From Findings to a Plan

From Findings to a Plan — Building the Diagnosis

The woman with four illnesses, and the therapist who found none of them

A composite case, assembled to teach the reasoning rather than taken from one patient's file.

She came in with her daughter and a list, because a neighbour had told her to write everything down. Four items, each in a different pen, added over eighteen months as each new trouble arrived. Knees. Hair falling. Chakkar — giddiness on rising from the floor. And at the bottom, underlined twice, sugar has come.

The student on duty did what a careful, frightened student does: he began four plans, one for each item. He had four sheets of paper when the senior therapist came past, looked at them, and asked one question — about none of the four.

"How many days a week does she open her bowels?"

The student did not know; it was not on the list. The answer was two, with effort, and had been so for six years — three years longer than anything on the paper. Her tongue was coated. She was tender at three points around the navel and silent at the right flank. She had never once looked at her stools, and when she was asked to, she came back three days later describing the skin of a tomato so exactly that her daughter laughed.

Four complaints. One picture. The senior therapist turned the four sheets face down and wrote nine lines on a single card — and those nine lines said what was wrong with her, in an order that could be acted on that morning.

WHAT YOU WILL LEARN HERE

By the end of this article you will be able to:

Work the five steps that turn a history, a set of findings, a bowel picture, a direction and a file of reports into one plan — including the step students always skip.

Ask of a patient with several complaints whether they are several problems or one, and name the signs that decide it.

Say which finding leads when two findings point different ways — the digestive fire, the tender flank, the silent finding, the red flag.

State the order of correction, and how many days go into the digestion before treatment proper begins.

Carry out a first visit from the door to the door, and say why day one is different from every day after it.

Write a diagnosis card complete enough that a therapist who has never met the patient can act on it next Tuesday.

Mark the blocked points on that card before any treatment is planned, and give for each block the condition that makes it bite.

Recognise within days rather than weeks that the first approach is not working, and know what is done then.

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Where diagnosis ends and treatment begins

Forty findings, one plan — and findings, diagnosis, plan, prescription

Everything in has been an instrument: the map that names the places (The Navel Speaks First, "The Navel Speaks First"), the scale that grades them (The Educated Hand, "The Educated Hand"), the flanks that sort a patient into one of two families (The Two Kingdoms, "The Two Kingdoms"), the fire and the ash (The Fire and the Ash), the bowel (What the Bowel Tells You), the history (The History That Cannot Mislead You), and the folder read until every page had been declared to change the plan or change nothing (Reading the Reports).

You now hold perhaps forty pieces of information about one person. A plan is not forty pieces of information. A plan is one sentence about what is wrong, and one decision about what is done first.

Students find this the hardest hour of the training. Everything before it rewarded thoroughness; this step rewards the opposite — deciding that thirty-six of the forty items are context and four are the plan.

THE WORDS WE USE

Findings · diagnosis · plan · prescription

Findings. What you observed — a grade at a point, a form of stool, a value on a report, a sentence in her own words.

Diagnosis. Not a disease name, but a statement of which organs are working below par, in which direction the body has gone, and how long it has been so. "Digestion running slow with undigested food; large bowel slowed with it; acidic direction; six years." That is a diagnosis. "Osteoarthritis of both knees" is a name.

Plan. What you will do, in order, beginning today: the first work, the blocked points, the parhez, the days she must come, and what you will measure. Prescription. The formulas actually given at a session, in the notation of The Shorthand, "The Shorthand".

Four different things, in four places on the card — or in six weeks you will not be able to tell which was a fact and which your opinion.

Key teaching

What the whole procedure is for

Check the pain points to determine which part or parts of the body are not functioning to their optimal level. Logically analyse and determine the root cause for the malfunctioning of that organ. Stimulate the diseased organ or organs and restore their normal functioning.

By these steps we not only relieve the symptoms of that particular disease, but also remove the very tendency of the body to develop a diseased state — thus achieving a total cure.

Read the last line twice. Relief of the complaint is a by-product, arriving on the way to something larger: a body no longer disposed to fall ill in that way.

The five steps

Gather, set the direction, name organs, find the root, decide the work

THE METHOD, STEP BY STEP

Building a plan, in five steps

Step 1 — Gather, by every method, and correlate. Not one instrument but several, and the information from all of them has to be correlated to arrive at a proper diagnosis: the pain points around the navel, graded (The Educated Hand); pain at the B₁₂ and folic acid points at the hip, one of the major tools of this diagnosis; the nature of the stools — a very important aspect of the diagnosis, provided the patient answers your questions correctly (The Fire and the Ash); and, in women, the menstrual history — an additional and a very valuable tool. To these add the history (The History That Cannot Mislead You) and whatever in the folder changed the plan (Reading the Reports).

Step 2 — Establish the direction. Prone Left Right The flank pair, compared against each other, then reversed and compared again. A tender Mu° against a quiet Liv° puts her in the acidic family; the reverse puts her in the alkaline one. This is the first step in diagnosis proper: to check which kidney is sluggish, and everything after it is read inside that answer (The Two Kingdoms).

Step 3 — Name the organs, not the diseases. Supine Convert the graded points into a list of organs working below par, in plain words. A disease name at this step will quietly decide the rest of the plan for you.

Step 4 — Analyse logically, and find the one thing underneath. Is there a single fault upstream of all of it? Usually there is, and usually it is digestive. This is the step students skip, and skipping it is what produces four plans for one patient.

Step 5 — Decide the first work, and write it down. Block the points that must not be given, before the treatment is planned. Choose the first work, which is nearly always the digestion. Name what you will measure. Write the card. Tell the patient what you are doing and in what order, in words she will repeat correctly at home.

Steps 1 to 3 are collection and sorting; a diligent student learns them in a week. Step 4 is judgement, and the whole of the art: what single thing, if corrected, would make most of the rest unnecessary?

Four problems, or one?

Many names, one root — and the signs that decide it

Key teaching

Many names, one root

In allopathy the names of diseases are attached to the symptoms themselves.

When several symptoms come together, and the same cluster recurs in other people, that cluster is given a name, so that one word brings several symptoms to mind at once and choosing a medicine becomes easy. That is all a disease name is for.

Now watch a body. If food is not digested properly in the stomach, the patient will have sometimes a headache, sometimes gas, sometimes loose motions or vomiting, sometimes burning in the chest — on one day or on different days. Named, the headache is migraine, the burning acidity, the gas flatulence, the loose motions diarrhoea, and for each a different medicine is given.

Although the symptoms are different, the root cause of all of them is one and the same — indigestion. Correct that one root cause, and not only these four but even more diseases or symptoms will be corrected, and they will not recur either.

The general form: all diseases — however many lakhs of names may be given to them — come only from a few among eight to ten glands not working in the proper way. That root appears in different persons as different symptoms, and in one person as different symptoms on different days; but on paying attention it will be found that the root cause is one and the same.

The question asked of every patient with more than one complaint is: are these four problems, or one problem with four faces? It is not answered by intuition. There are signs. (Figure 13.2)

The last row settles arguments, and it is why this therapy can afford confidence here: the test is built into the treatment. You act as though the complaints might be one, give the digestive work, and by the tenth day the body has answered you — what belonged together improves together, and what did not stays put, now visible because the noise has gone. (Figure 13.1)

A MISTAKE STUDENTS MAKE

Four complaints, four plans

A student comes away from a careful history with a list — knees, hair, giddiness, sugar — and treats it as a list, assembling something for each and producing a plan four times too long for the time he has, aimed in four directions at once.

Three things go wrong every time. The session over-runs, so the parts he believed in least get dropped at the end, and the plan he gave is not the plan he made. Nothing can be learnt from the result, because four things changed at once. And the patient learns the wrong lesson — that she has four illnesses, which is frightening, expensive and, in her case, untrue.

The correction is not to treat fewer things out of modesty, but to ask Step 4 before writing anything: what one fault, corrected, makes most of this list unnecessary?

One picture, or more than one?. Five signs, side by side, that several complaints are one picture — and the matching signs that they are not, ending with the test built into the treatment: ten days of digestive work.

Four complaints, one picture. Knees, hair falling, giddiness and sugar drop into one funnel — 'Is this four problems, or one?' — and come out as one root: digestion running slow, bowel slowed with it, acidic direction, six years. Dotted arrows carry the answer back to all four complaints by the tenth day.

Which finding leads

The order of precedence, the red flag, and the postmaster's knees

Two findings will point different ways in your second week of practice and go on doing it for the rest of your working life: the complaint says knee and your fingers say stomach. There is an order of precedence, and it is not a matter of taste. (Figure 13.3)

Key teaching

The order of precedence — which finding leads

First: the red flag.

Any finding that belongs to a doctor leaves the room before any plan is made. ▲ Take care

Second: the block. A point that must not be given for this patient's condition is marked off before the plan is built, not weighed against it afterwards. Where a block and a recommendation collide, the block wins.

Third: the digestive fire. Where digestion is not sound it leads, whatever the complaint — the raw materials of every gland are made only from the end products of digestion, so a plan aimed elsewhere is built out of nothing.

Fourth: the direction. Acidic or alkaline decides which of two opposite families of treatment may be used at all (The Two Kingdoms).

Fifth: the tender flank, and the region it belongs to. Where the two sides disagree, the tender side gets the work — and which side is the substance of the instruction, not a detail of it. Left Right

Sixth: the silent finding. A minus is a finding. A quiet Const in a patient reporting hard motions sends you to look at the outlet instead (What the Bowel Tells You); a silent flank is what makes the other side's plus mean anything.

Last: the complaint the patient came with — not because it does not matter, but because it reports where pain is felt, not where the fault lies.

That last line needs saying carefully at the mat, because it can be heard as dismissal. It is not: the complaint decides what you must eventually fix, and everything above it decides what you fix first.

TAKE CARE

The findings that leave the room before any plan is made

Said in the same flat voice you use to ask about sleep, and said today. Blood from anywhere — stool, urine, vomit, cough — even once and even a little. Breathlessness at rest. Chest tightness coming with effort and going with rest. A rigid, board-like belly with exquisite tenderness, vomiting or distension. Fever with a stiff neck, or a rash that does not fade under pressure. Weight coming off without trying, never called the treatment working. A report naming a new growth, a mass, or a raised creatinine nobody has taken to anybody.

A unifying story is exactly the thing that can absorb a dangerous presentation without alarm. The habit of mind this article teaches — four complaints, one root — is what will one day explain away a symptom that should have ended the conversation. So the red flag sits above the reasoning, not inside it.

A CASE FROM PRACTICE

The retired postmaster who came about his knees

A composite case, assembled to teach the reasoning rather than taken from one patient's file.

Shivnath Prasad Tiwari · 66 · retired postmaster · Gorakhpur · came with "both knees, four years — and now I cannot sit on the floor at all"

In his own words. "Knees. Only knees. Doctor has said the grease is finished." He said it three times in two minutes, warned by a relative that this place would want to talk about his stomach.

Observed and palpated. Supine Tongue thickly coated; abdomen soft and heavy. Gas middle ring +++ HP; Liv ++ H; Const middle ring +++ HP; Dys and Spl silent. Prone Liv° R +++ HP against Mu° L −, sides reversed and re-checked. UDF – Yes (tomato skin, jeera). Stools semi-solid twice daily, never hard, which he had taken for good health.

Several conditions read as one picture. Four items by the end of the history: knees; an evening burning in the chest for years, never called a complaint; wind; tiredness by four o'clock, put down to age. One picture — food not being finished, a body in the alkaline direction, joints repaired out of what was left over. The knees were the fourth link.

Which reports mattered. A knee X-ray reporting narrowing and marginal osteophytes — changed nothing, said aloud twice, because he had carried it two years as an explanation. A year-old uric acid at the top of its range and a normal thyroid — changed nothing today, dated (Reading the Reports).

The choice, and why. Not a knee plan. The digestion first. Mu being silent, the inflammation step was not needed, so the undigested-food work ran until the stools became normal, with a parhez of curd, tamarind and lemon named in his own kitchen; ten days at a stretch (Setting the Stomach · Clearing the Ash · Food as Medicine).

Session by session. Day 3: less wind, reported with irritation by a man who wanted to report about knees. Day 6: stools once daily and formed, evening burning gone, Const ++. Day 10: Gas ++, Liv° R ++, and at the door — "Standing up is a little easier. Maybe." Only then did the joint work begin (The Stiffening Joint). Week 5: down to the floor and up again.

What went wrong because he withheld something. Week seven he slid back. The plan was not changed; the history was retaken as "show me what you put in your mouth yesterday, from waking" — and his daughter-in-law had been sending curd with the evening meal for a fortnight, worried that he had lost weight. It was not a sour thing in his mind; it was curd. Taught again, to her rather than him, he was ahead of week six in nine days.

What this case teaches

The complaint names where it hurts; the findings name where the fault is — said plainly on day one, so day four did not feel like neglect.

A silent point is a finding. Mu silent removed a whole step from the order of work.

A report that explains a complaint is the most dangerous kind, because it stops the enquiry.

A parhez must be translated into the actual kitchen and taught to whoever cooks.

Which finding leads. The order of precedence as a seven-rung ladder, from the red flag at the top to the patient's complaint at the bottom, with the one-line reason for each rung's place.

The order of correction

The digestion first, whatever the disease — and the ten days

Key teaching

The digestion is corrected first, whatever the disease

Improper digestion — of proteins mainly, and to a lesser extent of fats — is the root cause of all diseases.

The reason: the raw materials of all the glands are made by the body only from the end products of digestion. Without them the glands cannot produce their chemicals in the correct quantity, and hence all sorts of disorders set in.

Therefore the very first treatment to be given is the one that corrects this tendency — and any treatment which does so brings substantial relief from the present ailment, irrespective of whatever that ailment may be.

Say it to a patient in a kitchen image. One kitchen supplies a hundred households. If it runs at half strength every house is short, and the weakest shows it first. Your knee is the weakest house.

The full order of the work where the right flank is the tender one — the inflammation work while Mu is tender, then the abdominal sequence after a five-minute gap, then the undigested-food work until the stools become normal, and only then, if the flank is still tender, the alkali family — is taught in The Fire and the Ash, "The Fire and the Ash".

Key teaching

The ten days, as one centre practises it

Patients are told, right at the time of their registration on the first day, that it is mandatory that they must come for the first ten days at a stretch, without break, to set their digestive system in good working order.

For those ten days or thereabouts they are given only the treatment for undigested food 6 sec , along with the appropriate Muscle Relaxation Treatment in extreme cases. Afterwards, depending upon their ailments, a further treatment schedule is prescribed.

And the result that convinced them was not the result they were measuring: by the end of the first ten days a majority of the symptoms had been totally alleviated, even though no specific treatment had been given exclusively for the ailment they came about.

The undigested-food work itself may take between one week and ten days, or even more, to bring the stools to normal (The Fire and the Ash).

Three things in that belong in any practice. The rule is announced at registration, so it is never felt as a delay imposed because her case is difficult. Ten days at a stretch, because a course interrupted on day four is not a shorter course but a different one. And the improvement is expected in the complaints you are not treating — which is what you tell the family to watch for.

And say the order out loud on day one, or the day you finally turn to the digestion will look like a change of mind: "For ten days I am going to work on your digestion. I am not ignoring what you came for. Everything I do afterwards for that is built out of what your digestion releases, and if I start at the other end it will help you for a week and then stop."

The first visit

From the door to the door, and why day one is different

Day one is different from every day after it, and the difference is not its length. On day one you are not only treating; you are building the instrument by which every later day will be judged.

THE METHOD, STEP BY STEP

The first visit, from the door to the door

· What is done · Chips

1 · Registration, and the rule stated before anything else — which days a week she can realistically come, and the journey. The ten-day rule is announced here, before the examination and before hope. · Seated

2 · The history, at length and in its order (The History That Cannot Mislead You) — her own words, the complaint mapped, the neutral doorway, digestion, bowel, head to foot, the life, the past, what is swallowed, habits, the women's questions. · Seated

3 · Sugar and BP, asked of everybody. Many take a daily tablet and remember it only once asked. If either is present, mark it in its proper place on the card and inform the chief therapist — not later. · ▲ Take care

4 · The folder, read once, with your mouth moving — every page declared to change the plan or change nothing, said aloud and written with the date (Reading the Reports). · Seated

5 · The patient is prepared. Pockets emptied, phone off; watch, keys, bangles or kada taken off and kept safely; a chain or mangalsutra kept so that it cannot prick the therapist's foot when the chest-bone treatment is given. Bladder emptied where possible; loose clothing, body covered. At least one hour after breakfast, two to two and a half hours after the midday meal, longer after a heavy one. · Seated

6 · The examination — every point graded in route order, minuses written (The Educated Hand); the flank pair with the sides reversed (The Two Kingdoms); the tongue. The therapist places the patient himself: when a pillow goes under the thigh she is not to lift her waist, nor the leg when it goes under the leg. · Supine Side-lying Prone

7 · The plan is built by the five steps, with the card open — and the blocked points are marked before treatment is planned. · ▲ Take care

8 · The first treatment is given at the determined places, counts, angle and order — and in the gap after each formula the patient is asked how she is feeling. · 6 sec Left Right Both sides × 3

9 · What she must do before tomorrow — the parhez in three named items from her own kitchen, the water, the sleeping and rising (Between Two Sessions · Food as Medicine). Then the card is completed and signed and the baseline figures entered. · Seated

Two rules run through the whole of it. Do not raise the forehead at any time, and take no pillow under the head if there is no need of one. Do not talk during the treatment — anything to say, say in the gap between treatments; otherwise breathe long and easy through the nose, attention on the sensations around the navel, because the more relaxed you remain, the more benefit you take. ▲ Take care

Two warnings belong to the patient rather than the therapist, both said in her own language before she lies down. She should not ordinarily feel pain from your pressure. If pain occurs she must tell you at once, and you will change the angle or the manner of placing the foot — and the effect of the treatment is not reduced by this. If she feels pain and does not say so, pain may remain even after the treatment, or weakness may be felt. And: women are not to take treatment for other problems during the menstrual period, though they may come during the menses where the bleeding is excessively heavy, or does not stop, or is very scanty, or where there is pain or clots — all of which can be corrected by the appropriate treatment.

Key teaching

Why day one is different

Because day one is the only day on which the body has not yet been treated.

Everything you write today measures the disease; everything from tomorrow measures the disease plus whatever you did yesterday, and the two can never again be separated.

So on day one, and only on day one, you get the untreated grades at every point; the untreated flank comparison; the baseline six — hunger, sleep, energy, weakness, lightness, and glasses of plain water yesterday, the items this therapy expects to move first and therefore the items that will prove it moved; the bowel as it was; and her own words about what she can no longer do.

A first visit that produced no figures produced no baseline — and a course without a baseline can never be shown to have worked.

The diagnosis card

A first-visit card a stranger could act on next Tuesday

The card is what lets this week be compared with last week, and comparison is the only honest evidence this therapy will ever have. Its test is one question: can a therapist who has never met this patient pick it up next Tuesday and act on it? Here is a first-visit card for the woman in the opening story, in the notation of The Educated Hand.

DIAGNOSIS CARD · first visit

Name · age · occupation · town	Kamla Devi Sahu · 58 · housewife · Bilaspur
Accompanied by · journey	Daughter · 40 minutes by bus · can come 6 days a week
Date · time · relative to food	14.3 · 10.40 a.m. · two hours after a light breakfast

In her words — "Ghutne. Baal jhad rahe hain. Chakkar aata hai uthne mein. Aur ab sugar bhi aa gaya."

Complaint mapped — Knees 18 months, worse rising from the floor · hair falling 14 months · giddiness on standing 8 months, no fall · sugar found 4 months ago at a camp · cannot sit cross-legged for prayers, the loss she minds.

Baseline six — Hunger 2/5 · Sleep 3/5 · Energy 2/5 · Weakness ++ · Lightness − · Water (glasses yesterday) 3

Digestion and bowel — Tongue coated, thick, white · wind after meals · UDF - ? (asked, not answered; to observe 3 days) · Stool form 2 / 4 · 2 per week · strain ++, 12 minutes sat · incomplete ++ · blood nil · isabgol occasionally, 6 years — longer than any complaint on her list

Head to foot — cold hands ✓ · daytime sleepiness ✓ · dry skin ✓ · night cramps ✓ · breathlessness ✗ · chest pain ✗ · bleeding ✗ · weight loss ✗

The life · the past — Cooks for seven · standing 5–6 hours daily · window closed all night · tension: son's employment · fall onto the right hip, 2011 · 4 home deliveries · no operations

Swallowed — Metformin 500 mg twice daily (Dr. ——, 4 months) · calcium tablet, bought herself, 2 years · churan after dinner, 20 years — she counted neither of the last two as medicine until asked

Findings Left Right

Point	Side	Ring	Grade	H / P	Note
Liv° · Mu°	R · L	—	− · +++	HP	reversed and re-checked
Gas	—	2	++	H
Const · Dys	L · R	2	+++ · −	HP	"there is something there"
Gal · Spl	R · L	1	+ · −	P
Pan	—	2	++	H
Acid · Fluid	L · R	1	++ · −	HP
B₁₂ · FA	R · L	—	− · ++	P	folic acid point tender
Tongue	—	coated, thick, white

Direction — Acidic. Mu° L +++ HP against Liv° R −; hard infrequent stool; dry skin; cold hands; three glasses of water yesterday.

Reports — Fasting sugar, 4 months, 148 mg/dl — changed nothing today, dated · Knee X-ray, 2 years — changed nothing, said aloud · HbA1c, thyroid and calcium — none; asked for through her own doctor

Diagnosis (organs, direction, duration — not a disease name) Digestion running slow, with probable undigested food; large bowel slowed with it, 6 years; acidic direction; folic acid point tender. Four complaints, one picture. Thyroid to be excluded through her own doctor.

BLOCKED — marked before treatment is planned ▲ Take care Diabetes: Th · Th+Ch · Spl · Lymph · Armpits · Ton 'P' · Ton 'T' · Pit · (4) Adr · (6) Adr · (4) Pan · (10) Medulla Constipation: Gas Only · (10) Medulla · Dys Reasons written beside each. Un-blocking is a dated, named decision. Chief therapist informed of sugar — 14.3.

First work — Digestion first, ten days at a stretch. Undigested-food work — and because she is constipated, after Gas Only, Gas 'I' must be given, otherwise the constipation will increase; and because she is diabetic, (10) Medulla is not given even in the undigested-food work. Parhez: curd, lemon, tamarind. Water to 8 glasses, sitting, not with meals. Window open at night.

Measured — the baseline six; stool form, frequency, effort; Const and Mu° re-pressed every session; "can sit cross-legged", weekly.

Referred · Not answered — Thyroid and HbA1c requested through Dr. ——, 14.3 · UDF - ? outstanding, due day 4

Therapist — initials

Nine blocks, never merged. Four of them carry the weight. The baseline six must be figures, because these move first and without today's figures you cannot prove it. Findings include every point examined, minuses and all. Reports get one line each and the words changed the plan or *changed nothing* (Reading the Reports). And Blocked carries the reason beside each point — which is what lets a block survive a change of therapist. Her own words go in unedited, because her words are evidence and your paraphrase an opinion; the diagnosis line is organs, direction and duration and never a disease name.

From the second visit: three figures and two points, in one line a day — a line a day for six weeks is a graph, six weeks of paragraphs a diary.

The warnings that shape a plan — blocking

The blocked list, its substitutions, and the conductor with a stent

There are some diseases in which certain glands become hyper — that is, they work more than they should. Since through this therapy we provoke many glands, it is necessary to know in which diseases which glands must not be provoked. In the list that follows, for each disease, the points which are not to be given are shown enclosed on all sides by a box. Doing this is called blocking.

Key teaching

Blocking, and why it comes before the plan

When the patient comes for the first time, then — even before beginning treatment — on their diagnosis card block those points which, according to their disease, are not to be given, so that both you and the therapist will remember this, and no harm will come to the patient.

And the part that surprises students: it is not necessary that this warning is for ever. This avoidance is needed only for as long as the chief symptoms of that disease have not ended. Afterwards, if the need arises, those points can be given. That is a special feature of this therapy, and it is the proof that by our treatment the glands have improved.

The order of those paragraphs is the instruction. A block is not a warning attached to a plan; it is the constraint the plan is built inside. A therapist who plans first and checks afterwards will one day find his plan mostly blocked — and be tempted, with the patient already on the mat, to decide that this block is probably about something else.

Table 2 — The conditions, and the points blocked in each

Disease or condition	Blocked points
Autoimmune disorders, arthritis, inflammation / polio	Th · Th+Ch · Lymph · Armpits · Ton 'P' · Ton 'T' · Spl
Asthma	Spl · Thrd · Gal
Acidity or ulcer in the stomach	Gas Only · (10) Medulla
Fistula, anal fissure, descent of the rectum, piles	(10) Medulla · Gas Only · Dys
Bamboo spine and spur	Thrd 'P' · Thrd
Low blood pressure	Ku (old version) · Gas 'I' · (30) Medulla
High blood pressure	Pit · Mu° · Swt · Lu + Sh · (20) Medulla · (2) Adr · (6) Adr
Cancer	Lt.Ov · Rt.Ov · WD · (10) Medulla · Pit · (4) Adr · (6) Adr · (4) Pan · Spl
Cold, running nose	Mu · (6) Adr · Spl
Constipation	Gas Only · (10) Medulla · Dys
Dysentery or loose motions	Gas 'I' · Const
Convulsions, epilepsy, fits, seizures	Pan · Pit
Diseases of infection	(6) Adr · (30) Medulla
Diabetes	Th · Th+Ch · Spl · Lymph · Armpits · Ton 'P' · Ton 'T' · Pit · (4) Adr · (6) Adr · (4) Pan · (10) Medulla
Septicaemia	(6) Adr
Heart disorders	(10) Medulla · (20) Medulla · (30) Medulla · Lu + Sh · Swt · Katka · Loveleen · Thymus · (4) Thrd
Kidney disorders	Th · Th+Ch · Spl · Lymph · Armpits · Ton 'P' · Ton 'T' · Spl
Schizophrenia	Pan
The teenage years	Lt.Ov. · Rt.Ov. · WD · Ton 'P' · Ton 'T'
Wounds	Heparin formula

When the Hand Must Stop, "When the Hand Must Stop", owns the complete account. What belongs here is smaller: the entries that do not merely forbid but redirect, because those decide what a plan contains.

TAKE CARE

The blocks that carry a substitution — the planning half of the list

A block that only forbids leaves a hole in a plan; a block that names a substitute fills it. Each with the condition that makes it bite.

In a diabetic: Pit, (4) Adr and (4) Pan raise sugar — in their place (10) Pan. (10) Medulla is not given even in the undigested-food treatment, because from it the blood sugar will rise. The Full Round Arrow provokes both the thymus and the adrenal gland, so Round Arrow is given only as far as L1–L5. On injury: (8) Ch. Only (20) ↑|↓ in place of Th + Ch — the same substitution in autoimmune disorder, inflammation and kidney disorders where there has been an injury. For infection: in place of the viral formula, TF 'Gal-Liv', or (½) Ku – 20 secs, or (½) Ku – 13 secs, or (1) Single point liver × 6 treatments.

In heart disorders: in place of (4) Thrd, (2) Thrd — from (4) Thrd the metabolism increases and a burden falls on the heart. (2), (4) or (6) Medulla may be given; (10) Medulla is not given on both sides — nowadays (10) Left Medulla is given. In place of (30) Medulla or G. Heparin, J. or P. Heparin. In place of (3) Gal (7) Liv, which raises cholesterol by improving the digestion of fats, (1) Single point liver × 6 treatments. Not giving Loveleen, give only Ulta Sulta — but with the hands kept up at 135°.

In high blood pressure: Mu° is not given alone, because if acid falls the symptoms of alkali will increase — in its place Mild Alkali or the Ulta Kidney formula; where there is pain at Mu°, the B₁₂ formula or Left vitamin formation relieves it. In place of (20) Medulla, which makes dopamine and raises the pressure, (30) Medulla or the Chole formula.

In low blood pressure: those who have had it for years are not given the angiotensin #2 formula; they are given only (2) Para. Those in whom it came on suddenly, from an accident, a miscarriage or heavy menstrual bleeding, are not given (2) Para; they are given only the angiotensin #2 formula.

In constipation, and in acidity, ulcer, fistula, fissure, descent of the rectum and piles: from Gas Only and (10) Medulla the acid of the stomach will increase three times and the trouble with it — so both are blocked; and if the undigested-food treatment is to be given, then after Gas Only one must give Gas 'I', otherwise the constipation will increase.

In cancer, above all the point names: do not give a treatment that stimulates the organ in which the cancer is — in cancer of the pancreas, not (2) Pan; in lung cancer, not Ch Only or Thymus, and in their place Pan, Gas Only, or (1) Single point liver × 6 treatments. Where (4) Adr and (4) Pan are withheld for raising sugar, (2) Pan is given in their place — and when giving (2) Pan, pressure must be given for exactly six seconds 6 sec , or a disturbance can follow.

In the teenage years: oestrogen and progesterone provoke the epiphyseal line to close early, and once it has closed the height will not increase — so those whose height is low are not given Lt.Ov. and Rt.Ov.; WD provokes the genital organs, from which oestrogen may be made; and Ton 'P' and Ton 'T', thought to have some relation with infertility, are not given to young people, especially not to women up to the age of bearing children.

In wounds: heparin treatment is not given, because heparin prevents the blood from clotting, so the wound will not heal quickly. In septicaemia: (6) Adr reduces the thymus and immunity, already lacking there — if it is given by mistake, fits can come on immediately; these are given only Thymus, Th + Ch and the viral treatment formula.

Two entries show most clearly why context must travel with an instruction. Low blood pressure, twice. Long-standing: only (2) Para, never the angiotensin formula. Sudden, after an accident, a miscarriage or heavy bleeding: only the angiotensin formula, never (2) Para. Strip the qualifying word from either sentence and you have a rule that is right half the time and harmful the other half. The word suddenly is the teaching.

The adrenal points, twice. (6) Adr is given in autoimmune disorder, arthritis and inflammation — those are what it is for — and blocked in infection, septicaemia and cancer, because it reduces the thymus and immunity, and there immunity must not be reduced. The same point, opposite instructions, no contradiction once the condition travels with it. Infectious disorders and inflammatory ones are treated in opposite ways (Fire and Swelling and 25).

Two states block by circumstance rather than by disease. During the menses, no treatment at all is given for four days — except where the flow is excessive, very scanty or painful, when the appropriate treatment is given to reduce it; and where the flow is heavy, heparin treatment is not given, because heparin does not let the blood clot, so the flow will be greater still. In pregnancy, Thymus and Th + Ch are not given, because after them the child begins to kick hard and move about, an indication that it is having some trouble; and in general no treatment of any kind is to be given from which the child may have trouble.

A CASE FROM PRACTICE

The retired conductor whose plan was decided by the blocked list

A composite case, assembled to teach the reasoning rather than taken from one patient's file.

Abdul Rehman Shaikh · 61 · retired bus conductor · Bhusawal · came with "no strength, and the legs swell by evening — one year"

In his own words. "Ten minutes standing at the bus stand and I want to sit. Legs swell after four o'clock. Angina is there since three years — they have put one stent."

Observed and palpated. Supine Gas ++ H; Const +++ HP at the middle ring; Dys silent; Pan ++ H. Prone Mu° L +++ HP against Liv° R −. Hard stools every third day for eleven years; tongue coated; UDF – Occasionally. Ankles pitting by evening. Both feet examined before any pressure, sensation intact.

One picture — and one thing outside it. Tiredness, hard stools, coated tongue, cold hands and dry skin made one picture in the acidic direction. The swelling and the chest history were not absorbed into it: a stent and an angina diagnosis are not a face of indigestion, and evening ankle swelling in a man with known heart disease belongs to a physician as well as to a therapist.

Which reports mattered. The discharge summary naming angina and the stent — changed the plan, more than anything else in the folder, because it decided the blocked list. A kidney function report, eight weeks old, normal — changed nothing today, dated, re-requested at six weeks through his own doctor. Two lipid panels and an ECG — changed nothing, said aloud twice, because he had carried the ECG in fear.

What the block decided. Marked before anything was planned: heart disorders — (10) Medulla · (20) Medulla · (30) Medulla · Lu + Sh · Swt · Katka · Loveleen · Thymus · (4) Thrd — and beside them, in the same hand, the substitutions set out above: (2) Thrd for (4) Thrd; (10) Left Medulla; J. or P. Heparin; (1) Single point liver × 6 treatments for (3) Gal (7) Liv; and Ulta Sulta in place of Loveleen, hands kept up at 135° (The River — Heparin · Water and Salt). Also blocked: constipation, with the note that Gas 'I' must follow Gas Only. Two lists overlapping at (10) Medulla, which settled that point twice over.

Session by session. Ten days at a stretch, water to eight glasses. Day 6: stool daily and formed for the first time in years. Day 10: Const ++, energy 2/5 to 3/5, and — the item nobody had asked him to watch — "the swelling is the same," which separated the two pictures cleanly. Week 3: twenty minutes standing. Week 6: the repeat kidney report unchanged, which changed nothing either, and was written down.

What was done when it stopped working. Week five the tiredness returned and the stools slipped. The plan was not changed. The history was retaken, and the answer was in the water: a heat wave, a fan that had stopped, and a man back to three glasses a day because the earthen pot stood empty. The plan had not failed; it had stopped being carried out.

What this case teaches

The blocked list can decide more of a plan than the findings do.

Not everything joins the one picture. Ankle swelling in a man with a stent is on the far side of that limit.

(2) Thrd for (4) Thrd; hands at 135°; (10) Left Medulla. A substitution stripped of its number, its angle or its side is a guess.

When a good plan stops working, ask what stopped happening before you ask what to change.

Choosing where to begin

Block, direction, digestion, today's body — then the first formula

THE METHOD, STEP BY STEP

Turning a plan into a first treatment

1. What is blocked? Read the blocked list aloud at the head of the mat before anything else. Nothing that follows may contradict it.

2. Which direction is she in? Acidic or alkaline decides which family of treatments is available at all: a treatment that corrects acidity, given in the alkaline direction, is not a weak treatment but the wrong one (The Two Kingdoms).

3. Is the digestion sound? If not — and it usually is not — that is the first work (The Fire and the Ash).

4. What does today's body need, rather than yesterday's? This therapy treats according to the condition of the body. A diabetic who normally has constipation will be given a different treatment on the day when he has loose or semi-solid motions — and both treatments will be found to be effective in reducing his blood sugar. Neither was aimed at the sugar.

Then name the formula and give it in the determined order — because change the order and you have given another treatment, whose effects you have not been taught — and in the gap after each formula, ask the patient how she is feeling.

Day one: the blocked list read aloud before the first treatment. The last act before the first treatment. The therapist kneels at the patient's side with the diagnosis card on a clipboard, one hand raised a hand's breadth above the thigh and not yet touching, reading aloud the points blocked for this patient. Nothing has yet been given.

Two constraints decide as much as physiology. The days she can actually come: a ten-day course begun on a Thursday, for a woman who cannot travel on Sundays, is a wish and not a plan. And what the household will actually do: a parhez of three items named in her own kitchen and taught to whoever cooks will be kept; avoid sour things will not, because in a Tamil kitchen tamarind is not a sour thing, it is how food tastes (Food as Medicine). (Figure 13.4)

The formulas themselves belong to and are named here and nowhere else; the points belong to ; and the course over weeks belongs to Weeks, Not Sessions, "Weeks, Not Sessions". This article plans the first treatment only — the correct unit, because the condition of the body will have changed by the second week.

When the plan must change

Signs the first approach is failing, and changing one thing at a time

A plan is a hypothesis with a body attached. Sooner or later one of yours will be wrong, and the useful question is not how to avoid that but how quickly you will admit it, and what you will do.

Key teaching

The signs that the first approach is not working

Within three or four days: the small effects have not begun. Hunger, sleep, energy, weakness and lightness ordinarily start to move within a day or two, whatever the disease; if none of the baseline six has shifted by day four, the fault lies in the plan, the attendance or the parhez — one of those three, not the disease, is what to examine. And: the trouble increased after a particular point or formula. In the gap after each formula, ask how she is feeling. If the trouble increases after any point or formula, immediately take the opinion of the chief therapist as to whether the treatment should be changed — and write this clearly on the card, so that in future that point is not given again, or, if it must be given, so that proper caution is taken. ▲ Take care This entry outranks everything else here.

By the end of the first ten days: the stools have not become normal and the undigested food is unchanged; nothing has moved that you were not treating, where the picture really is one picture; and the points have not moved — Const +++ on day one and +++ on day ten, pressed the same way by the same hand, is the plainest failure there is, and it is visible only because a grade was written on day one.

At any time: improvement that began and then stopped — the commonest event in a practice, with most of its causes outside the treatment room.

THE METHOD, STEP BY STEP

What is done when the first approach is not working

1. Do not change the treatment yet. Seated A plan altered before the reason is known leaves you two changes to explain instead of one.

2. Ask first whether the plan was carried out. Attendance — the actual days, not the intended ones. The parhez — asked as "tell me everything you ate and drank yesterday, from waking", never as "are you keeping the restriction?". The water, in glasses, yesterday. A plan that stopped being carried out is not a plan that failed.

3. Re-examine from the beginning, as though this were a first visit — every point, both flanks, the tongue, minuses included; then lay the new card beside the old one. A finding may have moved without going away: a tenderness travelled from the middle ring to the inner one is a treatment given at the wrong station, not a treatment failure (The Navel Speaks First · The Educated Hand).

4. Retake the history, asking it differently. Not "has anything changed?", to which everybody says no, but about the room, the bed, the window, the water, the kitchen, the sleep, the tension. Ask "what do you put in your mouth for health?" rather than "what medicines do you take?" — powders and churan are not filed under medicine by the person swallowing them. And ask the family: one sentence from a daughter outranks a session of guessing (The History That Cannot Mislead You).

5. Ask whether a red flag has appeared that was not there on day one. ▲ Take care

6. Only then change the plan — and change one thing. × 3 Write what you changed, the date, and what you expect to see if it was the right change.

Be exact about the timing. A therapist should be prepared to say by the end of the first ten days that his first approach has not worked — not on day three, when nothing has had time, and not in week six, by which point the patient has stopped coming. Patients are less alarmed by a therapist who re-examines than by one who repeats himself.

One failure deserves naming on its own. A plan can be right and a picture still be wrong. A schoolgirl of fifteen came with afternoon headaches and a mother's complaint that she was not growing. The findings made one picture in the acidic direction — a long-slowed bowel, undigested food, tender folic acid and B₁₂ points, a heavy irregular flow — and ten days of digestive work moved every one of them. The headaches did not move at all. Nine-tenths of the findings shifting while one complaint stands still is the sign that the complaint was never a face of the same root. Retaking her history about the room, the desk and the water bottle produced what no examination could: she drank nothing at school from eight until two, because the girls' toilet was unusable, and she copied from a neighbour's book because she could not see the board. Water at school, an eye test through the school, and one change to the treatment, not three.

What improvement looks like

What moves first, what moves by day ten, and how it is written

Key teaching

What moves, and when

Within a day or two — the small effects. Hunger improves, sleep improves, energy rises, weakness reduces, the body feels light, life becomes enjoyable.

These are the six you wrote on day one, and they move first in almost every patient whatever the disease. Even where the disease itself is slow to go, those changes matter in themselves, because a body in that state is far less likely to acquire the next disease.

Within three or four days — considerable relief in the small ailments, where fevers, colds, coughs, indigestion, constipation and stomach ache are treated at once and without delay.

By the end of ten days — the complaints you were not treating. Where the picture was one picture, a majority of symptoms improve even though no specific treatment was given for the ailment the patient came about — and families report what is never on the card: the irritability gone, the disposition changed.

Session by session — the points. A point at +++ on the first visit and + on the fourth has told you what no conversation can: if the pain at a place is relieved, the blood supply to that place has been restored.

Over the whole course: for ordinary ailments, a week to ten days; for chronic ailments, about a year or more; kept regularly with the parhez, many diseases are cured in two to four months; for conditions present from birth, some years.

What is written, so that it can be compared: Hunger · Sleep · Energy · Weakness · Lightness each out of five, and water in glasses, yesterday; Stool 2 / 4 with frequency, strain ++, minutes sat, incomplete ++; UDF – Yes (items); the points as point · side · ring · grade · H/P; the flank pair; what she can no longer do, in her own words; and the list of complaints nobody is treating, which is what tells you by day ten whether it really was one picture. (Figure 13.5)

Two warnings about measuring. Do not measure the loudest complaint first — it is the slowest thing on the card, and if it is her only measure she will conclude in week two that nothing is happening. And do not let her scale drift: "better" in week four means better than last week. Read out what she said on day one.

Building the first plan. One-sheet summary: the five steps (step four, the one students skip, marked), the order of precedence, the order of correction across days 1, 4 and 10, and what is measured against when it moves.

WHAT TO CARRY AWAY

A plan is one sentence about what is wrong and one decision about what is done first. Forty findings are not a plan.

The five steps: gather by every method and correlate — the pain points, the B₁₂ and folic acid points, the nature of the stools, and in women the menstrual history, an additional and very valuable tool; establish the direction from the flank pair; name the organs and not the diseases; analyse logically and find the one fault underneath; then block, choose the first work, and write it down.

Many names, one root. Different symptoms on different days come from the same few glands not working properly — correct that one root cause and not only these but more symptoms are corrected, and they will not recur either. The test is built into the treatment: ten days of digestive work improves complaints you were not treating, or it does not.

Order of precedence: the red flag · the block · the digestive fire · the direction · the tender flank · the silent finding · and last the complaint.

The digestion is corrected first whatever the disease, because the raw materials of all the glands are made only from the end products of digestion. Ten days at a stretch, without break, announced at registration, undigested-food work only — and by day ten a majority of symptoms had improved with no treatment given for the ailment they came about.

Day one is the only untreated day: the baseline six and the untreated grades cannot be recovered later.

Block before you plan. When the patient comes for the first time, even before beginning treatment, block on the diagnosis card those points which according to their disease are not to be given. The block wins over any recommendation, and is not for ever: it is lifted when the chief symptoms of that disease have ended, as a dated, named entry — itself the proof that the glands have improved.

The substitutions are the planning half of the blocked list: (2) Thrd for (4) Thrd in heart patients; (10) Left Medulla; J. or P. Heparin for (30) Medulla or G. Heparin; (1) Single point liver × 6 treatments for (3) Gal (7) Liv; Ulta Sulta for Loveleen, hands up at 135°; (10) Pan in diabetes, Round Arrow only to L1–L5; (8) Ch. Only (20) ↑|↓ for Th + Ch on injury; Gas 'I' after Gas Only in a constipated patient. In low BP: long-standing, only (2) Para; sudden, only the angiotensin #2 formula. In cancer: do not give a treatment that stimulates the organ in which the cancer is.

When it is not working, do not change the treatment yet. Ask whether the plan was carried out; re-examine; retake the history differently; check for a red flag; then change one thing. Measure events, not adjectives.

Questions students ask

1. I am nineteen and this is the part I cannot do. I can palpate and take a history — then I sit with the card and nothing comes. Say the five steps out loud, in order, with a pencil in your hand. Most beginners are not failing at judgement; they are trying to do Step 4 while still collecting, which nobody can. Finish gathering, finish sorting, then ask Step 4's question — and write its answer as a full sentence before anything else.

2. I have no science at all. What does "the digestion is the root cause" actually mean? Every gland in your body builds its chemicals out of what your digestion releases from food. If the digestion is short, every gland is short, and whatever was already weakest complains first. That is why one slowed digestion does not produce one disease — it produces whichever disease that body is disposed to.

3. I am a physician. What kind of claim is "four complaints, one picture"? A claim about functional symptoms, not about every disease with a name, and it should be stated at that strength. What this article adds is a safeguard: the unifying picture sits below the red flag in the order of precedence, precisely because a good unifying story is what is most likely to absorb a dangerous presentation without alarm.

4. I practise in a village. No reports, no laboratory, no second therapist to ask. Can I build a plan? Yes — the examination is the diagnosis, and no step requires a laboratory. What you must have instead is a referral list you know by heart, and the discipline of writing down what you asked for and did not get. When the Hand Must Stop is the article you learn cold.
5. A patient has three of the blocked conditions at once. Half my atlas is gone. That is common, and it is the plan telling you what it is. Write all three lists and note where they overlap — the overlaps are the firmest instructions you have — then look at the substitutions, where the plan actually lives. A narrow plan carried out exactly beats a wide one carried out approximately.
6. When may I lift a block? When the chief symptoms of that disease have ended — not when the patient feels better, which is a different claim. Write the date, your name, what you went by, and what you expect to see. If you cannot name what you went by, you are not ready to lift it.
7. Must I really write all this down? I remember my patients. You remember three things about each: the loudest, the first, and the one you expected — a summary of your own expectations, not a record. And a grade decays in about a minute. The card is not for your memory; it is the instrument that lets this week be compared with last week.
8. Am I allowed to be wrong? You are required to be, sooner or later, and this article's architecture assumes it — a baseline you can be measured against, one change at a time so a mistake is visible, and a fixed point at which you re-examine. What you may not do is be wrong invisibly: unrecorded, unmeasured, repeated with growing conviction.

Questions patients ask

1. "I have four different problems. Why are you writing so little?" Because I think three of them are coming from the same place, and the card records what I found rather than what you told me — which is shorter, and it is what I will compare against next week. If I am wrong about that, the next ten days will show it plainly, and I will tell you.
2. "I came about my knees. Why are you treating my stomach?" Because your knees are repaired out of the same materials as the rest of you, and those materials are released by your digestion. If the digestion is short, the knee gets what is left over — which is why treating the knee alone gives relief that wears off in days. I am not ignoring your knees; I am making sure the work on them holds.
3. "How long before I feel something?" In the first day or two you should notice hunger, sleep and energy, and I will ask you about each every visit. Considerable relief in the small troubles usually comes within three or four days. What you actually came about is slower, and I would rather tell you now than have you measure week one against a cure.
4. "You have written some things in a box on my card. What are they?" Those are the treatments I must not give you, because of conditions you already have. I write them before I plan anything else, so that neither I nor anyone else who treats you can forget. They are not permanent — when the main trouble settles some can be used again, and that will be a decision I write down with the date.
5. "Last time you did something different. Have you changed your mind?" No. Your body was not the same today as on Monday, and this therapy treats the body in front of it rather than the name of a disease. When your motions change, or your sleep changes, the right treatment for that morning changes with them.

6. "My reports are all normal, so is there really anything wrong with me?" Your reports are normal, and that is good news worth having — the things those tests look for have been ruled out. They were not built to show how briskly an organ is working, which is what I find with my hands and what you can tell me by watching your own hunger, sleep and motions. Nothing I found argues with your reports.

7. "If it does not work, will you tell me?" Yes, and at ten days rather than ten weeks. That is why I wrote down today's figures — so neither of us has to rely on an impression. If nothing has moved I will examine you again from the beginning, and if I still cannot make sense of it I will say so and tell you who else to see.

Words used here

Hindi	English	Neurotherapy code / usage
निदान (nidān) · शिकायत (shikāyat)	Diagnosis · complaint	The first is not a disease name but which organs are below par, in which direction, and for how long; the second is the patient's own words, and is last in the order of precedence
निष्कर्ष (nishkarsh) · मूल कारण (mūl kāraṇ)	Finding, conclusion · root cause	Kept in a separate block from what she said; the root is the one fault upstream of several complaints, found at Step 4
—	Blocking · un-blocking	Marking on the card, before treatment is planned, the points not to be given for this patient's conditions, with the reason beside each; and restoring one as a dated, named entry when the chief symptoms have ended
परहेज़ (parhez) · क्रम (kram)	Restriction · order	Three items, named in the patient's own kitchen and taught to whoever cooks; and the sequence, which is part of the act — change the order and it is a different treatment
—	UDF	Undigested food in the stools; the first work in almost every plan — The Fire and the Ash
—	The baseline six	Hunger · Sleep · Energy · Weakness · Lightness · Water — recorded on day one, asked every visit
—	Diagnosis card	The whole picture in one place, written so it can be compared next week — The Record That Shows the Truth, the reference pages

Language

From Findings to a Plan

Watch

Where diagnosis ends and treatment begins

What the whole procedure is for

The five steps

Four problems, or one?

Many names, one root

Which finding leads

The order of precedence — which finding leads

The order of correction

The digestion is corrected first, whatever the disease

The ten days, as one centre practises it

The first visit

Why day one is different

The diagnosis card

The warnings that shape a plan — blocking

Blocking, and why it comes before the plan

Choosing where to begin

When the plan must change

The signs that the first approach is not working

What improvement looks like

What moves, and when

Questions students ask

Questions patients ask

Words used here

Ready to begin?