7 Stages of Health and Disease (Including Constitutional Imbalance)

Why Conventional Medicine Misses the Middle Ground

Long before an imbalance becomes clinically detectable, we can work with plant medicine to strengthen the body and improve vitality to prevent the onset of more serious disease.

How we define health and wellness, as well as disease and the stages in between, are important concepts. Chronic illness is not a sudden occurrence! We aren’t just living our daily lives with everything humming along perfectly, and then all of a sudden, chronic disease appears out of nowhere. Instead, there is a progression, and, of course, the earlier we catch these issues and start addressing them at a root level, the better. 

The Allopathic Model

In the allopathic model, you go to a doctor, and there are certain characteristics, markers, numerical factors, or boxes you have to tick to be diagnosed as having a particular disease. Of course, you need a diagnosis to receive treatment. If you tick one or two boxes, but not all of the boxes required for a diagnosis, you don’t meet the diagnostic criteria. Technically speaking, this means you don’t have that disease, and therefore, they won’t be able to treat you. The doctor might say, “We’ll keep checking on it. If you eventually do meet the criteria for diagnosis, then we can prescribe drugs for you. Meanwhile, though you might be suffering, we can’t do much for you.” 

The Herbal Medicine Model

One of the strengths of herbal medicine is that, in these pre-clinical imbalance or disease states, we can treat a person. We can work with plants at various stages — from peak health to some degree of constitutional imbalance, through various stages of progression to full-blown disease.

What are the points between being well and having a disease, and how can we consider plants as treatment options throughout that process?

Health is a Spectrum, Not a Static State

The health or lack of health of the body is not a static state. In medical biochemistry, anatomy, and physiology, we have the term “homeostasis.” This term denotes a state of equilibrium or balance within the body. Homeostasis is generally thought of as a state of health. When your body is in a state of homeostasis, it’s balanced, and nothing is malfunctioning. But what’s the operative word there? The operative part of that word is “stasis.” It indicates a static state of being. You’re either in homeostasis, and you’re healthy, or you’re not, and you’re sick. The homeostasis example highlights how most of us think of health and disease as being static states.

What is Homeodynamis?

One of my herbalist heroes, the late Stephen Harrod Buhner, used the term “homeodynamis.” I love that word because it illustrates that health and disease are dynamic states, and that our health constantly fluctuates, just like everything in nature. Spring follows winter, summer follows spring, and the sunrise follows night. There is a rhythm and a structure to nature’s movement. But within that structure, there is dynamic change and fluctuation. The same is true within our bodies. Homeodynamis reflects that dynamic state and, therefore, offers a more optimal way of thinking about the spectrum of health and disease, with multiple points in between.

When you work with clients, it is helpful to recognize where a person falls along that spectrum, as this can indicate which remedies are best, how strong they should be, and the frequency and duration of use. A person’s state of health along the spectrum should influence the therapeutics you consider for them. 

Health is Not About Perfection

Although you may not have a full-blown disease or be acutely sick (with a cough, cold, or flu), you may sense that you’re not optimally healthy. You might notice minor, annoying things happening in your body. Everyone has aches, pains, and little physical upsets that it’s helpful to be aware of. At the same time, it’s a good idea not to let every little discomfort bog you down — there is a balance. Many people assume everything is fine and tough it out, move on, and ignore discomfort. Perhaps there is a time and a place for that. However, if you do that too often, you may miss something important. The vital intelligence of your body is trying to tell you something.

On the other end of that spectrum, some people are hyper-aware, which can lead to hypochondria. They might call in sick for work because of minor discomforts or go to the doctor for every little thing. Some discomfort is just a part of having a body, and you will be uncomfortable in your body from time to time. You can’t always expect to be in a state of perfection, and that’s a pitfall some people in the alternative medicine movement fall into. People who are very health-conscious and try to eat, exercise, and use herbs “perfectly,” sometimes become overly vigilant and perfectionistic. Being health-conscious can be advantageous, but it’s also important to recognize that we all live in a body, in mortal flesh. We are not going to be perfect, and our bodies will have issues. It’s just part of life, and the more we can accept that, the more sane we will feel. To strive to exist in a state of physical perfection, with no pain or problems in your body, is perhaps equivalent to seeking perfect spiritual enlightenment. There are saints and enlightened mystics, but for most of us mere mortals, we’re not quite there. So we have to accept that living in a body means living on a health spectrum. 

How Herbal Medicine is Ideal for the Entire Spectrum

The unique nature of herbal medicine does not require us to be in a full-blown disease state to make good use of it — we can work with herbs to support health, rejuvenate our systems, and enhance vitality.

Every point along the spectrum from optimal health to disease helps us identify which herbal remedies are appropriate. Examples on the mild side are Nettle Leaf (Urtica dioica), Alfalfa (Medicago sativa), and Oat Straw (Avena sativa). On the other end of the spectrum, we have low-dose, potentially toxic herbs such as Poke Root (Phytolacca americana), Lily of the Valley (Convallaria majalis), Lobelia (Lobelia inflata), and Pulsatilla (Pulsatilla vulgaris).

There is also a spectrum of plant strength in between. If someone has a minor constitutional imbalance, it’s important to give them an herb that matches the severity of their problem in terms of strength, so you wouldn’t give them a super potent, low-dose herb. A lesson I learned from Paul Bergner is to always to use the mildest remedy that will get the job done. Don’t give someone Gentian (Gentiana lutea) as a digestive bitter when Dandelion root (Taraxacum officinale) will do the job. Don’t give them Hops (Humulus lupulus) as a sedative or nervine if Chamomile (Matricaria chamomilla) will do the trick. To go even further, don’t even use the mildest herb if the best corrective measure would be to alter the diet or lifestyle — an herb cannot replace a bad habit. You have to match your therapeutics to the severity of the issue the person is dealing with, and a solid rule of thumb is to use the mildest remedy that will get the job done. If getting the job done requires a dietary or lifestyle modification, that’s the best action, and no herb can replace it.

The Journey From Health to Disease

As a father, the purest state of health I can think of is a baby, newly arrived in this world. Some traditions see the child as a clean slate, a fresh new life. At that stage, the baby hasn’t been exposed to much of anything yet. The moment a baby is born, they may be exposed to all kinds of things, depending on how the birth goes. But that baby hasn’t made any bad decisions or eaten any food yet — they have a clean slate.

Of course, we sometimes inherit things. This is a discussion you may have encountered — are we a blank slate? The way we turn out — is it nature or nurture? Are we conditioned by our experiences, and therefore become the people we are because of what the culture, TV, our parents, and schools tell us? Or do we have a unique nature with which we are born? I think both are true. I think we are born into this world unconditioned, with a clean slate. Yet there is a slate, and there is a particular nature, even to that clean slate.

From a traditional perspective, we would say that we are born with a particular constitutional pattern — a unique composition of the elements. This, of course, goes back to Greek philosophy in the Western tradition: Aristotle and the elements and humors. Ayurveda and Chinese medicine talk about this. Many medical traditions hold that every human has a constitution, a specific nature. We all have Earth, Water, Fire, and Air, but in unique ratios. Those qualities shape the nature of the body and the temperament of the mind, personality, and disposition. Those qualities generate strengths and weaknesses within the body’s organs. Using a more modern scientific understanding, we inherit genes from our parents. Of course, there are some very unfortunate incidences for babies born with genetic diseases. Something goes haywire, and they are born with health problems from the get-go.

So we have this clean-slate dynamic, in which we are unconditioned. We also have our core constitutional nature. As we grow and develop, things happen. We begin to eat food, and we put clothes on our skin. Some babies are very sensitive to some fabrics or soaps. Maybe they try certain foods, and then they get rashes. Then they get their first cold, their first flu, their first fever, their first bumps, scrapes, and bruises. 

We are born and raised in a particular environment, a particular ecosystem. We may take medications and get vaccinations. We’re exposed to a home life, a culture, a community, and a school. All of these things are interfacing with the body, mind, and consciousness. So, we encounter the world around us, put things into our bodies and minds, and perceive things with our senses, and these all start to build layers onto us and influence us in various ways. 

We have that core constitutional nature with which we were born, and maybe that constitutional nature is that we’re hot and fiery. But perhaps we live in a cold environment and don’t move around much. Instead, we sit in front of the TV and become couch potatoes, and eat a lot of cold, wet, damp food. So these layers are put on top of the core constitution.

In Ayurveda, it is said that there are two constitutional patterns: prakruti, your inborn constitution, and vikruti, your current state of imbalance. This is like the layers of an onion. It is your current state of being that is incongruent with the core constitutional pattern. Vikruti is the beginning stages of this progression toward deeper imbalance. 

So, as humans, when we experience the world, it changes our bodies. For some people, the progression from health to disease can happen very quickly. For others, it takes a long time, and the process becomes more and more complicated as it progresses.

Sometimes a child has an allergy to a food they don’t know about, so they keep eating it and develop problems quickly. Sometimes they don’t have any major problems until they get older. It’s perfectly normal and natural to get sick in childhood — acute coughs, colds, flus, RSV, COVID, etc. — that’s just part of life. Acute childhood illnesses are part of the maturation of the immune system. The body becomes sick and therefore learns to cope with and find balance in the environment. Getting sick is actually a very important process in the development of health and vitality.

However, suppressing illness can lead to deeper health problems. When I work with a client, I often ask how many times they had fevers that were suppressed. If they always had Tylenol or Advil when they had a fever as a kid, that can sometimes be an indicator of chronic suppression of the vital force, which can lead to chronic disease. The vital force strives to express itself and to clear the body, so suppression can drive things deeper. ​

Consider the onion analogy: the core constitution is the center of the onion, and as we grow and experience the world, layers are added to it, and often by the time we’re in midlife, there are multiple layers. As herbalists, our job is to use therapeutics to peel back those layers, exposing and treating them layer by layer until we get back to the purity of the core constitutional nature. From there, the work is to make an effort to live in accordance with our constitutional nature to maintain its homeodynamic state.

The 7 Stages of Health and Disease

There are many ways to look at these stages along the spectrum from health to disease. I will offer my perspective to provide definitions, so that we can hopefully wrap our minds around the possible treatment options. The most important thing is that we’re on the same page in recognizing that the spectrum is more than just the black-and-white of health or disease. There is a process from health to disease, and from disease back to health. We don’t magically go from being chronically ill to perfectly healthy overnight in the same way we don’t go from perfectly healthy to chronically ill overnight. 

Stage 1: The Enlightened State

Let’s begin by moving from health to disease. We can say the perfected state is the ultimate goal. This is like an enlightened state, encompassing not just physical health but also psychological, emotional, and spiritual health.​

Paracelsus said, “If man were in possession of a perfect knowledge of self, he would not need to be sick at all. He should study himself and the rest of creation so that he may attain self-knowledge. And this self-knowledge should be above all obtained by the physician.” Paracelsus was a proponent of the physician-as-philosopher. Not simply a philosopher sitting in an armchair thinking about things, but a philosopher who studies the patterns of nature, and sees that these patterns are reflected in the life and the body of the human being. This is what he referred to as “anatomia,” or anatomy—the macrocosmic and microcosmic anatomies — and the connection between the two. 

Stage 2: Peak Health

Most of us mere mortals are not in a state of perfect enlightenment, and we may not aspire to be. The next stage along the spectrum is peak health. For most of us, this is what we’re aiming for. Peak health is not just the lack of disease or simply health in the organs, systems, and tissues of the body, but a state of physical strength and flexibility. There is ample vitality and energy so that we’re not just slogging through each day. In peak health, we wake up feeling well-rested. Peak health is also a clear and inspired psychological state. It is a state of mental clarity and focus. In a state of peak health, your mind is not bogged down, cloudy, or distracted and scattered. There is a sharpness and focus to the mind.

If we think of the alchemical concept of the spirit as being differentiated from the soul, the spirit is the Mercury principle, and the Air and Water elements. So it relates to the mind, Air, and the emotional side, which is the Water element. When someone is in high spirits, what does that mean? It is an optimism of the mind and a hopeful feeling in the heart. It is a striving toward goodness and virtue. I think of this as emotional buoyancy. You don’t control your emotions; you allow yourself to feel what you’re feeling and express it in a healthy, appropriate way based on your surroundings and circumstances.

​Peak health is a state in which you can attend to your spiritual development, whether that be religion, prayer, or meditation. You have enough vitality to ask the bigger questions of life, such as, “Why am I here? What is my moral compass? How can I strive to be the best version of myself? How can I be in service to something greater than myself, God, Great Spirit, the creator, etc.?”

In Alchemy, we say that peak health is a state of living in accordance with our own constitutional nature, both internally and externally, where we express the most virtuous aspects of our unique archetypal nature. Jordan Peterson, speaking about archetypes, says that we all live out an archetypal story. The question is whether we’re aware of it and whether we are living out the shadow side or the virtuous side of that archetype. There is no such thing as an option without an archetype. In the alchemical view, peak health means we are expressing the most virtuous aspects of the archetypes we’re in congruence with. That is done through an understanding of the planetary bodies, because the structure of the solar system reflects the structure of the human psyche, enabling us to live in harmony with nature. 

What does this mean? I think it means we’re living in accordance with our own nature, and that we understand our constitution and live, act, eat, and think in ways that maintain the balance of our constitutional nature without getting too uptight about it. You have to be able to enjoy your life too, and not always be thinking, “I can’t eat that little thing because it’s dried and it’s going to imbalance my constitution.” You have to live a little, too. 

To be honest, peak health is a fleeting state. I often joke that you’ll have a moment of perfect balance when your body, heart, mind, and spirit are in harmony with nature. But then the wind blows, and you’re off balance again. Your skin gets dry, you get a little gassy and bloated because you ate garbanzo beans. So once again, you’re back to being a bit out of balance. It’s important to remember that health is not a static state; it is in constant flux.

Stage 3: Constitutional Imbalance

The next layer is constitutional imbalance. I jokingly call this state “healthy enough.” You might consider yourself to be generally healthy, but you still have a little constitutional imbalance — you’re just healthy enough. This is a minor alteration of your constitutional pattern. There may be a little excess heat, cold, damp, or dry, but not enough to become a major issue. You may have minor health annoyances that come and go. Perhaps you have a little gas here and there, a sleepless night once in a while, a few minor aches and pains, those little minor health issues that we all deal with. These can be annoying, but it’s not enough to send you to the doctor. In this state, you might have minor degrees of nutrient deficiency. Sometimes those little annoyances can be due to nutrient deficiencies. These little annoyances and nutrient deficiencies are the beginning of a process of weakening vitality. If we don’t turn things around, we will be more susceptible to manifesting disease. This state is easily countered, typically through simple dietary and lifestyle modifications, simple supplementation, and mild herbs.​

This state is important to be aware of! It’s helpful to be aware of minor constitutional imbalances. Of course, there is a danger of becoming overly worried, uptight, cautious, and narcissistic, where you’re hyper-focused on every little imbalance. But as long as you can simply observe and act, you have a valuable tool for seeing an imbalance that’s just beginning and correcting it.

Stage 4: Acute Sickness or Injury

The next layer is acute sickness or injury. This happens to all of us. We catch something that’s going around, and we end up in a temporary state of imbalance that’s a bit more serious than a constitutional imbalance. But at this stage, nothing has become chronic enough to produce distinctly uncomfortable signs and symptoms. These are the standard coughs, colds, flu, and infectious states that come and go.

The ideal situation when these arise is to allow the acute symptoms to express themselves. It’s best not to suppress symptoms, so that the vital force can restore health on its own. You can support your body’s vital force through gentle, natural remedies. Ideally, you don’t suppress your fever with Tylenol, and you allow your immune system to fight the infection on its own if it is minor, or with the assistance of natural remedies. If acute symptoms are suppressed, it will likely weaken the system in the long term and can lead to further problems. Acute injury is part of this stage — accidents, broken bones, etc.

Can you see the progression? First, we’re enlightened, then we have peak health, then minor constitutional imbalances. We may become acutely sick or injure ourselves now and then, but if we treat ourselves in accordance with our constitution and the wisdom of the vital force, we can still come back to peak health. 

Stage 5: Generalized Illness

Generalized illness is when people notice that something in their body feels off, and it’s typically more consistent. This is not the type of discomfort that comes and goes. You might notice a nagging pain or a constant upset in your digestion, for example.

​At this stage, constitutional imbalances have progressed to the point where there are consistent, recurring symptoms. There is either an increase in symptom severity or frequency, or both. This stage is below the level of chronic disease, but there are deeper levels of imbalance that can cause suffering. Depending on a person’s strength or stubbornness, this is when people may either seek a practitioner’s help or ignore the symptoms and tough it out. The person may know what changes they need to make and make them themselves. Oftentimes, people in the world of health, medicine, herbs, and nutrition look to the internet to figure out what’s going on and work with it on their own. That isn’t always a good idea, but sometimes people can find decent information if they’re discerning. 

The challenge at this stage is that, in conventional medicine, people sometimes don’t meet diagnostic criteria for a specific disease. So this can be a gray area where, maybe their labs are at the high or low end of normal — they’re in range, but they’re right on the edge. Perhaps they don’t check all the boxes to be diagnosed with a disease, and their symptoms aren’t bad enough to warrant drug treatment, so they end up in limbo. The doctor can’t give them a drug because they can’t diagnose them with a disease. After all, they don’t meet the set criteria. They have to get worse before they can receive treatment. 

This is the perfect time to introduce herbal medicine. At this stage, we can work with stronger herbs and in-depth supplementation. It’s important to consider lifestyle, diet, and the types of habitual changes a person can make to reorient toward health. You want to try to steer things back toward a minor constitutional imbalance, because this is the stage where, if the situation keeps progressing, it will become much more difficult to correct.

Stage 6: Disease

The sixth stage is disease, at which point a person meets the diagnostic criteria for a particular disease or pathological pattern. Obviously, at this stage, the person doesn’t feel well. Most people at this point will seek medical attention, and they should.​

Typically, this stage is more chronic. Symptoms no longer come and go and are no longer at the level of simple constitutional imbalance, where they’re annoying but can be ignored. It is also unlike generalized illness, where symptoms are present, and the person wishes they weren’t, but they can bear it. Once you reach the disease stage, something feels very wrong, and the person realizes they need help. Symptoms are more severe and frequent, and there are often multiple complaints that negatively impact the person’s life. The function and structure of the body is compromised, and quality of life is affected.​

As practitioners, we have to think about the state a person is in when they come to us. They’ve been on this journey for some time, and now they are sitting in front of you asking for help. It is important to put yourself in their shoes. They’ve been living their lives, maybe feeling alright, when they suddenly manifest minor symptoms. They shrug those symptoms off, but then a couple of years go by, and it gets worse. Then, seemingly all of a sudden, they reach a point where they can’t take it anymore and need help. Maybe they go to the MD, and even try a couple of MDs, and see some specialists. Maybe they try acupuncture or a nutritionist. And then they find themselves sitting in front of the herbalist because no one else can help. 

This situation is intimidating for many herbalists because they think, “If those other practitioners couldn’t help this person, why would I be able to?” It is important to have a slightly different approach than other practitioners. In this stage, you should usually use stronger herbal medicines, typically at higher dosages, dosed more frequently. You will also need to incorporate full protocols that involve deep dietary and lifestyle assessment. Are they living in a way that is adversely impacting their health? You don’t need to boss people around and tell them what to do and how to be, but if they hire you for your help, they’re asking you for your perspective. They are hiring you to share what you know. If you see them doing something that is adversely impacting their health, it’s your duty to inform them of what you see. From there, they can take the information and do with it as they will. 

Stage 7: Death

The final stage is death, which, obviously, is a part of life, and we cannot circumvent death.

While I broke the stages down to describe them for you, these are not set in stone or even clearly defined. These are simply my definitions of the herbal potency and dosage frequency that make sense to me for each stage on this spectrum.

The Herbalist’s Role Across The Spectrum

I think it’s helpful to think of these milestones along the progression from peak health to disease, and then, hopefully, on the journey back from disease to peak health, and all the points in between. Of course, our goal as herbalists is to guide people back down that pathway toward peak health and support them along the way. And yet, I also think it’s important to understand that the complete amelioration of suffering in someone’s life is not always possible. Suffering is inevitable as a human being. I think the way we have been created and the intelligent design of this life is that we will suffer, and how we navigate that process shapes our experience.

As herbalists, recognizing where someone is on this spectrum is a very helpful skill to develop. One of the biggest strengths of herbal medicine is that we can work with someone who is at peak health and perhaps address their psychological and emotional sides, even their spiritual side. Perhaps our clients want to express themselves better. Maybe they want to feel more confident in themselves. Maybe they want to feel stronger in their body. These are all situations that herbs have the power to support. We can address minor constitutional imbalances with simple, nutritive tonic teas and perhaps herbs to move a person’s blood, or we may give them something to relax tension, or help with digestion. Working with people in this way can keep them in that peak health state for longer. Even in generalized illness, we can use herbs to bring someone back. 

I hope this has been helpful in considering the health-to-disease spectrum and that you can begin using this information with yourself and your clients.

FAQ About Constitutional Imbalance

What is constitutional imbalance?

Constitutional imbalance is a minor alteration of your inborn constitutional pattern, where small excesses of heat, cold, dampness, or dryness begin to surface as recurring annoyances like occasional gas, sleeplessness, or minor aches. It sits between peak health and acute sickness on the health-to-disease spectrum, and it’s the stage where simple changes to diet, lifestyle, and mild herbs can most easily restore balance before deeper imbalance sets in. It’s one of the key topics we cover at the School of Evolutionary Herbalism.

What’s the difference between homeostasis and homeodynamis?

Homeostasis describes the body as being in a static state of equilibrium, implying you’re either healthy or you’re not. Homeodynamis, a term I first heard from herbalist Stephen Harrod Buhner, reframes health as a dynamic, fluctuating state, more like the rhythms of nature than a fixed condition. The distinction matters because it opens up the middle ground between health and disease, where herbal medicine works most effectively.

What’s the difference between prakruti and vikruti?

In Ayurveda, prakruti is your inborn constitution, the unique composition of elements you were born with. Vikruti is your current state of imbalance, the layers that accumulate on top of your core nature through diet, lifestyle, environment, and life experience. The herbalist’s role is to peel back the layers of vikruti to restore alignment with prakruti.

When should I use mild herbs vs. more potent remedies?

Match the strength of the remedy to the severity of the imbalance. Mild nutritive herbs like Nettle Leaf, Oat Straw, and Alfalfa are appropriate for minor constitutional imbalances. Stronger tonics and clinical-grade herbs become appropriate at the generalized illness and disease stages. Low-dose, potentially toxic herbs like Lobelia or Pulsatilla are reserved for serious conditions and require trained guidance. A reliable rule, taught by herbalist Paul Bergner, is to use the mildest remedy that will get the job done.

Can herbs replace diet and lifestyle changes?

No. An herb cannot replace a bad habit. If poor sleep, a stressful schedule, or a problematic diet is driving the imbalance, those are the first things to address. Herbs work best as support for the foundational work of living in alignment with your constitutional nature, not as a substitute for it.

At what stage should someone see an herbalist?

Herbal medicine can support every stage of the health-to-disease spectrum, which is one of its greatest strengths. People in peak health can work with herbs to maintain vitality and address psychological or spiritual goals. Those with constitutional imbalance benefit from gentle correction before symptoms deepen. And people with generalized illness or diagnosed disease often find that herbalism meets them in places conventional medicine can’t, particularly when they’re stuck in the diagnostic gray zone where their labs are “in range” but they don’t feel well.