44 Journal of Chinese Medicine | Issue125 | February 2021 Professor Huang Huang’s Clinical Application of Da Chai Hu Tang He Gui Zhi Fu Ling Wan Disease, chapter on Fox-Creeper, Yin and Yang Toxin, line 10), specific symptoms and conditions (状态, zhuang tai, e.g. 默默不欲饮食, taciturnity with no desire for food or drink, Shang Han Lun, line 96), but also modern diseases (e.g. Behcet’s disease). ‘Disease’ can refer to one single disease/symptom/condition or to a variety thereof, in which case the various items could possibly fall under more than one disease category. The importance of constitution The Chinese medicine concept of constitution (体质) is rooted in the Huang Di Nei Jing (黄帝内经, Yellow Emperor’s Inner Classic), which discusses both pre-heaven and post-heaven, including heredity, diet, environment, lifestyle, exercise and other factors, and their influence on a person’s physiological and pathological characteristics. The concept of constitution can also be recognised in the Shang Han Za Bing Lun in the recurrent use of terms such as ‘strong person’ (强人), ‘emaciated person’ (羸人), ‘respected and honoured person’ (尊荣 人), 29 ‘bleeding patient’ (衄家), ‘dampness patient’ ( 湿家), ‘strangury patient’ (淋家), ‘patient with habitual retching’ (呕家) or ‘panting patient’ (喘家). Xu Ling-Tai (徐灵 胎) also stressed the role of constitution in his Yi Xue Yuan Liu Lun (医学 源流论, On the Origins and Development of Medicine) in the chapter Bing Tong Ren Yi Lun (病同人异论, Same Disease, Different People) where he stated: Under the heaven there are [instances of ] the same disease where treatment of this [case] is successful and treatment of that [case] is ineffective, and not only is it ineffective, but it also causes great damage. How can this be? [is is] because the disease is the same but the person [contracting it] is different. 天下有同此一病, 而治此则效, 治彼则不效, 且不唯 无效, 则反有大害者, 何也? 则以病同而人异也。 30 Professor Wang Qi (王琦) introduced and thematised the concept of constitution in traditional Chinese medicine in 1978 31 and published his Zhong Yi Ti Zhi Xue Shuo (中 医体质学说, Constitution Theory in Chinese Medicine) four years later. 32 Professor Wang also conducted studies which showed that patients with the same disease and different constitutions are to be treated with different formulas, if clinical efficacy is to be achieved. 33,34 He differentiated Chinese people’s constitutions into nine basic types: temperate (平和质), qi deficiency (气虚 质), yang deficiency (阳虚质), yin deficiency (阴虚质), phlegm-damp (痰湿质), damp-heat (湿热质), blood stasis (血瘀质), qi depression (气郁质) and special congenital and hereditary (特禀质) 35 constitutions. He also developed a Chinese medicine constitution scale intended to guide choices in disease prevention, health management and clinical practice. 36 Professor Wang Qi has applied his constitution theory to the treatment of acne, recurrent oral ulcers and diabetes, just to give a few examples. Patients were treated with classical formulas chosen on the grounds of their constitution and classical presentations, and the results were screened in his clinical trials. As a further development, Professor Huang introduced the concept of the ‘herbal person’ (药人), which refers to a constitutional type for which a specific herb is suitable, even for long term treatment. He categorised formulas on the basis of their key herb, each formula family being suitable for the corresponding ‘herbal person’; the correct identification of a patient’s ‘herbal person’ and their treatment with the corresponding formula family ensures treatment efficacy and safety, as well as reducing treatment time. Da Chai Hu Tang He Gui Zhi Fu Ling Wan’s applicable population Professor Huang also introduced the concept of a ‘formula person’ (方人), which guides to a more specific choice of treatment. A patient with a Gui Zhi (桂枝,Cinnamomi Ramulus) constitution may benefit from any of the formulas in the Gui Zhi formula family, which includes Gui Zhi Tang (桂枝汤, Cinnamon Twig Decoction), Gui Zhi Jia Fu Zi Tang (桂枝加附子汤，Cinnamon Twig plus Aconite Accessory Root Decoction) and numerous other formulas. However, each ‘formula person’ is unique both in terms of their constitution and the clinical symptoms they might present – for example the Gui Zhi Jia Fu Zi Tang ‘person’ is more yang deficient and more sensitive to cold than the Gui Zhi Tang one. To understand the Da Chai Hu Tang He Gui Zhi Fu Ling Wan ‘person’, all the cases from Professor Huang’s clinic that were successfully treated with this combination Professor Huang introduced the concept of the ‘herbal person’ (药人), which refers to a constitutional type for which a specific herb is suitable, even for long term treatment.