The Six Tissue States

As the Disease Tree™ model used by the School of Modern Herbal Medicine shows, there is one common denominator in the entire disease process, and that is biological terrain.  Just as a tree has only one trunk, so the body has one biological terrain.  The biological terrain is essentially the internal environment of the body.

For many years my colleagues and I worked with a model of four tissue states, based on the Western four element model.  These tissue states were hot, cold, damp and dry.  Although this model worked reasonably well, we knew there was something missing because we couldn’t quite make the system fit everything we were observing.  Then Matthew Wood, an excellent clinical herbalist and personal friend, introduced us to the concept of the six tissue states.  We immediately saw the relevance of what he was teaching, and everything that didn’t fit before fell into place.

According to Matthew, “The six tissue states represent simple excesses and deficiencies in three basic physiological factors.”  The first of these physiological factors is the metabolic rate, i.e., how fast or slow the tissues are functioning.  That is, tissues can be overactive (hyperactive or hyperfunctioning) or they can be underactive (hypoactive or hypofunctioning).  These correspond to the ideas of heat (overactive) and cold (underactive).  We call the hyperactive state, Irritation, and the hypoactive state, Depression.

The second physiological factor is density.  This relates to the mixture of solids to liquids.  When liquids exceed solids, then we have a state of Stagnation, like a swamp.  In the opposite extreme, where solids are not balanced properly with fluid elements, we get a hardening and drying of the tissues which we call Atrophy.  These two tissue states correspond to the ideas of dampness and dryness.

The third physiological factor, and the one missing from the previous model, is tension.  This has to do with the tone of the tissues.  Excess tone to the tissues results in Constriction, where a lack of tone results in an atonic state of excess Relaxation.  

Let’s look at each of these six tissue states in detail, starting with the first and, most important, pair—irritation and depression.  Here is a basic description of these three pairs of opposite qualities.

Energy Production

Irritation and Depression have to do with metabolism and energy generation. In irritation energy production is excessive; in depression it is deficient.

Irritation has a strong correlation to oxidation, inflammation and fever, which is why it is often referred to as “heat” in traditional herbalism. Tissues that are irritated are red and warm to the touch. Irritation is often accompanied by sharp pains. A red tongue, rapid pulse, ruddy (or reddish) complexion and hyperactivity are also signs of heat or irritation.

Irritation is often caused by chemical, infectious or metabolic irritants. In response to the irritant, the tissues increase their production of energy to throw off the irritant. Irritation (inflammation) is also the mechanism by which cells initiate the healing process. Part of the job of the inflammatory response is to destroy damaged cells and draw immune and stem cells to the area for tissue repair. Acute irritation isn’t a bad thing; it’s when that irritation becomes chronic that problems arise.

Irritation is treated herbally with cooling and moistening remedies. Directly cooling remedies are often anti-inflammatory and/or antioxidant. Often they are plants with a sour taste (like berries). Indirect, or secondary, cooling remedies are moistening remedies that typically have a slimy or mildly sweet taste. In our list of the energetic properties of an herb, we refer to remedies that reduce irritation as cooling. Herbs that that are good for reducing irritation include lemon, lycium, peach bark and bilberry. These cooling remedies reduce inflammation and “heat” in the body.

Depression is the opposite of irritation. Tissues that are depressed are cool to the touch and pale, which is why it is often referred to in traditional herbalism as “cold.” If pain is present it is usually dull and achy. Other signs of tissue depression are hypoactive function, a pale complexion, pale tongue and slow pulse rate.

Tissue depression is tricky to treat because it can be mimicked by a false cold, caused by low thyroid function and anemia. Infection in depressed tissues can also give rise to a “false heat.” The key to identifying a general state of tissue depression is to look for a general feeling of fatigue, a pale or dark purple tongue and a slow pulse rate.

True tissue depression is treated herbally with warming remedies. These remedies are generally stimulating to circulation and/or metabolism. They are typically aromatic and/or pungent, qualities found in most kitchen spices. We refer to herbs that counteract tissue depression as warming in our list of an herb’s energetic qualities.

It’s important to understand that you aren’t going to help balance the body if you treat a hot (irritated) condition with warming herbs, or a cold (depressed) condition with cooling herbs. So, pay attention to the energetics of the condition and select remedies with the correct properties.
Herbs that are good for relieving tissue depression include capsicum, ginger, rosemary, horseradish and thyme.

Some herbs are neutral or balancing in their effects on energy production. We use the term Neutral to describe the energetics of herbs that do not heat or cool.

Minerals and Fluids

Stagnation and Atrophy have to do with the balance between the solid (mineral) components of the body and the fluid (water and fat) components in the body. In stagnation, there is too much fluid with insufficient minerals to move it. In atrophy, the mineral content is too high and there is not enough fluid to keep it in solution.

Stagnation can be seen when fluid accumulates in tissues. This can take the form of edema, swollen lymph nodes and sluggish flow of body fluids. In traditional herbalism, stagnation is often called “dampness.” Tissues that have stagnation are soft and spongy or hard and swollen to the touch. The tongue will be pale and damp and the pulse feels congested or slippery.

Stagnation was called torpor by the Eclectic physicians of the late 1800s and early 1900s. Herbs that removed this stagnation were called alteratives and have also been called blood purifiers. Generally speaking, herbs with a bitter taste fall into this category. Herbs that have this quality are considered drying.Herbs for relieving stagnation include burdock, echinacea, red clover and yellow dock. These remedies have a drying energy. Most are also cooling.

Atrophy is seen when tissues become hard and brittle. With a loss of good fats and water, tissues become hard and inflexible or brittle. Traditional herbalism often refers to this tissue state as “dryness.” Many of the diseases of aging have this quality, such as bone spurs, the formation of arterial plaque, the stiffness of arthritis and the loss of elasticity in the lungs in emphysema. The dry wrinkled skin associated with aging and the brittle bones of osteoporosis are other examples of atrophy. The tongue tends to be dry and withered, and the pulse becomes thin and weak.

Herbs used to treat conditions of atrophy are sometimes called tonics, because they help to revitalize people when they become weak or sickly. Remedies for atrophy include many herbs with a slightly sweet or bland flavor, such as ginseng. Demulcents or mucilaginous herbs (we call them mucilants for short) are also useful for conditions of atrophy. We refer to these herbs as moistening. Herbs that help to overcome atrophy include cordyceps, Korean ginseng, American ginseng, slippery elm, marshmallow and licorice. All of these remedies are moistening to dry tissues and nourishing them back to health.

Again, it won’t be helpful to use drying herbs with atrophy or moistening herbs with stagnation. However, some remedies actually help to balance the solids and liquids within the body. These could also be referred to as neutral, but to avoid confusion we refer to them as Balancing.

Tissue Tone

The final pair of opposing imbalances has to do with muscle tension or tone. Muscles act as gates in the body to control the flow of energy and fluids. When muscles tense, flow is reduced or obstructed. Conversely, when tissue is damaged, or muscle tone becomes too relaxed, fluids can drain or leak from tissues. Constriction is the tissue state where muscles are overly tight, and Relaxation is where muscles are overly relaxed or tissues are damaged and leaking.

Constriction typically happens because muscles get tired from overuse. A muscle expends energy when it contracts, and it rebuilds an energy charge when it relaxes. When muscles fatigue, either due to excessive use or nutritional deficiencies, they spasm. This can not only cause sharp pain and constricted movement, it can also obstruct flow. Examples of conditions involving constriction include some cases of high blood pressure, tension headaches, asthma attacks and a spastic colon.

Conditions involving constriction can periodically relax, causing the “dam” to break and excessive flow or secretion to occur. Alternating diarrhea and constipation, alternating fever and chills and migrating pains are examples of this. These are called “wind” disorders in some traditional systems of medicine.

Antispasmodics are the herbal remedies that are helpful for conditions of constriction. These remedies are generally acrid in flavor, although some nervines that are aromatic or slightly bitter also have this quality. We use the term relaxing to describe these remedies. Relaxing herbs include lobelia, kava kava, lavender and wild yam. These remedies relax tissue and overcome conditions of tension and constriction.

Relaxation is when tissues are unable to hold fluids due to damage or loss of muscle tone. Examples of this include diarrhea, leaky gut, excessive mucus production, bleeding, urinary incontinence and excessive sweating.

Herbs containing tannins are used to tighten tissues and stop excessive drainage. These herbs are called astringents and have a slightly bitter and drying taste. We refer to remedies with this property as constricting. Examples of astringent herbs include white oak bark, uva ursi, yarrow and bayberry.

There is one final energetic property that sort of sits at the center and that is Nourishing. Herbs that are nourishing in their energetic properties help to build up the body in general by providing nutrition that helps the body function normally.

This approach to herbs not only makes it easier for people to learn herbal medicine, it also makes it easier to select effective remedies. Here, in summary are the tissue states and the remedies you use to correct them.

Cooling herbs reduce irritation and excess heat.

Warming herbs relieve depression and cold.

Neutral herbs are neither warming nor cooling.

Drying herbs treat stagnation and water retension.

Moistening herbs restore flexibility and tissue function in atrophy.

Balancing herbs help to bring tissues back to normal from either stagnation or atrophy.

Constricting herbs stop leakage by toning up tissue relaxation.

Relaxing herbs ease muscle spasms and improve the flow of energy and fluids by easing constriction.

Nourishing herbs provide nutrients that help the body heal itself and restore normal function.

Biological Terrain Chart

The following chart also helps summarize this concept. It comes from our course, The ABC+D Approach to Natural Healing. Below the chart is a link to download a pdf version of the chart. You can print this chart, email it, post it to a blog or website or otherwise use it as long as you do not alter it in anyway.