The Differential Diagnosis

I am often asked to give an opinion on a product claiming certain health benefits.  These products make tempting claims such as all natural, scientifically proven, an ancient remedy, a new discovery, etc. etc. etc.

While some of the people asking my opinion expect me, as a natural health provider, to give my approval because a product is natural or holistic.  Others expect me to universally poo-poo these products as quackary because they know I am also very Western minded in many ways.  The truth is, neither one of these opinions should be universally expected from me.  They are, in fact, too black and white and once again my view winds up being a bit more gray.  Here's why...

In holistic medicine there is an extremely important concept called differential diagnosis.  Simply put, differential diagnosis means that even when two people have the exact same main complaint, when looked at as whole beings, they more than likely have different underlying imbalances and therefore the treatments that would most benefit each person is more than likely different.  So, when a product makes a claim to help  ALL people suffering from XYZ condition, the truth is it probably would help some, not help others, and potentially make still others worse.

For example, two people, both have a main complaint of pain... let's say headaches (but it could really be any thing):

Person A is a post-menopausal woman, tends to be hot, has dry skin, gray hair, has a low appetite, okay energy, low sex drive, has trouble staying asleep some times, has low stress, her headaches are worse when she overdoes it, better when she rests, the headaches are dull and all over her head.

Person B is a 25 year old woman, tends to have cold hands and feet, but is otherwise comfortable, has bad PMS, dark heavy periods with cramps, tends to be very active, has a high stress job, sleeps okay, but has vivid active dreams, her headaches are worse when she is stressed and when she is pre menstrual, they are mostly on the sides of her head and can be pretty intense and sometimes sharp.

You can see that the main complaint is the same.  Headaches.  And from a western perspective, the most obvious treatment choice (pain medications) would be the same.  There are many "natural" treatments for headaches too that might seem to be good in either case.  But, in reality, these women have many more differences than likenesses.  Their differential diagnoses would be extremely, well, DIFFERENT.  And therefore, any treatment recommendations I would make would be tailored to their WHOLE picture and very different as well.

So, say they both heard about DLPA.  A "natural pain killing supplement" that has been getting attention in the medical world for its ability to reduce pain.  They might both think, "hmmm.  This seems like a good idea for me."  So they try it and get very different results.  No wonder, as they have very different differential diagnosis.

The bottom line is this.  As a holistic practitioner, my opinion is that it's always best not to blindly self medicate. Even if a product is natural, scientifically proven, etc. doesn't mean it's going to be the right holistic fit for you.  Taking time to be seen by a practitioner who can take the time to analyze your whole health picture and then make recommendations that fit you as a whole person and not just piecemeal symptom by symptom is a much better approach.  Not to mention that when you take this approach you can stop treating things one by one and treat your WHOLE imbalance.

The herbs, lifestyle suggestions, and acupuncture I would do for Person A wouldn't just help her headaches, they would help her feel less overly hot, improve her energy and sex drive, help her sleep more soundly, etc.  And the very different herbs, lifestyle suggestions and acupuncture I would give Person B wouldn't just help her headaches, but would decrease her pms, improve her circulation so her hands and feet warm up, help her deal with stress better, etc.

That said, I know not everyone has the time, money, and access to an acupuncturist who can not only make their differential diagnosis but also spend the time to educate them on it (I happen to be extremely committed to the idea of patient education so that the women I work with do understand their big picture imbalances and can know how to make choices that will help themselves).  If you are reading this and thinking... well, I guess I'm just out of luck and need to stay in the dark.  Look for my next post on this subject coming in a few days.  It will help you navigate trying to make these choices on your own.