Warm Needling Moxibustion at Zhongji (CV 3) and Zusanli (ST 36) for Urinary Retention after Gynecological Surgery

1 Department of Traditional Chinese Medicine, Air Force General Hospital, Chinese People's Liberation Army, Beijing 100142, China

2 Department of Rehabilitation Medicine, Air Force General Hospital, Chinese People's Liberation Army, Beijing 100142, China

CLINICAL STUDY

Warm Needling Moxibustion at Zhongji (CV 3) and Zusanli (ST 36) for Urinary Retention after Gynecological Surgery

Song Xiao-lin1, Yu Xin2

1 Department of Traditional Chinese Medicine, Air Force General Hospital, Chinese People's Liberation Army, Beijing 100142, China

2 Department of Rehabilitation Medicine, Air Force General Hospital, Chinese People's Liberation Army, Beijing 100142, China

Author:Song Xiao-lin, master degree candidate.

E-mail: song_xl0128@sina.com

Objective: To observe the clinical effect of warm needling moxibustion at Zhongji (CV 3) and Zusanli (ST 36) in treatment of urinary retention after gynecological surgery.

Methods: Forty patients with urinary retention after gynecological surgery were randomly divided into two groups by the randomized method, 20 cases in each group. Patients in the treatment group were treated by warm needling moxibustion at Zhongji (CV 3) and Zusanli (ST 36). Patients in the control group were treated by inductive urination. The therapeutic effects of the two groups were observed after one course of treatment.

Results: The total effective rate was 95.0% in the treatment group and 70.0% in the control group. The difference in the total effective rate between the two groups was statistically significant (P＜0.05).

Conclusion: Warm needling moxibustion at Zhongji (CV 3) and Zusanli (ST 36) is more effective than inductive urination in treating urinary retention after gynecological surgery.

Acupuncture Therapy; Moxibustion Therapy; Acupuncture-moxibustion Therapy; Warm Needling Therapy; Postoperative Complications; Urinary Retention; Women

Urinary retention is a common complication after gynecological surgery. Without timely treatment, it can influence the restoration of the reproductive organ and also can cause cystitis, pyelonephritis, etc, and even cause partial necrosis of the bladder. Currently, it is often treated by local warm application, fumigation and wash of the external genitalia with warm water, inductive urination by listening to running water, or injection of Neostigmine, and psychological suggestion. But, the effects are not satisfactory. This disease belongs to the scope of ‘retention of urine’ in Chinese medicine. We treated 20 cases of urinary retention after gynecological surgery by warm needling moxibustion at Zhongji (CV 3) and Zusanli (ST 36), in comparison with 20 cases treated by inductive urination. Now, the report is given as follows.

1 Clinical Materials

1.1 Diagnostic criteria

The diagnostic criteria of ‘urinary retention’ in theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional ChineseMedicine[1]were referred. The main clinical symptoms and signs were inability to urinate automatically over six hours after the catheter was removed following gynecological surgery or ability to urinate, but ≥100 mL residual urine in the bladder showed by B ultrasonic scan, with simultaneous distension in the lower abdomen, and strong and intolerable intention for urination; urinary retention induced by organic diseases was excluded.

1.2 Inclusion criteria

The patient had intention to urinate but unable to urinate or can pass a little volume of urine by repeated effort. In the physical examination, obvious elevation could be seen in the bladder area above the pubic bone, aggravated by pressure, with dull sound by percussion. Urinary retention was shown by B ultrasonic scan.

1.3 Exclusion criteria

Those with scanty urine or anuria caused by urinary stones, tumors, acute and chronic renal failure, with stranguria; those complicated with severe primary diseases in the cardiovascular, hepatic and hemopoietic system; those with surgery incision near Zhongji (CV 3); and those unable to cooperate with the treatment.

1.4 Statistical analysis

The SPSS 17.0 version statistical software was used for statistical analysis. The total effective rates were processed by Chi-square test and Fisher’s exact probability method. APvalue ＜0.05 considered as a statistical significance.

1.5 General data

All cases were the inpatients from Gynecology and Obstetrics Department of Air Force General Hospital, Chinese People’s Liberation Army from January of 2010 to May of 2014. All the cases were divided into a treatment group and a control group by the random digital table according to their visiting order. The differences in the age, duration and surgery types in the two groups were not statistically significant (allP＞0.05), indicating that the two groups were comparable.

Table 1. Comparison of general data between the two groups

2 Therapeutic Methods

2.1 Treatment group

The patients in the treatment group were treated by warm needling moxibustion.

Acupoints: Zhongji (CV 3) and bilateral Zusanli (ST 36).

Operation: After the patient took a supine position and the acupoint areas were routinely disinfected, the filiform needles of 0.3 mm in diameter and 40 mm in length were selected and inserted into the above acupoints. After the arrival of the needling sensation, a piece of moxa roll (1.2 cm in diameter, 1.5 cm in height, and 1 g in weight) was stuckt on the needle handle and ignited. The needles were taken out after three cones of moxibustion each time. The treatment was given once per day and five sessions made one course. During the treatment, medical staff stood next to the patient and put a piece of hardboard under the needle, to prevent moxa ashes from dropping down to burn the skin or clothes.

2.2 Control group

The inductive urination method was used, i.e. offering psychological suggestion, listening to running water, and giving hot compression on the bladder area of the lower abdomen. The treatment was given once per day and five sessions made one course.

3 Observation of Therapeutic Effects

3.1 Criteria of therapeutic effects

In reference to theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[1]promulgated by the State Administration of Traditional Chinese Medicine.

Cure: After treatment, able to urinate smoothly, and the symptoms and signs completely disappeared.

Improvement: After treatment, able to pass a little urine but not smoothly, the symptoms and signs were improved and no catheter was needed.

Failure: After treatment, still unable to urinate automatically and the catheter was still needed.

起病或急或緩，發病前往往有1～2天的上呼吸道感染癥狀，包括鼻癢、噴嚏、流清涕、揉眼睛、揉鼻子等表現，并且有明顯的咳嗽、喘息。年長兒起病往往較突然，常以一陣陣咳嗽為開始，繼而出現喘息，呼吸困難等。

3.2 Therapeutic results

The total effective rate was 95.0% in the treatment group and 70.0% in the control group. The difference between the two groups in the total effective rate was statistically significant (P＜0.05), indicating that the therapeutic effect in the treatment group was better than that in the control group (Table 2).

Table 2. Comparison of clinical effects between the two groups (case)

4 Discussion

It is believed in Chinese medicine that the pathological position of urinary retention is in the bladder and it is closely related to the lung, spleen, kidney and three jiao. The gynecological surgery damages Zang-fu organs, meridians and collaterals, causing obstruction of the meridians and collaterals and unsmooth circulation of qi and blood, and hence leading to deficiency of yang, failure of the bladder in qi transformation. Once qi transformation is in dysfunction and water passage is blocked, the lower abdomen will be full and urine will be unable to pass.

Judging from modern anatomy, the plexus dominating the bladder are situated in the vaginal and paracervical tissues. The gynecological surgery can cause injury and contusion in the ureter, bladder, urethra and nerves in varying degrees. It has been indicated in the clinical reports that the gynecological surgeries of vaginal hysterectomy and radical hysterectomy with pelvic lymphadenectomy may induce obvious dysfunction of the bladder in patients, and it might be related to nerve injury and bladder injury[2]. It is believed recently that there are four types of major reasons in urinary retention after gynecological surgery: first, the sympathetic nerves and parasympathetic nerves in the cardinal ligaments and sacral ligaments of the uterus are cut off during the surgery, forming the neurogenic bladder dysfunction, and further resulting in the reduced function of the bladder detrusor after surgery; secondly, the contraction of the detrusor is decreased due to traction of the bladder during the surgery; thirdly, the autonomic nervous system is affected by anesthetics during general anesthesia, causing weakness of contraction in the bladder; and fourthly, blood circulation of the bladder is impaired.

During the warm needling moxibustion, the heat produced by burning of moxa wool can be quickly transmitted to the deep area of the acupoint, to reduce downbearing distension and pain induced by urinary retention in the patient’s abdomen. The combination of acupuncture and moxibustion can enable the warm and heating effect to better penetrate into the deep layer of the muscles, to promote local blood circulation and accelerate local metabolism[3-5], so as to warm up the meridians and collaterals, dredge the meridians, activate blood, assist yang to transform qi, and regulate and dredge water passage. In the selection of acupoints, Zhongji (CV 3) is the Front-Mu point of the bladder, situated above the bladder, an acupoint where qi of Zang-fu organs and meridians gatheres in the abdomen, also a crossing acupoint of the Conception Vessel and three yin meridians of foot and is the first choice for bladder problems. Zusanli (ST 36) is the He-Sea point of the Stomach Meridian of Foot Yangming, bearing effects to strengthen the spleen yang, support the spleen to produce Yuan-Primordial qi and is an important acupoint for correcting deficiency[6]. Moxibustion has the effects to dredge the meridians and collaterals, activate blood, disperse blood stasis, circulate qi and stop pain. The warm needling moxibustion at the above two acupoints can excite Yuan-Primordial qi of the lower jiao and regulate the three jiao. The bidirectional regulation of acupuncture in combination with thermal stimulation of moxibustion can enable the warm and thermal effect to reach the bladder directly through the muscles, to excite the pelvic splanchnic nerve reflectively, and strengthen the conduction of the signals of the pelvic nerve, so as to excite the paralyzed sphincter of the bladder, and restore the function and pass urine[7-8].

The clinical effects are noticeable in acupuncture treatment of urinary retention and there are many reports[9-10]. It has been proven by the results in this study that the warm needling moxibustion at Zhongji (CV 3) and Zusanli (ST 36) for urinary retention after gynecological surgery is simple and convenient in the method, brief in acupoints and remarkable in the therapeutic effects.

Conflict of Interest

The authors declared that there was no conflict of interest in this article.

Acknowledgments

Statement of Informed Consent

Informed consent was obtained from all individual participants included in this study.

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Translator: Huang Guo-qi

R246.3

: A

Date: July 26, 2014