TREATMENT OF SHOCK WITH MOXIBUSTION AT GUANYUAN POINT

Yang Yuechu Director: Xi Yongjiang, Li Chengyi, Pan Weimin, Ye Qiang

(Department of Acupuncture and Massage Medicine, Shanghai College of TCM, Shanghai)

Shock is considered as one of the collapse syndrome with cold limbs in TCM (traditional Chinese medicine). Moxibustion at point Guanyuan is often adopted as one of its treatments in TCM.

In the clinical observations, 20 cases in shock (haemorrhagic shock 5 cases and toxic shock 15 cases) were treated with moxibustion at point Guanyuan Point (Ren). The results were: marked improvement 4 cases, improvement 11 cases, no effect 5 cases, and the total effective rate amounted to 75%. During the course of moxibustion, there were significant increases in systolic pressure and pulse pressure, slight increase in diastolic pressure, significant elevation in temperature of fingertip, and significant decrease in difference between rectal temperature and the temperature of fingertip, while no significant changes in heart rate (HR), respiratory rate and rectal temperature were observed. These indicated that the treatment of shock with moxibustion at point Guanyuan might result in an increase not only in arterial pressure, but also in perfusion of the peripheral capillary blood flow.

In the animal experiments, the effects of moxibustion at point Guanyuan on the haemodynamics and the arterial oxygen transport capacity of the dogs in haemorrhagic shock were studied.

Seventeen dogs were rapidly bled until the arterial BP dropped to 50 mmHg in 5 minutes and was then maintained at the same level for 25 minutes. Ten dogs of the experimental group were treated with moxibustion at point Guanyuan after cessation of bleeding. No treatment was given to the seven control dogs.

During the course of moxibustion, there were steady increases in stroke index (SI),-cardiac index (CI), mean arterial BP (MBP) and left ventricular stroke work index (LVSWI);

while no significants changes in heart rate (HR), central venous pressure (CVP), total peripheral resistance (TPR) and haematocrit (Hct) were observed. The increases in SI and LVSWI were due to the strengthening of myocardial contractility, which might result from the positive inotropic effect of the cardiac muscle by moxibustion. However, further experiments are needed for its confirmation.

During the course of moxibustion, there was an increase in arterial oxygen transport capacity per minute, while no significant changes in arterial oxygen tension (Pa02), arterial oxygen saturation (SaOa), arteriovenous oxygen content difference (AVD02) and haematocrit (Hct) were observed. Therefore the increase in arterial oxygen transport capacity was mainly due to the steady increase of cardiac index However three hours after the treatment, a significant increase in Vo2 as well as a significant decrease in oxygen extraction (Oaext) were noticed. These indicated that the abnormal state of oxygen extract at the doubled speed from blood per unit volume in haemorrhagic shock was partly corrected. At the same time the Vo2 of the experimental animals remained at a higher level than the controls,

Moxibustion at point Guanyuan resulted also in a steady increase in mixed venous oxygen tension (PyOa), which showed a better prognosis for the treated animals than the control. The changes of Py02 were closely related to those of CI in both the experimental and control animals. This indicated that the increase in Py02 was mainly due to the increase in CI.

It may be concluded that moxibustion at point Guanyuan Point (Ren) may strengthen the compensatory ability of the subject and improve the conditions of the haemodynamics and the functions of oxygen transport in the subjects in shock. Thus it may be adopted as a part of the complex emergent measures for a critical or severe case in shocks.