The Importance of Considering the Constitution in Treatment
By Gary Wagman, LAc
In clinical practice, we may wonder why a particular formula isn't working well, despite our carefully planned herbal strategy. Treating wind heat or wind cold, for example, might seem straight-forward.
Yet cold symptoms occasionally get worse after the patient drinks an herbal formula. There is more than meets the eye when it comes to understanding the complexity of the human body. What may seem obvious on the surface actually can be the reflection of an opposite disregarded energy, internally.
In my student days, due to my frail constitution, I tried several different herbal formulas. My seniors and classmates would take my pulse, ask a few questions and then mix me up a formula. My symptoms would fade as time went on, but my digestion and bowel movement always was affected. After a period of time, however, the symptoms for which I was getting treated also came back. In my third year of study, I received a formula from a professor who was visiting from the Orient for a short time. The formula seemed so far removed from my symptoms that I was reluctant to take it at first. The formula was ban xia xie xin tang. This is a complex formula which treats a mixture of heat in the upper body and cold in the lower body. For me, it was the answer not only to sensitive digestion, but to quickly resolving my other symptoms.
My decision to study under the above-mentioned professor led me to Korea, where I studied a medicine called Sasang constitutional medicine. This medicine focuses on one's inborn zhang-fu strengths and weaknesses. Before administering my formula, my teacher inquired thoroughly about my tendencies, including those of my childhood. My teacher came to the conclusion that I was born with a weaker digestive system and that my weak organ from birth was the spleen. By using my kidney (my body type's stronger organ) energy to strengthen the spleen, I was able to overcome other symptoms, which surprisingly revolved around digestion. It became apparent to me that digging deeper and finding more about our clients helps us uncover their constitution.
Symptoms, according to Sasang medicine, are only a manifestation of what exists internally. Even in an exterior wind cold situation, we need to treat the internal deficiency as well. On the other hand, even when zhang-fu energy is weakened, we need to strengthen the exterior as well. Nothing in the body exists in isolation. Even when a patient exhibits extreme heat signs exteriorly, they might be extremely cold interiorly. My body type also is born with a cold constitution. Even if someone with my body type has red-hot inflammation of the joints, fu zi with other warm-property medicines can be used (in some situations). For those with a cold constitution, heat symptoms usually are a result of cold pushing heat out to the exterior. Using such medicines can produce remarkable results if administered correctly.
In writing this article, I wish to express how looks might be deceiving and the importance of treating our patient's whole system, whether we practice Sasang medicine or not. After one obtains a depth of knowledge of the basic formulas, it is necessary to modify each one according to the individual's constitution. While we are in front of the patient, we need to make every effort to get to know them, not just their symptoms or what is happening in the present. For example, if a patient was born with weak kidney qi, then treatment of the kidney qi might be necessary, even if they exhibit a wind-cold excess pattern. In order to discover such a situation, one may need to ask questions about a patient's childhood as well.
Herbs, just like humans, have their own constitution. Each herb has its own unique smell, taste and appearance. When administering each herb, we have to be aware of its own uniqueness. Sheng di huang, for example, is dark, thick and heavy, compared to other herbs that cool the blood. Therefore, we might use this herb for those who have a thin and lighter constitution. Also, because of its heaviness, sheng di huang can be used to treat blood heat due to yang stagnation in the upper body, by encouraging it to sink downward. Matching the constitution of each herb with the constitution of the body can be very challenging, but extraordinarily beneficial.
Whether it is herbs or patients, the theory is the same. The more we know about the nature and individuality of the herb or patient, the better we can treat them. Each body type may exhibit the same exact symptoms and yet be treated in totally different ways. Symptoms can be very deceiving. By taking into account one's innate inclinations, the treatment focus becomes more accurate and efficient.
Gary Wagman graduated from Emperor's College of Oriental Medicine and studied Sasang medicine in Korea at Daejeon University. He currently works full time at Harmony Acupuncture and Herbs in West Linn, Ore.