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 (2021MS539, 2023MS608). Sichuan Science and Technology Program (2023ZYD0050, 24NSFJQ0077), Science and Technology Development Fund Project of Hospital of Chengdu University of Traditional Chinese Medicine (22HL11).

The study protocol was reviewed and approved by the Clinical Research Approval Committee of the Hospital of Chengdu University of Traditional Chinese Medicine (KY2022027). Written informed consent was obtained from all subjects.
1. Preparation of materials
NOTE: See Figure 1 and the Table of Materials for details about materials used in this protocol.
<ol>
	<li>Use a utility knife to cut out five pieces of ginger, each piece ~0.4-0.6 cm-thick and 2-3 cm in diameter. Prick out five small holes in each piece with a cotton swab24.</li>
	<li>Take the moxa sticks apart, remove an appropriate amount of moxa, and knead them into a mass in the palm. Make a moxa cone with a bottom diameter of ~0.3 cm and a height of ~0.3 cm.</li>
</ol>
2. Preparation of the doctor
<ol>
	<li>Prepare a separate treatment room to avoid exposing the patient&#39;s privacy and keep the patient warm.</li>
	<li>Select cases according to the inclusion and exclusion criteria formulated in advance (see Table 1).</li>
	<li>Wear a clean white coat, medical surgical mask, and disposable operating cap.</li>
	<li>Disinfect hands before operation.</li>
</ol>
3. Subject preparation
<ol>
	<li>Ask the patient to empty their bladder, lie on the back, expose the abdomen, and relax.</li>
</ol>
4. Operation
<ol>
	<li>Locate the Shenque Acupoint (CV 8) according to the national standard: Nomenclature and location of meridian points25. Disinfect the skin for ~5 cm around the acupoint. 
	NOTE: The Shenque acupoint is in the upper abdomen, in the center of the umbilicus, located at the intersection of the anterior superior iliac spine level and the midline of the abdomen26 (see Figure 2).</li>
	<li>Cut a hole in the center of the treatment towel and lay it over the Shenque Acupoint to prevent the rest of the abdomen from getting cold and prevent burning of the skin by the burning moxa.</li>
	<li>Place the moxa cone on a piece of ginger and light it. With tweezers, transfer the ginger piece with tweezers from the operating table to the patient&#39;s Shenque Acupoint (Figure 3A,B).</li>
	<li>Place a new moxa cone on top of another piece of ginger and light it after 3 min. 
	NOTE: A moxa cone takes ~3-5 min to burn.</li>
	<li>Remove the ginger and moxa cone from the patient&#39;s Shenque Acupoint. When the cone burns out, replace it with a new one. Put the burnt-out moxa cone into water to extinguish it (Figure 3C).</li>
	<li>Repeat steps 4.4 and 4.5 4x. Then, finish the treatment. 
	NOTE: The entire treatment lasts for 5 days and must be performed once a day.</li>
</ol>

Assessing the Efficacy of Ginger Moxibustion in Diarrhea Management in COPD

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	<li>Venkatesan, P. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=GOLD+COPD+report:+2024+update.">GOLD COPD report: 2024 update.</a> Lancet Respir Med. 12 (1), 15-16 (2024).</li><li>Agusti, A., 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=Global+initiative+for+chronic+obstructive+lung+disease+2023+report:+Gold+executive+summary.">Global initiative for chronic obstructive lung disease 2023 report: Gold executive summary.</a> Eur Respir J. 61 (4), 2300239 (2023).</li><li>Quanying, H., Cuiling, F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Expert+consensus+on+integrated+chinese+and+western+medicine+management+of+chronic+obstructive+pulmonary+disease+(2023+edition).">Expert consensus on integrated chinese and western medicine management of chronic obstructive pulmonary disease (2023 edition).</a> Journal of Chinese General Practice. 26 (35), 4359-4371 (2023).</li><li>Wang, C., 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=Prevalence+and+risk+factors+of+chronic+obstructive+pulmonary+disease+in+china+(the+china+pulmonary+health+[cph]+study):+A+national+cross-sectional+study.">Prevalence and risk factors of chronic obstructive pulmonary disease in china (the china pulmonary health [cph] study): A national cross-sectional study.</a> Lancet. 391 (10131), 1706-1717 (2018).</li><li>Arasaradnam, R. P., 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=Guidelines+for+the+investigation+of+chronic+diarrhoea+in+adults:+British+society+of+gastroenterology,+3rd+edition.">Guidelines for the investigation of chronic diarrhoea in adults: British society of gastroenterology, 3rd edition.</a> Gut. 67 (8), 1380-1399 (2018).</li><li>Schiller, L. R., Pardi, D. S., Sellin, J. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chronic+diarrhea:+Diagnosis+and+management.">Chronic diarrhea: Diagnosis and management.</a> Clin Gastroenterol Hepatol. 15 (2), 182-193.e3 (2017).</li><li>H&#246;genauer, C., Hammer, H. F., Krejs, G. J., Reisinger, E. 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The authors have no conflicts of interest to declare.

The causes of diarrhea in COPD patients are various, including gastrointestinal infection, irritable bowel, antibiotic abuse, food factors (cold diet, lactose intolerance, excessive fat intake), drugs (laxatives such as magnesium sulfate and lactulose, dehydrating agents such as mannitol and sorbitol)6, Chinese medicinal herbs-natural herbs-are used worldwide and have significant effects on human glucose and lipid metabolism, intestinal inflammation, and oxidative stress30....

Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, sputum production, or exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction1,2. COPD has become a severe chronic disease with high morbidity, high mortality, high disability rate, and heavy disease burden. The &#34;China Lung Health Study&#34; shows that the incidence of COPD in people over 40 years old in China is 13.7%3. The total number of COPD patients in China is ~100 million. Acute exacerbations occur 0.5-3.5 times in patients with COPD each year and are the main cause of death in COPD patients. In 2013, the total number of deaths from COPD in China was 910,000, ranking third for a single disease, accounting for 31.1% of the total number of deaths from COPD in the world4.
Diarrhea refers to an increased frequency of bowel movements, thin stool, mucus, pus, blood, undigested food, urgent bowel movements, or even fecal incontinence. Precisely, diarrhea consists of more than three bowel movements per day, with the fecal water content greater than 85%5,6. Diarrhea is a common extrapulmonary complication in COPD patients and is usually accompanied by loss of appetite, bloating, fatigue, anxiety, and other discomfort. Studies have shown that the incidence of diarrhea in COPD patients during antibiotic treatment is ~5%-25%7. Diarrhea leads to water and electrolyte disturbances in patients and aggravates the risk of malnutrition in patients. It not only reduces the quality of life of patients with COPD but also impedes the recovery of respiratory function and affects the prognosis of COPD8,9,10. The management of diarrhea mainly includes antidiarrheic, oral or intravenous rehydration, probiotics, antibiotics (where there is evidence of infection)11,12,13,14, zinc treatment15, and diet therapy16,17. However, antidiarrheal drug treatment can only temporarily control the symptoms of diarrhea, which cannot be cured entirely. Other methods have a longer course of treatment, which increases the burden on patients. Therefore, an easily implemented non-pharmacological therapy is necessary for treating diarrhea in COPD patients.
Ginger moxibustion involves cutting fresh ginger (Zingiber officinale) into thin slices, lighting moxa sticks on the ginger slices, and then placing moxibustion at specific acupuncture points. Moxa is a traditional Chinese herbal medicine, which can warm channels to dispel coldness Moxibustion can eliminate many uncomfortable symptoms through the warming meridian. It is effective in treating knee joint disease, irritable bowel syndrome, chronic atrophic gastritis, post chemotherapy nausea, and vomiting18,19,20,21. Ginger slices have the effect of dispelling cold22,23. In clinical practice, most COPD patients have diarrhea symptoms. Acute exacerbation of DOPD is usually triggered by infection; antibiotics can control the infection but tend to worsen diarrhea symptoms. Dietary adjustment, antidiarrheal drugs, and intestinal flora supplementation have some benefits for diarrhea, but they are not enough. Ginger moxibustion is an ancient traditional Chinese medicine technique, which has the functions of warming the body and dispelling cold, reconciling qi and blood, fueling health, and enhancing spleen and stomach function. It has been observed to have an outstanding effect on diarrhea in clinical settings. It is simple and easy to perform, has no apparent side effects, and is easy for patients to accept.
Here, we present a randomized controlled trial using ginger moxibustion as a non-pharmacological therapy to treat COPD patients with diarrhea, comparing it to conventional therapy to confirm the effectiveness and superiority of ginger moxibustion therapy. Detailed descriptions of the procedure and video demonstrations will help further promote this traditional Chinese medicine therapy.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>box cutter</td>
			<td>Deli Group Co., LTD</td>
			<td>/</td>
			<td></td>
		</tr>
		<tr>
			<td>disposable medical treatment towel</td>
			<td>Sichuan Hualikang Medical Technology Co., LTD</td>
			<td>2024010902</td>
			<td></td>
		</tr>
		<tr>
			<td>dry cotton swabs</td>
			<td>Chengdu Zhongxin sanitary materials, LLC.</td>
			<td>20240102</td>
			<td></td>
		</tr>
		<tr>
			<td>fresh ginger</td>
			<td>Qingyang community comprehensive market</td>
			<td>/</td>
			<td></td>
		</tr>
		<tr>
			<td>iodophor cotton swabs</td>
			<td>Zhejiang Beijiaer hygiene Technology Co., LTD</td>
			<td>20231201</td>
			<td></td>
		</tr>
		<tr>
			<td>lighter</td>
			<td>Xiayi Shuntong Lighter manufacturing Co., LTD</td>
			<td>25625</td>
			<td></td>
		</tr>
		<tr>
			<td>medical bending disc</td>
			<td>HYNAUT</td>
			<td>100062487683</td>
			<td></td>
		</tr>
		<tr>
			<td>moxa sticks</td>
			<td>Nanyang Fuaitang wormwood biological products Co., LTD</td>
			<td>15941917095</td>
			<td></td>
		</tr>
		<tr>
			<td>tweezers</td>
			<td>HYSTIC</td>
			<td>100013619175</td>
			<td></td>
		</tr>
	</tbody>
</table>

ginger moxibustion, a non-pharmacological treatment, for diarrhea in patients with chronic obstructive pulmonary disease

Chronic Obstructive Pulmonary Disease (COPD) is a common and frequently occurring disease in the elderly population, and it tends to progressively worsen. Diarrhea is a common extrapulmonary complication in patients with COPD. Diarrhea can cause dehydration, electrolyte imbalances, weakness, and a loss of appetite, among other adverse consequences, which seriously affect the quality of life and nutritional status of patients. These consequences are not conducive to improving airway obstruction in COPD patients. At present, modern medicine has poor curative effects, fails to control symptoms fully, causes a relapse after drug withdrawal, has side effects, and increases the medication burden of patients. Ginger moxibustion is a unique non-pharmacological therapy of traditional Chinese medicine, which is safe and effective in controlling diarrhea, has few side effects, and is easy to accept. It is, therefore, an ideal alternative therapy. This article aims to introduce the protocol of ginger moxibustion for treating diarrhea in COPD patients.

Author Spotlight: Exploring Non-Pharmacological Therapies for Chronic Respiratory Diseases &#8212; Linking Intestinal Microbiome Insights to COPD Treatment

Ginger Moxibustion, A Non-pharmacological Treatment, for Diarrhea in Patients with Chronic Obstructive Pulmonary Disease

Basic conditions 
A total of 18 patients with COPD complicated with diarrhea were divided into a treatment group (9 cases) and a control group (9 cases) (see Table 2). All patients met the diagnostic criteria1, accompanied by symptoms of diarrhea, and were type 5 or above according to the Bristol stool chart5. The treatment group received ginger moxibustion treatment and conventional symptomatic treatment (including inhalation preparat...

Here, we present the method of using ginger moxibustion to treat diarrhea in patients with chronic obstructive pulmonary disease.

Chronic Obstructive Pulmonary Disease (COPD) is a common and frequently occurring disease in the elderly population, and it tends to progressively worsen. ...

ginger-moxibustion-non-pharmacological-treatment-for-diarrhea

Research

JoVE Journal

Medicine

Ginger Moxibustion for Treating Diarrhea in COPD Patients

338 Views.  Hospital of Chengdu University of Traditional Chinese Medicine.  Here, we present the method of using ginger moxibustion to treat diarrhea in patients with chronic obstructive pulmonary disease.

Assessing the Efficacy of Ginger Moxibustion in Diarrhea Management in COPD

Summary