What Is Sasang Constitutional Medicine (SCM)?

Posted by Sam’s Acupuncture Clinic

 

SCM is a unique traditional Korean therapeutic alternative form of medicine. Based on the Yin and Yang theory and on Confucianism, humans are classified into four constitutions.

These differ in terms of 1. Sensitivity to a certain groups of herbs and medicines, 2. Equilibrium among internal organic functions, 3. Physical features, and 4. Psychological characteristics.

Historical Background

Prior to the introduction of SCM, the concept of the constitution in the discipline of OM was first mentioned in Chapter 72 of LingShu of Inner Classic as five body types such as Greater Yang type, Lesser Yang type, Greater Yin type Lesser Yin type and Yin-Yang balanced type. But the concept was not practically used for treatment.

Lee, Jema, a devout Neo-Confucian, the mind-body interaction concept in SCM. Lee, Jema was based on the four Neo-Confucianism moral concepts Benevolence, Rightness, Propriety and Wisdom. His observation implied that the adverse response of the human body to a specific medicinal herb was not temporary but congenitally influenced. He also emphasized the mutual interaction of mind and body in a whole as the crucial point of human physiology and pathology.

Lee, Jema created SCM theory, classifying human beings into four constitutional types: Greater Yang (Tae Yang), Lesser Yang (SoYang), Greater Yin (TaeEum), and Lesser Yin (SoEum), and developed systematically unique physiological, pathological, herbal pharmacological, dietary and mind-body-related theories. For example, SCM uses the same medicinal herbs found in Traditional Chinese Medicine (TCM) but they operate on a different principle based on a constitutional perspective.

Constitutional Physiological Principles of SCM

TCM describes the human internal visceral system, which consists of two groups, zang and fu viscera, based on the concept of the five elements of the material world: fire, metal, wood, earth and water. The zang viscera include the heart, lungs, liver, spleen, and kidneys; they are in mutual relation to the corresponding fu organs, such as the small intestine, the large intestine, the gall bladder, and the stomach, and the urinary bladder, respectively. By the rule of the five elements, the proper functioning of zang and fu viscera in an interactive circular principle maintains the balance between Yin and Yang in the human body, the essential condition for health.

SCM excludes the theory of the five elements and considers the human internal visceral system differently. Even though the visceral theory of SCM uses the same terminology found in TCM, they have different meanings. SCM regards the heart as the king among the viscera, which is equivalent to the mind. Departing from the visceral theory in TCM where viscera are assigned in pairs, zang and fu, SCM assumes a theory of visceral groups: The lung, kidney, liver and spleen groups. The lung group includes lungs, tongue, esophagus region, ears, brain and skin. The spleen group consists of spleen, stomach, breasts, eyes and tendon. The constituents of the liver group are the liver, small intestine, nose, lumbar region and muscle. The kidney group has the kidney, large intestine, urethra, bladder, mouth and bones.

Among these groups, it Is believed that specific inter-regulatory relations are present between specific pairs of visceral groups. As such, visceral groups are classified into two pairs: one consists of the spleen and the kidney group, and the other is composed of the lung and the liver group. The relation in each pair of visceral groups is compared to the balancing state of a seesaw. In this respect, a hyperactive state of one group leads to a relatively deficient state of its counterpart.

Physiological Functions of Visceral Groups and the Key Features of constitutional Types

According to SCM, the spleen group is in charge of the intake of raw materials such as food and drink, whereas the kidney group regulates the process of waste discharge, including bowel movement and urination. The functions of the lung and liver groups are described as dealing with critical bodily substances, including the Qi and body fluid. Within this perspective, the lung group is in charge of the process of consuming Qi and body fluid, whereas the liver group is responsible for the process of producing and storing these inner substances.

According to the perspective of SCM, most of the humans have a tendency of skewed state in terms of the seesaw balance between the visceral groups of the specific pair: the lung-liver pair and the spleen-kidney pair. Based on a skewed equilibrium of these visceral group pairs, SCM classifies human beings into four constitutions: TaeYang type (Greater Yang person-TY), SoYang type (Lesser Yang person-SY), TaeEum type(Greater Yin person-TE), SoEum type(Lesser Yin person-SE)

The TY type has a hyperactive lung group and a hypoactive liver group that manifests a state of strong consumption and weak storage of Qi and body fluid. In contrast, the lungs of the TE type are hypoactive, whereas the liver of this type is hyperactive. As such, the TE type is characterized by a state of weak consumption and strong storage of Qi and body fluid. The SY type has a hyperactive spleen group and hypoactive kidney group, which leads to a consistent state of strong raw material intake and weak waste discharge. In contrast, the SE type has a state of weak raw material intake and strong waste discharge due to its congenital hypoactive spleen and hyperactive kidney groups.

Such differences in physiological patterns result in a series of typically distinct characteristics of each constitution, including external appearance, personality traits, a manifestation of healthy and unhealthy states, and response to medicine and treatment.

 

CONSTITUTIONS
CHARACTERISTICS	TY type	SY type	TE type	SE type
HYPERACTIVE VISCERA AND FUNCTIONS	Lung-process of consuming Qi and body fluid	Spleen-process of raw material intake	Liver-process of producing and storing Qi and body fluid	Kidney process of waste discharge
HYPOACTIVE VISCERA AND FUNCTIONS	Liver-process of producing and storing Qi and body fluid	Kidney process of waste discharge	Lung-process of consuming Qi and body fluid	Spleen-process of raw material intake
PERSONALITY TRAITS	Creative Positive Progressive Charismatic Heroic Rash mind	Unstable Easily get bored Sacrificing Righteous Easily acceptable Hot temper Anxious mind	Gentle Commercial Endurable Humorous Coward Fearful mind	Neat Mild Negative Selfish Organized Jealous Persistent Nervous mind
EXTERNAL APPEARANCE	Developed nape of the neck Slender waist	Developed chest Small hip	Thick waist Weak nape of the neck	Developed hip Weak chest
HEALTHY SIGN	Smooth urination	Good bowel movement	Existence of perspiration	Good digestion
UNHEALTHY SIGN	Musculoskeletal weakness, emesis	Existence of constipation	Absence of perspiration	Indigestion

 

Constitutional Approach of SCM and Tailored Medicine

The human DNA is 99.9% identical, but the difference of only 0.01% in the human genome results in our diversity. People with different inherited genetic information develop distinctive personality traits, predisposition to certain kinds of diseases, and reactions to certain drugs. The ultimate goal of medical science is to develop an overall improved therapy that minimizes the risk of adverse reactions while increasing efficacy. Recent breakthroughs in biotechnology enable us to tailor medicine (also called individualized or personalized medicine). Tailored medicine links an individual’s molecular and clinical profile, allowing physicians to make the right patient-care decisions. It also allows patients the opportunity to make informed and directed lifestyle decisions for their future well-being.

Within this perspective, SCM shares the same vision with tailored medicine-that individuals not only can be cared for with individualized therapy, which takes into account entirely their distinctive factors, but they also can prevent specific susceptible chronic diseases and live healthily by individualized self-regulation. The shortcoming of an individual due to the hypoactive visceral group should be controlled by specific constitutional medication, diet, physical training, and psychological caution. Scientific evidence indicates that the constitutional basis of SCM has a genetic background. It is commonly known that human leukocyte antigen (HLA) types are variable in humans and are closely associated with the determination of susceptibility to certain diseases. Among individuals possessing the HLA-C*4 allele, the frequency of the SE and SY types is highest in the groups containing the HLA-C//87 allele and HLA-C*14, respectively.

(This is a summary of the article “Sasang Constitutional Medicine as a Holistic Tailored Medicine”, published online by Evidence-based Complementary and Alternative Medicine on 9/19/2011.)