Professor Liu Zhishun 's Experience In Promoting The Diagnosis And Treatment Of Neurological Function

BackgroundTransverse Myelitis (TM) occurs urgently, with a critical condition which often causes patients death, The proportion of disability among TM patients is more higher than other nervous system diseases,about 67% of the patients left the symptoms of nerve dysfunction, mainly for motor dysfunction, the bowel and bladder dysfunction, bringing physical and mental harm to patients, not conducive to the late rehabilitation, too.Therefore, more and more attentions of clinicians are given to TM in recent years.. The pathogenesis of this disease is not clear, hormone is the main therapy of Western medicine, there is no specific therapy at present. Related reports are not conducive to clinical application and promotion for uncertain and unreliable long-term curative effect. As a part of the traditional chinese medicine,acupuncture may be a new attempt for TM. This study aims to summarize the experience of Zhishun Liu, using electroacupuncture (EA) to promote the nervous function of TM patients. ObjectiveAnalyze and summarize the experience of Zhishun Liu,which promoting the motor function,the bowel and bladder function of TM patients. MethodDuring 2014.1 to 2016.3,selected cases of TM outpatients in China Academy of traditional Chinese medicine Guang’an men Hospital received treatments from Zhishun Liu,the director of department of acupuncture and moxibustion. the included 21 cases (only 19 cases finished the treatments), were treated by electroacupuncture. AS a prospective clinical observation of tutor’s treatments for 19 TM patients, the evaluation index including motor function score, independent ability of urination, weekly frequency of incontinence,24-hour urinary frequency, nocturia, ultrasonic residual urine volume(RUV), auxiliary urination and defecation method, independent ability of defecation were observed in short and long-term efficacy; at the same time, detailed records included dialectical treatment, acupuncture points, operation parameters of electroacupuncture, treatment frequency, total treatment time and the frequency of times,the characteristics and patterns of addition and subtraction methods and adjuvant treatments. To analyze and summarize the experience of Zhishun Liu,which promoting the motor function,the bowel and bladder dysfunction of TM patients. ResultClinical efficacy of motor function:11 patients have motor dysfunction,their motor function score on baseline was 4 (2,5) (M (QR), decreased to 2 (0,3) after 12 weeks EA treatment, indicating that EA could promote the recovery of motor function, during follow-up (6 months),10 patients’symptoms had no apparent changes compared to the end of treatment, indicating that EA may have a long-term effects; bowel and bladder functions:among 15 patients with retention of urine,11 recovered spontaneous or partly autonomous urination (11/15,73.33%),average residual urine amount reduced 186.91+ 56.89ml (P=0.008) compared to the baseline, indicating that EA can promote the bladder function. After 12 weeks of treatment,in patients with urinary incontinence, the average weekly frequency of incontinence reduced by 12 (4,20) (P=0.008),average 24 hours micturition times reduced by 4 (0,8) (P=0.030), average frequency of nocturia reduced by 4 (0,8) (P=0.033) (Note:three numbers are m (QR)), indicating that EA can inhibit the overactive bladder caused by TM, and was helpful to TM patients with urinary incontinence. Among 10 patients with defecation dysfunction,9 (9/10,90.00%) recovered independent or partly independent defecation, reducing auxiliary defecation measures as well; Within 5 (5/10, 50.00%) patients recovered partly independent defecation,4 regained rectal sensation,1 occasionally regained relaxation sense of anus, indicated that EA had Curative effects for rectum and anus sense recovery. All the data of 19 patients during Follow-up (6 months) had no significant difference compared with the end of treatment, showed that EA may have a certain long-term effect.There was no adverse event observed during the treatment. Experience summary of tutorLEA for motor dyfunction,bowel and bladder dyfunctions:refer to symptoms and pathogenetic locations of TM, Du Meridian, bladder and rectum are considered the main pathogenetic locations,The pathogenesis attributes to the damage of Du Meridian,as well as the bladder and bowel dysfunction.Treatments aims to motivate Qi of Du Meridian and to promote the bladder and bowel’ gasifications; prominent identifying main symptoms are important, so as to the lesion location; selected points included:Jiaji points (bilateral), Zhongliao (bilateral), Ciliao (bilateral), Huiyang (bilateral), EA can help to strengthen the quantity of stimulus and improved the curative effects.2 Treatment programAcupoints:Jiaji nearly to the lesion segment for the motor dysfunction, local Ashi points for hyperalgesia, patients with apparent limbs need points like Zusanli, Qihai and Guanyuani, patients with numbness need points likeXuehai, Qihai and Geshu, Clliao, Zhongliao, Huiyang are selected for bowel and bladder dyfunctions,paitients with frequent urination need San yinjiao, Shenshu, Mingmen, paitients with constipation need Yangchi, Zhigou and Hegu,paitients with defecation and urination weakness need Qihai and Zu Sanli.Operation method:healers select 0.30x40mm needle, pierce straight into the points about 25mm deepness; stab at midline oblique 45 to 60 degrees with 0.45 mm x 125mm needle into the third sacral hole about 80mm-100mm namely is Zhongliao acupoints; Huiyang points use 0.30 mmx75mm needle out above the thorn, the penetration depth is about 50mm. Ciliao, Zhongliao and Huiyang points are needled deeply, and local ache or hemp inductance is preferred during the treatment. The rest of routine acupoint needling. Side clip ridge point and on the side are respectively connected with a group of electrodes, Zhongliao and Ciliao on one side are respectively connected with a group of electrodes, bilateral Huiyang points are connected with a group of electrodes, too.Adjust the EA instrument’s frequency to 20～40 Hz,and the current intensity to patients tolerance, each treatment sustain 20 minutes,In the first four weeks patients get 5 times treatments per week,From fifth weeks adjusted to three times a week, once every other day. The total treatment time is 12 weeks.