Qiological Community

Post COVID Syndrome

This is the first post COVID case that I have been able to treat with Saam. I’m so thankful that she has gotten such quick relief. Her response to UB+ is a particularly interesting reminder that you can use UB+ in a patient with no real heat signs.

42 year old nurse’s aide

Diagnosed with COVID on 4/2. Active covid symptoms included body pain, malaise, fever, lack of appetite, erratic bowel movements, abdominal pain. Denies respiratory involvement. Hasn’t been able to work since because of disabling symptoms. Chief and secondary complaints are all s/p COVID.

Chief Complaints:

  • · Body pain and pressures- all symptoms bilateral, in constant pain but location changes through the day
    • sharp pains travelling through her limbs
    • intense pressure on UB36 area bilaterally when she sits or lays flat
      • none when standing and moving
    • pressure at occiput- Cut off all of her hair to facilitate frequent warm showers which give relief. Warm water creates a minty tingle on her scalp.
    • worse with eating- eats then feels pressure rising from her stomach that then aggravates pain
    • worse when she notices her hands get wrinkled as if they are dehydrated
    • all pain better with movement- walks 4 miles a day even though this is exhausting
    • Pain disturbs sleep: hard to get comfortable and waking every 2 hours.
  • · Glomus: Uncomfortably full in entire abdomen after eating 9+. Low appetite and afraid to eat because aggravates body pain. Heartburn eliminated with omeprazole. Has lost 30 lbs since COVID.
  • · Bowels: erratic, dry stools that are hard to pass or loose with undigested food, can skip days; feels strong vibration 8+ down both legs during bowel movements

Secondary complaints:

  • · itchy papular rash on forehead and cheeks- comes and goes, notices in conjunction with increased abdominal noises; feels tight
  • · Loss of smell- gradually returning but not 100, 1+
  • · exhausted 5+
  • · infrequent hot flashes, mild sweats or chills 1+
  • · body vibrations 3+; dizziness with position change 3+, feels movements in her head

Appearance and demeanor: pretty 5+, attention to appearance 5+; quiet voice 8+; polite 6+, great reporter 10+.

Lifestyle: unable to work, mother of 3 children under 18yo

Morphology: sturdy frame, thicker flesh 3+, normal weight

Skin: dry coarse 5+, sweats normally

Body temp: normal when not having infrequent hot flashs/chills

Thirst: not thirsty but drinks lots of water because of the hand dehydration symptom; prefers room temperature water

Emotions: even tempered

Respiratory: fine

Urination: clear to light yellow, denies problems

OB/Gyn: monthly period with normal to flow that is light pink brief and scant; denies dysmenorrhea or problems. After giving birth to twins via c-section10 years ago, went into a coma for several days but doctors are unsure of cause. Coming out of coma she had body pain similar to the pain she is currently experiencing

Tongue: light purple, thin body, normal moisture and coat; curled up edges and tip

Pulse: thin

Abdomen: deep empty epigastrium 10+ on an abdomen with otherwise good muscle tone; pressing on right lower quadrant and K16 recreates the vibration she feels when having a bowel movement

Treatment 1: SI+ on the right; herbs- gui zhi tang + chen pi, ban xia, ma huang, fu zi

All symptoms are at least 50% better-the UB36 and occipital pressure are now the most troublesome areas. Sleeping like a baby. Glomus is better and is able to eat more but is still afraid of eating. No more undigested food in stools, stools are now dry and is skipping days. Epigastrium is still strangely cavernous. Tongue is no longer purple but still has curled up edges and tip.

Treatment 2: UB+

Symptoms are 90% gone. Light pressure sensation at Ub36 and occiput are the most troublesome along with constipation with hard dry stools. Epigastric are has more tone. Eating much more with only occasional sense of fullness after eating. Energy and smell “almost normal”. Papular rash on face comes and goes but less frequently.

Treatment 3 (today): SI+ on the right and LI1+/ST36- on the left

All treatments relieved pain while she was on the table.

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Thank you for sharing this case! What was your treatment strategy with Treatment 3? From the points I see you are helping the digestion, improving fluids and moving circulaton. Advanced jazz playing with Sa’am as George says:)
I have a few post covid patients as well and I see a deep fluid deficiency that leads to the patient having a lot of dryness and a couple patients who have heart palpitations post covid. The bladder treatment has been very helpful on these patients as well.

Thanks for sharing your experiences too @lauramcgraw. I posted this case hoping to start a conversation about how these patients are presenting. I am thankful that my patient freely reported all the strange details of her condition. Other patients might not think to report certain things so sharing experiences will help us ask better questions and look more closely to evaluate fluids and blood stasis.

Her deeply empty epigastrium was such an odd sign on the background of the rest of her presentation. Without the Sa’am indication of H excess I might not know what to make of it.

Thanks for articulating this @lauramcgraw. I considered using the regular UB+ for the third treatment but hesitated to use ice cold water twice in a row so opted for partial UB+ and SI+ to keep bringing movement and fluids to the UB channel since her dominant symptoms were there.
At the second visit, I considered changing herbs because of the bowel dryness but she remarked that they really improved her appetite when she took them. At the third visit I changed her formula to be more moistening.

Other, please let us know what strategies work for these patients. I suspect we will be seeing more and more of them.

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@KristinWisgirda, thanks for the case–just to clarify, is emptiness at the epigastrium a HT excess sign? I don’t think this was mentioned in the intro seminar I took.

FWIW I’ve also had good results lately using UB+ in the absence of heat signs for channel-related issues (one case each of headache and whiplash-related neck pain)

Jonathan

Technically, softness and warmth of the abdominal midline between rem15 and ren8 is the indication for H excess that is included in the power point of the intro class. Tony describes it as 2 inch band.
The epigastrium is part of that real estate.

Great! It is important that we don’t get fixated on channel or quality in our methodology. While we have to be careful with the channels that double up on qualities, ie LI dry, Spleen damp, Heart fire and UB water- there are times when the channel location is the most important indication.

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my post-covid case was a woman I started seeing in late May; she’d been having symptoms since mid-March. The main issues remaining were fatigue 6+ and shortness of breath 8+, both ww exertion. This was before I learned Saam… with Kiiko-style acu and herbs (variations of Gui zhi tang, sheng mai san mod with hou po, xing ren, dan shen, gua lou), all symptoms improved to 2-3+ level. Then I did Saam LU+, ST+; fatigue and SOB improved to 1+, but she could never get past that baseline feeling of something on her chest.

She is a retired accountant, rule follower, plus was repressing a lot of emotions as her husband was going through health issues; so I did GB+ one week. The next time she reported in general doing ok, but during one walk, had quite intense SOB along with a cold sweat. This was a more severe presentation than she’d had in weeks.

So on to PC+ and the next day she wrote to say her chest sensation had been “ZERO ZERO all day - never have I been so happy to be a zero”

It’s been a stable zero for 2 weeks now, energy completely back to normal.

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@KristinWisgirda and @lauramcgraw my question is regarding using UB+ in these situations. When you know that someone’s current symptoms were caused by/followed a sickness from exterior pathogens, would that make you put UB among the top treatments to consider, whether or not clear heat signs are present? I understand that there’d need to be some quality or channel calling for UB+, of course. But do you consider UB+ to be a very important (or even essential?) layer to address in post-exterior cases?

For example, I’ve got a tricky case of 3-year chronic cough that’s not responded to LU, ST, SJ, SI; perhaps ww GB, perhaps bw LV. Upon further digging, the patient had a very severe case of chicken pox at age 36, then a few years later, acute intra-ocular herpes zoster that preceded the start of the cough. This string has made me consider UB+ for him, which previously seemed inappropriate because he is typically so cold. I’m going to write up his case to get feedback… but, would welcome your musing on UB+ in the meantime.

Cassiopeia,
I would be cautious to use UB+ in these situations. In the past I have used UB+ with a patient who had an acute tai yang invasion with very early signs on the day they came in to see me, this is a new way of using UB for me and am cautious with it.
Typically when I am treating a patient with Sa’am I look at what is happening in the moment, I do not put a lot of weight on the past, nor on western diagnoses, as we know can be from many different chinese medicine patterns. I have found with Sa’am that the patients symptoms can change dramatically especially after giving the body a big shove in one direction so I need to be careful to re assess the diagnosis each treatment. I always hear Toby’s voice reminding me to make a list of top three treatments and try my best to see what is needed in the moment, that can change so fast!
Similarily with herbs, if I have a patient with left over symptoms of a cold/flu that have no current exterior symptoms I would not use a Taiyang Rx to treat the patient, that would not be helpful for the patient, and could actually harm them.
Typically with UB suppl I am looking for a person who needs cold water and the possiblity it is bothering the heart function, the heart is in excess. A couple patient’s post covid symptoms that I have treated have a lot of fluid damage, thirst, dry tongue,dry throat, dry feeling in chest, and burning pain. Some times pain is on the bladder channel, sometimes not. The heart pathology I have been seeing has been varied, palpitations, angina, racy feeling in chest. Ultimately to get the heart to relax with that cool water has been really helpful.

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HI,
Is this a concept that we can use in our treatments? IF we feel that using a full tonification of a certain organ would be too much can we use half of it on one side and another full organ on the other?

The only partial treatment that has been discussed on this forum is partial UB+= LI1+ and St36-. This is an established partial treatment strategy and not just a choice of 2 of the 4 points. I don’t feel comfortable breaking up channel pairs on my own. The advanced class will introduce other partial treatment options.

@cassiopeia I agree with @lauramcgraw on all of her points. I would want to see clear current UB+ indications for channel/organ/location or qualities.

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Okay. This is the first time I am hearing of this established partial treatment strategy for UB+. Can you please direct me to where else is was discussed on the forum so that I can learn more about it?
Thank-you so much!

It was mentioned in a crowdcast. Please use the search bar and I am sure you will find it.

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HI @lauramcgraw I totally hear you about not jumping to using UB in these cases. I was thinking of it in the context of remembering hearing that Toby had chosen to use UB+ when treating someone whose headaches began after catching a cold. I don’t know enough about that case to know if they manifested symptoms showing a need for UB+.
What I’m hearing is that UB+ is not indicated unless it’s indicated :grimacing:

I saw T treat such a patient. He explained that the etiology was part of his decision making but the location on the UB channel had to have helped too.

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Yes I have used it that way once, but I was very careful that the symptoms were only in Tai yang and it was the day of the onset of symptoms. I remember Toby mentioning that you have to be careful as you are sealing up the Taiyang surface after you treat it this way, if the pathology is in a different conformation or a combo it could make it worse.
Kristin do you have any more insight into what Toby said about this? Am I correct in this? Trying to remember his exact wording.

All of my notes on Taiyang surface issues are worded such that UB+ releases Taiyang. It is highly likely that T worded it this way. Notes go on to say that UB+ can release pathogenic factors from the exterior even if they are old or incompletely released.

I haven’t heard T say this but then again I haven’t been to every teaching event.

For sure.

Here on my notes on the headache case mentioned above.
A internally/externally dry woman complains of UB channel headaches since catching a cold 3 months earlier. She treated the cold with wind heat herbs.
The headache tends to be worse on the right but can affect both sides. She tends to be cold but since getting sick she has been warmer than usual.
Toby treated UB+ on the left. During the treatment, the patient experienced symptoms similar to when she first had the cold includign an earache.
I’m not sure about the outcome but the patient was one of our colleagues who attended an intro class last year.

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I just found the video where Toby talks about the Tai Yang bladder treatment for acute illness. The patient feels like they are getting sick and it is very superficlal, still in the Tai Yang. He says it is risky because you are putting a cold layer and sealing in the surface, locking it in. You are also completely releasing the surface and knocking the illness away.
You can find the discussion on the Using Saam for acute illness video- starts at minute 2- til about 4minutes. What a great reminder!

It makes sense that inappropriate application of ice cold water could block the surface or freeze up the function of other areas too. But a flush of ice cold water can restore function for a body that needs it, especially if that area is governed by the UB or Heart.

Thanks @lauramcgraw for sharing the crowdcast episode and time so that we all can hear Toby speak to this directly.

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I submitted a case for the advanced class but will be seeing this patient on Thursday, and wonder if someone can give input on the usefulness of this partial UB+ treatment for her.

47yo female with CC of migraines (pain). I’ve peeled back a few layers and a couple sessions back was ready to do SI+. When the 4th needle (UB66) was inserted, it set off her chronic neuropathic pain in the R foot, and instantly triggered a migraine. I removed all needles and did KD+ on L, which helped her to feel better on the table, but didn’t do much for her overall migraine state post-treatment.

She had broken the R foot in 2009, it never healed well, and has RSD-like neuropathic pain: extreme sensitivity to most kinds of touch. A similar kind of pain is mirrored in the L foot.

SI+ and UB+ seem to be the best fits for addressing her migraine pain (much trauma/injury/surgeries, located in UB10-2 band, and hot hyperfunction all around). But I am afraid to do these treatments for fear of the neurologic pain reaction.

so is partial UB+ the answer? could I do that as a first step to address the migraines AND calm down the hyperfunction of the UB channel? Would those 2 points be the only ones she gets during one treatment?

Hopefully Toby will talk about this case next weekend, but if anyone can chime in in the meantime, I thank you in advance.

fang

Since this is a class case study, I’m going to withhold comments. I would need more info anyway.

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