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Aimin Deng, Shanghai Pudong Hospital Chinese medical team in Morocco,
Key words: acupuncture manipulation, mountain fire, Sanyinjiao (SP6), enuresis
Enuresis refers to involuntary urination in patients over three years old during sleep. During eight years of working in Morocco, the enuresis patients treated by the author were quite different from those in China. Typical Chinese patients with enuresis have a short course of disease, and most of them are children under ten years old. Symptoms are mild, once every few nights, and one occasionally sees enuresis every night. Treatment is effective, as the children’s constitutions are sensitive, and they respond quickly to acupuncture. After daily acupuncture and moxibustion treatment over the course of a week the frequency of enuresis in most cases is significantly reduced or even eliminated. After treatment the children develop and improve their ability to control their urination, and recurrence of the condition is rare. Morocco is predominantly Muslim, and, it seems, less open about disorders like enuresis. Thus it is kept secret and allowed to develop over a prolonged course. It is often not until the eve of marriage that patients try to find a way to treat it. Since Western medicine currently has no effective specific treatment for this disease, patients made inquiries and traveled long distances to find a Chinese doctor, requesting treatment for the en- uresis with traditional Chinese acupuncture and moxibustion. The typical patient’s course of disease is long, all more than 20 years, and relatively severe, with most having enuresis every night, or even several times a night. The author’s initial use of conventional acupuncture methods only relieved symptoms somewhat, with a low remission rate and a high recurrence rate. After consulting the classic medical literature the author found that, in the past dynasties, the needle manipulation method of “mountains fire” was used on the Sanyinjiao point (SP6), which significantly improved the therapeutic effect, and also provided a new treatment method for the treatment for patients with intractable enuresis.
1. Clinical data: There were 44 males and 28 females, their ages ranged from 24 to 39 years old, with an average of 28 years old. The history of enuresis in all cases exceeded 20 years.
2. Treatment methods
2.1 Main point: Sanyinjiao (SP6). After the patient emptied their bladder, Sanyinjiao points (SP6) was needled bilaterally at a shallow level using 0.4mm×50mm stainless steel acupuncture needles after routine alcohol disinfection. The point is stimulated by gently twirling the needle left and right until the patient feels a slight soreness, numbness, or distending sensation. The needle is then advanced slowly into the middle third of the depth of the acupoint, again twirling the needle to increase needling sensation. Then the needle is slowly inserted into the lower third of the acupuncture point’s depth, and again twisted, and lifted and thrust, causing the patient to feel a strong needling sensation which may feel warm. The needle is retained for 15 minutes. The manipulation steps are reversed as the needle is withdrawn. The manipulation in the lower part of the acupuncture point is heavy, the middle part is slow, and the upper part is lightly twisted, lifted and thrust, and then the needle is removed. In short, the mountain fire technique is not done once, as with conventional acupuncture manipulation techniques, but is performed three times in the superficial, mid- dle and deep layers of the acupuncture points.
2.2 Acupoints Guanyuan (CV4) and Qihai (CV6) After conven- tional disinfection, puncture 20mm with 0.4mm×40mm stainless steel acupuncture needles. The needle was retained for 15 minutes after conventional twirling, lifting and inserting.
The treatments were given once a day, 7 days constituting a course of treatment. After resting for three days, the treatment was repeated, and three courses of treatment were done on average.
3. Results The effects of treatment can be divided into three categories:
3.1 Recovery, where enuresis disappeared, followed up for three months without recurrence: 45 cases, 62.5%
3.2 Effective, where the frequency of enuresis was less than half of pretreatment levels: 17 cases, 23.6%
3.3 Ineffective, where there was no significant change after treatment: 10 cases, 13.8%
3.4 Typical case: Muhammad, a 37-year-old male, had enuresis for more than 30 years, with an average frequency of once every two days. On physical examination, his general condition was acceptable, the tongue fur was thin and greasy, and the pulse was slippery and rapid. There was no nocturnal enuresis after two ten day courses of treatment with the above method, but the treatment was interrupted because the patient needed to leave for work. Three months later, facing marriage, he returned, complaining of recurrence of the enuresis about twice a week. After continuing with the above treatment for two courses for a total of 14 treatments , he recovered, except for occasional enuresis when he was fatigued. Over two years of follow up treatments he did not have significant recurrence of the condition.
4. Discussion: Traditional Chinese medicine believes that the pathogenesis of enuresis is vacuity and weakness of kidney qi, and loss of consolidation of the opening and closing of the bladder. The typical treatment is to invigorate the kidney and boost qi, and secure the bladder. Sanyinjiao point (SP6) is located at the junction of the Foot Taiyin, Foot Jueyin, and Foot Shaoyin channels. The Huang Di Nei Jing explains of the diseases of the three yin meridians of the foot. In the Su Wen ·Jue Lun (chapter 45) it says: “In cases of shaoyin disease, patient will feel cold hands and feet, [abdominal] fullness and vomiting, diarrhea, and clear urination “, Ling Shu · Jing Mai (chapter 10) says: “The main diseases of the liver … are vomiting and diarrhea, [and] dysfunction of urination”, Lingshu · Ben Shen (chapter 8) points out: “If the spleen is weak, the limbs will not function normally… and the urination is not disinhibit- ed.” Acupuncture at Sanyinjiao (SP6) can strengthen the innate qi of the kidney meridian of foot Shaoyin; in line with the prin- ciple of “liver and kidney are from the same source”, it can benefit the liver and nourish the kidney, and also invigorate the spleen meridian of foot Taiyin, which the foundation of the postnatal qi. This point has the capacity to regulate the qi, blood, yin and yang of the three yin meridians of the foot, which are all key concerns for the treatment of enuresis. The addition of Guan Yuan (CV4) and Qi Hai (CV6) help to replenish vitality and strengthen curative effect.
The Mountain fire needle manipulation is a special acupuncture technique for moving the qi and supplementing and draining. It was first rec- orded in the Jin Zhen Fu (Golden Needle Lyrics) in the book Zhen Jiu Da Cheng (Compendium ofAcupuncture and Moxibustion) in the Ming Dyn- asty. However, the original work is complicated. After needle insertion, the practitioner needs to “advance three times and retreat once, press firmly and lift slowly, count to nine, exhale to insert the needle, inhale to withdraw the needle, and then press the point”. It is said that patients can feel warmth from the needle, and that is where the name “mountain fire” comes from. The technique is suitable for vacuity syndrome and has the effect of supplementing. However, according to the author’s long-term clinical practice and personal experience, there is no need for such cumbersome and complicated operations, and there is no need to deliberately pursue the warm feeling under the needle. When performing the moun- tain fire technique, the superficial, middle, and deep layers of the acupuncture points are repeatedly twisted, lifted and inserted, resulting in a strong sense of qi and a large stimulation value. It can indeed improve the therapeutic effect of specific acupuncture points. For the acupoints on the chest, abdomen and below which there are important nerves and blood vessels, such as Guanyuan (CV4) and Qihai (CV6), it is not suitable to perform mountain fire manipulation in order to avoid injuring the patient.
“燒山火”手法重刺三陰交穴治療頑固性遺尿72例
上海浦東醫院(籌) 中國駐摩洛哥醫療隊 鄧愛民
關鍵詞：針刺手法 燒山火 三陰交 遺尿
遺尿是指三歲以上患者夜間睡眠時無意識的排 尿行為，也是針灸門診中常見的病例。但筆者在中國駐摩洛哥王國醫療隊工作近八年期間，所接診的遺尿患者卻和國內大不相同。國內遺尿患者表現為病程短，多為十歲以下兒童。症狀輕，數夜一次，偶見夜夜遺尿。療效好，兒童臟腑輕靈，針刺敏感，經常規針灸取穴治療，每日一次，持續七天后大多遺尿次數明顯減少以至杜絕。日後隨著兒童發育完善，自控能力加強，少有遷延復發。而摩洛哥王國居民均為穆斯林，信仰伊斯蘭教。對遺尿這種隱私 性疾病秘不宣人，任其發展。直至婚姻前夕，才想法設法，求醫尋藥。由於西醫目前對該病 症尚無有效的特異性治療方法，於是又多方打聽，長途跋涉尋找中國醫生，請求用中醫傳統針灸方法治療遺尿。此時患者病程長，均在二十年以上。症狀重，大多每夜遺尿甚至一夜數次。筆者初期採用國內常規的針刺方法僅能緩解症狀，治愈率低，復發率高。後經查詢歷代中醫經典醫學文獻，使用燒山火手法重刺三陰 交穴，明顯提高了治療效果，也為治療國內國外少數頑固性遺尿患者，提供了新的治療手 段。
1 臨床資料 男性44例，女性28例，最小年齡24歲，最大年齡39歲，平均28歲。遺尿史均在二十年以上
2 治療方法
2.1 主穴三陰交穴。患者排空膀胱後，取雙側三 陰交穴，常規酒精消毒後用0.4mm×50mm不銹鋼針灸針，首先直刺30mm ，捻轉提插得氣後， 將針緩慢的提至穴位的上1/3處，輕輕地左右捻轉，患者產生輕度的酸麻脹感，然後慢慢地將針刺入穴位的中1/3處，加重捻轉手法，患者的針感進一步加強。再緩慢的將針刺入穴位的下1/3處，大幅左右捻轉加上下提插，患者此時會產生強烈的針感，並可能有針下溫熱的感覺。然後留針15分鐘。 出針時的手法步驟與進針時相反，分別在穴位的下部重手法，中部緩手法，上部輕手法捻轉提插後出針。簡而言之，燒山火手法不像常規針刺手法那樣進針得氣一次性完成，而是在穴位的淺層、中層、 深層分三次施行手法得氣。
2.2 配穴 關元、氣海 常規消毒後用0.4mm×40mm不銹鋼針灸針直刺20mm。常規捻轉提插得氣後留針15分鐘。每日一次，7天一療程。休息三天后繼續治療，平均施行三個療程。
3 治療效果
3.1 痊癒 遺尿消失，隨訪三月無復發45例， 62.5%
3.2 有效 遺尿次數少於治療前一半，遺尿量減少17 例23.6%
3.3 無效 治療前後無明顯變化，10例13.8%
3.4 典型病例 默罕默德 男性 37歲 遺尿三十餘年，平均兩天一次。查體一般情況尚可，苔薄膩，脈滑數。採用上述方法治療兩療程十次後無夜間遺尿， 後因外出工作中斷治療。三個月後面臨婚姻又來中國醫療隊，訴遺尿復發，約每週兩次，繼續以上法治療兩療程十四次後，除偶在勞累疲乏後遺尿外，基本痊癒。隨訪兩年無復發。
4 討論 祖國醫學認為遺尿的發病機理為腎氣虛弱不固，膀胱開合失攝。治療上當以補腎益氣，固攝膀 胱為根本大法。三陰交穴位於足太陰、足厥陰、足少陰匯聚之要衝。中醫經典著作《黃帝內經》對足 三陰經脈之病變有精闢的闡述。《素問•厥論》篇 中曰：“少陰闕逆，虛滿嘔變，下泄清”，《靈樞•經脈》篇中曰：“主肝所生病者……嘔逆，遺溺”，《靈樞•本神》篇中指出：“脾氣虛則四肢不用……涇溲不利”。針刺三陰交穴能壯足少陰腎 經之先天之氣，能合足厥陰肝經“肝腎同源”之原 則益肝補腎，能振足太陰脾經之後天之本。綜合調 節足三陰經脈的氣血陰陽，為治療遺尿之要穴。陪關元、氣海培補元氣，加強療效。燒山火是一種特殊的行氣補瀉針刺手法， 最早記載見於明代《針灸大全》一書的《金針賦》中。但原著論述紛繁，操作複雜。要求進針後：“三進一退，緊按慢提，行九數，呼氣進針，吸氣出針，出針捫穴”。據稱患者可有針下溫熱之感覺， 故名“燒山火”。適用於虛症，有補益之效。但據筆者長期臨床實踐及親身體驗，並無如此繁瑣複雜操作的必要，也無需刻意追求針下溫熱的感覺。由於施行燒山火 針刺手法，在穴位的淺層、中層、深層反复捻轉提插，得氣感強，刺激值大。確能 提高特定穴位的治療效果。對於胸腹部及下方有重要神經血管經過的穴位如關元、 氣海則不宜施行燒山火手法，以免造成各類損傷。
