Application of auricular acupoints therapy in relieving the gastrointestinal side effects induced by chemotherapy：an integrative review

Ying-Xin Li，Yun-Ln Jing，Yin-Ping Yi，Wn-Lin Liu，Yi-Xun Tng，Yi-Xin Liu，Yun-Feng Liu

aChengdu University of Traditional Chinese Medicine，Chengdu，Sichuan 610075，China

bTeaching Hospital of Chengdu University of Traditional Chinese Medicine，Chengdu，Sichuan 610075，China

Review article

Application of auricular acupoints therapy in relieving the gastrointestinal side effects induced by chemotherapy：an integrative review

Ying-Xin Lia，Yun-Lan Jiangb，*，Yin-Ping Yia，Wan-Lin Liua，Yi-Xun Tanga，Yi-Xian Liua，Yun-Feng Liua

aChengdu University of Traditional Chinese Medicine，Chengdu，Sichuan 610075，China

bTeaching Hospital of Chengdu University of Traditional Chinese Medicine，Chengdu，Sichuan 610075，China

A R T I C L E I N F O

Article history：

Received 24 January 2016

Received in revised form

28 February 2016

Accepted 19 April 2016

Available online 16 June 2016

Auricular acupoints therapy

Chemotherapy

Side effects

Gastrointestinal

Review

Background：It is an urgent matter to relieve the side effects induced by chemotherapy.In recent years，auricular acupoints therapy，which is a nursing technique used in traditional Chinese medicine（TCM），has been used on many patients who are undergoing chemotherapy without causing any side effects. Furthermore，it has a good efficacy and is inexpensive.

Aim：The aim of this study was to provide evidence for the need of further research in the treatment and nursing of patients during chemotherapy.

Methods：We conducted an integrated review of the reports in CNKI，WanFang Data，SinoMed，and PubMed databases for journal articles published after 1990.The search terms included auricular acupoints taping and pressing，auricular acupoints therapy，auricular point sticking，ear points，chemotherapy，and side effects and relevant Medical Subject Heading terms.We then analyzed the mechanism，acupoints，and operation method and summarized the application of auricular acupoints therapy in patients suffering from chemotherapy side effects.

Results：This review included 102 articles published between 1990 and 2016，and we brought 63 other articles into the study.Eighteen articles focused on auricular acupoints therapy，combined with other therapy，to relieve patient side effects during chemotherapy.

Conclusions：Auricular acupoints therapy can prevent and relieve the side effects induced by chemotherapy.It deserves further clinical applications.

?2016 Shanxi Medical Periodical Press.Publishing services by Elsevier B.V.This is an open access article under the CC BY-NC-ND license（http：//creativecommons.org/licenses/by-nc-nd/4.0/）.

1.Introduction

Chemotherapy is an important method to treat tumors.Studies showthat70-80%oftumorpatientsneedtoundergochemotherapy to increase its clinical curative effect.1，2Chemotherapy can control the development of tumors，prevent tumor recurrence and metastasis，3and prolong survival time for tumor patients.4However，chemotherapy can also cause normal tissue damage while killing cancercells，whichmeansthatchemotherapysideeffectsmayoccur. The side effects induced by chemotherapy seriously influence a patient'stolerance ofand compliance with chemotherapy.Gastrointestinal side effects are the most common side effects，affecting 75%of tumor patients.5These side effects include nausea and vomiting，dyspepsia，hiccups，constipation，and oral ulcers. Therefore，relieving these chemotherapy side effects with effective nursing is an urgent matter.Presently，patients generally take drugs to relieve chemotherapy side effects，but drug therapy may cause new side effects.In addition，the efficacy for delayed vomiting by drug therapy is not obvious.The auricular acupoints therapy，which is a nursing technique used inTCM，has been used in recent years to treat patients during chemotherapy and presents no side effects. Furthermore，it has a good efficacy and is inexpensive.This study summarizes the operation method and the application of auricular acupoints therapy in patients suffering from the side effects of chemotherapy to provide evidence for further research in the treatment and nursing of patients during chemotherapy.

2.A summary of auricular acupoints therapy

2.1.Definition

Auricular acupoints therapy is an external treatment method，which is developed on the basis of auricular acupuncture therapy.It needs to put the vaccaria seed on the auricular acupoints accurately，and make patients feel hot，anesthesic，distendinglike and pain by kneading，tapping，pinching，pressing the acupoints.

2.2.The mechanism

2.2.1.The mechanism of chemotherapy drugs causing the gastrointestinal side effects

Because a chemotherapy course can last for an extended period of time，patients may become weak，and the function of their zang and fu（viscera）may become deficient.As an exogenous pathogenic factor，chemotherapy can injure the spleen and the stomach，disorder the qi and blood，disturb the transportation and transformation of the spleen，and impair the harmonious descending of the stomach.The qing-qi（lucid qi）is not ascending，and the turbid qi flows in reverse，which leads to nausea and vomiting.6Hiccups are caused by the adverse rising of the stomach qi.Oral ulcers are caused by fire flames up.7

2.2.2.The mechanism of auricular acupoints therapy

Twelve meridians are on the flux in the ears，and each viscera is connected to the ears in our body.The application of auricular acupoints therapy，through stimulating certain auricular acupoints，is to activate the meridians and collaterals on the whole body and to regulate the function of the internal organs，qi，and blood to relieve the gastrointestinal side effects.The stomach acupoints balance the stomach qi and promotes antiemetic function.The shenmen acupoints work for sedation，tranquilization，and has some antiemetic effect，while the jiaogan acupoints adjust the autonomic nerve to relieve nausea and vomiting caused by the excitation of the vagus nerve.These acupoints are stimulated in patients to regulate and balance stomach qi and stop vomiting in patients.

2.3.The choice of acupoints and operation method

There are two principles on selecting acupoints：the main acupoints and supporting acupoints.Generally，it takes Wangbuliuxing（vaccariae）as the main drug beans；some learners also choose the magnetic beads.However，there is no uniform criterion of a specific method，such as the frequency of pressing and the duration of pressing.

2.3.1.The choice of auricular acupoints

Generally，the main acupoints include 3-5 acupoints，consisting of the shenmen，stomach，endocrine，spleen，jiaogan，and subcortical acupoints.Xiao8studied the influence of auricular acupoints and defecation in patients during chemotherapy.He chose the constipation point，large intestine，sub rectum，triple energizer（sanjiao），and lung acupoints as the main acupoints.Zhang9et al state that the cardia acupoint is the key point for antiemetic；therefore，they chose the cardia acupoint as the main acupoint.The choice of the distribution should be based on the result of the syndrome differentiation.

2.3.2.Operation method（Table 1）

2.4.Criteria of curative effect

The WHO classification of standard chemotherapy drug toxicity reaction was mostly chosen.This classification divides the symptoms of nausea and vomiting into the following degrees：degree 0（no nausea or vomiting），degree I（nausea with no influence on diet and daily life），degree II（minimal vomiting with some influence on diet and daily life），degree III（vomiting needing treatment and obvious influence on diet and daily life），and degree IV（frequent vomiting causing an inability to eat）.After treatment，if a patient is classified as degree 0 or I，the treatment is considered to have a good effect.If a patient is classified as degree II，the treatment is considered effective.If a patient is classified as degree III or IV，thetreatmentisconsidered ineffective.However，some learners19choose the National Cancer Institute Common Toxicity Events Standard（NCI-CTCAE）as the evaluation parameter.

Table 1 The method of auricular acupoints therapy.

3.Application of auricular acupoints therapy

3.1.Nausea and vomiting

Li16et al observed the effect of auricular acupoints therapy for vomiting induced by chemotherapy in cervical cancer patients. Eighty-four subjects were randomized into a control group and an observation group.The cases in the control group received common antiemetic drugs，while the subjects in the observation group received additional auricular acupoints therapy 30 min before chemotherapy until the end of the chemotherapy.The results showed that the rate of nausea and vomiting was significantly lower in the observation group than the rate in the control group.In addition，the quality of daily life was improved in the observation group as compared with the control group.

To explore the effect of auricular acupoints therapy in relieving vomiting induced by chemotherapy and to observe its effect on the usage of Ondansetron，Bi20conducted a randomized controlled trial. It was found that auricularacupointstherapycan reduce the dose of Ondansetron in patients undergoing chemotherapy.

You13et al observed the effect of auricular acupoints therapy in preventing EP chemotherapy-induced gastrointestinal reaction and evaluated its safety.The patients who received EP chemotherapy were randomly divided into two groups.The observation group was given ear bean pressure，and the control group was not given auricular acupoints therapy.Then，the gastrointestinal reactions and the stress states were observed.It was observed that in the cases of abdominal pain，abdominal distention，nausea，vomiting，and blood glucose level，the HAMD，HAMA，and NRS scores of the observation group were significantly lower than the scores in the control group.However，the insulin levels in observation group were significantly higher than those in the control group.Therefore，they pointed out that auricular acupoints therapy has positive clinical value.

3.2.Hiccups

Lu21et al applied auricular acupoints therapy in intractable hiccups induced by chemotherapy.Fifty-four tumor patients were randomly divided into an observation group and a control group. The cases in the control group received common acupuncture，while those in the observation group received additional auricular acupoints therapy combined with acupoint injections for 6 days. The study showed that auricular acupoints therapy combined with point injections had a better effect than common acupuncture.

In addition，Hu7et al applied auricular acupoints therapy for preventing the occurrence of oral ulcers for gastric cancer patients during chemotherapy.The results showed that auricular acupoints therapy could prevent the occurrence of oral ulcers for stomach tumor patients during chemotherapy and can reduce ulcer severity. Xiao8found that auricular acupoints therapy combined with abdominal massage can improve the defecation of tumor patients.

3.3.Application of auricular acupoints therapy combined with other therapy

To increase the effect of auricular acupoints therapy in gastrointestinal side effects induced by chemotherapy，many learners applied it in combination with other therapies，such as point injection，point massage，acupuncture，and moxibustion（Table 2）.

4.Prospect

Auricular acupoints therapy in relieving the gastrointestinal side effects induced by chemotherapy is based on the function of promoting circulation of the qi and blood，freeing meridians and collaterals，adjusting nerves，and balancing the endocrine system.Its application becomes more and more broad，and the effects also continue to obtain recognition.However，there is no criteria or uniform application of auricular acupoints therapy for its method，such as the frequency of pressing，the duration of pressing，and the start and end times.Therefore，the best times and frequency should be further explored.All of the analyses showed that，as a nursing technique used in TCM，auricular acupoints therapy is simple，convenient，and inexpensive and has a significant curative effect.It should be used in patients during chemotherapy.At the same time，medical staff should do further research on the therapy so that more patients can benefit from it.

Table 2 Auricular acupoints therapy combined with other therapy.

Conflicts of interest

All contributing authors declare no conflicts of interest.

Acknowledgments

First，we would like to express our appreciation to Chengdu University of Traditional Chinese Medicine.In addition，we thank teachers，especially Miss Zhong Zhen for valuable information regarding TCM English，and useful advice on this manuscript.

1.Bergkvist K，Wengstrom Y.Symptom experiences during chemotherapy treatment-with focus on nausea and vomiting.Eur J Oncol Nurs.2006；10：21-29.

2.Wang CL，Dai XJ.Research status of TCM on relieving oral ulcer induced by chemotherapy.J Nurs.2011；05：16-19（in Chinese）.

3.Qiu XY.Side effects induced by chemotherapy in tumor patients and nursing. Mod J Integr Tradit Chin West Med.2002；12：1182（in Chinese）.

4.Liu YL，Shi HL.Nursing research status about side effects of chemotherapy.Chin J Nurs.2004；11：60-61（in Chinese）.

5.Li XJ.Treatment of 32 Case of adverse effects induced by radiotherapy and chemotherapy with moxibustion combined with auricular acupoint taping and pressing therapy.Chin Acupunct Moxibustion.2001；09：12-13（in Chinese）.

6.Cao CQ，Cao XJ.Effect of acupuncture therapy and auricular points compression on nausea and vomitting caused by chemotherapy.J Nurs Sci.2007；23：29-30（in Chinese）.

7.Hu ZX，Yu YM，Yuan JH，Wan HP，Wu LP.Effect observation of auricular acupoints pressing with cowherb seed on relieving stomatitis of gastric cancer patients.J Nurs.2013；12：56-57（in Chinese）.

8.Xiao AH.Influence of ear point taping and pressing and abdominal massage on defecation of tumor patients treated with chemical therapy.Chin J Mod Nurs. 2008；142：2947-2949（in Chinese）.

9.Zhang Q，Cheng J.Clinical observation of moxibustion plus auricular-seedpressing preventing 60 cases with gastrointestinal reaction after Cisplatin treatment.J Emerg Tradit Chin Med.2012；06：874-875（in Chinese）.

10.Liu LH，Chen ZZ.Effect observation of pressing beans at points on relieving the gastrointestinal side effects induced by chemotherapy after lung cancer.Mod J Integ Tradit Chin West Med.2011；36：4651-4652（in Chinese）.

11.Zhang LH，Qiao SL.Effect observation of auricular-seed-pressing preventing 87 cases with gastrointestinal reaction induced by chemotherapy.J Qilu Nurs. 2010；28：82-83（in Chinese）.

12.Jin LL.Auricular acupoints treating the toxicity induced by chemotherapy.Chin Acupunct Moxibustion.2002；S1：193（in Chinese）.

13.You LY，Ding QF，Li Q，Hu YQ.Effect of ear beans pressure in preventing EP chemotherapy induced gastrointestinal reaction and its safety evaluation. Liaoning J Tradit Chin Med.2013；11：2312-2313（in Chinese）.

14.Xie AW，Niu M，Chan YY，Xu YY，Hu SY，Lin XX.Effect observation for Acupuncture point therapy for chemotherapy-induced gastrointestinal reaction in children with acute leukemia.J Nurs Train.2016；06：488-491（in Chinese）.

15.Sun XX.Experience of auricular-seed-pressing relieving the gastrointestinal reaction induced by chemotherapy.Shandong J Tradit Chin Med.2003；02：95-96（in Chinese）.

16.Li JH，Wu HJ，Chen XF，Zheng QH，He MQ.Effect observation of auricular-seedpressing relieving nausea and vomiting induced by chemotherapy oncervical cancer patients.Zhejiang J Prev Med.2014；02：196-198（in Chinese）.

17.Qin HY，Ma SD，Jiang LM.Auricular-seed-pressing combined with point massage preventing 30 cases with nausea and vomiting induced by chemotherapy on breast cancer patients after operation.J Emerg Tradit Chin Med.2011；12：1955-1965（in Chinese）.

18.Han G，Li LC，Zhou YL，et al.Curative effectiveness of combined use of auricular point sticking and antiemetic in the treatment of chemotherapy induced gastrointestinal reactions.J Nurs Sci.2004；05：34-35（in Chinese）.

19.Guo CM，Xiu MN.Clinical observation about prevention and treatment for chemotherapy induced nausea and vomiting in gastric cancer patients with ear pressure therapy and nursing.J Liaoning Univ Trad Chin Med.2014；04：113-115（in Chinese）.

20.Bi HD.Observations on auricular plaster therapy for reducing zofran dosage in patients receiving chemotherapy.Shanghai J Acupunct Moxibustion.2005；01：17-18（in Chinese）.

21.Lu LM.Hydro-acupuncture plus auricular point sticking treating stubborn hiccup induced by chemotheropy.Zhejiang J Integr Tradit Chin West Med. 2012；08：625-626（in Chinese）.

22.Liu Y，Cheng J，Zhang Q，Zhou WJ，Ying J，Qiu M.Moxibustion with pressing pills at ear points to prevent cisplatin after treatment gastrointestinal reaction of clinical observation.J Emerg Tradit Chin Med.2012；10：1564-1567（in Chinese）. 23.Wang SL，Sheng LJ，Sun YH，An YJ，Ren GH.Clinical observation of auricular acupoint application of Chinese medicine combined with compression on controlling delayed vomit induced by Cisplatin.Chin Clin Oncol.2010；03：260-262（in Chinese）.

24.Ding ZF.Clinical study of points injection combined with beans pressure on ear-points on vomiting caused by chemotherapy in patients with cancer. J Hunan Univ Chin Med.2011；01：68-69（in Chinese）.

25.Huang GF，Wang JH，Ji R，Zhou SZ，Li JT.Point embedding therapy plus auricular point sticking preventing delayed vomiting induced by chemotherapy.Chin J Clin.2006；09：39-40（in Chinese）.

How to cite this article：Li Y-X，Jiang Y-L，Yi Y-P，et al.Application of auricular acupoints therapy in relieving the gastrointestinal side effects induced by chemotherapy：an integrative review. Chin Nurs Res. 2016；3：58-61. http：//dx.doi.org/10.1016/ j.cnre.2016.06.004

*Corresponding author.

E-mail address：18980880152@163.com（Y.-L.Jiang）.

Peer review under responsibility of Shanxi Medical Periodical Press.

http：//dx.doi.org/10.1016/j.cnre.2016.06.004

2095-7718/?2016 Shanxi Medical Periodical Press.Publishing services by Elsevier B.V.This is an open access article under the CC BY-NC-ND license（http：//creativecommons. org/licenses/by-nc-nd/4.0/）.