Name: Acupoint Application as a Traditional Chinese Medicine Treatment for Fatigue Associated with Chronic Obstructive Pulmonary Disease (Video) | JoVE Journal
Uploaded: 2025-09-05T13:30:00.000+00:00
Duration: 4 min 24 s
Description: Learn acupoint application therapy to reduce fatigue in COPD patients using traditional Chinese medicine techniques. This non-invasive method improves walking distance and enhances patient compliance.

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5 minutes

This research was funded by the Sichuan Provincial Department of Science and Technology project (approval number: 2024YFFK0170) and the National TCM Clinical Excellent Talents Training Program (National TCM Renjiao Letter [2022] No. 1).

This research protocol was reviewed and approved by the Clinical Research Approval Committee of the Hospital of Chengdu University of Traditional Chinese Medicine (2024-09-30-02). Written informed consent was obtained from all subjects.
1. Research design
<ol>
	<li>Assign patients with COPD-related fatigue (n = 12) to a randomized controlled trial design. Predetermine sequential numbers for all 12 patients, generate random numbers using the random number table method, and divide the subjects into an experimental group (6 cases; receiving conventional treatment combined with AA) and a control group (6 cases; only receiving conventional treatment) for observation.</li>
	<li>Ask all patients to complete the 6MWT and fill out the MFI-20 and CAT 24 h before AA.
	<ol>
		<li>For 6MWT, ask patients to walk as quickly as possible in a straight corridor to determine the walking distance over 6 min, which is used to assess functional exercise capacity.</li>
		<li>Guide the research staff to systematically explain the questionnaire items and their purposes to the patients. Ask the patients to complete the MFI-20 questionnaire to assess changes in multidimensional fatigue and the CAT questionnaire to assess the disease-specific quality of life changes in COPD patients.</li>
	</ol>
	</li>
	<li>Ensure all enrolled patients receive identical routine treatment and care.
	<ol>
		<li>Hospital environment: Maintain clean wards with adequate ventilation, minimal noise, and appropriate bed spacing.</li>
		<li>Pharmacological intervention: Administer conventional Western medicine treatment, including antibiotics, bronchodilators, glucocorticoids, and mucoregulators.</li>
		<li>Respiratory function training: Instruct patients to perform diaphragmatic breathing, pursed-lip breathing24, or respiratory exercises25.</li>
		<li>Lifestyle intervention: Supervise smoking cessation, remind patients to avoid exposure to dust or chemical gases, and emphasize balanced nutrition with high-quality protein sources (e.g., milk, eggs) and fiber-rich vegetables and fruits.</li>
		<li>Health education: Teach self-management strategies and disease-related fundamentals, such as effective sputum expulsion techniques26. Address maladaptive cognitive and behavioral factors to enhance rehabilitation adherence, confidence, and anxiety reduction.</li>
	</ol>
	</li>
	<li>Administer routine treatment and care to the control group (for detailed procedures, please refer to Step 1.3) and provide the experimental group with AA treatment every 2 days in addition to routine treatment and care (see Step 4).</li>
	<li>Require all patients to repeat 6MWT and complete the MFI-20 and CAT questionnaires after 2 weeks of treatment.</li>
	<li>Screen raw data to exclude invalid results with missing values or outliers beyond acceptable ranges. Process experimental observations and questionnaire data using statistical software and present quantitative data as mean &#177; standard deviation. Confirm that all indicators conform to a normal distribution (see Supplementary Table 1). To check this, apply the independent samples t-test for comparisons between the two groups, apply the paired samples t-test for comparisons before and after treatment, and set the significance level to 0.05 as the criterion for indicating statistically significant differences. 
	NOTE: To ensure consistency in data collection, a uniformly trained research team is responsible for explaining the trial procedures, questionnaire items, and objectives to patients in detail throughout the study, strictly avoiding any leading suggestions.The reasonable range for the 6MWT is between 150 m and 450 m27. Ensure that the scores from the MFI-20 and CAT questionnaires fall within a reasonable range.</li>
</ol>
2. Eligibility criteria
<ol>
	<li>Inclusion criteria
	<ol>
		<li>Include patients meeting COPD diagnostic criteria based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD COPD Report 2024 Update)28.</li>
		<li>Include patients fulfilling diagnostic criteria for fatigue outlined in the Chinese Expert Consensus on Fatigue Diagnosis and Management29.</li>
		<li>Include conscious, mentally competent patients capable of understanding the study.</li>
	</ol>
	</li>
	<li>Exclusion criteria
	<ol>
		<li>Exclude patients with chronic debilitating illnesses, general weaknesses, emaciation, diabetes mellitus, severe cardiac, hepatic, or renal dysfunction, or other severe physical or mental comorbidities.</li>
		<li>Exclude patients declining acupoint application therapy. Exclude patients with allergies to medication or excipient components.</li>
		<li>Exclude pregnant women or young children. Exclude patients with skin lesions, eczema, or keloid predisposition.</li>
		<li>Exclude patients enrolled in concurrent clinical trials.</li>
	</ol>
	</li>
	<li>Withdrawal and exclusion criteria
	<ol>
		<li>Exclude patients developing severe complications, disease progression, or adverse reactions during the study.</li>
		<li>Exclude patients voluntarily withdrawing from the study.</li>
	</ol>
	</li>
</ol>
3. Preparations before procedure
<ol>
	<li>Material preparation
	<ol>
		<li>Prepare the following materials: Herbal medicines: Sinapis alba L, Pinellia ternata (Thunb.) Ten. ex Breitenb, Astragalus membranaceus (Fisch.) Bunge, Atractylodes macrocephala Koidz, Tetradium ruticarpum (A. Juss.) T. G. Hartley, disposable tongue depressors, treatment bowls, non-woven acupoint patches, breathable medical tape, tweezers, sterile cotton swabs, 75% alcohol cotton balls, fast-drying waterless hand sanitizer, disposable sterile medical rubber gloves, and disposable treatment sheets (See Figure 1 and Table of Materials for details).</li>
		<li>Measure 20 g each of Pinellia ternata (Thunb.) Ten. ex Breitenb, Astragalus membranaceus (Fisch.) Bunge, Atractylodes macrocephala Koidz, Tetradium ruticarpum (A. Juss.) T. G. Hartley, and 10 g of Sinapis alba L, totaling 90 g. Grind the herbs into fine powder using an ultra-micro pulverizer, and then sieve out impurities using a sieve with an aperture size of 80 mesh, which corresponds to 0.18 mm.</li>
		<li>Mix 30 g of herbal powder with 10 mL of ginger juice in a treatment bowl to form a paste before treatment.</li>
		<li>Use a tongue depressor to evenly spread the paste onto the center of a sterile non-woven patch (3 cm x 3 cm) to a thickness of 2 mm. Press the adhesive areas surrounding all sides of the patch firmly together to seal it, store under refrigeration at 4 &#176;C for later use, and observe that the validity period does not exceed 72 h.</li>
	</ol>
	</li>
	<li>Patient preparation
	<ol>
		<li>Inform the patient of the purpose, procedure, precautions, and potential sensations (e.g., warmth or mild tingling) post-application to prevent anxiety. Instruct the patient to avoid vigorous exercise and consumption of alcohol, coffee, or other stimulants 30 min prior to the procedure.</li>
	</ol>
	</li>
	<li>Practitioner preparation
	<ol>
		<li>Escort the patient to a clean, quiet treatment room and instruct them to assume a seated position. Adjust curtains to ensure privacy, strictly protect patient confidentiality, and implement warming measures to prevent hypothermia.</li>
		<li>Reconfirm the patient&#39;s name, age, gender, bed number, and hospitalization ID.</li>
		<li>Obtain and arrange items correctly, completely, concisely, and orderly as needed. Verify the validity periods of all items. Maintain strict separation between sterile and contaminated zones.</li>
		<li>Apply at least 3 mL of fast-drying, non-rinse skin disinfectant to the palm of the operator&#39;s hand and then proceed with the seven-step hand washing method30. Allow hands to air-dry for approximately 20 s without using paper towels. Finally, wear disposable sterile medical rubber gloves.</li>
		<li>Use tweezers to hold a 75% alcohol cotton ball. Disinfect the skin of the medial forearm region on one of the patient&#39;s hands twice. Maintain an approximate circular disinfection area with a radius of 3-4 cm.</li>
		<li>Retrieve a non-woven acupoint patch; completely remove the protective film covering the medicinal ointment surface to expose it. Apply the patch to the medial aspect of the patient&#39;s forearm31. Observe the patient for 30 min and inspect the skin at the application site for allergic reactions such as erythema, swelling, or pruritus.</li>
		<li>If there are no adverse reactions, carry out the next step. If an allergic reaction occurs, discontinue the trial immediately and implement prompt management.</li>
	</ol>
	</li>
</ol>
4. Treatment procedure
<ol>
	<li>Acupoint localization
	<ol>
		<li>Select the following acupoints for AA application: Dan zhong (CV 17) on the chest region, Guan yuan (CV 4) on the lower abdomen, Bilateral Fei shu (BL 13) and Pi shu (BL 20) on the back, Bilateral Zu san li (ST 36) on the lower limbs. Use the following localization methods, namely surface anatomical landmark measurement, bone-length proportional measurement, and finger-cun measurement26. See Figure 2 and Table 1 for details. 
		NOTE: Acupoint selection and localization adhere to the National Standard of the People&#39;s Republic of China: Nomenclature and Location of Meridian Points (GB/T 12346-2021)32.</li>
	</ol>
	</li>
	<li>Disinfection of the treatment area
	<ol>
		<li>Use tweezers to hold a 75% alcohol cotton ball. Disinfect the skin around each acupoint 2x, starting from the center of the acupoint and moving outward in a spiral motion, covering an area 3-4 cm from the acupoint. 
		NOTE: If the patient is allergic to alcohol, substitute povidone-iodine for disinfection.</li>
	</ol>
	</li>
	<li>Acupoint application procedure
	<ol>
		<li>Retrieve the prepared acupoint patch; carefully grasp one corner and completely remove the protective film covering the medicinal ointment surface to expose it.</li>
		<li>Stabilize the patient&#39;s skin to keep the periacupoint skin naturally tensioned and positionally stable, then precisely align the medicated area of the patch with CV 17, CV 4, BL 13, BL 20, and ST 36 acupoints. Ensure full skin contact at all target points, gently place the patch, and allow it to adhere to the patient&#39;s skin; refer to Figure 3 for detailed illustrations.
		<ol>
			<li>When applying the patch, start from the center of the patch and gently press outward with the fingertips in an even manner to smooth it down. Ensure that the entire patch, particularly the edges, adheres securely to the skin without any bubbles or wrinkles.</li>
		</ol>
		</li>
		<li>Instruct the patient to retain the applied patch for 4-6 h and administer the patch every 2 days. Ask the patient to remove the patch themselves after this period and clean the skin with warm water after removal.</li>
	</ol>
	</li>
</ol>
5. Post-treatment procedures
<ol>
	<li>Dispose of contaminated materials, organize the medication cart and instruments, wash hands, and document the AA therapy.</li>
	<li>Instruct the patient to refrain from strenuous exercise and sweating for 4 h after AA to prevent dislodgement. Prohibit the use of soap or alcohol for cleansing.</li>
	<li>Instruct the patient to abstain from consuming raw, cold, spicy, or seafood products during the treatment period.</li>
</ol>
6. Adverse incident management
<ol>
	<li>Instruct the patient to immediately remove the transdermal patch if mild skin irritation occurs, such as erythema accompanied by pruritus. If symptoms persist following removal, direct the patient to seek immediate assistance from the trial personnel.</li>
	<li>Instruct the patient to immediately discontinue treatment and notify trial personnel if symptoms such as nausea, vomiting, dizziness, or palpitations occur during the procedure.</li>
</ol>

The authors have nothing to disclose.

This study uses traditional Chinese medicine external treatment methods, acupoint application, to explore the operation and clinical efficacy in treating related fatigue symptoms in patients with COPD. In this study, AA, a traditional Chinese medicine treatment method, was used to investigate the operation and clinical efficacy of the treatment of fatigue symptoms associated with COPD patients. COPD-related fatigue is the result of low lung function and poor health35, which affects their quality o...

Chronic obstructive pulmonary disease (COPD) is a heterogeneous chronic respiratory disease characterized by persistent respiratory symptoms and airflow limitation due to airway and/or alveolar abnormalities1, which primarily results in symptoms such as dyspnea, cough2, sputum production, and fatigue1,3. COPD is a common respiratory disease associated with higher morbidity and mortality rates4, and it is prone to causing pulmonary hypertension, leading to clinical deterioration5,6. In 2021, COPD was one of the four leading causes of death globally4,7. The World Health Organization predicts that COPD will be the third leading cause of death worldwide by 20308.
Fatigue is the second most common symptom in COPD patients after dyspnea9, affecting nearly 75% of COPD patients10, and is defined as a subjective, unpleasant symptom that includes the entire physical sensation from tiredness to exhaustion, creating a relentless overall condition that interferes with an individual&#39;s ability to perform their normal abilities11. Current research results suggest that fatigue is a key factor in reducing patients&#39; quality of life, which can have a serious negative impact on physical, emotional, cognitive, and social functioning, leading not only to decreased social participation, deterioration of health status, and impairment of quality of life, but also to trigger significant psychological load, and then to weaken survival belief12. Notably, there is a significant clinical correlation between the severity of fatigue symptoms and the level of functional limitation and the risk of poor prognosis13. However, due to cognitive biases and the lack of symptom assessment systems, these core symptoms often do not receive adequate intervention priority in clinical management14. At present, pulmonary rehabilitation is the main non-drug treatment for COPD fatigue15, but the lack of patient compliance and participation16, limited long-term maintenance effect17, and the high economic and time costs have led to unsatisfactory results18, so exploration of safe and effective interventions for COPD-related fatigue has become an important problem to be solved urgently.
Acupoint application (AA) is one of the traditional treatment methods of traditional Chinese medicine19. Through the meridians and acupoints theory to locate specific acupoints, the Chinese herbal medicine is prepared into a paste, ointment, pills, or cakes, applied to the body surface at acupoints. Then, the dual effects of drug transdermal absorption and acupoint stimulation are used for dredging the meridians, harmonizing qi and blood, and strengthening the body20. It combines the pharmacology of traditional Chinese medicine with the effect of acupuncture point conduction, and is often used to regulate the respiratory system21, digestive system diseases22, and chronic diseases23, and is non-invasive, safe, and convenient to apply. This study refers to a randomized controlled trial design to systematically evaluate the intervention effect of AA therapy on patients with COPD-related fatigue and its potential clinical application value. The method is not suitable for critically ill patients. The study randomly divides subjects into an experimental group (receiving conventional treatment combined with AA) and a control group (only receiving conventional treatment). The quantification of physiological function, fatigue levels, and comprehensive disease status is assessed between the two groups and before and after treatment using three dimensions: the 6-Minute Walk Test (6MWT), the Multidimensional Fatigue Inventory (MFI-20), and the COPD Assessment Test (CAT). This study serves as a practical demonstration of a preliminary feasibility method. In order to standardize technical operations and facilitate clinical promotion, the protocol shows all the key steps, which will help to further promote this traditional Chinese medicine method through visual technology.

<table><tbody><tr><td>75% alcohol cotton balls</td><td>Qingdao Hainuo Bioengineering CoLtd</td><td></td><td></td></tr><tr><td>80 mesh sieve</td><td>Anping County Jiufeng Metal Wire Mesh Manufacturing Co., Ltd.</td><td>J2025070101</td><td></td></tr><tr><td>Acupoint application</td><td>Jiangsu Guangyi Medical Dressing CoLtd</td><td>20241005</td><td></td></tr><tr><td>Adhesive tape</td><td>Minnesota Mining Manufacturing Medical Devices (Shanghai) CoLtd</td><td>2406GA0</td><td></td></tr><tr><td>Astragalus membranaceus&amp;nbsp;(Fisch.) Bunge</td><td>&amp;nbsp;Sichuan Guoqiang Traditional Chinese Medicine Co., Ltd.</td><td>230401</td><td></td></tr><tr><td>Atractylodes macrocephala Koidz.</td><td>Kangmei Century Traditional Chinese Medicine Co., Ltd.</td><td>241100179</td><td></td></tr><tr><td>Cotton swab</td><td>Chengdu Zhongxin Sanitary Materials CoLtd</td><td>20250120</td><td></td></tr><tr><td>Disposable Medical Rubber Gloves&amp;nbsp;</td><td>Shanghai Colback Medical Latex Equipment CoLtd</td><td>240811HS</td><td></td></tr><tr><td>Pinellia ternata (Thunb.) Ten. ex Breitenb.</td><td>Chengdu Ji An Kang Pharmaceutical Co., Ltd.</td><td>240918-71</td><td></td></tr><tr><td>Quick-drying hand sanitizer&amp;nbsp;</td><td>Shandong Lierkang Medical Technology CoLtd</td><td>20241009B</td><td></td></tr><tr><td>Sinapis alba&amp;nbsp;L.</td><td>&amp;nbsp;Sichuan Guoqiang Traditional Chinese Medicine Co., Ltd.</td><td>221201</td><td></td></tr><tr><td>Tetradium ruticarpum (A. Juss.) T. G. Hartley</td><td>Sichuan Jinlin Pharmaceutical Co., Ltd.</td><td>241001</td><td></td></tr><tr><td>Therapeutic towel</td><td>Sichuan Hualikang Medical Technology CoLtd</td><td>25030702</td><td></td></tr><tr><td>Tongue depressor</td><td>&amp;nbsp;Yangzhou Xiaokang Medical Equipment CoLtd</td><td>20240708</td><td></td></tr><tr><td>Treatment bowl</td><td>Yuekang Hardware and Medical Equipment FactoryCaitang TownChao&#039;an DistrictChaozhou City</td><td></td><td></td></tr><tr><td>Tweezers&amp;nbsp;</td><td>Shandong Weigao Group Medical Polymer Products CoLtd</td><td>20250201</td><td></td></tr><tr><td>Ultra-micro pulverizer</td><td>Ruian City Kangyuan Pharmaceutical Machinery Co., Ltd.</td><td></td><td></td></tr></tbody></table>

acupoint application as a traditional chinese medicine treatment for fatigue associated with chronic obstructive pulmonary disease

Acupoint Application as a Traditional Chinese Medicine Treatment for Fatigue Associated with Chronic Obstructive Pulmonary Disease

Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and progressive airflow obstruction. Research has found that the prevalence of COPD is high and continues to rise globally and regionally. COPD has now become a major cause of death and disability worldwide. Fatigue is a subjective discomfort of the body and weakness that is closely related to physical and mental state and is a common symptom in patients with COPD. Fatigue can lead to limitations in daily functioning and decreased health-related quality of life, which in turn can severely affect the prognosis of COPD. At present, pulmonary rehabilitation is the main non-drug treatment for COPD fatigue, but patient compliance and participation are insufficient, the long-term maintenance effect is limited, and economic and time costs are high, so it is important to seek safer and more effective treatments. Acupoint application (AA), as one of the classic external treatment methods in traditional Chinese medicine, is characterized by its minimal side effects, ease of operation and dissemination, multi-target synergistic effects, and low economic costs. Preliminary findings show their role in improving the clinical symptoms of fatigue in COPD.This study will provide a detailed presentation of the process of using AA therapy to treat COPD and the observed trends, aiming to offer a reference for non-pharmacological treatment approaches.

In this study, a total of 12 patients who met the criteria participated in and completed the trial, including the experimental group (6) and the control group (6), none of whom were discharged or excluded during the process. The 6MWT before and after treatment, as well as the MFI-20 and CAT, were measured in the same way for patients in the experimental and control groups. The 6MWT requires patients to walk as quickly as possible in a straight corridor for 6 min to assess their functional exercise capacity<sup class="xre...

This protocol describes the specific process and efficacy of acupoint application in treating fatigue symptoms associated with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) is characterized by persistent respiratory symptoms and progressive airflow obstruction. Research has found ...

This study provides a detailed presentation of the process of using acupoint application therapy to treat COPD and observe the trends, aiming to offer a reference for nonpharmacological treatment approaches. My protocol is to attempt to alleviate the fatigue symptom of COPD patients, a common but often overlooked symptom through traditional Chinese medicine external treatment methods. Acupoint application therapy is non-invasive and directly acts acupoints through skin absorption.It offers several advantages, including ease of operation and better patient compliance. To begin, escort the patient to a clean and quiet treatment room and instruct them to assume a seated position. Adjust the curtains to ensure privacy, strictly protect the patient's confidentiality and implement warming measures to prevent hypothermia.Reconfirm the patient's name, age, gender, bed number, and hospitalization identification number. Collect and arrange all necessary items in an organized and complete manner. Verify the validity period of each item and maintain strict separation between sterile and contaminated zones.Next, apply at least 3 milliliters of fast drying non-rinse skin disinfectant to the palm of the operator's hand. Proceed with the seven step hand washing method. Then wear disposable sterile medical rubber gloves.Now select the acupoints for acupoint application. Use surface anatomical landmark measurement, bone length proportional measurement, and finger-cun measurement to localize each point. Using tweezers, hold a 75%alcohol cotton ball and disinfect the skin around each acupoint two times.Move outward in a spiral motion from the center of each acupoint, covering an area of 3-4 centimeters. Retrieve the prepared acupoint patch. Carefully grasp one corner and remove the protective film covering the medicinal ointment surface to expose it.Stabilize the patient's skin to keep the area tense and stable. Then precisely align the medicated area of the patch with the CV 17, CV 4, BL 13, BL 20, and ST 36 acupoints. Gently place the patch and allow it to adhere fully to the skin, ensuring complete contact at all target sites.Start from the center of the patch and press outward with fingertips to smooth it down evenly. Ensure the edges adhere securely without any bubbles or wrinkles. The average six-minute walking distance increased significantly in both the treatment group and the control group after treatment, with a greater increase observed in the treatment group.The mean multi-dimensional fatigue inventory score decreased significantly in both the treatment group and the control group after treatment, with the treatment group showing a greater reduction. The chronic obstructive pulmonary disease assessment test score decreased significantly after treatment in both the treatment group and the control group, with the treatment group exhibiting a greater improvement.

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Learn acupoint application therapy to reduce fatigue in COPD patients using traditional Chinese medicine techniques. This non-invasive method improves walking distance and enhances patient compliance.

Acupoint Application as a Traditional Chinese Medicine Treatment for Fatigue Associated with Chronic Obstructive Pulmonary Disease (Video) | JoVE Journal

Acupoint Application as a Traditional Chinese Medicine Treatment for Fatigue Associated with Chronic Obstructive Pulmonary Disease

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