{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T07:18:19Z","timestamp":1787815099845,"version":"build-2784847793"},"reference-count":28,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T00:00:00Z","timestamp":1786320000000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,8,1]],"date-time":"2026-08-01T00:00:00Z","timestamp":1785542400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Evaluation Clinical Practice"],"published-print":{"date-parts":[[2026,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale, Aims and Objectives<\/jats:title>\n                    <jats:p>Clinical classifications operate at different explanatory levels\u2014from molecular subtypes to phenotypic syndromes\u2014yet the epistemological standing of a classification is often treated as though it depends on which level it occupies. This conflation of explanatory level with epistemological standing is unfounded. This essay identifies the minimal epistemological conditions that any clinical classification must satisfy and examines whether these conditions depend on explanatory level.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Philosophical analysis drawing on natural kinds theory (Boyd's homoeostatic property cluster theory), operationalism (Bridgman) and interventionist causation (Woodward). Traditional Chinese Medicine (TCM) constitution theory, developed by Wang Qi over four decades, is used as a developing top\u2010down case study whose three core tenets\u2014classifiable, measurable and modifiable\u2014map onto the three philosophical frameworks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Three conditions were identified as necessary for a clinical classification to be scientifically tractable: ontologically grounded categories, operationalized measurement and testable causal propositions. These conditions are level\u2010independent: they can be met by bottom\u2010up molecular taxonomies and top\u2010down phenotypic classifications alike. The TCM constitution case demonstrates uneven progress across the three conditions\u2014operationalization is relatively advanced, ontological grounding has partial empirical support and causal validation remains nascent\u2014illustrating the framework's utility as a diagnostic tool for assessing research programme maturity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The epistemological standing of a clinical classification depends not on the explanatory level at which it operates, but on whether it satisfies the three identified conditions. This analysis is consistent with explanatory pluralism: molecular investigation and phenotypic classification address different questions along different axes, and evidence\u2010based medicine's evaluative framework applies to both without prejudice.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jep.70549","type":"journal-article","created":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T18:58:44Z","timestamp":1786388324000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Classification Without Reduction: The Epistemology of Clinical Taxonomy Examined Through TCM Constitution Theory"],"prefix":"10.1111","volume":"32","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-8770-8265","authenticated-orcid":false,"given":"Sikai","family":"Ge","sequence":"first","affiliation":[{"name":"Department of Urology, Jinling Hospital, Affiliated Hospital of Medical Nanjing University Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-1136-0090","authenticated-orcid":false,"given":"Xing","family":"Zhou","sequence":"additional","affiliation":[{"name":"The First Hospital of Hunan University of Chinese Medicine Changsha Hunan China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9402-1464","authenticated-orcid":false,"given":"Xuejun","family":"Shang","sequence":"additional","affiliation":[{"name":"Department of Urology, Jinling Hospital, Affiliated Hospital of Medical Nanjing University Nanjing China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,8,10]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1038\/35021093"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291709005753"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2010.09091379"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.126.7.983"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-clinpsy-032816-045020"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.dcmed.2025.03.002"},{"issue":"4","key":"e_1_2_13_8_1","first-page":"1","article-title":"Classification and Diagnosis Basis of Nine Basic Constitutions in Chinese Medicine","volume":"28","author":"Wang Q.","year":"2005","journal-title":"Journal of Beijing University of Traditional Chinese Medicine"},{"issue":"3","key":"e_1_2_13_9_1","first-page":"15","article-title":"Preliminary Assessment on Performance of Constitution in Chinese Medicine Questionnaire","volume":"10","author":"Zhu Y.","year":"2006","journal-title":"Chinese Journal of Clinical Rehabilitation"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/481491"},{"issue":"1","key":"e_1_2_13_11_1","first-page":"7","article-title":"Epidemiological Investigation of Constitutional Types of Chinese Medicine in General Population: Based on 21,948 Epidemiological Investigation Data of Nine Provinces in China","volume":"24","author":"Wang Q.","year":"2009","journal-title":"China Journal of Traditional Chinese Medicine and Pharmacy"},{"issue":"6","key":"e_1_2_13_12_1","first-page":"3240","article-title":"Metabolomics Study of Plasma Samples From Women of Nine Constitutions in Chinese Medicine","volume":"20","author":"Li L.","year":"2021","journal-title":"Journal of Proteome Research"},{"key":"e_1_2_13_13_1","volume-title":"The Stanford Encyclopedia of Philosophy","author":"Bird A.","year":"2024"},{"key":"e_1_2_13_14_1","volume-title":"Naming and Necessity","author":"Kripke S. A.","year":"1980"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1017\/CBO9780511625251.014"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.7551\/mitpress\/6396.003.0012"},{"key":"e_1_2_13_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-005-1876-2"},{"key":"e_1_2_13_18_1","volume-title":"The Logic of Modern Physics","author":"Bridgman P. W.","year":"1927"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1037\/h0046016"},{"key":"e_1_2_13_20_1","volume-title":"The Research Act: A Theoretical Introduction to Sociological Methods","author":"Denzin N. K.","year":"1978"},{"key":"e_1_2_13_21_1","volume-title":"Making Things Happen: A Theory of Causal Explanation","author":"Woodward J.","year":"2003"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.1097\/MD.0000000000042488"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.a1655"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.k4245"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.1093\/0198247044.001.0001"},{"key":"e_1_2_13_26_1","volume-title":"The Disorder of Things: Metaphysical Foundations of the Disunity of Science","author":"Dupr\u00e9 J.","year":"1993"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.2307\/j.ctv1pncnrh"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.312.7023.71"},{"key":"e_1_2_13_29_1","volume-title":"The Design of Experiments","author":"Fisher R. A.","year":"1935"}],"container-title":["Journal of Evaluation in Clinical Practice"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jep.70549","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jep.70549","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jep.70549","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T06:33:57Z","timestamp":1787812437000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jep.70549"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8]]},"references-count":28,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,8]]}},"alternative-id":["10.1111\/jep.70549"],"URL":"https:\/\/doi.org\/10.1111\/jep.70549","archive":["Portico"],"relation":{},"ISSN":["1356-1294","1365-2753"],"issn-type":[{"value":"1356-1294","type":"print"},{"value":"1365-2753","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8]]},"assertion":[{"value":"2026-07-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-24","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-08-10","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70549"}}