Guidelines on Acupuncture and Moxibustion Intervention for COVID-19 (second edition)

Guidelines on Acupuncture and Moxibustion Intervention

for COVID-19 (second edition)

        COVID-19 is an acute respiratory infectious disease, which is highly infectious and commonly susceptible, and poses a serious threat to people's life and health. Modern clinical and experimental studies show that acupuncture-moxibustion can regulate the human immune function, and act on anti-inflammatory and anti-infection. Acupuncture-moxibustion plays an active role in the prevention and treatment of infectious diseases. In the face of COVID-19, Chinese acupuncture and moxibustion therapy has actively participated in prevention and control, and achieved good results. Therefore，we formed Guidelines on Acupuncture and Moxibustion Intervention for COVID-19 (second edition) for medical workers in acupuncture implementation and guidance in order to help patients recover.

I. Principles of Acupuncture Intervention

i. During the epidemic, acupuncture intervention work should be strictly implemented in accordance with the requirements of quarantine and disinfection. Acupuncture treatment for confirmed and recovering cases, several patients can be treated in the same room; while

for suspected cases, different patients should be treated in separate rooms. During         respiratory-support oxygen therapy, moxibustion can be used under safe conditions.

ii. The clinical diagnosis, staging, classification, and syndrome differentiation of TCM for COVID-19 shall follow the COVID-19 diagnosis and treatment plan issued by the General Office of the National Health Commission and the General Office of the National Administration of Traditional Chinese Medicine.  The acupuncture intervention, according to the evolution of the pathogenesis, will be divided into three phase’s medical observation phase, clinical treatment phase, and convalescence phase. Through the differentiation of the syndromes of organs and meridians, the treatment will mainly apply on main acupoints matching with other acupoints according to clinical symptoms, with respect of the principle of "less is more". Acupuncture and moxibustion operation will be selected as appropriate

according to the specific conditions, following the principle of convenient, simple, safe and effective. Acupuncture can be used together with herbal medicine in the clinical treatment phase to play the synergy role of acupuncture.

II. Methods of acupuncture and moxibustion intervention

i. Acupuncture and moxibustion intervention during the phase of medical observation (suspected cases)

Main points:

1)    Fengmen (BL12), Feishu (BL13), Pishu (BL20);

2)     Hegu (LI14), Quchi (Ll11), Chize (LU5), Yuji (LU10)；

3)     Qihai (CV6), Zusanli (ST36), Sanyinjiao (SP6);

For each time, select 1-2 points in each group of acupoints.

Matching points:

1)    symptoms combined with fever, dry throat, dry cough, match with Dazhui (G V 14), Tiantu (C V 22), Kongzui (LU6);

2)    symptoms combined with nausea and vomiting, loose stool, tongue fat coating greasy, soft (soggy) pulse, match with Zhongwan (C V 12), Tianshu (ST 25), Fenglong (ST40);

3)    symptoms combined with fatigue, weak, and inappetence, match with Zhongwan (CV 12), the 4 points around umbilicus (l inch each side from umbilicus), Pishu (BL20);

4)    symptoms combined with clear runny nose, soreness on shoulder and back, pale tongue white coating, slow pulse, match with Tianzhu (BL10), Fengmen (BL12), Dazhui(GV 14)

ii. Acupuncture and moxibustion intervention during the phase of clinical treatment (confirmed cases)

Main acupoints :

1)    Hegu (LI4), Taichong (LR3), Tiantu (C V 22), Chize (LU5), Kongzui (LU6), Zusanli (ST 36), Sanyinjiao (SP6);

2)     Dazhu (BL11), Fengmen (BL12), Feishu (BL13), Xinshu (BL15), Geshu (BL17);

3)    Zhongfu (LU1), Danzhong (CV17), Qihai (CV6), Guanyuan (CV4),Zhongwan (C V 12); to treat light and general cases, for each time, select 2- 3 main points in group (1) and (2); to treat severe cases, select 2-3 main points in group (3).

Matching points:

1)    symptoms combined with longtime fever, match with Dazhui (GV14), Quchi (LII l); or ear tip and fingertip bloodletting;

2)    symptoms combined with chest tightness, shortness of breath, match with Neiguan (PC6), Lieque (LU7); or Juque (CV14), Qimen (LR14), Zhaohai (K16);

3)    symptoms combined with coughing up phlegm, match with Lieque (LU7), Fenglong (ST40), Dingchuan (EXB l); symptoms combined with diarrhea, loose stools, match with Tianshu (ST 25), Shangiuxu (ST37);

4)    symptoms combined with coughing up sticky and/or yellow phlegm, constipation, match with Tiantu (CV 22), Zhigou (TE6), Tianshu (ST 25), Fenglong (ST40); symptoms combined with low fever, hiding fever, or even no fever, vomiting, loose stools, tongue pale or pale rose with white greasy coating, match with Feishu (BL13), Tianshu (ST 25), Fujie (SP14), Neiguan (PC6).

iii. Acupuncture and moxibustion intervention during convalescence

Main points: Neiguan (PC6), Zusanli (ST 36), Zhongwan (CV12), Tianshu (ST25), Qihai (CV6).

l. Deficiency of the Qi of lung and spleen: symptoms as shortness of breath, fatigue, poor appetite and vomiting, stomach distension, lack of force for defecate, loose stools, tongue slightly fat with white greasy coating.

1)    For those with obvious symptoms such as chest tightness, shortness of breath, match with Danzhong (C V 17), Feishu (BL13), Zhongfu (LU1).

2)    For those with obvious spleen and stomach symptoms such as indigestion and diarrhea, match with Shangwan (CV13), Yinlingquan (SP9).

2. Deficiency of Qi and Yin: symptoms as weakness, dry mouth, thirst, palpitations, excessive sweating, poor appetite, low or no fever, dry cough with few phlegm, dry tongue with less saliva, pulse fine or weak.

1)    For those with obvious weakness and shortness of breath, match with Danzhong

(CV17), Shenque (CV 8).

2)    For those with obvious dry mouth and thirst, match with Taixi (KI3), Yangchi (TE4). For those with obvious palpitations, match with Xinshu (BL15), Jueyinshu (BL14).

3)    For those with excessive sweating, match with Hegu (LI4), Fuliu (KI7), Zusanli (ST36). For those with insomnia, match with Shenmen (HT7), Yintang, Anmian, Yongquan (KI1).

3. Deficiency of Lung and spleen, stasis of phlegm blocking the meridians: symptoms as chest tightness, shortness of breath, disinclination of speak, fatigue, sweating when as move, cough with phlegm, and phlegm blocked, scaly dry skin, mental fatigue, poor appetite, etc., match with Feishu (BL13), Pishu (BL20), Xinshu (BL15), Geshu (BL17), Shenshu (BL23), Zhongfu (LUI), Danzhong (CV17). For those with phlegm blocked, match with Fenglong (ST40) and Dingchuan (EXB 1).

      Acupuncture and moxibustion operation: According to the implementation environment and management requirements, choose as appropriate. During the above phases, it is recommended that the choice of using acupuncture only or moxibustion only, or combine both, or combined with acupoint application, auricular acupuncture, acupoint injection, scraping, pediatric massage, acupressure, etc. should be made according to the situation. Acupuncture shall be manipulated with mild reinforcing and reducing method. Needles should be left on each point for 20 to 30 minutes; as for moxibustion, on each point for 10 to 15 minutes. Treatment shall be applied once a day. For specific operations, please refer to the national standard of Standardized Manipulations of Acupuncture and Moxibustion and clinical experiences.

Ill. Home acupuncture and moxibustion intervention under the guidance of doctors

        To help prevent and control the epidemic of COVID-19, while reducing going out, avoiding cross-infection, blocking the source of infection, and ensuring safety, patients who are under home quarantine and discharged from hospital can perform acupuncture-moxibustion  intervention through online clinic, guidance, and science popularization and education, under the guidance of professionals.

Moxibustion therapy: self-moxibustion on Zusanli (ST36), Neiguan (PC6), Hegu (L14), Qihai (CV6), Guanyuan (CV4), Sanyinjiao (SP6). Each moxibustion takes about 10 minutes.

Application therapy: apply moxibustion hot paste or warming  moxibustion cream to apply on points such as Zusanli (ST 36), Neiguan (PC6), Qihai (CV6), Guanyuan (CV4), Feishu (BL13), Fengmen (BL12), Pishu (BL20), Dazhui (GV14).

Meridian massage: use methods like kneading, pressing, rubbing, tapping, patting on the lung and heart meridian of upper limb, spleen and stomach meridian below the knee. 15-20 minutes for each operation. It is appropriate to have soreness at the operated part.

Traditional exercises: Choose appropriate traditional exercises, such as Yi Jin Jing (Muscle/ Tendon Change Classic), Tai Chi, Ba Duan Jin(Eight Pieces Brocade), Wu Qin Xi (Five Animal Exercise), etc., based on one's recovery situation. Practice once a day, 15-30 minutes each time.

Mental health: Adjust one's emotions. It can be used with auricular points, moxibustion, massage, medicated diet, herbal tea, herbal bath, music and other methods to relax both physically and mentally, to relieve anxiety or to aid sleep.

Foot bath: Select Chinese herbs with the function of dispelling wind and heat, eliminating pathogens. Take nepeta(jingjie), wormwood(aiye), mint(bohe), houttuynia(yuxingcao), indigowoad leaf(daqingye), eupatorium fortune(peilan), acorus tatarinowii(shichangpu), polygonum flaccidum(laliaocao), radix curcumae(yujin), clove(bingpian), 15g each, together with 3g of borneol(bingpian) to make a decoction. Pour the decoction into a foot bath, add some warm water, wait until it cools down to about 38- 45^oC , soak for about 30 minutes.

This guidance is formulated by the expert group of the China Association of Acupuncture-Moxibustion to achieve auxiliary disease treatment and promote physical and mental rehabilitation.