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Emphasis is placed on nourishing the most underlying imbalance via treatment of the CF ('Causative Factor') or constitutional imbalance The diagnosis and treatment of a primary constitutional imbalance lies at the heart of the style. Chapter 64 of the Ling Shu set out the concept of the Five Element types, including the concept of each element having each of the Five Elements represented within it. It is therefore possible to diagnose twenty five constitutional types. Most practitioners, however, concentrate on diagnosing and treating the primary element, or CF, as it is known. Very little, if any, treatment is carried out specifically focused upon a particular physical symptom. CF stands for 'Causative Factor', a term borrowed from homoeopathy. J.R. Worsley's assertion that 'all' imbalances result from the Causative Factor is a simplification that fails to take into account the pernicious effects on a person's health of diet, climate, drugs, etc. For this reason the term is unclear and many practitioners prefer the term Constitutional Factor. What is striking is how treatment focused on the CF has the ability to initiate extraordinary changes in a person's health and sense of well-being. As the CF is the primary imbalance, change is commonly initiated in other organs and elements not treated directly. This is due to the relationships between the elements expressed in the sheng and ke cycles. Diagnosis is based entirely on 'signs' as opposed to symptoms Most styles of Chinese medicine base their diagnosis on a mixture of signs, such as pulse and tongue, and the nature of the patient's symptoms. Worsley taught that physical symptoms are not to be relied upon for diagnosis of the underlying imbalances in the person's qi. The colour on the face, the sound of the voice, the odour and the predominant inappropriate emotion are the primary indicators of the CF.5 Diagnosis is therefore dependent on the sensory acuity of the practitioner, rather than the answers to any questions the practitioner might ask. In an innovation, he attributed an inappropriate need for sympathy, to feel cared for, as being indicative of imbalance in the earth element. Sympathy largely replaces si, over-thinking or worry, which is not a true emotion. According to Su Wen, Chapter 39, si 'knots' the qi, which is not a movement of qi as implied in the word emotion. The traditional associations outlined in Su Wen chapter 5 - anger for wood, joy for fire, grief for metal and fear for water - provided diagnostic indicators for the condition of each of the other elements. The nature of each element is also revealing diagnostically. An extreme expression of an element's characteristics reveals imbalance. For example, as it says in the Shu Jing, wood 'permits of curved surfaces or straight edges'.6 A tendency towards excessive rigidity or inappropriate flexibility in the mind and spirit can often be seen in people whose wood element is imbalanced. Metal CFs tend to be somewhat inert emotionally compared to fire CFs who are usually more volatile. These kinds of characteristics can reveal much about the balance of the Five Elements. The patient's underlying health is enhanced to alleviate the patient's physical and psychological complaints. Subsequently emphasis is placed on preventive treatment Focusing treatment on the root or underlying imbalance leads to an overall improvement in the patient's health. This is usually reflected in the person 'feeling better in her or himself'. A key goal of treatment, therefore, is an improvement in the patient's feelings of well-being and vitality. As diagnosis is based on signs rather than symptoms it is relatively easy for the practitioner to make a diagnosis of dysfunction before symptoms arise. Preventive treatment based upon 'nourishing the root' (yangben) is emphasised. This is in keeping with the recommendation in both the Nei Jing and the Nan Jing to treat people preventively.7 |