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Guidelines on Acupuncture and Moxibustion Intervention for COVID-19

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. It has been included in the infectious diseases of class B prescribed in the Law of the People's Republic of China on Prevention and Treatment of Infectious Diseases, and is managed according to class A infectious diseases.

COVID-19 belongs to the category of "epidemic" disease in traditional Chinese medicine. For thousands of years, traditional Chinese medicine has accumulated rich experience in the long-term medical practice of fighting against epidemics. As an important part of traditional Chinese medicine, acupuncture-moxibustion has its own distinctive characteristics and unique advantages, and has made important contributions in the history of anti-epidemic in China. There are related records of acupuncture and moxibustion for epidemic prevention and treatment in classical literatures of TCM. For example, Sun Simiao, doctor in the Tang dynasty, put forward in his book Beiji Qianjin Yao Fang (Prescription Worth a Thousand in Gold for Every Emergency), "Those who travel to infectious disease areas often need moxibustion and form purulent moxibustion, so they will not be infected by malaria and warm malaria." In Compendium of Materia Medica, Li shizhen, physician in the Ming dynasty, elaborated, "Artemisia argyi... Moxibustion can smooth the meridian patency, cure hundreds of diseases, and recure people who suffer from long-term illness." These two books both record that acupuncture can prevent and treat infectious diseases. 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. With further understanding of COVID-19 and accumulation of clinical experience in acupuncture and moxibustion therapy, according to Diagnosis and Treatment Plan for COVID-19 (trial version sixth) and Suggestions on TCM rehabilitation during convalescence of COVID-19 (trial version) issued by the General Office of National Health Commission and the General Office of National Administration of Traditional Chinese Medicine, we formed Guidelines on Acupuncture and Moxibustion Intervention for COVID-19 (second edition) for medical workers in acupuncture implementation and guidance of patients at home.

1. Principles of Acupuncture Intervention

ⅰ) During the epidemic, acupuncture intervention work should be subordinated to the overall situation and carried out methodically under the guidance of medical institutions at all levels. During acupuncture treatment, 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. At the same time, the characteristics of acupuncture should be fully considered to make the acupuncture intervention more pertinent. COVID-19 is one of the "five epidemics" and is generally susceptible. "all are easy to be infected, regardless of age, and the symptoms are similar." The epidemic came into human body through mouth and nose, and most of them invade the lung first, then the spleen, stomach, and large intestine, and the lesions were relatively mild; a small proportion of them pass to the pericardium, liver, and kidney, and became critically ill. The disease changes rapidly and has a clear core pathogenesis and syndrome evolution. Acupuncture will stimulate the acupoints on the limbs through the meridian internal viscera and outer collateral branches, and directly smash the nidus to stimulate and strengthen the viscera and its Qi, so that the invading evil of epidemics can be separated and expelled. Acupuncture is also to stimulate the Qi while improving self-protection of the viscera, and to reduce the damage of the organs caused by the epidemic.

ⅲ) The acupuncture intervention, according to the evolution of the pathogenesis, will be divided into three phases - 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. We shall create suitable conditions and strive to play the role of acupuncture in all clinical stages. Acupuncture can be used together with herbal medicine in the clinical treatment phase to play the synergy role of acupuncture. Treatment of the recovering patients should give full play the core role of acupuncture. We recommended to establish new acupuncture-based rehabilitation clinics for COVID-19.

ⅳ) The choice of acupoints and methods draws on the evidence from ancient literatures, modern clinical and basic researches, and incorporates acupuncture research results shown in previous studies of improving lung function, regulating innate immunity, anti-inflammatory and proinflammatory factors, activating the vagal-cholinergic anti-inflammatory pathway and regulating the respiratory system and overcoming the damage of lung inflammation.

ⅴ) Under the guidance of acupuncture professionals, patients should be encouraged to carry out moxibustion, acupoint application, acupoint massage, etc., by using the Internet, mobile terminals and related APPs, WeChat, etc., to achieve auxiliary disease treatment and promote physical and mental rehabilitation. Pay attention to the doctor-patient communication and follow-up, as well as the collection, summary, analysis of diagnosis and treatment data in a timely and wholly order.

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2. Methods of acupuncture and moxibustion intervention

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

Objective: to stimulate the vital Qi and the functions of lung and spleen, and to dispel, separate and remove the pathogens of pestilence, to enhance the defense of viscera against the pathogens.

Main points: (1) Fengmen (BLl2), Feishu (BLl3), Pishu (BL20); (2) Hegu (LI4), Quchi (LI11), 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:

  • symptoms combined with fever, dry throat, dry cough, match with Dazhui (GVl4), Tiantu (CV22), Kongzui (LU6);

  • symptoms combined with nausea and vomiting, loose stool, tongue fat coating greasy, soft (soggy) pulse, match with Zhongwan (CVl2), Tianshu (ST25), Fenglong (ST40);

  • symptoms combined with fatigue, weak, and inappetence, match with Zhongwan (CVl2), the 4 points around umbilicus (1 inch each side from umbilicus), Pishu (BL20);

  • symptoms combined with clear runny nose, soreness on shoulder and back, tongue pale coating white, slow pulse, match with Tianzhu (BLl0), Fengmen (BLl2), Dazhui (GVl4).

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

Objective: to stimulate the vital Qi of lung and spleen, to protect the viscera and reduce damage, to dispel the perverse of pathogens, and to “reinforce the earth to generate metal /gold”, to stop the tendency of the disease, lighten the mood, to enhance the confidence to overcome the disease.

Main acupoints: (1) Hegu (LI4), Taichong (LR3), Tiantu (CV22), Chize (LU5), Kongzui (LU6), Zusanli (ST36), Sanyinjiao (SP6); (2) Dazhu (BLll), Fengmen (BLl2), Feishu (BLl3), Xinshu (BLl5), Geshu (BL17); (3) Zhongfu (LU1), Danzhong (CVl7), Qihai (CV6), Guanyuan (CV4), Zhongwan (CVl2); 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:

  • symptoms combined with longtime fever, match with Dazhui (GVl4), Quchi (LI11); or ear tip and fingertip bloodletting;

  • symptoms combined with chest tightness, shortness of breath, match with Neiguan (PC6), Lieque (LU7); or Juque (CVl4), Qimen (LR14), Zhaohai (KI6);

  • symptoms combined with coughing up phlegm, match with Lieque (LU7), Fenglong (ST40), Dingchuan (EXB1);

  • symptoms combined with diarrhea, loose stools, match with Tianshu (ST25), Shangjuxu (ST37);

  • symptoms combined with coughing up sticky and/or yellow phlegm, constipation, match with Tiantu (CV22), Zhigou (TE6), Tianshu (ST25), 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 (BLl3), Tianshu (ST25), Fujie (SPl4), Neiguan (PC6).

ⅲ) Acupuncture and moxibustion intervention during convalescence

Objective: to remove residual virus, restore vitality, to repair functions of viscera such as lung and spleen.

Main points: Neiguan (PC6), Zusanli (ST36), Zhongwan (CVl2), Tianshu (ST25), Qihai (CV6).

  1. 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. For those with obvious symptoms such as chest tightness, shortness of breath, match with Danzhong (CVl7), Feishu (BLl3), Zhongfu (LU1). For those with obvious spleen and stomach symptoms such as indigestion and diarrhea, match with Shangwan (CVl3), 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. For those with obvious weakness and shortness of breath, match with Danzhong (CVl7), Shenque (CV8). For those with obvious dry mouth and thirst, match with Taixi (KI3), Yangchi (TE4). For those with obvious palpitations, match with Xinshu (BLl5), Jueyinshu (BL14). For those with excessive sweating, match with Hegu (LI4), Fuliu (KI7), Zusanli (ST36). For those with insomnia, match with Shenmen (HT7), Yintang (GV29), Anmian(EX), 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 (BLl3), Pishu (BL20), Xinshu (BLl5), Geshu (BL17), Shenshu (BL23), Zhongfu (LU1), Danzhong (CVl7). For those with phlegm blocked, match with Fenglong (ST40) and Dingchuan (EXB1).

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.

3. 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 (LI4), 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 (ST36), Neiguan (PC6), Qihai (CV6), Guanyuan (CV4), Feishu (BLl3), Fengmen (BLl2), Pishu (BL20), Dazhui (GVl4).

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, wormwood, mint, houttuynia, indigowoad leaf, eupatorium fortunei, acorus tatarinowii, polygonum flaccidum, radix curcumae, clove, 15g each, together with 3g of borneol to make a decoction. Pour the decoction into a foot bath, add some warm water, wait until it cools down to about 38 ~ 45 ℃, soak for about 30 minutes.

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This guidance is formulated by the expert group of the China Association of Acupuncture-Moxibustion. Counselors: Shi Xuemin, Tong Xiaolin, Sun Guojie Head of expert group: Liu Baoyan, Wang Hua Expert group member: Xiaochun Yu, Wu Huanyu, Gao Shuzhong, Wang Linpeng, Fang Jianqiao, Yu Shuguang, Liang Fanrong, Ji Laixi, Jing Xianghong, Zhou Zhongyu, Ma Jun, Chang Xiaorong, Zhang Wei, Yang Jun, Chen Rixin, Zhao Jiping, Zhao Hong, Zhao Baixiao, Wang Fuchun, Liang Fengxia, Li Xiaodong, Yang Yi, Liu Weihong, Wen Biling

Translated by the Secretariat of the World Federation of Acupuncture Moxibustion Societies

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