Journal of Chinese Medicine • Number 117 • June 2018 Constitutional/Conditional Acupuncture: Basic Theory and Clinical Practice 45

Constitutional/Conditional
Acupuncture: Basic Theory
and Clinical Practice
Abstract
This article presents the basic theories of the system of Constitutional/Conditional Acupuncture developed by the By: Peter Eckman
author. These are illustrated by case studies from a three-day clinical workshop on this approach to acupuncture
held in Kunming in October 2017. Keywords:
Acupuncture,
Chinese
Introduction who had been treated previously to return for both a medicine,
In October 2017 I had the unique opportunity to progress report and follow-up treatment, if necessary. constitution,
teach a three-day clinical workshop on the system of The case histories in this article include all the condition, pulse
acupuncture that I have developed (Constitutional/ patients from this workshop.3 The patients treated diagnosis, Korean
Conditional Acupuncture1) to acupuncture students are identified only by number, both for purposes of acupuncture,
and practitioners in Kunming (People’s Republic confidentiality4 and to reflect the order in which they ayurveda
of China, [PRC]) under the auspices of the Yunnan were treated.
University of Traditional Chinese Medicine. Since
2013, the Yunnan University of Traditional Chinese Basic theory
Medicine has held an annual Forum in Kunming Constitutional/Conditional Acupuncture is based
devoted to examining the contributions of Western on the premise that each human being is endowed
practitioners, researchers and scholars in the field at conception with a unique set of strengths and
of Chinese medicine, with the aim of critically weaknesses in terms of the functioning of their zangfu
examining the limitations that might impact the and associated conduits (jingmai). The particular
fullest development of TCM in the PRC. In 2014, order of these strengths and weaknesses reflects the
following an invitation from Professor He Ting (賀 person’s yuan qi (original energy5), and in my system
霆) I gave an online presentation to this forum with is called their Constitution. If this order becomes
the title, ‘Jacques Lavier; a presentation to the Second altered by the influence of any of the external, internal
International Forum of Anthropological Research or miscellaneous causes of disease as recognised
on Chinese Medicine in the West’.2 Professor He has in Chinese medicine, then one organ (official) will
continued to spearhead the investigation of Western become relatively hyperactive, while another will
contributions to Chinese medicine and, in early become relatively hypoactive (or vice-versa), reflecting
2017, he organised the founding conference in Paris basic yinyang theory. Such an alteration disturbs the
of a new organisation devoted to this subject, the original optimal state of the qi mechanism of the
Centre de Recherche sur les Apports Occidentaux organs. When this alteration occurs, the individual
à la Médecine Chinoise (CRAOMC), at which I no longer feels like themselves, or in other words
was asked to serve as a vice-president. During has developed a Condition (premorbid or even frank
this meeting, plans were made for the fifth annual illness). The goal of this style of acupuncture treatment
forum in Kunming, and I was invited to conduct a is to restore the original order of functioning of the
pre-forum clinical workshop for Chinese students officials, so that the individual once again feels like
and practitioners, to demonstrate Constitutional/ themselves, thus changing a state of illness back to
Conditional Acupuncture. The workshop was one of wellness. Diagnosis of both the Constitution
designed to last three days, during which each and the Condition is primarily via various methods
morning I would examine and treat patients, and
each afternoon I would explain the methods I used
and give personal feedback to the attendees on how
Each human being is endowed at conception with a unique
to conduct the examination procedures and formulate set of strengths and weaknesses in terms of the functioning
the treatment protocols that I had demonstrated. On
of their zangfu and associated conduits (jingmai).
the second and third day, I arranged for the patients
46 Constitutional/Conditional Acupuncture: Basic Theory and Clinical Practice Journal of Chinese Medicine • Number 117 • June 2018

of pulse examination as transmitted from China, Korea, four different foods (cucumber, banana, potato and
India and other Asian countries. My own contribution carrot respectively). If the food resonates with the
to this system has been mostly one of synthesising these individual’s constitutional type, then the O-Ring test
apparently disparate traditions into a coherent whole, will show better neuromuscular coordination. There is
reflecting their common recognition of nature’s unity. also a method of pulse diagnosis developed by Puramo
That is, although Ayurvedic medicine, Korean medicine Chong, one of my Korean teachers, which can be used
and Chinese medicine differ in their theoretical postulates, to confirm this finding. In my practice I interpret these
they share a vitalistic6 understanding of human health four types as indicative of the following relationships:
and illness, and holistic models which I think of as lenses soyangin has the earth element stronger than the water
through which one might understand human life. These element, taiyangin has the metal element stronger than
lenses reveal different aspects of life, but by combining the wood element, soeumin has the water element
their different viewpoints, a more complete understanding stronger than the earth element and taeumin has the
of life’s nature can be synthesised. Western medicine, on wood element stronger than the metal element.10
the other hand, is not based on vitalism, and thus has
not been included in the development of Constitutional/
Conditional Acupuncture. In this synthetic approach to
acupuncture, typically the distal shu (transport) points
(five element7 points) are most commonly employed
for treatment, as these points regulate the interactions
between the zangfu.8

Diagnosis
In the following section I briefly summarise the
background theory and diagnostic procedures used in
Constitutional/Conditional Acupuncture, which were
employed in the case histories that follow:

Korean Sasang medicine (derived from the Yijing)

1) 
posits four constitutional types (soyangin, taeyangin,
soeumin and taeumin), which are diagnosed
kinesiologically through Omura’s O-Ring test,9
comparing the patient’s reactions when holding Figure 1: Maijing medial/lateral pulse deviations

Figure 2: Korean Constitutional Acupuncture proximal locations

Journal of Chinese Medicine • Number 117 • June 2018 Constitutional/Conditional Acupuncture: Basic Theory and Clinical Practice 47

2) Book 10 of the Maijing (Pulse Classic) describes locations with the relative strengths or weaknesses of all the other
for feeling the pulses of the conduits (jingmai) of the elements and organs. The following steps in the pulse
zangfu.11 The positions where these pulses may be felt examination provide information about the current state
can be described as radial or ulnar ‘deviations’ to the of the qi mechanism (the Condition):
three standard pulse positions known as cun, guan
and chi.12 Two of these positions (see Figure 1) can 1) The original pulse diagnosis paradigm described in
be observed to be equidistant from the flexor tendon the Neijing involved the comparison of carotid and
(i.e. connecting their positions forms a line parallel to radial arteries at acupoints Renying ST-9 and Jingqu
the flexor tendon), while the remaining pulse can be LU-8, named renying cunkou diagnosis (RYCK)
felt either closer to or further away from the tendon after the locations where the pulses of these arteries
than the other two pulses. These deviations in how the are taken to be compared.16 If renying is bigger than
pulses at cun, guan and chi line up remains the same cunkou it indicates either yang excess or yin deficiency.
whether the individual is examined in health or illness, If cunkou is bigger than renying this indicates either
so I understand them as reflecting the individual’s yin excess or yang deficiency. The exact proportions
Constitution, specifically in terms of the six pairs of between renying and cunkou can more narrowly
yinyang conduits and their associated organs. identify which of the six yinyang conduits is associated
with an imbalanced Condition.17 If the RYCK pulses
3) In 1965, a Korean acupuncturist named Kuon Dowon are felt to have a normal quality, the imbalance is
presented a new approach to acupuncture based on his attributed to the foot branch of the indicated conduit.
discovery of eight pulse types that never changed during If the RYCK pulses have a ‘bustling’ (zào 躁) quality,
the lifetime of an individual. He called his method the imbalance is attributed to the hand branch of the
Korean Constitutional Acupuncture (KCA).13 I have indicated conduit. Commentators disagree on what a
studied directly with Kuon at his clinic in Seoul, and have ‘bustling’ pulse feels like; for me it presents as a pulse
subsequently concluded that his discovery of these eight that has clearly defined edges all the way from the
pulse types is accurate. The location for taking the KCA surface to its root.18 The reason I classify this method of
pulses is in positions four, five and six, further proximally pulse diagnosis as Conditional is that after treatment,
along the radial artery than cun, guan and chi (See Figure the RYCK ratio can be observed to change - indeed this
2). The KCA pulses are felt by pressing on the artery to is stated as an expectation in the Neijing. It is not an
obliterate the pulse, then releasing the pressure to feel invariant signal like the first four listed above.
where the pulse first emerges.
2) Nanjing chapter 5 presents the associations of body
4) Ayurvedic medicine from India also has a theory of tissues (skin, vessel, flesh, tendon and bone) and organs
constitutional types, which can be diagnosed via the (Lung, Heart, Spleen, Liver and Kidney), implying
radial pulse. Interestingly, Ayurvedic constitutional their five element correlations, which resonate with
pulse diagnosis shares several features with KCA pulse the amount of pressure exerted by the examiner’s
diagnosis. Both systems examine the pulse in the same fingers at the cun, guan and chi positions. The greater
proximal locations that I refer to above as positions 4, 5 the pressure, the deeper the level where the pulse is
and 6. Also, both systems diagnose the constitution by examined. In a state of health, the depth where the pulse
examining the deepest impulse at these three positions. is biggest should match its elemental correspondence.
Ayurveda uses the concept of three doshas, which is Thus the left cun should be felt at the vessel depth,
not directly equivalent to any idea in Chinese medicine, which corresponds to fire. If it is felt at the bone depth
however it is possible to find correspondences between (corresponding to water), then there is an imbalance
Ayurvedic and Chinese medical designations.14 The between fire and water. This method of examination
three doshas are vata, pitta and kapha. These doshas can be refined even further by slightly shifting one’s
can be present at the constitutional level either singly fingers either proximally or distally at cun, guan and
or in couples. Thus there are six possible Ayurvedic chi.19 I have found that distal placement of cun, guan
constitutional types: vata, pitta, kapha, vata/pitta, and chi reflects the yang conduits associated with the
vata/kapha and pitta/kapha. fu organs, while proximal placement of cun, guan and
chi reflects the yin conduits associated with the zang
1. By using a combination of these first four diagnostic organs. Both yin and yang finger positions for cun, guan
findings, it is possible to determine the specific and chi give accurate information when applying the
Constitution of most individuals15 in terms of which ideas in Nanjing chapter 5. One goal of Constitutional/
of the five elements is at the root, which organ is Conditional Acupuncture treatment is to return these
specifically involved and whether it tends toward excess pulse depths to their proper level, and this can be
(hyperfunction) or deficiency (hypofunction), along used as a guide to the success of treatment. It is often
48 Constitutional/Conditional Acupuncture: Basic Theory and Clinical Practice Journal of Chinese Medicine • Number 117 • June 2018

found that these imbalances reflect each other in terms Case studies
of the individual’s Constitution and Condition. For Case 1
example, if the Constitution is Stomach excess and A 43 year-old Chinese man sought treatment for insomnia/
the Condition is Kidney deficiency, then the Stomach having trouble sleeping. He could fall asleep easily, but
pulse (right yang guan position) will be biggest at the woke up several times each night, and was experiencing
bone depth (water), while the Kidney pulse (left yin more intense and diverse dreams than usual. This problem
chi position) will be biggest at the flesh depth (earth). had started two months previously for no apparent reason.
He was happily married with one child, and worked as the
3) Perhaps the most difficult part of the Conditional director of a massage clinic. He had no previous illnesses
pulse exam is determining which of the Ayurvedic of any importance, nor was he taking any medications.
subdoshas are producing signals in the superficial part His only other symptom, which started at the same time
of the pulse wave as it strikes the examiner’s three as his insomnia, was a mild headache accompanied by
fingers (at positions 4, 5 and 6). Each of the three doshas left-sided neck stiffness. He had tried standard TCM-style
previously discussed is in turn comprised of five acupuncture (a total of seven treatments), but had only
subdoshas. The different subdosha impulses appear experienced temporary improvement.
as spikes at four equidistant places examined by the Sasang kinesiology testing showed a positive tropism
examiner’s fingers at locations. I have discovered that for cucumbers (diagnostic of a soyangin [‘young yang’]
these locations on the examiner’s fingers where the Constitution meaning earth was stronger than water). On
different subdoshas are felt reflect the xiang ke (control examining his radial pulse, I found the chi (third) position
cycle) order of the elements, so that a subdosha finding was ulnarly deviated (yin direction) bilaterally, indicative
can be translated into a Chinese elemental signal.20 of a shaoyin conduit imbalance as per the Maijing. From
My experience is that most often the Constitutional these two findings I already knew that his Constitution
element’s subdosha will be found on the radial could only be either Heart excess or Kidney deficiency.
artery on one side of the body, while the Conditional I then examined his left yin cun position and found that
element’s subdosha will be found on the opposite side. it was biggest just above the bone (water depth). This
These findings are more specific than just identifying finding confirmed that the Heart qi dynamic was not
the element involved. They actually reveal the organ functioning normally.
producing this signal, assuming one already knows Since insomnia is traditionally interpreted as being due
the individual’s Constitution, and thus their elemental to the spirit not being able to settle comfortably in the
tendencies toward excess or deficiency. Heart at night, I decided to test this finding by dispersing
the Heart on the right side using a four-point Korean hand
Obviously this brief presentation is not sufficient to enable acupuncture technique using press pellets.21 This test
one to practice Constitutional/Conditional Acupuncture, confirmed (via the pulse and the O-Ring test) that Heart
but it will make the case histories somewhat more excess was most likely his Constitution.22 As this was the
understandable, and perhaps spark an interest in the first patient I treated in Kunming, I decided to treat only
possibilities in this approach. the Constitutional component of his diagnosis in order to
demonstrate how powerful it can be to treat Constitution
alone, especially when the main symptom (insomnia in
this case) is typical of that Constitution (Heart excess). On
the right-hand side I dispersed Taibai SP-3 and Shenmen
HE-7, and supplemented KID-10 Yingu and Shaohai HE-
3. With the needles in place he reported that his neck felt
immediately better. I left the needles in place for 20 minutes
and asked him to return the next day when he reported
that he had slept much better and that his neck had also
significantly improved.

Case 2
A very talkative 35 year-old Chinese woman was seen for
a chronic problem that had started two years previously.
She was happily married, with a five year-old daughter
and worked as a hair-dresser. Her problems began due to
increased stress at work. She initially felt shocked by the
Figure 3: Constitutional/Conditional Acupuncture in Kunming, China change in her situation, and developed a headache. Soon
at the Sheng-Ai Hospital of TCM organised by the Yunnan University
of TCM
she began to worry continuously, and lost her sense of
Journal of Chinese Medicine • Number 117 • June 2018 Constitutional/Conditional Acupuncture: Basic Theory and Clinical Practice 49

balance (which she described as feeling dizzy), so that she transfer technique as transmitted by J.R. Worsley,26 based
could not stand or walk without holding on to someone on both the creative cycle (xiang sheng) of the five elements
or something. She described feeling as if she was drunk and the luo-connecting points of the yin and yang organs
all the time.23 Her condition seemed worse after exposure of the same element. All treatment was given on the left
to rain, dampness or additional stress, and she had been side because of the marked disparity between carotid
treated during the two years of her illness with both and radial pulses on that side. Thus the first needle was
Chinese herbal medicine and acupuncture, based on a inserted at Dadu SP-2 (angled towards the direction of
diagnosis of dampness and yang deficiency. Despite some flow), and the other needles were sequentially inserted at
improvement from this treatment, she had not recovered Shaochong HE-9, Ququan LIV-8 and Dazhong KID-4 (all
her balance or the ability to walk unaided. In the past she perpendicularly). The needle at Dadu SP-2 was twisted
had experienced problems with numbness in her hands clockwise on removal, then all the other needles were
and legs and pain and burning on both sides of her tongue, removed in the same sequence as they had been inserted
without any apparent cause, and both of these symptoms and ‘closed’ by finger pressure.
had resolved spontaneously. She tried several things
to help herself. The first was a vegetarian diet, but this
only made her feel worse. Eating meat was one of the few
things that helped her feel better. The second was to begin
Immediately after treatment she reported that her
Buddhist meditation, and although this improved her dizziness had gone
sense of well-being, it did not affect her other symptoms.
She consulted a doctor of Western medicine who
diagnosed her as having psychiatric problems, but she Immediately after treatment she reported that her
declined to take the medicine he prescribed. On reviewing dizziness had gone, although she still could not stand
her history, she reported several more symptoms. Prior to or walk by herself. She was not able to return until
meditating, she had had a bad temper, but not since. Her two days later. The examination again confirmed her
sleep was often interrupted and she drooled while asleep. Spleen deficiency Constitution, but now it was her Gall
She had some neck/shoulder and low back pain. Her Bladder rather than her Bladder that showed excess in
menstrual cycle was unremarkable, as were her appetite the Conditional exam, and the carotid/radial disparity
and digestion. was now clearer on the right side.27 This time I decided
My first step in examination was to muscle-test the four to use the Korean four-needle technique to treat her,
foods that differentiate the Korean Sasang constitutional with all needles on the right side (per RYCK findings). I
types. She had a positive response to carrot, indicating needled the following points: Shaofu HE-8 and Dadu SP-2
a taeumin (old yin24) classification. Next I compared the (supplemented), Dadun LIV-1 and Yinbai SP-1 (dispersed),
size of the pulse of her carotid and radial arteries. On the Zusanli ST-36 and Yanglingquan GB-34 supplemented,
left side her carotid pulse was three times bigger than her and Zutonggu BL-66 and Xiaxi GB-43 dispersed. Deqi
radial artery, while on the right side they were of equal size. was elicited at all points, but without needle retention.28
The pulse quality was normal (not ‘bustling’), indicating As soon as the treatment was finished I asked her to stand
that the imbalance was in the foot rather than the hand up and try walking. To the amazement of the whole class,
conduits. From the RYCK ratio, one may conclude she myself included, she ambled back and forth up and down
had either an excess in the foot yangming conduits or a the hallway without needing to hold on to anything for
deficiency in the foot taiyin conduits. Taeumin does not support. How can we make sense of such a response?29
include any type of yangming excess, so foot taiyin (SP) According to KCA theory, which has contributed greatly
deficiency was the preliminary diagnosis.25 The deviation to my understanding of how the qi dynamic operates,
of her radial artery was in the guan position, going in the the relationship of the Gall Bladder to the Spleen in
ulnar (yin) direction bilaterally, indicating a constitutional an individual with a Spleen deficiency Constitution
taiyin conduit imbalance and confirming her Constitution is responsible for that individual’s maintenance of
as Spleen deficient. The Ayurvedic subdosha pulses were ‘vitalisation’.30 Some of the hallmarks of ‘devitalisation’
consistent with these findings, showing pitta/vata (earth are numbness and an inability to hold one’s body upright
type) on the left and pitta/kapha (water type) on the right. against gravity - both cardinal symptoms that pointed to
Putting all these findings together, her Constitutional this patient’s chief imbalance, and which once addressed
diagnosis was Spleen deficient with a Bladder excess successfully corrected the functioning of her qi dynamic.
Condition. The elemental order for Spleen deficiency
Constitution is earth<fire<metal<water<wood, which Case 3
is consistent with taeumin’s wood stronger than metal A 35 year-old female Chinese anthropologist specialising
nature. The goal of treatment for her was to harmonise in the history of Chinese and Western medicines presented
the Spleen and Bladder. I decided to use the five element with a number of complaints that, while not serious
50 Constitutional/Conditional Acupuncture: Basic Theory and Clinical Practice Journal of Chinese Medicine • Number 117 • June 2018

illnesses, were nevertheless distressing to her. These the following four days, during which time she said that
included dream-disturbed sleep (chasing or being chased) she felt better overall with much higher energy levels; her
for the last 10 years, low back pain for the last nine years back pain had started to gradually return, although not
(which started after a lifting injury), increasing fatigue yet to the pre-treatment level.
for the last five years (although present to a minor degree
since high school), dry eczema on her hands and around Case 4
her lips for four years, and emotional fragility (anger A 31 year-old Chinese female acupuncturist had been
alternating with depression) since the birth of her child born with a congenital double uterus. As a baby she had
three years previously (by Caesarian section with epidural undergone surgery to remove the septum dividing her
anesthesia). She did not trust Western medicine, so she uterus. She successfully delivered a healthy baby of her
had not taken any drugs, but she had tried acupuncture own three and a half years before consultation, but since
a number of times, which had only helped for one or two then she had begun feeling hot at night, having delayed
days after treatment. She was currently taking Chinese menses (every six weeks) of dark colour and scanty
herbal medicine, but did not think it had produced any flow, accompanied by abdominal and back pain. For the
effect so far. previous three months she had been trying to get pregnant
Examination revealed a positive muscle test for carrot, a second time without success. During these three months
indicating a taeumin (old yin) constitutional type (wood her sleep had become disrupted by frequent waking and
stronger than metal). Her radial pulses in the yang position intense dreaming. She also reported chronic constipation
showed the left cun to be at the water depth and the left for ten years, often going two or three days without
chi at the fire depth. Both left and right radial arteries were defecation, accompanied by a diminished appetite. She
radially deviated in the cun position. From this data, there was prone to shoulder and neck pain and intermittent
were only two possibilities for her Constitution: Small migraine headaches along the shaoyang conduit pathway,
Intestine excess or Bladder deficiency. These findings were which she tried unsuccessfully to treat with Xiao Yao San
confirmed by the subdoshas: the left side showed vata (Rambling Powder).
(water type, compatible with Bladder deficiency) while At the time of examination she was experiencing fatigue
the right side showed vata (fire type, compatible with and lower abdominal pain that she rated at an intensity of
Small Intestine excess). I tried to see if the RYCK pulses four to five on a scale of zero to ten, which she attributed
could clarify the diagnosis, as I was not yet clear on which to intestinal gas. The Sasang food test was positive for
was her Constitution and which her Condition. On the left banana, indicative of taeyangin (old yang) constitution
side renying and cunkou were of equal size, but on the (metal stronger than wood). On the left side RYCK
right side renying was twice as big as cunkou, although palpation showed a slightly bigger carotid than radial
the pulse quality was not bustling. This ratio indicated pulse (ratio 1.5/1), but they were of equal size on the right
Small Intestine excess, but the pulse quality pointed to and the bustling quality was not present. These initial
Bladder, so I still was not sure which was the Constitution findings were only compatible with a Liver deficiency
and which the Condition. I decided that her Constitution Constitution. The other pulse readings supported such a
was most likely Bladder deficiency because according to conclusion. Her cun pulse was ulnarly deviated bilaterally.
KCA theory the relationship between Bladder and Small Her left yin guan pulse was at the earth depth, while her
Intestine would again be that of devitalisation if her right yin guan pulse was at the wood depth. Furthermore,
Constitution was Bladder deficiency, while it would have her left subdosha was kapha (earth type) and her right
represented an infectious pathology if her Constitution subdosha was kapha (wood type). This clearly indicated a
had been Small Intestine excess.31 For someone with a Constitutional diagnosis of Liver deficiency with a Spleen
Bladder deficiency Constitution the elemental order is excess Condition.
water<metal<wood<fire<earth. Fortunately there is a Treatment was given on the left side because of her RYCK
treatment that can treat either Constitutional possibility. pulse findings. The four-needle technique used the following
I chose to use a simple xiang sheng32 transfer treatment, points: Jingqu LU-8 and Zhongfeng LIV-4 dispersed and
as this would direct excess Small Intestine qi to the Yingu KID-10 and Ququan LIV-8 supplemented, plus Jingqu
deficient Bladder. Treatment was given on the right side LU-833 and Shangqiu SP-5 dispersed and Dadun LIV-1 and
because of the RYCK pulse. The first needle was therefore Yinbai SP-1 supplemented. The needles were left in place for
inserted in Zhiyin BL-67 in the direction of flow, followed 20 minutes. During that time her abdominal pain decreased
by needles in Quchi LI-11 and Jiexi ST-41, both inserted to a level of one to two. Her pain stayed at this level the next
perpendicularly and left in place for 10 minutes. At the time day, and her appetite returned to normal.
the needles were removed, the patient reported feeling The relationship of an excess Spleen to a deficient Liver
more relaxed, energetic and experiencing significantly less in this patient’s Constitution is typical of KCA’s pattern
low back pain. As she was both a student in the class and of inflammatory problems of the fu organ systems, which
an attendee at the forum, I was able to check on her over include both the intestines and the uterus. Individuals of
Journal of Chinese Medicine • Number 117 • June 2018 Constitutional/Conditional Acupuncture: Basic Theory and Clinical Practice 51

this Constitution should not eat meat from land animals, the next day he always felt intensely cold from his thighs
however this patient really liked such foods and continued down to his feet, and as a result he could not sit still for
to eat them against my recommendation. As the patient was long. He always felt cold in bad weather, and needed
involved in the administration of the forum which followed many layers of clothing compared to others. Changes
my workshop, she was experiencing more than the usual in air temperature also elicited bouts of sneezing and a
degree of stress, which together with her diet led, I believe, runny nose in the morning with clear mucus. He also
to a recurrence of abdominal discomfort several days later. reported always feeling tired and had very poor exercise
She was treated again, and her symptoms again improved; tolerance; he could walk on flat terrain without a problem,
she was again strongly encouraged to change her diet. but climbing even one flight of stairs was difficult and
necessitated a period of rest before he could continue.
Case 5 He slept for many hours each night, but still woke up
A 37 year-old Chinese woman had been suffering from feeling tired, and would sometimes need to take naps up
rheumatoid arthritis for four and a half years. She had to four times a day. This symptom was strongly associated
pain in many different joints, which was aggravated by with his mental state: if he was excited or interested in
cold and during her menses. At the time of the workshop, something, he felt OK with eight hours sleep, but if he
she complained of sharp pain in her neck and shoulders, was bored, he could sleep all day and still feel exhausted.
both wrists and her left knee. She had previously tried He snored loudly at night, and could usually be heard
acupuncture, Chinese herbs and Western medicine with in an adjoining room. For two years he had experienced
minimal benefit, and expressed doubt that acupuncture episodes where both lateral ankles began to hurt so
could significantly help her. badly that he could not walk. He had tried both Chinese
Food testing was positive for potato (soeumin or young medical herb compresses and manipulative therapy for
yin, water stronger than earth). The RYCK exam showed this problem, with only transient improvement. There had
cunkou bigger than renying on the right side by a ratio been no injury to explain the onset of this problem. He
of three to one with a bustling quality, while these pulses also reported pain and stiffness around acupoint Dazhui
were equal on the left side. There was ulnar deviation DU-14 if he had been reading a book in the same posture
under the guan finger bilaterally. These findings were all for too long. He was always hungry and ate excessively,
consistent with a Constitutional diagnosis of Lung excess. and had bowel movements three or four times a day with
In KCA, arthritis is usually associated with inflammation soft stools (but not diarrhoea). He felt better after a bowel
of the zang organ system,34 so I was not surprised to find movement, but could not walk very far because he always
that her subdoshas reflected that prediction. On the right needed to be near a toilet. Perhaps his most serious issue
side she had vata/kapha (Lung excess), while on the left was his mental state. He frequently felt either depressed
she had vata of fire type (Heart deficiency). For Lung or obsessed about something, and often had the feeling
excess Constitutions, Heart deficiency indicates pathology that people were whispering about him. Of note, he was
involving inflammation of the zang organ system. The the most talkative and inquisitive student in the class,
order for Lung excess is metal>water>earth>wood>fire, and displayed no signs of abnormal mental or emotional
reflecting the water>earth aspect of soeumin balance. He was a vegetarian, and had tried a number of
constitutions. I treated her with gold and silver pellets on Chinese herbal prescriptions including Liu Wei Di Huang
the corresponding Korean Hand Acupuncture points on Wan (Six-Ingredient Pill with Rehmannia) and Ba Wei Di
the right side (following the RYCK findings) as follows: Huang Wan (Eight-Ingredient Pill with Rehmannia), but
Yingu KID-10 and Chize LU-5 dispersed, Shaofu HE-8 did not like the way either made him feel.
and Yuji LU-10 supplemented, Jingqu LU-8 and Lingdao Examination revealed a positive O-Ring test for
HE-4 dispersed, and Dadun LIV-1 and Shaochong HE-9 cucumber (soyangin or young yang: earth>water).
supplemented. As soon as I put the pellets in place she The RYCK diagnosis showed renying was bigger than
said the pain was greatly reduced at all locations. Her cunkou on the right side with a normal pulse quality,
O-Ring test had also become markedly stronger. The next while renying was the same size as cunkou on the left.
day in class she said that she was amazed at how much The guan position was deviated radially on both sides.
better she felt. She stayed for the whole forum, and before These findings allowed only one conclusion about
leaving told me that all her joints had stayed better except his Constitution: Stomach excess. Next his pulse was
her knee, which had started to hurt again, but she felt very examined to determine his Conditional diagnosis. On
happy at her overall sense of well-being. the left side he had pitta/vata (earth type) subdoshas
(consistent with Stomach excess), while on the right side
Case 6 he had pitta/kapha (water type) subdoshas, suggesting
A 29 year-old Chinese man had a number of health issues, Kidney deficiency. The Nanjing depth analysis confirmed
including extreme sensitivity to cold. If the temperature this: his right yang guan pulse was at the water depth,
changed abruptly by more than three degrees Celsius, while his left yin chi pulse was at the earth depth.
52 Constitutional/Conditional Acupuncture: Basic Theory and Clinical Practice Journal of Chinese Medicine • Number 117 • June 2018

I decided to treat him with a simple qi transfer on the right Food testing showed a positive response to potato
side (because of his RYCK imbalance). The first needle was (soeumin or young yin: water stronger than earth). On
inserted in Fuliu KID-7 in the direction of flow, followed by the left side renying was three times bigger than cunkou
perpendicular insertions into Taiyuan LU-9 and Gongsun with a normal pulse quality, while renying was the same
SP-4.35 Immediately after treatment, the O-Ring test showed size as cunkou on the right. Her guan pulse was radially
a vast improvement in strength. The next morning he deviated bilaterally. Thus her Constitution was diagnosed
reported that there had been no runny nose on waking, as Stomach deficiency. This finding was confirmed
which was unusual. He had also reported only having two by checking her KCA pulses, which exactly matched
bowel movements, which was also unusual, especially Kuon’s description of the pattern for Stomach deficiency
as they were 12 hours apart. He experienced an increase (one of the original eight types Kuon discovered). Her
in his energy to a normal level, although this was difficult Conditional diagnosis was indicated by a right yang guan
to evaluate due to his increased level of excitement and pulse at the water depth and a left yin chi pulse at the
interest. Significantly, his wife (also in the class) reported earth depth. Additionally, her left subdosha was vata
that his snoring had noticeably diminished. His usual (water type) and her right subdosha was kapha (earth
excessive appetite had decreased to normal and his legs type). Thus her Conditional diagnosis was Kidney excess.
were warmer than previously. His only concern was that I treated her on the left side (based on the RYCK test)
he did not feel as clear headed, and wondered if more with the four needle technique as follows: Yanggu SI-5
treatment was required. I checked his pulses, and as they and Jiexi ST-41 supplemented and Zutonggu BL-66 and
now felt normally balanced, I recommended that he wait a Neiting ST-44 dispersed, plus Taibai SP-3 and Taixi KID-3
few days, as I could always treat him again if necessary. By supplemented and Dadun LIV-1 and Yongquan KID-1
the time the forum took place, he was feeling clear headed dispersed. Her O-Ring test got much stronger right away
and his other symptoms remained improved, including his and she commented that her feet felt warmer. The next
mental and emotional state. day she reported that both her hands and feet were much
warmer than usual, and soon after treatment she had felt
Case 7 a need to go to sleep, but when she woke up she had a
This 23 year-old Chinese woman had three health noticeable increase in appetite, and she continued to feel
complaints. She always suffered from cold hands and feet better during the time of the forum.
and had a very poor appetite, but was more concerned
with her menstrual function. Her menarche had been at Five more individuals were treated with this Constitutional/
age 13, but her cycles had always been irregular and her Conditional Acupuncture method during the following ten
period usually arrived late with dark clots and scanty days while I travelled in Yunnan Province with a group
flow, lasting seven days. When she was under stress in of foreign (mostly French) practitioners, several of whom
high school, her periods had stopped for six months. She asked for treatment. Their case histories are available by
had tried Chinese medicine for one year in 2013 without request to: [email protected].
any improvement, after which she tried biomedical
hormonal treatment for three months. This successfully Peter Eckman MD, PhD, MAc (UK), has practised acupuncture in
regulated her periods, but she did not want to stay on that the San Francisco Bay Area since 1973. His latest books, The Compleat
Acupuncturist and Grasping the Donkey’s Tail, are published by
kind of medicine permanently, and when she stopped, the
Singing Dragon.
irregular cycle recurred. At present she was not receiving
any treatment and otherwise felt well.

References
1 This approach to treatment has been translated works by Wu Wei-p’ing share with readers following email (<www.thefreedictionary.com>)
introduced in two books written by of Taiwan into French. He wrote a request. 7 I use the translation ‘element’ rather
theauthor-TheCompleatAcupuncturist number of books on acupuncture, 4 My workshop was videotaped, than ‘phase’ both to honour my
andGraspingtheDonkey’sTailpublished and translated the Su Wen (Basic with the permission of everyone teachers (both Worsley and Korean
by Singing Dragon Press - but is still Questions) into French. His career is present, and is available at the Uni- teachers) who used this term, and
being refined. The cases presented reviewed in Eckman, P. (1996). In the versity library, so my attention to because I want to keep our profession
here introduce developments that Footsteps of the Yellow Emperor. Cypress confidentiality is simply an added from ostracising those trained by
have not been previously published. Books: San Francisco, second edition courtesy. Worsley and his colleagues. The
2 Jacques Lavier was a French (2007). Long River Press: South San Chineselanguageissuchthatmultiple
5 Whilstthetranslationofqiinto‘energy’
acupuncturist, most active in the Francisco. translations are often possible, and in
is not perfect, neither are any of the
1960s, who was an early teacher of 3 Due to the positive results, after the alternatives. this case both terms have something
J. R. Worsley, founder of a number of workshop I was asked to treat a to offer.
6 Vitalism is ‘'The theory or doctrine
schools of Five Element Acupuncture numberofattendees,fellowpresenters 8 I use the term zangfu rather than
that life processes arise from or
in various countries. Lavier was and their family members. These channels here as there are no channel
contain a nonmaterial vital principle
self-taught in the classical Chinese cases make up a second group of case pathways from a given shu point
and cannot be explained entirely as
language, but also studied with and histories, which I would be pleased to to another associated channel. For
physical and chemical phenomena.’
Journal of Chinese Medicine • Number 117 • June 2018 Constitutional/Conditional Acupuncture: Basic Theory and Clinical Practice 53

example, Lingdao HE-4 is the metal exams are needed to identify the correct sasang diagnosis of young yang. foreign doctor in front of a group of
point of the Heart channel, from which choice in each case. In my experience 23 My translator used the term ‘dizziness’ interested observers. This phenomenon
there is no connection to either the Lung there are 20 different Constitutional types, to refer to two different symptoms is not unknown in religious settings, for
or Large Intestine channels. I consider all reflecting excess or deficient tendencies of experienced by this woman. One was example, and ideally it would be best
these elemental effects to be ‘delocalised’ the ‘formed’ organs (i.e. excluding Sanjiao a feeling that she compared to being to have a long term follow-up report
and based on resonance. As such, they and Mingmen). I believe these ‘ministerial constantly drunk. The other symptom to more properly evaluate the degree
work by influencing the organs not the fire’ organs, which have functions but not was an experience of unsteadiness if she of recovery; unfortunately this was not
channels,whichiswhytheyaresoeffective form,areneverthebasisofaConstitutional tried to stand or walk without support. possible in this case. My reasons for not
intreatinginternalproblems,asopposedto type, perhaps because an imbalance in attributing this particular result purely
the more superficial pain syndromes that either of them might be incompatible 24 Of note, patients with a taeumin
to placebo include the following: this
could be seen as more related to channel with foetal life. In any case, my clinical Constitution typically need meat in their
patient had never experienced an ability
effects. experience is that no Constitution based diet in order to main-tain a good state of
to walk unaided during two years of
on ministerial fire can be found using health.
9 The O-Ring test was developed by prior acupuncture and herbal treatment
YoshiakiOmura,aJapanesephysicianand the synthetic examination method I am 25 The interpretation of the ratios of carotid (still ongoing), a modality in which she
acupuncture re-searcher, and is described describing. and radial arteries as described in the be-lieved as opposed to her rejection of
on his website (http://bdort.org). The 14 Eckman, P. (1995). Ayurveda and Neijing is a matter of controversy. My Western pharmaceutical treatment. The
author attended a class by Omura in Korean Hand Acupuncture: A Brief conclusions are explained in detail in setting, with a foreign doctor and an
1988, where this technique was taught. It IntroductiontoSomeSimilaritiesbetween Chapter 5 of Grasping the Donkey’s Tail. audience could have been an enhancer
was first applied to Sasang diagnosis via Constitutional Typologies, The American 26 Details of this treatment style can be found of the placebo effect, but this was also
food testing by Myung-Bok Lee and is Journal of Acupuncture, 23(2), pp.153-158. in In the Footsteps of the Yellow Emperor, true for her first treatment, which had not
described in his book Know Your Body Type This information was later reprised in The along with notes on the lineage of this produced this dramatic response. In fact,
and You Will See Health (Korean language) Compleat Acupuncturist. methodology as having originated in when she returned the second time, she
published by Daekwang Publishers China. Briefly, one option, as in this case, appeared to be disappointed that the first
15 Differentiating fire constitutions from
(Seoul, 1993). is to have the first needle inserted in the treatment had only provided a minor and
waterconstitutionsmayrequireadditional
most deficient conduit at its tonification transient benefit, so if anything, I felt there
10 My interpretation of these four types does examination methods, but this involves
point, angled in the direction of flow. may have been something of a negative
notstrictlyfolloworthodoxSasangtheory. only a small minority of cases.
Then needles are added sequentially in placebo present at her second treatment.
The original theory only deals with four 16 There is controversy about the location the tonification points of the conduits that It seems to me more appropriate in this
zang organs, and was not based on five of cunkou in this method, with many precedeitalongthexiangshengcircleuntil circumstance to attribute the result to a
element theory, nor does it recog-nise believing that cunkou refers to the pulse the excess element has been depleted by specific response to the Constitutional/
the pairing of zang and fu according at Taiyuan LU-9. I have found that the its child. If needed, the luo point of the Conditional Acupuncture treatment.
to element that is a basic component of interpretation of cunkou given by Wang
Chinese medicine. My interpretation excess element is the last needle inserted 30 The concepts of vitalisation and
Bing in his commentary on chapter 2 of when there is a need to transfer from a yin
creates a ‘middle way’ that synthesises devitalisation are used by Kuon Dowon
the Lingshu, which identifies cunkou as conduittoayangconduitorvice-versa.All
both Korean and Chinese teachings. who associates them with symptoms
JingquLU-8,givesbestresults.Thisissueis theneedlesexceptthefirstoneareinserted such as numbness (rather than pain)
11 This is a totally different set of relations discussedatlengthinGraspingtheDonkey’s perpendicularly. and prolapse. I conceptualise them as
between cun, guan and chi to those Tail.
27 Gall Bladder at the earth depth, Spleen at something like the deficiency patterns of
presented earlier in the Maijing and in 17 The meaning of the various RYCK the wood depth, left subdosha: pitta/vata qi and jing.
the Nanjing (Classic of Difficulties). The ratios in the Neijing is open to various
associations given by the Maijing in Book (earth type) and right subdosha: kapha 31 These KCA auxillary patterns -
interpretations. See Grasping the Donkey’s (wood type).
10 for the foot conduits are equally valid, devitalisation,infectionandinflammation
Tail for a description of the controversy
in my experience, for the hand conduits 28 The four-needle Sasang method for of the zang and fu organ systems - are
and my own conclusions.
of the same yin or yang nature (i.e. taiyin, treating the Constitutional conduit too complex to explain in this article,
shaoyin, jueyin, taiyang, shaoyang and 18 Theoretically this quality could be felt on follows orthodox rules described by but are presented in The Compleat
yangming).TheMaijinggivesmoremedial both pulses, but practically speaking it is its originator, Sa Am. However the Acupuncturist. The important point
locations for three hand conduits and unwise to compress the carotid pulse for four-needle technique used to treat the being made here is that this patient’s
makes no mention of the remaining three very long for obvious reasons. Conditional conduit can vary from this, presentation and history (back pain,
hand conduits. My application of Maijing 19 See Eckman. P. (2015). Precision in Finger as it must follow the order of relative fatigue and deterioration after pregnancy,
theory is not strictly orthodox, but rather Placement for Pulse Diagnosis, The Journal strengths and weaknesses of the elements epidural anesthesia and surgery) showed
an adaptation developed to fit clinical of Chinese Medicine, 109, pp. 40-55. as determined by the individual’s no indication of infection (the other KCA
observations. It is crucial to recognise Constitution. In this case, in order to possibility to be considered), which is
20 From radial to ulnar sides of each finger,
that the Maijing does not prioritise this disperse the Gall Bladder, the water why I chose to treat the Condition as
the order is metal, wood, earth and water.
newer set of associations for cun, guan element rather than the fire element was devitalisation.
Iftwoofthesesubdoshasignalsareequally
and chi over the older ones. Both are present on any finger, it indicates the fire dispersed because it was the stronger of 32 A transfer from fire to earth to metal to
simultaneouslytrue,butprovidedifferent element. the two elements as shown in the element water using three tonification points.
typesofinformationabouttheirassociated order for Spleen deficiency. This is an
21 All of my treatments were done 33 The repeated mention of LU-8 is to
conduits. excellent example of why the translation
unilaterally. The side chosen for treatment emphasise the logic of the four needle
12 Cun, guan and chi refer to locations in the ofxiangshengshouldbe‘mutualcreation’
does not always follow any absolute technique: I did not add an additional
distal/proximal dimension. The Maijing ratherthan‘creativecycle’,asdisper-sionin
rule that I have so far discovered, but needle there, but am acnowledging that
deviationsrefertolocationsinthemedial/ this case involves dispersing the ‘mother’
often acute and subacute problems are this point was active in both the Constitu-
lateral dimension. rather than the ‘son’. There was no needle
best treated contralaterally (as in this tional and Conditional parts of treatment.
retention in this case simply because there
13 See Kuon, D. (1965). A Study of case), while chronic problems may need 34 Zang inflammation is another auxiliary
was limited time available. I view these
Constitution Acupuncture, Journal of the treatment on either side. In the cases pattern, like devitalisation, identified
Constitutional/Conditionaltreatmentsas
International Congress of Acupuncture and reported in this article, the side with the by Kuon (explained in The Compleat
‘energetic messages’, which are received
Moxibustion, 10, pp.149-167. While I agree obvious imbalance between carotid and Acupuncturist).
as soon as the needles are inserted. There
withKuonthatonlytheseeightpulsetypes radial pulses (RYCK method) was usually
maybesomebenefittoleavingtheneedles 35 The standard order of needling when
are found to occur, I disagree about their chosen for treatment. Currently I use
longer, but this needs further study; in any performing transfers is to start with the
interpretation. Kuon believed that each of Korean Hand Acupuncture press pellets
case, as this case demonstrates, needle deficient conduit, in order to draw qi to it
theeighttypesrepresentedasingleunique to pre-test which side is more effective in
retention is not a necessary requirement fromthemostexcessconduit.Eventhough
Constitution. My observation after many normalising the pulse or changing some
for effective treatment. in this case the Constitution was excess in
years of study is that people of different other aspect of the presentation.
29 When considering such a ‘miraculous’ the Stomach, no needles were inserted in
Constitutions may share the same KCA 22 The elemental order from strongest to
response, the first interpretation might the Stomach conduit. The luo-connecting
pulse pattern. Specifically, each KCA weakest in the Heart excess Constitution
be the placebo response, given that point of the Spleen was used to draw qi
pattern may reflect two or three different is fire> earth> wood> metal> water. Earth
this patient was being treated by a out of the Stomach.
Constitutions,andtheotherConstitutional is stronger than water, agreeing with the