Experience And Clinical Verification Of Treating Neurogenic Bladder With Acupuncture Of Chief Physician Liu Zhishun

Background:Neurogenic bladder is a general term for a wide range of diseases characterized by nervous system related diseases that cause bladder dysfunction and bladder function,resulting in a variety of lower urinary tract symptoms.The causes of the disease are complicated.They are common in spinal cord injury,peripheral neuropathy,congenital dysplasia,central nervous system diseases and iatrogenic factors.A history of the nervous system is important in the diagnosis of the disease.The treatment is a medical problem has not been solved until now.If not timely correct treatment,Lower urinary tract symptoms of neurogenic bladder may lead to irreversible damage to the kidneys,ultimately lead to renal failure.The primary goal of the current treatment is to protect the kidneys,followed by recovery,or as much as possible,to restore voluntary urination,reduce residual bladder volume,and improve quality of life.All the possible effects of urine storage and voiding(or)the neural regulation of disease are likely to cause bladder urethral dysfunction and(or),the location and the degree of nerve injury and clinical manifestation of neurogenic bladder might have a certain correlation,but there is no regularity.At present,there is a lack of epidemiological data on neurogenic bladder with a large sample.The incidence of lower urinary tract dysfunction varies among various etiologies.Purpose:To introduce the clinical experience of Liu Zhishun in the treatment of neurogenic bladder with acupuncture,and preliminary validation of its efficacy.Methods:1.Diagnosis and treatment experience summary methods are:literature analysis,clinical follow-up,special interviews.Summarizes the diagnosis and treatment of neurogenic bladder by reading the literature and monographs about neurogenic bladder published by chief physician Liu Zhishun.Weekly follow-up study,record the tutor acupuncture treatment program,acupuncture point,operation,manipulation,addition and subtraction,frequency and course of treatment information,and further summarize the experience of the treatment.Through the special interview to solve the existing doubts,we sorted out the diagnosis and treatment plan of acupuncture and moxibustion treatment of neurogenic bladder by Dr.Liu Zhishun.2.Clinical observationThe observation cases were from December 2014 to December 2016 in 32 patients with neurogenic bladder who were visited by Liu Zhishun director of Acupuncture Department of Guanganmen hospital.All patients received acupuncture treatment at the acupuncture clinic.The main point is:BL32,BL33 and BL35.To collect and record the symptoms,signs and auxiliary examination indexes of patients with neurogenic bladder before and at the end of treatment in Liu Zhishun's outpatient clinic,and follow up 6 months after the end of the treatment.Patients with urinary retention index for urination ability and main symptoms and efficacy of follow-up,patients with urinary incontinence as the evaluation index,the number one week urinary incontinence and nocturia night urination for 24 hours the number of therapeutic effect and follow-up curative effect.At the same time,record the tutor's acupuncture treatment plan,acupoint selection,operation,manipulation,addition and subtraction,frequency and course of treatment.On this basis,we further analyze and summarize the experience of the treatment of neurogenic bladder with acupuncture and moxibustion.Results:Clinical efficacy Urine retention:32 patients were included in the statistics,all had urinary retention and required assistance to urinate.Among them,10 patients had urinary incontinence symptoms.In the end of the week when evaluating,(6/32,18.75%)patients by completely involuntary urination or partial recovery of automatic micturition complete urinary continence,(9/32,28.13%)patients recovered completely by involuntary urination to urinate,(15/32,46.88%)patients with urinary retention effect.For the end of the week,when evaluated,(6/32,18.75%)patients before and after treatment did not change the level of urination,urination symptoms improved significantly,there are(6/32,18.75%)patients were effective,the total efficiency(21/32,65.63%),showed that acupuncture treatment for neurogenic bladder urinary retention has certain curative effect.Follow up 6 months after the end of treatment,(1/32,3.13%)patient with symptoms of cauda equina injury cases occur repeatedly,in part by urination before treatment to regress completely involuntary urination,more than patients without symptoms repeatedly,that acupuncture treatment for neurogenic bladder urinary retention has certain curative effect.Urinary incontinence:10 cases of patients with urinary retention associated with symptoms of urinary incontinence,urinary leakage is reduced by 12 times per week(7,5)(P=0.008),24 hour urinary number reduces 4(2,4)(P=0.030),night nocturia decreased by 4(2,4)(P=0.033)and that has certain curative effect on patients with acupuncture and moxibustion for treatment of neurogenic bladder urinary retention and urinary incontinence.During the treatment period,serious adverse events were not recorded,and acupuncture is safe and reliable.Tutor experience1.Liu Zhishun director of the study that neurogenic bladder pathogenesis mainly bladder gasification Department failure.In the treatment,prominent disease-disease-position comprehensive syndrome differentiation method.Pay attention to the disease and the sense of.Emphasis on clinical diagnosis.Pay attention to differentiation and subtraction.To determine the prescription of acupoints,often by Liao,Liao and Huiyang acupoints,clinical syndrome differentiation.Through deep needling can cause gas to the disease by regulating qi,bladder,bladder function recovery.2.Diagnosis and treatment planAcupoints:treatment of prominent disease-disease-a dialectical and comprehensive method to determine the prescription of acupoints,often BL32,BL33 and BL35 acupoints prescription.Limb weakness,can with the addition of ST36,RN6 and RN4,with numbness,add SP10,RN6,GB20;have hyperalgesia,can be combined with local treatment;defecation urination of patients,can add RN4,ST36.Operation points:Acupuncture BL32,BL32 General specifications for the use of elongated needle 0.45mmX125mm.Below 30-45 DEG obliquely inward from the needle tip point,to breakthrough sense to stop,general adult 75-100mm,children's acupuncture needling depth depth is 50-75mm;BL35 commonly used specifications for 0.30mmX75mm needle,along the skin outside the top oblique penetration depth,generally need to reach about 50mm,in patients with local consciousness Expansion.EA:take the side of BL32,BL33,BL35respectively with the contralateral corresponding acupoints connected electrode,a total of three groups of acupoints;using conventional acupuncture,electro acupuncture does not need to answer.At the frequency adjustment range is generally between 2-20Hz,current intensity gradually increased from 0,in general can be observed in patients with both thighs slightly outward rotation,and foot plantar flexion,but does not exceed the tolerable range of patients.Treatment time:treatment of patients for 4 weeks before the general frequency of 5 times per week,4 weeks after adjustment for every other day;each treatment for 20 minutes,20 minutes after the main points of acupuncture,acupuncture frequency range 2-20Hz.Patients after 4 weeks of treatment according to the condition of the patients and determine whether to proceed with acupuncture treatment,if the treatment is invalid or the symptoms disappeared,if patients stop treatment,symptoms improved,there are still lower urinary tract dysfunction symptoms,continue treatment.Conclusions:In this study,a complete scheme for the treatment of neurogenic bladder with acupuncture and moxibustion has been put forward,which has certain reference value for the clinical treatment of neurogenic bladder.In addition,the efficacy and safety of the acupuncture treatment of neurogenic bladder in the treatment of neurogenic bladder were verified by observation of 32 cases.Acupuncture can promote patients with bladder independent movement,assist in the recovery of automatic micturition function,partial recovery row urinary tract infection and to improve the voiding symptoms have certain curative effect,long-term effect is relatively stable.Acupuncture has a two-way regulation effect,and some patients can be treated by acupuncture.The treatment of acupuncture and moxibustion has the same improving effect on the patients with urinary incontinence and urinary retention at the same time,and the follow-up effect is stable.Acupuncture treatment has better effects on neurogenic bladder due to postoperative incontinence,diabetic neurogenic bladder,rupture of intracranial cavernous hemangioma and tethered cord syndrome.Acupuncture is more effective in patients with neurogenic bladder than in patients with severe symptoms.The treatment of neurogenic bladder with acupuncture is safe,and there is no serious adverse event of acupuncture.Acupuncture Ciliao,Ciliao Huiyang acupoints can be used as a supplement of sacral nerve stimulation replacement therapy is simple.It can obviously reduce the pain during operation and have certain curative effect on bladder dysfunction.It is worth further studying its therapeutic mechanism.