A Systematic Review on Sasang Constitutional Type-Associated Susceptibility to Disorders in Korea

Resting Metabolic Rate for Diagnosing Tae-Eum Sasang Type and Unraveling the Mechanism of Type-Specific Obesity

Increased resting metabolic rate (RMR), representing augmented energy expenditure, is a preferred physical characteristic; however, the Tae-Eum Sasang type, with a high incidence of obesity and metabolic diseases, has a higher RMR. This study scrutinized the physical characteristics of Sasang typology, a traditional Korean personalized medicine, to resolve this discrepancy, which can unravel the mechanism of Tae-Eum-type-specific obesity and improve the Tae-Eum Sasang-type diagnosis. A total of 395 healthy participants provided Sasang-type diagnosis using Sasang Constitutional Analysis Tool and physical features, including skeletal muscle mass, body fat mass, and RMR, along with those standardized using body weight. The Tae-Eum-type group showed significantly higher body weight, body mass index, body fat mass, and unstandardized RMR (kcal/day) than others, while their standardized measures of RMR per weigh (RMRw, kcal/day/kg) and percent skeletal muscle (PSM, %) were significantly lower. The logistic regression model revealed that the RMRw is pivotal for discriminating Tae-Eum type from others and explaining the developmental mechanism of Tae-Eum-type obesity. The aforementioned might provide a theoretical framework for Sasang-type diagnosis and Sasang-type-specific health promotion using bodily exercise and medical herbs.

Sasang Constitution May Act as a Risk Factor for Depressive Symptoms-A Survey for Local Residence

This study investigated whether a person’s Sasang constitution (SC) could be a risk factor for depressive symptoms. We classified the SC of 653 participants into Taeeumin (TE), Soeumin (SE), and Soyangin (SY), using the KS−15 questionnaire. We also categorized them into depressive and non-depressive symptom groups using the Center for Epidemiologic Studies Depression scale questionnaire. A t-test and chi-square test were used to compare the general characteristics of the depressive and non-depressive symptom groups. A one-way analysis of variance compared the scores of depressive symptoms according to SC, and a multiple logistic regression obtained the odds ratios (ORs); p < 0.05. The depressive symptom score for SE (13.6 ± 9.97) was significantly higher than that for SY (9.2 ± 6.51) and TE (10.8 ± 7.70; p < 0.001; SE > TE, SY, Scheffé). SE was associated with an increased prevalence of depressive symptoms compared with SY (OR: 2.315; 95% confidence interval [CI]: 1.389−3.860, p < 0.01) and TE (OR: 1.660; 95% CI: 1.076−2.561, p < 0.05), as well as an increased prevalence of depressive symptoms compared with SY (OR: 2.907; 95% CI: 1.379−6.144, p < 0.01) after adjusting for average height and distribution of living with family, medication, and drinking. This study reveals that SC, particularly SE, could be significantly associated with and be considered a risk factor for depressive symptoms.

Investigating the Biomarkers of the Sasang Constitution via Network Pharmacology Approach

Sasang constitutional (SC) medicine classifies people into Soeum (SE), Soyang (SY), Taeeum (TE), and Taeyang (TY) types based on psychological and physical traits. However, biomarkers of these types are still unclear. We aimed to identify biomarkers among the SC types using network pharmacology methods. Target genes associated with the SC types were identified by grouping herb targets that preserve and strengthen the requisite energy (Bomyeongjiju). The herb targets were obtained by constructing an herb-compound-target network. We identified 371, 185, 146, and 89 target genes and their unique biological processes related to SE, SY, TE, and TY types, respectively. While the targets of SE and SY types were the most similar among the target pairs of the SC types, those of TY type overlapped with only a few other SC-type targets. Moreover, SE, SY, TE, and TY were related to "diseases of the digestive system," "diseases of the nervous system," "endocrine, nutritional, and metabolic diseases," and "congenital malformations, deformations, and chromosomal abnormalities," respectively. We successfully identified the target genes, biological processes, and diseases related to each SC type. We also demonstrated that a drug-centric approach using network pharmacology analysis provides a deeper understanding of the concept of Sasang constitutional medicine at a phenotypic level.

Analysis of Sasang Constitutional Medicine as an Optimal Preventive Care Strategy for Hemophilia Patients

Introduction. Medical improvements have allowed hemophilia patients to anticipate an increased quality of life and life expectancy similar to that of the general population. Analysis of the potential disease symptoms of hemophilia patients based on a survey of Sasang Constitutional Medicine (SCM) is important for optimal preventive care and adjunctive therapy to avoid life-threating complications.

Effect of Lifestyle Factors on Hypertension by Constitution Type: A Large Community-Based Study

Background. The risk of hypertension differs according to lifestyle factors and individual constitution types. The aim of this study was to investigate the effect of lifestyle factors on hypertension and to assess whether those effects differ according to the constitution types. Methods. A total of 5,793 men and women were recruited between 2012 and 2014. Odds ratios for hypertension associated with constitution types and lifestyle factors were estimated. Lifestyle factors included smoking status, body mass index, alcohol consumption, physical activity, and sleep quality. Constitution types were estimated based on the Sasang constitutional medicine as the TE type, SE type, and SY type. Results. The risk of hypertension was significantly higher for SY (odds ratio 1.25 (95% confidence interval 1.03 to 1.52) and TE types (1.38 (1.10 to 1.74)) than the SE type even with adjustment of health behaviors. Compared with individuals who had an unhealthy lifestyle, those with healthy lifestyle scores showed significantly lower risk of hypertension in only SY (odds ratio 0.62 (95% confidence interval 0.48 to 0.81)) and TE types (0.69 (0.58 to 0.81)). The difference in risk for hypertension among constitution types was decreased with a healthy lifestyle (1.34 in SY and 2.35 in TE types, as compared with the SE type) versus an unhealthy lifestyle (2.21 in SY and 3.64 in TE types, as compared with the SE type). Conclusion. The risk of hypertension was different by Sasang constitution types. The impact of lifestyle factors differed according to Sasang constitution types, and the difference in risk of hypertension among constitution types was decreased with a healthy lifestyle.

Heart rate variability in middle-aged adults: Use of Sasang typology to distinguish individuals susceptible to stress

While stress is known to cause many diseases, there is no established method to determine individuals vulnerable to stress. Sasang typology categorizes humans into four Sasang types (So-Eum, Tae-Eum, So-Yang, and Tae-Yang), which have unique pathophysiologies because of their differential susceptibilities to specific stimuli, including stress. The purpose of this study was to determine if Sasang typology can be used identify individuals who are vulnerable to stress by evaluation of heart rate variability (HRV).This was a cross-sectional study. A total of 399 healthy men and women aged 30 to 49 years were recruited. Physical examinations for stress included HRV measurement and blood tests. The subjects also completed questionnaires about psychological stress, self-awareness, and lifestyle. HRV was analyzed using frequency-domain analysis. Subjects were divided into So-Eum (SE) and non-So-Eum (non-SE) groups according to their diagnosis.The weight and body mass index in the SE group were significantly lower than those in the non-SE group (both, P = .000). There were no significant between-group differences in any other demographic variables. In HRV analysis, the normalized high frequency (nHF) was higher (P = .008) while the normalized low frequency (nLF; P = .008) and LF:HF ratio (LF/HF; P = .002) were lower in the SE group than in the non-SE group.Although there was no difference in variables affecting HRV, HRV values were significantly different between groups. The LF/HF value for the SE group was at the lower limit of the normal range, although there were no associated clinical problems. These findings suggest that individuals with the SE type are more susceptible to stress than those with the other types. Thus, middle-aged individuals who are vulnerable to stress can be identified using Sasang typology.

Traditional Herbal Formula Taeeumjowi-Tang (TJ001) Inhibits p53-Mutant Prostate Cancer Cells Growth by Activating AMPK-Dependent Pathway

Dysregulated lipid metabolism is a prominent feature of prostate cancers (PCas); several enzymes involved in lipid accumulation are highly expressed. Here, we elucidated efficacy of TJ001, a traditional herbal decoction, in inhibiting de novo lipogenesis. TJ001 had significant cytotoxicity against DU145 but not PC3 and LNCaP cells and, similarly, TJ001 markedly AMPK phosphorylation only in DU145 cells. This was accompanied by the downregulation of phosphorylated-acetyl coenzyme A carboxylase (ACC) expression and sterol regulatory element-binding protein 1 (SREBP1) proteolytic cleavage, thereby inhibiting its role as a transcription factor to induce lipid biosynthesis. When Oil Red O staining was performed, it is reflected in the reduction of lipid droplets (LDs). TJ001 also induced G₁/S cell cycle arrest via a cell cycle inhibitor (CKI) p21^WAF1/CIP1 upregulation. Although p53 proteins remained unchanged, both cyclin E and cyclin D1 were decreased. Moreover, TJ001 suppressed the mammalian target of rapamycin (mTOR) signaling pathway. Generally, the prolonged G₁/S phase arrest accompanies apoptosis, but TJ001 failed to work as a trigger apoptosis in DU145 cells. We showed that mutant p53 proteins were required for the survival of DU145 cells. In presence of TJ001, inhibition of endogenous mutant p53 by RNAi led to cell viability reduction and induction of the p-AMPK/AMPK ratio. In addition, it induced apoptotic cell death in DU145 cells. At the cellular level, induction of PARP, caspase-3, and caspase-9 cleavages was observed, and caspase-3 activity was increased in the p53 knockdown cells treated with TJ001. Taken together, we demonstrated that TJ001 inhibited cell growth in DU145 prostate cancer cells as indicated by blocking lipogenesis and induction in G₁/S cell cycle arrest. In addition, we may provide an evidence that mutant p53 protein has potential role as an oncogenic action in DU145 cells. Collectively, the combination of mutant p53 targeting and TJ001 treatment resulted in decreased cell growth in DU145 cells.

Metabolite Markers for Characterizing Sasang Constitution Type through GC-MS and 1H NMR-Based Metabolomics Study

Sasang constitutional medicine classifies human beings into four types based on their physical and psychological characteristics. Despite its potential value in achieving personalized medicine, the diagnosis of sasang constitution (SC) type is complex and subjective. In this study, gas chromatography–mass spectrometry and ¹H nuclear magnetic resonance–based metabolic analyses were conducted to find maker metabolites in serum and urine according to different SC types. Although some samples were overlapped on orthogonal projection to latent structure discriminant analysis score plots, serum samples showed separation between different SC types. Levels of lactate, glutamate, triglyceride, and fatty acids in serum and glycolic acid in urine of Tae-Eum type were higher than those of So-Eum and So-Yang type. Fatty acids, triglyceride, and lactate levels were found to be metabolites related to body mass index, indicating that marker metabolites for the diagnosis of SC type could be associated with obese. However, Tae-Eum type showed higher lactate levels in serum than So-Yang type for both normal weight and overweight groups, suggesting that the contents of serum lactate might be dependent on the SC type regardless of body weight. These results suggest that metabolomics analysis could be used to determine SC type.

Pulmonary Function Difference in Sasang Constitutional Types

The purpose of this study was to determine the differences in pulmonary function among Sasang constitutional types in young adults. The Sasang Constitutional Analysis Tool (SCAT), pulmonary function tests (PFTs), and cardiopulmonary exercise tests were conducted in 417 participants from 2009 to 2015. Subjects with the Tae-Eum (TE) type had significantly higher inspiratory capacity (IC) and inspiratory reserve volume (IRV) values than those with the So-Yang (SY) and So-Eum (SE) types (P < 0.0001). The TE and SY types showed higher forced vital capacity (FVC) and forced expiratory volume in 1 sec (FEV₁) values than the SE type (P < 0.0001). An increase in IRV and a decrease in expiratory reserve volume (ERV) in TE type males remained even after adjusting for covariate factors. These results indicate that young adults with the TE type have weaker lung function than those with the other constitutional types, suggesting its innate physiological pulmonary features.

A juvenile case with nonalcoholic steatohepatitis and traditional Korean medicine-based treatment

Nonalcoholic fatty liver disease (NAFLD) has become the common cause leading to chronic liver diseases recently. Unlikely past humankind history, NAFLD is like a new illness especially in developed countries due to decreased number of hepatic virus carriers and increased population with obesity. Among subjects with NAFLD, development of nonalcoholic steatohepatitis (NASH) is a key pathological step which determines the clinical progression. This study reports a case of a boy who has suffered from NASH for 2 years. This study aims to discuss the clinical feature, risk aspect, and treatment strategy of NASH as well as potential of traditional Korean medicine (TKM) therapies.

Sasang constitutional types for the risk prediction of metabolic syndrome: a 14-year longitudinal prospective cohort study

BACKGROUND

To examine whether the use of Sasang constitutional (SC) types, such as Tae-yang (TY), Tae-eum (TE), So-yang (SY), and So-eum (SE) types, increases the accuracy of risk prediction for metabolic syndrome.

METHODS

From 2001 to 2014, 3529 individuals aged 40 to 69 years participated in a longitudinal prospective cohort. The Cox proportional hazard model was utilized to predict the risk of developing metabolic syndrome.

RESULTS

During the 14 year follow-up, 1591 incident events of metabolic syndrome were observed. Individuals with TE type had higher body mass indexes and waist circumferences than individuals with SY and SE types. The risk of developing metabolic syndrome was the highest among individuals with the TE type, followed by the SY type and the SE type. When the prediction risk models for incident metabolic syndrome were compared, the area under the curve for the model using SC types was significantly increased to 0.8173. Significant predictors for incident metabolic syndrome were different according to the SC types. For individuals with the TE type, the significant predictors were age, sex, body mass index (BMI), education, smoking, drinking, fasting glucose level, high-density lipoprotein (HDL) cholesterol level, systolic and diastolic blood pressure, and triglyceride level. For Individuals with the SE type, the predictors were sex, smoking, fasting glucose, HDL cholesterol level, systolic and diastolic blood pressure, and triglyceride level, while the predictors in individuals with the SY type were age, sex, BMI, smoking, drinking, total cholesterol level, fasting glucose level, HDL cholesterol level, systolic and diastolic blood pressure, and triglyceride level.

CONCLUSIONS

In this prospective cohort study among 3529 individuals, we observed that utilizing the SC types significantly increased the accuracy of the risk prediction for the development of metabolic syndrome.

Energy metabolism and whole-exome sequencing-based analysis of Sasang constitution: a pilot study

BACKGROUND

Traditional Korean Sasang constitutional (SC) medicine categorizes individuals into four constitutional types [Tae-eum (TE), So-eum (SE), Tae-yang (TY), or So-yang (SY)] based on biological and physiological characteristics. As these characteristics are closely related to the bioenergetics of the human body, we assessed the correlation between SC type and energy metabolism features.

METHODS

Forty healthy, young (22.3 ± 1.4 years) males volunteered to participate in this study. Participants answered an SC questionnaire, and their face shape, voice tone, and body shape were assessed using an SC analysis tool. Thirty-one participants (10 TE, 10 SE, 3 TY, and 8 SY) were selected for further analysis. Collected blood samples were subjected to blood composition analysis, mitochondrial function analysis, and whole-exome sequencing.

RESULTS

The SY type showed significantly lower total cholesterol and high-density lipoprotein cholesterol levels than the SE type. Cellular and mitochondrial Adenosine triphosphate (ATP) levels were similar across types. All types showed similar basal mitochondrial oxygen consumption rates, whereas the TE type showed a significantly lower ATP-linked oxygen consumption rate than the other types. Whole-exome sequencing identified several genes variants that were exclusively detected in particular SC types, including 19 for SE, seven for SY, 11 for TE, and six for TY.

CONCLUSION

SC type-specific differences in mitochondrial function and gene mutations were detected in a small group of healthy, young Korean males. These results are expected to greatly improve the accurate screening and utilization of SC medicine.