Sasang constitutional medicine (SCM) is a unique form of traditional Korean medicine that divides human beings into four constitutional types (Tae-Yang: TY, Tae-Eum: TE, So-Yang: SY, and So-Eum: SE), which differ in inherited characteristics, such as external appearance, personality traits, susceptibility to particular diseases, drug responses, and equilibrium among internal organ functions. According to SCM, herbs that belong to a certain constitution cannot be used in patients with other constitutions; otherwise, this practice may result in no effect or in an adverse effect. Thus, the diagnosis of SC type is the most crucial step in SCM practice. The diagnosis, however, tends to be subjective due to a lack of quantitative standards for SC diagnosis. We have attempted to make the diagnosis method as objective as possible by basing it on an analysis of quantitative data from various Oriental medical clinics. Four individual diagnostic models were developed with multinomial logistic regression based on face, body shape, voice, and questionnaire responses. Inspired by SCM practitioners’ holistic diagnostic processes, an integrated diagnostic model was then proposed by combining the four individual models. The diagnostic accuracies in the test set, after the four individual models had been integrated into a single model, improved to 64.0% and 55.2% in the male and female patient groups, respectively. Using a cut-off value for the integrated SC score, such as 1.6, the accuracies increased by 14.7% in male patients and by 4.6% in female patients, which showed that a higher integrated SC score corresponded to a higher diagnostic accuracy. This study represents the first trial of integrating the objectification of SC diagnosis based on quantitative data and SCM practitioners’ holistic diagnostic processes. Although the diagnostic accuracy was not great, it is noted that the proposed diagnostic model represents common rules among practitioners who have various points of view. Our results are expected to contribute as a desirable research guide for objective diagnosis in traditional medicine, as well as to contribute to the precise diagnosis of SC types in an objective manner in clinical practice.

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Development of an integrated Sasang constitution diagnosis method using face, body shape, voice, and questionnaire information

Sasang Constitutional Medicine, which is a branch of traditional Korean medicine, states that medications for diabetes should be individualized according to the patient's individual constitution. However, the effect of constitution on diabetes has not been evaluated to date. Therefore, this study was conducted to determine if constitution is an independent risk factor for diabetes by comparing the prevalence and odds ratios (ORs) of the disease according to constitution. The medical records of 1443 adults who had been examined and classified based on their constitution at Kyung Hee University Hospital in Seoul, Korea were reviewed. A chi-squared test and Fisher's exact test were used to compare the prevalence of diabetes according to constitution, and multiple logistic regression was used to calculate the ORs for diabetes. The prevalence of diabetes differed significantly according to constitution (χ2 = 36.20, df = 2, P < 0.001). Specifically, the prevalence of the disease was higher in Tae-eumin (11.4%) individuals than in Soyangin (5.0%) or Soeumin (1.7%) individuals. In addition, multiple logistic regression revealed that Tae-eumin individuals had a greater risk for diabetes than Soeumin individuals. When compared to Soeumin individuals, the adjusted ORs were 2.01 (95% CI 0.77–5.26) for Soyangin individuals and 3.96 (95% CI 1.48–10.60) for Tae-eumin individuals. These results show that constitution has a significant and independent association with diabetes, which suggests that constitution is an independent risk factor for diabetes that should be considered when attempting to detect and prevent the disease.

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Sasang Constitution as a Risk Factor for Diabetes Mellitus: A Cross-Sectional Study

Objective. Sasang typology is a traditional Korean medicine based on the biopsychosocial perspectives of Neo-Confucianism and utilizes medical herbs and acupuncture for type-specific treatment. This study was designed to develop and validate the Sasang Personality Questionnaire (SPQ) for future use in the assessment of personality based on Sasang typology. Design and Methods. We selected questionnaire items using internal consistency analysis and examined construct validity with explorative factor analysis using 245 healthy participants. Test-retest reliability as well as convergent validity were examined. Results. The 14-item SPQ showed acceptable internal consistency (Cronbach's alpha = .817) and test-retest reliability (r = .837). Three extracted subscales, SPQ-behavior, SPQ-emotionality, and SPQ-cognition, were found, explaining 55.77% of the total variance. The SPQ significantly correlated with Temperament and Character Inventory novelty seeking (r = .462), harm avoidance (r = -.390), and NEO Personality Inventory extraversion (r = .629). The SPQ score of the So-Eum (24.43 ± 4.93), Tae-Eum (27.33 ± 5.88), and So-Yang (30.90 ± 5.23) types were significantly different from each other (P < .01). Conclusion. Current results demonstrated the reliability and validity of the SPQ and its subscales that can be utilized as an objective instrument for conducting personalized medicine research incorporating the biopsychosocial perspective.

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Development and Validation of a Personality Assessment Instrument for Traditional Korean Medicine: Sasang Personality Questionnaire

The purpose of this study was to examine the biopsychological personality profiles of traditional Korean Sasang typology based on the Temperament and Character Inventory (TCI) in a Korean adult clinical sample. A total of 97 adults completed the Korean version of the TCI. The participants were classified as one of three traditional Korean Sasang types (31 So-Yang, 41 Tae-Eum, 25 So-Eum) by three specialists in Sasang typology. The seven dimensions of TCI were compared between the different Sasang types using analysis of variance (ANOVA) and profile analysis. There were no significant differences in age, gender and education across the Sasang types. The TCI profile for each of the Sasang types was significantly different (profile analysis, df = 5.038, F = 3.546, P = .004). There were significant differences in the temperament dimensions of Novelty Seeking (F = 3.43, P = .036) and Harm Avoidance (F = 5.43, P = .006) among the Sasang types. The Novelty Seeking score of the So-Yang type (31.90 ± 9.87) was higher than that of the So-Eum type (25.24 ± 9.21; P = .019) while the So-Eum type (44.64 ± 8.47) scored higher on the Harm Avoidance score compared to the So-Yang type (35.16 ± 11.50; P = .003). There were no significant differences in the temperament dimension of Reward Dependence and Persistence, and the three character dimensions of Self-Directedness, Cooperativeness and Self-Transcendence. Results demonstrated distinct temperament traits associated with traditional Korean Sasang types using an objective biopsychological personality inventory. With further study, the Sasang typology may lead to enhanced clinical safety and efficacy as part of personalized medicine with traditional medicine.

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Temperament and Character Profiles of Sasang Typology in an Adult Clinical Sample

The purpose of present study was to examine biological and psychological characteristics of people according to the Sasang typology, which is popular in Korea. We evaluated the Sasang Personality Questionnaire (SPQ) as a measure of temperament, and Body Mass Index (BMI) as a measure of the somatic properties of each Sasang type. Subjects were 2506 (877 males, 1629 females) outpatients between the ages of 20 through 70 who requested traditional medical assessment and treatment in Korea. The structural validity of the SPQ was examined and its correlation with BMI was analyzed. The SPQ and BMI measures of each Sasang type across age and gender were presented and their differences were analyzed with Analysis of Variance. Confirmatory factor analysis and path analysis identified an acceptable three-factor structure of the SPQ measuring differences in individual’s behavior, emotion, and cognition. SPQ scores (29.71 ± 1.00, 28.29 ± 0.19 and 26.14 ± 0.22) and BMI scores (22.92 ± 0.09, 25.56 ± 0.10 and 21.44 ± 0.10) were significantly (p < 0.001) different among So-Yang, Tae-Eum and So-Eum Sasang types, respectively. The results showed that the SPQ and BMI is a reliable measure for quantifying the biopsychological characteristics of each types, and useful for guiding personalized and type-specific treatment with medical herbs and acupuncture.

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

1. Objectives: This study was performed to research the relationship between Sasang Constitution and characteristics of tongue diagnosis based on Donguisusebowon's Experience prescriptions(經驗方). 2. Methods: We searched tongue diagnosis factors in Donguisusebowon and classified this. Based on Donguisusebowon's Experience prescriptions(經驗方), we find tongue diagnosis factors in 6 contemporary Oriental medicine prescription books. 3. Results: Most So-eumin has white thin tongue coating and clear redish tongue color. Yellow tongue coatings are found in symptoms for Yinjinho-tang(Yinchenhao-tang), Soseungki-tang(Xiaochengqi-tang), Daeseungki-tang(Dachengqi-tang). Shortened Tongue is found in So-eumin's experience prescription and So-yangin's treat histroy. It didn't shown that So-eumin's Semen Crotonis included 6 prescritions' factors of tongue diagnosis. So-yangin's white tongue coating is found in Hyungbangpaedok-san(Jingfangbaidu-san), Sipjo-tang(Shizao-tang), Sosiho-tang(Xiaocihu-tang), Shinki-hwan(Shenqi-wan). Most of other So-yangin's tongue coatings are Yellowish and tongue color is deep red. Tae-eumin have thin white tongue coating at the Mahuang-tang(Mahuang-tang). Red tongue color and drying tongue are found at Jowiseungki-tang(Tiaoweichengqi-tang)Daesiho-tang(Dacihu-tang)Saengmaek-san(Shengmai-san) 4. Conclusions: Following So-eumin's Experience prescriptions, So-eumin's tongue color is clear red and tongue coatings are thin white and greasy. Following So-yangin's Experience prescriptions, So-yangin's tongue color is deep red and tongue coatings are yellowish and scarce except Exterior cold disease. And So-yangin has specific symptom of irritability, oral sores. Tae-eumin's tongue has two sides of white thin tongue coatings and Red and drying tongue.

A Literature study on the Sasang Constitutional Tongue Diagnosis based on Experience Prescriptions(經驗方) in the Donguisusebowon (Longevity and Life Preservation in Oriental Medicine)

1. Objectives: We would know what kind of symptom are different according to Cold and Heat characteristics and health state. We also tried to suggest the development of Sasang Constitution diagnosis model considering of them. 2. Methods: We recruited 1,523 subjects between 10 and 80, excluding individuals who have physically or psychologically serious disease or women in pregnancy in the 21 Oriental Medical Clinics. We seperated group according to Cold and Heat characteristics and health state in CRF(Case Report Form, C-2009-002439) questionnaire and we also developed Sasang constitution diagnosis program to compare agreement according to sex and age group with Cold/Heat and health state one. 3. Results: The number of discordance items are much more than that of accordance items in group seperated according to Cold and Heat, and Health state Sasang constitution agreement rate of Cold/Heat and health state group is higher than that of total group through program. When we diagnosed Sasang constitution with different group characteristics to know the group differences, the disparity rate of the group according to Heat/Cold and Health state is lower than that of the group according to sex and age. 4. Conclusions: As Sasang constitution characteristics are different according to Cold/Heat group and Health state classification, we can upgrade Sasang constitution agreement rate with questionnaire considered of Heat/Cold and health state.

Influence of Cold and Heat Characteristics and Health State in Sasang Constitution Diagnosis

1. Objectives As a basic trial for identification of Sasang constitutional gene marker, we genotyped and analysed statistical relationships of STR(short tandem repeat) alleles and its distribution in each constitution. 2. Methods After obtaining basic constitutional data with questionnaire (QSCC II), decision of constitution was made by 3 different constitution specialists' diagnosis, and only the samples of specialists' agreement of each constitution by discussion were taken into this research. Using multiplex PCR kit, total 146 constitutional samples were amplified in 16 autosomal STR marker, genotyped, and analysed statistically. Among 16 markers, 15 were analysed in this study excluding the amelogenin marker is used for in gender identification. 3. Results and Conclusions It is difficult to determine the relationship between constitution and STR marker as the sample size is small, however, Penta D and vWA were shown to be related statistically with constitution. It has been know that STRs has no genetic informations, however there are some recent research results showing STRs as a regulatory element, relationship between microsatellite instability and repeat number and size, and post-transcriptional sigualing. STRs which is not known about its function currently, are proposed to have function and/or regulatory activities anyhow with Sasang constitution. It is believed that the results of this study can halp determine and deatify the markers related to Sasang Constitutional Medicien.

Short Tandem Repeat Allele Frequencies in Sasang Constitution

1. Objectives: In SCM, a personal Sasang constitution must be determined accurately before any Sasang treatment. The purpose of this study is to develop an objective method for classification of Sasang constitution. 2. Methods: We collected samples from 5 centers where SCM is practiced, and applied two-stage decision tree analysis on these samples. We recruited samples from 5 centers. The collected data were from subjects whose response to herbal medicine was confirmed according to Sasang constitution. 3. Results: The two-stage decision tree model shows higher classification power than a simple decision tree model. This study also suggests that gender must be considered in the first stage to improve the accuracy of classification. 4. Conclusions: We identified important factors for classifying Sasang constitutions through two-stage decision tree analysis. The two-stage decision tree model shows higher classification power than a simple decision tree model.

Kim Jong-Yeol

Papers

A Literature study on the Sasang Constitutional Tongue Diagnosis based on Experience Prescriptions(經驗方) in the Donguisusebowon (Longevity and Life Preservation in Oriental Medicine)

Influence of Cold and Heat Characteristics and Health State in Sasang Constitution Diagnosis

Short Tandem Repeat Allele Frequencies in Sasang Constitution

Two-Stage Decision Tree Analysis for Diagnosis of Personal Sasang Constitution Medicine Type