Qiological Community

Case Study Format

Here is a proposal for case a case study format for our forum. I welcome any and all feedback. The goals are to help you sharpen your Saam diagnostic skills, help your readers see your patient and stimulate conversation that will helps us grow as Saam practitioners.

When presented with the idea of a case study format/intake sheet, this was Toby’s response:

Great idea, basically the Saam diagnosis is interested in everything. I think the Shen Kuo quote from the lecture is a good starting framework, then add abdominal palpation, face observation, chief complaint, etc…

“When the ancients treated patients, they became familiar with the cycles of yin

and yang and of time, and with the exhalations of qi from mountain, forest, river

and marsh. They discerned the patient’s age, body weight, social status, style of

life, disposition, likes, feelings, and vigor. In accordance with what was appropriate

to these characteristics, and avoiding what was not, they determined which

medicine was appropriate.”

Shen Kuo, Su Shen Liangfang , 12th century (Rosenberg)

Toby emphasizes that can’t always believe our patients words and we really need observe our patients closely. Please include your impressions. What does this patient look like walking through the door? How does the story they tell about themselves mesh with your impressions?

Please indicate the patient’s chief complaint and 1-2 other secondary complaints since these should be strongly guiding your treatment. What is the most troubling to the patient?

Help your readers by reducing the number of words and organize your findings by

  • · listing symptoms and qualities under functional headings
  • · summarizing complicated histories but do include precipitating factors relating to their chief problems such as illnesses, accidents, childbirth, major stressors
  • · distill emotional states into themes

Grading symptoms and qualities on a scale of +1 to +10 will help us know how much clinical weight to place.

· For instance, bright eyes +1=mildly bright, +5=moderately bright and piercing, +10=diamond eyes.

Please organize your findings into the appropriate Saam channel categories, even if it is to say that there aren’t any stand-out findings. This will help you to start observing patients in a Saam way. Some qualities/symptoms may not have a clear slot. You can put a question mark if you think it might belong in that category but aren’t sure. See the case below for examples.

60 year old woman

Chief complaint : vision changes R>L from macular degeneration (rare dry type with abnormally large drusen overgrowth); eye chart lines look wavy, black colors seen as gray; light sensitivity +9 (wears sunglasses in her house)

Second complaint: left knee pain-Liver/ Spleen channels, daily intermittent 5/10, pain during activities, cam throb at rest

  • · worse with: sitting in odd positions for long hours researching her many projects, carrying grandkids up and down stairs, walking hills
  • · started after taking Levaquin for sinus infection, 9 months ago; made worse by knee strengthening exercise with a physical therapist

Appearance and demeanor : average facial symmetry; neatly but casually dressed, warm and friendly +5; polite +5, animated talker+5 but doesn’t overtalk, points her index finger at you in stabbing motions for emphasis; bright eyes +8; slight malar flush +1; brings homemade cookies and/or flowers to every visit +10 J; drives a Prius

Lifestyle: Former social worker who retired because of major burn out and recurrent debilitating respiratory infections. Has many projects (+8) involving creative activities along with caretaking for adult children, grandchildren and husband; exercises regularly; self critical with a spiritual bent +8

Body morphology and flesh quality: Average frame, overweight +3; soft droopy flesh over good muscle tone

Skin Quality: “needs” to moisturize daily so assuming dry

Body Temp: runs warm +4, occasional hotflash+1; cool feet +2

GI: fine currently, gas and loose stools when eats too much veg; heartburn with tomatoes or overeating(rare)

Respiratory: rhinitis controlled by claritin; recurrent sinus infections in the winter

Sleep: late bedtime because of many projects, 6 hours, wakes unrested, diagnosed with mild apnea that is worse when she stops taking Claritin (will get cpap)

Emotions: positive attitude that feels a bit forced +9; tends to neglect her own needs so that others can be cared for +7 (getting better); lack of self assertivenesss +4

Urination: stress and urge incontinence +5 since pregnancies
** Gyn: 2 csections, menopause 7 years ago
Other Body: very few varicosities; average recurrent right SI joint pain (not currently)+1; whole back is jumpy to palpation +7

Tongue: small body +5, coat peeled in patches, sl thick coat in rear

Excess Presentations:

Heart: warm friendly +5

UB: fear of mortality +3, incontinence+5(?)

GB: pointy index finger

P: lack of self assertiveness ; loves researching?

SJ: bright eyes +8, light sensitive +9, self critical and spiritual +8, black seen as grey (?): malar flush +1; warmer above with cool feet (?); Liver channel knee pain on the left

Liver: none, Liver channel knee pain on the left

Lung: damp inside/dry outside?; good resources; rhinitis(?)

Stomach: none

LI: hyperactively project oriented +8; Spleen channel knee pain

Spleen: Spleen channel pain

SI:puts others needs before her own+7; mixed warm and cool(generally warm with cool feet)

K: mixed warm and cool, pain

The Grossest Thing(s) in the Room: light sensitivity, bright eyes, hyperactive projected oriented doer

Main treatment ideas: Liv+ on right, Sp+ on right,

Other treatment ideas: SI+, K+; ST+(damp inside, dry outside)

Treatments 1+2: Liver+ on right

· noticed improvement in light sensitivity, no change in wavy lines, no change in knee pain

Treatment #3: Wanted to focus on knee, Spleen + on right

· Eliminated knee pain. Patient noted that she was no longer jumping up to take care of others at the concerts she attends weekly. Instead she was able to enjoy the music. The lack of motivation to be constantly doing and tending to other people made her wonder if she was depressed!

6 Likes

This is really helpful and clear. Categorizing Excess Presentations like you’ve listed is a great way to help retrain our brains to think in that manner. I can already see myself editing my charting to reflect this.

Well it’s just like Toby start with a quote like this :stuck_out_tongue_winking_eye:

Thanks @KristinWisgirda, this is really helpful and in my own clinical work I’ve been moving in the direction of something like this. I especially find the way of charting the clinical weight of the various things that stand out to be very helpful. It’s a helpful blend of objective measures and the intuitive “feel” of clinic.

I find it helpful too to have something that helps me stay “on track” with Saam thinking.

:pray: thanks for you contribution with this

Perfect. Thank you Kristen. Really appreciate all your hard work.

Thank you @KristinWisgirda. That is a really great format.

Hi @michaelmax,
Is there a way we could pin this post to the top so it can be found easily?

yes @Donley. I’ve got it set to that now

1 Like

What is the best way to get a printed copy?

I really appreciate the clear, concise format. I think it will be very helpful. Thanks for taking the time to put it together.

I cut and pasted the format into a word doc, and took out the particulars of this case to make myself a kind of worksheet to go through. Under the “other body” heading, this example had some varicosities, I’d like to put a list there of the other for sure signs we have like the dry cracked medial heel, and the deflated thenar eminence, the diffuse tongue cracks, red tipped or dots on tongue, left side or right side rib tightness, midline cold and tight vs warm and slack. What else goes on that list? I want to remember to check all these things when I’m with the patient at the intake.

1 Like

Thanks Kristin! This is so helpful!

There could be 2 lists- physical findings and subjective indications such as light sensitivity, demeanor, etc.
Anybody want to have a go at organizing all the channel indications from class, observing Toby and podcasts? Use slides from class as your base.

One of my next projects will be to reorganize my intake form to make the Saam indications pop out at me.

Over the weekend, I questioned if it was clear to grade symptoms and put them in under channels. For instance my patient was warm and friendly +5, meaning that she was warm and friendly in an average way. This really shouldn’t have gone under Heart excess because her behavior was pretty normal. My mistake. So don’t place a symptom under the excess category unless it is really an excess presentation.
My goals are clarity and ease, not fussiness. We will all just do the best we can and ask questions as we go along.

I really have to give our wonderful @sweiz a shoutout here for some of the pieces going into the case study format. The teachings in her Graduate Mentorship Program help one develop a grounding in our medicine through observation, organization and critical thinking that really cranks up the clinical efficacy. All of this easily translates to Saam work- what do we know for sure about our patients if we forget their story and look at them through the lens of Saam? Thanks Sharon!

2 Likes

Thats a good way to think about it. I was thinking channels but i like subjective/objective better. I’ll take a crack at it as a first pass then folks can add in whatever i missed

I put it all into a word doc table but when I cut and paste it here, it loses its chart-ness. not seeing a way to do an attachment. Suggestions?