A pathogenesis flowchart help you trace current disorders step by step, following imbalance to their root causes, for easy identification of intervention points. In biocharacteristics medical theory every client's pathogenesis is unique, even those who have the same symptoms. Though each case is unique, some common patterns emerge as well. Constructing well-formed pathogenesis flowcharts takes practice! It is the culmination of everything a student of biocharacteristics has learned. Here are some of the most common mistakes made in pathogenesis flowcharts, and how to avoid them!

The Flowchart Uses Incorrect Formatting

We recommend the 'Biocharacteristic in Location (Evidence)' format. This ensures all essential information is included in an accurate, concise, easy to read manner, for easy followup and presentation. Many logical errors can result from not following the suggested format. Incorrect formatting often leads to skipping important stages or missing evidence, location, etc. This includes extra, potentially confusing, words clogging up the flowchart.

How to Avoid this Mistake

• Use arrows (=>) between each stage to indicate progression
  • EG: "Lyme disease creates vata in rasa, rakta, mamsa, majja" becomes "lymes => V in rasa, rakta, mamsa, majja"
• Provide evidence in every step (i.e. between arrows)! Evidence should appear in parenthesis, right after biocharacteric and location involved in the imbalance. The evidence is the 'proof' that the stated biocharacteric imbalance is occurring. Often those new to pathogenesis put the evidence as an effect, rather than evidence - making for a confusing, inaccurate chart.
  • EG: "V in majja => fear and anxiety" becomes "V in majja (fear and anxiety)"
• Use commas, rather than +, &
  • EG: "Vata in Majja (anxiety + cramping & tension)" becomes "V in Majja (anxiety, cramping, tension)"
• Capitalize the first letter of each word in the syndrome, but put the evidence in lower case:
  • E.g. "hot phlegm in lungs (Yellow mucus)" would become "Hot Phlegm in Lungs (yellow mucus)".

The Flowchart Has Become Too Wordy

Always remember the purpose of the pathogenesis flowchart - to easily hand over to a consulting practitioner or quickly skim before a follow-up. Excess words can make for confusion and lead to less effective treatment.

How to Avoid this Mistake

• Every word should have a clear, individual purpose - look out for several words meaning the same thing, or vague phrasing that adds no value.
• Remove the words 'Aggravating', "Increased", and symbols like '+' - if it is included in the chart, it's implied that it is aggravating
• Remove the words 'Vaha Srotas', Dosha', and 'Guna' - it's clear that 'Vata' is a dosha, for example
  • Vata dosha in purisha should simply be 'Vata in purisha'
  • Eg: Rasa Vaha Srotas should simply be 'Rasa'
• Use 1-2 biocharacteristics per term, only
  • "Sweet, Heavy, Oily, Dense, Thick in Rasa" should be "Sweet in Rasa".
• Use commas between multiple causes/effects
• Do not repeat the evidence for an imbalance already mentioned. Give the evidence the first time time the pattern is mentioned, only.
• Review the chart 2-3 times, eliminating extra words or making it more concise each time.

It Is Complex & Difficult to Read

The pathogenesis flowchart should be quick and easy to read and comprehend. If it is confusing, complicated or difficult to get through, it's not doing its job. This may be a sign that the stages of imbalance are not fully understood, or that logical branches/breaks have been missed.

How to Avoid this Mistake

• Do not put the whole chart in one big line. Remember, charts are generally a tree with branches, not a snake. Instead of: A => B => C => D => E => F => G try:
  • A => B, C
  • B => E => G
  • C => D => F
• These breaks make it easy to show the different effects of a cause without it becoming confusing. Separate lines are often used, for example, to show the effect on two doshas / locations, such as if a cause results in vitiating in both Pitta and Kapha in different areas of the body. EG:
  • ROOT: Heat, P ama in blood, liver (inflamed skin acne, skin redness) => sharp, heat in nervous system (trouble staying asleep) => V in Majja (Tired)
  • GROUP1: P in Diet, P in Rakta => P in Artava (increase in blood flow)
  • GROUP2: Ama in Artava => V in Artava (debilitating vice-like cramping, unproductive menstrual contractions)
  • GROUP3: Unproductive contractions => Stagnation in Artava (clotting)
  • GROUP4: P in Artava => Deficient Rakta (diagnosed anemia, feeling faint)

Common Logical Errors in Flowcharts

The biocharacteristic in location (evidence)' formula really puts the practitioner's logic to the test! It forces them to get very clear on what is happening with their client, and how their imbalance progresses. It is very common to get confused in the logic of the flowchart! Commonly, practitioners believe every cause must have an effect, or they get tied up in all the different biocharacteristics going on in their client. Don't worry! This is something a little practice and attention can clear up.

How to Avoid this Mistake

• Do not assume every cause has an effect. The cause does not automatically imply the effect. Do not assume that a cause always has an effect. Always come back to the evidence gathered during the consultation:
  • EG: Daily red wine after dinner => increased heat (evidence?)
  • EG: Fasting => Dryness in Rasa - What if the person is fasting because Rasa is Damp?
  • EG: "vishama agni (snacks often)" - snack often is not a sign of vishama agni, but a potential cause, only.
• Emotional states are not proof a dosha or guna is aggravated in the body. Pitta may be aggravated in the mind by any of the doshas being aggravated in the body.
  • Hot, Pitta in Rasa (Angry)
• Do not assume the cause or outcome - always look to the evidence. Every client and every pathogenesis is unique. Practice approaching it with fresh eyes each time.
• Do not put effects before causes. This is very common when practitioners are getting used to writing flowcharts. Essentially putting the cart before the horse! Slowing down and using the right format will be very helpful with this:
  • EG: Cold in rasa => Hypothyroid - In this example from a student, Hypothyroid likely caused the cold in rasa, not the other way around.
• Using an arrow instead of a comma is another example of getting causes and effects mixed up. If there is a cause leading to 2-3 effects, separate them with a comma not arrows.
  • EG: "Stress => Tension in mamsa => snacking" should be Stress => Tension in mamsa, snacking
• Putting the wrong biocharacteristic, srotas or dhatu with a symptom
  • EG: Dryness in asthi (Cavities) should be Sweet or sour in rasa (Cavities)
• Putting the Evidence as an Effect - In the case below, low appetite is the only evidence of cold given.
  • EG: "Aggravated cold => Weakened Agni (Low Appetite)" should be Cold, Weakened Agni (Low Appetite)
• Skipping a step in the progression of imbalance. This can be due to lack of understanding of the pathogenesis, an error or because we know the client very well. Check every (=>). Ask yourself, does what comes before the arrow directly lead to what I have after it? Always ask "why" and "how?".
  • EG: "Eating Pizza => Mobile in Majja (Increased heart rate)" should be Eating Pizza => Ama in GI (Gas & Bloating) => Vata in Majja (Increased Heart Rate)

Make the Flowchart as Specific as Possible

Don't be vague. Practitioners tend to be vague when they aren't completely clear on the cause / effect relationship. Or when they assume a cause or effect without working through the pathogenesis of the imbalance fully.

How to Avoid this Mistake

• Avoid using a dosha when a guna is more specific. Students who aren't yet clear on the type or exact mechanism causing a condition will broadly claim a dosha is aggravated, instead of using more specific gunas. Only label a dosha as a cause when fully understand how, where, why the dosha is aggravated.
  • EG Vata in Majja (Anxious) - This example doesn't prove Vata is the cause. Even kapha people get anxious.
• Remember, the qualities (gunas) are the building blocks. Bring the imbalance, causes right back to qualities at play for the most specific, useful pathogenesis chart.
  • EG: "Vata in Purisha (Hard Stools)" becomes the more accurate, useful, "Rough, Dry in Purisha (Hard Stools)"

Practice, Practice, Practice

Pathogenesis success comes from continuous practice and learning about imbalances, anatomy, and biochemistry.

1. Read about the condition, it's causes etc
2. Research the Ayurvedic perspective on these conditions, eg: via writeups, biocharacteristics research data, on Joyful Belly website.
3. Use this information to determine the biocharacteristics that are out of balance.
4. Create the most likely pathogenesis flowchart for this client, from what you know