30 minutes for the first consultation; subsequent consultations are usually 15 minutes or so to check on the response to the first herbal prescription and make any necessary alterations or adjustments.
A change of prescription is almost always required after a certain amount of time has passed, due to several reasons:
a) As some symptoms clear up, others may then appear more prominent (eg if constipation was originally a major factor but the bowels become regular, or where there were several different types of pain involved at first, but following herbal treatment only a single type of pain remains which then requires a change of herbs to address).
b) The body habituates (becomes used to) a prescription that originally worked well. This tendency is the bane of those who only have a single treatment for endometriosis: it may indeed work well for a while, but then ceases to help. The reputation for the great effectiveness of Chinese medicine rests squarely on its flexibility there are many approaches to treatment, and if one begins to be less helpful, another is designed to maintain progress.
c) Circumstances change. These circumstances can be as crucial as grief or increased workplace stress, or as ‘peripheral’ as seasonal change, for example if a patient is temperature or weather-sensitive.
What does a consultation involve?
Thorough questioning about symptoms, for example details of periods; the nature, location, and timing of pain; ‘unrelated’ symptoms such as state of energy, digestion, and sleep; then examination of the pulse and the tongue.
There is no internal examination.
Details of Western examinations performed so far are required. Patients are often surprised at the detailed questions and the level of bodily awareness expected of them (this awareness grows as one learns what to look for). The reason for these detailed questions is that Chinese medicine diagnosis is based upon how you feel and how you look, rather than blood tests or tissue samples.
Therefore it is quite important to notice and report sensations as accurately as possible. Herbs for pain in the central lower abdomen, for instance, are different than the herbs for pain on the sides; and again herbs for a stabbing type of pain may not work for dragging heavy ache. In another situation, if one notices (for example) that lower backache only occurs together with constipation, this observation can usefully shorten treatment time if recalled and mentioned at the consultation.