Auricular Acupressure as an Adjuvant Treatment for Wheezing in Stable Chronic Obstructive Pulmonary Disease
Summary
This protocol describes an effective therapy using auricular acupressure to relieve wheezing symptoms in stable chronic obstructive pulmonary disease.
Abstract
Chronic obstructive pulmonary disease (COPD) is a major public health problem. Due to the restriction of expiratory airflow, it is characterized by emphysematous destruction of the lungs. Shortness of breath is one of the main clinical symptoms. Auricular acupressure is a clinical therapy characteristic of Chinese medicine that treats the disease by compressing ear points. Usually, the seeds of Vaccaria segetalis are used to stimulate ear points, which has the effect of regulating qi and alleviating wheezing. In this paper, we propose this characteristic therapy of traditional Chinese medicine (TCM) for the clinical symptoms of wheezing of lung and kidney qi deficiency type in stable COPD patients. Ear points are selected as the treatment protocol for Lung (CO14), Spleen (CO13), Kidney (CO10), Shen Men (TF4), and Ping Chuan (AT1.2.4i) points. The protocol describes a case study using auricular acupressure for a patient with chronic obstructive pulmonary disease to relieve wheezing symptoms.
Introduction
Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable chronic respiratory disease. The disease is characterized by persistent respiratory symptoms and airflow limitation, usually associated with airway and/or alveolar abnormalities caused by significant exposure to harmful particles or gases1. In 2016, more than 3 million people died from COPD, accounting for 6% of all deaths worldwide2. Healthcare costs for COPD are an increasing burden on the world3. COPD is now a major public health problem with high rates of death, morbidity, disability, and disease burden4.
The main symptoms of COPD are chronic cough, sputum, dyspnea, wheezing, and chest tightness. Depending on the symptoms and lung function, it can be divided into an acute exacerbation phase and a stable phase5. Aggressive treatment during the stable phase can effectively reduce the number of acute exacerbations and delay the deterioration of lung function. Currently, treatment in the stable phase relies largely on pharmacological treatments such as bronchodilators, glucocorticoids, and expectorants. Non-pharmacological treatment modalities still have limitations6. The experiment here provides a special traditional Chinese medicine therapy, auricular acupressure, to expand the treatment modality.
For in-ear acupressure, small round granular objects are applied to the surface of the ear points. Moderate kneading, pressing, pinching, and squeezing are used to produce stimulation sensations such as soreness, numbness, swelling, and pain. As the main ingredient in auricular pressure, the seeds of Vaccaria segetalis can stimulate acupuncture points for the treatment of disease7. It is a non-drug external treatment method for the treatment of diseases8. The therapy is easy to use, inexpensive, safe, has no side effects, and is less prone to infection. It has certain advantages, like improving clinical symptoms, quality of life, and reducing acute exacerbations. It is suitable for adjuvant treatment of patients with stable COPD9.
As for the mechanism of auricular acupressure for wheezing, Chinese medicine believes that pressing certain acupuncture points on the auricle can communicate with qi, blood, meridians, and internal and external organs and harmonize the internal and external organs. In this way, acupuncture can play a role in regulating qi and relieving wheezing10. Modern medicine has shown that auricular acupressure stimulates blood vessels, nerves, and lymphatic vessels in the ear11. It regulates the immune system and suppresses the inflammatory response by activating the cholinergic anti-inflammatory signaling pathway, which in turn relieves bronchial inflammation and alleviates wheezing symptoms. The theory of holographic biology states that the auricle is allometric to the body's information. According to the correspondence, there could be a connection between auricular acupressure and wheezing symptoms12.
According to related studies, lung and kidney qi deficiency account for 23.20% of COPD in the stable stage13. The patients have frequent chronic coughs with wheezing, which means deficiency in the lungs; simultaneously, cold intolerance, weakness in the waist and knees, and self-perspiration show a deficiency in the kidney14. In this experiment, we implemented auricular acupressure for COPD patients with lung and kidney qi deficiency. In identifying wheezes of the lung and kidney qi deficiency, reference was made to the 2020 edition of the Committee on Auricular Acupuncture Diagnosis and Treatment of the Chinese Society of Acupuncture and Moxibustion8. The ear points formulated for this experiment were Lung (CO14), Spleen (CO13), Kidney (CO10), Shen Men (TF4), and Ping Chuan (AT1.2.4i).
The aim of this study is to provide a non-pharmacological treatment modality for stable COPD patients with wheezing and lung and kidney qi deficiency using auricular acupressure. Auricular acupressure was introduced after screening patients for a stable phase of COPD. The treatment protocol is clinically simple, safe, and cost-effective.
CASE PRESENTATION:
The patient is a 64-year-old male from Sichuan, China. He has been experiencing repeated cough and sputum for the past 5 years, along with worsening chest tightness over the last month. The patient has had diabetes for 5 years and has been taking metformin to manage his blood sugar levels, although he does not regularly monitor them. Additionally, he has a history of hypertension for 7 years and takes amlodipine besylate orally to control his blood pressure, which is also not regularly monitored. The patient denies any surgical history, trauma history, or blood transfusions. He smoked an average of 2 packs per day for 30 years but quit smoking 10 years ago. Furthermore, the patient denies any family genetic history.
Diagnosis, Assessment, and Plan:
After the doctor's specialized examination of the patient, he found a barrel chest and widened rib space. Chest CT showed chronic bronchitis, emphysema, and coronary artery calcification. Pulmonary function showed that the patient had moderate obstructive ventilation dysfunction, slightly obstructed airflow in the large airways, and increased total airway resistance. Combined with the patient's symptoms and signs, auxiliary examinations, and past medical history, a diagnosis of chronic obstructive pulmonary disease, hypertension, and diabetes mellitus was made. For treatment, Budesonide, Glycopyrronium Bromide, and Formoterol Fumarate Inhalation were performed twice daily in the morning and in the evening15. Additionally, hydroxypropyl theophylline intravenous drip (2 mL: 0.25 g, dilute 1 vial with 5% of 250 mL sugar water) was administered 1x day16. Auricular acupressure was given to relieve wheezing.
Protocol
Representative Results
Discussion
Modern medicine treats COPD patients mainly with long-acting β2 agonists (LABAs), long-acting muscarinic antagonists (LAMAs), and ICS23. Chinese medicine classifies COPD as wheezing based on the clinical characteristics of cough, sputum, shortness of breath, and dyspnea24. At the same time, Chinese medicine believes that the 12 meridians are connected to the ear. Auricular points are interconnected with meridians, tissues, and organs. It is closely related to the body&…
Disclosures
The authors have nothing to disclose.
Acknowledgements
We appreciate the financial support from the National TCM Clinical Excellent Talents Training Program (National TCM Renjiao Letter [2022] No. 1), 100 Talent Plan 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), 2022 Tianfu Qingcheng Plan Tianfu Science and Technology Leading Talents Project (Chuan Qingcheng No. 1090) and Sichuan science and technology program of Science & Technology Department of Sichuan Province (2022YF0392).
Materials
| Auricular acupressure patch template | Hengshui Runhuang Trading Co., Ltd | ||
| Cotton balls with 75% ethanol | Qingdao Hainuo Biological Engineering Co., Ltd | 20172640783 | |
| Medical blades | Suzhou Kaiyuan Medical Equipment Co., Ltd | 20192020831 | |
| Medical tape | Zhende Medical Supplies Co., Ltd | 20170090 | |
| Sterile forceps | Yangzhou Zhixiang Medical Technology Co., Ltd | 20210081 | |
| The seeds of Vaccaria segetalis | Anhui Kang Yunuo Biotechnology Co., Ltd | SC10334161107893 |
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