This research was supported by the National Natural Science Foundation of China (82374291), 2022 &#34;Tianfu Qingcheng Plan&#34; Tianfu Science and Technology Leading Talents Project (Chuan Qingcheng No. 1090), the National TCM Clinical Excellent Talents Training Program (National TCM Renjiao Letter [2022] No. 1), &#34;100 Talent Plan&#34; Project of Hospital of Chengdu University of Traditional Chinese Medicine (Hospital office [2021] 42), Special subject of scientific research of Sichuan Administration of Traditional Chinese Medicine (2021MS539, 2023MS608), Sichuan Science Technology Program (2023ZYD0050, 24NSFJQ0077),&#34;Hundred Talents Program&#34; of the Hospital of Chengdu University of Traditional Chinese Medicine (grant nos. 20-Q06) and Sichuan Philosophy and Social Science Planning Major Programs (SC22ZD010).

This is a before and after self-controlled trial of seven patients diagnosed with AECOPD complicated with sleep disorders from the Hospital of Chengdu University of Traditional Chinese Medicine between December 2023 and January 2024. The clinical study protocol was reviewed and approved by the Clinical Research Approval Committee of the Department of Respiratory Medicine, Hospital of Chengdu University of Traditional Chinese Medicine (KY2022031).
1. Patient selection
<ol>
	<li>Inclusion criteria:
	<ol>
		<li>Include patients who meet the diagnostic criteria of AECOPD per the Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2024 report) (GOLD 2024)11.</li>
		<li>Include patients who meet the diagnostic criteria of sleep disorders per the third edition of the International Classification of Sleep Disorders (ICSD)12or the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)13.</li>
		<li>Include patients who are hospitalized for treatment.</li>
		<li>Include conscious, mentally normal patients informed about the study.</li>
		<li>Include patients with no serious diseases of the heart, liver, kidney, immune system, or hematopoietic system and who are not involved in other clinical studies.</li>
	</ol>
	</li>
	<li>Exclusion criteria:
	<ol>
		<li>Exclude patients having other serious mental illnesses, sleep disorders not caused by AECOPD, and having received sedative-hypnotics treatment and other AA or EPT therapy in the past 1 month.</li>
		<li>Exclude patients allergic to medical devices such as adhesive tapes, medical non-woven fabrics, and related herbal medicines.</li>
		<li>Exclude patients with auricle injury, sensory disturbances, and skin breakage.</li>
	</ol>
	</li>
	<li>Shedding and rejection criteria:
	<ol>
		<li>Reject patients who cannot adhere to the treatment and have serious adverse reactions or aggravate the original disease during the test.</li>
	</ol>
	</li>
</ol>
2. Research design
<ol>
	<li>Adopt the comparative test method of the same patient before and after treatment. Observe patients (n = 7) who suffer from AECOPD complicated with sleep disorders.</li>
	<li>Ask patients to complete the PSQI questionnaire1424 h before AA and EPT.</li>
	<li>Ensure that all the included patients receive the same standardized AECOPD nursing interventions.
	<ol>
		<li>Basic interventions: keep the ward clean, comfortable, and tidy, and reduce noise.</li>
		<li>Drug intervention: Ensure patients undergo cough expectorant and conventional anti-infective treatment. 
		NOTE: Drugs used include Doxofylline, compound ipratropium bromide solution for inhalation, Salmeterol ticarcoson inhalation powder mist, sensitive antibiotics, and glucocorticosteroid.</li>
		<li>Dietary intervention: Instruct patients to avoid taking excitatory substances (strong tea, etc.), alcohol, and tobacco, and avoid overeating before going to bed.</li>
		<li>Psychological intervention: carry out sleep education, communicate with patients, and eliminate their negative emotions such as anxiety and depression.</li>
		<li>Respiratory function exercise: Instruct patients to correctly expectorate and cough and perform abdominal and lip retraction breathing.</li>
	</ol>
	</li>
	<li>Have the patients receive AA and EPT therapy (see section 4).</li>
	<li>Fill in the PSQI questionnaire again after 1 week of treatment.</li>
	<li>Collate the questionnaire data by two researchers simultaneously and remove the incomplete or incorrect data. Express the PSQI questionnaire scores with mean &#177; standard deviation using appropriate data analysis software. Consider P &#60; 0.05 as statistically significant in the Paired t-test. 
	NOTE: The same researcher who has received relevant professional training explains the contents of the questionnaire to the patient throughout the trial without making any directional prompts.</li>
</ol>
3. Preparations before procedure
<ol>
	<li>Equipment preparation
	<ol>
		<li>Prepare items such as the Chinese herbal medicine about Sinapis alba Linnaeus, Asarum sieboldii Miq, Euphorbia kansui T. N. Liou ex S. B. Ho and Corydalis yanhusuo W. T. Wang, acupoint patches, magnetic treatment plaster, sterile cotton swabs, medical tape, tweezers, 75% alcohol cotton balls, medical hand disinfectants, medical disposable sterilization rubber gloves (see Figure 1 and Table of Materials for details).</li>
		<li>Take 30 g each of Sinapis alba Linnaeus, Euphorbia kansui T. N. Liou ex S. B. Ho, Corydalis yanhusuo W. T. Wang and 10 g of Asarum sieboldii Miq for a total of 100 g, prepared in the ratio of 3:3:3:1. Use an ultra-micro pulverizer to make them into powder in advance and seal it in a plastic bag for later use.</li>
		<li>Before treatment, take 15 g of the mixed powder and use 15 mL of ginger extract to make a paste of medicinal powder. Place the paste on a curved plate.</li>
	</ol>
	</li>
	<li>Patient preparation
	<ol>
		<li>Create a comfortable, quiet, and clean environment, and tell the patient to avoid taking excitatory substances such as alcohol and tobacco. Let the patient sit upright with the shoulders relaxed and arms bent naturally on the knees.</li>
	</ol>
	</li>
	<li>Physician preparation
	<ol>
		<li>Pull the bed curtain, pay attention to protect the privacy of the patient, and prevent the patient from catching a cold.</li>
		<li>Recheck the patient&#39;s name, gender, age, and inpatient number.</li>
		<li>Wash hands with soap and water. Disinfect hands with medical hand disinfectant after drying. Finally, wear medical disposable rubber gloves.</li>
	</ol>
	</li>
</ol>
4. Treatment procedure
<ol>
	<li>Positioning of acupoints
	<ol>
		<li>Select Tian tu (CV22) on the patient&#39;s anterior cervical region and bilateral Fei shu (BL13) on the back for AA. Select binaural Fei (CO14), Qi guan (CO16), Shen men (TF4), and Pi zhi xia (AT4) for EPT. 
		NOTE: In the two treatment methods of AA and EPT, the selection of relevant acupoints and their specific positions are based on the recorded efficacy and positions of National Standard of the People&#39;s Republic of China: Nomenclature and location of meridian points published in 2021(GB/T12346-2021)15and Nomenclature and location of auricular points published in 2008 (GB/T13734-2008)16. The methods for locating acupuncture points include the anatomical landmark method, proportional bone measurement, and finger-cun measurement15. See Figure 2 and Table 1 for details .</li>
	</ol>
	</li>
	<li>Disinfection of patient treatment areas
	<ol>
		<li>Use tweezers to clamp 75% alcohol cotton balls to disinfect the patient&#39;s binaural CO14, CO16, TF4, AT4, CV22, and bilateral BL13 from the inside to the outside with the acupoint point as the center, with an appropriate range of 5 cm. 
		NOTE: Each acupoint should be disinfected three times, and the scope of each disinfection should be narrowed than the previous one. If the patient is allergic to alcohol, iodophor can be used as a substitute.</li>
	</ol>
	</li>
	<li>Acupoint application procedure
	<ol>
		<li>Take the prepared medicine from the medical curved plate, roughly divide it into 3 equal parts, remove the ointment with a tongue depressor, and apply it in a regular pattern to the center of the acupoint patches(diameter x thickness of about 3 cm x 0.5 cm).</li>
		<li>Fix the prepared acupoint patches to the Tian tu (CV22) and Fei shu(BL13) points. See Figure 3 for details.</li>
	</ol>
	</li>
	<li>Ear plaster therapy procedure
	<ol>
		<li>Let the patients take the sitting position, fix one side of the auricle with one hand, take the magnetic treatment pill with tweezers in the other hand, and then apply it at the CO14, CO16, TF4, and AT4. Repeat the procedure on the other side (see Figure 4A-E for details).</li>
		<li>Gently press the pill in a clockwise direction with a force that allows the patient to feel acid, numbness, bloating, pain, and heat but can tolerate it as a measure (De qi17). See Figure 4F for details.</li>
	</ol>
	</li>
</ol>
5. Post-treatment care
<ol>
	<li>Keep the AA therapy for 4-6 h each time, 1 time/day, and 7 days of continuous treatment. Advise the patient to press the auricular acupoints in the morning, at noon, at night, and before going to bed, 5 min/time, every other day on either ears once for 7 days throughout the treatment course.</li>
	<li>Tell the patients to keep the treatment site dry and clean as much as possible to avoid the patch falling off.</li>
</ol>
6. Adverse incident handling methods
<ol>
	<li>Tell the patients not to scratch the skin with their hands if there are local allergic reactions such as skin itching, redness, blisters, and exudation. Apply anti-allergy ointment locally to relieve symptoms if necessary.</li>
	<li>Inform the patients in advance that if nausea, vomiting, dizziness, palpitation, and other discomfort occur during the treatment process, immediately stop the therapy.</li>
</ol>

Acupoint and Ear Plaster Therapy for Treating Sleep Disorders in AECOPD Patients

<ol>
	<li>Luo, M. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Radical+oxygen+species:+an+important+breakthrough+point+for+botanical+drugs+to+regulate+oxidative+stress+and+treat+the+disorder+of+glycolipid+metabolism.">Radical oxygen species: an important breakthrough point for botanical drugs to regulate oxidative stress and treat the disorder of glycolipid metabolism.</a> Front Pharmacol. 14, 1166178 (2023).</li><li>Zhu, L. Y., Lu, X. D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Discussion+on+the+correlation+between+the+pathogenesis+of+lung+deficiency+and+collateral+stasis+and+oxidative+stress+in+COPD.">Discussion on the correlation between the pathogenesis of lung deficiency and collateral stasis and oxidative stress in COPD.</a> Journal of Liaoning University of Traditional Chinese Medicine. 3, (2024).</li><li>Ren, C. S., Wang, G. S., Qian, G. S. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Nosogenesis+of+chronic+obstructive+pulmonary+disease+and+the+perplexity+and+hope+of+treatment.">Nosogenesis of chronic obstructive pulmonary disease and the perplexity and hope of treatment.</a> Chinese Journal of Lung Diseases (Electronic Edition). 12 (2), 127-141 (2019).</li><li>Ren, C. X., Liu, H. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Progress+in+management+and+intervention+of+sleep+disorders+in+patients+with+chronic+obstructive+pulmonary+disease.">Progress in management and intervention of sleep disorders in patients with chronic obstructive pulmonary disease.</a> J Med Res. 50 (02), 153-156 (2021).</li><li>Tsai, S. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Chronic+obstructive+pulmonary+disease+and+sleep+related+disorders.">Chronic obstructive pulmonary disease and sleep related disorders.</a> Curr Opin Pulm Med. 23 (2), 124-128 (2017).</li><li>Latshang, T. D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sleep+and+breathing+disturbances+in+patients+with+chronic+obstructive+pulmonary+disease+traveling+to+altitude:+a+randomized+trial.">Sleep and breathing disturbances in patients with chronic obstructive pulmonary disease traveling to altitude: a randomized trial.</a> Sleep. 42 (1), (2019).</li><li>Chabowski, M., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Sleep+disorders+and+adherence+to+inhalation+therapy+in+patients+with+chronic+obstructive+pulmonary+disease.">Sleep disorders and adherence to inhalation therapy in patients with chronic obstructive pulmonary disease.</a> Adv Exp Med Biol. 1160, 43-52 (2019).</li><li>Du, D., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prevalence+and+clinical+characteristics+of+sleep+disorders+in+chronic+obstructive+pulmonary+disease:+A+systematic+review+and+meta-analysis.">Prevalence and clinical characteristics of sleep disorders in chronic obstructive pulmonary disease: A systematic review and meta-analysis.</a> Sleep Med. 112, 282-290 (2023).</li><li>De Crescenzo, F., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparative+effects+of+pharmacological+interventions+for+the+acute+and+long-term+management+of+insomnia+disorder+in+adults:+a+systematic+review+and+network+meta-analysis.">Comparative effects of pharmacological interventions for the acute and long-term management of insomnia disorder in adults: a systematic review and network meta-analysis.</a> Lancet. 400 (10347), 170-184 (2022).</li><li>Lu, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparative+effectiveness+of+multiple+acupuncture+therapies+for+primary+insomnia:+a+systematic+review+and+network+meta-analysis+of+randomized+trial.">Comparative effectiveness of multiple acupuncture therapies for primary insomnia: a systematic review and network meta-analysis of randomized trial.</a> Sleep Med. 93, 39-48 (2022).</li><li>. Global strategy for the prevention, diagnosis and management of OPD: 2024 report Available from: <a target="_blank" href="https://goldcopd.org/2024-gold-report/">https://goldcopd.org/2024-gold-report/</a> (2024)</li><li>. International classifcation of sleep disorders Available from: <a target="_blank" href="https://aasm.org/clinical-resources/international-classification-sleep-disorders/">https://aasm.org/clinical-resources/international-classification-sleep-disorders/</a> (2014)</li><li>American Psychiatric Association. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Diagnostic and Statistical Manual of Mental Disorders. , (2022).</li><li>Tang, P. T., Yin, C. Y., Cai, L. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+study+on+auricular+point+pressing+for+acute+exacerbation+of+chronic+obstructive+pulmonary+disease+complicated+with+insomnia.">Clinical study on auricular point pressing for acute exacerbation of chronic obstructive pulmonary disease complicated with insomnia.</a> New Journal of Traditional Chinese Medicine. 55 (4), 182-185 (2023).</li><li>National Administration of Traditional Chinese Medicine. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Nomenclature and location of meridian points. , (2021).</li><li>National Administration of Traditional Chinese Medicine. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Nomenclature and Location of auricular points. , (2008).</li><li>Liu, C., Wei, X. C., Lu, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Mechanism+and+efficacy+of+acupoint+application+in+the+treatment+of+insomnia+in+recent+ten+years.">Mechanism and efficacy of acupoint application in the treatment of insomnia in recent ten years.</a> Smart Healthcare. 8 (5), 29-32 (2022).</li><li>Zhao, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Acupuncture+for+the+treatment+of+insomnia.">Acupuncture for the treatment of insomnia.</a> Int Rev Neurobiol. 111, 217-234 (2013).</li><li>Liu, G. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> The effects of Chinese medicine patches with acupoint application on monamine neurotransmitter and IL-1&#946; in hypothalamus of Insomnia Rats [Master's Thesis]. , (2007).</li><li>Li, Q. S., Wang, S. X. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Protective+effects+of+eleutherosides+acupoint+application+on+rats+with+sleep+deprivation.">Protective effects of eleutherosides acupoint application on rats with sleep deprivation.</a> Mil Med of Joint Log. 16 (2), 11-14 (2002).</li><li>Hu, J. X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+Jingyi+Anshen+powder+acupoint+application+on+behavior+and+the+related+cytokines+in+rats+with+insomnia.">Effects of Jingyi Anshen powder acupoint application on behavior and the related cytokines in rats with insomnia.</a> Western Journal of Traditional Chinese Medicine. 31 (11), 41-45 (2021).</li><li>Chen, Y. Y., Chen, Y. B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Forty-five+cases+of+elderly+patients+with+acute+exacerbation+of+chronic+obstructive+pulmonary+disease+treated+with+the+aid+of+acupoint+application+of+white+mustard+powder.">Forty-five cases of elderly patients with acute exacerbation of chronic obstructive pulmonary disease treated with the aid of acupoint application of white mustard powder.</a> Zhejiang Journal of Traditional Chinese Medicine. 56 (5), 357 (2021).</li><li>Shao, B., Shen, Z. L., Chen, J., Chen, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+observation+on+55+cases+of+acute+phase+of+chronic+obstructive+pulmonary+disease+with+phlegm+and+turbid+lung+obstruction+treated+by+acupoint+patch+therapy.">Clinical observation on 55 cases of acute phase of chronic obstructive pulmonary disease with phlegm and turbid lung obstruction treated by acupoint patch therapy.</a> Hunan Journal of Traditional Chinese Medicine. 34 (7), 116-118 (2018).</li><li>Duan, W. B., Zhu, F. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+acupoint+application+combined+with+traditional+Chinese+medical+care+on+pulmonary+function,+immune+function+and+vascular+endothelial+function+indexes+of+AECOPD+patients.">Effects of acupoint application combined with traditional Chinese medical care on pulmonary function, immune function and vascular endothelial function indexes of AECOPD patients.</a> Guangming Journal of Chinese Medicine. 37 (3), 513-515 (2022).</li><li>Yang, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=.">.</a> Clinical observation of Huangqin Wendan decoction combined with ear acupoint pressing bean in treatment of AECOPD with insomnia due to phlegm heat accumulation [Master's Thesis]. , (2021).</li><li>Wang, X. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Application+effect+of+auricular+pressure+bean+care+combined+with+acupoint+patch+on+sputum+symptoms+in+patients+with+acute+exacerbation+of+chronic+obstructive+pulmonary+disease.">Application effect of auricular pressure bean care combined with acupoint patch on sputum symptoms in patients with acute exacerbation of chronic obstructive pulmonary disease.</a> Jilin Med. J. 43 (10), 2852-2854 (2022).</li><li>Dong, Z. Q. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+analysis+of+acupoint+patch+combined+with+auricular+pressure+bean+in+the+treatment+of+acute+exacerbation+of+COPD.">Clinical analysis of acupoint patch combined with auricular pressure bean in the treatment of acute exacerbation of COPD.</a> Shenzhen Journal of Integrative Traditional Chinese. 28 (10), 73-75 (2018).</li><li>Wang, Y. J., Ai, Q. X. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+Chinese+medicine+characteristic+nursing+techniques+on+exercise+endurance+and+lung+function+in+patients+with+acute+exacerbation+of+chronic+obstructive+pulmonary+disease.">Effects of Chinese medicine characteristic nursing techniques on exercise endurance and lung function in patients with acute exacerbation of chronic obstructive pulmonary disease.</a> The Journal of Medical Theory and Practice. 35 (9), 1574-1576 (2021).</li><li>Wang, X. H., Xiao, L. Y., Wang, B. F., Yuan, Y. D., Pan, W. S., Shi, Y. Z. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Influence+of+auricular+plaster+therapy+on+sleeping+structure+in+OSAS+patients.">Influence of auricular plaster therapy on sleeping structure in OSAS patients.</a> J Tradit Chin Med. 29 (1), 3-5 (2009).</li><li>Lei, X. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Observation+on+the+effect+of+auricular+point+pressing+beans+in+the+treatment+of+insomnia.">Observation on the effect of auricular point pressing beans in the treatment of insomnia.</a> Journal of Frontiers of Medicine. 9 (13), 195-196 (2019).</li><li>Tian, T., Wang, D. W., Li, Y., Song, L. M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Observation+on+the+effect+of+acupuncture+and+moxibustion+combined+with+auricular+point+pressing+pill+intervention+on+insomnia+patients+with+coronary+heart+disease.">Observation on the effect of acupuncture and moxibustion combined with auricular point pressing pill intervention on insomnia patients with coronary heart disease.</a> Journal of Practical Traditional Chinese Internal Medicine. 37 (11), 52-55 (2023).</li><li>Zhang, Q., Qiao, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Research+Progress+on+antiasthmatic+effect+and+mechanism+of+Ding+chuan+and+Tian+tu+acupoints.">Research Progress on antiasthmatic effect and mechanism of Ding chuan and Tian tu acupoints.</a> Journal of Guangxi University of Chinese Medicine. 23 (03), 64-66 (2020).</li><li>Fu, K. L., Lin, K. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+observation+on+point+application+treating+80+patients+of+chronic+obstructive+pulmonary+diseases.">Clinical observation on point application treating 80 patients of chronic obstructive pulmonary diseases.</a> Journal of Traditional Chinese Medicine. 56 (11), 948-952 (2015).</li><li>Wu, Z. L., Zhang, Q. R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ancient+and+modern+research+on+Fei+shu+point.">Ancient and modern research on Fei shu point.</a> Liaoning Journal of Traditional Chinese Medicine. 34 (04), 504-505 (2007).</li><li>Gu, Z. L., Xie, Y., Wang, Y., Xu, B. C. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Literature+analysis+on+the+mechanism+of+acupuncture+in+the+treatment+of+chronic+obstructive+pulmonary+disease.">Literature analysis on the mechanism of acupuncture in the treatment of chronic obstructive pulmonary disease.</a> Journal of Traditional Chinese Medicine. 62 (22), 2003-2010 (2021).</li><li>Liu, X. L., Yi, K. L., Zhu, W. X., Mi, H., Yuan, Y. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Research+on+Acupoint+selection+for+insomnia+treated+by+auricular+acupoint+pressing+beans+based+on+data+mining+technology.">Research on Acupoint selection for insomnia treated by auricular acupoint pressing beans based on data mining technology.</a> Prog Mod Biomed. 22 (21), 4168-4174 (2022).</li><li>Du, B. X., Zhao, X. D., Wen, D., Xue, X. S., Wang, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Research+progress+of+auricular+point+sticking+in+the+treatment+of+depression+with+insomnia.">Research progress of auricular point sticking in the treatment of depression with insomnia.</a> World J of Sleep Med. 9 (11), 2231-2234 (2022).</li></ol>

The authors have nothing to disclose.

This study combined AA with EPT to explore the procedure and efficacy of the treatment of sleep disorders in patients with AECOPD. AA refers to the external treatment method of grinding specific drugs into powder and then mixing them into a paste with water, white wine or rice wine, vinegar, ginger juice, etc., and finally making the paste, pill, powder, paste, mud, cake and other dosage forms, which are applied to specific acupoints. Reviewing the literature on AA in the treatment of sleep disorder in the past ten years...

Chronic obstructive pulmonary disease (COPD) is a disease characterized by incomplete reversibility of airflow limitation, with gradual progression, primarily involving the lungs, but also causing damage to various other organs outside the lungs. Its pathogenesis is mainly related to the regulation of apoptosis and promotion of inflammatory response by radical oxygen species (ROS) during oxidative stress (OS)1, affecting gene transcription and exacerbating protease-antiprotease imbalance finally2. It often causes chronic coughing, coughing up sputum, shortness of breath or difficulty breathing, wheezing, and chest tightness. According to a WHO survey, COPD is the third leading cause of death globally, posing a serious threat to human health, and by 2060, the number of deaths from this disease will exceed 5.4 million annually3. Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) refers to acute changes in respiratory distress, cough, and sputum in COPD patients at baseline levels. AECOPD patients often experience shortened sleep time and decreased sleep quality due to various factors such as serious respiratory symptoms, nocturnal hypoxia, accompanying psychological problems, medication use, and socio-economic conditions4. Therefore, sleep disorders, including obstructive sleep apnea (OSA), restless leg syndrome (RLS), and insomnia, have become common complications for AECOPD patients, especially in elderly severe patients.
The reasons for sleep disorders in AECOPD patients include increased airway resistance and reduced airflow at night and/or in the morning, which aggravate ventilation disorders and ultimately lead to frequent awakenings, shortened sleep time, and difficulty falling asleep5,6. Moreover, the large financial burden of AECOPD on families makes patients often accompanied by anxiety, depression, and other psychological problems4. More notably, sleep disorders can, in turn, increase the risk of pulmonary hypertension in AECOPD patients and are closely related to higher disease severity, more frequent exacerbation, higher utilization of emergency medical services, and higher mortality rates7. According to the latest research, the prevalence of OSA, RLS, and insomnia in AECOPD patients, respectively, reached 29.1%, 21.6%, and 29.5%. Patients with OSA may have a higher risk of hypertension and diabetes. Patients with RLS are related to higher Epworth sleepiness scale (ESS) score and a longer COPD duration(year). Furthermore, insomnia is more common in female patients8. Therefore, it is essential to carry out timely nursing interventions for AECOPD patients with sleep disorders.
At present, the clinical treatment of AECOPD patients mainly focuses on improving respiratory symptoms while ignoring sleep problems. In addition, benzodiazepines, melatonin, melatonin receptor agonists, and antipsychotics used by patients with severe sleep disorders have adverse reactions such as respiratory inhibition, drug dependence, cognitive impairment, dizziness, and somnolence; therefore, it is mostly used for acute sleep disorders, while it is limited in the application of chronic sleep disorders9. Other special intervention methods, including nocturnal oxygen therapy, cognitive behavioral therapy for insomnia, and pulmonary rehabilitation exercise, are not commonly used because of their high cost, unclear effect, and difficulty in clinical practice4. Therefore, there is an urgent need to find an effective, safe, and simple treatment for AECOPD patients with sleep disorders.
Traditional Chinese Medicine (TCM) has a long history and rich experience in the treatment of sleep disorders. Acupoint application (AA) and ear plaster therapy (EPT) are both traditional Chinese medicine techniques. A systematic review study also found that AA and EPT have significant curative effects in the treatment of primary insomnia10. In this study, we will elucidate in detail the process and efficacy of the two treatments for AECOPD, including the medical equipment used, acupoint selection, treatment procedure, nursing, treatment of related accidents, etc. By comparing the changes in the Pittsburgh sleep quality index (PSQI) before and after treatment to evaluate their clinical efficacy, we aimed to provide a new reference for the clinical treatment of this kind of disease.

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	<tbody>
		<tr>
			<td>75% alcohol cotton balls</td>
			<td>Shanghai Honglong Industrial Co., Ltd</td>
			<td>20231116</td>
			<td></td>
		</tr>
		<tr>
			<td>Acupoint patches</td>
			<td>Jiangsu Guangyi Medical Dressing Co., Ltd</td>
			<td>20230718</td>
			<td></td>
		</tr>
		<tr>
			<td>Chinese herbal medicine</td>
			<td>Guangdong Kanghe Pharmaceutical Co.,Ltd</td>
			<td>230802</td>
			<td></td>
		</tr>
		<tr>
			<td>Magnetic treatment plaster</td>
			<td>Suzhou Medical Supplies Factory Co., Ltd</td>
			<td>233010</td>
			<td></td>
		</tr>
		<tr>
			<td>Medical disposable sterilization rubber gloves</td>
			<td>Shandong Yuyuan Latex Gloves Co., Ltd</td>
			<td>230806R22</td>
			<td></td>
		</tr>
		<tr>
			<td>Medical hand disinfectants</td>
			<td>Shanghai Likang Disinfection High tech Co., Ltd</td>
			<td>20230113J</td>
			<td></td>
		</tr>
		<tr>
			<td>Medical tape</td>
			<td>Minnesota Mining Manufacturing Medical Equipment (Shanghai) Co., Ltd</td>
			<td>23063GO</td>
			<td></td>
		</tr>
		<tr>
			<td>Sterile cotton swabs</td>
			<td>Shanghai Honglong Medical Equipment Co., Ltd</td>
			<td>20231108</td>
			<td></td>
		</tr>
		<tr>
			<td>Tweezers</td>
			<td>Yangzhou Huayue Technology Development Co., Ltd</td>
			<td>20231106</td>
			<td></td>
		</tr>
	</tbody>
</table>

acupoint application combined with ear plaster therapy for treating sleep disorders with acute exacerbation of chronic obstructive pulmonary disease

Chronic Obstructive Pulmonary Disease (COPD) is a lung disease characterized by persistent airflow limitation, which is not fully reversible and progressive. Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) refers to acute changes in respiratory distress, cough, and sputum in COPD patients at baseline levels. Sleep disorders are a very common complication in patients with AECOPD. At present, long-term use of sedative-hypnotics alone has many side effects, such as mental and physical dependence and cognitive impairment. While the efficacy of other special intervention methods is not clear, and the cost is high, there is an urgent need for effective and safe treatment in clinics. Acupoint application and ear plaster therapy are considered the characteristic therapies of traditional Chinese medicine. They have the advantages of small side effects, high safety, and simple procedure. This study will elucidate in detail the specific process and efficacy of the two treatment methods for AECOPD complicated with sleep disorders, including medical devices used, selection of acupoints, procedure, and posttreatment care. This study is intended to provide a new reference for the clinical treatment modality of this type of disease.

Author Spotlight: Traditional Chinese Medicine for Sleep Disorders in Acute COPD &#8212; A Safe, Cost-Effective Approach

Acupoint Application Combined with Ear Plaster Therapy for Treating Sleep Disorders with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

Our research focus is treatment of sleep disorders in patients with acute exacerbation of COPD through the application of acupoint application and the ear plaster therapy. We aim to investigate further this through traditional Chinese medicine techniques can effectively improve the symptoms or physical signs of patients. Our protocol also needs to add clinical data on whether acupoint application combined with ear plaster therapy can improve symptoms in the acute chronic obstructive pulmonary and the incorporated data.Our results provide an effective, safe, and simple treatment that can be applied to a wide range of diseases compared to the adverse effects of modern medicine medications and the high cost and the ineffective leaps of other specific treatments.

Based on the changes before and after treatment, it was found that the total PSQI scores and five components score results of PSQI, including time to fall asleep, sleep quality, sleep time, sleep disorders, and daytime function, were all lower than before, and the differences were statistically significant (P &#60; 0.05). However, there were not many changes before and after treatment regarding sleep efficiency (P = 0.056) and application of medications for sleeping (P = 0.103) (See Tab...

The present protocol describes the specific process and efficacy of the acupoint application combined with ear plaster therapy for sleep disorders in a patient with acute exacerbation of chronic obstructive pulmonary disease, including medical devices, selection of acupoints, operating methods, and posttreatment care.

Chronic Obstructive Pulmonary Disease (COPD) is a lung disease characterized by persistent airflow limitation, which is not fully reversible and ...

acupoint-application-combined-with-ear-plaster-therapy-for-treating

Research

JoVE Journal

Medicine

566 Views.  Hospital of Chengdu University of Traditional Chinese Medicine. La nostra ricerca si concentra sul trattamento dei disturbi del sonno in pazienti con esacerbazione acuta della BPCO attraverso l'applicazione di punti di agopuntura e la terapia con cerotto auricolare. Il nostro obiettivo è quello di approfondire questo attraverso le tecniche di medicina tradizionale cinese in grado di migliorare efficacemente i sintomi o i segni fisici dei pazienti. Il nostro protocollo deve anche aggiungere dati clinici sul fatto che l'ap...

Video: Autore in primo piano: Medicina tradizionale cinese per i disturbi del sonno nella BPCO acuta: un approccio sicuro ed economico

Evaluating the Efficacy of the Acupoint Application Combined with Ear Plaster Therapy for Sleep Disorders

To begin, prepare all the required Chinese herbal medicines and other items such as acupoint patches, magnetic treatment plaster, sterile cotton swabs, et cetera. Take 30 grams each of Sinapis alba Linnaeus, Euphorbia kansui, and 10 grams of Asarum sieboldii Miq. After grinding the mixture, transfer the powder to a plastic bag for later use.Before treatment, prepare a paste of the herbal powder with ginger extract. Then place the paste on a curved plate for application. Next, create a comfortable, quiet, and clean environment for the patient.Ask the patient to sit upright with shoulders relaxed, and arms resting naturally on the knees. Then pull the curtains in the treatment room to ensure patient privacy and prevent them from catching a cold. Recheck the patient's details, including name, gender, age, and inpatient number.After washing and disinfecting hands with medical hand disinfectant, put on medical disposable sterilization rubber gloves. Select CV 22 on the patient's anterior cervical region and bilateral BL 13 on the back for auricular acupuncture. For ear plaster therapy, select CO 14, CO 16, TF 4 and AT 4.Use tweezers to clamp 75%alcohol cotton balls to disinfect the patient's acupoints. Clean the binaural CO 14, CO 16, TF 4, AT 4, CV 22, and bilateral BL 13 from the inside to the outside, centering on the accu point with a range of five centimeters. For acupuncture application, take the prepared medicine from the curved plate and divide it into three equal parts.Then use a tongue depressor to apply the ointment in a regular pattern to the center of the acupoint patches. After that, fix the prepared acupoint patches to the tiantu and faishu points. For ear plaster therapy, let the patient sit and stabilize one side of the oracle with one hand.Then using tweezers, Apply the magnetic treatment pill at CO 14, CO 16, TF 4 and AT 4, and repeat for the other ear. Tell the patient to secure the acupoint patches and keep the treatment area as dry and clean as possible to avoid dislodging them. Gently press the pill clockwise until the patient feels sensations like acid, numbness, bloating, pain, and heat, ensuring it is tolerable.Press auricular acupoints for five minutes each morning, noon, night, and before bed. The total PSQI score of time to fall asleep, sleep quality, sleep time, sleep disorders and daytime function were significantly reduced after treatment compared to before with statistically significant differences. There was no statistically significant improvement in sleep efficiency after treatment with a P-value of 0.056.The application of medications for sleeping did not change significantly after treatment with a P-value of 0.103.