Analysis of skin humidity variation between sasang types.

Abstract

The purpose of this study was to examine the relationship between variations in skin humidity (SH) induced by perspiration across Sasang types and to identify novel and effective Sasang classification factors. We also analyzed the responses of each Sasang type to sweating-related QSCC II items. The results revealed a significant difference in SH across gender and significant differences in SH before and after perspiration between Tae-Eum and So-Eum men. In addition, Tae-Eum women showed significant differences in SH compared with women classified as another Sasang type. Furthermore, evaluation of the items related to sweating in the QSCC II and their relationship to each constitution revealed a significant difference between Tae-Eum and other Sasang types. Overall, the results of this study indicate that there is a distinct SH difference following perspiration between Tae-Eum and other Sasang types. Such findings may aid in Sasang typology diagnostic testing with the support of further sophisticated clinical studies.

Full text

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Original Article
Analysis of Skin Humidity Variation Between Sasang Types
Soon-Oh Jung1, Soo-Jin Park2, Han Chae3, Soo Hyun Park4, Minwoo Hwang5,
Sang-Hyuk Kim6and Young-Kyu Kwon3
1Dong Jin Oriental Medical Clinic,2Department of Pharmacology and Pharmacogenomics Research Center,
College of Medicine, Inje University,3Division of Longevity and Biofunctional Medicine, School of Oriental
Medicine, Pusan National University,4Department of Occupational Therapy, College of Health Sciences,
Yonsei University,5Department of SCM, School of Oriental Medicine, Pusan National University and
6Division of Constitutional Medicine Research, Korea Institute of Oriental Medicine, South Korea
The purpose of this study was to examine the relationship between variations in skin humidity
(SH) induced by perspiration across Sasang types and to identify novel and effective Sasang
classification factors. We also analyzed the responses of each Sasang type to sweating-related
QSCC II items. The results revealed a significant difference in SH across gender and significant
differences in SH before and after perspiration between Tae-Eum and So-Eum men. In addi-
tion, Tae-Eum women showed significant differences in SH compared with women classified as
another Sasang type. Furthermore, evaluation of the items related to sweating in the QSCC II
and their relationship to each constitution revealed a significant difference between Tae-Eum
and other Sasang types. Overall, the results of this study indicate that there is a distinct SH
difference following perspiration between Tae-Eum and other Sasang types. Such findings may
aid in Sasang typology diagnostic testing with the support of further sophisticated clinical
studies.
Keywords: QSCC II – Sasang typology – skin humidity
Introduction
Sasang typology divides humans into Tae-Yang (TY),
So-Yang (SY), Tae-Eum (TE) and So-Eum (SE) types.
The differences in the physiology of the internal organs
across different constitutions can be influenced by the
characteristic temperaments of each Sasang type (1,2).
Indeed, each Sasang type has a distinct temperament,
physical characteristics and unique physiological and
pathological symptoms (1,3,4). Such differences in phy-
sique are used for type classification, although much
research has been conducted with the goal of establishing
a more objective method of classification for clinical
use (5–7).
Specifically, many studies have been conducted to eval-
uate the use of various measures, biochemical markers
and other methods (8) for obtaining clear characteristics
that enable different Sasang types to be distinguished.
Recent studies conducted under the premise that Sasang
typology views the body and mind as one have led to
the development of an objective diagnostic method for
Sasang classification based on a self-evaluation method
known as the Questionnaire of Sasang Constitution
Classification II (QSCC II) (9). Although this survey
has proven to be clinically useful, there is still a strong
need for further development of an objective tool that
can be used to classify Sasang types (9).
Physiological symptoms associated with perspiration,
defecation, urination, sleep and digestion are espe-
cially important in Sasang classification, identification
For reprints and all correspondence: Young-Kyu Kwon, Division of
Longevity and Biofunctional Medicine, School of Oriental Medicine,
Pusan National University Mulgeum-eup, Yangsan, Kyungnamdo
626-770, South Korea. Tel: þ82-51-510-8471; Fax: þ82-51-510-8420;
E-mail: kwon@pusan.ac.kr
eCAM 2009;6(S1)87–92
doi:10.1093/ecam/nep087
? 2009 The Author(s).
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/
licenses/by-nc/2.0/uk/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is
properly cited.

Page 2

of type-specific diseases and management of disease
symptoms. Perspiration or sweat is not only a physiolog-
ical phenomenon, but can also be construed as a patho-
logical symptom suggestive of a problem in the body’s
physiological mechanism for temperature control and
waste excretion (10–13).
In traditional Korean medicine, sweat is formed by the
addition of yang qi to yin. In other words, when there is
sufficient yin, there is an interchange with yang qi, and
after fumigation, sweat is formed. Perspiration is a form
of waste fluid and humor excretion. Fluid belongs to
yang and is distributed with defensive qi, while humor
belongs to yin and flows through the body via nutrients
and blood. Therefore, identification of deficiency of fluid
and humor is pathologically important in differentiating
excessive and deficient yin and yang, as well as in decid-
ing upon a method of treatment through the diagnosis of
internal organs (11). As a result, individuals with consti-
tutional characteristics of excessive yang and heat and a
deficiency in yin and fluid will perspire more to maintain
temperature, while individuals with constitutional charac-
teristics of deficiency in yin and cold, and yin and fluid,
will perspire less (11).
In Dong-eui-soo-se-bo-won (Longevity and Life Preserva-
tion in Oriental Medicine), perspiration in TY and TE
types is described as a result of qi and humor energy
that occurs due to the expansion and absorption forces
of the lung and liver, while perspiration in individuals of
the SY and SE constitution is described as a result of the
ascension and descent of yin and yang due to the water
and food energies of the spleen and kidneys (2).
For the SE types, perspiration is an important factor
that represents the level of yang qi, which is very impor-
tant for the SE type. The spleen is considered as a weak-
ness in the SE types; therefore, the strength and weakness
of the spleen play a major role in the pathology process
of SE types. Perspiration can be used to evaluate the
state of the spleen in SE types. In addition, the presence
of perspiration is used to differentiate diseases. Because
internal symptoms follow a similar pathological course as
the external symptoms, perspiration is the most impor-
tant factor for SE types. Although there is a lack of
empirical data pertaining to perspiration in SY types,
perspiration reportedly occurs as a result of the descent
of yin when external symptoms are recovering, and when
the qi of pure yang cannot fully ascend due to a weakness
in yang as a result of internal symptoms (2).
TE types have deficient expansion energy due to their
lungs being weak. In TE types, perspiration serves as an
important indicator of health because it indicates that
their weak point is functioning normally. Furthermore,
perspiration is viewed as the core factor in treating
disease; therefore, the characteristics of the disease are
specifically differentiated. There is no empirical data con-
cerning perspiration in TY types; however, because their
strong point is lung functioning, it can be assumed that
they normally perspire more easily. In summary, perspi-
ration may be a more important diagnostic factor for SE
and TE types than for SY or TY types (11).
Current available literature (11–12,14) and pre-existing
empirical data (10,13) have indicated that variations
in skin humidity (SH) after perspiration can reflect the
quantity of perspiration, and that this variation will likely
differ across Sasang constitution types. Therefore, we
analyzed differences in SH after perspiration among
Sasang types. Sasang type classification was made using
the QSCC II, and individual items on the QSCC II
pertaining to sweating were then further analyzed for
each Sasang type.
Methods
Subjects
Participants in the present study included 99 students
from the College of Oriental Medicine at Daegu Haany
University. Because the formal institutional review board
(IRB) was not yet established at the time of this study,
we assessed the appropriateness of the protocol by con-
sulting with the senior faculty of the college. This study
was conducted in accordance with the Declaration of
Helsinki and the faculty at the College of Oriental
Medicine,Daegu Haany
tests. All participants gave oral consent for the full
assessment, which is described in detail below.
University, supervised the
Procedures
The results of the QSCC II were analyzed using the
computerized scoring version of Win QSCC II (Sord
Medicom& SordOMS(Inc)/Association
Korean Oriental Medical Society). The internal consis-
tency (Cronbach’s alpha) of this inventory was 0.57, 0.59
and 0.63 for the SY, TE and SE types, respectively (1,9).
The following procedure was used to measure the Skin
Humidity Variation (SHV) following Forced Perspiration
(FP). Participants were asked not to move the body area
that was being used for the measurement during the prep-
aration phase. Each participant was then asked to phys-
ically mark the Neiguan (PC6) point (15) approximately
9cm towards the elbow from the inner side of the wrist
with a marker to ensure that an identical area was used
for the actual measurements. Skin Humidity (SH) was
then measured at the PC6 point using a portable humid-
ity measurement instrument (MY707S-Moisture Checker
for skin: scalar KOREA, Japan).
Prior to FP, participants were asked to measure the SH
on their own. This value was regarded as the baseline SH.
To induce the FP condition, the arm that included PC6
point was wrapped 3 times using sealing wrap while
ensuring that air flow was not prevented. After 3min
ofSCM,
88Skin humidity variation between Sasang types

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of FP, participants were instructed to take off the wrap-
ping by themselves, after which the SH of PC6 was
immediately measured. After waiting for the SH to
return to baseline, another measurement was taken
using the same method. In total, three SH measurements
were taken (Fig. 1a1), and the average value was used for
comparison of data before and after FP. SHV was calcu-
lated by subtracting the average pre-FP value from the
Figure 1. The effects of FP on SH. (a1) Procedure for the measurement of SH before and after FP. (a2) Classification of subjects (n¼99) into Sasang
type according to QSCC II. (b1 and 2) Comparison of male (n¼69) and female (n¼30) SH (b1) before and after FP and variation in SH (b2). (c1
and 2) Comparison of SH among Sasang types (c1) before and after FP and variation in SH (c2) in males. (d1 and 2) Comparison of SH among
Sasang types (d1) and variation in SH (d2) before and after FP in females. Data are expressed as the means?SEM. Data were analyzed by one-way
ANOVA followed by Duncan multiple comparison tests. *P50.05 compared with values before FP or among groups.
eCAM 2009;6(S1)89

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average post-FP value. The SHV was then analyzed by
gender and across Sasang constitution types.
Next, the relationship between the six QSCC II items
related to sweating (items number 10, 106, 107, 110, 120
and 121) and constitution types were evaluated using a
previously described method (5). Questions consisted of
one multiple choice question (items number 10 and 5)
and ‘yes/no’ questions (items number 106, 107, 110, 120
and 121; Table 1). Differences in the responses to these
items were then evaluated across gender and Sasang con-
stitution types. The responses to these items were also
examined with regard to SHV, according to gender and
Sasang type (9).
Statistical Analysis
Statistical analysis was performed with one-way ANOVA
followed by Duncan’s multiple comparison test to iden-
tify potential differences in SH or SHV across Sasang
types or using chi-squared tests to compare the response
with QSCC II questions among Sasang constitution
types. All analyses were conducted using SPSS 16.0.1
for Windows (SPSS Inc., Chicago, IL). A P-value 50.05
was considered to be statistically significant.
Results
Figure 1a2 shows the prevalence of each Sasang type
classified by QSCC II, and the gender of the participants.
SH of Each Gender Before and After FP
SH and SHV were measured before and after FP
and then compared across gender. The SH before FP
was 31.44?2.82 for male participants and 29.69?3.19
for female participants (F¼7.34, P50.01). Following
FP, SH was 36.23?3.96 for male participants and
33.56?3.85 for female participants (F¼9.63, P50.01).
However, there was no difference between male and
female participants when SHV was evaluated (F¼3.26,
P¼0.07; 4.79?2.49 for male participants and 3.86?1.95
for female participants; Fig. 1b1 and b2).
SH for Each Sasang Type Before and After FP
SH and SHV were measured before and after FP and
then compared among Sasang types. SH prior to FP
was 32.85?2.05 for the TE type, 32.14?2.01 for the
SY type and 30.54?3.08 for the SE type when male
participants were evaluated. The SH differed significantly
between the TE and SE types (F¼4.97, P50.05). SH
after FP increased significantly to 37.81?3.92 in the
TE type, 37.34?3.96 in the SY type and 35.11?3.71
in the SE type (F¼3.69, P50.05). Post hoc analysis indi-
cated that the SH differed significantly between TE and
SE types. The SHV did not differ significantly among
male participants across the different constitutions, as
indicated by values of 4.96?2.48 for the TE types,
5.19?2.87 for the SY types and 4.57?2.40 for the SE
types (F¼0.37, P¼0.69; Fig. 1c1 and c2).
The SH prior to FP was 29.96?3.39 for the TE type,
30.91?1.88 for the SY type and 28.86?3.64 for the SE
type in female participants. These values did not differ
significantly (F¼1.20, P¼0.32). The SH after FP was
35.45?3.78 for the TE type, 34.18?3.21 for the SY
type and 32.43?4.08 for the SE type, which did not
differ significantly (F¼1.54, P¼0.23). The SHV was
5.49?1.72 for the TE type, 3.26?1.93 for the SY type
and 3.57?1.79 for the SE type. There was a significant
difference in the values of SHV between the TE and SE
types, and between the TE and SY types (F¼3.08,
P¼0.04; Fig. 1d1 and d2).
Sweating-Related Items in QSCC II and Sasang Types
Participants’ responses to the 6 QSCC II questions (items
number 10, 106, 107, 110, 120 and 121) were analyzed for
each constitution type and across gender. There were no
significant differences in the sweating-related items across
gender. For item number 10, which pertained to the rela-
tionship between the respondents’ physical condition and
sweating, 69.6% of TE types, 43.5% of SY types and
56.6% of SE types selected 10-A, 10-C and 10-B, respec-
tively. These responses differed significantly between the
TE and SY types and the TE and SE types (P50.01).
For item 110 (‘When I don’t feel good, perspiration
makes me feel refreshed’), 60.9% of TE types, 34.8% of
SY types and 17.0% of SE types replied ‘Yes’. Duncan’s
post hoc analysis revealed that these responses differed
significantly between the TE and SY types and the TE
and SE types (P50.01). For item 120 (‘I normally don’t
perspire a lot, but when my sickness worsens, I experi-
ence more cold sweats’), 8.7% of TE types, 30.4% of SY
types and 45.3% of SE types replied ‘Yes’. Statistical
analysis of these responses revealed a significant differ-
ence between TE and SE types (P50.01). In summary,
Table 1. Sweating-related questionnaire items in QSCC II
10-Aa
10-B
I normally sweat a lot, and after sweating, I feel refreshed.
I normally don’t sweat a lot, and I become tired even if
I perspire a little.
I’m not really tired after perspiration.
I feel my body gets better after my hands and feet sweat.
I feel my body gets better after perspiration occurs below
my nose.
When I don’t feel good, perspiration makes me feel refreshed.
I normally don’t perspire a lot, but when my sickness worsens,
I experience more cold sweats.
I perspire a lot during winter, even after eating cold food.
10-C
106
107
110
120
121
aNumbers indicate item number in QSCC II.
90Skin humidity variation between Sasang types

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the responses to items 10, 110 and 120 differed signifi-
cantly across Sasang types, while the responses to items
106, 107 and 121 did not (P¼0.34, P¼0.13 and
P¼0.99, respectively; Table 2).
Discussion
We evaluated variations in SH after perspiration to deter-
mine if the amount of perspiration differed across differ-
ent Sasang types (10,11). To this end, and to identify a
novel method of diagnosing Sasang types, we induced
perspiration in participants and then compared the differ-
ences in SHV before and after perspiration among
Sasang types.
The results of this study revealed significant differences
between male TE and SE types (Fig. 1c1). In addition,
female TE types showed more perspiration compared
with the SE and SY types (Fig. 1d2). It has been reported
that the TE type has more total body water compared
with SE and SY types when gender differences are not
regarded (14). Therefore, the volume of body water and
perspiration may be physiological characteristics of the
TE type, and the SHV induced by FP may enable differ-
entiation of the TE type from other Sasang types.
In regards to the relationship between sweating-related
QSCC II items (9) and constitution type (Tables 1 and 2),
the TE type tended to choose the answer, ‘I normally
sweat a lot, and after sweating, I feel refreshed’ (item
10-A), while the SY type chose, ‘I’m not really tired
after perspiration’ (item 10-C) and the SE type preferred
the answer, ‘I normally don’t sweat a lot, and I become
tired even if I perspire a little’ (item 10-B). These findings
indicate that there is a close correlation between sweating
and Sasang typology.
When the responses to questions regarding pathological
perspiration were evaluated, the TE type chose, ‘When I
don’t feel good, perspiration makes me feel refreshed’
(item 110) more often than SE and SY types. The SE
type more frequently selected the response ‘I normally
don’t perspire a lot, but when my sickness worsens,
I experience more cold sweats’ (item 120) when compared
with the TE type. The answers ‘I feel my body gets better
after perspiration in my hands and feet’ (item 106), ‘I feel
my body gets better after perspiration below my nose’
(item 107) and ‘I perspire a lot in the winter even after
eating cold food’ (item 121) did not differ significantly
across the Sasang types.
Regarding post-perspiration states, many of the SY and
TE types replied that they felt refreshed after perspira-
tion, while a majority of the SE type replied that they felt
tired. When an identical comparison of Sasang types was
conducted, there was a significant difference between SE
and SY types and between SE and TE types. These find-
ings confirm the results of a previous study in which the
TE and SY types replied that they normally perspire
a lot, while the SE type replied that they normally
do not (10).
In the present study, there was a significant difference
in SH between male TE and SE types under normal
conditions and after FP, while the SHV induced by FP
differed significantly between female TE and SE types
and between TE and SY types. Further studies are
needed to find differences between the TE and other
Sasang types in regional sweat distribution, sweat rate,
onset threshold for sweating and neural control in a
larger clinical sample using a more stringent instrument
(10,11,13,16–18).
This study was conducted to determine if there is a
relationship between SH induced by FP and Sasang
typology. Although this study cannot rule out the influ-
ence of other environmental factors such as temperature,
humidity and the air flow, evaluation of forced sweating
may be a methodological option for making comparisons
across Sasang types.
The SH of male participants differed between the TE
and SE types under normal conditions and after FP,
while significantdifferences were observed
female TE and SE types and between female TE and
SY types. Based on these results, we conclude that
there is a need for further study regarding the use of
differences in SH as a diagnostic index for the differen-
tiation of the TE types from individuals with other
Sasang constitutions.
between
Funding
Korea Science and Engineering Foundation (KOSEF)
grant funded by the Korea government (MEST) (Grant
No. M10643020004-08N4302-00400).
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Table 2. Sweating-related items and Sasang types
No.Tae-Eum
type (n¼23),
n (%)
So-Yang
type (n¼23),
n (%)
So-Eum
type (n¼53),
n (%)
Total,
n (%)
10-A 16 (69.6)a
10-B
3 (13)
10-C
4 (17.4)
106 6 (26.1)
107 1 (4.3)
11014 (60.9)a
1202 (8.7)a
1211 (4.3)
6 (26.1)
7 (30.4)
10 (43.5)b
2 (8.7)
3 (13.0)
8 (34.8)b
7 (30.4)a,b
0
10 (18.9)
30 (56.6)b
13 (24.5)
8 (15.1)
1 (1.9)
9 (17.0)b
24 (45.3)b
3 (5.7)
32 (32.3)
40 (40.4)
27 (27.3)
16 (16.2)
5 (5.1)
31 (31.3)y
33 (33.3)y
4 (4.0)
99 (100)y
No. denotes item number in QSCC II; Superscripted letters denote
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Received March 16, 2009; accepted June 18, 2009
92Skin humidity variation between Sasang types