CHAPTER 18 Interpreting the diagnosis

The interpretation of the material gathered through the four methods of diagnosis involves a combination of intuitive sensitivity and logical deduction. Each receiver manifests a unique combination of symptoms, signs, presentation and behavior, and our own responses to the receiver are an additional factor which may confuse the issue. At the beginning it can seem almost impossible to bring everything together, but interpretation is a skill which improves with experience and as you progress in Shiatsu practice you find yourself, if not always certain, at least more flexible and more comfortable with different possibilities for interpretation.

In Zen Shiatsu the key form of diagnosis is the palpation of the Hara or back. This will pinpoint the two meridians which are the focus of the session, the Kyo and the Jitsu meridians which react together on the Hara at the time of treatment. These two meridians provide the most effective Shiatsu treatment for the receiver’s immediate condition. If you have a clear Hara diagnosis, but cannot connect it with the general picture which you have put together from the asking, observing and listening diagnosis, treat according to the Hara diagnosis anyway. After giving a Shiatsu based on these two meridians, you may find that the Hara or back diagnosis at the second session reveals a more recognizable pattern. It is better to be open to uncertainty than to impose a preconceived or theoretical view on to the situation, since human beings are complex by nature and new information tends to arrive little by little during the course of treatment which gradually amplifies your understanding of the diagnosis.

Why Diagnose at All?

Diagnostic interpretation is not a necessary part of the healing process; rather it is an accompaniment and a result of thousands of years of healing and the study of healing. It is a way of involving the mental faculties of the giver in the Shiatsu session. When our mind joins our feelings and intuition in our response to the receiver, the possibility arises of forming a mental structure or context in which we can hold the receiver’s condition and our own intention to support her self-healing process. This mental structure, the interpretation of the diagnosis, includes ‘what the diagnosis means’ and, by implication, ‘what the situation needs’. It is a stable reference point in the flow of the interaction between giver and receiver; this is its advantage and also its disadvantage if it becomes too rigid and dogmatic.

Understanding the diagnosis increases our confidence and consequently the trust of the receiver, resulting in mutual support and encouragement during the duration of treatment. Understanding should come from both subjective and objective impressions; it should be neither vague nor dogmatic, but based on observation of phenomena and awareness of their significance within the framework of East Asian medical theory. Above all, it should be infused with respect and compassion.

The objectives in interpreting the diagnostic material are:

• to understand the receiver’s immediate condition

• to form a long-term picture of the receiver’s history, which includes the strength of his basic Ki and constitution as well as his imbalances

• to ascertain a possible cause for both current and long-term problems

• to determine an appropriate treatment approach

• to be able to estimate how long and how often the receiver needs to come for Shiatsu.

In order to do this, the sum of the diagnostic material which is the product of your observation and intuitive responses must be integrated as much as possible with your theoretical knowledge, using the Zen Shiatsu and the traditional Chinese medicine (TCM) models (as well as any other systems with which you are familiar).

Interpreting the Hara Diagnosis

When we find a Kyo–Jitsu reaction on the Hara and treat those two meridians in the session we are specifically following the Zen Shiatsu method and we interpret our diagnosis via the Zen Shiatsu theory model of the ‘Life-Cycle of the Amoeba’; not the Five Phases, nor the TCM functions of the organs.

The Hara (or back) diagnosis is the axis of the Zen Shiatsu treatment mode. It is used experientially to focus our attention on two meridians out of the 12: the two which join together in the Kyo–Jitsu reaction. The Kyo–Jitsu reaction is essentially the meeting and interaction of Yin and Yang, of positive and negative charge that generates Ki. When we experience the reaction we are tuning in to the process which is generating the receiver’s Ki-field at the time of the session, and it can be interpreted on a wide range of levels, from the structural to the spiritual. The meridians involved in the Kyo–Jitsu reaction are in a relationship similar to that of Yin and Yang – they are the movements of Ki which combine to produce the receiver’s Ki-field, her life and consciousness, at that moment in time. Considered together, they are a composite picture including both obvious and hidden.

The catchphrase for each meridian pair or individual meridian is a fundamental movement of energy which can be taking place on any level from the physical level of the cells to the subtlest vibration of the Ki-field. In interpreting a diagnosis such as Stomach Jitsu, Lung Kyo we need to keep the basic function such as ‘Obtaining Nourishment’ or ‘Making a Border and Exchange with the Universe’ in mind as well as the specific function such as ‘Hunger for …’ or ‘Intake of Ki’.

One interpretation of the Hara diagnosis is on the level of current physical symptoms, for example:

• Stomach Jitsu – bleeding gums (meridian pathway)

• Lung Kyo – cough.

This works only if there are actual physical symptoms. If there are no current acute symptoms, there may be other aspects on the physical level to consider, such as the features of the receiver’s body type. If one or both of the meridians in the diagnosis can be connected with some aspect of the receiver’s physical structure, it usually indicates that the diagnosis is a fairly long-term one, as the structure has had time to form itself around the Ki pattern. An example would be:

• Stomach Jitsu – heavy thighs, large stomach

• Lung Kyo – stooped shoulders.

The diagnosis may also relate to the receiver’s past health history, for example:

• Stomach Jitsu – peptic ulcer 6 years ago

• Lung Kyo – colds as a child.

Finally, on the physical level, the meridians in the diagnosis can be related to lifestyle and habits, if they are known. For example:

• Stomach Jitsu – always snacking

• Lung Kyo – just given up smoking.

We can interpret the Hara diagnosis solely on the basis of physical symptoms, but to do so is to ignore the wider significance of Ki, which encompasses all aspects of the receiver, the psychological as well as the physical, and thus to underestimate the deeper potential of Shiatsu treatment. We do not need to go into profound investigation of the receiver’s psychological state; simple observation or information provided by the receiver can provide enough material to confirm the diagnosis. Examples of the kind of psychological observation we can make are:

• Stomach Jitsu – worries a lot

• Lung Kyo – seems to be in low spirits.

Interpreting a diagnosis on anything other than a physical level can, indeed should, involve questions. The movements of energy expressed via the Kyo–Jitsu reaction are profound and we cannot expect always to understand them completely, since with the Kyo–Jitsu reaction we are potentially tapping into the source of life and the deepest aspects of our receiver’s path. Putting together the diagnosis and symptoms above, we might make mental notes for ourselves like the following:

Stomach Jitsu

• Obtaining nourishment; need is emphasized.

• Kyo–Jitsu relationship – hungry for … what? Is trying to make up for low intake of Ki by Lungs.

• Always eating – heavy thighs, large stomach; long-term need has influenced physical shape.

• Worries a lot; hungry for security?

• Worry and over-eating led to the peptic ulcer?

• Some physical problem with Stomach meridian still – bleeding gums.

• Needs a calming and comforting treatment: plus, Stomach needs to know that Lungs are being attended to, then it can stop worrying.

Lung Kyo

• Intake of new Ki is neglected; low spirits.

• Stooped shoulders and had colds as a child – long-term issue? (compensates with eating?).

• Has just given up smoking; Lungs extra vulnerable at the moment; currently has cough.

• What about borders? Identity? Lack of self-worth, perhaps – is this the relationship with Stomach Jitsu need for security?

• Needs a sense of clarity and structure in the session with a precise touch and attention to the rhythm of her breath.

These mental notes do not have to be worked out before we start the session; that would take far too long. We only have time between the Hara diagnosis and beginning the Shiatsu to say to ourselves ‘Emphasis on need for nourishment, no attention given to intake of Ki’ and to allow ourselves to put these two together in our awareness as we begin the session. The fuller picture and the questions that accompany it are considerations that can surface during the session itself as we experience contact with the receiver’s Ki. As we find the right rhythm and tempo and settle into our contact with the receiver, the questions can come up and be part of our awareness or stored for later consideration, since the Zen of Zen Shiatsu is to be present in the here and now.

The above example shows two long-term imbalances manifesting in the Hara diagnosis, but either or both meridians could reflect a more recent situation, or even a very temporary one resulting from feelings (of which the receiver may not even be conscious) to do with the session itself, for example:

• Stomach Jitsu: needs to be looked after (hunger)

• Lung Kyo: feels cut off and weary of hoping; thinks session probably won’t help (intake of Ki neglected).

On the whole, the healthier and more balanced the receiver, the more variable the Hara diagnosis, since it is in the nature of Ki to move and change according to circumstances. The longer a receiver manifests a fixed pattern of Ki, the more likely she is to develop symptoms of disharmony.

The relationship between the Kyo and the Jitsu meridians in the Hara diagnosis generates a ‘composite’, a multi-dimensional picture of the receiver’s pattern on any or all of the physical and psychological levels, containing all the possibilities of the two meridian functions. In his amoeba pictures (see p. 147) Masunaga showed the Jitsu as a result of the Kyo, as a messenger for a hidden function unable to draw attention to itself. Occasionally we can see diagnoses that lend themselves to an interpretation the other way around and the Jitsu appears to generate the Kyo. An example would be Spleen Jitsu Bladder Kyo in someone who can’t sleep because their mind is so active with worrying and is therefore tired. The relationship between Kyo and Jitsu does also include this possibility, that a Jitsu action which does not truly express and satisfy the Kyo, an incomplete or inappropriate Jitsu, generates further deficiency or emptiness, one of the attributes of the Kyo. This is why in stuck patterns we can often find that the Kyo and Jitsu meridians alternate – one week it is Spleen Jitsu Bladder Kyo, the next it is Bladder Jitsu Spleen Kyo. This demonstrates that we are not dealing with a situation as simple as Excess or Deficiency. The relationship between the two meridian functions or Five-Phase qualities is not supportive or harmonious, and so the receiver’s energy shifts from one to the other function without being able to resolve, complete and move on; this is the origin of the dis-ease and where Shiatsu can help by bringing the relationship between the two functions into focus via the Kyo–Jitsu reaction and treating the meridians involved.

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