Ironing Therapy Combined with Acupoint Application for Treating Stable Chronic Obstructive Pulmonary Disease Complicated with Functional Constipation

Summary

This study demonstrates the use of Chinese Medicine Ironing Therapy combined with Acupoint plaster treatment for functional constipation in patients with stable-stage Chronic Obstructive Pulmonary Disease (COPD).

Abstract

In this study, we put forward a protocol for patients with Chronic Obstructive Pulmonary Disease (COPD) who experience functional constipation during the stable stages, which combines the traditional Chinese Medicine Ironing Therapy with Acupoint plaster treatment. The Ironing Therapy can be briefly described as a therapeutic operation that combines Chinese herbal medicine with heat and some Chinese traditional massage techniques to directly contact the skin surface. This combination therapy has been shown to significantly relieve constipation symptoms in randomized controlled trials. Moreover, it is easy to implement, has few side effects, and is cost-effective, thus serving as an effective alternative method for managing constipation in COPD patients. Grounded in traditional Chinese medicine theory, this paper systematically elaborates on the methodology of integrating Ironing Therapy with Acupoint for treating constipation in COPD patients, including acupoint selection, key operational aspects, treatment duration, and specific procedures.

Introduction

Chronic Obstructive Pulmonary Disease (COPD) is a respiratory disease primarily characterized by persistent respiratory symptoms and airflow limitation¹. The global prevalence of COPD is currently estimated at approximately 480 million², with around 100 million patients in China alone-one of the highest COPD prevalence rates in the world^3,4. By 2050, it is expected that the global prevalence will rise to 600 million². As is well known, the treatment of stable COPD focuses on managing symptoms, preventing disease progression, and improving quality of life. According to a survey, many COPD patients experience severe constipation during the stabilization period. The prevalence rate of chronic constipation in modern society is approximately 10.1%⁵. Functional constipation (FC) is one of the most common functional disorders of the digestive system, characterized by persistent and recurring symptoms. It remains a significant area of both domestic and international research and is mainly manifested by difficulty in defecation, reduced frequency of bowel movements, dry stools, and a sense of incomplete evacuation⁶.

In Western medicine, functional constipation in COPD patients is primarily linked to long-term hypoxia, decreased smooth muscle function⁷, gastrointestinal mucosal inflammation⁸, improper medication use, intestinal flora imbalance⁹, and lack of exercise^10,11. As chronic diseases progress to later stages, the long-term decompensation of heart and lung functions leads to poor systemic circulation¹², which affects gastrointestinal blood flow. This, in turn, impairs intestinal function and disrupts peristalsis. When COPD patients develop constipation, it can worsen symptoms such as cough and difficulty breathing, significantly increasing the risk of cardiovascular and cerebrovascular events¹³. The two conditions interact and exacerbate each other, forming a vicious cycle, which in turn increases the risk of death for COPD patients¹⁴.

From a TCM perspective, COPD is categorized under conditions such as "lung distension" and "cough." Constipation, also referred to as "Bian Mi" in TCM, is commonly seen in elderly individuals, just like COPD. Both conditions are more frequently observed in the aging population. The concept of "deficiency as the root, excess as the branch" is a summary made by TCM practitioners regarding the pathogenesis of lung distension in¹⁵COPD patients with concomitant constipation. The pathogenesis is also a mixture of deficiency and excess. According to clinical literature, the excess is often attributed to the underlying lung distension disease, which causes phlegm and qi stagnation in the lungs. This leads to disruption of the lung's ability to disperse and descend qi, and in severe cases, results in internal obstruction of lung qi, which in turn affects the large intestine's ability to transmit and lead to constipation¹⁶. On the deficiency side, chronic illness causes depletion of qi and body fluids, leading to reduced propulsion and a loss of moisture in¹⁶. This results in stagnation, as a boat without water cannot move, symbolizing the stagnation caused by insufficient fluid to nourish the intestines, which then causes constipation. During the stable phase of COPD, most patients are elderly, and lung-spleen qi deficiency is one of the common clinical patterns. Elderly individuals are generally more prone to deficiencies, and the chronic nature of COPD makes it difficult to heal, leading to lung qi deficiency. This results in the impaired circulation of body fluids, qi, and blood, which in turn leads to the production of dampness and phlegm. These pathological products can stagnate, obstructing the normal flow of qi, blood, and body fluids, creating a vicious cycle. When qi is obstructed, it can cause dysfunction of the triple burner (a TCM concept), disrupting transmission and ultimately causing constipation¹⁷. Clinical evidence indicates that the majority of patients with lung-spleen qi deficiency, on the basis of pre-existing deficiency and impairment, frequently present with concurrent stagnation syndromes. Therefore, in the management of patients with COPD during the stable phase, attention should be given not only to resolving phlegm and regulating qi to address the superficial manifestations, but also to tonifying deficiency to strengthen the root cause. Consequently, during the process of tonification, it is essential to appropriately resolve phlegm and promote qi circulation to ensure the smooth flow of qi.

During the Qing Dynasty, the "Li Bo Eunuchs" advised, "First, identify the evidence, then discuss the treatment¹⁸, and subsequently administer the medicine¹⁹." This emphasizes that external treatments should be grounded in understanding the disease mechanism and based on evidence of the condition being treated. For COPD patients experiencing a stable period of functional constipation, the underlying issue is a deficiency and stagnation of qi. Therefore, the treatment should aim to replenish what is deficient and alleviate the stagnation. Ironing treatment, also known as the traditional Chinese medicine hot pack method, is an ancient technique of compressing and ironing. Today, it commonly involves dry hot compresses. This involves wrapping pungent and warm Chinese herbs in a cloth bag, heating them, and then applying them externally to the skin. The aim is to penetrate the medicinal power and heat to promote qi, assist yang, and transform qi²⁰. Modern research has shown that ironing therapy can reduce the excitability of injured nerves, improve blood circulation, and promote intestinal peristalsis through the physical effects of drugs and temperature²¹. Acupoint therapy is primarily based on the theory of Chinese medicine meridians and acupoints, where drugs are applied to the skin at specific points²². The drugs are absorbed through the acupoints, enhancing meridian circulation and leveraging the combined effects of the drugs and the meridian functions. This approach reconciles the qi and blood functions within the internal organs, thereby treating diseases effectively²³. For patients with stable COPD, applying tonifying lung qi and line qi through acupoints can be beneficial. By clearing the meridians and harmonizing the internal organs, it aims to tonify the deficiencies and act as a laxative. The lungs, spleen, and kidneys are closely related in function. Kidney tonics benefit the kidneys and assist in yang energy, while spleen tonics regulate the stomach, promote the elimination of dampness, and strengthen the spleen. Lung tonics aim to nourish and regulate lung qi.

In this condition, the current clinical approach primarily concentrates on the utilization of osmotic, irritant, and prokinetic medications²⁴. Additionally, some non-pharmacological treatments²⁵, such as biofeedback therapy and sacral nerve stimulation, have been introduced²⁶. However, studies have shown that the long-term use of purgative and osmotic laxatives can lead to drug dependency²⁷, and other adverse reactions due to medication abuse²⁸. Moreover, long-term use of bronchodilators in COPD patients can affect the motility of intestinal smooth muscles to some extent, contributing to the development of functional constipation in these patients²⁹. For COPD patients in the stable phase, treatment should include not only guideline-based medications but also rehabilitation and preventive measures, which should not be neglected³⁰. It is important to explore more effective, safer, low-side-effect, and highly acceptable rehabilitation treatments, aiming to prevent the occurrence of refractory constipation at an early stage, and if it occurs, to effectively improve the condition. TCM treatments, such as Ironing Therapy and acupoint plaster therapy, are widely used traditional methods. These treatments are believed to have benefits in promoting circulation, relieving constipation, and improving overall health in COPD patients.

This study aims to investigate therapeutic approaches that are safer and more effective, which can either prevent constipation at an early stage or effectively alleviate it once it has begun. Furthermore, hot ironing therapy and acupoint application therapy require minimal physical exertion from patients, are generally well-tolerated by stable COPD patients, cause little pain or burden, and demonstrate strong feasibility for clinical implementation. These methods are relatively simple to perform, do not require complex equipment, and can be mastered by healthcare professionals with brief training. By examining the therapeutic effects of hot ironing therapy combined with acupoint application on COPD patients in stable stages who also have constipation, this research seeks to provide new clinical treatment options and evidence. The goal is to improve constipation symptoms, enhance patients' quality of life, reduce the incidence of gastrointestinal diseases, break the adverse interaction between COPD and constipation, and lower mortality risks. The proposed treatment methods can effectively alleviate constipation severity in stable COPD patients and hold promise for future application in managing other gastrointestinal complications.

Protocol

The protocol was conducted in accordance with the Helsinki Declaration and was approved by the Chengdu University of Traditional Chinese Medicine Hospital (Ethics Approval No. 2024KL-193). The subjects of this study were patients with COPD combined with functional constipation who were treated at the Chengdu University of TCM Hospital. All patients voluntarily signed an informed consent form before participating in the study.

NOTE: COPD diagnostic criteria: Based on the Global Strategy for Prevention, Diagnosis, and Management of COPD: 2025 Report³¹, considering clinical manifestations, history of exposure to risk factors, physical signs, and laboratory test results. Pulmonary function tests are considered the gold standard for diagnosing COPD (with FEV1/FVC < 0.7 after the use of a bronchodilator). Stable-stage COPD is characterized by relatively stable symptoms without significant exacerbations. Patients may experience chronic cough, sputum production, and dyspnea, with symptoms typically not worsening rapidly. Chronic Functional Constipation diagnostic criteria: refer to the Rome IV criteria for functional constipation³²: The following criteria must be met for at least two of the listed conditions: At least 25% of the time, defecation is difficult; At least 25% of the time, stools are dry, lumpy, or hard ((corresponding to types 1 and 2 on the Bristol Stool Scale); At least 25% of the time, there is a feeling of incomplete evacuation; At least 25% of the time, there is a sensation of anorectal obstruction or blockage; At least 25% of the time, defecation requires manual assistance (such as using a finger or pelvic floor support); Fewer than three spontaneous bowel movements per week. Rarely passing loose stools without the use of laxatives. The symptoms do not meet the diagnostic criteria for irritable bowel syndrome. The symptoms must have been present for at least six months, and the symptoms during the last three months should meet the diagnostic criteria listed above³³.

1. Pretreatment evaluation

1. Inclusion criteria: Include patients who meet the following criteria:
   1. Patients who are diagnosed with COPD, meeting the diagnostic criteria for mild to moderate stable COPD according to Western medicine; COPD patients with lung and spleen qi deficiency syndrome according to TCM diagnostic criteria.
   2. Patients who are diagnosed with functional constipation.
   3. Patients who are aged between 35-80 years.
   4. Patients who voluntarily participate and sign the informed consent form.
2. Exclusion criteria: Exclude patients who meet the following criteria:
   1. Patients with tumors or severe heart, liver, kidney, gastrointestinal diseases, or other serious conditions.
   2. Patients with organic intestinal obstruction or lesions.
   3. Patients who have undergone major intestinal surgery.
   4. Patients with a history of drug allergies or serious adverse reactions to the medications used in this study.
   5. Patients who have not discontinued any medications affecting gastrointestinal function for at least one month prior to treatment.
   6. Pregnant or breastfeeding women.
   7. Patients with cooperation difficulties, or those with depression, anxiety, or who are unable to follow medical instructions.
   8. Patients deemed unsuitable for the trial due to other factors by the investigator.
      NOTE: Patients must abstain from smoking for at least 4-6 h (preferably 24 h) prior to pulmonary function testing to prevent interference with airway responsiveness and diffusion capacity. Avoid heavy meals 2 h before the test to prevent diaphragmatic elevation from affecting breathing. Discontinue bronchodilators as prescribed (salbutamol should be discontinued 4-6 h prior). During testing, instruct patients to exhale forcefully and completely, maintaining a minimum duration of 6 s. Avoid hesitation or coughing during the procedure (failure to comply will require retesting). Perform at least three tests, with optimal results showing no more than 5% variation between the two most reliable readings.

2. Research design and efficacy evaluation

1. Randomized Controlled Trial (RCT)
   1. Employ a simple randomization method for group allocation, following these procedures: perform random sequence generation by statistical personnel, independent of the clinical research team, using SPSS 26.0 software to create randomized sequences (1:1 allocation, experimental group versus control group).
      NOTE: Given the small sample size and relatively uniform baseline characteristics, stratification or block design was not implemented in the sequence.
   2. Referring to the 85% effective rate observed in similar studies³⁴, set the expected effective rate at 85%, establish a significance level α = 0.05 (two-tailed test), and calculate the test power (1-β) = 0.8.
      NOTE: The software computation indicated that each group required at least 10 samples. During actual enrollment, considering the feasibility of clinical recruitment, each group ultimately enrolled 12 patients, totaling 24 participants. Due to individual patient attrition during the intervention period, there were 2 missing cases per group (a dropout rate of approximately 16.7%, slightly higher than the preset 10%). Ultimately, each group retained 10 valid samples, meeting the predefined "valid sample size after attrition" requirement.
   3. Implementation of Blinding: Considering the operational differences between the TCM external therapy intervention and the control measures in this study, implement the blinding protocol as follows: Outcome assessors, who were researchers responsible for evaluating outcome indicators, were blinded and did not participate in the intervention implementation, nor were they aware of the subject groupings. Ensure all participants sign a blinding declaration prior to assessment to prevent evaluation bias.
2. Treatment methods of the treatment group and the control group
   NOTE: The COPD management protocol for both the trial and control groups was based on the "Chronic Obstructive Pulmonary Disease Diagnosis and Treatment Guidelines (2025 Edition)"³¹.
   1. Ensure the trial group receives daily administration of long-acting inhaled bronchodilators once daily, oral expectorants twice daily, and supplemental oxygen therapy.
   2. Ensure the control group receives oral lactulose solution (15 mL per dose) three times daily for four consecutive weeks as part of their baseline treatment regimen.
   3. Additionally, ensure the trial group undergoes heat therapy combined with acupoint patch application once daily for 30 min, with the entire treatment course lasting four weeks.
3. Evaluating Indicator
   1. Key outcome measures for the evaluation of efficacy: weekly complete spontaneous bowel movements (CSBM), constipation symptom scores (CSS), and PAY-SYM Score.
      NOTE: PAC-SYM score: Patient-Assessed Constipation Symptoms scores. CSBM: It usually refers to complete spontaneous defecation, that is, the natural occurrence of defecation without the need for laxatives, enemas or manual assistance, and no sense of residual stool after defecation.
   2. Secondary outcome indicators: Lung function indicators include Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), the ratio of Forced Expiratory Volume in one second to Forced Vital Capacity (FEV1/FVC)³⁵, the Chronic Obstructive Pulmonary Disease Assessment Test (CAT) score³⁶, and the Modified Medical Research Council dyspnoea scale (m-MRC) score³⁷. The primary outcome measures were designed to assess the effect of the intervention on constipation, whereas the secondary outcome measures aimed to evaluate the effects of the two treatments on lung function.
      NOTE: FEV1/FVC: The ratio of the forced expiratory volume in the first second (FEV1) to the forced vital capacity (FVC), which is an important indicator for evaluating the pulmonary ventilation function.
   3. Ensure the patient fills in the medical diary according to the defecation situation every week, and the staff collect and record it every week.
      NOTE: When filling out subjective indicators such as scales, patients must complete the ratings independently without any prompts or hints.

3. Preparation before operation

1. Preparation of instruments and materials
   1. Prepare the following materials: disposable acupoint patches, medical sterile cotton swabs, medical adhesive tape, disposable tongue depressors, sterilized cotton ball, medical tweezers, iodine cotton swabs, hand disinfectant, disposable sterile rubber gloves, disposable sterile cloth bags (20 cm x 30 cm), and a nursing towel (50 cm x 40 cm).
      NOTE: Check the packaging for proper sealing and ensure that the materials are within their expiration date to confirm their availability. Ensure all instruments are properly disinfected (Table of Materials and Figure 1).
   2. Prepare equipment: a grinder with a capacity of over 300 g, and a microwave capable of reaching an internal temperature of 80-90 °C in medium or high mode (Figure 2A, Figure 2B).
   3. Prepare the herbal powder for acupoint plaster: Rhei Radix et Rhizoma (60 g), Atractylodis Macrocephalae Rhizoma (60 g), Raphani Semen (60 g), and Sinapis Semen (20 g), for a total of 200 g of herbal powder (Figure 2C). Grind and mix in a 3:3:3:1 ratio. Before treatment, take 20 g of the mixed powder and combine it with 20 mL of fresh ginger juice to form a paste (Figure 2D). Use a disposable tongue depressor to evenly spread the paste onto the acupoint plaster (Figure 2E). Seal the remaining herbal powder in a plastic bag for future use. Process both Rhei Radix et Rhizoma and Atractylodis Macrocephalae Rhizoma into decoction pieces with a thickness of 2-4 mm (Rhei Radix et Rhizoma as straight slices and Atractylodis Macrocephalae Rhizoma as thick slices). Clean Raphani Semen and Sinapis Semen and then process into raw or stir-fried products as needed (to be crushed when used). Divide Foeniculi Fructus into raw products and salt-roasted products.
   4. Prepare the ironing therapy heat pack: Place 300 g of fennel into a prepared disposable sterile cloth bag (20 cm x 30 cm) (Figure 2F).
2. Patient preparation
   1. Prior to the procedure, assess the patient's skin condition and ask the patient to empty their bladder. Ensure that the patient is placed in a supine position, with knees bent and the abdomen relaxed.
      NOTE: When evaluating the skin condition of patients, attention should be paid to skin damage, skin inflammation and other skin diseases.
   2. After exposing the treatment area, use tweezers to hold a 75% alcohol cotton ball to disinfect the upper abdomen in a circular motion from the inside out. Ensure the disinfected area has a diameter greater than 3 cm.
      NOTE: Each acupoint is disinfected three times, with each successive disinfection area smaller than the previous one. If the patient is allergic to alcohol, iodine can be used as a substitute.
3. Operator preparation
   1. Close the doors and windows, and draw the curtains around the bed to ensure patient privacy and prevent the patient from catching a cold.
      NOTE: Ensure that another healthcare worker is present at the treatment site.
   2. Reconfirm the patient's name, gender, age, and hospital admission number.
   3. Disinfection: Use hand disinfectant to sanitize the operator's hands, following the Seven-step hand wash procedure. Once the hands are disinfected, wear disposable gloves and begin the procedure.

4. Intervention process

1. Ironing therapy
   1. Position selection: Ensure that the patient lies in a supine position, exposing the abdominal skin. Inspect the abdominal area to ensure the skin is intact and there are no abrasions.
   2. Acupoint selection and localization: Choose the following four acupoints in the patient's abdominal area. Zhongwan (CV12): Located in the upper abdomen, along the anterior midline, 4 F-cun above the umbilicus. Shenque (CV8): Located at the center of the umbilicus. Tianshu (ST25): Located in the abdominal region at the horizontal level of the umbilicus, 2 F-cun lateral to the anterior midline³⁸. Qihai (CV6): Located in the lower abdomen, 1.5 F-cun below the umbilicus, on the anterior midline (Figure 3).
      NOTE: The selection of acupoints is based on the efficacy and locations recorded in the National Standard of the People's Republic of China: Naming and Location of Meridian Acupoints (GB/T12346-2021).
   3. Preparation of heat pack: Moisturize the heat pack by 20% and heat it in a microwave for 3 min (until the temperature reaches 50-70 °C). Tie the heat pack securely and wrap it tightly with the pre-prepared nursing towel.
   4. Specific procedure
      1. Control the temperature of the heat pack between 40-50°C according to the patient's tolerance. Hold the heat pack and perform continuous, clockwise rubbing and pressing around the patient's umbilical area. While pressing, ensure that the operator straightens his or her elbows and slightly leans forward, using part of his or her body weight to gradually apply downward pressure (about 3-5 cm of abdominal skin depression). During the process, ask the patient whether the temperature of the heat pack is comfortable, and check the local skin every 5 min. Don't operate violently during the operation, and gradually increase the pressure.
      2. When the heat pack is warmer, apply lighter pressure and move it more quickly to avoid staying too long in one spot. As the heat pack cools, apply heavier pressure and move it more slowly, continuing for about 5 min. Alternate between clockwise and counterclockwise rubbing during the procedure.
      3. When the patient's skin feels warm but not burning, attach the heat pack sequentially to the Shenque (CV8), Zhongwan (CV12), Tianshu (ST25), and Qihai (CV6) acupoints. Continue applying the heat for 5 min at each acupoint, combined with slight rubbing and pressing movements.
      4. Ensure that each session lasts for 25 min, and is performed once a day at 6:00 AM, continuing for 4 weeks.
2. Acupoint Plaster Therapy
   1. Position selection: Instruct the patient to sit in a comfortable position. Inspect the patient's abdominal, lower back to ensure it is intact and free from abrasions.
      NOTE: Avoid choosing positions where the skin is broken, inflamed, or bleeding.
   2. Acupoint selection and localization:
      1. Feishu (BL13): Located on the back, 1.5 F-cun lateral to the posterior midline, below the spinous process of the 3rd thoracic vertebra³⁹.
      2. Pishu (BL20): Located on the back, 1.5 F-cun lateral to the posterior midline, below the spinous process of the 11th thoracic vertebra³⁹.
      3. Shenshu (BL23): Located on the lower back, 1.5 F-cun lateral to the posterior midline, below the spinous process of the 2nd lumbar vertebra. The other acupoints are the same as those used in the Ironing therapy section³⁹(Figure 4).
         NOTE: The measurement of acupuncture points adheres to the proportional finger-cun system (F-cun), a method that uses the patient's own fingers to determine the relevant distance. In detail, the width of the four fingers-with the crease of the middle joint of the middle finger serving as a reference-corresponds to 3 F-cun. The combined width of the index finger and the middle finger is equivalent to 1.5 cun, while the combined width of the index finger, middle finger, and ring finger amounts to 2 F-cun^40,41.
   3. Take the prepared acupoint plaster, apply it to the pre-disinfected skin, and gently press the plaster onto each acupoint to stimulate the acupoints, promote the circulation of qi and blood, and improve therapeutic outcomes (Figure 5). Use proper point pressing techniques. Ask the patient about their comfort every 5 minutes during the operation. Gradually increase the point pressing force; avoid violent operation.
      NOTE: First, identify the spinous process of the seventh cervical vertebra, and then move down to the third thoracic vertebra. Using the same method, find the twelfth thoracic vertebra and then move down to the 2nd lumbar vertebra. The time of application is 6-8 h, and the sensitive skin is shortened to 2-4 h. Avoid applying it to thin and tender areas (such as around the eyes and damaged areas).

5. Management of adverse events

1. Inquire about the patient's allergy history, particularly regarding components of topical medications, skin conditions, such as eczema, abrasions, or scarring tendencies, and underlying medical conditions like diabetes with poor skin repair or bleeding disorders. Before applying heat therapy, confirm the patient's thermal tolerance. Prioritize informing patients about medication components before acupoint application. Those with allergic predispositions should undergo a small-area skin patch test, especially on the inner wrist area, followed by 24 h observation. If symptoms such as a rash, palpitations, chest tightness, dyspnea, or hypotension (a precursor to anaphylactic shock) arise, immediately cease treatment, remove the applied medication, position the patient supine, and administer oxygen (at a rate of 3-5 L per min. In the event of severe allergic reactions, promptly seek emergency medical care and monitor the patient's recovery from the allergic reactions.
2. Inform the patient in advance that if they experience discomfort such as nausea, vomiting, dizziness, or palpitations during the treatment, they must stop it immediately. Support the patient to lie flat, open the window for ventilation, and monitor their blood pressure and heart rate. If the blood pressure is low, they should drink warm sugar water.
3. Inform the patient that if they experience skin reactions such as itching, burning pain, redness, blisters, or other local allergic responses at the treatment site, they should not scratch the skin. Instead, apply an antihistamine ointment to relieve the symptoms, and seek medical attention if necessary⁴².
4. If a burn occurs at the treatment site during the Ironing therapy, immediately assist the patient by rinsing the burn area with cold water for 20-30 min or applying an ice pack for cold compression. Afterward, apply a topical burn ointment. In severe cases, urgent consultation with a burn specialist is required, and the experiment should be terminated.
5. Upon occurrence of an adverse event, immediately document the time, manifestations, corrective measures, and patient response, with signatures from the involved healthcare provider. Mild reactions: Report to the department head within 24 h. Moderate-to-severe reactions (especially eulceration, anaphylactic shock): Immediately notify the department director and medical affairs office, completing the Adverse Event Report Form. For patients with moderate-to-severe reactions, conduct follow-up until symptoms completely resolve, document prognosis outcomes, analyze root causes, and optimize operational protocols.

6. Statistical analysis

1. Present continuous variables as mean ± standard deviation. Analyze categorical variables, such as gender comparisons, using the chi-square test. After confirming normal distribution of data, employ paired t-tests for pre-and post-treatment comparisons within the same group. For statistical analysis of differences between control and experimental groups, apply paired t-tests. Set the significance level at α = 0.05 (two-tailed test).
   NOTE: All statistical analyses utilized two-tailed tests; throughout the study, differences were considered to reach statistical significance only when the p-value was < 0.05.

Results

This study enrolled 20 COPD patients with functional constipation (FC) who visited the Chengdu University of Traditional Chinese Medicine Hospital between December 2024 and March 2025. The patients were randomly assigned to either the experimental group (Ironing therapy ± acupoint plaster treatment) or the control group (oral lactulose), with 10 patients in each group. In the control group, there were 6 male and 4 female patients, with an average age of 73.90 ± 7.20 years and an average disease duration of 5.47 ± 1.85 ye...

Discussion

Based on the TCM diagnostic principles of the four diagnostic methods, we use external treatment by first applying Ironing therapy to open the acupoints with both medicinal and thermal effects, which facilitates the flow of Qi and blood in the meridians. According to the principles of TCM's Ziwuliuzhu (the cycle of Qi movement through meridians), the lung meridian's flow time is between 3-5 AM, while the large intestine meridian's flow time is between 5-7 AM⁴³. Thus, treatment is applied during th...

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Chinese herbal decoction piece rhubarb	Sichuan Guoqiang Chinese Medicine Decoction Pieces Co., Ltd	24120104
Chinese herbal decoction piece Fennel Seed	Sichuan Guoqiang Chinese Medicine Decoction Pieces Co., Ltd	24120104
Chinese herbal decoction piece Atractylodes macrocephala	Sichuan Guoqiang Chinese Medicine Decoction Pieces Co., Ltd	24120104
Chinese herbal decoction piece Radish Seed	Sichuan Guoqiang Chinese Medicine Decoction Pieces Co., Ltd	24120104
Chinese herbal decoction piece Semen Sinapis albae	Sichuan Guoqiang Chinese Medicine Decoction Pieces Co., Ltd	24120104
Disposable sterile rubber gloves	Shanghai Kebang Medical Latex Equipment Co., Ltd.	241030HM
Disposable acupoint patches	Jiangsu Guangyi Medical Dressing Co., Ltd.	20160028B27
Disposable sterile cloth bags	Anhui Meijianan Household Products Co., Ltd, Anhui, China	N411
Disposable tongue depressors	Yangzhou Xiaokang Medical Device Co., Ltd.	20240908
Grinder	Zhaofenger Industry and Trade Co., Ltd., Hunan, China	J80031
Gauze bag	Zhongxin Sanitary Materials Co., Ltd., Sichuan, China	20241222
Hand disinfectant	Gamma Disinfection Products (Foshan) Co., Ltd. Sichuan Branch	CNSQV6280590A
Iodine cotton swabs	Zhejiang Baikal Health Technology Co., Ltd.	20241201
Microwave	Galanz Group Co., Ltd., Guangdong, China	P70D20N1P-G5(W0)
Medical tweezers	Weigao Grope Medical Polymer Co., Ltd., Shandong, China	20222540118
Medical sterile cotton swabs	Chengdu Zhongxin Hygiene Materials Co., Ltd.	20250120
Medical adhesive tape	3M Medical Devices (Shanghai) Co., Ltd.	2406GA0
Treatment towel	Sichuan Hualikang Medical Technology Co., Ltd, Sichuan, China	2111901