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Complementary Therapies in Medicine, 2019-04-01, Volume 43, Pages 44-48

Association of traditional Chinese medicine body constitution and moderate-to-severe cancer-related fatigue in cancer patients

Ming-Hsien Yeh, Chiu-Hui Chao, Malcolm Koo, Chiu-Yuan Chen, Chia-Chou Yeh and Te-Mao Li
(authors are from various institutions in Taiwan)

Abstract

Background and purpose: Fatigue is one of the most prevalent adverse events reported by cancer patients. The aim of this study was to investigate the association between traditional Chinese medicine body constitution (TCMBC) and moderate-to-severe cancer-related fatigue in cancer patients.
Materials and methods: A cross-sectional study was conducted on cancer patients recruited from a regional hospital in southern Taiwan. The association between TCMBC, measured using the Constitution in Chinese Medicine Questionnaire (CCMQ) and moderate-to-severe cancer-related fatigue (based on the Taiwanese version of the Brief Fatigue Inventory score = 4) was evaluated using multiple logistic regression analysis.
Results: Of the 170 participants, 37 (21.8%) had moderate-to-severe fatigue. Yang-deficiency (adjusted odds ratio [aOR]=3.55, 95% confidence interval [CI]=1.50–8.40) and Qi-deficiency (aOR=2.84, 95% CI=1.18–6.82) TCMBC were significantly associated with moderate-to-severe cancer-related fatigue.
Conclusion: TCMBC could be used as a clinical tool to identify cancer patients prone to experience moderate-to-severe cancer-related fatigue, and to provide Chinese medicine practitioners a basis for selecting an appropriate treatment approach based on TCMBC.

https://www.sciencedirect.com/science/article/abs/pii/S0965229918309968

Excerpts:

"According to TCM theory, Yang and Qi are the driving forces of biological activities in the human body. Deficiencies in Yang and Qi are common in patients with 'fatigue syndrome'. Cancer patients often suffer from vital Qi deficiency, and those with cancer-related fatigue and Qi deficiency is associated with a poor quality of life. Therefore, identifying patients with Qi deficiency is critical for predicting prognosis or disease progression and guide the corresponding treatment principles of Chinese Medicine.

"Traditional Chinese Medicine body constitution (TCMBC) ('Tizhi' in Chinese) refers to an integrated, relatively stable, and natural system of classifying individuals according to developmental, physiological, and psychological characteristics, innate or acquired over time. The TCMBC includes nine constitutions: Gentleness (Neutral, Balance), Qi-deficiency, Yang-deficiency, Qi-depression (Qi stagnation), Yin-deficiency, Phlegm-wetness (Phlegm-dampness), Blood-stasis, Wetness-heat (Dampness-heat), and Special diathesis (Inherited special constitution). Based on the sign and symptoms presented, the type of TCMBC of a patient can be determined. The TCMBC not only relates to the susceptibility and predisposition to certain pathogens and diseases, but it can also influence the prognosis and treatment of diseases. Therefore, the aim of the present study was to investigate the association between TCMBC and cancer-related fatigue in cancer patients."

"All of the participants completed a Constitution in Chinese Medicine Questionnaire (CCMQ) developed by Qi Wang for measuring the type of TCMBC. The scale consisted of 60 items with nine sub-scales scored on a 5-point Likert scale for classifying a person into one or more of the nine types of TCMBC, namely, Gentleness (8 items), Qi-deficiency (8 items), Yang-deficiency (7 items), Yin-deficiency (8 items), Phlegm-wetness (8 items), Wetness-heat (6 items), Blood-stasis (7 items), Qi-depression (7 items), and Special diathesis (7 items). The coexistence of multiple TCMBC types is possible and is consistent with the traditional Chinese medicine theory. A score of 30 or higher on each of the nine sub-scales of the CCMQ was set as the threshold for the respective TCMBC, following original CCMQ scoring algorithm. In this study, we selected CCMQ over other TCMBC scales such as the Body Constitution Questionnaire (BCQ), because we believe that it is necessary to use a scale with more body constitution types in order to differentiate the conditions in cancer patients.

"The reliability and validity were previously evaluated on 2500 participants recruited from five different geographical districts in China. Good internal consistency with Cronbach’s a ranged from 0.76 to 0.90 and good test-retest reliability ranged from 0.76 to 0.90 for the nine sub-scales were reported. In addition, good criterion validity was demonstrated by the correlations between CCMQ and health-related quality of life scores.

"Furthermore, the psychometric properties of the CCMQ were evaluated in 1084 adult patients attending a Western medicine outpatient clinic and two Chinese medicine outpatient clinics in Hong Kong. Satisfactory internal reliability with a Cronbach’s a>0.6 and good test-retest reliability with intraclass correlation coefficients ranged from 0.71 to 0.88 was obtained. In addition, content validity of the CCMQ was confirmed using convenience samples of 10 patients and 10 Chinese medicine practitioners. Construct validity was supported by moderate correlations between CCMQ and health-related quality of life scores. Moreover, confirmatory factor analysis showed a reproducible structure as hypothesized."

"Discussion

"This study is the first to show a significant association between TCMBC and moderate-to-severe cancer-related fatigue in cancer patients. Specifically, patients with Qi-deficiency TCMBC and Yang-deficiency TCMBC were independently associated with a higher risk of moderate-to-severe cancer-related fatigue, whereas those with a Gentleness TCMBC were independently associated with a lower risk of moderate-to-severe cancer-related fatigue. The larger magnitude in the adjusted odds ratio for Yang-deficiency (aOR=3.55) compared with that for Qi-deficiency (aOR=2.84) was consistent with the TCM theory that Yang-deficiency generally represents a more severe condition than Qi-deficiency. Conversely, the significant inverse association between a Gentleness TCMBC was also in line with the TCM theory. Individuals with a Gentleness TCMBC mean that their bodily condition is in a state of relative balance of Yin and Yang. These individuals are therefore, less prone to suffer from moderate-to-severe cancer-related fatigue.

"According to TCM theory, the TCMBC of individuals is formed by Yin and Yang, and an imbalance between Yin and Yang in the body can render them more prone to certain diseases. Several abnormalities underlie the pathogenesis of cancer-related fatigue, including the promotion of inflammatory cytokines imbalance, hypothalamus-pituitary-adrenal axis dysfunction, anemia, and cachexia have been postulated. In addition, Yang-deficiency may not only be related to hypothalamic-pituitary-adrenal axis and hypothalamic-pituitary-thyroid axis dysfunction, but also to functional disorders of the cyclic nucleotide and immune systems.

"The present study found that patients with Yang-deficiency TCMBC were strongly associated with a higher risk of moderate-to-severe cancer-related fatigue. Yang is the energy needed for maintaining proper body function, and Yang deficiency can be defined as the decline of energy level. Symptoms of Yang deficiency typically include cool extremities, weak pulse, and aversion to cold temperatures. It should be noted that the CCMQ should not be used as a diagnostic tool, but rather as a way to assist syndrome differentiation in TCM practice. The CCMQ is a well-validated instrument that can be used for guiding the treatment approach by Chinese medicine practitioners during disease consultation."

"Increasing evidence showed that TCM can safely be used as a helpful adjunct to conventional care in the treatment of cancer-related fatigue. Clinical studies have also shown that Yang-deficiency TCMBC could be improved by acupuncture and moxibustion. Chen et al. reviewed the evidence for using TCM in the treatment of chronic fatigue syndrome. The authors indicated that ginseng root has been the most widely studied herb for fatigue because of its effect of invigorating Qi and Yang. A recent systematic review of Panax ginseng concluded that it is a viable and promising treatment for fatigue in people with chronic illness. Moreover, Leong et al. proposed that Yang- and Qi-invigorating tonic herbs, such as Cistanches Herba and Schisandrae Fructus , might be beneficial in the treatment of chronic fatigue syndrome through their enhancement in mitochondrial function and regulation."

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Comment:

Remember that these kind of classifications have now been included in the International Classification of Diseases (ICD-11):
https://respectfulinsolence.com/2019/05/29/mao-triumphant/