TCM Acupuncture and Massage

Chapter 53 Genitourinary System Diseases (2)
[-]. Point massage

([-]) Acupuncture therapy

1. Select acupoints Guanyuan, Shuishui, Shuidao, Zhongji, Shenshu, Bladdershu, Lieque, Hegu, Weiyang, Zusanli, Yinlingquan, Sanyinjiao.

2. Locate the water - upper abdomen, anterior midline, 1 cun above the middle of the navel.

Guanyuan—lower abdomen, on the front midline, 3 cun below the middle of the navel.

Waterway—lower abdomen, 3 cun below the middle of the navel, 2 cun from the anterior midline.

Middle pole—lower abdomen, on the front midline, 4 cun below the middle of the navel.

Shenshu—waist, below the spinous process of the second lumbar vertebra, 2 cun lateral to the midline.

Bladder Shu—waist, below the spinous process of the second sacral vertebra, 2 cun lateral to the midline.Lie Que—Cross the mouth of a tiger with both hands, and the tip of the index finger reaches the place.Hegu—the radial edge of the midpoint of the second metacarpal.Weiyang—the lateral end of the carmine stripe, the medial side of the biceps femoris tendon.Zusanli - 1.5 inches below the calf's nose, a finger across from the front edge of the tibia.Yinling Spring—the inner side of the calf, in the depression below the medial condyle of the tibia.Sanyinjiao—3 cun above the tip of the medial malleolus, on the posterior border of the medial tibia.

([-]) Self-massage
1. Massage the abdomen with the Guanyuan point as the center, and perform abdominal massage on the lower abdomen for 5 minutes.

2. Acupuncture Point and press the above-mentioned points, taking the degree of soreness and swelling as the degree, and each point for 1 minute.

3. Stretch both hands back to wipe Shenshu, rub the Shenshu points on both sides, and use local diathermy as the degree.

Benign prostatic hyperplasia
An overview of the disease

([-]) Relevant knowledge

Prostatic hyperplasia is a common disease in elderly male patients. With the development of the gonads, the prostate tissue is stimulated by androgen to hyperplasia and hypertrophy.

More than 50% of 30-year-old men have benign prostatic hyperplasia, and clinical symptoms only appear after the age of 60. The enlarged prostatic tissue compresses the urethra, making the prostatic urethra thinner and longer, causing poor urination and dysuria.In the early stage, weak urination, thinner urine line, increased nocturia, and incessant urination may occur. With the development of the disease, urinary retention, even hydronephrosis, and uremia may occur in severe cases.

([-]) Etiology and pathogenesis

At present, the etiology of BPH is still not very clear, and it is believed that BPH is closely related to the imbalance of androgen and estrogen in the body.Testosterone is the main androgen in men, under the action of enzymes, it becomes dihydrotestosterone, and dihydrotestosterone is the active hormone that androgen stimulates benign prostatic hyperplasia.Estrogen also has a certain effect on benign prostatic hyperplasia.

The symptoms of benign prostatic hyperplasia are related to the changes in the following three aspects: 3. After the lesion and obstruction of the detrusor muscle, the detrusor muscle of the bladder changes significantly, the nerve endings in the detrusor muscle decrease, and the volume of the bladder increases, but the muscle contraction The strength is relatively weak.

2. Prostate dynamic factors The human prostate contains more α1-A receptors, which can stimulate smooth muscle contraction, increase tension, and cause bladder outlet obstruction.

3. Prostatic static factors, that is, the gradual increase in prostate volume, causes compression on the bladder neck and causes obstruction symptoms.

([-]) Clinical manifestations

Early manifestations include increased frequency of urination, especially frequent urination at night, ranging from 3 to 4 times to as many as 7 to 8 times.The urination is urgent, but it cannot be discharged in time. It needs to wait for some time and gradually force it out.Gradually, the urination range is not far, and the urine stream becomes thinner.In the late stage, the urine flow cannot be formed into a line but is drip-like, and there may be a sudden inability to urinate, unbearable pain in the lower abdomen, and a strong desire to urinate but cannot pass.In addition, the increased abdominal pressure caused by long-term dysuria can also cause the occurrence and aggravation of hemorrhoids, rectal prolapse, blood in the stool, and hernia.

([-]) Inspection

1. Digital rectal examination Digital rectal examination is an important step in the diagnosis of benign prostatic hyperplasia. The enlarged prostate can be felt, with a smooth surface and medium hardness.

2. Cystoscopy Cystoscopy can directly observe the hyperplasia of each lobes of the prostate, and can understand whether there are other lesions in the bladder.

3. Determination of residual urine The amount of residual urine in the bladder reflects the severity of bladder compensatory failure, so this is one of the important diagnostic steps and one of the factors that determine whether to perform surgical treatment.

4. Cystography Cystography is feasible for cases where cystoscopy cannot be performed.

5. B-ultrasound examination can measure the size of the prostate, including transverse diameter, front-to-back diameter and upper-lower diameter.

6. Urodynamic examination When the lower urinary tract obstruction is caused by prostatic hyperplasia, the maximum urinary flow rate decreases and the intravesical pressure increases during urination.

7. Radioisotope renogram can understand the secretory function of both kidneys and the drainage of renal pelvis and ureter.

8. Other examinations include renal function tests and urine culture.If surgery is required, heart, lung, and liver function tests should be performed.

([-]) Diagnosis

Diagnosis of benign prostatic hyperplasia mainly depends on medical history, symptoms, digital rectal examination and prostate B-ultrasound.

1. Most patients are men over 50 years old.

2. Symptoms of urinary tract obstruction, early manifestations are frequent urination and nocturia, followed by waiting to urinate, weak urination, thinning or interruption of urine stream, and acute urinary retention and filling incontinence in severe cases.

3. Digital rectal examination: It is an important examination method for the diagnosis of benign prostatic hyperplasia. It can objectively understand the size of the prostate, the degree of protruding into the rectum, its hardness, whether there is tenderness, whether there are nodules, whether the gland is fixed, etc., so that doctors can Obtaining first-hand clinical data is helpful for the diagnosis of benign prostatic hyperplasia and its differentiation from other diseases.

4. Residual urine appears and increases with changes in the condition.

5. Prostate B-ultrasound shows its hyperplasia.

([-]) Treatment

Prostatic hyperplasia does not require treatment if there is no symptom of urinary tract obstruction and bladder and kidney dysfunction. If it has affected urination and normal life, it should be treated. 1. The treatment of acute urinary retention must be treated urgently. α-adrenergic receptor blockers can be used to relax the bladder neck, which is conducive to urine discharge, or an indwelling catheter can be placed to drain urine.

2. Non-surgical treatment is suitable for non-surgical treatment for patients with mild urinary tract obstruction, or those who are old and infirm, have cardiopulmonary insufficiency, etc. and cannot tolerate surgery.Including hormones, alpha adrenergic receptor blockers and other drug therapy.

3. Surgical treatment includes radical prostatectomy and bilateral orchiectomy.

4. Other therapies include cryotherapy, microwave and radiofrequency therapy, laser therapy, etc., but they all have defects and can be selected according to the situation.

([-]) Prevention

1. Living Care
(1) Maintain an optimistic mood, persist in physical exercise, and reduce local blood stasis.

(2) Do not hold back your urine, and expel it immediately when you feel the urge to urinate.

(3) Keep the stool unobstructed.

(4) It is not advisable to sit for a long time or ride a bicycle for a long time to avoid poor blood flow in the prostate.

(5) Sex life should not be too frequent.

(6) Dress warmly to avoid catching a cold.

(7) Avoid taking atropine and other drugs to avoid acute urinary retention. 2. Physical therapy Regular participation in physical exercise can enhance physical fitness and promote blood circulation in the perineum.

(1) Abdomen retraction and anal lift exercise: The method is to follow your own breathing, retract your abdomen and shrink your anus when you inhale, and relax when you exhale. Do it a hundred times in a row. Do it once a day in the morning and afternoon. The posture is not limited. Both sitting and lying positions are available.

(2) Increase the amount of exercise in the perineum: For example, practicing Tai Chi all the year round can improve the blood circulation in the perineum and prevent benign prostatic hyperplasia.

[-]. Point massage

([-]) Acupuncture therapy

1. Take acupuncture points
Water, Sea of ​​Qi, Guanyuan, Waterway, Zhongji, Shenshu, Bladdershu, Zhibian, Yinlingquan, Sanyinjiao, Taixi.

2. Positioning
Water—upper abdomen, on the front midline, 1 cun above the middle of the navel.

Sea of ​​Qi—lower abdomen, on the front midline, 1.5 cun below the middle of the navel.

Guanyuan—lower abdomen, on the front midline, 3 cun below the middle of the navel.

Waterway—lower abdomen, 3 cun below the middle of the navel, 2 cun from the anterior midline.

Middle pole—lower abdomen, on the front midline, 4 cun below the middle of the navel.

Shenshu—waist, below the spinous process of the second lumbar vertebra, 2 cun lateral to the posterior midline.

Bladder Shu—waist, below the spinous process of the second sacral vertebra, 2 cun laterally, about level with the second posterior sacral foramen.

Zhibian—level with the fourth posterior sacral foramen, 3 cun lateral to the median sacral crest.

Yinling Spring—the inner side of the calf, in the depression below the medial condyle of the tibia.

Sanyinjiao—3 cun above the tip of the medial malleolus, on the posterior border of the medial tibia.

Taixi—the midpoint of the line between the tip of the medial malleolus and the Achilles tendon.

([-]) Self-massage
1. Palm kneading and vibration of Shenque first rub and press Shenque acupoint with the heel of palm for 3 minutes, then palm and vibrate Shenque acupoint for 1 minute.

2. Massage the lower abdomen with overlapping palms, with Guanyuan point as the center, massage the abdomen for 5 minutes.

3. Acupuncture Point and press the above-mentioned points, taking the degree of soreness and swelling as the degree, and each point for 1 minute.

4. Stretch both hands back to wipe Shenshu, rub the Shenshu points on both sides, and use local diathermy as the degree.

(End of this chapter)