Constructing Rhetorical Ethos : Traditional Chinese Medicine Doctors’ Management of Patient Resistance in Online Medical Consultations

Introduction This study examines how doctors address patient resistance in Traditional Chinese Medicine (TCM) online consultations, aiming to understand how culturally grounded communication practices influence care quality and patient engagement. Methods A total of 395 TCM consultations (307,414 Chinese characters) from Chunyu Doctor were analyzed using interactional discourse analysis and multiple correspondence analysis, informed by rhetorical ethos theory. Results TCM doctors managed resistance by balancing credibility, ethical care, and empathy. Phronesis was demonstrated through dynamic diagnosis or recommendation adjustment and integration of theory with experience, linking with personalized and TCM-based rationales and the value of hé (和, harmony). Arête appeared in transparency in limitations and patient-safety prioritization, occurring with consensus-based rationale, digital adaptation of Western medicine (WM) tool usage, epistemological integration of WM and TCM, and the values of chéng (诚, sincerity) and zhōngyōng (中庸, doctrine of the mean). Eunoia was reflected in offering patients affective alignment, and empowerment through education, associated with procedural-based rationale and rén (仁, benevolence) and lǐ (礼, ritual propriety) values. Conclusion Patient resistance can be used as a resource to enhance patient-centered care. By integrating cultural values, medical tradition, and digital interaction practices, TCM doctors sustain trust, improve adherence, and promote effective online care. These findings highlight the importance of culturally sensitive communication and relationship-building in healthcare delivery, providing practical implications for designing digital health services in China and similar cultural contexts.