Qiological Community

Damp dry interior exterior

Sa'am Clinical Insights
#1

Treating myself recently taught me a bit about damp/dry exterior/interior.

Chief complaint:

  • hands are rough/dry (7+), red (3+), itchy (3+)

  • itchy forearms 4+ (Lung/LI channels(, itchy lower legs 7+ (yang channels mostly) and sometimes armpits. Gui zhi ge ban ma huang tang kinda helps the itching but not wonderfully. Scratching in the night leads to bloody excoriations on the arms and legs that are slow to heal (4+)

  • one firm red papule/zit on the chin after drinking milk; milk and rich foods reliably lead to acne

Skin/body: In the past Toby saw me as “dry on the inside and slightly dry on the outside”. Presentation at the time of treatment.

  • mildly dry skin overall (3+), dry legs (5+)

  • thin skin (lots of veins visible underneath) with lots of sagging skin from a 60 lb weight loss 20+ years ago; thin receding gums not improved by gum grafting 5+

  • body weight normal to slightly thin, normal muscle tone

  • fog- a soft cushion of fluid in the subcutaneous layer- only from the hips up. 3+

  • spider veins at ribs 5+; varicosities on legs 2+

  • sweat-normal

Temp: cold 7+; not particularly bothered by dampness unless it is cold
Menses: painful 4+, irregular (skipping periods alternating with short cycles) 7+

Treatment: Stomach+ no change. SI+ no change. These treatments were not settling.
Within a day or 2 of treating LI+, my hands were much smoother and softer, my excoriations were healing faster and the itching was almost gone. Aha! So the fog acts like a layer of turbid water that blocks blood circulation to the surface. The image is of oil and water not mixing.

LI+ is also always deeply settling for me, more so than any other treatment. This is interesting given that I am more of a LI excess personality- never bored, always multiple fascinating projects going. Once before going to Tucson in May, I treated SP+ which was deeply settling. Repeating Sp+ back then gave me pains in my teeth and jaw.

A few days after treating LI+, I tried H+ which didn’t improve my skin any further. Heart+ never even warms me up that much. The positive result of that treatment was that I wrote long overdue letters to old friends, instead of terse Christmas cards.:slight_smile:

Repeating LI+ again improved my skin another step and was settling as well with no over drying. I am more damp than I appear to be. My sweet tooth was also calmed by LI+. The fog might be slightly less squishy but it is hard to tell.

Yesterday, with some mild dryness on my hands, mild acne on the Stomach channel of my chest from holiday overindulgence, and some anxiety themed around perceived lack of resources I treated Lung+ which helped the anxiety but didn’t clearly change the skin. I was hoping that treating Lung+ might give me better insight into whether LI+ improved my skin by drying the interior or the exterior. Is the fog interior or exterior dampness?
Relatively healthy people can be harder to treat, especially when there is a mix of damp and dry.

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Psoriasis and tonify Bl
#2

I find that too. Not only are the signs/symptoms subtler, but it becomes harder to tell if the S/S are due to pathology or from the patient attempting to balance themselves. It becomes easier to find S/S from each side of paired channels. I find it easy to get lost in the details, and have been trying to find a way to keep the bigger picture in mind.

For instance, with LI/SP - is someone LI+ inherently very active, or do they stay active because they really dislike boredom? It’s kind of a chicken or the egg situation.

I’m curious as to why you ever tried LI+, I would have thought you are already more LI than SP, and seems contraindicated by having dry skin.

#3

Thanks so much for sharing this. I too have been finding that dry skin can be super challenging vis a vis “damp dry interior exterior” differentiation . . . sometimes it is really exterior dryness and sometimes it is dampness lurking just below the surface (still ‘exterior’) that is blocking moisturising of the surface! And sometimes it seems the only way to figure it out is to experiment with treatments in the Lung-Stomach and Spleen-Large Intestine domains.

#4

At the May Tucson class, Toby suggested that I try LI+ for my thin receding gums, as it is firming to the tissues of the oral cavity, namely teeth and gums. He was comfortable with this recommendation based on the presence of fog, my recent experiences with supplementing SP+ twice, my dry presentation being on the milder side, and my general good health.

Since then I have used LI+ a number of times, with some slight improvement in my gums but always a good settling response from the treatment and general improvement in well being. This gave me confidence to try LI+ for the skin. At the time I was wondering if the general thinness and lack of tone could be firmed by LI+, as it firms the teeth and gums. As well, I just had an acne breakout on my chin from drinking milk- so I knew that poor processing of damp foods was part of my picture. The LI channel distribution of the itching/excoriated region on my arm also supported LI+. In the back of my mind, the slow to heal nature of my skin also suggested some dampness knowing that blood nourishing never really helped my skin much at all, having had a variety of dermatitis conditions for decades.
Getting the positive responses of improved moisture! and much reduced itchiness, I reached out to Toby. His take was that the LI+ counterbalanced the fog. I agreed. This helped refine my understanding of LI function of firming in the presence of dampness.

It is also really interesting that my skin is always worse in the winter, which is a mix of damp and dry cold here in Massachusetts. Damp and warm doesn’t bother my skin at all. But H+ and SI+ don’t help my skin in any obvious way, though they could be supportive without me directly experiencing improvement. My conclusion, based on my body’s response to treatment, is that I am more damp than cold. The damp locks in the cold for me, just as much as it can lock in the heat for other people.

I probably can treat myself more often and see if the gums get better.

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#5

Willing to be vulnerable so we can all be better clinicians. 11+

This is great Kristin, thank you.

I have a stubborn dry constipation case with dry skin, but with considerable more fog than you. Thirsty a lot. Tongue is moist. (is that inside or outside hmmm) ST+, SP+ have not helped. Treated LU+ one time too. I’ve thought about going to LI+ but the dry skin and thirst caused me to shy away from it. However given what you’ve kindly shared that is what I am doing next for sure.

I remember in Amherst when Toby palpated your arm and said “fog”. At the time I equated it to interior damp and it has stuck with me in my diagnosis.
But now you provided a different image of it blocking the surface.

What does the LI+ counterbalancing the fog mean? Do you see it that it dried up the fog which allowed the surface to be moistened? I am still in somewhat of a fog on how to apply your experience to the SAAM lexicon as to how it improved your skin.

Do you recall how many days apart for the treatments? You only felt calm from the first treatment but no change, correct?
Anything get worse afterwards in terms of skin? - is it possible you pushed SP+ too far and especially needed LI+ now.

And yes I much prefer unwell people with gross imbalances to walk in the door. I feel a high level of “I’ve got this” confidence because their most deficient/excess channels are screaming. However as people get well then clinic gets hard as I find it harder to get some sort of measurable results.

We can market LI+ treatments around the holidays - Holiday sweet tooth? We can fix that. :slight_smile:

#6

Kristin,
Can you explain what you mean by “fog”?
Thanks

#7

@mgreenberg Fog is a soft, fluidy layer in the subcutaneous tissue. To evaluate the subcutaneous rest a relaxed hand lightly on the skin. If there is fog, you will feel it floating on a cushion of fluid. It doesn’t feel like healthy fat. Compare that to other patients who are dry and desiccated or to other qualities of subcutaneous tissue. It should have a nice firm integrity. Fog is pretty common, even in thin patients. Sometimes it is quite dramatic.

Toby’s take on fog is that it is not clearly interior/exterior.
I had one case where it was clearly exterior damp: A postpartum woman with a chief complaint of scanty breast milk. She also had foggy edema AND dry skin. Treatment with Lung+ increased her breast milk, reduced her fog and moistened her skin.

@George_Mandler Let us know how your self treatment goes. You seem like you could be one of those tricky, mostly healthy patients.

I see LI+ as drying up the fog allowing circulation to the skin being improved. At first I was wondering if it was increasing the absorptive capacity of the tissue- a thought influenced by Sharon’s idea of chalky herbs. But increasing the absorptive capacity is a Spleen+ quality. The image that makes the most sense is of oil and water not mixing. The damp fog presented a barrier of fluid that prevented normal blood and fluids from getting to the skin.

In regard to my Spleen treatments back in May, I just remember a deep sense of peace with the first SP+ and can’t remember symptoms per se. Since then I have treated LI+ a whole bunch of times- at least once a month- always feeling great afterward in some way. I don’t think 2x Sp+ created a relative LI deficit. Thinking about my case more, I have other damp signs, like water retained in the stomach creating sloshing long after drinking and frequent rhinitis of clear fluids, worse with cold. I also have other dry exterior signs- like nasal dryness with small amounts of bleeding that lasts most of the winter.

I think we could develop a whole menu of holiday services. Need to increase your love for your mostly benign family? H+. Need to be shielded from holiday overwhelm? Liv+. Need to process long stuck grief stirred up by the holidays? Maybe ST+. Unable to see the light? SJ+. Feel free to add more to the list.

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Psoriasis and tonify Bl
#8

This is really Great! …

#9

Hummm… this system seems to cover a lot of clinical reality :wink:

Thanks for sharing this @KristinWisgirda. I remember Toby showing us your “fog” condition and it’s something I think about a lot in clinic. That there can be quite dry skin, but there is a layer of “not interior, not exterior” fluid. And as you’ve pointed it… it can be obstructive of the clear fluids and qi getting to the surface. But I usually associate this “fluid layer” more something denser than the “fog.” So the fact that the +LI are settling and helpful shows me that even this kind of “thin foggy fluid” can cause significant problems.

Now this is a stretch, but maybe something to consider. When I think of “not interior, not exterior” it makes me thing of the Shaoyang and the way it gets talked about in the Shang Han Lun tradition as “half interior, half exterior”… so maybe consider treating your Shaoyang.

I know you’ve got those diamond bright eyes (along with many classic signs of +LI). But since the SJ is considered the pathway for fluids and yuan qi, maybe have a treatment of +SJ and see if that might improve the fluid metabolism.

Indeed it is much easier to work the gross imbalances, much tricker when people are “healthier.” Makes us refine our diagnosis and clinical eye.

#10

In Saam, SI+ and H+ are definite adjuncts for treating dampness. I remembered Toby stating that SJ+ “is only slightly drying” but have a note that SJ+ can be considered in obesity with cold. With obesity, I wonder if SJ+ only works if the density of Liver excess is present.

I did recently benefit from a SJ+ treatment. Needling Liv+ for insomnia caused anxiety. Counterbalancing with SJ+ calmed me right down and I slept like a baby. This was in the dark of November. It didn’t help my skin at all.

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#11

I am so grateful to have read about Fog in this forum, it helped me feel more confident in using ST+ for a patient this week. She complained of feeling puffy, which I otherwise may have thought of as more of an exterior damp issue. Here is her email to me 2d after the ST+ treatment. I love her description of the crayon outline extending from her whole body. like a child’s rendition of fog.

My feeling – so much less puffy. before I came in I’d felt like there was an extra inch of blah feeling extending from all of my body (like an outline in crayon), it also felt a lot like the period puffiness I get or the pregnancy feeling, plus a vague feeling of yuck in my abdomen and overall.

Today I was about 2.5 lbs lighter on scale in am and that feeling of the outline was gone and my skin was normal (not puffy) with no yuck feeling in tummy or anywhere.

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