Frontiers of Architectural Research (2014) 3, 141153

Available online at www.sciencedirect.com

Higher Education Press

www.elsevier.com/locate/foar

RESEARCH ARTICLE

Therapeutic landscapes and healing gardens:

A review of Chinese literature in relation
to the studies in western countries
Shan Jiang
Planning Design and Built Environment, Clemson University, Clemson, SC 29631, USA
Received 29 September 2013; received in revised form 24 December 2013; accepted 26 December 2013

KEYWORDS

Abstract

Therapeutic landscapes;
Healing garden;
Literature review;
China;
Western countries

The paper deciphers the Chinese literature to English speaking scholars and bridges the gap
between China and the western countries on the topics of therapeutic landscapes and healing
gardens. Three parts of contents are included in the paper. Firstly, four schools of theories
explaining how and why nature can heal, are introduced based on the studies in western
countries with the examination of terminology used. In the second part, 71 publications in
Chinese are systematically reviewed, with 19 signicant studies analyzed in details, including
focus areas, the research method, and major ndings. In the nal part, Chinese studies are
evaluated in relation to the theories in western countries.
& 2014. Higher Education Press Limited Company. Production and hosting by Elsevier B.V.
Open access under CC BY-NC-ND license.

1.

Introduction

There have been accumulated research interests on the

therapeutic effects of nature since 1970s in western countries. Research evidences have explained how and why
natural views and landscape sceneries ease people0 s pressure and change their mood from various perspectives,
including medical geography (Gesler, 2003), environmental

E-mail addresses: [email protected], [email protected].

Peer review under responsibility of Southeast University.

psychology (Kaplan and Kaplan, 1989; Kaplan, 1992; Ulrich,

1984, 1999), ecological psychology (Vries, 2010; Moore
and Cosco, 2010), and horticultural therapy (Detweiler,
et al., 2012; Sderback et al., 2004). The once disappeared
courtyards in hospitals revives in the early 1990s accompanied by the increasing research interest of therapeutic
landscapes/healing gardens in the United States. Researches
on this topic in western countries have a great impact
on China.
Aiming to decipher the Chinese literature to English
speaking scholars and bridge the gap between China and
the western countries on the topics of therapeutic landscapes and healing gardens, three parts of contents are
included in the paper. Firstly, four schools of theories
explaining how and why nature can heal are introduced
based on the studies from western countries, with the

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142

S. Jiang

examination of terminology used. In the second part, 71

publications in Chinese are systematically reviewed, with 19
signicant studies analyzed in details, including focus areas,
the research method, and major ndings. In the nal part,
Chinese studies are evaluated in relation to the theories and
studies in western countries.

2. Theories and terminology of therapeutic

landscapes and healing gardens in the western
countries

(1991) conducted similar interviews and found out that

people went to natural environment for self-help under
stressed or depressed conditions. As a result, several schools
with different bodies of knowledge emerged, establishing a
relationship between landscape and health to explore the
healing mechanisms of nature (Table 1). In the following
text, the author discusses four major schools based on the
studies in western societies, including: medical geography,
environmental psychological, salutogenic environment
and the ecological approach, and horticultural therapy.

2.1.
There has been a long tradition to view nature as healer
in different cultures. Garden for the ill rst appears in
Europe during the Middle ages, with monastic hospitals
providing enclosed vegetation gardens with an earnest wish
for the spiritual transformation of patients (Gerlach-Spriggs
et al., 1998). The therapeutic effects of nature to improve
patients0 recovery has been, for the rst time, precisely
written and published by Florence Nightingale in Notes on
Nursing in 1860. She believes that visual connections to
nature, such as natural scenes through window and bedside
owers, aid the recovery of patients (Nightingale, 1863).
Since the 1970s there have been continuous empirical
studies in western countries indicating that natural environments have therapeutic effects. For instance, Olds (1985)
examines the therapeutic effects of nature by interviewing
focus groups in a coherent workshop for several years, and
concludes that places with natural features can heal
people0 s emotional depression. Francis and Cooper Marcus

Table 1

Medical geography

In view of explaining the healing effects of nature, a

signicant amount of research come from cultural geography leading to the development of the medical geography
school. The concept of therapeutic landscape is rst
introduced by medical geographers, to dene places with
natural or historic features for the maintenance of health
and well being (Velarde et al., 2007). The term therapeutic
landscape has traditionally been used to describe landscapes with enduring reputation for achieving physical,
mental and spiritual healing (Gesler, 2003; Velarde et al.,
2007). This term has also been linked to sense of place,
leading to four dimensions of therapeutic landscape including: natural environment, built environment, symbolic environment and social environment (Gesler, 2003). Branched
from environmental psychology, two streams of theories have
explained the therapeutic effects of nature with discussions
as followed.

Therapeutic landscapes and healing gardens: four schools of theories in western studies.

School

Terminology

Theories

1 Medical
geography

Therapeutic
landscape

Sense of place; four dimensions of

Gesler (2003)
therapeutic landscapes: natural
environment, built environment, symbolic
environment and social environment

2 Environmental Restorative
psychology
environment

Therapeutic
landscapes and
healing garden

Attention-Restoration Theory (ART); four

features as restorative environment: being
away, extent, fascination, and action and
compatibility
Esthetic-Affective Theory (AAT); psychoevolution theories; three features of
healing gardens: relief from physical
symptoms, illness or trauma; stress
reduction for individuals dealing with
emotionally and/or physically stressful
experiences; and an improvement in the
overall sense of well-being

3 Ecological
psychology

Salutogenic
Theories of environmental affordances;
environment and ecological psychology
therapeutic
landscape

4 Horticultural
Therapy

Healing garden
and therapeutic
garden

Theory of ow experience; sensory

stimulation theories

Representatives

Kaplan and Kaplan (1989); Kaplan (1992);

Kaplan and Berman (2010)

Cooper-Marcus and Barnes (1999); CooperMarcus and Sachs (2013); Ulrich (1984,
1999); Ulrich, et al. (1991); Ulrich and
Parsons (1992).

Heft (1999, 2010); Grahn et al. (2010);

Grahn and Stigsdotter (2003).

Sderback et al. (2004); Detweiler, et al.

(2012).

Therapeutic landscapes and healing gardens

2.2.

Environmental psychology

2.2.1. Attention-Recreation Theory and the restorative

environment
Kaplan and Kaplan starts the research of restorative environment, which describes the types of environments that
help people recover from mental fatigue (Kaplan, 1992;
Vincent, 2009). According to their Attention-Restoration
Theory (ART), people process surrounding information
through two kinds of attention: directed attention and
fascination or involuntary attention (Kaplan, 1992; Kaplan
and Berman, 2010). Directed attention is employed in tasks
such as problem solving. Directed attention fatigue is a type
of temporary symptom of the brains that makes people feel
distractible, impatient, forgetful, or cranky, and hence
result in a decline of working efciency (ibid.). Recovery
of directed attention is enhanced best in restorative
environments where fascination system is used. Additionally, nature encompasses four features as a restorative
environment: being away, extent, fascination, and action
and compatibility; hence performs well in mental fatigue
recovery (ibid.). The following paragraphs introduce
another stream of theories in the framework of environmental psychology.
2.2.2. Psycho-evolution theories and healing gardens
Another stream of research reveals that environmental
stressors (e.g., crowding, noise) can elicit substantial stress
in people, while visual access to nature shows effects on
stress recovery (Ulrich, 1984; Ulrich et al., 1991). Psychoevolution theories consider that the nature0 s therapeutic
effect is a matter of unconscious processes and affects
located in the oldest, emotion-driven parts of the brain that
inform people when to relax (Grahn, et al., 2010; Ulrich,
1999). Backed up by these theories, a signicant quasiexperimental study conducted by Ulrich (1984) concludes
that patients get recovered more quickly when looking out
of a window with natural scenes. Ulrich (1999) and CooperMarcus and Barnes (1995, 1999) refer the term healing
garden to gardens or landscape settings as variety of
garden features that have in common a consistent tendency
to foster restoration from stress and have other positive
inuences on patients, visitors, and staff or caregivers.
They also present that a healing garden has either one or a
mixture of the three following processes: relief from
physical symptoms, illness or trauma; stress reduction and
increased levels of comfort for individuals dealing with
emotionally and/or physically tiring experiences; and an
improvement in the overall sense of well-being (CooperMarcus and Barnes, 1999). Moving forward, the term healing garden has been widely recognized, referring to green
outdoor spaces in healthcare facilities that provide a chance
of stress relief for patients, staff and families (Eckerling,
1996; Gharipour and Zimring, 2005; Lau and Yang, 2009;
Stigsdotter and Grahn, 2002).

2.3. Salutogenic environments and the ecological

approach
Landscape architects and psychologists also believe that
green urban open spaces improve quality of everyday life by

143
providing salubrious environments and perceived visual
esthetics to the public. Frederick Law Olmsted, who is
internationally renowned as the founder of modern landscape architecture in America, practices dynamically
towards healthful environments and landscape designs for
the improvement of public health, dened as salubrious
landscape (Szczygiel and Hewitt, 2000). He stated that
an environment containing vegetation or other nature
employs the mind without fatigue and yet experiences
it gives the effect of refreshing rest and reinvigoration to
the whole (health) system (Olmsted, 1865). Olmsted0 s
ideas about the healthful, therapeutic nature in cities is
still a major inuence today on urban park system and
community green open spaces (Ulrich and Parson, 1992).
Since the 1970s, perceptual psychologists, represented by
J.J. Gibson, suggests an environment-behavior model identifying that the environment affords certain behaviors
(Kleiber et al., 2011; Greeno, 1994). The model no longer
considers viewers as receptors of meaningless environmental stimulations; conversely, they emphasize on the dynamic
and reciprocal relationship between perceiver and what the
environment affordsthat is, environmental affordances
(Heft, 2010; Gibson, 1979). This approach of perceptual
research is known as ecological approach. In this framework, researchers believe that environmental affordance in
landscape plays a key role in alleviating the so-called
lifestyle-related symptoms (e.g., burnt out disease, stressrelated pain), by stimulating physical activity, facilitating
social contacts and social cohesion among residents (Vries,
2010), and encouraging meaningful communications among
children and the environment (Moore and Cosco, 2010).
Theories and applications related to salutogenic environment in a manner of ecological psychology have been
elaborated in Innovative Approaches to Researching Landscape and Health: Open Space: People Space 2 edited by
Thompson, Aspinall and Bell (2010).

2.4.

Horticultural therapy school

The horticultural therapy school believes that working in a

garden is particularly obvious, meaningful, and enjoyable,
hence therapeutic (Stigsdotter and Grahn, 2002). Leisure
theories back up their research in the way that adults
feel rewarded during gardening activities and may go
through ow experiences with feelings of well-being,
total commitment, and forgetfulness of time and self
(Czikszentmihalyi, 1990). Horticultural therapy scientists
usually refer to healing gardens or therapeutic gardens
as settings that provide places for gardening activities and
encourage physical movements, such as therapeutic walking
(Detweiler et al., 2012). In recent decades in the United
States, some healing gardens focus on the design of sensory
stimulation and accommodation of horticultural activities.
This approach has been proven benecial for the patients
with dementia or post-traumatic stress symptoms(Detweiler
et al., 2012; Sderback et al., 2004).
To broaden the views of research, this paper refers to
therapeutic landscapes as general public open spaces that
improve people0 s physical, mental/ spiritual/ emotional,
and social well being. Additionally, the term healing
garden is referred to gardens and natural settings in

144

S. Jiang

healthcare facilities that support users0 stress reduction and

enhance patients0 recovery. Following the author systematically reviews Chinese literature in realm of therapeutic
landscapes/healing gardens. Research topics, research
methods and major ndings are discussed.

3. Systematic literature review of

therapeutic landscapes/healing gardens
in China
In view of understanding the current philosophies of therapeutic landscapes/healing gardens in China, this part
systematically reviews 71 publications in Chinese language
using the search engine of CNKI databaseChina Knowledge
Resource Integrated Database, which records academic
publications and outstanding dissertations with English
abstract and keywords since 1979. Research methods and
results of the literature review are discussed in the following
section.

3.1.

Keywords and search combinations

Keywords and search combinations are set up for the

literature search after the discussion with experts (shown
in Figure 1). A systematic review strategy is developed
including three procedures: (1) literature search using the
keywords and combinations; (2) analysis of the inner connections among the search results, amount of citations and
inuence factors of the literatures; (3) analysis of the
signicant studies. 71 Studies written by Chinese scholars
are analyzed, including 33 peer-reviewed articles, 2 books
and 36 dissertations. The analysis of citations and inuences
of the 71 research studies are shown in the next section.

3.2. Analysis of 71 studies written by Chinese

scholars
In Figure 2, horizontal axis represents the reviewed publications from the year 2000 to 2012. Publications are clustered by
year and classied by source type. The black histogram above
the horizontal axis represents the times being cited of the
particular publication according to the record of CNKI. The
gray histogram below the horizontal axis represents the
inuence factor of the journal where the particular article is
published according to the record of CNKI.
This gure shows that intrinsic research interests in realm
of therapeutic landscapes starts from the study of horticultural therapy (Li, 2000a, 2000b).The application of salubrious plantings in garden design emerges from the
understanding of traditional Chinese medicine (Zhao,
2001; Chen, 2004). In 2009, the most inuential Chinese
journal in the realm of landscape architectureChinese
Landscape Architectureedits a special issue of therapeutic
landscapes/healing gardens in which research topics and
theories in the western countries are generally introduced
to Chinese scholars.
According to Figure 3, the 71 reviewed studies generally
fall into 9 categories of topics, including: general introduction of therapeutic landscapes/healing gardens (22/71);
hospital exterior environments (24/71); therapeutic urban
parks (3/71); therapeutic environments especially for children (3/71); horticultural therapy (5/71); hospital planting
design (4/71); application of traditional Chinese medicine in
therapeutic landscapes (5/71); evidence-based design (1/71)
and post occupancy evaluation of healing gardens (2/7). Two
among the 71 studies are unclassied; an article introduces
Zen and Japanese meditation garden (Zhang et al., 2010),
and a thesis talks about landscape design of post-disaster
trauma center on basis of Wenchuan earthquake (Ma, 2010).
Among all the categories, therapeutic landscapes/healing

Figure 1 Flow chart of systematic literature review.

Therapeutic landscapes and healing gardens

Figure 2

Analysis of 71 studies written by Chinese scholars.

gardens and hospital exterior environmental study have

gained the most research interests. Inter-connections of
the 71 studies are illustrated in a circular literature map
(shown in Figure 3). All the studies are arranged along a
circle. Each line represents that the connected two studies
are closely related. Connections are identied according to
the citation and bibliography in the end of each study. The
top 19 studies with the most connections are selected for the
further analysis, as discussed in the following section.

3.3.

145

Detailed analysis of the 19 studies

Among the 19 studies there are 2 empirical studies, and 9

case studies. 13 Sources discuss design recommendations for
therapeutic environments informed by the authors0 literature
researches but not based on empirical evidences. 7 sources
report that healing garden design should combine Yin and
Yang and ve elements (i.e., metal, wood, water, re
and soil) from the theories of traditional Chinese medicine.
5 studies focus on the appropriate application of medicinal
plants in the design of therapeutic landscapes. 1 introduces
evidence-based approach as the major research method in
this realm, and 1 study talks about the evaluation issue that a
grading standard from the professional opinions excluding
users0 experience and satisfaction is suggested (shown in
Table 2).
There are also 2 important translated studies which have
great impact to Chinese studies. One is Healing Garden in
Hospitals originally written by Cooper-Marcus and
translated by Cooper-Marcus et al., 2009. In this article, a
survey to 143 users of 4 hospitals in San Francisco bay area is
introduced. It has been stated that gardens in hospitals
can reduce users0 stress, enhance patients0 sense of
control and then facilitate patients0 recovery. Detailed

recommendations of healing garden design are also suggested in the translated article. Another article introducing
case studies done by Cooper-Marcus and Barnes (1999) is
included in the detailed analysis (Jiang, 2009).Comparison
of the research philosophies, historical research on therapeutic landscapes/healing gardens, focus areas and methodology is further analyzed in the third part of the paper.

4. Comparison of research status between

China and western countries
4.1.

Terminology

As Gerlach-Spriggs and Healy (2010) states, health care

gardens are described by a broad and vague collection of
overlapping terms . Different terms are used from
various perspectives in both Chinese and western societies.
In western studies, Medical Dictionary denes therapeutic as including the healing powers of nature (Hooper,
1839). Discussion of terminology issues can be retrieved
from the rst part of the paper and Table 1.
In China, Jiang (2009)refers healing landscape to
green spaces in healthcare facilities, and Wang and Li
(2012) refer healing landscape to landscape which has
therapeutic effect on physical and mental health. However,
the most commonly used denition by Chinese scholars is
healing garden described by Eckerling (1996): healing
garden is a garden in a healing setting designed to make
people feel better (Lei et al., 2011; Li and Tang, 2012). Lei
et al. (2011) have classied healing gardens into two
categories: (1) gardens in healthcare facilities which can
improve the recovery process of patients; (2) public parks
for people suffering from life-style depression. Wang and

146

S. Jiang

Figure 3 Inter-relationship among 71 studies written by Chinese scholars.

Li (2012) discriminates the meanings of the terms used in

this realm and have stated that healing gardens are usually
the places where horticultural therapy activities happen.
While therapeutic landscapes consist of various natural
settings with therapeutic effects, including healing gardens,
rehabilitation gardens, meditation gardens and memorial
gardens. Historical researches of therapeutic environments,
especially gardens in hospital environments, are comparatively different between China and the west, as discussed in
the following paragraph.

4.2.

Historical research

One Chinese research briey reviews the history of therapeutic environment in China (Tian, 2005). BeiTian Yuan,
built around the year 717 A.D., is the rst public hospice/
hospital in ancient China. Temples located in the remoteness with wild natural surroundings are the places where
monks provide treatments and palliative care (ibid.).
Between the year1085 A.D. and 1145 A.D., the rst public
hospital is opened to patients where green settings
become essential in the form of courtyards. However, no
additional research is found on the history and development
of therapeutic landscapes/healing gardens.
Comparatively, there are already plenty of studies on
history and development of therapeutic landscapes/healing

gardens in western countries. A chronologically based historical introduction of healing gardens, from the Medieval,
Renaissance, until the 19th century, can be found from
Restorative Gardens: The Healing Landscape (GerlachSpriggs et al., 1998). Architectural historian Hickman (2013)
has systematically studied hospital gardens in England since
1800. In addition, Ziff (2012) narratives the stories behind
the landscape design of asylums in Ohio after Civil War in the
United States. In the 20th century, Cooper-Marcus and Barnes
(1999) claries that, from the year 1950 to 1990, the healing
garden almost disappeared from hospitals in most western
countries because of the inuence of the International
Style and high-rise buildings which dominates hospital
designs. Empirical studies since the 1980s have revealed that
nature has positive inuences on health outcomes, and the
1990s patient-centered care movement triggers the revival
of therapeutic landscapes and healing gardens (ibid.). There
are also several differences between Chinese studies and the
western studies regarding the research focus and theories,
discussed in the following paragraphs.

4.3.

Research focus and methods

In China, studies on horticultural therapy and the design of

facilities accommodating horticultural activities have gained
most interest. Topics on hospital exterior environments

Therapeutic landscapes and healing gardens

Table 2

147

Detailed Analysis of 19 selected Chinese Studies.

No. Source Author

type
(s) and
year

Focus area

Research method

Major ndings

Design
recommendation

Case study: University

of Hyogo (Awaji
Campus) Horticultural
Therapeutic Garden,
Awaji Island, Japan

Three benets of
horticultural therapy:
spiritual, social and
physical aspects;
procedures of
horticultural therapy:
pre-evaluation, set the
therapeutic goal,
implementation, key
steps of the program,
post-program
evaluation

China should combine

traditional Chinese
medicine into its own
horticultural therapy
program and healing
garden design

Article

Li
Horticultural therapy
(2000a), and design of healing
(2000b) gardens for gardening
activities

Article

Zhao, R. Nature has therapeutic Literature research

(2001)
effects; treatments of
traditional Chinese
medicine integrated
into therapeutic
landscape design

Treatment using natural

resources can heal
illness; viewing natural
scenes helps to reduce
stress

Article

Chen, L. Therapeutic landscapes Literature research

(2004)
and planting design; the
application of medicinal
plants

People-centered design
principles based on the
public behavior
psychology; the
application of medicinal
plants can heal and
improve well-being

Make medicinal plants

the fundamental plant
in the whole planting
community; using a
large amount of plants
to form visual comfort
ability; tness
equipment can be
placed near to the
medicinal planting
community

Master
thesis

Cui, Y.
(2004)

Hospital exterior
environments; related
theories and design
recommendations

Survey to patients at
hospitals in Beijing,
Nanjing and Zhengzhou,
China Case study of
3 hospitals in USA and
2 hospitals in China

Garden is a key
component of hospital
healing environment;
therapeutic landscape
settings help users
relief stress, enhance
recovery from illness
and change mood

Healing gardens should

focus on planting
design; multidimensional design of
green open spaces in
hospital environment;
visual connections from
inward to outdoor
natural environment is
essential to patients

Master
thesis

Tian, S.
(2005)

Hospital exterior
environments; related
theories and design
recommendations

Case study of multiple

hospitals inside and
outside China

Five types of hospital

exterior open spaces
are classied, including:
trafc space, gathering
space, relaxation space,
viewing space and roof
garden

Design for different

users0 needs.
Accessibility, visibility,
adaptability for multiuse, esthetic
attractiveness, and
borrowed landscapes
for the patients and
families; private
gardens should be
designed for caregivers

148

S. Jiang

Table 2 (continued )
No. Source Author
type
(s) and
year

Focus area

Research method

Major ndings

Design
recommendation

Article

Han, X., Hospital exterior

Case study of multiple
et al.
environment and
hospitals inside and
(2006)
healing gardens; design outside China
recommendations

Employing sustainable
garden design
strategies; visual
connections to healing
gardens can facilitate
patient recovery

Hospital courtyards
should be designed
according to users0
needs; Healing gardens
should be esthetic,
accessible and visible.
Proper selection of
plants, organized paths,
water elements of
landscape design, and
the selection of art
work with positive
meanings

Article

Niu, Z.
Horticultural therapy
and Xu, and healing gardens;
F. (2006) integration of
traditional Chinese
medical into healing
garden design

Literature research

People-centered design
principles; landscape
design according to
ve elements in
traditional Chinese
medicine; design using
knowledge of
environmental
psychology

Properly use of
different landscape
elements, such as
water, medicinal plants
and sunlight; design of
topography and paths to
encourage therapeutic
exercise.

Article

Xiu, M. Inuence of
and Li,
horticultural therapy
S. (2006) activities on the
physical and mental
health of the elderly

Quasi-experiment: Selfreport and

measurement of blood
pressure (n =40)
residences at Holly
Nursing Home, Beijing

Horticultural Therapy

program can help the

elderly people
ameliorate cardiovascular system
degradation, change
the mood positively and
improve the sense of
well-being

Master
thesis

Yao, C.
(2006)

Case study of 1 hospital

in Beijing, China and
2 hospitals in Shenyang,
China

Features of hospital
outdoor environment
include: privacy, sense
of territory, and
recognizability. Healing
gardens should be
designed for various
activities and needs of
different user groups

Buffer zone near the

entrance; interiorexterior visual
connections;
accessibility to the
garden; spatial design
encouraging physical
activities; high
accessibility of the
healing garden and
barrier-free design.
Application of medicinal
plants

10

Master
Thesis

Wang, Z. Healing garden design; Literature research

(2007)
design principles and
special needs for
children and the elderly
patients

Healing garden should

fulll various needs of
patients, visitors and
staff. The garden should
be visible and contain
diverse spaces. Cold
color, quiet
environment with
fragrance of plants can
enhance recovery

Organized trafc and

clear spatial layout,
plants and water are
important design
elements; comfortable
seats, paths with
smooth materials and
wide enough for wheels,
positive art works;
surveillance space near
children0 s playground

Hospital exterior
environments; related
theories and design
recommendations

Therapeutic landscapes and healing gardens

149

Table 2 (continued )
No. Source Author
type
(s) and
year

Focus area

Research method

Major ndings

Design
recommendation

11

Master
thesis

Ying, J.
(2007)

Urban therapeutic open

spaces for people0 s
physical and mental
health; healing gardens
design

Case study: The

Elizabeth & Nova Evans
Restorative Garden,
Cleve- land, OH

Green open spaces are

benecial to the
patients0 health
outcomes. Healing
gardens should be
designed according to
varied needs of
patients, visitors and
caregivers

Design different types

of spaces for privacy
and social
communication; a large
amount of plants in the
garden provides a sense
of amenity; the use of
medicinal plants assists
patients0 recovery
according to the ve
elements in traditional
Chinese medicine

12

Article

Li, S.
and
Zhang,
W.
(2009)

A review of the
Literature research
methodologies
employed in
horticultural therapy
worldwide; Introduction
of horticultural therapy
in USA, European
countries, Japan and
China

13

Article

Yang, H., Application of

et al.
traditional Chinese
(2009)
theories in healing
garden design.
Comparison of design
guidelines between
China and the West

Case study of a healing

garden designed by the
author for a professor
with minor depression
and insomnia

Theories inuencing the

design of healing
gardens include: sense
of control, social
support, natural
distractions, physical
movement and
exercise. Differences of
design guidelines
between China and the
West: design
philosophy, peoplenature relationship,
concept, and the
application of
traditional Chinese
medicine

Design to keep the

balance between body
and mind, people and
nature, Yin and
Yang; ve elements
and landscape elements
should be closely
related in design

14

Article

Zhang,
W.,
et al.
(2009)

Case study: Buehler

Enabling Garden,
Chicago, MI; William T.
Bacon Sensory Garden,
Chicago, MI

Primary goal of healing

garden is stress relief;
features of healing
garden include: clarity,
access, gathering
spaces, private/
intimate spaces,
people-nature
connections. Three
approaches through
which healing gardens
promote people0 s wellbeing: natural

Healing garden design

should emphasize
sensory environment:
green visual scenery,
sound of birds and
water, aroma from
plants to stimulate the
sense of smell, design
encouraging people to
touch plants and water,
art works with positive
meanings; design should
combine horticultural

Nature has therapeutic

effects. Evidence-based
design as primary
methodology of healing
garden research and
design; common
features of healing
gardens and design
recommendations

The research trend in

this realm in China:

urban green spaces and
the public health, plant
and its contribution to
human well-being
through the ve sensory
stimuli, horticultural
activities and its effect
to mental and physical
symptoms

150

S. Jiang

Table 2 (continued )
No. Source Author
type
(s) and
year

Focus area

Research method

Major ndings

Design
recommendation

environment facilitating therapy and learn from

physiological process,
traditional Chinese
sensory perception and medicine
psychological stimuli
and activities for
physical tness
15

Article

Jiang, Y. Introduction to 2 cases

(2009)
of healing gardens in
United States

Case study: Healing

garden of the Oregon
Burn Center at Legacy
Emanuel Hospital,
Portland, OR; healing
garden of Good
Samaritan Regional
Medical Center,
Phoenix, AZ

Design of healing
gardens should also
focus on special needs
for disadvantaged
population

16

Article

Zhang,
Introduction of Taoism
J., et al. culture and the
(2010)
application of Taoism
theories in healing
garden design

Literature research

Well-designed
ecological environment
can contribute to
people0 s physical and
psychological health.
Taoist health
preservation culture
provides great
inspiration to healing
garden design

The application of
Taoism theories
including: a balance of
person-nature relationship, forms of the space
should follow both
stillness and
movement, and Yin
and Yang. Selection
of medicinal plants
based on the ve
elements theory

17

Article

Lei, Y.,
et al.
(2011)

Case study: Joel

Schnaper Memorial
Garden, New York, NY;
The Elizabeth & Nova
Evans Restorative
Garden, Cleveland, OH

Four stages of healing

garden design: forming
stage, rudiment period,
silent period,
development period;
Western country has
implemented theories
to healing garden design
practice, while it is still
theoretical research
period in China on this
topic

Healing garden design

should learn from
traditional Chinese
medicine and design in
humanist approaches

18

Article

Wang, X. Intention and extension Literature research

and Li,
of the meanings of
J. (2012) therapeutic
landscapes and
terminology
discrimination

Therapeutic landscapes
include healing gardens,
rehabilitation gardens,
meditation gardens and
memorial gardens. A
healing garden is usually
the place where
horticultural therapy
activities happen

19

Article

Li, Q.
Development of quality Post-occupancy
and
evaluation index system evaluation
Tang, X. of healing garden
(2012)

Qualitative evaluation
index system of healing
gardens is established
by using level
analyzing method

A brief review of history

and current research
status of healing garden
in western and eastern
countries

Therapeutic landscapes and healing gardens

stably gain interest from the year 2007, and the topic of
healing garden becomes popular since the year 2010.
There had also been a few number of Chinese scholars who
talked about therapeutic landscapes/healing gardens for
unique user groups, such as children and the elderly people.
Methods used in Chinese studies are mainly literature
research and case study; very few of them conduct
empirical studies or controlled trails. As mentioned in
the rst part of the article, the western literature encompasses 40 years0 study on theories and mechanism of the
therapeutic effects of nature, some of which have been
proven by scientic evidences (Ulrich, 1984; Verderber,
1986); post-occupancy evaluation is also an effective way
to summarize design guidelines (Cooper-Marcus and
Barnes, 1999). Western studies in this realm are rather
highly specialized with topics covering various user groups
(i.e., children0 s hospital gardens, gardens for the veterans,
gardens for the old people, gardens of crisis shelters, etc.),
various disease (i.e., gardens for dementia patients,
gardens for cancer patients, gardens for visual impaired
patients, gardens for mental and behavioral health facilities, and hospice gardens etc.), and various activities
(i.e., gardens for rehabilitation, gardens for horticulture
therapy and public open spaces with restorative features)
(Cooper-Marcus and Barnes, 1999; Cooper-Marcus and
Sachs, 2013). Currently, for the research of healing gardens
in western societies, evidence-based approach has become
a dominating method. Learnt from evidence-based medicine, design guidelines of healing gardens should be proven
by empirical studies; a systematic evaluation of the actual
therapeutic effects of the setting may also be included
(Cooper-Marcus and Sachs, 2013).

4.4.

Theories

Theories discussed in the Chinese literature are mainly from

the realm of horticultural therapy and traditional Chinese
medicine. Among the 19 detailed analyzed studies, 7 studies
mention using theories from traditional Chinese medicine in
the healing garden design. Planting design with medicinal
vegetation is also important in Chinese culture, which can
be seen in 5 studies. There have been well established
theoretical frameworks in western countries in this realm
(see the four major schools of theories discussed in the rst
part), by contrast, Chinese studies are relatively segmented. There is a signicant gap in Chinese literature that
theoretically, scholars suggest using traditional Chinese
medicine theories in healing garden design. However, when
talking about the application of theories, most of the
studies learn from western cases and employ design guidelines suggested by western scholars. There is a need
to integrate traditional theories from Chinese culture into
the western frameworks and work in a multiculturalist
approach.

5.

Conclusions

To understand the research status in both China and

western countries, also to discriminate the terms used in
the realm of therapeutic landscapes/healing, terminology
has been comparatively examined; research topics,

151
research methods and related theories are also examined.
It has been found that in both cultures, the term therapeutic landscapes is referred to green public spaces
which are benecial to people0 s physical, mental and social
health, by providing spaces for therapeutic activities and
contemplation, relieving pressures and encouraging social
communications. Studies of healing gardens in healthcare facilities aim to improve the quality of hospital
environment and reduce stress accompanied by the stressful hospitalization experience. Also, the appearance of
healing gardens and natural settings in hospitals can
enhance the sense of well being for caregivers in such
high-pressure work places. Results of the analysis have
shown that research of therapeutic landscapes/healing
gardens in China are being heavily inuenced by horticultural therapy. Meanwhile, Chinese researches focus on the
application of medicinal plants and traditional Chinese
medicine theories in healing garden design. However, the
body of knowledge has not been well formed in Chinese
context and empirical tests to the design recommendations
are needed in the future.

Acknowledgement
Thanks Deborah Franqui, Ph.D. candidate at Clemson
University, for reviewing the draft manuscript.

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