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The 6 Tissue States: A Means for Health Assessment-Part 1 of 4

The Four ElementsThis 4 part article series will briefly outline the 6 tissue states.  The basis of the article is a 12-16 week course that I teach yearly, that I originally pared down for a 90 min. presentation for the Midwest Women’s Herb Conference held this past summer.  In this first post, I will talk a little about how the tissue states came to be, address what they are measured by-the 4 qualities and 2 tensions, and introduce you briefly to each one.  Future articles will give a slightly deeper introduction to each state individually coupled with bits about the energetics of taste, and how taste resonates with the states.

Because this article series is to promote my Tissue State Intensive coming up this January in New Mexico, here is a link for more information about that: http://www.redrootmountain.com/ancient-greeks-meet-the-eclectic-herbalists-the-6-tissue-states-as-a-means-for-health-assessment/607

The Tissue States (tissue being “histo”, in Greek) is sometimes shrouded in mysticism, seemingly complex beyond understanding. It encompasses, though, one of the most holistic views of an individual, taking into account a complex matrix of information. While it is beneficial to understand and study all the intricacies of the tissue states, one can apply some basic principles and theories of them when deciding what plants to employ for yourself or your clients.

The Four Qualities and Tensions

Each state is measured by the 4 qualities-hot, cold, dry and wet- coupled with the two tensions to expose the imbalance of deficiency and excess. They define the temperament of our internal shortcomings, the nature of the Tissue States, as well as the plant medicines we use to balance them.

While I hear many speak of the 4 qualities as polarities with opposing personalities, their relationship is far more complex than that. It is essential to see that one opposite cannot exist without the other, much like yin and yang. And we should envision each sitting in circle with the other, moving together, not individually. For example, when we warm something, cold is decreased.

Hot: Heat is the active part of our vital force. It is our sunny inner fire that fuels our passions and stimulates us to thrive and grow. Heat also disperses, moving energy, separating that which needs to be separated, and stimulating combustion. Heat is our immune system in action, the action fight or flight, and our digestive tract working.

If allowed to overwhelm us, the dark side of fire disrupts our heart-mind-spirit-soul connection. Excessive heat stimulates hot bloodedness, anger and inflammation. In the end, it will breakdown our relationships and our physical body.

Cold: Cold is the resting part of the vital force. It is the place in ourselves that allows us to process and integrate that which we achieved through heat, and is seen as the Earth element. The restfulness of coolness is the place that order and function move from. It is security.

Cold in tissue constricts to bind that should be solid. Just as heat inspires function, cold balances it to lower decibels of reaction. Cold is rest to digest/process, (whether it is food of information), and rest to heal. Cold is stillness.

In excess, however, cold can cause depression and disconnect, and rigidity of body, mind, spirit and soul. We retreat to our “home/self”, and disengage from the process of life in a community, thus, we deny our souls work and purpose.

Dry: Just as we cannot truly separate the importance of cold and hot in function, organ system or plant, we also cannot separate the importance of dry from moist. These two elements also form a balance that is essential to health.
Dryness creates tension that helps the tissue or cell hold its tone. It disallows particles that should be kept out from penetrating the wall of the tissue or cell, and keeps in that which should be contained.

Air and wind are also a part of the dry element. We’ll talk more about wind in the tissue states.

Wet: Water is vital support for tissues and cells and requires an appropriate balance of minerals to function properly. Water helps our cells and tissues maintain a balanced state of permeability and flexibility. It is protection for tissues, diluting that which is bothersome and cooling that which is dry and hard. It helps carry nutrition to cells, and assists cells and tissues in nutrient absorption.

Water spiritually is the element that facilitates reconciliation.
Too much water makes for watery blood that is cold. Emotionally, we drown in a sea of our own over emotion, and our energy is dampened.

Introduction to the Tissue States

The 6 Tissue States as we know came to be used around the 19th century, and were configured from several old systems of Ancient Greece combined with new ideas. To put it briefly, the Greeks had two medical schools of thought. One school was introduced by Aristotle in the 300-400’s B.C. It acknowledged that health was defined by the 4 qualities- hot, cold, dry and wet. The other belief system was that of the Greek Methodists, whose two tissue state practice excluded the qualities, and focused on relaxation and tension.

Keep in mind, the Greeks did not possess thermometers or have means of measuring their philosophies. Nor did they have an understanding of the nervous system or physiology the way we do today. But they observed and theorized enough to ascertain that tension and relaxation were vital in maintaining health, as were the 4 qualities.

The two diagnostic theories of the Greeks did not mix then. I attribute that to competition between the two schools of thought. But in the 18th century Dr. John Brown, with the assistance of other doctors, combined them to bring the 6 tissue state system to plant medicine. With advanced knowledge in physiology, he also introduced the idea that the nervous system was foundational for understanding the tissue states.

The 6 states of the early western physicians are:

o Heat/Excitation-involves excess heat characterized by an excited nervous system, and an over stimulated heart and immune system

o Cold/Wind/Constriction- excess wind and tension constricting the nervous system, causing an polarized imbalance of cold and hot and a symptom picture that changes like the wind (unpredictable)

o Dry/Atrophy- excess heat and tension from dryness (lack of nutrition, oil and water); evolves into atrophy (a hardening and wasting of the muscle)

o Cold/Depression- deficient function, where internal process will not be properly stimulated, whether it’s an illness that fails to elicit a strong immune response or deficient endocrine function (sub-clinical or clinical hypothyroid)

o Damp/Relaxation/Flowing- deficient heat and oils that are the result of excess water; water and cold cause tissue to erode, distend and weaken

o Damp/Torpor/Stagnation-deficient organs of elimination which cause a build-up of metabolic waste in the blood and poor circulation resulting in too much heat in the tissues

Each state, in theory, also allows us to assess the 4 humors (blood, black and yellow bile, and phlegm), to take into account organ system deficiency and excess, and to take a closer look at what a someones personal root of dysfunction is, and how best to deal with deficiencies and excess.

Of course, no understanding is straight forward.  I won’t be addressing all the ins and outs of the practice in this articles series.  What I hope to do, though, is outline how the tissue states can help us all advance and deepen our alternative health practices.

Next week: Heat/Excitation!


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  • Shelley Sisson

    I’m excited to learn more about the 6 tissue states.  Will you be continuing this series soon?


    • Thanks for writing!  Yes, very soon.  Though I may have to condense it into a 3 part article.  I’m so glad for your interest. I love how the Tissue State practice embodies the way energy moves.