Liu Zhishun, Chief Physician Electroacupuncture Treatment Of Cauda Equina Injury After Two Dysfunction Experience

ObjectiveTo summarize Dr.Liu Zhishun’diagnosis and treatment experience of acupuncture in treatment with bladder and bowel function obstacle caused by cauda equina injury.MethodsObserving 20 patients with bladder and bowel dysfunction caused by cauda equina injury from October 15th 2013 to June 30th 2015, elevate the change of voiding ability, residual urine volume, the maximum urinary flow rate, micturition desire, defecation desire and ability, then observe the short-term efficacy and the follow-up efficacy; record the characteristics and the disciplines of tutor’s syndrome diagnosis, principle of treatment, method of acupoints selection and application, Electrical frequency, frequency, course of treatment, etc; analyze and summarize Dr.Liu Zhishun’diagnosis and treatment experience of acupuncture in treatment with bladder and bowel function obstacle caused by cauda equina injury.Results1.Clinical data:7 patients resumed their bladder-filling sensation(7/8,87.5%).12 patients regained their self-voiding ability and were catheter free(12/20,60.0%). The mean residual urine volume of the total enrolled patients decreased from 321.8± 130.7ml at baseline to 80.0±49.0ml at the end of the treatment(p<0.000). The maximum urinary flow rate of the 6 enrolled patients increased from 3.6 ± 2.5ml/s at baseline to 12.0 ± 5.6ml/s at the end of the treatment(p=0.017).4 of 6 patients who didn’t have the sensation of defecation at baseline gained the defecation desire after treatment(4/6,66.7%).66.7%(6/9 cases) of the 9 patients resume their self-defecation ability(p=0.031). There was no change in the follow-up period. No adverse events occurred during the treatment period.2.Treatment plan:(1)Bladder dysfunction:Ciliao(BL32), Zhongliao(BL33), Huiyang(BL35). Modification according to symptoms:if lower extremities weakness, add Weizhong(BL40), Qihaishu(BL24), Zusanli(ST36); if erectile dysfunction, add Shenshu(BL23), Mingmen(DU4); if dry stool,add Zhigou(SJ6), Hegu(LI4). Method of needling:inserted a 3-5 inch needle obliquely to Ciliao(BL32) and Zhongliao(BL33), let the patient felt heaviness and numbness locally or even a shooting sensation along to the genitalia; inserted a 3 inch needle to Huiyang(BL55), let the patient felt heaviness and numbness locally; other acupoints use normal needling method. Paired alligator clips with negative and positive electrodes of the EA apparatus were attached to the needle holders at each pair of acupoints. Electrical frequency was set at 20-40Hz, the intensity of stimulus was gradually increased until plantar flexion of the entire foot by the patient, the duration of treatment is 20 min, five sessions of EA treatment each week for the first 4 weeks, three sessions a week for the following weeks, one course of treatment is 4 weeks, continuous treat for 1-4 courses. (2)Bowel dysfunction:Ciliao(BL32), Zhongliao(BL33), Huiyang(BL35), Dachangshu(BL25). Method of needling:the method of Ciliao(BL32), Zhongliao(BL33), Huiyang(BL35) are the same as bladder function obstacle; inserted a 3 inch needle to Dachangshu(BL25), let the patient felt heaviness and numbness locally. Electrical frequency, frequency of treatment and course of treatment are the same as the treatment of bladder function obstacle.Conclusion1.Electro-acupuncture could improve the bladder and bowel function, let patients regained their self-voiding ability,bladder-filling sensation and self-defecation ability, decreased residual urine volume, improve the detrusor contractility, and has certain long-term effect.2.Electro-acupuncture therapy is safety, there were no adverse events occurred during the treatment period.3.Dr. Liu Zhishun was majorly based on the combination of disease-symptom-position, use dredging meridians as the therapeutic principle, choose Ciliao(BL32), Zhongliao(BL33), Huiyang(BL35)(bowel dysfunction will add Dachangshu(BL25)), then modification according to symptoms. The duration of treatment is 20 min, five sessions of EA treatment each week for the first 4 weeks, three sessions a week for the following weeks, one course of treatment is 4 weeks, continuous treat for 1-4 courses.