Key Highlights

• CFIDs Case for Waypoint Heurisitc
• Tellier Waypoints Presentation

This webinar presents a practical clinical reasoning framework developed by Darren Tellier, an associate professor in the acupuncture program at MacEwan University in Edmonton, Alberta, with approximately 25 years of teaching experience and more than 20 years of clinical experience.

The central theme is how to make sense of complex, chronic, multi-system presentations without becoming overwhelmed by a long list of symptoms and differentiated patterns. Tellier describes a framework he calls the “Waypoint” model, which he developed largely through teaching students how to reason through difficult clinical cases.

The presentation is not intended to replace formal diagnosis or pattern differentiation. Rather, the Waypoint framework is presented as a triage, prioritization, and clinical reasoning tool that can be layered on top of conventional diagnostic processes.

1. The Clinical Problem: Complexity and “Polypathology”

Tellier begins with a problem familiar to experienced practitioners: some patients present with multiple overlapping complaints, chronic conditions, signs, symptoms, and pathological processes that seem to interact with one another.

He refers to this broadly as “poly-pathology”—complex presentations in which multiple pathologies or patterns coexist and become layered over time. For a practitioner, the difficulty is not necessarily identifying what is present. A complex patient may allow the practitioner to identify several plausible patterns quite readily.

The harder question is: Which of these findings actually matters most right now, and what should be treated first? Tellier observed this problem particularly among students. Even when students could successfully organize clinical information and generate several reasonable differential diagnoses, they often struggled to determine:

• which pattern was central. which findings were secondary. which findings were peripheral. which pathological process was driving another. whether several patterns were interacting. and how to convert the diagnostic information into a coherent treatment strategy.

In complex chronic cases, simply producing a longer list of diagnoses does not necessarily produce a better treatment plan.

2. Why Experienced Clinicians Handle Complexity Differently

One of the important educational observations underlying the model is the difference between novice and experienced clinical reasoning. Tellier describes experienced clinicians as having developed a large repertoire of clinical “scripts.” Through years of exposure to patients, experienced practitioners can often recognize meaningful patterns relatively quickly. New learners do not yet have this extensive pattern-recognition database. As a result, they tend to treat every piece of information as equally important.

A complex patient may therefore generate a reasoning process such as:

• symptom A → possible diagnosis;; symptom B → another diagnosis;; tongue finding → another pattern;; pulse finding → another pattern;; digestive symptoms → another pattern;; neurological symptoms → another pattern;; sleep symptoms → another pattern.

The result can be an increasingly long list without a clear hierarchy. 

Tellier’s teaching response was to give students a much simpler initial question: “Tell me three things about this patient’s presentation that you’re confident about.”

He subsequently structured those three things into three broad categories:

1. Deficiency 2. Disruption to flow 3. Pathogen

These became the foundation of the Waypoint model.

3. Why “Waypoints”?

Tellier borrows the concept of waypoints from navigation.

When navigating, a person needs reference points to determine where they are. Similarly, in a complex clinical presentation, the practitioner can use three broad pathological reference points to establish an initial position before determining the finer details.

The purpose is therefore not to create another elaborate diagnostic system. Instead, the Waypoints provide orientation. They help the practitioner move from: “There are 20 things happening with this patient.” toward: “There are three major pathological domains, and I need to understand how they are interacting.”

The framework is therefore explicitly presented as a heuristic—a shortcut or practical reasoning aid. Tellier emphasizes that it is not a replacement for formal pattern differentiation.

4. The Three Waypoint Categories

The model organizes complex presentations into three broad pathological clusters.

Waypoint 1 — Pathogen / Pathogen Accumulation

This includes pathological influences that may be:

• external;; lingering;; accumulated;; or generated secondarily by another pathological process.

Examples discussed include:

• wind;; heat;; cold;; damp;; phlegm;; and other forms of pathogen accumulation.

A pathogen may initially enter as an external influence but, under certain circumstances, become deeper or persistent.

Waypoint 2 — Deficiency

The second broad category is deficiency.

Tellier describes examples such as:

• Spleen Qi deficiency;; Kidney Yang deficiency;; Defensive Qi deficiency;; primary constitutional deficiency;; or deficiency that develops secondarily because another pathological process has persisted.

The important point is that deficiency is not necessarily simply an isolated “root.” It can participate dynamically in the development and maintenance of other pathological processes.

Waypoint 3 — Disruption to Flow

The third category concerns disruption, obstruction, or abnormal movement.

Examples include:

• Qi stagnation;; Blood stasis;; phlegm obstruction;; damp obstruction;; channel obstruction;; trauma-related obstruction;; counterflow;; and other disrupted or perverse movements of Qi.

Again, the category is deliberately broad. The objective is initially to recognize the presence of a meaningful disruption, rather than immediately attempting to differentiate every possible form of obstruction.

5. The Most Important Part: The Waypoints Interact

The major conceptual contribution of the presentation is that Tellier does not view these three categories as independent. Instead, they can form positive feedback loops in which one pathological process contributes to another.He describes three possible interactions.

Interaction A

Pathogen + Deficiency → Disruption to Flow

For example, a pathogen acting in the context of deficiency may eventually produce:

• stagnation;; obstruction;; phlegm;; Blood stasis;; or disrupted Qi movement.

Interaction B

Pathogen + Disruption to Flow → Deficiency

A pathogen combined with obstruction may eventually weaken the affected system.

For example, persistent obstruction may interfere with Qi and Blood movement and eventually contribute to:

• Qi deficiency;; Blood deficiency;; or other forms of functional weakness.

Interaction C

Deficiency + Disruption to Flow → Pathogen Accumulation

This is particularly important in the case presented. A deficient system that is simultaneously obstructed may fail to transform, transport, or regulate fluids appropriately.

This can create conditions for:

• damp;; phlegm;; retained fluids;; and further pathogen accumulation.

The result is a self-perpetuating cycle.

6. The Treatment Principle: Break the Cycle

This leads to the central treatment principle of the Waypoint model: Rather than treating all three pathological clusters equally, identify the two that are currently functioning as causal inputs and treat those first.

The third may then resolve as a downstream consequence. Tellier compares the concept to removing one of the elements necessary to sustain a fire. The practitioner does not necessarily have to attack every manifestation individually. Instead, the objective is to interrupt the feedback loop.

This changes treatment planning from: “How do I treat all of these patterns?” to: “Which two processes are currently sustaining the cycle?” That is the key clinical reasoning shift presented in the webinar.

The Case: A Complex Chronic Fatigue Presentation

Tellier applies the model to a complex case involving a 32-year-old female elementary school teacher with disabling fatigue that had persisted for approximately 14 months following an acute febrile illness. The case had undergone conventional medical investigation, with several significant conditions reportedly ruled out.

The initial illness included:

• acute fever;; sore and swollen throat;; tender cervical lymph nodes;; chills;; diffuse myalgia.

Although the acute illness was considered resolved, some symptoms persisted.

Over the following months, the patient developed a broader chronic presentation including:

• profound fatigue;; post-exertional malaise;; unrefreshing sleep;; cognitive impairment/“brain fog”;; substantial reduction in occupational and social functioning;; persistent throat irritation;; persistent cervical/supraclavicular lymphadenopathy;; limb heaviness;; numbness and paresthesia;; digestive weakness;; musculoskeletal symptoms;; poor sleep;; irregular menstruation;; and other systemic complaints.

The presentation was therefore multi-system and highly complex.

Conventional TCM Interpretation of the Case

When viewed through conventional TCM pattern differentiation, Tellier describes multiple overlapping findings.

These included:

• chronic Spleen Qi deficiency;; Defensive Qi deficiency;; lingering Wind-Heat;; Damp/Phlegm-Damp accumulation;; channel obstruction;; Qi stagnation;; and Phlegm clouding the clear orifices.

The tongue was described as:

• pale;; swollen;; with teeth marks;; thick/greasy coating;; with yellow and white elements.

The pulse was described as:

• floating;; fine;; bowstring;; slightly rapid;; soft/slippery, particularly in the right Guan.

The problem is not that these observations are clinically useless. Rather, there are so many potentially valid observations that prioritization becomes difficult.

For a student—or any practitioner facing a particularly complicated case—the obvious question becomes: “Which of these things do I actually treat?”

Mapping the Case to the Three Waypoints

Tellier then compresses the presentation into the three broader categories.

Waypoint 1: Pathogen Accumulation

The patient demonstrates evidence of a deep-lying, lingering pathogen following the original acute febrile illness.

There is also secondary phlegm/damp accumulation.

Clinical indicators include:

• persistent throat symptoms;; cervical and supraclavicular lymph nodes;; sticky/greasy tongue coating;; and other findings associated with phlegm and lingering pathogen.

Waypoint 2: Deficiency

The patient has pronounced deficiency, particularly involving:

• Spleen Qi;; Defensive Qi.

Supporting findings include:

• poor appetite;; loose/sticky stools;; profound fatigue;; lack of strength;; pale, swollen tongue;; and teeth marks.

The deficiency is viewed as more than simply another diagnosis. It is also part of the mechanism that allowed the original pathogen to persist.

Waypoint 3: Disruption to Flow

The case also demonstrates significant disruption or obstruction.

Examples include:

• throat obstruction sensation;; limb heaviness;; limb numbness and paresthesia;; puffiness;; cognitive fog;; and a slippery pulse quality.

The obstruction is therefore considered part of the mechanism maintaining the patient’s presentation.

The Timeline Is Clinically Important

One of the useful aspects of the model is that the relationships between the three Waypoints can change over time. Tellier describes a possible sequence in this patient: Initial phase

Pathogen + deficiency → disruption

The patient’s pre-existing deficiency allowed the acute Wind-Heat pathogen to lodge rather than resolve. The combination then contributed to obstruction.

Middle phase

Pathogen + disruption → further deficiency

The lingering pathogen and developing obstruction continued to drain the patient’s resources, deepening the deficiency. This contributed to persistent and disabling fatigue.

Current phase

Deficiency + disruption → further pathogen accumulation

The current dominant loop is viewed as the combination of:

• continuing Spleen/Defensive Qi deficiency; and; Qi-mechanism/channel obstruction.

Together, these contribute to additional phlegm and retained fluids. The persistent lymphadenopathy, increasingly greasy tongue coating, limb heaviness/numbness, and slippery pulse are viewed as manifestations of this evolving process.

Thus, the framework is not merely a classification system. It provides a way to construct a rough pathophysiological timeline.

Treatment Prioritization in the Case

Because the model identifies the current dominant interaction as deficiency + disruption → pathogen accumulation, Tellier chooses the first two Waypoints as the major treatment targets.

Primary treatment target 1: Deficiency

The strategy is to:

• fortify Spleen Qi;; strengthen/support Defensive Qi;; improve the underlying functional weakness.

Primary treatment target 2: Disruption

The second major target is to:

• rectify the Qi mechanism;; transform Phlegm-Damp;; reduce channel obstruction;; improve the movement of Qi.

Together, these two areas represent approximately 80% of the treatment emphasis in the example.

The Lingering Pathogen Becomes an Adjunctive Target

The lingering pathogen is not ignored. However, it is deliberately de-emphasized.

Tellier proposes maintaining a gentle approach to:

• resolving the lingering exterior pathogen;; clearing residual heat;; addressing phlegm;; and preventing the pathogen from becoming reinforced.

The example allocates approximately 20% of the treatment emphasis to this third cluster. The rationale is that aggressively attacking the pathogen in a significantly deficient patient may not be appropriate within this particular framework. The strategy is instead to change the underlying conditions that allow the pathogen and phlegm to persist.

Examples of Treatment Approaches Discussed

Tellier deliberately states that he is not trying to teach experienced practitioners which points to select. The points are presented as examples illustrating the weighting of the strategy.

For the deficiency component, examples include:

• ST36;; BL20;; BL21;; CV12;; SP6;; moxibustion;; warming needle;; ST36;; CV6.

This component represents approximately 40% of the treatment strategy.

For Qi-mechanism obstruction and Phlegm-Damp, examples include:

• ST40;; SP9;; Four Gates;; SJ5;; GB34.

Additional modalities mentioned include:

• gua sha;; flash cupping.

An important clinical consideration is that the patient is described as quite deficient and weak, so the approach should avoid unnecessarily aggressive draining techniques.

For the lingering pathogen, examples include:

• GV14;; BL12;; gentle local treatment around cervical/supraclavicular lymph-node areas.

The latter is described as involving:

• shallow insertion;; mild stimulation;; and limited treatment emphasis.

Treatment Is Expected to Evolve

The treatment plan is not intended to remain fixed. As the patient improves, the practitioner reassesses the relative importance of each Waypoint. The amount of treatment devoted to the lingering pathogen can be reduced further if indicators such as:

• lymph-node size;; tongue coating;; and frequency of throat flares

This reflects the underlying principle: If the first two Waypoints are adequately addressed, the third may resolve as a downstream effect.

What to Monitor Clinically

A particularly practical component of the presentation is the emphasis on specific observable markers. Rather than simply asking whether the patient “feels better,” the practitioner tracks changes associated with each pathological cluster.

Indicators of improving deficiency

Monitor for:

• improved appetite;; improved stool consistency;; reduced fatigue;; improved sense of strength;; reduction in tongue puffiness;; possible reduction in teeth marks.

Indicators of improving disruption

Monitor for:

• reduced limb numbness;; reduced limb heaviness;; improvement in throat obstruction sensation;; improved cognitive clarity;; reduction in the slippery pulse quality.

Indicators of resolving pathogen accumulation

Monitor for:

• decreasing lymph-node size/tenderness;; thinning of the greasy tongue coating;; reduced frequency of low-grade throat flares.

This creates a feedback mechanism for treatment planning. If the expected markers are not changing, the practitioner has information that can be used to reconsider the working model.

The Two-Waypoint Strategy

The webinar’s central practical takeaway can therefore be summarized as: Instead of treating every identified pathology:

1. Identify the three broad Waypoints.

Deficiency → Disruption → Pathogen

2. Determine how they are interacting.

3. Identify which two are currently acting as causal inputs.

4. Prioritize those two.

5. Treat the third more conservatively when appropriate.

6. Establish measurable clinical markers.

7. Reassess and modify the relative treatment emphasis as the patient changes.

The model is therefore fundamentally about prioritization rather than diagnosis alone.

Why Tellier Believes the Framework Is Useful

Tellier identifies several advantages.

It reduces diagnostic overload

A patient may present with a very large number of symptoms and possible patterns. The Waypoint model compresses this information into a smaller number of clinically meaningful domains.

It provides treatment prioritization

Formal differentiation may tell the practitioner what patterns are present, but it does not necessarily tell them which should receive the greatest therapeutic emphasis. The Waypoint framework specifically addresses that gap.

It focuses on process rather than a static snapshot

Rather than treating the patient’s current presentation as a fixed collection of diagnoses, the model asks: How are these pathological processes producing and sustaining one another?

It accommodates uncertainty

Tellier describes complex poly-pathology as inherently blurred. The framework allows the practitioner to begin working with a clinically useful model without pretending that every relationship can be definitively established.

Who Is the Framework For?

An important qualification emerged during the Q&A. Tellier does not consider the complete Waypoint model particularly useful for beginners.

For students, he finds the simpler question “Tell me three things.” more useful. The full model requires a foundation of diagnostic knowledge and clinical experience. Tellier suggests that experienced practitioners develop script recognition over years of practice. The Waypoint framework can then provide a way to organize and prioritize complex cases without abandoning that underlying expertise.

For a beginner, however, relying too heavily on the shortcut could potentially bypass the methodical process of learning formal pattern differentiation. In other words: The framework is intended to sit on top of clinical reasoning, not replace the development of clinical reasoning.

Cases Where the Framework May Be Particularly Useful

During the discussion, Tellier identifies complex chronic presentations as particularly suitable.

He specifically mentions examples such as:

• fibromyalgia;; polymyalgia;; prolonged illness following an acute infection;; complex cases involving both illness and injury;; and patients with long trajectories of poor recovery.

These are cases where practitioners can become overwhelmed by multiple events occurring over time. The Waypoint model gives the practitioner a way to establish an initial direction even when the entire history cannot immediately be reduced to one simple diagnosis.

Communicating the Treatment Plan to Patients

Another valuable clinical application is patient communication. Tellier suggests that he does not explain complex terms such as “poly-pathology” to patients. Instead, he describes the treatment process in terms of finding one or two meaningful “levers”.

The practitioner may recognize that many things are happening simultaneously, but rather than promising improvement in six or seven different areas, the practitioner identifies two or three domains that will be monitored closely.

This helps manage expectations.

For example, instead of suggesting that treatment will simultaneously resolve:

• fatigue;; sleep;; throat symptoms;; cognitive symptoms;; pain;; and multiple other complaints,

the practitioner can establish a smaller number of measurable objectives and then evaluate what happens. This makes the treatment strategy more transparent and provides clearer feedback about whether the chosen approach is producing meaningful change.

Reported Impact on Tellier’s Own Practice

In the Q&A, Tellier reports that the framework eventually influenced more than his approach to individual cases. He found that it helped him work with cases that other practitioners considered particularly complex. He also applied the same logic to his herbal practice.

Rather than attempting to give equal emphasis to numerous treatment principles, he described:

• selecting a smaller number of key treatment principles;; increasing emphasis on the most important herbs;; and reducing emphasis on less central components.

Thus, the Waypoint concept became a broader clinical workflow and prioritization strategy, rather than simply an acupuncture diagnostic exercise.

Reflective Practice and the Development of the Model

An important underlying theme of the webinar is reflective practice. Tellier explains that the model emerged indirectly from teaching. He was attempting to help students deal with difficult cases. In the process, he began examining his own clinical reasoning and asking:

• What am I actually looking for?; How do I recognize what matters?; How do I decide what to prioritize?; How do experienced clinicians navigate complexity?

Teaching therefore became a form of reflection on his own clinical expertise. He describes this as a particularly valuable aspect of teaching: the process of explaining clinical reasoning to students can reveal previously implicit aspects of one’s own practice.

Overall Clinical Message

The webinar’s central message is that complexity does not necessarily require treating every pathological finding simultaneously.

A patient may legitimately demonstrate multiple patterns, but the practitioner still needs to determine: What is maintaining the current cycle?

The Waypoint framework proposes that complex presentations can initially be organized into three broad domains: Pathogen ↔ Deficiency ↔ Disruption

These domains are not viewed as static or independent. They can generate and reinforce one another.

The practitioner therefore looks for the currently dominant interaction, identifies the two processes acting as causal inputs, and concentrates treatment on those two.

The remaining pathology may then diminish as a downstream consequence.