• Users Online: 179
  • Print this page
  • Email this page

 
Table of Contents
ORIGINAL ARTICLE
Year : 2020  |  Volume : 6  |  Issue : 3  |  Page : 295-306

Guidelines for Chinese medicine rehabilitation of chronic obstructive pulmonary disease


Henan University of Chinese Medicine, Henan, China

Date of Submission22-Sep-2019
Date of Acceptance29-May-2020
Date of Web Publication05-Sep-2020

Correspondence Address:
Prof. Jian-Sheng Li
156 Jinshui East Road, Zhengdong New District, Zhengzhou, Henan 450046
China
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/wjtcm.wjtcm_44_20

Rights and Permissions
  Abstract 


Chronic obstructive pulmonary disease (COPD) is a common, chronic, frequently occurring, and difficult disease of the respiratory system and is a huge disease burden. Pulmonary rehabilitation is an important part of clinical treatment. Chinese medicine lung rehabilitation (CMLR), which is based on Chinese medicine theory and practice, is a comprehensive rehabilitation measure that can prevent and treat pulmonary diseases and preserve physical and mental functions. Its aim is to promote the return of patients to society as soon as possible. To better guide the clinical practice of COPD rehabilitation, the Specialty Committee of Pulmonary Rehabilitation of World Federation of Chinese Medicine Societies established a panel for formulating guidelines, systematically retrieved domestic and foreign literature, performed systematic evaluation after expert consultation and on-site discussion, and finally, formed the guidelines in accordance with the development standard of international evidence-based guidelines. The guideline has seven parts, which are the preface, introduction, scope, normative references, terms and definitions, types of disease syndromes, diseases assessment, CMLR techniques, and annex. The techniques of CMLR include 11 techniques in seven species, such as Simplified Taijiquan, Baduanjin, and Liuzijue. The guideline defines the technical points (time, frequency, course, etc.), optimal applicable population, use of drugs, common acupoints, operation methods, and so on for each technique. The release of the guidelines is helpful to improve the rehabilitation technique standardization and to improve the curative effect and level of rehabilitation.

Keywords: Chronic obstructive pulmonary disease, Chinese medicine rehabilitation, guidelines, technique


How to cite this article:
Li JS. Guidelines for Chinese medicine rehabilitation of chronic obstructive pulmonary disease. World J Tradit Chin Med 2020;6:295-306

How to cite this URL:
Li JS. Guidelines for Chinese medicine rehabilitation of chronic obstructive pulmonary disease. World J Tradit Chin Med [serial online] 2020 [cited 2020 Oct 26];6:295-306. Available from: https://www.wjtcm.net/text.asp?2020/6/3/295/294388




  Introduction Top


Chronic obstructive pulmonary disease (COPD) is a common, chronic, frequently occurring, and difficult disease of the respiratory system and is a huge disease burden. Hence, it has been given more attention in the recent years. The number of COPD patients in the world is about 384 million, and the disease is ranked as the fourth leading cause of death in the world, and it will rise to the third place in 2020 according to the WHO estimation. Every year, 3 million people die of COPD worldwide,[1],[2],[3] and an estimated 4.5 million people will die from COPD-related diseases by 2030.[4],[5] The harm of death and disability of COPD is becoming more and more serious all over the world. In China, COPD is the third leading cause of death, and there is a total of about 100 million patients.[6],[7] In 2016, the number of COPD deaths in China (876,300) accounted for 29.86% of the total number of COPD deaths in the world, making it the third leading cause of death in China, according to the global disease burden data.[8] A survey of mortality, morbidity, and risk factors in China and its provinces published in the Lancet in 2019 shows that according to the ranking of disability-adjusted life years, COPD has ranked third in diseases with the heaviest health burden among Chinese residents. It was the third leading cause of death and loss of life in 2017.[9] The preventive and treatment measures include prevention, early diagnosis, and standardized treatment (drug therapy, exercise therapy, psychological intervention, pulmonary rehabilitation [PR], etc.). PR is an important part of the process. Chinese medicine lung rehabilitation (CMLR), which is based on Chinese medicine theory and practice, is a comprehensive rehabilitation measure that can prevent and treat pulmonary diseases and preserve physical and mental functions. Its aim is to promote the return of patients to society as soon as possible. Rehabilitation has been widely used in pulmonary diseases and has achieved certain clinical effects; however, at the same time, there are also some problems, such as lack of high-quality evidence-based clinical research and lack of PR guidelines of Chinese medicine. Therefore, to better guide the clinical practice of COPD rehabilitation with Chinese medicine, the Specialty Committee of World Federation of Chinese Medicine Societies (WFCMS) made the guideline after systematically retrieving domestic and foreign literature, performing systematic evaluation, and seeking expert consultation and on-site discussion, in accordance with the development standard of international evidence-based guideline. The guideline is not a standard or norm of medical behavior, but a declarative document formulated based on the existing research evidence and specific methods. In clinical practice, practitioners can give patients' individualized diagnosis and treatment in accordance with this guideline and their specific conditions.


  Scope Top


The guideline specified the basic contents involving terms and definitions of COPD rehabilitation with Chinese medicine, PR with western medicines, types of disease syndromes, and the basic contents of CMLR. The guideline is applicable to the clinical practice of CMLR on COPD patients by doctors, technicians, and nurses in the respiratory, rehabilitation, and related departments.


  Normative References Top


The following documents are indispensable for the application of this document. For dated references, only the dated version applies to this document. For undated references, the latest version, including all amendments, applies to this document.

  • Chinese standard: GB/T21709.1-21-2008, Standardized Manipulations of Acupuncture and Moxibustion[10] (National Standards of the PRC)
  • WS 318-2010, Diagnosis Criteria for Chronic Obstructive Pulmonary Disease[11]
  • Chinese terms in traditional Chinese medicine (2010 Edition), China National Committee for Terms in Sciences and Technologies[12]
  • Chinese Medicine Syndrome Diagnostic Criteria of Chronic Obstructive Pulmonary Disease (2011 Edition), the Pulmonary Disease Specialized Committee in the Internal Medicine Branch of China Association of Chinese Medicine[13]
  • Qigong for Health Maintenance (Yi Jin Jing, Wu Qin Xi, Liuzijue, and Baduanjin), Management Center of Qigong for Health Maintenance, the State Administration of Sports of China[14]
  • ATS/ERS Task Force on Pulmonary Rehabilitation, an official American Thoracic Society/European Respiratory Society statement: key concepts and advances in PR (in 2013).[15]



  Terms and Definitions Top


The following terms and definitions apply to the guidelines.

Chronic obstructive pulmonary disease

COPD is characterized by airflow limitation which can be prevented and treated. The airflow limitation is incompletely reversible and develops progressively, which is related to the abnormal inflammatory reactions of the lungs to harmful gases, such as cigarette smoke, or harmful particles.[11]

Note: It mainly affects the lung but can also cause systemic adverse reactions of the whole body (or outside the lung).

Lung distension disease

The recurrent attacks and delayed healing of lung diseases, such as cough, wheezing, and dyspnea, can cause lung qi distension, affecting its descent and astringency, thus leading to symptoms of lung diseases, such as cough, expectoration, shortness of breath, chest distension and stuffiness, and even difficulty breathing and panting.

Chinese medicine lung rehabilitation

CMLR refers to comprehensive rehabilitation methods guided by the Chinese medicine theory. It follows the pulmonary disease characteristics and uses the rehabilitation techniques and methods in Chinese medicine to prevent and treat pulmonary diseases and protect physical and mental functions so as to enable patients to return to society as soon as possible.

Note 1: The CMLR focuses on the basic views, such as the concept of holism, syndrome differentiation, and function rehabilitation and prevention. It combines prevention with rehabilitation, internal treatment with external treatment, and drug therapy with diet therapy.[16]

Note 2: The CMLR includes, but is not limited to, the respiratory diseases (such as COPD) in western medicine. It also covers the rehabilitation of some nasal diseases (such as chronic rhinitis). By improving the clinical symptoms, lung functions, sports endurance, and life quality, it helps patients restore work–life ability as far as possible so as to return to society.

Note 3: The methods of CMLR include not only the traditional ones, such as Chinese herb therapy, acupuncture and moxibustion, and Daoyin therapy, but also the new techniques created by the integration of the concepts and methods of western medicine lung rehabilitation technology, such as catgut embedment and injection in acupoint. The methods for lung rehabilitation can be used alone or in combination.

Pulmonary rehabilitation in western medicine

PR refers to a comprehensive intervention method. Based on the overall assessment of patients, it makes individualized regimens, which include, but are not limited to, exercise training, education, and behavioral changes. The aim is to improve the physiological and psychological status of patients with chronic respiratory diseases and to encourage patients to adhere to the long-term regimen to promote health.[15]

Note 1: The PR, in a broad sense, includes sports and respiratory muscle training, long-term oxygen therapy, nutritional therapy, thoracic physical exercise therapy, and relaxation therapy. However, in a narrow sense, it contains exercise training, respiratory muscle training, health education, psychological and behavioral interventions, and evaluation of their effects. Exercise training is the cornerstone of the PR program, and lower limb exercise training is the key and core.

Note 2: The PR multidisciplinary team should include doctors, nurses, respiratory therapists, physiotherapists, occupational therapists, psychologists, sports specialists, and other professionals.

Note 3: The development of exercise prescription of PR should consider the exercise intensity, frequency, and duration.

Note 4: The PR can achieve obvious effects after 6–12 weeks, but the clinical benefit will gradually decrease after the rehabilitation training stops. Long-term lung rehabilitation can yield longer and sustained benefits.[17]

Note 5: The rehabilitation effect evaluation is mostly performed by adopting various evaluation methods and indicators, such as cardiopulmonary exercise test and 6-min walking test for exercise performance evaluation, Saint George's Respiratory Questionnaire and general health status questionnaire for life quality evaluation, and tests for improving lung functions and clinical symptoms.


  Types of Diseases Syndromes Top


“Healthy qi deficiency and impairment accumulation” is the main pathogenesis of COPD (lung distension disease). There are three common classifications and ten total syndromes encountered in the clinics. The types include deficiency syndromes, excess syndromes, and another syndrome. The types of deficiency syndromes include lung qi deficiency, lung–spleen qi deficiency, lung–kidney qi deficiency, and both qi and yin deficiency of the lung and kidney; the types of excess syndromes include wind–cold attacking lung, exterior cold with interior fluid retention, phlegm–heat obstructing lung, phlegm–dampness obstructing lung, and heart spirit confused by phlegm; while another type of syndrome is blood stasis. Among the common clinical syndromes, they can occur alone or in combination, such as lung–kidney qi deficiency combined with a syndrome of phlegm–heat obstructing lung, or lung–spleen qi deficiency combined with phlegm–dampness obstructing lung.[13],[18]


  Diseases Assessment Top


Before the implementation of CMLR, patients should be comprehensively assessed by taking their medical history, the incidence of this time, daily lifestyle, and mode of exercise, as well as 6-min walking distance, respiratory muscle function, cardiopulmonary exercise load, quality of life, exercise-related functions, nutritional status, and cognitive psychology. Then, suitable methods that patients can tolerate are selected for formulating an exercise prescription.

Meanwhile, through four examinations, namely, inspection, listening and smelling, inquiry, and pulse taking and palpation, the nature of the disease, i.e., deficiency or excess, cold or heat, is made clear. Afterward, the rehabilitation is assessed. The method that is easy to accept and learn, is convenient to implement, and has the least risk is selected so as to determine the methods of CMLR.


  Guidelines Development Method Top


This guideline followed the WHO specification and principle for guideline development[19] and is based on the report item (RIGHT) of the Health Care Practice Guide.[20] The development steps are briefly described below.

Registration

This guideline has been registered in both Chinese and English on the International Practice Guide Registration Platform (IPGRP-2018CN033), which is available in http://www.guidelines.registry.cn.

Guideline users and target groups

The guideline is applicable to the clinical practice of CMLR on COPD patients in stable condition by doctors, technicians, and nurses in the respiratory, rehabilitation, and related departments.

Working group

We set up a multidisciplinary working group, including experts in western medicine, Chinese medicine, rehabilitation, acupuncture, sports, epidemiology, and evidence-based medicine, doctors, COPD patients, technicians, and nurses specializing in PR. Patient participation in the guideline development process is reflected in two aspects – one is being involved in the selection of clinical problems, while the other is in giving recommendations. The participants were divided into five groups, namely, the guiding expert group, the methodological expert group, the clinical expert group, the technical standard validation group, and the systematic review group.

The fund and conflict of interest

The fund

The development of the guideline is funded by the China National Talents Cultivation Engineering (W02060076) and the Scientific Research Project of the National Construction of Practice of Chinese Medicine Clinical Research Base established by the National Administration of Traditional Chinese Medicine (JDZX2015152).

Conflict of interest

All members signed a declaration of conflict of interest and carried out the preparation of the guide completely independently, affirming that there are no commercial, professional, or other conflicts of interest relevant to the subject matter of this guideline.

Selection and determination of clinical problems

Clinical problems and outcomes were collected through a systematic search of domestic and foreign literature and guidelines. Then, a questionnaire survey was conducted on the Specialty Committee of Pulmonary Rehabilitation (SCPR) of the WFCMS (about 100 physicians). Meanwhile, patients also participated in the selection of clinical problems. Based on the survey results, 11 clinical problems and 14 outcomes were included.

Evidence retrieval and quality evaluation

Clinical problems were deconstructed, and retrieval strategies were determined according to the “Population, Intervention, Control, and Outcome (PICO)” Literature was retrieved through PubMed, Embase, Cochrane library, CNKI, VIP, CBM, and WANFAN DATA databases until March 1, 2017. AMSTAR tool[21] was used to evaluate the quality of the methodology in systematic reviews and meta-analyses, and risk of bias tool[22] was used to evaluate the quality of methodology in randomized controlled studies. Finally, this guideline fully evaluates the quality of 124 relevant articles.

Level of evidence and recommendation

This guideline adopted the grading of recommendations, assessment development, and evaluation (GRADE) system[23] for grading the quality of evidence. The recommendation strength was preliminarily formulated according to the comprehensive evidence formed by the literature evidence, respiratory monographs, and standardized documents.

Recommendation formation

Two rounds of surveys were conducted based on the comprehensive evidence and the strength of preliminary recommendation opinions, and the survey results were sorted out. In addition, COPD also was involved in the recommendation formation. Face-to-face consensus meeting was held, and the final recommendation opinions and recommendation strength were voted on by experts. This guideline finally formed 39 recommendations, among which six were strongly recommended, 31 were weakly recommended, and two were weakly not recommended.

Publishing and updating

The first draft of the guidelines was approved by the technical standard validation group and the board of SCPR by voting and then was sent to the international standards department for review and revision for release.

According to the requirements of the WFCMS, this guideline would be updated in 3–5 years.


  Chinese Medicine Lung Rehabilitation Methods Top


Simplified Taijiquan

  1. The Simplified Taijiquan was compiled by the Taijiquan experts of the State Administration of Sports of China in 1956. It extracts the essence of Taijiquan and is arranged into 24 movements, including Zuo You Yema Fenzong (parting a wild horse's mane), Baihe Liangchi (white crane spreads its wings), and Zuo You Louxi Aobu (brush knee and step forward). The movements are soft and focused on using the mind to guide breathing and coordinating with the movement of the whole body. It is characterized by warding off (Peng), rolling back (Lv), pressing (Ji), and pushing (An)[24]
  2. It is suitable for COPD patients in stable condition and can increase the 6-min walking distance (strong recommendation for use, level of evidence: B) and improve lung function, FEV1(weak recommendation for use, level of evidence: B)[25]
  3. Each rehabilitation session lasts 60 minutes
  4. The rehabilitation exercise should be performed 5–7 times a week
  5. The rehabilitation duration should be more than 3 months. It will achieve better effects with a longer duration.


Baduanjin

  1. It includes eight movements, namely, Shuangshou Tuotian Li Sanjiao (two hands supporting the sky to regulate triple energizer), Zuoyou Kaigong Si Shediao (drawing bows left and right), Tiaoli Piwei Xu Danju (single arm pushing up to regulate spleen and stomach), Wulao Qishang Wang Houqiao (turning head to look left and right backward to relieve various diseases), Yaotou Baiwei Qu Xinhuo (pointing tailbone left and right to clear heart-fire), Liangshou Panzu Gu Shenyao (both hands reaching the ground to strengthen kidney and waist), Cuanquan Numu Zeng Liqi (punching with angry eyes to generate physical energy), and Beihou Qidian Baibing Xiao (bouncing on the toes to get rid of hundreds of diseases). It emphasizes on the gentle, slow, and coherent movement, as well as the combination of tightness and softness, dynamic and static status, and the harmony between spirit and body. When doing the exercise, not only the body movement but also the qi movement is acquired. When practicing, one should be fully relaxed no matter the body or the mind, and the movements should be correct and flexible. It focuses on both the movement and the thoughtless awareness during the process, which should be achieved step by step
  2. It is suitable for COPD patients in stable conditions and can increase the 6-min walking distance (strong recommendation for use, level of evidence: C). It can also reduce the score of Saint George's Respiratory Questionnaire (strong recommendation for use, level of evidence: C) and improve the quality of life. In addition, it can improve the lung function, FEV1, FEV1%, and FVC (weak recommendation for use, level of evidence: C)[26],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36],[37],[38],[39],[40],[41],[42],[43],[44],[45]
  3. Each rehabilitation exercise lasts 30 minutes
  4. The rehabilitation exercise should be performed more than 4 times a week
  5. The rehabilitation duration should be more than 3 months. It will achieve better effects with a longer duration.


Liuzijue

  1. It is an exercise of inhalation and exhalation that regulates qi and blood circulation of zang-fu organs and meridians and collaterals through different mouth forms with the six healing sounds – “Si, He, Hu, Xu, Chui, and Xi.” The six healing sounds are related to lung, heart, spleen, liver, kidney, triple energizer, and other zang-fu organs and meridians and collaterals. When practicing, it follows the order of “Preparation Movement–Opening Posture–Xu Sound–He Sound–Hu Sound–Si Sound–Chui Sound–Xi Sound–Closing Posture.” There are a total of nine movements[14]
  2. It is suitable for patients with COPD in stable condition and can increase the 6-min walking distance (weak recommendation for use, level of evidence: C). It can also reduce the score of Saint George's Respiratory Questionnaire (strong recommendation for use, level of evidence: C) and improve the score of COPD Assessment Test (CAT) (strong recommendation for use, level of evidence: D) and the quality of life. It can reduce acute exacerbation (weak recommendation for use, level of evidence: C), improve the modified British Medical Research Council (mMRC) score (strong recommendation for use, level of evidence: D), and improve lung function, FEV1% (weak recommendation for use, level of evidence: C)[46],[47],[48],[49],[50],[51],[52],[53],[54]
  3. Exercise 6 times for each word, 30 minutes for each rehabilitation exercise
  4. The rehabilitation exercise should be performed more than 5 times a week
  5. The rehabilitation duration should be more than 3 months. It will achieve better effects with a longer duration.


Acupoint application therapy

Traditional acupoint application

  1. Treatment of applying certain Chinese medicine on acupoint[55]
  2. It is suitable for COPD patients in stable condition with deficiency syndrome and can increase the 6-min walking distance (weak recommendation for use, level of evidence: B), reduce the score of Saint George's Respiratory Questionnaire (weak recommendation for use, level of evidence: C), and improve the quality of life. It can decrease acute exacerbation (weak recommendation for use, level of evidence: C) and improve the mMRC score (weak recommendation for use, level of evidence: C) and lung function, FEV1%, FVC, and FEV1(weak recommendation for use, level of evidence: C)[56],[57],[58],[59],[60],[61],[62],[63],[64],[65],[66],[67],[68],[69],[70],[71],[72],[73],[74],[75],[76]
  3. The medicine that can warm yang and replenish qi, dredge meridians and activate collaterals, open orifices and activate blood, and ventilate the lungs and relieve cough and dyspnea is the first choice for the paste, with the most commonly used medicine, such as Herba Asari, Semen Sinapis, Radix Euphorbiae Kansui, and Rhizoma Corydalis
  4. The acupoint for the application is selected according to the disease condition and syndrome differentiation, with Feishu (BL 13), Dingchuan (EX-B1), Shenshu (BL 23), Tiantu (CV 22), Dazhui (GV 14), and Tanzhong (CV 17) as the major ones. Matching points for different syndromes: for lung qi deficiency, Taiyuan (LU 9) and Zusanli (ST 36) are used; for lung–spleen qi deficiency, Taiyuan (LU 9) and Pishu (BL 20) are added; for lung–kidney qi deficiency, Taiyuan (LU 9) and Zusanli (ST 36) are added
  5. The duration of application is determined by medicine stimulation, blisters, and skin reaction. Drugs with less irritation can be changed every 1–3 days, while those with strong stimulation should be changed every few minutes to few hours. The application mostly lasts for 4–6 h each time
  6. The application is applied with an interval of 10 days
  7. Application of three times for 1 month each is considered as one course of treatment
  8. Pigmentation, flushing, mild itching and pain, mild redness and swelling, and mild blisters appearing after the application are all normal reactions, which are inconsequential to the treatment. However, if skin sensitization reactions, such as skin erythema, blisters, itching, and pain, are large and significant, the application should be stopped immediately and symptomatic treatment should be performed. When necessary, the hospital should be consulted.


Acupoint application in summer to treat and prevent diseases easily occurred in winter based on Chinese medicine theory

  1. It refers to an external treatment that uses medicine application on specific acupoints of the human body in dog-days to treat and prevent diseases and is also known as “Sanfu Tie.”
  2. It is suitable for COPD patients in stable condition with deficiency syndrome and can reduce the score of Saint George's Respiratory Questionnaire (weak recommendation for use, level of evidence: C) and improve the quality of life. It can also decrease acute exacerbation (weak recommendation for use, level of evidence: C) and improve the mMRC score (weak recommendation for use, level of evidence: C)[77],[78],[79],[80],[81],[82],[83],[84],[85],[86],[87],[88],[89],[90],[91],[92],[93],[94],[95],[96],[97],[98],[99],[100],[101],[102],[103],[104],[105],[106],[107],[108]
  3. The basic drug prescription consists of Semen Sinapis, Rhizoma Corydalis, Radix Euphorbiae Kansui, Herba Asari, Rhizoma Zingiberis Recens, and so on. Artificial Moschus, Herba Ephedrae, Cortex Cinnamomi, and Fructus Foeniculi are often added
  4. Feishu (BL 13) is the basic applied acupoint, and Tanzhong (CV 17), Dazhui (GV 14), Dingchuan (EX-B1), and Gaohuang (BL 43) are often added. Xinshu (BL 15), Geshu (BL 17), Shenshu (BL 23), Pishu (BL 20), and other acupoints are used according to the syndrome differentiation
  5. When performing application, the local area should first be disinfected with 75% ethanol or iodophor routinely. Then, the medicinal paste with a length of 1 cm and a height of 0.5 cm is taken. The medicine is applied at the acupoint before being fixed with a desensitized adhesive tape of 5 cm × 5 cm
  6. It is applied in summer each year, the first day of the first, middle, and last of the dog-days (Three 10-day periods of the hot season. If the middle dog-days are 20 days, then it is used with an interval of 10 days)
  7. Each application lasts for 3–6 h
  8. The application is performed with an interval of 7–10 days
  9. Three years of continuous application is considered as a course of treatment. The efficacy can be enhanced with multiple courses.


Shufei Tie (lung-regulating paste)

  1. On the basis of traditional acupoint application therapy technology, a new type of external application is formed by combining with the modern drug preparation technology. About 1.5 g lung-regulating medicinal paste is injected into the depression of the paste film, then it is applied on the acupoint. After that, it is pressed gently and evenly
  2. It is suitable for COPD patients in stable condition with deficiency syndrome, and can improve the score of Saint George's Respiratory Questionnaire and the quality of life (weak recommendation for use, level of evidence: B). It can also decrease acute exacerbation (weak recommendation for use, level of evidence: B), improve cough, expectoration, chest stuffiness, shortness of strength, fatigue, and other clinical symptoms (weak recommendation for use, level of evidence: B), and decrease the score of mMRC (weak recommendation for use, level of evidence: B)[109],[110],[111],[112]
  3. The medicine used in the paste consists of Semen Sinapis, Rhizoma Corydalis, Flos Genkwa, and Semen Zanthoxyli, functioning for warming and inspiring lung qi, expelling phlegm and activating blood, and relieving cough and asthma
  4. The acupoints used include Feishu (BL 13), Dazhui (GV 14), Gaohuang (BL 43), Tanzhong (CV 17), Dingchuan (EX-B1), and Tiantu (CV 22)
  5. It is used for 6–8 h each time
  6. The interval between two applications is 10 days
  7. Five times is a course of treatment. It is applied on the 10th day before the dog-days, the 1st, 10th, and 20th day of the dog-days, and the 10th day after the dog-days once
  8. Mild redness, swelling, and blisters appearing after application are all normal reactions, which are inconsequential to the treatment. If serious skin erythema, blisters, and other phenomena occur, the medicine should be stopped immediately, and symptomatic treatment should be performed. For serious cases, the patients should be sent to the hospital immediately.


Acupuncture

  1. It is a method of treating diseases by inserting needles into specific acupoints of the human body[113],[114]
  2. It is suitable for COPD patients in stable condition and can increase the 6-min walking distance (weak recommendation for use, level of evidence: C), decrease acute exacerbation (weak recommendation for use, level of evidence: C), and improve lung function, FEV1%, and FEV1/FVC (weak recommendation for use, level of evidence: C)[111],[115],[116],[117],[118],[119],[120],[121],[122],[123],[124],[125],[126],[127],[128],[129],[130],[131]
  3. Filiform needle or electric needle is recommended
  4. The area for acupuncture is selected according to the condition of the disease. Tanzhong (CV 17), Guanyuan (CV 4), Dingchuan (EX-B1), Feishu (BL 13), Zusanli (ST 36), and Tianshu (BL 13) are often used. Matching points for different syndromes: for lung qi deficiency, Taiyuan (LU 9) is used; for lung–spleen qi deficiency, Pishu (BL 20) is added; for both qi and yin deficiency of the lung and kidney, Gaohuang (BL 43) and Taixi (KI 3) are added.
  5. When manipulating needles, it is the best to obtain qi, generating soreness, numbness, and distension and heaviness in the local area of acupoint
  6. The needles are retained for 20–30 min each time
  7. The acupuncture is performed 2–3 times a week.
  8. Two weeks of acupuncture is considered as a course of treatment. A few courses can be applied.


Moxibustion

Traditional moxibustion

  1. It is an external treatment that uses the ignited moxa wool or the moxibustion material, mainly made of moxa wool, to warm the acupoint or lesion site with suspended or direct moxibustion. By means of the heat of moxibustion and the functions of medicine, it achieves the goal of treating diseases[132]
  2. It is suitable for COPD patients in stable condition and can increase the 6-min walking distance (weak recommendation for use, level of evidence: C), reduce the score of Saint George's Respiratory Questionnaire (weak recommendation for use, level of evidence: D), and improve the quality of life. It can also improve the mMRC score (weak recommendation for use, level of evidence: C) and the lung function, FEV1, FEV1%, and FVC (weak recommendation for use, level of evidence: C)[133],[134],[135],[136]
  3. The medicine used in moxibustion is selected according to the syndrome and disease differentiation in Chinese medicine. Moxa stick and moxa wool are the common moxibustion materials
  4. The acupoint for moxibustion is reasonably selected according to different diseases, symptoms, and syndromes. Zusanli (ST 36), Dazhui (GV 14), Tanzhong (CV 17), and Shenque (CV 8) are mainly used. Matching points for different syndromes: for lung qi deficiency, Taiyuan (LU 9) is added; for lung–spleen qi deficiency, Taiyuan (LU 9) and Pishu (BL 20) are selected; for lung–kidney qi deficiency, Taiyuan (LU 9) and Shenshu (BL 23) are added. Matching points for different symptoms: for chest stuffiness, Tanzhong (CV 17) can be added; Kongzui (LU 6) and Chize (LU 5) are used for serious asthma and serious cough, respectively; for large amounts of phlegm, Zhongwan (CV 12) is added
  5. The moxibustion is performed once a week. The frequency can be adjusted according to different moxibustion materials, acupoints, and patients' tolerance degrees
  6. Each moxibustion lasts for 30 min or longer
  7. It is performed with an interval of 1–2 weeks
  8. Three months of moxibustion is a course of treatment. More courses can be applied
  9. After moxibustion, the skin probably has a burning sensation, which can disappear by itself and is inconsequential to treatment. If blisters appear with a diameter of about 1 cm, there is no need for treatment, in general. However, if the blisters are large, with skin edema and ulceration, exudation of body fluid, and suppuration, local disinfection shall be performed for mild ones. If there are redness, swelling, and heat pain in a large area, aside from local disinfection, oral administration or external anti-infective drugs should also be used. For the suppuration in deep parts, the surgical department should get involved.


YiFei moxibustion

  1. It is a method combining the effects of external medicinal treatment and moxibustion. Before moxibustion, Chinese herbal powder, mulberry paper, mashed ginger, and moxa wool are successively placed on the area of governor vessel (GV)
  2. It is suitable for COPD patients in stable condition with deficiency syndrome. It can increase the 6-min walking distance (weak recommendation for use, level of evidence: B) and improve the score of CAT (weak recommendation for use, level of evidence: B) and quality of life. It can also decrease acute exacerbation (weak recommendation for use, level of evidence: B), improve cough, expectoration, chest stuffiness, shortness of strength, panting, chest stuffiness, fatigue, and other clinical symptoms (weak recommendation for use, level of evidence: B), and improve mMRC score (weak recommendation for use, level of evidence: B) and lung function, FVC, and FEV1% (weak recommendation against use, level of evidence: B)[137],[138],[139]
  3. The medicine of moxibustion powder includes Moschus, Radix Paeoniae Alba, Flos Caryophylli, Cortex Cinnamomi, and Semen Sinapis, functioning as warming meridian and collateral, promoting qi and blood circulation, warming and ventilating lung collateral, and warming GV and strengthening yang.
  4. The acupoints from Dazhui (GV 14) to Yaoshu (GV 2) along the GV are selected for moxibustion
  5. The procedure of moxibustion includes 12 steps, which include choosing body position, selecting acupoints, disinfection, smearing ginger juice, spraying moxibustion powder, applying mulberry paper, placing mashed ginger, igniting moxa cone, changing moxa cone, removing mashed ginger, gently wiping the moxibustion area, and putting blisters. Three moxa cones are changed each time
  6. Each treatment lasts for 120 min
  7. The moxibustion is performed with an interval of 14 days
  8. Three months is a course of treatment.


Heat-sensitive moxibustion

  1. It is a kind of moxibustion therapy that involves suspended moxibustion on heat-sensitive acupoints, resulting in meridian qi conduction to the affected area through heat penetration, expansion, and transmission; thus, the therapeutic effects are improved[140]
  2. It is suitable for patients with COPD in stable condition and can improve lung function, FEV1/FVC, and FEV1% (weak recommendation against use, level of evidence: B)[19],[20],[21]
  3. The moxibustion material is mostly cone-shaped moxa wool. Moxa sticks with different diameters are selected according to the need of the disease condition and different diameters of heat-sensitive acupoint areas
  4. As for the body position, the patient should feel comfortable, and the moxibustion site must be fully exposed. The recumbent position is preferred
  5. The acupoint is selected based on the moxibustion–sensation positioning method. With the moxa heat about 3 cm away from the body surface, centered on the traditional acupoint positioning, suspended moxibustion is carried out by combining manipulations along the meridian, circling, pecking, and applying mild moxibustion, to search the heat-sensitive acupoint. If the local area feels moderate heat without burning pain, and the patient has one or more kinds of the six heat-sensitive moxibustion sensations, it is regarded as the heat-sensitive acupoint, regardless of whether it is in the standard position of traditional acupoint
  6. The duration of each moxibustion depends on the disappearance time of the heat-sensitive moxibustion sensation, which is different for different diseases, people, and acupoints. The average time is about 40 min
  7. At the first continuous 8 days, it is performed once a day. After that, at least 15 times of treatment is carried out every month
  8. There is no regular course of treatment. As long as the disease-related heat-sensitive acupoints exist, moxibustion is needed until all the related heat-sensitive acupoints are desensitized.


Pulmonary Daoyin

  1. It is a lung rehabilitation technique in Chinese medicine that uses limb movement and breathing to regulate breath, mind, and body position
  2. It is suitable for COPD patients in stable condition and can increase the 6-min walking distance (weak recommendation for use, level of evidence: B) and improve CAT score and quality of life (weak recommendation for use, level of evidence: B)[22],[23]
  3. Pulmonary Daoyin includes six steps: standing and relaxing the whole body and mind, breathing using the two Dantians (the energy center), regulating lungs and kidneys, turning around and referring to the side, rubbing and circling the kidney, and nourishing the spirit and closing the practice
  4. Each rehabilitation exercise lasts for 30 min
  5. The rehabilitation exercise is performed more than 5 days a week, twice a day
  6. The rehabilitation duration should be more than 3 months. It will achieve better effects with a longer duration.



  Appendix 1 Description Top


The Leading Drafting Organizations of the Guideline: Henan University of Chinese Medicine, theFirst Affiliated Hospital of Henan University of Chinese Medicine.

The Participating Drafting Organizations of the Guideline: Peking University People's Hospital, China-Japan Friendship Hospital, Chinese Rehabilitation Research Center, Beijing Hospital of Traditional Chinese Medicine affiliated to capital medical university, Beijing Xiaotangshan Hospital, Evidence-based Medicine Center of Beijing University of Chinese Medicine, Guang'anmen Hospital of China Academy of Chinese Medical Sciences, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, the Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, West China Hospital of Sichuan University, Chongqing General Hospital, Xiangya Hospital of Central South University, Hebei Provincial Hospital of China Medicine, Liaoning Provincial Chinese Medicine Research Institute, theFirst Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, theFirst Affiliated Hospital with Nanjing Medical University, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Anhui University of Chinese Medicine, theFirst Affiliated Hospital of Anhui University of Chinese Medicine, the Second People's Hospital of Fujian Traditional Chinese Medical University, Henan University of Chinese Medicine, theFirst Affiliated Hospital of Henan University of Chinese Medicine, Henan Province Hospital of TCM, the Third Affiliated Hospital of Henan University of Chinese Medicine, Henan Provincial People's Hospital, Taihe Hospital in Hubei Province, theFirst Affiliated Hospital of Guangzhou Medical University, the Third Affiliated Hospital of Guangzhou University of Chinese Medicine, and the Chinese Medicine College of Ningxia Medical University.

The Main Drafters of the Guideline: Li Jiansheng, Wang Minghang, and Zhang Hailong.

The participating drafters of the guideline (in the alphabetical order of last name):

China: Che Guowei, Cheng Xiankuan, Chen Wei, Feng Cuiling, Feng Jihong, Huang Yong, Li Jiansheng, Li Suyun, Lu Feng, Liu Suixin, Liu Jingxia, Li Guangxi, Li Youlin, Li Zegeng, Meng Yong, Qu Nini, Sun Zikai, Sun Zhijia, Sun Zengtao, Tian Wei, Wu Liang, Wang Yuguang, Wang Minghang, Wang Yanjun, Xie Yang, Yang Ting, Yu Xuefeng, Yang Junchao, Yu Xueqing, Zhao Hongmei, Zheng Zeguang, Zhou Linfu, Zhao Limin, Zhang Wei, Zhang Nianzhi, Zhu Yanxia, Zhou Miao, Zhang Mingli, and Zhang Hongchun.

Hong Kong, China: Bian Zhaoxiang and Liang Guohui.

The Reviewing Experts of the Guideline: Li Zhenji, Wang Yongyan, Zhang Boli, Chao Enxiang, Sun Sulun, Chen Lidian.

The Methodological Experts of the Guidelines: Xie Yanming, Liu Jianping, Yang Kehu, Zhan Siyan, Hu Jingqing, Zhang Junhua, and Wen Zehuai.

The Drafting Procedure of the Guideline complies with the SCM 0001-2009 Standards Development and Publication Work Specification issued by WFCMS and the 2011 [No. 20] document Measures for the Technical Standard Formulation and Implement of Specialized Committees of WFCMS issued by the Secretariat of WFCMS.

Please bear in mind that some of the contents in the guideline may involve patents. The publisher of this document is not responsible for identifying them.[141], [142,],[143],[144],[145]

The guideline is a clinical practice guidance of chronic obstructive pulmonary disease (COPD) rehabilitation with Chinese medicine methods. It shall not replace other clinical practice such as Chinese medicinal treatment based on syndrome differentiation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Martinez FJ, Han MK, Flaherty K, Curtis J. Role of infection and antimicrobial therapy in acute exacerbations of chronic obstructive pulmonary disease. Expert Rev Anti Infect Ther 2006;4:101-24.  Back to cited text no. 1
    
2.
Wedzicha JA, Seemungal TA. COPD exacerbations: Defining their cause and prevention. Lancet 2007;370:786-96.  Back to cited text no. 2
    
3.
Celli BR, Barnes PJ. Exacerbations of chronic obstructive pulmonary disease. Eur Respir J 2007;29:1224-38.  Back to cited text no. 3
    
4.
Hoogendoorn M, Hoogenveen RT, Rutten-van Mölken MP, Vestbo J, Feenstra TL. Case fatality of COPD exacerbations: A meta-analysis and statistical modelling approach. Eur Respir J 2011;37:508-15.  Back to cited text no. 4
    
5.
Piquet J, Chavaillon JM, David P, Martin F, Blanchon F, Roche N, et al. High-risk patients following hospitalisation for an acute exacerbation of COPD. Eur Respir J 2013;42:946-55.  Back to cited text no. 5
    
6.
Wang C, Xu J, Yang L, Xu Y, Zhang X, Bai C, et al. Prevalence and risk factors of chronic obstructive pulmonary disease in China (the China Pulmonary Health [CPH] study): A national cross-sectional study. Lancet 2018;391:1706-17.  Back to cited text no. 6
    
7.
Fang L, Gao P, Bao H, Tang X, Wang B, Feng Y, et al. Chronic obstructive pulmonary disease in China: A nationwide prevalence study. Lancet Respir Med 2018;6:421-30.  Back to cited text no. 7
    
8.
NETWORK GBODC. Global Burden of Disease Study 2016 (GBD 2016) Results. Seattle, United States: Institute for Health Metrics and Evaluation (IHME)[Z]; 2017.  Back to cited text no. 8
    
9.
Zhou M, Wang H, Zeng X, Yin P, Zhu J, Chen W, et al. Mortality, morbidity, and risk factors in China and its provinces, 1990-2017: A systematic analysis for the Global Burden of Disease Study 2017. Lancet 2019;394:1145-58.  Back to cited text no. 9
    
10.
General Administration of quality Supervision, Inspection and Quarantine of the P.R.C., Standardization Administration of the P.R.C. Standardized Manipulations of Acupuncture and Moxibustion (bound version); China Standard Press: Beijing, China; 2008.  Back to cited text no. 10
    
11.
Minister of Health of the P.R.C. Diagnosis Criteria for Chronic Obstructive Pulmonary Disease. Int J Respiration 2011;1:1-2.  Back to cited text no. 11
    
12.
China National Committee for Terms in Sciences and Technologies. Chinese Terms in Traditional Chinese Medicine. 2010 ed. Beijing, China: Science Press; 2011.  Back to cited text no. 12
    
13.
Li JS, Li SY, Wang ZW. Chinese medicine syndrome diagnostic criteria of chronic obstructive pulmonary disease (2011 Edition). J Tradit Chin Med 2012;53:177-8.  Back to cited text no. 13
    
14.
Management Center of Qigong for Health Maintenance of the State Administration of Sports of China. Qigong for Health Maintenance (Yijinjing, Wuqinxi, Liuzijue, Baduanjin). 1st ed.. Beijing, China: People's Physical Education Press; 2005.  Back to cited text no. 14
    
15.
Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, et al. An official American Thoracic Society/European Respiratory Society statement: Key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013;188:e13-64.  Back to cited text no. 15
    
16.
Chen LD. Traditional Rehabilitation Methodology. 1st ed. Beijing, China: People's Medical Publishing House; 2013.  Back to cited text no. 16
    
17.
Global Strategy for the Diagnosis. Management and Prevention of COPD[EB/OL]; 2018. Available from: http://goldcopd.org. [Last accessed on 2020 Aug 03].  Back to cited text no. 17
    
18.
Li JS, Li SY, Yu XQ. Guidelines for traditional Chinese medicine diagnosis and treatment of chronic obstructive pulmonary disease (2011 Edition). J Tradit Chin Med 2012;53:80-4.  Back to cited text no. 18
    
19.
World Health Organization. WHO Handbook of Guideline Development. 2nd ed. Available from: http://www.who.int/kms/handbook_2nd_ed.pdf. [Last accessed on 2020 Aug 03].  Back to cited text no. 19
    
20.
Chen Y, Yang K, Marušic A, Qaseem A, Meerpohl JJ, Flottorp S, et al. A reporting tool for practice guidelines in health care: The RIGHT statement. Ann Intern Med 2017;166:128-32.  Back to cited text no. 20
    
21.
Shea BJ, Grimshaw JM, Wells GA, Boers M, Andersson N, Hamel C, et al. Development of AMSTAR: A measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 2007;7:10.  Back to cited text no. 21
    
22.
Higgins JP, Altman DG, Gotzsche PC, Moher PJ, Oxman AD, Savovic J, et al. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials. BMJ (Clinical research ed). 2011;343:d5928.  Back to cited text no. 22
    
23.
Guyatt GH, Oxman AD, Vist GE, Kunz R, Falck-Ytter Y, Alonso-Coello P, et al. GRADE: An emerging consensus on rating quality of evidence and strength of recommendations. BMJ 2008;336:924-6.  Back to cited text no. 23
    
24.
Lu H. The review of Taijiquan headstrems from1949-2009. Fight (Wushu Science) 2010;7:27-8.  Back to cited text no. 24
    
25.
Ngai SP, Jones AY, Tam WW. Tai Chi for chronic obstructive pulmonary disease (COPD). Cochrane Database Syst Rev 2016 :CD009953.  Back to cited text no. 25
    
26.
Pan MY, Luo JH, Yang SC. Observation on rehabilitation exercise eight-section brocade in community patients with early metaphase chronic obstructive pulmonary disease. J Chengdu Univer Tradit Chin Med 2016;39:49-52.  Back to cited text no. 26
    
27.
Zhu ZG, Chen Y. Impacts of baduanjin qigong of sitting style on lung function in COPD patients. World J Integrated Tradit Chin Western Med 2014;9:846-8.  Back to cited text no. 27
    
28.
Sun YP. Clinical Studay on Observation on Effective of Health-Qigong “Baduanjin” On Stable Patients with Grade - Chronic Bbstructive Pulmonary Disease. Jilin: Changchun University of Traditional Chinese Medicine; 2014.  Back to cited text no. 28
    
29.
Liu SR, Chen YF. Clinical study on the improvement of 6 min walking distance in stable patients with chronic obstructive pulmonary disease by health Qigong Baduanjin. Sichuan Med J 2013;34:1090-2.  Back to cited text no. 29
    
30.
30. Huang F, Gao Y. Application of baduanjin combined with respiratory training in rehabilitation of patients with chronic obstructive pulmonary disease in community. Nurs Pract Res 2016;13:146-7.  Back to cited text no. 30
    
31.
Guo XJ, Cao C, Chen N, Yan X, Zhang HL. Effects of eight-section brocadeon improving extrapulmonary performance in the community elderly table chronic obstructive pulmonary disease patients. Chin J Pract Nurs 2016;32: 2291-5.  Back to cited text no. 31
    
32.
Deng YF. Effect of Baduanjin Single Lift on Pulmonary Rehabilitation in Patients with Chronic Obstructive Pulmonary Disease with Lung and Spleen Qi Deficiency Syndrome. Fuzhou: Fujian University of traditional Chinese Medicine; 2014.  Back to cited text no. 32
    
33.
Chen JX, Deng YF, Chen Q, Zhang WX, Deng LJ. Effect of the third formula of baduanjin on quality of life and exercise endurance in patients with chronic obstructive pulmonary disease with lung and spleen qi deficiency syndrome. Rehabil Med 2015;25:13-7.  Back to cited text no. 33
    
34.
Ye XP. Effect of baduanjin on quality of life in elderly patients with stable chronic obstructive pulmonary disease. Today Nurse (mid-issue) 2016:80-2.  Back to cited text no. 34
    
35.
Yang BY. Application of baduanjin tiao nourishing lung, spleen and kidney method in auxiliary therapy of COPD patients. Int J Nurs 2016;35:2357-9.  Back to cited text no. 35
    
36.
Huang BJ, Yao QP, Zhu YM. Clinical observation of health qigong ba duan jin on stable chronic obstructive pulmonary disease with lung and spleen deficiency. Hubei J Tradit Chin Med 2017;39:4-6.  Back to cited text no. 36
    
37.
Zhu ZG, Fang S, Liang BH, Lin J, Shi XX, Chen Y. The effect of Baduanjin of sitting style to the airway inflammatory response of patients with severe stable COPD. J Nurs Adm 2017;17:55-7.  Back to cited text no. 37
    
38.
Xue GW, Feng CL, Yao XQ, Qi Y, Wang YN, Ma J. Efficacy of fitness qigong ba duan Jin in pulmonary rehabilitation of patients with chronic obstructive pulmonary disease at stable stage. J Beijing Univer Tradit Chin Med 2015;38:139-44.  Back to cited text no. 38
    
39.
Liu SR, Chen YF. Clinical study on the effect of fitness qigong Baduanjin on stable patients with chronic obstructive pulmonary disease. Sichuan Med J 2014;35:1481-2.  Back to cited text no. 39
    
40.
Chen YF, Liu SR, Li R, Zhang X, Zhou L, Yang GF, et al. Effect of health qigong baduanjin on the pulmonary function of patients with chronic obstructive pulmonary disease in stable period. Chin Med Modern Distance Education China 2015;13:16-8.  Back to cited text no. 40
    
41.
Liu SR, Chen YF. Clinical study on theefficacy of health qigong ba duan jin on improving lung function of patients with chronic obstructive pulmonary disease in its stable period. West China Med J 2012;27:1248-50.  Back to cited text no. 41
    
42.
Liang XL. Effect of eight-stage single lift rehabilitation exercise on rehabilitation of patients with chronic obstructive pulmonary disease. Nurs Pract Res 2016;13:156-7.  Back to cited text no. 42
    
43.
Cao C, Guo XJ, Chen N, Yan X, Zhang HL. Research of effects of eight-section brocade of TCM on treating anxiety and depression in the elderly patients with lung-spleen qi deficiency in stable period of COPD. J Liaoning Univer Tradit Chin Med 2016;18:120-3.  Back to cited text no. 43
    
44.
Guo JC, Gao YF, Xie HX, Fang SR, Chen GY. Effect of baduanjin exercise on rehabilitation of stable patients with chronic obstructive pulmonary disease. J Qilu Nurs 2016;22:97-8.  Back to cited text no. 44
    
45.
Guo JC. Analysis of therapeutic effect of traditional heath method baduanjin on lung rehabilitation in stable patients with COPD. J Shandong Med Coll 2016;38:171-4.  Back to cited text no. 45
    
46.
Chen JX, Deng LJ. Rehabilitation effect of traditional six-character formula breathing exercise on stable patients with COPD. Chin J Rehabil Med 2009;24:944-5.  Back to cited text no. 46
    
47.
Zhao DX, Zhang NN. Study on the rehabilitation effect of six-word formula breathing exercise combined with oxygen therapy on COPD complicated with spontaneous pneumothorax. China Modern Med 2011;18:156-7.  Back to cited text no. 47
    
48.
Zheng YY. The Research of Rehabilitation Effect on Patients with COPD for Lung and Kidney Deficiency type by Treating Winter Disease in Summer Acupoint Sticking Therapy Combined with the Six Strategics Skills Training. Nanjing: Nanjing University of traditional Chinese Medicine; 2015.  Back to cited text no. 48
    
49.
Xiao CM, Zhuang YC. Efficacy of Liuzijue Qigong in individuals with chronic obstructive pulmonary disease in remission. J Am Geriatr Soc 2015;63:1420-5.  Back to cited text no. 49
    
50.
Zhu Z, Zhang SQ. Effect of heath qigong lung rehabilitation on respiratory function and quality of Life in stable patients with chronic obstructive pulmonary disease. Jilin J Tradit Chin Med 2012;32:803-4.  Back to cited text no. 50
    
51.
Chen JX. The effects of six-character formula respiratory gymnastics on quality of life in stable patients with COPD. Chin J Natural Med 2009;11:412-4.  Back to cited text no. 51
    
52.
Lan Y, Han X, Wang YY, Deng W, Liu SB, Feng YC. Impacts of the combined therapy of tiotropium bromide and medical exercise of the six-character formula on the living quality and pulmonary function in the patients of chronic obstructive pulmonary disease at the stable stage. World J Integrated Tradit Chin Western Med 2016;11:1369-71.  Back to cited text no. 52
    
53.
Wang ZW, Yang PL, Tang J. The randomized controlled trial of TCM pulmonary rehabilitation exercise on COPD patients pulmonary function and acute exacerbation rate. J Emerg Tradit Chin Med 2013;22:23-4.  Back to cited text no. 53
    
54.
Zhu Z. Effect of health qigong on respiratory function in 61 patients with stable COPD. J Nanjing Univer Tradit Chin Med 2011;27:235-7.  Back to cited text no. 54
    
55.
GB/T 21709.9-2008, Technical Practice of Acupuncture and Moxibustion Part 9: Acupoint Application [S].  Back to cited text no. 55
    
56.
Xia LQ, Peng Y, Tan YX, Li LR. Influence of peitushengj in acupoint sticking on quality of life and lung function chronic obstructive pulmonary disease patients. Chin Nurs Res 2016;30:2805-7.  Back to cited text no. 56
    
57.
Du LJ, Li FS, Yang HQ, Xu D, Yang WJ. Effect of Pingchuan paste on pulmonary function and quality of life in patients with chronic obstructive pulmonary disease. Chin J Exp Tradit Med Formulae 2013;19:319-22.  Back to cited text no. 57
    
58.
Xiao Y, Zhang L, Shao W. Effect of Jinshui Fuzheng plaster on quality of life and pulmonary function in patients with stable COPD. Oriental Diet Ther Health Care 2015;5:197-8.  Back to cited text no. 58
    
59.
Xu SQ, Chen Q. Effect of acupoint application of buxu pingchuan ointment on quality of life in stable patients with chronic obstructive pulmonary disease. J Pract Tradit Chin Med 2014,30:171-3.  Back to cited text no. 59
    
60.
Kong DD. Effect of acupoint application on quality of life in stable phase of patients with chronic obstructive pulmonary disease. Chinas Naturopathy 2015;23:23-4.  Back to cited text no. 60
    
61.
Xu YL, Zhao KM, Qu NN, Deng L, Zheng X. Clinical study of yongquan acupoint application in the treatment of stable chronic obstructive pulmonary disease. Liaoning J Tradit Chin Med 2008;35:1055-6.  Back to cited text no. 61
    
62.
Xie XQ, Wei SZ, Li SE. Observation on therapeutic effect of acupoint application of Kechuan formula on stable stage of chronic obstructive pulmonary disease. Shanxi J Tradit Chin Med 2012;33:941-3.  Back to cited text no. 62
    
63.
Shi KH, Zhe Z, Xiong BD, Yu X. Observation of clinical efficacy on chronic obstructive pulmonary disease treated with point application of kechuan san. World J Integrated Tradit Chin Western Med 2009;4:195-7.  Back to cited text no. 63
    
64.
Shu Y. Clinical observation of internal and external application in the treatment of COPD 37 in remission stage. Jiangsu J Tradit Chin Med 2004;25:20-1.  Back to cited text no. 64
    
65.
Xu XY, Zhou X, Liu W, Chen QW. Clinical study on acupoint application of zhike pingchuan ointment combined with western medicine in the treatment of 36 cases of chronic obstructive pulmonary disease. J Guiyang Coll Tradit Chin Med 2005;27:38-40.  Back to cited text no. 65
    
66.
Zhou SL, Li J, Tong JB, Li ZG. Effect of Chinese medicine acupoint sticking on COPD stabilization syndrome with lung and kidney qi deficiency and the quality of Life. J Liaoning Univer Tradit Chin Med 2016;18:84-7.  Back to cited text no. 66
    
67.
Chen YH. Observation on the efficacy of acupoint application of traditional Chinese medicine combined with drug atomization inhalation in the treatment of chronic obstructive pulmonary disease. Modern Med J China 2012;14:92-3.  Back to cited text no. 67
    
68.
Li YN. Clinical Study on Treatment Of Chronic Obstructive Pulmonary Disease in Remission Stage with Acupoint Sticking of Traditional Chinese Medicine-Application of Acupoint Sticking of Traditional Chinese Medicine in the Treatment of Chronic Obstructive Pulmonary Disease in Remission Stage. Guiyang: Guiyang University of Traditional Chinese Medicine; 2012.  Back to cited text no. 68
    
69.
Liu HY, Xiong YY, Li L, Ye Y. Clinical observation of acupoint application in improving pulmonary function in stable stage of chronic obstructive pulmonary disease. China Health Care Nutr 2012;13:361-2.  Back to cited text no. 69
    
70.
Li RT. Observation on the efficacy of acupoint application of traditional Chinese medicine combined with drug atomization inhalation in the treatment of chronic obstructive pulmonary disease. Yiayao Qianyan 2016;6:355.  Back to cited text no. 70
    
71.
Li J. Effect of acupoint application of traditional Chinese medicine on pulmonary function in patients with stable chronic obstructive pulmonary disease. Acta Chin Med 2016;31:787-90.  Back to cited text no. 71
    
72.
Deng JY. 45 cases of chronic obstructive pulmonary disease treated by acupoint application combined with drugs. Chin J Gerontol 2012;32:5025-6.  Back to cited text no. 72
    
73.
Ahmad C, Aziz N. Effect of acupoint application of traditional Chinese medicine combined with routine western medicine on inflammatory factors and immune function in elderly patients with chronic obstructive pulmonary disease. Modern J Integrated Tradit Chin Western Med 2016;25:3393-6.  Back to cited text no. 73
    
74.
Ji WJ, Lai LY. Clinical observation on acupoint application of traditional Chinese medicine in the treatment of chronic obstructive pulmonary disease. China Higher Med Educ 2014:133-4.  Back to cited text no. 74
    
75.
Xie HH. Observation on the Therapeutic effect of acupoint application of traditional Chinese medicine combined with drugs in the treatment of acute attack of chronic obstructive pulmonary disease. Nei Mongol J Tradit Chin Med 2017;36:98-9.  Back to cited text no. 75
    
76.
Chen WZ, Zhang Z, Chen LG, Chen J. A comparative study of acupoint application in the treatment of acute exacerbation of chronic obstructive pulmonary disease (COPD) with turbid phlegm. Nei Mongol J Tradit Chin Med 2016;35:79-81.  Back to cited text no. 76
    
77.
Zhu XL. Clinical Observation on Therapeutic Effect of Acupoint Application on Patients with Pulmonary and Kidney Qi Deficiency of Chronic Obstructive Pulmonary Disease. Guiyang: GuiYang college of Traditional Chinese Medicine; 2010.  Back to cited text no. 77
    
78.
Li ZY, Tian CY, Gao FL. Clinical study on treating sixty patients with COPD at stable stage by point application of Chinese medicine. China J Tradit Chin Med Pharm 2015;30:4186-8.  Back to cited text no. 78
    
79.
Li F. Effect evaluation and nursing of acupoint application in stable period of COPD. J Community Med 2013;11:45-7.  Back to cited text no. 79
    
80.
Guan QH, Wu WP, Tian XY, Su HP, Jin CX, Feng CL, et al. Clinical observation of yiqi huoxue huatan paste in the prevention and treatment of chronic obstructive pulmonary disease. Chin J Informat Tradit Chin Med 2009;16:60-1.  Back to cited text no. 80
    
81.
Hu FZ, Li XR, Sun HH, Wu ZL, Zhang C, Huo F. Research on the efficacy and safety of acupoint application combined with salmeterol and fluticasone propionate powder in the treatment of patients with chronic obstructive pulmonary disease. China Med Herald 2016;13:142-5.  Back to cited text no. 81
    
82.
Wang L, Li GQ, Bian YJ, Lin YX, Lin JT, Zhang JH. Effect of xiaochuan acupoint adhesive plaster on chronic obstructive pulmonary disease in stable stage: A clinical study on 64 cases. J Tradit Chin Med 2011;52:1831-5.  Back to cited text no. 82
    
83.
Fu KL, Lin K. Clinical observation on point application treating 80 patients of chronic obstructive pulmonary diseases. J Tradit Chin Med 2015;56:948-52.  Back to cited text no. 83
    
84.
Yang YW, Yang J, Wang PD, Zhang B, He Y, Wang SF. Clinical observation of shuangxi kechuan ointment in the treatment of stable chronic obstructive pulmonary disease of lung and kidney qi deficiency type. Beijing J Tradit Chin Med 2017;36:307-9.  Back to cited text no. 84
    
85.
Ding RM, Pan HF, Liu JT, Liu XM. Efficacy of xiao chuan paste point application in stable chronic obstructive pulmonary disease and effect on airway inflammation. World Chin Med 2016;11:2669-72.  Back to cited text no. 85
    
86.
Guo MZ, Huang JC, Yang ZX, Wu Q, Cao Y, Zhang LN. A clinical study on the syndrome differentiation acupoint sticking treatment on the stable phase of chronic obstructive pulmonary disease. Clin J Tradit Chin Med 2015;27:491-5.  Back to cited text no. 86
    
87.
Chen X, Wang WT, Shi MY, Zhang W. Evaluation of acupoint application of Kechuan dressing in the treatment of stable chronic obstructive pulmonary disease of lung and kidney qi deficiency type. Beijing J Tradit Chin Med 2017;36:303-6.  Back to cited text no. 87
    
88.
Pu MZ. Observation on therapeutic effect of acupoint application combined with fuzheng capsule on stable stage of COPD with deficiency of lung and kidney. Shanxi J Tradit Chin Med 2010;26:40-1.  Back to cited text no. 88
    
89.
Tao HQ, Li J, An WH, Zhao XY. Clinical observation on acupoint application combined with western medicine in the treatment of 50 cases of chronic obstructive pulmonary disease in remission stage. J Sichuan Tradit Chin Med 2013;31:117-8.  Back to cited text no. 89
    
90.
Jia YY, Lei X, Yu X, Chen X. Observation on the therapeutic effect of acupoint application therapy on patients with COPD. Clin Res Pract 2016;1:134-5.  Back to cited text no. 90
    
91.
Meng ZP. Study on the effect of acupoint application of traditional Chinese medicine in the treatment of chronic obstructive pulmonary disease. J Bethune Med Sci 2016;14:481-2.  Back to cited text no. 91
    
92.
Yang YZ, Guo MZ, Liang W, Liu YF, Cao Y. A clinical study on the point application in treating chronic obstructive pulmonary disease in stable phase. Liaoning J Tradit Chin Med 2011;38:1192-4.  Back to cited text no. 92
    
93.
Wang W, Zheng CX, Zhang NZ. Clinical observation on 90 cases of chronic obstructive pulmonary disease treated with acupoint application. J Emerg Tradit Chin Med 2009;18:186-7.  Back to cited text no. 93
    
94.
Liu MY, Li YF, Qiu XH, Gao Y, Jiao Y. Clinical observation on the acupoint application with warming yang to reduce phlegm treating 110 patients with the stable phase of chronic obstructive pulmonary disease. J Tradit Chin Med 2016;57:1670-3.  Back to cited text no. 94
    
95.
Li C, Yao Y, Zhang SM, Sun YH. Observation on therapeutic effect and nursing care of traditional Chinese medicine acupoint paste in the treatment of chronic obstructive pulmonary disease. Chin Foreign Women Childrens Health 2011;19:19-20.  Back to cited text no. 95
    
96.
Huang PF, Wang S, Zhao ZF. The clinical observation of winter disease summer therapy applicator combined with western medicine in treatment of 30 patients with stable COPD. Chin Foreign Med Res 2014;12:64-6.  Back to cited text no. 96
    
97.
Dai LQ, Chen XL, Cai YM, Gao X, Di KX, Hu YJ. Observation on the therapeutic effect of acupoint application in winter disease and summer treatment on stable stage of chronic obstructive pulmonary disease. Peoples Military Surgeon 2016;59:1038-9.  Back to cited text no. 97
    
98.
Tan GB, Hu XJ, Yin TL, Bo ZP. Effects of acupoint sticking therapy on quality of life in patients with steady chronic obstructive disease. Guangming J Chin Med 2011;26:1585-7.  Back to cited text no. 98
    
99.
Li GQ, Wang L, Lin YX, Lin JT, Bian YJ, Zhang JH, et al. Randomized controlled trial of xiaochuangao acupoint paste to treat chronic obstructive pulmonary disease in the stable phase: treating winter diseases in summer. Chin J Integrated Tradit Western Med 2011;31:1187-90.  Back to cited text no. 99
    
100.
Wu RH, Li GQ, Bian YJ, Li GX, Li H, Wang L, et al. Evaluation of therapeutic effect of winter disease xia zhi xiaochuan ointment on stable stage of chronic obstructive pulmonary disease [C]. // Chinese Society of Integrated Chinese and Western Medicine. Proceedings of the 12th National Symposium on Integrated Chinese and Western Medicine for the Prevention and Treatment of respiratory diseases. 2012:609-15.  Back to cited text no. 100
    
101.
Yang CY, Fu Y, Zhang AH, Wu HB, Zhang PY, Liu Q. Clinical study on comprehensive evaluation of curative effect of “Internal and External Treatment of Winter Disease in Summer”on stability of COPD. Guangming J Chin Med 2017;32:700-2.  Back to cited text no. 101
    
102.
Mao LN, Luo GW, Wan J, Huang YL, Yang S, Mao XM, et al. Observation for 3 Years on prognosis of stable COPD patients treated “Sanfu Stikers”. Guangming J Chin Med 2014;29:1682-3.  Back to cited text no. 102
    
103.
Li ZY, Wang T, Teng C. Clinical observation of sanfu paste in the treatment of stable chronic obstructive pulmonary disease. J Emerg Tradit Chin Med 2017;26:112-4.  Back to cited text no. 103
    
104.
Liu J, Zhang CL, Xu DX. Impacts of acupoint sticking in Dog Days on systenic inflammation and prognosis of COPD patients*. Progress Modern Biomed 2014;14:4123-26.  Back to cited text no. 104
    
105.
Fan C, Zhou YH. Clinical study on sanfutian acupoint application combined with jinshuibao oral administration in the treatment of 30 cases of stable COPD of lung and kidney deficiency type. Jiangsu J Tradit Chin Med 2011;43:69-70.  Back to cited text no. 105
    
106.
Chen X, Mao B, Che DY, Liu J, Wen MC. Clinical study of winter disease cured in summer by acupoint sticking therapy of traditional Chinese medicine treating chronic obstructive pulmonary disease in catabatic period. J Emerg Tradit Chin Med 2014;23:1072-4.  Back to cited text no. 106
    
107.
Wu ZX, Chen DP, Zhang HF, Dong YQ, Xia Y, Zhao J, et al. Chronic obstructive pulmonary disease on treating winter disease in summer for acupoint sticking therapy. J Sichuan Tradit Chin Med 2015;33:161-3.  Back to cited text no. 107
    
108.
Zhou DX, Hu M. Observation on stable period of sanfu patch in the treatment of chronic obstructive pulmonary disease. Clin Educ General Pract 2015;13:77-8.  Back to cited text no. 108
    
109.
Li LG, Li HH, Zhang PK, Yu XQ, Li JS. Clinical effects of Shu-lung post with different stimulation intensities on chronic obstructive pulmonary disease at stable stage. Modernization Tradit Chin Med Materia Med World Sci Technol 2014;16:2415-9.  Back to cited text no. 109
    
110.
Li HH, Li LG, Yu XQ, Li JS, Zhang HL. Effects on quality of life for stable chronic obstructive pulmonary disease by Shu-Fei paste for different sticking time. Modernization Tradit Chin Med Materia Medica World Sci Technol 2014;16:2605-10.  Back to cited text no. 110
    
111.
Zhang PK, Yu XQ, Li JS, Li SY, Wang MH, Wang HF, et al. Analysis of application time in 112 patients with stable chronic obstructive pulmonary disease treated with shu-fei paste. Tradit Chin Med Res 2013;26:63-6.  Back to cited text no. 111
    
112.
Li JS, Li SY, Yu XQ, Xie Y, Wang MH, Li ZG, et al. Bu-Fei Yi-Shen granule combined with acupoint sticking therapy in patients with stable chronic obstructive pulmonary disease: A randomized, double-blind, double-dummy, active-controlled, 4-center study. J Ethnopharmacol 2012;141:584-91.  Back to cited text no. 112
    
113.
GB/T 21709.20-2009, Standard Standardized Manipulation of Acupuncture and Moxibustion, Part 20, Basic Needling Method of Filiform Needle.  Back to cited text no. 113
    
114.
GB/T 21709.11-2009, Standard Standardized Manipulation of Acupuncture and Moxibustion, Part 11, Electroacupuncture.  Back to cited text no. 114
    
115.
Deng CH, Zhang DT, Wang NW. 22 cases of stable chronic obstructive pulmonary disease were treated with abdominal acupuncture. Yunnan J Tradit Chin Med Materia Med 2016;37:73-4.  Back to cited text no. 115
    
116.
Tong J, Guo YM, He Y, Li GY, Chen F, Yao H. Regulatory effects of acupuncture on exercise tolerance in patients with chronic obstructive pulmonary disease at stable phase: A randomized controlled trial. Zhongguo Zhen Jiu 2014;34:846-50.  Back to cited text no. 116
    
117.
Wang Z, Chen YH, Xie Y. Effect of acupuncture for rehabilitation treatment of patients with chronic obstructive pulmonary disease. Nurs Res China 2017;31:969-70.  Back to cited text no. 117
    
118.
Ge Y. Study on the Effect of Acupuncture on Improving the Motor Ability of Peripheral Skeletal Muscle in Patients with Stable Chronic Obstructive Pulmonary Disease. Guangzhou: Guangzhou Medical University; 2016.  Back to cited text no. 118
    
119.
Guo YM, Tong J, Yao H. Effect of acupuncture on respiratory function of stable chronic obstructive pulmonary disease. J Guangzhou Univer Tradit Chin Med 2013;30:658-63.  Back to cited text no. 119
    
120.
Liu LJ, Shi MY, Song XM, Zhang W, Jiang CJ. Clinical effect observation on acupuncture for chronic obstructive pulmonary disease. J Acupuncture Tuina Sci 2015;13:306-11.  Back to cited text no. 120
    
121.
Feng J, Wang X, Li X, Zhao D, Xu J. Acupuncture for chronic obstructive pulmonary disease (COPD): A multicenter, randomized, sham-controlled trial. Medicine (Baltimore) 2016;95:e4879.  Back to cited text no. 121
    
122.
Coyle ME, Shergis JL, Huang ET, Guo X, Di YM, Zhang A, et al. Acupuncture therapies for chronic obstructive pulmonary disease: A systematic review of randomized, controlled trials. Altern Ther Health Med 2014;20:10-23.  Back to cited text no. 122
    
123.
Suzuki M, Namura K, Ohno Y, Tanaka H, Egawa M, Yokoyama Y, et al. The effect of acupuncture in the treatment of chronic obstructive pulmonary disease. J Altern Complement Med 2008;14:1097-105.  Back to cited text no. 123
    
124.
Deering BM, Fullen B, Egan C, McCormack N, Kelly E, Pender M, et al. Acupuncture as an adjunct to pulmonary rehabilitation. J Cardiopulm Rehabil Prev 2011;31:392-9.  Back to cited text no. 124
    
125.
Li XY, Peng L, Cao JZ, Yang AH, Huang C, Liu XJ. Clinical study of acupuncture combined with medicine in the treatment of moderate and severe stable chronic obstructive pulmonary disease. Continuing Med Educ 2016;30:158-60.  Back to cited text no. 125
    
126.
Guan W, Shang F, Wang Y. The effcet of abdominal acupuncture on respiratory muscle fatigue in acute exacerbation of chronic obstructive pulmonary disease. J Emerg Tradit Chin Med 2016;25:594-7.  Back to cited text no. 126
    
127.
Gao Y, Ma Y, Sun L, Li DM, Zhang Y, Li SX. Study on therapeutic effect and evaluation of acupuncture in acute exacerbation of chronic obstructive pulmonary pisease. Chin J Clin 2014;42:42-4.  Back to cited text no. 127
    
128.
Chen ZY. The Study of the Clinical Effect of Pulse Acupuncture Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease Patients. Guangzhou: Guangzhou University of Chinese Medicine; 2013.  Back to cited text no. 128
    
129.
Cao L. The Clinical Research of Acupuncture Combined with Auricular Acupuncture for Patients with Acute Exacerbation of COPD to Improve their Quality of Life and Pulmonary Function. Wulumuqi: Xinjiang Medical University; 2012.  Back to cited text no. 129
    
130.
Liu H. Acupuncture combined with acupoint application improves symptoms, daily life quality and lung function in chronic obstructive pulmonary disease patients during acute exacerbation. Zhen Ci Yan Jiu 2016;41:251-4.  Back to cited text no. 130
    
131.
Zhang YM, HL, Qin SJ, Wei QX, Wei SF, Zhuo B. Effect of acupuncture and moxibustion on pulmonary function in patients with acute attack of chronic obstructive pulmonary disease. J New Chin Med 2016;48:66-8.  Back to cited text no. 131
    
132.
GB/T 21709.1-2008, Technical Practice for Acupuncture and Moxibustion part 1: Moxibustion; 2008.  Back to cited text no. 132
    
133.
Liu SR. Clinical efficacy of Chinese medicine moxibustion on stable chronic obstructive pulmonary disease. Pract J Cardiac Cerebral Pneumal Vascular Dis 2015;23:150-52.  Back to cited text no. 133
    
134.
Gao TY. Moxibustion Medicine Combined with the Effect of Life Quality in Patients with Chronic Obstructive Pulmonary Disease Stabilization. Guangzhou: Guangzhou University of Chinese Medicine; 2013.  Back to cited text no. 134
    
135.
Wen X, Chen CY, Liang MA. Clinical research of the moxa cone moxibustion for improving life quality of chronic obstructive pulmonary disease patients in the tranquilization period. World Chin Med 2013;8:658-60.  Back to cited text no. 135
    
136.
Wang WH, Qiu YH, Huang JM Chen MJ. Observation on therapeutic effect and nursing of moxibustion in stable stage of chronic obstructive pulmonary disease. Nei Mongol J Tradit Chin Med 2016;35:69-70.  Back to cited text no. 136
    
137.
Zhang P. Evaluation of Therapeutic Effect of Yifei Moxibustion on Chronic Obstructive Pulmonary Disease and its Effect of the Regulation Of Serum Levels of IL-32/caspase-1. Zhengzhou: Henan University of Chinese Medicine; 2016.  Back to cited text no. 137
    
138.
Qian H. Evaluate the Efficacy of Moxibustion Therapy Yifei Stable COPD Lung and Kidney Qi Deficiency. Zhengzhou: Henan University of Chinese Medicine; 2015.  Back to cited text no. 138
    
139.
Li N. Efficacy on Chronic Obstructive Pulmonary Disease Patients at Stable Stage Treated with YiFei Moxibustion. Zhengzhou: Henan University of Chinese Medicine; 2015.  Back to cited text no. 139
    
140.
Specialty Committee of Heat-sensitive Moxibustion of WFCMS. Standardized manipulations of heat-sensitive moxibustion therapy. World Chin Med 2017;12:1959-64.  Back to cited text no. 140
    
141.
Gong QH, Huang C, Li C, Zeng XB, Zeng MS. Clinical observation of heat-sensitive moxibustion in the treatment of chronic obstructive pulmonary disease. Chin Gen Pract Nurs 2015;13:3468-70.  Back to cited text no. 141
    
142.
Wu LM, Xue LJ, Wu SK. Clinical observation on 31 cases of chronic obstructive pulmonary disease treated by heat-sensitive moxibustion combined with self-made shenge powder. Guiding J Tradit Chin Med Pharm 2014;20:82-4.  Back to cited text no. 142
    
143.
Wang XY. Clinical effective observation on treating chronic obstructive pulmonary disease by Remin acupuncture. Clin J Chin Med 2011;3:11-3.  Back to cited text no. 143
    
144.
Yu XQ, Li JS, Li SY, Xie Y, Wang MH, Zhang HL, et al. Functional and psychosocial effects of pulmonary Daoyin on patients with COPD in China: Study protocol of a multicenter randomized controlled trial. J Integr Med 2013;11:140-6.  Back to cited text no. 144
    
145.
Zhang HL, Li JS, Yu XQ, Li SY, Halmurat U, Xie Y, et al. An evaluation of activity tolerance, patient-reported outcomes and satisfaction with the effectiveness of pulmonary daoyin on patients with chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2017;12:2333-42.  Back to cited text no. 145
    




 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Scope
Normative References
Terms and Defini...
Types of Disease...
Diseases Assessment
Guidelines Devel...
Chinese Medicine...
Appendix 1 Descr...
References

 Article Access Statistics
    Viewed97    
    Printed6    
    Emailed0    
    PDF Downloaded16    
    Comments [Add]    

Recommend this journal