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There is an unfortunate side-effect to the non-shamanistic approach to medicine these days – or the “hospital” form of medicine: and it is that there are two common groups of people that fall right through the cracks and don’t get the care and healing that they deserve. I’m not talking about poor education of a doctor, misdiagnosis, or malpractice. I’m talking about the reason the patient is slipping through the cracks.

Walking through modern healthcare.
I am writing to these patients and their practitioners in an effort, perhaps vain, to get through to them and help them understand what it will take to get the healing they deserve; but unfortunately have not yet earned.
First the reader must understand that everything in TCM is about Yin and Yang; and in this case excess [of something bad] or deficiency [of something good]. These two types of people can of course be broken down into many different patterns, syndromes, and then eventually the individual versions of said pattern+syndrome (combined with psychological data)… but the causation of their demise and slippage through the cracks of modern differential diagnosis based healthcare will remain the same.
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In the final section I will talk about how to get them treated – if it is their time to heal1.

Deficiency Syndrome

Typically speaking generalized deficiency is a systemic version of the normal/average deficiencies. So a Qi Deficiency is basically Spleen Qi Xu, but instead of minor issues of digestion we see: atrophy, extreme pensiveness, hormonal disorders and/or autoimmune disorders, recurrent illness, inability to heal, aggravated or anxious emotional states, literally wasted flesh and haggard appearance such as dark-sunken eyes or continual fatigue with spasms that do not appear knotted but rather “fibromyalgia-like” in that they are powerful, painful, but diffuse.
This person tends to worry excessively – and for good reason. They’ve been treated before, and they’ve not seen changes , but they know something is wrong and tend to dwell on the fact that something is wrong but cannot be found. This isn’t mere imaginations, this is a real occurrence.
You may even suspect that they forget or habitually do not eat enough, worsening their wasting syndrome. For their age the flesh will be more flaccid than normal. It is normal for the flesh to become softer with age, but at a certain point it appears almost squishy or watery.
They may in fact have water accumulations or a soggy pulse.
The reason that they cannot get the help they need is actually a very sinister “chicken-and-egg” phenomena that has a third more sinister component.
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#1 – they are not very aware – and by aware I mean self-honest or pre-planned – about the choices they make as individuals, and constantly are experiencing things being taken from them by the Universe/God. Internally there is a feeling of unworthiness and so innate goodness is shunned. Doesn’t make them “bad” people, just sometimes they cannot seem to make the healthy decision in relationships, life choices, or lifestyle/health.
It’s okay if this sounds judgmental I am meaning to incite pride in these individuals because it is only the ability of the soul’s Wei Qi (immunity/defense) that will cause the person to snap out of the situation and cease self-pity and take the reigns. But activity isn’t the problem, here; it’s the decisions prior.
Now in treating this person, the practitioner cannot be overly forceful because the Qi is saggy and weak, and has no uprightness. You wouldn’t ask a limp-noodle to ice skate, and life in the world requires us to skate all the time, but these people need time to regain their feet.
The problem most practitioners are going to run up against isn’t volition – these people try and try and try to get better – it’ll be in focus because Deficiency Syndrome weakens the Kidneys (endocrine system) and this weakens the willpower and intellect. Many of these cases will actually involve insulin/glucose or thyroid hormone issues, or both. Some will be starvation issues or recent traumas/childbirths. But it doesn’t matter, what matters is that the practitioner use the appropriate [and the patient request it] modality: moxabustion, herbs, and minimal acupuncture.
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#2 Because of discouragement, the patient may begin to give up on healing and living right.
This causes more weakness of the Qi, weakness of digestion, or weakness in general. Also because the deficiency worsens, the intellect becomes more pensive and glucose is wasted in idle thought and worry and does not go to nourishing the muscles (via ATP).
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#3 The thing that the deficiency leads to is the inability to make forceful movement in the direction they so desire: such as exercise or changing aspects of their life that they wish to change. This leads to more discouragement, and lack of awareness. The lack of force means that in the doctor’s office though they’ve come they do not insist on receiving the help they need; indeed if even that person could reach to the soul level that they need to be treated from. But often they get misdiagnosed, they get ignored, forgotten, and it  is a crying-shame to happen because this person has tried repeatedly to get help, they just turn to anyone and everyone, without success.

Many Excesses Syndrome

This is actually a very similar problem, but with the opposite result. It may even be the result of long term Deficiency Syndrome. In other cases it’s caused by accumulation from excess habits.
stop and ask for help a bit late?

Excess Syndrome is the tendency to accumulate problems and diseases, and by the time they stop and ask themselves, “Am I doing this right?” they have accumulated three or even four or five patterns, eight, ten, or a dozen or more  medications, supplementation, herbal formulas, etc…

The main cause of this Syndrome is again, the belief that they are not worthy, as well as a tendency to overwork and not pay attention (though when they do they are typically hyper-aware of things that have little to no bearing on happiness or health; and can be knit-picky on superfluous items). It is also a tendency to outsource their health management to others, rather than taking responsibility for the accumulations they have acquired.
Sometimes the habit of accumulation is a matter of mental constipation; and this can be demonstrated in a cluttered lifestyle and a cluttered mind; even over attachment to details or small items (like knic-knacks). Other times though the person is constantly trying to flush out things, without success, and try to do it physically with cleanses (because they feel so good emotionally afterwards) leading to, guess what: an increase in the underlying Deficiency Syndrome, and this slack Qi is unable to get rid of the: phlegm, toxins, stasis, plaques, fluids, and even urea/bilirubin (jaundice) that accumulate in fat cells and interstitial spaces (even the brain itself!).
The solution here is primarily about lifestyle, diet, exercise (that leads to exorcise and not deficiency); and also it’s about honesty and scaling back activities that are wasting Jing (essence), focus, and not getting the person anything but more stuff.
There is a fourth thing to mention in Many Excesses people, who tend to slip through the cracks not because they can’t be helped but because they do not help themselves enough2 : the karmic portion.
You see, Karma is about choices and acquired conditioning. Which means that the tendency to ignore a problem and let it get worse or the tendency to accumulate problems and not flush out the waste in our lives has a karmic component for the person. They are experiencing a turbulent lifestyle that has teachings that are not reaching through to the person… and on the occasion it does and for a time they get rid of that which causes the unnatural growth of problems… they very often go back to making the same mistakes as before because again: outsourcing and also normal natural momentum/inertia.
This. too, Deficiency Syndromes that lead to Excesses are karmic in nature. There is a problem not getting better, the person gives up, and then the problem compounds and gets way worse. Now there is not only not sufficient Qi-energy but there is something that stands in the way of fixing it: so the problem is now more improbably solved.
In this way people end up with CHF, COPD, Heart Diseases, etc…

Getting the Proper Treatment

First things first, one must use a new kind of differential diagnosis: an emotional based kind. The analytical kind has not worked for the Deficiency Syndrome and over-worked in Excesses Syndrome without producing their long lasting effect. Why? Because the problem starts at the psychic level; either soul level traumas or mental programming gone awry are leading to more problems. Though some Deficiencies are inherited, these are usually easily diagnosed correctly and treated (even if ineffectively, they get the treatments that are available, and don’t slip through cracks.)
But in these patients we are talking about some reason they can deal with; albeit, with a guiding hand to help.
Which means the practitioner must have five important qualities:
  1. Compassion
  2. Insight
  3. Wisdom
  4. Potency (experience)
  5. Gong Fu
The last quality is often related to inborn talent, but can be developed if the person wants to. The others are more or less the qualities every healer aspires to. Some of them can be easily augmented, others cannot. But at some point, if a healer is open enough, they will have these cases walk in their door.
With the right umfph,  and the right care, these cases absolutely can see results. It’s just not easy. Previous experiences for the patient, plus a lack of focus and indecision, make these treatments more difficult. But if it can happen, oh how powerful they can be for both people.
I sincerely hope for the success of both patient and practitioner and the end to slipping through the cracks.
-Shifu Ramon Careaga
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