| ObjectiveAs the main manifestation form of unique individual in human life process, constitution has very close relationship with health, sub-health and diseases. The research on constitution and its relative fields complies with the change from disease-centered to people-centered tendency of medical development. Besides being useful for mastering the individual life feature from a holistic point of view, it also helps to explain the relationship between the constitution and health. It can also help to understand the function and law of constitution in disease onset, development and change as well as provide theoretical basis and improvement measures for individualized clinical diagnosis, treatment, disease prevention and health preservation. Therefore constitution has special importance.As the medical model nowadays is changing from biology medicine-psychological medicine-social medicine, the author intends to adopt the modern epidemiology method to explore the distribution feature, law and relative impact factors of Taiwan urban population’s TCM constitution types and hopes to provide relatively standard basis and mature evaluation system for the prevention and improvement of various biased constitution.MethodsOn the basis of literature review, the author chose Taiwan urban population as the subjects and adopted epidemiology methods to carry out large-sample investigation.1217qualified subjects are selected. Mainly based on Wang Qi’s Scale of9Constitution Types (Gentleness Type, Qi Deficiency Type, Yang Deficiency Type, Yin Deficiency Type, Phlegm Dampness Type, Damp Heat Type, Blood Stasis Type, Qi Depression Type and Special Constitutional Type) and also the self-designed scale and diagnosis form (Yang Excess Type, Blood Deficiency Type and Cold-Syndrome with Pseudo-Heat Symptoms), the author primarily set up the basic database about the TCM constitutional types of Taiwan urban population. Rank the constituent ratio of each constitution type and discuss the distribution feature of the TCM constitutional types among this population. Conduct layered research on different factors including gender, age, education degree, profession, marriage status, ethnic groups, bodyweight and Body Mass Index (BMI) in order to understand its inner law. Research on the mutual impact and inner mechanism of different constitution types by constituent ratio and cluster analysis. Further explore the relative influencing factors and improvement measures for different constitution types.Results1. Literature ReviewOn the basis of discussing the definition and research range of constitution, the author sorted out the relative literature from historical development and modern research aspects. The TCM literature review studies the development of the TCM title of "constitution", classification and impact factors for the formation of constitution, the application of constitution theory, etc. Former study points out that the first person who proposed the title of TCM "constitution" was Zhang Jingyue in Ming Dynasty or Zhang Nan or Ye Tianshi in Qing Dynasty, etc. After research, the author found Qian Yi in Song Dynasty first used the word "constitution" in "Chapter of Bianzheng" of his Therapeutics of Children’s Diseases. The literature research of the origin of TCM "constitution" demonstrates that literature study is not just the stepping-stone for practical and operational studies. However, it has its own substantial research significance.Modern literature research first made it clear the concept of constitution, its basic principle, modern TCM constitutional types, the relationship between constitution and syndrome, constitution and disease prevention, etc. The epidemiology investigation researched from two aspects, namely social population and clinical population. Research on the clinical adjustment and experiments about constitution has been sorted out in detail.2. Epidemiology Research (1) The author took Taiwan urban population as research subjects and selected1217qualified cases. Based on Wang Qi’s9Constitutional-Type Scale and self-designed scale and by conducting a large-sample investigation with epidemiology methods, the author primarily set up a basic database.(2) Research on the distribution law and features of Taiwan urban populations’ TCM constitution types.(3) Research on the constitution distribution law and features from aspects of gender, age, educational degree, profession classification, marriage status, ethnic groups, bodyweight and BMI of Taiwan urban populations.(4) Former studies on constitution mainly focused on its general distribution law and seldom considered the mutual relationship between constitution types and the inner mechanism. This study researched from constituent ratio and cluster analysis; therefore it has enlightening significance for research in this field.(5) Though the statistical study on the affecting factors and improvement measures for different constitutional types is quite preliminary, it is quite enlightening for research in this field.(6) The author thought there may be deficiency in the9Constitution-Type Scale of Wang Qi, therefore in the self-designed scale, the author attempted to add Blood Deficiency Type, Yang Excess Type and Cold Syndrome with Pseudo-Heat Symptoms. Research shows this supplementary scale has clinical significance and it’s helpful for the refinement of constitution classification and for the close connection with clinical work.Conclusion1. Literature ReviewWith the development of TCM constitution study, the focus of research has changed from sorting out the historical academic material to the clarification of concepts related to constitution, the establishment of classification methods and standard, epidemiological investigation, multi-disciplinary methods or techniques combining physiology, pathology, genetics, biochemistry and immunology, etc. Research on constitution tends to combine theoretical study with clinical work, modern methods with traditional ways as well as macro and micro aspects. The branch subjects of TCM constitution study at different levels have formed. Though certain achievements have been obtained, there’s still large room for future development, especially in research methods and techniques. At the same time, the connection between theoretical study and clinical practice should be enhanced.2. Epidemiological Investigation(1) The author discussed the distribution feature of TCM constitutions in Taiwan urban population (1217qualified subjects included) from different angles including constituent ratio, major constitution type constituent ratio, Wang Qi’s major constitution type constituent ratio and found the top5constitution types are all Qi Deficiency Type, Phlegm Dampness Type, Yang Deficiency Type, Qi Depression Type and Dampness Heat Type which demonstrates the regularity indeed exists. Besides major constitution type, there are usually more or less other constitution types within each individual.(2) Research on the layered distribution law from aspects of urban populations’gender, age, education degree, profession classification, marriage status, ethnic groups, bodyweight and BMI is described as follows:①There’s no obvious significance in the distribution of Wang Qi’s9constitution types in terms of gender, but significance is found in the distribution of Blood Deficiency Type in male and female when comparing the affiliated two types. This shows Blood Deficiency Type should be listed in constitution types and this point is meaningful in studying female constitution. The function of affiliated scales in this research manifests itself.②In terms of age, the ranking of constitution types for those above the sample’s average age is Phlegm Dampness Type, Qi Depression Type, Blood Stasis Type and Blood Deficiency Type and for those lower than samples’ average age is Yin Deficiency Type, Yang Deficiency Type, Special Constitutional Type, Qi Deficiency Type, Yang Excess Type, Dampness Heat Type and Gentleness Type. The distribution feature of constitution types in different age periods conforms to the change of vital essence, qi, blood, body fluid and the physiological function of Zangfu organs and collaterals in the life process discussed in TCM.③Difference is found in constitution types of subjects with various education background which has the possibility of being influenced by age factors.④Different profession including headworker, physical worker and mental-physical worker has certain effect on the distribution feature of constitution. For headworkers, the lower the age period is, the denser the distribution. For physical workers and mental-physical workers, there’s dense distribution in middle age-period while scarce distribution in young and old age period. Therefore it can’t be overlooked the effect of age on the constitution distribution for people with different professions.⑤What contains significance in comparing the constitution distribution of married and non-married people are Phlegm Dampness Type, Qi Deficiency Type, Blood Deficiency Type, Gentleness Type and Yang Excess Type. Marriage status actually is influenced by multiple factors. What can be confirmed is that the two different statuses contain age difference.⑥Some distribution features of different ethnic groups in Taiwan can be primarily confirmed, yet there are many factors involved in comparison, therefore it needs further study to get a more accurate conclusion.⑦The top3based on average bodyweight from heavy to light are Phlegm Dampness Type, Special Constitutional Type, Wang Qi’s Gentleness Type; the top3from light to heavy are Blood Stasis Type, Yin Deficiency Type, Type of Cold Syndrome with Pseudo-heat Symptoms. The top3based on BMI from high to low are Phlegm Dampness Type, Special Constitutional Type, Wang Qi’s Gentleness Type; the top3from low to high are Yin Deficiency Type, Type of Cold Syndrome with Pseudo-heat Symptoms, Blood Stasis Type. Similar results are achieved with two statistical methods. The results basically conform to the TCM points of view that "fat people tend to have phlegm","thin people tend to have internal heat","extreme excess tend to have deficiency signs". As BMI takes height into consideration, it has greater significance for reference.(3) Carrying out statistical analysis on the influencing factors of different constitution types, the author finds there are some laws of major influencing factors. The relationship between constitution and influencing factors conforms to TCM theories and therefore has practical value.(4) Statistical analysis about the improvement measures for different constitution types shows certain corresponding relationship, yet we still need to take practical situation into consideration in order to make it clear whether some measure is taken after the formation of certain constitution or some constitution is formed due to certain measure that has always been taken. This preliminary study can be regarded as the exploration in this aspect.(5) Conduct analysis about relationship between constitution types from two angles including the constituent ration and cluster analysis.①For each constitution type, based on the constituent ration order of other constitution types existing in this constitution type, the author finds the closely linked constitution types and the inner TCM mechanism for this close relationship.②Using the similarity coefficient matrix to demonstrate the closeness between constitution types, the author finds there are close links between Blood Deficiency Type and Qi Deficiency Type, between Yang Excess Type and Dampness Heat Type, between Yang Deficiency Type and Qi Deficiency Type, between Qi Depression Type and Qi Deficiency Type, between Special Constitutional Type and Yang Deficiency Type, between Total Gentleness Type and Wang Qi’s Gentleness Type. This conforms to the findings in constituent ratio study. There are also explainable inner mechanism for the close relationship between Yin Deficiency Type and Yang Deficiency Type, between Blood Stasis Type and Qi Deficiency Type, between Phlegm Dampness Type and Yang Deficiency Type.③Using max-distance algorithm for the system cluster on the close relationship between constitution types, the author finds the closest links exist between Gentleness Type and Total Gentleness Type, between Yang Deficiency Type and Type of Cold Syndrome with Pseudo-Heat Symptoms, and between Yang Excess Type and Dampness Heat Type. What is next in terms of closeness degree are between Qi Depression Type and Yang Excess Type/Dampness Heat Type, between Qi Deficiency Type and Yang Deficiency Type/Type of Cold Syndrome with Pseudo-Heat Symptoms. Finally make analysis about the clustering results.The study mentioned above is a meaningful discussion on the distribution feature, layered features, mutual relationship and each affecting factor and lays solid foundation for further research in this field. |
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