Reading the Terrain

Understanding Tissue States


At the core of how I practice herbalism are two elements. The first is my personal relationship with the herbs, and my intense adoration of both plants and fungi (and lichen, I might add). The second is the sensory and common sense approach I take to working with both herbs and humans. I teach herbal energetics as being primarily organoleptic, perceivable to a great degree through our senses. While I am certainly (and constantly) informed by passed-on knowledge (tradition, texts and teachers), scientific research and biomedical understandings it is the experiential that underlies it all. Because after all, how will I integrate and utilize something unless it functions well in the context of my work? So I start here, with characteristics that I can observe with my senses and learn to understand as something meaningful and indicative of the larger picture of wellness in each person. 

The plants speak to us through our bodies. Every time we taste the acrid burn of Cayenne or the slippery coolness of Marshmallow root, our bodies respond to their unique makeup in specific ways. When we learn how the human body in general tends to respond to a plant, and then how people of certain constitutions are likely to respond, and then how our own body specifically responds, then we begin to perceive and remember the actions of each plant on a variety of types of people and imbalances. 

In order to best match herb to human we need to be able to describe and differentiate patterns. These include patterns of effects on the human body by plants that are currently termed “energetics” such as cold, hot, moist or dry, relaxing or stimulating. They also include various types of diagnostics in which we look at observable patterns of function or dysfunction in the body. Tissue states falls into the latter category, and has its origins in in Greek humoral medicine, then the work of Physiomedicalist doctor, J. M. Thurston, as recorded in his book The Philosophy of Physiomedicalism in 1900. Matthew Wood has recently revived, popularized and expanded upon this incredibly useful diagnostics tool. Jim McDonald has also helped to both expand and simplify the tissue states into a yet more accessible format and terminology.  What is presented here is how I understand and use the tissue states in my own practice and the way I teach them to my students and what makes best sense to me.

Those of you familiar with Traditional Chinese Medicine, Ayurveda, Unani Tibb, Kampo, Jamu, or other traditional systems of medicine will immediately recognize the usefulness of being able to quickly and competently identify these patterns. By now you are likely asking what a tissue state actually IS. Some herbal or medical terminology are obtuse and borderline incomprehensible but this one is fairly straightforward. It is simply the condition of the tissues, usually system-wide but potentially localized. Matthew Wood defines them as “conditions of imbalance”. These are just the elemental extremes our bodies are prone to told in the language and metaphors common to our culture.  Depending on innate constitution, some of us are more prone to certain tissue states than others, and some disorders/diseases trigger specific tissue states in most people. 

Observing the overall tissue state of the person as well as any local deviations can greatly enhance the practitioner’s ability to to discern the nature of an ailment, as well as its corresponding treatment. Let me note that this is not necessarily a replacement for biomedical diagnosis and related testing. This is a dynamic tool born of observation and experience and thus can greatly complement conventional test results and even give us a headstart on emerging issues or imbalances.

6 Qualities & 3 Energetic Spectrum

In order to fully understand tissue states, we need to first look at the components and concepts tissue states are made up of. The most commonly referenced aspects of energetics are sometimes known as The Four Qualities, which are cold, hot, damp and dry. These can be applied to states in the human body or to the effects that food or medicine has on the body. 

These original four qualities are enormously helpful in holistic diagnostics all on their own, but adding tense and lax to the mix makes for an even more useful and common sense system or identification. Matthew Wood says:

Galen acknowledged only the four qualities of Aristotle, but for the sake of completion, and better clinical work, we need also to include the two basic conditions described by his opponents, the methodist physicians: too much tension (status strictus) or too much relaxation (status laxus). The four qualities represent fixed, oppositional imbalances, while the two states represent dynamic imbalances due to change or exhaustion. Putting them altogether we have a system of six types, which corresponds to the system of six “tissue states” introduced by the physiomedicalists, or botanical physicians (the descendants of Samuel Thomson) in the early twentieth century.

Don’t get too caught up in the names of the states when you read about them in books, just focus on hot, cold, dry, damp, lax and tense and it will probably make sense to you more quickly. These are common sense qualities that you can easily experience in your own body and not just abstract theory. Consider that these six qualities are really three primary energetic spectrums. Rather than approaching them as polar opposites, try looking at them as spectrums on a color wheel where there will be inevitable overlap and blending of colors and tones.  

Thermal Spectrum: Cold-cool-neutral-warm-hot

Note that cold and hot in this context specifically mean diminished (cold) or heightened (hot) physiological activity. Cold in diagnostics will often refer to a subjective sense of cold as a part of a larger picture of depressed metabolic and other vital functions. Likewise, hot is associated with excited (increased) metabolic/vital function sometimes resulting in hyperfunction.

Fluid Spectrum: Very dry-dry-neutral-damp-very damp

A very literal and easily observable spectrum for the most part. Here we’re looking for either fluid deficiency (not holding enough fluids) or excess (holding too much fluid) in the tissues. 

Structural Spectrum: Lax-neutral-tense

Structural Energetics are those that directly effect the tension and laxity of the tissues, often most noticeable in the musco-skeletal and nervous systems but having important effects on all systems in the body.

To relax is to make less tense, rigid, tight or to loosen. From the Latin "lax", literally "loose". I have picked up the habit of using the word lax itself rather than relaxed from Jim McDonald, who rightly points out that the specific use of such a general and commonly used word such as relaxation, can be misleading and easily misunderstood. Tension is to be stretched tight. Excess tension is associated with restricted circulation of blood, fluids and most importantly, the vital force.

Additional Energetic Spectrums

Additional spectrums include the Vitality Spectrum of excess and deficiency and the Flow Spectrum of stimulation and relaxation. They’re also important but less necessary for the current look at tissue states. 

The 6 Tissue States

Hot (Excitation)

Definition: This is the state in which there is general overactivity, sometimes termed “excitement”, of the organism. This hyperfunction can result in irritation, overstimulation and a tendency to easily triggered inflammation. There is often an overreaction to allergens, bacteria, viruses etc., 

Observable Characteristics: Redness and general inflammation of tissues (especially mucosa), subjective sensations of overheatedness, perceived oversensitivity to stimuli, including pain.  Red tongue, with or without coating, often with a pointed tip. Rapid pulse. 

Corresponding Herbs:  Herbs most suited for this tissue state will usually be cooling. The tastes sour and bitter are often the best for calming excitation and cooling heat in the tissues. Herbs with these primary tastes are almost invariably cooling, and can calm excitement and reduce irritation. Matthew Wood terms the herbs that cool and calm the hot tissues state as “sedatives” with a especial emphasis on sour, fruity remedies such as Strawberry leaf and Rose hips. 

Heat can arise from several different primary sources, including irritation which will call for the simple sour sedatives, also heat from dryness (also see the dry tissue state) where a lack of vital fluids is causing the vital heat to roar out of control and indicates a need for demulcents, many of which are bland or sweet tasting. Lastly, bitters commonly used to calm the hot tissue state are often also considered calming to the nervous system as well, and some, like Alder, also have a somewhat sour secondary taste.

Sour: Rosa fruit, Fragaria leaf, Crataegus fruit, Filipendula leaf and many other remedies in the Rosaceae family. Many Rumex species are also sour and cooling, and do a commendable job of reducing inflammation and overall heat. Rhus spp., (especially the fruit) and Melissa also fall under this heading.

Demulcent: These are simple moistening herbs that are usually neutral to cooling in nature, with bland to sweet taste. Althaea, Malva, Sphaeralcea, Alcea and many others in the Malvaceae family are cooling and moistening and excellent for this application. Tilia is another soothing and moistening herb often appropriate here.

Bitter: Included are Artemisia (an aromatic bitter sometimes classified as warming, but that clearly reduces inflammation and the hot tissue state, especially in the hepatic/digestive tissues), Scutellaria (a slightly to extremely bitter calmative, depending on the species), Frasera, Gentiana, Alnus bark (sweet, sour and bitter), Matricaria flower and Achillea leaf and flowers.

Cold (Depression)

Definition: The state in which there is a general underactivity/depression of the organism. This hypofunction can result in a lack of response to normal stimulation due to a deficiency of vital force, lack of digestive fire and thus, malabsorption of nutrients. There is often a lack of appropriate immune response to allergens, bacteria, viruses etc., 

Observable Characteristics: Pallor, subjective sensations of coldness, slow movement, decreased intensity of sensation. Feelings of tiredness and difficulty thinking clearly. Pale tongue or bluish and slow pulse. Achy, dull pain that feels better with heat or warming herbs. Bloating, food stagnation, flatulence and belching may occur as a result of impaired digestive fire. Matthew Wood asserts that “Depression in the peripheral vasculature can cause heat symptoms, but the underlying cold still needs to be treated with warming, stimulating herbs.

Corresponding Herbs: Remedies most appropriate for this tissue state are very often warming and aromatic and/or spicy in taste. Matthew Wood calls this category of herbs “stimulants” since they stimulate increased physiological activity. Many warming Lamiaceae plants belong here, as do a number of Brassicaceae and Apiaceae members. A great many herbs are relevant here, including most kitchen spices. 

Spicy: Rosmarinus, Capsicum, Thymus, Monarda, Cinnamomum spp., Capsella, Sisymbrium irio, Armoracia rusticana, Allium spp., etc.,

Warming Aromatics: Pinus, Abies, Lavandula, aromatic Salvia spp., Juniperus spp., etc.,

Aromatic Bitters: Solidago spp., Juglans spp., Artemisia spp. (also included under the Heat tissue state because of the phenomenal ability of this genus to both increase physiological activity while also soothing excess tissue excitement), Ligusticum spp., Acorus calamus, Angelica spp., Inula helenium, etc.,

Dry (Atrophy)

Definition: The state in which there is a lack of fluids in the tissues, either because not enough oil or water is actually being produced or because it is not being properly contained by the body. This dryness, if long term and/or severe can eventually lead to a state of atrophy (lack of function) in the tissues (Wood). As Matthew Wood and Jim McDonald both point out quite often (and for good reason), there is more than one kind of dryness. Both oil and water are necessary to the proper function of the body, and someone may be deficient in either one or both fluids. Wood also notes that a lack of digestive secretion can also be considered an indication of a dry condition.

Observable Characteristics: Dry (progressing to withered) skin, hair and mucosa, constipation with dry, hard stools. Tongue usually thin and dry, and may be withered if dryness has progress to atrophy (Wood). In some cases the tongue may seem lax or swollen but is still dry and may be cracked as well. There may also be stiffness in the joints from a lack of lubrication and feeling of brittleness throughout the body.

Corresponding Herbs: It is important to note when using herbs to address dry conditions that using herbs to simply stimulate secretion can actually cause MORE dryness rather than less by triggering further loss of fluids. It is not just a matter of producing or introducing fluids but is equally important to help the body best hold, absorb and utilize them. Thus we have several different categories of herbs most appropriate to this tissue state, depending on whether they actually help to build more fluids in the body (adaptogens), help tonify tissues to better hold in fluids being lost through excessive sweating, urination, bleeding or similar (astringents, see also the lax tissue state) or simply provide additional immediate moisture (as with oily tonics and demulcents).

Adaptogens & Sweet Tonics (Builds Fluids): Withania somniferum, Panax spp, Aralia spp., Glycyrrhiza glabra and allied spp. Codonopsis pilosula, Avena spp., Polygonatum spp.,

Demulcents (Contributes Fluids): Althaea, Malva spp and other Malvaceae, Ulmus rubra, Ulmus pumila (and other mucilaginous U. species), Linum spp.

Oily Tonics (Contributes Oils): aromatic Salvia spp., Ligusticum spp., Angelica spp., Aralia spp., Arctium spp., Linum spp.

Astringents (Holds Fluids): aromatic Salvia spp., Rhus spp., 

Damp (Stagnation)

Definition: As opposed to the previous tissue state where there is not enough fluid in the body, the damp tissue state occurs where there is too much fluid in the organism, which will eventually result in stagnation and torpor. This generally seems to happen because the usual channels of elimination are somehow being blocked or impaired or there is weakened metabolic function.

Observable Characteristics: Full, overly plump tissues (edema), dull looking skin,  lessened tissue expression (most easily seen in the face, rendering the person somewhat dull or expressionless looking), hypoimmunity with lymphatic stagnation. Excessive phlegm and an overall feeling of heaviness or being weighed down. Tongue usually coated, often swollen and damp. 

Corresponding Herbs: Remedies most appropriate to this tissue state usually increase elimination and encourage greater metabolic function. In Western herbalism we tend to think of these sorts of herbs as alteratives or blood cleansers. Almost all of these plants are at least somewhat bitter in taste, and some have an aromatic element as well. These herbs drain dampness, move stuck lymph and generally increase circulatory, hepatic, renal and digestive function. There is also a class of nutritive, salty herbs that supplement the metabolism and aid in gently increasing elimination. 

Digestive Bitters: Gentiana, Cynara, Frasera, Iris, Taraxacum, Berberis, Rumex crispus, Juglans spp., etc.

Salty Metabolic Tonics: Urtica spp., Trifolium pratense, Stellaria media, Galium aparine, Sambucus spp. flowers etc.

Tense (Constriction)

Definition: Tension is basically to make tight. If you play a musical instrument, you will be well aware of the importance of having just the right amount of tension. Too little tension and the strings will be loose and soundless, the drumhead dull and the voice flat and expressionless. Too much tension and the strings pop, the drumhead splits and the voice goes sharp. Just the right amount and we have dynamic, easily adaptive and beautiful sound. The same is true of the tissues, just enough tension and our bodies respond as intended, absorb blows and recover, hold and move fluid efficiently and age gracefully and gradually. Too much tension creates emotional irritability, spasmodic afflictions and eventual wearing down of the tissues that are wound too tight. The tense tissue state is associated with restricted circulation of blood, fluids and most importantly, the vital force. This often results in muscular (smooth and skeletal) tension, muscle spasms, nervous tension, and feelings of restlessness and irritability. Eventual exhaustion can follow chronic constriction due to long-term energy stagnation and lack of vital circulation.

Observable Characteristics: Emotional irritability and tension, spasms, spasmodic pain, repeating or alternating symptoms (Wood) such as rotating chills and fever or alternating constipation and diarrhea. Random bouts of hiccoughing and vomiting can also be associated with the tense tissue state. Impaired or irregular circulation due to vascular constriction, shaking hands, tremors and a shaking tongue (although this can also be due to straight up deficiency) are also telltale signs of this tissue state.

Corresponding Herbs: The primary category of herbs suitable for the tense state is acrid. Like astringent for the lax tissue state (and remember that Tense~Lax is a spectrum), acrid is not a flavor but an impression. It is the burning, prickly sensation (especially noticeable on mucus membranes) caused by certain plants to one degree or another. It is most obvious in herbs such as Cayenne where breathing in even a tiny bit of the powder can cause a burning, tic-like feeling in the back of the throat. In the same way, getting freshly chopped Anemone leaves or roots on your cuticles, mouth or just anywhere ~near~ your eyes can cause notable discomfort. 

The acrid taste in the correct amount relaxes tension and lessens constriction in the tissues. These herbs are relaxant (anti-spasmodic) in a specific way that is particularly good for relaxing excess tension. Acrid herbs come in many flavors (literally), including the straight up acridity of Lobelia to the sweet (with varying amounts of bitter) flavor with acrid impression of Actaea rubra and racemosa to the oddly aromatic acridness of Valeriana. All are excellent for eliminating spasms and reducing tension but have different subtleties based on their primary flavors. 

Acrid: acrid Anemone spp., acrid Lobelia spp., Capsicum spp., Agrimonia spp., Morus alba leaf, 

Acrid & Sweet: Actaea rubra, Actaea racemosa, Liriodendron, Chrysanthemum flowers.

Acrid Aromatics: Symplocarpus foetidus, Piper methysticum,, Valeriana spp., Mentha arvensis, Nepeta cateria, Vitex spp.

Acrid BittersVerbena spp., Humulus lupulus, Garrya spp.

Lax (Atony)

Definition: Laxity is commonly seen as overtly relaxed tissue that lacks expression and no longer holds their form or fluids. This can be observed in skin that has lost its elasticity, organ prolapse, water-logged mucus membranes (as with spongy gums), varicose veins and a wet, flabby tongue. Fluids tend to flow through lax tissues rather than properly containing and transporting them, creating a swampy, inefficient environment, usually accompanied by disrupted bacterial ecology. There is often excessive fluid loss through urine, sweat, diarrhea and blood, depending on the situation. In cases of moderate to severe tissue laxity there will also be a drain on improper containment of the vital force, resulting in long-term fatigue and general low energy.

Observable Characteristics: Loose, expressionless tissue (especially noticeable in the face), organ prolapse, vulnerable to chronic infections, excessive fluid loss via urination, sweat, diarrhea, vomiting, bleeding etc., which may result in long term constitutional dryness. Tongue may be wet and formless. 

Corresponding Herbs: Here we are looking for herbs that give tone and help the tissues to hold their form and function efficiently. To tone is to tighten and pull together, thus lessening the permeability of the tissues. Astringents fit the bill perfectly here as they cause the contraction of tissue they come in contact with, and as such help prevent loss of fluids while assisting the organism in proper function wherever there is excessive relaxation/laxity. 

Astringents often (but not always) have a sour flavor, some may instead (or also) be sweet or bitter or aromatic or some combination. Note that overuse of astringents, can eventually impede nutrient absorption via the gut, by tonifying to the point of making the tissues impermeable. Gentle astringents tend to be better, especially in chronic issues. Strong astringents do have a place in the treatment of acute fluid loss, such as hemorrhaging or life threatening dysentery. Astringency is caused by tannins in the plant, which gave their name to the process of tanning hides. Tanning an animal skin renders it less vulnerable to breakdown and also makes it much less fluid permeable. Astringent is an impression, meaning that it affects any tissue it comes in contact with rather than being dependent on being tasted or ingested, so astringents are very useful in the same way externally although of course treating a systemic lax tissue state should be done internally as well. 

Astringents: Quercus spp., Rosa spp., Rhus spp., Malus spp., Myrica spp., Agrimonia spp., Geum spp., Rubus spp., Camelia sinensis, Collinsonia, aromatic Salvia spp., Hamamelis virginiana

A Reminder: Don’t get stuck in forcing things into categories, tissue states and other diagnostics are general observable patterns not hard and fast rules. There are plentiful exceptions and idiosyncrasies so be flexible in your approach and think of these as guideposts rather than a set route. Seeing mixed tissue states in an individual is very common and should be expected, and this is where the beauty of formulating comes in.

Resources and References

The Philosophy of Physiomedicalism: Its Theorem, Corollary, and Laws of Application for the Cure of Disease by J. M. Thurston (1900)

The Practice of Traditional Western Herbalism by Matthew Wood

Study Guide to the Six Tissue States handout by Matthew Wood

Herbal Properties & Actions by Jim McDonald

Personal correspondence with Jim McDonald

The Western Herbal Tradition by Graeme Tobyn, Alison Denham and Margaret Whitelegg

Out of the Earth; the Essential Book of Herbal Medicine by Simon Mills

Culpeper’s Medicine by Graeme Tobyn