Liu Zhishun, Director Of Electroacupuncture Treatment Of Lower Motor Neurogenic Dysuria Case Analysis And Experience Summary

BackgroundNeurogenic dysuria,which belongs to the category of neurogenic bladder,refers to the lower urinary tract dysfunction caused by damage to the nerves of the urination mechanism.The clinical manifestations are mainly dysuria and urinary retention or accompanied by urge incontinence in severe cases.These symptoms are classified to "Uroschesis" in traditional Chinese medicine(TCM).Since modern medicine has no specific treatment to the neurogenic dysuria,the main purpose of treatment is to protect kidney function and prevent complications such as upper urinary tract damage,hydronephrosis,and uremia caused by long-term dysuria.In clinical practice,"catheterization" is generally applied to protect patient from renal injury,but catheterization cannot help the recovery of patients' bladder function.Long-term catheterization not only severely affects patients' quality of life and self-esteem,but repeated lower urinary tract infections cannot be avoided.New therapies such as Sacral Neuromodulation(SNM)have curative advantages over conservative treatments,however,SNM is a surgical procedure,invasive and adverse effect are inevitable,and the high cost of the treatment is also unaffordable for most patients.TCM has a long history of treating "Uroschesis".There are various methods for treating neurogenic dysuria.Whether it is taken medication orally or externally,acupuncture,or other external methods,it has been validated in various studies.Among them,electroacupuncture shows significant efficacy.This study prospectively observed 64 cases of motor neurogenic dysuria under the clinical treatment of Director Liu Zhishun,and through the study to analyze and summarize his treatment program and clinical experience.In this study,64 cases of lower motor neurogenic dysuria were observed prospectively by the clinical treatment of Director Liu Zhishun,and their treatment ideas and experience were analyzed and summarized.PurposeThrough sequential research of clinical case observation,we analyzed and summarized Director Liu Zhishun's treatment ideas and clinical experience in the lower motor neurogenic dysuria.MethodWe observed and recorded 64 patients with lower motor neurogenic dysuria treated by Dr.Liu Zhishun,director of the Acupuncture Department of Guanganmen Hospital,from December,2018,to December,2020.First,we record patients' personal data,signs and symptoms,postvoid residual(PVR)urine volume,the degree of dysuria and the subjective evaluation of the patient's treatment efficacy at baseline,4 weeks,8 weeks,and 12 weeks.Responders were defined as participants with PVR volume<100 mL,without recurrent symptomatic urinary tract infection.Responders were seen as the main indicator to observe the efficacy in in each stage of treatment.Second,record the tutor's acupuncture diagnosis and treatment program,the main acupoints,individual difference according to patient clinical manifestations,the operating technique,the electric acupuncture parameters,etc.The experience of the tutor's diagnosis and treatment on lower motor neurogenic dysuria with electroacupuncture was analyzed and summarized from the data collected.Research result1.Clinical efficacyAll 64 patients completed 4 weeks treatment,52 patients completed 8 weeks treatment,and 37 patients completed 12 weeks treatment.At baseline,all patients had varying severity of dysuria and inability to urinate spontaneously.After 4 weeks treatment,18 patients regained the ability of spontaneous urination(28.1%),the number of difficulty urination reduced from 12 cases to 5 cases(7.8%),46 cases(71.9%)felt dysuria have improved.After 8 weeks treatment,patients' responders came to 21 cases(38.4%),mild difficult urination had increased from 1 case at baseline to 21 cases(40.4%).The average PVR volume was reduced by about 100ml after 8 weeks treatment,and the patient's subjective efficacy evaluation was improved more than 80%.At the end of the 12-week treatment,there were 28 cases(43.7%)recovered from dysuria to spontaneous urination,and PVR volume was reduced by an average of 200ml compared with baseline volume;only 1 patient was incapable of urination after 12-weeks treatment,the total ratio of patient without any or only mild difficult voiding was about 60%,and the ratio of improvement measured subjectively by patient was about 90%.During the whole observing and treating period,no patients had serious adverse events of acupuncture,and the incidence of local subcutaneous congestion in acupuncture was about 6.2%.The results of this study indicate that electroacupuncture may be effective and safe in the treatment of lower motor neurogenic dysuria.2.Tutor's experienceAcupuncture diagnosis and treatment of lower motor neurogenic dysuria should be combined with Chinese and Western disease differentiation,and TCM dialectical comprehensive diagnosis,which refers to,"disease-disease symptom-disease position"method.The method combines comprehensive differentiation and treatment thoughts,including western medicine diagnosis,TCM differentiation of main symptoms and disease positions,differentiation of symptoms and meridians,local acupoint selection and acupoint selection along the meridian.During the treatment,Dr.Liu Zhishun emphasizes deep needling at acupoints combing electroacupuncture treatment to strengthen the conduction of meridian qi and promote qi extending to affected parts.Deep needling at the BL32 and BL33 can also stimulate the anterior branch of the sacral nerve,which is similar to response of Sacral Neuromodulation(SNM).Plus,treatment with electroacupuncture for more than 30 minutes can further help restore nerve conduction pathways and relieve the patient's dysuria.3.Tutor's diagnosis and treatment planAccording to the "disease-disease symptom-disease position" method,Dr.Liu Zhishun conduct acupuncture treatment by needling BL32,BL 33(the bladder meridian),BL35(the confluence acupoints of the bladder meridian and the governor channel),and BL 23(the back-shu acupoint of kidney meridian)as main acupoint prescription.SP6 as the remote acupoint and local discomfort acupoint as the auxiliary acupoints.During treatment,long needles are usually applied for deep puncture.BL32 and BL33:insert the needles about 1cm above the S2 and S3 Foramen,and puncture inward to the S2 and S3 Foramen obliquely at an angle about 70 degrees.The depth is about 70?95mm,and stop at the sense of breakthrough from the needle tip.BL35 penetrates 60?70mm obliquely outwards and upwards.BL23 and SP6 are pierced straight into 25?30mm.After acupuncture at the main acupoints,electric acupuncture with an intensity of 3-6.5 mA is used,and the stimulation amount can reach the patient's bilateral internal rotation of the thigh,plantar flexion of the feet but beyond the patient's tolerance.Connect a set of electrodes on both sides of SP6,with an intensity of 1-2mA,which is subject to patient tolerance.The electroacupuncture frequency is 10 Hz,continuous wave,and the needles are retained for 30 minutes.The frequency of treatment is generally 3 times/week for a total of 12 weeks of treatment.Conclusion1.This study verified the efficacy and safety of the tutor's electroacupuncture treatment by observing 64 cases.Results shows electroacupuncture can improve the dysuria.There was nearly 30%of patients showed improved after 4 weeks treatment.The responders was significant after 12 weeks treatment,which over 40%of patients regained the ability of spontaneous urination,PVR volume was reduced by about half,and nearly 90%of patients have subjective evaluated the treatment were effective.The treatment was more effective to the patient with postoperative pelvic disease,cauda equina injury and sacral plexus injury.No serious adverse events of acupuncture occurred during the treatment.It shows that electroacupuncture can promote the patients to resume autonomous urination,reduce PVR volume,and improve patients' difficulty with neurogenic dysuria.2.Director Liu Zhishun's treatment of lower motor neurogenic dysuria is based on "disease-disease symptom-disease position" method.Selecting acupoints from the kidney meridian and bladder meridian;the main points are BL32,BL33,BL35,BL23 and SP6,which are added or subtracted according to the symptoms;BL32,BL33 and BL35 adopt deep piercing needles and electric acupuncture;the treatment course should be last for 3 months.