Rules of thumb are useful. Being able discern a constitutional type is a broad brushstroke rule of thumb. We can effectively condense experience, and it is often a shortcut to where we are headed. Except for when it is not.

I was working through the diagnosis on a young woman recently and thought I had immediately and accurately slotted her in the gui zhi tribe. She had the fine white skin, sweating, floating pulse and slender build of a cinnamon girl. However, tossing out the usual defining question for this type brought an unexpected response.

“Do you have a sensitivity to drafts?”

The unexpected reply of “what do you mean?” completely threw me.

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Gui zhi types pretty much always answer with an emphatic YES!
Those who do not understand the question are generally not of this constitution. Those with this kind of wei qi deficiency usually are quite aware of any nearby draft; even if it is just a slightly cracked window two rooms away. I’ve taken “what does that mean?” as a rule of thumb to mean they are not this type.

As with any shorthand or rule of thumb, there are those who to whom it does not apply. I could not figure out how she could not be sensitive to wind as she had that pale sweat moisturized skin, and a lack of heat signs.

A different tack was called for, and the question of “do you get cold easily?” brought it all back into focus. “Yes, I get cold because the drafts evaporate my sweat and makes me chilled. It really bothers me.” So there you have it, sensitivity to wind. But, she was focusing on the sweating and it did not occur to her that she was sensitive to wind. It was the fault of the sweat. Still, a gui zhi girl in my book. And moreover a reminder that clever bits of shorthand are just that; a way of compressing and abbreviating experience. Definitely useful, but not to be confused with the patient’s reality!

Today we have another guest post from a member of the group that journeyed to Nanjing this past November to study jing fang with Dr. Huang. Bernd Schleifer is a practitioner from Munich who has an active practice, and weak spot for good books on medicine written in Chinese.

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Reading the Ten Key Formula Families I always tried to create a picture in my mind of how these people might look. Working with Dr. Huang in the hospital was great, because a lot of those pictures really came to life.

As it was written before I was also very impressed by his use of Ephedrae Herba (má huáng) for acne. By seeing those introverted, closed-in Ephedra type acne patients, with their silent voices and reduced expression, the idea of using a warm and acrid herb to open them up was striking to me.

Another very interesting thing for me to see was his view of the Pinellia constitution and his extensive use of Pinelliae Rhizoma preparatum (zhì bàn xià) for different emotional issues. Using Warm the Gallbladder Decoction (wën dân täng) for anxiety disorders or waking up with fright was not new to me. But apart from that my idea of a person with bàn xià issues was more one of a slow reacting, plump or puffy person; more the phlegmy kind of thing, as it is also described in the Ten Key Formula Families book.

To my surprise it was often the funniest and most entertaining people in the clinic that were labeled as Pinellia constitution!

Later on in the lecture Dr. Huang explained that he distinguishes between a bàn xià heat and a bàn xià cold type. In general these are people with round faces and round eyes. However, the cold ones are more dull and slow; while the hot ones are very talkative, have lively quick moving eyes, mood swings and are very expressive with their emotions like actors or other performing artists. Most of them don’t have serious health problems, but loads of strange complaints that they feel in their body. That’s why they are kind of full-time patients, or like Dr. Huang said “those people are always at the hospital”.

Additionally I observed a funny thing in the clinic; it was almost always the bàn xià types who after saying goodbye would came back once or twice, just to ask another question or get reassurance that all of their complaints had been considered within the formula. It might have been their anxiety issues, their muddle-headedness due to the phlegm, or their vast variety of subjective problems that moved them to behave that way.