BIOTYPE CONSIDERATION
Before starting any treatment, it is necessary to study and understand the postural characteristics of the patient. The first stage is clearly observation, which makes it possible to understand which biotype the patient belongs to and to locate his fulcrums in his body. Establishing the biotype to which they belong is the premise for developing the most effective strategy to undertake the treatment, starting from a careful analysis of the constitution, temperament and dominant tissues.
Starting from the concept of “constitution”, which is determined by factors such as morphological, physiological (functional metabolic) and psychological components – which mutually influence each other – we can identify three biotypes: the ectomorphic, the endomorphic, the mesomorphic. Taking a cue from Chinese medicine, doctors have used this methodology to better understand the patient.
The analysis of the constitution allows the understanding of the peculiar psycho-physical dynamism of the patient, and consequently to predict and prevent the appearance of dysfunctions and possible pathologies. Pathologies that involve different organs or systems for which one can be more or less predisposed depending on one’s constitution.
The characteristics of the biotype will tend to create fulcrums in the patient’s structure and fluid stasis. Precisely because of its predisposition. By knowing the patient’s biotype, it is possible to practice preventive treatment and achieve better patient homeostasis. We will present the various methods of identifying the body constitution.
The Constitutional Model of Hippocrates: Humoral Approach.
Hippocrates in the fifth century B.C. extended the doctrine of the four fundamental elements (Air, Fire, Earth and Water) to human nature by introducing the theory of the four humors, according to which four basic humors (phlegm, blood, black bile and yellow bile) govern the human body determining its state of health or disease. After various elaborations of this theory, in the mid-nineteenth century this classification of temperaments (including physicality) was defined, which is still adopted today: LYMPHATIC TEMPERAMENT: refers to a corpulent individual, tending to be obese, blissful, calm, slow, lazy in which the nutritional function prevails. SANGUINE TEMPERAMENT: refers to a normal, ruddy, cheerful, active and mobile individual, who tends to be unstable in which the reproductive function prevails. NERVOUS TEMPERAMENT: refers to a thin, weak, pale, sad, stingy individual, with frequent inhibitions in which the receptivity function prevails. BILIOUS TEMPERAMENT: refers to a handsome-colored, unbalanced, irascible, touchy, strong individual, with a tendency to excitement in which the reactivity function prevails.
Vannier’s model: psycho-somatic approach.
Homeopathic medicine needs to proceed towards a constitutional analysis that, always starting from morphological, physiological and psychological characteristics, allows to classify the terrain of the individual on which the disease has the possibility of settling, that is, the potential tendency of an individual to contract certain diseases. The classification of constitutions:
CARBONIC CONSTITUTION: corresponds to the brachytype, i.e. a subject that has shorter limbs than the trunk, stubby and large hands, round face, square teeth, muscle rigidity, tendency to develop more in width than in height, tendency to retain liquids, obesity. He is tidy, tenacious, slow, cold, greedy, loves to eat.
The child’s constitutional predispositions are inflammatory diseases of the skin (eczema, itching, urticaria), respiratory system (laryngitis, tracheitis, bronchitis), gastrointestinal system (enteritis, gastroenteritis), urogenital system (cystitis, urethritis, prostatitis, vaginitis, vulvitis) and those affecting the eye (conjunctivitis, blepharitis). In mature age, the predispositions are rheumatic diseases (arthritis, arthrosis) and degenerative diseases towards sclerosis (arteriosclerosis, atherosclerosis, sclerosis affecting the liver, pancreas, kidney, heart, brain). It can suffer from thrombophlebitis, changes in turnover with hypercholesterolemia, diabetes, obesity. It is associated with lymphatic temperament.
SULPHURIC CONSTITUTION: corresponds to the normotype, i.e. a subject with a harmonious build, medium height and weight, well-developed and toned muscles, well-proportioned hands and fingers. It has good resistance to exertion, is dynamic, active, sporty, creative, sociable, but sometimes unstable and fickle. It shows a tendency to autointoxication due to the accumulation of toxins. In general, it is in good health, although the pathologies it encounters are those affecting the cardiovascular and respiratory systems and skin problems (dermatitis, dermatosis, urticaria, blackheads, acne, pustules, etc.), as it eliminates through the skin the toxins that its excretory organs are unable to dispose of. It is associated with a sanguine temperament. Other authors represent this constitution with two biotypes: the “fat sulphic”, whose constitution, while remaining predominantly sulphurous, is close to the carbonic one, and the “lean sulphur” (or “muriatic”) which is close to the phosphoric one.
PHOSPHORIC CONSTITUTION: corresponds to the longitype, i.e. a slender, tall, slender, elegant subject, with long limbs and hypotrophic musculature, slender thorax, triangular and elongated face, pale complexion. He is cold, lacks vigor, tires easily, but recovers quickly because he knows how to save money. He suffers from low blood pressure that rises only because of emotionality He is an intellectual, hypersensitive, emotional, idealistic, cares about aesthetics, melancholic, depressed, worried about his health. Morbid predispositions are neurovegetative dystonia, diseases of the nervous system, problems of the respiratory system due to chest insufficiency (pharyngitis, bronchitis, asthma, whooping cough, etc.), rheumatic diseases, scoliosis, flat feet, gastric and intestinal atony with consequent gastrointestinal disorders, colitis, constipation. It is associated with nervous temperament.
FLUORIC CONSTITUTION: corresponds to a subject with pronounced asymmetry and morphological irregularity of the physique, lean, elongated and thin fingers, with a decalcified skeleton, muscle hypotonia, fragility and laxity of the ligaments. He is comparable to the acrobat in his ability to assume particular postures. He is very intelligent, but unstable, he reacts in an unpredictable and impromptu way, that is, he is the classic genius. Morbid predispositions are psychic instability tending to paranoia, scoliosis, sclerosis, osteoporosis, dental caries, joint problems (sprains, dislocations), low back pain, ptosis of the stomach, kidney and uterus, congenital hernias, varicose veins, hemorrhoids. Several authors do not include this constitution among the basic ones (they limit themselves to considering only the first three), as it would be a pathological expression deriving from the phosphoric constitution, i.e. corresponding to the most asthenic longitype.
Pende’s model: endocrinological approach.
The Italian endocrinologist Nicola Pende (1880-1970) carried out an analysis of the constitution in which the connection between morphological, physiological and psychological characteristics and the endocrine functions of human organisms was traced, thus laying the foundations for the introduction of constitutional endocrinology. In other words, it is observed how the functioning of the endocrine glands can act on the physical appearance and psychological disposition of the individual. According to Pende, constitution is the morphological, physiological and psychological result, varying from individual to individual, of the properties of all the cellular and humoral elements of the body and their combinations, determined by the laws of heredity and incidentally by the perturbing actions exerted by the environment.
The Pende school therefore describes four endocrine frameworks corresponding to as many constitutions:
ASTHENIC BREVILINIUM: characterized by poor functioning of the thyroid gland (hypothyroidism), adrenal cortex (hypoadrenocortism) and sex glands (hypogonadadism). It corresponds to the carbonic biotype or lymphatic biotype.
BREVILINIUM STENICO: characterized by an increased functioning of the adrenal cortex (hypercoticoadrenism). It corresponds to the fatty sulfuric biotype or blood biotype.
ASTHENIC LONG-LIMBED: characterized by increased functioning of the thyroid gland (hyperthyroidism) and adrenal medullary (hypermedulloadrenism), but poor functioning of the adrenal cortex (hypoadrenocortism). It corresponds to the phosphoric biotype or nerve biotype.
LONG-LIMBED STENICUS: characterized by increased functioning of both the medulla and the adrenal cortex (hyperadrenism). It corresponds to the lean sulphuric biotype (muriatic) or to the bilious biotype, although the latter correspondence is a bit forced, it is only didactic, as the bilious biotype can be associated with any constitution.
Martiny’s model: embryological approach.
The French physician Marcel Martiny (1897-1982), the most brilliant of Pende’s disciples, introduces a constitutional analysis of an embryogenetic type that tries to give an answer regarding the origins of the morphological, physiological, neuroendocrine, psychological signs that characterize the biotype. According to Martiny, the constitution of each individual depends on the development of the germ disc and therefore of the embryonic layers that will give rise to all the structures of the human being. In the first three weeks of gestation, following the gastrulation process, the germinative disc develops, consisting of three overlapping layers of cells, the embryonic layers, from which the different organs and systems will originate.
The first sheet, the deepest one, is the endoblast from which the mouth, esophagus, stomach, small intestine, large intestine, rectum, anus, liver, pancreas, thymus, prostate, epithelium of the bronchi, mucous membranes of internal organs, etc., originate.
The second embryonic layer, the one in a central position, is the mesoblast from which the heart, blood vessels, muscles, lungs, adrenal cortex, anterior pituitary, skeleton, ovaries, testicles, corpuscular elements of both blood (white blood cells, red blood cells and platelets) and lymph (lymphocytes) originate, etc.
The third and last sheet, the outermost one, is the ectoblast from which the skin, brain, nerves, adrenal medulla, posterior pituitary gland, retina, etc., originate.
The predominance in the development of one embryonic leaflet over the others determines an exuberance of the respective organs to which it belongs and consequently the origin of three constitutions, to which a fourth is added when the three leaflets are in a situation of perfect equilibrium. More precisely, according to Martiny, human constitutions are:
ENDOBLASTIC: in which the endoblast sheet prevails. It corresponds to the asthenic breviline or the carbonic or lymphatic.
MESOBLASTIC: in which the mesoblast sheet prevails. It corresponds to the sthenic brevilineus or the sulphuric fat or blood.
ECTOBLASTIC: in which the ectoblast sheet prevails. It corresponds to the long-limbed, asthenic, or phosphoric or nervous.
CHORDOBLASTIC: in which there is a balance in quantity of the three embryonic layers. It corresponds to long-limbed sthenic or lean sulphuric (muriatic) or bilious. This last correspondence, we repeat, is a bit forced as the bilious biotype can be associated with any constitution.
Sheldon’s model: Somatotypes.
Sheldon’s Omatotypes represent a 1940 classification devised by William H. Sheldon. American psychologist and physician . In the 1950s and 1960s, other scholars refined and deepened Sheldon’s principles such as Richard W. Parnell, Barbara H. Heath and J.E. Lindsay Carter, creating anthropometric measurement methods to establish whether a subject belongs to a given somatotype.
Sheldon theorized Constitutional Psychology, a science that links different constitutions with temperamental types. Sheldon argued that the human body should be classified according to the relative contribution of three fundamental somatic elements, named after the three embryonic layers: the endoderm (from which the digestive and respiratory systems develop), the mesoderm (from which skeletal muscle, the heart, and blood vessels originate), and the ectoderm (from which the skin and nervous system originate).
In his 1954 book, Atlas of Men: A Guide for Somatotyping the Adult Man at All Ages, Sheldon ranked all possible biotypes on a scale of 1 to 7 for each of the three “somatic” models, where pure “endomorph” is 7-1-1, pure “mesomorph” is 1-7-1, and pure “ectomorph” is 1-1-7. Sheldon was the first to coin the term somatotype, but in the context of biotypology it can be replaced by these other terms interchangeably.
Endomorph: characterized by increased fat deposition, a wide waist, and a robust bone structure. The endomorph is more predisposed to storing fat, so the degrees of belonging to the endomorphism outline the tendency to the accumulation of lipids of a subject.
Mesomorph: characterized by medium-sized bones, solid trunk, low levels of body fat, broad shoulders with narrow waists, usually referred to as muscle type. The mesomorph tends to develop muscles, but not to store fat, and the degrees of belonging to mesomorphism outline the tendency to muscle development of a subject.
Ectomorph: Characterized by long, thin muscles and limbs and reduced fat accumulation, usually referred to as thin. The ectomorph is not predisposed to storing fat or building muscle, so the degrees of belonging to ectomorphism outline the tendency to maintain a thin, lean, not very muscular, and long-limbed body of a subject. Classifications have therefore been formulated on the respective psychic tendencies of these models, which, depending on the prevailing components, can be divided into emotional, named as viscerotonic (relative to the endomorph), active, called somatotonic (relative to the mesomorph), passive, called cerebrotonic (relative to the ectomorph).
According to Sheldon, however, these characteristics are not so specifically defined. In reality, the constitutional components are widely variable, individual, complex, mutable or continuous, therefore these biotypological models represent an extreme indicative simplification. These types do not, therefore, correspond to any real and concrete individual. Pure biotypes are very rare, while the majority of individuals are characterized by mixed values of belonging, on the psychological side, they can serve to broadly understand the relationships between the size of the organism and the personalities of individuals. It is no coincidence that the classification scale that catalogs an individual’s belonging to these biotypes provides for a great variety of possible models that is very precise and individualized.
Conclusions.
The constitutional models set out over time have become richer and more complete.
It starts with the model dating back to Hippocrates based on the theory of the four humors.
We pass through Vannier’s model based on the analysis of physical and psychic characteristics
We go through the Pende model based on the analysis of endocrine functions
Finally, we arrive at Martiny’s model based on an embryogenetic analysis
Finally, Sheldon’s model, which is very similar to Martiny’s, but excludes the Cordoblast constitution.
These models, even if they start from different considerations and approaches, all present evident similarities and convergences that do nothing but confirm the validity of the methods adopted.
The correspondences between the different constitutional models dealt with are shown in the diagram. The human constitution, whatever the approach with which it is identified, must be understood as the set of morphological, physiological (metabolic-functional) and psychological characteristics of an individual capable of influencing its reactivity. These traits, mainly linked to heredity and little conditioned by the environment, make individuals all different from each other, especially in their external appearance. The study of human constitutions is of considerable clinical interest, because it allows us to obtain indispensable information on the characteristics of the client and his pathological predispositions.
From an osteopathic point of view, a biotype analysis already allows us to understand which osteopathic method to prefer depending on the patient’s morphology.
The endoblast is a patient who will have lymphatic stasis over the years and the methods to be preferred will be the visceral of the abdomen and endocrine, due to a slow metabolism.
The mesodermal is a patient who must pay attention to the respiratory system, lungs, pleura and bronchi; In the inspiration phase, there is a tendency to over-excite the endocrine, medullary part of the adrenals and thyroid.
The ectoblastic patient dominates the central nervous system.
The three embryonic layers.
Given their importance, let us therefore come to define more carefully the embryonic leaflets, to which we have already referred.
Around the ninth day of development, the embryo is completely sunk into the uterine membrane. The placenta begins to form around the 10th day, this structure acts as a link between the embryo and the mother. The set of parts of the placenta is the structure necessary for the exchange of nourishment between the mother and the embryo.
On the tenth day, the small embryo looks like a tiny disk, made up of the overlapping of two sheets called Ectoderm (or outer leaflet) and Endoderm or inner leaflet; in a second phase, a third layer will develop, the Mesoderm (or middle sheet). These three components are also called “primitive germ sheets”.
The cells in each leaflet then continue to differentiate, thus giving rise to various specific organs and systems.
These three embryonic layers represent the summary of biological evolution, which has allowed a simple cell to become a very complex organism: the human organism. Now let’s take a closer look at each piece of paper.
Endoderm (inner leaflet).
Symbolically, it represents vegetative life, in fact it gives rise to the organs of nourishment and assimilation (mucous membranes of the digestive and respiratory systems).
Many glands and the inner lining of many cavities originate from this leaflet, but also the respiratory system, mouth (but not the final part that derives from the ectodermal leaflet), nose, pharynx, larynx, trachea, bronchi, lungs. The digestive system, mouth, esophagus, stomach, liver, pancreas, gallbladder, duodenum, small intestine, cecum, large intestine, rectum (but not its final part which comes from the ectodermal leaflet, just like the mouth) are also formed here. A prevalent development of this part compared to the others determines the birth of individuals defined as endoblastic or phlegmatic morphology.
The mesoderm (middle leaflet).
It is the point of origin of many organs and also for the structures that support the tissues formed by the ectoderm and endoderm. It represents, symbolically, the dynamism of the animal world; In fact, the organs of movement and activity in general, such as the skeletal system and bones (except for some of the head, cartilage, tendons, aponeuroses, membranes (dura mater, fascia in general, joints) originate from it;
The development of the muscular system is also based in this area. In fact, the muscles (striated and smooth), the cardiovascular system, the blood, the heart, the blood vessels are formed; but also the lymphatic system, lymphatic vessels, lymphatic nodes, the spleen (first hematopoietic then lymphoid organ) and the genitourinary system, gonads, kidneys, adrenocorticals, anterior pituitary; the fascial apparatus, the cellular matrix or connective tissue.
It is also the center of origin for the dermis of the skin. The particular development of this leaflet gives rise to individuals with mesoblastic or blood morphology.
Ectoderm (outer leaflet).
Symbolically, it represents the highest evolutionary point in the organization of living matter. It is to all intents and purposes an intimate link between the body and the nervous system, and is therefore the channel through which all perceptions pass at the epidermal level, thus playing the role of a speaker between the outside and the inside of the body and vice versa.
The prevalence of this leaflet during embryonic life will give rise to individuals with ectoblastic or nervous morphology.
It is the last piece of paper that is formed. Many of the structures close to the outer surface of the body originate from it: the outer epidermis with its different layers, hair, nails, hair, stomodeum and proctodeum (opening of the mouth and anus) develop from the integumentary apparatus; the eye, cornea and lens (the muscles inside the eye are also of ectodermal origin but sclera and extraocular muscles come from the mesoderm); the inner ear (the outer and middle ears are derived from the endoderm); the nose, which arises as ectodermal thickening (olfactory placodes);
-the oral cavity, formed by the ectodermal layer and the initial tract of the endodermal intestine that fuse together towards the middle of the 4th week, at which time it is no longer possible to recognize with certainty which structures of the mouth derive from the ectoderm and which of the endoderm, tooth enamel; the central nervous system, brain and spinal cord; the peripheral nervous system, neurons and glial cells.
Understanding the biotype makes it much easier for us to understand how to intervene with osteopathic techniques, which are the weak points of the biotype become physiological fulcrums of the patient, but in the long run also somatic dysfunctions. Which we will always find in that subject.