Biopsychological traits of Sasang typology based on Sasang personality questionnaire and body mass index

Resting Metabolic Rate for Diagnosing Tae-Eum Sasang Type and Unraveling the Mechanism of Type-Specific Obesity

Increased resting metabolic rate (RMR), representing augmented energy expenditure, is a preferred physical characteristic; however, the Tae-Eum Sasang type, with a high incidence of obesity and metabolic diseases, has a higher RMR. This study scrutinized the physical characteristics of Sasang typology, a traditional Korean personalized medicine, to resolve this discrepancy, which can unravel the mechanism of Tae-Eum-type-specific obesity and improve the Tae-Eum Sasang-type diagnosis. A total of 395 healthy participants provided Sasang-type diagnosis using Sasang Constitutional Analysis Tool and physical features, including skeletal muscle mass, body fat mass, and RMR, along with those standardized using body weight. The Tae-Eum-type group showed significantly higher body weight, body mass index, body fat mass, and unstandardized RMR (kcal/day) than others, while their standardized measures of RMR per weigh (RMRw, kcal/day/kg) and percent skeletal muscle (PSM, %) were significantly lower. The logistic regression model revealed that the RMRw is pivotal for discriminating Tae-Eum type from others and explaining the developmental mechanism of Tae-Eum-type obesity. The aforementioned might provide a theoretical framework for Sasang-type diagnosis and Sasang-type-specific health promotion using bodily exercise and medical herbs.

Exploratory Analysis of the Sasang Constitution by Combining Network Analysis and Information Entropy

Sasang constitutional medicine is a unique concept in Korean medicine that can provide valuable insights into personalized healthcare and disease treatment. In this study, we combined network analysis and information entropy to systematically investigate the related information of Sasang constitutional (SC) types. A feature network was constructed using SC type and clinical information. The SC type-associated features and feature classes were identified using statistical analysis and entropy ranking. The patient network was constructed based on SC-type-associated features. We found that the feature network was closely connected within the features of the same classes and between several feature class pairs, including the symptom class. Most of the separation values between the feature classes, including the symptom class, were negative. In addition, we found 42 clinical features related to the SC type, and two important classes -personality and cold/heat- that increase the entropy ranking of the SC type. In the patient network, we found sparsely connected modules between SC types and a positive separation value between the Taeeumin–Soeumin and Taeeumin–Soyangin pairs. Our data-driven approach provides a deeper understanding of modernized forms of SC types and suggests that SC type is a practically useful concept for stratified healthcare and personalized medicine.

Machine Learning Applications for the Development of a Questionnaire to Identify Sasang Constitution Typology

Sasang constitutional medicine emphasizes personalized disease prevention and treatment and has been used in various fields. Nevertheless, more efforts are required to improve the validity and reliability of the Sasang analysis tools. Hence, this study aimed to (1) identify key constructs and measurement items of the Sasang constitution questionnaire that characterize different Sasang constitutions and (2) investigate the similarities and differences in pathophysiological and personality traits between Sasang constitutions. The results of the Sasang constitution questionnaire were analyzed using multiple machine learning-based approaches, including feature selection, hierarchical clustering analysis, and multiple correspondence analysis. The selected 47 key measurement items were clustered into six groups based on the similarity measures. The findings of this study are expected to be beneficial for future research on the development of more robust and reliable Sasang conservation questionnaires, allowing Sasang constitutional medicine to be more widely implemented in various sectors.

Developing a best practice framework for clinical competency education in the traditional East-Asian medicine curriculum

BACKGROUND

While clinical competency is crucial for traditional East-Asian medical education, available studies on the educational system for fostering clinical performance are scarce. This study aimed to review the educational system, curriculum, facilities, and management of current traditional East-Asian medicine in a well-established university of Korea and develop a Best Practice Framework (BPF) of clinical competency education.

METHODS

The clinical competency education system in Pusan National University School of Korean Medicine was systematically described through 5 steps of governance of the educational system, competency of the graduates, educational resources, assessment strategies and tools, and gaps in the curriculum. We also reviewed the experiences in education and the points to be improved.

RESULTS

The Office of Traditional Korean Medicine Education governs the development, implementation, and evaluation of the educational curriculum for cultivating students' clinical competency. Medical students have undertaken 39 modules of clinical biomedicine and 21 of traditional medicine during the clinical clerkship courses in an affiliated hospital, Clinical Skill Practice Center, clinical research center, practice lab for medical herb, and other locations. After training, 15 modules of simulated clinical training using standardized patients, students' clinical competency are evaluated by a Clinical Performance Test using a Clinical Performance Examination (CPX) and an Objective Structured Clinical Examination (OSCE) for biomedical and traditional medical skills.

CONCLUSIONS

A clinical competency framework is required for a qualified physician of traditional East-Asian medicine. This study reviewed the current well-organized educational system of Korean traditional medicine in detail, which can be used for the BPF of competency-based clinical education. We expect the current study to be a representative reference for establishing an educational system of traditional medicine such as acupuncture and medical herbs in other countries.

Relationship between Low Vegetable Consumption, Increased High-Sensitive C-Reactive Protein Level, and Cardiometabolic Risk in Korean Adults with Tae-Eumin: A Cross-Sectional Study

An anti-inflammatory diet has many beneficial effects on cardiometabolic diseases. Constitution type of traditional Korean medicine can predict cardiometabolic risk factors. We examined the relationship between vegetable consumption and the high-sensitive C-reactive protein (hs-CRP) level on cardiometabolic risk factors in Korean adults by constitution types. Data from 1,983 eligible participants (mean age, 44.3 years) were included in the present cross-sectional study. The inflammatory status of the participants was categorized into low- (<3.0 mg/L) or high-risk (≥3.0 mg/L) groups based on their constitution types. Cardiometabolic risk factors (abdominal obesity, elevated triglycerides, reduced high-density lipoprotein-cholesterol, elevated blood pressure, elevated fasting plasma glucose, and ≥2 concurrent cardiovascular diseases (CVDs) risk factors) and dietary assessment of the participants were assessed. A total of 11.1% of Tae-eumin (TE) and 4.9% of non-TE groups had a higher hs-CRP level (TE: 6.6 ± 0.2, non-TE: 8.4 ± 0.3) than a low hs-CRP level TE and non-TE (TE: 0.9 ± 0.1, non-TE: 0.6 ± 0.1). Vegetable consumption of <91.5 g/day was highly associated with a high-risk hs-CRP level (adjusted odds ratio (ORs): second tertile (T2): 2.290, (95% confidence interval (CI): 1.285-4.082); first tertile (T1): 2.474 (95% CI: 1.368-4.475), P=0.003) compared with that of the highest (T3) in TE. Low (T1 and T2) vegetable consumption was associated with a 54-63% increased prevalence of more than two concurrent CVDs risk factors compared with that of the highest in the TE group (P=0.012). Higher vegetable consumption greatly decreased the prevalence of CVDs risk factors by 63-86% in the low-risk and high-risk hs-CRP TE groups. Our results highlight the cardioprotective effects of higher consumption of vegetables in Korean adults with TE. Evidence-based clinical risk factor management and multifaceted approaches at the community and population levels targeting prevention in high-burden groups are recommended to reduce the premature mortality attributed to CVD.

Urinary Function of the Sasang Type and Cold-Heat Subgroup Using the Sasang Urination Inventory in Korean Hospital Patients

Introduction

The Sasang type-specific pathophysiological symptom is pivotal for the Sasang type classification and pattern identification. The Sasang Urination and Defecation Inventory (SUDI) for urinary function analysis was developed; however, the clinical usefulness of urination-related subscales of SUDI in the Sasang type and Cold-Heat subgroup was not reported with acceptable validation analysis.

Methods

The clinical diagnosis of the Sasang type and Cold-Heat subgroup, responses to SUDI items, and weight and height of the 350 hospital patients were acquired retrospectively. The Sasang Urination Inventory (SUI) with SUI-CHR (problematic physical characteristics of urine), SUI-HSS (hypersensitivity of urinary urgency and high frequency), and SUI-DIS (urinary discomfort of hesitancy and residual urine sense) subscales using 12 items of SUDI were improvised. The item and construct validity of the SUI were examined using item response theory and confirmatory factor analysis, and the clinical usefulness of the SUI in Sasang type and Cold-Heat subgroup differentiation was attested.

Results

The SUI and its subscales showed acceptable structural validity and have clinical usefulness in the Tae-Eum type. The Tae-Eum type has a significantly higher SUI-CHR score than did the So-Yang type, and the Heat subgroup has a significantly higher SUI-HSS score than did the Cold subgroup in the Tae-Eum type. Discussion. The distinctive Sasang type- and Cold-Heat subscale-specific pathological symptoms in urinary function were revealed using the SUI. The SUI combined with objective Sasang typology measures might be useful for integrative precision medicine combining Eastern and Western practice and for evidence-based clinical education for medical professions.

Analysis of the bio-psychological characteristics of Sasang typology in Korean preschool children using the ponderal index and the temperament and character inventory

OBJECTIVES

The aim of this study was to identify different physical and mental characteristics among three common Sasang types, Tae-eum, So-yang, and So-eum (except scarce type, Tae-Yang) in preschoolers, to improve constitutional diagnoses.

METHODS

Our study included 65 boys and 67 girls from six kindergartens in South Korea. The number of children who were categorized as Tae-Yang, Tae-Eum, So-Yang, and So-Eum types were 1, 56, 40, and 35, respectively. We measured height, weight, mid-parental height, predicted adult height, ponderal index (PI), and findings from the junior temperament and character inventory 3 to 6.

RESULTS

The Tae-eum type exhibited higher weight percentiles and PIs than the other types (p < 0.001), and the So-eum type displayed higher harm avoidance (HA) scores than the Tae-eum type (p = 0.033).

CONCLUSIONS

Children with high PIs and low HA scores have a higher probability of being classified as the Tae-eum type than as the So-eum type.

The Yin-Yang personality from biopsychological perspective using revised Sasang Personality Questionnaire

Background

The biopsychological, pathological and physical characteristics of Yin-Yang (Eum-Yang in Korean) have been suggested using Sasang Personality Questionnaire (SPQ), however, the revision of SPQ is required for escalating its clinical use and multidimensional study on Yin-Yang.

Methods

274 university students were recruited to complete the SPQ, candidate items of revised SPQ (rSPQ) along with the Temperament and Character Inventory (TCI). After selecting rSPQ items using Item Analysis and Explorative Factor Analysis, its psychometric property was examined using Confirmatory Factor Analysis, Pearson’s correlation and t-test. The biopsychological features of Yin and Yang personality groups based on rSPQ total score were illustrated with the TCI using ANOVA and Profile Analysis.

Results

The behavior, cognition and emotion subscales of 15-item rSPQ had robust psychometric construct and showed distinctive psychological characteristics of Yin-Yang. The rSPQ-total score was correlated positively with SPQ-total (r = 0.644, p < 0.01) and TCI Novelty-Seeking (r = 0.398, p < 0.01), and negatively with TCI Harm-Avoidance (r = −0.364, p < 0.01). And, the Yin personality group (34.45 ± 10.36 and 46.82 ± 12.27) has significantly different scores in Novelty-Seeking and Harm-Avoidance compared to Yang personality group (43.2 ± 9.1 and 36.53 ± 10.78). Yin and Yang personality groups showed distinctive TCI subscale profiles as shown in previous studies.

Conclusion

The current study showed the organized subscale structure and clinical validity of rSPQ for Yin-Yang personality, and it would provide foundation for East-West cross-cultural psychology and integrative medicine.

Nutrikinetic study of fermented soybean paste (Cheonggukjang) isoflavones according to the Sasang typology

BACKGROUND/OBJECTIVES

In Oriental medicine, certain foods may be beneficial or detrimental based on an individual's constitution; however, the scientific basis for this theory is insufficient. The purpose of this study was to investigate the effect of body constitution, based on the Sasang type of Korean traditional medical classification system, on the bioavailability of soy isoflavones of Cheonggukjang, a quick-fermented soybean paste.

SUBJECTS/METHODS

A pilot study was conducted on 48 healthy Korean men to evaluate the bioavailability of isoflavone after ingestion of food based on constitution types classified by the Sasang typology. The participants were classified into the Taeeumin (TE; n = 15), Soyangin (SY; n = 15), and Soeumin (SE; n = 18) groups. Each participant ingested 50 g of Cheonggukjang per 60 kg body weight. Thereafter, blood was collected, and the soy isoflavone metabolites were analyzed by ultra-performance liquid chromatography/quadrupole time-of-flight mass spectrometry. Ntrikinetic analysis of individual isoflavone-derived metabolites was performed.

RESULTS

Our nutrikinetic analysis identified 21 metabolites derived from isoflavones in the blood samples from 48 healthy Korean men (age range, 21-29 years). Significant differences were observed in the time to maximum concentration (T _max) and elimination half-life (t _1/2) for nine metabolites among the three groups. The T _max and t _1/2 of the nine metabolites were higher in the SE group than in the other groups. Moreover, the absorption rates, as determined by the area under the plasma-level curve (AUC) values of intact isoflavone, were 5.3 and 9.4 times higher in the TE group than in the SY and SE groups, respectively. Additionally, the highest AUC values for phase I and II metabolites were observed in the TE group.

CONCLUSIONS

These findings indicate that isoflavone bioavailability, following Cheonggukjang insgestion, is high in individuals with the TE constitution, and relatively lower in those with the SE and SY constitutions.

Development and validation of Sasang Urination and Defecation Inventory (SUDI) for pathophysiological symptoms of Sasang typology

Background

The pathophysiological symptom of Sasang typology is essential for getting clinical diagnosis and analyzing treatment effects. The clinical index for examining urination and defecation related symptoms were developed and validated with established clinical measures.

Methods

Questionnaire items of six subscales of Sasang Urination and Defecation Inventory (SUDI) were developed based on previous systematic reviews, and its clinical validity was examined with clinical measures of Urogenital Distress Inventory-6 (UDI-6), Overactive Bladder Symptom Score (OBSS), and ROME 3 criteria for Irritable Bowel Syndrome (ROME3-IBS) and Functional Constipation (ROME3-FC) using 48 healthy participants. The internal consistency of six subscales of SUDI were examined with Cronbach alpha. The Pearson correlation was used to examine correlation between SUDI and Western clinical measures, and the ANOVA was adopted to investigate differences among Sasang type groups in clinical measures.

Results

The SUDI-UCHR (problematic characteristics of urine) and SUDI-ANMD (defecation anomaly discomfort) were found to represent unique concept of traditional Korean medicine, however SUDI-IRRB (irritability of bowel movement) and SUDI-FCON (functional constipation) were similar with functional gastrointestinal disease of western medicine. SUDI-URET (ability to retain urine), SUDI-UDIS (urinary discomfort) and SUDI-ANMD of So-Yang type (7.95 ± 2.16, 14.33 ± 2.01, and 13.10 ± 2.57) are significantly different from those of So-Eum type (9.94 ± 2.54, 12.18 ± 2.96, and 10.59 ± 3.47, respectively).

Conclusion

The pathophysiological symptoms of urination and defecation in Sasang typology were systematically scrutinized, and summarized into six subscales of SUDI in this study. The SUDI would be useful for analyzing clinical symptoms of Sasang typology along with integrative collaboration of traditional Korean and Western medicine.

Metabolite Markers for Characterizing Sasang Constitution Type through GC-MS and 1H NMR-Based Metabolomics Study

Sasang constitutional medicine classifies human beings into four types based on their physical and psychological characteristics. Despite its potential value in achieving personalized medicine, the diagnosis of sasang constitution (SC) type is complex and subjective. In this study, gas chromatography–mass spectrometry and ¹H nuclear magnetic resonance–based metabolic analyses were conducted to find maker metabolites in serum and urine according to different SC types. Although some samples were overlapped on orthogonal projection to latent structure discriminant analysis score plots, serum samples showed separation between different SC types. Levels of lactate, glutamate, triglyceride, and fatty acids in serum and glycolic acid in urine of Tae-Eum type were higher than those of So-Eum and So-Yang type. Fatty acids, triglyceride, and lactate levels were found to be metabolites related to body mass index, indicating that marker metabolites for the diagnosis of SC type could be associated with obese. However, Tae-Eum type showed higher lactate levels in serum than So-Yang type for both normal weight and overweight groups, suggesting that the contents of serum lactate might be dependent on the SC type regardless of body weight. These results suggest that metabolomics analysis could be used to determine SC type.

Association between Sasang constitutional types with obesity factors and sleep quality

BACKGROUND

The purpose of this study was to investigate differences in obesity factors according to Sasang constitutional types and quality of sleep among Korean female college students.

METHODS

Surveys using Sasang-types questionnaires(QSCCⅡ) and quality of sleep questionnaires(PSQI; Pittsburgh Sleep Quality Index) were conducted with 339 Korean female college students. Additionally, obesity factors, including weight, fat mass, fat percent, abdominal fat percent, body mass index (BMI) and obesity rates were measured. All data analyses were performed using one-way ANOVA and two-way ANOVA.

RESULTS

The interaction between Sasang types and quality of sleep was presented in the quality of sleep status, subjective quality of sleep (domain 1), sleep duration (domain 3) and sleep disturbance (domain 5). Variables with interaction effects had significant differences in terms of obesity factors between groups with different quality of sleep according to the Sasang types. Moreover, significant differences in obesity factors between different Sasang types according to the quality of sleep were also observed.

CONCLUSION

This study characterized the reduction effect of improvement in quality of sleep on the fat mass of So-Yang type individuals and obesity factors in Tae-Eum type individuals. The results of this study will be used in improving sleep quality according to the Sasang types.

Manifestations of Sasang Typology according to Common Chronic Diseases in Koreans

Sasang typology is a traditional Korean medical classification scheme that combines medical management with general medicine and can be applied to chronic diseases. We aimed to analyze differences in Sasang Personality Questionnaire (SPQ) and Sasang Digestive Function Inventory (SDFI) results in patients with diabetes mellitus (DM), hypertension, functional dyspepsia, major depressive disorder (MDD), and adenomyosis. In this cross-sectional study, data were collected at a medical college hospital in South Korea. A total of 248 patients were included: 52 with DM, 47 with hypertension, 36 with functional dyspepsia, 26 with MDD, and 87 with adenomyosis. The subjects took both the SPQ and the SDFI. The outcome measures in this study were body mass index (BMI), SPQ score, and SDFI score. The DM and hypertension groups, which were expected to demonstrate many Taeeum-type traits, exhibited high BMI, high SPQ-Behavior and SDFI-Appetite scores, and low SPQ-Emotionality and SDFI-Digestion scores. The functional dyspepsia group showed low BMI and high scores for SPQ-Behavior, SPQ-Emotionality, SDFI-Digestion, and SDFI-Appetite. The MDD group demonstrated high SPQ-Emotionality and SDFI-Digestion scores, low BMI, and low SPQ-Behavior and SDFI-Appetite scores. The adenomyosis group demonstrated high scores for SPQ-Behavior, SDFI-Digestion, and SDFI-Appetite, low BMI, and low SPQ-Emotionality scores. Different characteristics distinguishing Sasang traits according to chronic diseases were ascertained, especially for Taeeum and Soeum types.

Analysis of Facial Features according to Sasang Types between Native Japanese and Native Korean Populations

Background. Facial diagnosis is a common practice and essential diagnostic method used in the Sasang Constitution Medicine (SCM). SCM is a kind of personalized medicine in Traditional Korean Medicine which categorizes people into four types, namely, Tae-Yang (TY) type, Tae-Eum type (TE), So-Yang (SY) type, and So-Eum (SE) type. This study was conducted to compare and analyze the differences in the facial feature across Sasang types among native Japanese and native Koreans. Methods. A total of 843 subjects were recruited for this study, 127 native Japanese and 716 native Koreans, respectively. Facial feature points and the measurements of facial features were assigned and calculated automatically using a facial analysis program. Data of each Sasang type for both genders were also extracted and analyzed. Analysis of covariance was then used to examine the differences in facial feature variables among native Japanese and native Koreans and Sasang types. Results. Significant differences were seen in the facial feature variables related to lower face area and eye shape. In males, TE types had wider mid-face and lower face as compared to other constitutions. Male TE types were also seen to have narrower eyes whereas male SY types had rounder eyes. In females, TE types had wider lower face width and area compared to SY types and SE types. Female SY types also had rounder eyes. Conclusions. This study presented distinctive feature in the lower face area and eye shape among the Sasang types in both native Japanese and native Koreans. This proposed that facial feature variables can also be used as an objective tool in distinguishing the Sasang types in native Japanese. Further studies are needed in the future to generalize these results.

Biopsychological and pathophysiological features of Cold-Heat subgroup of Sasang typology with Sasang Digestive Function Inventory, Sasang Personality Questionnaire and Body Mass Index

Background

The Sasang typology is a traditional Korean personalized medicine and its Cold-Heat subgroup identification is essential for effective use of medical herbs and acupuncture. The purpose of this study was to discover differences between Cold-Heat subgroups with objective clinical measures and to examine its clinical usefulness.

Methods

The pathophysiological symptoms of the digestive system, temperament and body shape of 241 patients were measured using the Sasang Digestive Function Inventory (SDFI), Sasang Personality Questionnaire (SPQ) and Body Mass Index (BMI). The differences between Cold and Heat subgroups of each Sasang types were tested by Analysis of Covariance considering age and sex, while the associations of SDFI, SPQ and BMI with Cold-Heat subgroup were examined by logistic regression analysis.

Results

There were significant differences between Cold and Heat subgroups in SDFI, SPQ and BMI for the So-Yang, SDFI and BMI for the Tae-Eum type and SDFI-Digestion subscale for the So-Eum type. Moreover, the SDFI-Digestion was a substantial predictor for Cold-Heat subgroup identification in three Sasang types. The logistic regression model with SDFI, SPQ and BMI correctly predicted 81.9%, 77% and 75.5% of the Cold-Heat subgroups in So-Yang, Tae-Eum and So-Eum types, respectively.

Conclusion

The results of the present study showed that the objective and validated clinical measures of SDFI, SPQ and BMI would be useful for differentiating Cold-Heat subgroups of Sasang typology. Further clinical studies on pathophysiological mechanisms in Cold-Heat subgroup are required to generalize these results.

Validity of Yin-Yang temperament in Sasang Personality Questionnaire

Background

The Yin-Yang is a pivotal concept of traditional East-Asian medicine, however the stability of Yin-Yang temperament in Sasang Personality Questionnaire (SPQ) over time has not been extensively studied. The purpose of this study was to examine the test-retest validity of SPQ with a large number of participants.

Methods

SPQ test was conducted two times with three months interval in 247 Korean university students. The structural validity of first SPQ data was examined with Factor analysis and Cronbach's alpha, and the correlation between first and second measure of SPQ was attested with Pearson's correlation. Yang, Uncertain and Yin temperament groups were determined with SPQ total scores, and agreement of temperament group clustering between first and second measures were analyzed with Cohen's Kappa.

Results

Three subscales of SPQ explained 55.25% of total variances, and internal consistency of SPQ total score was 0.772. The correlation coefficient between first and second measures of SPQ were 0.851 and 0.888 in male and female, respectively, and the agreement of first and second Yin-Yang temperament group clustering as Cohen's Kappa was 0.536 for male and 0.637 for female.

Conclusion

The repeatability of SPQ measuring Yin-Yang temperament at three months of interval was found to be satisfactory. The SPQ would be a reliable clinical measure for the biopsychological studies of traditional East-Asian medicine.

Body composition and personality traits in so-Yang type males

BACKGROUND

The purpose of the present study was to examine the body composition of So-Yang type males according to Sasang constitutional medicine, which is popular in Korea. Different Sasang constitutional types are associated with different muscle distributions, body shapes, and disease susceptibilities. We used the Sasang Personality Questionnaire (SPQ) as a measure of the temperament of each Sasang type.

METHODS

In total, 953 subjects aged over 20 years were recruited in Korea. We collected anthropometric parameters and bioimpedence information from the subjects and administered the SPQ. A logistic regression was conducted to calculate propensity scores.

RESULTS

The percentage of skeletal muscle mass in So-Yang (SY) and non-So-Yang (non-SY) males was 45.8 ± 2.7 and 44.2 ± 3.3, respectively, before matching and 45.8 ± 2.6 and 44.9 ± 3.0, respectively, after propensity score matching. The extracellular water (ECW)/intracellular water (ICW) and extracellular water (ECW)/total body water (TBW) ratios and SPQ scores were significantly different between the SY and non-SY types.

CONCLUSIONS

This study suggested that the SY type may be significantly and independently associated with body composition and could be associated with personality.

Personalized acupuncture treatment with Sasang typology

The Sasang typology, traditional Korean personalized medicine, divides people into four Sasang types and suggests type-specific medical herbs and acupuncture for more safe and effective treatment. The main idea of Sasang typology seems relatively simple; however, the Sasang type diagnosis and type-specific treatment in clinical situation has been difficult for the clinicians and researchers. This study provided clinical procedures of type-specific Tae-Geuk Acupuncture (TGA) therapy along with basic understandings on Sasang typology and clinical indices for Sasang type differentiation. The TGA therapy would be useful for psychosomatic complaints and chronic pains by restoring the balance of Yin–Yang. The clinical application of TGA, its related biological mechanisms, and implications for further prospective clinical study were discussed.

Pharmacognostic outlooks on medical herbs of Sasang typology

The purpose of this study was to review the pharmacognostic characteristics of Sasang type-specific medical herbs and suggest biological mechanisms that might be related to the personalized treatment of the East.

Major compounds and their pharmacological activities of medical herbs for each Sasang types were systematically reviewed. The pharmacognostic characteristics of its main compounds were systematically analyzed with previous studies and three web-based databases.

Sasang type-specific medical herbs were selected, and biological effects of their phytochemicals were reviewed from the pathophysiological features of each Sasang types. Phenolics were dominant in Tae-Yang type-specific herbs, iridoids and triterpenes with antipyretic and diuretic effects were in So-Yang type-specific, saponins (triterpene saponins and steroidal saponins) with antitussive effects were in Tae-Eum type-specific, and monoterpene and sesquiterpenes with stomachic effect were in So-Eum type-specific herbs.

Pharmacognostic understandings on Sasang type-specific medical herbs with consideration of type-specific pathophysiological features were provided for the first time. This study would contribute to in-depth understandings on the pathophysiology of Sasang typology and integration of East-Asian and Western personalized medicine.

Analysis of seven animation characters in Pororo the Little Penguin with Sasang typology

Background

Animation characters are created to embody distinctive personalities and body images; however, these features have not been analyzed with objective measures based on East Asian theory. The purpose of this study was to analyze the biopsychological features of seven animation characters in Pororo the Little Penguin, which scored unprecedented success in Korea, with clinically validated and standardized measures of Sasang typology.

Methods

Forty-one graduate students completed a survey examining body mass index (BMI) and Sasang Personality Questionnaire (SPQ) of seven characters in Pororo the Little Penguin after watching three selected episodes. The differences in physical appearance and psychological traits among animation characters were analyzed with analysis of variance.

Results

SPQ and BMI showed distinctive biopsychological features of seven animation characters. Pororo (28.29 ± 6.38 and 36.61 ± 3.09) was a typical So-Yang type boy, Petty (20.98 ± 4.07 and 31.66 ± 4.59) was a typical So-Yang type girl, and Loopy (28.05 ± 6.60 and 22.78 ± 4.78) was a typical So-Eum type girl in terms of BMI and SPQ, respectively. The BMI and SPQ of Poby (41.10 ± 4.26 and 22.32 ± 3.48) and Harry (19.63 ± 5.17 and 37.61 ± 2.40) showed the most obvious contrast.

Conclusion

This study showed that SPQ and BMI are useful objective measures for analyzing the biopsychosocial features of animation characters as well as patients. The interdisciplinary research methodology of Sasang typology suggested here would provide useful tools for educating healthcare professionals and the general public about Korean medicine, and also contribute to the development of animation characters.

A Systematic Review on Sasang Constitutional Type-Associated Susceptibility to Disorders in Korea

BACKGROUND/OBJECTIVE

Sasang constitutional medicine is a component of traditional Korean medicine that classifies individuals into four Sasang constitutional types (SCTs) by their physical and psychological traits. Each SCT is known to show different susceptibilities to disorders. This systematic review investigated the effect of SCT as a risk factor for various disorders.

METHODS

A systematic literature survey was conducted by searching seven databases for all articles on the prevalence rates of disorders according to SCT and sex.

RESULTS

From 14,272 relevant articles, 15 studies (13 disorders) were ultimately identified to verify different prevalence rates by SCT. Of the 13 disorders, 6 (prehypertension, general obesity, abdominal obesity, metabolic syndrome, diabetes mellitus, and irritable bowel syndrome [IBS]) had a significantly different prevalence by SCT. Metabolic syndrome and its associated disorders showed the highest prevalence in Taeumin-type individuals, whereas IBS was most prevalent in Soeumin-type individuals. In general, these findings were consistent with the results obtained in an analysis of male and female participants.

CONCLUSIONS

This study revealed that susceptibility to disorders was affected by SCT to some extent. Further studies are needed to determine the concrete features of SCT-related susceptibility, which may be helpful in preventive medicine with Sasang constitutional practice.

Validation of the Sasang Personality Questionnaire in high school students

Background

The Sasang Personality Questionnaire (SPQ) is an objective measure of Yin–Yang temperament of Sasang typology with proven clinical and structural validity; however, it has not been validated in people younger than 20 years. The purpose of this study was to examine the biopsychological structure of the SPQ in high school students.

Methods

A total of 670 Korean high school students (365 boys and 305 girls) completed the SPQ, Junior version of Temperament and Character Inventory (JTCI), and weight and height measures. The correlation between the SPQ and JTCI subscales was investigated, and the differences of these subscales, body mass index, and Pondera Index between the high (30%), middle (40%), and low (30%) SPQ total score groups were examined with analysis of variance. The profile analysis was also performed to compare JTCI subscale profiles of the three SPQ total score groups.

Results

The SPQ total score significantly correlated positively with JTCI novelty seeking (r = 0.548 and r = 0.540) and negatively with JTCI harm avoidance (r = –0.393 and r = –0.395) in boys and girls, respectively. The JTCI novelty-seeking score is significantly higher in the high SPQ total score group (24.12 ± 5.27 and 24.15 ± 5.17 for boys and girls, respectively) than in the low SPQ total score group (16.49 ± 5.08 and 17.24 ± 4.83, respectively), and the JTCI harm-avoidance score is significantly higher in the low SPQ total score group (25.34 ± 6.08 and 26.64 ± 5.77 for boys and girls, respectively) than in the high SPQ total score group (19.27 ± 6.62 and 19.23 ± 6.00, respectively). The JTCI subscale profiles for the three SPQ total score groups were significantly different for boys (degrees of freedom = 3.416, F = 292.16, p < 0.001) and girls (degrees of freedom = 3.4, F = 230.51, p < 0.001). There were no significant correlations or differences in body mass index and Pondera Index among the SPQ total score groups.

Conclusion

The results showed that the biopsychological structure of the SPQ in adolescents is robust, similar to that in the adult population. The SPQ might be useful for the application of Sasang typology in pediatrics.

Biopsychological structure of Yin-Yang using Cloninger's Temperament model and Carver and White's BIS/BAS scale

Introduction. The purpose of this study was to examine the psychological structure of Yin-Yang based on the Sasang Personality Questionnaire (SPQ) in relation to Carver and White’s Behavior Inhibition/Behavior Activation System (BIS/BAS) Scale and Cloninger’s temperament model of the West.

Methods. A total of 188 university students were classified as high (30%), middle (40%), and low (30%) groups based on their SPQ score and their differences in Cloninger’s temperaments and BIS/BAS subscales were analyzed using analysis of covariance after controlling the sex. Correlation among SPQ, Cloninger’s four temperaments and BIS/BAS subscales was also examined.

Results. Significant differences in BAS (F = 11.703, p < .001), Novelty-Seeking (F = 4.945, p < .01), and Harm-Avoidance (F = 10.912, p < .001) were observed between high and low SPQ score groups after controlling for sex. The SPQ showed significant correlation with BAS (r = 0.303), Novelty-Seeking (r = 0.225), and Harm-Avoidance (r = − 0.273). However, BIS showed no significant differences between SPQ groups, and did not show correlation with the SPQ.

Discussion. The current study demonstrated that Yin-Yang has similarities with and disparities from the Western tradition and may be examined with objective instruments. We showed that the emotionality of the East which is defined as mobility of emotion, not emotional instability as traditionally defined in Western theories, is pivotal for understanding the nature of emotion in the East. Suggestions are made for cross-cultural psychobiological study of the East and West.

Diagnosis and treatment principle in Sasang medicine: original symptom

The purpose of this review was to demonstrate the definition of the original symptom (OS) and how it works in medical procedures as to the Sasang medicine based on the Jema Lee's Donguisusebowon (Longevity and Life Preservation in Eastern Medicine). OS is defined as the sum of all clinical information featured by an individual's intrinsic characteristics as Sasangin and health state prior to onset. It is the key factor in the clinical application of Sasang medicine including the diagnosis of constitutional type and Sasang symptomatology because the imbalance of metabolic functions of each Sasangin originates from that. The working principles of the OS and Sasang symptomatology can be summarized as follows. First, clinical information regarding cold or heat intolerance determines the cold or heat pattern of Sasang symptomatology. Another is the present worsening of the severity of Sasang symptomatology by one level as compared with that in the past. Symptoms prior to the onset worsen to a higher level of severity after any disorder breaks out. Finally, the treatment strategy and progress of each Sasangin are determined following the characteristics of the OS. Theoretical and clinical studies should be conducted to show the specific criteria for the diagnosis of Sasang symptomatology in the future.

The past, present, and future of traditional medicine education in Korea

Korea has kept the heritage of Korean traditional medicine (KM) during the 19th century harsh modernization, and has established a medical system in parallel with Western medicine. The purpose of this study was to review systematically the history and current system for educating highly qualified traditional medical doctors in Korea. KM produces 750 certified medical doctors every year with a 4–7-year curriculum in 12 universities and their affiliated hospitals. There are 22,074 clinicians along with 2474 clinical specialists in eight departments as of 2014. A national licensing examination and continuing medical education for KM are used for maintaining qualifications of KM doctors, and independent organizations are established for the evaluation of educational institutes. KM has thrived to establish an independent and competitive educational system for KM doctors, equivalent to Western medicine, and has regained a pivotal role for public health in Korea. This study would be useful for cultivating traditional medicine and establishing its educational system in the world.

Analysis of the association between problem behaviors and Sasang typology in high school students

Background

Some studies have shown that Sasang typology is related to specific problem behaviors, but research on the associations between Sasang types and problem behaviors in children is scarce. The purpose of this study was to examine the associations between Sasang types and problem behaviors in Korean high school students.

Methods

A total of 686 Korean high school students (371 boys and 315 girls) completed the Korean version of Youth Self-Report (YSR) for describing the problem behaviors in adolescents and the Sasang Personality Questionnaire (SPQ) for measuring the temperament characteristics of Sasang typology. The correlation between YSR and SPQ subscales was investigated, and the differences of YSR among the high (30%), middle (40%), and low (30%) SPQ total score groups were examined with Analysis of variance. The profile analysis was also performed to compare YSR subscale profiles of three SPQ total score groups.

Results

The SPQ total score significantly (p < 0.001) correlated positively with YSR externalizing problems (r = 0.293 and r = 0.248) and negatively with YSR internalizing problems (r = –0.211 and r = –0.150) in males and females, respectively. The YSR externalizing problem score is significantly higher in the high SPQ total score group (13.14 ± 9.33 and 10.03 ± 5.34 for males and females, respectively) than in the low SPQ total score group (8.18 ± 5.53 and 8.58 ± 5.73, respectively), and the YSR internalizing problem score is significantly higher in the low SPQ total score group (11.28 ± 8.92 and 12.97 ± 8.69 for males and females, respectively) than in the high SPQ total score group (9.35 ± 9.00 and 11.28 ± 7.58, respectively). The YSR profiles for three SPQ total score groups were significantly different for males (profile analysis, df = 12.324, F = 18.164, p < 0.001) and females (df = 12.677, F = 11.601, p < 0.001).

Conclusion

These results could be recognized as the SPQ, and Sasang typology would be useful for predicting the pathological patterns even of psychological problems in high school students. This study would be useful for the screening of psychopathological problems and character development in adolescents.

Study on the Difference of BIS/BAS Scale between Sasang Types

Introduction. The purpose of this study was to examine the differences in temperament between So-Yang (SY) and So-Eum (SE) Sasang types using Behavioral Inhibition System/Behavioral Activation System (BIS/BAS) scale to elucidate the biopsychological mechanism underlying the Sasang typology, a traditional Korean personalized medicine. Methods. 248 university students were categorized into three Sasang types, and series of t-tests were conducted, separately for male and female participants, to examine the difference of Behavioral Inhibition System (BIS), Behavioral Activation System (BAS), BAS-Drive (BAS-D), BAS-Fun Seeking (BAS-FS), and BAS-Reward Responsiveness (BAS-RR) scores between SY and SE Sasang types. Results. There were significant differences between Sasang types in the BIS/BAS subscales with consideration of gender. In male participants, BAS-total score of SY type (39.75 ± 4.56) was significantly (t = 2.462, p = 0.016) higher than that of SE type (36.68 ± 4.97). On the other hand, in female participants, BIS score of SY type (20.10 ± 4.01) was significantly (t = -2.097, p = 0.039) lower than that of SE type (21.83 ± 3.91). Discussion. The current study suggested relationship between Sasang typology and Behavior Inhibition and Activation Systems and showed significant differences in BIS/BAS scale between SY and SE Sasang types. Further studies on biological base of Sasang typology are needed.

Systematic review of type-specific pathophysiological symptoms of Sasang typology

Previous studies on the Sasang typology have focused on the differential diagnosis of each Sasang type with type-specific pathophysiological symptoms (TSPS). The purpose of this study was to elucidate the latent physiological mechanism related to these clinical indicators. We searched six electronic databases for articles published from 1990 to 2015 using the Sasang typology-related keywords, and found and analyzed 35 such articles. The results were summarized into six TSPS categories: perspiration, temperature preference, sleep, defecation, urination, and susceptibility to stress. The Tae-Eum and So-Eum types showed contrasting features with TSPS, and the So-Yang type was in the middle. The Tae-Eum type has good digestive function, regular bowel movement and defecation, high sleep quality, and low susceptibility to stress and cold. The Tae-Eum type has relatively large volumes of sweat and feels fresh after sweating; however, the urine is highly concentrated. These clinical features might be related to the biopsychological traits of the Tae-Eum type, including a low trait anxiety level and high ponderal and body mass indices. This study used the autonomic reactivity hypothesis for explaining the pathophysiological predispositions in the Sasang typology. The Tae-Eum and So-Eum Sasang types have a low threshold in parasympathetic and sympathetic activation, respectively. This study provides a foundation for integrating traditional Korean personalized medicine and Western biomedicine.

Serum Levels of Stress Hormones and Oxidative Stress Biomarkers Differ according to Sasang Constitutional Type

Objectives. This study investigated whether Sasang constitutional type is associated with differences in the serum levels of stress hormones and oxidative stress. Methods. A total of 236 participants (77 males and 159 females) were enrolled. The serum levels of cortisol, adrenaline, reactive oxygen species (ROS), and malondialdehyde (MDA) were analyzed. Results. The distribution of Sasang constitutional types was as follows: Taeumin, 35.6%; Soumin, 33.0%; and Soyangin, 31.4%. The serum cortisol levels of Taeumin were significantly lower than Soumin (p < 0.1 in both sexes) and Soyangin (p < 0.05 in males and p < 0.1 in females). The adrenaline levels were also significantly lower in Taeumin than in Soumin (p < 0.05 in males and p < 0.1 in females) and Soyangin (p < 0.1 in males). Serum ROS levels were significantly higher in Soyangin than in Taeumin and Soumin (p < 0.05 in males), whereas MDA levels were significantly lower in Taeumin compared with Soumin and Soyangin (p < 0.05 in males and p < 0.1 in females). Conclusion. Taeumin type may tolerate psychological or oxidative stress better than other types, which suggests a biological mechanism to explain the different pathophysiological features of Sasang constitutional types.

Sasang constitution affects the prevalence of functional dyspepsia

Background

Functional dyspepsia (FD), which is a very common disorder worldwide, is known to be caused by multiple factors including environmental and genetic factors. Sasang constitutional medicine (SCM) is a component of traditional Korean medicine that emphasizes inherited characteristics of the physical and psychological patterns of a patient. This study investigated whether the prevalence of FD differs depending on Sasang classification.

Methods

A total 517 subjects (190 males and 327 females) were recruited, and interviewed for the presence of FD using a Rome III-based questionnaire. The Sasang constitution of all subjects were diagnosed using a Sasang constitutional analytical tool (SCAT). A Chi-square test was performed to compare prevalence of DF among different Sasang constitutional types.

Results

Of the 517 subjects, 115 (22.2 %) met the diagnostic criteria for FD, and the prevalence was significantly higher in females (26.9 %) than males (14.2 %, p < 0.01). The Sasang-constitution-based prevalence among all subjects was 27.5 % for Taeumin, 23.1 % for Soumin, and 16.4 % for Soyangin (p = 0.055). When compared by sex, the prevalence of FD among Sasang types showed significantly different patterns between males and females (p < 0.05); in females with FD, Taeumin predominated (32.5 % compared with 29.5 % and 18.8 % for Soumin and Soyangin, respectively; p < 0.05), whereas males with FD displayed a higher prevalence of Soumin (17.3 % compared with 9.1 % and 11.3 % for Taeumin and Soyangin, respectively; p > 0.05).

Conclusions

This study identified significant differences in FD prevalence depending on Sasang constitution and sex. Our findings provide data to guide future research on the prevention and management of FD.

Comparisons of physical fitness and body composition among Sasang types with and without body mass index as a covariate

Background

The purpose of this study was to examine the difference of physical fitness and body composition among Sasang types with BMI as covariate, which is reported to have influence on physical fitness and body composition.

Methods

We measured the physical fitness and body composition of 930 korean female college students, and compared the differences among Sasang type groups with or without considering Body Mass Index (BMI). We evaluated muscle strength, agility, muscle endurance, power and flexibility for the physical fitness, and total body water, protein, muscle mass, mineral, lean body mass and fat mass for the body composition.

Results

We got 352 So-Yang (SY), 385 So-Eum (SE), and 193 Tae-Eum (TE) Sasang types, and there were significant differences among Sasang types in height, weight and BMI. The significant differences among TE and SY types were disappeared in muscle strength, total body water, protein when BMI is used as a covariate. In ANOVA, there were significant differences that TE was higher on the mineral and fat mass compared to the SY type and SE type. However it disappeared when we introduced BMI as covariate.

Conclusion

The results demonstrated that the BMI should be considered as an important element for studying physical characteristics of Sasang typology.

Effects of oriental medicine music therapy in an ovarian cancer patient with So-Eum-type constitution: a case report

The cancer incidence in Korea has been increasing, although there is a serious lack of supportive care for the treatment and management of the rapidly increasing number of cancer patients, and there is an immense need for therapeutic interventions to support cancer patients. A 47-year-old So-Eum-type Korean female patient, who was diagnosed with ovarian cancer, had been receiving chemotherapies. She was experiencing pain due to swelling of her hands and feet, and under extreme stress due to hardships of life. During the patient's fourth chemotherapy treatment, she received oriental medicine music therapy twice per week for 2 weeks, for 1 hour each time (4 sessions in total). A self-administered questionnaire and the visual analog scale were used to assess and determine the level of negative and positive feelings. After receiving the oriental medicine music therapy, her negative and positive feelings as well as the visual analog scale score that reflects subjective health conditions have improved and stabilized. This case report suggests the potential of oriental medicine music therapy as a complementary and alternative medical treatment method to promote and enhance quality of life and health conditions of cancer patients in postsurgical care and chemotherapy treatment.

Personality construct of Sasang Personality Questionnaire in an adolescent sample

Background

Sasang typology is a widely used personalized traditional medicine in clinical diagnosis and treatment in Korea. The aim of this study was to examine the personality construct of the Sasang Personality Questionnaire (SPQ) to replicate the previous findings in the adolescent sample.

Methods

A total of 543 high school students completed the SPQ and the Korean version of the Junior Temperament and Character Inventory (JTCI). The relationships between the subscales of JTCI and SPQ were examined using Pearson's correlation. The profile analysis and analysis of variance were used to investigate the difference among high, middle, and low SPQ total score groups.

Results

The SPQ and its subscales were significantly correlated with the JTCI subscales. SPQ total score was positively correlated with Novelty Seeking (r = 0.424) and negatively correlated with Harm Avoidance (r = –0.291). The high, middle, and low SPQ total score groups showed significantly different JTCI profile (flatness with Greenhouse–Geisser correction, df = 3.424, F = 443.812, p < 0.001; parallelism with Greenhouse–Geisser correction, df = 6.848, F = 18.610, p < 0.001).

Conclusion

The validity of the SPQ construct was confirmed with adolescents. Further investigation on its personality construct would extend the clinical application of SPQ to young age groups including children.

Best-fit index for describing physical perspectives in Sasang typology

INTRODUCTION

We examined the best-fit index for describing the constitutional or physical characteristics of Sasang typology for its universal application.

METHODS

Ponderal index (PI), body mass index (BMI), and basal metabolic rate (BMR) of the nationwide participants (n = 1663; age, 31-60 years) were calculated. We described and analyzed the usefulness of each index for maximizing the differences between Sasang types across age and sex using box plots, Pearson's correlation, and analysis of variance.

RESULTS

We found that the So-Eum, So-Yang, and Tae-Eum Sasang types were significantly (p < 0.001) different from each other in terms of PI, BMI, and BMR by the World Health Organization with weight (BMR-WHOw). The BMI was significantly correlated with PI (r = 0.933) and BMR-WHOw (r = 0.577).

DISCUSSION AND CONCLUSION

These study results show that PI, BMR, and BMI have their own clinical values, and could contribute to the study of the pathophysiological mechanism underlying the Sasang typology as the hypothalamus hypothesis.