Alvaro: July 28, 2019, 7:22pm
Patient: 62 yr old male from Jamaica
Chief Complaint: Joint Pain due to Rheumatoid Arthritis. Started 7 years ago and pain went away with
methotrexate. Stopped medication 2 years later due to stage 4 colon cancer. Despite not taking Methotrexate during
chemo, didn’t experience joint pain until a couple of weeks ago. Trying Acupuncture to see if he can get away with
not going back on Methotrexate. Wakes up stiff and sore in the morning; whole body stiff but worse in hands,
especially L hand, Neck worse turning to L, swollen ankles and knees (R side worse). No change with cold or heat,
but usually better with movement. No numbness.
Appearance and demeanor: average facial symmetry, relaxed and friendly 5, polite 5, drives and BMW and used
BMW credit card to pay for appointment.
Lifestyle: Used to be very active but now unable to even tie his shoes some days due to arthritis in hands. CEO of
an education software company. Stays pretty busy +7, but has time for holidays and vacation.
Body morphology: Average body but flesh below knees feel tight. Swelling R ankle and R knee +8.
Skin quality: Normal. Warm +7 to the touch even fingers and toes.
Body temp: sensitive to cold AC +8. He moved here about a month ago and new office is kept very cold for his
liking. This seems to coincide to when he started having joint pain again. Sweats easily if hot. His daughter says
that at home he tends to get colder than others especially if AC is kept below 75. I kept temp at 76 at the office and
he was very comfortable.
GI, Respiratory, Sleep, Urination: good
Emotions: positive, friendly and warm during the treatment. Very appropriate in terms of amount of talking.
Tongue: no subling vein engorgement, mild swelling on sides, normal coat and body otherwise.
Pulse: strong, tense to tight, L side has more pound, 80 bpm, hesitant wave form (shen hammer).
More noticeable excess presentations:
BL: sensitivity to Cold AC +8
Kid: pain and stiffness usually better w movement +10
SP: swelling especially R ankle and knee +8 all around front from SP to GB
Grossest thing in the room:
Swelling of R ankle and knee25/01/2024, 11:57Rheumatoid Arthritis – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/rheumatoid-arthritis/415/print2/7
Treatment ideas:
Supplement
1.LI
2.SI
3.Ht
First treatment I supplemented LI. He reported next day felt less stiff and painful but swelling was same. Stiffness
and pain came back following day
Second treatment wasn’t a Saam treatment although I included Ht and SI sup points in addition to local points
around knee and ankle.
I appreciate any suggestions or comments
KristinWisgirda: July 25, 2019, 11:49pm
Thanks for the case.
I’m not fully understanding his temperature.
Alvaro:
new office is kept very cold for his liking. This seems to coincide to when he started having joint pain again.
Sweats easily if hot.
Does this mean that he has some heat sensitivity at work, so he keeps his office cold but likes it warmer at home?
How easily does he overheat?
Treating SI+ is a good way to test adding heat to the system when you aren’t sure about appropriateness of the
double fire H+. Toby mentioned that during Laura McGraw’s MS case in St Louis which you have access to. It will
be interesting to see how your patient responded to SI+, even if it wasn’t a pure treatment.
Given everything he has been through it is hard to imagine that he is a perfect specimen. It would be good to know
more about his tissue quality: any deformed joints or swelling besides the swollen right knee/ankle? Any fog under
his skin? Since he had less stiffness and pain (generally? or just with the right knee/ankle/) after the first visit, you
would expect to see some swelling or fluidiness in his tissues.
Any anxiety about resources or recent significant loss of resources? Are his thenar eminences plump or deflated?
Just thinking along the lines of St/Lung with the right knee issue.
Alvaro: July 26, 2019, 12:32am
Sorry, meant to say the office is kept too cold for his liking. I forget the specifics, but he can’t change the AC
setting for the office due to some construction happening within the building. He doesn’t like having AC below 75
because makes him feel internally cold. I suggested wearing a long sleeve shirt at work.25/01/2024, 11:57Rheumatoid Arthritis – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/rheumatoid-arthritis/415/print3/7
I can’t remember how easily he overheats. I don’t have that info on my notes but will ask on Saturday when he
comes in again.
His joints don’t appear to be deformed; just very stiff with some very mild swelling except for R knee and ankle
which are much more noticeably swollen. After first treatment he had less stiffness and pain generally for about a
day.
I didn’t feel fog under his skin.
No anxiety about resources. He’s very well off in terms of finances. I didn’t check his thenar eminences but will do
that on Saturday.
Thank you Kristin
Alvaro: July 26, 2019, 6:26pm
I meant to ask you how do you approach when pain happens on L arm and R Leg or vice-versa. With this RA
patient, he has severe pain and stiffness in L hand but his R ankle and knee are very swollen. Not sure which side
to choose for Saam treatment or if it’s ok to do R arm and L leg for points since those are the extremities less
affected… When I saw him the first time I chose the L side only
KristinWisgirda: July 29, 2019, 2:42pm
Hi Alvaro, Good to see that you got your questions for this case answered directly from the source during
yesterday’s Crowdcast.
AJSClaussen: September 10, 2019, 9:22pm
In the vein of RA, what would deformed joints indicate? Is this considered a convex symptom?
KristinWisgirda: September 10, 2019, 10:39pm
Bone deforming arthritis consider K+, alternating with more moving and warming treatments, namely SI+ and H+.
Deviated finger joints= cold contracture. Treat as above.
2 Likes25/01/2024, 11:57Rheumatoid Arthritis – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/rheumatoid-arthritis/415/print4/7
AJSClaussen: September 11, 2019, 8:51pm
Makes perfect sense. I am excited to see if Sa’am can decrease bone deformaties. This is something I have not had
much success with in the past. Would bone spurs also fall within KD+ or is it patient dependent?
KristinWisgirda #9September 11, 2019, 10:14pm
AJSClaussen:
Would bone spurs also fall within KD+ or is it patient dependent?
Are you asking if bones spurs are a sign of Kidney excess as they are too much bone growth? I’m not sure and will
have to ask Toby. My first thought is that it wouldn’t be a definitive sign by itself.
Jeffrey: September 12, 2019, 8:02pm
KristinWisgirda:
Bone deforming arthritis consider K+, alternating with more moving and warming treatments, namely SI+ and
H+.
Deviated finger joints= cold contracture. Treat as above.
I clearly understand bone deformities/arthritis =Kxs. With RA., would saam not consider this heat, more so than
osteo.? also since its auto-immune, body essentially attacking itself often creating hot and painful joints. I know
these are western terms, just trying to categorize. thanks
KristinWisgirda: September 12, 2019, 10:48pm
Jeffrey:
I clearly understand bone deformities/arthritis =Kxs.
I wouldn’t say that.
A couple of things:
Not all arthritis, even RA, involves significant bone deformities that we can see and that would guide our
treatment.
Through a Saam lens not all “arthritis” presentations would have a K or Si excess component.25/01/2024, 11:57Rheumatoid Arthritis – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/rheumatoid-arthritis/415/print5/7
Jeffrey:
With RA., would saam not consider this heat,
Not all RA presents with heat signs. My current batch of RA patients have no heat signs in their joints. For
instance, one of my patients has RA in her hands/feet/knees. She does well toggling through H/SI/K/ST primarily
but also LI/Liv/P.
In my understanding, most of the time, heat in the joints is caused by a backup physiological yang because of
stagnation of wind/cold/damp/blood. Most of the time it is more effective to treat those pathologies than to directly
clear heat. However, if a joint is screaming hot, you can consider using UB+ even if the patient’s presentation isn’t
Heart excess.
In the discussion of bone deformities, Toby has directly said that they are = to SI excess and thus should be treated
with K+. Instead he has given treatment considerations suggesting they can be a mixed Kidney and SI excess
problem + cold (UB excess).
Jeffrey:
western terms,
The western terms just aren’t helpful for us.
Jeffrey: September 12, 2019, 11:11pm
curious, I’ll put that in my saam basket. thanks.
Taran: September 13, 2019, 4:54pm
KristinWisgirda:
In my understanding, most of the time, heat in the joints is caused by a backup physiological yang because of
stagnation of wind/cold/damp/blood. Most of the time it is more effective to treat those pathologies than to
directly clear heat. However, if a joint is screaming hot, you can consider using UB+ even if the patient’s
presentation isn’t Heart excess.
Would you clarify the above statement, please? It seems to me like it says two contradictory things.
KristinWisgirda: September 13, 2019, 5:44pm
25/01/2024, 11:57Rheumatoid Arthritis – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/rheumatoid-arthritis/415/print6/7
insert the word However in front of the statement about screamingly hot joints, might make it more sensible.
In cases where the heat in the joint is the grossest thing in the room, you can consider treating UB+, no matter what
the underlying pathology might be.
Most of the time, the heat is not the primary element in the presentation of joint pain.
George_Mandler: September 13, 2019, 9:01pm
KristinWisgirda:
In the discussion of bone deformities, Toby has directly said that they are = to SI excess and thus should be
treated with K+. Instead he has given treatment considerations suggesting they can be a mixed Kidney and SI
excess problem + cold (UB excess).
Kristin . – When we say bone deformities is it just RA you are talking about, but others, for example bone spurs.
Also is that first sentence I copied above incorrect, I am not following as the sentences seem to contradict each
other. ??
KristinWisgirda: September 16, 2019, 10:17pm
Typo alert: Should read,
In the discussion of bone deformities, Toby has NOT said that they are = to SI excess
Thank you for your patience with the poor proofreading of my posts. I promise to do better.
While I have your attention. I asked Toby about bone spurs. My question is in the brackets. His answer is in bold.
<Are bone spurs a sign of Kidney excess? My instinct is no, not as an isolated symptom . But then Kidney excess
Griddle Man’s mastoid was a kind of spur.>
Exactly my feeling. It’s a Kidney excess sign, but kind of a weak one.
Jeffrey: September 17, 2019, 4:15pm
KristinWisgirda:
In the discussion of bone deformities, Toby has NOT said that they are = to SI excess
Phew, that makes more sense to me.25/01/2024, 11:57Rheumatoid Arthritis – Sa’am Clinical Questions – Qiological Community
https://forum.qiological.com/t/rheumatoid-arthritis/415/print7/7
KristinWisgirda:
<Are bone spurs a sign of Kidney excess? My instinct is no, not as an isolated symptom . But then Kidney
excess Griddle Man’s mastoid was a kind of spur.>
was this “mastoiditis”? my thinking is that more of a deformity/growth rather than a spur like condition. Thoughts?