Downloaded from http://bmjopen.bmj.com/ on October 17, 2015 - Published by group.bmj.com Open Access Research Experiences with, perceptions of and attitudes towards traditional Korean medicine (TKM) in patients with chronic fatigue: a qualitative, one-on-one, in-depth interview study Haeng-Mi Son,1 Eun Young Park,2 Duck Hee Kim,3 Eunjeong Kim,4 Mi-Suk Shin,5 Tae-Hun Kim6 To cite: Son H-M, Park EY, ABSTRACT et al Strengths and limitations of this study Kim DH, . Experiences Objectives: To explore perceptions and experiences with, perceptions of and of patients with chronic fatigue with traditional Korean ▪ attitudes towards traditional For our one-on-one, in-depth interviews, we medicine (TKM) and their motivation for choosing Korean medicine (TKM) in recruited interviewees through referrals from patients with chronic fatigue: TKM. traditional Korean medicine (TKM) physicians a qualitative, one-on-one, in- Design: Qualitative, one-on-one, in-depth interview and used a snowball sampling method, which depth interview study. BMJ study. potentially introduced a bias, favouring intervie- Open 2015;5:e006178. Setting: Primary TKM hospitals in Seoul, Incheon and wees with positive opinions of TKM treatments. doi:10.1136/bmjopen-2014- Daejeon, South Korea. ▪ The limitation is that the study findings can be 006178 Results: 15 patients with chronic fatigue were only applied to the Korean population that uses interviewed in this study. Patients with chronic fatigue or is at least familiar with TKM. ▸ Prepublication history for experienced physical and psychological symptoms that this paper is available online. resulted in severe difficulties associated with routine To view these files please daily activities. The motivations for choosing TKM were However, many patients who present with visit the journal online primarily dissatisfaction with conventional medicine severe disability in their daily lives have (http://dx.doi.org/10.1136/ and previous positive experiences with TKM. While bmjopen-2014-006178). fatigue symptoms that cannot be explained undergoing TKM treatment, patients found that TKM by pathological causes.3 Chronic fatigue syn- Received 13 March 2015 practitioners considered fatigue to be a treatable drome, a condition that is defined by a – Revised 5 August 2015 illness; also, patients felt comfortable with the doctor period of more than 6 months of continuous Accepted 12 August 2015 patient relationship in TKM. fatigue without the presence of a specific Conclusions: Healthcare providers need to be underlying disease, is prevalent among the concerned about the symptoms of chronic fatigue to a ’ general population in Korea. The prevalence degree that is in line with the patient sown – perceptions. Korean patients with chronic fatigue is estimated to be 0.6 2.0%, which is quite choose TKM as an alternative to fulfil their long-term similar to that found in Western societies – 4 needs that were unmet by conventional medicine, and (0.5 2.5%). they are greatly positively influenced by TKM. TKM may Traditional Korean medicine (TKM) is a present a possible therapy to alleviate symptoms of medical practice system included in the cat- diseases that conventional medicine does not address egory of orthodox medicine in Korea. TKM and is an approach that has a considerable effect on interventions consist of herbal medicine, acu- Korean patients. puncture, moxibustion and cupping therap- ies, similar to those of traditional Chinese medicine. However, TKM has developed unique medical theories, including Sasang INTRODUCTION constitutional medicine and the syndrome Fatigue is generally accepted to be a combin- differentiation method based on Donguibogam, and styles of practice, includ- For numbered affiliations see ation of symptoms that is an acute response end of article. to physical or mental exertion and is charac- ing the Saam acupuncture method, that have terised by recovery after rest. When fatigue been influenced by medical practices in 5 Correspondence to symptoms continue for more than 6 months, other East Asian countries. Sasang constitu- 1 Professor Tae-Hun Kim; it is defined as a chronic condition. Various tional medicine explains physiology and [email protected] types of illnesses are associated with fatigue.2 pathology based on the different types of Son H-M, et al. BMJ Open 2015;5:e006178. doi:10.1136/bmjopen-2014-006178 1 Downloaded from http://bmjopen.bmj.com/ on October 17, 2015 - Published by group.bmj.com Open Access inherited constitutions of an individual person. One visiting TKM hospitals, and chronic fatigue is also one of patient’s constitution, whether it be of the Taeyang, the major reasons for visiting TKM hospitals.13 Taeeum, Soyang or Soeum type, does not change during Participants were primarily recruited through referrals their lifetime, and symptom patterns can be different from physicians in local TKM hospitals in Seoul, based on specific constitutions, even though the patho- Incheon and Daejeon, South Korea, from July to logical causes do not differ between patients. In this November 2012. In addition, acquaintances who were sense, treatment strategies are preferentially focused on recommended by participants were also included in the patient’s specific constitution, not on the pathology, interviews, if appropriate. Interviewees were recruited which is distinct from the practices of TCM.6 thorough a snowball sampling method until the sample Donguibogam, written by Heo Jun in 1610, is consid- data were saturated. Research participants participated ered to be the canonical work on the clinical practice of on their own initiative, and no one refused to participate TKM in Korea.7 The system of diagnosis and modality in the data collection of this study. Fifteen patients with for treatment in Donguibogam is constructed on the chronic fatigue were interviewed for this study. Of the basis of the specific Korean context. For example, all of participants, 12 had underlying diseases that might have the names of medicinal herbs were written in Hangul, been related to fatigue, 3 did not. Five patients were the Korean alphabet, to make them easier to under- male, and 10 were female. The age distribution was as stand. In the book, substitutes for some herbs that do follows: three were in their 20s, two in their 30s, one in not naturally grow on the Korean peninsula are sug- their 40s, six in their 50s and three in their 60s. As for gested. Saam acupuncture is based on a principle of the the duration of the fatigue symptoms, six had symptoms selection of acupuncture points and stimulating for 10 or more years, four for 5–9 years, four for methods of needles based on TKM theory. As with 1–4 years and one for less than 1 year. All participants Sasang constitutional medicine, Saam acupuncture also had previous experience with TKM treatments, such as suggests an individualised and tailored therapeutic strat- acupuncture, moxibustion and cupping, as well as egy. Saam acupuncture adopted TCM theories such as herbal medications (table 1). the five elements and their interactions, but detailed that the features of acupuncture practice are quite dif- Data collection ferent from those of TCM.89 Data collection was performed using one-on-one, Systematic reviews on the effectiveness of complemen- in-depth interviews of participants. Among all research- tary and alternative medicine (CAM) interventions ers, four who are experts in data collection by conduct- including acupuncture, moxibustion and herbal medi- ing qualitative research interviews participated in the cines suggest that these alternative therapies may be interview process. For each interview, one single effective in improving symptoms related to chronic researcher conducted it alone and every researcher con- fatigue.81011In addition, recent survey results suggest ducted 3–5 individual interviews. The interviews were that many Korean patients have had experience with audio recorded by the interviewers, and the contents TKM for the treatment of chronic fatigue.12 However, were transcribed verbatim. The interview questions com- there is no research available examining why patients prised the main questions and any additional questions prefer and select CAM interventions, what they experi- asked by the research team after internal discussion. ence during these treatment sessions, or how they are The main questions were open-ended, such as ‘Tell us affected at the end of the sessions. The purpose of this about your experience with TKM treatment of chronic qualitative study was to assess the personal experiences fatigue’. The time spent on each interview was between of patients with chronic fatigue administered TKM treat- 1 and 2 h. Interviews were conducted in places where ments. We tried to understand the patients’ experience participants felt comfortable to be interviewed, such as a of their symptoms, the physical, psychological and social quiet café, a hospital conference room or a participant’s influences related to chronic fatigue, as well as their home. To clarify interview components that were motivation for choosing TKM and their perceptions of unclear and to supplement the interview for some parti- TKM interventions. cipants (B, J, O), additional phone interviews were con- ducted (table 2). The content of the interviews was considered to be saturated when no novel content was METHODS obtained from participants. Three part-time students Recruitment of interviewees worked on the transcription of the gathered interview Participants who visited TKM hospitals with symptoms