REVIEW J. Physiol. Sci. Vol. 58, No. 7; Dec. 2008; pp.

433–440
Online Oct. 21, 2008; doi:10.2170/physiolsci.RV004208

Physiome and Sasang Constitutional Medicine

Eun Bo SHIM1,*, Siwoo LEE2,*, Jong Yeol KIM2, and Yung E. EARM3
1
Department of Mechanical & Biomedical Engineering, Kangwon National University, Hyoja-dong, Chuncheon, Kangwon-do 200-701,
Republic of Korea; 2Department of Medical Research, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea; and
3
Department of Physiology, College of Medicine, Seoul National University, Republic of Korea

Abstract: Sasang Constitutional Medicine (SCM) is a tradi- Moreover, physiome and systems medicine are introduced as
tional Korean form of medicine widely used in the clinical diag- plausible candidates for integrative medicine and are compared
nosis and treatment of disease. This paper reviews the main to reductionism-based molecular biology. We also discuss the
aspects of SCM and “physiome” with emphasis on integrative conceptual similarity of SCM with predictive, preventive, per-
and holistic characteristics. Methodological and physiological sonalized, and participative (P4) medicine. It is emphasized that
aspects of SCM are summarized with reference to existing the integrative and creative combination of SCM and physiome
studies. The main characteristics of SCM, such as the four will unlock a new era of holistic medicine.
physical constitutions and diagnostic methods, are introduced.

Key words: Sasang Constitutional Medicine, physiome, integrative holistic approach.

Western medicine was founded by the collective works ineffectiveness of modern Western medicine in the treat-
of Hippocrates, who developed a humoral system of medi- ment of chronic complex diseases such as metabolic
cine in which the treatment goal was to restore the balance syndrome, heart disease, and cancer suggests a need for
of humors in the body. Similar views were espoused in alternative medicinal approaches [1–3].
China and India; however, these ideas of medicine were Alternative medicine is now incorporated into the cur-
challenged in Europe by the rise of experimental investiga- riculums of educational institutions in several nations. In
tion originating from the works of Andreas Vesalius and Asian countries, traditional oriental medicine is taught in
William Harvey. Modern medicine was revolutionized parallel with Western medical programs of study, and in
in the nineteenth century by advances in chemistry and Korea, oriental medicine is recognized and approved for
germ theory by Ignaz Semmelweis and Louis Pasteur, and public use. Oriental medicine in Korea has a few theories,
although the germ theory was not appreciated until the an- with “Sasang Constitutional Medicine (SCM),” initiated
tiseptic method was discovered, its validity was supported by Jema Lee in 1894 [4], being one of the most popular of
by the discovery of penicillin in the midtwentieth century. traditional medicines there. In his book titled Donguisuse-
The scientific method in Western medicine was estab- bowon (東醫壽世保元, Longevity and Life Preservation
lished by Claude Bernard, and his ideas were conveyed in in Oriental Medicine) [4], Lee constructed the framework
his famous book An Introduction to the Study of Experi- of SCM by evaluating the oriental medical literature of
mental Medicine in 1865. He emphasized the importance China and Korea and classified the physical constitution of
of “milieu interieur” (internal environment), with the goal a human into four types. Although SCM enjoys little sci-
of medicine being the restoration of homeostasis. How- entific support, studies to test the applicability and effec-
ever, discoveries in classical genetics and molecular biol- tiveness of SCM in modern science are being performed
ogy and technological revolutions such as the X-ray, the at the Korea Institute of Oriental Medicine (KIOM).
electrocardiogram (ECG), and other modern instruments, The methodology of modern medicine is based on
have changed medicinal practices from their original ho- reductionism introduced by René Descartes, a well-
listic form. Moreover, the mass production of penicillin- known French philosopher and scientist. Reductionistic
based antibiotics and other drugs has further changed the approaches attempt to understand the nature of complex
principles of medical practice. Nevertheless, the overall things by breaking problems into several pieces and

Received on Mar 17, 2008; accepted on Jun 30, 2008; released online on Oct 21, 2008; doi:10.2170/physiolsci.RV004208
*These two authors have equally contributed to this article.
Correspondence should be addressed to: Yung E. Earm, Department of Physiology, College of Medicine, Seoul National University,
Youn gun-Dong, Jongro-Ku, Seoul, Republic of Korea. Tel: +82-2-250-6318, Fax: +82-2-250-6318, E-mail: [email protected];
and Jong Yeol Kim, Project Leader of “Lee Jema Project,” Department of Medical Research, Korea Institute of Oriental Medicine,
Daejeon, Republic of Korea. Tel: +82-42-868-9483, Fax: +82-42-868-9480, E-mail: [email protected]

The Journal of Physiological Sciences Vol. 58, No. 7, 2008 433

 E. B. SHIM et al.

Fig. 1. An example of the seesaw metaphor to explain physical constitution in SCM.

solving each piece separately. For instance, in life sci- tion of the syndrome (辨證) theory” and analyzed each
ences it may be assumed that if we understand the inner symptom, classifying them into symptomatic types (證
workings of the lowest-level elements, genes, and pro- 型). If patients with similar dominant complaints showed
teins, the mechanisms of more complex life forms will different symptomatic types, they were treated with dif-
then become clear. Thus unveiling these molecular events ferent therapies. Although traditional Korean medicine
may be essential for understanding health and disease. before SCM was influenced by TCM in many aspects, it
In spite of this, the primary limitation of reductionism is progressively developed a unique constitutional view that
its ignorance or rejection of the integrative nature of life. the mind and body are inseparable and the physical state
This approach is particularly ineffective in the diagnosis of the human body can be remarkably changed by mental
and treatment of complex diseases such as heart disease, factors. This belief of traditional Korean medicine led to
cancer, and diabetes, which arise from the combined SCM in the latter half of the nineteenth century.
action of many genes, environmental factors, and risk-
conferring behaviors. Therefore integration-oriented 1.2. Classification of human physical constitution
approaches such as physiome (or systems biology) have Although SCM was also influenced by Taoism and
emerged as alternatives to overcome the limitation of re- neo-Confucianism, some of its key concepts, such as four
ductionistic medical approaches. organ systems and human psychological nature, were ad-
In this paper, we first introduce SCM and the present opted from the oriental philosophical theory of “Confu-
status of physiome research. The limitations of this re- cianism.” SCM intended to delineate human physiological
search are then discussed in the context of a systems med- and pathological phenomena by employing the character-
ical approach. Lastly, we provide arguments for the need istics of four organ systems: lung, pancreas, liver, and kid-
to incorporate the physiome and SCM in a nonconflicting ney. In the SCM view, each organ represents a functional
context with modern life science and medical approaches. group representing the respiratory, digestive, preserva-
tive, and excretive systems, respectively. The mind is a
1. Introduction to SCM very important factor in SCM. The harmonic interrelation
1.1. Historical background of SCM among peoples is emphasized in SCM, whereas TCM
In all ages and countries, the classification of physical takes a definite view in the relationship between people
constitution into certain types has been attempted for the and environment based on the Five Elements Theory (五
effective diagnosis and treatment of disease. Hippocrates 行說), one of the traditional Chinese branches of philoso-
and Galen of ancient Greece proposed classification phy. Jema Lee explicated four physical constitutions in
through the Four Humors, whereas the modern scientists the chapter entitled “Organ Theory (臟腑論)” of the book
Ernst Kretschmer and William H. Sheldon classified hu- Donguisusebowon, introducing balancing mechanisms
mans into three categories according to their body shape. among the four organs (lung, pancreas, liver, and kidney).
In traditional Indian medicine (Ayurverda medicine), a In this concept, the lung and the liver pair to control some
classification theory of physical constitution was sug- physiological processes, and the pancreas and the kidney
gested; it was based on therapeutic measures that relate to compose another pair (Fig. 1). The pancreas and kidney
physical, mental, social, and spiritual harmony. are related to the digestion of food and the excretion of
Unlike these theories, SCM classified the physical metabolites and perform in a counteractive manner (see-
constitution according to the traits of an individual’s mind saw). Thus in this view, if one organ system is relatively
and body, indicating that personal sensitivity to a certain hyper-active, the other becomes hypo-active. A similar
drug can be different according to physical constitution. metaphor to the seesaw in the pancreas and the kidney is
The establishment of this physical constitution theory applied to the lung and the liver. These organ systems re-
differentiates SCM from the other theories mentioned late to and regulate the usage and storage of energy in the
above [4]. Even before the appearance of SCM, personal human body. According to the SCM theory, every person
sensitivity to certain drugs had been noticed. Traditional is born with one unbalanced seesaw, and there can be four
Chinese Medicine (TCM) established the “Differentia- different types of physical constitution. Jema Lee termed

434 The Journal of Physiological Sciences Vol. 58, No. 7, 2008

 Physiome and Sasang Constitutional Medicine

Table 1. Characteristics according to physical constitution.

Taeyang Soyang Taeeum Soeum
Hyper-active
Lung Pancreas Liver Kidney
Organa
Hypo-active
Liver Kidney Lung Pancreas
Organ
Moody Pragmatic Neat, Mild
Creative
Easily bored Endurable Logical
Progressive
Character Sacrificing Humorous Organized
Charismatic
Righteous Reflective Egocentric
Heroic
Hot tempered Cautious Persistent
Developed nape Thick waist,
Developed chest, Developed hip,
Body shape of the neck, Weak nape
Small hip Weak chest
Slender waist of the neck
Healthy sign Normal urination Normal bowel habit Normal sweating Normal digestion
Unhealthy sign Bubbles in mouth, Emesis Constipation No perspiration Indigestion
Nature Sorrow Anger Gladness Enjoyment
a In
the view of SCM, the lung, pancreas, liver, and kidney represent a functional system of organ groups that represent
respiratory, digestive, preservative, and excretive systems, respectively. This table is modified from Chae et al. [5].

these types as Tae-yangin, So-yangin, Tae-eumin, and 1.3. Classification of physical constitution
So-eumin, as shown in Table 1 [5]. This terminology was Classification of physical constitution is performed by
adopted from the well-known Chinese philosophical writ- oriental medical doctors based on the traditional diagnos-
ing Book of Changes (周易 ). tic methods involving seeing, listening, questioning, and
Jema Lee also emphasized that the human mind and touching (Four Diagnoses; 四診). Seeing (inspection) is
body are not separate, but that they closely reflect each inspecting appearance and color. It includes observing the
other. He mentioned in the chapter “Origin of Oriental shape of the face, the body, the hands, and the feet for the
Medicine (醫原論)” of Donguisusebowon that a disease determination of physical constitution, and examining the
can be provoked by environmental factors, but of more color of the face for a diagnosis of plausible symptoms.
importance is the influence of psychogenic factors such as Listening (auscultation) is inspecting vocal sounds such
sorrow (哀), anger (怒), gladness (喜), and enjoyment (樂). as voice, breathing, and coughing. Personal voice depends
In scientific sense, the seesaw metaphor between organ on physical constitution. Voices have different pitches,
systems may be explained by the balancing mechanism of tempos, and volumes according to physical constitution.
hormonal and nervous systems, which has not been scien- Breathing and coughing are checked for the diagnosis of
tifically revealed. The system biological approach will be likely symptoms. Questioning (interview) involves ask-
useful for delineating the balancing mechanism between ing patients how they feel in order to determine whether
organ systems. pathological symptoms may exist. The personal traits
A disease occurs when the inherent imbalance between and habits obtained from interviewing patients are highly
body and mind are triggered by a certain external condition. important factors to determine their physical constitu-
Under this view, the physical constitution of a patient is tion. Touching (palpation) is inspectings the skin and the
therefore diagnosed in advance, and then an understanding pulse. However, these traditional diagnostic methods are
of the inherent imbalance of the patient should be the next conducted by subjective observation and are catechetic
step to be undertaken for treatment. Food and medicine to methods, thus making the method difficult to objectify
complement these imbalances can be prescribed while the and quantify.
mental state of the patient is maintained or treated. In Don-
guisusebowon, Lee emphasizes the importance of regula- 2. Scientific approach for SCM
tion of the mind during treatment, especially in chronic 2.1. History
diseases. Although SCM is a medical theory suggested Quantification and objectification of diagnostic meth-
more than 100 years ago, it is highlighted in the present ods are the critical problems to be solved in traditional
situation. Assuming that immune system dysfunction and medicine. In SCM, this emerges as a more serious problem
psychogenic disorders are the main causes of chronic dis- because there are no clear guidelines for treatment without
ease, treatment based on SCM using natural herbal medi- physical constitutional classification. Research over the
cines and regulation of the mind could be effective. past 10 years dealing with this matter is described below.

The Journal of Physiological Sciences Vol. 58, No. 7, 2008 435

 E. B. SHIM et al.

2.1.1. Seeing diagnosis (inspection). Oriental medicine in the Temperament and Character Inventory (TCI) cri-
after the The Yellow Emperor’s Internal Classics (黃帝 terion, which distinguishes inherited temperament and
內經 ) asserted that the functional strengths and weak- acquired character.
nesses of the human body are expressed by the face and 2.1.4. Touching diagnosis (palpation). Pulse objectifica-
the physical features. Efforts to diagnose physical consti- tion research is beginning to develop a scientific approach
tution by analyzing facial features have been in progress in oriental medicine. Three companies currently market
since 1994. Analyses were performed based on the length a pulse analyzer, and the use of these instruments is cov-
and the angle of features in the front and side views of ered by insurance programs in Korea. In traditional ori-
the face; however, the accuracy of diagnosis has not been ental medicine, the symptoms of a patient are evaluated
adequate for clinical applications and requires further through pulse variations, but SCM claims that even the
investigation. In the Far Eastern societies, facial features baseline type of normal pulse differs according to physi-
have never been used for racist purposes and are regarded cal constitution.
as a means of diagnosing disease or physical constitution. Recently, a pulse analyzer with a robot arm has been
Moreover, the classification of physical constitution ac- developed by KIOM that detects and analyzes pulse
cording to the size and form of other body parts is another waves (Fig. 2).
area of study. Although picture data for these investiga- Furthermore, based on the observation that skin, mus-
tions have been accumulated over decades, quantitative cle, and bone development differ according to physical
analyses are lacking [6–10]. constitution, diagnoses using this principle are now be-
2.1.2. Listening diagnosis (auscultation). Voice is a ing made. We believe that recent developments in sensor
specific characteristic that depends on physical constitu- technology will expedite the progress of this research.
tion and health condition. The voice itself, the speed of 2.1.5. Biochemical research related to physical constitu-
speech, the crying sounds during infancy, and the sharp- tion. Over the past 10 years, remarkable progress has been
ness of the voice differ according to physical constitution. made in the search to find biochemical indexes related to
There has been research to investigate differences in voice physical constitution. It was reported that the density of
frequency, volume, and pitch according to physical consti- white blood cells (WBC), red blood cells (RBC), and plate-
tution since 1996. Analyzing algorithms for these factors lets is relatively low in certain physical constitutions and that
have been developed to a certain extent, but emphasis is cytokines that stimulate the growth and differentiation of
now placed on obtaining methodological diversity in the cells may also be indexes of physical constitution. Moreover,
analysis of data [11–13]. an analysis of body fat and indexes of patients have shown
2.1.3. Questioning diagnosis (interview). The objectifi- that certain physical constitutions are prone to obesity.
cation and quantification of traditional diagnostic meth- Recently, many researchers have been searching for
ods have been regarded as the most important category of certain genes related to the physical constitution. Clini-
SCM research. The Questionnaire for Sasang Constitu- cians can now investigate correlations between genes and
tion Classification (QSCC) is a program widely used in physical constitution by DNA chip analysis. Although
this field, and it has been shown that physical constitution much experimental research has been conducted to delin-
changes according to appearance, character, common eate relationships between angiotensinogen (AGN) genes,
symptoms, and reactions to certain foods. More than 30 polymorphisms of the apolipoprotein E (ApoE) gene, and
papers have been published since 1991 in this field, and physical constitution in stroke patients, no notable corre-
many scientific methodologies have been introduced lation has been found. It was shown that interleukin (IL)-
from consultations with psychologists, Korean language 4 and IL-6 in blood decreased and assisted the recovery
experts, and statisticians [14–21]. of damaged neuronal cells [25, 26]. Furthermore, studies
SCM is a medical system with philosophical and psy- related to the regulation of cytokine secretion have been
chological components. Therefore it is inferred that the performed [27–30]. Although these studies have not been
Sasang physical constitution may be related to modern productive because of the technological limitations of
psychology. Over the years, Sasang medical doctors and standard molecular biology, SCM experiments using ex-
psychologists have worked together and published many isting clinical data of Western medicine combined with
papers comparing and analyzing the relationships be- gene information may reveal relationships worthy of fur-
tween the Sasang physical constitution and the MMPI ther study. It may be necessary to also perform research
(Minnesota Multiphasic Personality Inventory) test, the using integrative and holistic approaches rather than rely-
MBTI (Myers-Briggs Type Indicator) test, the 16PF (per- ing solely on the methodologies of Western reductionism.
sonality factors), and Beck’s depression criteria [22–24]. Life scientists in developed countries have developed new
Nevertheless, little progress has been made in this re- integrative and holistic methods, such as physiome and
search, probably because temperament and character systems medicine. Complementary and synergistic com-
were not properly evaluated. Recently, for the psychologi- binations of physiome and SCM hold promise in uncover-
cal study of SCM, many researchers have been interested ing higher-level biological functions.

436 The Journal of Physiological Sciences Vol. 58, No. 7, 2008

 Physiome and Sasang Constitutional Medicine

Fig. 2. Pulse analyzer developed by KIOM.

Fig. 3. Ventricular scroll wave dynamics and a tornado are examples of the similarities between life
phenomena and climate dynamics. The figure in the left panel is redrawn from the computational
result of Fenton et al. [31], whereas the image in the right panel is a photograph of a tornado.

2.2. Universe Human Mapping theory fibrillation, scroll waves of electric potential in tissue are
Scientific approaches for physical constitution classifi- generated through the ventricular tissue layer between the
cation are based on the premise that physical constitutional epicardium and the endocardium, which can be compared
features, which are modulated by the strengths and weak- to the airflow dynamics of a tornado (Fig. 3) [31].
nesses of internal organ systems, are expressed by face, This theory is applied not only between universal sys-
body, voice, skin, pulse, and personality. This perspective tems and human systems, but also between organs inside
is popular in oriental medicine and is based on an oriental the body. A typical example is pulse diagnosis, which is a
philosophical theory called the Universe Human Mapping popular method in oriental medicine. By palpation of the
(UHM) theory (天人相應論). In the UHM theory, human arterial pulse, doctors are able to diagnose the pathologi-
beings are regarded as a small universe in themselves, cal state of the patient. The five viscera and six bowels (五
with all the factors in the actual universe having corre- 臟六腑) are mapped within the small area on the wrist,
sponding pairs or parts in humans as well. For example, as shown in Fig. 4. The vital gate (命門) has traditionally
the human mind and body correspond to the sky and the been referred to the right kidney, which is supposed to
earth, changes in emotion correspond to changes in cli- originate the primordial Yang (元陽).
mate, and a disease is compared with abnormal weather. According to the UHM theory, universal systems and
One noticeable example of this correspondence can be individual systems always have similar structures and
found in ventricular reentry waves and in recirculating show similar dynamics.
air waves of tornados. During ventricular tachycardia or

The Journal of Physiological Sciences Vol. 58, No. 7, 2008 437

 E. B. SHIM et al.

ing genes, proteins, lipids, metabolism, and environment.

To overcome this limitation, the Physiome Project was
proposed to study how genes and proteins interact, how
basal life functions are maintained, and how diseases
arise. Therefore physiome tries to develop databases and
biological systems models to understand human physiol-
ogy based on individual genomes and proteomes, as well
as purported pharmaceutical effects. The ultimate goal
of physiomic research is to model cell, organ, and human
systems to study individual human physiology and dis-
ease based on virtual networks.

3.2. Examples of the physiome study

Fig. 4. Measurement locations in pulse diagnosis and their Research related to physiome is under way in various
corresponding internal organs.
biological fields. Cardiome is derived from the physiome
of the cardiovascular system, and the cancer physiome
applies physiome technology and knowledge to analyze
3. Physiome and SCM the production, growth, and metastasis of tumors. Further
3.1. Background of physiome research fascinating fields have arisen from the physiome initia-
It is well recognized that biotechnology is a promising tive. Theoretical studies of cellular signal transduction
cutting-edge industry that could dramatically improve hu- and cellular electrophysiological modeling of exciting–
man life and welfare. Genomics, proteomics, and metabo- contraction coupling mechanisms integrate mathematical
lomics are examples of fields that have evolved from mo- equations to understand physiology and disease.
lecular biology. Physiome, however, is a new approach to In 1952, Sir Alan Hodgkin and Andrew Huxley made
the understanding of human biology and life that differs the first mathematical model about electrophysiological
from methods in molecular biology. Physiome promotes phenomena and were awarded the Nobel Prize for their
integrative and holistic methods and is progressively contribution. In 1960, Denis Noble at Oxford University
spreading throughout the world. As termed by James B. studied the mathematical model for the ion channels of
Bassingthwaighte from the University of Washington, cardiac pacemaker cells [34]. Theoretical studies on the
physiome was devised as a combination of “physio,” cellular electrophysiology of cardiac cells have been pub-
which means life, and “ome,” which means whole in Latin lished by DiFrancesco & Noble [35], Kimura et al. [36],
and, in total, conveys the meaning “life as a whole.” As re- Hilgemann & Noble [37] and Earm & Noble [38]. Models
viewed by Hunter and Borg [32], the goal of the Physiome at the cell level were integrated into tissues and eventu-
Project is to make computational programs and databases ally into the whole heart. Hunter et al. [39] formulated
that gather and analyze data from genes, proteins, cells, electrical propagation and mechanical contraction of the
and organs to get a macroscopic view of total body func- heart using the partial differential equation solved by the
tion. The human genome project (HGP) initiated this vi- finite element method. Various mathematical models for
sion for the recognition and treatment of fatal diseases by electrical conduction and arrhythmias in the heart were
providing a complete human genetic map. Unfortunately, also presented and were used to reproduce and predict
data gathered from the HGP have limited utility, and the pathological phenomena, such as ventricular tachycardia
complexity of life makes it difficult to explain biological or fibrillation [40]. At the systems level, Guyton et al. [41]
phenomena by genetic parameters alone. As remarked in presented an overall circulation model including a variety
the book The Music of Life [33] written by Noble, genes of physiological factors, and recently Shim et al. [42] pro-
code for proteins, but protein synthesis itself is extraordi- posed an integrative circulation model connecting cellular
narily complex and is not a linear phenomenon. Although events to circulation hemodynamics and autonomic nerve
approximately 30,000 genes exist in humans, there are control. Thus the works of several researchers have led to
more than 100,000 different proteins, suggesting that a an understanding of the interrelatedness of biological and
one-to-one relationship between a gene and a protein can- pathological phenomena.
not be valid. This also implies that extreme reductionism
emphasizing the importance of molecular phenomena 3.3. Limitations of physiome research
has critical limitations for unveiling physiological and A variety of physiome models has been presented, but
pathological occurrences [34]. Biological phenomena are they have mainly focused on reproducing existing clinical
affected not only by genes, but also by environmental fac- and experimental results. Although physiological pertur-
tors. Human life functions arise from complex, integrative bations such as arrhythmias have been predicted in clini-
mechanisms related to multiple biological factors, includ- cal settings on the basis of physiome-type theories [43,

438 The Journal of Physiological Sciences Vol. 58, No. 7, 2008

 Physiome and Sasang Constitutional Medicine

44], many limitations remain in physiome research. Defi- cations.

cient information on the kinetics and dynamics of systems Overall, little research has been performed on holistic
is one of the most serious problems, but this is primarily and integrative models. To make a plausible mathematical
due to a lack of data-based observations. Though new model in a holistic manner, more advanced physiologi-
information is continually being generated, the informa- cal theories for integrative life functions and databases of
tion required for the modeling either cannot be found or clinical data are needed; however, these requirements are
has never been obtained [45]. Specifically, holistic mod- unlikely at the present time to be met in Western medicine.
els that integrate physiological functions with scientific Regardless, empirical data of human physiological
meanings have not been presented. functions observed from holistic viewpoints such as SCM
do exist, but these data have not been scientifically ana-
3.4. Systems biology and medicine lyzed. The holistic theories, such as SCM, have been used
Systems biology involves understanding the manner for years in Korea and other Asian societies. In this sense,
in which the parts of an organism interact in complex SCM may be an important candidate that could provide
networks, and the application of systems biology to medi- holistic data for human physiological functions. It may be
cine is termed systems medicine. Systems medicine was difficult, however, to integrate physiome with SCM be-
proposed to overcome the limitations of modern Western cause of differences in theoretical systems. Nevertheless,
medicine, which depends mostly on biostatistics [46]. It it is probable that SCM may provide holistic theories that
tries to understand perturbed physiological systems and promote the advancement of physiome research.
complex pathologies in their entirety by integrating all It is noteworthy that diagnosis and treatment in SCM
levels of quantitative functional, structural, and morpho- already adopts the concept of P4 medicine. First, SCM
logical information into a coherent model. In contrast to is a personalized medicine that classifies individuals by
systems biology, systems medicine seeks an integrative four types of physical constitution (personalized medi-
and systemic approach for the diagnosis, therapy, and pre- cine). Second, it emphasizes prevention before therapeutic
vention of diseases [47]. It investigates the physiological treatment. Thus through analysis of the physical constitu-
network of diseases from gene to organ systems with four tion of a patient, susceptibility to certain diseases may be
main goals — predictive, preventive, personalized, and predicted. This is similar to the predictive concepts and
participative medicine (P4 medicine). This approach to viewpoints of P4 medicine (predictive medicine). Based
medicine arose by reflection of the averaged and statisti- on predictions, its goal is to prevent disease by chang-
cal diagnosis/treatment systems in Western medicine and ing the lifestyle of a patient to promote health. These
is regarded as an ideal paradigm to be pursued in future changes may be as simple as prohibiting some foods and
medicine. promoting others based on the physical constitution of the
patient. During the process of questioning (interview), pa-
4. Discussions tients can deliver their opinions and feelings about patho-
In this paper, we introduced SCM and addressed the logical symptoms and get responses from clinicians. This
possibility of SCM being a useful holistic medical theory kind of interview enhances the interaction of clinicians
and database for physiome research. First, we discussed with patients, which can encourage diagnostic and thera-
the general aspects and characteristics of SCM with the peutic processes (participative medicine).
four types of physical constitution and diagnostic meth- Based on the view that life phenomena can be well
ods. The background and current status of physiome re- understood by using integrative approaches, systems
search were also briefly described. medicine pursues an integrative diagnosis and treatment
Hodgkin and Huxley’s first model concerning electro- approach for human disease, with the goal being similar
physiological phenomena demonstrated that mathemati- in scope to SCM. Physiomic research tries to construct
cal predictions could be used in clinical applications. the framework of integrative physiology and supports the
Although some models were successful in the clinic, oth- fundamental scientific basis for systems medicine and
ers proved useful only for teaching medical students. For SCM, and both approaches could contribute to accumu-
example, Guyton et al. [41] presented a pioneering model lating clinical data supporting holistic models for phys-
for overall circulation that included a variety of physi- iome research. This kind of interaction between physiome
ological factors (circulatory dynamics, autonomic control, and SCM as well as systems medicine could expedite the
metabolism, pulmonary dynamics, kidney dynamics, construction of a holistic framework for P4 medicine and
blood flow control, electrolytes balances, capillary mem- promote scientific studies to verify the efficacy of SCM.
brane dynamics, and others). Recently it was shown that Scientists and clinicians with an interest in these fields
this model provides useful simulations for the treatment of could therefore both contribute and benefit from this syn-
hypotension during anesthesia [48]. Despite this success, ergism. We therefore believe that new interest in holistic
as reviewed by Bassingthwaighte [45], this model has not and integrative medicine could increase our understand-
been widely accepted as a research tool for clinical appli- ing of the physiological and pathological bases of health

The Journal of Physiological Sciences Vol. 58, No. 7, 2008 439

 E. B. SHIM et al.

and disease. Constitutions and C.G. Jung’s psychological types. J of Sasang Constitutional
Medicine. 1998;10:41-50.
This study has been supported by the Korean Ministry of Education, Sci- 24. Park HG, Lee JH, Lee NG, Park WB. A study on relationship between Sasang
ence and Technology (Grant No. M1064302000-07N4302-00000) and by Constitutions and hypnotizability. J of Sasang Constitutional Medicine.
the Korea Research Foundation (Grant No. KRF-2006-521-D00612). 1997;9:175-85.
25. Shin HY, Jeong HJ, Lee JH, Joo JC, Kim KY, Song HJ, Lee SG, Chae HJ,
Kim HR, Kim JJ, Kim HM. Regulatory effect of cytokine production in patients
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440 The Journal of Physiological Sciences Vol. 58, No. 7, 2008