 12:51am
26/01/2024, 11:32Proprioception Issues, Tics, and Discombobulated Thoughts – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/proprioception-issues-tics-and-discombobulated-thoughts/360/print3/4
What a very interesting case! With the diet to cool him down and the restless energy, I am wondering about heat
and what his sense of his own temperature is – does he feel hot most of the time?
What have you tried so far?
Brightraven: July 9, 2019, 1:43am
Thanks again for your insight, Kristin. The sense I have is that I want to cool him down and moisten him. He has
definite heat, but also what appears to be severe Liver Blood deficiency leading to wind. When thinking of the cool
moist redwood forest environment, I’m thinking he could use that Liver energy! He is not aggressive in any way…
he sits extremely still and rigid in the chair while waiting for his appointment, very quiet and internally focused
like he is working on holding himself together inside…does one have to be outwardly aggressive for GB to be
excess?
Brightraven: July 9, 2019, 1:49am
Hi Molly,
He does feel hot much of the time, but then again he is outside all day long, running, walking, and working out to
discharge his pent up energy, which makes him feel much better. He came in the other day covered in acne and
sunburned. He only wants to eat fruit, so I suggested he focus on some watermelon. When he came in the
following week his skin was all clear – he said the watermelon cleared everything up and cooled him down. He has
felt the most relief from my bleeding his ear apex. I have used some Master Tung points, addressing Liver and GB
and calming shen (as well as ST40 occasionally), and he seems to get better for a little while and then falls back
again into a rut. He is in a definite rut right now… I have not used Saam yet for fear of getting the dx wrong!
Hence, I am here…thanks so much…
KristinWisgirda: July 9, 2019, 2:49pm
Brightraven:
he sits extremely still and rigid in the chair while waiting for his appointment, very quiet and internally focused
like he is working on holding himself together inside…does one have to be outwardly aggressive for GB to be
excess?
Brightraven:
He also suffers from severe tics (which he struggles to hold in), where his body and head will flail around
violently, and at one point was so intense that he sustained a head injury.26/01/2024, 11:32Proprioception Issues, Tics, and Discombobulated Thoughts – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/proprioception-issues-tics-and-discombobulated-thoughts/360/print4/4
His body can bust out with violent movements at times. How much of his stillness and rigidity is his attempt to
hold these impulses and tics at bay?
The spectrum of GB aggression/impulsive outward action has reactive/impulsive thoughts on one end to violent
action on the other end. Sustaining a head injury from a tic means some serious GB excess.
With his response to watermelon, internal dryness, strong smell (which is some kind of heat) and
hyperactivity/restlessness, UB+ is still an option to consider.
He has lots going on. It would be a good exercise to go through his symptoms and presentation and place them in
the appropriate channel category. You can grade strength of symptom presentation with a + system (+1 to +5, if
you will), so you will see which symptoms have more weight.
haunani: August 18, 2019, 11:22am
Just reading this. Did you get the chance to treat him using Saam?
Brightraven: August 21, 2019, 2:08am
Yes! I chose to tonify PC as he came in with some smoldering anger and expressed feeling very irritable at the
sound of his parents’ voices. I hadn’t seen this side of him yet…he was always super polite with me but I wonder
what he was like outside the clinic? All his other symptoms were pretty much the same, with increased mental
noise and tension throughout his body. Along with the tics, I felt this was another defining characteristic to
supplement PC. He seemed calm and content after the treatment, but that was several weeks ago… I haven’t heard
from him since… thanks for checking in…