ABSTRACT: Colorectal polyps are thought to be the potential precursors to colorectal cancer (CRC). Endoscopic removal of these polyps is conductive to decreasing the risk of deaths due to CRC, but for some complex colorectal polyps, they have to be resected surgically instead of endoscopic removal. However, surgical excision is associated with higher morbidity and mortality. Recently, traditional Chinese medicine (TCM) has shown a better therapeutic effect on improving the quality of life and reducing the recurrence in patients with colorectal polyps. Therefore, this article primarily investigated the key points of common syndromes, TCM nursing methods and healthy guidance of colorectal polyps, aiming at maintaining and developing the strengths of TCM, improving its efficacy and standardizing its behavior.

KEY WORDS: colorectal polyps; abdominal pain; Traditional Chinese Medicine nursing; syndrome differentiation

Colorectal cancer (CRC) is the fourth cause of cancer-related deaths worldwide, with an increased risk in patients with large and multiple polyps[1-2]. Recent studies showed that colorectal polyps are the potential precursors to CRC[3]. Endoscopic removal of these polyps is conductive to decreasing the risk of deaths due to CRC. Some of the colorectal polyps are thought to be too complex for endoscopic removal, thus they can be resected surgically. Nevertheless, surgical excision has a close association with higher morbidity and mortality[4].

Recently, Traditional Chinese Medicine (TCM) has shown a better therapeutic effect on improving the quality of life and reducing the recurrence in patients with colorectal polyps[5]. Guan et al.[6]found that modified Shenling Baizhu Powder could effectively prevent the recurrence of patients with colorectal polyps after endoscopic surgery. Xie et al.[7]investigated the clinical efficacy of Qingre Huashi Changning Decoction on inflammatory colorectal polyps due to accumulation of dampness-heat into spleen, and believed that use of Qingre Huashi Changning Decoction could improve clinical symptoms and decrease the recurrence rate of patients with inflammatory colorectal polyps due to accumulation of dampness-heat into spleen. For patients unable to undergo the radical operation and those unwilling to receive surgeries, oral administration of TCM combined with enema could also be adopted[8]. In view of TCM advantages in the treatment of colorectal polyps , State Administration of Traditional Chinese Medicine of the People’s Republic of China formulated a TCM nursing protocol for colorectal polyps, aiming at maintaining and developing the strengths of TCM, improving its efficacy and standardizing its behavior.

Keypointsofcommonsyndromes

Syndrome of dampness-stasis occlusion: loose stool or mucous stool, or fresh red or dark red blood after defecation, or abdominal discomforts, epigastric depression, poor appetite; dark red tongue or with ecchymosis, white thick or greasy coating.

Syndrome of dampness-heat in the intestinal tract: abdominal distension and pain, loose stool, or mucous stool, tenesmus and foul-smelling diarrhea, or bloody stool, or constipation accompanied by thirst, preference for drinking, yellow urine, scorching and distending anus; red tongue with yellow greasy coating.

Syndromeofqistagnationandbloodstasis: epigastric distension, depression and pain, or presence of stabbing pain, constipation, bloody stool or loose stool, or sometimes presence of lumps; dark red tongue or with ecchymosis.

Syndromeofspleendeficiencywithstasis: dull pain in the abdomen, loose stool, light-colored bloody stool, lassitude, sallow complexion, anorexia, or aversion to cold, limbs lack of warmth; light-colored bulgy tongue, or with ecchymosis.

Nursingforcommonsymptoms/syndromes

Abdominalpain

·Closely observe the location, nature, onset time and inducing factors of abdominal pain, as well as the changes of patient’s mental status, blood pressure and heart rate at the time of severe abdominal pain.

·Stay in bed at the time of pain onset.

·According to the doctor’s advice, perform acupoint application, and select the points like Zhongwan, Tianshu, Weishu, Guanyuan, etc.; take auricular-plaster therapy, and select the points like large intestine, spleen, stomach, Shenmen, sympathia, abdomen, endocrine, etc,; conduct acupoint injection, and select the points including Tianshu, Sanyinjiao and Zusanli; do moxibustion on the points of Guanyuan, Tianshu and Dachangshu; massage the points like Zusanli, Dachangshu, Tianshu, etc. ; perform infrared radiation on the points of Shenque, Tianshu, Guanyuan and Qihai.

Diarrhea

·Observe the frequency, times, color and texture of stool, as well as presence or absence of dehydration and electrolyte disturbance, and timely inform the doctor.

·Keep the anus and perineum clean, scrub with soft paper after defecation and wash with warm water.

·Based on the doctor’s advice, do moxibustion (circling moxibustion) on the abdomen, and select the points like Shenque, Zhongwan, Tianshu, Guanyuan, Qihai, etc.; take auricular-plaster therapy, and select the points like small intestine, large intestine, stomach, spleen, etc.; perform acupoint application on the points of Tianshu, Shenque and Guanyuan; massage the points like Zusanli, Dachangshu and Tianshu, etc.

Constipation

·Massage the abdomen clockwise to promote bowel movements 1-2 hours after meals.

·According to the doctor’s advice, massage the points like Tianshu, upper Juxu, Dachangshu, etc.; take auricular-plaster therapy, and select the points like large intestine, rectum, spleen, subcortex, constipation point, etc.

TCMspecialnursing

Medications

InternalapplicationofChineseherbs

·Medication time: Each dose of herbs can be taken generally in twice or three times. The specific medication time depends on the property and function of herbs as well as the patients' pathological condition. Chinese herbs for relieving exterior and clearing heat should be taken 1 h before meals, in which application of exterior-reliving Chinese herbs should avoid wind chill, or putting on more clothes or having some porridge induces diaphoresis. Chinese herbs for promoting digestion, purgation, expelling parasites, tranquilization and tonification are taken respectively after meals, before meals, on an empty stomach in the morning, before sleep and on an empty stomach. Emergency drug use follows the doctor's advice.

·Medication temperature: The administered warm is usually adopted. For the patients with special treatment, the herbs should be taken according to the doctor's advice.

·Medication dose: 200 mL is taken per time for the adult; 100 mL is taken per time for the patients with heart failure and those of controlling the dose. The elderly and children should take herbs according to the doctor's advice.

Injection

·Inquire the history of allergy carefully before medication.

·Make allocation and administration according to the requirements and injection speed recommended in the drug instructions.

·Apply TCM injection alone, and use it right after it was ready.

·Chinese and western drugs should be separated when Chinese and western injections are in combination.

·It is inappropriate to use a venous channel for two or more kinds of drugs except for special instructions.

·Medication reactions are observed closely, especially for the elderly, children, people with liver and kidney dysfunction and those that use TCM injections initially. Medication is suspended, and the doctors should be told to deal with it if adverse reactions occur.

·Nursing for allergic reactions: stop to use the drugs immediately, change the infusion channel and inform the doctor; seal the liquid and channels that cause adverse reactions; do allergic identification and inform patients and their relatives firmly to avoid re-medication; guide the patients to have a bland diet during the treatment of allergic reactions, forbid to eat the food like fish, shrimps, etc.

Specialtechniques

Acupointapplication

·Conduct acupoint application following the doctor’s advice.

·Nursing assessment: the skin condition in the part of acupoint application; forbid to use it for pregnancy women.

·Expose the part of acupoint application completely, and pay attention to keeping warm and protecting the privacy.

·Keep a proper thickness of plaster (0.2-0.3 cm) and a certain humidity in order to smear easily.

·Observe the local and systemic condition. Stop to use it and inform the doctor to manage immediately if the allergy occurs, such as erythema, pruritus and vesicles.

·Avoid smoking, drinking alcohol, and taking cold, salty and spicy food, seafood, beef and mutton during application.

·Record the application part, time and patients’ feelings after all the operations are finished.

Acupointinjection

·Perform acupoint injection following the doctor’s advice.

·Based on the doctor’s advice, use the correct drugs and pay attention to the drug incompatibility.

·Assess the current primary symptoms, previous history, history of drug allergy and the condition of local skin in the part of acupoint injection.

·Strictly abide by aseptic techniques to prevent infection.

·At the time of injection, avoid the location with abundant blood vessels to prevent drugs from entering into blood vessels; drop out the needlepoint a little and then inject when the patient has electrical sensation.

·Closely observe the patient’s reactions after administration, and inform the doctor immediately to manage them if discomforts emerge.

·Record the location, drugs and dose of acupoint injection, as well as the patients’ feelings after all the operations are finished.Moxibustion

(1) Circling moxibustion: do circling moxibustion distant to 1-1.5 cun of Shenque for 5-10 min.

(2) Others.

·Perform moxibustion following the doctor’s advice and select the proper ways of moxibustion, such as moxibustion with moxa cone, moxibustion with moxa stick, moxibustion with moxa box, tec.

·Nursing assessment: the condition of skin in the area of moxibustion and acceptance level of patients to the moxibustion smell. It is unsuitable for moxibustion in the face, in the part of larger vessels as well as in the abdominal and lumbosacral portion of pregnant women.

·Regulate the room temperature timely, and maintain good indoor ventilation.

·Select a reasonable position to fully expose the part of moxibustion, and be cautious to keep warm and protect privacy.

·Do moxibustion from top to bottom, namely the top of the head and chest-back first, and then the abdomen and four limbs.

·During moxibustion, inquire the patients whether they feel a burning sensation, regulate the distance and flip the moxa ash into the kidney basin to avoid burning the skin.

·Pay attention to the moxibustion time. For instance, moxibustion is done for the patients with insomnia before sleep instead of moxibustion immediately before meals or after meals.

·After moxibustion, local reddish scorching skin is normal. The moxibustion-induced small vesicles can be absorbed by themselves, but for the large ones, the doctor should be informed immediately and corresponding measures are taken according to the doctor’s advice.

·Place the moxa cone or moxa stick in the flame-out bottle to extinguish the moxibustion fire immediately after moxibustion.

·Small-dose and short-time moxibustion is applied to the initially-used patients, and the dose is increased gradually when the patients are tolerant.

·After moxibustion, record the way, part and skin of moxibustion as well as the patient’s feelings.

Auricular-plastertherapy

·Embed beans at auricular points and select acupoints correctly according to the doctor's advice.

·Assess the condition of ear skin and degree of tolerance to the pain; prohibit using them in the inflammatory, ruptured and frozen skin as well as in pregnant women.

·Keep the intensity of probe moderate and accurately seek the sensitive point in acpoint area.

·Scrub the ears with 75% alcohol by volume.

·Observe the patients' condition, stop immediately and inform the doctor to deal with it if discomforts occur.

·Select one ear for routine performance, keep the beans usually for 3-7 days and use them in two ears alternately; guide the patients to press them correctly.

·Observe the fixed degree of auricular point sticking, the improvement condition of symptoms and ear skin (redness, swelling, rupture, etc.).

·Record the bean-embedded location and time at auricular points as well as the patients' feelings after the operation is finished.

Acupointmassage

·Conduct acupoint massage according to the doctor's advice.

·Assess the skin condition around the massage area and degree of tolerance to the pain; prohibit using it in women during menstruation and pregnancy.

·For the operator, trim the fingernails to prevent the skin from injury.

·Keep the strength even and moderate, and pay attention to keep warm for the patients and protect their privacy.

·Observe the patients' reactions closely when the operation is done; stop the massage and take corresponding measures once discomforts occur.

·Record the massage acupoints, techniques and time as well as the patients' feelings.

Infraredradiation

·Use infrared ray to irradiate corresponding points for 30 min every time, and keep the probe away from the skin for 30 cm.

Healthyguidance

Dailylife

·Stay in bed at the time of acute onset of abdominal pain.

·Reduce the postures that can increase abdominal pressure, such as squat and holding the breath. Do not sit, stand and walk for a long time and overwork.

Dietaryguidance

·Syndromeofdampness-stasisocclusion: It is advisable to eat the food that can promote qi circulation and resolve dampness, such as dried orange peel, coix seed and turmeric. Potatoes and soda water should be taken less, and cold, raw and greasy food should be forbidden.

·Syndromeofdampness-heatintheintestinaltract: It is advisable to eat the food that can eliminate dampness and heat, such as white radish, water chestnut, dandelion, lily and purslane. Vegetables and fruit should be eaten more to promote bowel movements. The pepper and wine should be forbidden.

·Syndromeofqistagnationandbloodstasis: It is advisable to eat the food that can tonify spleen and regulate qi, such as citrus, ginger, kelp, white radish and peach seed. The food that can cause flatulence like sweet potato, taro, broad bean and chestnut should be eaten less, and cold drinks and ice creams are forbidden.

·Syndromeofspleendeficiencywithstasis: It is advisable to eat the food that can invigorate spleen and regulate qi, such as Chinese yam, lean pork, mutton and white hyacinth bean. The cold, raw and greasy food should be forbidden.

·Guide the patients with constipation to drink much water especially water with honey, eat more vegetables and fruits to promote bowel movements.

Emotionaladjustment

·Guide the restless patients to use tranquilization method for relaxing and calmly breathing; tell them to keep the optimistic mood using transference method, such as taking moderate exercises, enjoying music and drawing pictures.

·Encourage the patients to frequently communicate with each other to improve their recognition on disease prevention and treatment and to enhance their confidence.