Does place have an effect on the traditional Chinese medicine concept of body constitution?

Abstract

Traditional Chinese Medicine (TCM) has long perceived the human body as a holistic system to sustain a healthy state. It emphasises that natural and social environments influence the physical and emotional balance of the human health. Contemporary health geography also recognises that place or environment is indispensable in studying population health. Both TCM and health geography share some similar views on the place effects on human health and wellbeing. However, the effects of TCM concept of body constitution and those of the living environment on the state of human health have not been supported with much empirical evidence. This study is an attempt to address three issues: a) Is there a place effect on body constitution? b) What are the possible individual or neighbourhood/community explanations behind the place effect? and c) Is there an association between body constitution and disease occurrence?

The study uses multilevel logistic models to explore the evidence of place on body constitution. This study proposes to generalise “place” by means of an actual geographical division at the level of street block group for hypothesis testing through examining their covariance components in the multilevel analysis. The analysis also takes simultaneous accounts of both individual-level (gender, age, BMI, type of housing) and area-level (percent greenery, percent road surface, total road intersection, sky view factor, temperature, relative humidity, rainfall, and social deprivation index) characteristics to explain the geographical variation of body constitution. The bivariate choropleth mapping technique in cartographic design is employed to visualise and generalise the spatial correlation between body constitution and neighbourhood effects. The association between body constitution and disease prevalence are tested using the binary logistic regression analysis.

The individual data of body constitution comprise a cohort of 3,277 patients attending the Centre of Integrated Health Management providing TCM services at the Kwong Wah Hospital. The attendance period was between 1/3/2009 and 31/12/2012 inclusive. The majority of patients was middle-aged Chinese (40 to 60) living within the remit of the Kowloon West Cluster. Despite limitations in the data, the findings unveil different views on human and environmental health pertaining to the Chinese population. It confirms that place does matter in the outcome of body constitution and the variability between neighbourhoods involves a dynamic interplay between individual and environmental factors. Specifically, the use of different geographic aggregation units (street block group and 800m buffer around each subject’s home location) to parameterise environmental factors brings out place characteristics of select body constitutions and exemplifies the modifiable areal unit problem in population health studies.

This study is a first attempt to bring together health geography and body constitution theory to illuminate the interconnectedness between health, disease, personal attributes, and place. Because the TCM concept of body constitution is not an exact science and each individual can have more than one dominant body constitution which may change in time, it has been a challenge to resolve data issues and methodological constraints. Nonetheless, the study has contributed some interesting observations about TCM body constitution and its relationship with place.