Abstract

In Japan, education in Chinese medicine nursing is not officially recognized, but the knowledge, techniques, and ideas of Chinese medicine nursing are considered to be an essential area of modern nursing. The purpose of this study was to clarify the current state of Chinese medicine nursing in Japan through a narrative review of Japanese literature. Using Ichushi-Web, a Japanese medical literature database, a search was conducted for original articles using the keyword “Chinese medicine nursing,” yielded 50 hits. All literature was collected and carefully read, and seven articles on Chinese medicine nursing in Japan were narratively reviewed. Of these, three articles concerned education in Chinese medicine nursing and four related to research. In terms of education, the educational effects of Chinese medicine nursing, which was introduced on a trial basis, were observed, but the trustworthiness of the evaluation of its outcomes was unclear. One issue was securing of educators for Chinese medicine nursing. In terms of research, Chinese medicine nursing was practiced for palliative care patients, outpatients with insomnia, and expectant mothers, but the trustworthiness of the evaluation of its outcomes was unclear. Certified Nurse Specialists in Japan are expected to combine cure and care in their practice, and application of Chinese medicine nursing is feasible. In the future, it will be necessary to propagate Chinese medicine nursing, which takes into account the constitution of the patient and emphasizes the patient’s natural healing powers.

Key Words: Chinese Medicine Nursing, Japan, Narrative Review, Oriental Medicine, Kampo (traditional Japanese medicine)

Introduction

Conventional medicine is based on a fundamentally mechanical view of the body. It regards the body as a machine, with each part functioning and in need of repair when it becomes ill or disabled. This approach aims to treat specific symptoms and diseases, and emphasizes scientific methodology in diagnosis and treatment [1]. However, in Japan, not only conventional medicine but also oriental medicine is widely accepted. Oriental medicine regards the entire body as an integrated system and emphasizes balance and the flow of qi (often translated as “vital energy,” “vital force,” “material energy,” or simply “energy”). Therefore, the Japanese medical system frequently provides integrative medical care that incorporates both conventional and oriental medicine [1].

Oriental medicine consists of Kampo (traditional Japanese medicine)(pharmacotherapy) and acupuncture/moxibustion (physical therapy) [1]. In Japan, herbal medicines are taken for mental instability, swelling, and constipation, while acupuncture and moxibustion are used to relieve pain. Oriental medicine refers to the traditional medical system in use throughout Asia, including traditional medicine in various countries and regions such as China, Japan, Korea, Vietnam, and Thailand. In other words, Chinese medicine is a major component of oriental medicine, used here as a general term for traditional medicine practiced throughout Asia.

In Japan, in 2001, “Be able to provide an overview of wakan-yaku (Japanese and Chinese medications)” was added to the Model Core Curriculum for Medical Education in Japan. Furthermore, in 2011, the curriculum was revised to provide an overview of the characteristics and current state of use of wakan-yaku and Chinese herbal medicines [2]. Currently, the number of hospitals with Japanese and Chinese departments is increasing, but on the other hand, in nursing, Chinese medicine nursing has not become widely disseminated [3]. While in China, for example, traditional Chinese medicine is taught in undergraduate nursing courses [4], in Japan nurses do not have the authority to prescribe medicine, thereby discouraging the teaching and practice of traditional Chinese medicine nursing.

Hohashi has defined Chinese medicine nursing as “a practical science that enables the alleviation of symptoms, prevention of illness, treatment, and recuperation by comprehensively diagnosing the overall condition of a person (family member) and improving their constitution and environment” [1]. While only a few nursing schools in Japan have adopted Chinese medicine nursing [4], the knowledge, techniques, and ideas of Chinese medicine nursing are considered essential to modern nursing. Chinese medicine nursing encompasses wisdom for living a healthy and happy life, but owing to its characteristics it is difficult to produce evidence for its effectiveness. As Chinese medicine nursing is based on a holistic approach to improving one’s constitution and environment, it is difficult to quantitatively assess its overall effectiveness [1].

This study aimed to clarify the current status of Chinese medicine nursing in Japan through a narrative review of literature in the Japanese language. Based on this content, it is considered urgent to construct a basis for the theory, practice, education, and research into Chinese medicine nursing.

Methods

Search strategy

We searched for all original articles registered on Ichushi-Web, Japan’s only comprehensive medical literature database, and searched for articles that contained the keyword somewhere in the title, abstract, or keywords (conducted at the end of July 2024). In order to confirm the actual status of Chinese medicine nursing in Japan, we thought it was important to first utilize the literature available in Japan. As a result, we were able to obtain a total of 50 original articles after removing duplicate literature: one for “Chinese medicine nursing”; none for “Kampo nursing”; and 50 for “Chinese medicine AND nursing.”

Data analysis and synthesis

The 50 articles were collected and carefully reviewed, and it was determined that the inclusion criteria were related to Chinese medicine nursing [1] in Japan. Of the total of 50 papers, 37 papers were not related to Japanese Chinese medicine nursing. In addition, the quality of the papers was evaluated according to the method of DiCenso et al. [5]. The classification of original articles in Ichushi Web includes literature reviews and short reports, and six papers were determined to be of low quality, and finally 7 papers were subjected to analysis [6-12].

Descriptions regarding the current status of Chinese medicine nursing in Japan were extracted for each context, and each description was designated as a meaning unit. After organizing them using Garrard’s matrix method [13], the contents were integrated and written in a descriptive manner. All analyses were reviewed repeatedly by seven researchers until a consensus was reached to ensure the trustworthiness of the analyses.

Ethical consideration

Since this study is a literature review and does not involve humans or animals, approval by an institutional review board was not required. Research ethics were applied, copyright law was strictly observed, and sources were clearly indicated. In addition, the contents of the papers were faithfully read, and when citing the materials, the expressions in the literature were adopted, with care taken not to deviate from the author’s intention or meaning.

Results

Of the 50 papers, the first authors of 16 papers were Chinese who were studying in Japan, where they conducted research on traditional Chinese medicine. Of the seven papers analyzed, three concerned education in Chinese medicine nursing, and the other four, research.

Education in Chinese medicine nursing

A nursing university had attempted to introduce traditional Chinese medicine in Japan [6]. However, because the concepts utilized differ from conventional medicine and no faculty members were available to provide instruction, it was not possible to introduce traditional Chinese medicine at the undergraduate level. At a graduate school in Japan, Chinese medicine nursing was introduced by a Chinese person who had come to Japan for studies. This individual, who had taught traditional Chinese medicine, conducted seminars on such topics as tongue diagnosis. One pressing issue was the training of researchers and educators of Chinese medicine nursing who understood conventional medicine. One report involved a university that conducted lectures and exercises on holistic care in midwifery based on traditional Chinese medicine at its graduate school [7]. According to the results of a questionnaire survey of graduates, the reason for implementing holistic care in clinical practice was that it is considered to be outstanding in terms of healing the mind and spirit. It was also reported that an undergraduate nursing university had incorporated traditional Chinese medicine breathing techniques, and massage and acupressure using meridians into lectures on health self-management [8]. A descriptive survey of students who attended the lecture revealed that the lecture could contribute to enhancing students’ ability to independently manage their own health.

Research on Chinese medicine nursing

There was a case study in which a public health nurse engaged in health consultation introduced Tui Na, Qigong, Tai Qi exercises, and breathing techniques as self-care methods [9]. The incorporation of traditional Chinese medicine as a method achieved relaxation, fostered a calm and peaceful state of mind, and was able to reduce pain. In a study in palliative care, a nurse performed heat therapy using an electric moxibustion device [10]. It was found that electric moxibustion treatment reduced pain that could not be managed with painkillers, and reduced overall physical pain. In another study, a nurse performed foot massage and directed abdominal breathing for outpatients, and investigated the effects on insomnia and associated symptoms [11]. Patient responses showed improvement in symptoms of patients who had difficulty falling asleep and feeling as if they were not sleeping well, as well as improvement in such associated symptoms as a heavy feeling in the head and headaches. One study involved midwives implementing Qigong that combined the four elements of relaxation, imagination, exercise, and breathing (RIEB) in safe childbirth classes for expectant mothers [12]. Based on the experiences of the mothers, it was noted that RIEB can be effective in achieving relaxation and maintaining health during pregnancy and the postpartum period, and even in exceptional circumstances such as during childbirth. These four studies claim that Chinese medicine nursing is effective, but evaluation using objective indicators is insufficient.

Discussion

Only seven papers exist on the current status of Chinese medicine nursing in Japan, which is extremely limited. Chinese medicine nursing, which takes into account the constitution of the patient and emphasizes the patient’s natural healing power, has shown to be effective in preventing and treating a wide variety of illnesses and conditions. In the future, we foresee the education and practice of Chinese medicine nursing becoming essential for Japanese nursing professionals.

The content of undergraduate nursing education in Japan is set out in the “Regulations for the designation of public health nurse, midwife, and nurse training schools” [14]. However, the above regulations do not include any items related to traditional Chinese medicine, so education on Chinese medicine nursing is not generally provided in Japan. This situation notwithstanding, three papers have attempted to provide instruction in Chinese medicine nursing [6,8]. Although a certain level of educational effectiveness has been achieved, unfortunately the results are not at a level that can be considered evidence, due to issues with the evaluation methods. This is due in part to the difference between the educational curriculum in China and Japan, and the fact that even foreign students who have completed their nursing education in China cannot obtain a nursing license unless they pass the national nursing examination in Japan. The lack of instructors who can teach Chinese medicine nursing in nursing education in Japan can be cited as a problem. In the future, it will be important to collaborate with Chinese students in order to secure faculty members who can teach Chinese medicine nursing.

When observing, judging, and caring for patients’ complaints and symptoms, traditional Chinese medicine is based on the holistic view of the patient, which is consistent with the holistic view of nursing that views the patient as a whole. In Japan, Certified Nurse Specialist (CNS) is a qualification that can be acquired through graduate school education as an Advanced Practice Nurse, and allows the CNS to provide advanced nursing practice involving diagnosis and treatment, combining care and cure [15]. At our university, we teach and practice CNS in Family Health Nursing. As there are many students from China, we provide instruction in traditional Chinese medicine with Japanese and Chinese doctors of traditional Chinese medicine as lecturers, and we are focusing on the application of Chinese medicine nursing as a form of cure performed by CNSs [15], although nursing professionals are not authorized to prescribe medication in Japan. In particular, the CNS curriculum includes advanced pharmacology, and we believe it would be a good idea to incorporate Chinese medicine into this subject area.

Regarding research into Chinese medicine nursing, reports have been issued by public health nurses, midwives, and nurses, and various nursing professionals have conducted research [9-12]. The main subjects of the research were palliative care patients, insomnia outpatients, and expectant mothers, with such traditional Chinese medicine methods as Tui Na and Qigong utilized. Unfortunately however, due to inadequacies in the rigor of the research methods, the level of evidence was lacking. In the future, it will be necessary to conduct research in Japan using objective indicators while referring to research on Chinese medicine nursing and complementary health approaches in China.

To cite one example of Chinese medicine nursing, the program at the Beijing University of Traditional Chinese Medicine in China incorporates Chinese medicine into nursing education, with particular emphasis on pulse diagnosis, one of the traditional diagnostic methods [16]. In addition, massage, acupuncture, and cupping are used to stimulate the meridians, improving blood flow, and meals tailored to the patient’s constitution are provided in collaboration with herbalists. Anma (traditional Japanese massage), acupuncture, and moxibustion were introduced from China and have long been familiar to the Japanese, and in 1988 masseurs, acupuncturists, and moxibustionists became nationally certified. The knowledge and techniques of traditional Chinese medicine are incorporated into daily practice, and sometimes they work in collaboration with nursing professionals.

In Japan, the first Japanese-language book on Chinese medicine nursing, authored by a Chinese national, was published in 2020 [17]. In the future, we hope that formal education in Chinese medicine nursing will begin in Japan, and that the practice and research into Chinese medicine nursing will advance appropriately. In the future, we would like to endeavor to disseminate the theory and practice of Chinese medicine nursing, which takes into consideration the constitution of the patient and emphasizes the patient’s natural healing power [18].

Conclusion

Currently, Chinese medicine nursing is not widely recognized as a field of nursing in Japan, but conventional medicine and oriental medicine are nonetheless used extensively in the medical field. In Japan, which is historically influenced by China, medical theories of traditional Chinese medicine have also permeated modern lifestyles, and many of them are easily accepted in the home environment. It is hoped that in the future, the education, research and practice of Chinese medicine nursing will progress in Japan.

Funding Sources:

This work was supported by a Grant-in-Aid for Scientific Research (B) from the Japan Society for the Promotion of Science (JSPS) in Japan (Grant Number: JP22H03400). JSPS had no role in study design, data collection, analysis and interpretation, writing of the manuscript, and decision to submit the manuscript.

Conflict of interest:

The authors have no conflicts of interest to declare that are relevant to the content of this article.

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