DIABETIC PATHOLOGICAL CHANGES OF URINARY BLADDER

Zheng Huitian, Huang Xianming, Sun Jishan

(Shanghai Institute of Acpuncture and Meridian, Shanghai)

Miao Tingjie, Wang Guoming, Yang Yuquan

(Zhongshan Hospital, Shanghai First Medical College, Shanghai)

Since 1982 we have observed by means of urodynamics, the effects of acupuncture on 30 patients with diabetic pathological changes of the urinary bladder. We have also made a preliminary study on the mechanism of acupuncture in treatment of disease by analyzing several factors such as differentiation of syndromes in TCM, length of course, amount of residual urine and renal function etc.

Method: On the basis of continuous diet control and oral administration of antidiabetie drugs, we selected points according to differentiation of syndromes in TCM to treat the patients diagnosed as having the disease.

1. Insufficiency of true Ying, deficiency of Qi in lung and kidney.

(1) Qihai (moxibustion), Lieque, Zhaohai, Shuidao.

(2) Huiyang, Zhongliishu, Weiyang.

All the points were punctured by reinforcing manipulation.

2. Deficiency of true Ying, asthenia of kidney Yang.

The points selected: The former prescription with the addition of moxibustion on Ming-men, Shenshu, Guanyuan. Each point selected was tonified by lifting and thrusting, twisting and twirling of the needle. Point Huiyang and Zhongliishu were deeply inserted with long needles for acupuncture sensation to reach the lower abdomen and the perineal area. Moxibustion on each point with moxa stick was applied for 15 minutes. The treatment was given every other day with alternation of two groups of points, each course containing 10 treatments.

Results: Of the 30 patients treated after 1-3 course, 20 showed marked improvement, 7 with some improvement and 3 no improvement. The total effective rate was 90%. It can be seen that acupuncture is remarkably effective for treatment of the disease and worth popularizing as it has no side effects.

1. The result of study of urodynamics: In the 30 cases of the group, residual urine was measured before and after treatment. All the patients were found to have more than 20cc of residual urine before treatment, one case having as much as 305cc. After treatment it returned to less than 20cc in 24 cases, being 245cc in only one case. The difference is statistically significant before and after treatment (P<0.001). The measurement of Intra-Vesical Pressure showed sensory paralysis type and auto-neurogenic bladder before treatment. After treatment, the curves of 24 cases were restored to normal, 5 improved and 1 case had no effect,

We also made a synchronous examination of intra-vesical pressure, EMG, measuring urine flow and performed ice water test (the stress was put on obsessing the anesthesia of the bladder in ice water at 4°C). The result indicates that acupuncture may promote the vesical detrusor to contract and improve the co-ordination of the detrusor muscle and the urine flow rate curve, so as to lessen or eliminate residual urine and to restore the sensation of the bladder.

2. Analysis of the relationship between the differentiation of syndromes in TCM and the therapeutic effects indicates that early diagnosis and treatment of the disease is important. It is suggested that the ultrasonic examination of the patient with disease should be performed frequently and acupuncture treatment should be administered as soon as residual urine is found.

3. Observation of detrusor EMG: It was found that needling points Huiyang and Zhonglushu had the most obvious immediate effect on the detrusor EMG by observing detrusor EMG on every point of the group. It had been proved by probing the points that point Huiyang and Zhonglushu which were deeply inserted with needles were the very sites of the pelvic neuroplex. So it is probable that one of the ways in which the disease is treated by acupuncture is to excite the pelvic neuroplex to improve the edematous degeneration of the vesical nerve endings. The mechanism of acupuncture in the treatment of the disease remains to be further studied.