The notion that people have a particular constitutional imbalance is very old and widespread in Chinese medicine. Ling Shu Chapter 64 is devoted to an exploration of Five Element constitutional types, based mainly on physical shape and aspects of a person’s character. Another system given in Ling Shu Chapter 72 outlines a four-fold yin/yang system that divides people into taiyang, shaoyang, taiyin and shaoyin types (see Flaws and Lake, 2000, p. 27). In Japan there is a strong tradition of treating people according to constitutional type. For example, there is a style based upon the six-fold system outlined in the late Han dynasty classic, the Shanghan Lun. Using somewhat different criteria it divides people into six types, taiyang, shaoyang, taiyin, shaoyin, yangmimg and jueyin (Schmidt, 1990). Master practitioners such as Fukushima and Honma (Eckman, 1996) have also developed styles that diagnose and treat constitutional types. In Korea, Kuon Dowon teaches yet another constitutional style (see Eckman, 1996, p. 209).

The phrase that is currently used in Chinese medicine today to describe a person’s constitution is chang ti, which means ‘bodily type’. This is an appropriate phrase to describe diagnosis that is primarily based upon the physical shape of the person’s body (see Maciocia, 2005, pp. 292–298, or Requena, 1989, pp. 81–93, for discussion of these systems). J. R. Worsley, however, developed his style based upon completely different diagnostic criteria, which are set out in the Nei Jing and Nan Jing. The practitioner’s focus is on certain signs that arise as a patient’s qi goes out of balance.

The Constitutional Factor, known as the CF, is one of the most important concepts in Five Element Constitutional Acupuncture. J. R. Worsley used the phrase ‘Causative Factor’ because, as it is the primary imbalance, it ‘causes’ other Elements to become imbalanced. Although this is true there are also other causes. Along with many other practitioners of this style we prefer, for clarity, the term ‘Constitutional Factor’. The word factor is used, partly because it is the word used by J. R. Worsley and partly because it is commonly used in Chinese medicine, as in ‘pathogenic factor’. It is the main focus of the practitioner’s diagnosis and much of the patient’s treatment is centred on it. Because it is the patient’s most underlying imbalance it creates much of the imbalance that can be detected in other Elements. For this reason, as it returns to a better state of health through treatment, it in turn enables many other imbalances to respond and improve. Many of the most dramatic and profound changes that patients can experience from acupuncture treatment are achieved by focusing treatment on it.

The word constitution is defined in the Oxford English Dictionary as: ‘The character of the body as regards health, strength, vitality, etc. Condition of mind; disposition; temperament.’ The concept of a person’s constitution covers both the physical body and the mind and temperament. The word gives a sense of a person’s constitution having lifelong characteristics that may manifest in their physical health or psychological make-up.

There is some debate amongst practitioners of Five Element Constitutional Acupuncture about whether the CF is always inherited or whether it can be acquired in early childhood. Examining the occurrence of the same CF in several members of different generations in a family suggests that many constitutional imbalances are carried in the genes. The person’s responses to subsequent traumatic life situations further imbalance that Element. Other Elements are also affected over time but the CF is the person’s Achilles heel and is the most vulnerable.

Just as people can inherit diseases or weaknesses in particular Organs, people can also inherit imbalances in their temperament or disposition depending on the balance of the Five Elements. The ‘nature versus nurture’ debate is probably irresolvable and will continue wherever people study humanity, whether they are psychologists, educationalists, acupuncturists or anyone interested in the formation of character. The key task of the acupuncture practitioner is to diagnose the pattern of the person’s imbalances and to assist them to achieve a better state of health.

According to Chinese medicine theory the jing is the main vehicle by which imbalances are handed down from generation to generation. Jing is governed by the Kidneys and determines people’s constitutional strength or weakness. This is different from the CF. It is obvious that not all congenital imbalances are found in people’s Kidneys. Just as, for example, heart problems or skin problems can be inherited, so also are imbalances in any of the Elements or Organs.