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.
