INTRODUCTION TO DIAGNOSIS
The Art of Knowing Through
The word "diagnosis" comes from the Greek, and literally means, "knowing through". Diagnosis is the ability to see through the often bewildering maze of manifest signs and symptoms to arrive at a sure and certain knowledge or conclusion as to their root cause, or what is really going on.
Unfortunately, disease can't always be counted on to be open and straightforward about its activities, and what it is really doing. Like a stealthy thief, disease quietly and insidiously goes about undermining the health of the individual, especially if it is deeply entrenched, or chronic. And so, disease will often throw out false leads or puzzling, anomalous clues as to its activities and whereabouts.
This requires the physician to be something like a detective or supersleuth, sifting through the vast maze of clues, many of them puzzling or anomalous. Diagnosis requires an ability to look beneath surface appearances to see what's really going on. Things aren't always what they seem, and the astute physician and diagnostician will see through this, and avoid jumping to any premature conclusions until all the clues have been duly analyzed.
Diagnosis, the Heart of the Medical Art
Diagnosis is the heart of the medical art; it is what separates medicine as a definite, rational science from medical magic and superstition. Diagnosis is also the central, golden link in the chain of medical knowledge that brings together all its theoretical aspects to provide the practical key to treatment. Diagnosis, to be accurate and sound, must be built upon a broad yet definite base of knowledge regarding all aspects of human anatomy, physiology and pathology.
A knowledge of anatomy will enable the physician to spot and correct any deviations or abnormalities in the structure of body parts, organs or tissues and use them as clues to pathology.
A knowledge of physiology, or the normal, righteous functioning of the body will help the physician to recognize and pinpoint pathological deviations from it, and to identify exactly what needs to be restored. In Greek Medicine, all physiological concepts are based on the Seven Natural Factors, which are discussed in the Basic Principles section.
A knowledge of pathology, or how the normal, healthy structure and function of the body becomes altered and deranged by disease, enables the physician to identify these morbid changes and deviations when he sees them in his patient. In Greek Medicine, pathology involves deviations in one or more of the Seven Natural Factors (see above), as well as negligence in one or more of the Six Hygienic Factors, which are described and discussed in the Hygiene section; transgressions of hygiene are the most common cause of pathology.
In addition, there is one other essential ingredient to accurate, effective diagnosis that enables the physician to make proper use of all the technical medical knowledge described above. And that's a knowledge of philosophy, which hones and clarifies the physician's powers of reasoning and deduction, and enables him to discern the underlying truth behind mere surface appearances. This is why Galen considered philosophy to be a central, essential part of the physician's training.
In conclusion, proper diagnosis is the key to all effective medical treatment. The more precise and accurate your diagnosis, the more specific and effective will be the treatment. You can't fix something properly unless you know exactly what is wrong, or out of order.
Diagnosis: Traditional versus Modern
The practice of diagnosis in modern medicine has been radically altered by the advent of high technology. The modern physician relies heavily on technology and sophisticated machinery throughout the diagnostic process: EEGs, EKGs, diagnostic scanners and imaging equipment, radiography and lab tests.
The traditional physician had none of that to fall back on. He had nothing but his five senses and a few simple diagnostic tools, like a stethoscope or a reflex hammer.
This lack of outer equipment made it essential for the physician to train his inner, human instrument - his mind, and his five senses - honing them to a high degree of perfection. In addition to sensory data and observations, and the deductions made from them, intuition and instinct often came into play in arriving at a diagnosis.
In the modern diagnostic process, with its heavy reliance on technology and machinery, there is a danger that these traditional diagnostic skills and sensitivities can become atrophied from disuse. Also, the modern medical environment tends to favor an exclusive reliance on quantitative data that can be numbered and measured as the only information that's really reliable and trustworthy; the qualitative data and observations used in more traditional forms of medical diagnosis tend to be belittled or discounted.
For example, the traditional physician would observe a patient's yellowish or sallow complexion and conclude, along with other signs and symptoms, that he/she was suffering from jaundice, or a bilious disorder. The modern physician wouldn't be content with that qualitative observation alone, and would order lab tests to quantify raised levels of bilirubin or liver enzymes before arriving at that conclusion.
In all traditional medical systems, the diagnostic model used in that system is based on the basic physiological and pathological concepts of that system. The therapeutic system and modalities of treatment offered by that same traditional medical system are also keyed in to these same basic pathophysiological concepts.
For example, black bile, or the Melancholic humor, exists as a pathophysiological concept or clinical entity in Greek Medicine, and diagnostic conclusions are based on it. And Greek Medicine also has reliable medicines and tools in its therapeutic arsenal for correcting disorders and imbalances of black bile.
Modern medicine may protest that black bile doesn't really, objectively exist, and perhaps it actually doesn't. But for all practical purposes, clinically useful diagnoses can be arrived at and effective treatment strategies can be designed and carried out based on the pathophysiological concept of black bile.
Greek Medicine isn't the only traditional medical system to have clinical entities and pathophysiological concepts that don't check out, or have a one-to-one correspondence with clinical entities in modern medicine. Ayurveda has Vata and the five Vayus, or Vital Airs; Chinese Medicine has a whole subtle organ, the Triple Warmer. The point is that, working from the framework of the respective traditional medical system, these "fictitious" clinical entities and concepts can be used to produce consistent, reliable results.
Besides constant practice in the traditional diagnostic techniques, the traditional physician often works to sharpen and hone the sensitivity of his senses through meditation and special exercises. In addition, meditation also develops the physician's powers of insight and intuition.
Whereas modern medicine tends to be quite literal and concrete in its approach to diagnosis, traditional healing systems like Greek Medicine tend to take a more poetic, figurative approach. Through the tongue, pulse or other diagnostic signs, the patient's body is trying to communicate to the physician what is wrong with it; the physician's job is to learn the language of the patient's signs and symptoms, listen to them, and get the message.
Signs, Symptoms and Syndromes
Hippocrates, when he set out to revolutionize medicine, had certain issues with the Cnidian school, which preceded him. Many of these centered on their faulty and incomplete methods of diagnosis.
First of all, the Cnidians considered only the patient's subjective symptoms, and not any objective signs. Hippocrates countered that a complete diagnostic assessment required a consideration of both the patient's signs and symptoms.
A symptom is what the patient tells the physician about how he or she feels - feelings of pain, discomfort, hunger, thirst, nausea, or anything strange or abnormal. Symptoms are the subjective feelings and sensations of the patient about his/her condition.
A sign is an objective phenomenon observed or diagnosed by the physician in the patient. A rapid pulse, contracted "pinpoint" pupils, or red, bloodshot eyes would be examples of signs. Certain signs can be diagnostic of certain diseases.
The Cnidians also made long lists of symptoms that denoted certain diseases, which they memorized by rote, without trying to make any further sense of them. Hippocrates was the first to systematize, prioritize, and correlate the various signs and symptoms found in different diseases, and give explanations as to what might be causing them. And so, Hippocrates virtually founded the art of differential diagnosis.
Hippocrates approached the art of diagnosis holistically, taking the entire organism - body, mind and spirit - to be one indivisible whole, or physis. Since the whole organism is responding in a unified manner to the challenge of disease, Hippocrates was the first to recognize that signs or symptoms appearing in one part of the body could be indicative of a disease process happening in another distant part of the body.
In their diagnosis and treatment, the Cnidians lacked this holistic overview. They saw symptoms arising in a certain part of the body as indicating a disease or disorder pertaining to that part only, which was treated in isolation from the rest of the body.
A syndrome is, literally, a certain constellation of associated signs and symptoms that "run around together". Some of these sign - symptom constellations are indicative or diagnostic of certain diseases, whereas other syndromes have yet to be fully explained or linked to a definite pathology or disease. Nevertheless, Greek Medicine recognizes that many syndromes can be successfully treated and resolved, even though their pathological and causative mechanisms aren't fully known.
In his clinical instincts and insights, in his powers of observation and deduction from a patient's signs and symptoms, Hippocrates, as a clinician, has seldom been equaled in the history of medicine. Hippocrates' profound knowledge of disease symptomatology and semeiology (the study of signs) evoked awe and praise from the Roman physician Celsus, who wrote some four centuries later:
Succeeding physicians, notwithstanding their improvements in the treatment of disease, are indebted to Hippocrates for their whole knowledge of signs.
Traditional Methods of Diagnosis
The traditional physician had to be very perceptive and resourceful in using all his five senses, and whatever was at his disposal in diagnosing disease, and assessing the patient's condition. Above all, the first and most important method of diagnosis was taking a good medical history in the initial patient intake process, and then following up with one's careful observations of the patient and the disease as it develops and progresses.
Visual diagnosis includes careful observation and inspection of the patient's general behavior, spirit and demeanor; posture and physique; skin color, or complexion; facial signs, eyes and physiognomy; nails, tongue, hair, etc...
Palpation, or tactile diagnosis obviously includes pulse diagnosis, as well as palpating the chest and abdominal cavities. It involves feeling heat or coldness, softness or hardness, dryness or moisture, and fullness or emptiness.
Auscultation, or auditory diagnosis includes listening to the patient's voice or breathing sounds; using a stethoscope to listen to the patient's heartbeat, gastrointestinal or lung sounds; and percussion of the chest and abdomen to listen for either hollow, resonant or dull sounds.
Olfaction can also be used to smell the patient's breath or body odor, as well as odors of any of the bodily secretions or excreta.
Taste can also be used upon occasion to taste any of these same secretions or excreta. Sweet tasting urine, for example, is diagnostic of diabetes.
The bodily excreta are important diagnostic indicators in themselves, that also deserve careful inspection and study. Excretion, or elimination, is the final stage of pepsis, or digestion and metabolism. You can tell a great deal about the body's metabolic processes by what they excrete as superfluous or unusable waste.
The main excreta that are inspected for diagnostic purposes are the urine and the stool. Greek Medicine is especially known for its urine diagnosis, although the stool, or Alvine Discharge, is also important.
There are some master physicians that have developed such consummate skill in a particular diagnostic technique, like the pulse, that no further information is needed for an accurate diagnosis than hearing the patient's chief complaint and taking his/her pulse. But for the majority of physicians, especially beginning practitioners of the medical art, forming a broad, composite picture from many different diagnostic methods is the surest way to arrive at an accurate diagnosis.
A Final Caveat, or Disclaimer
The traditional diagnostic methods used in Greek Medicine often require a lifetime of study to master them properly. To master an intricate clinical skill like diagnosis usually requires much more than mere didactic study, or book learning; it also requires personal instruction and guidance from a master physician, preferably in a clinical setting.
Therefore, I must strongly caution the reader that the articles that I present here in this Diagnosis section are strictly introductory in nature, and primarily intended for educational purposes, to facilitate a general understanding of the diagnostic method and how it works. It is not intended to substitute for actual clinical training in diagnosis under the personal tutelage of a master physician. And especially, this information is not intended to substitute for actual diagnosis and treatment from a physician or licensed holistic healthcare professional.
Regarding Hippocratic diagnosis:
Medicine Throughout Antiquity
by Benjamin Lee Gordon, MD
@1949 by E. A. Davis and Company, Great Britain
pp. 519 - 527