Constitutions: The 6 Tissue States

Introduction to the 6 Tissue States

“Modern science and medicine are reductionistic; that is to say, they reduce all phenomena to
their smallest pieces to gain understanding. This perspective ignores the possibility that there
is a unified being, consciousness, identity pattern, or functional whole at the base of a human,
animal, plant or disease organism. Holism, in contrast, concerns itself with this underlying,
unifying entity… The holistic practitioner, in almost every field of holistic medicine, attempts
to establish the individual identity and pattern of the sick person, the disease, and the
therapeutic tool. This is one of the most important and characteristic differences between
conventional and alternative medicine.”
-Matthew Wood

In the discussion of constitutional systems, oftentimes there is a strong focus on the

constitution of the whole person- that is, how someone’s overall physiology, appearance,
tendencies, and predispositions are influenced by the Elements, the Doshas etc. But an
important consideration in the study of constitutional theory is not just the overall constitution
of the person, but the specific constitution of the tissues which comprise the various organs
and systems of the body.

This can be achieved through many different models, such as the pattern of yin and yang in
excess and deficiency, an excess of vata, pitta, or kapha, or melancholic, phlegmatic, choleric
and sanguine. While someone can have an overall constitutional pattern influencing the whole
organism, it is possible for there to be a different constitutional pattern within the tissues
themselves. This is important, for it will radically change how we approach our therapeutics
and protocols.

For example, it is possible for a vata type constitution to get sick and have a kapha type
imbalance in their respiratory system. So whereas vata tends to be cold, dry and tense, in this
situations we see that they actually have a cold, damp condition in the respiratory system. If we
were to merely look at the whole constitution (vata) and let that guide our therapeutics
(which would usually be moistening type remedies) we will actually do more harm than good,
because the constitution of the specific tissues themselves is different from the overall
constitution.

Thus our constitutional system is two-fold, on the one hand we have the big picture pattern of
the forces that influence the person as a whole, and on the other we have the more specific
state of the tissues themselves right now. From the Ayurvedic perspective, this can be seen as
the prakruti and the vikruti. The prior is the core innate constitution, that which we are born
into, whereas the latter is the assumed constitution, or whatever our current state is. This is a
crucial differentiation whenever you are assessing a person- never overlook the current
constitutional state of the whole person, as well as the specific tissues.

In our North American tradition, we have a truly wonderful pattern for assessing the
constitutional state of the tissues- called the 6 tissue states. These were devised by the
Physiomedicalists in the early 1900’s and formed the crux of their model of evaluation and
assessment of their patients, which naturally guided their therapeutics. It was first written
about by Dr. Joseph Thurston in his book “The Philosophy of Physiomedicalism”, published

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in 1900. My understanding of this model of practice was learned primarily through the
teachings of one of our greatest modern herbalists, Matthew Wood. He says, “This theory,
based as it is on actual physiology, is more compatible with the modern perspective, yet it is
not incompatible with the ancient. It can serve as a language of energetics and a conceptual
bridge.”

The 6 tissues states are formed through looking at 3 primary qualitative states of the tissues,
based on our traditional models of energetics. These 3 primary qualities are: temperature,
moisture and tone. While the first two are very commonly used in energetic models of
herbalism, the concept of tissue tone is oftentimes overlooked, and is in fact a critical
consideration for holistic therapeutics.

Each of these 3 qualities exist on a polarity or a spectrum, which make the 6 tissue states. The
quality of temperature can manifest as the patterns of hot or cold, the quality of moisture can
manifest as damp or dry, and the quality of tone can manifest as relaxed or tense.

Thus our 6 tissue states are referred to as: heat/excitation, cold/depression, dry/atrophy,
damp/stagnation, wind/tension, and damp/relaxation. Naturally the first words here refer to
the more classic terminology used in Greek medicine and other older systems. The second
words are those commonly used in 19th and 20th century North American medicine, and it is
these that I say are essential to remember and understand when studying the 6 tissue states,
for they open your eyes to seeing deeper into how these different patterns manifest within not
only the tissues, but also within the psychological sphere. (Note that those second words are
commonly used to indicate certain states of mind)

It’s important to understand that while there are 6 seemingly different tissue states, it is more
common for people to have a blend of these different tissue states together- for example
tissues that are very cold and damp, or very hot and tense. This forms the crux of what you
are striving to look for and determine in every person you work with so your therapeutics are
going to balance and not aggravate the underlying state of the tissues.

This model of physiology and energetics looks to the deeper levels of imbalance within a
person, rather than focusing on a particular disease entity or eliminating a symptom. For
example, 2 people can have a respiratory tract infection or bronchitis. From a modern medical
perspective, they simply want to kill the infectious agent which they see as being the root
cause of the disease. Though from a holistic perspective, we want to look at the exact nature
or pattern of the cough. One person might have a very dry and hot type of respiratory
infection, and the second might have a more cold and damp situation- both of which will be
treated very differently indeed! The holistic practitioner doesn’t focus on “killing the bugs,”
but rather asks the question of “what enabled the body to host the pathogen, and how can we
shift the state of the tissues so it is inhospitable to the infectious agent.” It is not mechanistic
perspective of the human organism, but rather an ecological model of medicine.

Lastly, while the common ways of describing the tissues states are related to hot and cold etc,
these terms are not simply referring to the temperature itself that can be measured with a

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thermometer. I always encourage my students to look at the underlying qualities behind heat or
cold, dampness or dryness, tension or relaxation. For example, a tissue afflicted by heat is not
only hot in temperature, but it is in a state of overactivity, it is breaking things down too
quickly, metabolism is increased, and the overall vital force tends to move up and out (like a
fire).

In the following lessons within the tissue state section, you are going to learn about these 6
different tissue states and how to learn to directly see them within the people you serve. This
includes recognizing how they tend to manifest within the different organ systems of the body,
general signs and symptoms that point to it, as well as some of the primary categories of plants
that you would want to consider for treating that tissue state.

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