运用扎根理论方法探索中医复杂干预组成要素的定性研究

目的：探索并建立中医复杂干预的组成要素及要素间相互关系的理论模型。方法：采用社会学定性研究的方法,开展41次参与性观察和7例个体深入访谈以收集资料;使用扎根理论方法设计和分析数据。结果：中医复杂干预组成要素包括处方药物、医嘱、心理干预、医患关系和患者依从性,它们之间相互作用、相互协同可以产生或提高疗效。中医诊断过程和治疗过程存在交叉,体现动态特征。诊断过程具有潜在的治疗作用,中医药物干预作为主要干预发挥治疗作用。中医复杂干预措施的组成要素包含在整个中医干预过程中,可以上升为发现问题、解决问题的过程,通过宏观与微观的途径产生作用,体现整体观指导下的高度个体化辨证论治的原则。结论：中医临床实践是一种复杂的整体性干预,中医疗效的体现是中医诊疗过程中诸多因素共同作用的综合结果。未来需要扩大样本量开展定性研究以增加中医复杂干预组成要素模型的稳定性和普适性,并通过随机对照临床试验验证和探索本扎根理论所获得的各要素与总体疗效的关系。

A qualitative study of exploring the therapeutic components of traditional Chinese medicine as a complex intervention through grounded theory

Objective：To explore and identify the therapeutic components of traditional Chinese medicine （TCM） as a complex intervention through grounded theory,and the correlation and interaction within this model and the possible effects that they may have on the therapeutic effects of TCM.Methods：Data were collected through 41 half-day participant observations and 7 in-depth interviews,and the study design and data analysis were based on the grounded theory.Results：The components of TCM practice that emerged were：prescribed Chinese medicinal herbs,doctor＇s medical advice,psychological intervention,doctor-patient relationship,and patient adherence.There were some overlaps in the TCM diagnosis and treatment process,and there were underlying therapeutic effects associated with diagnosis.TCM herbal intervention was considered as a main therapeutic component which might dominate patients＇ outcome.We summarized this process as a process of problem finding and solving from macroscopic and microcosmic perspectives,which embodies the concept of a holistic approach and highly individualized pattern through syndrome differentiation and treatment.Conclusion：TCM is a complex whole system,and all therapeutic components of TCM may contribute to global treatment effect.In the future,we need more participants to test and improve the model of grounded theory through qualitative and quantitative methods such as randomized controlled trials so as to identify and explore the relevance of each therapeutic component of TCM with the treatment effect.