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!
Hmmm, what about a cultural predisposition toward being sensitive to drafts? I think it is not an exaggeration to say that all East Europeans are brought up to be aware of the nefarious potential of drafts. I speak from personal experience. You will find all kinds of people, big, small, cold, hot etc running to close any window that might be “pulling the draft”. When I moved to Canada at age 12, I was stunned to see that sensitivity to drafts was by no means part of the human condition, and here, even babies were carelessly left to perish in the drafts!
Thirty years later, I continue to suffer from this condition, even though constitutionally I am anything but a gui zhi type. Same goes for the East European obssession about avoiding any chill to the lumbar area – a sensitivity to cold in the kidneys, or a mind body symptom of cultural indoctrination?
Having said all this, I do believe one can still tease out the truly sensitive from the rest, but still, I find it fascinating to compare such cultural symptomology
@ Adina Indeed, the Chinese also have a rather acute awareness of cold in particular. That being said, I have asked the question of both Chinese and Westerners (well, Americans for the most part) and the Chinese while they may “fear cold” if they are not sensitive to wind or drafts, they will say so.
Your point is well taken that there are cultural predispositions and biases. Which is one more reason that when working out our differential diagnosis it is best to not rely on one symptom, but collaborate it against the other signs and symptoms.
Thanks for the reminder that cultural habits do play their part in a patient’s experience of themselves!
The discussion is very impressive.In clinical practice in China, this kind of things often happen to me.The patient from different provinces sometimes responds variously to same question.As a doctor, you should know the dialect of your patient and understand correctly of words used by your patinet. If you do not, sometimes you can try abdonimal diagnosis,for example fullness in the chest and hypochondrium, this can not be misunderstood.
Indeed the differences between “meaning” and “understanding” can be quite vast. And you are so right that abdominal patterns and pulses speak their own direct language, for those who know how to listen.
this is helpful information. Thank you!