The idea that individuals differ by a constitution that determines their needs, their frailties and their ideal diet is not Chinese: it is also Western, and it has its own history there, forgotten since medicine became centred on disease rather than terrain. Recovering this tradition illuminates what TCM calls “constitution” and what modern medicine increasingly calls “personalised medicine”.
Terrain, constitution, diathesis: the vocabulary laid out
Three words cover the same territory. The terrain is the soil: the organism’s general state, which determines what develops in it. The constitution is the innate structure, inherited, what one is born with and which does not change. The diathesis is the pathological tendency: the direction in which the terrain goes wrong when pushed (gouty, allergic, arthritic tendencies).
A terrain system answers three questions: what the constitutions are, how to recognise them, and how to take them into account daily, diet included. Every tradition has answered differently, and all converge on one point: individual differences are real and significant.
The 4 Hippocratic temperaments and their table
The oldest and most influential system. Hippocrates, then Galen who codified it, describe four temperaments linked to the four humours: the sanguine (blood: hot and damp, jovial, sociable, plethoric tendency), the bilious or choleric (yellow bile: hot and dry, active, irritable, inflammatory tendency), the lymphatic or phlegmatic (phlegm: cold and damp, calm, slow, congestive tendency), and the melancholic (black bile: cold and dry, thoughtful, depressive tendency).
The logic is that of crossed elementary qualities (hot/cold, dry/damp): exactly the same matrix that TCM applies to foods. Hippocratic dietetics adapted the regimen to the temperament: cooling the bilious, warming the phlegmatic, moistening the melancholic, moderating the sanguine. It is a terrain dietetics two thousand years before the term existed.
French biotypology: Sigaud, Mac Auliffe, Marchesseau
France produced its own terrain tradition. Sigaud (early twentieth century) described four functional morphological types: the respiratory, the digestive, the muscular and the cerebral, each dominating a function and carrying its associated frailties. Mac Auliffe refined this into electrolytic types. Marchesseau, founder of French naturopathy, systematised the terrains (fibrinous, lymphatic, biliary, nervous) and drew rules of vital hygiene from them, diet first.
This French current has something remarkable: it kept diet at the centre of terrain reasoning just as academic medicine was removing it. The “diet according to terrain” is a French invention as much as a Chinese one.
Vannier’s diatheses and homoeopathic constitutions
Léon Vannier, a French homoeopathic physician, proposed the diatheses: constitutional pathological tendencies that orient pathology. His diatheses (uricaemic, arteritic, cancerous, herpetic, for example) describe not what one has, but what one risks developing according to one’s terrain. The notion joins what TCM calls a pathological terrain: not the disease, but its condition of possibility.
Homoeopathy produced its own constitutions (carbonic, phosphoric, sulphuric, fluoric in some authors) crossing morphology, metabolic and dietary tendencies. These systems share the same flaw as the others: they describe better than they prove.
Sheldon’s somatotypes and the point of convergence
Sheldon (1940s) objectified constitutions through morphology: the endomorph (tendency to mass, digestive), the mesomorph (muscular, energetic), the ectomorph (nervous, thin). His measurement method (somatotype) had a scientific posterity: somatotypes are used today in sports medicine and nutritional anthropology.
This is the most interesting point of convergence: the system that tried to be the most objective (Sheldon) rediscovers profiles that overlap with those of the subjective traditions. The endomorph resembles the Hippocratic phlegmatic and the Ayurvedic Kapha; the ectomorph resembles Marchesseau’s nervous type and Vata; the mesomorph resembles the bilious and Pitta.
| System | Origin | Types | Dietary application |
|---|---|---|---|
What these systems share, and what TCM adds
All these systems converge on four ideas: individual differences are constitutional; constitution determines frailties; diet must adapt to it; and prevention proceeds through knowledge of the terrain.
TCM brings three things the Western systems lacked: an internal coherence (the same system of qualities serves diagnosis, pharmacopoeia and diet), a fineness of measurement (the nine CCMQ constitutions are today a validated tool), and an articulation with the acquired (constitution is not fixed: the TCM diagnosis distinguishes the innate from the moment). The Korean Sasang constitutions show the same ambition of systematisation on the Asian side.
FAQ: Western constitutions
Do the four temperaments have a scientific basis?
Not strictly: they describe observed regularities (the same kind of body, temperament and frailty recurs) without an established physiological foundation. Their value is heuristic and clinical: they oriented terrain dietetics for two millennia and overlap with measurable modern constitutions (somatotypes, CCMQ).
What is the difference between constitution and terrain?
Constitution is innate: the structure received at birth, stable. Terrain is the current state: the innate modified by the acquired (diet, lifestyle, pathologies). Dietetics works the terrain from the constitution: it adapts the acquired to the innate.
How can I know my constitution?
The ancient systems used observation (morphology, complexion, temperament, tendencies). The most validated modern version is the CCMQ questionnaire for Chinese medicine constitutions; for Western systems, consultation with a naturopath or terrain-trained physician remains the route.
Can systems be crossed (Hippocratic and TCM)?
Yes, with caution: the correspondences are real but not univocal. The Hippocratic bilious resembles the TCM Liver Heat pattern, the phlegmatic resembles Dampness, the melancholic resembles Yin deficiency. These overlaps are useful for understanding, not for a prescription that would require a proper diagnosis.
The terrain tradition, Western too
The West has its own constitutional tradition, a thousand times older than its medicine of disease: the four temperaments, the French biotypologies, Vannier’s diatheses, Sheldon’s somatotypes. All say the same thing as TCM in a different language: people do not resemble each other, and the diet that suits one may exhaust the other. Recovering this tradition is not a step backwards; it is picking up a thread that modern personalised medicine is reweaving. To locate your own profile: the Yin Shi energy test maps your constitution in a few minutes.
To go further
Yin Shi ecosystem resources directly related to this article.
And on the TCM side, what is your constitution?
The CCMQ questionnaire complements the Western reading with the Chinese terrain.
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The lesson presents the Hippocratic temperaments and how to nourish them.
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