This work was supported by the 2022 &#34;Tianfu Qingcheng Plan&#34; Tianfu Science and Technology Leading Talents Project (Chuan Qingcheng No. 1090), the National TCM Clinical Excellent Talents Training Program (National TCM Renjiao Letter [2022] No. 1), &#34;100 Talent Plan&#34; Project of Hospital of Chengdu University of Traditional Chinese Medicine (Hospital office [2021] 42), Special subject of scientific research of Sichuan Administration of Traditional Chinese Medicine (2021MS093, 2021MS539, 2023MS608).

The clinical study protocol was reviewed and approved by the Clinical Research Approval Committee of the Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine (Record No. KY 2022010).
1. Equipment preparation
<ol>
	<li>Prepare disposable sterile acupuncture needles (size 0.25 mm x 40 mm), moxa sticks (size 1.2 cm x 1.2 cm), medical sterilization swabs, iodophor swabs, lighter, and several 60 mm x 60 mm cardboards (see <strong clas...

Warm Acupuncture and Moxibustion to Relieve COPD with Abdominal Distension

<ol>
	<li>Li, N., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Gut+microbiota+dysbiosis+contributes+to+the+development+of+chronic+obstructive+pulmonary+disease.">Gut microbiota dysbiosis contributes to the development of chronic obstructive pulmonary disease.</a> Respiratory Research. 22, 274 (2021).</li><li>Kirschner, S. 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W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Diagnostic+criteria+for+Chinese+medical+evidence+of+chronic+obstructive+pulmonary+disease+(2011+version).">Diagnostic criteria for Chinese medical evidence of chronic obstructive pulmonary disease (2011 version).</a> Journal of Chinese Medicine. 53 (02), 177-178 (2012).</li><li>Feng, Z., Xie, Y., Chun, L., He, W., Li, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+study+of+the+underlying+evidential+features+in+the+literature+of+stable+chronic+obstructive+pulmonary+disease+based+on+association+rules+combined+with+hidden+structure+models.">A study of the underlying evidential features in the literature of stable chronic obstructive pulmonary disease based on association rules combined with hidden structure models.</a> World Science and Technology - Modernization of Chinese Medicine. 23 (02), 552-559 (2021).</li><li>He, W., Li, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+efficacy+of+Shizi+heat+ironing+therapy+to+improve+gastrointestinal+function+in+patients+with+chronic+obstructive+pulmonary+disease.">The efficacy of Shizi heat ironing therapy to improve gastrointestinal function in patients with chronic obstructive pulmonary disease.</a> New Chinese Medicine. 44 (02), 31-32 (2012).</li><li>Commission Emergency Medical Quality Control C, Emergency Medical Branch Of Chinese Medical A, Chinese Medical Doctor Association Emergency Medical B, World Federation Of Chinese Medicine Societies Emergency Professional C, Pulmonary Disease Academy Of China Association Of Chinese M, Chinese Society For Integrated Chinese And Western Medicine Intensive Medicine Specialized C. 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H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effect+of+electroacupuncture+at+different+acupoints+on+the+expression+of+NMDA+receptors+in+ACC+and+colon+in+IBS+rats.">Effect of electroacupuncture at different acupoints on the expression of NMDA receptors in ACC and colon in IBS rats.</a> Evidence-Based Complementary and Alternative Medicine: eCAM. 2019, 4213928 (2019).</li><li>Anastasi, J. K., McMahon, D. J., Kim, G. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Symptom+management+for+irritable+bowel+syndrome:+A+pilot+randomized+controlled+trial+of+acupuncture/moxibustion.">Symptom management for irritable bowel syndrome: A pilot randomized controlled trial of acupuncture/moxibustion.</a> Gastroenterology Nursing. 32 (4), 243-255 (2009).</li><li>Wu, X., Guo, Y., Zheng, J., Liu, Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Protective+effect+of+warm-through+acupuncture+on+stress+gastric+mucosal+injury.">Protective effect of warm-through acupuncture on stress gastric mucosal injury.</a> Shanghai Acupuncture and Moxibustion Journal. 4, 40-41 (2001).</li><li>Zhang, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Efficacy+comparison+of+different+acupuncture+treatments+for+functional+dyspepsia:+A+systematic+review+with+network+meta-analysis.">Efficacy comparison of different acupuncture treatments for functional dyspepsia: A systematic review with network meta-analysis.</a> Evidence-Based Complementary and Alternative Medicine: eCAM. 2020, 3872919 (2020).</li><li>Liu, Q., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Rehabilitation+effects+of+acupuncture+on+the+diaphragm+dysfunction+in+chronic+obstructive+pulmonary+disease:+A+systematic+review.">Rehabilitation effects of acupuncture on the diaphragm dysfunction in chronic obstructive pulmonary disease: A systematic review.</a> International Journal of Chronic Obstructive Pulmonary Disease. 16, 2023-2037 (2021).</li><li>Xie, F., Wu, Y. P., Liu, L., Ren, J. G., Zhang, B. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Warm+acupuncture+on+chronic+obstructive+pulmonary+disease+with+phlegm-turbid+obstructing+of+the+lung:+a+randomized+controlled+trial.">Warm acupuncture on chronic obstructive pulmonary disease with phlegm-turbid obstructing of the lung: a randomized controlled trial.</a> Zhongguo Zhen Jiu. 39 (9), 918-922 (2019).</li><li>Gao, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+comparative+study+of+the+effects+of+warm+acupuncture+on+lung+function+and+quality+of+life+in+patients+with+stable+COPD.">A comparative study of the effects of warm acupuncture on lung function and quality of life in patients with stable COPD.</a> Chinese Acupuncture. 31 (10), 893-897 (2011).</li><li>Shi, Z., Ni, T., Wang, X. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+study+on+moxibustion+combined+with+salmeterol+xinafoate+and+fluticasone+propionate+powder+for+inhalation+for+COPD+in+stable+stage.">Clinical study on moxibustion combined with salmeterol xinafoate and fluticasone propionate powder for inhalation for COPD in stable stage.</a> Chinese Medicine. 53 (14), 150-153 (2021).</li><li>Yang, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+efficacy+of+warm+acupuncture+in+55+cases+of+functional+dyspepsia.">Clinical efficacy of warm acupuncture in 55 cases of functional dyspepsia.</a> Modern Wellness. 282 (18), 170 (2016).</li><li>Yuan, Y., Hai, Y., Gu, X., Wang, Z., Peng, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Preliminary+study+on+the+standardization+of+acupuncture+techniques.">Preliminary study on the standardization of acupuncture techniques.</a> Journal of Traditional Chinese Medicine. 2, 230-231 (2002).</li><li>Zhou, H. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+moxa-stick+ignition+locations+on+temperature+of+needle+body+and+surrounding+environment+during+warm+needling.">Effects of moxa-stick ignition locations on temperature of needle body and surrounding environment during warm needling.</a> Zhongguo Zhen Jiu. 34 (7), 675-677 (2014).</li><li>Chinese Medical Association. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Primary+care+guidelines+for+chronic+obstructive+pulmonary+disease+(2018).">Primary care guidelines for chronic obstructive pulmonary disease (2018).</a> Chinese Journal of General Practitioners. 11, 856-870 (2018).</li><li>Geyer, M., Guller, U., Beglinger, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Carbon+dioxide+insufflation+in+routine+colonoscopy+is+safe+and+more+comfortable:+results+of+a+randomized+controlled+double-blinded+trial.">Carbon dioxide insufflation in routine colonoscopy is safe and more comfortable: results of a randomized controlled double-blinded trial.</a> Diagnostic and Therapeutic Endoscopy. 2011, 378906 (2011).</li><li>Chen, L., Jin, X., Li, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Analysis+of+the+current+situation+and+problems+in+the+development+of+warm+acupuncture+operation+technology.">Analysis of the current situation and problems in the development of warm acupuncture operation technology.</a> Chinese Journal of Traditional Chinese Medicine. 33 (09), 3768-3771 (2018).</li><li>Huang, K., Liang, S., Sun, Z., Zhang, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Startup+mechanism+of+moxibustion+warming+and+dredging+function.">Startup mechanism of moxibustion warming and dredging function.</a> Zhongguo Zhen Jiu. 37 (9), 1023-1026 (2017).</li><li>Gao, X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Experimental+study+on+the+effect+of+acupuncture+on+gastric+mucosal+barrier+function.">Experimental study on the effect of acupuncture on gastric mucosal barrier function.</a> China Chinese Medicine Technology. 5, 277-278 (2001).</li><li>Liang, F., Wang, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Science+of+Acupuncture+and+Moxibustion.">Science of Acupuncture and Moxibustion.</a> China Press of Traditional Chinese Medicine. 133, (2016).</li><li>Liang, F., Wang, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Science+of+Acupuncture+and+Moxibustion.">Science of Acupuncture and Moxibustion.</a> China Press of Traditional Chinese Medicine. , 136-137 (2016).</li><li>Zheng, W., Zhang, J., Shang, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ancient+Chinese+medicine+practitioners'+understanding+of+the+contraindications+of+acupuncture.">Ancient Chinese medicine practitioners' understanding of the contraindications of acupuncture.</a> Chinese Journal of Traditional Chinese Medicine. 26 (09), 1928-1930 (2011).</li><li>Shi, X. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acupuncture+and+Moxibustion.">Acupuncture and Moxibustion.</a> Chinese Traditional Clinical Medicine Series. , (2004).</li><li>National Standard of the People's Republic of China. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acupuncture+technical+practice+part+1:+Moxibustion.">Acupuncture technical practice part 1: Moxibustion.</a> Chinese Acupuncture. 30 (06), 501-504 (2010).</li><li>Zhang, M., Gao, X. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+clinical+application+of+warm+acupuncture+and+penetration+moxibustion+by+professor+GAO+Xiyan.">The clinical application of warm acupuncture and penetration moxibustion by professor GAO Xiyan.</a> Zhongguo Zhen Jiu. 38 (12), 1325-1328 (2018).</li></ol>

It is well known that the pathogenesis of abdominal distension caused by COPD is not fully understood, which hinders the development of new therapies and drugs. In recent years, warm acupuncture and moxibustion have been widely applied to COPD combined with abdominal distention.The therapeutic mechanism of warm acupuncture and moxibustion is mainly the effect of acupuncture, the moxibustion warming effect, and the heat-conducting effect of the needle body31. Moxibustion focuses on the local warmin...

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.

<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

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.

Author Spotlight: An Effective Traditional Chinese Medicinal Treatment for Chronic Obstructive Pulmonary Disease with Abdominal Distension 

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

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.

General conditions 
A total of 12 patients (Table 1) with COPD combined with abdominal distension were divided into observation and control groups, with 6 cases in each group, respectively. All met the diagnostic criteria of the &#39;&#39;Primary Care Guidelines for Chronic Obstructive Pulmonary Disease (2018)&#39;&#39;29 and had abdominal distension. The control group was given pseudo-needling. We chose the same acupoints as the observation group and inserte...

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

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

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

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JoVE Journal

Medicine

946 vistas.  Hospital of Chengdu University of Traditional Chinese Medicine. Proponemos una manipulación estandarizada de la acupuntura caliente y la moxibustión para el tratamiento de la enfermedad pulmonar obstructiva crónica, o EPOC, combinada con distensión abdominal. Este método puede ayudar a responder preguntas clave en el campo de la EPOC con distensión abdominal. Las ventajas manuales de la acupuntura tibia y la moxibustión incluyen la alta efectividad del método en la operación, la facilidad de ejecución y la asequibilidad.Estas formas de tr...