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
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(?)
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!