Today we will talk about methods to regulate several special constitutions. TCM emphasizes syndrome differentiation and treatment; different constitutions have different symptoms and therefore different regulating formulas. We will discuss the four constitutions of heat above and cold below, cold above and heat below, cold both above and below, and heat both above and below.

First, heat above and cold below. People with this constitution have an upper body like a furnace—dry and intolerably hot—with swollen gums and recurrent oral ulcers; the lower body, however, is like an icehouse, with cold painful waist and knees, cold hands and feet, and occasional diarrhea. This is actually an imbalance of yin and yang in the body. Wumei Wan can be useful here; it can clear heat above and warm below, like reducing the fire in the upper body and warming the lower body to restore yin-yang balance. The Wumei in Wumei Wan can astringe and regulate liver qi and harmonize the spleen and stomach; Coptis (Huanglian) can clear fire of the upper burner; dried ginger and Sichuan pepper can warm the middle and dispel cold. In this way, the symptoms of heat above and cold below can be alleviated.

Now let’s talk about upper-cold, lower-heat. This constitution is essentially the opposite of upper-heat, lower-cold: the upper body has poor appetite, vomiting of clear fluids, and cold abdominal pain; the lower body has scant, reddish urine, dry, hard stools, and hot lower limbs. This is often caused by liver qi stagnation transforming into fire and counterflowing to invade the stomach. Zuo Jin Wan can really show its strengths here: it can purge liver fire and soothe the liver to relieve stagnation, like giving the liver a “thorough cleaning,” sweeping out the constrained liver fire and restoring smooth liver qi. The Coptis (Huanglian) in Zuo Jin Wan clears heat and purges fire, while Evodia (Wuzhuyu) soothes the liver, relieves stagnation, and descends rebellious qi to stop vomiting. Used together, these two herbs naturally improve the symptoms of upper-cold, lower-heat.

Next is cold in both upper and lower. People with this constitution feel aversion to cold with cold limbs, soreness and weakness of the loins and knees, clear and long urination, and loose stools — all signs of kidney yang deficiency. Kidney yang is like the body’s “small stove”; when kidney yang is insufficient, the body cannot warm itself. Yougui Wan (Right-Restoring Pill) can be put to use here: it warms and tonifies kidney yang and replenishes essence to stop seminal emission, like adding “firewood” to the kidney yang to warm the body again. Cinnamon and aconite in Yougui Wan warm and tonify kidney yang; prepared rehmannia, Chinese yam, and others nourish yin and benefit the kidney, seeking yang through nourishing yin. In this way, the symptoms of cold in both upper and lower can be relieved.

Finally, both upper and lower are hot. People with this constitution present with flushed face and eyes, swollen and painful gums, mouth and tongue ulcers, dry stools, and short, reddish urine — all manifestations of exuberant heat in the sanjiao. The sanjiao is the body's "major conduit"; when sanjiao heat is excessive, the conduits become blocked and various heat syndromes arise. Sanyinhua (Three-Yellow Pills) can work wonders here: it clears heat and detoxifies, drains fire and unblocks the bowels, effectively giving the sanjiao a "major clearance" to expel heat-toxin and stasis. Scutellaria (Huangqin) and Coptis (Huanglian) in Sanyinhua clear heat and detoxify; Rhubarb (Dahuang) drains fire and unblocks the bowels. With these three herbs combined, symptoms of heat both above and below are naturally improved.

So, different constitutions require different methods of regulation. When adjusting your body, you must choose prescriptions appropriate to your own constitution. Of course, it's best to consult a doctor before using any medication.