To aid in recalling all the different paintings, a medicine man will refer to pre-painted drawings on muslin. The drawings are called picture writing by the Navajo. They are always incomplete, but incorporate the symbols and images that appear in the sand paintings and are painted with the same earthen pigments that are used for sand paintings. 

The patient, in traditional Navajo medicine, sits in the middle of a painting drawn with earthen pigments on the dirt floor of the Hogan by the medicine man. The healing ceremony chant, can last 9 days, and involves a score of different sand paintings drawn in the dirt and then erased.