Nursing perspective of the expert consensus on diagnosis and treatment of integr

Jing ZHANG, Tao MA, Shuhong LIU, Yan ZHAO,Ling TANG

1School of Nursing, Beijing University of Chinese Medicine,Beijing, China; 2Experimental Center, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China;3Department of Oncology, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China; 4Department of Nursing, Dongfang Hospital of Beijing University of Chinese Medicine, Beijing, China

ABSTRACT

Lung cancer is a malignant tumor with the highest incidence and mortality in China, which seriously affects the quality of life of patients.Traditional Chinese medicine (TCM) plays a unique advantage in the treatment and rehabilitation of lung cancer.In order to standardize TCM diagnosis and treatment and disease management of clinical medical workers, the Chinese Association of Integrative Medicine issued the“Expert Consensus on the Diagnosis and Treatment of Lung Cancer by Integrated Traditional Chinese and Western Medicine” in August 2021.Experts’ recommendations were made on the clinical staging and syndrome differentiation and classification of lung cancer, characteristic TCM therapies, and nursing care of integrated traditional Chinese and Western medicine.This article interpreted the Consensus on the above aspects from a nursing perspective, hoping to provide references for clinical medical workers in the treatment and nursing care of lung cancer.

Keywords:Consensus, integrated traditional Chinese and Western medicine nursing, lung cancer, traditional Chinese medicine nursing

INTRODUCTION

With the increasing severity of factors such as population aging and environmental pollution, the incidence of lung cancer is increasing year by year.Lung cancer is primary bronchial lung cancer which originates from bronchial mucosa, glands, or alveolar epithelium.It can be divided into two main categories, non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC), of which NSCLC accounts for approximately 80%-85% and the rest are SCLC.[1]According to global cancer statistics issued in 2021,[2]the incidence of lung cancer is 14.3% of total cancer in men and 8.4% of total cancer in women in 2020; lung cancer is the leading cause of cancer death, accounting for 18.0% of all cancer deaths.With the in-depth research of traditional Chinese medicine (TCM), TCM has become prominent in the diagnosis and treatment of lung cancer and disease management after the three conventional treatments of surgery, chemotherapy, and radiotherapy.At present, the theories and methods for the treatment of lung cancer with integrated Chinese and Western medicine have gradually formed, which has improved the efficacy of comprehensive treatment of lung cancer.[3,4]In 2021, the Chinese Association of Integrative Medicine issued the “Expert ConsensusontheDiagnosisandTreatmentofLungCancerby IntegratedTraditionalChineseandWesternMedicine” (hereinafter referred to as “Consensus”).The Consensus is compiled by oncologists from the First Affiliated Hospital of Guangzhou University of Chinese Medicine and Sun Yat-sen University Cancer Center according to the main results of the clinical collaboration pilot project (lung cancer) of Chinese and Western medicine for major and difficult diseases approved by the National Health Commission, the State Administration of TCM, and the Health Bureau of the Logistics Department of the Central Military Commission.[1]The Consensus highlights the characteristics of the combination of Chinese and Western medicine in the treatment of malignant lung tumors, places the equal emphasis on Chinese and Western medicine, and promotes the complementation of Chinese medicine and Western medicine.This article will mainly interpret the Consensus from a nursing perspective and puts forward corresponding points of view in order to provide references for clinical medical workers in the treatment and nursing care of lung cancer.

ETIOLOGICAL FACTORS AND PATHOGENESIS OF LUNG CANCER

The Consensus states smoking, occupational and environmental pollution, ionizing radiation, genetics,viruses, and others as common lung cancer-related etiologies,among which smoking is the foremost risk factor for lung cancer.Specific occupational exposures such as asbestos can increase the incidence of lung cancer.Carcinogens such as benzopyrene in outdoor air pollutants have also been associated with lung cancer.There is also a familial aggregation phenomenon in lung cancer, illustrating that genetic factors may play an important role for population and/or individuals who are susceptible to environmental carcinogens.TCM believes that the overall pathogenesis of lung cancer is due to “excess caused by deficiency” and“intermingled deficiency and excess.” Lung cancer is located in the lungs, and closely related to the dysfunction of the lung, spleen, and kidney.[5]Deficiency of lung and spleen Qi is the root cause of lung cancer.

CLINICAL STAGING, SYNDROME DIFFERENTIATION, AND CLASSIFICATION OF LUNG CANCER

Clinical staging of lung cancer from the perspective of Western medicine

The Consensus points out that the diagnostic idea of lung cancer is based on the clinical symptoms and signs of patients, the clinical diagnosis and TNM staging are obtained by imaging examination, and the pathological (including tissue or cytology) and molecular diagnoses are further clarified.The early diagnosis of lung cancer has important clinical significance.If a patient is diagnosed and treated in the early stage of the disease, a better curative effect can be obtained.For the clinical staging of lung cancer, the Consensus classifies lung cancer into stage I (IA and IB), stage II (IIA and IIB), stage III (IIIA, IIIB, and IIIC), and stage IV (IVA and IVB) according to the Union for International Cancer Control/American Joint Committee on Cancer TNM staging system (8thedition).[6]The Consensus is consistent with international guidelines regarding specialized examinations such as imaging examinations, pathological examinations,and tumor marker detection.[7]

Syndrome differentiation and classification of lung cancer from the perspective of traditional Chinese medicine

The Consensus puts forward that lung cancer is clinically intermingled with deficiency and excess, and can be seen in several syndrome types.The five common basic types are “lung depression and phlegm stasis,” “spleen deficiency and phlegm dampness,” “Yin deficiency and phlegm heat,” “dual deficiency of Qi and Yin,” and “deficiency of kidney yang.” The Consensus also states that at the early stage of the disease, it is dominated by lung depression and phlegm stasis, so the treatment is diffusing the lung to regulate Qi and resolving phlegm to dispel stasis; at the middle stage of the disease, the main syndrome is spleen-lung Qi deficiency or spleen deficiency and phlegm dampness, so the treatment is tonifying Qi to strengthen the spleen and reinforcing earth to generate metal; with the progression of the disease, Qi and Yin are depleted and the kidney is damaged by deficiency, so“dual deficiency of Qi and Yin” and “deficiency of kidney yang” are predominant, and the treatment should be focused on tonifying Qi, nourishing Yin, and warming Yang to nourish the kidney.

The Consensus recommends combined use of disease staging and syndrome differentiation and classification, which provides an important reference for nursing of lung cancer.

INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE TREATMENT OF LUNG CANCER

The therapeutic means of modern medicine are mainly based on surgery, radiotherapy, chemotherapy, targeted therapy, immunotherapy, and so on.These treatment modalities also cause certain harm to the human body while killing cancer cells.The Consensus states that for lung cancer patients who receive treatment such as surgery,radiotherapy, chemotherapy, or targeted therapy and who are eligible for treatment, treatment modalities of integrated traditional Chinese and Western medicine can be adopted to promote rehabilitation, resist recurrence and metastasis,attenuate side effects, and enhance efficacy, thus improving symptoms and quality of survival of patients.It is especially recommended for elderly patients with lung cancer to use TCM treatment as the leading treatment, with the main effects of improving healthy Qi and strengthening spleen, tonifying kidneys, and alleviating the adverse effects of antitumor therapy.[8]TCM can be used throughout the whole course of lung cancer treatment.Based on the basic treatment principle of “strengthening healthy Qi to eliminate pathogenic factors,”treatment strategies according to syndrome differentiation are provided for patients at different stages.

INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE NURSING OF LUNG CANCER

Daily life care

Good living habits contribute to disease recovery and are recommended in the Consensus for living care of lung cancer patients.The Consensus recommends improving environmental hygiene, with attention to maintaining the relative humidity and cleanliness of the air inside the room where it is housed.Nurses should educate patients to maintain good lifestyle habits such as smoking cessation and avoiding active and passive smoking.According to the nutritional management guidelines for oncology patients,[9]it is recommended that oncology patients should maintain a healthy body weight, with body mass index in the range of 18.5-25 kg/m2.For patients with targeted drug-induced oral mucositis, the Consensus specifically states that active prevention and care are required during medication administration, and the main measures include (1) oral hygiene can be maintained by brushing teeth in the morning and evening and gargling after meals; (2) eating hard objects is avoided to prevent damage to the oral mucosa; and (3) for denture wearers, attention should be paid to mucosal damage caused by mechanical stimulation of denture.

Dietary care

TCM dietary therapy, guided by the theories of Chinese Materia Medica (including “drug and food homology;” “four properties and five tastes;” “ascending, descending, floating,and sinking” as well as “meridian distribution”),[10]is a method of preventing and treating diseases through rational compatibility of food and drugs based on the characteristics of patients’ diseases.It is used in the body’s daily conditioning,especially suitable for rehabilitation nursing, and adjuvant treatment of chronic diseases as well as weak people.

The treatment of lung cancer is mainly chemotherapy.Chemotherapy-induced gastrointestinal toxicity often leads to poor nutrition and low immunity and is detrimental to the physical and mental health of patients.[11,12]For this reason, the Consensus proposes that diet can be arranged for lung cancer patients based on disease staging and syndrome differentiation,which provides a standardized reference basis for dietary care according to syndrome differentiation.The specific content of dietary care for lung cancer patients is as follows:(1) during the radiotherapy of patients, it is easy to cause heat toxin and damage Yin, so it is recommended to choose foods with the effects of clearing heat, promoting fluid, cooling blood,and detoxifying, such as ginkgo-olive-rock-sugar water and water-chestnut-lotus-root nectar drink.(2) Postoperative patients with damage of primordial Qi are manifested as fatigue, weakness of limbs, restless sleep, poor appetite,so it is recommended to choose foods with the effects of replenishing Qi and nourishing blood.(3) Patients receiving chemotherapy present with gastrointestinal toxic and side effects such as loss of appetite, nausea and vomiting, chest tightness,epigastric pain, and stagnant stools, so it is recommended to choose foods with the effects of stimulating the appetite and refreshing the spleen, such as braised pork tripe withAmomumandGinkgoyam porridge.(4) For patients with myelosuppression and fatigue, it is advised to choose foods with the effects of tonifying the kidney to produce marrow,such as stewed duck withCordycepsand lean meat soup with wolfberry and sea cucumber.(5) If the patients with retention of phlegm and dampness are manifested as obesity, chest distress, excessive phlegm, easily sleepy, it is recommended to choose foods that strengthen the spleen, excrete dampness,and harmonize the stomach to help digestion, such as lotus seed yam porridge and semen coicis soup with fish balls.(6)For patients with oral ulcers caused by targeted drugs, excess syndrome and deficiency syndrome should be differentiated.Those with deficiency fire should avoid eating anything raw or cold, while those with excess fire should not eat spicy,irritating, and fat-sweet-flavored foods.(7) For patients with targeted drug-related skin rashes, dietary therapy is used as adjuvant treatment according to the clinical manifestations of patients.If papules or pustules occur, mung bean soup with root of raw rehmannia and node of lotus rhizome is used to clear heat, cool the blood, nourish Yin, and promote fluid; for patients with multiple skin rashes manifested with redness,swelling, heat, pain, or patients with ulceration and exudation,semen coicis soup with black snake is used to clear heat and detoxify, nourish Yin, and dispel dampness; for patients with maculae and pustules accompanied with dry mouth and yellow urine, bamboo cane water with honeysuckle flower and couch grass root can be used to clear away heat and detoxify, and disperse the lung and induce diuresis.

Emotional care

The Consensus pointed out that cancer patients are prone to pessimism, despair, fear, anger, and other psychological problems, and medical staff should use seven-emotion health-preserving method and five-element music therapy for emotional care according to the specific conditions of the patients.Five-element music therapy is a music therapy based on the theory of five elements, with the five tones Gong, Shang, Jiao, Zhi, and Yu corresponding to five elements, five Zang organs, and five emotions, to promote physical and mental rehabilitation.[13]A Cochrane systematic review suggested that music interventions may have beneficial effects on depression, pain, fatigue, and quality of life in patients with cancer.[14]The five-element music affects Qi mechanism of the body by means of sound oscillations in different modulations, which promote the circulation of Qi and blood, maintain the functional stability of Zang-Fu organs, and keep the patient in a peaceful and calm state, thus achieving the purpose of tranquilizing mind and preserving health.A systematic review that included a total of 22 studies with 2053 cancer patients showed that five-element music therapy had beneficial effects on relieving depression (Standardized mean difference (SMD) = -1.11,95% confidence interval [CI] [1.41, -0.82],P＜ 0.00001) and improving sleep quality (Mean difference (MD) = -1.73,95% CI (2.34, -1.12),P＜ 0.00001).[15]Several studies have confirmed that five-element music therapy combined with acupoint application, acupoint massage, or auricular acupressure can increase the therapeutic effect in relieving symptoms of patients such as cancer-related fatigue, anxiety,depression, and sleep disturbance.[16-18]

Exercise in lung cancer care

The American College of Sports Medicine expressed high confidence evidence that exercise plays a role in preventing multiple types of cancer and increasing the lifespan of cancer survivors, and public health professionals as well as health-care providers should be encouraged to instruct cancer survivors to actively exercise as their age, ability,and cancer status allows.[19]Results of a systematic review show that exercise training can improve symptoms and quality of life in lung cancer survivors.[20]Health Qigong,a combination of musculoskeletal exercise, cognitive function, and breathing adjustment training, can promote the physical and mental recovery of patients.[21]The Consensus points out that patients can be instructed to exercise health Qigong such as Baduanjin and Tai Chi to dredge meridians and collaterals, improve Qi and blood circulation, and achieve the purpose of alleviating anxiety,strengthening the body, and promoting the recovery of the patients’ viscera.Moreover, a systematic review shows that it takes more than 6 weeks of Qigong exercise to effectively improve fatigue, dyspnea, and anxiety.[22]The Consensus also recommends systematic respiratory exercises for lung cancer patients.Effective respiratory exercises can improve the lung function and reduce postoperative complications and hospital stay in patients after lung cancer surgery.[23]A systematic review shows that in the perioperative period,combined with a breathing exerciser for breathing training based on routine care, training more than 4 times/day for about 15 min each time for 1 week or more can improve the lung function of patients undergoing lung cancer surgery and reduce the incidence of postoperative pneumonia.[24]Respiratory function exercise techniques include cleaning up the respiratory tract, controlled breathing techniques, and exercising skeletal muscles of the whole body.It is advised to provide health education to patients through mind mapping,feedback method, multimedia centralized health education,plan-do-check action cycle management, and so on.[25]In the clinical work of TCM nursing, it is often recommended for patients after lung cancer surgery to practice breathing exercises with Six-Word Qigong with pronunciation of “He,”“Si,” “Xu,” “Hu,” “Chui,” and “Xi.”[26]Studies have shown that Six-Word Qigong breathing exercise follows the order of the five elements’ mutual generation and restraint.It can drive muscles and joints of the limbs and the whole body through relaxing and gentle movements, thus increasing muscle endurance and improving mitochondria’s ability to transmit oxygen and the ability of aerobic metabolism which helps provide sufficient oxygen to tissues and improves blood circulation.[27,28]

Appropriate traditional Chinese medicine techniques

Lung cancer patients have long been treated with anticancer therapy consequently to disrupt the body’s Yin-Yang balance,so adverse symptoms have recurred.TCM has good efficacy in improving symptoms and alleviating toxic and side effects,and has accumulated considerable therapeutic experience for patients with lung cancer-causing cough, shortness of breath, fatigue, constipation, nausea and vomiting, pain,radiation pneumonitis, and oral mucositis.Not only TCM drugs but also the application of appropriate TCM techniques plays important roles in improving the balance of Yin and Yang, promoting healthy Qi, and preventing recurrence of the disease.Clinically, an appropriate TCM technique will be applied on a specific case in accordance with syndrome and disease differentiation.[29]The Consensus recommends TCM’s characteristic therapies for lung cancer patients.This article will interpret technical operations mentioned in the Consensus which are suitable for the implementation by nursing staff.

External application of Chinese medicine

External application of Chinese medicine mainly focuses on the treatment of cancer-related pain, so as to achieve the effects of promoting blood circulation, removing blood stasis,and relieving swelling and pain.The Consensus recommends Chanwubabu Ointment and Ailitong Plaster for local application.Chanwubabu Ointment is directly applied on the painful part, or applied externally on acupoints Tiantu (CV22)and Danzhong (CV17), 1 patch/time, dressing change once every 1-2 days.Ailitong Plaster needs to be baked until it becomes soft, and then is applied on the painful area after washing the affected skin, with gentle massage on the plaster by hands for 3-5 min to make it stick tightly, 2 times/day,10 days as a course of treatment.

Auricular acupressure

Auricular acupressure can be used to prevent chemotherapy-induced digestive tract reactions.The Consensus recommends relevant acupoints according to syndrome types.For patients with deficiency-cold of the spleen and stomach, nurses can choose sympathetic,subcortex, stomach, spleen, and kidney.For those with stomach Yin deficiency, nurses can choose sympathetic,stomach, cardia, esophagus, and Shenmen; for those with liver Qi invading the stomach, nurses can choose sympathetic,Shenmen, stomach, liver, and spleen.Auricular acupressure is performed every other day, pressing 3-5 min/time, 3-4 times/day.

Acupoint application

Acupoint application is suitable for gastrointestinal reactions caused by chemotherapy and diarrhea caused by targeted drugs.Acupoints are selected according to syndrome differentiation.For patients with deficiency-cold of the spleen and stomach, acupoints double Feishu, Pishu, Weishu, and Zusanli are selected.For those with deficiency of stomach Yin, acupoints double Feishu, Weishu, Zusanli, and Neiguan are selected.For those with liver Qi invading the stomach,acupoints double Feishu, Pishu, Yanglingquan, and Taichong are selected.Acupoint application should be applied once a day and removed after 4-h application.

For patients with diarrhea caused by targeted drugs,Dingxiang (FlosCaryophylli), raw Banxia (RhizomaPinelliae),Wuzhuyu (FructusEvodiae), and prepared slices of Fuzi (Radix AconitiLateralisPreparata) are used to be ground into powder,and mixed into paste with ginger juice to make patches.Acupoints such as Zhongwan, Neiguan, and Shenque are selected for application, 6 h/day, consecutively 3-5 days.

Moxibustion

The Consensus recommends moxibustion on each point for 20 min each time to alleviate cancer-related fatigue, with Shenque, Guanyuan, Qihai, and Zhongwan selected as the main points.Nurses may use ginger moxibustion as prescribed to relieve diarrhea caused by targeted drugs.The specific operation is as follows:a 3-4-mm fresh ginger slice with several small holes is placed on Shenque point over which a moxa cone is ignited for moxibustion, once daily, consecutively 3 days.

Traditional Chinese drug soaking and washing

Traditional Chinese drug soaking and washing has the effects of warming meridians and dredging collaterals, promoting blood circulation, and removing blood stasis.It can be used for treating peripheral neurotoxicity and targeted drug-related rash.Peripheral neurotoxicity, belonging to the category of blood paralysis in TCM, frequently occurs in patients with lung cancer treated with hemotherapy.Therefore, for those patients, a warm Chinese herbal decoction containing Guizhi (RamulusCinnamomi), Chishao (RadixPaeoniae Rubra), Chuanxiong (Rhizoma Ligustici), Danshen (Radix SalviaeMiltiorrhizae), Weilingxian (RadixClematidis), and Xuchangqing (RadixCynanchiPaniculati) is appropriately given to soak and wash hands and feet once daily, 30 min/time.

Targeted drug-related rash belongs to the categories of“drug rash” and “lung wind acne” in TCM and its etiology and pathogenesis is mainly “internal Yin deficiency and blood dryness but external accumulation of pathogenic toxin.” It is recommended Chinese herbal decoction or Itching-Stop Skin-Smoothing Liquid to externally apply or soak the rash, 2 times daily.The Chinese herbal decoction is composed of Jinyinhua (FlosLonicerae),Pugongying (HerbaTaraxaci), Difuzi (FructusKochiae),Guanghuangbai (CortexPhellodendri), Zihuadiding (Herba Violae), Baixianpi (CortexDictamni), and Borneol (Borneolum Syntheticum).Itching-Stop Skin-Smoothing Liquid mainly contains Huangqin (RadixScutellariae), Kushen (Radix SophoraeFlavescentis), Baixianpi (CortexDictamni), and Machixian (HerbaPortulacae).

Herbal gargling

Oral mucositis caused by targeted drugs belongs to the category of “aphtha” in TCM.Its pathogenesis is mainly “accumulation of heat in the heart and spleen” and “hyperactivity of fire due to Yin deficiency.” Oral mucosal ulcers are common clinical manifestations.Herbal gargle has the effect of clearing away heat and detoxification.It is recommended to use 500-mL gargle decoction containing Daqingye (FoliumIsatidis), Xuanshen (Radix Scrophulariae), and Gancao (RadixGlycyrrhizae) for gargle,3 times/day.Kangfuxin Liquid, a mouth rinse mainly composed of ethanol extract of dried body of American cockroaches, can also be selected to gargle, 3 times/day.

Herbal gargle is equally applicable to radiotherapy-induced oral mucositis, but radiotherapy is in the form of fire evil in TCM, so “nourishing Yin and clearing away heat” and “purging fire for removing toxin” should be noted.

Traditional Chinese medicine iontophoresis

Traditional Chinese medicine iontophoresis is an auxiliary means of rehabilitation.According to the principle of iontophoresis, it combines electroosmosis and drug ionization technology to achieve the function of directional drug penetration, thus promoting the body’s absorption of the active ingredients of drugs.It can be used to treat radiation pneumonia.Firstly, drug patches (the main components of which contain Beishanshen [RadixGlehniae],Baiji [RhizomaBletillae], Jinyinhua [FlosLonicerae], Baihe [Bulbus Lilii], Shengdihuang [RadixRehmaniaeRecens], and prepared Gancao [RadixGlycyrrhizae]) are pasted on the left and right Feishu acupoint.Then, the treatment was started by switching on the power supply after adjusting the required parameters well according to the patient’s tolerance level.The drug patches are fixed on the original acupoints for 2-4 h after the end of treatment to ensure full absorption of drugs through the skin.The treatment is performed once daily, 30 min/time, 7 days as one course of treatment, 3-4 courses in total.

CONCLUSION

Significance of interpreting the Consensus from the perspective of nursing

At present, the clinical treatment of tumors has entered a plateau, and the optimal regimen and efficacy of its maintenance therapy are unsatisfactory.[30]TCM follows a view of dynamic syndrome differentiation and a diagnosis and treatment pattern of combination of disease and syndrome, and shows certain advantages in regulating the body’s immune function, improving related symptoms,and prolonging survival.[31]Integrated traditional Chinese and Western medicine nursing also plays an increasingly important role in palliative care for tumor rehabilitation.[32]Therefore, distinguished from the traditional cognition of“anticancer by Western medicine and recuperating by Chinese medicine,” the innovative diagnosis and treatment of cancer by integration of traditional Chinese and Western medicine should keep a foothold of the diagnosis and treatment pattern of combination of disease and syndrome, enrich the contents of cancer diagnosis and treatment, and improve clinical efficacy.[33]The Consensus which this article interprets is a professional consensus on both theory and clinical practice, which describes the pathogenic mechanism, clinical manifestations, and diagnostic principles of lung cancer from the perspective of integrated traditional Chinese and Western medicine.It focused on the ideas, principles, and specific routine diagnosis and treatment of integrated traditional Chinese and Western medicine in lung cancer.In addition to providing standardized and accurate elucidation of syndrome patterns, the recommendations of combination of TCM syndrome differentiation and clinical staging, characteristic therapies for complications, and integrative nursing care based on syndrome differentiation are beneficial to improve the accuracy of clinical nurses’ care in the management of lung cancer.

Extend traditional Chinese medicine nursing service to realize “green tumor nursing”

TCM nursing is an important part of TCM, which fully embodies the concept of holistic view and syndrome differentiation of TCM.Under the mode of “green treatment of tumor,” it is essential to carry out “green nursing” to reduce patients’ pain and improve patients’ quality of life.To promote patients’ physical and mental health, provides safe, effective and humanized medical services, the green medical standard compilation group believes that green medical treatment should be patient-centered and pay attention to the continuous improvement of medical services and the coordinated development of medical services and environmental resources.[34]In 2004, Hu[35]proposed the concept of “green treatment of tumor”based on traditional Chinese philosophy and Chinese medicine, which adhered to the principle of “low-damage and sustainable” treatment and integrated into modern treatment technology.In June 2020, the Dongfang Hospital of Beijing University of Chinese Medicine organically integrated “green treatment of tumor” with the TCM nursing outpatient system to open an outpatient clinic for symptom management of tumor.Symptom management clinics are directed at symptoms such as nausea and vomiting, pain,cough, and limb numbness of cancer patients, to implement appropriate TCM nursing techniques such as moxibustion,scraping therapy, cupping, and Chinese medicine ointment rubbing based on syndrome differentiation and treatment,so as to relieve the patients’ discomfortable symptoms and thus improve the patients’ quality of life.[36]TCM green nursing clinic is centered on the ability of TCM syndrome differentiation, which is supplemented by TCM nursing technology.According to the patients’ situation,individualized, safe, and reasonable medical services are implemented, and excessive medical treatment is rejected.Meanwhile, TCM green nursing clinics pay more attention to extending ward care to outpatient, ensure the continuity of treatment, and alleviate discomfortable symptoms of patients.Besides, as TCM theory focuses on the regulating effect of emotional nursing on people, TCM green nursing clinic is patient centered to provide humanistic services throughout the treatment and thus improve the health level of patients.

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Conflicts of interest

There are no conflicts of interest.