Retrospective Study Open Access
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Mar 19, 2025; 15(3): 103033
Published online Mar 19, 2025. doi: 10.5498/wjp.v15.i3.103033
Harmonizing the mind and body: The interrelationship between traditional Chinese medicine body constitution, mental health and sleep quality
Juan-Juan Yang, Qian Wang, Department of Health Management, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
Wei Jiang, The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710004, Shaanxi Province, China
ORCID number: Juan-Juan Yang (0009-0001-6123-2038); Wei Jiang (0000-0001-5965-7689).
Author contributions: Jiang W and Yang JJ conceived and designed the study and analyzed the clinical data; Yang JJ and Wang Q collected the clinical data; Yang J, Wang Q, and Jiang W wrote the paper; and all authors critically reviewed and provided final approval of the manuscript, and are responsible for the decision to submit the manuscript for publication.
Supported by the National Natural Science Foundation of China, No. 82103022; and the Science Foundation of the Second Affiliated Hospital of Xi’an Jiaotong University, No. RC(XM)202012.
Institutional review board statement: The study was approved by the Ethics Committee of Xi’an Jiaotong University College of Medicine (No. 2022-892).
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: All data generated during this study are included in this published article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wei Jiang, Associate Professor, MD, The Comprehensive Breast Care Center, The Second Affiliated Hospital of Xi’an Jiaotong University, No. 157 West 5th Road, Xi’an 710004, Shaanxi Province, China. jiangweixjtu@163.com
Received: November 6, 2024
Revised: December 31, 2024
Accepted: January 20, 2025
Published online: March 19, 2025
Processing time: 112 Days and 13.2 Hours

Abstract
BACKGROUND

Traditional Chinese medicine (TCM) body constitution is a key factor in determining and influencing the occurrence, development, and variation of diseases. As the mind interact with the body, TCM body constitution is useful in preventing and treating psychiatric disorders and insomnia.

AIM

To investigate the interrelationship between TCM body constitution, psychiatric disorders and sleep quality.

METHODS

A total of 2441 participants were enrolled in our study. TCM body constitution was measured using the Constitution in Chinese Medicine Questionnaire, sleep quality was assessed using the Chinese version of the Pittsburgh Sleep Quality Index, and psychopathological symptoms were evaluated using Symptom Checklist-90. Logistic regression was used to estimate the interrelationship between TCM body constitution, psychiatric disorders and sleep quality.

RESULTS

The Pittsburgh Sleep Quality Index score and the proportions of participants with Qi-deficiency constitution, Qi-stagnation constitution, and blood-stasis constitution were significantly higher in the psychiatric symptoms group. Additionally, psychiatric symptoms were considerably associated with sleep quality, Qi-deficiency constitution, and Qi-stagnation constitution, but were inversely associated with male sex. Obsessive–compulsive symptoms were considerably associated with sleep quality, Qi-deficiency constitution and Qi-stagnation constitution. Depression was considerably associated with sleep quality, hyperuricemia, and Qi-stagnation constitution. Anxiety was considerably associated with sleep quality, diabetes, and Qi-stagnation constitution. Finally, poor sleep quality was considerably associated with Qi-deficiency constitution, Qi-stagnation constitution, dampness-heat constitution, phlegm-dampness constitution, and blood-stasis constitution but was inversely associated with male sex and body mass index > 23.9.

CONCLUSION

TCM body constitutions are strongly associated with psychiatric symptoms and sleep quality. Further research is needed to verify whether TCM body constitution can be used to treat and prevent psychiatric conditions as well as enhance sleep quality.

Key Words: Traditional Chinese medicine; Psychiatric symptom; Depression; Insomnia; Mental health

Core Tip: This retrospective study investigated the correlations between traditional Chinese medicine body constitution, psychiatric disorders, and sleep quality. traditional Chinese medicine body constitution was associated with psychiatric symptoms and sleep quality. The Pittsburgh Sleep Quality Index score and the proportions of participants with a Qi-deficiency constitution, blood-stasis constitution, and Qi-stagnation constitution were significantly higher in the psychiatric symptoms group. Psychiatric symptoms were considerably associated with sleep quality, Qi-deficiency constitution, and Qi-stagnation constitution but inversely associated with male sex. Finally, poor sleep quality was considerably associated with Qi-deficiency constitution, phlegm-dampness constitution, dampness-heat constitution, blood-stasis constitution, and Qi-stagnation constitution but inversely associated with male sex and body mass index > 23.9.
INTRODUCTION

The fundamental principles of traditional Chinese medicine (TCM) are the Yin-Yang theory and Wu Xing in Chinese theory, which are explained in the book Yellow Emperor’s Canon of Medicine[1]. TCM states that diseases are caused by blocked energy channels, and Yin-Yang emphasizes the importance of energy balance[2]. TCM has a thousand-year history as a form of health management. TCM body constitution is a branch of TCM that emphasizes a complete, relatively stable, and natural physical condition, including general characteristics, physical characteristics, TCM clinical manifestations, psychological characteristics, and the body’s response to pathogenic factors[3]. TCM body constitution is divided into gentleness constitution and eight types of unbalanced constitutions, comprising special diathesis constitution, Qi-deficiency constitution, dampness-heat constitution, Qi-stagnation constitution, Yin-deficiency constitution, phlegm-dampness constitution, blood-stasis constitution, and Yang-deficiency constitution[4]. TCM body constitution is influenced by congenital and acquired factors, including ethnicity, inheritance, gender, lifestyle behavior, dietary habits, living environment, emotions, and diseases[4]. A previous study identified that lifestyle behavior and dietary habits as the cause of unbalanced TCM constitutions[5]. TCM body constitution is a key factor determining and influencing the occurrence, development, and variation of diseases because it is a relatively stable variable in life[6]. The research results on TCM body constitution have been applied in public health and clinical practice[7]. The theory of TCM body constitution indicates that a balanced constitution represents a healthy physical state. Thus, people with unbalanced TCM body constitutions are prone to some diseases[8].

Psychiatric disorders such as depression, post-traumatic stress disorder, and anxiety are the leading public health issues worldwide, being considered important factors of total disease burden[9-11]. Despite many treatment options for patients with mental disorders, such as antipsychotic medications, psychotherapy, and electroconvulsive therapy, these can cause many side effects because of drug-drug interactions and the risk of disease recurrence[12]. Consequently, fundamentally preventing and treating mental disorders are crucial. The association between psychiatric disorders and TCM is complex and incompletely understood. According to the theory of TCM, the five viscera, namely the heart, spleen, kidney, liver and lung, are parallel to the Wu Xing, namely metal, wood, water, fire and earth, while the Wu Xing is transformed into emotions, namely happiness, anger, sadness, missing and fear[13]. Qi in TCM is energy to maintain the normal function of internal organs. Mood is mainly regulated by the liver, liver Qi dysfunction will lead to the disharmony of Qi among the five viscera, especially the liver, spleen and heart, which will lead to Qi and blood imbalance, resulting in psychiatric disorders, such as depression[13,14]. An increasing number of studies have suggested that TCM may be an effective method for diagnosing and treating psychiatric disorders[15-17]. For example, TCM, such as Xiaoyao pills, can ameliorate depression[18]. A meta-analysis showed that the evaluation of the TCM body constitution could be useful in preventing and treating depression[19]. However, the association between TCM body constitution and psychiatric symptoms remains unclear.

Sleep is essential for physiological function and is important for energy conservation, immune function, brain waste clearance, and emotions[20]. The association between psychiatric disorders and sleep is also complex[21]. On the one hand, people with psychiatric symptoms are prone to having bad sleep. On the other hand, bad sleep was associated with a higher incidence of psychiatric symptoms[22,23]. According to the theory of TCM, the basic pathogenesis of insomnia, namely sleepless, is Yang excess and Yin decline, and Yin and Yang are out of harmony. However, TCM may be an effective method for treating sleep disorders. For example, the Shumian capsule could improve mental symptoms and sleep disorders in sleep-deprived mice, while Qigong is an effective approach to improve the quality of sleep of patients with drug abuse[24,25]. However, the association between TCM body constitution and sleep is also unclear.

The advantages of TCM include the improvement of sleep quality and mental health. The correlations between TCM body constitution, psychiatric symptoms, and sleep quality are still unclear. Accordingly, this study aimed to investigate the impact of TCM body constitution on psychiatric symptoms and sleep quality. Our investigation could contribute to the body of knowledge regarding the application of TCM in mental health and insomnia treatment.

MATERIALS AND METHODS
Participants

Our research data were collected in our hospital between April 1, 2021 and April 10, 2024. The inclusion criteria in the study were: (1) People who underwent physical examinations and were surveyed by the Symptom Checklist-90 (SCL-90), the Constitution in Chinese Medicine Questionnaire, and the Pittsburgh Sleep Quality Index (PSQI); (2) Han Chinese ethnicity; and (3) Aged ≥ 18 years. The exclusion criteria comprised: (1) Immune-related diseases, infection, or malignant tumors; (2) People taking traditional Chinese medication; (3) Current pregnancy or breastfeeding; (4) Taking antipsychotics; and (5) A history of psychiatric symptoms. This retrospective study finally included 2441 participants. This study was approved by the Ethics Committee of Xi’an Jiaotong University College of Medicine (No. 2022-892).

Demographic and clinical data collection

Demographic and clinical data, including age, sex, smoking history, hypertension history, diabetes history, body mass index (BMI), uric acid, fasting blood sugar (FBS), total cholesterol, triglyceride, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol were extracted from the electronic health examination records in the Department of Health Management of our hospital.

Assessment of TCM body constitution

TCM body constitution was assessed using the Constitution in Chinese Medicine Questionnaire, a questionnaire promulgated by the China Association of Chinese Medicine in 2009[17]. It comprises nine subscales and 60 items. The score of each item ranges from 1 (none at all) to 5 (very much). The original score of each subscale was obtained by summing the scores of the corresponding items and converting them into a conversion score using a standard formula. The conversion score was used to determine the type of body constitution. A participant was considered to have a balanced constitution if the conversion score for the gentleness constitution was > 60, and all other unbalanced constitution scores were < 40. If the conversion score of the other unbalanced constitutions was ≥ 40, the participant was considered to have the constitution represented by the highest score of unbalanced constitution[17].

Assessment of psychiatric symptoms

As our previously reported, the Chinese version of the SCL-90 was used to assess psychiatric symptoms of participants in recent weeks[21]. SCL-90 was designed to evaluate diverse psychiatric symptom dimensions including obsessive compulsions, depression, anxiety, somatization, phobic anxiety, interpersonal sensitivity, anger hostility, paranoid ideation, and psychoticism. All items were summed to obtain a total SCL-90 score and the items relevant to each subscale symptom were averaged to obtain a subscale score[26]. If the total score exceeded 160, any subscale psychiatric symptom score was > 2, or the number of positive items exceeded 43, the participants were considered to have positive psychiatric symptoms[21,26]. The Chinese version of the SCL-90 has been verified to have good reliability and validity[27].

Assessment of sleep quality

The Chinese version of the PSQI, a 19-item questionnaire designed to assess the quality of sleep, was used to assess sleep quality[21]. The total PSQI score ranges from 0 to 21, with a total PSQI score > 5 reflecting poor sleep quality[28].

Statistical analysis

IBM SPSS Statistics 24.0 (IBM Corp., Armonk, NY, United States) was used to analyze the data. Continuous variables are showed as the mean ± SD, whereas categorical variables are showed as absolute values. The normality test was performed by the Shapiro-Wilk test. Student’s t-test was used to evaluate the differences in continuous variables, and the χ2-test was used to assess the differences in dichotomous variables between control group and psychiatric symptoms group. Logistic regression was used to explore the risk factors of psychiatric symptoms and sleep disorders among all participants. A P < 0.05 indicated statistical significance.

RESULTS
Demographic and clinical characteristics

This study included 2190 controls (the control group) and 251 participants experiencing de novo psychiatric symptoms (psychiatric symptoms group). Table 1 presents the age, sex, hypertension history, systolic blood pressure (SBP), diastolic blood pressure (DBP), diabetes history, BMI, smoking history, uric acid, FBS, total cholesterol, triglyceride, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, PSQI score, and TCM body constitution of participants. The mean age in the psychiatric symptoms group was lower than that in the control group (36.0 ± 11.5 years vs 38.3 ± 10.6 years, P = 0.001, Table 1). The proportion of females in the psychiatric symptoms group was higher than in the control group (61.8% vs 39.5%, P < 0.001, Table 1). Additionally, the SBP and DBP in the psychiatric symptoms group were lower than in the control group (SBP: 119.6 ± 15.2 mmHg vs 121.8 ± 14.5 mmHg, P = 0.023; DBP: 75.2 ± 11.1 mmHg vs 77.5 ± 10.9 mmHg, P = 0.001, Table 1). The BMI in the psychiatric symptoms group was also lower than in the control group (23.8 ± 3.8 vs 24.3 ± 3.6, P = 0.043, Table 1). The uric acid level in the psychiatric symptoms group was 323.1 ± 90.8 μmol/L, which was lower than in the control group (340.1 ± 91.4 μmol/L, P = 0.006, Table 1). As expected, the PSQI score in the psychiatric symptoms group was 10.3 ± 3.5, which was higher than in the control group (5.8 ± 3.3, P < 0.001, Table 1). There was no significant difference between the two groups in hypertension history (P = 0.206), diabetes history (P = 0.747), smoking history (P = 0.096), FBS (P = 0.227), total cholesterol (P = 0.754), triglyceride (P = 0.866), low-density lipoprotein cholesterol (P = 0.158), and high-density lipoprotein cholesterol (P = 0.148). Among the 251 participants in the psychiatric symptoms group, 111 participants had only one psychiatric symptom, while the remaining 140 participants had ≥ 2 psychiatric symptoms simultaneously. For specific psychiatric symptoms, 53 participants had somatization, 130 participants had obsessive compulsion, 82 participants had interpersonal sensitivity, 122 participants had depression, 70 participants had anxiety, 105 participants had anger hostility, 27 participants had phobic anxiety, 62 participants had paranoid ideation, and 40 participants had psychoticism.

Table 1 Demographic and clinical characteristics of healthy controls and psychiatric symptoms group, n (%).
Variable
Healthy controls (n = 2190)
Psychiatric symptoms group (n = 251)
P value
Age, years38.3 ± 10.636.0 ± 11.50.001
Male1325 (60.5)96 (38.2)< 0.001
Female865 (39.5)155 (61.8)< 0.001
Hypertension171 (7.8)14 (5.6)0.206
No hypertension2019 (92.2)237 (94.4)0.206
SBP, mmHg121.8 ± 14.5119.6 ± 15.20.023
DBP, mmHg77.5 ± 10.975.2 ± 11.10.001
Diabetes60 (2.7)6 (2.4)0.747
No diabetes2130 (97.3)245 (97.6)0.747
FBS, mmol/L5.2 ± 1.15.1 ± 1.30.227
BMI, kg/m224.3 ± 3.623.8 ± 3.80.043
Uric acid, μmol/L340.1 ± 91.4323.1 ± 90.80.006
Total cholesterol, mmol/L4.5 ± 0.94.4 ± 0.80.754
Triglyceride, mmol/L1.6 ± 1.31.6 ± 1.40.866
Low-density lipoprotein cholesterol, mmol/L2.7 ± 0.72.7 ± 0.70.158
High-density lipoprotein cholesterol, mmol/L1.3 ± 0.31.3 ± 0.30.148
Smokers446 (20.4)40 (15.9)0.096
No smokers1744 (79.6)211 (84.1)0.096
Pittsburgh Sleep Quality Index5.8 ± 3.310.3 ± 3.5< 0.001
Gentleness constitution1162 (53.1)6 (2.4)< 0.001
Unbalanced constitution1028 (46.9)245 (97.6)< 0.001
Qi-deficiency constitution148 (6.8)46 (18.3)< 0.001
Yang-deficiency constitution222 (10.1)35 (13.9)0.063
Yin-deficiency constitution62 (2.8)5 (2.0)0.441
Phlegm-dampness constitution112 (5.1)19 (7.6)0.102
Dampness-heat constitution268 (12.2)38 (15.1)0.188
Blood-stasis constitution67 (3.1)18 (7.2)0.001
Qi-stagnation constitution94 (4.3)80 (31.9)< 0.001
Inherited special constitution55 (2.5)4 (1.6)0.370
Continuous variables were presented as mean ± SD. SBP: Systolic blood pressure; DBP: Diastolic blood pressure; FBS: Fasting blood sugar; BMI: Body mass index.
The comparisons of traditional TCM body constitution between two groups

Table 1 also compares the proportions of participants with or without psychiatric symptoms for each of the nine types of TCM body constitution. The proportion of participants with a balance constitution was significantly higher in the control group (53.1% vs 2.4%, P < 0.001, Table 1). Conversely, the proportions of participants with Qi-deficiency constitution (P < 0.001), blood-stasis constitution (P = 0.001), and Qi-stagnation constitution (P < 0.001) were significantly higher in the psychiatric symptoms group. No significant differences were observed between the two groups in the remaining five types of TCM body constitutions.

Association between TCM body constitution, sleep quality and psychiatric symptoms

In multiple logistic regression analysis, psychiatric symptoms were significantly associated with sleep quality [odds ratio (OR): 4.410, 95% confidence interval (CI): 2.601-7.476, P < 0.001, Table 2], Qi-deficiency constitution (OR: 3.635, 95%CI: 1.228-10.760, P = 0.020, Table 2), and Qi-stagnation constitution (OR: 9.464, 95%CI: 3.219-27.824, P < 0.001, Table 2), but inversely associated with male sex (OR: 0.647, 95%CI: 0.427-0.981, P = 0.040, Table 2). For specific psychiatric symptoms, similarly, obsessive compulsion was significantly associated with sleep quality (OR: 3.045, 95%CI: 1.578-5.876, P = 0.001, Table 3), Qi-deficiency constitution (OR: 5.216, 95%CI: 1.197-22.734, P = 0.028, Table 3), and Qi-stagnation constitution (OR: 6.543, 95%CI: 1.500-28.539, P = 0.012, Table 3). Our results also showed that depression was significantly associated with sleep quality (OR: 4.722, 95%CI: 2.009-11.102, P < 0.001, Table 4), hyperuricemia (OR: 1.978, 95%CI: 1.049-3.728, P = 0.035, Table 4), and Qi-stagnation constitution (OR: 8.780, 95%CI: 2.018-38.187, P = 0.004, Table 4). Anxiety was significantly associated with sleep quality (OR: 4.385, 95%CI: 1.310-14.674, P = 0.016, Table 5), diabetes (OR: 4.216, 95%CI: 1.173-15.155, P = 0.027, Table 5), and Qi-stagnation constitution (OR: 11.497, 95%CI: 1.506-87.740, P = 0.019, Table 5). Results from the multiple logistic regression analysis showed that interpersonal sensitivity, somatization, paranoid ideation, anger hostility, phobic anxiety, and psychoticism were not associated with TCM body constitution. However, somatization (OR: 12.318, 95%CI: 1.666-91.085, P = 0.014), interpersonal sensitivity (OR: 2.845, 95%CI: 1.201-6.736, P = 0.017), anger hostility (OR: 2.878, 95%CI: 1.338-6.189, P = 0.007), phobic anxiety (OR: 8.855, 95%CI: 1.075-72.947, P = 0.043), and paranoid ideation (OR: 3.638, 95%CI: 1.260-10.504, P = 0.017) were significantly associated with sleep quality.

Table 2 Multivariable logistic regression analysis of psychiatric symptoms.
Variable
OR
95%CI
P value
Sex, male0.6470.427-0.9810.040
Sleep quality4.4102.601-7.476< 0.001
Qi-deficiency constitution3.6351.228-10.7600.020
Qi-stagnation constitution9.4643.219-27.824< 0.001
OR: Odds ratio; CI: Confidence interval.
Table 3 Multivariable logistic regression analysis of obsessive–compulsive.
Variable
OR
95%CI
P value
Sleep quality3.0451.578-5.8760.001
Qi-deficiency constitution5.2161.197-22.7340.028
Qi-stagnation constitution6.5431.500-28.5390.012
OR: Odds ratio; CI: Confidence interval.
Table 4 Multivariable logistic regression analysis of depression.
Variable
OR
95%CI
P value
Sleep quality4.7222.009-11.102< 0.001
Hyperuricemia1.9781.049-3.7280.035
Qi-stagnation constitution8.7802.018-38.1870.004
OR: Odds ratio; CI: Confidence interval.
Table 5 Multivariable logistic regression analysis of anxiety.
Variable
OR
95%CI
P value
Sleep quality4.3851.310-14.6740.016
Diabetes4.2161.173-15.1550.027
Qi-stagnation constitution11.4971.506-87.7400.019
OR: Odds ratio; CI: Confidence interval.
Association between TCM body constitutions and sleep quality

We also analyzed the relationship between TCM body constitutions and sleep quality. Results from the multiple logistic regression analysis demonstrated that poor sleep quality was significantly associated with Qi-deficiency constitution (OR: 3.041, 95%CI: 1.572-5.882, P = 0.001, Table 6), phlegm-dampness constitution (OR: 1.976, 95%CI: 1.012-3.857, P = 0.046, Table 6), dampness-heat constitution (OR: 1.971, 95%CI: 1.088-3. 572, P = 0.025, Table 6), blood-stasis constitution (OR: 2.239, 95%CI: 1.028-4.875, P = 0.042, Table 6), and Qi-stagnation constitution (OR: 6.038, 95%CI: 2.810-12.973, P < 0.001, Table 6), but inversely associated with male sex (OR: 0.779, 95%CI: 0.613-0.989, P = 0.041, Table 6) and BMI (BMI > 23.9, OR: 0.762, 95%CI: 0.620-0.937, P = 0.010, Table 6). Hence, female participants and those with BMI < 24, Qi-deficiency constitution, Qi-stagnation constitution, dampness-heat constitution, blood-stasis constitution, and phlegm-dampness constitution had poor sleep quality.

Table 6 Multivariable logistic regression analysis of sleep disorders.
Variable
OR
95%CI
P value
Sex, male0.7790.613-0.9890.041
BMI, > 23.90.7620.620-0.9370.010
Qi-deficiency constitution3.0411.572-5.8820.001
Phlegm-dampness constitution1.9761.012-3.8570.046
Dampness-heat constitution 1.9711.088-3.5720.025
Blood-stasis constitution2.2391.028-4.8750.042
Qi-stagnation constitution6.0382.810-12.973< 0.001
OR: Odds ratio; CI: Confidence interval.
DISCUSSION

The present study confirms that TCM body constitutions are associated with psychiatric symptoms and sleep quality. First, we found that the PSQI score and the proportions of participants with Qi-deficiency constitution, blood-stasis constitution, and Qi-stagnation constitution were significantly higher in the psychiatric symptoms group. Second, psychiatric symptoms were considerably associated with sleep quality, Qi-deficiency constitution, and Qi-stagnation constitution but were inversely associated with male sex. For specific psychiatric symptoms, obsessive-compulsive symptoms were considerably associated with sleep quality, Qi-deficiency constitution, and Qi-stagnation constitution. Furthermore, depression was considerably associated with sleep quality, hyperuricemia, and Qi-stagnation constitution. Anxiety was considerably associated with sleep quality, diabetes, and Qi-stagnation constitution. Finally, poor sleep quality was considerably associated with Qi-deficiency constitution, Qi-stagnation constitution, dampness-heat constitution, blood-stasis constitution, and phlegm-dampness constitution but was inversely associated with male sex and BMI > 23.9.

TCM is one of the oldest medical systems in the world, with a thousand-year history. It is a form of health management that maintains or restores the harmony and balance of Yin and Yang in the human body[15,19]. TCM believes that the prevention and treatment of diseases need to be individualized. Syndrome differentiation is the core principle of TCM in clinical practice. During the development of the disease, the syndrome changes dynamically with the patient's physiological and psychological state[15,29]. The TCM body constitution is a branch of TCM, which is formed from five fundamental substances[19]. Chinese medicine has a history of thousands of years, however, the theory of TCM body constitution was not put forward until the late 1970s[4]. The TCM body constitution is influenced by congenital and acquired factors, reflecting the physical, physiological and psychiatric functions of the body[4,15,19]. The TCM body constitution is a key factor determining and influencing the occurrence, development, and variation of diseases[6,30]. Previous studies have focused on exploring the relationship between TCM body constitution and mental health in people with special diseases or specific occupations, such as cancer patients, workers and students[31-33]. This study is to investigate the relationship between TCM body constitutions and the mental health of general public. We found mental health was significantly associated with Qi-deficiency constitution and Qi-stagnation constitution. Our research results are to provide prevention and treatment strategies for the mental health of the public from the perspective of TCM.

For psychological characteristics of TCM body constitution, gentleness constitution is a harmonious constitution. People with Qi-stagnation constitution are prone to such symptoms as emotional instability, excessive worry, frequent sighing, low mood, and emotional fluctuations, while those with Qi-deficiency constitution are prone to such symptoms as fatigue, introversion, and timidity[4,19]. People with blood-stasis constitution are forgetful and impatient[33]. Additionally, people with phlegm-dampness constitution usually have a mild and calm personality[30,34]. Furthermore, people with a Yin-deficiency constitution are extroverted and impatient, while people with a Yang-deficiency constitution are quiet and introverted[33,35]. People with dampness-heat constitution are irritable while with special diathesis constitution sensitive to allergens[33]. As mentioned before, Qi in TCM is energy to maintain the normal function of internal organs and Qi dysfunction will lead to Qi and blood imbalance, resulting in diseases, such as psychiatric disorders[13,14]. Evidence shows that TCM body constitution is related to psychiatric symptoms. Kong et al[17] reported that Qi-deficiency and Qi-stagnation constitutions were associated with depression, whereas Qi-stagnation constitution was associated with anxiety in systemic sclerosis patients. Similarly, Yap et al[33] showed that Qi-stagnation had was positively correlated with depression, while balanced constitution was negatively correlated with depression. A meta-analysis demonstrated that Qi-deficiency, Yang-deficiency, Qi-stagnation, and Yin-deficiency are major predictors of depression, while gentleness constitution is a protective factor against depression[19]. However, Chen et al[36] demonstrated that women with Yin-deficient and Yang-deficient constitutions are prone to depression. Our results found that the proportions of participants with Qi-deficiency constitution, Qi-stagnation constitution, and blood-stasis constitution were significantly higher in the psychiatric symptoms group. We also found that psychiatric, symptoms especially obsessive compulsion, was strongly associated with Qi-stagnation constitution and Qi-deficiency constitution. Furthermore, depression and anxiety were strongly associated with Qi-stagnation constitution. Therefore, the evaluation of a person’s TCM body constitution could be useful in indicating a person’s mental condition.

TCM body constitution is the basis of TCM diagnosis, treatment and prevention of diseases[15]. TCM body constitution is determined by congenital genetic factors and acquired environmental factors. Although TCM body constitution is relatively stable, it can be adjusted and changed[4,19]. Prescription interventions, acupuncture, diet, and exercise, such as Qigong and yoga can effectively regulate TCM body constitution[37]. TCM could provide effective methods to treat psychiatric disorders according to TCM body constitution. For example, Xiaoyaosan is a TCM that can improve the syndrome of liver Qi-stagnation and spleen deficiency, being primarily used for the treatment of mental illnesses, such as anxiety and depression[38,39]. Qigong is a concept for various traditional Chinese energy exercises and therapies that enhance the flow of Qi and eliminate any blockage that might create stagnant Qi[40,41]. Clinical studies showed that Qigong could reduce anxiety and depression symptoms[41-43]. We found that Qi-stagnation and Qi-deficiency constitutions are positively associated with psychiatric symptoms, possibly representing the cause of psychiatric disorders. Hence, these findings suggest that the evaluation of a person’s TCM body constitution, such as Qi-deficiency constitution and Qi-stagnation constitution could be useful in the prophylaxis and treatment of mental disorders.

Regarding sleep quality, one case-control study found that insomnia was strongly associated with Qi-stagnation[44]. Another previous study found that the distribution of TCM body constitution was mostly mixed constitution, among which Qi-deficiency constitution was most likely to merge with other constitutions, in elderly people with insomnia[45]. Furthermore, a study found that dampness-heat constitution has a significant indirect effect on the PSQI[46]. Our results found that sleep quality was strongly associated with phlegm-dampness constitution, Qi-deficiency constitution, Qi-stagnation constitution, blood-stasis constitution, and dampness-heat constitution. This link between TCM body constitution and sleep quality implies that adjusting TCM body constitution could be an effective method for preventing and treating sleep problems. Xia et al[45] found that identifying and classifying TCM body constitutions in patients with insomnia can provide a further reference for the development of systematic measures to treat insomnia. Health Qigong, a TCM therapy, has been found to effectively improve sleep quality in patients with drug abuse[25]. Furthermore, a meta-analysis demonstrated that TCM Yangxin Anshen therapy is an effective and safe alternative therapy for insomnia[47].

Our previous study demonstrated an interaction between psychiatric symptoms and sleep quality[21]. Sleep problems may predict later psychiatric symptoms, which, in turn, may decrease sleep quality[22]. On one hand, patients with psychiatric disorders are more likely to smoke and drink, leading to lower sleep quality[28]. On the other hand, sleep is important for regulating emotions, and poor sleep could disrupt the emotional processing by the brain[48]. We found that the PSQI score was significantly higher in the psychiatric symptoms group. Our results also indicated that almost all specific psychiatric symptoms were considerably associated with sleep quality. However, the specific relationship between TCM body constitution, psychiatric symptoms, and sleep needs to be further explored and clarified.

This study has several limitations. Because of the cross-sectional characteristics, this study only indicated that TCM body constitutions are associated with psychiatric symptoms and sleep quality, but a causal relationship could not be made. Second, some other potential influencing factors, such as life events and stress, that may also influence psychiatric symptoms and sleep quality were not analyzed in our research. Finally, the present study revealed that TCM body constitutions are associated with psychiatric symptoms and sleep quality, although the conclusions need verification in large clinical studies.

CONCLUSION

In summary, our study found that TCM body constitutions are strongly associated with psychiatric symptoms and sleep quality. Adjusting TCM body constitutions may be an effective approach to prevent and treat mental diseases and insomnia.

ACKNOWLEDGEMENTS

We want to express our gratitude to all participants for their cooperation.

Footnotes

Provenance and peer review: Unsolicited article; Externally peer reviewed.

Peer-review model: Single blind

Specialty type: Psychiatry

Country of origin: China

Peer-review report’s classification

Scientific Quality: Grade C, Grade D

Novelty: Grade B, Grade C

Creativity or Innovation: Grade B, Grade C

Scientific Significance: Grade B, Grade D

P-Reviewer: He KJ; Zhou R S-Editor: Wei YF L-Editor: A P-Editor: Xu ZH

References
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