Apr 20 2007
Constitution and Terrain
Will Cooper writes:
“By the presentation, prescribe the herbs” as being the rationale and foundation of Dr. Huang’s approach to treatment. Dr. Huang obviously has decided for himself what is meant by “presentation”, but do we know what the original author meant by that use of the word?
In a sense, yes, it is “root.” I was talking with him the other day, and told me about an insight he had at one point. That what originally he was seeing as “symptoms” in a patient was not really “symptoms” at all. It was just who they were.
Let’s take for example a “gui zhi” constitution person. They tend to have fair and fine skin, generally are thin and wispy, they are prone to stomach aches, they tend to sweat easily.
Now, you can look at their tendency to sweat and think “qi deficiency” or you could look at it and think “gui zhi people, they just are like that.”
…a more Japanese concept of the root is, “the root of the person, i.e., the background of who they are”, and that being resonant with the French concept of “terrain”, as being the background of who someone is as well. I remember when Volker Scheid was visiting us at SIOM, and he worked people up, it seemed that he utilized this approach also.
When he worked me up, he saw me as a “yang ming” type constitution, for example, and he used this ‘lens’ or perspective of what sort of constitution/terrain I had to then view my signs/symptoms/complaints, which then informed the herbal prescription he gave me.
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Yes, I think Dr. Huang is looking at it more like this.
Constitution, or as is said in Chinese 體質 (tî zhì), or the French concept of Terrain. If we use that lens to view our patients illnesses (or health for that matter) we come up with a different picture. It is another way of looking.
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Gui zhi people have a tendency to get sick in a certain way. Their illness tends to be different from, say, a shi gao person. Where this gets interesting is when the gui zhi person gets sick like a shi gao person, then you know you have an unusual problem on your hands.
I think one of the contributions of Dr. Huang’s work is bringing this concept of constitution, and its affinity toward the function of key herbs, into play.
Actually, there is a triangular relationship that he uses. It involves Herbs, Person (constitution), Illness. But, more about that in another post!
2 responses so far
Yes!! I’ve been thinking a lot about this recently. I have been getting the sense in my brief time practicing that there is value in figuring out what kind of person the patient is, in regards to herbs and acupuncture. I have already had experiences where the signs and symptoms point to a pattern differentiation, but where the treatment that works is completely different from what you might first expect.
Just briefly — I have a patient who was suffering from severe “stomach duct pain” with no observable cause (no GB or pancreas involvement, and no signs of gastritis). She had been diagnosed as GB / ST disharmony d/t the symptoms and a thin wiry pulse. She was prescribed Xiao Chai Hu Tang and Si Ni San combined but with little effect. I initially tried using this same approach adding blood breaking and qi rectifying herbs, but with similiarly little effect - the sharp severe fixed pain continued to come back.
So I had to take a few steps back and look at her as a whole person. She’s strong / robust physically. When she has symptoms of illness, they tend to affect her digestion - diarrhea mainly - and she always has lots of belching. Indeed, her entire family loooooves to eat, and belch. In addition, she sweats profusely, but mostly along her Stomach channel on her legs. Her tongue is sl. red, with a thin yellow coat, and when she is in pain, her pulse slows and tightens considerably, to about 50 BPM.
The next episode of pain occured, and this time she had pronounced glomus and smelly diarrhea, again with a very slow pulse. This made it more clear. I prescribed Da Cheng Qi Tang - the glomus and diarrhea were gone within a day, but just below her ribcage was still very uncomfortable. I prescribed Bai Hu Tang for one week, and all symptoms disappeared, including the slow tight pulse. It’s been a few months, and the pain has not recurred.
I remember reading a line in the SHL equating a certain kind of slow pulse with a heat bind pattern. But mostly, I think of her as a yangming type of person.
My son is the same way - physically robust, loves food and eating, reacts strongly to food in general, has the tightened corners of the mouth that Dan Bensky describes in yangming types, and his problems respond to formulas that clear yangming excess.
david
David
This is an interesting point your bring up, that sometimes treats that look like they should work, just don’t. Or, something odd is what does work. I look forward to getting more of this material into English, so we can look and see if there is some kind of constitutional aspect that might be playing a role here.
This case you mention, where you used the Bai Hu Tang, makes sense, especially if the person is a shi gao constitution. the kind of sweating you mention certainly makes me think they might be.