The diagnosis continued with the practitioner asking him for more specific details about his main complaint. The asthma began over 20 years ago. He had had a bout of bronchitis with frequent coughing so had decided to give up smoking. A couple of days later he developed bronchial asthma and had had it ever since. ‘Maybe I should start smoking again!’ he quipped.

He described feeling as if a ‘brick’ was sitting across his chest. He felt as if couldn’t get any more air into his lungs as they felt so full and congested. Occasionally he would bring up some thick white phlegm. He also said that his chest was much worse when lying down and he slept with at least three pillows most of the time.

The asthma was controlled by inhalers but as soon as he had a cold or flu it would go to his chest and he would often have a full-blown asthma attack. The last one had been two months ago and he had been taken into hospital and ‘pumped full of steroids’. He admitted that he was scared of this happening again and that was why he had come for treatment. (The practitioner judged that considering the seriousness of the situation that the way he expressed his fear was appropriate.)

Howard said that his sleep was ‘dreadful’. It was light and the smallest thing would wake him, even the birds singing. He got off to sleep easily but would then wake at 2–3 a.m. and couldn’t get off again. He would then go to sleep after what seemed like a long time and would wake with a muzzy head. (When the practitioner offered him sympathy about his poor sleep Howard accepted it.)

Howard said his appetite was ‘too good’ and he loved to eat. He would often consume dairy products and had a hot milky drink before bed, ‘to help him sleep’. He would often bloat after eating and would have loose stools which didn’t have a strong odour.

Howard also said he had poor energy and said he felt ‘totally worn out’. He loved his job but whereas once it had been easy, it now exhausted him and he was wondering whether it was time to retire.

The practitioner continued to ask Howard specific questions about his health such as thirst, urination and perspiration, and wrote down all of Howard’s answers. At the same time she assessed how Howard responded emotionally to her questions.

She also asked Howard about his health history, his family health and his personal history. This included questions about areas such as his childhood, emotional stresses, difficult phases in his life and relationships, as well as which areas of his life were most problematic for him. These were all important to get to know Howard as a person. The questions are also important to get a sense of the balance of a patient’s emotions. This is easier when they are talking about difficult issues in their life than when describing less problematical topics like perspiration, urination, etc.

Howard described having a happy childhood: ‘I always had lots of friends and I could always make them laugh.’ He also said that he was generally happy with his life at present but that he thought he suffered from Seasonal Affective Disorder (SAD) and got quite depressed in the winter: ‘We’re going to move to Italy in the winter months.’ He said he thought it had got worse as he became older. When questioned more about this he said things were generally fine and that he didn’t wish to dwell on his difficulties. He did, however, mention in passing that his elder daughter from his first marriage was dependent on heroin and this caused him much pain and sadness. He had tried to help her but she didn’t seem to want to help herself. (He looked very sad when talking about this issue. The practitioner noted that she might talk with him some more about this later.) When asked about his current wife, he laughed and said everything was ‘fine’, but his eyes and facial expression belied this.

Howard’s pulses all felt deficient and the practitioner wrote down this pulse picture:

Left		Right
SI –1	Ht –1 (Floating)	Lu – ½	LI – ½ (Floating)
GB – ½	Liv – ½	Sp – 1½	St – ½ (Slippery)
Bl – ½	Kid – 1½ (Deep)	PC – 1½	TB –1½ (Deep)

Howard had a pale, swollen tongue with a midline crack going to the tip. At the rear of the tongue he had a sticky white tongue coating. The tip was redder than the main tongue body.

Having taken Howard’s pulses and looked at his tongue, the practitioner carried out other parts of the physical diagnosis such as feeling his three jiao, palpating the front mu and back shu points, testing the Akabane and observing his colour, sound and odour. After the diagnosis was completed and Howard had left, the practitioner went over all the information she had written down. She then wrote up the diagnosis, including drawing a diagnostic diagram.

The practitioner knew that she needed to diagnose Howard’s whole condition in order for both the root and the manifestation of his problem to improve. This meant that she should identify all of the patterns present. This included his CF as well as any syndromes that were present.

She put these together and drew a diagram. The purpose of the diagram was to give the practitioner an overview of the diagnosis. The diagram could connect Howard’s ‘patterns’ aetiologically and bring in specific internal, external and miscellaneous causes of various patterns. The practitioner also included the signs and symptoms supporting each pattern. This allowed for easier monitoring of Howard’s progress.

The practitioner opted for Howard being a Fire CF. This is because he laughed inappropriately and showed excess joy even when he might have become angry, or suffused with grief. He also showed appropriate fear and accepted sympathy appropriately. At the same time he would drop into sadness and seemed vulnerable and uncertain when the practitioner stopped chatting.

Howard did not want to dwell on his difficulties when questioned. Although he admitted to having SAD in the winter months he did not wish to talk about this and he mentioned but didn’t talk in any depth about his daughter’s dependency on heroin. He preferred to laugh, chat and joke. Keeping his cup ‘half full’ was probably a positive way for him to deal with his difficulties – but this was to the detriment of looking at his whole situation and was probably contributing to his underlying depressed condition. To back up the diagnosis of Fire, the practitioner saw a lack of red colour by the side of Howard’s eyes and smelt a scorched odour.

The practitioner thought that some of Howard’s treatment would need to be directed towards the level of his spirit. She hoped that when Howard felt stronger and trusted her he would probably be able to open up and talk more about himself.

The practitioner also considered whether Howard was suffering from possession, had a Husband–Wife imbalance or had an Entry–Exit block. She did not think that any of these were present.