Constitutions in Chinese Medicine: A Five Element Perspective with Deficiency and Excess Patterns

In Traditional Chinese Medicine (TCM), every person has a unique constitutional makeup influenced by the Five Elements: Wood, Fire, Earth, Metal, and Water. Each element represents a set of physical, emotional, and energetic traits, along with tendencies toward imbalance. Understanding constitutional types helps practitioners tailor treatments, lifestyle recommendations, and emotional guidance in ways that support individual health.

Each element can express as either balanced, deficient, or excess, with different implications for health and behavior. Here's a look at the core characteristics of each constitutional type, along with how deficiency and excess patterns manifest.

Wood Constitution

Exercise Recommendations

• When Deficient: Gentle yoga, Tai Chi, walking in nature, slow stretching—encouraging mobility without strain.

• When Excess: Martial arts, running, strength training, vigorous flow yoga—release pent-up energy and anger constructively.

Dietary Focus by Color

• For Deficiency: Warm, sweet, and mildly sour foods in green, yellow, and orange hues—e.g., cooked leafy greens, squash, sweet potatoes.

• For Excess: Cooling, detoxifying foods in green and blue-green shades—e.g., cucumber, celery, mung beans, bitter greens.

Herbal Support

• Eastern Herbs:

  • For Deficiency: Dang Gui (Angelica sinensis), Bai Shao (White Peony), Gou Qi Zi (Goji Berry)

  • For Excess: Chai Hu (Bupleurum), Long Dan Cao, Zhi Zi (Gardenia)

• Western Herbs:

  • For Deficiency: Nettle, Oatstraw, Burdock root (nourishing Liver and Blood)

  • For Excess: Dandelion root, Skullcap, Milk Thistle (detoxifying and cooling)

• Organ Systems: Liver and Gallbladder

• Season: Spring

• Emotion: Anger / Assertion

• Color: Green

• Body Type: Tall and slender with a strong, upright posture

• Facial Features: Long face with a broad forehead and narrow jawline

• Hand Shape: Long fingers and nails, with visible veins and tendons

Balanced Wood:

• Ambitious, driven, visionary, organized

• Strong leadership qualities, thrives on movement and change

• Assertive, flexible, and creative

Deficient Wood:

• Timid, indecisive, lacks direction or confidence

• Weak sinews, fatigue in limbs, poor adaptability

• Prone to depression, withdrawal, or procrastination

Excess Wood:

• Easily angered, rigid, controlling, aggressive

• Tension in muscles, tight tendons, migraines

• Dominating personality, excessive ambition

Influence of Shock, Emotion & Lifestyle:

• Sudden trauma or chronic frustration can damage the Liver, increasing rigidity or emotional volatility.

• Sedentary lifestyle leads to Qi stagnation, while movement and creative outlets support balance.

• Emotional repression or lack of assertive expression often results in internalized tension.

Fire Constitution

• Organ Systems: Heart, Small Intestine, Pericardium, San Jiao

• Season: Summer

• Emotion: Joy / Excitement

• Color: Red

• Body Type: Delicate build with a pointed chin and prominent cheekbones

• Facial Features: Heart-shaped face with a wide forehead and narrow chin

• Hand Shape: Small hands and feet, with well-defined fingers

Balanced Fire:

• Charismatic, joyful, expressive, emotionally intelligent

• Enthusiastic, warm-hearted, inspires others

• Good communicator and socially adept

Deficient Fire:

• Lack of joy, melancholy, emotional flatness

• Cold hands/feet, palpitations, insomnia with dream-disturbance

• Social anxiety or withdrawal, stuttering speech

Excess Fire:

• Overexcitement, manic behavior, restlessness

• Insomnia, anxiety, racing heart, loud or inappropriate laughter

• Easily overwhelmed, scattered focus

Influence of Shock, Emotion & Lifestyle:

• Emotional trauma or overstimulation can disturb the Shen (spirit), causing heart imbalances.

• Overwork and lack of rest burn out Fire types quickly.

• Consistent joyful expression and emotional connection nourish Fire; isolation weakens it.

Earth Constitution

• Organ Systems: Spleen and Stomach

• Season: Late Summer

• Emotion: Worry / Sympathy

• Color: Yellow

• Body Type: Stocky and robust with a tendency toward weight gain

• Facial Features: Round face with full cheeks and a yellowish complexion

• Hand Shape: Square palms with short fingers

Balanced Earth:

• Nurturing, grounded, supportive, compassionate

• Stable and dependable, thrives in routine

• Strong digestion and good concentration

Deficient Earth:

• Worry-prone, overthinking, dependent on others

• Digestive issues (bloating, loose stools), fatigue, brain fog

• Weak muscles, sugar cravings, dampness tendencies

Excess Earth:

• Smothering, overly protective, clingy

• Stagnation, obsession with control or perfectionism

• Overweight, sluggish digestion, mucus accumulation

Influence of Shock, Emotion & Lifestyle:

• Chronic over care or caretaking depletes Earth energy.

• Diet high in sugar, processed foods, or irregular meals weakens the Spleen.

• Emotional overattachment and worry lead to digestive stagnation.

Metal Constitution

• Organ Systems: Lung and Large Intestine

• Season: Autumn

• Emotion: Grief / Letting Go

• Color: White

• Body Type: Lean and well-proportioned with broad shoulders

• Facial Features: Square face with sharp, well-defined features and a pale complexion

• Hand Shape: Strong, well-formed hands with prominent knuckles

Balanced Metal:

• Disciplined, refined, introspective, moral integrity

• Appreciates order, values ritual, clear communication

• Accepts life’s cycles and losses with grace

Deficient Metal:

• Grief-stricken, lack of boundaries, low self-worth

• Frequent colds, allergies, weak voice, dry skin

• Constipation, unresolved sadness or nostalgia

Excess Metal:

• Rigid, overly critical, judgmental

• Emotionally cold, dismissive, unable to adapt

• Skin issues, tight chest, shallow breathing

Influence of Shock, Emotion & Lifestyle:

• Unresolved grief or chronic suppression of sadness can constrict Lung Qi.

• A rigid lifestyle, devoid of emotional expression, causes imbalances.

• Practices that encourage breath, reflection, and letting go restore harmony.

Water Constitution

• Organ Systems: Kidney and Bladder

• Season: Winter

• Emotion: Fear / Willpower

• Color: Black / Deep Blue

• Body Type: Rounded with a tendency to retain water

• Facial Features: Large head with a broad forehead and dark circles under the eyes

• Hand Shape: Plump, soft hands with short fingers

Balanced Water:

• Deep thinker, wise, calm, resilient

• Resourceful, contemplative, preserves energy well

• Strong willpower and endurance

Deficient Water:

• Fearful, lacking confidence, easily fatigued

• Lower back/knee pain, cold extremities, reproductive weakness

• Urinary frequency, premature aging, lack of initiative

Excess Water:

• Emotionally frozen, withdrawn, overly suspicious

• Water retention, phobias, bone issues

• Obsessive behaviors, over-controlling tendencies

Influence of Shock, Emotion & Lifestyle:

• Shock and trauma deeply affect the Kidneys, leading to chronic fear or depletion.

• Overwork, irregular sleep, and excessive sexual activity drain Kidney essence.

• Rest, quietude, and nourishment strengthen Water and promote longevity.

Final Thoughts

Understanding the Five Element constitutions and how they express in deficiency and excess allows us to better understand ourselves and others. These archetypes offer a map of human nature—pointing toward both our vulnerabilities and our strengths. By nurturing balance within our constitutional tendencies, we move closer to health, harmony, and a fuller expression of our nature.

Would you like to explore how to support each constitution through acupuncture, herbs, or lifestyle practices?