Intradermal Acupuncture on the Prevention and Adjuvant Treatment of Coronavirus Disease 2019

SHAN Kai (單 凱), Li Ning-cen (李檸岑), GUO Yi (郭 義), CHEN Ze-lin (陳澤林),

YU Shu-guang (余曙光)4,5, QIU Ji-wen (邱繼文)1,2, CHEN Bo (陳 波)1,2, ZHOU Dan (周 丹)1, TANG Yong (唐 勇)4,5,WANG Mei-juan (王美娟)1, YANG Hua-yuan (楊華元)6, YASUO ONO (小野泰生)2, ZHOU Ang (周 昂)2,4

1. Tianjin University of Traditional Chinese Medicine, Tianjin 301617, China

2. Specialty Committee of Evaluation and Promotion of Chinese Medicine Appropriate Technology of WFCMS, Beijing

100101, China

3. National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, China

4. Professional Committee on Intradermal Needles, Chinese Association of Acupuncture-Moxibustion, Beijing 100700, China

5. Chengdu University of Traditional Chinese Medicine, Chengdu 610072, China

6. Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China

#: is co-first author

Correspondence to: Guo Yi, Professor, Doctoral Supervisor, Tel: 13920921016; E-mail: guoyi_168@163. com;Chen Ze-lin, Professor, Doctoral Supervisor, Tel: 13622090391; E-mail: chenzelin328@163.com

Supported by: 2011 Special Projects in Scientific Research of TCM Profession (201107006); 2018 Preventive Treatment of Disease in Tianjin University of Traditional Chinese Medicine (XJ201801)

ABSTRACT In view of the serious threat to people's health caused by the Coronavirus Disease 2019(COVID-19), according to the relevant spirit of the Notice on Establishing the Cooperation Mechanism of traditional Chinese and Western Medicine in the Prevention and Treatment of COVID-19 and other Infectious Diseases issued by the National Health Commission of the People's Republic of China, National Administration of Traditional Chinese Medicine of the People's Republic of China, on the basis of our early clinical research of using press needle embedding (intradermal acupuncture) to prevent and treat related diseases, the symptoms, etiology and pathogenesis of the disease were analyzed. We try to use the simple and easy intradermal acupuncture therapy to prevent and assist the treatment of the disease and its complications, hoping to make a modest contribution to help patients relieve part of suffering, and also provide advice for the doctors in the treatment of the disease.

KEYWORDS COVID-19; Plagues; Intradermal acupuncture; Thumbtack needle; Immunity

The plague is a kind of disease with strong epidemic and infectiousness caused by pestilential qi. Pestilential qi is strongly pathogenic and infectious, and belongs to external pathogens. In the literature of traditional Chinese medicine (TCM), it is also known as "pestilent toxin", "epidemic gas","different qi", "outrageous qi", "poisonous qi", "surly qi" and so on. Pestilential qi is not directly observed by people's senses, and it has the pathogenic characteristics of sudden onset, critical illness,strong infectivity, and easy to epidemic, etc[1].

The spread of plagues is closely related to climate, environment and diet[2]. The climatic factors are sometimes unpleasant, especially the longterm drought, extreme heat, floods, wet mist, etc.;the environment and diet such as air, water, living environment, and food are contaminated. It is recorded inMedical Enlightenment and Epidemic(《醫(yī)學(xué)心悟·論疫》): "If a person gets sick, it will be transmitted to a family; if a family gets sick, it will be spread to a township; if a township gets sick, it will be spread to people in a country. This is sickness and dirty gas infection, which enters the body from the mouth and nose." If the prevention and isolation work is not done in time, it is easy to accelerate the spread and spread of the plagues.

When the plagues occurs, exogenous pathogenic qi is an important condition for the onset of illness, and lack of vital qi is an internal factor[3].Huangdi Neijingsaid: "If the vital qi exists inside the body, the pathogenic qi can not cause interference."When the pathogenic qi invades, if vital qi is full, the ability of zang-fu viscera and channel to function will be enhanced, and they will rise up to resist the pathogenic qi, the pathogenic qi will dissipate.

Therefore, in the face of the external pathogenic qi such as the plagues, enhancing vital qi and improving immunity are important factors for the prevention and restriction to the development of the epidemics.

Intradermal acupuncture therapy is a kind of acupuncture therapy, which has the functions of strengthening vital qi to eliminate pathogenic factors,dredging the channels and meridians, regulating yin and yang, which can improve the body's immunity and reduce the damage caused by such viruses in the body[4].

INTRODUCTION OF INTRADERMAL NEEDLE THERAPY

Thumbtack needle is a type of intradermal needle. Intradermal acupuncture therapy is a kind of therapy in which a special small needle is fixed inside or under the skin of acupuncture points for a long time to prevent and treat diseases. It is also called buried needle method. The meaning is similar to the ancient "stay for a long time"[5]. Its role is to stimulate the skin weakly and for a long time to achieve the purpose of preventing and curing diseases. Intradermal acupuncture therapy was developed based on the shallow acupuncture technique and acupuncture to retain needles.The shallow acupuncture technique of TCM has a long history, which can be traced back to the time whenHuangdi Neijingwas written, in which"floating acupuncture", "burr", "raising acupuncture","half acupuncture", "straight acupuncture" laid the foundation for the formation of intradermal needles,which were then supplemented and perfected by the medical doctors of all generations to form a system[6].

The TCM theory basis of intradermal needle therapy is same with the acupuncture theory,especially closely related with the skin areas of the 12 channels and meridians theory, the wei qi theory. The reaction of skin areas of the 12 channels and meridians is the 12 channels and meridians functional activity in the part of the body surface,somewhere in the outermost layers of the human body, is the body guard outside the barrier, where gas runs between the skin and muscles, can raise muscle, skin temperature, has the function of barrier defense shallow method which is based on meridian theory, stimulate the 12 skin areas, adjust the gas of a kind of method of prevention and treatment[7,8].Modern medicine is based on various functions of the skin and the local microenvironment changes caused by acupoints stimulation, regulating the overall homeostasis of the neural endocrine-immune network[9,10]. Studies have shown that acupuncture can produce anti-inflammatory effects through the autonomic nervous feedback system and the immune adjustment[11]. Some scholars think that acupuncture could have anti-effects on COVID-19 through the way of cholinergic anti-inflammatory pathway of by local and systemic anti-inflammatory effect, to reduce the risk of "storm" inflammation factors. And the rapid anti-inflammatory pathway nerve function, in the initial key stages of inflammatory reaction plays a more important role, this may be COVID-19 early important basis of acupuncture intervention. For late disease stage, it can also be through improving concurrent sepsis immunosuppressive state to adjust their own state[12,13]. In terms of clinical treatment, it follows the principles of proximal, distal, dialectical and symptomatic points of acupuncture and moxibustion,including meridional and extrinsic points, auricular points, and simple Ashi points and reaction points for family application.

Since the founding of the People's Republic of China, in order to standardize the intradermal needles, the standards for intradermal needles in the medical and pharmaceutical industry have been issued. In order to standardize the operation, the National Standard Commission issued the technical operation specification of intradermal needle (GB/T 21709.8-2008). The publication of these 2 standards not only accelerated the development of the industry, but also promoted the clinical application of the intradermal needle[14].

Intrader malneedle therapy has the characteristics of simple operation, safe and timesaving, dynamic retention of needle can accumulate effects, wide adaptation, and easy to be accepted.

INTRADERMAL NEEDLE THERAPY NEEDLE: DISPOSABLE STERILE THUMBTACK NEEDLE

Intradermal needle therapy is an invasive operation. In order to overcome the shortcomings of traditional intradermal needles that must be strictly sterilized repeatedly, a new type of disposable sterile needles has appeared, with a variety of specifications and models, suitable for ear points or body different parts, the end of the disposable sterile needle is covered with sterile skin color tape[6].

New Disposable Sterile Needle

OPERATION OF THE NEEDLE-STICKING TECHNIQUE

Needle Selection

According to the different diseases and operation sites, select the corresponding needles.

The recommended model for acupuncture points (quoted from the manual of clinical application of QinglingThumbtack Needle)

Location Selection

It is advisable to choose the acupoints that are easy to fix and do not hinder activities.

Position Selection

It is advisable to choose the treatment position that is comfortable for the patient and easy for the doctor to operate. Commonly used postures in the clinic are: supine, lateral, prone, supine, prone, and lateral.

Operation of Disposable Sterile Needle

Open the package of disposable sterile needles, hold the base of the sterile needles with one hand, tear the tape directly or with tweezers with the other hand, take out the sterile needles,pierce the needle into the skin, and press it to fix it.Simultaneously press for about 1 minute, according to the patient's tolerance.

Place the Needle

Postoperative Treatment and Local Care

After the operation, press 3-5 times a day for about 1 minute each time, based on the patient's tolerance.

Take Out the Needle

Needle embedding time should be 2-3 days,according to different climate, temperature and humidity, it can be adjusted appropriately. The needles can be buried again after 3 days from the same needle embedding site.

When pulling out the needle, peel off the fixing tape on both sides and lift the needle perpendicular to the skin. The treatment of the needle after use is the same as other medical supplies (such as infusion needle, adhesive tape, etc.).

Home Prevention Period

Purpose: To strengthen the body and regulate the immune system

Acupoints:

(1) Body points: Zúsnl, Hég, Zhngf ,Dànzhng, Fèishù

(2) Ear points: endocrine, lung, liver, spleen

Acupoint Selection:

① Zúsnl : The depressions on both sides of the patella (the round bones of the knee) are called knee eyes, the medial knee eye is the inner side,and the lateral knee eye is the outer side. Zúsnl is located 3 inches directly under the tibia along the eye of the external knee, and 1 transverse finger outside the anterior crest of the tibia (the same size as the thumb, see the attached page for details).(Putting the index finger to the little finger and the four fingers together, the width of the 4 fingers at the level of the joint between the proximal fingers of the middle finger is 3 inches, which is called the"4-finger-breadth measurement")

⑥ Fèishù: sitting and bowing your head, making a vertical line in the center of the back (posterior midline), on the posterior midline, there is a high process (seventh cervical spinal process) that moves with the head and back when it swings left and right,Pushing 3 vertebral bodies vertically downward from this high process is the third thoracic spinous process, where a horizontal line is made under the third thoracic spinous process and the inner edge of the scapula. The midpoint of this horizontal line (about 2 lateral fingers apart) is this point.

Operation: After routine disinfection of the acupuncture points, apply a disposable sterile press on the skin of the selected acupuncture point, and press the tape to ensure that the adhesion is secure.Press 3-5 times a day for 1-3 minutes each time,according to the patient's tolerance. 2-3 treatments per week, every 2 treatment intervals of 1 day.

Suspected Cases

Purpose: Dispersing the lund to relieve cough,benefiting qi for tranquillization

Acupoint Map[14]

Acupoints: (1) Body points: Fèishù, Zúsn,Chzé, Hég , Dàzhu, Shénmén (2) Ear points:sympathies, large intestine, lung, spleen, endocrine

Acupoint selection:

① Fèishù: Same as above

⑤ Dàzhu: the posterior median line, in the depression of the 7th cervical spine. Sit and bow your head, make a vertical line in the center of the back(posterior midline), on the posterior midline, there is a high protrusion (seventh cervical spinal process)that moves with the head and the left and right at the junction of the neck and back. There is a depression under the spinous process, which is this point.

⑥ Shénmén: At the wrist, the ulnar end of the transverse stripes of the palmar side of the wrist,and the radial depression of the flexor tendon of the ulnar side. Stretch your elbows and raise your palms to make a fist. You can touch a large tendon (ulnar wrist flexor tendon) on the inner forearm of the hand.On the lateral rib of the proximal palm, the inside of this tendon is the main point.

Operation: After routine disinfection of the acupuncture points, apply a disposable sterilized thumbtack needle on the skin of the selected acupuncture point, press the tape to ensure that the adhesion is secure. Press 3 times a day for 1-3 minutes each time, according to the patient's tolerance. 2-3 treatments per week, every 2 treatment intervals of 1 day.

Acupoint Map[14]

Light Cases of Confirmed Cases

Objective: To protect vital qi, improve symptoms, and shorten the course of disease

Acupoints: (1) Body points: Fèishù, ZhngfChzé, Dàchángshù, Dàzhu, Hég, Ynlíngquán (2)Ear points: sympathies, large intestine, lung, spleen,stomach, endocrine

Acupoint Selection:

① Fèishù: Same as above

④ Dàchángshù: 1.5 inches below the spinous process of the 4th lumbar spine. The intersection of the highest point of the pelvis on both sides (highest point of the iliac crest) and the spine (poster median line) is the 4th lumbar spinous process, and there is a depression under the 4th lumbar spinous process.,The middle finger is close together, with the width of the 2 fingers at the level of the joint between the proximal fingers of the middle finger is 1.5 inches),which is the acupoint.

Operation: After routine disinfection of the acupuncture points, apply a disposable sterile press on the skin of the selected acupuncture point, and press the tape to ensure that the adhesion is secure.Press 3 times a day for 1-3 minutes each time,according to the patient's tolerance. 2-3 treatments per week, every 2 treatment intervals of 1 day.

Acupoint Map[14]

Serious Cases of Confirmed Cases

Purpose: Maintaining vital qi and supplementing pathogenic qi

Acupoints: (1) Body points: Fèishù, Yúnmén,Dàchángshù, Zúsnl, Dànzhng, Gohung (2) Ear points: endocrine, sympathies, large intestine, lung,spleen, stomach, adrenal glands

Acupoint Selection:

① Fèishù: Same as above

② Yúnmén: Above the front of the chest wall,above the coracoid process of the scapula, in the depression of the inferior clavicle, 6 inches from the midline of the front. Standing with hands on hips,a triangular depression can be seen at the lower edge of the lateral end of the clavicle, which is the point.

③ Dàchángshù: Same as above

Operation: After routine disinfection of the acupuncture points, apply a disposable sterile press on the skin of the selected acupuncture point, and press the tape to ensure that the adhesion is secure.Press 3 times a day for 1-3 minutes each time,according to the patient's tolerance. 2-3 treatments per week, every 2 treatment intervals of 1 day.

Recovery Period

Objective: To strengthen the lungs and spleen to benefit qi

Acupoints: (1) Body points: Fèish, Píshù,Zúsnl, Dànzhng (2) Ear points: endocrine, lung,spleen, stomach

Acupoint Map[14]

Acupoint Selection:

① Fèishù: Same as above

② Píshù: Under the spinous process of the 11th thoracic spine, open 1.5 inches. Take a line through the midpoint of the navel and horizontally around the waist and abdomen; the intersection of this line and the posterior median line is the 2nd lumbar vertebra; push 3 vertebral bodies vertically upward from the 2nd lumbar spinous process, which is the 11th thoracic spinous process; There is a depression under the spinous process of the 11th thoracic vertebrae. 2 lateral fingers (forefinger and middle finger are close together, the width of the 2 fingers at the level of the joint between the proximal fingers of the middle finger is 1.5 inches), which is the acupoint.

Operation: After routine disinfection of the acupuncture points, apply a disposable sterile press on the skin of the selected acupuncture point,and press the tape to ensure that the adhesion is secure. Press 3 times a day for 1-3 minutes each time, according to the patient's tolerance. 2-3 treatments per week, every 2 treatment intervals of 1 day.

Other Complications

The epidemic has a great impact, causing a certain amount of panic, which caused insomnia,anxiety, depression, and loss of appetite.

Acupoint Map[14]

Insomnia

In Chinese medicine, it is called "insomnia" and"not lying". Manifested as difficulty falling asleep, or waking up from time to time, or can no longer sleep after waking up, severe sleepless throughout the night.

Acupoints: (1) Body points: Gnshù, Shénmén,Xnshù, Snynjio. (2) Auricular points: Shénmén,subcortical, endocrine, heart, pancreas and Snjio.

Acupoint selection:

② Shénmén: Same as above

Operation: After routine disinfection of the acupuncture points, apply a disposable sterile press on the skin of the selected acupuncture point, and press the tape to ensure that the adhesion is secure.Press 3 times a day for 1-3 minutes each time,according to the patient's tolerance. 2-3 treatments per week, every 2 treatment intervals of 1 day.

Acupoint Map[14]

Depression

Clinically, it can be seen that the mood is low,the thought association speed is slow, the response is slow, the behavior is slow, the life is passive,lazy, does not want to do things, and is unwilling to contact with the surrounding people; the memory of the recent events is reduced, the attention disorder,the reaction time is prolonged, and the alertness is increased; sleep Disorders, fatigue, loss of appetite,weight loss, constipation, pain in any part of the body.

Acupoints: (1) Body points: Tàichng,Hég, Gnshù, Xnshù , Shénmén, Píshù (2) Ear points: Shénmén, liver, spleen, subcortical, endocrine

Acupoint Selection

⑤ Shénmén: Same as above

⑥ Píshù: Same as above

Operation: After routine disinfection of the acupuncture points, apply a disposable sterile press on the skin of the selected acupuncture point,and press the tape to ensure that the adhesion is secure. Press 3 times a day for 1-3 minutes each time, according to the patient's tolerance. 2-3 treatments per week, every 2 treatment intervals of 1 day.

Anxiety

Also known as anxiety neurosis, it is mainly characterized by anxious emotional experience. It can be divided into 2 forms of chronic anxiety and acute anxiety. Emotional nervousness, uneasiness,and restlessness can lead to symptoms such as palpitations, shaking hands, sweating, frequent urination, and restlessness.

Acupoint Map[14]

Acupoints: (1) Body points: Xnshù, Gnshù,Píshù, Shénmén, Bihuì (2) Ear points: Shénmén,sympathies, heart, liver, spleen

Acupoint selection:

③ Píshù: Same as above

④ Shénmén: Same as above

Operation: After routine disinfection of the acupuncture points, apply a disposable sterile press on the skin of the selected acupuncture point, and press the tape to ensure that the adhesion is secure.Press 3 times a day for 1-3 minutes each time,according to the patient's tolerance. 2-3 treatments per week, every 2 treatment intervals of 1 day.

Loss of Appetite

It is one of the abnormal dietary conditions, and it is mainly characterized by decreased appetite and reduced food intake.Combined with the epidemic situation, the loss of appetite is mostly caused by emotional tension, poor mood, or epidemic invasion of the body, which makes the body's lungs, spleen,liver, large intestine and other organs dysfunctional,and eventually the spleen and stomach dysfunction,luck disorders.

Acupoint Map[14]

Acupoints: (1) Body points: Zúsnl,Ynlíngquán, Píshù, Wèishù, Tàichng (2) Ear points: sympathies, liver, spleen

Acupoint selection:

③ Píshù: Same as above

④ Wèishù: is located under the spinous process of the 12th thoracic vertebrae, 1.5 inches apart. Take a line through the midpoint of the navel and circle the waist and abdomen horizontally;the intersection of this line and the midline of the posterior is the 2nd lumbar vertebra; push 2 vertebral bodies vertically upward from the 2nd lumbar spinous process, which is the 12th thoracic spinous process; There is a deep hollow under the spinous process of the 12th thoracic vertebra. 2 lateral fingers (forefinger and middle finger are close together, and the width of the two fingers of the horizontal joint between the proximal fingers of the middle finger is 1.5 inches), which is the acupoint.

Operation: After routine disinfection of the acupuncture points, apply a disposable sterile press on the skin of the selected acupuncture point, and press the tape to ensure that the adhesion is secure.Press 3 times a day for 1-3 minutes each time,according to the patient's tolerance. 2-3 treatments per week, every 2 treatment intervals of 1 day.

PRECAUTIONS FOR ONE-TIME STERILE NEEDLE INTERVENTIONr

(1) Patients who are treated for the first time should eliminate their nervousness ahead of time.

(2) Use with caution in joints, facial areas, and vascular pulsations.

(3) After embedding the needle, if the patient feels tingling or hinders limb movement, the needle should be taken out and re-embedded or changed to other acupuncture points.

(4) Before embedding the needle, the needle body should be inspected in detail.

(5) It is not advisable to bury the needle at the site of skin suppuration infection, purpura and scars.Patients with bleeding disorders should not bury the needle.

(6) During the use of disposable sterile needles to intervene in the infection of the new coronavirus, strictly follow the requirements of isolation and disinfection.

(7) If it is used in an isolation ward, the physician has gloves. Sterile skin color tape is particularly easy to stick to the gloves when starting the needle, and special attention should be paid to the operating specifications

Acupoint Map[14]

ATTACHED PAGES

Location Method of Acupoints

There are 4 common methods of positioning acupoints:

(1) Finger positioning method: Also known as "finger positioning method", it refers to the positioning method of measuring acupoints according to the size of the patient's own finger.

① Middle finger size: the distance between the 2 ends of the radial section of the middle section of the patient's middle finger (the thumb and middle finger flexed into a ring) is 1 inch.

② Thumb size: the width of the joint between the thumb of the patient is taken as 1 inch.

③ 4-finger-breadth measurement: also known as the "one-man method", the patient's index finger, middle finger, ring finger and little finger are combined, the middle finger of the middle finger is the standard, and the width of the four fingers is 3 inches.

Middle Finger Body Size, Thumb Body Size,Cross Finger Body Size Chart[15]

(2) Proportional bone measurement: Taking the ganglia as the mark, the length between the 2 bones is converted to a certain centimeter, and then used to determine the position of the acupoint. No matter men, women, children, children, tall, short, fat, tall or thin, you can perform self-test according to a certain bone size[15].

(3) Method of anatomical landmark: also known as natural landmark positioning method, based on various body surface markers to determine the location of acupoints, divided into fixed signs and active signs.

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① Fixed signs: visible in natural posture,protrusions, depressions formed by ganglia,muscles, facial features, hairline, nails, nipples,navel. For example, 3 inches above the tip of the medial malleolus, behind the medial border of the tibia is the Snynjio; brows are reserved for the bamboo points; the navel is the sign, the navel is the god Que, and the 2 inches is the Tianshu.

② Activity mark: It only appears during activities,such as joints, muscles, tendons, skin and other gaps, depressions, wrinkles, and tips that appear with the activity. If the mouth is slightly opened, the depression between the tragus and the mandible joint is the Tingong point; the anterior and inferior 1 of the mandibular angle refers to the cheek car point when the masseter muscle is raised when chewing.

(4) Convenient positioning method: simple and easy to use, commonly used in clinical to assist positioning. For example, standing upright, the arm sags naturally, the middle finger touches the Fengshi acupoint; the tiger mouth of both hands naturally crosses, the index finger of one hand is pressed against the high bone of the other wrist, and the index finger is a column of missing points.

Schematic Diagram of the Location of Ear Acupuncture Points