| Background and purpose:Chronic obstructive pulmonary disease（COPD）is a common respiratory disease,which is mainly characterized by pulmonary airflow restriction symptoms such as dyspnea,cough and asthma,chest tightness and shortness of breath[1],which has a great impact on the quality of life of patients.At present,COPD ranks third among the top ten causes of death in the world and develops with a high incidence in China[2].The risk factors for its formation are mainly considered to be composed of individual susceptibility factors and environmental factors,which are highly correlated[3].However,the pathogenesis of COPD is not completely clear in modern medicine.It is considered that the development of pulmonary fibrosis caused by"inflammatory reaction" is one of the core mechanisms of the disease[4,5].Therefore,at present,terbutaline,budesonide,doxofylline and other drugs are mostly used in clinic to inhibit inflammatory reaction and reduce the accumulation of inflammatory substances[6,7].However,although anti-inflammatory,bronchiectasis and other treatment methods can effectively improve patients’ symptoms,they still need long-term medication,which is difficult to significantly improve the pulmonary function of COPD patients,with long course of treatment and high cost.Therefore,one of the core breakthroughs of this study is to seek new treatment ideas,avoid the continuous development of COPD,and give full play to the treatment advantages of traditional Chinese medicine "prevention before disease,prevention of both disease and change".Modern research shows that COPD patients are prone to changes in the coagulation fibrinolysis system in the human body,which makes the blood in a hypercoagulable state,promotes the formation of pulmonary arteriole thrombosis,and finally leads to the development of pulmonary fibrosis and reduces the pulmonary function of COPD patients[8,9].Therefore,this study believes that the abnormality of coagulation fibrinolysis system in human body is the key mechanism under the lung function of COPD patients.From the perspective of traditional Chinese medicine theory,COPD belongs to the category of "lung distention"and "asthma syndrome" in traditional Chinese medicine,which is based on the deficiency of positive Qi and marked by the combination of phlegm,dampness and blood stasis.Therefore,the heat sensitive moxibustion therapy with Tonifying Qi and activating blood circulation,strengthening Zheng and Peiyuan,improving blood circulation and enhancing lung function was selected.The cat score,related indexes of lung ventilation function,PAI-1,t-PA and TNF were observed before and after the treatment of lung function in patients with stable COPD-α、To explore the mechanism of heat sensitive moxibustion in improving pulmonary function of patients with COPD in rehabilitation stage,in order to become an important means to improve and prevent the progress of COPD,and provide basis for clinical work and scientific research.Method:In this study,a total of 60 patients diagnosed as stable COPD in the outpatient department of acupuncture and moxibustion of Wuhan first hospital from December 2020 to December 2021 were collected.They were randomly divided into heat sensitive moxibustion group and routine treatment control group,with 30 cases in each group.The control group referred to the treatment scheme for patients with stable COPD in the guidelines for the diagnosis and treatment of chronic obstructive pulmonary disease（2013 Revision）,Select budesonide suspension（AstraZeneca Pty Ltd,gyzz h20140475,the specification is 2m1:1 mg each）for atomization inhalation,0.5～1mg each time,twice a day;Add formoterol powder inhaler（Zhengda Tianqing Pharmaceutical Co.,Ltd.,gyzz h20103179,specification:12ug*30 capsules/box）for inhalation and administration,12ug each time,twice a day.The treatment lasted for 6 weeks.The heat sensitive moxibustion group was treated with heat sensitive moxibustion on the basis of routine treatment and control group.The operation is as follows:first,find the sensitization point,ignite the moxa stick,and then apply moxibustion and exploration 3～5cm above the high incidence areas of Feishu,gaoblind,Zhongwan,Pishu,Shenshu,Guanyuan and other heat sensitization acupoints.When the patient has heat expansion（diffusion around the moxibustion site as the Center）,diathermy（moxibustion heat penetrates from the moxibustion site to the deep tissue）One or more thermal moxibustion sensations of heat transfer（conduction of wormwood heat along a certain direction）and non thermal sensation（acid,hemp,weight,swelling,pressure,pain,etc.）are the thermal sensitization phenomenon of acupoints,and the operation site is thermal acupoints;Moxibustion at heat sensitive acupoints for 40 minutes,once a day,for a total of 6 weeks.Before the first day of treatment and after the last treatment,a small amount of blood was taken from the back of the hands of the two groups.The levels of PAI-1,t-PA,TNF-a and IL-6 in the blood of the two groups before and after treatment and the pulmonary function of the two groups before and after treatment,including FEV1%,FEV1/FVC,PaO2 and PaCO2 levels,were observed and recorded accordingly.Keep follow-up during the whole process of treatment and within 3 months after treatment,and pay attention to whether patients have treatment-related adverse reactions.The clinical effects of the two groups were comprehensively analyzed.Finally,the statistical software SPSS 20.0 was used to make statistics and Analysis on the above observation index data in combination with the corresponding statistical methods to determine whether the difference was statistically significant.Result:（1）Before treatment,the indexes in the heat sensitive moxibustion group and the control group were comparable（P>0.05）;After treatment,compared with before and after treatment,cat score,PaO2,PaCO2 and comprehensive curative effect score of traditional Chinese medicine in the two groups were improved in varying degrees,which was statistically significant（P<0.05）;In terms of improving FEV1%and FEV1/FVC indexes,compared before and after treatment in the two groups,the comparison in the control group（P>0.05）,indicating that western medicine has little significance in improving the degree of airflow restriction and can not play a role of continuous improvement;Finally,the two groups were compared after treatment,P<0.05,which showed that the thermal moxibustion group was better than the control group in improving the clinical efficacy of patients with stable COPD.（2）Before treatment,the comparison between the heat sensitive moxibustion group and the control group showed that P>0.05,there was no statistical significance,and the two groups were comparable;After treatment,compared with before and after treatment in the two groups,the comparison in the control group showed that P>0.05,indicating that conventional western medicine combined treatment can inhibit TNF-α、The expression of IL-6,PAI-1 and t-PA has little significance in reducing the occurrence of persistent inflammatory reaction and improving the coagulation fibrinolysis system;The intra group comparison of the heat sensitive moxibustion group before and after treatment showed that P<0.05,indicating that the heat sensitive moxibustion has a certain effect on inhibiting the inflammatory reaction and improving the coagulation fibrinolysis system;After treatment,the comparison between the heat sensitive moxibustion group and the control group showed that P<0.05,which showed that the heat sensitive moxibustion was stronger than the western medicine in inhibiting the process of inflammatory reaction,alleviating blood hypercoagulability,thrombosis and so on.Conclusion:（1）Compared with the simple use of Western medicine,heat sensitive moxibustion can significantly improve the pulmonary ventilation function and clinical symptoms in patients with stable COPD.It shows that thermal moxibustion can effectively improve patients’ respiratory airflow restriction and oxygen uptake by pulmonary capillaries through the thermal sensitization of acupoints,so as to enhance patients’ lung function and promote the clinical effect of pulmonary function rehabilitation.（2）In terms of inhibiting the long-term persistent inflammatory reaction and coagulation fibrinolysis imbalance in patients with stable COPD,the combined treatment of Western medicine is difficult to have specific improvement,while thermal moxibustion does play an important role in reducing the local inflammatory reaction of airway,inhibiting the expression of inflammatory factors,alleviating blood hypercoagulability,reducing blood viscosity,preventing and treating thrombosis and degrading fibrin,which provides a scientific demonstration for its curative effect.（3）Based on the comprehensive analysis of various indicators in this study,the imbalance of coagulation fibrinolysis system is indeed highly correlated with the occurrence of continuous aggravating inflammatory reaction and the reduction of pulmonary function in COPD patients.By regulating coagulation fibrinolysis system,the occurrence of inflammatory reaction in patients can be effectively inhibited and pulmonary ventilation function can be improved,This also reflects the imbalance of coagulation fibrinolysis system from the side,or it is one of the important mechanisms of pulmonary dysfunction in patients with COPD.It shows that heat sensitive moxibustion can be used as one of the important and effective means to improve the pulmonary function in the stable stage of COPD. |
