Current Situation and Development Strategy of Residents’Cognition and Use of TCM in Liaoning Province

Wang Shuling,Ren Zhaoxia,He Yalan

(School of Business Administration,Shenyang Pharmaceutical University,Shenyang 110016,China)

Abstract Objective To investigate and analyze the residents’ cognition and use of traditional Chinese medicine (TCM)and put forward corresponding countermeasures for its existing problems.Methods A questionnaire survey was conducted to investigate the cognition and trust of TCM from 380 residents in Liaoning Province.Then,the differences of residents’ way of purchasing TCM and gaining the knowledge of TCM.Finally,Polygonum multiflorum was taken as an example to analyze the problems in residents’ cognition and use of Chinese medicinal materials,Chinese traditional decoction pieces,and Chinese patent medicine.Results and Conclusion A total of 402 questionnaires were collected,and 380 were valid.The effective rate was 94.53%.Residents’ understanding of the top three TCM processing techniques were simmering (58.95%),baking (56.84%),and parching (45.00%).The top three best-known TCM for them were chrysanthemum (72.63%),tangerine peel (63.16%),and hawthorn(62.11%).The main factors influencing residents’ willingness to purchase TCM were doctors’ advice (52.63%),and experts or experienced people’s suggestion (54.21%).The top three ways of residents’ gaining TCM knowledge were:TCM knowledge lecture (64.21%),health care knowledge (55.79%),and personal experience of Chinese medicine such as acupuncture and cupping (54.21%).However,due to the lack of professional knowledge of TCM,insufficient supervision and inconsistent standards,residents frequently took TCM by mistake.Residents have a high recognition of TCM,so its future development is optimistic.However,some residents’ insufficient knowledge of TCM often leads to the misapplication of the medicine.Therefore,to improve residents’ cognition of TCM,it is not only to actively publicize the professional knowledge of TCM,but also to improve the professional skills of practitioners,and the supervision standards and intensity of TCM market,so as to make residents feel at ease to buy safe and high-quality TCM products.

Keywords:traditional Chinese medicine (TCM);purchase;Polygonum multiflorum;cognitive level

Traditional Chinese medicine (TCM) is the crystallization of Chinese wisdom over the past five thousand years.As the carrier of Chinese medicine,TCM is the basic guarantee for the inheritance of TCM culture.Cognition refers to the process of people’s understanding of objective things[1].Residents’cognition of TCM culture is the basis for its inheritance and development[2].In recent years,with the rapid rise of scientific and technological innovation and the large number of aging population,new demands are released in the TCM market for its development.However,in real life,some people have a shallow understanding of the professional knowledge of TCM,and their cognitive attitude is biased,which leads to some problems in purchasing and using TCM.Based on the investigation of the residents’ cognition and trust of TCM in Liaoning Province,Polygonum multiflora was taken as an example to analyze their cognition status and misuse of TCM.This will provide a reference for improving the residents’ cognitive level of TCM and ensuring their safe and rational use of medicine.

1 Investigation and analysis of residents’cognition of TCM in Liaoning Province

TCM,as a treatment method in China,has a direct impact on people’s health in its research and development,production,supervision,and use.At the same time,TCM protects people’s health with its unique advantages of treating common diseases,major difficult diseases,and public health event.With the change of concepts in the new era and the strong support of the government,residents’ cognition of TCM is also changing constantly.

1.1 Basic situation in Liaoning Province

China has a vast latitude span,which nourishes a rich TCM resource.There is a variety of more than 10 000 kinds of herbs and the distribution of TCM resources varies from region to region.Liaoning Province is located on the east of Eurasia with typical temperate continental monsoon climate.Due to the sufficient rainfall,it is wet in the east and dry in the west.Its fertile land and the best temperature and humidity are good for Chinese herbal medicine growth.Thanks to the unique geographical climate advantage,Chinese herbal medicines in Liaoning also have excellent natural quality and rich yield.

According to the sampling survey data of Liaoning Provincial government,compared with the sixth national census in 2010,the permanent population of Liaoning Province increased by 0.17%.The proportion of people aged 0–14 decreased by 1.04%,people aged 15–59 decreased by 4.13%,people aged 60 and above increased by 5.16%,and people aged 65 and above increased by 2.51%.The growing population and the serious aging will inevitably lead to the increase of drug demand.With the improvement of living standards and the change of health concept,TCM industry has also faced great opportunities.The TCM industry is an important part of Liaoning Province’s economy and has a broad market prospect.The increase of drug demand will undoubtedly stimulate the expansion of the scale of TCM market share in Liaoning Province.However,with the development of Chinese medicine market in Liaoning Province,some problems such as residents’lack of knowledge of TCM,misuse of TCM,exaggeration of the efficacy of TCM,and ignorance of drug toxicity should be solved.

1.2 Sources of survey data

To learn more about residents’ awareness of TCM,the investigation team selected residents in Liaoning Province to carry out a questionnaire survey.In this study,the questionnaire was issued from October to November 2020.The questionnaire was sampled by non-probabilistic judgment,and the electronic questionnaire was delivered to the residents with the help of the Starline app.Before the survey,the team interviewed 20 residents in Shenyang,extracting the most concerned points in the interview content,and finally designed the questionnaire in four aspects:cognition,trust and attitude,way of purchasing,and the popularization of TCM knowledge.There are 18 questions in the questionnaire,16 subjects are selected to test in the pilot survey,and the content validity is tested by expert judgment method.A total of 402 questionnaires are collected,including 22 invalid ones with poor credibility and 380 valid ones (94.53%).The results of the questionnaire data are input into excel 2019 to establish a database and analyzed with the help of SPSS25 software.

1.3 Analysis of survey results

1.3.1 Basic information

Among the 380 respondents,179 (47.11%) are males and 201 (52.89%) are females,with a relatively balanced ratio between males and females.Among the respondents in all age groups,63.95% are 18-29.There are only 2 persons over 60 years old,accounting for 0.53%.The respondents are generally younger,as shown in Table 1.In terms of health,81.84% of the respondents are good.Sixteen suffer from chronic diseases,accounting for 4.21%,and one person is physically disabled,accounting for 0.26%,as shown in Table 2.

Table 1 Age of 380 respondents (n=380)

Table 2 Health conditions of 380 respondents (n=380)

1.3.2 Residents’ awareness of TCM

To understand the residents’ understanding and cognition of TCM,the questionnaire has two multiple choice questions based on the processing method of TCM and the name of common Chinese herbs (all categories of TCM are involved).The survey results show that among the processing methods of TCM,residents’ understanding of the top three processing methods are simmering (58.95%),baking (56.84%),and parching (45.00%),and the least understood method is duplication (8.95%),as shown in Fig.1.Among the common TCMs,residents are familiar with chrysanthemum (72.63%),tangerine peel (63.16%),and hawthorn (62.11%).It can be seen that residents have a high degree of recognition and understanding of TCM,which may be related to the frequent use of TCM in their daily life.

Fig.1 Familiar degree of common Chinese medicine processing techniques

1.3.3 Residents’ trust and attitude towards TCM

There are three questions in the questionnaire aimed at the residents’ trust and attitude towards TCM.They are:(1) Do you prefer TCM or western medicine when you are sick? (2) What do you think of the effect of TCM? (3) What do you think of the future development of TCM? The results show that western medicine is still the preferred treatment method for patients,accounting for 55.39%.In terms of the recognition of the effect of TCM,the majority (189 people,49.74%) believe that TCM is effective for chronic diseases,while the minority (9 people,2.73%) have a negative attitude towards the effect of TCM,as shown in Fig.2.Correspondingly,75.53% of residents believe that TCM has great potential in the future,as shown in Fig.3.It can be seen that further efforts are needed to realize the equal status of Chinese and Western medicine.But in general,residents have a high degree of trust and recognition for TCM,which has a mass base.

Fig.2 Residents’ attitudes toward the therapeutic effects of TCM

Fig.3 Residents’ attitude towards the future development of TCM

1.3.4 Chinese medicine purchase behavior

Through reviewing relevant literature and combining with the actual situation,the questionnaire lists 6 factors that affect residents’ willingness to purchase TCM.The influencing factors are as follows:54.21% follow the doctor’s advice,52.63%follow the expert or experience people in this field.39.74% are introduced by friends or relatives.22.37%are introduced by pharmacy clerks. choosing by themselves and affected by advertising account for 18.42% and 10.26% respectively,as shown in Fig.4.In addition,brand effect is also one of the factors affecting residents’ willingness.The survey results show that 58.42% of residents prefer well-known brands when buying TCM.41.58% pay more attention to curative effect than brand.Therefore,patients are relatively rational when purchasing TCM and have a better understanding of TCM.Few patients blindly follow the trend.TCM produced by well-known manufacturers with guaranteed quality is more favored by patients.

Fig.4 Factors influencing purchase of TCM

1.3.5 Ways to gain knowledge related to TCM

To improve the residents’ understanding of TCM and enhance effectiveness of TCM health rehabilitation,several common methods to popularize TCM knowledge are given in this paper.According to the survey results,the top three ways of acquiring TCM knowledge are TCM knowledge lectures(64.21%),health care knowledge (55.79%),and personal experience of TCM treatment techniques such as acupuncture and cupping (54.21%).As shown in Fig.5.

Fig.5 The ways to gain TCM knowledge

2 Analysis of residents’ cognition of TCM and drug use by taking Polygonum multiflorum as an example

After understanding the basic situation of Chinese medicine of residents in Liaoning Province,we take Polygon multiflorum as an example to study the problems of purchasing and using TCM by patients.

TCM refers to the general name of the drugs used to prevent and cure diseases under the guidance of TCM theories[3].They include Chinese medicinal materials,Chinese medicine decoction pieces,and Chinese patent medicine.Polygonum multiflorum is a TCM for nourishing qi and black hair,which enjoys a high reputation among the people.Polygonum multiflorum medicinal materials,decoction pieces and related products have wide clinical application in China with a long history.However,in recent years,due to residents’ insufficient understanding of the efficacy and toxicity of Polygonum multiflorum,irrational clinical application events have occurred many times.The hepatotoxicity caused by Polygonum multiflorum has become a research hotspot in recent years,and the safety of Polygonum multiflorum also attracts the attention of regulatory departments and scientific research institutions at home and abroad.Therefore,this study takes Polygonum multiflorum as the research object to find out the possible problems that may endanger the life and health of residents when they purchase or use the Chinese medicinal materials of Polygonum multiflorum,Chinese medicine decoction pieces,Chinese patent medicine,and other related products. At the same time,this study has important theoretical value and practical significance for improving residents’ cognition of TCM which will ensure their safe and rational drug use.

Polygonum multiflorum is the dried root ofPolygonum multiflorumThunb.This raw herb has the effect of detoxifying,moistening intestines,and relieving constipation.The processed Polygonum multiflorum has the effect of tonifying liver and kidney,enriching blood and strengthening muscles and bones[4].Polygonum multifolia is also a prescription that is highly praised by people for hair loss or turning white hair black.Most people believe its magical effect.It is not only used in a variety of anti-stripping and washing products,but also in the daily cooking of soup,wine,and other medicated food.However,in recent years,there have been more and more clinical cases of toxic and side effects caused by Polygonum multiflorum and its preparations,especially druginduced liver damage events[5].

2.1 Analysis on the cognition and use of Chinese medicinal material Polygonum multiflorum

Chinese medicinal materials are the raw materials of Chinese medicine decoction pieces,generally referring to the medicinal parts of plants and animals initially processed in the producing area[4].Chinese medicinal materials can be divided into drug category and non-drug category.The processed Chinese medicinal materials must meet the drug regulatory standards.The non-drug category of Chinese medicinal materials must be applicable to general agricultural and sideline products[6].The safety problems of Polygonum multiflorum include the followings.

First,residents pay attention to the curative effect and ignore the harm of taking too much.Due to the residents’ low cognition of the medicinal properties of Polygonum multiflorum,they don’t know the side effects and adverse reactions.Therefore,they believe that Chinese medicinal materials are safe and nontoxic,which leads to serious liver damage caused by long-term or overdose use of Polygonum multiflorum.

Second,it is difficult for residents to distinguish the quality of Polygonum multiflorum.On the one hand,the qualifications of Chinese medicinal materials enterprises are uneven,so the quality of Polygonum multiflorum cannot be guaranteed.Besides,the threshold of processing Chinese medicinal materials is low.Individual farmers,individual growers,and enterprises can conduct preliminary treatment on the original medicinal materials.Therefore,the production process of Chinese medicinal materials is chaotic,and the quality cannot reach the standard.On the other hand,due to the lack of professional knowledge to identify TCM by supervisors,there are many fake TCM materials.There are two kinds of Polygonum multiflorum,wild and cultivated.There is a big difference in price between wild and cultivated Polygonum multiflorum.Some criminals want to make huge profits through certain means such as the use of banana root carving,mold cultivation of human shape Polygonum multiflorum to fake thousands of years of human shape Polygonum multiflorum.Because of insufficient cognition and ineffective supervision,it is inevitably lead to the occurrence of events in which most patients’ illness grow worse after purchasing fake TCM at a high price.The curative effect is the key factor for people to trust TCM.The gradual accumulation of such incidents will surely cause residents’ distrust of Chinese medicine and TCM.

2.2 Analysis on the cognition and standard status of TCM decoction pieces of Polygonum multiflorum

Chinese herbal medicine decoction pieces are products made from Chinese herbal materials through processing and can be directly used in TCM clinical practice or preparation production[7].Chinese herbal medicine decoction pieces include part of Chinese herbal medicine slices processed in the origin area,original medicinal materials decoction pieces,and sliced and processed decoction pieces[8].Chinese medicine decoction pieces are often used in people’s daily life and clinical treatment.Due to residents’ lack of professional knowledge of TCM decoction pieces,the problems of TCM efficacy and medication safety are reflected in the following two aspects.

Firstly,ordinary residents do not have the professional knowledge to distinguish the advantages and disadvantages of processing methods and cannot distinguish the quality of decoction pieces.Polygonum multiflorum can be divided into raw Polygonum multiflorum and processed Polygonum multiflorum.The toxicity of processed Polygonum multiflorum is significantly lower than that of raw Polygonum multiflorum,and different processing techniques are used to reduce the toxicity to different degrees[9].At present,the processing technique that can minimize the harmful components of Polygonum multiflorum is the method of nine steaming and nine baking[10].The effect and toxicity of raw Polygonum multiflorum are different.However,at the present,there are some problems in the processing market of TCM,with both individual merchants and enterprises in it.Different levels of processing professionals and different processing requirements result in the bad quality and low effective ingredients of Polygon multiflorum.Ordinary people do not have the professional knowledge to judge the processing standards,so they cannot distinguish the quality of Chinese medicine decoction pieces.When patients use TCM decoction pieces that do not meet the processing standard,it is likely to cause adverse reactions,which naturally poses a huge challenge to the health of residents.

Secondly,it is difficult for residents to distinguish between the real and fake decoction pieces.In the trading market,some illegal merchants cut sweet potatoes into small cubes and process them into fake Polygon multiflorum to make profits.In addition,the production process of TCM decoction pieces is not standardized,leading to excessive harmful substances and heavy metals in them,which affects their quality and efficacy.If the patients purchase and use it,the expected effect cannot be achieved.When the patients go to the hospital for a second visit,the doctors may not be able to find out the reason for the poor efficacy,which will seriously affect the patients’ health.With the increase of these vicious events,people will gradually lose confidence in TCM.

2.3 Analysis of the status quo of Chinese patent medicines containing Polygonum multiflorum

Chinese patent medicine mainly refers to the TCM that meets national standards and has the effect of preventing and treating diseases[11,12].Chinese patent medicine usually has a variety of forms,such as injection,pill,tablet,powder,and capsule.It possesses the characteristics of easy to carry and take.The safety problems of Chinese patent medicine Polygonum multiflorum include the following two.

First,the adverse reactions are weakened that can mislead residents.Most Chinese patent medicines containing Polygonum multiflorum are nonprescription drugs,which can be purchased directly in drugstores.The instructions simply indicate that adverse reactions are not clear,which will harm the health of patients.In addition,lax supervision and irresponsible advertising have persuaded most residents to believe that Chinese patent drugs are safe and nontoxic.With the continuous expansion of the list of drugs containing Polygonum multiflorum,the adverse reactions caused by these drugs are also increasing year by year.The frequent occurrence of events also limits the application of TCM with Polygonum multiflorum.Therefore,it is imperative to guide residents to establish correct concepts and standardize the instructions of Chinese patent medicine.

Second,lack of knowledge of clinical compatibility application endangers the residents’health.According to some reports,after taking Chinese patent medicine of Polygonum multiflorum,residents mainly have such adverse reactions as liver damage,allergic reaction,and gastrointestinal reaction[13].Among them the incidence of liver damage is the highest.When doctors who are not specialized in treating liver diseases prescribe Chinese patent medicine containing Polygonum multiflorum to patients,they cannot realize the severity of liver injury caused by it.In addition,when patients use different kinds of Chinese patent medicines containing Polygonum multiflorum for different diseases,the overdose of Polygonum multiflorum,is likely to threaten the patient’s health,which is common in the integration of Chinese and western medicine.

2.4 Analysis of the use of other products containing Polygonum multiflorum

Because Polygonum multiflorum has the effect of growing hair and strengthening immune system,many health care and washing products contain Polygonum multiflorum.But these products do not specify the exact content.Due to residents’ insufficient understanding,they may overuse these products.Since every medicine has its side effect,the use of multiflorum product must be cautious.

3 Discussion

3.1 Residents have a good awareness and trust of TCM,but the popularization of TCM knowledge needs to be innovated

With the development of economy,people also change their concept of medical treatment and health services.Therefore,the demand for TCM is increasing.To realize the safety,rationality,and effectiveness of the application of TCM,a correct understanding of TCM is the premise.There are many Chinese medicine materials resources in China,and the phenomenon of variety confusion and mixed use of drugs and materials is common.The adverse reactions caused by improper processing and mixing of raw and processed product have also become the focus of research in recent years.The unreasonable application of drugs may endanger the health of patients.With the increasing trust in TCM,it is worth improving residents’ cognitive level of TCM.Catering to the trend of the times,catching the attention of young people and innovating the way of popularizing TCM can be regarded as a starting point.This survey shows that establishing TCM knowledge lecture halls,publicizing TCM knowledge and personally experiencing TCM services are the most acceptable ways for residents in Liaoning Province.

3.2 Factors cause the adverse reactions in TCM

According to the survey results,the main factors influencing the residents’ purchase of TCM are suggestions from doctors or experts.This also reflects that residents have a certain understanding of the features of TCM,and they are more rational when choosing TCM.Most patients do not blindly follow the trend.Moreover,the survey also shows that residents prefer well-known manufacturers with guaranteed quality when choosing TCM.Although residents have some knowledge about TCM,the adverse reactions,toxic side effects and malignant events caused by TCM have not stopped.It indicates that the improvement of patients’ knowledge of TCM cannot fundamentally solve the development problems of TCM.Based on the existing literature and the analysis of the status quo of Chinese herbal medicine market,it is concluded that the market chaos of Chinese herbal medicine,the lack of regulatory power,and different standards lead to these problems.To ensure the safety of TCM,improve the public’s trust,and promote the development of TCM industry,it requires the joint efforts of the government,enterprises,and medical institutions.

4 Solutions to improve residents’ cognition

4.1 Popularize professional knowledge of TCM and improve residents’ awareness

Although medicine belongs to the category of commodity,it is also a special commodity for it has a direct impact on people’s health.Due to the complex composition,the mechanism of TCM to exert clinical efficacy and induce adverse reactions is not as clear as western medicine.Therefore,the use of TCM needs the support of professional knowledge.It is necessary to popularize TCM knowledge with media tools such as WeChat,radio,web page and health programs,which can promote residents’ safe and rational use of medicine.TCM hospitals or TCM museums should be encouraged to carry out TCM culture themes,popularize professional knowledge to reduce mistakes in drug use.Besides,residents’ awareness of adverse reactions or side effects of TCM must be enhanced.Residents should not take all kinds of Chinese herbal medicine or health care products with herbal materials for a long time without doctors’ guidance.At the same time,residents should be informed of the toxicity of TCM in an appropriate way to avoid causing unnecessary panic.

4.2 Strengthen the training of professional knowledge of TCM for supervisory personnel

Supervision departments should be established,and the number of supervisory personnel must be increased.Meanwhile.professionals in TCM should be recruited to improve the intensity and supervision of TCM market.The supervision team and law enforcement personnel should be trained in a targeted way.The cooperation between the government and universities should be enhanced.At the same time,the investment in the training of compound talents of TCM must be increased to expand the faculty,develop apprenticeship education,and bring up highlevel talents.the construction of the licensed Chinese pharmacists should be promoted to improve the quality of pharmaceutical care[14].community residents are encouraged to sign up with pharmacists to guide their use medicine scientifically and rationally.

4.3 Strengthen the supervision of Chinese medicinal materials market and raise the threshold of access

The lack of supervision and inspection by the community-level government have led to the frequent violations of laws and regulations in the market.On the one hand,the grass-roots government should attach importance to strengthening the supervision,formulating the reward and punishment mechanism to improve the enthusiasm of grass-roots supervisors.On other hand,in the market of Chinese medicinal materials,it is necessary to establish the trading departments and quality management institutions to improve the rules and regulations for market trading and quality management.The standards for market access should be strictly controlled to ensure the quality and effectiveness of Chinese medicinal materials from the source.Finally,the supervision should introduce social forces to mobilize the people to participate in the management of the TCM market through the network information platform,which can reduce the illegal phenomenon.

4.4 Improve the unified quality standard of decoction pieces and the processing technology

The quality standard and application of TCM decoction pieces should be further standardized to reduce the quality differences due to different standards.Relevant departments should increase funding,improve testing methods and inspection facilities to prevent substandard or harmful TCM decoction pieces from being bought by patients.The processing norms of TCM should be unified,and the processing of Chinese medicinal materials must be strictly complied with the laws and regulations.Besides,Chinese medicinal materials should be processed according to local conditions to accelerate the integration of the origin,production,and processing of Chinese medicinal materials[15],which can promote the development of TCM decoction piece industry.

4.5 Improve the management of instructions and labels of TCMs

The instructions of Chinese patent medicine should use plain language as far as possible,avoiding some terminology,which can facilitate the compliance of patients’ medication.The instruction of Chinese patent medicine should clearly mark the adverse reaction precautions and other information.The data of clinical application cases should be timely updated to offer patients scientific and effective guidance for their rational drug use.

Patients tend to rely on the advice of doctors or pharmacists when buying TCM.Therefore,relevant departments should actively organize lectures to encourage pharmacists,physicians,especially Western medicine physicians,to acquire TCM knowledge.In addition,the skill training of practitioners should be strengthened to improve their practical ability.Meanwhile,hospitals should establish a prescription review system,in which TCM professionals are responsible for the review and dispensing of prescriptions,and providing medication guidance to patients.