Lost in Translation=Bad Diagnosis
I’m going to show you two ways to ask diagnostic questions.
First you will see how I ask in clinic with respect for Western cultural differences. Then I will show you how Jin Zhao refines his questions to the absolute essential questions.
First lets look at cultural and socioeconomic variables we can take into account to keep the diagnosis clear.
When it is not clear people move past fluid physiology and go right into moving blood. When people use blood moving herbs prematurely they spread pathogens into the tendons, diagphragm and fascia leading to long term respiratory challenges, fatigue, and joint pain. This temporarily alleviates symptoms, but later they return with a vengeance.
Volume and tone of voice is often taught in Chinese medicine school as an indicator of excess or deficiency. This is why you should not take it seriously. Very few women ages 35-65 of means are going to be loud. Their are socioeconomic reasons why. People who are educated or wealthy tend to speak softly as though they are in a library or in a space with fewer people, while people who work in the fields, around machinery, or among groups of people need to project their voices in order to be heard. This causes many tcm doctors to hear “weak” and automatically say that it is a deficient or empty condition in need of nourishment. This assumption must be questioned. “Who” is this patient is the question we must ask to frame all other questions and we must refer back to it in order to question our diagnostic assumptions.
A common question in Chinese clinics which does not work well in the west is whether people have an aversion to cold. In Chinese this is literally “Do you fear cold?” This requires a cultural adaptation) Most Western European people do not have a sense of aversion to cold and it will be confusing and break the flow. “You you tend to run cold compared to other people.” is better, but even this confuses people. Use observation instead.
If it’s warm outside and they are wearing a lot you have your answer. Fearing cold and wind is a sign that their immune system is weak, but hey, so it seeing a professional for a chronic disease. As a result I omit this question and look visually for clues.
Ask a Chinese person about urine and they know. Ask a westerner about urine color and they tend to say, “Well when I drink more water it’s clear, when I drink less it’s yellow.” Avoid the temptation to facepalm. Also in China the toilets haven’t had basins of water until recently. If people are looking at the toilet water it may look light yellow when it’s dark based on how much water is in the toilet bowl. If they have that blue disinfectant in the toilet then it will look slightly green. It’s difficult to get this kind of information clearly. What you can tell much easier is UTI and yeast infections. For whatever reason western women seem to get more of these which makes it easy to get an answer on the urogenital microbiome.
In China people sweat a lot climbing stairs and they dress warmer in general. people are very aware of how easily they sweat and it’s less likely to be stinky because of a phenotypical variation in many Asian people. Asking a Western woman about her sweating is less likely to yeild accurate answers. Often the reflex answer whether consciously or not is to deny sweating because it has aspects of social embarrassment. Also with climate control most western people are simply not sweating enough throughout the day to be healthy. As a result look for indirect clues about sweating, but it may be a line of questioning to avoid with this demographic.
The irony: Here are the two biggest signs of dampness and dysbiosis in China: Severe aversion to cold and absence of sweating.
Very few people are getting the right diagnosis of dampness because the two main signs are covered by climate control and culture around ladies feeling ashamed of having body fluid.
What is the most important?
Pulse and palpation
Appearance and movement