27. Diagnosis – levels and golden keys
Chapter contents
Introduction216
Diagnosing level – body, mind or spirit216
The golden key approach to discovering CFs220
Introduction
This chapter covers two important methods of diagnosis. The first is based on the notion that a person functions on three levels: a physical level, a mental level and a spirit level. (We have described in Chapter 3 how Traditional Chinese Medicine spoke somewhat differently about levels. Shen encompasses both mind and spirit. In this chapter we will discuss the mind and spirit separately.)
The second method is called ‘Golden Keys’. This involves noting particular aspects of a patient’s behaviour that are so strikingly individual to that person that they are indicative of a profound level of imbalance in one of the Elements.
Diagnosing level – body, mind or spirit
The purpose of determining the level
Determining the correct level of treatment affects both the selection of points and the practitioner’s intention (yi). Patients who are primarily imbalanced at the level of their ‘spirit’ may require practitioners to use points that predominantly affect this level. Points have many overlapping uses and can often affect more than one level, so this emphasis is a matter of degree. In many cases the yuan-source points and/or the Element points are sufficiently broad ranging to have the required effect. At other times, however, focusing on spirit points can be crucial. Point selection is discussed in Chapter 45 on treatment planning.
Clarifying the terms body, mind and spirit
Although the terms ‘body’, ‘mind’ and ‘spirit’ are not used in the common translations of Chinese medical texts, Chinese medicine has always been concerned with the patient’s spirit. Indeed, much of acupuncture’s appeal in the West has been because Chinese medicine pays attention to a patient’s spirit as well their body.
It is desirable to classify which of a patient’s symptoms stem from imbalance of which level. For example, a person with a sprained ankle has a physical problem. A person who is unable to think clearly or remember things has a mental problem. A person who is well qualified and wanting to get work when it is available, but who somehow cannot manage to get that work, probably has a spirit problem. In this case the body is not complaining, the mind seems to function well, but it might be said that the spirit is not willing.
Some classifications are less easy to make, however. For example, nightmares that arise from eating cheese late at night or skin problems apparently due to an allergy are more difficult to classify. J. R. Worsley partially explained this issue when he wrote:
If the body is sick, the mind worries and the spirit grieves. If the mind is sick, the body and spirit will suffer from its confusion; if the spirit is sick, there will be no will to care for body or mind … imbalances, and the illnesses arising from them, are always experienced at all levels.
(Worsley, 1990, p. 185)
There are some circumstances when a patient is sick on one level only and the other levels are healthy. As the quote above explains, however, illness on one level will generally affect the others so all levels are usually affected to some degree. In spite of this, a practitioner still needs to decide on the level that is primarily out of balance. Treatment is then directed towards that level.
However, we make a decision about the primary level of illness and that will determine our selection of points and the type of treatment required. We decide which of the three levels is in the most trouble and needs to be the focus of our help at this time.
(Worsley, 1990, p. 186)
Although practitioners can be guided by their patient’s signs and symptoms, they should not be misled by them. Whatever the patient presents, whether this is a sprained ankle or a reluctance to get out of bed in the morning, practitioners still need to make a decision about the ‘primary level of illness’. The primary level is the one that will most improve the patient’s functioning as a whole.
A patient’s imbalance is not diagnosed by simply adding up the symptoms or other signs manifesting from the body, mind and spirit and arriving at a result. Although signs and symptoms matter and a practitioner should notice their balance, it is still important to remember that a disturbance on one level causes a subsequent disturbance on another.
So how do we decide?
Making the diagnosis of the level
In order to diagnose the level of a patient’s imbalance, the practitioner needs to look deeper than the symptoms and observe how well a person’s body, mind or spirit is working. The following sections are designed to help the practitioner to focus attention on these different levels.
The physical level
Because the body is frequently affected by dysfunction of the mind or spirit, it is essential to discover how a patient’s physical problems arose. The more obvious the physical or environmental cause, the more likely it is that a symptom is a genuinely physical problem. A sports injury, sunstroke, being caught in a snow storm and suffering from cold, food poisoning, living in a damp area and having stiff joints are all predominantly physical problems because their origin appears to be physical. At the same time, however, a person may also have underlying deficiencies, which have resulted from problems at a deeper level and these must still be taken into account.
Practitioners can make a further check by discovering what affects the symptom, for example, whether further activity makes the injury worse, whether exposure to the sun is debilitating or whether wearing wet clothes after a rain storm makes the joints even stiffer. Physical symptoms can, however, also be radically affected by the state of the patient’s mind or spirit. For example, a patient’s pain in the neck may get worse when she or he is anxious or frustrated but the cause is still physical.
The mental level
People’s ability to think is a reflection of their mental level. Practitioners can therefore evaluate the mental level by assessing a patient’s mental clarity, memory and by noticing their ability to solve problems. For example, when people’s minds are clear they can solve problems by:
• staying focused
• clearly defining what their goals are
• knowing what resources they already have and what they need to obtain
• drawing on the expertise of others who have already solved such a problem
• balancing costs (of all sorts) against benefits
• assessing whether the solutions are achievable
• considering the effect of each solution on the rest of their life
• making a good choice
While taking a case history the practitioner can observe how well the patient’s mind has worked when dealing with past problems. It also provides opportunities to ask patients how they will deal with current situations.
Another common sign of a mental level problem is an unrealistic attitude to what causes events to occur. People have widely differing notions of what makes things happen, so it is useful for the practitioner to explore this area generally when using it to make an assessment of the patient’s mental level. If a patient says that in order to get a larger house, they are going to buy more lottery tickets, the practitioner may wonder if the patient’s imbalance is primarily at this level.
The spirit level
Because the spirit is more subtle than the mind and body, it can be more difficult to diagnose. In order to diagnose this level accurately, it is often important for practitioners to be aware of the context of the patient’s life situation. For example, some patients may seem to be very healthy until a difficulty arises. The fragility of their spirit then manifests as they crumble under the strain of what appears to others to be a relatively minor problem. In contrast, even a very healthy person may have difficulty coping with an emotional shock if it is severe enough.
The health of the spirit manifests in various ways. Listed below are some areas that the practitioner can observe:
• The look in the eyes and eye contact. The sparkle in a patient’s eyes and the patient’s ability to make eye contact are two of the most reliable ways of assessing the spirit. The eyes of a healthy person are shiny, clear and bright and the person is able to make good eye contact. If the spirit is not healthy the eyes may be dull and lifeless and eye contact is less direct. In some cases the eyes may reveal something of the agitation in the patient’s spirit.
• Posture. A person whose spirit is healthy has an upright posture. A person with a less healthy spirit is often more slumped. The posture may be slumped in the head, chest or abdomen or the person may not stand upright but instead tilts to one side. Agitation in the spirit may make it hard for patients to keep their body still.
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