Reply To: Acupuncture Bootcamp
Julie,
You ask a very good question. Let me see if I can give you some simplified guidelines as to whether something is interior or exterior (or both).
Exterior can mean there is an External Pathogenic Factor (EPF) / External Pathogenic Influence (EPI) present or that there is a channel problem. For simplicity’s sake I’ll stick to just EPF like a Wind-Cold or a Wind-Heat. Notice how both pathogenic factors have the word “Wind” in them? For both of these, there will be an aversion to Wind — that’s a huge give-away that it’s Exterior. Next is going to be pulse: if a pulse is superficial, along with other suspected EPF symptoms, that’s Exterior.
The next is going to be time. The first case you offered (68) can be understood as happening now due to the wording. There are definitely External signs; however, the fact that the patient “easily catches cold” and suffers from “spontaneous sweating upon exertion” tells of (Internal) Wei Qi Deficiency. The second case (11) says the patient caught a cold two years ago. Nobody is sick with a Wind-whatever for two years, so the time specified is obviously significant for the rest of the case (we can have a hunch some part of the Wind-whatever has moved inside and lingered — which is confirmed due to a rash coinciding with seafood). We can therefore deduce that the Wind-whatever had moved inside.
Lastly, how do we know if there’s both? As I wrote above, there are only two possible Exterior diagnoses: a Wind-whatever and a channel concern. For both Exterior and Interior pathogenic factors to be present, we’ll need to see Wind-Cold or Wind-Heat or Wind-Damp, etc. signs as well as a Zang-Fu diagnosis. For example:
A patient has an aversion to wind, aches all over their body, and can’t get warm (Wind-Cold), as well as constant rumination, bloating and slightly loose stool (Spleen Qi Deficiency).
I would like to offer something different than the “trio” you were taught:
Wind-Cold: aversion to wind, more achy all over, runny nose, cold and can’t get warm, superficial pulse (and maybe slow)
Wind-Heat: aversion to cold, fever, sore throat, maybe constipation, superficial pulse (and maybe rapid)
Think about how you feel when you have a Wind-Cold…maybe you’ll have a slight fever, but you’re going to feel those body aches, have a runny nose and not be able to get warm — definitely more Cold symptoms.
Think about how you feel when you have a Wind-Heat…you’ll have a sore throat, and you’ll generally feel hot …maybe to the point where you become dried out a bit and constipated.
And one last thing to think about… think about what it’d be like to catch a Wind-Cold just after catching shingles (jeez, that’d be no fun at all). You’d have Wind-Cold symptoms (Exterior!) while dealing with a bunch of Damp-Heat in the Liver and Gallbladder (Interior!).
So, in summary:
1. Think aversion to wind and superficial pulse for Exterior.
2. See if the case talks about time elapsed.
3. Wind-Cold is more cold and achy; Wind-Heat is more sore throat, hot and dry
4. Internal Zang-fu diagnosis? Interior as well.
Sincerely,
Kenton