Classification and Assessment Standards of TCM Constitution

Classification and Assessment Standards of TCM Constitution

On April 9, 2009, the “Classification and Assessment of TCM Constitution” standard was officially released. This standard is the first document in China to guide and regulate the research and application of TCM constitution, aiming to provide a basis for the identification of constitution and the prevention and treatment of diseases related to TCM constitution, as well as health management, making the classification of constitution scientific and standardized.

The formulation of the “Classification and Assessment of TCM Constitution” standard officially started in June 2006, supervised by the State Administration of Traditional Chinese Medicine and compiled by the Constitution Branch of the Chinese Association of Traditional Chinese Medicine. The standard is divided into five parts: scope, terminology and definitions, nine basic classifications and characteristics of TCM constitution, assessment of TCM constitution classification, and appendices (classification and assessment table of TCM constitution). TCM constitution scholars classified human constitution based on body morphology, physiological functions, psychological characteristics, and response states, formulating the TCM constitution scale and the “Classification and Assessment of TCM Constitution” standard. This standard applies interdisciplinary methods from TCM constitution, genetics, epidemiology, psychological measurement, and mathematical statistics, established after multiple discussions and validations by experts in TCM constitution, clinical experts, and epidemiology experts, and has undergone a nationwide epidemiological survey of 21,948 cases, showing good adaptability and feasibility.

This standard divides constitution into nine types: Pinghe Zhi (Balanced Constitution), Qi Xu Zhi (Qi Deficiency Constitution), Yang Xu Zhi (Yang Deficiency Constitution), Yin Xu Zhi (Yin Deficiency Constitution), Tan Shi Zhi (Phlegm-Damp Constitution), Shi Re Zhi (Damp-Heat Constitution), Xue Yu Zhi (Blood Stasis Constitution), Qi Yu Zhi (Qi Stagnation Constitution), and Te Bing Zhi (Special Constitution). It employs interdisciplinary methods from epidemiology, immunology, molecular biology, genetics, and mathematical statistics, established as a standardized tool for constitution identification after multiple validations by clinical experts, epidemiology experts, and constitution experts, and has been further improved in the national 973 program “Research on the Theoretical Basis of TCM Constitution Based on Individualized Treatment”.

Through the epidemiological survey of 21,948 cases, this standard is guiding, universal, and referable, applicable to TCM clinical practitioners, researchers, and related management personnel engaged in TCM constitution research, and can serve as an important reference for clinical practice, assessment standards, and quality evaluation. This standard has been trialed in many “Preventive Treatment” centers and TCM research institutions across 26 provinces, cities, and autonomous regions (including Hong Kong Special Administrative Region and Taiwan).

TCM Constitution Scale and the “Classification and Assessment of TCM Constitution” Standard

This standard divides constitution into nine types: Pinghe Zhi (Balanced Constitution), Qi Xu Zhi (Qi Deficiency Constitution), Yang Xu Zhi (Yang Deficiency Constitution), Yin Xu Zhi (Yin Deficiency Constitution), Tan Shi Zhi (Phlegm-Damp Constitution), Shi Re Zhi (Damp-Heat Constitution), Xue Yu Zhi (Blood Stasis Constitution), Qi Yu Zhi (Qi Stagnation Constitution), and Te Bing Zhi (Special Constitution).

1. Classification and Assessment of TCM Constitution

(1) Pinghe Zhi (A Type)

Overall Characteristics: Harmonized Yin, Yang, Qi, and Blood, with moderate body shape, rosy complexion, and abundant energy as main features.

Physical Characteristics: Well-proportioned and robust body shape.

Common Manifestations: Rosy complexion and skin, thick and shiny hair, bright eyes, clear nasal color, good sense of smell, rosy lips, not easily fatigued, abundant energy, tolerant to cold and heat, good sleep, good appetite, normal bowel movements, pale red tongue, thin white coating, and soft, strong pulse.

Psychological Characteristics: Easy-going and cheerful personality.

Predisposition to Illness: Rarely falls ill.

Adaptability to External Environment: Strong adaptability to natural and social environments.

(2) Qi Xu Zhi (B Type)

Overall Characteristics: Insufficient vital energy, with fatigue, shortness of breath, and spontaneous sweating as main features.

Physical Characteristics: Soft and weak muscles.

Common Manifestations: Usually has a weak voice, shortness of breath, easily fatigued, low spirits, prone to sweating, pale red tongue with tooth marks, and weak pulse.

Psychological Characteristics: Introverted personality, not fond of taking risks.

Predisposition to Illness: Prone to colds, organ prolapse, etc.; slow recovery after illness.

Adaptability to External Environment: Poor tolerance to wind, cold, heat, and dampness.

(3) Yang Xu Zhi (C Type)

Overall Characteristics: Insufficient Yang energy, with fear of cold, cold hands and feet as main features.

Physical Characteristics: Soft and weak muscles.

Common Manifestations: Usually fears cold, cold hands and feet, prefers warm food, low spirits, pale and swollen tongue, and deep, slow pulse.

Psychological Characteristics: Generally calm and introverted personality.

Predisposition to Illness: Prone to phlegm retention, swelling, diarrhea, etc.; easily affected by cold.

Adaptability to External Environment: Tolerates summer but not winter; easily affected by wind, cold, and dampness.

(4) Yin Xu Zhi (D Type)

Overall Characteristics: Insufficient Yin fluids, with dry mouth and throat, hot palms and feet as main features.

Physical Characteristics: Generally thin body shape.

Common Manifestations: Hot palms and feet, dry mouth and throat, slightly dry nose, prefers cold drinks, dry stools, red tongue with little moisture, and thin, rapid pulse.

Psychological Characteristics: Impulsive, extroverted, and lively personality.

Predisposition to Illness: Prone to deficiency fatigue, nocturnal emissions, insomnia, etc.; easily affected by heat.

Adaptability to External Environment: Tolerates winter but not summer; poor tolerance to heat and dryness.

(5) Tan Shi Zhi (E Type)

Overall Characteristics: Phlegm and dampness accumulation, with obesity, fullness in the abdomen, and sticky coating on the tongue as main features.

Physical Characteristics: Obese body shape, soft and full abdomen.

Common Manifestations: Oily skin on the face, excessive sweating, chest tightness, phlegm accumulation, sticky or sweet taste in the mouth, prefers fatty and sweet foods, thick coating on the tongue, and slippery pulse.

Psychological Characteristics: Generally mild and steady personality, good at enduring.

Predisposition to Illness: Prone to diabetes, stroke, chest obstruction, etc.

Adaptability to External Environment: Poor adaptability to rainy seasons and damp environments.

(6) Shi Re Zhi (F Type)

Overall Characteristics: Internal damp-heat, with oily skin, bitter mouth, and yellow sticky coating on the tongue as main features.

Physical Characteristics: Medium or slightly thin body shape.

Common Manifestations: Oily skin, prone to acne, bitter mouth, heavy body, sticky or constipated stools, short yellow urine, men prone to damp scrotum, women prone to increased vaginal discharge, red tongue, yellow sticky coating, and slippery, rapid pulse.

Psychological Characteristics: Easily irritated and anxious.

Predisposition to Illness: Prone to sores, jaundice, heat dysuria, etc.

Adaptability to External Environment: Poor adaptability to humid and hot climates at the end of summer and beginning of autumn.

(7) Xue Yu Zhi (G Type)

Overall Characteristics: Poor blood circulation, with dull skin color and purple tongue as main features.

Physical Characteristics: Can be either thin or fat.

Common Manifestations: Dull skin color, pigmentation, easy bruising, dark lips, purple or spotted tongue, purple or thickened sublingual veins, and choppy pulse.

Psychological Characteristics: Prone to irritability and forgetfulness.

Predisposition to Illness: Prone to masses and pain syndromes, blood disorders, etc.

Adaptability to External Environment: Poor tolerance to cold.

(8) Qi Yu Zhi (H Type)

Overall Characteristics: Qi stagnation, with depressed mood and anxiety as main features.

Physical Characteristics: Generally thin body shape.

Common Manifestations: Depressed mood, emotional fragility, unhappiness, pale red tongue, thin white coating, and wiry pulse.

Psychological Characteristics: Introverted, unstable, sensitive, and anxious personality.

Predisposition to Illness: Prone to organ disorders, plum pit syndrome, lily disease, and depression.

Adaptability to External Environment: Poor adaptability to mental stimuli; not suited to rainy weather.

(9) Te Bing Zhi (I Type)

Overall Characteristics: Congenital abnormalities, with physiological defects and allergic reactions as main features.

Physical Characteristics: Generally no special features for allergic constitution; congenital abnormalities may present as deformities or physiological defects.

Common Manifestations: Allergic constitution often presents with asthma, hives, itchy throat, nasal congestion, sneezing, etc.; hereditary diseases may show vertical inheritance, congenital, or familial characteristics; fetal transmission diseases may show maternal influence on fetal growth and development and related disease characteristics.

Psychological Characteristics: Varies according to the specific constitution.

Predisposition to Illness: Allergic constitution is prone to asthma, urticaria, hay fever, and drug allergies; hereditary diseases such as hemophilia, congenital mental retardation, etc.; fetal transmission diseases such as five delays (delayed standing, walking, speaking, teething, and language) and five soft (soft head, neck, limbs, muscles, and mouth), cranial deformities, and fetal fright.

Adaptability to External Environment: Poor adaptability, such as allergic constitution being poorly adapted to seasons that easily cause allergies, easily triggering chronic diseases.

2. Assessment of TCM Constitution Classification

(1) Assessment Method

Answer all questions in the “Classification and Assessment Table of TCM Constitution”. Each question is scored on a 5-point scale, calculate the raw score and converted score, and determine the constitution type according to the standard.

Raw Score= Sum of scores for each item.

Converted Score= [(Raw Score – Number of Items) / (Number of Items × 4)] × 100

(2) Assessment Standards

Pinghe Zhi is the normal constitution, while the other eight types are considered biased constitutions. The assessment standards are shown in the table below.

Assessment Standards for Pinghe Zhi and Biased Constitutions

Constitution Type	Condition	Assessment Result
Pinghe Zhi	Converted Score≧60 points	Yes
Other 8 types with converted scores < 30 points
Converted Score≧60 points	Basically Yes
Other 8 types with converted scores < 40 points
Those not meeting the above conditions	No
Biased Constitution	Converted Score≧40 points	Yes
Converted Score 30～39 points	Tendency to be
Converted Score < 30 points	No

(3) Example 1: A person’s converted scores for each constitution type are as follows: Pinghe Zhi 75 points, Qi Xu Zhi 56 points, Yang Xu Zhi 27 points, Yin Xu Zhi 25 points, Tan Shi Zhi 12 points, Shi Re Zhi 15 points, Xue Yu Zhi 20 points, Qi Yu Zhi 18 points, Te Bing Zhi 10 points. According to the assessment standards, although the converted score for Pinghe Zhi is ≥60 points, the other 8 types do not all have scores <40 points, among which Qi Xu Zhi has a converted score ≥40 points, so this person cannot be assessed as Pinghe Zhi and should be assessed as Qi Xu Zhi.

Example 2: A person’s converted scores for each constitution type are as follows: Pinghe Zhi 75 points, Qi Xu Zhi 16 points, Yang Xu Zhi 27 points, Yin Xu Zhi 25 points, Tan Shi Zhi 32 points, Shi Re Zhi 25 points, Xue Yu Zhi 10 points, Qi Yu Zhi 18 points, Te Bing Zhi 10 points. According to the assessment standards, the converted score for Pinghe Zhi is ≥60 points, and the other 8 types have scores <40 points, which can be assessed as basically Pinghe Zhi, while the converted score for Tan Shi Zhi is between 30 and 39 points, indicating a tendency towards Tan Shi Zhi, so this person’s final constitution assessment result is basically Pinghe Zhi with a tendency towards Tan Shi Zhi.

(4) Table

Yang Xu Zhi

Please answer the following questions based on your experiences and feelings over the past year	No (Not at all)	Very Rarely (A little)	Sometimes (Somewhat)	Often (Quite a bit)	Always (Very much)
(1) Do you have cold hands and feet?	1	2	3	4	5
(2) Do you feel cold in your stomach, back, or lower back?	1	2	3	4	5
(3) Do you feel cold and wear more clothes than others?	1	2	3	4	5
(4) Are you more sensitive to cold than others (cold in winter, cold air conditioning, fans in summer, etc.)?	1	2	3	4	5
(5) Are you more prone to colds than others?	1	2	3	4	5
(6) Do you feel uncomfortable or avoid eating/drinking cold things?	1	2	3	4	5
(7) Do you easily have diarrhea after getting cold or eating/drinking cold things?	1	2	3	4	5
Assessment Result:□ Yes □ Tendency to be □ No

Yin Xu Zhi

Please answer the following questions based on your experiences and feelings over the past year	No (Not at all)	Very Rarely (A little)	Sometimes (Somewhat)	Often (Quite a bit)	Always (Very much)
(1) Do you feel heat in your palms and feet?	1	2	3	4	5
(2) Do you feel heat in your body or face?	1	2	3	4	5
(3) Is your skin or lips dry?	1	2	3	4	5
(4) Are your lips redder than usual?	1	2	3	4	5
(5) Do you easily have constipation or dry stools?	1	2	3	4	5
(6) Do you have facial flushing or redness?	1	2	3	4	5
(7) Do you feel dry eyes?	1	2	3	4	5
Assessment Result:□ Yes □ Tendency to be □ No

Qi Xu Zhi

Please answer the following questions based on your experiences and feelings over the past year	No (Not at all)	Very Rarely (A little)	Sometimes (Somewhat)	Often (Quite a bit)	Always (Very much)
(1) Do you easily feel fatigued?	1	2	3	4	5
(2) Do you easily feel short of breath (difficulty breathing)?	1	2	3	4	5
(3) Do you easily feel palpitations?	1	2	3	4	5
(4) Do you easily feel dizzy or lightheaded when standing up?	1	2	3	4	5
(5) Are you more prone to colds than others?	1	2	3	4	5
(6) Do you prefer quiet and feel lazy to talk?	1	2	3	4	5
(7) Is your voice weak?	1	2	3	4	5
(8) Do you easily sweat after activity?
Assessment Result:□ Yes □ Tendency to be □ No

Tan Shi Zhi

Please answer the following questions based on your experiences and feelings over the past year	No (Not at all)	Very Rarely (A little)	Sometimes (Somewhat)	Often (Quite a bit)	Always (Very much)
(1) Do you feel chest tightness or abdominal fullness?	1	2	3	4	5
(2) Do you feel uncomfortable or unwell in your body?	1	2	3	4	5
(3) Is your abdomen soft and full?	1	2	3	4	5
(4) Do you have excessive oil secretion on your forehead?	1	2	3	4	5
(5) Are your upper eyelids more swollen than others (slightly raised)?	1	2	3	4	5
(6) Do you have a sticky feeling in your mouth?	1	2	3	4	5
(7) Do you usually have a lot of phlegm, especially feeling phlegm stuck in your throat?	1	2	3	4	5
(8) Do you have thick or sticky coating on your tongue?	1	2	3	4	5
Assessment Result:□ Yes □ Tendency to be □ No

Shi Re Zhi

Please answer the following questions based on your experiences and feelings over the past year	No (Not at all)	Very Rarely (A little)	Sometimes (Somewhat)	Often (Quite a bit)	Always (Very much)
(1) Do you have an oily feeling on your face or nose?	1	2	3	4	5
(2) Do you easily develop acne or sores?	1	2	3	4	5
(3) Do you feel bitter in your mouth or have an unusual taste?	1	2	3	4	5
(4) Do you feel sticky and uncomfortable when passing stools?	1	2	3	4	5
(5) Do you feel a burning sensation when urinating, and is your urine dark (deep)?	1	2	3	4	5
(6) Do you have yellow vaginal discharge (limited to female respondents)?	1	2	3	4	5
(7) Is your scrotum damp?	1	2	3	4	5
Assessment Result:□ Yes □ Tendency to be □ No

Xue Yu Zhi

Please answer the following questions based on your experiences and feelings over the past year	No (Not at all)	Very Rarely (A little)	Sometimes (Somewhat)	Often (Quite a bit)	Always (Very much)
(1) Do you have unexplained bruises (subcutaneous bleeding)?	1	2	3	4	5
(2) Do you have fine red lines on your cheeks?	1	2	3	4	5
(3) Do you have any pain in your body?	1	2	3	4	5
(4) Do you have a dull complexion or easily develop brown spots?	1	2	3	4	5
(5) Do you easily have dark circles under your eyes?	1	2	3	4	5
(6) Do you easily forget things?	1	2	3	4	5
(7) Are your lips dark in color?	1	2	3	4	5
Assessment Result:□ Yes □ Tendency to be □ No

Te Bing Zhi

Please answer the following questions based on your experiences and feelings over the past year	No (Not at all)	Very Rarely (A little)	Sometimes (Somewhat)	Often (Quite a bit)	Always (Very much)
(1) Do you sneeze even when you are not sick?	1	2	3	4	5
(2) Do you have nasal congestion or runny nose even when you are not sick?	1	2	3	4	5
(3) Do you cough or wheeze due to seasonal changes, temperature changes, or odors?	1	2	3	4	5
(4) Are you easily allergic (to drugs, food, odors, pollen, or during seasonal changes)?	1	2	3	4	5
(5) Does your skin easily develop hives (wheals, urticaria)?	1	2	3	4	5
(6) Have you ever had purpura (purple spots, bruises) due to allergies?	1	2	3	4	5
(7) Does your skin turn red and show scratch marks when scratched?	1	2	3	4	5
Assessment Result:□ Yes □ Tendency to be □ No

Qi Yu Zhi

Please answer the following questions based on your experiences and feelings over the past year	No (Not at all)	Very Rarely (A little)	Sometimes (Somewhat)	Often (Quite a bit)	Always (Very much)
(1) Do you feel depressed?	1	2	3	4	5
(2) Do you easily feel tense or anxious?	1	2	3	4	5
(3) Are you sentimental and emotionally fragile?	1	2	3	4	5
(4) Do you easily feel scared or startled?	1	2	3	4	5
(5) Do you have pain in your sides or chest?	1	2	3	4	5
(6) Do you sigh for no reason?	1	2	3	4	5
(7) Do you feel a lump in your throat that you cannot swallow or spit out?	1	2	3	4	5
Assessment Result:□ Yes □ Tendency to be □ No

Pinghe Zhi

Please answer the following questions based on your experiences and feelings over the past year	No (Not at all)	Very Rarely (A little)	Sometimes (Somewhat)	Often (Quite a bit)	Always (Very much)
(1) Do you feel energetic?	1	2	3	4	5
(2) Do you easily feel fatigued?*	1	2	3	4	5
(3) Is your voice weak?*	1	2	3	4	5
(4) Do you feel depressed?*	1	2	3	4	5
(5) Are you more sensitive to cold than others (cold in winter, cold air conditioning, fans in summer)?*	1	2	3	4	5
(6) Can you adapt to changes in the natural and social environment?	1	2	3	4	5
(7) Do you easily suffer from insomnia?*	1	2	3	4	5
(8) Do you easily forget things?*
Assessment Result:□ Yes □ Tendency to be □ No

(Note: Items marked with * need to be scored in reverse, i.e., 1→5, 2→4, 3→3, 4→2, 5→1, and then use the formula to convert the score.

3. How to Adjust After Identifying Constitution?

Constitution can be adjusted. It is both congenital and related to acquired factors. The stability of constitution is formed by similar genetic backgrounds, and factors such as age and gender can also cause constitution to show certain stability. However, the stability of constitution is relative; individuals may experience changes in constitution due to various internal and external factors such as environment, spirit, nutrition, exercise, and disease throughout their life cycle. Constitution has only relative stability while also possessing dynamic variability. This characteristic is the basis for the adjustability of constitution.

Medications and related treatment methods can correct imbalances of Yin, Yang, Qi, Blood, and body fluids, which is the practical foundation for adjusting constitution. For example, our formulated phlegm-resolving and damp-dispelling formula can reduce fat accumulation in the body, alter lipid metabolism, lower blood viscosity, and improve phlegm-damp constitution, reversing pathological fatty liver and preventing liver fibrosis.

Emphasizing the intrinsic connection between different constitutions and diseases and the differences in responses to treatments is a specific practice of individualized diagnosis and treatment, implementing the principle of “treating according to the person”. Based on different constitution types or states, one may tonify Qi, nourish Yin, warm Yang, resolve dampness, relieve stagnation, or invigorate blood to adjust the dynamic balance of Yin and Yang, reflecting the treatment principle of “people-oriented” and “treating the root of the disease”; early detection and intervention of biased constitution states, conducting etiological prevention, preclinical prevention, and clinical prevention, achieving quality adjustment to reject pathogens, prevent diseases, and prevent changes, thus practicing TCM’s principle of “preventing disease before it occurs”. For example, individuals with Yang deficiency constitution who fear cold can consume more warming foods such as beef, lamb, leeks, and ginger, while avoiding cold foods like pears, watermelons, and water chestnuts, and reducing green tea intake. They may also consume Angelica and ginger lamb soup.