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Home > Education > Diagnosis > Traditional Diagnosis

Traditional Diagnosis

There is a story about a man who lived about 3,000 years ago in China. Maybe it was Korea. Maybe not. That part's kind of sketchy. Anyway, one day, as he was walking merrily along, he bumped his leg. (Some variations on this story suggest that he banged his knee on an end-table.) Without thinking, he began to rub his wound, and the pain went away. He found that when you bump your leg, it doesn't hurt as much if you rub it. In this moment, or perhaps a moment much like this, what we now call Traditional Chinese Medicine was born out of an instinctive response to pain.

Meanwhile, Taoist adepts were making it a habit to give in to their most natural responses as well. They became aware of the constant interplay between nature outside the individual and the nature within. They were able to blur the boundaries between the individual and his environment.

As such, they began to witness the wonders of naked perception unfettered by reason. They saw light radiating from children's eyes and became sensitive to these less tangible visual experiences.

In time, their sensitivity grew to the point where internal organs and channels were illuminated to those with a developed sense of sight and the body of knowledge that became TCM grew and grew.

Today, we must memorize point locations and syndrome differentiation to pass a test. Rather than spend our time learning to trust our instincts, letting go of left brain perceptual limitations, or intuiting the appropriate series of points to needle, we are taught to memorize what others have already discovered for us. Ancient Taoist masters of healing would probably view this memorization much like teaching a sighted person to read Braille.

The body of knowledge that we are taught in our diagnosis and Zang fu classes are nothing more than the notes left behind by all those before us who have banged their knees and rubbed away the pain. Even though we must feverishly study for finals and State board examinations we will discover, in the end, that TCM is not memorized, it is remembered.

In this paper, I hope to describe some of the more important steps necessary to rediscover the Traditional Chinese art of diagnosis within us all. There are three that I address in this paper.

  1. The Now
  2. Vision minus comparison
  3. Cessation of personal ego

In one form or another, every major religion in the world today strives to reach one of these above mentioned goals. Usually in the form of #3, though 1 and 2 often come up as bi-products, or steps toward the third. They are religious pinnacles that holy men from all walks of life have achieved and from the unique perspective of these levels of personal development, these spiritual adepts have all realized the same truths. It is from this same perspective that TCM is elevated from a medical science of memorizing signs and symptoms to a career that actually mimics the priesthood. TCM can become a spiritual path of self-realization utilizing the same internal disciplines that are expected of any monk in a Tibetan lamasery, a Franciscan parish, or a Taoist monastery.

Intuitive diagnosis can only be achieved in The Now.

The human body exists in three dimensions. It reacts to the fourth, that of time and space, but it is the fifth dimension that has been set aside for mankind's next step in evolution. Or perhaps it is a return to the intelligence of our primal nature. Either way, it can be described as "The Now," and it is from this unique vantage point that Taoist adepts realized the diagnostic genius of TCM.

Meeting a patient for the very first time can be a blinding experience from a diagnostic standpoint. Our human defenses and subconscious memories get in the way from seeing anybody for the very first time unimpeded by these unconscious reactions.

To diagnose, it is essential to see things As They Are, and this can only happen in The Now. When we step out of The Now, we begin to compare what we see to what we've seen in the past, or our expectations of the future. It is a subtle shift in focus but once done, we become conscious not of What Is, but of What Isn't. We cease to see things or people As They Are in and of themselves and instead, see everyone in relation to others.

One key to transcending even the most unconscious of judgments is to remain in The Now. In my experience, once this goal is achieved, one will find that The Now isn't a static level of consciousness, but a starting point from which more and more subtle experiences eventually begin to manifest. There are realms of perception that can be explored wherein you are so present to the moment that you loosen your attachment to the five senses and begin to perceive people on a level that is all feeling, or colors and sounds or any mixture of senses that may or may not be consistent with commonly accepted applications of these senses. Appearances take on sounds, sounds have taste, tastes have shape and weight, and feelings have tone. Suddenly, Yin deficiency is no longer the signs and symptoms we memorize in class, but a sense of lacking attachment to the earth, or the feeling that the patient could be shoved over easily. In The Now, we find a symphony of new sensations swimming all around. Sensations we've known before, but didn't realize were present all the time until we could step out of time.

In The Now, signs and symptoms can be read into any expression of the patient. Clothes are no longer what the patient happened to wear that day, but costumes wherein each accessory says volumes about the one who wears it. It is as if there is a Hollywood costume designer just outside your office creating these dimensional "looks" for everybody's unique personality. There is no more such a thing as wearing "nothing special."

For diagnostic purposes clothing tells a great deal about one's lifestyle both externally and emotionally. It is just like a costume worn that the Shen picks out everyday. It is as much a reflection of the person's health as are the colors on their tongue. When approaching the patient and seeing them "As They Are," everything speaks to the doctor.

Unfortunately, blue jeans doesn't mean anything in particular unless connected to a person. We couldn't sit in class and learn, under signs and symptoms, that wearing blue jeans always denotes an imbalance in the fire element. Jeans ripped in horizontal bands at the knees worn by a high school student from Beverly Hills says more about that student's need to fit in with her peers, than the jeans ripped in the same manner worn by a longshoreman from Los Angeles Harbor. The signs have to be kept in context, and not removed from The Now, nor the patient.

Some clothing designers take their inspiration from military fashion. Depending on the person, gravitating toward militaristic fashions can denote a deficiency of earth yang energy. Liver is known as the general, but it is the spleen and stomach that I associate with the military mentality. Earth is what gives you the strength to hold your ground, wood is where we find the propulsion to move. One who tends toward the built up shoulders and square lines of military based fashion may feel deficient in personal power. The broad shoulders and square lines, along with the decidedly masculine texture of the clothing suggests a need for stability and discipline which can include a deficiency in spleen yang. The person who feels the need to dress with a military attitude may be doing so for the added energetics of earth energy. On a constitutional level, you'll find these people to be thin and lacking in muscle tone. They are, among men, the so-called "99 pound weakling." They grow mustaches to make themselves look more "manly," but they don't exercise much, they don't have the drive, nor the energy. If they do work out, it doesn't show well on their bodies, because their spleen yang is deficient and the muscles simply don't grow and develop definition. They make up for it the best they can through their fashion, and the energetics of that fashion.

The above scenario is just an example, not a hard and fast rule. Again, I stress, one's clothing must be kept in context. If the clothing doesn't agree with any other signs and symptoms or one's internal sense, it may be that they've run out of clean clothes and are wearing what they've got on only because they don't smell as bad as the dirty ones they would have rather worn. Keep in mind that on this level of diagnosis, signs and symptoms are not separate from the patient, they all roll together into a highly unified package, like a well constructed paragraph wherein every word supports the underlying message.

Pulse diagnosis had to have been discovered in The Now. It is another blending of senses, like listening with your fingertips. For the West to perceive pulse as slippery, or choppy is quite a leap in faith, and yet we've all come to know the difference. In The Now, we can discover numerous other signs and symptoms above and beyond those described in class as we reach back and connect with the Taoist Ancients whose energies of diagnostic brilliance still exist in The Now.

Staying in The Now with your patient, or anybody for that matter, is the same as viewing someone without any comparison to past memories or future expectations. There is another way of looking at this experience, and that is viewing things by themselves, with no relationship.

Seeing it As It Is-
Vision minus comparison.

The subtle prejudgement of viewing someone solely as a "sick patient" is the first of many limiting perceptions that get in the way of a clear and accurate diagnostic response. To view someone as a child sees, with no judgment, conscious of nothing upon which one could base any comparisons, with total acceptance and lack of expectation is truly an eye opening experience. It is this ability to see without interpreting that is another way of describing the foundation of TCM diagnosis on the intuitive level.

Many, if not all traditional paths, (and even numerous alternative traditions) describe a perceptual shift that accompanies the cessation of all judgment. Some approach this point with disciplines that retain one in The Now. Others approach this point as the cessation of all judgments, comparisons, and expectations. It always has the same effect, you can still see things As They Are and diagnose on a whole new level because of cessation of judgment, this removal of illusion.

To describe anybody in terms other than what they are nearly always assumes a judgment of some sort. When I say that you are tall, smart, well dressed, or funny, I am not seeing you As Your Are, but solely in comparison to some other arbitrarily set standard. To whom or what am I comparing your height, intelligence, fashion sense, or sense of humor? With any comparison we lose the essence of our perceptions and with it, a great deal of diagnostic insight.

Interestingly, the Hindu tradition spends a great deal of time teaching it's adherents to transcend "Maya" which translates to "illusion." The word "Maya" made it's way from the Indian Sanskrit to the European Latin where it became the word "Mensura" which evolved further to eventually be known in modern English as "measure." This supports again, the fact that illusion comes from measurements, or comparisons. Unfortunately, to this day, man has yet to devise a fool-proof method by which to judge one another. When we compare someone to the way we feel they should be, or fear that they might be, we are already creating an arbitrary measuring stick which doesn't take into account What Is. We blind ourselves in this need to compare what we see to what we were expecting. We lose the simple powers of observation for diagnostic purposes when this occurs, and it happens all the time.

I was looking at the feet of a friend recently. They caught my eye because of their unique shape. They are rather wide at the toes and narrow at the heel. When I stopped comparing her feet to the way I felt feet should look I began to realize that her feet resembled the talons of an eagle. They have their own unique beauty and an energetic quite different from my own long flat feet. Until I could look at her feet As They Are, I couldn't see their energetics.

I asked her if she had good balance, assuming that with feet with the energetics like eagle's talons, she would have a predisposition to activities that could energetically grip the earth. She said she did, and proved it to me with some gymnastic moves she'd learned on the balance beam as a child.

Seeing without comparing is something our minds do all the time. When we notice what we are perceiving, unconsciously, we find energetic information coming to us in volumes at a time.

I was downstairs in a Chinese herb pharmacy. I started going through the drawers of herbs just to explore what new materials I could find. I wasn't thinking about what I was doing, I was just waiting for someone. I dipped my hand into one of the herbs and let it run through my fingers. It felt good, a little like when you sift sand through your fingers at the beach. It had a similar consistency, and yet it wasn't dry like sand. There was a sense of moisture in the little seeds. Without thinking, my hands had discovered the energetics of this herb which was lubricating and descending. Learning the herbs with the conscious mind doesn't allow for the personal discovery of their energetics, we are too focused with their attributes in comparison to the other herbs to notice. We do not establish a direct relationship with the herbs, instead we become acquainted with their data. In the end, memorizing the qualities of the herbs in class, and discovering them for one's self provides us with the same information, but when you discover the energetics for yourself, there's no need to memorize, you already know.

Seeing without interpreting is the state in which the ancient Taoist adepts remained 24 hours per day. This made them sensitive to the totality of the patient. Their client's essence was never fractured by comparisons to arbitrary standards, past memories or future expectations. To the TCM master, the patient was the very first person they ever saw in their entire life. Every nuance of movement, every slight color or odor, sound or texture was a symphony that stood out in all of it's resonant simplicity. Signs and symptoms were multi-dimensional experiences that the master could not ignore. For the Taoists, seeing without interpretation became a way of perceiving the world outside one's self. These visionaries gained the ability to See, but as yin and yang would have it, they lost something in the process. They lost themselves...

The sage does nothing, and yet everything gets done.
Cessation of personal ego in TCM

Watching T.V. for a few hours slows down your mind. Afterwards, when you turn off the television, you are only conscious of the room. There are no thoughts in your head. Sometimes, there is no me, and no non-me, there is just the state of silent awareness of one's immediate environment. This is a little like the cessation of the personal ego. It begins with silence in the mind. The famous Yaqui Indian sorcerer, Don Juan, used to tell his student, Carlos Castaneda, to "turn off his internal dialog." Yogi's sit for years in silence. Catholic monks contemplate God in silence. My dad used to always tell me to "Sit down and shut-up." My dad's way didn't work very well, but the rest of them do.

Different paths approach these steps differently. In the East, meditation or yoga may be employed so as to still the mind and transcend it into a more pure and universal consciousness. The Masters of the East talk about blending into the "Nothing," or becoming nothing. In the West the same result of transcending the personal ego is achieved through a relationship with God. Adepts of the Western paths give up to God, any and all personal needs, or as Jesus put it, "Not my will, but thine will be done." This is something that can only be said by someone with no other purpose in life but to serve God. Again, their personal ego is put aside and their essential nature is realized.

Transcendence of the personal ego is not an issue of overcoming pride or arrogance, even though these are bi-products. Rather, it is the sense of self as a separate entity that is the personal ego one can overcome. There is some activity in which everyone can partake in which the enjoyment is so deep and complete that they lose all awareness of themselves in the activity. It brings out our unbridled divinity. This is another way of describing the transcendence of the personal ego.

Meditation is famous for taking you to this point as well. At one point, no matter what your focus is, a sound, posture, martial art, or the flame of a candle, this so called "nothingness" can be achieved, and it is this acting without self-consciousness that is the other half of the diagnostic skills set forth in this paper.

I've written about the clarity that comes from The Now, or seeing things without any comparisons to anything other than itself. With the transcendence of the personal ego, one can also act on what one perceives with the same precision and inspiration. In Zen Buddhism, the words "intimate" and "spontaneous relationship" come up frequently. It is this same automatic response to what one's unconscious perceives that brought out the genius of the TCM masters who came before us.

When acting from a place of non-being, where you don't matter anymore, your Hun (soul of the Liver) acts in perfect accordance the needs of the moment. With the monarch's (Heart in five element theory) approval, with the stepping aside of the bureaucracy of the twelve officials, the general (Liver) can respond to it's environment with wisdom, clarity and spontaneity. In this state, one finds the distinctions blurred between doctor and patient. You don't think about it. You witness your patient, and without thinking, you act. There is, however one draw back to practicing medicine in this spontaneous manner. In many doctor/patient relationships, the doctor needs to stop and ask permission, or provide explanation before treating the patient, especially with points such as Du 1, Ren 1, or the channels of the chest on a woman. For the TCM masters of yesterday, this presumably wasn't an issue.

Acting without ego boundaries makes it difficult to stop, turn around, look into the past and remember what you did in a treatment, since the part of you that memorized information and became a licensed acupuncturist didn't do anything. In fact, this level of Traditional Diagnosis completely skips the step between the diagnosis, and the treatment. There is no need for treatment principle. There is no need for diagnosis either. It is, as some martial arts teach, a block and a punch at the same time. It is responding to the diagnosis with the treatment before the disharmony ever even becomes conscious.

Given a list of signs and symptoms, pulse qualities and tongue appearances ancient masters of TCM would likely be at a loss to provide a medical examiner a specific pattern of disharmony. They might ask to see the patient themselves to remember what they did, because a list of signs and symptoms is what comes after the patient is diagnosed, not before. Signs and symptoms are the verifications for those who watched the master point out the disharmony long before anyone else could see what was wrong. The students of the master might ask how he knew to do what he or she did, and the master might ask himself the very same question. Chances are, the master would not be able to provide a very good answer until he looked again at the patient and broke down the patient's totality into individual expressions of what the master saw. Signs and symptoms, as we are taught, are the afterthoughts of the earliest TCM masters in an attempt to give their students clues to get them to the bigger picture. Signs and symptoms then, are pieces of a puzzle that mean nothing until all of the pieces are put together, and the picture becomes clear again.

Summary: "What Is"

It is written that the Great Tao is invisible, yet everywhere. To become conscious of the Tao is to truly see What Is. The great TCM masters understood how to see the Great Tao. I used to believe that to see The Great Tao was to somehow be able to read between the lines of life to discover something hidden from mortal man. However, in my experience with Taoism and TCM, I've found the opposite to be true. The hidden that becomes clear is not something that has to be searched for, rather it is our internally generated illusions that must be removed unveiling the reality of the obvious. The TCM masters of ancient times removed the veils of perceptual habit to discover vast volumes of knowledge unfolding constantly before their eyes. They did it in The Now; they did it by seeing things As They Are without any interpretation, comparisons or judgment, and they blended diagnosis with treatment through the cessation of their personal ego.

Any career path can lead one to self-realization, but only TCM can elevate even it's first year interns to witness a little glimpse of eternity. Someday, I want to master the stilling of my conscious mind and the realize the much larger chunk of divine consciousness that silently awaits my discovery. Until then, I'll search for TCM in my heart, I'll seek to understand what is taught in class, and when it's absolutely positively without a doubt-no way out- necessary, I'll memorize. For my goal is not to know TCM, not to practice it, but to be it, just like the ancient masters.

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