Este trabalho foi apoiado pelo 2022 "Tianfu Qingcheng Plan" Tianfu Science and Technology Leading Talents Project (Chuan Qingcheng No. 1090), o National TCM Clinical Excellent Talents Training Program (National TCM Renjiao Letter [2022] No. 1), "100 Talent Plan" Project do Hospital da Universidade de Medicina Tradicional Chinesa de Chengdu (Escritório do hospital [2021] 42), Tema especial de pesquisa científica da Administração de Sichuan de Medicina Tradicional Chinesa (2021MS093, 2021MS539, 2023MS608).

O protocolo do estudo clínico foi revisado e aprovado pelo Comitê de Aprovação de Pesquisa Clínica do Departamento de Medicina Respiratória do Hospital da Universidade de Medicina Tradicional Chinesa de Chengdu (Registro nº. KY 2022010).
1. Preparação do equipamento
<ol><li>Prepare agulhas de acupuntura estéreis descartáveis (tamanho 0,25 mm x 40 mm), bastões de moxa (tamanho 1,2 cm x 1,2 cm), swabs de esterilização médica, cotonetes iodóforos, isqueiros e vários cartões de 60 mm x 60 mm (ver Figura 1).</li>
</ol>2. Preparo do médico
<ol><li>Garantir que os pacientes preencham os critérios diagnósticos para DPOC nas Diretrizes de Atenção Primária para Doença Pulmonar Obstrutiva Crônica e tenham distensão abdominal.</li>
	<li>Excluir pacientes com as seguintes condições:(1) aqueles com ulceração cutânea, mau controle glicêmico, mau controle da pressão arterial e tontura; (2) portadores de silicose, tuberculose, tumores malignos, asma, distúrbios de coagulação e insuficiência cardíaca grave; (3) portadores de cardiopatia reumática, cardiopatia congênita, insuficiência renal, insuficiência hepática, entre outros; (4) aqueles com baixa adesão.</li>
	<li>Use máscara médica e chapéu.</li>
	<li>Lave as mãos com água e sabão, deixe-as secas e use álcool desinfetante para as mãos antes de segurar a agulha para operar.</li>
</ol>3. Preparo do paciente
<ol><li>Peça ao paciente para esvaziar a bexiga.</li>
	<li>Medir a pressão arterial, frequência cardíaca, frequência respiratória e saturação de oxigênio do paciente.</li>
	<li>Certifique-se de que a pele não está danificada e festering.</li>
	<li>Depois que os sinais básicos acima estiverem normais, instrua o paciente a escolher a posição supina ou prona para expor os pontos de acupuntura.</li>
	<li>Aconselhar o paciente a informar o médico em caso de desconforto durante o procedimento.</li>
</ol>4. Seleção de acupontos
<ol><li>Limpe a pele dos locais a serem agulhados com cotonetes Iodophor.</li>
	<li>De acordo com os pontos de acupuntura padronizados, escolha Feishu (BL13), Taiyuan (LU9), Dingchuan (EX-B1), Zusanli (ST36), Zhongwan (RN12), Tianshu (ST25)24,25,26 (ver Figura 2).</li>
</ol>5. Acupuntura e manipulação de agulhamentos
<ol><li>Estique os cinco dedos da mão esquerda e afaste os dedos indicador e médio no local da facada.</li>
	<li>Segure a alça da agulha pelo polegar e indicador da mão direita, a extremidade do dedo médio está perto do ponto e a barriga do dedo está contra o corpo da agulha.</li>
	<li>Pressione o polegar e o indicador para baixo enquanto o dedo médio é flexionado e insira a agulha nos ângulos e profundidades de acupuntura padronizados internacionalmente.</li>
	<li>Levante e empurre uniformemente a alça da agulha ao longo do ângulo de acupuntura, a profundidade é de cerca de 3 mm e a frequência é de cerca de 60 vezes/min27.</li>
	<li>Girar a alça da agulha para frente e para trás em um ângulo de 180 graus ou menos; a frequência é de cerca de 60 vezes/min até que o paciente sinta De-qi27.</li>
</ol>6. Coloque palitos de moxa
<ol><li>Acender a moxa gruda do fundo2-3 cm da pele 28 para que o paciente tenha uma sensação de calor e vermelhidão na superfície corporal. O tratamento leva cerca de 30 min.</li>
</ol>7. Coloque papelões
<ol><li>Coloque o cartão de 60 mm x 60 mm sob os palitos de moxa para evitar que as cinzas queimem a pele até que os palitos de moxa queimem (ver Figura 3).</li>
</ol>8. Pegar as agulhas
<ol><li>Pegue suavemente os palitos de moxa queimados com a extremidade do cotonete de bambu.</li>
	<li>Aplique suavemente pressão nos locais da agulha com cotonetes de esterilização médica na mão.</li>
	<li>Faça uma pequena torção com as agulhas e leve-as lentamente até o subcutâneo, deixe-as por um momento e depois remova-as.</li>
	<li>Depois que as agulhas saírem, use cotonetes de esterilização médica para pressionar levemente os orifícios da agulha por um momento para evitar sangramento e reduzir a dor.</li>
	<li>Depois que as agulhas forem retiradas, verifique cuidadosamente se os orifícios da agulha estão sangrando, pergunte ao paciente se há algum desconforto e verifique se o número de agulhas está faltando.</li>
</ol>

Acupuntura quente e moxabustão para aliviar a DPOC com distensão abdominal

<ol>
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Os autores declaram não haver conflitos de interesse.

Sabe-se que a patogênese da distensão abdominal causada pela DPOC não é totalmente compreendida, o que dificulta o desenvolvimento de novas terapias e fármacos. Nos últimos anos, a acupuntura quente e a moxabustão têm sido amplamente aplicadas na DPOC combinada com distensão abdominal. O mecanismo terapêutico da acupuntura quente e da moxabustão é principalmente o efeito da acupuntura, o efeito de aquecimento da moxabustão e o efeito condutor de calor do corpo da agulha31. A moxabust?...

A doença pulmonar obstrutiva crônica (DPOC) é uma doença crônica consumptiva comum do sistema respiratório. Os pacientes com DPOC manifestam-se principalmente em tosse crônica e escarro, com desenvolvimento progressivo da doença e declínio gradual da função pulmonar. A doença pode ser complicada por doença cardíaca pulmonar crônica, insuficiência respiratória e insuficiência cardíaca nos estágios mais avançados da doença, o que afeta seriamente a qualidade de vida dos pacientes. É relatado que alterações na microbiota intestinal estão associadas à progressão da doença na DPOC1. Além dos sintomas pulmonares, 40,31% dos pacientes com DPOC estável relataram distensão abdominal. A distensão abdominal pode ter um impacto significativo na piora dos sintomas pulmonares, aumentando a frequência de exacerbações agudas da DPOC e prejudicando a qualidade de vida de pacientes com DPOC estável 2,3. As causas de distensão abdominal na DPOC são consideradas multifatoriais que podem incluir: (1) disbiose bacteriana; (2) ascite, que aumenta a pressão intra-abdominal; (3) distúrbios eletrolíticos; (4) insuficiência cardíaca direita e congestão do fígado ou trato digestivo; (5) repouso prolongado no leito4; (6) medicamentos5 e ventilação mecânica6.
Alguns estudiosos da medicina chinesa propuseram que o processo de desenvolvimento da DPOC é o processo de quatro estados:(1) deficiência de qi pulmonar; (2) deficiência de qi do baço; (3) deficiência de qi renal; (4) Deficiência de Yin e Yang 7,8. Se o baço não consegue transportar e se transformar e o estômago está fraco e incapaz de receber, pode ocorrer distensão abdominal, que por sua vez pode levar ao afinamento muscular e fraqueza devido à falta de fontes químicas9. Atualmente, os fármacos comumente utilizados no tratamento clínico da DPOC incluem broncodilatadores, glicocorticoides, antibióticos e outras drogas10. Não há diretrizes que especifiquem protocolos padronizados de tratamento da DPOC associada à distensão abdominal, que muitas vezes é tratada sintomaticamente.
A acupuntura quente e a moxabustão na medicina tradicional chinesa podem guiar o Qi para dragar os meridianos, revigorar a circulação sanguínea, remover a estase sanguínea, repor a deficiência para aquecer o yang e dissipar o frio. Podem produzir substâncias antioxidantes e, assim, desempenhar um papel regulador, o que pode promover a resposta do sistema imune ao estresse e melhorar a circulação sanguínea11,12. A acupuntura quente e a moxabustão podem ser usadas para tratar espondilose cervical 13, artrite de joelho 14, dismenorreia15, constipação16, síndrome do intestino irritável 17 e assim por diante. Estudos experimentais demonstraram que a acupuntura pode aliviar a distensão abdominal regulando o eixo cérebro-intestino18. A acupuntura associada à moxabustão reduz significativamente a distensão abdominal19, que pode ser exercida através da regulação dos níveis plasmáticos de prostaglandina E2 e gastrina nos tecidos plasmáticos e da mucosa gástrica20. Enquanto isso, a acupuntura quente e a moxabustão são superiores à acupuntura procinética e sham em termos de melhora dos sintomas da dispepsia funcional21. A acupuntura pode fortalecer o diafragma e aliviar a fadiga muscular respiratória, além de melhorar a retenção de dióxido de carbono e a hipóxia, além de prevenir e aliviar a insuficiência respiratória22. A acupuntura aquecida e a moxabustão melhoram a função pulmonar, os sintomas clínicos e a qualidade de vida em pacientes com DPOC estável23,24.
De acordo com a teoria da medicina chinesa de que "O pulmão está em relação interior-exterior com o intestino grosso", o tratamento de acupuntura e moxabustão de aquecimento utilizado neste estudo visa promover a recuperação da função gastrointestinal e melhorar a função pulmonar e a qualidade de vida. A acupuntura quente e a moxabustão são formas altamente eficazes, fáceis de executar e baratas de tratamentos da medicina tradicional chinesa. Em conclusão, é necessário propor um protocolo padrão sobre como operar adequadamente o uso de acupuntura aquecida e moxabustão para aliviar a DPOC com distensão abdominal. Este artigo descreve como manipular adequadamente o uso de acupuntura aquecida e tratamento com moxabustão para aliviar a DPOC com distensão abdominal.

<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

A maioria dos pacientes com DPOC tem uma combinação de distensão abdominal, que demonstrou afetar adversamente os sintomas pulmonares, a frequência de exacerbações agudas e a qualidade de vida em pacientes com DPOC. A acupuntura quente e a moxabustão demonstraram ser eficazes no alívio dos sintomas em pacientes com DPOC combinada com distensão abdominal. A acupuntura quente e a moxabustão são formas altamente eficazes, fáceis de executar e baratas de tratamentos da medicina tradicional chinesa. A prática padronizada de acupuntura quente e moxabustão é muito importante para o tratamento da DPOC combinada com a distensão abdominal. As etapas específicas incluem a seleção dos acupontos apropriados para agulhamento através do tratamento de diferenciação da síndrome e a seleção de bastões de moxa de comprimento apropriado para moxabustão por cerca de 30 minutos após o De-qi. O curso do tratamento dura uma semana. São avaliados especificamente os seguintes indicadores: o escore do COPD Assessment Test (CAT) e a escala analógica visual (EAV) de distensão abdominal. Este artigo ilustrará claramente como padronizar a manipulação da acupuntura quente e da moxabustão para alívio da DPOC combinada com distensão abdominal.

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.

Autor em destaque: Um tratamento medicinal tradicional chinês eficaz para doença pulmonar obstrutiva crônica com distensão abdominal 

Estudo Preliminar da Acupuntura Quente e Moxabustão no Tratamento da Doença Pulmonar Obstrutiva Crônica com Distensão Abdominal

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.

Condições gerais Um total de 12 pacientes (Tabela 1) com DPOC associada à distensão abdominal foi dividido em grupos observação e controle, com 6 casos em cada grupo, respectivamente. Todos preencheram os critérios diagnósticos do ''Primary Care Guidelines for Chronic Obstructive Pulmonary Disease (2018)''29 e apresentavam distensão abdominal. O grupo controle recebeu pseudoagulhamento. Escolhemos os mesmos acupontos do grupo de observação e inserimo...

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

Apresentamos um protocolo para manipulação adequada da acupuntura a quente e da moxabustão no tratamento da doença pulmonar obstrutiva crônica (DPOC) com distensão abdominal.

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

Propomos uma manipulação padronizada de acupuntura quente e moxabustão para o tratamento da doença pulmonar obstrutiva crônica, ou DPOC, combinada com distensão abdominal. Esse método pode ajudar a responder questões-chave no campo da DPOC com distensão abdominal. As vantagens manuais da acupuntura quente e da moxabustão incluem a alta eficácia do método na operação, a facilidade de desempenho e a acessibilidade.Estas formas de tratamentos da medicina tradicional chinesa podem beneficiar muitos pacientes. Nosso laboratório estará empenhado em estudar o mecanismo básico da acupuntura quente e da moxabustão para aliviar a DPOC com distensão abdominal. Nosso trabalho futuro se concentrará no estabelecimento de manipulações mais inteligentes de aquecimento, acupuntura e moxabustão.

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Research

JoVE Journal

Medicine

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

1.0K visualizações.  Hospital of Chengdu University of Traditional Chinese Medicine. Propomos uma manipulação padronizada de acupuntura quente e moxabustão para o tratamento da doença pulmonar obstrutiva crônica, ou DPOC, combinada com distensão abdominal. Esse método pode ajudar a responder questões-chave no campo da DPOC com distensão abdominal. As vantagens manuais da acupuntura quente e da moxabustão incluem a alta eficácia do método na operação, a facilidade de desempenho e a acessibilidade.Estas formas de tratamentos da medicina tradicional chinesa ...

Vídeo: Autor em destaque: Um tratamento medicinal tradicional chinês eficaz para doença pulmonar obstrutiva crônica com distensão abdominal 

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.

Medicina

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.