组态视角下中医体质干预提升生命质量的路径探究

Exploration on the Paths of Traditional Chinese Medicine Constitution Intervention to Improve the Quality of Life:Based on the Perspective of Configuration

目的为适应中医体质变化的动态多维性,从组态视角提出中医体质干预提升生命质量的路径。方法纳入研究对象509例,均自愿参与并完成中医体质干预,于干预前和干预6个月后分别完成60条目中医体质量表(包括平和质、气虚质、阳虚质、阴虚质、痰湿质、湿热质、血瘀质、气郁质和特禀质9个亚量表)评分评价中医体质,进行中文版简明健康状况调查问卷(SF-36)调查[包括SF-36总分、SF-36的生理领域(PCS)得分、SF-36的心理领域(MCS)得分]评价生命质量。采用必要条件分析(NCA)和模糊集定性比较分析(fsQCA)探究提升总体、生理与心理领域生命质量的中医体质维度变化的必要条件和优势组态。结果NCA结果显示,改变平和质得分和气郁质得分是影响SF-36总分变化的必要条件(P<0.05);改变平和质和血瘀质得分是影响PCS得分变化的必要条件(P<0.05);而除了阴虚质和特禀质得分的改变外,其他7种体质得分的改变均为MCS得分变化的必要条件(P<0.05)。fsQCA结果显示,单独某一体质亚量表得分的改变对高/非高SF-36总分改变、高/非高PCS得分改变、高/非高MCS得分改变的必要一致性达不到fsQCA的必要条件要求(一致性均<0.9),故以NCA方法得出的结果为准。组态分析结果显示,体质干预实现高SF-36总分改变、高PCS得分改变的组态各有6个,实现高MCS得分改变的组态有7个,总体一致性均>0.7。提升SF-36总分需要着重降低气虚质得分或者在提升平和质得分同时降低阳虚质得分;降低痰湿质与气郁质得分利于提升PCS得分;提升平和质得分,降低气虚质、阳虚质、痰湿质、气郁质得分利于提升MCS得分。结论中医体质干预能提升生理、心理及总体生命质量,其对心理领域与总体生命质量的提升路径关系密切。提升生命质量除增加平和质倾向外,也要更有针对性地降低气虚质、阳虚质、气郁质和痰湿质的程度。

Objective To adapt to the dynamic multidimensional changes in traditional Chinese medicine(TCM)constitution,the paths of improving the quality of life through TCM constitution intervention are proposed from a configuration perspective.Methods Five hundred and nine subjects were included in the study,all of whom voluntarily participated in and completed TCM constitution interventions,and completed 60-item Constitution in Chinese Medicine Questionnaire(CCMQ)(including 9 subscales:neutral type,qi deficient type,yang deficient type,yin deficient type,phlegm-dampness type,damp-heat type,blood stasis type,qi stagnation type,and special constitu⁃tion type)to evaluate the TCM constitution,and the Short Form Health Questionnaire(SF-36)in Chinese version(including overall,physical component scores(PCS),and mental component scores(MCS))before and 6 months after the intervention to evaluate the quality of life.The necessary condition analysis(NCA)and fuzzy set qualitative com⁃parative analysis(fsQCA)were used to explore the necessary conditions and advantage configurations for improving the overall,physical and mental quality of life of TCM constitution dimension changes.Results The results of NCA showed that the changes in the scores of neutral type and qi stagnation type can serve as necessary conditions for improving the SF-36 overall quality of life scores(P<0.05).The changes in the scores of neutral type and blood stasis type can serve as necessary conditions for improving PCS scores.The changes in scores of the other 7 types can serve as necessary conditions for improving MCS scores.The fsQCA results showed that the necessary consistency of a change in a particular physical subscale score alone did not reach to a necessary condition for a change in SF-36 total score,PCS score,and MCS score(consistency<0.9 for all),so the results of NCA were considered.The results of configuration analysis found that 6 configurations were included in increasing the overall quality of life scores and PCS scores,and 7 in increasing the MCS scores,with overall consistency>0.7.Improving the overall quality of life scores required a focus on lowering the qi deficient type scores,or reducing the yang deficient type scores while increasing the neutral type scores;reducing the scores of phlegm-dampness type and qi stagnation type is beneficial for improving the PCS scores;increasing the neutral type scores and reducing the scores of deficient type,yang defi⁃cient type,phlegm-dampness type,and stagnation type is beneficial for increasing MCS scores.Conclusion TCM constitution interventions can improve physical,mental and overall quality of life,and its improvement in the mental domain of quality of life is closely related to the paths of overall quality of life.In order to improve the quality of life,in addition to increasing the tendency of the neutral type,more focused and targeted measures should also be taken to decrease the degrees of qi deficient type,yang deficient type,qi stagnation type,and phlegm-dampness type.