藏医体质量表的研制与初步应用研究

The phenomenon of body constitution is an important form of human life. Tibetan body constitution is applied in the whole process of clinical practice of Tibetan medicine, including prevention, diagnosis, treatment and prognosis. According to Tibetan classics The Four Medical Tantras, population can be divided into seven types, including “rLung”, “mKhris-pa”, “Badkan”, and their mixed four types, which is widely accepted by Tibetan medicine physicians in ancient and modern times. However, due to a lack of standardized and quantitative scale for the classification of constitution types of Tibetan medicine, further research and application of Tibetan medicine’s body constitutional theory is restricted. Therefore, based on procedures and methods of scale development, this project establishes the preliminary scale of Tibetan constitution by literature research and expert interview, and then tests its language by recruiting 20 participants; after that a pre-survey on 200 participants is conducted to evaluate the scale’s reliability and validity, and finally a quantitative and standardized measurement tool for Tibetan constitution is developed. On the basis of previous researches, across-sectional study involving 1580 participants would be conducted to investigate the distribution of constitution types among population, and to identify relevant demographic factors associated with constitution. In a word, this project would become the basic content to Tibetan medicine’s body constitutional study, enrich the content of Tibetan constitutional theory, and provide a scientific and feasible tool for Tibetan medicine clinical practice and research so as to promote Tibetan medicine to play a more important role in the prevention and treatment of human’s diseases.

体质现象是人类生命活动的重要表现形式。藏医对体质的重视，贯穿于对疾病预防、诊断、治疗、预后的全过程。藏医经典《四部医典》将个体体质分为隆型、赤巴型、培根型及其组合而成的七种类型，是藏医体质的公认分类方法。但一直以来缺乏对《四部医典》分类方法的客观、量化判定标准，是制约藏医体质研究和临床应用的主要瓶颈。因此，本项目拟根据量表开发的方法，采用文献研究、专家访谈等方法构建量表初稿后，依次进行20例受试者的量表语言测试、200例受试者的量表预调查和信度效度分析，最终形成定量、标准化的藏医体质量表；并在此基础上开展基于1580例受试者的横断面研究，调查各体质类型在人群的分布特征，筛选与藏医体质相关的人口学因素。故本项目将成为开展藏医体质研究的基础性工作，有助于解决藏医体质研究面临的瓶颈问题，充实藏医体质学的内涵，为藏医临床和科研提供科学可行的体质测量工具，从而推动藏医在我国卫生事业中发挥应有的作用。

体质现象是人类生命活动的重要表现形式。藏医对体质的重视，贯穿于对疾病预防、诊断、治疗、预后的全过程。本项目旨在基于藏医经典体质理论，建立客观、量化的体质判定标准，为藏医体质研究和临床应用提供可靠工具。采用文献研究、专家访谈等方法构建量表初稿，依次进行39名藏医专家的德尔菲法研究、40例受试者的量表语言测试、622例受试者的量表预调查和信度效度分析，最终形成定量、标准化的藏医体质量表，用于开展多中心大样本横断面研究。结果显示：藏医体质量表的内部一致性系数为0.754。两周重测总分的相关系数为0.726。分割半系数为0.689。因子分析证实，量表条目可以分为8个潜在因子，归属于形态结构、生理功能、性格和适应能力4个维度，与中医体质量表的相关性研究证实，藏医体质量表具有良好的效标效度。对北京、河南郑州、青海西宁、西藏拉萨16岁以上2322例一般人群横断面调查显示，隆型体质占14.81%，赤巴型占4.78%，培根型占8.44%，隆赤合并型占20.37%，隆培合并型占31.96%，赤培合并型占16.32%，三因聚合型占3.32%。男性赤巴型、隆赤合并型、赤培合并型、聚合型体质比例高于女性，女性隆型、培根型、隆培合并型体质比例高于男性。年龄与隆型体质评分呈正相关，与培根型体质评分呈负相关，与赤巴型体质评分未见相关。高原地区汉、藏和其他民族人群7种藏医体质类型的分布比例无统计学差异。各体质比例在不同职业人群中的分布未见差异。小学及以下文化人群的隆型体质比例高于其他人群。说明藏医体质流行病学调查结果符合藏医体质理论认识，藏医体质分类可适用于青藏高原和内地各民族一般人群，不同性别、年龄人群的体质类型分布不同。本研究表明，藏医体质量表是一种客观可靠的测量一般人群藏医体质的工具，今后可应用该量表开展藏医体质的研究，探讨各体质类型间生物学特性的差异，研究体质与疾病的关系等，从而为深化藏医体质的基础研究、推动藏医体质在疾病防治中的应用，提供了有效的标准和工具。