Anybody who looks and knows it is to be called a spirit; anybody who listens and knows it is to be called a sage; anybody who asks and knows it is to be called an artisan; anybody who feels the vessels and knows it is to be called a skilled workman.
— Nanjing: Sixty-First Difficult Issue

Constitutional Type
Man receives the decree of heaven (ming), and therefore is loftier (than other) creatures.
— Dong Chongshu

Heaven, in conferring destiny on humans, has cast us as mediators between heaven and earth, making us one of the three primal powers in the universe. Although heaven may will a unique nature for each of us, it is not certain that each individual will be true to this nature and manifest destiny. Just as the dao loses its original nature of unity to give birth to the “ten thousand things,” so too do we humans fall from our original nature as we gain self-consciousness. The concept of constitutional type provides practitioners with a window deep into their patients’ being that helps illuminate both the nature of their destiny and what blocks its expression.

Constitutional type is one of the features that distinguishes Chinese medicine’s complement to the practice of Western medicine. Inherent in the concept are the very deepest traditions of Chinese philosophical and spiritual thought as well as the worldview of the more modern holographic paradigm. In this chapter I trace the origins of constitutional type and discuss its relevance to Chinese medicine as a modern science of the human condition. I show how constitutional type provides a framework for both assessing the quality of humans’ destiny and guiding them back toward the full self-expression that is synonymous with health.

The dao as unity is always present at the heart of each thing, and, in each moment, it continually falls from, and spontaneously returns to, its original nature. This rhythm is both the heartbeat and breath of life. The motion of the dao, eternally moving away from and returning to itself, is the ever-present cause that lies at the heart of all creation. By centering our “self” and shutting off the senses, we are able to return immediately to the truth that lies in heaven’s heart. Meditation is the symbolic act of closing the seven holes in our head and returning the primordial influence of dao to our life.

The dao as the primary cause is not a “cause” in the sense used by modern science, however, which views time as linear and thus claims a cause must always precede an effect. Chinese medicine, in contrast, proceeds by synthesizing a picture out of all the information present in a given moment.

Cause is not seen as a past event but rather as that which ties together and generates every event. Clinically, this “cause” is the patient’s constitutional type, which “colors” the spontaneous expression of dao as it unfolds in each individual’s life, contributing simultaneously both the nature and the nurture of the individual. This cause may be described as each person’s reason for being. In this sense the term “cause” may be viewed as that “cause” for which we work in life. It is the purpose (zhi) that lies in each human heart, placed there by heaven at conception. Acting in a way that is consistent with our innermost purpose constitutes the fulfillment of destiny.

Every novel, from the first word to the last, has a central theme around which the plot is organized. In a similar fashion, the events of human life are organized around a theme that ties the moment of conception to the moment of death. This is the thread of individual destiny that weaves together the “fabric” of each human life and lies at the heart of each individual’s constitution. The theme around which our life unfolds is organized in a way that is both knowable and therapeutically useful to the practitioner of the internal tradition. The concept of constitutional type allows the practitioner to know the nature of the thread of dao as it is uniquely present in each patient. This is not to say that the practitioner knows the precise destiny of each individual. That corresponds to the eternal dao, which always eludes our knowing. This principle is addressed by the Dao De Jing, Chapter 14, which tells us that the dao may be looked at but not seen, listened to but not heard, and grabbed yet ever caught. A system such as the five elements affords us a glimpse into another’s true nature and destiny, yet this is not to be equated with fully knowing the destiny of another. We may know the quality of a patient’s inborn nature but the ultimate truth of their being cannot be arrived at, for that is known only to heaven.

Rather, constitutional type provides a framework for looking ever onward toward that “light” which burns in each person’s depth so long as life exists. We are reminded by Han Feizi (280 b.c.e.) that “[t]he enlightened ruler holds fast to the beginning in order to understand the wellspring of all beings.”
Just as the central theme of a story never changes from the first word to the last, so too does individual constitution remain the same throughout life. Although the theme may never change, the plot may be transformed from one of disharmony to one of harmony. This transformation is the aim of the traditional practitioner. The pristine purity of dao, always present at the patient’s core, must be the aim with the placement of every acupuncture needle and the prescription of every herb.

The Sheng and Ke Cycles
Think of the twelve functional relationships that constitute the dynamic web of the sheng and ke cycles as a chain. The patient’s constitutional type is
the weakest link in that chain. Therapeutically, if everything is done to strengthen the other eleven links, it is analogous to focusing therapy on only the symptomatic expressions of, and compensations for, the underlying weakness. If the weakest link is not addressed, then, despite other actions, nothing has been done to strengthen the chain. By first addressing the weakest functional link as the focus of treatment, the other functions may stop compensating for its aberrant behavior. Treatment must be addressed toward the whole, but with an emphasis on the patient’s constitutional element, which is the common thread of imbalance that touches each function.

Constitutional Diagnosis as Family Therapy
Family therapy addresses the functional dynamics of a group rather than focusing intervention on a given individual who exhibits the most obvious behavioral problems. For example, a child may be underperforming in school and beginning to be a discipline problem. Rather than focusing intervention on the symptom and disciplining the child, it might prove more fruitful to examine the functional dynamics of the entire family. Should it be determined that the mother is an alcoholic, focusing therapy on her drinking problem might improve the child’s well-being more than any intervention aimed directly at the child. To focus treatment on the child’s symptoms would only result in a long gradual decline in the child’s situation with greater disciplines being needed and eventual involvement in the legal system. But therapy that addresses the mother’s behavior will touch the root cause of the imbalance.

This example illustrates the mother/child relationship, which is of great importance in the five-element tradition. It states that when symptomatology is seen in a given element, it is frequently the element that precedes it on the sheng cycle that is the root cause of the imbalance and often corresponds to the patient’s constitutional type. The notion of constitutional type allows the practitioner of the inner tradition to see past symptoms toward the primary cause of all imbalances, which is the constitutionally destined tendency of each individual to forget the true self and to neglect the fulfillment of life’s purpose.

The twelve officials may be conceived as constituting a family of interrelated functions. So long as each family member does his or her assigned job efficiently, harmony in the personal household of being is maintained. However, as soon as one member fails to perform adequately, the entire balance on which peace in the home depends becomes compromised. The practitioner’s task is to determine which official stopped working first and is therefore the root source of all imbalances and symptoms. Every other clinical sign and symptom in every aspect of being is understood to be a secondary compensation for the failure of the constitutionally weak official to perform its function.

Consider a home in which twelve individuals live, each possessing a particular responsibility for running the household. One person is in charge of taking out the trash (large intestine), one cooks the food (stomach), one makes the plans (liver), one coordinates all activities (heart), and so forth. Life progresses smoothly until one day the large intestine, rushing to an appointment, neglects to pick up an empty soft drink can from the table and deposit it in the trash. Noticing that the large intestine has failed to perform its function, the stomach, busily cooking at the stove, obliges by taking a moment to walk to the table and deposit the can in the garbage where it belongs. The stomach is only too happy to do this because it likes the large intestine and, after all, it is only one can.

The moment the stomach expends its qi to support the poor function of the large intestine, a dysfunctional relationship is established that will eventually undermine the balance of the entire household. The time spent throwing away the solitary can is not spent by the stomach fulfilling its own function of cooking. Further, because another official performed the large intestine’s job, the large intestine itself was disempowered, and in fact reinforced, not to fulfill its function appropriately in the future.

Noticing the following day that the can had been thrown away, the large intestine rushes out of the house and leaves a bag of garbage in the kitchen. The stomach realizes there will not be room in the trash for refuse after the next meal and so once again obliges by putting the trash out at the curb.

This scenario progresses until eventually the large intestine is not performing its function at all. The stomach is now exhausted from both having to cook and take out the trash and, in disgust at having to cater to everyone else, stops cooking entirely. Now everyone in the home becomes distressed and the heart, in charge of coordinating all activities, calls a family meeting. Everyone is hungry and outraged at the stomach for failing to perform its function of cooking, and the large intestine sits quietly in the corner. The gallbladder demands justice and screams unrelentingly at the poor stomach.

An outside observer seeking to remedy this situation might be inclined to focus intervention on the member in the room who is screaming the loudest, in this case the gallbladder. Extending this analogy to the realm of medicine would entail treating the physical symptom that the person complains about the most (for example, treating the headache generated by the gallbladder’s shouting in response to the current stress). A more astute observer might discern that all shouting in the room is directed at the stomach and infer that by aiming therapy at that organ, peace will be restored. We could consider this situation analogous to treating an underlying symptom that is thought to generate the primary complaint. For example, we might treat a person’s headaches by addressing the digestion if we thought poor digestion was contributing to the genesis of the symptom.

The notion of constitutional type allows the subtlest practitioner to see past the current situation and all secondary compensations back toward the root of the problem. By supporting the function of the large intestine, the official that stopped working first, the stomach will be supported to once again begin cooking, and every other official will be empowered to cease compensating for the underlying primary imbalance. In this way not only will the patient’s headaches subside, but improvement will be seen in every functional domain of life as well.

This article is abstracted from Lonny’s book, Nourishing Destiny: The Inner Tradition of Chinese Medicine available on the web at Spiritpathpress.com.

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