Practice of Distinguishing Between Constitutions

Distribution of the Eight Constitutions
Up till now we studied the various characteristics of the eight constitutions. 
How are these eight constitutions distributed among the people of the world? The answer isn't simple. There aren't yet concrete studies of constitutional distribution among the various races, ethnic groups and countries.

Nevertheless, Lee Jema in his book Dongyi Soose Bowon described constitutional distribution thusly:

"I have been observing people with the four constitutions in mind.

For example, a district in a northern mountainous province has 10,000 residents. Among them, there are 5000 soyangins, 3000 teumins, 2000 soumins, and very few teyangins, from 3 or 4 to a dozen or so.

Another example: a district in a southern agricultural province has 10,000 residents. Among them there are 4000 soyangins, 4000 teumins, 2000 soumins, and very few teyangins, from 3-4 to a dozen or so."

He gave examples from the northern mountainous district and southern agricultural district to explain constitutional distribution and wrote that in the north soyangins are in the majority, while in the south, soyangins and teumins are tied for the leading spot. By this analysis we can see that the number of soyangins is the largest, but it varies by district. It is natural that constitutional distribution varies by district or country. The constitutional distribution described by Lee Jema, who lived well over a hundred years ago, isn't equally valid for the modern world.

Nevertheless, he gives us the fact that of the four constitutions, soyangins are most numerous, teumins and soumins are plentiful, but teyangins are very few.

The idea of constitutional distribution has been unceasingly discussed by his successors, resulting in various opinions.
There is the opinion that his constitutional distribution reflects only the situation in his time and place, and can vary according to time, district, nation and race. There is the opinion that among other things he exaggerated the rareness of teyangins; 3-4 out of 10,000, while in reality there are many more, for example 3-10 out of 100. This is a result of recent observations of successors. If their opinion is right, it is a hundred times as many as Lee Jema said.

Research results are different among various scientists, so conclusions still haven't been drawn about which numbers most closely conform to objective fact. Nevertheless, it is clear that the number of soyangins is the highest, while that of teyangins is very low.

The constitutional distribution given by Lee Jema provides learners of constitutional medicine a rough idea of constitutional distribution. Supposedly, his constitutional distribution varies by time, nation, race and country. Therefore it is to some extent worth consulting, but not an absolutely precise constitutional distribution acknowledgeable worldwide.
Another thing is that it is done not from eight; but only from the four constitutions.  Therefore, we are interested in how the distribution of the eight constitutions will look. There is a need to do various research in the future by race and nation.

Here I presented soyangin, soumin, teumin and teyangin one after another. My order is not the same as that of Lee Jema. He in his book mostly presents teyangin first and afterward soyangin, teumin, and soumin. He follows the position order from the upper jiao to the lower jiao.
However, he doesn't follow that order in the chapter about syndromes, where he concretely describes syndromes of each constitution, but the order of soumin, soyangin, teumin and teyangin. There he follows the order by which he recognized pathologies of each constitution in clinical practice.

Here I used the order of soyangin, soumin, teumin and teyangin only because it is convenient for my lectures. Soyangin is the most numerous and easily distinguishable of all the constitutions and therefore is presented first to easily appeal to novices with constitutional medicine. If they have a clear understanding of soyangin, they can effortlessly understand also soumin, the opposite of soyangin; therefore I chose to present soumin second. Teyangin is the rarest, so I put it last.

Methods of distinguishing constitutions
The first action to cure an illness in a person is find its reality and cause by various diagnoses. But in constitutional medicine, the constitution is determined before diagnosing an illness.
Indeed, it isn't easy to determine the constitution. To accurately determine the constitution it is necessary to understand generally not only the body shape, but also the temperaments, characteristics and physiological-pathological states of each constitution.

However, even with such a general understanding, there are still various difficulties in determining the constitution of a patient in a short time. Constitutional medicine's lack of a method of easily, objectively and repeatably distinguishing a person's constitution is the biggest reason that constitutional medicine hasn't yet caught on and been generally accepted.

Lee Jema in his book Dongyi Soose Bowon described various constitutional characteristics, but didn't provide a concrete method of determining the constitution. Many have sought various ways of determining constitutions based on his descriptions. Below I present methods of determining constitutions which are used by practitioners of constitutional medicine.

Determining by Body Shape
This is a way to determine the constitution principally by the external body shape.
A person whose breast and areas above the breast are well developed is teyangin or soyangin.
A person who is well developed below the breast is teumin or soumin.
If the neck is well developed, it's a teyangin.
If the breast is well developed, it's a soyangin.
If the belly is well developed, it's a teumin.
If he is well developed below the navel or in the buttocks, he is soumin.

Determining by Character or Physiognomy
This is a way to determine the constitution mainly by character, temperament or physiognomy.
If the eyes are brilliant and the body slender, he is teyangin.
If he is thin and nervous, he is soyangin.
If he is slow and timid he is teumin.
If he is scrupulous and narrow minded, he is soumin.

Determining by Syndrome
This is a way of determining the constitution by the typical syndrome which appears specially in each constitution.
If the legs become weak and thin, he is teyangin.
If he often suffers knee or lumbar pain, urinates frequently, and has heels that tend to burn, he is soyangin.
If he has high blood pressure, a great danger of falling into paralysis, eyes that are often blood-streaked, and gets tired easily, he is teumin.
If he often has indigestion and diarrhea, he is soumin.

Determining by Taking the Pulse
This is a way to determine constitution by a typical feeling of the pulse for each constitution.
If the pulse is slow and weak, he is soumin.
If the pulse is rapid, he is soyangin.
If the pulse is strong, he is teumin.
However, this taking of the pulse is simple and general and different from the constitutional method of taking the pulse, which I will present in the following chapter.

Determining by Reaction to Constitutional Medicine
Lee Jema put into order medicines and recipes appropriate for each constitution. If a recipe is appropriate for the constitution of a patient, he will improve; otherwise, he will get worse or a refusal symptom will appear.
A medicine is first tried for 2 or 3 days for the diagnosed constitution. If no noticeable refusal symptom appears, the constitutional determination is regarded as correct.

Determining by Reaction to acupuncture treatment
The points below receive acupuncture treatment. If then the patient suffers dizziness or increased pain, the constitutional determination is wrong. If the pain disappears or the patient feels refreshed, the constitutional determination is correct.

Teyangin:  Tonify Taichong (LR 3), sedate Taiyan (LU 9)
Teumin: Tonify Taiyan (LU 9), sedate Taichong (LR 3)
Soyangin: Sedate Taibai (SP 3), tonify Taixi (KI 3)
Soumin: Sedate Taixi (KI 3), tonify Taibai (SP 3)

Determining by Muscle Strength
If a person holds a constitutionally useful food in his hand, his muscle strength increases; if he holds a harmful food, the strength decreases. This is an application of the so-called "O-ring test" initiated into constitutional determination by Yoshiaki Omura. The patient is asked to hold in his hand a food or herbal medicine appropriate for his constitution, then the muscle strength of his hand or arm is tested. If the muscles become weaker, the constitution is wrong. If they become stronger, it is the right constitution.

Determining by verbal examination
This method uses a test sheet made for determining constitutions. The test sheet has various characteristics of each constitution. The patient reads through the list and answers. The examiner analyzes the answers and determines the patient's constitution. This examination can be done by computer, with the computer analyzing the answers given by the patient.

There are various other methods tried and researched, besides those listed above.
For example, there is a method of determining one's constitution by observing the shapes of the ears, neck, mouth and nose, by observing the body's trunk, by computer analysis of a voice diagram and by half-moon figures on one's nails.

But each of these methods of determining constitutions is not as objective and scientifically defined as a blood test, which gives 100% reproducible results; therefore it has its limits in that the results may vary with the examiner and the method.

In other words, the main reason that constitutional medicine hasn't progressed and become widely popular in spite of its amazing curative effect, is the problem of  the limits of determining the patient's constitution. If sometime it becomes possible to perfectly determine the human constitution by objective and reproducible means, the world of medicine will certainly see a revolutionary change.

Right now, the only way to practice constitutional medicine is to find and utilize a method that will most closely approximate determining the actual constitution. Here I for novices deal mainly with methods that use looks and temperamental characterization of each constitution, and with constitutional pulse taking.