Zhuang Ding, Wang Yuanchao, Yang Xiuzhen, (Institute of Acupuncture and Moxibustion. Academy of Traditional Chinese Medicine.)
Tian Zaishan,Yuan Heping, Liu Yingyun,Li Donghua, (Tianjin Institute of Acute Abdomen.)
In the nonoperative treatment by integrating traditional Chinese and western medicine in the management of acute perforation of gastroduodenal ulcer, a serious complication of peptic ulcer, acupuncture is employed as the main method in the acute stage, to relieve severe pain, to enhance body resistance and to promote the healing of the perforation, hence to prepare the patient ready for herbal medication in the second stage. As shown in statistics of near 10,000 cases, good immediate result was obtained in about 60-70% of the patients; and satisfactory long-term result in the follow-up cases as well.
The clinical progressive observation of the course of treatment in the acute stage of 41 patients is herewith presented.
Precise diagnosis was confirmed by roentgenography and abdominal paracentesis, etc. in all cases. Of them 36 were male and 5 female, ranging in age between 20-73 years.
Measures of treatment: mainly acupuncture, gastrointestinal decompression, Fowler's position, intravenous infusion, no analgesics, no antibiotics.
The most frequently used acupuncture points are: Zusanli or adjacent tender points (bilateral), Zongwan, Liangmen (bilateral). Tienshu (bilateral), and in case of severe nausea and vomiting, Neiguan (bilateral). After needle response is produced, apply strong stimulation by hand manipulation to induce the propagation of sensation along the channels, the use electroacupuncture lasting one hour, with the interval of 4 hours between the two needlings.
Criteria of therapeutic results:
Good result: Obvious relief of severe abdominal pain after 1-2 acupunctures, localization of tenderness, softening of abdomen, disappearance of board-like rigidity, reappearance of peristaltic sound, bowel movement, or passage of flatus. These suggest the sealing up of the perforation and that herbal medicine can be administered with safety.
Poor result: No obvious relief of symptoms, or recurrence of symptoms and signs after transient relief. Operation is indicated.
26 of the series have the former result (63.4%); 15 have the latter (36.6%).
Record of investigation:
1. Respiratory movement curve: A respiratory movement curve recorded before treatment shows increased respiration frequency, diminished amplitude especially that of abdominal respiration due to severe pain and restriction of respiratory movements. Arrest of respiratory movement as shown by irregular wave pattern may even occur. Increase of respiratory amplitude particularly that of abdominal respiration is seen after the first maneuver of electroacupuncture, it is found statissically significant in good result group, but not in the poor result group. Although slight increase in the frequency is seen, it is not statistically significant. Improvement of wave pattern of respiratory movement indicates the rapid analgesic effect of acupuncture.
2. Myoelectricity of rectus muscle. When perforation occurs, spillage of gastroduodenal contents in the peritoneal cavity causes marked peritoneal irritation, leading to reflective muscle spasm and continuous release of myoelectricity by rectus abdominis muscle. 17 cases of the good result group have their release of myoelectricity decreasing gradually till entire disappearance. The time for the disappearance of rectus myoelectricity is 4.7 hours in average. 13 of poor result group show release of myoelectricity decreasing gradually, yet no entire disappearance. The disappearance of rectus myoelectricity suggest the sealing up of the perforation. Hence the rectus myoelectricity may possibly be an indication for judging whether a patient can be continuously treated nonoperatively or not.
Relation of needle response and therapeutic result.
In the present series, when Zusanli point was punctured, 22 patients felt a needle sensation coursing towards the lesion, mostly passing through the knee joint, rarely reaching the lesion; another 19 had their needle sensation localized or merely radiated to the foot. When the abdominal points were punctured, 25 felt their needle sensation coursing along the channels on the abdomen, and another 16 localized. Statistical study reveals that those having needle sensation coursing towards the lesion gain a better result than those having their needle sensation radiating to foot or localized. This confirms the significance of hand manipulation and the study of needle sensation in clinical acupuncture. Its significance has long been explained by ancient doctors with their rich clinical experiences.
Tian Zaishan,Yuan Heping, Liu Yingyun,Li Donghua, (Tianjin Institute of Acute Abdomen.)
In the nonoperative treatment by integrating traditional Chinese and western medicine in the management of acute perforation of gastroduodenal ulcer, a serious complication of peptic ulcer, acupuncture is employed as the main method in the acute stage, to relieve severe pain, to enhance body resistance and to promote the healing of the perforation, hence to prepare the patient ready for herbal medication in the second stage. As shown in statistics of near 10,000 cases, good immediate result was obtained in about 60-70% of the patients; and satisfactory long-term result in the follow-up cases as well.
The clinical progressive observation of the course of treatment in the acute stage of 41 patients is herewith presented.
Precise diagnosis was confirmed by roentgenography and abdominal paracentesis, etc. in all cases. Of them 36 were male and 5 female, ranging in age between 20-73 years.
Measures of treatment: mainly acupuncture, gastrointestinal decompression, Fowler's position, intravenous infusion, no analgesics, no antibiotics.
The most frequently used acupuncture points are: Zusanli or adjacent tender points (bilateral), Zongwan, Liangmen (bilateral). Tienshu (bilateral), and in case of severe nausea and vomiting, Neiguan (bilateral). After needle response is produced, apply strong stimulation by hand manipulation to induce the propagation of sensation along the channels, the use electroacupuncture lasting one hour, with the interval of 4 hours between the two needlings.
Criteria of therapeutic results:
Good result: Obvious relief of severe abdominal pain after 1-2 acupunctures, localization of tenderness, softening of abdomen, disappearance of board-like rigidity, reappearance of peristaltic sound, bowel movement, or passage of flatus. These suggest the sealing up of the perforation and that herbal medicine can be administered with safety.
Poor result: No obvious relief of symptoms, or recurrence of symptoms and signs after transient relief. Operation is indicated.
26 of the series have the former result (63.4%); 15 have the latter (36.6%).
Record of investigation:
1. Respiratory movement curve: A respiratory movement curve recorded before treatment shows increased respiration frequency, diminished amplitude especially that of abdominal respiration due to severe pain and restriction of respiratory movements. Arrest of respiratory movement as shown by irregular wave pattern may even occur. Increase of respiratory amplitude particularly that of abdominal respiration is seen after the first maneuver of electroacupuncture, it is found statissically significant in good result group, but not in the poor result group. Although slight increase in the frequency is seen, it is not statistically significant. Improvement of wave pattern of respiratory movement indicates the rapid analgesic effect of acupuncture.
2. Myoelectricity of rectus muscle. When perforation occurs, spillage of gastroduodenal contents in the peritoneal cavity causes marked peritoneal irritation, leading to reflective muscle spasm and continuous release of myoelectricity by rectus abdominis muscle. 17 cases of the good result group have their release of myoelectricity decreasing gradually till entire disappearance. The time for the disappearance of rectus myoelectricity is 4.7 hours in average. 13 of poor result group show release of myoelectricity decreasing gradually, yet no entire disappearance. The disappearance of rectus myoelectricity suggest the sealing up of the perforation. Hence the rectus myoelectricity may possibly be an indication for judging whether a patient can be continuously treated nonoperatively or not.
Relation of needle response and therapeutic result.
In the present series, when Zusanli point was punctured, 22 patients felt a needle sensation coursing towards the lesion, mostly passing through the knee joint, rarely reaching the lesion; another 19 had their needle sensation localized or merely radiated to the foot. When the abdominal points were punctured, 25 felt their needle sensation coursing along the channels on the abdomen, and another 16 localized. Statistical study reveals that those having needle sensation coursing towards the lesion gain a better result than those having their needle sensation radiating to foot or localized. This confirms the significance of hand manipulation and the study of needle sensation in clinical acupuncture. Its significance has long been explained by ancient doctors with their rich clinical experiences.
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