The current situation and factors influencing the use of traditional Chinese medicine therapies among patients with chronic disease in china: a cross-sectional study

In recent years, numerous studies have confirmed that TCM therapies have unique advantages in the prevention and treatment of diverse medical conditions^16,17,18,19. Research has revealed that nearly 50% of middle-aged and elderly people in China tend to use TCM therapies, and the characteristic of suffering from chronic diseases is the main factor affecting the use of TCM therapies by this group of people²⁰. In addition, a study in Iran²¹ confirmed that the use of traditional Chinese herbal medicine and acupuncture to treat chronic diseases is very popular among patients with cardiovascular diseases, which also provides an empirical basis and application ideas for the prevention and treatment of chronic diseases with TCM therapies. However, the above mentioned studies have not yet systematically identified the relevant decision-making factors that influence the choice of TCM therapies by patients who have chronic diseases. Therefore, this study applied nationally representative datasets from China to delve into the factors that influence the adoption of TCM therapies by patients who have chronic diseases to explore ways to further enhance the awareness and utilization of TCM therapies among patients with chronic diseases worldwide.

Our research revealed that among the included patients with chronic diseases, the utilization rate of TCM therapies in general was 49.07%. These data indicate that, driven by relevant TCM policies and prevailing trends, the chronic disease population has a certain degree of recognition of the ability of TCM therapies to improve health status and quality of life, which is consistent with the findings of Zhang X et al.²². However, since only around half of the chronic disease population uses TCM, this implies that there is still considerable room for improvement in the utilization rate of TCM therapies among patients with chronic diseases. Among the six types of TCM therapies covered in this study, the utilization rate of Chinese herbal medicine treatment was the highest (73.11%). Compared with Chinese herbal medicine treatment, other TCM therapies, including acupuncture, moxibustion, cupping therapy, finger pressure therapy, and massage, are special TCM therapies that require services provided by professional institutions or health care professionals; thus, their accessibility is relatively limited, leading to a relatively lower utilization rate. Therefore, enhancing the accessibility and acceptability of special TCM therapies, encouraging TCM scholars from different countries to further study and apply these therapies, increasing the promotion and recognition of special TCM therapies, and promoting their widespread application in chronic disease management are necessary.

Furthermore, research shows that there is no significant urban‒rural difference in the proportion of people with chronic diseases using TCM therapies, indicating its balanced popularization in urban and rural prevention and treatment. This is attributed to the effective promotion of TCM policies in China and the universal value of TCM. Given the uneven distribution of medical resources between urban and rural areas worldwide, TCM therapies offer a Chinese solution for narrowing the medical gap between urban and rural areas and provide empirical evidence for the assistance of TCM therapies in chronic disease health management globally.

Our research further revealed that age, self-rated health status, the frequency of drinking, the frequency of medical visits in the past year, media information sources, types of chronic diseases and comorbidities are factors influencing the use of TCM therapies among patients with chronic diseases. Specifically, patients who aged 41–60 years, who have chronic diseases and who drink alcohol a few times a year or even less and those who have medical visits several times a week, approximately once a week, approximately once a month, or several times a year tend to have a higher utilization rate of TCM therapies. This may be attributed to the stronger health awareness among this group, which prompts a higher overall utilization of medical services and, consequently, a higher frequency of TCM therapy use. The utilization rate of TCM therapies is lower among patients with chronic diseases whose self-assessed health status is normal than among those whose self-assessed health status is poor. This should be attributed to relatively healthy people directing a lower level of attention toward different chronic disease therapies, their lesser enthusiasm for seeking help from TCM therapies, and their understanding of the characteristics of TCM, which include having a gentler regulatory effect^23,24 and being relatively less burdensome to the body. Compared with residents with diverse media usage, patients with chronic diseases who obtained media information only through TV exhibit a lower utilization rate of TCM therapies. This is likely due to their limited access to media sources, which hinders their acquisition of more comprehensive knowledge about TCM therapies, thus resulting in a lower utilization rate. Compared with patients who suffered from more than three chronic diseases simultaneously, patients with a single condition, such as hypertension, diabetes, musculoskeletal diseases, or other chronic diseases, as well as those with two or three chronic diseases simultaneously, exhibited a lower utilization rate of TCM therapies. This may be attributed to the fact that the greater the number of chronic diseases, the greater the complexity of their health status, leading to a greater likelihood of selecting different TCM therapy options. Consequently, patients with fewer chronic diseases tend to have a lower utilization rate of TCM therapies. Additionally, existing research has shown that TCM therapies, characterized by their simplicity, accessibility, and low cost, have become one of the distinctive tools for the prevention and treatment of chronic disease comorbidities. They can comprehensively improve overall health, which is also one of the reasons for the higher utilization rate of TCM therapies among patients with more chronic diseases^25,26.

Yu Yanhong, director of the National Administration of Traditional Chinese Medicine of China, mentioned at the side event “Traditional Medicine” of the World Health Assembly that the Chinese government attaches great importance to the development of TCM and gives full play to the advantages and potential of traditional medicine in primary health care and universal health coverage. China has been closely cooperating with the World Health Organization and has included a chapter on traditional medicine in the 11th Revision of the International Classification of Diseases for the first time. At present, TCM has spread to 196 countries and regions, effectively contributing to the building of a community of health for humanity²⁷. Additionally, according to statistics, 113 member countries of the World Health Organization have recognized the use of acupuncture, and the International Organization for Standardization has established the Traditional Chinese Medicine Technical Committee (ISO/TC249) to formulate and promulgate over 110 international standards for traditional Chinese medicine. Therefore, the use of TCM therapies for health care will be widely popular among patients with chronic diseases.

Notably, in China, the innovative strategies and practical experiences of TCM therapies in the prevention and treatment of chronic diseases are particularly valuable for reference. The Healthy China Initiative (2019–2030) policy²⁸ provides clear guidance for the prevention and treatment of several major chronic diseases. For example, in cancer prevention and treatment, innovative integration of traditional Chinese medicine with modern technology has been employed; for chronic respiratory diseases, distinctive TCM services such as “Sanfu Paste” therapy have been promoted. On the basis of the above research results and relevant policies, we propose the following suggestions. First, we recommend leveraging modern communication methods to strengthen the promotion and dissemination of TCM therapies. This can be achieved by utilizing “Internet+” methodologies²⁹ to establish a dissemination matrix related to TCM therapies. By creating online and offline promotional platforms for TCM health preservation and wellness, we can expand the reach of TCM therapies, increase the awareness and utilization rate of TCM therapies among the global chronic disease population regarding their advantages in preventing and treating chronic diseases, increase patients’ awareness of TCM therapies, foster and optimize health-related behaviors among patients with chronic diseases, promote the use of TCM therapies among patients with mild chronic conditions, and motivate patients with chronic diseases to actively adopt TCM therapies. Additionally, through the snowball effect among patients³⁰, we can leverage the approach of “patients attracting other patients” to achieve the goal of “leading to the formation of groups”. In the process of motivation and practice, the work and service capabilities of scholars and technicians in TCM around the world can be enhanced.

On the basis of the advantages and high level of attention that TCM therapies have demonstrated in recent years, governments and their health departments around the world should prioritize the introduction and use of various TCM therapies. Importantly, strengthening the supervision of the application scope of TCM therapies and effectively managing the ethical norms governing their use in the field of chronic diseases are crucial. Moreover, in light of the World Health Organization’s emphasis on vigorously promoting primary health care and considering that most chronic diseases are characterized by their prolonged duration³¹ and can be effectively managed at the grassroots level³², we propose strengthening the capacity building of TCM services within the primary health care systems of various countries, enhancing the ability of primary health care institutions to guide patients with chronic diseases in utilizing TCM therapies, gradually achieving a favorable situation where “TCM therapies support the prevention and treatment of chronic diseases at the grassroots level, and assist in the rehabilitation of chronic diseases at the grassroots level”³³. Furthermore, establishing reimbursement policies for TCM therapies that are compatible with the medical insurance systems of various countries and incorporating a diverse range of TCM therapies into the reimbursement scope to alleviate the economic burden on patients with chronic diseases³⁴ are key factors in promoting the widespread application of TCM therapies in the prevention and treatment of chronic diseases worldwide.