1. Site preparation:

Ask the patient to spread a bath towel and lie on the edge of the bed,  naturally arch the upper leg to expose the buttocks. Do not be too far  from the bathroom; otherwise, one can prepare a chamber pot nearby.  The patient can ask family members for assistance or perform this task  in a sitting position by themself.

(1) Enema using ginger soup: 

Preparation of ginger soup: The temperature is around 37 degrees  Celsius; the amount of ginger soup is approximately 300 to 500 ml. If  ginger soup is not readily available, one can use ginger powder brewed  with hot water, wait till the temperature subsides, and the ginger powder settles as sediment to the bottom, then use the brewing water as  a substitute. 

Method I: Enema procedure using enema bag and enema tube

1.1) Materials preparation:

Enema bag and enema tube (18F, approximately 44 cm in length) are  available in general medical equipment stores.

1.2) Enema procedure:

① Pour the ginger soup into the enema bag and hang the bag at a high  place (roughly the height of a person).

② Open the stop valve of the enema tube, allowing the ginger soup to  flow out so that the air inside the enema tube is discharged. Then  close the stop valve. 

③ The enema tube is preferably a soft, flexible tube. The operator wears  single-use gloves and coats the far end of the tube with petroleum  jelly or sesame oil. Pinch the tube at approximately 7 cm from its tip  using the thumb and the middle finger, and then push gently with  two fingers to insert the enema tube into the anus of the patient. 

At this time, the enema tube will bend due to the force exerted on  it. Use the index finger to lightly squeeze the bend to facilitate the  enema tube to enter the anus smoothly

④ Insert the enema tube approximately 30 cm deep into the anus,  open the stop valve, and it will take about 5 minutes to complete the  dripping of the ginger soup. The speed of the drip will be adjusted  according to the individual’s situation. Close the stop value and try  to keep the ginger soup inside the intestinal tract for a few minutes,  then just discharge. 

Method II: Enema procedure using a syringe and nasogastric tube

2.1 Materials preparation:

Nasogastric tube (18F, approximately 1.0 m in length); Syringe with  50 ～ 60 ml volume; they are available in general medical equipment  stores

2.2 Enema procedure:

① Insert the nasogastric tube into the anus approximately 40 ～ 50  cm: e operator wears single-use gloves and coats the far end with  petroleum jelly or sesame oil within 50 cm of the nasogastric tube.  Pinch the tube at approximately 5 cm from its tip using the thumb  and the middle finger, and then push gently with two fingers to  insert the nasogastric tube into the anus of the patient. At this time,  the nasogastric tube will bend due to the force exerted on it. Use the  index nger to lightly squeeze the bend to facilitate the nasogastric  tube to enter the anus smoothly. Anal contraction motion (drawing  up the anus) can also be performed so that the nasogastric tube can  enter the anus more smoothly. 

② Draw the ginger soup using the syringe and inject the fluid into  the nasogastric tube. This process can be repeated several times.  After the last shot, take the syringe out. Pull the syringe plunger  out and reconnect the empty syringe with the nasogastric tube.  Push the remaining ginger soup inside the tube into the intestine.  If there is too much resistance and the fluid cannot be pushed in,  the nasogastric tube can be appropriately pulled outward a bit,  or prepare an empty syringe to exert the air pressure to push the  remaining ginger soup inside the tube into the intestinal tract. Use  the two syringes alternately until the enema process is completed.

(2) Enema using ginger powder paste:

2.1 Materials preparation:

① Nasogastric tube (18F, approximately 1.0 m in length), or enema  tube (18F, approximately 44 cm in length); syringe with 50 ～ 60 ml  volume; they are available in general medical equipment stores.

② Ginger powder paste: Each dose of ginger powder paste is  approximately 10 ～ 60ml, with a temperature slightly below body  temperature.

2.2 Enema procedure:

① Insert the nasogastric tube or enema tube into the anus with a  depth of approximately 40 ～ 50 cm using the nasogastric tube and  approximately 30 cm using the enema tube. The operator wears  single-use gloves and coats the far end of the tube with petroleum  jelly and sesame oil. Pinch the tube at approximately 5 cm from its  tip using the thumb and the middle nger, and then gently use two  fingers to insert the nasogastric tube or enema tube into the anus.  At this time, the nasogastric tube or the enema tube will bend due  to the force exerted on it. Use the index nger to lightly squeeze the  bend to facilitate the nasogastric tube or the enema tube to enter the  anus smoothly. Anal contraction motion (drawing up the anus) can  also be performed so that entry into the anus is smoother. 

② Draw the ginger powder paste using the syringe and inject the paste  into the nasogastric tube or enema tube. Aer that, take the syringe  out from the nasogastric tube or enema tube. Pull the syringe  plunger out and reconnect the syringe with the nasogastric tube  or enema tube to push the remaining ginger powder paste inside  the tube into the intestine. If there is too much resistance and the  paste cannot get in, the nasogastric tube or enema tube can be  appropriately pulled outward a bit and injected again, or prepare  an empty syringe to exert air pressure to push the remaining  ginger powder paste into the intestinal tract. Use the two syringes  alternately until the enema process is completed

(3) Enema using ginger powder pills made from ginger powder  paste:

3.1 Materials preparation:

Ginger powder, ginger soup, microwave oven

3.2 Production process:

Use about 10 ～ 30 ml (5 ～ 15 grams) ginger powder each time.

(After heating, the outer skin of the ginger powder pill will turn  yellowish white and slightly hard, whereas the inside of the pill is so.  e ginger powder pills should be prepared and used up each time; if  they are stored for too long, they will harden and not easily absorbed.) 

3.3 Enema procedure:

Let the patient lie down and use the middle nger to moisten the anus  of the patient with a little water. Dip the ginger powder pill with a bit  of water to moisten it, and then push the ginger powder pill into the  anus with the middle nger, as deep as possible. e middle nger stays  in the anal canal while the patient performs anal contraction motion  (drawing up the anus), and then the middle finger withdraws. The  ginger powder pills are inserted into the anus one by one.

(4) Enema using ginger powder:

4.1 Materials preparation: 

① Enema tube (18F, approximately 44 cm in length); two syringes with  a volume of 50 ～ 60 ml each; they are available in general medical  equipment stores.

② Ginger powder: The amount of ginger powder used each time is  approximately 10 ～ 30 ml (or 5 ～ 15 grams)

4.2 Enema procedure:

① Remove the plunger from the syringe and ll the syringe with ginger  powder. 

② The operator wears single-use gloves and places the enema tube  coated with petroleum jelly or sesame oil approximately 30 cm into  the anus. 

③ First, use an empty syringe to push air into the enema tube to  conrm that the enema tube is unblocked. 

④ Replace the syringe with the one that has been filled with ginger  powder, and inject a small amount of ginger powder into the enema  tube.

⑤ Replace the syringe with the empty syringe; use air pressure to push  the ginger powder in the enema tube into the intestinal tract.

⑥ Repeat Steps ④ and ⑤ : Use the two syringes alternately until the  pre-determined amount of ginger powder is injected.

⑦ The amount of ginger powder for each shot should not be too much;  otherwise, the tube can be easily blocked. If there is too much  resistance, pull the enema tube out a bit and inject it again.

Recommendations:

① The amount and temperature of ginger soup, ginger powder paste,  ginger powder pills, and ginger powder used for enemas are  for reference only. In the end, the supreme principle should be  according to what the patient can accept and absorb, as well as if the  patient’s condition can be improved.

② After the enema, all the tools/equipment used can be reused after  being cleaned and dried. e parts that have been in contact with  the anus must be washed with soap and hot water

③ When administering the enema for patients with severe disease and  illness, injection speed should not be too fast. To avoid discomfort  for the patient, inject only a small amount each time and do it  multiple times.