Modern medicine and yoga have different ways of deciding on treatment. In conventional medicine, whenever possible, we try to make a diagnosis first. Once the diagnosis is made, appropriate therapies can be prescribed—ideally ones that don't just ameliorate symptoms but that get at the underlying cause. This isn't always possible, of course, but that's the theory.
In therapeutic yoga, we learn to observe individual students with care and attention and then formulate a plan of action based on what we see. Indeed, two students might have the identical medical diagnosis—say, breast cancer—but a teacher might recommend very different approaches based on their overall fitness, other medical conditions, energy levels, time available to practice, prior yoga experience, and a host of other factors. And good teachers also learn to modify their students' regimens depending on what else is going on in their lives. Whatever your long-term plan, you might need to temporarily alter your approach if your student has just sprained an ankle, has come down with a cold, or is going through an unusually stressful period.
The Yogic Diagnosis
In yoga therapy, we aren't treating the diagnosis so much as we're treating the student with the diagnosis. Even in instances when tests are inconclusive and the doctors can't explain your student's symptoms, there still may be yogic tools that will help. You might notice, for example, that a particular student doesn't breathe well but instead takes quick, erratic breaths mostly into the upper chest. Teaching such a student slow, deep, mindful breathing might improve her well-being and potentially benefit a wide variety of medical conditions.
Similarly, you might observe dysfunctional postural habits, muscle tightness or weakness, difficulty with balance, or a lack of "felt sense" (poor proprioception), all of which could be helped by various yogic tools, particularly asana. Other students, you might conclude, could benefit from a regular restorative practice, guided visualizations, or seated meditation (in fact, research on mindfulness meditation suggests that it helps patients largely independent of diagnosis).
One advantage of some traditional medical approaches such as Ayurveda and Chinese medicine is that they can detect imbalances before they manifest in full-blown disease. Thus practitioners can often provide effective treatment even when no precise Western diagnosis can been made. Ayurveda's system of looking at imbalances of vata, pitta, and kapha can be particularly useful for yoga teachers, due to Ayurveda's and yoga's shared history and philosophical basis.
Consider an illustrative case: A yoga therapist I know was asked by a local hospital to see a woman with schizophrenia. Even though she's an experienced teacher and therapist, she'd never treated anyone with that condition before and had never read anything about how to approach such a student with yoga. With some trepidation, she agreed to see what she could do.
When the woman arrived for her first appointment, the teacher could see that she was fidgety, had difficulty paying attention, and that her gaze was moving all over the room. Based on these and other clues, the teacher concluded that the student was showing signs of vata derangement. She prescribed a regimen to try to ground the student using standing poses and other yogic tools, and they proved so helpful that now the hospital is referring several other schizophrenics to her. Some of these other schizophrenics, by the way, appear to have a vata imbalance and some don't, so she's adjusted her approach accordingly.
When the Diagnosis Isn't Known
While it's possible to help a student without knowing precisely what the student has, it still can be useful to know his or her diagnosis. For one thing, it can help you anticipate and avoid potential contraindications. So if you know that a student has diabetes, you'd be sure to have him cleared by an eye doctor before you allowed him to do inverted poses such as Sirsasana (Headstand) and Sarvangasana (Shoulderstand), since this student runs a higher risk of a retinal hemorrhage. When the diagnosis is unknown, all you can do is base your approach on what you observe and what your students report to you when they try the practices you suggest—always erring on the side of caution.
In the case of rare medical diagnoses, learn what you can from medical reference books, the Internet, or the students themselves (who sometimes are extremely well informed). Some conditions are rare enough that even physicians may not know much. When you don't know the cause of your students' symptoms, encourage them to follow up with their doctors to be sure something serious, and potentially treatable, isn't being missed. Often symptoms either disappear over time or progress to the point that a diagnosis can be made. Either way, in the meantime, your student will have been benefiting from yoga.
Dr. Timothy McCall is a board-certified internist, Yoga Journal's Medical Editor, and the author of Yoga as Medicine: The Yogic Prescription for Health and Healing (Bantam). He can be found on the Web at www.DrMcCall.com.