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 (2021MS539, 2023MS608). Sichuan Science and Technology Program (2023ZYD0050, 24NSFJQ0077), Science and Technology Development Fund Project of Hospital of Chengdu University of Traditional Chinese Medicine (22HL11).

The study protocol was reviewed and approved by the Clinical Research Approval Committee of the Hospital of Chengdu University of Traditional Chinese Medicine (KY2022027). Written informed consent was obtained from all subjects.
1. Preparation of materials
NOTE: See Figure 1 and the Table of Materials for details about materials used in this protocol.
<ol>
	<li>Use a utility knife to cut out five pieces of ginger, each piece ~0.4-0.6 cm-thick and 2-3 cm in diameter. Prick out five small holes in each piece with a cotton swab24.</li>
	<li>Take the moxa sticks apart, remove an appropriate amount of moxa, and knead them into a mass in the palm. Make a moxa cone with a bottom diameter of ~0.3 cm and a height of ~0.3 cm.</li>
</ol>
2. Preparation of the doctor
<ol>
	<li>Prepare a separate treatment room to avoid exposing the patient&#39;s privacy and keep the patient warm.</li>
	<li>Select cases according to the inclusion and exclusion criteria formulated in advance (see Table 1).</li>
	<li>Wear a clean white coat, medical surgical mask, and disposable operating cap.</li>
	<li>Disinfect hands before operation.</li>
</ol>
3. Subject preparation
<ol>
	<li>Ask the patient to empty their bladder, lie on the back, expose the abdomen, and relax.</li>
</ol>
4. Operation
<ol>
	<li>Locate the Shenque Acupoint (CV 8) according to the national standard: Nomenclature and location of meridian points25. Disinfect the skin for ~5 cm around the acupoint. 
	NOTE: The Shenque acupoint is in the upper abdomen, in the center of the umbilicus, located at the intersection of the anterior superior iliac spine level and the midline of the abdomen26 (see Figure 2).</li>
	<li>Cut a hole in the center of the treatment towel and lay it over the Shenque Acupoint to prevent the rest of the abdomen from getting cold and prevent burning of the skin by the burning moxa.</li>
	<li>Place the moxa cone on a piece of ginger and light it. With tweezers, transfer the ginger piece with tweezers from the operating table to the patient&#39;s Shenque Acupoint (Figure 3A,B).</li>
	<li>Place a new moxa cone on top of another piece of ginger and light it after 3 min. 
	NOTE: A moxa cone takes ~3-5 min to burn.</li>
	<li>Remove the ginger and moxa cone from the patient&#39;s Shenque Acupoint. When the cone burns out, replace it with a new one. Put the burnt-out moxa cone into water to extinguish it (Figure 3C).</li>
	<li>Repeat steps 4.4 and 4.5 4x. Then, finish the treatment. 
	NOTE: The entire treatment lasts for 5 days and must be performed once a day.</li>
</ol>

Assessing the Efficacy of Ginger Moxibustion in Diarrhea Management in COPD

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<li>Wang, C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Clinical+observation+of+ginger+moxibustion+combined+with+external+application+of+chinese+medicine+and+tdp+magic+lamp+irradiation+in+the+treatment+of+knee+arthralgia+with+cold+and+damp+arthralgia%5BTitle%5D)+AND+%22China%27s+Naturopathy%22%5BJournal%5D)">Clinical observation of ginger moxibustion combined with external application of chinese medicine and tdp magic lamp irradiation in the treatment of knee arthralgia with cold and damp arthralgia.</a> China's Naturopathy. 32 (11), 49-52 (2024).</li>
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</ol>

The authors have no conflicts of interest to declare.

The causes of diarrhea in COPD patients are various, including gastrointestinal infection, irritable bowel, antibiotic abuse, food factors (cold diet, lactose intolerance, excessive fat intake), drugs (laxatives such as magnesium sulfate and lactulose, dehydrating agents such as mannitol and sorbitol)6, Chinese medicinal herbs-natural herbs-are used worldwide and have significant effects on human glucose and lipid metabolism, intestinal inflammation, and oxidative stress30. Continuous diarrhea often causes dehydration, electrolyte disturbance, fatigue, loss of appetite, and other problems in patients, which delays the recovery of patients with COPD and hinders the selection of treatment drugs for the patients.
Ginger moxibustion is a unique non-pharmacological traditional Chinese medicine therapy. In recent years, ginger moxibustion has achieved good clinical effects in treating diarrhea. The theory of meridians and collaterals states that the Shenque acupoint is an essential acupoint on the Ren channel. The Shenque acupoint is connected to the 12 meridians and the 12 visceral organs and the whole body29,31; it regulates the intestine, preventing diarrhea, strengthening the spleen and stomach, and regulating Yin and Yang. According to modern medicine, the navel has thin skin, high sensitivity, strong permeability, and fast absorption as it contains a large number of microvessels. Drug molecules are more accessible to pass through the corneum of the umbilical skin, enter the interstitial cell, quickly disperse into the blood, and play a role in the whole body. Moxibustion has the functions of warming meridians and collaterals, warming the middle, strengthening the spleen, and preventing diarrhea. Ginger is of immense value in treating various digestive diseases like gastric ulcerations, gastritis, dyspepsia, nausea, indigestion, belching, bloating, epigastric discomfort, and vomiting32. Ginger moxibustion on Shenque Acupoint strengthens the spleen, soothing the liver, warming kidneys, and stopping diarrhea. When we introduced it to treating diarrhea in COPD patients, we found that it also had excellent efficacy. Our experimental results show that the combined use of ginger moxibustion in the treatment of COPD accompanied by diarrhea has a better effect than conventional therapy.
Some possible accidents and countermeasures 
First, if patients feel burning when the moxa pillar is not fully burned, replace the patient&#39;s navel with a thicker piece of ginger. Second, if the moxa wick has burned out but the patient has no unmistakable warm feeling, replace it with thinner ginger slices or prick more holes in the ginger slices. Be careful that the patient is not sensitive to temperature perception. Third, if blisters appear on the patient&#39;s navel after the treatment, ask the patient to avoid touching the navel and destroying the blisters. If the blisters are too large, use disposable acupuncture needles to puncture the blisters and release the exudate without damaging the blister membrane. During the treatment, if the patient feels the need to defecate or pass gas, pause the treatment and proceed after the bowel movement; calm the patient&#39;s stress. For patients with empty stomachs, excessive stomachs, extreme fatigue, and fear of moxibustion, moxibustion should be used carefully to prevent the burning moxa from falling off, burning the skin and clothes.
Limitations 
Frequent operation: The operator needs to light the moxa cone during the treatment process, pay attention to the patient&#39;s feelings, observe the patient&#39;s skin, and replace the moxa cone, all of which will be carried out in a very short time. Insufficient sample size: This experiment mainly confirmed that the standard operation of ginger moxibustion had a significant effect on relieving diarrhea symptoms in patients with COPD lung disease, but the sample size is small. Limited effect: This operation can only control the diarrhea symptoms associated with COPD. It is necessary to identify the cause and actively control the primary disease. Given these situations, we put forward some improvement measures to facilitate the follow-up work.
Improvement measures 
There should be two medical personnel present during the operation; one is the operator, and each operation step should be skillfully mastered before the operation to avoid accidents during the operation. The other is an observer, responsible for recording the problems and accidents that may occur in operation, paying attention to the reaction of patients, and dealing with emergencies promptly. Since the sample size of this trial is small, we will continue to carry out this operation in the future to obtain more trial data to ensure the universality of this therapy.
As an effective non-pharmacological therapy, ginger moxibustion can effectively improve diarrhea. Our trial shows that ginger moxibustion can also help treat diarrhea in COPD patients. We hope our conclusions can help more researchers focus on this field and jointly alleviate the life troubles of COPD patients.

Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, sputum production, or exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction1,2. COPD has become a severe chronic disease with high morbidity, high mortality, high disability rate, and heavy disease burden. The &#34;China Lung Health Study&#34; shows that the incidence of COPD in people over 40 years old in China is 13.7%3. The total number of COPD patients in China is ~100 million. Acute exacerbations occur 0.5-3.5 times in patients with COPD each year and are the main cause of death in COPD patients. In 2013, the total number of deaths from COPD in China was 910,000, ranking third for a single disease, accounting for 31.1% of the total number of deaths from COPD in the world4.
Diarrhea refers to an increased frequency of bowel movements, thin stool, mucus, pus, blood, undigested food, urgent bowel movements, or even fecal incontinence. Precisely, diarrhea consists of more than three bowel movements per day, with the fecal water content greater than 85%5,6. Diarrhea is a common extrapulmonary complication in COPD patients and is usually accompanied by loss of appetite, bloating, fatigue, anxiety, and other discomfort. Studies have shown that the incidence of diarrhea in COPD patients during antibiotic treatment is ~5%-25%7. Diarrhea leads to water and electrolyte disturbances in patients and aggravates the risk of malnutrition in patients. It not only reduces the quality of life of patients with COPD but also impedes the recovery of respiratory function and affects the prognosis of COPD8,9,10. The management of diarrhea mainly includes antidiarrheic, oral or intravenous rehydration, probiotics, antibiotics (where there is evidence of infection)11,12,13,14, zinc treatment15, and diet therapy16,17. However, antidiarrheal drug treatment can only temporarily control the symptoms of diarrhea, which cannot be cured entirely. Other methods have a longer course of treatment, which increases the burden on patients. Therefore, an easily implemented non-pharmacological therapy is necessary for treating diarrhea in COPD patients.
Ginger moxibustion involves cutting fresh ginger (Zingiber officinale) into thin slices, lighting moxa sticks on the ginger slices, and then placing moxibustion at specific acupuncture points. Moxa is a traditional Chinese herbal medicine, which can warm channels to dispel coldness Moxibustion can eliminate many uncomfortable symptoms through the warming meridian. It is effective in treating knee joint disease, irritable bowel syndrome, chronic atrophic gastritis, post chemotherapy nausea, and vomiting18,19,20,21. Ginger slices have the effect of dispelling cold22,23. In clinical practice, most COPD patients have diarrhea symptoms. Acute exacerbation of DOPD is usually triggered by infection; antibiotics can control the infection but tend to worsen diarrhea symptoms. Dietary adjustment, antidiarrheal drugs, and intestinal flora supplementation have some benefits for diarrhea, but they are not enough. Ginger moxibustion is an ancient traditional Chinese medicine technique, which has the functions of warming the body and dispelling cold, reconciling qi and blood, fueling health, and enhancing spleen and stomach function. It has been observed to have an outstanding effect on diarrhea in clinical settings. It is simple and easy to perform, has no apparent side effects, and is easy for patients to accept.
Here, we present a randomized controlled trial using ginger moxibustion as a non-pharmacological therapy to treat COPD patients with diarrhea, comparing it to conventional therapy to confirm the effectiveness and superiority of ginger moxibustion therapy. Detailed descriptions of the procedure and video demonstrations will help further promote this traditional Chinese medicine therapy.

<table><tbody><tr><td>box cutter</td><td>Deli Group Co., LTD</td><td>/</td><td></td></tr><tr><td>disposable medical treatment towel</td><td>Sichuan Hualikang Medical Technology Co., LTD</td><td>2024010902</td><td></td></tr><tr><td>dry cotton swabs</td><td>Chengdu Zhongxin sanitary materials, LLC.</td><td>20240102</td><td></td></tr><tr><td>fresh ginger</td><td>Qingyang community comprehensive market</td><td>/</td><td></td></tr><tr><td>iodophor cotton swabs</td><td>Zhejiang Beijiaer hygiene Technology Co., LTD</td><td>20231201</td><td></td></tr><tr><td>lighter</td><td>Xiayi Shuntong Lighter manufacturing Co., LTD</td><td>25625</td><td></td></tr><tr><td>medical bending disc</td><td>HYNAUT</td><td>100062487683</td><td></td></tr><tr><td>moxa sticks</td><td>Nanyang Fuaitang wormwood biological products Co., LTD</td><td>15941917095</td><td></td></tr><tr><td>tweezers</td><td>HYSTIC</td><td>100013619175</td><td></td></tr></tbody></table>

ginger moxibustion, a non-pharmacological treatment, for diarrhea in patients with chronic obstructive pulmonary disease

Chronic Obstructive Pulmonary Disease (COPD) is a common and frequently occurring disease in the elderly population, and it tends to progressively worsen. Diarrhea is a common extrapulmonary complication in patients with COPD. Diarrhea can cause dehydration, electrolyte imbalances, weakness, and a loss of appetite, among other adverse consequences, which seriously affect the quality of life and nutritional status of patients. These consequences are not conducive to improving airway obstruction in COPD patients. At present, modern medicine has poor curative effects, fails to control symptoms fully, causes a relapse after drug withdrawal, has side effects, and increases the medication burden of patients. Ginger moxibustion is a unique non-pharmacological therapy of traditional Chinese medicine, which is safe and effective in controlling diarrhea, has few side effects, and is easy to accept. It is, therefore, an ideal alternative therapy. This article aims to introduce the protocol of ginger moxibustion for treating diarrhea in COPD patients.

Basic conditions 
A total of 18 patients with COPD complicated with diarrhea were divided into a treatment group (9 cases) and a control group (9 cases) (see Table 2). All patients met the diagnostic criteria1, accompanied by symptoms of diarrhea, and were type 5 or above according to the Bristol stool chart5. The treatment group received ginger moxibustion treatment and conventional symptomatic treatment (including inhalation preparations, antibiotics, and antidiarrheal medications), and the control group only received conventional symptomatic treatment for 5 days.
Observed indicators 
The COPD Assessment Test (CAT)1 and Stool characteristics and defecation frequency (SCDF) were compared between the two groups. CAT is an 8-item questionnaire that assesses COPD patients&#39; health status. It was developed to be applicable worldwide. SCDF is used according to the Bristol stool chart5,27 and defecation frequency score standard28. (see Table 3)
Experimental results 
We used the independent sample T-test to determine whether there were differences between the control and the treatment groups before treatment. A paired-sample T-test was used to compare the mean values before and after treatment in the groups to determine whether there were differences in efficacy.
The CAT scores between the two groups post treatment are shown in Table 4. After treatment, the mean values of CAT in both groups were lower than before treatment, and the mean CAT value in the treatment group was lower than that in the control group (P &#60; 0.05).
The SCDF scores of the two groups post treatment are shown in Table 5. After treatment, the mean SCDF values of the two groups were lower than before, and the mean SCDF value of the treatment group was lower than that of the control group (P &#60; 0.05). The results showed that the combined application of ginger moxibustion and conventional therapy could improve the symptoms of COPD and diarrhea better than conventional therapy alone.
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/67224/67224fig01.jpg" /> 
Figure 1: Materials. Ginger; moxa cones; dry cotton swabs; box cutter; tweezers; iodophor cotton swabs; medical bending disc; disposable medical treatment towel; lighter. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/67224/67224fig01large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/67224/67224fig02.jpg" /> 
Figure 2: Shenque acupoint (CV 8). A photograph of the Shenque acupoint as described in the national standard: Illustrations for the location of acupuncture points26. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/67224/67224fig02large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/67224/67224fig03.jpg" /> 
Figure 3: Before and during treatment. (A) The position of the navel (CV 8) before treatment. (B) The ignited moxibustion and ginger slices were placed on the CV 8. (C)&#160;The extinguished moxa cone. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/67224/67224fig03large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Inclusion criteria</td>
			<td>(1) The COPD patient should has&#160; dyspnea, chronic cough or sputum productionand/or a history of exposure to risk factors for the disease. At the same time, spirometry demonstrates the presence of FEV1/FVC &#60; 0.7; 
			(2) The Definition of diarrhea met the type 5 and above for &#34;Bristol stool chart&#34;. (Type 5 feces: Soft blobs with clear-cute dges (passed easily); Type 6 feces: Fluffy pieces with ragged edges, a mushy stool; Type 7 faeces: Watery, no solid pieces ENTIRELY LIQUID)</td>
		</tr>
		<tr>
			<td>Exclusion criteria</td>
			<td>(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 
			(5) those with known diarrhea due to other diseases</td>
		</tr>
	</tbody>
</table>
Table 1: Patient inclusion and exclusion criteria. Determine the inclusion criteria according to GOLD 20241 and Bristol stool chart6. Exclusion criteria are based on previously published literature29.
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>GROUP</td>
			<td>Gender</td>
			<td>Age(years)</td>
			<td>BMI</td>
			<td>FEV1/FVC (%)</td>
			<td>pre-CAT</td>
			<td>pre-SCDF</td>
			<td>post-CAT</td>
			<td>post-SCDF</td>
		</tr>
		<tr>
			<td>1</td>
			<td>Male</td>
			<td>55</td>
			<td>20.07</td>
			<td>54.50</td>
			<td>23.00</td>
			<td>8.00</td>
			<td>18.00</td>
			<td>4.00</td>
		</tr>
		<tr>
			<td>1</td>
			<td>Female</td>
			<td>75</td>
			<td>26.48</td>
			<td>68.69</td>
			<td>16.00</td>
			<td>6.00</td>
			<td>15.00</td>
			<td>0.00</td>
		</tr>
		<tr>
			<td>1</td>
			<td>Male</td>
			<td>61</td>
			<td>28.13</td>
			<td>67.25</td>
			<td>21.00</td>
			<td>8.00</td>
			<td>16.00</td>
			<td>6.00</td>
		</tr>
		<tr>
			<td>1</td>
			<td>Female</td>
			<td>61</td>
			<td>34.34</td>
			<td>64.12</td>
			<td>22.00</td>
			<td>10.00</td>
			<td>17.00</td>
			<td>4.00</td>
		</tr>
		<tr>
			<td>1</td>
			<td>Female</td>
			<td>65</td>
			<td>22.18</td>
			<td>62.13</td>
			<td>20.00</td>
			<td>8.00</td>
			<td>16.00</td>
			<td>4.00</td>
		</tr>
		<tr>
			<td>1</td>
			<td>Male</td>
			<td>58</td>
			<td>31.23</td>
			<td>61.23</td>
			<td>22.00</td>
			<td>8.00</td>
			<td>17.00</td>
			<td>4.00</td>
		</tr>
		<tr>
			<td>1</td>
			<td>Male</td>
			<td>69</td>
			<td>24.54</td>
			<td>60.54</td>
			<td>21.00</td>
			<td>10.00</td>
			<td>20.00</td>
			<td>4.00</td>
		</tr>
		<tr>
			<td>1</td>
			<td>Male</td>
			<td>55</td>
			<td>18.81</td>
			<td>54.53</td>
			<td>26.00</td>
			<td>8.00</td>
			<td>20.00</td>
			<td>2.00</td>
		</tr>
		<tr>
			<td>1</td>
			<td>Female</td>
			<td>77</td>
			<td>23.78</td>
			<td>35.02</td>
			<td>27.00</td>
			<td>10.00</td>
			<td>23.00</td>
			<td>2.00</td>
		</tr>
		<tr>
			<td>2</td>
			<td>Female</td>
			<td>57</td>
			<td>23.50</td>
			<td>68.20</td>
			<td>15.00</td>
			<td>6.00</td>
			<td>15.00</td>
			<td>2.00</td>
		</tr>
		<tr>
			<td>2</td>
			<td>Female</td>
			<td>50</td>
			<td>25.97</td>
			<td>68.52</td>
			<td>18.00</td>
			<td>6.00</td>
			<td>16.00</td>
			<td>4.00</td>
		</tr>
		<tr>
			<td>2</td>
			<td>Male</td>
			<td>48</td>
			<td>20.20</td>
			<td>65.33</td>
			<td>18.00</td>
			<td>8.00</td>
			<td>16.00</td>
			<td>6.00</td>
		</tr>
		<tr>
			<td>2</td>
			<td>Male</td>
			<td>54</td>
			<td>25.14</td>
			<td>63.98</td>
			<td>17.00</td>
			<td>10.00</td>
			<td>15.00</td>
			<td>4.00</td>
		</tr>
		<tr>
			<td>2</td>
			<td>Male</td>
			<td>73</td>
			<td>29.03</td>
			<td>63.22</td>
			<td>25.00</td>
			<td>10.00</td>
			<td>23.00</td>
			<td>4.00</td>
		</tr>
		<tr>
			<td>2</td>
			<td>Female</td>
			<td>50</td>
			<td>25.39</td>
			<td>61.34</td>
			<td>22.00</td>
			<td>10.00</td>
			<td>21.00</td>
			<td>2.00</td>
		</tr>
		<tr>
			<td>2</td>
			<td>Female</td>
			<td>44</td>
			<td>22.04</td>
			<td>59.67</td>
			<td>23.00</td>
			<td>8.00</td>
			<td>19.00</td>
			<td>2.00</td>
		</tr>
		<tr>
			<td>2</td>
			<td>Female</td>
			<td>59</td>
			<td>17.12</td>
			<td>48.18</td>
			<td>26.00</td>
			<td>12.00</td>
			<td>25.00</td>
			<td>6.00</td>
		</tr>
		<tr>
			<td>2</td>
			<td>Male</td>
			<td>69</td>
			<td>24.69</td>
			<td>46.34</td>
			<td>27.00</td>
			<td>8.00</td>
			<td>25.00</td>
			<td>10.00</td>
		</tr>
	</tbody>
</table>
Table 2: Case data. Including basic patient Information (groups, sex, age, BMI, FEV1/FVC), CAT scores before treatment (preCAT), SCDF scores before treatment (preSCDF), CAT scores after treatment(postCAT), and SCDF scores after treatment(postSCDF). Abbreviations: BMI = body mass index; FEV1/FVC = (forced expiratory volume in 1 second/ forced vital capacity); COPD = chronic obstructive pulmonary disease; CAT = The COPD Assessment Test; SCDF = Stool characteristics and defecation frequency.
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td></td>
			<td>0 score</td>
			<td>2 score</td>
			<td>4 score</td>
			<td>6 score</td>
		</tr>
		<tr>
			<td>stool property</td>
			<td>Like a sausage or snake, smoothand soft</td>
			<td>Soft blobs with clear-cut edges(passed easily)</td>
			<td>Fluffy pieces with ragged edges, amushy stool</td>
			<td>Watery, no solid pieces.Entirely Liquid</td>
		</tr>
		<tr>
			<td>Frequency of bowel movements (times/day)</td>
			<td>&#60;3</td>
			<td>3-4</td>
			<td>5-6</td>
			<td>&#8805;7</td>
		</tr>
	</tbody>
</table>
Table 3: The SCDF Scoring Criteria. These were developed with reference to the Bristol stool chart5,27 and defecation frequency score standard28. Abbreviation: Stool characteristics and defecation frequency.
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td></td>
			<td>Number of cases</td>
			<td>Pre-treatment</td>
			<td>Post-treatment</td>
		</tr>
		<tr>
			<td>treatment group</td>
			<td>9</td>
			<td>22.00&#177;3.24</td>
			<td>18.00&#177;2.55</td>
		</tr>
		<tr>
			<td>control group</td>
			<td>9</td>
			<td>21.22&#177;4.35</td>
			<td>19.44&#177;4.19</td>
		</tr>
	</tbody>
</table>
Table 4: The CAT scores comparison between the two groups. Scores are expressed as x &#177; s. Abbreviation: COPD = chronic obstructive pulmonary disease; CAT = The COPD Assessment Test.
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td></td>
			<td>Number of cases</td>
			<td>Pre-treatment</td>
			<td>Post-treatment</td>
		</tr>
		<tr>
			<td>treatment group</td>
			<td>9</td>
			<td>8.44&#177;1.33</td>
			<td>3.33&#177;1.73</td>
		</tr>
		<tr>
			<td>control group</td>
			<td>9</td>
			<td>8.67&#177;2.00</td>
			<td>4.44&#177;2.60</td>
		</tr>
	</tbody>
</table>
Table 5: The SCDF scores comparison between the two groups. Scores are expressed as x &#177; s. Abbreviation: Stool characteristics and defecation frequency.

Author Spotlight: Exploring Non-Pharmacological Therapies for Chronic Respiratory Diseases &#8212; Linking Intestinal Microbiome Insights to COPD Treatment

Here, we present the method of using ginger moxibustion to treat diarrhea in patients with chronic obstructive pulmonary disease.

Ginger Moxibustion, A Non-pharmacological Treatment, for Diarrhea in Patients with Chronic Obstructive Pulmonary Disease

Chronic Obstructive Pulmonary Disease (COPD) is a common and frequently occurring disease in the elderly population, and it tends to progressively worsen. ...

ginger-moxibustion-non-pharmacological-treatment-for-diarrhea

Nanyang Technological University

Research

JoVE Journal

Medicine

719 Views.  Hospital of Chengdu University of Traditional Chinese Medicine. Here, we present the method of using ginger moxibustion to treat diarrhea in patients with chronic obstructive pulmonary disease.

Video: Author Spotlight: Exploring Non-Pharmacological Therapies for Chronic Respiratory Diseases — Linking Intestinal Microbiome Insights to COPD Treatment

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Patients with chronic kidney disease (CKD) have significantly increased risk of cardiovascular disease (CVD) compared to the general population, and this is only partially explained by traditional CVD risk factors. Vascular dysfunction is an important non-traditional risk factor, characterized by vascular endothelial dysfunction (most commonly assessed as impaired endothelium-dependent dilation [EDD]) and stiffening of the large elastic arteries. While various techniques exist to assess EDD and large elastic artery stiffness, the most commonly used are brachial artery flow-mediated dilation (FMDBA) and aortic pulse-wave velocity (aPWV), respectively. Both of these noninvasive measures of vascular dysfunction are independent predictors of future cardiovascular events in patients with and without kidney disease. Patients with CKD demonstrate both impaired FMDBA, and increased aPWV. While the exact mechanisms by which vascular dysfunction develops in CKD are incompletely understood, increased oxidative stress and a subsequent reduction in nitric oxide (NO) bioavailability are important contributors. Cellular changes in oxidative stress can be assessed by collecting vascular endothelial cells from the antecubital vein and measuring protein expression of markers of oxidative stress using immunofluorescence. We provide here a discussion of these methods to measure FMDBA, aPWV, and vascular endothelial cell protein expression.

The degree of vascular dysfunction and contributing physiological mechanisms can be assessed in patients with chronic kidney disease by measuring brachial artery flow-mediated dilation, aortic pulse-wave velocity, and vascular endothelial cell protein expression.

Patients with chronic kidney disease (CKD) have significantly increased risk of cardiovascular disease (CVD) compared to the general population, and this ...

Network Analysis of Foramen Ovale Electrode Recordings in Drug-resistant Temporal Lobe Epilepsy Patients

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control seizures. However, a significant minority of patients continues to exhibit post-operative seizures, even in those cases in which the suspected source of seizures has been correctly localized and resected. The protocol presented here combines a clinical procedure routinely employed during the pre-operative evaluation of temporal lobe epilepsy (TLE) patients with a novel technique for network analysis. The method allows for the evaluation of the temporal evolution of mesial network parameters. The bilateral insertion of foramen ovale electrodes (FOE) into the ambient cistern simultaneously records electrocortical activity at several mesial areas in the temporal lobe. Furthermore, network methodology applied to the recorded time series tracks the temporal evolution of the mesial networks both interictally and during the seizures. In this way, the presented protocol offers a unique way to visualize and quantify measures that considers the relationships between several mesial areas instead of a single area.

This protocol describes a procedure to track the evolution of mesial network measures in temporal lobe epilepsy (TLE) patients. It is based on the combination of intracranial recordings with a novel numerical technique for data analysis. Specifically, we present a protocol for network analyses of foramen ovale recordings.

Approximately 30% of epilepsy patients are refractory to antiepileptic drugs. In these cases, surgery is the only alternative to eliminate/control ...

Generation of a Chronic Obstructive Pulmonary Disease Model in Mice by Repeated Ozone Exposure

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and lung parenchymal destruction. It has a very high incidence in aging populations. The current conventional therapies for COPD focus mainly on symptom-modifying drugs; thus, the development of new therapies is urgently needed. Qualified animal models of COPD could help to characterize the underlying mechanisms and can be used for new drug screening. Current COPD models, such as lipopolysaccharide (LPS) or the porcine pancreatic elastase (PPE)-induced emphysema model, generate COPD-like lesions in the lungs and airways but do not otherwise resemble the pathogenesis of human COPD. A cigarette smoke (CS)-induced model remains one of the most popular because it not only simulates COPD-like lesions in the respiratory system, but it is also based on one of the main hazardous materials that causes COPD in humans. However, the time-consuming and labor-intensive aspects of the CS-induced model dramatically limit its application in new drug screening. In this study, we successfully generated a new COPD model by exposing mice to high levels of ozone. This model demonstrated the following: 1) decreased forced expiratory volume 25, 50, and 75/forced vital capacity (FEV25/FVC, FEV50/FVC, and FEV75/FVC), indicating the deterioration of lung function; 2) enlarged lung alveoli, with lung parenchymal destruction; 3) reduced fatigue time and distance; and 4) increased inflammation. Taken together, these data demonstrate that the ozone exposure (OE) model is a reliable animal model that is similar to humans because ozone overexposure is one of the etiological factors of COPD. Additionally, it only took 6 - 8 weeks, based on our previous work, to create an OE model, whereas it requires 3 - 12 months to induce the cigarette smoke model, indicating that the OE model might be a good choice for COPD research.

This study describes the successful generation of a new chronic obstructive pulmonary disease (COPD) animal model by repeatedly exposing mice to high concentrations of ozone.

Chronic obstructive pulmonary disease (COPD) is characterized by persistent airflow limitation and lung parenchymal destruction. It has a very high ...

Exploring the Therapeutic Potential of Du-Moxibustion in Ankylosing Spondylitis

Du-Moxibustion in a Mouse Model of Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a progressively worsening and disabling form of arthritis that primarily affects the axial skeleton. This disease mainly involves the spine and the sacroiliac joint. Fusion of the spine and the sacroiliac joint may occur in the later stage of the disease, resulting in spinal stiffness and kyphosis, as well as difficulty in walking, which seriously affects the quality of work and daily living activities and imposes a heavy burden on the patient, the family, and society. Increasing attention has been paid to non-pharmacotherapy as an alternative therapy for AS. Moxibustion is an ancient therapeutic technique used in Traditional Chinese Medicine (TCM). Du-moxibustion therapy, a unique and innovative external treatment developed on the basis of ordinary moxibustion, has a definite therapeutic effect on AS. Du-moxibustion skillfully combines the compatible techniques of TCM to integrate meridians, acupoints, Chinese herbal medicine, and moxibustion. This paper describes the operation procedures and precautions to be taken during Du-moxibustion in experimental mice in detail to provide an experimental basis for the study of the mechanism of Du-moxibustion in the treatment of AS.

Author Spotlight: Evaluating Traditional Chinese Therapy for Ankylosing Spondylitis in Mice 

This paper describes in detail the operation procedures and precautions to be taken during Du-moxibustion in the treatment of ankylosing spondylitis in experimental mice.

Ankylosing spondylitis (AS) is a progressively worsening and disabling form of arthritis that primarily affects the axial skeleton. This disease mainly ...

Immunology and Infection

Transcatheter Pulmonary Valve Replacement from Autologous Pericardium with a Self-Expandable Nitinol Stent in an Adult Sheep Model

Transcatheter pulmonary valve replacement has been established as a viable alternative approach for patients suffering from right ventricular outflow tract or bioprosthetic valve dysfunction, with excellent early and late clinical outcomes. However, clinical challenges such as stented heart valve deterioration, coronary occlusion, endocarditis, and other complications must be addressed for lifetime application, particularly in pediatric patients. To facilitate the development of a lifelong solution for patients, transcatheter autologous pulmonary valve replacement was performed in an adult sheep model. The autologous pericardium was harvested from the sheep via left anterolateral minithoracotomy under general anesthesia with ventilation. The pericardium was placed on a 3D shaping heart valve model for non-toxic cross-linking for 2 days and 21 h. Intracardiac echocardiography (ICE) and angiography were performed to assess the position, morphology, function, and dimensions of the native pulmonary valve (NPV). After trimming, the crosslinked pericardium was sewn onto a self-expandable Nitinol stent and crimped into a self-designed delivery system. The autologous pulmonary valve (APV) was implanted at the NPV position via left jugular vein catheterization. ICE and angiography were repeated to evaluate the position, morphology, function, and dimensions of the APV. An APV was successfully implanted in&#160;sheep J. In this paper, sheep J was selected to obtain representative results. A 30 mm APV with a Nitinol stent was accurately implanted at the NPV position without any significant hemodynamic change. There was no paravalvular leak, no new pulmonary valve insufficiency, or stented pulmonary valve migration. This study demonstrated the feasibility and safety, in a long-time follow-up, of developing an APV for implantation at the NPV position with a self-expandable Nitinol stent via jugular vein catheterization in an adult sheep model.

This study demonstrates the feasibility and safety of developing an autologous pulmonary valve for implantation at the native pulmonary valve position by using a self-expandable Nitinol stent in an adult sheep model. This is a step toward developing transcatheter pulmonary valve replacement for patients with right ventricular outflow tract dysfunction.

Transcatheter pulmonary valve replacement has been established as a viable alternative approach for patients suffering from right ventricular outflow ...

A Traditional Chinese Medicine Characteristic Therapy for Bronchial Asthma: Moxibustion

Bronchial asthma is a chronic inflammatory disease of the airway which can lead to symptoms such as recurrent wheezing, shortness of breath, chest tightness, or cough, as a result of increased airway reactivity. With high diurnal variation, these symptoms often occur or worsen at night or in the morning. By burning and roasting the Chinese medica above human acupoints, moxibustion is a type of treatment that stimulates the activity of the human meridians through drugs and heat stimulation to prevent and treat diseases. According to the principle of syndrome differentiation and treatment of traditional Chinese medicine, acupoints are selected on the corresponding parts, which has a definite effect. It is regarded as a characteristic traditional Chinese medicine therapy for bronchial asthma. This protocol elaborates the methods and steps of patient management, material preparation, selection of acupoints, operation, and postoperative nursing to ensure safe and effective moxibustion treatment to significantly improve the clinical symptoms and quality of life of patients with bronchial asthma.

This protocol presents a curative procedure of moxibustion in treating patients with bronchial asthma.

Bronchial asthma is a chronic inflammatory disease of the airway which can lead to symptoms such as recurrent wheezing, shortness of breath, chest ...

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

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.

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

Chronic obstructive pulmonary disease (COPD) is a common and frequent disease in elderly patients, with a tendency for progressive exacerbation. ...

Warm Acupuncture and Moxibustion to Relieve COPD with Abdominal Distension

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 

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 ...

A Moxibustion Platform for Herbal Cake-Based Treatment of Rats with Renal Failure

Using Herbal-Cake-Separated Moxibustion for the Treatment of Rats with Chronic Renal Failure

In the process of moxibustion in clinical practice, subjects need to be in a stable mood and comfortable posture to avoid problems such as moxa ash falling, scalding skin, and poor curative effect. Such problems also exist in the rat moxibustion experiment. To simulate clinical practice, it is necessary to introduce an experimental instrument in animal experiments, that is, a moxibustion device with fixed rats and moxibustion treatment synchronization, which can make experimental rats receive moxibustion treatment quietly and comfortably under non-anesthesia.
Our research group designed a rat moxibustion experimental platform. The device was framed by a wooden board with a supporting base plate, multiple fixed components, and partitioned components. The device can achieve the operation mode of moxibustion in rats without binding, avoiding anesthesia and scalding and simultaneously exposing multiple acupoints on the back. This operation can avoid physical and mental injury to rats and operators, which improves the research efficiency and further promotes the development and research of moxibustion animal experiments.
The device has a simple structure, is easy to operate and popularize, is comprehensively and innovatively designed, reusable, and is suitable for rat experiments mainly based on moxibustion. This article mainly introduces the structure of the experimental platform device for rat moxibustion, the basic procedure of herbal-cake-separated-moxibustion in experimental rats using the device and describes the establishment of a rat model of chronic renal failure (CRF) and representative experimental results.

Author Spotlight: Understanding the Effect of Herbal-Cake-Separated Moxibustion in Rats with Renal Faliure

The moxibustion experimental platform can fix the rats without restriction, and the rats can undergo multi-acupoint moxibustion in the awake state, ensuring the welfare of the rats, protecting the safety of the operators, ensuring therapeutic efficacy, and improving the efficiency of the experiment.

In the process of moxibustion in clinical practice, subjects need to be in a stable mood and comfortable posture to avoid problems such as moxa ash ...

Herbal Moxibustion on Shenque Acupoint for Alleviating Primary Dysmenorrhea

Herbs-Partitioned Moxibustion on the Navel in a Rat Model of Primary Dysmenorrhea with Cold Coagulation and Blood Stasis

Primary dysmenorrhea (PDM) refers to the occurrence of spasmodic colicky pain in the lower abdomen without any obvious pelvic pathology, often accompanied by other systemic symptoms, which significantly reduces the quality of life of women with PDM, 45%-95% of menstrual women are affected by it. Despite the high incidence of PDM, it is often not well treated and is ignored by relevant researchers and women themselves. Herbs-partitioned moxibustion (HPM) is a characteristic external therapy in traditional Chinese medicine (TCM), which is widely used to treat diseases in China; it treats diseases by applying a Chinese herbal formula on the patient's acupoints and then igniting moxa sticks on the herbal formula for moxibustion therapy. The primary effectiveness of the herbs utilized in this study is meridian activation and warmth, which encourages qi circulation to relieve pain. Moxibustion's heat stimulation could hasten the infusion of the herbs into the human body. Consequently, HPM, which combines acupoint, herbal, and heat stimulations, is appropriate for treating gynecological disorders, particularly functional diseases such as PDM. This paper provides a detailed description of the procedures and precautions for HPM at the Shenque (CV8) acupoint in female experimental rats, which 0provides an experimental basis for better promoting the application and development of HPM on the navel in PDM.

Here, we describe in detail the operation procedures and precautions to be taken during herbs-partitioned moxibustion on the navel in the treatment of primary dysmenorrhea in rats with cold coagulation and blood stasis, which can significantly improve the writhing reaction of dysmenorrhea rats and alleviate pain.

Primary dysmenorrhea (PDM) refers to the occurrence of spasmodic colicky pain in the lower abdomen without any obvious pelvic pathology, often accompanied ...