Abstract
Dear Editor,
We read with great interest the secondary qualitative analysis by Liu et al, 1 entitled “Traditional Chinese Medicine Combined Group Psychotherapy Experiences Among Colorectal Cancer Survivors.” The authors adeptly illuminate the transformative journey of patients through an integrative intervention, highlighting foundational outlook shifts and tangible lifestyle reforms. As practitioners and researchers in Traditional Chinese Medicine (TCM), we commend this vital work for aligning modern psychosocial support with the holistic principles of TCM, thereby addressing both the physical form (形) and spirit (神) of cancer survivors.
Although the study provides valuable patient-centric insights, we believe that a deeper integration of TCM theory and methodology could significantly strengthen the interpretation of findings and guide future research. We wish to offer the following constructive perspectives.
First, the intervention incorporated TCM practices such as self-acupressure, dietary advice, and Five-Element Music Therapy (TCM-FEMT), yet the qualitative analysis grouped benefits under broad themes like “psychological resilience” and “symptom relief” without exploring the specific TCM mechanisms perceived by patients. For instance, did patients attribute sleep improvements to the calming of the Heart (心) and tranquilization of the spirit (安神) through acupressure, or primarily to group support? Similarly, was appetite improvement understood through the TCM concept of “fortifying the Spleen” (健脾)? Future qualitative studies should explicitly investigate patients’ understanding of how these TCM modalities worked, potentially revealing whether the intervention’s success stems from culturally resonant explanations—a hypothesized advantage of integrative TCM care.
A second consideration involves the missed opportunity to incorporate TCM constitution (体质) theory into personalization strategies. Although the study noted that patients received “tailored” TCM lifestyle coaching, the analysis did not examine whether variations in constitution—such as Qi deficiency or Yin deficiency—shaped their experiences or outcomes. A patient with Liver Qi Stagnation (肝郁气滞) might have found emotional expression in the group particularly liberating, whereas a patient with Spleen Qi Deficiency could have benefited most from dietary guidance. We strongly recommend that future trials administer the Classification and Determination of TCM Constitution at baseline, thereby enabling qualitative analyses to stratify experiences by constitution and move beyond a uniform interpretation of the intervention.
Third, the theme of “Tranquilized mind and empty thinking” resonates strongly with the TCM ideal of “nurturing the heart and calming the spirit” (养心安神), while “Valuing life” aligns with the TCM emphasis on “treasuring the vital energy” (珍惜精气). The authors could have enriched their discussion by framing these cognitive shifts as manifestations of restored balance between the Heart, which houses the spirit, and the Kidneys, which store vital essence—grounding the observed psychological benefits within TCM’s foundational physiology.
Finally, the study documented that patients “actively practiced” methods such as acupressure and foot baths, but the qualitative data lacked detail on the fidelity, frequency, and perceived efficacy of each technique. As highlighted in moxibustion research, the “dose” of TCM practice is critical. 2 Did more diligent acupressure practice correlate with better outcomes? Were certain acupoints perceived as more helpful for specific symptoms? Incorporating brief quantitative surveys on TCM practice adherence alongside in-depth interviews could help illuminate dose-response relationships within patients’ qualitative experiences.
In conclusion, Liu et al have made a commendable step toward validating a culturally sensitive, integrative model of survivorship care. To advance this promising field, we advocate for research designs that more deeply embed TCM theory—particularly constitutional differentiation—and employ mixed methods to clarify the specific roles, mechanisms, and optimal “dosing” of TCM components within integrative psycho-oncological interventions.
Footnotes
Author Contributions
Mingyue Chen: Conceptualization, writing—original draft preparation; Yan Han: Methodology, writing—review and editing; Fenxiang Zhang: Conceptualization, writing—review and editing; All authors have read and agreed to the published version of the manuscript.