Teaching traditional Chinese medicine classics to clinical nurses: Taking Treatise on Cold Damage for example

Ling TANG, Jing LIU, Jing-Jin XU,Xue-Ling MADepartment of Nursing, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, China; Department of Outpatient,The Third Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China; Department of TCM Nursing, School of Nursing, Beijing University of Chinese Medicine, Beijing, China

The classics of traditional Chinese medicine (TCM) are the origin and essence of TCM and the embodiment of the essence of TCM. Classic works such asTheYellowEmperor’sInner Classic,TreatiseonColdDamage,SynopsisofGoldenChamber,andSystematicDifferentiationofWarmDiseasesare not only the source of the theoretical system of TCM, but also the fundamental law to guide the clinical practice of TCM, which is of great significance in the history of the development of TCM.[1]An in-depth study of TCM classics is crucial to anyone who develops as a well-recognized TCM practitioner.

TCM nursing is an essential discipline in TCM as a broad science, and TCM classics lay the foundation for TCM nursing.TCM classics not only offer both theoretical knowledge and operational skills of TCM nursing, but also contain rich concepts for nursing practice, which still show value in contemporary nursing clinical practice. Therefore, the classics are fundamental for career development in TCM nursing and are indispensable in education.

At present, increasingly more attention has been paid to TCM classics in the routine teaching. However, formal curriculums are still scarce. As one of the classics of TCM, the content and thought ofTreatiseonColdDamage has also shed light in TCM nursing. In this paper, takingTreatiseonColdDamageas an example, we aim to discuss teaching methods for TCM classics,and explore the ideas of how to guide nursing clinical practice.

CLARIFY THE PURPOSE OF CLINICAL NURSES IN LEARNING TRADITIONAL CHINESE MEDICINE CLASSICS

In recent years, TCM nursing in China has developed vigorously,but throughout the course of clinical development of TCM nursing, the low TCM literacy level of nurses has always been the key barrier for the exertion of clinical advantages.[2]Higher education of TCM nursing in China started late and developed slowly. At present, most of the nurses have graduated from western medical colleges. Only a small portion of the nurses have graduated from TCM colleges or universities, but even among them, curriculums in western medicine are significantly dominant. A considerable number of nurses practicing in TCM hospitals have little basic knowledge of TCM. The TCM knowledge they learned cannot meet the needs of TCM clinical nursing under most circumstances (e.g., the new situation, patients’ needs, disease prevention, treatment, and rehabilitation).[3]To improve the quality of TCM nursing, much attention should be paid to the training of TCM nursing talents,so that TCM nurses have basic knowledge of TCM and nursing ability of syndrome differentiation.[4]In the past, the nursing education of TCM tended to explain the basic knowledge points, but a large number of dialectical thoughts contained in the classics of TCM were ignored.[5]

TakeTreatiseonColdDamageas an example.Treatiseon ColdDamageis the first TCM classic that has combined the fundamental theories of TCM with pearls for clinical practice. It has created a precedent of “treatment based on syndrome differentiation.” The book exhaustively describes key elements for successful nursing for each prescription,including frequency, dosing, and timing. It also emphasizes the observation of patients’ postmedication reactions and formulates postmedication measures to ensure the curative effect of clinical treatment. Appropriate observation of the changing phases of a disease plays an important role in recovery.[6,7]TreatiseonColdDamagealso stresses the importance of diet management based on syndrome differentiation. For nursing modalities, it discusses in detail the fuming therapy,steaming washing therapy, cauterization therapy, and so on. In addition, TCM nursing theories and methods are also discussed in detail in other TCM classics such asTheYellowEmperor’sInner Classic,SynopsisofGoldenChamber,andSystematicDifferentiation ofWarmDiseases.[8,9]

Chinese General Secretary Xi Jinping clearly pointed out that it is necessary to follow the law of the development of TCM,inherit the essence, and uphold integrity and innovation.Inheriting the classics of TCM is the embodiment of the law of the development of TCM. As the guardians of people’s health,only by deeply studying the classics of TCM, can nurses give full play to the unique advantages and role of TCM in disease prevention and treatment.

CARRY OUT RICH AND VARIOUS LEARNING ACTIVITIES IN CLINICS

Although TCM classics contain rich nursing connotations of TCM, the contents of TCM classics are obscure and difficult to understand. For highly professional ancient documents,only with the help of ancient Chinese dictionaries, we can understand the meaning, structure, and use of the original text.Moreover, the task of clinical nurses is heavy, and some nurses who graduated from western medical colleges and universities are lack of basic knowledge of TCM and are a certain degree of fear of difficulties. Therefore, there are great challenges for learning classical knowledge of TCM. For those reasons, it is necessary to carry out a variety of learning activities step by step with gradually increased level of difficulty to stimulate clinical nurses’ interest in learning.

SORT OUT TRADITIONAL CHINESE MEDICINE CLASSIC PROVISIONS RELATED TO NURSING

There are a large number of classical ancient books of TCM and a wide range of knowledge, and the nursing content is scattered in the medical works of early dynasties, which is not convenient for nurses to read and learn directly. Therefore, it is necessary to sort out the classical provisions with nursing connotations pertinently to help nurses to focus on learning the classic provisions. Some scholars have expounded the nursing contents in the classics of TCM from different perspectives.For example, Shi[10]analyzedTreatiseonColdDamageandSynopsisofGoldenChamberfrom the point of view of diet nursing and clinical nursing. Diet nursing includes four aspects:conditioning diet to prevent disease, precautions for diet conditioning, diet care for fever, and diet nursing after taking medicine. Clinical nursing includes condition observation,medicine nursing, and nursing operation techniques. Wanget al.[11]summarized Zhongjing’s nursing thoughts through five parts: nursing before illness onset, nursing based on syndrome differentiation, nursing with medicine, diet nursing, and nursing after illness. Liuet al.[12]combed the TCM classics from philosophical thinking, human physiology, disease prevention and treatment, daily life nursing, psychological and emotional nursing, diet nursing, and medication nursing. These lessons provide enlightening and guiding models for us to sort out and learn the nursing contents of TCM classics according to the characteristics of the disciplines.

MAKE FULL USE OF INTERNET RESOURCES FOR LEARNING

With the development of computer science and technology,images, video, animation, and other applications in the field of education are becoming more and more extensive and mature.These forms of resources are accepted by more and more people because of their good image and interest. Through the alternating demonstration of a variety of information,the abstract and complex theories of TCM are displayed directly and vividly, the static teaching is gradually changed into dynamic teaching, and the profound medical theory is integrated into the vivid explanation. With good visualization to bring positive teaching effect to the classical teaching of TCM, it is helpful to stimulate students’ interest in learning and improve their autonomy and enthusiasm in learning.[13]

Due to clinical nurses’ different work experience and graduation from different universities, there exist differences in the mastery of TCM knowledge among them, so the schedule is different, which brings a certain difficulty to carry out unified offline classroom learning. However, the Internet has just solved this problem. In the Internet learning, clinical nurses can master the learning progress by themselves and repeat the course, combined with the rich network resources to achieve the maximum learning efficiency, and stimulate the interest in learning.[14]

DEVELOP CASE-BASED LEARNING–TEACHING METHODS

In the previous clinical teaching, case-based learning (CBL) has been widely used,[15]and its core is the case-led, problem-based,student-centered, teacher-guided group discussion teaching method.[16]“Case-led, question-based” provides students with a simulated clinical environment to help students form clinical thinking as early as possible; “student-centered,teacher-guided” can improve students’ initiative to learn, give full play to the main role of students, and cultivate students’self-learning ability and innovation ability.[17,18]

For example, the teacher can prepare a teaching case every week, and encourage students to think and to discuss problems from the perspective of classical nursing of TCM, and each student report in turn, and then start the discussion. In the CBL teaching method, teachers point out a certain direction for students to think about problems, which is conducive to improving efficiency and saving time; moreover, students think deeply around a case, and the specific content of the report is different, which is conducive to the collision and blending of ideas. In the process of sharing and discussion, students can exchange thoughts and make supplement their own views, and learn more rich knowledge in a relatively short period of time.

GRAND ROUNDS OF TRADITIONAL CHINESE MEDICINE NURSING INHERITANCE TEACHING

The original strength of TCM comes from clinical practice,and nurses learn TCM classics in order to better practice TCM clinically. Therefore, in the process of learning TCM classics,we should not work behind closed doors, but should actively participate in the discussion of real clinical cases, so as to combine theory with practice and put what we have learned into practice.

The TCM nursing inheritance teaching rounds, through following TCM nursing experts into the TCM nursing clinics to learn and summarize their TCM academic thoughts, is a teaching method of organic combination of TCM theory and practical experience. Emphasis is placed on the cultivation of TCM clinical thinking of specialist nurses.[19]Nursing teaching rounds are based on real cases in which teachers perform their clinical assessment through four diagnostic methods: inspection, listening and smelling, inquiring, and pulse taking. They extensively collect patients’ condition information and make clear nursing diagnosis, then focus on the disease to explain the basic theory, analyze the etiology and pathogenesis, clarify the syndrome type and nursing diagnosis,and formulate the nursing plan of syndrome differentiation all from the perspective of TCM. In the process of ward rounds, teachers show students the whole process of TCM clinical thinking, and gradually cultivate their thinking mode of syndrome differentiation and nursing through interactive questions and discussion.[20]

TCM nursing teaching rounds can make students feel the great charm of TCM classics intuitively, and help to stimulate students’ interest in learning TCM classics. At the same time,the study of the practical application of TCM classics also provides important help for students to further understand TCM classics and learn TCM classics.

THE PROSPECT OF LEARNING THE CONNOTATION OF NURSING IN TRADITIONAL CHINESE MEDICINE CLASSICS

With the change of modern medical model and people’s concept of health, the advantages of TCM nursing are becoming more and more obvious and are constantly affirmed and respected by the medical community. It plays an important role in improving health-care quality and improving overall quality of life, but at present, the advantages of TCM nursing have not been brought into full play, and TCM nursing more often means simple technical level such as scraping and cupping. However, the real characteristics of “syndrome differentiation and nursing” are difficult to demonstrate.[21,22]At the same time, the lack of theoretical knowledge of TCM will also greatly affect the quality of nurses’ nursing operation and their confidence in continuing learning.

The full play of the advantages of TCM nursing is inseparable from the strengthening of the basic education of TCM for nurses. The development of TCM nursing should follow the path of inheritance, innovation, and development. Although the theory of TCM is in a relatively stable state within the system, it must develop and enrich the corresponding prevention and treatment ideas and methods with the changes of disease spectrum and pathogenesis of human society.[23]Therefore, in the process of learning the basic theory of TCM and excavating the connotation of nursing of TCM classics,clinical nurses should practice in combination with the actual situation, transform the basic knowledge into a tool to solve clinical problems, and promote the deep and extended specialization of TCM nursing.