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Characteristics and practice of TCM nursing

TCM is a traditional medicine with a history of thousands of years that reflects the traditional Chinese culture. Through the efforts of generations of doctors and continued to grow and develop, it has been formed a unique discipline system of TCM. TCM nursing is accompanied by the development of TCM, based on the theory of TCM, constantly improving the theoretical system and the standardization of technical operation, forming a nursing discipline with strong characteristics of TCM. It is an important part of TCM. In clinical nursing, we must inherit, carry forward and innovate.

1.The holistic view is the guiding ideology of TCM nursing

TCM believes that the human body is an organic whole, centered on the viscera and connected by the meridians, structurally inseparable, functionally interacting, and pathologically affecting each other. Human beings connect with the nature and the social environment. Human physiology changes along with climate and living environment. And human diseases are closely related to changes in climate, geographical environment, and social environment. Based on this point of view, TCM nursing comprehensively assesses the patient's existing or potential health problems through analyzing the patient's physiology, psychology, natural and social environment, and provides health care for patients by nursing based on disease differentiation, syndrome differentiation and symptom differentiation.

2.Nursing based on syndrome differentiation is the basic rule of TCM nursing

Nursing based on syndrome differentiation includes two interrelated contents of " syndrome differentiation " and " nursing". " Syndrome differentiation " refers to the use of basic theories of TCM to analyze the medical history, signs, and symptoms collected by the four diagnose methods and determine the syndrome types of the disease. "Nursing" is to determine the corresponding nursing principles and methods on the syndrome differentiation basis. Syndrome differentiation is the premise and basis for deciding nursing, and nursing is a method to alleviate or solve the suffering of patients, so nursing based on syndrome differentiation is the embodiment of the combination of TCM theory and practice. The  nursing principle adapting to individual, climate and local condition is the embodiment of features of TCM nursing.

2.1 Adapting to individual conditions: Different nursing methods should be adopted in accordance with the patient's age, lifestyle, body constitution and cultural accomplishment. For example, in terms of the amount of medication, adults are larger than children; patient with yin-deficiency should live in ventilated room, take nourishing yin foods, avoid hot natured foods and cautiously use warm-dry natured herbal medicines; and patient with yang-deficiency should avoid from wind and cold invading, keep warm, take nourishing and warm foods, and cautiously use bitter cold natured herbal medicines.

2.2 Adapting to the climate: The climate change at four seasons has a certain impact on the physiology and pathology of the human body. Abnormal climate is an important condition for inducing disease. Nursing should give guidance on health care, health preservation and medication according to different seasonal climate characteristics. For example, in winter, after taking the herbs for relieving exterior syndrome with pungent-warm property, the patient should add clothes or drink hot porridge to ensure the pathogenic factors be expelled with sweat; in summer, after taking the herbs for relieving exterior syndrome with pungent-warm property, the patient should be carefully prevented to perspire seriously.  Some chronic diseases often occur or worsen when the climate changes, such as asthma and stroke.

2.3 Adapt to local conditions: Different living habits and geographical environment can affect the physiological and pathological changes of the human body, which should be cared in nursing. For example, the terrain in northwest of China is high and the climate is cold, and the disease is induced mostly by wind and cold. Therefore, avoiding wind and cold, carefully using cold and cool products are the key points in nursing care. The climate in the southeast is humid, and the disease is induced mostly by heat and dampness. Therefore, clearing heat and resolving dampness, and carefully using heat products are the key points. The northern climate is dry, the products that can promote the secretion of body fluid should be given. The southern climate is hot with damp, the products that can remove dampness, diuretic products and light foods should be given.

3. TCM nursing technology occupies an important position in TCM nursing

TCM nursing technology has the characteristics of possessing simple appliances, easy operation, wide application, fast curative effect, affordable expense and easy acceptance by the people. It embodies the principles of "safety, high efficiency, low consumption, innovation and development" and has created good social and economic benefits. The methods of massage, cupping, medicinal application, fumigation and washing, ear acupressure, and Tai Ji Quan that are included in TCM nursing technology are easy to master and are widely used in clinical nursing work, which relieve the pain and improves the life quality of patients. In recent years, the herbal iontophoresis and herbal retention enema have enriched the content of TCM nursing technology and expanded the scope of TCM nursing, indicating TCM nursing has a broader development space.

4. Characteristic content of TCM nursing

4.1 Emotional and psychological adjustment: TCM believes that joy, anger, anxiety, contemplation, grief, terror, and fear are the so-called "seven emotions", which are the spiritual activities of human beings. The external manifestation of physiological function. Moderate mental activity is a healthy sign of both body and mind, and excessive or bad mental activity is an important factor of a disease and aging.

In the practice of TCM nursing, nurses observe emotion's changes in according to the personality characteristics of patients, strive to keep patients in a good emotional state, comprehensively apply correction methods of empathy, persuasion, and interaction to change patients' feelings, cognition, emotions, attitudes and behaviors, keeping the patient in a comfortable and peaceful psychological environment, and build confidence in defeating the disease.

4.2 Rational diet: Diet is the indispensable material basis for maintaining human life activities, and is nutritious source of internal organs and limbs of the human body. Rational diet plays the same important role as medical treatment, medicine and nursing in improving the therapeutic effect. The choice of food should be carefully based on TCM theories such as four natures (cold, hot, warm, cool), five flavors (bitter, salty, sour, spicy, sweet), lifting, lowering, floating and sinking and herbal meridian tropism. In case of heat syndrome or in humid and hot seasons, foods with actions of clearing heat and purging should be chosen to achieve the effect of "heat syndrome managed with cold method". Bitter flavor has the actions of drying and purging. Those bitter in flavor are used to treat syndromes of heat, dampness and reversed qi. Rational diet can provide sufficient nutrition for the body and promote disease recovery.

4.3 Rational medication: Traditional Chinese medicine treatment is determined according to characteristics of herbal medicines. The so-called cold, heat, warm, and cool are the reactions that occur when the medicine acts on the body. Pungent, sweet, sour, bitter, and salty are the five flavors of medicinal herbs, with different tastes and different effects. Lifting, lowering, floating and sinking refer to four different directions of actions of Chinese medicinal herbs in  human body when they are taken.

These characteristics of Chinese medicinal herbs should be noticed, especially " the 18 incompatible medicaments" and "19 medicaments of mutual antagonisms" in nursing work, as well as the time and method of taking the herbal medicines.

4.3.1 The time of taking herbal medicine is coordinated with the time rhythm of the human body: As for the time of taking herbal medicine, the tonics should be taken before meals; most of the anthelmintic and purging herbal medicines should be taken when stomach is empty. Those for managing stomach or irritant to stomach and intestine should be taken after meals; the herbal medicine for treating malaria should be taken 1-2h before the attack; the herbal medicine for sleep should be taken before bedtime; the herbal medicine for sweating should be taken before noon; the herbal medicine for inducing vomiting should be taken in the early morning. Traditional Chinese medicine has rich knowledge about the time of taking herbal medicine.

4.3.2 The method of taking herbal medicines varies according to the patients' condition and dosage form: the herbal decoction for treating cold syndrome should be taken hot or warm; the herbal decoction for treating heat syndrome should be taken cold. Diaphoretics should be taken warmly so as to promote the medicinal actions until sweating. Herbal medicines with functions of clearing heat, cooling blood and stopping blood should be taken in cold. Powder should be taking after mixing it with warm water or be put in the capsule. Medicinal extract should be taken with warm water. Severe patients should take herbal medicines frequently in a small amount. The patient with coma, child, after esophageal surgery, may be fed through his nose.

4.4 "Treating before sick": "Su Wen. Si Qi Tiao Shen Da Lun" emphasizes "Treating before sick". It refers to firstly prevention without disease and secondly prevention deterioration of the disease. Nursing work plays a very important role in the diseases prevention and health care. Patients' awareness of disease prevention can be increased by health education in various forms and multiple level. The balance of the body's yin and yang can be maintained through diet, exercise, mental adjustment and other personal health care methods, and disease prevention and health state can be reached by adjusting Zheng Qi and improving the disease resistance.

4.5 Guide patients to establish a healthy lifestyle that follows nature:

Spring is warm and everything resuscitates. Summer is hot and everything grows. Autumn is cool and everything declines. Winter is cold and everything stores. In the four seasons , human beings should follow the changes of seasons and keep balanced with nature. One should avoid to be invaded by wind and cold in spring, by heat in summer, by dryness in autumn and by cold and wind in winter. When nursing patients, we should guide patients to combine dynamic and static exercises at different conditions and different stages of illness, and have a healthy lifestyle, for example, practicing Qigong and Tai Ji Quan, having cold water bath, sun bath and forest bath.