Concepts of body constitution, health and sub-health from traditional Chinese medicine perspective

Validation of the Cantonese version of the Traditional Chinese Medicine (TCM) Body constitution Questionnaire in elderly people

BACKGROUND

The Traditional Chinese Medicine (TCM) Body Constitution Questionnaire (For Elderly People) (TCMECQ) is a patient-reported outcome questionnaire developed in Mandarin in 2013 to differentiate the body constitutions of the elderly aged 65 and above. Considering the cultural and linguistic differences between Mainland China and Hong Kong (HK) Special Administrative Region, the TCMECQ was translated into Cantonese following "back translation" policy and validated in proper process.

METHODS

Ten Chinese Medicine Practitioners (CMPs) and 30 senior citizens aged 65 or above were recruited to evaluate the first version of the Traditional Chinese Medicine Body Constitution Questionnaire (For Elderly People) (Cantonese version) (TCMECQ-C). Based on their comments, the second version was developed and discussed in the panel meeting to form the third version, validated the third version on 270 recruited seniors. Based on the validation results, a panel of 5 experts finalized the Questionnaire as the final version. The TCMECQ-C developers finalized the Questionnaire as the validated endorsed third version (i.e. final version).

RESULTS

The item-level content validity index of most items of the TCMECQ-C (First Version) were ranging from 0.80 to 1.00 in terms of clarity, relevance and appropriateness. Factor loadings of Qi-deficiency Constitution ranging from 0.37 to 0.71, Yang-deficiency Constitution ranging from 0.36 to 0.65, Yin-deficiency Constitution ranging from 0.36 to 0.65, and Stagnant Qi Constitution ranging from 0.68 to 0.82. The chi-squared degree-of-freedom ratio was 2.13 (928.63/436), Goodness-of-Fit Index (0.83), Adjusted Goodness-of-Fit Index (0.79), Normed Fit Index (0.66), Comparative Fit Index (0.78), Incremental Fit Index (0.78), Relative Fit Index (0.61) and Tucker-Lewis Index (0.75), and Root Mean Square Error of Approximation (0.07) and Standardized Root Mean Square Residual (0.07), implied acceptable Confirmatory Factor Analysis model fit of the overall scale. A Pearson correlation coefficient (r) showed the sufficient convergent validity for excessive subscales (Phlegm-dampness Constitution and Dampness-heat Constitution with r = 0.35, p < 0.01). Cronbach's alpha coefficient ranged from 0.56 to 0.89, including Qi-deficiency Constitution (0.67), Yang-deficiency Constitution (0.84), Yin-deficiency Constitution (0.59), Stagnant Blood Constitution (0.56), Stagnant Qi Constitution (0.89), Inherited Special Constitution (0.76) and Balanced Constitution (0.73), indicating acceptable internal consistency for subscales. The intra-class correlation coefficients of the TCMECQ-C ranged from 0.70 to 0.87 (p < 0.001), indicating moderate to good test-retest reliability.

CONCLUSION

TCMECQ-C is a valid and reliable questionnaire for assessing the body constitution in Cantonese elderly.

Body Constitution and Unhealthy Lifestyles in a Primary Care Population at High Cardiovascular Risk: New Insights for Health Management

Background

Adherence to lifestyle recommendations remains insufficient in cardiovascular (CV) health management globally. Body constitution, from the perspective of traditional Chinese medicine, is primarily influenced by an individual's internal metabolism and susceptibility to external pathogenic factors. Nevertheless, less is known about whether body constitutions may play a role in the presence of unhealthy lifestyles. We aimed to explore the associations between body constitutions and unhealthy lifestyles among Chinese individuals at high CV risk.

Methods

Computerised data were retrieved from a primary care population-based health record for all 1739 eligible individuals at high CV risk who attended routine check-up in an urbanised, medium-size district in Guangzhou, China. Unhealthy lifestyles were determined in accordance with guideline recommendations. The body constitution was assessed on the basis of physical signs, personality, body symptoms, and the susceptibility to environmental changes, following nationally standard procedure. Binary logistic regression analyses were performed using marginal standardisation method.

Results

The participants ranged in age from 20 to 96 years, with a mean age of 69.55 years. There were slightly more females than males (52.3% vs 47.7%). Current smoking, regular drinking, and physical inactivity were most common. Participants with a body constitution of phlegm-and-dampness type (adjusted odds ratio [aOR]=1.999, 95% confidence interval [CI]=1.003-3.984; p=0.049) tended to be current smokers, and those assessed with special diathesis type (aOR=2.166, 95% CI=1.029-4.559; p=0.042) had a higher likelihood of being regular drinkers. Having a body constitution type of blood stasis (aOR=1.375, 95% CI=1.029-1.838; p=0.031) or qi deficient (aOR=1.711, 95% CI=1.080-2.709; p=0.022) was associated with physical inactivity.

Conclusion

Our findings add to current evidence suggesting that an individual's body constitution is closely related to the presence of unhealthy lifestyles. This offers new insights for health management through body constitution-based strategies to target those at high CV risk who need tailor-made attention in lifestyle modifications during routine primary care.

Relationship between Physiological Health Status, Lifestyle Behaviors, and Cardiovascular Disease Among Adults in Two Arab Countries

Purpose:

Identify the relationships among participants’ lifestyle and their perceptions toward physiological health status.

Methods:

This is a cross-sectional research study. A convenience sampling was used to recruit 480 adult clients from Jordan and Saudi Arabia.

Results:

The majority of the participants (48.8%) rated their physiological health status as sub-optimal health. Significant positive associations were found between participants’ perceptions about physiological health status as ‘healthy’ and their positive lifestyle and low-risk behaviors for Cardiovascular Disease (CVD). Specifically, the associations were between not being smoker (χ2 = 4.17, p = 0.04), practicing physical activity (χ2 = 60.9, p < 0.001), eating ≥ 5 cups of fruits and vegetables daily (χ2 = 8.33, p = 0.004), and being normal/under-weight (χ2 = 65.5, p < 0.001).

Conclusion:

Perception about poor/sub-optimal physical health status is associated with many CVD risk factors. Using a brief screening tool to assess physical health status is recommended at each clinic visit. In addition, periodic physical assessment, full check-up, and follow-up with healthcare providers are highly suggested for those who perceived their physical health status as “poor” to prevent further CVD. Health education is pressingly recommended to improve the awareness of these Arab communities toward the prevention of CVD risk factors and enhancement of positive lifestyle behaviors.

The Unfolding Method to Explore Health-Related Quality of Life Constructs in a Chinese General Population

OBJECTIVES

Health-related quality of life (HRQOL) is a complicated concept that can be measured using multiple health items. Although HRQOL is closely associated with people's subjective assessment of their own health, a limited number of studies have investigated which health items are considered most important and relevant by the general population. Even fewer empirical studies have investigated how HRQOL is understood in non-Western populations. This study used multidimensional unfolding analysis in a Chinese general population to explore the constructs of HRQOL.

METHODS

A scoping review of Chinese generic HRQOL measures and a series of qualitative interviews produced a list of 42 potentially important health items in a Chinese cultural setting; 110 Chinese participants in face-to-face interviews ranked the health items from most important to least important. Responses were coded into a rectangular 110 × 42 matrix, and multidimensional unfolding was conducted to analyze participants' preferences for health items.

RESULTS

It was found that demographic characteristics and one's health condition affected views of HRQOL. Meanwhile, 3 health items were considered to be most important across the whole sample: sleep quality, body constitution, and spiritual appearance.

CONCLUSION

This study used a novel approach to explore how people coming from a Chinese cultural setting may perceive HRQOL and which aspects of HRQOL are most important to them. The study shows that multidimensional unfolding is a feasible approach to assess preferences in a general population. Future studies using this approach are recommended to further explore the constructs of HRQOL in other general populations.

Exploring subjective constructions of health in China: a Q-methodological investigation

BACKGROUND

With an increasing awareness of people's satisfaction and feeling, health-related quality of life (HRQoL) has become an essential aspect of measuring health. HRQoL is fundamentally a foreign concept introduced to China from the West. While a growing number of studies applied western HRQoL measures, few content validity tests examined the legitimacy of applying Western developed HRQoL measures in a Chinese cultural setting. If there are distinct differences in health conceptualisation between China and the West, it can be argued that those western measures may fail to ask the most appropriate and important questions among a Chinese population in assessing health. As a limited number of studies have investigated Chinese people's understandings of health, this study aimed to explore how health is defined and described in China.

METHODS

A Q-methodological study was conducted to explore subjective constructions of health among Chinese participants. A scoping review of Chinese generic HRQoL measures, supplemented by a series of qualitative interviews conducted in China, produced a list of 42 statements representing aspects of health considered as being important in a Chinese cultural setting. Chinese participants in face-to-face interviews ranked and sorted these statements. Data were analysed to identify clusters of participants who shared a similar perspective, using a by-person factor analysis procedure.

RESULTS

110 Chinese participants with various demographics characteristics completed sorting interviews. Five independent factors emerged: (I) "Physical independence and social interaction skills"; (II) "Physical health"; (III) "Sensations and feelings"; (IV) "Lifestyles"; (V) "Learning and working abilities".

CONCLUSIONS

The Q-study showed that many health statements were rated highly as most important by a diverse range of Chinese participants but were not covered in the commonly used Western HRQoL measure EQ-5D. It then suggests that the EQ-5D descriptive system might need modification to improve its capacity to measure health status in China. The study thus raises a general question as to how appropriate the Western-developed HRQoL measures are when used to assess health in a significantly different cultural setting.

Differing Spontaneous Brain Activity in Healthy Adults with Two Different Body Constitutions: A Resting-State Functional Magnetic Resonance Imaging Study

Traditional Chinese medicine (TCM) practitioners assess body constitution (BC) as a treatment basis for maintaining body homeostasis. We investigated patterns in spontaneous brain activity in different BC groups using resting-state functional magnetic resonance imaging (rsfMRI) and determined the relationship between these patterns and quality of life (QOL). Thirty-two healthy individuals divided into two groups (body constitution questionnaire (BCQ)-gentleness [BCQ-G] and BCQ-deficiency [BCQ-D]) based on the body constitution questionnaire (BCQ) underwent rsfMRI to analyze regional homogeneity (ReHo) and the amplitude of low-frequency fluctuation (ALFF). The World Health Organization Quality of Life Instruments (brief edition) scale was used to evaluate the QOL. The BCQ-G group (n = 18) had significantly greater ReHo values in the right postcentral gyrus and lower ALFF values in the brainstem than the BCQ-D group (n = 14). In the BCQ-D group, decreased ReHo of the postcentral gyrus correlated with better physiological functioning; increased ALFF in the brainstem correlated with poor QOL. BCQ-subgroup analysis revealed a nonsignificant correlation between ReHo and Yang deficiency/phlegm and stasis (Phl & STA). Nonetheless, the BCQ-D group showed a positive correlation between ALFF and Phl & STA in the parahippocampus. This study identified differences between BCQ-G and BCQ-D types of healthy adults based on the rsfMRI analysis. The different BCQ types with varied brain endophenotypes may elucidate individualized TCM treatment strategies.

Need of integrated dietary therapy for persons with diabetes mellitus and "unhealthy" body constitution presentations

From a perspective of Chinese medicine (CM), persons with unregulated "unhealthy" body constitution (BC) will further develop chronic diseases, such as diabetes mellitus (DM). Conventional dietary therapy with nutrition component has its limitations in the regulation of "unhealthy" BC. However, empirical evidence supports that "unhealthy" BC can be regulated with food natures and flavors from a perspective of CM. Presentations of "unhealthy" BC types, such as Yin-deficiency, Yang-deficiency and Yin-Yang-deficiency were found in persons with DM. It would be necessary to regulate the "unhealthy" BC presentations with integration of conventional dietary therapy and Chinese food therapy. The ultimate goal is to either stabilize glycaemic control or prevent the development of other chronic diseases leading to reduction of disease burden, such as disease-related poor quality of life, stress of healthcare professionals and the rising of healthcare cost.

Initial validation of the Yin-Yang Assessment Questionnaire for persons with diabetes mellitus

AIM: To initially test for the content validity, comprehensibility, test-retest reliability and internal consistency reliability of the Yin-Yang Assessment Questionnaire (YY-AQ).

METHODS: The process of initial validity and reliability test covered: (1) content validation from the findings of 18 multiple-case studies, validated Yin- and Yang-deficiency assessment questionnaires, relevant literatures and registered Chinese medicine practitioners; (2) comprehension with the levels of comprehensibility for each item categorized on a 3-point scale (not comprehensible; moderately comprehensible; highly comprehensible). A minimum of three respondents selecting for each item of moderately or highly comprehensible were regarded as comprehensive; (3) test-retest reliability conducted with a 2-wk interval. The intraclass correlation coefficients (ICCs) and their 95%CIs were calculated using a two-way random effects model. Wilcoxon Signed Rank test for related samples was adopted to compare the medians of test-retest scores. An ICC value of 0.85 or higher together with P > 0.05, was considered acceptable; and (4) internal consistency of the total items was measured and evaluated by Cronbach’s coefficient alpha (α). A Cronbach’s α of 0.7 or higher was considered to represent good internal consistency.

RESULTS: Eighteen Yin-deficiency and 14 Yang-deficiency presentation items were finalized from content validation. Five participants with type 2 diabetes mellitus (T2DM) performed the comprehensibility and test-retest reliability tests. Comprehensibility score level of each presentation item was found to be moderate or high in three out of the five participants. Test-retest reliability showed that the single measure ICC of the total Yin-deficiency presentation items was 0.99 (95%CI: 0.89-0.99) and the median scores on the first and 14^th days were 17 (IQR 6.5-27) and 21 (IQR 6-29) (P = 0.144) respectively. The single measure ICC of the total Yang-deficiency presentation items was 0.88 (95%CI: 0.79-0.99) and the median scores on the first and 14^th days were 10 (IQR 6-18) and 14 (IQR 7-23) (P = 0.144) respectively. The results of a descriptive correlation study on 140 survey participants with T2DM using the YY-AQ showed that internal consistency of the total Yin-deficiency and Yang-deficiency presentation items was satisfactory, with Cronbach’s α of 0.79 and 0.78 respectively.

CONCLUSION: The YY-AQ will be tested further for comprehensibility, test-retest and internal consistency reliabilities, scoring system validity, construct validity, convergent and discriminant validities, responsiveness and predictive validity.

The effects of two Chinese herbal medicinal formulae vs. placebo controls for treatment of allergic rhinitis: a randomised controlled trial

Background

Allergic rhinitis is a chronic illness, affecting 10 to 40% of the worldwide population. Chinese herbal medicines, the treatment of allergic rhinitis, adopted thousands of years in ancient China, has recently raised much attention among researchers globally. This study evaluates the effects of two Chinese herbal formulae [Cure-allergic-rhinitis Syrup (CS) and Yu-ping-feng San (YS)] in treating undergraduate nursing students with allergic rhinitis over a 3-month follow-up, when compared to a placebo control group.

Methods

A double-blind, randomised controlled trial with repeated-measures, three-parallel-groups design was conducted in a random sample of 249 participants recruited from one university in Hong Kong. After baseline measurements, participants were randomly assigned to CS, YS, or placebo groups (n = 83 per group). The main outcomes, including symptom severity, quality of life, and body constitution, were measured with self-administered questionnaires at baseline and immediately, 1 and 3 months after the 4-week interventions.

Results

240 participants completed the trial, with 9 (3.6%) drop-outs. The results of Generalised Estimating Equations test followed by pairwise contrasts tests indicated that the participants who received CS showed significantly greater reduction of symptoms (mean difference of CS vs. placebo = 26.13–34.55, P <0.0005) and improvements in quality of life (mean difference of CS vs. placebo = 12.81–16.76, P <0.001), and body constitution in ‘Qi-deficiency’, ‘Yang-deficiency’, and ‘Inherited Special’ (mean difference of CS vs. placebo = 7.05–8.12, 7.56–8.92, and 4.48–8.10, P = 0.01– < 0.0005, 0.001–0.004, and 0.01– < 0.0005, accordingly, at three post-tests). The participants who received YS also indicated significant greater improvements in symptom severity, quality of life, and a few patterns of body constitution when compared to the placebo group. However, its effects were lesser in strength (i.e., smaller effect sizes), varieties of symptoms, and body constitution and sustainability over the 3 months.

Conclusions

The herbal formula CS was found effective to reduce symptoms and enhance quality of life in young adults (nursing students) with allergic rhinitis in ‘Yang- and/or Qi-deficiency’ body constitution. Further controlled trials of its effects in Chinese and/or Asians with allergic rhinitis in terms of socio-demographic, ethnic and illness characteristics and a longer-term follow-up are recommended.

Trial registration

The trial has registered at ClinicalTrials.gov with an ID: NCT02027194 (3 January 2014).