Acupoint Application Combined with Acupoint Massage for Treating Constipation in a Patient with Chronic Obstructive Pulmonary Disease

Summary

Here we demonstrate acupoint application combined with acupoint massage for treating constipation in a patient with chronic obstructive pulmonary disease (COPD).

Abstract

Chronic obstructive pulmonary disease (COPD) is a common and frequent disease in elderly patients, with a tendency for progressive exacerbation. Constipation that reduces the quality of life and triggers the risk of diseases is a common concomitant symptom in patients with COPD. Currently, western medical treatment does not achieve the desired results for patients. A high recurrence rate accompanies it, whereas traditional Chinese medicine (TCM) has a long history and rich experience in treating chronic diseases. Both acupoint application and acupoint massage are characteristic therapies of TCM, with minor side effects, high safety, simple operation, and outstanding advantages. They are effective in treating constipation for patients with COPD and are considered an ideal alternative therapy for patients with chronic constipation. The purpose of this article is to introduce the method of acupoint application combined with acupoint massage for the treatment of constipation in patients with COPD, including the selection of points, items, treatment time, and operation procedure.

Introduction

Chronic respiratory diseases are the third leading cause of death in the world, and COPD is the leading cause of death from chronic respiratory diseases, placing a heavy burden on both individuals and society¹. China has the largest number of patients with COPD in the world: about 99 million, with a prevalence rate of 8.6%². Constipation is a common complication in COPD patients and is associated with high levels of polypharmacy³. There is evidence that more than 39% of COPD patients experience constipation, and constipation was positively correlated with the severity of dyspnea, timing of exacerbations, and complications of COPD⁴. It is highly suspected that constipation is associated with acute exacerbations of chronic obstructive pulmonary disease (AECOPD). AECOPD accelerates the disease progression in COPD patients and is the leading cause of death in COPD patients⁵. Therefore, it is time to pay attention to the treatment of constipation in patients with COPD.

The majority of patients manage their constipation by themselves, mainly using dietary adjustments and laxatives. Studies have shown that osmotic laxatives are often the drug of choice for people with constipation⁶. However, the use of medications is sometimes not effective in improving constipation symptoms. It is associated with adverse reactions or poor tolerance. Up to 50% of patients with constipation are not fully satisfied with the results of their current treatments^7,8. Therefore, it is necessary to find alternative therapies with good efficacy and high security. In the treatment of chronic constipation, acupoint stimulation therapy is beginning to show some advantages⁹. With the guidance of the concept of holism, syndrome differentiation, and treatment, as well as meridian acupoint theory in TCM, both acupoint application and acupoint massage are used to treat diseases by stimulating specific acupuncture points on the body surface^10,11. Acupoint application can make the drug directly absorbed by the local skin. It achieves the effect of channeling meridians and harmonizing qi and blood by stimulating the acupuncture points, thereby improving the symptoms of constipation¹⁰. Acupoint massage stimulates the sacral nerve, regulating defecation by increasing the interstitial cell number and controlling rhythmic contractions or peristalsis through activating bowel movements¹². Numerous pharmacological and clinical studies have confirmed the clear efficacy of herbs such as Rheum officinale Baill in the treatment of constipation^13,14. A demonstration of acupoint application combined with acupoint massage for treating constipation in a patient with chronic obstructive pulmonary disease is presented in this article.

Protocol

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. KY2022014).

1. Preparations before operation

1. Items preparation:
   1. Prepare items such as Rheum officinale Baill, normal saline, Iodine volts swab, medical tape, medical gauze, medical bending plate, hand disinfectant, and medical rubber glove (Table of Materials).
   2. Use an ultra-micro pulverizer to make 100 g of Rheum officinale Baill into powder in advance and seal it in a plastic bag for later use.
   3. Before treatment, please take 15 g of Rheum officinale Baill powder and use 15 mL of normal saline to make a paste of medicinal powder. Place the paste on a curved plate.
2. Patient preparation:
   1. Advise the patient to empty the bladder in advance. Let the patient lie on his/her back, bend the knees, relax, and fully expose the abdomen.
3. Operator preparation:
   1. Close doors and windows, pay attention to protect the patient's privacy and prevent the patient from catching a cold.
   2. Select Shenque point (RN8) and bilateral Tianshu points (ST25) on the patient's abdomen¹⁰, and evaluate the local skin of the patient's points to ensure that the skin around the selected points is free of lesions or damage while keeping the local points clean and dry (Figure 1 and Figure 2).
      ​NOTE: The Shenque acupoint (RN8) is in the umbilical region, central umbilical cord. The Tianshu point (ST25) is located in the abdomen, 2 finger-cun each around the navel (finger-cun means the proportional unit of the thumb, 2 finger-cun equals ~6.67 cm)¹⁵.

2. Operating steps

1. Disinfect the hands, then press the Shenque point (RN8) and bilateral Tianshu points (ST25) of the patient's abdomen with the thumb fingertip. Press each acupuncture point 50 times, and make sure to rotate the thumb in a clockwise direction while pressing (Figure 3).
   1. Change the intensity of pressing the acupoints from weak to strong. Press at ~1 s/time and at a frequency of 30-60 times/min until the patient feels a slight feeling of soreness. If the patient does not tolerate it during the procedure, stop the operation immediately.
2. Rub the palms of both hands until they are warm, then massage the patient's abdomen 50 times clockwise with the palms (Figure 4). Gradually massage from the navel to the outer circle and then from the outer circle back to the navel.
   NOTE: The scope of the circle is centered on the navel, with 2 finger-cun as the radius, i.e., the radius is equal to ~6.67 cm.
   1. Ensure the massage action is gentle and the force is not too heavy. Ensure the frequency of massage is from slow to fast, stable and moderate, about 30-50 times/min. It is best to feel slightly warm in the abdomen. If the patient develops intolerance during the procedure, stop the operation immediately.
3. Wear medical rubber gloves and use iodine volts swabs to disinfect the patient's local acupoints. Take about 3/4 of the prepared medicine from the medical bent plate, roughly divide it into 3 equal parts, make them into a shape similar to a ring (diameter x thickness of about 3 cm x 0.5 cm) and apply them to medical gauze separately.
4. Fix the medical gauze containing the medicine to the Shenque point (RN8) and Tianshu points (ST25) in the patient's abdomen with medical tape, respectively. Remove it 6 h later.
5. Require the patient to wear clean and breathable clothes after the acupoint application operation.
   1. Ask the patient to avoid strenuous exercise to prevent the drug from falling off and flowing. Promptly remove the drug residues from the patient's local skin and assist the patient in getting dressed.
   2. Inform the patient not to scratch if the local skin is itching, burning, or painful, and remove the drug in time. Keep the local skin clean with normal saline.

Results

Patients with COPD are diagnosed and treated according to "The Global Initiative for Chronic Obstructive Lung Disease", published in 2023¹⁶. The diagnostic criteria for constipation referred to the "Clinical Practice Guideline on the Evaluation and Management of Chronic Constipation for Chinese Adults" issued by the Chinese Society of Colorectal Surgery, Chinese Society of Surgery, Chinese Medical Association in 2022¹⁷. Efficacy was assessed based on the Patient Assessment ...

Discussion

The elderly population is at high risk of COPD. Older people experience varying degrees of gastrointestinal decline, while hypoxia and reduced activities in COPD patients increase the risk of constipation. In addition, COPD patients are prone to negative psychological emotions such as nervousness, anxiety, depression, depression, and restlessness, which can cause increased pelvic floor muscle tone, resulting in paradoxical movements between rectal and canals during defecation and inhibition of intestinal peristalsis

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Chinese herbal decoction piece rhubarb	Sichuan Guoqiang Chinese Medicine Decoction Pieces Co., Ltd	21120104
Gauze swab	Shandong Angyang Medical Technology Co., Ltd	2022060201
Hand disinfectant	Gamma Disinfection Products (Foshan) Co., Ltd. Sichuan Branch	CNSQV3180322A
Iodine volts swab	Zhejiang Baigar Health Technology Co., Ltd	20220301
Medical adhesive tape	Minnesota Mining Manufacturing Medical Equipment (Shanghai) Co., Ltd	2105NF8
Medical bending plate	Shanghai Medical Instrument (Group) Co., Ltd. Surgical Instrument Factory	181001
Medical rubber glove	Shanghai Kebang Medical Latex Equipment Co., Ltd	2112019S
Normal saline	Sichuan Kelun Pharmaceutical Co., Ltd	N22061906