Chapter 31 of Volume 4 of the “Classic of Categories” (Lei Jing, 1624) summarizes the characteristics of people with a constitutional excess of Yin, people with a constitutional excess of Yang and people with a balance of Yin and Yang:

People gifted with pure Yin are known as the Greater-Yin type; those with a mixture of Yin and Yang but more Yin than Yang are known as the Lesser-Yin type; those with pure Yang are known as the Greater-Yang type; those with a mixture of Yin and Yang but more Yang than Yin are known as the Lesser-Yang type. Together with the type of people with equal Yang and Yin, these constitute the five different types of people. Therefore, for people with abundant-Yang constitution, it is advisable to use cooling methods of treatment. For people with abundant-Yin constitution, it is advisable to use warming methods of treatment.²

Body shape abundant in Yang

Chapter 67 of the same book says:

A person with abundant Yang is emotional and as warm as fire; he talks fast and is swollen with arrogance. It is because the Heart- and Lung-Qi of such a person are abundant; Yang-Qi is therefore plentiful and flows freely and vigorously. For this reason, it is easy to stimulate his spirit, and the Qi arrives quickly when acupuncture is given.⁵

The “Golden Mirror of Medicine” (Yi Zong Jin Jian, 1742) points out in the chapter “Keys to the Four Diagnostic Methods”:

People with abundant Yang hold their head high while standing because it is in the nature of Yang to rise. They shake their body while walking because it is in the nature of Yang to move. They often hold their hands behind the body with the arms and elbows by the sides of the body as it is in the nature of Yang to be exposed. This is the picture of the personality of the Lesser-Yang type of people.⁶

The same book says:

The six external pathogenic factors attack people in the same way but diseases caused by them will have different manifestations in different people. Why? The reason is that a person’s body can be either strong or weak, Qi can be full or deficient, and the internal organs can be of cold or hot. After the external pathogenic factors invade the body, they will transform according to the condition of the internal organs. Therefore, the syndromes vary. They can transform into deficient or excessive conditions, and into cold or hot conditions.⁷

This last quotation highlights an important principle of Chinese medicine: pathogenic factors tend to develop in their pathology according to the pre-existing constitution of the person. For example, if a person who is constitutionally abundant in Yang suffers an invasion of external Wind, this will develop into Wind-Heat, while if a person who is constitutionally abundant in Yin suffers the same invasion, the external Wind will manifest as Wind-Cold.

Body shape abundant in Yin

Observation

The typical characteristics of a person of the abundant-Yin type are: a tendency to obesity, relatively dark complexion, loose muscles with thick skin, quiet, reticent and introverted nature, soft voice, a preference for heat and a desire to wrap up warm (Fig. 1.2).

Fig. 1.2 Body shape abundant in Yin

Clinical significance

The above-mentioned features indicate an abundant-Yin constitution. It is important to stress that such a body shape indicates only a constitutional tendency to excess of Yin and not necessarily an actual pattern of Yin excess. In pathological conditions, a person with an abundant-Yin constitution will have a tendency to excess of Yin, that is, Cold, Dampness or Phlegm. Common patterns appearing in people with an abundant-Yin constitution include Cold, Dampness, Damp-Phlegm, Cold-Phlegm, Phlegm-Fluids, Qi stagnation, Blood stasis, etc. In treatment, emphasis should be put on reducing Yin, expelling Cold, resolving Dampness and Phlegm and tonifying Yang. At the same time, attention should be paid to regulating Qi and invigorating Blood.

Quotations from the classics

Chapter 72 of the “Spiritual Axis” says:

Persons of the Greater-Yin type have a sombre countenance and pretend to be humble. They have the body build of a grown-up, but make themselves smaller by bending their back and knees slightly. This is the picture of a Greater-Yin type of person … They are restless while standing, and walk as if to hide themselves. This is the picture of a Lesser-Yin type of person.⁸

…

Persons of the Greater-Yin type are constitutionally excessive in Yin and deficient in Yang. Their Yin and Blood are thick and turbid. Their Defensive Qi does not flow freely. Yin and Yang are not in a harmonious state, which leads to loose sinews and thick skin. When needling patients with an abundant-Yin constitution, only through reducing the Yin quickly and immediately can an improvement be expected.⁹

…

The Yellow Emperor asks: “How is it that sometimes the body will react only after several acupuncture treatments?” Qi Bo answers, “Such a person is excessive in Yin and deficient in Yang. The movement of Qi is restrained and therefore it is difficult for Qi to arrive when the patient is needled. This is the reason why the body will react to the acupuncture only after several treatments.¹⁰

The last passage clearly relates the ease or difficulty with which a patient reacts to acupuncture to the relative balance of Yin and Yang: patients with a constitutional abundance of Yin will react to acupuncture more slowly.

Body shape deficient in Yang

Observation

The typical characteristics of a person with the deficient-Yang type of body shape are as follows: overweight/swollen body, pale or pale-bluish complexion, listlessness, low spirits, slow movement, weak, loose muscles, a preference for warmth, aversion to cold, cold limbs and a desire to wrap up (Fig. 1.3).

Fig. 1.3 Body shape deficient in Yang

Clinical significance

The above-mentioned body appearance indicates that the patient is constitutionally deficient in Yang. It is important to stress that such body shape indicates only a constitutional tendency to Yang deficiency: it does not necessarily follow that every person with such a body shape actually suffers from Yang deficiency.

When such a constitutional tendency does manifest with an actual Yang deficiency, these people will suffer symptoms of Cold, Cold-Dampness, Cold Phlegm, Damp-Phlegm and Phlegm-Fluids.

Body shape deficient in Yin

Observation

The typical characteristics of a person with a deficient-Yin type of body shape are as follows: thin body build, sometimes red cheeks and lips, an excited look, a restless expression in eyes, a propensity to be excited, a feeling of heat and quick movements. People of Yin-deficient body shape are often deficient in Yin and excessive in Yang. The body is thin and tall with a long-shaped head, thin long neck, narrow shoulders and a narrow, long, flat chest. These people often bend forward when they walk or stand (Fig. 1.4).

Fig. 1.4 Body shape deficient in Yin

Clinical significance

The above-mentioned features indicate a deficient-Yin constitution. It is important to stress that such a body shape indicates only a constitutional tendency to deficiency of Yin and not necessarily an actual pattern of Yin deficiency. In pathology, these patients will tend to Yin or Essence deficiency and hyperactivity of Yang. When they fall ill, they will easily develop Empty-Heat or Dryness.

Body shape with Yin and Yang in balance

Observation

The body shape with harmony of Yin and Yang is of medium build, not too tall or short, neither too stout nor thin. The movements are balanced and the personality is stable. People with such a constitution are better able to adapt themselves to changes caused by the stresses of life (Fig. 1.5).

Fig. 1.5 Body shape with harmony of Yin and Yang

Clinical significance

The above-mentioned features indicate a harmony of Yin and Yang. These people are less easily attacked by external pathogenic factors. When they do fall ill, the pathogenic factors are often not strong, the location of the disease is superficial and the disease itself is mild.

Quotations from the classics

Chapter 72 of the “Spiritual Axis” says: “People with the body shape with harmony of Yin and Yang look elegant and graceful.”¹¹

CLASSIFICATION OF BODY SHAPE ACCORDING TO THE FIVE ELEMENTS

The body shapes according to the Five Elements are:

Wood type

Observation

People of the Wood type have a subtle shade of green in their complexion, a relatively small head and long-shaped face, broad shoulders, straight back, tall, sinewy body and elegant hands and feet. In terms of personality, they have developed intelligence but their physical strength is poor. Hard workers, they think things over and tend to worry (Fig. 1.6, see also Plates 1.1 and 1.2 on p. P1).

Fig. 1.6 Wood type: (a) face; (b) body

Clinical significance

People of the Wood type often suffer from diseases caused by pathogenic factors in autumn and winter. They are in relatively good health in spring and summer.

Quotations from the classics

Chapter 64 of the “Spiritual Axis” says:

The Wood type of people correspond to Shang Jiao of the note Jiao, which is one of the five notes and is related to the element of Wood. Their complexion colour is similar to that of the Green Emperor, who is one of the five heavenly emperors, and represents the East. Their complexion has a subtle green colour, they have a small head, long-shaped face, broad back and shoulders, straight body trunk and small hands and feet. They are intelligent, and keep their mind working hard. They are not strong physically. The are often worried. They like Spring and Summer and dislike Autumn and Winter.¹²

…

People of the Wood type can tolerate Spring and Summer but not Autumn or Winter. In Autumn or Winter, they suffer from diseases caused by invasion of pathogenic factors.¹³

The chapter “Key to the Four Diagnostic Methods” in the “Golden Mirror of Medicine” (Yi Zong Jin Jian, 1742) says:

People of the Wood type respond to the colour green, which is at its best when, like green wood, there is moisture in it. People of the Wood type have a straight body just like the trunk of a tree. They have the so-called five kinds of Smallness, i.e. a small head, small hands and small feet, just like the twigs of a tree. They have the so-called five kinds of Thinness and Length, implying a long, thin body trunk and limbs, like the branches of a tree. Just as wood has various uses and can be cut in different ways as wanted, people of the Wood type are versatile, and are apt to intellectual work. Just as wood is seldom quiet [i.e. always swaying in wind and breeze], people of the Wood type tend to worry, and are often exhausted by what they do. If wood is not straight but is short and soft, it is not good timber for use.¹⁴

Box 1.1 summarizes the characteristics of the Wood type.

BOX 1.1 WOOD TYPE

• Greenish complexion

• Small hands and feet

Fire type

Observation

People of the Fire type have a red, florid complexion, wide teeth, a pointed, small head, possibly with a pointed chin, hair that is either curly or scanty, well-developed muscles of the shoulders, back, hips and head and relatively small hands and feet. In terms of personality, they are keen thinkers. The Fire type is quick, energetic and active. They are short-tempered. They walk firmly and shake their body while walking. They tend to think too much and often worry. They have a good spirit of observation and they analyse things deeply (Fig. 1.7, see also Plate 1.3 on p. P1).

Fig. 1.7 Fire type: (a) face; (b) body

Clinical significance

People of the Fire type are healthy in spring and summer but sick in autumn and winter from invasion of pathogenic factors. When compared with other Elemental types, people of the Fire type may tend to suffer a sudden death.

Quotations from the classics

Chapter 64 of the “Spiritual Axis” says:

People of the Fire type correspond to Shang Zhi of the note Zhi, which is one of the five notes, and is related to the element of Fire. The colour of their complexion is similar to that of the Red Emperor, who was one of the five heavenly emperors, and represents the South. They have a red complexion, wide teeth, a thin small face, small head, well-developed and nice-looking shoulders, back, thighs and abdomen. They have small hands and feet. They walk with quick steps but tread the ground softly and soundlessly, and their body shakes as they walk. They are short-tempered. They act boldly and make light of money, but they are not trustworthy. They worry too much. They have a good sense of judgment. The colour of their complexion is attractive, but they are short-tempered. They like Spring and Summer and dislike Autumn and Winter.¹⁵

…

People of the Fire type have a short life often ending with a sudden death. They can tolerate Spring and Summer but not Autumn or Winter. In Autumn or Winter they will suffer from diseases caused by invasion of pathogenic factors.¹⁶

The chapter “Keys to the Four Diagnostic Methods” of the “Golden Mirror of Medicine” says:

People of the Fire type have a red complexion which is best when it is also bright [i.e. with shen]. They have the so-called Five Pointed Structures, i.e. a pointed head, forehead, nose, face and mouth: they are similar to the pointed shape of a flame when it flares up … People of the Fire type are bold and daring because Fire is Yang in nature and rich in Qi. They make light of money, which is similar to the scattering nature of Fire. They are not trustworthy for just like a fire they are constantly changing. They tend to worry, mirroring the flickering of a flame. They move constantly just like a fire which is always moving. They are short-tempered, sharing fire’s quickness and suddenness. If these people have symptoms of mental confusion and abnormality of Qi and colour, it means that their body is in disharmony.¹⁷

Box 1.2 summarizes the characteristics of the Fire type.

BOX 1.2 FIRE TYPE

• Red complexion

• Wide teeth

• Pointed, small head

• Well-developed shoulder muscles

• Curly hair or not much hair

• Small hands and feet

• Walking briskly

Earth type

Observation

People of the Earth type have a yellowish complexion, round-shaped face, relatively big head, wide jaws, well-developed and nice-looking shoulders and back, large abdomen, strong thigh and calf muscles, relatively small hands and feet, and well-built muscles of the whole body. They walk with firm steps without lifting their feet very high. The Earth type is calm and generous, has a steady character, likes to help people and is not overambitious. It is easy to get on with (Fig. 1.8, see also Plate 1.4 on p. P1).

Fig. 1.8 Earth type: (a) face; (b) body

Clinical significance

People of the Earth type are in relatively good health in autumn and winter. They fall prey easily to invasions of pathogenic factors in spring and summer.

Quotations from the classics

Chapter 64 of the “Spiritual Axis” says:

The Earth type of people correspond to Shang Gong of the note Gong which is one of the five notes, and is related to the element of Earth. Their complexion is similar in colour to that of the Yellow Emperor, who is one of the five heavenly emperors and represents the Centre. They have a yellow complexion, round-shaped face, large head and well-developed and nice-looking shoulders and back. The abdomen is large and their thighs and legs strong and well-built. They have small hands and feet, but well-developed muscles. Every part of their body, from the upper to the lower, is well proportioned. They walk steadily, and are trustworthy. They are calm and like to help people. They are not interested in pursuing power or position. They like to establish good relations with other people. They like Autumn and Winter and dislike Spring and Summer.¹⁸

The chapter “Key to the Four Diagnostic Methods” of the “Golden Mirror of Medicine” says:

People of the Earth type respond to the yellow colour, which is best when it is also shiny. They have the so-called Five Kinds of Roundness similar to the round shape of the Earth. They have the so-called Five Kinds of Solidity and Thickness which in nature resemble the solid Earth. They have the so-called Five Kinds of Shortness which is similar to the appearance of the Earth being solid and short. Although people with the Earth type of body have the characteristics of roundness, solidity, thickness and shortness, each person will have a particular, individual shape. The round face, the big head, the large abdomen and the well-built shoulders and legs all resemble the dense and solid appearance of the Earth. People of the Earth type are sincere and trustworthy. They take their time in doing things. They are calm at heart. All these characteristics mirror the nature of Earth in being honest and reliable.¹⁹

Box 1.3 summarizes the characteristics of the Earth type.

Metal type

Observation

People of the Metal type have a relatively pale complexion, a square-shaped face, a relatively small head, small shoulders and upper back, a relatively flat abdomen, and small hands and feet. They have a strong voice, move swiftly and have keen powers of thought. They are honest and upright. They are generally quiet and calm in a solid way, but also capable of decisive action when necessary. They have a natural aptitude for leadership and management (Fig. 1.9, see also Plate 1.5 on p. P2).

Fig. 1.9 Metal type: (a) face; (b) body

Clinical significance

People of the Metal type are in relatively good health in autumn and winter, but may suffer ill health in spring and summer.

Quotations from the classics

Chapter 64 of the “Spiritual Axis” says:

People of the Metal type correspond to Shang [a musical note] while keeping still, but are intrepid and fierce when active. They have a natural aptitude for leadership and management … People of the Metal type correspond to Shang, which is one of the five notes and is related to the element of Metal. Their complexion is similar to that of the White Emperor, who is one of the five heavenly emperors and represents the West. They have a relatively pale complexion, a small head, small shoulders and upper back, a flat abdomen, and small hands and feet. They have strong heels as if the bones grew outside rather than in. They are quick and swift in movement, and are honest and upright in personality. They are short-tempered. They appear quiet and calm when keeping still, but fierce and bold once they make a move. They have the talent to be officials. They like Autumn and Winter and dislike Spring and Sumner.²⁰

…

People of the Metal type can tolerate Autumn and Winter but not Spring or Summer when they may suffer diseases from invasion of external pathogenic factors.²¹

The chapter “Keys to the Four Diagnostic Methods” of the “Golden Mirror of Medicine” says:

People of the Metal type correspond to the colour white and their complexion is best when it is pure. They have the so-called Five Kinds of Squareness similar to the square structure of metal. They have the so-called Five Kinds of Moisture similar to the quality of metal under water. Individuals who deviate from the typical characteristic of Metal may not display square and regular features. If the muscles become thinner, their bones will show. These are all signs of exhaustion. People of the Metal type are quiet and calm when keeping still but fierce once in action. This mirrors the nature of metal which is silent and resilient. People of this kind are honest and upright as metal is pure and strong in quality. As officials, people of the Metal type are awesome and dignified just as metal is solemn.²²

Box 1.4 summarizes the characteristics of the Metal type.

• Small shoulders and upper back

• Flat abdomen

• Strong voice

Water type

Observation

People of the Water type have a relatively dark complexion, wrinkles, a relatively big head, a round face and body, broad cheeks, narrow and small shoulders and a large abdomen. They keep their body in motion while walking and find it difficult to keep still. They have a long spine. The Water type is sympathetic and slightly laid-back. They are good negotiators and loyal to their work colleagues. They are aware and sensitive (Fig. 1.10, see also Plates 1.6 and 1.7 on p. P2).

Fig. 1.10 Water type: (a) face; (b) body

Clinical significance

People of the Water type are often in relatively good health in autumn and winter but not in spring or summer when they may suffer diseases from invasion of external pathogenic factors.

Quotations from the classics

Chapter 64 of the “Spiritual Axis” says:

People of the Water type correspond to Shang Yu of the note Yu, which is one of the five notes and is related to the Water element. Their complexion is similar in colour to that of the Black Emperor, who was one of the heavenly emperors and represents North. They have a relatively dark complexion, wrinkled face, a big head, broad cheeks, small shoulders and a large abdomen. Their hands and feet are seldom at rest, and their body quivers while walking. They have a long spine. They like Autumn and Winter and dislike Spring and Summer.²³

The chapter “Keys to the Four Diagnostic Methods” in the “Golden Mirror of Medicine” says:

People of the Water type correspond to the colour purple, and their complexion is best when it possesses lustre. Their face is fat and uneven just as the sea’s surface is vast and rolling with waves. They have the so-called Five Kinds of Fatness just as water is wide. They have the so-called Five Kinds of Tenderness mirroring the moistness of water. They have the so-called Five Kinds of Smoothness resembling the clear nature of water. With a fat body build, people of the Water type tend to have a mobile body when they walk, mirroring the flowing movement of water. This kind of people have no respect for anybody nor do they fear; like water, they always run to a lower place. They pretend to be humble but actually tend to be deceivers; water, too, feels empty and lacking a solid structure.²⁴

Box 1.5 summarizes the characteristics of the Water type.

Clinical application of the Five Element types

The first thing to note is that very few people will display all the characteristics of a “pure” Element type as there will always be deviations from the ideal type caused by life influences. For example, the Wood type should have a tall and slender body; however, if they overeat they may develop a large abdomen. It is important, therefore, when evaluating an Element type, to take into account all physical and behavioural characteristics of the patient. In the above example, if we drew a conclusion only from observation of the large abdomen, we might wrongly conclude that that person is an Earth type. Vice versa, an Earth type should have a relatively large abdomen and large thighs: however, if they lose weight due to a serious disease such as cancer, they may not have a large abdomen and thighs and we should pay attention to all the other physical characteristics.

Secondly, each Element type should have a strong point (Box 1.6) and a weakness in that area indicates a poor prognosis. For example, people of the Wood type should have strong sinews; if they do not, it indicates a possible illness. People of the Fire type should walk fast and their strong point should be the Heart and blood vessels; for the Fire type to walk slowly indicates a potential problem. People of the Earth type should have strong muscles; if they do not it indicates a weakness in the Stomach and Spleen and the tendency to rheumatism. People of the Metal type should walk slowly and deliberately and their voice should be strong; if they walk fast and their voice is weak it indicates a potential problem. People of the Water type should have strong Kidneys and may easily suffer from overindulgence in sexual activity.

BOX 1.6 STRONG POINTS OF ELEMENT TYPES

• Wood: strong sinews

• Fire: strong heart and blood vessels

• Earth: strong muscles

• Metal: strong voice

• Water: strong Kidneys

Thirdly, patients should be observed carefully and their Element type assessed so that deviations from the type can be noted. If a person has a certain trait which is unrelated to the person’s particular type, the prognosis is worse than if the trait represents an exaggeration of a trait that is normal for that type. For example, people of the Fire type should walk fast; if they walk too fast it is not so bad as a Metal type walking fast (as the Metal type should walk slowly and deliberately). Another example: if a Metal type has too loud a voice, it is not so bad as another type having a loud voice.

Finally, the prognosis is better if a person of a certain Element type suffers from a disharmony in the same Element rather than in another Element. For example, it is better for a Wood type to suffer from a disharmony in this (for example Liver-Qi stagnation) than in another Element (for example Lung-Qi deficiency, Heart-Fire, Spleen-Yang deficiency or Kidney-Yin deficiency).

CLASSIFICATION OF BODY SHAPE ACCORDING TO PRENATAL AND POSTNATAL INFLUENCES

The body shapes according to prenatal and postnatal influences are as follows:

• body shape with strong prenatal constitution

• body shape with weak prenatal constitution

• body shape with strong Postnatal Qi

• body shape with weak Postnatal Qi.

Body shape with strong prenatal constitution

Observation

People with a strong prenatal constitution have a full and broad forehead and glabella (the frontal bone between the eyebrows). Their nose is long and wide. The area from the cheek to the front of the ear is wide with well-developed muscles. The lower jaw is high, thick and protruding. The ear is long, wide and regular-shaped with long ear-lobes. The eyes, nose, ears and mouth are well spaced and in the right proportion to each other. The philtrum (the vertical depression between the nose and mouth) is long. The complexion is normal in colour and lustrous. Breathing is even and smooth. The bones, muscles and skin are strong. The whole body is full of life.

Clinical significance

The above features indicate a good prenatal constitution: when this person is ill, the disease is easy to treat. People with a strong prenatal constitution generally have a long life and they are able to survive even serious illnesses. A strong prenatal constitution often explains why one person can survive a serious disease such as cancer, where another person does not. A person with a strong constitution may also “get away with” living in an unhealthy way and still live a long life. Of course, it is also possible to ruin a good prenatal constitution through unhealthy living. A good prenatal constitution is very often the crucial determining factor in prognosis.

To summarize, the main features indicating a good prenatal constitution are as follows (Fig. 1.11):

Fig. 1.11 Good prenatal constitution

Quotations from the classics

Chapter 37 of the “Spiritual Axis” says:

A life as long as 100 years can be expected if the forehead and glabella are full and broad; the cheek and the area from the cheek to the front of the ear have well-developed muscles and protrude from the face, connecting a strong lower jaw and long ear lobes together; the eyes, nose, ears and mouth are well spaced and well proportioned; the face colour is normal. These people have abundant Qi and Blood. Their skin and muscles are strong. They respond well to acupuncture treatment.²⁵

Chapter 54 of the same book says:

A person will have a long life if the five Yin organs are strong, blood circulates normally without obstruction, the skin is firm, the circulation of Nutritive and Defensive Qi is normal, breathing is regular, Qi circulates smoothly, and the six Yang organs transform and transport the food essences and body fluids smoothly to all parts of the body, maintaining its normal physiological functions … People with long life expectancy have long and deep nostrils. The muscles of the cheek and of the area from the cheek to the front of the ear are thick and high and well formed. The circulation of Nutritive and Defensive Qi is smooth. The upper, middle and lower parts of the face are in the right proportion, with well-developed and distinct muscles and prominent bones. People of this type can live out their normal life expectancy, or even up to the age of 100.²⁶

Chapter 6 says:

People with a strong body build and relaxed skin, in whom Qi flows smoothly, will live a long life; while those with a strong body build but tense skin, in whom Qi stagnates, will die young. A strong build, a big pulse and a firm Exterior and Interior are signs of longevity; a strong build but a weak, empty pulse, a deficient Interior and a strong Exterior, with empty Qi, indicate a short life. A strong build but hollow, small zygomatic bones indicate weak bones and a short life expectancy; a strong build with well-developed muscles indicates long life; a strong build but with weak and underdeveloped muscles indicates a short life. These are all signs of pre-natal constitution which give an indication of life expectancy. As medical practitioners, we must understand the connection between body build and body shape so that we may have an idea of the patient’s life expectancy.²⁷

The chapter “Keys to the Four Diagnostic Methods” in the “Golden Mirror of Medicine” says: “If the forehead is high, the glabella is full, the nose is high and straight, the cheeks are full and the skeleton is well built, the person will have a long life expectancy.”²⁸

Body shape with weak prenatal constitution

Observation

The physical features of people with a weak prenatal constitution are as follows: the eyes, nose, ears and mouth are close together; the forehead is narrow and the space between the eyebrows small; the nose is narrow with nostrils turned up and exposed; the philtrum is short; the cheek and the area between the cheek and the front of the ears are narrow; the ears are short, small and turning outwards; the lower jaw is flat, sunken, low and narrow; breathing is coarse and the skin is loose (Fig. 1.12).

Fig. 1.12 Weak prenatal constitution

Clinical significance

When the above-mentioned physical features are observed, they indicate that the person has a poor prenatal constitution. These people will have a tendency to suffer from a deficiency of Qi, Blood, Yin or Yang. Compared with people with a strong prenatal constitution, these people are more easily invaded by external pathogenic factors and, when this occurs, the treatment will be relatively more difficult.

Quotations from the classics

Chapter 37 of the “Spiritual Axis” says:

When the five senses are not sharp, the forehead and glabella are narrow, the nose is small, the area between the cheek and the front of the ears is narrow, the lower jaw is flat and the ears turn outwards, the pre-natal constitution is poor even though the complexion and colour may be normal. These people are intrinsically unhealthy, even more so when they are ill.²⁹

Chapter 54 of the same book says:

When the five Yin organs are weak, the nostrils are small and splay outwards, breathing is shallow, the cheek muscles are sunken, the pulse is thin and weak and the muscles are loose, the person is easily invaded by Wind-Cold. As a result, Qi and Blood become more deficient, and the circulation in the vessels is impaired, which will predispose the person to further invasions of pathogenic factors.³⁰

Body shape with strong Postnatal Qi

Observation

Physical features indicating strong Postnatal Qi are as follows: ruddy complexion with lustre, strong body build with solid muscles and firm, elastic skin, shiny hair with moisture, vigour and swift movements (Fig. 1.13).

Fig. 1.13 Strong Postnatal Qi

Note that the features indicating strong Prenatal Qi relate more to the actual structure of the face, ears, nose, eyes and mouth and to the body build (i.e. inherited features), while the features indicating strong Postnatal Qi relate to lustre, hair, muscles (i.e. features subject to the state of Qi and Blood).

Clinical significance

The above features indicate a good Postnatal Qi. The Spleen and Stomach are strong, and they function properly. Qi, Blood, Yin and Yang are abundant and the body will not be easily attacked by external pathogenic factors. If there is any disease, it will be easy to treat.

Quotations from the classics

The chapter “On the Pre-natal and Post-natal” of the “Complete Works of Jing Yue” (Jing Yue Quan Shu, 1624) says:

If the pre-natal constitution is good, life will be long; if the pre-natal constitution is weak, life may be short. If people with a good pre-natal constitution take care of their post-natal Qi [with a good lifestyle and diet], they may live even longer; if people with a poor pre-natal constitution do not take care of their post-natal Qi [instead following a poor lifestyle and diet], their life may be even shorter. The build of the skeleton depends on the pre-natal constitution, while the build of the muscles depends on the post-natal Qi. The spirit [Shen] reflects the pre-natal constitution, while the complexion reflects the post-natal Qi. A deep colour of the complexion indicates long life, while a tender, light colour may indicate a short life. A strong, loud voice may indicate a long life, while a feeble voice may indicate a short one. A strong body build may indicate a long life while a weak body build may indicate a short one. One should also differentiate the mental state, paying attention to whether it is calm or restless: a calm mental state may indicate long life while a restless mental state may indicate a short one. As for the development of the body in youth, if a person appears weak when young, but grows stronger as he or she grows up, it is a good sign.³¹

Body shape with weak Postnatal Qi

Observation

The physical features of people with weak Postnatal Qi are as follows: poor energy, haggard, sallow complexion, dry, withered hair, a thin, small build and loose skin without elasticity (Fig. 1.14).

Fig. 1.14 Weak Postnatal Qi

Note that the features indicating weak Prenatal Qi relate more to the actual structure of the face, ears, nose, eyes and mouth and to the body build (i.e. inherited features), while the features indicating weak Postnatal Qi relate to lustre, hair, muscles (i.e. features subject to the state of Qi and Blood).

Clinical significance

When the above-mentioned physical features are observed, it indicates that the person has weak Postnatal Qi. The Spleen and Stomach are weak and Qi, Blood, Yin and Yang are deficient. The body will be easily invaded by pathogenic factors and any diseases will be of a deficient nature.

Quotations from the classics

The “Complete Works of Jing Yue” says:

!Remember: make an assessment of the constitution of the patient from the observation of the body shape. A strong or weak post- or prenatal constitution gives us an immediate idea of the patient’s general health and prognosis.

CLASSIFICATION ACCORDING TO BODY BUILD

Chapters 38 and 59 of the “Spiritual Axis” describe five types of body shape: robust, compact, muscular, thin and overweight. The physical characteristics of these five types generally coincide with those according to Yin and Yang mentioned above; for example, the robust type has a tendency to abundance of Yang, the thin type has a tendency to deficiency of Blood or Yin, the overweight type has a tendency to deficiency of Yang, etc.

The five body shapes described in these chapters of the “Spiritual Axis” indicate inherited constitutional traits and not acquired ones; for example, the overweight type is constitutionally overweight from an early age and not someone who becomes overweight through overeating and lack of exercise.

The classification of the body type according to body build is as follows:

Robust type

Observation

People of the robust type have large, firm muscles, smooth moist skin, a large abdomen, intolerance to heat and a preference for cold. Figure 1.15 shows a robust body type.

Fig. 1.15 Robust body type

Clinical significance

The above-mentioned physical features indicate that the person has a constitutional abundance of Yang-Qi. Such a person has strong resistance to cold. These people will have a tendency to diseases of Hot nature.

Quotations from the classics

Chapter 59 of the “Spiritual Axis” says: “Robust people are rich in Qi, and abundant Qi will keep the body warm. Therefore, they have strong resistance to cold.”³³

Compact type

Observation

People of the compact type have the following physical features: a small skeleton, compact solid muscles, thick fat under the skin and a small but full body build. Figure 1.16 shows a compact body type.

Fig. 1.16 Compact body type

Clinical significance

The above-mentioned physical features indicate that the person has a smooth circulation of Qi and Blood, but he or she may also have a tendency to Qi and Blood deficiency. The diseases these people suffer from are either Cold in nature due to deficiency of Qi, or are Hot in nature due to deficiency of Blood.

Quotations from the classics

Chapter 59 of the “Spiritual Axis” says: “The muscles of compact type of people are compact and solid, and their skin is full and tight … People with a compact body build have compact muscles but a small body … Although people with a compact body build have some fat, their body build is not big.”³⁴

Muscular type

Observation

The physical features of people of the muscular type are as follows: large skeleton, plump and solid body build with the skin and muscles compacted tightly together. Figure 1.17 shows a muscular body type.

Fig. 1.17 Muscular body type

Clinical significance

The above-mentioned physical features indicate that the person has abundant Blood and harmonious Qi. Such a person will not be easily invaded by pathogenic factors.

Quotations from the classics

Chapter 59 of the “Spiritual Axis” says: “People of the muscular type have skin and muscles tightly compacted together … big, broad body size … and large limbs” and also: “People of the muscular type have abundant Qi, their body build is full and strong and their Qi is harmonious.”³⁵

Thin type

Observation

People of the thin type have the following physical features: thin body build, thin muscles and lips and a feeble voice. Figure 1.18 shows a thin body type.

Fig. 1.18 Thin body type

Clinical significance

The above-mentioned physical features indicate that the person’s Qi and Blood circulate smoothly. Thin, pale people have a tendency to deficiency of Qi and Blood. In treatment, attention should be paid to tonifying and caution should be exercised when eliminating pathogenic factors. Thin people with a relatively dark complexion tend to suffer from Yin deficiency and possibly Empty-Heat. In herbal treatment, warm and drying herbs (which have a tendency to injure Yin) should be used with caution.

Quotations from the classics

Chapter 38 of the “Spiritual Axis” says: “Thin type of people have thin pale skin as well as thin muscles and lips. They talk in a feeble voice. Their Blood is clear, and their Qi is smooth and slippery. Their Qi will dissipate easily, and their Blood will exhaust easily. Therefore, when needling these people, insertion should be superficial and the needles should be withdrawn quickly.”³⁶

Overweight type

Observation

The overweight body type has loose skin and muscles, fat abdomen and thighs, moves slowly and often becomes breathless on walking.

Clinical significance

The overweight body type indicates either an actual condition of Damp-Phlegm with Qi deficiency or a predisposition to it. Figure 1.19 shows an overweight type.

Fig. 1.19 Overweight body type

CLASSIFICATION OF BODY SHAPE ACCORDING TO PAIN AND DRUG TOLERANCE

The body shapes indicating high or low tolerance to drugs and pain may be either constitutional or the result of postnatal influences.

The body shape may be classified according to drug and pain tolerance as follows:

• body shape indicating high pain and drug tolerance

• body shape indicating low pain and drug tolerance.

Body shape indicating high pain and drug tolerance

Observation

People with a high drug (including herbs) and pain tolerance have certain physical features: the complexion is relatively dark, the body build is big and full with a strong skeleton, the tendons are soft, the muscles are loose and the skin firm.

Clinical significance

The above-mentioned physical features indicate that the person has strong drug and pain tolerance. When treating such a patient, the practitioner should be aware of the strong drug and pain tolerance and consider using medicines in relatively large doses.

Quotations from the classics

Chapter 53 of the “Spiritual Axis” says:

The Yellow Emperor asks Shao Yu: “People’s tendons and bones can be strong or weak, the muscles can be solid or loose, the skin can be thick or thin, the space between skin and muscles can be firm or weak, how does this affect people’s tolerance of pain caused by needling and the burning of the moxa? People’s stomach and intestines can be strong or weak, how does this affect their tolerance of medicinal drugs? I hope that you will explain this to me in detail.” Shao Yu answers: “People with strong bones, soft tendons, relaxed muscles and thick skin, have a strong tolerance to pain. They can tolerate pain caused by needling as well as the burning of moxa.” The Yellow Emperor asks: “How can you know that people can tolerate the burning pain of moxibustion?” Shao Yu answers: “In the above-mentioned people who have strong bones, soft tendons, relaxed muscles and thick skin, if their complexion colour is relatively dark and their skeleton is well-built and strong, they can tolerate the burning pain of moxibustion. People with a thick stomach, dark complexion colour, solid skeleton and a large body build have sufficient Qi and Blood. They have a good tolerance to medicinal drugs.”³⁷

Chapter 50 of the same book says:

The Yellow Emperor says: “The tolerance of pain does not depend only on the courage of a person. A person who is brave but intolerant of pain, will act without fear in a difficult and dangerous situation, but he or she cannot stand pain. Vice versa, a person who is cowardly but tolerant of pain, will be panic-stricken in a difficult and dangerous situation, but he or she will tolerate pain. A person who is brave and also tolerant of pain is not afraid in a difficult and dangerous situation and can also tolerate pain. A person who is timid and intolerant of pain will be overwhelmed by difficulties, danger or pain: these people will be so afraid that their heads spin and their vision is blurred; they lose their voices and become pale; they cannot look people in the eye and their hearts beat violently. They are scared to death. I have encountered all these kinds of people, but I do not know what the causes are. I would like to know the reasons.” Shao Yu answers: “Tolerance to pain depends on whether the skin is thin or thick and the muscles are solid or weak and loose or tense. It cannot be determined by the bravery or cowardice of a person.”³⁸

Chapter 70 of the “Simple Questions” says: “For people who have strong drug tolerance, use medicines with strong flavours and medicinal action. For people who have weak drug tolerance, use medicines of mild flavour and medicinal action.”³⁹

Body shape indicating low pain and drug tolerance

Observation

The body shape indicating a low tolerance of pain and drugs is as follows: a thin body, solid muscles and thin, tender, loose skin.

Clinical significance

The above physical features indicate that the person has a relatively lower tolerance to pain and medicinal drugs. Such a patient tends to complain more about the illness and does not tolerate Chinese herbal medicines well: we should therefore use lower doses when treating these patients.

Quotations from the classics

Chapter 53 of the “Spiritual Axis” says: “People with solid muscles and thin skin are intolerant of pain caused by needling and of the burning pain of moxibustion … People who are thin with a weak Stomach cannot tolerate the strong irritation of medicinal herbs.”⁴⁰