Personalizing Traditional Chinese Medicine: A Longitudinal Study on How Constitution-Based Configurations Relate to...

Traditional Chinese Medicine (TCM) constitution theory underpins personalized health management, but most studies examine constitution types in isolation, whereas overlapping constitutions are the rule rather than the exception in practice. This study examined how combinations of TCM constitution subscale scores were related to health-related quality of life (QoL) over six months of constitution-based comprehensive intervention.

In a single-arm prospective study, 509 adults aged 19-84 years completed a 6-month constitution-based self-management programme. Constitution was assessed with the 60-item Constitution in Chinese Medicine Questionnaire (CCMQ-60), which yields a Gentleness (Type A) score and scores on eight biased types (Qi-Deficiency, Yang-Deficiency, Yin-Deficiency, Phlegm-Dampness, Damp-Heat, Blood-Stasis, Qi-Depression, Special-Diathesis). QoL was measured with the 36-Item Short Form Health Survey (SF-36) at baseline, 3 months, and 6 months. Dynamic (panel) and "bottom-up" fuzzy-set qualitative comparative analysis (fsQCA) were used to identify constitution configurations associated with high QoL at each time point.

The mean SF-36 total score rose from 72.7 ± 16.1 at baseline to 75.1 ± 14.6 at 3 months and 75.6 ± 15.5 at 6 months (mean change 2.9 points, 95% CI 1.7 to 4.1; standardized change 0.21). No single constitution subscale was a necessary condition for high QoL (pooled consistency < 0.90). Dynamic fsQCA identified 5 overlapping configurations (consistency 0.946-0.953; solution coverage 0.540), each characterized by a high Gentleness score combined with low scores on most biased constitutions; unique coverage of individual configurations was small (0.006-0.049). Bottom-up analysis at a PRI threshold of 0.75 retained low Yang-Deficiency or low Blood-Stasis together with low Qi-Depression at baseline and 3 months (consistency 0.867-0.873), whereas at 6 months the retained pairs were low Qi-Deficiency with low Yang-Deficiency or low Blood-Stasis, and low Yang-Deficiency with low Phlegm-Dampness (consistency 0.856-0.866). Consistency of the configurations exceeded 0.90 in every age and sex stratum.

During the programme, high QoL was associated with a high Gentleness score combined with low scores on several biased constitutions rather than with any single constitution type, and the pairs of biased constitutions that distinguished high QoL at 6 months differed from those at baseline and 3 months. Because the study had no control group, these configurational patterns are descriptive and hypothesis-generating; they point to combinations of constitutions that could be prioritized and tested in controlled evaluations of constitution-based personalized health management.