2022年“天府青城计划”天府科技领军人才项目（川清城1090号）、国家中医临床优秀人才培养计划（国家中医仁教函[2022]1号）、成都中医药大学医院“百人计划”项目（院办[2021]42）、四川省中医药管理局科研专项（2021MS093、 2021MS539、2023MS608）。

该临床研究方案经成都中医药大学附属医院呼吸内科临床研究审批委员会审批（备案号.肯塔基州2022010）。
1、设备准备
<ol><li>准备一次性无菌针灸针（尺寸为0.25 mm x 40 mm），艾条（尺寸为1.2 cm x 1.2 cm），医用灭菌拭子，碘伏拭子，打火机和几个60 mm x 60 mm纸板（见 图1）。</li>
</ol>2. 医生准备
<ol><li>确保患者符合《慢性阻塞性肺疾病初级保健指南》中 COPD 的诊断标准，并且有腹胀。</li>
	<li>排除有下列情况的患者：（1）皮肤溃疡、血糖控制不佳、血压控制不佳、头晕者;（2）患有矽肺病、肺结核、恶性肿瘤、哮喘、凝血障碍、严重心功能不全者;（3）风湿性心脏病、先天性心脏病、肾功能衰竭、肝功能衰竭等;（4）依从性差的。</li>
	<li>戴上医用口罩和帽子。</li>
	<li>用肥皂水洗手，保持干燥，并在握住针头操作之前使用酒精免洗手消毒液。</li>
</ol>3. 患者准备
<ol><li>要求患者排空膀胱。</li>
	<li>测量患者的血压、心率、呼吸频率和血氧饱和度。</li>
	<li>确保皮肤没有受损和溃烂。</li>
	<li>待上述基本体征正常后，指导患者选择仰卧位或俯卧位，露出穴位。</li>
	<li>建议患者在手术过程中出现不适时通知医生。</li>
</ol>4.穴位选择
<ol><li>用碘伏拭子擦拭要针刺部位的皮肤。</li>
	<li>根据标准化穴位，选择飞书（BL13）、太原（LU9）、定川（EX-B1）、足三里（ST36）、中湾（RN12）、天舒（ST25）24、25、26（见图2）。</li>
</ol>5. 针灸和针刺操作
<ol><li>将左手的五根手指平伸，将食指和中指分开刺伤的地方。</li>
	<li>用右手的拇指和食指握住针柄，中指末端靠近针尖，手指腹部靠在针体上。</li>
	<li>拇指和食指向下按压，同时中指弯曲，将针插入国际标准针灸角度和深度。</li>
	<li>沿针刺角度均匀提起并推入针柄，深度约3mm，频率约60次/分27。</li>
	<li>将针柄前后旋转 180 度或更小的角度;频率约为60次/分钟，直到患者感觉De-qi27。</li>
</ol>6.放置艾条
<ol><li>从距离皮肤28 厘米的底部点燃艾条，使患者在体表上产生温暖的感觉和发红。治疗大约需要 30 分钟。</li>
</ol>7.放置纸板
<ol><li>将 60 毫米 x 60 毫米的纸板放在艾条下方，以防止灰烬灼伤皮肤，直到艾条烧坏（见 图 3）。</li>
</ol>8. 挑针
<ol><li>用竹签的末端轻轻捡起烧焦的艾条。</li>
	<li>用手中的医用消毒棉签轻轻按压针头部位。</li>
	<li>用针头轻轻扭转，慢慢将它们提升到皮下，放置片刻，然后取出。</li>
	<li>针头拔出后，用医用消毒棉签轻轻按压针孔片刻，以防止出血，减轻疼痛。</li>
	<li>拔针后，仔细检查针孔是否出血，询问患者是否有不适，检查针头数量是否缺失。</li>
</ol>

温针灸缓解慢性阻塞性肺病腹胀

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作者没有利益冲突需要声明。

众所周知，慢性阻塞性肺病引起的腹胀的发病机制尚不完全清楚，这阻碍了新疗法和新药的开发。近年来，温针灸被广泛应用于COPD合并腹胀。温针灸的治疗机理主要是针灸的效果、艾灸的温热作用、针体的导热作用31。艾灸的重点是穴位的局部变暖。它激活局部特异性受体、热休克蛋白、热敏免疫细胞等，发挥温经、开通侧支的局部作用32。现代中医认为，RN12?...

慢性阻塞性肺疾病（COPD）是一种常见的呼吸系统慢性消耗性疾病。慢性阻塞性肺病患者主要表现为慢性咳嗽和咳痰，病情进展，肺功能逐渐下降。疾病后期可并发慢性肺心病、呼吸衰竭、心力衰竭等，严重影响患者生活质量。据报道，肠道微生物群的改变与 COPD1 的疾病进展有关。除肺部症状外，40.31%的稳定期COPD患者报告腹胀。腹胀可对肺部症状恶化、增加 COPD 急性加重的频率以及损害稳定期 COPD 患者的生活质量产生重大影响 2,3。慢性阻塞性肺病腹胀的原因被认为是多因素的，可能包括以下几点：（1）细菌菌群失调;（2）腹水，增加腹内压;（3）电解质紊乱;（4）右心衰竭和肝脏或消化道充血;（5）长期卧床休息4;（6）药物5和机械通气6。
有中医学者提出，慢性阻塞性肺病的发展过程是四种状态的过程：（1）肺气虚;（2）脾气虚;（3）肾气虚;（4）阴阳虚 7,8.如果脾脏无法运输和转化，胃虚弱而无法接收，则可能会发生腹胀，进而导致肌肉因缺乏化学来源而变薄和无力9.目前，临床上常用的COPD药物有支气管扩张剂、糖皮质激素、抗生素等药物10。目前尚无指南规定COPD合并腹胀的标准化治疗方案，腹胀通常以对症治疗。
中医温针灸，可引导气疏通经络，活血化瘀，补虚温阳，消寒。它们可以产生抗氧化物质，从而发挥调节作用，从而促进免疫系统应激反应并改善血液循环11,12。温针灸可用于治疗颈椎病13、膝关节炎14、痛经15、便秘16、肠易激综合征17等。实验研究表明，针灸可以通过调节脑肠轴18来缓解腹胀。针灸联合艾灸可显着减少腹胀19，腹胀可以通过调节血浆前列腺素 E2 和血浆和胃粘膜组织中的胃泌素水平20 来发挥。同时，温针灸在改善功能性消化不良症状方面优于促动力药和假针灸21。针灸可以加强横膈膜，缓解呼吸肌疲劳，以及改善二氧化碳潴留和缺氧，预防和缓解呼吸衰竭22。温针和艾灸可改善稳定期慢性阻塞性肺病患者的肺功能、临床症状和生活质量23,24。
根据中医“肺与大肠内外关系”的理论，本研究采用温针灸治疗，旨在促进胃肠功能的恢复，提高肺功能和生活质量。温针和艾灸是高效、易于执行且价格低廉的中医治疗形式。综上所述，有必要就如何正确操作使用温针和艾灸来缓解腹胀性COPD提出标准方案。本文介绍如何正确操作使用温针和艾灸治疗来缓解腹胀的COPD。

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Moxa stick</td>
			<td>Dr. Moxi</td>
			<td>N/A</td>
			<td>size: 1.2 cm x 1.2 cm</td>
		</tr>
		<tr>
			<td>Disposable sterile acupuncture needle</td>
			<td>HWATO</td>
			<td>2001-0020</td>
			<td>size:&#160; 0.25 mm x 40 mm</td>
		</tr>
		<tr>
			<td>Iodophor swabs</td>
			<td>BEIJIAER</td>
			<td>20162140536</td>
			<td></td>
		</tr>
		<tr>
			<td>Cardboard</td>
			<td>In-house</td>
			<td>In-house</td>
			<td>size: 60 mm x 60 mm&#160;</td>
		</tr>
	</tbody>
</table>

a preliminary study on warm acupuncture and moxibustion for treating chronic obstructive pulmonary disease with abdominal distension

大多数 COPD 患者同时存在腹胀，这已被证明会对 COPD 患者的肺部症状、急性加重频率和生活质量产生不利影响。温针灸已被证明可有效缓解慢性阻塞性肺病合并腹胀患者的症状。温针和艾灸是高效、易于执行且价格低廉的中医治疗形式。温针灸的规范做法对于COPD合并腹胀的治疗非常重要。具体步骤包括通过辨证治疗选择合适的穴位进行针刺，以及选择合适长度的艾条进行脱气后约30分钟的艾灸。治疗过程持续一周。具体评估以下指标：COPD评估测试（CAT）和腹胀视觉模拟量表（VAS）的评分。本文将清楚地说明如何规范温针灸的操作，以缓解COPD合并腹胀。

Chronic obstructive pulmonary disease (COPD) is a common chronic consumptive disease of the respiratory system. Patients with COPD mainly manifest in chronic cough and sputum, with the progressive development of the disease and gradual decline in lung function. The disease may be complicated by chronic pulmonary cardiac disease, respiratory failure, and heart failure in the later stages of the disease, which seriously affects the quality of life of patients. It is reported that alterations in gut microbiota are associated with disease progression in COPD1. In addition to pulmonary symptoms, 40.31% of patients with stable COPD reported abdominal distention. Abdominal distension can have a significant impact on worsening pulmonary symptoms, increasing the frequency of acute exacerbations of COPD, and impairing the quality of life of patients with stable COPD2,3. The causes of abdominal distension in COPD are considered to be multifactorial which may include as follows: (1) dysbiosis of bacteria; (2) ascites, which increases intra-abdominal pressure; (3) electrolyte disturbances; (4) right heart failure and congestion of the liver or digestive tract; (5) prolonged bed rest4; (6) medications5 and mechanical ventilation6.
Some Chinese medicine scholars have proposed that the development process of COPD is the process of four states:(1) lung qi deficiency; (2) spleen qi deficiency; (3) kidney qi deficiency; (4) Yin and yang deficiency7,8. If the spleen fails to transport and transform and the stomach is weak and unable to receive, abdominal distension may occur, which in turn can lead to muscle thinning and weakness due to the lack of chemical sources9. At present, the drugs commonly used in the clinical treatment of COPD include bronchodilators, glucocorticoids, antibiotics, and other drugs10. There are no guidelines specifying standardized treatment protocols for COPD combined with abdominal distention, which is often treated symptomatically.
Warm acupuncture and moxibustion in traditional Chinese medicine can guide Qi to dredge the meridians, invigorate blood circulation, remove blood stasis, replenish deficiency to warm yang, and dissipate cold. They can produce antioxidant substances and thus play a regulatory role, which can promote immune system stress response and improve blood circulation11,12. Warm acupuncture and moxibustion can be used to treat cervical spondylosis13, knee arthritis14, dysmenorrhea15, constipation16, irritable bowel syndrome17, and so on. Experimental studies have turned out that acupuncture can relieve abdominal distension by regulating the brain-gut axis18. Acupuncture combined with moxibustion significantly reduces abdominal distention19, which may be exerted through the regulation of plasma prostaglandin E2 and gastrin levels in plasma and gastric mucosal tissues20. Meanwhile, warm acupuncture and moxibustion are superior to prokinetics and sham acupuncture in terms of improving the symptoms of functional dyspepsia21. Acupuncture can strengthen the diaphragm and relieve respiratory muscle fatigue, as well as improve carbon dioxide retention, and hypoxia, and prevent and relieve respiratory failure22. Warm acupuncture and moxibustion improve lung function, clinical symptoms, and quality of life in patients with stable COPD23,24.
According to the theory of Chinese medicine that &#34;The lung stands in interior-exterior relationship with the large intestine&#34;, the warming acupuncture and moxibustion treatment used in this study aim to promote the recovery of gastrointestinal function and improve pulmonary function and quality of life. Warm acupuncture and moxibustion are highly effective, easy to perform, and inexpensive forms of traditional Chinese medicine treatments. In conclusion, it is necessary to propose a standard protocol on how to properly operate the use of warm acupuncture and moxibustion to relieve COPD with abdominal distension. This article describes how to properly manipulate the use of warm acupuncture and moxibustion treatment to relieve COPD with abdominal distension.

作者聚焦：慢性阻塞性肺疾病腹胀的有效中医治疗方法 

温针灸治疗慢性阻塞性肺疾病伴腹胀的初步研究

We propose a standardized manipulation of warm acupuncture and moxibustion for treating chronic obstructive pulmonary disease, or COPD, combined with abdominal distention. This method can help answer key questions in the field of COPD with abdominal distention. The manual advantages of warm acupuncture and moxibustion include the method's high effectiveness in operation, ease of performance, and affordability.These forms of traditional Chinese medicine treatments can benefit many patients. Our laboratory will be committed to studying the basic mechanism of warm acupuncture and moxibustion to alleviate COPD with abdominal distension. Our future work will focus on establishing more intelligent manipulations of warming acupuncture, and moxibustion.

一般条件 将12例COPD合并腹胀患者（表1）分为观察组和对照组，每组6例。所有患者均符合《慢性阻塞性肺疾病初级保健指南（2018）》29 的诊断标准，并有腹胀。对照组给予假针刺。我们选择与观察组相同的穴位，在这些穴位旁边 2.5 厘米处垂直插入皮肤，并在没有针刺和艾灸的情况下将它们表面刺穿 1-3 毫米。对照组患者根据《慢性阻塞性肺疾病初级?...

Watch this Scientific Journal Video about An Effective Traditional Chinese Medicinal Treatment for Chronic Obstructive Pulmonary Disease with Abdominal Distension at JoVE.com

在这里，我们提出了一种正确操作温针灸治疗腹胀慢性阻塞性肺病 （COPD） 的方案。

Most patients with COPD have a combination of abdominal distension, which has been shown to adversely affect pulmonary symptoms, frequency of acute ...

我们提出了一种温针灸的标准化操作，用于治疗慢性阻塞性肺疾病（COPD）合并腹胀。这种方法可以帮助回答腹胀性阻塞性肺病领域的关键问题。温针和艾灸的手动优点包括该方法操作效率高、性能易用、价格实惠。这些形式的中医治疗可以使许多患者受益。我们的实验室将致力于研究温针灸缓解腹胀性阻塞性肺病的基本机制。我们未来的工作将集中在建立更智能的温热针灸操作上。

a-preliminary-study-on-warm-acupuncture-moxibustion-for-treating

Research

JoVE Journal

Medicine

A Preliminary Study on Warm Acupuncture and Moxibustion for Treating Chronic Obstructive Pulmonary Disease with Abdominal Distension

1.0K 次观看.  Hospital of Chengdu University of Traditional Chinese Medicine. 我们提出了一种温针灸的标准化操作，用于治疗慢性阻塞性肺疾病（COPD）合并腹胀。这种方法可以帮助回答腹胀性阻塞性肺病领域的关键问题。温针和艾灸的手动优点包括该方法操作效率高、性能易用、价格实惠。这些形式的中医治疗可以使许多患者受益。我们的实验室将致力于研究温针灸缓解腹胀性阻塞性肺病的基本机制。我们未来的工作将集中在建立更智能的温热...

视频: 作者聚焦：慢性阻塞性肺疾病腹胀的有效中医治疗方法 

Most patients with COPD have a combination of abdominal distension, which has been shown to adversely affect pulmonary symptoms, frequency of acute exacerbations, and quality of life in patients with COPD. Warm acupuncture and moxibustion have been shown to be effective in relieving symptoms in patients with COPD combined with abdominal distention. Warm acupuncture and moxibustion are highly effective, easy to perform, and inexpensive forms of traditional Chinese medicine treatments. The standardized practice of warm acupuncture and moxibustion is very important for the treatment of COPD combined with abdominal distension. The specific steps include selecting the appropriate acupoints for needling through syndrome differentiation treatment and selecting moxa sticks of appropriate length for moxibustion for about 30 min after the De-qi. The course of treatment lasts for one week. The following indicators are specifically assessed: the score of the COPD Assessment Test (CAT) and the abdominal distension visual analog scale (VAS). This article will clearly illustrate how to standardize the manipulation of warm acupuncture and moxibustion to relieve COPD combined with abdominal distention.

Here, we present a protocol to properly manipulate warm acupuncture and moxibustion for treating chronic obstructive pulmonary disease (COPD) with abdominal distension.

科研

医学

Performing Warm Moxibustion on Chronic Obstructive Pulmonary Disease (COPD) Patients with Abdominal Distension

Begin by preparing the required equipment for the procedure, which includes disposable sterile acupuncture needles, moxa sticks, medical sterilization swabs, Iodophor swabs, a lighter and several cardboards. Before proceeding with the patient preparation, wear a medical mask and hat. Then wash hands thoroughly with disinfectant.Once the hands are dried, apply alcohol-based hand sanitizer. Next, measure the patient's blood pressure, heart rate, respiratory rate, and oxygen saturation. Inspect the skin of the desired areas for any signs of damage or infection.If the basic vitals are normal, guide the patient to assume a supine or prone position to expose the acupuncture points. Wipe the skin of the sites to be needled with Iodophor swabs. Following the traditional Chinese medicine theory, select the standardized acupuncture points, or RN-12, or LU-9, or ST-25, or ST-36, or EXP-1, and or BL-13.Stretch out flat the five fingers of the left hand, placing the index and middle fingers on both sides of the stabbing site. Grip the needle handle between the thumb and index finger of the right hand with the end of the middle finger near the needle tip and the finger belly against the needle body. Apply downward pressure with the thumb and index finger while flexing the middle finger to insert the needle.Once positioned, uniformly lift and thrust the needle handle along the acupuncture angle at an appropriate depth and frequency. Then rotate the needle handle forward and backward at an angle of 180 degrees or less until the patient feels Lit the moxa stick from the bottom and place the moxa stick about two to three centimeters from the skin on the acupuncture needle inserted in the acupoint, such that the patient feels a warm sensation and there is redness on the body's surface. Place a cardboard under the moxa stick to prevent the ash from burning the skin and continue treatment until the stick burns out.Using the end of a bamboo swab, gently pick up the burned out moxa stick. Afterward, remove the cardboard from the acupoint and with a medical sterilization swab, apply slight pressure to the needle site. Perform a small twist with the needle, slowly lift it to a subcutaneous level and leave it there briefly before withdrawing it.After removing the needle, using a medical sterilization swab, gently press the puncture site momentarily to avoid bleeding and reduce pain. Inspect all the puncture sites for any sign of bleeding and inquire about the patient's comfort level. Finally, count the needles to ensure all needles are removed from the puncture sites.CAT scores of the observation group, which received warm acupuncture, moxibustion, and basic treatment, and the control group, which received basic treatment with pseudo needling, showed that the scores of both groups after treatment were lower than those before treatment. Moreover, the scores of the observation group were lower than those of the control group. The abdominal distension visual analog score of both groups lowered after treatment as compared to those before treatment.The scores of the observation group were lower than those of the control group.