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BACKGROUND: More efficient instruments for body constitution identification are needed for clinical practice. We aimed to develop the short-form version of the Constitution in Chinese Medicine Questionnaire (CCMQ) and evaluate for health management. METHODS: First, the short forms were developed through expert survey, classical test theory (CTT), and modern item response (IRT) based on the CCMQ. A combination of e-mail and manual methods was used in expert survey. Then, five indexes of CTT including criteria value-critical ratio, correlation coefficient, discrete tendency, internal consistency, and factor loading were used. And, IRT method was used through analyzing the discrimination and difficulty parameters of items. Second, the three top-ranked items of each constitution scale were selected for the simplified CCMQ, based on the three combined methods of different conditions and weights. Third, The psychometric properties such as completion time, validity (Construct, criterion, and divergent validity), and reliability (test-retest and internal consistency reliability) were evaluated. Finally, the diagnostic validity of the best short-form used receiver operating characteristic (ROC) curve. RESULTS: Three short-form editions were developed, and retained items 27, 23 and 27, which are named as WangQi nine body constitution questionnaire of Traditional Chinese Medicine (short-form) (SF-WQ9CCMQ)- A, B, and C, respectively. SF-WQ9CCMQ- A is showed the best psychometric property on Construct validity, Criterion validity, test-retest reliability and internal consistency reliability. The diagnostic validity indicated that the area under the ROC curve was 0.928 (95%CI: 0.924-0.932) for the Gentleness constitution scale, and were 0.895-0.969 and 0.911-0.981 for unbalance constitution scales using the cut-off value of the original CCMQ as 40 ("yes" standard) and 30 ("tendency" standard), respectively. CONCLUSIONS: Our study successfully developed a well short-form which has good psychometric property, and excellent diagnostic validity consistent with the original. New and simplified instrument and opportunity are provided for body constitution identification, health management and primary care implementation.
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ObjectiveTo construct and evaluate the transformation model of the Constitution in Chinese Medicine Questionnaire （CCMQ） to SF-6Dv1 health utility and broaden the applications of CCMQ. MethodsThe data of CCMQ and SF-6Dv1 were collected from 595 participants at baseline， 3 months and 6 months after the comprehensive intervention suitable for the corresponding traditional Chinese medicine （TCM） constitution. The estimation and validation datasets were constructed， and four statistical algorithms including the ordinary least squares （OLS）， MM robust regression （MM）， censored least absolute deviations （CLAD） and the Tobit model were used to create alternative models. The mean absolute error （MAE）， root mean square error （RMSE） and intraclass correlation coefficient （ICC） were used to evaluate the prediction performance of the model. ResultsThe constitution scores of all TCM constitutions by CCMQ was significantly correlated with the SF-6Dv1 health utility value measured at three timepoints； the health utility value of the SF-6Dv1 was positively correlated with gentleness type （r=0.596， r=0.578， r=0.606， all P＜0.05） and negatively correlated with eight unbalanced constitutions （r=-0.586~-0.301， all P＜0.05）. The MM established based on the subscale scores of CCMQ was the optimal mapping model， and the MAE， RMSE， and ICC values were 0.0741， 0.0930 and 0.766， respectively. Gentleness type， qi-deficiency type， phlegm-wetness type， qi-constraint type， and age were the primary factors included in the model. The measured and predicted value of SF-6Dv1 had a moderate positive correlation （r=0.673， r=0.617， P＜0.05） and a good consistency as shown by the Bland-Altman plot. ConclusionBy using MM， the CCMQ can be transformed into SF-6Dv1 health utility value for health economics analysis.
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Background: Body constitution is a fundamental concept in traditional Chinese medicine (TCM) for clinical diagnosis, treatment of illness, and community-based health promotion. Clinical assessment of patients' body constitutions, however, has never been easy and consistent, even by well-trained clinicians and TCM practitioners. Therefore, questionnaires such as the popular Constitution in Chinese Medicine Questionnaire (CCMQ) can be an appealing and convenient assessment alternative. The present research borrowed advanced methodologies for questionnaire development in psychology and other social sciences to examine the performance of the CCMQ in terms of (i) the strength of relations of each item with its designated constitution, (ii) the reliabilities of each constitution, and (iii) the overall 9-constitution structure. This research provided empirical evidence to support the use of the CCMQ and proposed directions for refinement in future revisions of the CCMQ or similar measures. Methods: A total of 1571 volunteers from three villages in southern China participated in the CCMQ survey. The item characteristics, reliabilities, interconstitution correlations, and confirmatory factor analysis of the 9-body-constitution structure were examined. Results: The results generally supported the appropriateness of the clinical observations (the questionnaire items) and the CCMQ 9-constitution classification structure. Nevertheless, some relatively weaker items, item pairs with similar meanings, and highly overlapping constitutions were identified for future CCMQ revisions. Conclusion: The CCMQ measured the 9 constitutions efficiently and with reasonably good reliability and construct validity. Given the various challenges to assessing TCM body constitutions even by experienced clinicians, the CCMQ provides an appealing alternative to measure the Chinese body constitutions of healthy participants in large-scale research or community health promotion programs. The present study also demonstrated how advanced methodologies in social sciences can help validate and refine the CCMQ and similar complementary medicine measures.
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OBJECTIVE: To develop the best short form of constitution in Chinese medicine questionnaire (CCMQ) and evaluate its psychometric properties in Chinese population. METHODS: A total of 21 948 subjects were used to refine the short form. Correlation coefficient, exploratory factor analysis (EFA) and Cronbach's alpha coefficient were used to analyze and select items to form the short form. Separate sample of 205 subjects were collected to further evaluate the short from. EFA, confirmatory factor analysis (CFA), item-scale correlation, discriminant validity, internal consistency reliability and split-half reliability were carried out to evaluate the short form. RESULTS: The short form CCMQ included 26 items. Seven common factors of characteristic root > 1 were extracted to explain 58.488% of the total variation. Result of CFA was consistent with the 9-factors structure. The mean differences of Blood-stasis body constitution and Qi-stagnation body constitution had statistical significance in body mass index differentiation. Cronbach's alpha coefficient of short form CCMQ was 0.863. The split-half reliability of total scale was 0.813, and each scale was 0.568-0.770. The item-scale correlations ranged from 0.620-0.849. CONCLUSION: The short form CCMQ consisted of 26 items with good psychometric properties. The short form should be recommended for the measurement of health of Chinese population in any clinical trial.
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Medicine, Chinese Traditional , China , Factor Analysis, Statistical , Humans , Psychometrics , Reproducibility of Results , Surveys and QuestionnairesABSTRACT
OBJECTIVE: Chinese medicine (CM) is widely applied in cosmetics and dermatology. The theory of CM believes that skin characterizations reflect the internal status of balance which can be represented by body constitution, but relevant studies are few. This study aims to analyze the relationship between body constitution of CM and skin condition. METHODS: Participants were recruited from a private health and beauty clinic in Tokyo, Japan from June 2013 to January 2015. Each participant was assessed using Constitution in Chinese Medicine Questionnaire (CCMQ) for body constitution and the Baumann Skin Type Questionnaire for skin type. Spearman's rank correlation and stepwise multiple linear regression were used to investigate the effect of body constitutions on skin types. RESULTS: A total of 187 Japanese females were recruited in this study. Higher dampness-heat and phlegm-dampness scores were associated with oilier skin while higher qi-depression and blood-stasis were associated with drier skin. Higher score in Inherited Special and yin-deficiency constitutions tended to have more sensitive skin, and higher score in blood-stasis was associated with more pigmented skin and wrinkles. CONCLUSIONS: Our findings supported the "Constitution-Skin Correlated theory" in CM. Understanding of the association between skin conditions and the body constitutions might be helpful to explore more individualized treatment options for skin care and dermatological diseases through modifications of the unique body constitutions using CM modalities.
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Body Constitution , Medicine, Chinese Traditional , Skin , Adult , Female , Humans , Japan , Middle Aged , Surveys and QuestionnairesABSTRACT
We conducted a clinical trial in 26 healthy adult women to evaluate the effect of foods containing placental extract ingested for 12 consecutive weeks on 9 constitutional types in Traditional Chinese Medicine.The body constitution analysis set consisted of 23 subjects (excluding 3 dropouts). Twelve-week ingestion of placental extract-containing foods improved individual scores for “Gentleness” type, a healthy constitution, and “Qi-deficiency,” “Yang-deficiency,” “Yin-deficiency,” “Wet-heat” and “Qi-depression” types, which are all mibyou constitution.The safety analysis set consisted of 25 subjects (excluding 1 dropout). Only one subject experienced an adverse event (exacerbation of urticaria, an underlying disease). No other safety concerns arose.
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With the cooperation of Kurobe City, we conducted a basic survey using the nine classification of constitution and an intervention survey using a constitutional guidance program. The basic survey was conducted by the Kurobe group (Kurobe River alluvial fan spring water drinker n=155, 60.6±10.4 years old) and the non-Kurobe group (normal tap water drinker n=99, 50.7±12.8 living in the Hokuriku region without Kurobe City). A total of three surveys were conducted using the constitution Questionnaire (CCMQ-J). As a result, the Gentleness type, which is usually called the healthy constitution, was clearly higher in the Kurobe group, with 44.6 % in the Kurobe group and 22.5 % in the non-Kurobe group. In the proportion of each biased constitution(Mibyo constitution), the Kurobe group had less Wet-heat type (4.5 % vs 11.8 %), Qi-depression type (5.4 % vs 10.7 %), Yin-deficiency type (7.1 % vs 12.3 %) , and Phlegm-wetness type (5.8 % vs 9.6 %) than the non-Kurobe group. After the basic survey was completed, the Kurobe group was randomly divided into two groups, an intervention group (n=65, 62.3±9.3 years old) and a non-intervention group (n=68, 62.7±9.8 years old), and compared with the non-Kurobe group (control group) (n=80, 51.9±13.6 years old). The survey design was a simple comparative study, and the primary endpoint was a comparative study of changes in constitutional scores before and after intervention. As a result, in the Yang-deficiency type, a significant difference was observed between the intervention group, the non-intervention group and the control group at the first time after the intervention (One-way ANOVA p=0.04). No change was seen in the second survey after the intervention. In the comparison of Phlegm-wetness type between the three groups, there was a tendency in the amount of change in the constitutional score (One-way ANOVA p=0.087). From the above, it was suggested that the constitutional survey can not only grasp the health and the pre-symptomatic state, but also improve the pre-symptomatic by combining the guidance methods according to the constitution.
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Chinese Medicine Questionnaire (CCMQ-J) consists of sixty independent questionnaires and 9 physical constitutions called subscales. One type is balanced constitution (i.e., gentleness), and the following eight types represent unbalanced constitution: Qi-deficiency constitution, Yang-deficiency constitution, Yin-deficiency constitution, Phlegm-dampness constitution, Damp-heat constitution, Stagnant Blood constitution, Stagnant Qi constitution, and Inherited Special constitution. In this study, we proposed to determine optimal number of groups in 851 participants recruited from crowdsourcing answered CCMQ-J questionnaire consisting of 60 questions. In the present study, we applied k-means clustering with gap statistics to the questionnaire data and the number of optimal groups was estimated by five. The five groups are mainly characterized by 3 subscales in CCMQ-J, i.e. (i) two subscales corresponding to Yang-deficiency and Qi-depress, (ii) three subscales corresponding to gentleness, Yang-deficiency and Qi-depress (iii) Yang-deficiency, (iv) gentleness, and (v) Qi-depress. In the crowdsourcing survey, two subscales, Yang-deficient and Qi-depress are the most frequently occurred in current Japanese people.
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Japanese version of the Constitution in Chinese Medicine Questionnaire (CCMQ-J) in Chinese consists of 60 items for 9 sub-scales called Gentleness, Qi-deficiency, Yang-deficiency, Yin-deficiency, Phlegm-wetness, Wet-heat, Blood-stasis, Qi-depression, and Special diathesis. Each question is answered by choosing one form 5 grades of a Likert scale where the grades from 1 to 5 corresponding to Never, Rarely, Sometimes, Often and Always, respectively. In the present study, we examined the relationship of scores based on 597 respondents to 60 items. We tentatively classified 60 items into 12 groups by utilizing the Ward’s hierarchical clustering method and discussed similarity of items and 9 body conditions. Body Mass Index (BMI) and age can be explained by the score of 60 items by partial least square model. Significantly high correlation coefficients between real and estimated values were obtained for BMI (0.81 for male and 0.82 for female) and age (0.82 for male and 0.83 for female). Those results indicate that the answers to the 60 items can reflect aging and BMI properties and CCMQ-J can be used to assess the situation of health for evaluating the actual aging conditions in human.
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ObjectiveTo explore the psychological characteristics of personality of the nine constitutions in Traditional Chinese Medicine(TCM),so as to enrich and develop the theory related with constitution in TCM.MethodsFrom May 2009 to June 2009,540 college students from two universities in Beijing were investigated by cross-sectional survey.Cluster sampling method was adopted and the constitution in Chinese Medicine Questionnaire(CCMQ) and Eysenck Personality Questionnaire Short Scale for Chinese (EPQ-RSC) was used.Results ①In extraversion-introversion dimension,Gentleness type had the highest score(56.52 ± 8.48) and Qi-depression type had the lowest score (45.88 ± 11.13 ).The scores of seven pathological constitutions (Qi-deficiency type,Yang-deficiency type,Phlegm-wetness type,Wet-heat type,Blood-stasis type,Qi-depression type and Special diathesis type) were significantly lower than the score of Gentleness type(P＜0.01 ).In neuroticism dimension,Qi-de-pression type had the highest score (59.31 ± 9.70) and Gentleness type had the lowest score (44.08 ± 8.55 ).There were significant differences (P ＜ 0.01 )between the score of Gentleness type and the scores of Qi-deficiency type,Yin-deficiency type,Wet-heat type,Blood-stasis type and Qi-depression type.In psychoticism dimension,there were no significant differences between the score of Gentleness type and the scores of eight pathological constitutions.② Gentleness type was used as control,multivariate logistic regression analysis of psychological characteristics of personality of the eight pathological constitutions showed that the extraversion-introversion dimension was the meaningful relation factor of Qi-deficiency type,Yang-deficiency type,Phlegm-wetness type,Wet-heat type,Blood-stasis type,Qi-depression type and Special diathesis type.The neuroticism dimension was the meaningful relation factor of Qi-deficiency type,Yin-deficiency type,Phlegm-wetness type,Wet-heat type,Blood-stasis type,Qidepression type and Special diathesis type.ConclusionPeople with nine different constitutional types in TCM have shown corresponding psychological characteristics of personality.This study illustrates that nine constitutions in TCM are related to psychological characteristics of personality.
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Objects:To describe the distribution regularity of constitutional types of Chinese medicine in general population and analysis the characteristics of different social demography population through epidemiological investigation of constitutional types of Chinese medicine in general population.Methods:Using 21,948 cases large sample data of Chinese medical constitution cross-section survey from general population of nine provinces and municipalities(Jiangsu,Anhui,Gansu,Qinghai,Fujian,Beijing,Jilin,Jiangxi and He’nan),from December 2005 to January 2007.8,448 samples in accord with sample data from 1% nationwide population survey in 2005,which could representative the general population of China were randomly selected.Using the standardized Constitution in Chinese Medicine Questionnaire(CCMQ) to evaluation the scores of all kinds of Constitutional types(Gentleness type,Qi-defi ciency type,Yang-defi ciency type,Yin-defi ciency type,Phlegm-wetness type,Wet-heat type,Blood-stasis type,Qi-depression type,Special diathesis type).Application Discriminant Analysis to distinguish the individual Constitutional types,and analysis the distribution regularity of constitutional types of Chinese medicine in general population.Variables grouped by social demographic,use ?2 test to compare the differences in each sub-group’s constitution composition.Results:In the general population in China,Gentleness type accounted for 32.14 percent,eight pathological constitutions accounted for 67.86 percent,and the former three types of eight pathological constitutions were Qi-defi ciency type,Wet-heat type and Yang-deficiency type,which accounted for 13.42 percent,9.08 percent and 9.04 percent respectively.The composition ratio of constitutional types in different geographical,gender,age,marital status,occupation and education level were different,and the difference was signifi cant(P
