Four-constitutional Medicine as Korean traditional Medicine's special subject

Four-constitutional Medicine as Korean traditional Medicine's special subject
-Special time with professor Lee part 1.


We can say that one of the main character of Korean traditional Medicine is Four-constitutional

Medicine. These days, many people are concerned about Four-constitutional Medicine but they

don't know what Four-constitutional Medicine exactly. What makes Four-constitutional

Medicine placed in special position of Korean traditional Medicine? what contents are there in

Four-constitutional Medicine?　what is the significance of existence of Four-constitutional

Medicine in Korean traditional Medicine? There are so many questions about Four-

constitutional Medicine. therefore, we had a special time with professor Lee who works for

Kyunghee Oriental Hospital.


Jun Hyoung : People say that Four-constitutional Medicine is different from existing Oriental

Medicine. I heard that in contrast with existing Oriental Medicine that is mainly based on

Taoism, Four-constitutional Medicine relies on Confucianism. What is prominent distinction

between these two Medicines?


Professor Lee : Existing Oriental Medicine is based on the Yin-Yang and Five phases theory that

are basic concepts of Taoism. Taoism describes human as beings who have to adapt themselves

to the nature, with the view that human-beings called Small Universe is parts of the nature,

Large Universe. Since Universe itself is Qi and human-beings are connected with Universe by

Qi, human-beings change themselves with their wholeness, following the order of change of

Universe. However, the perspective of Taoism put so much focus on the harmonization between

human-beings and nature that it could not reflect the autonomy of human-beings. Hence, it

could not explain various diseases caused by discords of human own, and between human and

society. That is, Taoism was no more able to elucidate diverse states that occur according to the

civilization of human society. Under this urge of the age, Four-constitutional Medicine appeared

as a concept overcoming Nature-focused theory. In Four-constitutional Medicine, we can figure

out that foci were moved from nature to human-beings, and materialism to spiritualism. Four-

constitutional Medicine puts human into center and concerns states they make. It was

Confucianism that was adequate for the human-oriented theory. In Four-constitutional

Medicine, Lee Je-Ma set the ethical doctrine of innate goodness as a background, and concerned

on the states that occured under the situation that postnatal factors blocked good nature of

human. In addition, in the Book of Changes, it says that the Great Absolute produces Yin and

Yang, Yin and Yang make Four-shape, Four-shape bears the Eight Trigrams for divination. it

consists of the structure of 'Great Absolute - Yin and Yang - Four-shape - the Eight Trigrams for

divination' and explains material phenomena with the Eight Trigrams for divination made by

Four-shape. Four-shape is just an intermediary and appears a little while at the process which

Great Absolute changes into he Eight Trigrams for divination. However, four constitutions in

Four-constitutional Medicine consist of the structure of 'Great Absolute - Yin and Yang - Four-

shape' and there is no branch after Four-shape. Four-shape becomes a substantial concept as 'Sa

Sim Sin Mul(事心身物)'. 'Sa Sim Sin Mul(事心身物)' is element of universe, controls birth and

change of all things and makes harmony by itself. Four-constitutional Medicine explains human

with the temper(性情) of Confucianism based on holism as 'Sa Sim Sin Mul(事心身物)' instead of

yin-yang and five phases theory. To sum up, Four-constitutional Medicine, with the temper(性

情) of Confucianism based on holism as 'Sa Sim Sin Mul(事心身物)' takes human-oriented

epistemology that regards human as beings with the ability of self-control that actively deal with

the nature.




Se Hyun : were there specific urges of the age or backgrouds that drived Lee Je-Ma to design this new Medicine?


Professor Lee : When Lee Je-Ma lived, there were many changes in government and society in

Joseon dynasty such as the confusion of administration, the change of the status system, popular

uprisings, external aggressions and etc. So there were requirements to establish new order of

society at that time. Accordingly, many scholars became criticizing the consuming controversy

between 主氣論 and 主理論 which are main doctrines in Sung Confucianism and new theory like

realism involving promotion of public welfare and contribution to the society which is progressive

Confucianism appeared. The society underwent drastic changes from the inflow of foreign

cultures and the birth of realism although there was a tendency called 衛正斥邪 where people

sticked to their existing theory in way that only the existing thought, the doctrines of Chu-tzu(朱

子學) is right but others like Catholicism are wrong. Those became the historical background of

philosophy in Joseon dynasty to make principals in Sung Confucianism concretize and actualize

by making them the practical logic. In detail, Lee(理) which is the main doctrine in Sung

Confucianism is absolute good. Originally, Confucians had thought that Lee(理) is equal to Sung

(性) saying '性卽理' but in 18-19 century, this thought was changed to the philosophy based on

Sim(心). In other words, the main concept in the doctrines of Wang Yang-ming(陽明學) is that

Sim(心) and Lee(理) are the same saying '心卽理'. This change of thought was a result from the

current regarding Sim(心) as the most important thing in Sung Confucianism, not a result of

transferring Sung Confucianism to Wang Yang-ming(陽明學). Namely, Because Lee(理)

considered as Sung(性) was an ideal concept in traditionally established Sung Confucianism, it

couldn't become a practical logic. Then, Appearance of Sim(心) made Sung Confucianism more

practical and concrete than Sung(性) in '性卽理' and Lee Je-Ma made use of this concept to

describe human body. in other words, he explained lung, spleen, liver, and kidney which are

more concrete objects with the absolute good which is abstract concept. Though Sung

Confucianism that is the main ideology in Joseon dynasty was degraded to the fight of the faction

by the historical view in japan, it had a slow development but continued to be modified in the

mainstream. what made this new theory appear at that times? First of all, If Joseon dynasty was

an ideal society, people had a happy life, but their life were miserable. also the nation incessantly

exposed to external aggressions. then most scholars were aware of serious problems in this

situation. Second, by explaining medicine with the concept of the absolute good in the established

metaphysical Confucianism the stronger practical will was expressed. This could represent much

to the history of philosophy. That means Lee Je-Ma, the scholar of Confucianism, stuck to the

specific and positive attitude through the practical means, medicine, in other to realize the aspect

of practice in the abstract Confucianism.



Yeu En : Four-constitutional Medicine has distinctive classifying system called four constitutions. What is the difference between Naegyeong's Ou-tae-in and four constitutions, and what meaning and significance does this difference infer? Four-constitutional Medicine uses the original classifying system, four constitutions to categorize people and clinically treat them. Can all people be actually categorized into four constitutions? Isn't it possible that there are other constitutions than the four? For example, might not some be half and half between lesser yin person and lesser yang person, or greater yang person and greater yin person?



Proffessor Lee : Yin Yang and Five phases theory, the rules of nature, is also applied to humans

uniformly, but uniform application can mean overlooking individual's characteristics. This might

work as a barrier in recognizing disease or treating. The endeavor to make up for the limits of

pattern identification-treatment method can be seen in Naegyeong's Ou-tae-in theory or 陰陽二

十五人論, Jang Jung-Gyeong's Yin Yang constitution theory and such. Four-constitutional

Medicine can also be seen as a descendant of those previous attempts to complement the limits

of pattern-treatment medicine. Yet while the previous attempts were based on the traditionally

established theory of yin-yang and five phase, thus locking themselves in its limits, Four-

constitutional Medicine defined a new paradigm based on a new way of thinking and

philosophical background. It did something more than simply categorizing with constitutions

concept, which was what previous theories did. Among those previous theories, Ou-tae-in

classifies people with Five phases theory and uses only people's outward appearance as a tool for

explaining configuration and form of five phase. In other words, it explains people's external

appearances as compared to five phase, but there are no constructive visions other than that.

That is why the categorization of Ou-tae-in isn't called 'medicine'. It just categorizes people, and

doesn't contain medical information according to the constitutions such as physiology, pathology,

preventive medicine, and life preservation medicine. In comparison, Four-constitutional

Medicine categorizes people by the largeness and smallness of internal organs, specifically lung,

spleen, liver, and kidney. Based on that category it explains a person's physiology, pathology,

preventive medicine, and life preservation medicine.

I can say with conviction that a person has one constitution among the four, and it does not

change. In Four-constitutional Medicine, it has three principles about constitutions. First is that

the four constitutions do not change. Second is that we should not blend treatment materials for

the four constitutions. Thirdly, constitutions are based on the permanent factors. It is said "人稟

臟理 有四不同"(People are born with the four principles of organs, and each principle is different

from one another), and that "太少陰陽之臟局短長 陰陽之變化也, 天稟之已定, 固無可論"(The

length and shortness of organs in Larger and Lesser yin and yang are variations of yinyang.

those are indisputable because they are already innately given by nature)

Also, Lee Je-ma asserted "太少陰陽之臟局短長 四不同中 有一大同 天理之變化也 聖人與衆人 一

同也 太少陰陽之短長變化 一同之中 有四偏... 聖人之臟 四端也 衆人之臟 四端也"(The The length

and shortness of organs in larger/lesser yin/yang persons can be differentiated into four, and the

four are not the same but they have one important similarity which is the variations of the laws

of nature. Saints and ordinary people have this in common. Based on this one sameness, the

larger and lesser yin and yang's long and short changes have four tendencies,.. The saints' organs

have four traces and ordinary people's organs also have four traces), saying that all people

belong in one of the category of four constitutions. That people are born with declinations of

organs such as larger lung-smaller liver and larger liver-smaller lung indicates the imperfection

of humans. Thus it can be said that people are born with innate strengths and weaknesses, and it

is the purpose of four constitutions medicine to know those strong and weak points in order to

strive for perfection. This is also why we say that given constitution is permanent for one's life.

Then, in actual lives when people change as they live, it is their symptoms that change, not the

constitution. Consequently, when we categorize people we must do so by the unchanging factors

and must treat diseases according to those.

In this article, we just talked about special characters of Four-constitutional Medicine, historical

demands for Four-constitutional Medicine and the classifying system called four constitutions.

Does this article make you know a little more about Four-constitutional Medicine? there are

more talks about Four-constitutional Medicine. To be continued.