florynb: November 8, 2021, 8:50am
I also have a case that I don’t know where to start. Male patient 50 years old, obese but only in the abdominal area,
thin hands and feet with the following symptoms:
Tachycardia 90-110 BPM
Mild HBP stage 1, especially high diastolic blood pressure
Insomnia, with waking up at 4 I then fall back asleep
Drowsiness during the day, especially after eating
Bags, swelling under the eyes (I think they come from adrenal exhaustion)
At any cold wind, or contact with something cold sneezing
Heartburn, CV15 area, no reflux, but very violent
Pain in GB21 radiating to GB20 only the left side
I tried to supplement BL +, the blood pressure drops only the systolic and a little diastolic but the pulse does not
change, but the drowsiness of the day increases.
And I admit that I got stuck here. I would welcome any suggestion.
Thank you!
George_Mandler: November 8, 2021, 2:10pm
Hello Florin
We need more info about him to assist as there are a lot of details missing. When you press his abdomen is it hard
and painful or he just feels the pain? Does he have any oketsu signs. Any other GI symptoms besides heartburn
given he is overweight in the abdomen.
How is is skin dry/moist? Resources?
Any blood stagnation signs/medial heels? Well kept?
For a rapid pulse we sometimes think supplementing BL+. But he also has sneezing with contact with anything
cold. (I don’t quite understand what is actually happening for him.). Does he run warm and that made you jump to
BL+?
Break down what you know about him. The possible pairs that jump out to me besides BL/HT are:
ST/LU – dynamic – how much LU excess? If dry skin and well resources with healthy thenars then that would fit in
snugly with a supplement ST+
KD/SI – stagnation signs? oketsu, varicosities? Does he move is body?
PC/GB – look a that dynamic with the left trap GB pain- sleep issues so does PC+ fit? Is he quick changing mood
or very thoughtful demeanor?
I hope that helps you see how you need to break it down.08/01/2024, 13:50Tachycardia and Heartburn plus – Qiological Community
https://forum.qiological.com/t/tachycardia-and-heartburn-plus/1672/print2/5
florynb: November 9, 2021, 5:07am
The abdomen is soft and relaxed, when pressed it does not feel any pain and does not influence the burn whether
you press or not.
He has only a small varicose vein in the LV8 area of max 2cm on the saphenous vessel at both legs.
The heels are not cracked. He doesn’t have much gray hair except a little at the temples
The skin is slightly oily, I would say more oily.
He has no pain on palpation on the meridians.
On the LV meridian at the feet from LV4 to the knees has some small swellings that are felt on palpation (lymph
nodes).
The tongue is white with the edges with tooth marks, and I thought SP was involved.
I thought that sneezing in the cold and the other symptoms involved LV (LV fire that produces LV wind). PC +
because all the symptoms are on the left side.
It also seems to me a complex case and 3 symptoms bother him the most.
1. Tachycardia
2. Heartburn
3. Insomnia
Pain in GB21 is rare once a month
George_Mandler: November 11, 2021, 2:53pm
Hi Florin
I still don’t have enough info here to make any confident suggestions. There is the case study format can be used.
florynb:
obese but only in the abdominal area, thin hands and feet with the following symptoms:
Toby has said this can suggest internal damp and to perhaps look at the LU/ST dynamic – looking at potentially
some LU excess. You said his skin is moist in which case we may substitute ST36 for ST41. How are his thenars
and resources? You didn’t say anything about digestion or elimination – if he has some weight in he middle there is
a good chance it is not as good as he may report.
florynb:
The heels are not cracked.
Does that mean the heels are plump or flat and not cracked?
florynb:
I thought that sneezing in the cold and the other symptoms involved LV (LV fire that produces LV wind).08/01/2024, 13:50Tachycardia and Heartburn plus – Qiological Community
https://forum.qiological.com/t/tachycardia-and-heartburn-plus/1672/print3/5
I would suggest not conflating other ideas of TCM into Sa’am. Keep the languages separate.
florynb:
PC + because all the symptoms are on the left side.
Symptoms on the left can suggest SJ excess. (so supplement LR+ not PC+)
florynb:
It also seems to me a complex case and 3 symptoms bother him the most.
1. Tachycardia
2. Heartburn
3. Insomnia
Pain in GB21 is rare once a month
Any channel can treat any issues so look at what is the GTITR and start there. You went with BL+ which seems
like.a reasonable choice. What other HT excess signs does he have – outward loving?
You could use your CM skills to look at what may be going on that he has tachycardia. What is blocked? In what
info has been provided so far the GTITR to me seems like LU excess depending on other factors such as resources,
thenar, digestion.
florynb: November 12, 2021, 2:36pm
George_Mandler:
Any channel can treat any issues so look at what is the GTITR and start there. You went with BL+ which
seems like.a reasonable choice. What other HT excess signs does he have – outward loving?
You could use your CM skills to look at what may be going on that he has tachycardia. What is blocked? In
what info has been provided so far the GTITR to me seems like LU excess depending on other factors such as
resources, thenar, digestion.
I want to thank you for your suggestions and involvement, it helped me a lot.
I know that the decision taken is somewhat undesirable or so I understood from Toby’s online courses but I
assumed it.
After trying to supplement ST + on one side, I chose to supplement ST + on both sides because the thenar
eminence is swollen and hard, nothing has changed dramatically, so I decided to sedate LU- (I know it’s totally
unsuitable) and the results appeared (the situation was decongested). Then in the next session I supplemented BL +
and the blood pressure dropped, but the pulse jumps after about 3 days at 100-110 bpm, here I think I have to insist.
Now the stomach has burns, hoarseness, and flatulence about once every 3-4 days and pulse about 3 days, I will
continue to supplement ST + and BL +.08/01/2024, 13:50Tachycardia and Heartburn plus – Qiological Community
https://forum.qiological.com/t/tachycardia-and-heartburn-plus/1672/print4/5
There was still a problem that did not move at all. High diastolic blood pressure (Now it has a blood pressure of
125/90 -95 mm HG) The diastolic value seems dangerous to me close to the systolic value.
In addition to high diastolic blood pressure, I forgot to mention the bags under the eyes (which can be an adrenal
obsession).
If you have any suggestions on this.
Once again I want to thank you for your suggestions and involvement!08/01/2024, 13:50Tachycardia and Heartburn plus – Qiological Community
https://forum.qiological.com/t/tachycardia-and-heartburn-plus/1672/print5/5
George_Mandler: November 13, 2021, 4:23pm
You are welcome. I am always jazzed to talk Sa’am.
florynb:
After trying to supplement ST + on one side, I chose to supplement ST + on both sides because the thenar
eminence is swollen and hard, nothing has changed dramatically, so I decided to sedate LU- (I know it’s totally
unsuitable) and the results appeared (the situation was decongested).
I am confused. You supplemented ST+ and got no change and then you did bilateral? If you did not get.a shift on
the first 4 needle treatment you do not want to add in 8 needles and double the failure.
Thenars are one aspect of a LU excess – others being well resourced, dry skin, dampness. I am not clear where he is
on this spectrum. It sounds like he got benefit from the drain LU-, but what benefit? We also want to drain when
we are close to a full moon and have just passed a quarter waxing gibbous, so the timing may not be right.
Remember draining means taking something from the body and we always want to add first.
florynb:
Now the stomach has burns, hoarseness, and flatulence about once every 3-4 days and pulse about 3 days, I
will continue to supplement ST + and BL +.
I am not sure how often you are treating, but you do not want to do a treatment more than 2x in a row unless you
have a very very strong reason to do so. It does not sound like it in this case, although it sounds like BL+ has been
clearly helpful.
florynb:
There was still a problem that did not move at all. High diastolic blood pressure (Now it has a blood pressure
of 125/90 -95 mm HG) The diastolic value seems dangerous to me close to the systolic value.
In addition to high diastolic blood pressure,
I do not have enough experience with high blood pressure and Sa’am. But if he has Heart excess then it sounds like
BL+ supplementation can be one of your channels.
Again there is not enough info on this case to get a clear picture.