Winter disease and summer treatment is a kind of external treatment method to treat and prevent diseases by applying medicine to certain acupuncture points in the body during the three volt days in summer, so it is also called “three volt moxibustion” and “three volt paste”. It is used for chronic and stubborn diseases that are prone to recurrence or aggravation in autumn, winter and spring, with the advantages of less side effects, low cost, easy operation, safe and effective, and suitable for young and old. At present, it has been accepted by more and more patients. Winter and summer acupressure is a comprehensive intervention method, the effect of which is related to the prescription of the medicine, the preparation, the preparation process, the acupuncture points, the time of application, and the skin reaction. In order to guarantee the clinical efficacy and safety of this therapy, regulate the clinical operation and guide the patients to seek medical treatment scientifically, the Chinese Acupuncture and Moxibustion Society and the Chinese Academy of Traditional Chinese Medicine organized the national “Eleventh Five-Year Plan” Science and Technology Support Program “Research on the operation standard of winter and summer acupressure” (participating units: Chinese Acupuncture and Moxibustion Society, Chinese Academy of Traditional Chinese Medicine, Chinese Academy of Traditional Chinese Medicine). (Participating organizations: China Acupuncture Association, Chinese Academy of Traditional Chinese Medicine, Institute of Clinical Basic Medicine of Chinese Academy of Traditional Chinese Medicine, Dongzhimen Hospital of Beijing University of Traditional Chinese Medicine, Liaoning Provincial Hospital of Traditional Chinese Medicine, First Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Xiyuan Hospital of Chinese Academy of Traditional Chinese Medicine, Oriental Hospital of Beijing University of Traditional Chinese Medicine, Guang’anmen Hospital of Chinese Academy of Traditional Chinese Medicine, Guangdong Provincial Hospital of Traditional Chinese Medicine, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Anhui Hospital of Traditional Chinese Medicine, Jiangsu Province) (The Affiliated Hospital of Acupuncture and Moxibustion of Anhui College of Traditional Chinese Medicine, Jiangsu Provincial Hospital of Traditional Chinese Medicine, The First Affiliated Hospital of Guiyang College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine Affiliated Hospital), based on the literature review, fully based on clinical research evidence, and based on the experience of clinical use, a draft guideline of clinical application of “winter and summer acupressure” was developed for the reference of doctors and patients. It is intended to be used by physicians and patients for reference. Indications Mainly used for chronic and persistent pulmonary diseases that tend to recur or worsen in autumn, winter and spring. Key recommendations: 1. chronic cough, chronic bronchitis, bronchial asthma, chronic obstructive pulmonary disease; 2. allergic rhinitis, chronic sinusitis, chronic pharyngitis; 3. children who are weak and susceptible to colds, recurrent respiratory infections; in recent years, some experts have also explored its use for osteoarthritis and other diseases. Contraindicated groups 1.Patching area with skin trauma, skin ulcer, skin infection; 2.Allergic to the dressing drug or dressing components; 3.Keloid; 4.Coughing yellow sputum, hemoptysis patients; 5.Patients whose doctors think it is not suitable for use. Caution: 1.Pregnant women; 2.Patients with AIDS, tuberculosis or other infectious diseases; 3.Patients with diabetes, blood diseases, malignant hypertension, severe cardiovascular diseases, severe liver and kidney dysfunction, bronchiectasis, malignant tumors; 4.Patients with acute attack or exacerbation of the disease; 5.Infants under 2 years old, because the reaction of the child cannot be known for sure, the crying of the infant must be closely observed. Operation specification 1. The composition of drugs basically follows the prescription recorded by Qing-Zhang Lu in the book “Zhang’s Medical General”, with white mustard seed, Yanhuo, Gansui, Hosin, ginger, and musk as the basic formula, and add or subtract with clinical experience and regional characteristics. Other drugs can be used, such as soapberry, bupleurum, Qianhu, clove, ice chips, musk, etc. At present, musk is no longer a mandatory part of the formula, and there are users who use artificial musk in their prescriptions. At present, the drug ratios in the ointments prepared by various schools vary greatly, and there is no consensus conclusion yet. According to reports in the literature, the general proportion of each drug in different prescriptions, relative to other drugs of different compositions, ranges from: white mustard seed accounts for the largest proportion, about 35-40%, followed by fine spice, about 15-25%, the other Yanhuosuo about 10-30%, Gansui 10-20%. 1.Drug composition White mustard seed, Yanhuosuo, Gansui, Hossein and ginger as the basic prescription, can be combined with previous clinical experience and regional characteristics, etc. to add or subtract. 2, herb concoction White mustard seed, Yanhuo, Gansui and Hossein are used as authentic herbs, and white mustard seed can be fried or its proportion can be adjusted to control the degree of skin irritation, while the rest of the drugs are used as raw herbs. 3, drug preparation The drug preparation process is required to be carried out in a sterile, clean, room temperature environment, or completed in the special preparation room of local medical institutions. Drug preparation method: using clean herbs, drying the drug, crushed, sieved through 80 – 120 mesh, set aside. Preparation method of ginger juice: ginger is used, washed, crushed and squeezed in three layers of sterile gauze to extract the juice. Ginger juice concentration of local hospitals can be adjusted according to the original experience and regional characteristics between 50% – 100%, the concentration adjustment can be made by adding the appropriate amount of distilled water blending. The ratio of raw herbal powder and ginger juice is 10g:10ml, which can be adjusted appropriately according to the climatic factors and experiences around the world. Take the raw herbal powder with ginger juice to make a dry and thick paste, the drug should be prepared on the day of use, or placed in the refrigerator freezer for backup. 4.Patching method First the patching site with 75% ethanol or iodine volt conventional disinfection, and then take the diameter of 1 cm, the height of 0, 5 cm or so of the ointment, the drug on the acupuncture point, with 5 cm × 5 cm (pediatric patients can be appropriately reduced) of desensitizing tape fixed. 5, the timing of the patch generally in the summer of each year, the first day of the first, middle and last day of the three volt days of the lunar calendar for patching treatment (if the middle volt is 20 days, the interval of 10 days can be added to the patch once). It can also be applied during the three volt days, with an interval of 7 – 10 days between each application. At present, some units are still exploring the “three nine” days or the usual time for compressing, in order to improve the clinical efficacy. 6.Patching time ①Adults each patching time is 2–6 hours, pediatric patients patching time is 0,5–2 hours. ②The specific time of the dressing depends on the patient’s skin reaction. Patients can take it off by themselves if they feel any obvious discomfort at the patch. 7.Course of treatment Continuous application for 3 years is a course of treatment. After the course of treatment, the patient can continue to apply the patch to consolidate or improve the therapeutic effect. 8.Patching parts The patching parts are usually based on meridian points, and the commonly used clinical points are Lung Yu, Ding Qi, Ankylosis, Dazhi, Zhong Fu, Tan Zhong and so on. According to the patient’s condition, the points commonly used in clinical practice are Fengmen, Di Yu, Xin Yu, Spleen Yu, Kidney Yu, and Feosanli, etc. Commonly used acupoints for treating pulmonary diseases are Lung Yu, Ding Qi, Ankylosis, Zhong Fu and Tan Zhong. Acupoints such as Fengmen, Di Yu, Heart Yu, Spleen Yu, Kidney Yu, and Foot Sanli can be added according to the patient’s constitution and condition identification and diagnosis. In addition, acupuncture points including Dazhi, Dinggyu, Tanzhong, Zhongfu, Tiantu, Guangyuan, Shenqu, Zhonggui, and Neiguan are also used. For the treatment of osteoarthritis diseases, commonly used acupoints include Dazhi, Kidney Yu, Hanging Bell, Guan Yuan, and A-Yi points. For the treatment of spleen and stomach diseases, the commonly used acupoints are Zhonggui, Spleen Yu, Stomach Yu, Foot Sanli and Sanyinjiao. Skin reactions and treatment after dressing 1. Normal skin reactions and their treatment Local skin flushing, burning, mild tingling, or small blisters, very few can appear large blisters. Most of the patient’s skin will remain pigmentation for a period of time. If small blisters appear at the site of the dressing, no special treatment is usually necessary and they are allowed to absorb naturally. Alternatively, a moist burn cream may be applied topically to reduce discomfort. A large blister should be disinfected with a sterile needle by picking the bottom of the blister and draining the fluid to prevent infection. Broken blisters should be disinfected and then wrapped with sterile gauze to prevent infection. 2.Adverse skin reactions and treatment methods After the patching, the local skin appears serious redness, large blisters, ulceration, pain, skin allergy, hypothermia. After patching local skin redness and swelling, can be applied externally Pi Bao cream, Pi Kang cream, etc. to slow down the stimulation; skin local blisters or ulcers should avoid scratching, protect the wound or apply scalding ointment, universal oil, erythromycin ointment, etc. Skin allergies can be treated with topical anti-allergy creams. If there is a larger and more severe skin erythema, blistering and itching, the medication should be stopped immediately and symptomatic treatment should be carried out. Those who have systemic skin allergy symptoms should go to the hospital for treatment in time. If the blisters are too large, or if there is purulent discharge in the blisters, or if the skin breaks down, exposing subcutaneous tissue and bleeding, seek treatment at a specialized hospital. In the above cases, patients should pay attention to keep the local area dry, do not rub or scratch the local area, and do not use bath products or apply other anti-itch drugs to prevent further stimulation of the local skin. Precautions 1. For the applied medicine, it should be fixed firmly to avoid displacement or dislodgement. 2.For those who have blisters on the area where the medicine is applied, pay attention to prevent local infection. 3.For those who are allergic to adhesive tape, desensitizing tape or bandage can be used to fix the applied medicine. 4.For the residual ointment in the skin, it should be washed with water only, and should not be scrubbed with irritating items such as gasoline or soap. 5, the prepared drug should not be left too long, the drug should be airtight, low-temperature storage. 6, during the treatment period, prohibit the consumption of cold, seafood, spicy stimulating food. 7, a long time sick, weak, thin people, the amount of medicine should not be too large, the compress time should not be too long, and in the compress period pay close attention to changes in the condition and any adverse reactions. Other precautions Winter and summer acupressure is a method of “treating the disease before it happens” that supports the body’s vital energy, increases immunity, and mobilizes the body’s own ability to prevent and fight disease, requiring at least 3 years of long-term use. It is very important to manage the patient during the period of compressing. Patients should actively seek medical attention to control the disease if it flares up or worsens, and should carefully record the time, degree and treatment of each attack; clinicians should regularly follow up with patients to give advice and guidance on treatment and rehabilitation. At the same time, the use of this therapy should be carried out with the patient’s informed consent, and before carrying out this therapy, the patient should be carefully introduced to the indication disease and precautions, etc. The implementation time of this therapy is concentrated and there are many patients, so the implementation department should be fully prepared, make arrangements for the implementation process, and pay attention to the collection and organization of the diagnostic basis of the disease. As a medicine of the patch, whether it is Chinese medicine, Western medicine, more or less there are precautions, including some adverse reactions. First, in the middle of acupressure, we advocate not to eat cold, such as cold drinks, spicy food. Second, the drug is stimulating the skin, by stimulating the body’s acupuncture points to regulate yin and yang, so the skin feels warm, hot, there is some slight tingling, but this is a normal phenomenon, this is the phenomenon of drug action, so do not worry. However, for some rare patients, it causes severe pain and itching, so the medicine can be removed at this time. Thirdly, in the past, like the ancients with winter and summer compresses, the more foaming the better the curative effect, but now people have changed their views on this, that is, they ask the doctor not to foaming, the curative effect should also be better than the ancient curative effect. If you encounter a patient with foam, one, do not use soapy water or cold water to wash, foam more should go to the hospital inside, we have a part of each year to deal with some patients with foam, so through the treatment, these patients quickly have healing. But for some patients, his skin is prone to infection, we advocate that these patients caution, especially lesbians, because it affects her beauty, caution, precautions also note these. Children within 3 years of age should not be posted, why? These children’s skin is more tender, he used the adult drug patch, easy to irritate the skin, easy foaming, foaming after easy skin infection, so we do not advocate the children within 3 years old patch. At the time of the appointment, or when the patient comes to see the doctor, I would like to remind everyone that I hope the patient will bring something when they come. First, it is very difficult to give you a diagnosis on the same day. Your disease, because it is an episodic disease, may be many years old, so you should bring the information from your original hospital visit as a basis for the doctor to diagnose the disease. Secondly, these diseases are often in remission now, and may not take medication or take very little medication, but you should sort out what medications you have taken in the past period of time, if you can write it out, it is best to provide to the doctor, the doctor can know how your condition in the end, I go to treat from which perspective, this is very important.