Qian Cai, MM

Linye Wu, MM
Yunxian Zhou, PhD

Experiences With Traditional Chinese

Medicine Among Patients With
Inflammatory Bowel Disease
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A Qualitative Study

ABSTRACT
Despite the increasing number of inflammatory bowel disease (IBD) patients using traditional Chinese medicine
(TCM), relatively few studies have examined their experiences with TCM in the Chinese healthcare context. The aim
of this study was to explore these experiences from the perspective of IBD patients. Adopting a qualitative descriptive
method, IBD patients from several comprehensive hospitals in Hangzhou, Zhejiang were recruited through purpo-
sive sampling. Data were collected using semistructured interviews and analyzed by a conventional content analysis
method. The results are presented thematically. Fourteen IBD patients participated in the study. They often used TCM,
such as Chinese herbal medicine, retention enemas of Chinese medicine, and acupuncture, as a complementary
therapy instead of as an alternative to conventional therapies. Three themes emerged from the analysis: triggers for
initiating TCM, the experienced efficacies of TCM, and disturbances caused by TCM use. The IBD patients initiate
TCM treatment due to the unsatisfactory effects of conventional therapies and TCM culture. However, the efficacies of
TCM are subjective and slow acting and vary across individuals. There are communication gaps between physicians and
patients concerning TCM. Thus, healthcare professionals are encouraged to gain more knowledge on these therapies
and employ a participatory decision-making style based on this understanding.

I
nflammatory bowel disease (IBD), including ulcera-
tive colitis (UC) and Crohn disease (CD), is a group
of inflammatory conditions of the gastrointestinal
tract without a clear etiology or pathogenesis (Zhang
Received June 4, 2018; accepted August 13, 2018.
About the authors: Qian Cai, MM, School of Nursing, Zhejiang Chinese
Medical University, Hangzhou, Zhejiang, China.
Linye Wu, MM, School of Nursing, Zhejiang Chinese Medical University,
Hangzhou, Zhejiang, China.
Yunxian Zhou, PhD, School of Nursing, Zhejiang Chinese Medical
University, Hangzhou, Zhejiang, China.
The authors declare that they have no competing interests.
The work was sponsored by Zhejiang Provincial Program for the
Cultivation of High-level Innovative Health Talents (http://www.zjwst.gov.
cn/) and Zhejiang Provincial Administration Bureau of Traditional
Chinese Medicine (Grant no. 2016ZB031, http://www.zjtcm.gov.cn/pub-
lic/Default.aspx).
Correspondence to: Yunxian Zhou, PhD, School of Nursing, Zhejiang
Chinese Medical University, 548 Binwen Rd, Binjiang District, Hangzhou,
Zhejiang 310053, China (yunxianzhou@hotmail.com).
DOI: 10.1097/SGA.0000000000000418
& Li, 2014). Patients with IBD often experience various
symptoms, such as abdominal pain, diarrhea, intestinal
bleeding, and fever, along with extraintestinal manifesta-
tions and complications (Committee of Inflammatory
Bowel Disease, Chinese Society of Gastroenterology,
2012; Ott & Scholmerich, 2013). In the last three dec-
ades, IBD has become a global disease with accelerating
incidence in newly industrialized countries, particularly in
Asia (Kamm, 2017; Ng et al., 2018). For example, IBD is
now one of the most common gastrointestinal diseases in
China (Committee Of Inflammatory Bowel Disease,
Chinese Society of Gastroenterology, 2012). It is a chron-
ic disease with intermittent relapse, and there is currently
no cure. Inflammatory bowel disease can severely affect
the social productivity and quality of life of patients
(Knowles et al., 2018; Zhou, Ren, Irvine, & Yang, 2010).
Background
Conventional therapies for IBD are mainly based on
medications such as aminosalicylates, corticosteroids,
immunosuppressive agents, and new biological agents.

VOLUME 43 | NUMBER 2 | MARCH/APRIL 2020 135

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Experiences With Traditional Chinese Medicine
However, these medications may be associated with
severe side effects, body image alterations, high relapse
rates after withdrawal, and high costs (Ghosh &
Premchand, 2015; Quezada, Briscoe, & Cross, 2016).
Surgery can promote remission, but it has disadvan-
tages such as a high recurrence rate, and more than one
surgery is usually required (Baker, Lee, Jones, Brown,
& Lobo, 2017). Because of their dissatisfaction with
conventional therapies, some IBD patients opt to try
complementary and alternative medicine (CAM)
(Hung, Kang, Bollom, Wolf, & Lembo., 2015;
Quattropani, Ausfeld, Straumann, Heer, & Seibold,
2017).
The World Health Organization (WHO) defines
CAM as a broad set of healthcare practices, systems,
and products that are not generally considered part of
a country’s own tradition and are not integrated into
the main healthcare system (WHO, 2013). Traditional
Chinese medicine (TCM) is a form of CAM that
appeals to western healthcare systems because of its
comprehensive, holistic approach to managing chronic
diseases or conditions such as IBD (Joos et al., 2006;
Oxelmark et al., 2016; Quattropani et al., 2017;
Winter & Korzenik, 2017). As its name implies, the
TCM is originated in China and has been widely used
for more than 2,000 years. The philosophy of TCM
emphasizes that a balance between Yin and Yang is
vital to sustaining optimal body health (Xiao & Tao,
2017). The forms of TCM mainly include Chinese
herbal medicine, retention enemas of Chinese medi-
cine, acupuncture, moxibustion, Tuina, cupping and
auricular–plaster therapy, and so forth. Today, acu-
puncture and moxibustion are the most commonly
practiced modalities of TCM in the western world (Ji
et al., 2016; Stein, 2017).
In recent years, an increasing number of IBD
patients have turned to TCM therapies during or after
conventional treatment to alleviate their symptoms
and improve their quality of life (Opheim, Lie Høivik,
Bernklev, Jelsness-Jørgensen, & Moum, 2016; Winter
& Korzenik, 2017). A survey conducted in Taiwan
found that more than one-third of IBD patients visited
TCM clinics (Chen, Chen, Chen, Chou, & Hwang,
2008). Although TCM is based only on patients’ expe-
riences, and no specific details on TCM are mentioned
in IBD treatment guidelines, TCM is offered at both
private and public hospitals in China. Many rand-
omized controlled trials have been conducted on the
use of acupuncture and moxibustion for alleviating the
side effects of IBD treatments (Langhorst et al., 2015;
Lee et al., 2010), but to the best of our knowledge, no
research has examined patients’ motivations for, expe-
riences with, or perceptions of TCM use. Therefore,
this study aimed to explore such issues from the per-
spective of IBD patients to provide a reference for
136 Copyright © 2020 Society of Gastroenterology Nurses and Associates
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healthcare professionals in better understanding the
care-seeking behaviors of IBD patients. It also aimed to
indicate future directions for similar studies.
Methods and Participants
Participants
Purposive sampling was used to select IBD patients from
IBD clinics and gastroenterology wards of several com-
prehensive hospitals in Hangzhou, Zhejiang, China,
from October 2015 to June 2016. Participants were
eligible if they (1) were diagnosed with IBD based on the
Chinese consensus released in 2012 (Committee of
Inflammatory Bowel Disease, Chinese Society of
Gastroenterology, 2012), (2) had been using TCM treat-
ment for at least 3 months, (3) were aged between 18
and 60 years, and (4) participated in the study voluntar-
ily, without communication barriers. Participants were
excluded if they had other chronic diseases, such as
hypertension or diabetes, or were incapacitated by men-
tal deficiency. The sample size was determined by theme
saturation.
Data Collection
Data were collected using face-to-face semistructured
interviews conducted in private and quiet places, such
as wards or physician offices. Initially, an interview
guide was developed on the basis of clinical experience
and a literature review. It mainly included the following
questions: “What were the triggers for you to start the
TCM treatment?” “Could you share with me your
experiences of TCM treatment?” “What are the prob-
lems and challenges you encountered while receiving
TCM treatment?” During the interviews, open-ended
questions were asked first, and then, follow-up ques-
tions were used to encourage elaboration on responses
when necessary. Field notes were recorded on details of
observations, interactions, the environment, and partici-
pants’ body language. The interviewer remained neutral
and avoided making any judgment on the interview
contents. All interviews were audio-recorded, and their
average length was approximately 30–50 minutes.
Data Analysis
Conventional content analysis was used to analyze the
data (Elo & Kyngas, 2008; Hsieh & Shannon, 2005).
The first step was to read the entire transcript several
times to reach an overall understanding of the partici-
pants’ experiences. Then, important contents related to
their experiences with TCM treatment were highlight-
ed, coded line by line, and grouped into subthemes and
themes on the basis of similarities and differences.
Finally, a definition for each theme and subtheme was
created, and corresponding supportive quotes from the
data were selected. Data collection and analysis
Gastroenterology Nursing
 Experiences With Traditional Chinese Medicine
continued until no further themes or subthemes
emerged (Bowen, 2008).
Rigor
In this study, rigor was maintained by the following
two methods. First, credibility was established through
peer debriefings, in which the researchers consulted
with each other to address any ambiguities or disagree-
ment on methodological issues or data analysis. Second,
the themes and subthemes extracted from the collected
data were presented to the participants for feedback on
whether their feelings or experiences aligned with the
themes and to obtain any supplementary information.
Ethical Considerations
Ethical approval for this study was obtained from the
ethics committee of Zhejiang Chinese Medical
University, and written informed consent was obtained
from each participant. All participants were informed
that they had a right of refusal and that they could exer-
cise this right at any time without any negative impact
on the services delivered to them. We also guaranteed
the confidentiality of their personal information.
Results
A total of 14 IBD patients (eight UC and six CD) were
interviewed. The profile of the participants is shown in
Table 1. Overall, 93% of participants used Chinese
herbal medicine; 36% used a retention enema of
Chinese medicine, 21% used acupuncture, 14% used
moxibustion, and 14% used Tuina (Table 2). The analy-
sis yielded three themes and eleven subthemes (Table 3).
Triggers for Initiating TCM
The triggers for initiating TCM referred to the motiva-
tions of the IBD patients to start TCM therapy.
Participants were either past users of TCM who had
trust in TCM or had multiple information sources as
an introduction to TCM. Dissatisfaction with conven-
tional therapy made the patients eager to try TCM as
a complementary therapy. This eagerness was further
intensified by the TCM culture in China.
Being Influenced by Their Own or Others’
Past Experiences
Many participants indicated that the initial triggers for
them to try TCM were recommendations from family
members and friends.
A friend working in a hospital recommended that I
visit a local TCM practitioner. (P1)
Some participants revealed that their past TCM
experiences or the experiences of people around them
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influenced their choice. In particular, those successful
experiences made them believe in TCM and thus
choose this therapy.
I once had a fever. The Chinese herbs not only cured
me but also freed me from fever for many years after
that. Therefore, TCM came to my mind naturally
when I got this disease. (P6)
A number of participants mentioned that they had
heard that someone who suffered from the same dis-
ease was cured by TCM, which motivated them to see
the same TCM practitioner.
It may be related to communication among the ward-
mates. He told me his experiences and how great he
felt and where the disease was cured (by the TCM
practitioner). Therefore, I went to see the same TCM
practitioner as well. (P9)
Being Dissatisfied With Conventional
Therapies
In some cases, participants tried TCM when their dis-
eases were out of control under conventional therapies
or they faced side effects.
I’ve tried western therapies and taken all kinds of medi-
cines, such as mesalazine. The condition was still unstable,
and it recurred repeatedly. So, I wanted to try TCM. (P4)
The IBD patients engendered the idea of trying
TCM when they were informed that conventional
treatment was unable to cure their disease.
The western physician told me that this disease cannot be
cured for life, so I use TCM to build up my health. (P2)
Most participants considered that the side effects of
western medicine were severe, especially on liver and
kidney functioning, whereas TCM was relatively natu-
ral and had fewer side effects.
Western medicine is harmful to the liver and kidney,
while such disturbances do not exist when taking tra-
ditional Chinese herbs. (P8)
Some participants revealed that they initially chose
TCM out of irrationality rather than based on a full
understanding. Because conventional therapies failed
to produce the desired effect, they were eager to try
everything that might have a positive effect.
When you suffer a lot from the disease, you are like a
drowning man clinging to a straw. Anyway, the real
effects of TCM were unknown. So, why not have a
try? It may work. (P13)
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Experiences With Traditional Chinese Medicine

TABLE 1. General Information on the Participants (N = 14)

Combining
TCM With
Age Marital Type of Conventional
Participant Gender (Years) Occupation Status Education Level Disease Therapies

1 Female 31 Pharmacist Married Master’s degree UC Yes

2 Male 39 Accountant Married Bachelor’s degree CD Yes
3 Female 55 Farmer Married Primary school or CD Yes
less
4 Male 31 Worker Single Bachelor’s degree CD No
5 Male 21 Self-employment Single Junior high school CD No
6 Male 39 Unemployed Married Senior high school CD Yes
7 Male 48 Staff Married Primary school or UC Yes
less
8 Male 38 Staff Married Junior high school UC Yes
9 Male 39 Self-employment Married Bachelor’s degree UC No
10 Female 59 Retirement Married Primary school or CD Yes
less
11 Female 35 Self-employment Married Junior high school UC Yes
12 Female 32 Unemployed Married Associate degree UC Yes
13 Female 35 Nurse Married Bachelor’s degree UC Yes
14 Female 21 Unemployed Single Bachelor’s degree UC Yes
Note. CD = Crohn disease; TCM = traditional Chinese medicine; UC = ulcerative colitis.

Taking TCM as a Complementary Being Influenced by TCM Culture

Treatment
Some participants indicated that they would add
Chinese herbal medicine if their condition could not be
controlled because TCM and conventional therapies
can complement each other.
If my condition got worse and was out of control, I
would add some Chinese herbal medicine as a try, just
like last time. TCM and conventional therapies comple-
mented each other, and the effects were enhanced. (P6)
Traditional Chinese medicine has a long history, and
China has a profound TCM cultural heritage. Some
participants indicated that they were influenced by the
culture and thus had strong confidence in the therapy.
Following our ancestors, Chinese people usually have
some confidence in TCM. So just have a try. (P4)
As elderly people say, intestines and the stomach should
be taken care of slowly using TCM. (P12)

Many participants held the view that TCM could be
used not as the main therapy but as a complementary
therapy for conventional treatment.
I think it is impossible to stop taking western medicine
because TCM only plays an auxiliary role. (P14)
Accordingly, some participants revealed that they
would not consider using TCM when their diseases
were stable.
Since my current condition is stable, I would not con-
sider using TCM, even if it may have some effects. (P10)
Some participants believed that the use of TCM to
treat illnesses was well founded.
The theory of TCM does have some basis. (P14)
A number of participants held the view that conven-
tional therapies could remove only the symptoms of IBD,
whereas TCM was holistic and able to cure it. As a chronic
disease, IBD is suitable to be treated by the latter.
I consider the Chinese herbs are intended to improve
health in the long run, and it is better for one’s health
if he or she has a chronic disease. (P5)

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 Experiences With Traditional Chinese Medicine
TABLE 2. Modality of Traditional Chinese
Medicine Used (N = 14)
Number of Percentage of
Modality Used Patients Patients
Chinese herbal medicine 13 93
Retention enema of 5 36
Chinese medicine
Acupuncture 3 21
Moxibustion 2 14
Tuina 2 14
The Experienced Efficacies of TCM
In contrast to western medicine, TCM concerns the
body’s reaction to etiological agents and attempts
to settle internal maladjustment. Therefore, treat-
ment via TCM principally relies on visible signs
and symptoms. Generally, health outcomes and
efficacies appear slowly and vary from person to
person.
Subjective Efficacy Evaluation
Many participants indicated that TCM practitioners
usually evaluated treatment efficacy by observing and
inquiring about symptoms. The efficacy is mainly
based on feeling and is therefore less objective than the
efficacy of western medicines.
Basically, there are no laboratory examinations, and
most are based on inquiries, such as inquiring about
defecation and the frequency of defecation or the like.
(P6)
The participants noted that the efficacies of TCM
were mainly evaluated on the basis of the physical feel-
ings of the IBD patients, which are subjective.
TABLE 3. Themes and Subthemes of the Study
Themes
Triggers for initiating TCM
The experienced efficacies of TCM
Disturbances caused by TCM use
Note. TCM = traditional Chinese medicine.
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It is most important to pay attention to your own feel-
ings and not to rely on lifeless things such as labora-
tory data. (P10)
Slow-Acting Efficacies
Many participants thought that TCM was slow acting;
therefore, its efficacies could not be felt in the short
term. It is necessary to continue treatment for a long
period.
I felt that the Chinese herbs should be taken for a long
time and that their efficacies were quite slow, without
immediate effects. (P14)
The moxibustion did have some effects, but it was
slow acting. I felt it took a long time to heal. (P11)
Because there were no immediate effects, many par-
ticipants indicated that they tended to feel discouraged
and then give up on TCM.
The treatment course of Chinese herbs was too long. It
ranged from half a year to many years. I persisted for
two months, yet without effects. I gave up at last
because of stomachache. (P5)
Because of the slow action of the Chinese herbs,
many participants indicated that they were uncertain
whether they worked after taking them for a period of
time.
Well, until now, I am still not sure whether the Chinese
herbs work or not. The efficacies of western medicines
generally appear very quick, while this is not the case
with Chinese herbs. (P1)
Individually Varying Efficacies
The most concerning issue for IBD patients during
TCM treatment was its efficacies. Some participants
Subthemes
Being influenced by their own or others’ past experiences
Being dissatisfied with conventional therapies
Taking TCM as a complementary treatment
Being influenced by TCM culture
Subjective efficacy evaluation
Slow-acting efficacies
Individually varying efficacies
Cumbersome treatment process
Vague treatment instructions
Communication dilemmas
Concern about TCM reliability and safety
139
Experiences With Traditional Chinese Medicine
indicated that they experienced a positive effect after
adhering to TCM for a certain period.
After taking Chinese herbs, I felt quite good. In par-
ticular, my diarrhea improved a lot. Previously, my
bowel movement frequency was 3-5 times a day, and it
was almost once a day after I took the Chinese herbs
for over a month. (P7)
However, some participants experienced no obvious
effects after receiving TCM therapy.
No obvious effects at all after taking the Chinese
herbs; I almost felt the same as before. (P12)
Some participants indicated that their condition
even worsened after taking the Chinese herbs.
After I saw the TCM practitioner and took the Chinese
herbs, my bowel movements became more frequent
than before, up to 3 or 4 times a day, and the stool
contained blood and was dark green. (P11)
Disturbances Caused by TCM Use
Relatively speaking, it was difficult for the IBD patients
to practice and adhere to TCM therapy because the
implementation process was complicated and cumber-
some, and the treatment guide was usually confusing.
In addition, TCM and conventional therapies were
often used together in treating IBD. Consequently,
communicating treatment information with physicians
could put the patients in dilemma, which aggravated
the patients’ concern about the safety of TCM.
Cumbersome Treatment Process
The cumbersome treatment process was a major chal-
lenge that IBD patients faced. Because TCM was slow
acting, some participants indicated that it was not easy
to continue with it for a long time.
Young people may not have the patience, because
moxibustion is slow acting and it takes a long time,
about half a day each time, and you cannot do any-
thing at all, just stay in the room and do nothing. (P11)
To increase the therapeutic effects of Chinese herbs,
it is important to pay attention to extraction methods.
Patients usually choose to concentrate the Chinese
herbs at home rather than ask the hospital to do it,
which was cumbersome.
Every morning, I had to concentrate the Chinese herbs
and then took them to my office with an insulated cup.
After I got off work and returned home, I had to
extract the Chinese herbs again. This was really trou-
blesome. (P2)
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Enemas are one of the characteristic therapies of
TCM. Liquid comes into contact with the affected
areas, and the therapeutic effects appear relatively fast.
However, there were no ready-made TCM enema
products available, and the patients needed to prepare
the Chinese medicine liquid by themselves.
The TCM enema was quite troublesome. First, you
had to extract the Chinese herbs by yourself and then
use the herb liquid for the enema. It was quite different
from the western medicine enema, for which ready-
made products were usually available, and it was rela-
tively convenient. (P9)
In addition, the IBD patients had to maintain a cer-
tain posture during enema that restricted their activity
and was uncomfortable. Although it was tolerable in
the short term, it was difficult to do over a long period
of time.
I felt a lot of discomfort. When using a TCM enema, I
must sleep on my chest rather than my back because
the herb liquid will leak if I sleep on my back. (P3)
Vague Treatment Instructions
Some participants revealed that TCM practitioners
rarely conveyed their knowledge on the disease or
details on the medications. The patients expressed a
desire for more information from these practitioners.
In particular, the TCM practitioner may not explain
the medications clearly. However, as a patient, I was
eager to know about the disease, the herbs, and the
course of treatment. (P14)
I did not know the detailed herb ingredients; he (the
TCM practitioner) did not tell me, but he gave me the
prescription directly. (P5)
Some participants indicated that the instructions
given by the TCM practitioners lacked practicality and
may not be applicable.
I did not know whether the physician used hands-on
practices himself or not. He could have suggested
something only if he had personal experience with it.
(P1)
Some participants also expressed that they would
rather search for and obtain TCM knowledge via the
Internet by themselves than ask physicians because
they thought physicians were always too busy to give
detailed guidance.
It’s not that I am unwilling to ask a physician; I simply
cannot take a prescription to the physician to ask
about each ingredient in the herbs. It is unrealistic.
Gastroenterology Nursing
 Experiences With Traditional Chinese Medicine
The physician would not have enough time to explain
the therapeutic effects of each herb ingredient to me.
(P4)
Communication Dilemmas
Because TCM is often used as a complementary
therapy in chronic diseases, it is quite common for
patients to receive both TCM and conventional
therapies simultaneously. Some participants indicated
that they were hesitant to inform their physicians
about their use of western medicine or TCM. They
worried that this would affect their relationship with
the physicians. As a result, they tended to remain
silent on it.
If there is no influence between the Chinese herbs and
western medicines, I would choose not to tell. It is hard
to combine Chinese medicines and western medicines.
The TCM practitioners hope you won’t use western
medicines, and the western physician hopes you won’t
use TCM. (P10)
Some participants indicated that they did not even
realize the necessity to communicate with their physi-
cians about other treatments they concurrently
adopted.
I felt I had nothing to say at that time. I even didn’t
realize that it should be said. (P5)
Some participants considered that the physicians
would review the medical records or inquire of them if
necessary.
No (communication with the western physician).
Besides, all information was on my medical records, so
why wouldn’t the physicians read it themselves? (P13)
Some participants held the view that the TCM prac-
titioners and western physicians opposed one another.
They worried that western physicians would consider
the use of TCM to reflect a lack of patients’ trust in
them.
Some TCM physicians criticize western medicine,
while some western physicians have a negative view of
TCM…. I was afraid that the western physicians
would consider my use of TCM as an indication that I
had no trust in him. (P11)
Concern About TCM Reliability and Safety
Some participants thought that TCM was an experien-
tial therapy, without an adequate scientific basis, and
that TCM theory was not yet unified. Thus, they were
worried about the reliability of the treatment.
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I feel that different TCM practitioners have different
views on treating this disease. That’s to say, there is no
standard and systematic therapeutic regimen for this
disease yet. (P14)
In addition, some participants were worried about
the safety of TCM, fearing a possible interaction effect
between TCM and conventional therapies.
After taking so many western medicines, I began to take
Chinese herbs. I was worried that there might be a conflict
between Chinese medicine and western medicine. (P12)
In particular, participants questioned the safety of
TCM when they experienced side effects such as gas-
trointestinal discomfort and insomnia after receiving
TCM therapy.
I don’t know whether the dose of Chinese herbs was
too high or not; after taking this herb, I had diarrhea
and lost my appetite. (P10)
My sleep was not good, bad sleep quality, really; I did
not sleep soundly at night, and I had lots of dreams. (P9)
Until now, few clinical trials on TCM (except acu-
puncture and moxibustion) have been conducted, and
some participants were worried about its efficacies.
I think relatively few clinical trials have been con-
ducted for TCM. There is insufficient evidence about
its clinical effects and side effects. (P1)
Discussion
This study found that the main triggers for the choice
of TCM were participants’ dissatisfaction with con-
ventional therapies and their view that TCM is a com-
plementary and suitable therapy to improve the health
of people with chronic diseases. This finding is consist-
ent with studies conducted in the United States (U.S.)
and Switzerland (Hung et al., 2015; Quattropani et al.,
2017). Studies from Canada have also indicated that
some participants adopted CAM to gain greater con-
trol over their diseases (Li, Verhoef, Best, Otley, &
Hilsden, 2005; Zezos & Nguyen, 2017), which might
be influenced by the cultural factor of independence.
Chinese culture emphasizes favors, Guanxi (busi-
ness networks) and face (reputation). People in China
emphasize building social networks, which are viewed
as the key to solving problems of daily life (Chang,
2012). In our study, many participants indicated that
people in their network would recommend TCM and
even introduce them to a practitioner, which was a
favor that they would be unable to refuse. Therefore,
141
Experiences With Traditional Chinese Medicine
we believe that the cultural context and health beliefs
influence the choice of treatment method for IBD
patients. In addition, their own successful experiences
with TCM therapy or the experiences of others they
knew encouraged patients, which was consistent with
the finding in the study by Mountifield, Andrews,
Mikocka-Walus, and Bampton (2015). Although par-
ticipants adopting TCM were motivated by different
triggers, we found that they all held a certain expecta-
tion regarding the efficacies of the therapy at the
beginning.
Studies have shown that the proportion of IBD
patients who adopt acupuncture, moxibustion, and
other forms of TCM is high, and this number contin-
ues to increase every year (Ji et al., 2016; Stein, 2017).
Most patients who try this treatment are young,
female, employed, and well educated and have higher-
than-average incomes (Weizman et al., 2012; Xue,
Zhang, Lin, Da Costa, & Story, 2007). However, Joos
et al. (2006) indicated that 77% of IBD patients felt
insufficiently informed about and had an inadequate
understanding of CAM. In our study, the participants
believed that TCM provided an opportunity for the
body to heal itself and regain its balance, and it was the
most suitable treatment for chronic diseases. They per-
ceived TCM as holistic and capable of improving their
health. Therefore, they often held relatively high
expectations of the efficacies of TCM. However, the
perceived efficacies varied among individuals. This
perception might be influenced by factors such as sub-
jective evaluations of the efficacies and the slow-acting
nature of TCM. Other possible influencing factors
include extraction methods, the depth of the enema,
and the quality of Chinese herbs.
Determining the appropriate methods for evaluating
treatment outcomes in TCM is a problem that has long
perplexed researchers in this area (Xu et al., 2017;
Zhang et al., 2017). Many participants in our study
revealed that they evaluated the efficacies of TCM on
the basis of their physical feelings or subjective experi-
ence in the short term. A satisfactory efficacy would
inspire them to continue with the treatment. On the
contrary, they would question TCM, change their atti-
tudes toward it, and even abandon it if the effects were
unsatisfactory. Some IBD patients’ adherence signifi-
cantly decreased because TCM was slow acting and
involved a cumbersome treatment process.
Consequently, healthcare professionals should discuss
the basic knowledge and features of TCM with
patients through health education to enhance their
awareness and knowledge about the therapy (Winter
& Korzenik, 2017). Moreover, a multicenter, prospec-
tive study on the long-term effects of TCM should be
conducted in the near future to provide guidance for
IBD patients (Cheifetz, Gianotti, Luber, & Gibson,
142 Copyright © 2020 Society of Gastroenterology Nurses and Associates
Copyright © 2020 Society of Gastroenterology Nurses and Associates. Unauthorized reproduction of this article is prohibited.
2017). Our study also found that there are no ready-
made products for TCM enema, and the current
enema method limits patients’ activity. Therefore,
improvements should be made in enema-related prod-
ucts and equipment to make them easier for IBD
patients to use.
This study found that most IBD patients adopted
both TCM and conventional therapies in treating their
disease. During treatment, patients encountered many
dilemmas on how to communicate with their western
physicians about the use of TCM. In particular, some
participants were worried that their relationships with
their western physicians would be affected if they
chose to inform them about TCM proactively. A study
conducted in the U.S. also found that nearly 66% of
IBD patients tended not to inform their physicians
about other therapies that they were using simultane-
ously (Weizman et al., 2012). The reasons for such
behavior were mainly associated with patients’ con-
cerns about a negative response by the physicians, their
belief that the physicians did not need to know, and the
concern that it would worsen the physician–patient
relationship (Langmead & Rampton, 2006; Mountifield
et al., 2015; Robinson & McGrail, 2004). However,
such behavior might result in many risks, such as
adverse effects caused by the interaction between
Chinese medicines and western medicines and conflicts
between TCM and conventional therapies (Hu &
Calduch, 2017; Liu, Chuang, Lam, Jiang, & Cheng,
2015). Studies have shown that the communication
style of physicians could also affect physician–patient
communication quality, and that physicians with a
participatory decision-making style produce better
communication outcomes (Sleath, Callahan, DeVellis,
& Sloane, 2005). Accordingly, physicians should be
more approachable and open-minded in order to offer
patients psychological support. A study conducted in
Sweden indicated that IBD patients were more willing
to report their CAM treatment situation to nurses than
to physicians (Mountifield et al., 2015), which might
be related to the fact that the nurses were more patient
and compassionate toward the patients. Consequently,
we strongly recommend that patients be more proac-
tive in providing their physicians all the information
about their treatments, and physicians should actively
ask their patients about their usage of any other con-
current treatments.
The participants mentioned that most TCM practi-
tioners provided them little to no information on
TCM, and the treatment guides they provided were
not specific enough. This finding was similar to that of
Lindberg, Ebbeskog, Karlen, and Oxelmark (2013).
This lack of information was another patient–physician
communication barrier during TCM treatment. A
large portion of IBD patients in our study believed
Gastroenterology Nursing
 Experiences With Traditional Chinese Medicine
that their TCM practitioners were too busy to explain
the details of TCM, and some patients were worried
that too many questions would upset the physicians
and affect their relationships. Nowadays, IBD patients
can obtain massive quantities of information on TCM
from the Internet. However, this includes both good
and bad information, and it is difficult to distinguish
which information is credible. A number of IBD
patients in our study also thought that some TCM
practitioners lacked knowledge on TCM and were
unable to provide them sufficient information; this
finding was consistent with that of a study conducted
in the U.S. and Sweden (Lindberg et al., 2013; Winter
& Korzenik, 2017). Therefore, it is important for IBD
healthcare providers to become familiar with common
forms of TCM in order to provide general information
on TCM usage (Hilsden, Verhoef, Rasmussen, Porcino,
& DeBruyn, 2011). Undergraduate, graduate, and
continuing medical education programs could
be established to meet these particular needs (Liu,
Huynh, Broukhim, Cheung, Schuster, & Najm, 2014).
Furthermore, resources such as relevant guidelines
and websites should be created to assist healthcare
providers in obtaining information about TCM.
Compared with conventional therapies, TCM is
generally considered to be more natural, safer, and
have fewer side effects (Xiao & Tao, 2017). However,
previous studies on this area have mainly focused on
clinical experiences and reviews, whereas randomized
controlled trials on the safety and reliability of TCM
are sparse (Joos, 2011). It is worth mentioning that
many other mainstream treatments have also never
been rigorously verified by standardized research
(Eddy, 1993; Elash, 1997). Langhorst et al. (2005)
found that only 48% of IBD patients believed that the
scientific basis for CAM was important. However,
our study found that some patients encountered some
discomfort such as gastrointestinal symptoms and
poor sleep quality during TCM treatment, which
made them concerned about its safety. Some scholars
have also questioned the safety of TCM (Joos, 2011;
Liu et al., 2015). A Spanish study indicated that 11
out of 126 IBD patients who used CAM had experi-
enced adverse effects (Fernández et al., 2012), show-
ing that these therapies may not be safe and should be
implemented with monitoring and follow-ups by
healthcare professionals. As its acceptance and use
become increasingly widespread, there is a need for
clinical trials on the benefits and adverse effects of
TCM to provide evidence of its efficacy and safety.
Limitations
The study had limitations. First, theme saturation is a
relative concept. It was limited to the findings of this
study, and it might change with time. In addition, the
VOLUME 43 | NUMBER 2 | MARCH/APRIL 2020
Copyright © 2020 Society of Gastroenterology Nurses and Associates. Unauthorized reproduction of this article is prohibited.
participants were recruited from certain areas, which
might limit the transferability of the findings.
Conclusion
The triggers for TCM adoption by IBD patients are
diversified, including the influence of TCM culture and
unsatisfactory effects of conventional therapies.
However, most participants in our study had a limited
understanding of TCM. Because of the individualized
and complex experiences of TCM, the attitudes toward
and views of TCM vary across IBD patients. They may
encounter many disturbances during TCM treatment.
Therefore, healthcare professionals, including nurses
and physicians, should try to educate patients about
TCM to enhance compliance and promote health.
Nurses should encourage patients to be more proactive
in providing their healthcare providers all the informa-
tion on their treatments and should take the initiative
to routinely ask their patients about the concurrent
usage of any other treatments based on their recogni-
tion of such experiences.✪
ACKNOWLEDGMENTS
The authors thank all the participants who partici-
pated in this study for openly sharing their
experiences.
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