This patient is suffering so much; Thanks for taking time to read this and giving feedback!
Chief complaint: pompholyx eczema on first on feet, then hands. History of dry/cracked heels, worsened in autumn 2019, correlated with aftermath of a course of antibiotics for bronchitis. Started in feet, now affecting hands.
Skin Appearance: see attached photos. The brown discoloration is Dermatology-M Da Huang Gao.
Bilateral soles of feet fissured, dry, with weeping of serous fluid. Use of Da Huang Gao and gauze covering, plus tight socks and sensible shoes, allow her to be able to walk, otherwise very painful. Intense itch when removing bandages, needs to scratch, which irritates the skin further.
Bilateral palms have the same fissuring, dryness, some weeping, itch, and pain. If doesn’t use Da Huang Gao and gauze, the fissuring and subsequent dryness pull on the palms so much that the fingers curl inward.
Different herbal iterations gave limited improvement: initially, formulas to treat damp heat and fire toxin healed fissuring a lot, but also induced urgent diarrhea. I’ve tried both powdered and vacuum-decoctions; the limitation with herbs is always diarrhea. (even herbs that support spleen and gently clear damp)
She was making slow but positive progress until June, when danger of potential business closure really increased stress. Since then, the fissuring and all pompholyx symptoms intensified. The inflamed area has spread to the ankles, L>R: redness, swelling, pitting edema, warm to touch, and itchy red macular lesions up lower legs, worst on SP line.
Appearance: small stature, thin physique with soft belly, thin arms and legs; fingers deformed by arthritis; bright eyes 9+, symmetry 7+, grooming 10+; rosy cheeks 2+; warm soft midline 8+; dry cracked medial heels 10+; many varicosities esp KD 3-6 area; LU10 deflated 1+; overall thin, dry skin 5+
Affect: Polite 9+, clear, witty, and direct communicator. Chatty 6+. Controlling 8+ (“fix me by next week” – humorous and also commanding). Recently feels depressed, doesn’t want to get out of bed, “I have no vim and vigor”, “what’s the point of dieting?”.
Lifestyle: owns and runs high-end interior design firm that’s been in business for 40 years, but now, like so many businesses, is in danger of closing. Does not want to retire. Drives shiny red volvo SUV. Divorced and seems content living alone. Has a son and grandkids whom she only visits with sometimes in the driveway now; she doesn’t seem too bothered by this. Rarely talks about her grandkids.
GI: eats reasonably but then snacks on chocolate and popcorn after dinner; reflux and stomach pain if overeats (often does, out of boredom). With herbs, has loose stools – urgent diarrhea. Without herbs, bm ~formed, but sticky.
Thirst, temp, sweat, urine – normal
Msk: arthritis in neck, hands, knees; often stiff, achy. R hand can be numb upon waking or with too much computer work, attributes that to neck arthritis.
Sleep: long history of taking Benadryl most nights to help with sleep. Recently poor sleep d/t stress of business.
EMO: depression, “what’s the point?” typically a firecracker, but now often doesn’t want to get out of bed. Feels manipulated by employees.
GYN: no history taken; has one child
Tongue: dusky, swollen, little/no white coat; midline crack lung area
Saam Conformations (Excess unless noted)
SJ: bright eyes 9+, polite 9+, notices details, pink cheeks 2+, controlling 8+
HT: warm soft midline, talker 6+, lesions ht 8; erythema; skin needs moistening and cooling; neck pain
UB: not gaga about grandkids; lesions ht 8; neck pain
PC: concave lesions/fissures; lesions P8; Feels manipulated by employees.
GB: lesions P8; sudden extreme itch when removes bandages
SP: soft abdomen, diarrhea, eats carbs out of boredom, swollen L ankle, L SP line most affected, pitting edema; weepy lesions
LI: thin limbs, typically busy/productive, dry fissured skin; L SP line most affected
LU: well resourced; dry fissured skin
ST: thin limbs, swollen L ankle
KD: grooming 10+; volvo; still working at age 79; many varicosities; kd 1 area lesions
SI: Depressed. No vim and vigor. Dry cracked medial heels 10+; kd 1 area lesions
Saam treatments performed:
settled well, was v relaxed from most of these treatments
R SI+ neck pain improved
R LI+ L ankle swelling and redness decreased by end of session
R UB+ L ankle less swollen
R KD+ (“I’ve got no vim and vigor; what’s the point of dieting?”) - calm, rosy face
Bi LI+ ankle swelling and redness reduced
Despite her positive calming response and clear reduction of ankle swelling while on the table, the eczema is deteriorating.
The grossest thing in the room is the fissured skin, swollen red ankle with pitting edema.
I have no clarity on how to think about the damp/dry, interior/exterior issues.
Is this a clear Concave presentation? Does GB+ seem like a good idea?
Please send ideas and suggestions. Thank you!