Traditional healing systems from around the world incorporate constitutional medicine into their theory and practice.
Great examples are the three doshas of Ayurvedic (traditional Indian) medicine, the 4 humors of Hippocratic medicine, and constitutional homeopathy.
Each dosha, humor, or homeopathic remedy represents a different temperament that gives healthcare practitioners information about the personality of their patient, the most likely bodily systems to be affected by their temperament, what kind of weather their patient is likely or unlikely to be able to tolerate, foods that are helpful or damaging for them, and more.
In other words, constitutional medicine contextualizes the health issues we find in our patients within a larger organizing principle that provides a roadmap for comprehensive and personalized treatment.
Constitutional medicine allows us to start with the big picture of someone’s health and see all of someone’s symptoms and syndromes as interrelated. It views the body, mind, and spirit as an integrated whole where an imbalance in one area will affect the rest of the system.
This is in stark contrast to modern Western medicine which parses and treats the body by symptoms and neglects the mind and spirit.
Chinese medicine has its own constitutional medicine system in the 5 elements
Each constitution is made of 2 of the 5 elements of wood, fire, earth, metal, and water that we rely on the most.
The larger organizing principle behind the 5 elements is the natural world. We can look to nature to understand our health, relationships, and personalities because the qualities of qi in nature are the same qualities that are within us.
Unfortunately, the vast majority of acupuncturists in the United States aren’t taught the 5 elements in any depth. Instead they’re given a watered down version and the bulk of their education is in something called TCM or Traditional Chinese Medicine (which by the way, isn’t traditional at all).
Why is constitutional medicine so important?
Understanding these temperaments or constitutions provides practitioners with:
- a roadmap to the inner world of their patient
- unique insight into diagnosis, treatment, and prognosis
- the ability to personalize medicine in a way that we don’t see today in modern Western medicine
For example if a patient has a headache or a stomach ache, in the Western medical model the pain and discomfort are treated virtually the same way for anyone with these ailments. Analgesics are given for pain and it’s likely that an acid blocker is given for a stomach ache. Rarely does investigation into why these things are occuring take place.
In constitutional medicine, the constitution of the person, or their inherent nature, comes into play. In 5 element theory, constitutional imbalance represents the most fundamental imbalance that can occur for someone. As a result, it’s often the root cause of health issues and treating it will help to rebalance the entire system.
Headaches and stomach aches have different qualities and correlations associated with each constitution and those inform which treatments are going to be the most effective for that particular person.
Let’s take a look at how a headache could potentially be treated by incoporating constitution into an acupuncture treatment.
Wood Element Example
Typical presentation:
- The headache likely starts in the occipital region and might radiate into the temples or behind the eyes, following the gallbladder channel which is one of the organs associated with the wood element
- Most likely brought on by stress and overwork
- The patient may be very irritable as a result of the pain, especially if it’s preventing them from accomplishing tasks
- The headache is made worse by wind
Typical treatment:
- Balance their wood element in addition to doing local pain points for muscle tension
- Add points like GB 34 and Du 8 that address connective tissue tension throughout the body as the tissue of the wood element is connective tissue
- Encourage the patient to move around more, maybe even to moderately exercise to help break up stagnation as the liver (a wood element organ) hates feeling stagnant
Earth Element Example
Typical presentation:
- More diffuse pain and a feeling of foggy headedness, disconnection from their body, and heaviness of the head
- Pain can be located over the cheekbones or maxillary sinuses as the stomach meridian runs through this area (stomach and spleen are the organs of earth)
- Emotionally they’d be worried about inconveniencing others when they’re not feeling well and might start to ruminate on that thought
- Dampness makes the headache worse
Typical treatment:
- Balance their earth element
- Points to drain damp like ST 40 and SP 9
- Consider a local point like ST 3 for sinus pain if present
- If rumination is present consider Ren 12 (front mu of the stomach)
- Encourage them to rest as more activity will likely drain them or to get a massage since the tissue of earth is muscle
As you can see, these two headaches are treated almost entirely differently based on the patients' constitutional elements.
This is the beauty of personalized, root cause medicine: more effective and applicable treatments that create better results
Some personalization can be done with TCM in that it can address climatic factors like heat, damp, cold, wind, and dryness if those play a part of the patient’s headache picture. If not, local and distal pain points will be used as well as general TCM syndrome protocols that address symptom patterns.
But when there are mental, emotional, and spirit-based aspects to your patient’s issues, the 5 elements are much more effective at treating those levels of being in your patient.
These aspects of health are severely undertreated in the Western world and are often the root or part of the root issue for patients. When left unaddressed, these deep patterns of emotional and spirit-based struggle become ingrained and start to appear as physical symptoms.
It’s vital to look beyond TCM-based syndromes for our patients’ best health outcomes
The deeper we can go with the personalization of our medicine the better. We can start to ask why syndromes like liver qi stagnation, spleen qi deficiency, and kidney qi deficiency are always present for someone.
If we only treat at the level of these syndromes we’ll see a constant recurrence of symptoms. Patients may get better in the short term, but will eventually relapse.
Constitutional medicine, including the 5 elements of Chinese medicine, is about getting to the root cause of disease for your patient and is crucial for improving patient outcomes.
It’s an elegant and time honored way to understand your patients and provide them with comprehensive care that’s unique to them.
TCM is not constitutional medicine but it integrates beautifully with 5 element acupuncture, as not so long ago they weren’t separate.
If you’d like to learn more about what an individual constitution is in Chinese medicine, check out this blog.
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