Hong Chen,Jie Zhou

1Department of Surgery II Breast, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing 100078, China. 2Emergency Department, Dongfang Hospital of Beijing University of Chinese Medicine,Beijing 100078,China.

Abstract TCM has played an important role in the treatment of COVID‐19. TCM nursing is an important part of traditional Chinese medicine, and TCM nursing has unique advantages in clinical care of COVID‐19. This paper, from the perspective of TCM nursing, interprets the application of TCM nursing techniques in COVID‐19, and provides a reference for further research.

Keywords:COVID‐19; integrated traditional Chinese and Western medicine nursing;TCM

Background

Novel coronavirus pneumonia ("COVID‐19") is an acute infectious disease caused by the Novel coronavirus. Its main manifestations are fever, dry cough and fatigue. Some patients may have nasal congestion, runny nose, sore throat, loss of smell and taste,conjunctivitis, myalgia and diarrhea [1]. The disease has the characteristics of strong infectivity, rapid development of the disease and widespread susceptibility among the population. It has been included in class B infectious diseases and treated as class A infectious diseases [2]. In the COVID‐19 epidemic, TCM plays a role of truncation and reversal in the development of the disease, improving the overall body's resistance to disease, reducing the body's response to disease,reducing and alleviating the occurrence of storms,blocking the development of mild patients to critical patients, and playing an important role in improving the clinical symptoms of patients and eliminating physical pain. TCM nursing is an important part of traditional Chinese medicine, the use of traditional Chinese medicine nursing technology to carry out clinical care for COVID‐19,has unique advantages, for individual patients with a holistic concept, syndrome differentiation of the characteristics of care, easy to operate,significant curative effect, fewer side effects and other advantages.

TCM understanding of COVID-19

Traditional Chinese medicine will be attributed to the COVID‐19"epidemic" "epidemic happen" category. "Epidemic disease" refers to a situation in which a disease is highly contagious and epidemic. In Shuo Wen Jie Zi,he said,"Epidemic disease affects all the people."It is mentioned in "On epidemic epidemic · Primary Disease" that"epidemic victims feel the disease of heaven and earth, how many years they have, how thick or thin they are in the square, and how many ups and downs they have in four seasons. This gas comes,whether old or old strong or weak, touch the disease, evil from the mouth and nose. Pestilential happen gas is a kind of infectious pathogen, which invades human body from mouth and nose and causes infection of upper respiratory tract [3]. The pathogenesis is characterized by "dampness, heat, blood stasis, toxin and deficiency"[4].

TCM characteristic nursing

Life care

There is a time to hide from evil winds: According to the different patients themselves, and different TCM syndrome differentiation for patients to carry out effective daily life nursing, nursing staff should create a clean, dry, comfortable and tidy ward environment for patients. Ward should keep fresh air, can maintain good natural ventilation, ventilation 2‐3 times a day, each time no less than 30 minutes, avoid cold air convection direct blowing, especially protect the chest, back and abdomen,avoid abdominal cold [5].

Comply with the four, gu Yang qi: Regular work and rest, do not stay up late, sleep time is not less than 7 h a day, step by step,moderate indoor activities, increase light time, as early as possible to protect Yang Qi [6].

Medical care

Traditional Chinese medicine decoction is generally appropriate to be taken warm and hot. In the early stage of COVID‐19 patients, the symptoms are mainly superficial. It is recommended to follow the principle of timely administration of surface drugs to avoid pathogenic diseases from the surface into the body [7]. The COVID‐19 disease is located in the lung, which is the core of the lung. The spleen and stomach are injured by the involvement of middle coke. For the treatment of upper coke, it is advisable to take traditional Chinese medicine decoction about 1 hour after meals [8]. In case of critical and serious patients, medication should be given in time, and the required dosage should be given in different times as appropriate without being limited to the time, so as to ensure that the efficacy of medication can continue to play as soon as possible [7]. Chinese medicine granules should be thoroughly stirred with 100°C hot water until completely dissolved. After the medication, patients should be assisted in drinking a small amount of warm boiled water to reduce the discomfort in their mouth. Patients with diarrhea, vomiting and other obvious digestive tract should take a small number of times, and observe the stool, if the digestive tract symptoms should be aggravated, immediately inform the doctor, observe the changes in the patient's condition, and make a record. Nursing staff should choose the best time to give drugs to patients according to the needs of the condition,so as to increase the use of drugs and reduce the effects of toxic and side reactions.

Diet nursing care

This disease belongs to the category of "epidemic disease" in traditional Chinese medicine, and its pathogeny is affected by the gas of epidemic disease. The rise and fall of positive qi determines the prognosis and outcome of the disease. "Positive qi is stored in the stomach, and evil can not be dried". Positive qi depends on the grain food in the stomach to nourish it, so we should pay attention to the spleen and stomach in the diet [9]. In order to take care of patients'spleen and stomach as the principle, according to patients' symptoms and food attributes, add and subtract diet based on syndrome differentiation, avoid nourishing thick taste, cold, warm dryness injury Yin [10]. Should eat yang‐boosting hair (such as lamb, leek,garlic, green onion, mushroom, etc.), reduce acid suitable sweet food(soy milk, sweet potato, fish, spinach, etc.), do not eat wild animals(namely game), poultry, meat, eggs to be fully cooked after eating;pay attention to nutrition and ensure that you eat a variety of food,especially fresh vegetables and fruits; Elderly patients should ensure adequate protein, mainly intake of high‐quality protein food, such as:lean meat, fish, shrimp, eggs, soybeans, etc. Trace elements and vitamins can be properly supplemented, and the supplement and balance of nutrition can play a significant role in the body's immunity and antiviral ability.

Emotional nursing

TCM attaches great importance to the patient's spiritual and emotional care [11]. Ill patients out the body, in addition to the body and the mind of the suffering also bear great damage, in addition to help patients with normal daily life and basic nursing, tone should be patient's mood and mood changes,should with sincere gentle,because the nursing for the principle, the rationality of nursing methods, help patients relieve anxiety, reduce the degree of depression, keep the patient calm and stable mood. In the book, "The Four Qi Adjustment of God", the author discusses that in spring and March, "the ambition is born", in summer and March, "the ambition is free from anger", in autumn and March, "the ambition is quiet", and in winter and March,"the ambition is hidden and hidden" comply with the four seasons of Yin and Yang. During treatment in isolation, caregivers should talk to patients: Explain relevant knowledge for them to answer questions,clear and concentrate, help patients with a calm state of mind to face the disease and external things, lead patients to carry out Qigong therapy, has a positive effect on stabilizing the patient's vitality.Create favorable sleep conditions for patients to ensure sleep quality[12].

Exercise therapy

In terms of exercise rehabilitation for COVID‐19 patients, traditional Chinese medicine is a kind of medium‐low intensity holistic exercise combining the "three tones" (regulating heart, breath and form),mainly including Baduanjin, Taijiquan, Yi Jin Jing, and six‐character breathing, which can improve cardiopulmonary function, regulate mental state, and improve the body's immunity [13]. Traditional Chinese medicine Baduanjin is a relatively soft way of movement,with the movement of the body, with the combination of breath and heart regulation,gentle and slow,static and static phase can adjust the viscera of the human body as a whole,so as to achieve the harmony of qi and blood, smooth meridians and normal functions of the viscera[14]. Daily practice eight brocade, cooperate with the body to promote blood circulation, strengthen metabolism of the body,improve blood supply,can improve the body health,improve the body immunity and disease resistance. Taijiquan emphasizes on "settling qi into Dan tian", "moving qi through heart and moving body by qi". It uses abdominal breathing to regulate the breathing state, and uses traditional guidance and exhalation methods to exercise muscles,relax tendons and activate collaterals, regulate qi and blood, and stabilize emotions [15]. Six words formula breathing exercises through"xu""he""hu""si""chui""xi"six words of pronunciation mouth shape exhalation, chest and abdomen so the formation of different pressure,and then affect, dredge and harmonize the heart,lung, liver,spleen, kidney, three jiao meridian qi and blood operation, through the exercise of the viscera to achieve the effect of strengthening the lung respiratory function [16]. Patients with severe diseases should carry out physical training,carefully specify exercise prescription,step by step to enhance exercise intensity and timely long [12], activity controls the sensation of movement, without fatigue is best.

TCM features suitable techniques

Due to the destruction of Yin and Yang of the human body during the treatment of COVID‐19 patients, the intervention application of traditional Chinese medicine techniques (moxibustion therapy, ear point pill pressing, cupping technology, etc.) also plays an important role in the prevention and improvement of the disease in the treatment of PATIENTS with cough, fatigue, nausea, vomiting,diarrhea and other symptoms.

Moxibustion technology

In the Eastern Jin Dynasty, Ge Hong mentioned in the Urgent Prescription of Elbow Reserve: "To cut off the plague from each other and closely moxibustion the four corners of the patient's bed, each strong and beautiful." Studies have proved that moxibustion can be used for the prevention and treatment of infectious diseases, not only through moxibustion prevention and treatment, but also through moxa leaf fumigation to cut off the way of transmission, and achieve better results [17]. In addition, mugwort sticks are smoked at specific points on the body surface to achieve the purpose of warming Yang and strengthening qi and blood, effectively enhancing the human body to restore Yang qi and improve the ability of vitality [18].Choose Dazhui, Feishu, Life, Zusanli, Sanyinjiao and other points to benefit qi [19]. One end of moxa sticks is lit, and the burning end is away from moxibustion points or local 2‐4 cm moxibustion, so that the local has a warm feeling, with no burning degree, each moxibustion 15‐30 minutes, so that the local skin is ruddy and hot, to stimulate acupoints or specific parts of the human body, through stimulating the activity of qi to adjust the physiological and biochemical functions of the disorder of the human body, so as to achieve the purpose of treatment.

Auricular sticking technique

Auricular sticking is a non‐drug treatment in traditional Chinese medicine[20].By stimulating the ear specific acupoints,to dredge the meridians, regulating the effect of viscera [10]. Lung, trachea,shenmen, subcortical acupoints can be selected according to the patient's symptoms to xuanfei cough[21,22];choose spleen,stomach,three coke, pancreas, gallbladder and so on to strengthen spleen and stomach. Choose the right acupoints, cotton swabs dipped in alcohol to disinfect the skin, small forceps to pick up wang does not stick to the seed tape on the acupoints, irregular press to strengthen stimulation, can play a continuous stimulation,to achieve the purpose of treatment effect.

Cupping technology

COVID‐19 at the core of the pathogenesis of "wet, poison, blood stasis," closed, cupping technique is one of the traditional Chinese medicine therapy, through the adsorption tanks, cause local blood stasis, clearing damp in order to achieve detoxification, cold blood,invigorate the circulation, clean air and the action such as closure,slow benign stimulation process, can stimulate the function of immunity, improve the body's resistance to disease. Patients with COVID‐19 can use the back balance cupping. The main procedures include flash cupping, cupping removal and cupping retention, which have significant effects on cold and dampness obstruction and fatigue[23].Use a strip of paper or tweezers to clip a 95%alcohol cotton ball,fire the paper or alcohol cotton point and then stretch into the middle of the tank around a week, quickly exit the fire, the tank will be knocked at the selected site or acupoint, generally leave for 15 minutes.

Acupoint massage technique

Acupoint massage of traditional Chinese medicine is an important part of traditional Chinese medicine. It has obvious curative effect and is easy to master. First of all, it is clear and master the location of different acupoints of different diseases. Acupoint massage has the purpose of stimulating the specific acupoints of the human body and stimulating the qi of the meridians and collaterals, in order to achieve the purpose of channeling and activating the collaterals, adjusting the function of the human body, exorcising evil spirits and strengthening the right. The main clinical symptoms of COVID‐19 patients are fever and cough. Fever can choose Dazhui, Waiguan, Quchi, Hegu, etc., dry cough, pharyngeal itching choose Shaoshang, Chi Ze, etc., massage sequence from left upper limb to right upper limb, from the upper point to the lower point, in order to patients feel acid numbness swelling sense of gas,10 ～15min a time,can enhance human body qi[14]. Feng Yonghong [24] applied self‐designed cough relieving prescription plus acupoint massage of thenar, Shaoshang, Dazhui,Lieque and Zhaohai to treat post‐infection cough, with an effective rate of 90%. The purpose of the operation should be clear to avoid injury to patients.

Conclusion

The State Administration of Traditional Chinese Medicine clearly put forward in the Opinions on Strengthening the Nursing work of Traditional Chinese Medicine that the nursing technology of traditional Chinese medicine should be widely used and vigorously promoted[25].COVID‐19 is the seventh coronaviruses that have been discovered so far.Compared with SARS,it is more infectious and more susceptible to the general population. It can also be transmitted through contact and aerosol,so it is more difficult to control and bring greater impact. COVID‐19 belongs to the category of "epidemic disease" in TCM. In the late Ming Dynasty, Wu Hesheng discussed TCM nursing measures for infectious diseases in the chapters of "On Food", "On Drink" and "Recuperation method" in his treatise on Epidemic Temperature. TCM nursing has been applied in infectious diseases for a long time. In this paper, TCM nursing methods for COVID‐19 were summarized from aspects of daily life nursing,medication nursing, diet nursing, emotional nursing, sports nursing and appropriate techniques of TCM nursing, in order to provide evidence for TCM treatment and nursing of COVID‐19. TCM nursing treatment for COVID‐19 has certain advantages, such as simplicity,convenience, cheapness and experience, clear curative effect, simple operation, long acting time and economical and effective advantages,which are easily accepted by patients and can enhance patients'compliance and confidence in treatment. Therefore, it is worthy of further clinical application.