Journal of Traditional Chinese Medical Sciences (2018) 5, 6e15

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Application of TCM constitution in lifetime

health maintenance
Qi Wang a,*, Minghua Bai a, Yin Yang a, Xue Liang a,
Pengcheng Sun a, Junwen Han a, Taiping Fan b, Chunsu Yuan c

a
Center for Studies in Constitution Research and Reproductive Sciences of Traditional Chinese
Medicine, Beijing University of Chinese Medicine, Beijing 100029, China
b
Angiogenesis & Natural Products Laboratory Department of Pharmacology, University of Cambridge,
Cambridge CB2 1PD, United Kingdom
c
Tang Center for Herbal Medicine Research, University of Chicago, Chicago IL 60637, United States

Received 15 November 2017; received in revised form 17 January 2018; accepted 17 February 2018
Available online 5 April 2018

KEYWORDS Abstract Healthy full life cycle has become an important national strategy, which indicates
Full life cycle; that attention needs to be given to human health throughout the life course. The full life cycle
TCM constitution; includes the whole process of conception and birth, development, growth, aging, and death,
Health service which has been recorded in Yellow Emperor’s Canon of Medicine. From the perspective of
traditional Chinese medicine (TCM) constitution theory, the TCM constitution focuses on the
life process in a continuous evolution based on individual development at different phases
or stages from infancy to senility. The development of TCM constitution is beneficial in accu-
mulating the theoretical and practical experience for promoting the application of TCM consti-
tution health service into the full life cycle, and providing theory, technique and method for
TCM health service in the full life cycle, as well. Through this review, we’ve found that TCM
constitution has being widely used for clinical practice, but still needs further improvement.
ª 2018 Beijing University of Chinese Medicine. Production and hosting by Elsevier B.V. This is
an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/
by-nc-nd/4.0/).

The full life cycle refers to the period from the joining of
the sperm-egg to the termination of life including the
* Corresponding author.
E-mail address: wangqi710@126.com (Q. Wang).
Peer review under responsibility of Beijing University of Chinese
Medicine.
whole processes of conception, growth, maturity, senility,
and death. The healthy full life cycle indicates the entirety
of the human life course deserving comprehensive atten-
tion and protection. In traditional Chinese medicine (TCM),
investigating the full life cycle can be dated back to thou-
sands of years ago. In Yellow Emperor’s Canon of Medicine
containing two medical works of Plain Conversation and
Spiritual Pivot, there are such descriptions.

https://doi.org/10.1016/j.jtcms.2018.02.006
2095-7548/ª 2018 Beijing University of Chinese Medicine. Production and hosting by Elsevier B.V. This is an open access article under the CC
BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
TCM constitution in lifetime health maintenance
For a woman, her Shenqi (Kidney-Qi) becomes pros-
perous and her teeth begin to change at the age of seven
. at the age of forty-nine, as both the Renmai
(Conception Vessel) and Chongmai (Thoroughfare
Vessel) become deficient and menstruation stops, she
becomes physically feeble and is no longer able to
conceive a baby.
. For a man, at the age of eight, his Shenqi (Kidney-Qi)
becomes prosperous and his teeth begin to change .
With the exhaustion of Ttiangui (editor’s note:
reproduction-stimulating essence) and the reduction of
Shenqi (Kidney-Qi), his kidney is weakened and his body
becomes very weak, his teeth and hair begin to lose .
he walks with difficulty and is unable to have a baby.
dPlain Conversation1
[When] a person is 10 years old, [the development of]
the Five Zang-Organs is completed, the blood and Qi [in
his body] flow thoroughly through the body . [when he
is] 100 years old, [the blood and Qi in all] the Five Zang-
Organs are deficient and Shenqi (Spirit-Qi) has dis-
appeared. Though the body still remains, the life no
longer exists.
dSpiritual Pivot2
These records in Yellow Emperor’s Canon of Medicine
explain the life process from childhood to late adulthood.
TCM constitution holds that health refers to the physical
and mental harmony of individuals with different environ-
ments throughout their life and the ability to adapt to the
natural and social environment. With regard to constitu-
tion, it refers to the life process as continuous changes
based on individual development at different stages. The
TCM constitution health service is dedicated to individual
diagnosis and treatment, independent and self-help health
service, full life cycle health service, and early prevention
and intervention for chronic diseases, and has accumulated
abundant theoretical and practical experience for the full
life cycle of health service. It has been widely used in
clinical practice.
Application of TCM constitution health service
from embryonic period to childhood
From the embryonic stage to adolescence, every child has
his own TCM constitution. TCM constitution health service is
important for the maintenance of children’s health.
Embryonic period
The embryonic period is the pregnancy stage. At this time,
the individual’s constitution is mainly affected by the
maternal constitution. The distinguished TCM doctor,
Zhenheng Zhu in the Yuan Dynasty once said that a fetus
has one body with the mother; if the mother’s constitution
is hot, so is the baby’s; if the mother’s constitution is cold,
so is the baby’s; if the mother gets sick, the baby also will;
7
if the mother is healthy, the baby is well.3 Distinguished
TCM physicians, Su Dong and Xian Fang in the Ming Dy-
nasty, explained that the body shape, constitution and life
span of the baby all relied on the essence and the blood. If
the two substances are in harmony, conception will be
successful and delivery after 9 months in the mother’s
body. From this point, longevity or dying young as well as
cleverness or imbecility, can be predicted based on
mother’s constitution.4 Therefore, maternal body consti-
tution during pregnancy affects not only the individual
embryonic constitution, but also the full life process of
individuals. Similar studies of maternal constitution during
pregnancy have been carried out. Tang et al5 investigated
TCM constitution in pregnant women from Hualinjie
Community, Liwan District, Guangzhou. Among these 1892
participants, the unbalanced constitution accounted for
69.71%. The top three unbalanced constitutions were
yang-deficiency constitution (YADC), qi-deficiency consti-
tution (QDC) and dampness-heat constitution (DHC). For
pregnant women in balance constitution (BC) or unbal-
anced constitution, there were statistical differences in
high risk pregnancy, gestational pregnancy, adverse preg-
nancy outcomes, premature delivery, low birth weight,
and Apgar score 7, etc. Liao et al6 did a TCM constitution
investigation on 2610 pregnant women, and found that
50.19% of pregnant women whose TCM constitution iden-
tified at early pregnancy were varied from that in late
pregnancy. At the early stage of pregnancy, QDC was in
top first, and most of them were converted to YADC in
their late pregnancy. While in the late pregnancy, yin-
deficiency constitution (YIDC) was the most common in
pregnant women who were diagnosed as having DHC
earlier in pregnancy. Adverse pregnancy outcomes
differed significantly in women during their late pregnancy
with different types of constitution. In summary, the un-
balanced constitution has some influence on adverse
pregnancy outcome, high-risk pregnancy, complications of
pregnancy, and premature delivery in pregnant women.
Besides, the ratio of unbalanced constitutions in pregnant
women in different areas is different. It is necessary and
beneficial to provide the corresponding TCM health service
during pregnancy according to pregnant women’s TCM
constitution.
Infancy to preschool period
Infancy is the first stage after birth. Levels of maternal
specific antibodies are often suboptimal and therefore may
not be sufficient to confer full protective immunity to the
infants or may protect them for only a short period of time.
In addition, the levels of maternal antibodies wane over a
period of approximately 6 months after delivery.7 Research
displayed that infants with allergic diseases, especially
food allergies, are on the rise.8,9 In the 2010 United
Kingdom Infant Feeding Survey, 45% of the mothers of in-
fants aged 8e10 months reported avoiding giving particular
food to their infants, and the most common reason avoiding
foods was fear of allergy.10 The data from the maternal and
child healthcare center of China Center for Disease Control
and Prevention in 2016 showed that the proportion of
8 Q. Wang et al.
allergic diseases/symptoms occurred or occurring in 0e24
months infants in China was 40.9%, while the prevalence
rate of allergic diseases was 12.3%.11 Liu et al12 conducted a
face to face questionnaire survey on the foster parents of
0e3 years old infants from 8 cities in China using a multi-
stage random cluster sampling method. According to the
data from these foster parents, the allergy rate of infants
was 17.97%. The rising trend of allergic diseases not only
occurs in China, but also appears in many developed
countries. In the United States, the prevalence of allergic
diseases in the population under 18 years old increased by
18.2% from 1997 and 2007.13 In Australia, there was a
continuous increase in the rate of hospital admissions for
angioedema (3.0% per year), urticaria (5.7% per year), and,
most notably, anaphylaxis (8.8% per year). There was a
particularly steep increase in the incidence of hospitaliza-
tion for food-related anaphylaxis among children aged less
than 5 years.14 Based on a study, the prevalence of clinical
(oral food challenges proven) food allergy in preschool
children in developed countries is about 10%. In large and
rapidly emerging societies of Asia, such as China, the
prevalence of oral food allergy is now around 7% in pre-
schoolers. While food allergy appears to be increasing in
both developed and developing countries in the last 10e15
years.15 Therefore, allergies in infants and children have
become a global issue. Allergic disease starts from infancy
and usually lasts for the whole life, which not only affects
the quality of life of individuals and their family, but also
increases the economic burden. But, we can improve the
unbalanced constitution of infants by coordinating TCM
constitution so as to restore the state of BC, which can
shorten the allergic attack, prolong the interval between
attacks, and avoid the baby suffering from taking small
molecule milk.
Childhood
Obesity and myopia in childhood
Obesity and myopia are two common diseases affecting the
health of children. A study published in the Lancet
analyzed weight and height in nearly 130 million people,
including 31.5 million children ages 5e19 years. The
number of obese children and adolescents rose from 11
million in 1975 to 124 million in 2016 - a tenfold increase.
An additional 216 million children were overweight.16
Obesity in children and adolescents is associated with
morbidity such as mental health and psychological issues,
obstructive sleep apnea, asthma, orthopedic problems,
and adverse cardiovascular and metabolic outcomes.17 An
estimated 19 million children below age 15 are vision
impaired. Of these, 12 million children have vision
impairment due to refractive errors. Around 1.4 million
have irreversible blindness, requiring access to vision
rehabilitation services to optimize functioning and reduce
disability.18 According to the national student physique and
health survey issued by General Administration of Sport of
China in 2014, the physique and health of the national
students were generally improved, but the poor eyesight
rate of all students in different phases of study continued
to rise in younger age students. The poor eyesight rates of
students in primary school, junior high school, senior high
school, and college & university were 45.71%, 74.36%,
83.28%, and 86.36% accordingly, which were even higher
than those in 2010-year survey. The prevalence of obesity
and overweight continued to rise. The detection rate of
obesity among urban boys, urban girls, rural boys and rural
girls aged 7e22 years were 13.33%, 5.64%, 7.83%, 3.78% in
turn.19
In recent years, the rates of myopia and obesity in
children are rising year by year due to the dietary structure
of high glucose, fat and salt. On the other hand, they are
associated with the heavy schoolwork and few outdoor
activities. Simple reliance on parents to help their children
cultivate a health concept is not enough to solve the issues
of myopia and obesity. TCM health service should be given
importance by parents and the whole society.
By taking TCM constitution and applying a medicative
diet for food therapy, acupuncture and moxibustion, tuina,
and Chinese herbal medicines etc., we can correct the
degree of unbalanced constitution in children with myopia
and/or obesity, gradually restoring the state of BC. We can
control the development of myopia and obesity and alle-
viate the degree of myopia, eliminate pseudomyopia and
obesity by improving the overall health in children. If we
apply these traditional measures like the medicative diet,
massage on certain acupoints, and Tai Chi Chuan and
Baduanjin practice to coordinate the constitution in
healthy children without myopia or obesity, which cannot
only strengthen the body, but also can decrease the pos-
sibility of developing myopia and obesity.
Depression in childhood
Psychological problems, such as depression, are another
factor affecting the health of children. The prevalence of
“any anxiety disorder” including depression in studies with
children or adolescents is about 15%e20%. The most
frequent disorders among children and adolescents are
separation anxiety disorder, with estimates of 2.8% and 8%,
and specific and social phobias, with rates up to around
10% and 7%, respectively. Agoraphobia and panic disorder
are low-prevalence conditions in childhood (1% or lower);
higher prevalences are found in adolescence.20 Anxiety
and depression influence interpersonal relationships and
academic achievement, and increase the risk of suicide
and other psychopathology. Moreover, such negative ef-
fects may propagate forward into adulthood.21 In tradi-
tional medical cognition, children’s mental health is often
ignored. However, several children’s suicide incidents have
given us a painful lesson in recent years. An 11-year-old
boy from Yangzhou Garden Primary School in Jiangsu
Province hanged himself in the kitchen one day after
school.22 Four children at Tiankan Township, Bijie Qix-
ingguan District in Guizhou, committed suicide by taking
pesticides.23 A 12-year-old child jumped off the teaching
building and died at Xinhua Experimental Primary School,
Loudi City, Hunan Province.24 According to the WHO, sui-
cide is the second leading cause of death in 15e29 years
old,25 and worldwide 10%e20% of children and adolescents
experience mental disorders.26 All these incidents related
with children’s mental health have aroused the attention
TCM constitution in lifetime health maintenance
of the medical practitioners. Cheng et al27 conducted a
questionnaire survey on 2274 students from junior high
school in Ningbo City by a stratified cluster sampling. They
found that the total positivity rate of depression was
37.2%, and the mild, moderate, and severe cases were
17.9%, 15.0%, and 4.4%.
A questionnaire survey was conducted among 1596 stay-
at-home children in 2 middle schools in Zizhong County,
Sichuan Province by Ji et al The detection rate of depres-
sive symptoms in these children was 35.6%, and higher in
female students.28 Using a stratified cluster sampling, Li
et al29 investigated 4995 children in urban and rural areas
of Haikou City, and the total detection rate of depressive
symptoms was 32.3%. In rural students, the rate was 39.0%,
while in urban students, the rate was 29.4%. It is far from
enough to diagnose the psychological problems such as
depression in children. Apart from the attention and help of
teachers and parents, it is necessary to use TCM health
service, which provides rapid intervention and effective
solutions.
Nine constitution types in TCM are an important content
of children’s health service. TCM constitution coordination
is a key method for children’s health service, and TCM
constitutionedisease relation ensures the efficacy and
effectiveness in children’s health service.
Application of TCM constitution health service
in adulthood
Adulthood refers to people aged from 16 to 65 years old,
which is a crucial age range. Research on constitution and
health service in adults is of great significance from the
perspective of economy and society.
The epidemiological study of adult constitution types
is the basis and prerequisite for the development of
constitution health service in adults. Based on the
epidemiological investigation data collected from 9
provinces and municipalities, including 21 948 samples,
Wang et al30 concluded that in the general population in
China, BC accounted for 32.14%, and the other 8 unbal-
anced constitution types were QDC (13.42%), DHC
(9.08%), YADC (9.04%), YIDC (8.27%), blood stasis consti-
tution (BSC, 8.10%), qi stagnation constitution (QSC,
7.66%), phlegm-dampness constitution (PDC, 7.32%), and
inherited special constitution (ISC, 4.97%). The results
were analyzed from many aspects including region, sex,
age, marital status, occupation, and educational level,
etc. The study is helpful in grasping the characteristics of
constitution in China, so as to adjust the unbalanced
constitutions and improve the quality of life and health
conditions. It is of great practical value to explore
“treatment according to the variability of an individual”
and to “treat disease before it arises” in order to promote
the individual prevention stage of life preservation and
evil-warding off into group prevention, and improve the
health constitution.
The health service of TCM constitution in adults is
manifested in the guiding role of health preservation; on
the other hand, it also shows great significance in disease
management and guidance, especially in the management
and guidance of chronic diseases and sub-health.
9
TCM constitution in the management of
hypertension
Hypertension is a worldwide public-health challenge
because of its high frequency and concomitant risks of
cardiovascular and kidney disease. As an article published
in Lancet, 26.4% of the adult population in 2000 suffered
from hypertension, and 29.2% were projected to have this
condition by 2025. The estimated number of hypertensive
adults in 2000 was 972 million. The number was predicted
to increase by about 60% to a total of 1.56 billion in 2025.31
Through analysis of TCM constitution types and cardiovas-
cular risk factors in 1108 hypertensive patients, Huang
et al32 found that the percentage of BC was 20.67%, and the
unbalanced constitution accounted for 79.33%. Among
these unbalanced constitution types, PDC was the most
prominent, 25.54%, followed by YIDC and QDC, 15.16% and
13.18% respectively. They found that PDC was one of the
most related constitution types in cardiovascular risk fac-
tors. Hypertensive patients diagnosed as PDC had the
highest proportion of overweight, abnormal lipid level,
family history of cardiovascular disease (CVD), lack of
physical exercise and electrocardiographic abnormality. Xie
conducted constitution recognition for 214 senile patients
with hypertension that provided with herbal tea as inter-
vention, and evaluated the efficacy after one year. The
blood pressure, effect-developing rate of clinical symp-
toms, and total effectiveness rate were all higher in the
observation group than control group with western drug.33
Therefore, by taking into consideration the characteristics
of constitution and cardiovascular risk factors, community
management of hypertensive patients can be more tar-
geted, more standardized and more effective compared
with the conventional way, and provide new ideas and
methods for standardization management in the
community.
TCM constitution in the management of diabetes
mellitus
Diabetes is referred to a state of hyperglycemia in either
fasting or postprandial states. The chronic hyperglycemia
of diabetes mellitus (DM) is associated with multiple dis-
eases and organs failure. The International Diabetes
Federation estimates an overall prevalence of DM to be 366
million in 2011, and this is expected to rise to 552 million by
2030.34 Yuan et al35 did a correlation analysis between
different phenotypes and TCM constitution types in 246
type 2 diabetic patients, and found that the top three
constitution types were YIDC, PDC, and BSC, accounting for
38.6%, 46.3%, and 15.1% respectively. The levels of fasting
blood glucose (FBG) and blood lipid in YIDC and BSC were
high, and serum creatinine level and the rate of abnormal
electrocardiogram were highest in BSC. In addition, they
found PDC and YIDC were two basic constitution types in
patients with type 2 DM. Most obese patients were classi-
fied into PDC. The prognosis in BSC was poorer compared
with the other constitution types. By a prospective study,
Liu provided health guidance for 89 type 2 DM patients on
the basis of TCM constitution recognition, and were found
compared with the conventional treatment group; levels of
10
FBG and 2-h postprandial blood glucose after therapy were
both lower than those before treatment, and the indexes in
the observation group were even lower. In the two groups,
the levels of cholesterol, triglyceride (TG) and low density
lipoprotein (LDL) were all lower than those before therapy,
and high density lipoprotein (HDL) was higher after treat-
ment.36 Hence one can see that DM management by
constitution recognition can identify its prognosis with
different constitution types, and at the same time, health
guidance based on TCM constitution recognition is of clin-
ical value for effective control of blood glucose.
TCM constitution in the management of
hyperlipidemia
Hyperlipidemia is associated with many chronic diseases.
Elevated plasma LDL-C levels represent one of the most
important risk factors for the development of atheroscle-
rosis and subsequent CVDs and are in fact a prerequisite for
other risk factors such as smoking, inflammation, diabetes
and hypertension to be active.37 Yang et al38 studied the
regularities of constitution distribution of 534 hyperlipid-
emia patients and concluded high risk of unbalanced
constitution types related to hyperlipidemia were PDC,
QDC, YADC, and YIDC accordingly. Meanwhile, the levels of
total cholesterol (TC) and LDL were highest in hyperlipid-
emia patients with PDC. For these hyperlipidemia patients
identified as PDC, YIDC, QDC, and DHC, they were suscep-
tibly combined with hyperuricemia. In PDC, QDC, and DHC
patients suffering from hyperlipidemia, the blood uric acid
level was greatly increased. Zhang et al39 set up health
records for 130 residents with hyperlipidemia and carried
out health management measures like health assessment,
consultation, health education, and instruction of life style,
etc. as intervention, after one year, the life style and di-
etary habits of these residents were to some extent
improved after intervention, and the levels of TG, TC, and
LDL-C were all remarkably decreased compared with
before intervention. This indicates TCM constitution-based
clinical intervention has some guiding significance in
hyperlipidemia and screening for hyperuricemia and other
complications. Community health management may play a
positive role and lifestyle change is effective on blood lipid
control.
TCM constitution in the management of sub-health
Sub-health is a state of low physiological function between
disease and health because of the diversity and unfixed
symptoms of the chief complaint and the complexity of the
disease pathogenesis.40 There is no obvious positive sign
and lack of effective prevention and control methods in
modern medical examination. Traditional Chinese medicine
has always attached great importance to the status of
constitution and constitution factors in the process of dis-
ease occurrence and development. The state of constitu-
tion is an important basis for disease prediction. The
constitution is adjustable because of its relative stability
and dynamic variability. In the state of pro-disease, through
TCM constitution recognition, we can understand the
exuberance and debilitation of qi and blood, and yin and
Q. Wang et al.
yang in sub-health body, set out various intervention pro-
grams, and effectively predict the occurrence of disease by
early reasonable intervention. Therefore, it is deemed that
TCM constitution recognition plays a vital role in adjusting
sub-health.
Application of TCM constitution health service
in old age
The constitution identification and adjustment in over 65
years old people in the service project of national public
health covered 59.2 million people in 2014 accounting for
38.60%. In 2015, the proportion rose to 41.87% (65.315
million people). Driven by the policies of the relevant de-
partments of the state, TCM hospitals at certain levels has
basically set up the centers for disease prevention and
treatment, and the service scale of constitution identifi-
cation and coordination is increasing year by year. For the
elderly, research on constitution classification is the basis
for the development of elderly constitution health service.
Wang et al41 investigated the constitution of the elderly
aged from 60 to 69 years old and concluded the detection
rate of BC was highest, 36.70%, followed by YADC (16.00%)
and QDC (15.10%). The lowest detection rate in constitution
types was DHC (1.60%). It was calculated that the propor-
tion of BC was highest in 38.14%, followed by single un-
balanced constitution types in 28.60% and the lowest
proportion of mixed unbalanced constitution types was
13.49%. In addition, there was an age-related phenomenon
in the constitution state of the elderly. Yang investigated
the distribution of TCM constitution types in 5962 elderly
people, and obtained that the proportion of sub-health in
these unbalanced constitution types identified by TCM
constitution was higher than that by these elderly patients
with BC. Among them, the proportion of sub-health in QSC
was highest.42 TCM constitution identification not only can
make an objective judgement about the individual’s
constitution type and the state of sub-health, but also can
provide the baseline data to formulate healthcare programs
for health and sub-health populations. At the same time,
combined with elderly common and chronic diseases, it can
provide health services.
Cerebrovascular disease in the elderly
The study published in the JAMA said in the United States,
stroke is a main cause of disability. An estimated 700 000
ischemic strokes occur in the United States each year. Most
elderly patients do fear a disabling stroke more than they
fear death.43 The incidence of stroke increases steeply with
age and in the case of individuals over 80 years old is
approximately 27% compared with 13% for individuals
60e79 years old. Within the next 20 years, the incidence of
stroke is expected to increase even by as much as 40%.44
Along with China’s entry into aging society, cerebrovascu-
lar disease shows an upward trend year by year and has
become one of the main causes of death among residents.
Its high mortality and high disability rate have caused heavy
burden on individuals, families and society. Its occurrence,
development and prognosis are closely related to the in-
dividual’s constitution.
TCM constitution in lifetime health maintenance
Li et al45 did a TCM constitution investigation on 178
senile patients with ischemic stroke and found that the top
constitution types were QDC, BSC, YADC, and PDC, which
displayed statistical differences compared with normal
group. The constitution types in these participants were in
markedly correlated with sex and age. Gu investigated 127
senile patients with transient ischemic attack (TIA) on their
TCM constitution types. The results showed that the pa-
tients were all in unbalanced constitution. The first three
constitution types were QDC, YADC, and BSC, which were
closely associated with the occurrence and development of
TIA. Hence, it indicated the high risk factors of TIA.46
Therefore, for elderly patients with TIA risk factors, after
early TCM constitution identification, guidance on consti-
tution adjustment and health education by physicians, and
family healthcare like appropriate lifestyle and dietary
changes can alleviate the clinical symptoms and reduce the
morbidity, so as to guide the prevention, treatment and
rehabilitation of the cerebrovascular diseases.
Cardiovascular disease in the elderly
Cardiovascular disease is one of the major diseases that
have posed the greatest threat to human health and life
since the twentieth century. Elderly adults are a rapidly
growing part of the global population, thus resulting in an
increase in morbidity and mortality related to CVD, which
remains the major cause of death in elderly population. Up
to 85% of CVD patients are over 65 years.47 The elderly are
more affected by economics, disease, emotion, physiology,
and constitution, etc. and have become a high-risk group
for CVDs. In Europe, CVD kills 4 million people in each year.
More patients are surviving their first CVD event and are at
high risk of recurrences.48
Chen investigated 80 coronary heart disease (CHD) pa-
tients, and found that the elderly population was a high-risk
group of CHD in which men were concentrated at the age of
60e79 years old, and women were concentrated over 50
years old. Among patients with coronary angiography, the
constitution types of top three stenosis of coronary artery
were QDC, BSC, and YADC. Tri/Bilateral angiopathies
frequently occurred in QDC and BSC, and unilateral angi-
opathy was most common in QDC. It was believed that CHD
patients at acute attack were presented with excess pat-
terns including blood stasis, phlegm dampness, damp-heat,
and phlegm-stasis in combination. But the essential
constitution types were qi deficiency and yang deficiency in
principal, so the method of qi-reinforcing and yang-
warming used to adjust unbalanced constitution was
applied throughout the treatment of CHD.49
Senile dementia
With the aging of the population, dementia has grown
substantially over the years leading to the age-related na-
ture of many dementia-producing neurodegenerative dis-
eases.50 Senile dementia, as a disease without specific
treatment, has caused heavy burden and inconvenience to
physical and mental health and quality of life in the elderly
as well as family and society. Therefore, early detection,
early treatment, and early prevention have become an
11
important choice for the prevention and treatment of se-
nile dementia. From the perspective of TCM constitution,
how to realize early prevention, detection, and treatment
is also a subject that needs to be carefully thought out and
studied.
Xue et al51 investigated and analyzed 143 community
patients with senile dementia and found that the top 4
constitution types were QDC (including QDC tendency),
YIDC (including YIDC tendency), PDC (including PDC ten-
dency), and BSC (including BSC tendency), accounting for
38.5%, 28.7%, 18.2%, and 15.4% respectively. It was
believed that these four constitution types made the brain
face more risk factors in two aspects, namely, deficiency
and excess, which might contribute to the occurrence of
dementia and were the constitution factors of senile de-
mentia. Lin et al52 discussed the constitution types of mild
cognitive impairment (MCI) patients, and found that the
main risk factor in senile dementia was MCI. QDC, YADC,
BSC, and PDC were the main constitution types of MCI pa-
tients. Therefore, there were certain relationships be-
tween senile dementia and TCM constitution types, and
between MCI and TCM constitution types. From the point of
constitution, effective interventions including mental
adjustment, dietary control, regular life, and drug pre-
vention are the key to reversing the senile dementia and
have positive effects.
Meanwhile, studies of senile hypertension, depression,
DM, hyperlipidemia, fatty liver, constipation, osteoporosis,
hip fractures, insomnia, and gout, etc. are carried on in
order to encourage more applications of TCM constitution
in health management service in the elderly. Nursing pro-
grams like diet, exercise, drug, tuina massage, emotion,
acupoint care, and lifestyle based on the constitution were
implemented.53
Application of TCM constitution health service
in the life cycle of women
Women with infertility
Infertility refers to the failure to conceive, with no
contraception, after one year of regular intercourse in
women <35 years and after 6 months in women >35 years.
Epidemiological data suggest that around 10%e15% of
couples are infertile. Anovulatory problems are responsible
from 25% to 50% of causes of female infertility. Advanced
age, obesity, and drugs, have a negative effect on fertility.
Different hypothalamic, pituitary, thyroid, adrenal, and
ovarian disorders may affect fertility as well.54 By adjusting
constitution and health management on constitution, the
adjustment of the health state of pregnant women to
realize the goal of healthy contraception can be an
important way to improve the healthy level and the quality
of population. Hao analyzed 60 patients with infertility and
identified them all as having unbalanced constitution based
on the constitution theory. In the liver depression pattern
group, the main constitution type was QSC, and in the non-
liver depression pattern group, the main constitution types
were YADC and BSC, while in healthy women, they
belonged to BC. It was believed that QSC was related to
infertility in the liver depression pattern. QSC, YADC, and
12
BSC were the susceptible constitution types in infertility,
which were the pathological basis of constituting the clin-
ical symptoms in infertility.55
Women with pregnancy
Pregnancy is a special and important period in the female
life cycle; its health state not only affects her own quality
of life, but also has an important impact on the health of
the fetus. Therefore, it is necessary to focus on the health
management of pregnant women.
Ling investigated the constitution types of 101 normal
women at the early stage of pregnancy and found that the
percentages of different constitution types were BC
(52.8%), QDC (17.2%), YIDC (12.1%), YADC (10.3%), PDC
(5.2%), QSC (3.4%), DHC (1.7%), ISC (1.7%), and BSC (0%).56
Ge et al57 investigated the constitution types of women in
the second trimester of pregnancy, and found the general
distribution of constitution types were BC (20.2%), YADC
(28.5%), DHC (25.5%), YIDC (25.2%), QSC (23.1%), QDC
(23.1%), BSC (19.1%), PDC (10.9%) and ISC (7.0%). Ye et al58
investigated the constitution types of 213 community
pregnant women, and detected the percentages of BC,
QDC, YADC, YIDC, BSC, PDC, DHC, QSC, and ISC to be 32.4%,
16.4%, 23.0%, 8.5%, 1.9%, 7.5%, 5.6%, 2.3%, and 2.3%. Ling
also investigated the constitution types of pregnant women
with fetal irritability and obtained that the constituent
ratio of constitution types in these pregnant women was
different from that of the healthy pregnant women, char-
acterized by the obvious reduction of BC. In these pregnant
women with fetal irritability, the top 3 unbalanced consti-
tution types were YIDC, YADC, and PDC. The incidence of
fetal irritability was associated with the constitution fac-
tors, and patients with YADC, YIDC, and PDC were more
susceptible to the occurrence of fetal irritability.56 Liu
investigated the TCM constitution types of early pregnant
women in Zhengzhou City and found PDC was a susceptible
type leading to gestational diabetes. There was a statistical
difference in the constituent ratio of TCM constitution be-
tween women with gestational diabetes and healthy preg-
nant women.59 Yang researched on the constitution types in
220 patients with gestational diabetes and came to con-
clusions that the main constitution types of gestational
diabetes were PDC, DHC, and QDC and difference existed in
blood glucose and blood lipid metabolism in gestational
diabetes with different constitution types. There were
certain relations between body mass index and the above
mentioned indexes.60 Qiu carried out a constitution type
analysis in 118 pregnant women complicated with hypo-
thyroidism, and found that the typical constitution types
were YADC (26.57%), QDC (25.63%), and BC (22.47%). The
constituent ratio of YADC and QDC displayed a great dif-
ference compared with that in normal pregnant women.
These two constitution types were high risk ones in gesta-
tional patients with hypothyroidism.61
To summarize, constitution adjustment before preg-
nancy can improve the general health. For normal gesta-
tional women, under the guidance of “treat disease before
it arises” in TCM constitution theory, targeted pregnancy
care based on the constitution of pregnant women can
improve the quality of the population and prevent the
Q. Wang et al.
occurrence and development of gestational diseases. As for
patients in pregnancy, according to the state of constitu-
tion, and without drug intervention, constitution education
and promotion from the perspectives of living conditions,
dietary and living habits, physical life, emotional cultiva-
tion, and medicative diet for comprehensive adjustment
can help restore the TCM constitution balance to a certain
extent and realize the goals of preventing disease before it
arises, controlling the development of existing disease, and
alleviating patient’s discomfort.
Women after delivery
Postpartum is an important period of women’s perinatal
period. The quality of their health management will have
an important impact on postpartum recovery and infant
rearing, and should be given great attention in health
management. Chen et al62 analyzed the constitution of 121
women suffering from postpartum lochiorrhea and found
unbalanced constitution frequently occurred, especially
QDC, BSC and YIDC. The constitution ratio in these partic-
ipants was varied from that in healthy puerperae. Ning
et al63 did a constitution identification investigation in 253
primiparae, and found most of them were classified into
QDC, BC and QSC. The breast-feeding rates 72 h and 4
weeks after delivery in BC primiparae were both higher
than those in other constitution types. The 4-week breast-
feeding rate was greatly decreased in QDC, QSC, BSC, PDC
and DHC. Therefore, the constitution state of pregnant and
lying-in women is closely related with postpartum recovery,
disease prevention and breastfeeding. Targeting puerperae
with different constitution types, we can provide individual
health regimen and suggestions, coordinate constitution for
breast-feeding, largely prevent and reduce the occurrence
of postpartum diseases, improve healthcare mode after
delivery, improve the quality of life in puerperal, promote
the maternal and child healthcare level, guarantee the
breast-feeding demands in infants, and realize the goals of
resisting pathogenic factors, and prevent the occurrence
and development of disease by regulating constitution.
Women in menopause
Menopause, a transitional period from birth to old age, is
very important for women. During this time, the hormone
levels experience dramatic changes ending in a lower level
of estrogen and a senescent ovarian, which causes a series
of discomforts by influencing the function of the
hypothalamus-pituitary-ovarian axis. The health status of
this period is closely related to the health management of
the elderly, so it is very important to provide high-quality
health service in menopause.
He et al64 investigated the constitution types in 763
menopausal women, who were divided into climacteric
syndrome (n Z 580; with symptoms and signs) and the
absence of the syndrome (n Z 183; without symptoms or
signs). In the latter, most of the patients were BC ac-
counting for 71.6%, and in the former one, unbalanced
constitution types were highest, accounting for 87.4%.
Among them, most were in mixed constitution types char-
acterized by 2e6 kinds for 85.4%. Among the mixed
TCM constitution in lifetime health maintenance
constitution types in the two groups, YADC took the largest
proportion. In the climacteric syndrome group, unbalanced
constitution in single type mainly belonged to YADC, YIDC,
and QDC, while in the non-climacteric syndrome group,
BSC, QDC, and YADC were principal ones. Wang et al65
preliminarily explored the intervention of acupuncture
and moxibustion based on constitution identification at the
pre or early stage of menopause abided by the physiological
and constitution characteristics of women menopause. In
the principle of tonifying the kidneys and regulating thor-
oughfare, and harmonizing qi and blood, acupoints of
Sanyinjiao (SP6), Shenshu (BL23), Guanyuan (RN4) and
Baihui (DU20) were selected in appropriate stimulation. As
for the ear acupoints, Neifenmi (CO18) and Shen (CO10)
were chosen. With reference to constitution type, if in
QDC, Zhongwan (RN12), Shenque (RN8), Qihai (RN6), RN4,
Zusanli (ST36), and Pishu (BL20) were used in moxibustion
or tuina massage. In addition, ear acupoints like CO18,
CO10, Jiaogan (AH6a), and Shenshangxian (TG2p) were
pressed. In the case of YADC, the treatment principle was
to tonify the kidneys and warm yang, and boost the fire
source. Acupoints including RN8, RN6, RN4, Zhongji (RN3),
DU20, and BL23, etc. were selected. In dog days or the third
nine-day period after the winter solstice, one or two acu-
points were selected for mild moxibustion by moxa stick or
for hot compress or spectrograph irradiation. Ear points of
CO18, CO10, and AH6a were pressed. If in QSC, soothing the
liver and moving qi, and opening depression were the
treatment principles. Acupoints like RN12, RN6, PC6, RN17,
and LV3 were selected for acupunctural therapy or tuina
massage. Ear points like CO18, CO10, and CO12 were
pressed. Therefore, menopausal women have its own par-
ticularity in the characteristics of constitution and consti-
tution adjustment. Regulation and improvement on diet,
living habits, emotional adjustment, and TCM therapeutic
methods based on their constitution by timely constitution
identification play preventive roles in the occurrence of
climacteric syndrome and related diseases and are also
helpful in relieving symptoms, and ensuring that the
menopausal women that pass through this period are
stable.
Generally speaking, the full life cycle health service
focuses on maintaining and promoting human health in the
whole life cycle and establishes the strategic health sys-
tem covering the full life cycle, whose responsibility is
jointly shared by the government, community, hospital,
family, and individual. Take the characteristics at
different stages including gestation, growth, maturity,
senility, and terminal stage into consideration and
comprehensively apply various interventions such as
medical treatment, disease prevention, health care, life
preservation, and rehabilitation, and carry out individual-
oriented regulations such as medical services, health
management and promotion, health insurance and related
services, design of disease prevention, health care, dis-
ease treatment and care, rehabilitation after critical dis-
ease, hospice care, and psychological counseling in order
to establish the health records covering the full life cycle
and the service mode integrating medicine, health sci-
ence, psychology, informatics, and management science in
a comprehensive multi-disciplinary, multi-coordinated,
and systematic way.
13
With the development of TCM constitution and further
clinical application, it has affected scientific research and
clinical practice in every discipline. From the perspective
of population distribution, it has covered healthy pop-
ulations, sub-health, disease, and pregnancy. Based on
ages, it has involved infants, children, adults, and the
elderly. It can be said that the studying of the full life cycle
of different populations, by accumulating the experience
and data from scientific research and theory to clinical
practice has helped in the implementation of health service
management of the full life cycle based on TCM constitu-
tion theory. But at the same time, from the current scope
of TCM constitution studies, the current clinical and health
management research on constitution mainly emphasize
the constitution types at different population and disease
conditions, neglect the methods and techniques and effect
evaluation of health management, disease prevention,
treatment and rehabilitation based on the TCM constitu-
tion, which is one of the focus points for constitution health
services in the future.
Funding
The paper was supported by the Key Project of National
Natural Science Foundation of China (8173000574).
Conflicts of interest
The authors declare that they have no competing interest.
Author contributions
Qi Wang conceived the study, participated in its design and
coordination, and provided the funding. Minghua Bai and
Yin Yang drafted the manuscript. Xue Liang, Pengcheng Sun
and Junwen Han collected the literature and information.
Taiping Fan and Chunsu Yuan revised the manuscript and
contributed to valuable suggestions. All authors read and
approved the final manuscript.
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