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 Figure 1).</li>
</ol>
2. Doctor preparation
<ol>
	<li>Ensure that patients meet the diagnostic criteria for COPD in the Primary Care Guidelines for Chronic Obstructive Pulmonary Disease and have abdominal distension.</li>
	<li>Exclude patients with the following conditions:(1) those with skin ulceration, poor glycemic control, poor blood pressure control, and dizziness; (2) those with silicosis, tuberculosis, malignant tumors, asthma, coagulation disorders, and severe cardiac insufficiency; (3) those with rheumatic heart disease, congenital heart disease, renal failure, liver failure, and so on; (4) those with poor compliance.</li>
	<li>Wear a medical mask and hat.</li>
	<li>Wash the hands with soapy water, leave them dry, and use alcohol hand sanitizer before holding the needle to operate.</li>
</ol>
3. Patient preparation
<ol>
	<li>Ask the patient to empty the bladder.</li>
	<li>Measure the patient&#39;s blood pressure, heart rate, respiratory rate, and oxygen saturation.</li>
	<li>Make sure the skin is not damaged and festering.</li>
	<li>After the above basic signs are normal, instruct the patient to choose the supine or prone position to expose the acupuncture points.</li>
	<li>Advise the patient to inform the physician in case of discomfort during the procedure.</li>
</ol>
4. Acupoints selection
<ol>
	<li>Wipe the skin of the sites to be needled with Iodophor swabs.</li>
	<li>According to the standardized acupuncture points, choose Feishu (BL13), Taiyuan (LU9), Dingchuan (EX-B1), Zusanli (ST36), Zhongwan (RN12), Tianshu (ST25)24,25,26 (see Figure 2).</li>
</ol>
5. Acupuncture and needling manipulation
<ol>
	<li>Stretch out flat the five fingers of the left hand, and place apart the index and middle fingers at the place of stabbing.</li>
	<li>Hold the needle handle by the thumb and index finger of the right hand, the end of the middle finger is close to the point, and the finger belly is against the needle body.</li>
	<li>Press downward the thumb and index finger while the middle finger is flexed and insert the needle into the international standardized acupuncture angles and depths.</li>
	<li>Uniformly lift and thrust the needle handle along the acupuncture angle, the depth is about 3 mm, and the frequency is about 60 times/min27.</li>
	<li>Rotate the needle handle forward and backward at an angle of 180 degrees or less; the frequency is about 60 times/min until the patient feels De-qi27.</li>
</ol>
6. Place moxa sticks
<ol>
	<li>Lit the moxa sticks from the bottom 2-3 cm from the skin28 so that the patient has a warm sensation and redness on the body surface. Treatment takes about 30 min.</li>
</ol>
7. Place cardboards
<ol>
	<li>Place the 60 mm x 60 mm cardboard under the moxa sticks to prevent the ash from burning the skin until the moxa sticks burn out (see Figure 3).</li>
</ol>
8. Picking the needles
<ol>
	<li>Gently pick up the burned-out moxa sticks with the end of the bamboo swab.</li>
	<li>Gently apply pressure to the needle sites with medical sterilization swabs in the hand.</li>
	<li>Do a small twist with the needles and slowly lift them to the subcutaneous, leave them for a moment, and then remove them.</li>
	<li>After the needles come out, use medical sterilization swabs to lightly press the needle holes for a moment to prevent bleeding and reduce pain.</li>
	<li>After the needles are withdrawn, carefully check whether the needle holes are bleeding, ask the patient whether there is any discomfort, and check whether the number of needles is missing.</li>
</ol>

Warm Acupuncture and Moxibustion to Relieve COPD with Abdominal Distension

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The authors have no conflicts of interest to declare.

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

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996 Views.  Hospital of Chengdu University of Traditional Chinese Medicine. 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 patie...

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

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.