Safeguarding traditional Chinese medicine intangible cultural heritage and enabling its potential public health reuse: a theory-informed qualitative study in Jiangsu, China

Background TCM intangible cultural heritage (ICH) preserves medical knowledge, embodied therapeutic and pharmaceutical skills, and culturally embedded health practices. This study examined how such heritage may be safeguarded as a living knowledge system while enabling potential reuse in public health-related settings. Methods We conducted an abductive, theory-informed qualitative analysis using grounded theory coding procedures. Fifteen semi-structured stakeholder interviews constituted the primary analytical dataset, while 32 policy documents, safeguarding reports, public heritage descriptions, and media materials were used for contextualization and triangulation. Data-led open and axial coding generated 17 categories and six main categories. Only after this category system had stabilized was Schellenberg’s dual-value theory used for post-coding interpretation. Results The data-led stage generated 17 categories and six main categories. A subsequent theory-informed stage organized the six main categories into three higher-order interpretive domains: internal capabilities, external drivers, and amplification pathways. The model proposes that public-health-related reuse may generate resources, recognition, institutional support, and transmission incentives that feed back into primary-value safeguarding. The higher-order domains and the primary/secondary-value mapping constitute post-coding analytical interpretations. Conclusion TCM ICH can be understood as a living cultural and knowledge-practice resource with potential public health relevance. The findings offer a provisional, mechanism-generating account of interactions among safeguarding, institutional support, communication, technology, and regulated market activity. Evaluation of causal effects and population-level health outcomes requires further research.