The first time I meet a new patient, I spend a significant amount of time on an initial intake. The type of medical history I take is unfamiliar to someone who has never been to a practitioner of holistic medicine. In traditional Chinese medicine, diagnosis is different than what one may be accustomed to. Even the temperature of the water one drinks tells me something about him.
I am equally concerned with the history of what brought someone to my office as I am with black-and-white tests. Blood work, CT scans, and MRI reports all provide important information on bone health, overall chemical levels in the blood, current and past injuries, etc. However, they may fail to represent the individual as a whole.
Diagnosis doesn’t just begin during the intake. From the moment patients step into my waiting room, I am observing them. They are “under my microscope.” There are nuances that can tell me so much about a person. An obvious example would be his or her gait. Is a patient walking with a cane, hunched over, with a limp, leaning heavily to one side . . . These can all be symptomatic of pain that may be present in different areas of the body. There are other observations made that may be subtle but equally as important. An individual’s personality and view of the world can lend itself to a certain type as well.
Recently I was traveling to Chicago, excited to visit my daughter and son-in-law and my mechutanim (child’s in-laws). Flights to Chicago are notorious for delays. We were not spared this time, and our plane was parked at the terminal for what seemed like forever. We were told O’Hare was experiencing stormy weather and was closed to both inbound and outbound flights. As we were still on the ground, I called my daughter who told me that in Skokie the sun was shining, and she had no idea what was going on. I thought about using the time to write my next article; instead, I began observing the people around me.
I am used to observing patients daily, thus it shouldn’t have surprised me to realize I do it all the time, even when I am out of the office. You may make some of the distinctions on your own, similar to what I see. For me it is incorporated into the individual’s treatment. Looking around me, there is the passenger who is holding up the line in the aisle as people are boarding the plane. He is oblivious to the 35 people waiting behind him to get to their seats. He is angrily and noisily shoving his bags around into the overhead compartment. He has a dominating presence and no one wants to approach him to ask if he could kindly allow them to pass, as they are afraid of backlash and figure that it is safer to just wait it out.
A few seats across from me sits a frail-looking woman. She is quite pale and seems to be introverted. She sits quietly in her seat, covered up with an extra-big sweater and blanket. She doesn’t make much movement and is not talkative or busy with anything. Another passenger nearby is quite the opposite extreme. He is bouncing from one activity to the next. He’s wearing headphones, his laptop is open, and he is checking his phone by the second for e-mail, while simultaneously sending messages and making calls. If I could sketch him for you I would draw an octopus. Certainly, if this younger gentleman had eight legs, he would be busy utilizing all of them.
What I have portrayed for you may seem like three different personality types, and it can be that simple. However, in traditional Chinese medicine diagnosis, we are always looking at what the patient tells us, as well as what we observe on our own. Here is the way that I might classify these three passengers I observed, while waiting for takeoff.
The first gentleman–the tense, angry passenger concerned only with himself–I would surmise as having liver qi stagnation. He is overly huffy and emitting a certain amount of anger with just his body language alone. I could imagine that he may have high blood pressure, may suffer from anxiety that he does not have good control over. He may be someone who loses his temper often.
When looking closer, I can see his eyes are turning red as he becomes increasingly frustrated. The liver meridian opens to the eyes, and often when there are eye concerns, it confirms that the liver meridian is involved. I picture getting him on my table, and after inserting a few needles I would envision a deflated balloon. I see this often with similar constitutional types. As soon as I “calm their liver,” they immediately calm down and visibly begin to relax.
The slightly older woman–who is sitting quietly, appears to be cold on a hot summer day, and wants to be wrapped up–is an entirely different picture. The root of her concerns would stem from an overall deficiency. She is quiet and withdrawn. It appears that any movement would take a huge effort and thus she is content to just be still. She prefers to be covered up and warm. Taking into consideration her age, this may be a sign of kidney yang deficiency. This is comparable to the pilot light on the boiler not burning properly, or not being warm enough. She could use acupuncture points to boost her energy and stamina, perhaps along with some moxibustion, burning the herb moxa over certain acupuncture points or areas over the body that will help warm and reinforce her constitution.
The third gentleman is a typical New Yorker. He is busy doing many things at the same time. By the sheer magnitude of what he hopes to accomplish in a given time, he has lost the ability to properly focus and is all over the place. We often see this with youngsters who are quickly categorized as children who have ADD, attention deficit disorder. It affects adults as well–some of whom seem to thrive in business when they are able to multitask well. However, it can be unsettling when they cannot turn off their minds, cannot settle down, and lose the ability for proper focus. Often these types of individuals suffer from insomnia as they are never off the clock. Acupuncture will help them be able to settle and have proper focus, while still being able to multitask when appropriate for the moment.
What my patients tell me is of supreme importance. However, one’s body language can portray a significant image as well. I hope I have given the reader some insight into the nuances of diagnosis. Fair warning that I will be observing you from the moment you step into my waiting room!