The Initial Consultation – Getting to the Heart of the Matter

By Neil R. Gumenick, M.Ac. (UK), L.Ac., Dipl. Ac.

In Classical Five-Element Acupuncture, the goal of the Traditional Diagnosis is to identify the primary elemental imbalance (Causative Factor) of the patient’s disease and the level of the imbalance: physical, mental, or spiritual. The initial consultation, also called the Traditional Diagnosis, is an opportunity to bring all diagnostic skills into play: seeing, asking, hearing, feeling, and smelling.

It is not enough, however, to know what element or organ/function to treat. We must determine the unique and specific needs of the individual patient before us. To do this, we must skillfully question in order to reach beneath the patient’s superficial level of response to the deeper issues that must be addressed. We must remember that all patients, like all of us, wear “masks” or facades and do not openly reveal their true feelings, but only those that they wish to be seen. To gain the patient’s trust is of utmost importance and the vital skills of rapport lead to the creation of that trust.

In the initial consultation, we inquire into many aspects of a patient’s life, any or all of which can reveal a wealth of information about who the patient is and what he or she needs in order to be helped toward balance and harmony. As an example, in asking a patient’s occupation, the mere fact of a person having a specific occupation tells us relatively little. Discovering who that individual is in relation to that job tells us much.

We know that people have strong feelings about their jobs – positively, negatively, but rarely neutral. Work is a primary identity for most people, taking up most of their waking time. Thus, if a patient is a taxi driver, for example, I am led by my curiosity to ask further and question more deeply about it. I might ask how he or she enjoys the job. One taxi driver might simply love the job – meeting people, conversing socially, or always being on the move. Another might love the independence it provides. Another might be doing the job as a last ditch effort to make ends meet – perhaps having been laid off from a former more lucrative job, perhaps frustrated and resentful, fearful, depressed, or resigned. Who the patient is in relation to their job (or any area of inquiry) is what fascinates me and conveys what the person needs. What does this person get from the job? Why does he/she do it? What needs does it fulfill? Thus, I use questioning as a means of going deeper into a patient’s experience until I get to the “heart of the matter.”

Not all areas of inquiry will be equally or entirely fruitful. If there is no emotional charge or challenge in an area, I move on to another. When I am presented with an “opening” that strikes my curiosity, I venture inside. An area of a patient’s life that holds emotional charge is neither good nor bad, but merely indicates a place where balancing may be needed. Here, I must also consider if the emotion is appropriate to the situation. Nature has provided us with five emotions, all normal and healthy expressions in a given set of circumstances. When I perceive a patient’s emotion to be inappropriate, either by its excess or deficiency, it I view it as a cry for help and of great significance diagnostically.

Then, my choice of points, used for their spiritual connotations, will be an exact response to the need of the patient. The Chinese, in their brilliance, determined the physical, mental and spiritual gifts each point is capable of providing. The point names, translated from the Chinese characters, in conjunction with pulse diagnosis, accurate diagnosis of the Causative Factor, and the removal of specific energetic blocks, can and do provide the needed help for virtually every challenge a human being can face.

Professor Neil R. Gumenick is Founder and Director of The Institute of Classical Five-Element Acupuncture Inc. in Los Angeles, which provides training to licensed acupuncturists, physicians, and students in this profound body/mind/spirit system of acupuncture. Neil has been in private practice since 1981 and holds three degrees and an advanced teaching credential from the College of Traditional Acupuncture (UK), awarded by the late Professor J.R. Worsley. He will be presenting a seminar “The Initial Consultation – the Foundation of Practice” at the AAAOM Expo on Saturday May 12, 2007 from 2:15 – 6:15 PM. Neil can be reached at (310) 453-2235, at his website: www.5elements.com, or by email: nrg@5elements.com.