I believe that the theory of constitutional acupuncture of Kwon Dowon should be seen as a revolutionary and medical breakthrough from the historical point of view in the realm of Korean medicine and that, accordingly, his contribution should be highly appraised. Nevertheless, some theoretical errors that are found in his theory should be recognized and corrected to ultimately advance the quality of oriental medicine.

The first theoretical error found in Kwon's theory is that he interpreted the organ structure determined by the Five Element Theory's mutual generation and destruction concept that explains or relates to the excess and deficiency of four organs (lungs, spleen, liver, kidneys) as a real human organ structure. The former structure is one that is abstractly or ideologically described on the basis of Five-Elements Theory, not a real human organ structure. The structure is useful merely to ensure whether or not or when treatment by constitutional acupuncture is needed. Thus, it possesses little meaning in a clinical sense. What is worse, it causes unnecessary confusion not only when diagnosing constitutions afterwards, but also when considering the dimension of organs from the standpoint of Sasang Constitutional Medicine (hereafter, SCM).

The second error Kwon has committed is that in coming up with his TEC, he uses SCM as his starting point, but takes the traditional Chinese Viscera-state theory to explain his theory. By taking this approach, Kwon himself severs the relation between his theory and SCM. This is very important and deplorable considering that TEC would finally be maintained systematically and would regain its real value only until it lays a true foundation on SCM. As discussed beforehand, TEC can hardly be a constitutional theory separate from SCM. To rejoin the SCM category, TEC should confirm its theoretical point of view to Lee Jema's clinical and pathological theory and his organ structure.

Let us compare the organ structure found in TEC with that of eight constitutions that SCM differentiates.

(Organ Structure from TEC and Organ Structure of Eight Constitutions)

On the left side of the above chart are Kwon Dowon's eight constitutions and its organ structure, and on the right are SCM's eight constitutions that are subdivided by cold (Han) and heat (Yol) and its organ structure. The organ structure of Kwon's TEC results from the recognition of four organs (lungs, spleen, liver, kidneys) determined under the Five Element Theory's mutual generation and destruction relationships concept. The structure is not an actual organ structure of human, rather an ideological structure. This structure is very important in the sense that it is used to make prescription of Kwon's constitutional acupuncture. From the SCM standpoint, there are only four actual human organ structures: Lungs > Liver; Liver > Lungs; Spleen > Kidneys; and, Kidneys > Spleen. To subdivide the substructure in more detail by cold and heat, eight structures can be identified by inserting two more organs in the middle. These eight structures, as mentioned above, have no bearing on SCM's clinical and pathological aspects, because Lee Jema's SCM is a medical system that is established on the basis of four constitutions, rather than eight. Thus, the clinical and pathological aspect of eight constitutions is a notion developed in the post-Lee Jema era.

One can see Kwon's organ structure is identical with the organ structure chart of eight constitutions on the right side, given the assumption that the heart boldly marked in red from Kwon's TEC organ structure chart is taken out. This may seem remarkable on its face, but it is simply a result of a fact that two constitutional theories share the same root theory the basis of which is four organs (lungs, spleen, liver, kidneys). Thus, apart from the heart, these two constitutional theories are nothing but the same. However, TEC is a constitutional theory that originally included the notion of heart. With that notion in mind, two structures of each theory are quite dissimilar from each other. To be more specific, for instance, let us compare the organ structure of Cholecystotonia and Hepatotonia constitutions from TEC with that of Yol (heat) Taeum-in and Han (cold) Taeum-in from eight constitutions. The heart of Hepatotonia constitution finds itself between liver-kidney and thus is neither strong nor weak. That matches the organ size of Han (cold) Taeum-in as shown in the next chart. Thus, in both Hepatotonia constitution and Han (cold) Taeum-in, liver-kidneys are strong organs, and spleen-lungs are weak ones. Things are different in the case of Cholecystotonia constitution. The heart of Cholecystotonia constitution is located next to the second strongest organ, and the spleen becomes a medium size organ that is neither large nor small. On the other hand, the spleen is the strongest organ after the liver from the organ structure of Yol (heat) Taeum-inin the eight constitutions. Thus, the size of spleens in both theories differs from each other. These structural differences are found in other constitutions, which result from the concept that the heart is inserted in the organ structure. Thus, neither structure of human body can be said to be correct, because two organ structures illustrated above are different from each other. Only one of these can be an actual human organ structure.

This section analyzes the differences between the organ structure of Hepatotonia 1) constitution that is clinically applied to Yol (heat) Taeum-in generally recognized by TEC followers and that of Yol (heat) Taeum-in acknowledged by eight constitutions.

The chart (indicated in yellow) shows that Hepatotonia constitution in TEC is equivalent of Han (cold) Taeum-in, rather than Yol (heat) Taeum-in, in eight constitutions. Then, next question would be whether a true and real Yol (heat) Taeum-in is a Hepatotonia constitution in TEC or Yol (heat) Taeum-in that is categorized in eight constitutions. Yol (heat) Taeum-in from eight constitutions became so because it has Soyang-in's structure of its middle organs with small spleen and large kidneys. Han (cold) Taeum-in became so, because it has Soum-in's structure of its middle organs with large kidneys and small spleen. Thus, eight constitutions makes it clear that Taeum-in who is similar to Soyang-in can be nothing but Yol (heat) Taeum-in, and Taeum-in who is similar to Soum-in can be nothing but Han (cold) Taeum-in. In contrast, one can note that Hepatotonia that is considered as Yol (heat) Taeum-in TEC has its structure developed as a result of the excess in liver.

Specifically speaking, Hepatotonia's organ structure can be described as the following: lungs becomes the weakest organ as they are pressed by excessive liver. The kidneys, the mother organ of liver, becomes the second strongest organ, due to the excessive liver ; and, the spleen becomes the second weakest organ under the influence of the weakest lungs. In summary, the structure gets its form of liver>kidneys>heart>spleen>lungs. And this is, as we see, the result induced from the Five element Theory. Thus, without the heart, this structure implies Soum-in's structure that has large kidney and small spleen.

TEC does not recognize the implication of Soum-in's organ structure from its inception. Even not taking that approach, the analysis solely on the basis of a simple organ structure raises several questions. First, how can a constitution with an organ structure that has the kidney, the second strongest organ and an organ of water trait, have a warm attribute? Meanwhile, considering that an individual of Hepatotonia is known to be in large and obese body shape, how can it be so where Hepatotonia constitution has a spleen, a digestive organ, that is the second smallest in the structure? If the organ structure of Kwon's TEC is itself an actual and functional structure, it is unexplainable that an individual with an organ structure that has strong kidneys and weak spleen can be in large and obese body shape and have a warm trait.

Then let us study the logical ground for the recognition of Hepatotonia constitution as Yol (heat) Taeum-in in Kwon's TEC. It is probable that since Yol (heat) Taeum-in has an active liver its overactivity must have been considered as a cause of diseases and the organ structure of Hepatotonia constitution was calculated from the viewpoint of Five Elements Theory. This can also be noted from the fact that the fundamental prescription of Hepatotonia constitution becomes the prescription for Liver excess syndrome that sedate liver. It is then clear that Kwon misinterprets that Yol (heat) Taeum-in has a constitution resulting from a strong liver where Yol (heat) Taeum-in can develop hyperacitivity of Liver-Yang syndrome coming from the increase of liver-heat. Due to this misinterpretation on which Kwon's theory is established, Yol (heat) Taeum-in and Han (cold) Taeum-in can not be in correct order.

The cause of frequent development of hyperacitivity of Liver-Yang syndrome is not because of the strong liver, but because of the weak lungs. Let us visit the charts below to get down to specifics.

To easily discover which organ causes a certain disease, organs in the chart are transcribed in bold case. When specifically studeumg the chart, one can learn that 'Yol' constitutions of 'Yang' constitution, Yol Taeyang-in and Yol Soyang-in, are those resulting from strong organs that are even more strengthened and that 'Han' constitutions of 'Yang' constitution , Han Taeyang-in and Han Soyang-in, are those resulting from weak organ that are even weakened. Lungs and spleen are organs of Yang, the strong state of which makes the Yang aspect of each organ increase only to become 'Yol' (Heat) constitution. If the Yang aspect of two organs weakens, then one gets 'Han' (Cold) constitution.

In contrast to the above case, 'Yol' constitutions of ‘Yin', Yol Taeum-in and Yol Soum-in come from the weakening of already weak organs. And, 'Han' constitutions of ‘Yin' constitution result from the strengthening of already strong organs. Liver and kidneys are organs of 'Yin.'. Thus, when they become even stronger, the ‘Yin' aspect of two organs becomes enhanced only to cool down the body and to become 'Han' (Cold) constitution. On the other hand, if the ‘Yin' aspect of the organs lessens, one becomes 'Yol' (Heat) constitution.

Consequently, if organs of either Yin or Yang become strong, the original aspect of constitution shows the opposite due to the Yin and Yang of the organs. When organs of Yin become strong, cold syndrome. When organs of Yang become strong, heat syndrome. The principle of 'Yin Excess Causing Cold Syndrome'(陰勝卽寒), Yang excess Heat Syndrome'(陽勝卽熱) from The Classic of the Yellow Emperor(黃祭內經) can be applied here.

Thus, when one says the liver is active or strong, it would mean that the yin aspect of liver is enhanced to make the body cool and become Han constitution. The chart above explains how a constitution with active and strong liver becomes Han Taeum-in. This is also true where a person with active or strong kidneys becomes Han Soum-in.

Meanwhile, the reason why a person with weak lungs becomes Yol Taeum-in is that since weak lungs mean lacking of Yin in lungs, strong liver in this constitution tends to make liver-Yang strong and active. In other words, if one side of a coin be the lacking of lungs-Yin, then the other side would be the strengthening of liver-Yang. The actual pathological effect of liver-Yang could be symptoms of dryness-heat of liver that result from vigorous activity of Yang in liver, like hyperacitivity of Liver-Yang. Conversely, the constitution of Yol Taeum-in which frequently develops symptoms of dryness-heat of liver is a person not with strong Yin in liver. Instead, the person with that constitution has weak Yin in lungs, which relatively rendered a condition that the liver-Yang became boosted. In the same logic, the constitution of Yol Soum-in turns out to be a constitution with weak spleen the Yang aspect of which is relatively enhanced, due to the weakening of Yin in spleen.

Thus, the notion that anything - whether it is strong spleen, lungs, or liver, - that is vigorous would make a constitution take an aspect of Yol without carefully considering the Yin and Yang of each organ, does not establish its base on the principle of oriental medicine. It is now clear that TEC is incorrect in that a person with strong liver has Hepatotonia constitution, thus making him or her a Yol Taeum-in. Yol Taeum-in, in fact, is one with an organ structure in which lungs are weak, rather than a strong liver. For a better understanding, the following chart would be useful

Thus, the clinical treatment for a Yol Taeum-in with a well-developed body structure would be the prescription for Lung deficiency syndrome that supports or supplements the lungs, not the prescription for Liver excess syndrome that sedate liver. The prescription for Liver excess syndrome is a treatment that is applied to Han Taeum-in whose body structure is not well-developed. The case that the prescription for Lung deficiency syndrome is clinically applied is much more frequent than the cases of the prescription for Liver excess syndrome treatment since Yol Taeum-in far outnumbers Han Taeum-in.

In the early days of TEC's acupuncture, the basic treatment for Cholecystotonia constitution was the prescription of Large intestine deficiency syndrome, which is now replaced with the prescription for Lung deficiency syndrome. This very transition produced a famous controversy between Kwon Dowon and his head pupil, Yum Taehwan, which led to a separation. Then, the prescription for Lung deficiency syndrome (tonify K10, LU5, sedate LR1, LU11) was a treatment that was rarely used in the practice of TEC when Yum incidentally applied the prescription for Lung deficiency syndrome to and successfully cured a patient that adversely reacted to all of the eight basic TEC treatments. 2) When Yum later saw the increasing number of patients that benefit from the prescription for Lung deficiency syndrome, he reported to his mater Kwon to the effect that there might be more than eight constitutions in his medical opinion. With this as a momentum, the relationship between the two has ended. Yum later maintained his position and introduced so-called “24 Constitutional Acupuncture Theory” which is based on the weakness and firmness of the 12 acupoint system.

(Footnote)

1) Hepatotonia constitution : A person of this constitution usually has a large body that is well-developed. Like a snowman, the body begins with narrow shoulders, but gets thicker as it goes lower to have a thick waist. A healthy person of this type is always sweaty and feels light when he or she perspires. High blood pressure actually keeps him healthy and energetic. The person is usually taciturn and is not a good singer because of short breathing tempo. The person feels tired the most when he or she has been talkative. The person easily gets a strain in his left leg and frequently suffers from diseases that affect his left side of body. When consuming a large amount of vegetables or fish, but a small amount of meat, he generally feels tired for no reason or feels pain in the eyes and in the feet. The skin gets white when consuming meat and taking hot bath, whereas it gets darker when consuming vegetables and fish and take cold bath. (A quote from TEC)

2) The introductory part of Yum Taehwan's thesis '24 Constitutional Acupuncture and its diagonosis' reads as follows: 'I encountered a new fact in September of 1976 while treating patients at Yungdeungpo branch of Kyunghee Medical Center. The fact was that a certain group of patients showed the adverse after-effects of all eight constitutional treatments and that it turned out to be quite effective when the prescription for Lung deficiency syndrome was applied after a careful consideration. As a result of repeated experiments, I confirmed that only the prescription for Lung deficiency syndrome was effective to the patient group. When the similar cases accumulated to twenty, Iasked to myself whether there could be a constitution with weak lungs. Based on my close pulse examination of the patients in that group, I could discover a type of pulse in common and successfully draw the pulse map."