As some people know, I have had a strong interest in the process of diagnosis in my teaching and practice. I noticed when I first started teaching that what practitioners do in the journey between intake and herbal formula is often a kind of quagmire. When we do an intake we are collecting myriad signs and symptoms and we have to do something with this information in order to come out the other end with an accurate formula. We want a formula that is going to be really really effective. But what do we do with this information we gather? Having read literally hundreds of case studies from students over the last 20 plus years I’ve been teaching, I’ve had the chance to observe the hundreds of different things people do with these signs and symptoms to attempt to come to a viable treatment. I’ve seen the following happen after the intake many many times:
- The diagnosis is skipped and a formula is given for a symptom
- Parts of the intake are ignored and other parts emphasized
- Signs and symptoms are organized to make a case for a diagnosis that is actually wrong
- Patients are diagnosed with everything under the sun
- Symptoms are assigned a pathological meaning when the symptom could be caused by many other pathological mechanisms.
- Practitioners look up the disease their patient has in a Chinese medical book and give them the formula that fits the best.
- The diagnosis doesn’t accurately reflect the intake
- The treatment principle doesn’t accurately reflect the diagnosis
- The formula doesn’t accurately reflect the treatment principle
- Long formulas are given to cover all the bases just in case
All this is to say that what is supposed to happen between an intake and a formula is, to many, a mystery. Indeed many practitioners I have spoken to feel that they were taught to do an intake and then asked “what is your diagnosis”? That actually, they were never taught what to do with the information they gleaned. They were told to put it together in relation to the Zang Fu, the 8 parameters, the 3 warmers etc but not exactly what this means. From reading student case studies and working in the clinic I’ve discovered that it is kind of a big mess for most practitioners. For the last 20 years, I’ve been studying this and putting together some of my own ideas about how to remedy this. Really, this is the foundation of the Graduate Mentorship Program. Once we really learn what to do with these niggly signs and symptoms, we can so much more effectively learn about and work with herbs and formulas. If our diagnosis is murky, all the knowledge about herbs and formulas in the world won’t do us much good.
In the interest of illustrating what I have learned to do with the information I gather in an intake, I have created a couple of presentations. The foundation, for me, of accurate diagnosis is seeing each sign and symptom for what it actually IS before interpreting it. In this way, I am protected from jumping to conclusions and creating premature stories about what is going on with my patient. I think you will see from these two presentations how this allows the diagnosis to reveal itself. It is not something I have to figure out. This is the method I teach.