Five questions in a fixed order, List A read aloud, and the card
Key teaching
Why the patient's first answer is not information
In many instances the patient's answer does not reflect the true state of the body. The average patient, male or female, because of social custom, does not like even the mention of any talk about stools or defecation — the exceptions being when he has real difficulty passing them, or passes them so often that he becomes exhausted from dehydration.
Worse, many people hold that constipation is bad for health, whereas passing semi-solid stools, or passing stools frequently, is in their opinion a sign of normal health.
So the patient may answer whatever comes to mind, without giving thought to the matter — not because he wishes to lie, but because he wants to evade the topic.
The trained therapist must learn to distinguish between a correct answer and an answer given just to put an end to the talk.
Three obstacles, each defeated differently: shame, by asking in the same unhurried tone as every other question; a false norm, by never accepting the word normal; and inattention, by the second question — have you looked? The order of the questions below is doing work, so do not rearrange it. (Figure 9.5)
The list is read aloud, item by item, in the patient's own kitchen vocabulary, watching the face as you go.
(This list applies to all people eating food prepared in the Indian style of cooking.)
Key teaching
List A — the items to ask about
Skin of tomato, brinjal — egg plant — and the like.
Items of seasoning, such as jeera or mustard.
Seeds of bhindī — lady's finger — or of tomatoes.
Pieces of greens such as pālak, methī, curry leaves or dhaniyā.
Pieces of salad or raw vegetables such as carrot, beetroot, cabbage, lettuce.
Pieces of nuts such as groundnut or fried lentils.
The tongue and the curd
Lines and a coating on the tongue; milk vomited as milk or as curd
When undigested food comes, and to whom
Teething, weddings, the febrile child — and acidosis too
Key teaching
The ages and occasions at which UDF appears
UDF can come to anyone at any age.
In small children it comes for the first time when the teeth are coming out. After a certain age it begins when the child has eaten some odd or unsuitable thing, or when his liver is becoming weak.
It will often be seen that a few days after UDF appears in the motion, the child gets pain in the stomach or the head, or fever, for a day or two. And if jaundice — pīliyā — came in childhood, its effect remains upon the liver for many years.
In grown persons, UDF often begins in those days when they eat irregularly or without limit — the common example being eating at parties or weddings, on other people's insistence, even when there is no hunger.
Key teaching
The coming of fever, and what it is telling you
The coming of fever indicates that the liver needs rest for a few days.
A white layer-like coating appears on the child's tongue. At that time hunger is not felt.
Patients with the symptoms of alkalosis — pain at Liv° — have poor production of hydrochloric acid, and so usually have UDF. Does that mean patients of acidosis will not?
No. UDF may appear even in patients of acidosis — those with pain at Mu°. One should understand that the acidity of the blood is a different thing from the acidity in the stomach. The two may exist at the same time, but not necessarily always.
And this changes with age. A younger person usually complains of acidity and has pain at Mu° with the other signs of acidosis. As people age they tend to have more pain at Liv°. And sometimes an older person, because of poor water consumption, shows pain at Mu° and yet has UDF — meaning his stomach's secretion of hydrochloric acid is poor.
Key teaching
Does UDF belong only to the alkaline patient?
Never decide that a patient cannot have UDF because his flank finding was on the left. Ask everybody.
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