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Discovering your patients’ constitution is a core part of the diagnostic process in 5 element acupuncture. 

Without that knowledge your ability to personalize your treatments decreases and your patients won’t get the same results.

This process of constitutional diagnosis is unique to 5 element acupuncture; TCM, the dominant form of Chinese medicine in the US, does not use constitutions in its diagnosis and treatment process.

So let’s dive into what a constitution is, how it’s formed, how our constitutions affect us, and why it’s so important to treat at a constitutional level for your patients.

 

What is a constitution?

In 5 element acupuncture, constitution is a predisposition toward certain internal imbalances that are created by our primary and secondary elements, or the 2 of the 5 elements that we rely on the most.

These imbalances are the core of our physical, emotional, and spirit-based dysfunctions and they shape how we view the world. As a result, it’s super important to know our own elements as practitioners as well as the elements of our patients in order to treat these dysfunctions.

 

How is constitution formed?

Constitution is a blend of nature and nurture. Once formed, it’s with us for life.

Our primary element is inherited from our family. The primary element is the most likely element to become imbalanced because we rely on it the most, and it’s generally at the core of mental, emotional, and physical dysfunction for someone.

Our secondary element is a learned response to trauma, usually formed between the ages of 2-5 years old. Because we’re heavily influenced by our caregivers at that time, our secondary element is usually learned from their responses.

In Worsley 5 element acupuncture, he refers to constitution as CF, or causative factor, when speaking about the elements that influence someone the most.

 

Constitution… elements… are they the same thing?

I use the terms interchangeably as they both represent deep parts of our nature and a map to the inner self. Check this out to learn more about why constitutional medicine is such an important and effective tool to have in your skillset as a practitioner (and to know to look for providers who offer it as a patient).

 

How do the elements function together?

If your primary constitution or element gets super stressed and overwhelmed, your secondary element takes over. In the vast majority of people you’ll see their primary and secondary shine through together with the primary more prominent. If someone is really stressed, sometimes you’ll see their secondary element as dominant as it’s had to take over for the primary. 

If you’re unsure which element is primary, 5 element treatment will help things become clear. Secondary elements usually take longer to identify, but it’s very important to do so.

Treatment for a fire primary earth secondary person will be different from treatment for a fire primary wood secondary person. Folks with the same primary element but different secondary elements usually show up with distinct imbalances that are influenced by their secondary element. The secondary element imbalance needs to be addressed for comprehensive healing to occur.

 

How does constitution affect us? 

I like to think of a constitution as a filter through which we interpret ourselves and our surroundings. Every experience has to pass through this filter and is altered as a result. 

In other words, each constitution or element changes our perception of the world in a slightly different way. For example, a wood person whose core identity is about justice and progress is going to perceive the world and their interactions in a very different way than an earth person whose core identity is about cooperation and support.

 

Because our constitution is a filter, it doesn't represent our authentic selves. 

Constitution is largely a defense mechanism that protects us based on our own inherited and experienced core wounding.

As a result, constitution can get wrapped up in our ego, or our perceived sense of self, and bypass our authentic self. If we lack self-awareness and haven’t dealt with our core wounding, we tend to become preoccupied with defending ourselves because we feel vulnerable rather than having a healthy openness and receptivity to the world. 

For example, fire people’s core wound is that they don’t believe they’re loveable. They crave intimacy and the warmth of connection with others, but end up creating superficial relationships with many folks instead of deep, meaningful ones. Through these actions they keep their heart distanced and bypass the vulnerability needed to cultivate true intimacy. As a result, they continue to feel unloveable, creating a self-fulfilling prophecy around their core wound.

Metal people don’t believe in their own worth so they harshly criticize and judge themselves and others when their impossibly idealistic standards aren’t met so they can keep up the belief in their own worthlessness and hide it from others.

People can get locked into a cycle of reactivity when their elements are chronically out of balance. The more out of balance their elements get, the more intense someone’s defensiveness and more identified they become with their constitution or filter. People can spend years in these loops, acting as caricatures of their elements and lacking internal connection with themselves.

 

How can 5 element acupuncture help?

The goal of 5 element treatment is to balance our constitutions so we can see beyond them. 

When we become more balanced:

  • behavioral reactivity loops decrease
  • we start to see our pathological patterns and tendencies 
  • we recognize that our own behavior is keeping us from what we want the most 

5 element treatment puts us in a state of harmony with ourselves and nature, and in that state we have access to our deepest, most authentic selves. We become capable of living from this true place within us rather than from defensive behavior that protects our ego.

We’ll always be colored by our elements as they’re part of our inherent nature, but when we’re balanced and aware, we can choose when to engage in our elemental patterns and when not to. 

Another way of saying it is that balancing your constitution creates space between a stimulus and your response. It allows you the freedom to be yourself rather than to just react.

 

“Between stimulus and response there is a space. In that space is our power to choose our response. In our response lies our growth and freedom.”

—Viktor Frankl

 

When I speak with my patients about their constitution, I highlight that knowing it can: 

  • help them increase self-awareness so they have more agency in how they show up in the world
  • stop them from staying stuck in a cycle of defensiveness that holds up their personal growth 
  • give them new perspective on what matters most to them and how to cultivate that in their lives

All of these things lead to happier, healthier relationships and more fulfillment and satisfaction in life.

 

What about other constitutional medicines? How do they overlap with Chinese medicine?

Many cultures have a long tradition of constitutional medicine. The ayurvedic doshas and Hippocratic medicine’s 4 humors are great examples.

Each constitutional system is slightly different and is a valid way of interpreting the body, mind, and spirit. If you know multiple constitutional systems, you’ll have even greater insight into your patients and yourself.

For example, I love homeopathy, which is another form of constitutional medicine. There are certain remedies that tend to correlate with each of the 5 elements, and knowing my patients’ elements can help guide me to the correct remedy. When I know their remedy and their constitution, I have two methods of understanding their health and who they are. 

Layering constitutional medicines is always fascinating as a practitioner because you start to see more and more nuances of each patient’s uniqueness shine through. For example, a nux vomica wood person has a very different feel than a nat mur wood person, yet they both share the same primary element. 

This holds true with astrology as well. Astrological signs are a layer on top of the 5 elements that’s interesting to know. An Aries fire element person shows up differently than a Virgo fire element person.

Please note that the elements of western astrology are not the same as the 5 elements, even though several elements like fire, water, and earth, share the same name. The elements have very different correlations within each system.

 

How is constitution diagnosed?

There are three arms to 5 element constitutional diagnosis:

  • Color, sound, odor, and emotional correlations with each element
  • Behavioral cues
  • Physical characteristics
  • Energetic impression

All of these topics are complex and detailed and need to be studied in depth in order to become an accurate and effective 5 element diagnostician. If you’re interested in learning this skill set, sign up for the waitlist for my 5 element courses.

 

Why is it important to treat my patient’s constitution?

Constitution represents the core of who we are. As practitioners we must address the whole of our patients if we want to promote lasting healing, and because constitution is at the center of us, it’s also at the center of our health.

Environmental factors that TCM emphasizes like wind, cold, damp, and heat can be important, but typically in the Western world imbalances in health start internally when our elements become overly stressed and our mental, emotional, and eventually physical states are impacted.

5 element acupuncture’s strength lies in treating mental, emotional, and spirit-based issues, or the most common issues that result from imbalances in our elements. TCM’s strength is treating physically based issues. By integrating the two you can provide your patients with holistic, personalized, and more effective care than if you practiced only one of the two medicines.

To learn more about why balancing your patients’ elements improves their response to treatment, check out this blog.

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