- Email: [email protected]
Twenty cases of globus hystericus treated by bloodletting combined with thunder-fire moxibustion
World Journal ofAcupuncture-Moxibustion (WJAM) Vol. 24, No.3, 30th Sep.2014
·54·
ELSEVIER
Clinical Report Twenty cases of globus hystericus treated by bloodletting combined with thunder-fire moxibustion wu Shuang (~
.)r,
.~.
CHENYi-guo (F*¥,A 00)2
1. Acupuncture Department, Shenyang Municipal Hospital of TCM, Shenyang 110004, Liaoning Province, China; 2. Liaoning University ofTCM ( 1. tt~l:rrP9=l~~ 'ff~f4, :lI?ttlm 110004, 9=l~; 2. :lI?9=l~~
*~) ARTICLE INFO
ABSTRACT
First author: Wu Shuang (1982-), female,
Objective To observe the clinical effect in treatment of globus hystericus with acupoint bloodletting and thunder-tire moxibustion therapy. Methods Twenty patients were subject to bloodletting at Ganshu (JfFtrr BL 18) in both sides and to thunder-tire moxibustion at Danzhong (JlI~ CV 17) and Zh6ngwan (~ Jm CV 12). Once a day, twenty treatments were given. Results Sixteen cases were cured and 4 cases effective; cured rate was 80% and effective rate 100%. Conclusion Bloodletting combined with thunder-fire moxibustion therapy for globus hystericus is better in clinical efficacy, significantly improving the patients' clinical symptoms.
attending physician. Research field: acupuncture in treatment of diseases of the nervous system. E-mail: [email protected] Accepted on March 4, 2014
KEY WORDS: globus hystericus; bloodletting; thunder-tire moxibustion
Globus hystericus refers to a disorder characterized by the abnormal sensation in throat, however, it does not affect the eating. If on the throat, it may be not out by coughing or down by swallowing, thus resulting in the occassional discomfort in the throat. It is called paraesthesia in the throat in western medicine and often diagnosed as neurosis or hysteria in the throat, and globus sensation [1 1• It is more common in adults with female predomination. Clinical manifestations: sensations such as obstruction, itching, urgency, adhesion, and burning; often in the position of throat midline or cricoid cartilage or thyroid cartilage level, secondly, it is in the suprasternal region, less in hyoid bone level, and the minority of it is located uncertainly. Patients with longer duration of this disease often feel nervous and anxious etc. The authors treated 20 cases by bloodletting and thunderfire moxibustion therapy and achieved certain curative effect. The report is as follows.
CLINICAL DATA General data Twenty patients were from the acupuncture clinic
at Shenyang Municipal Hospital of TCM from 20 I0 to 2013, including 18 females and 2 males, ages were from 32 to 70 with an average of 45 years old, the duration of the disease was from I month to 6 years with an average of 3.6 years. The disease was casued by mental factors (mostly gloomly mood or worry). Symptoms worsened due to the mood swings.
Diagnostic criteria In accordance with Criteria of Diagnosis and Therapeutic Efficacy in TCM issued by State Administration of Traditional Chinese Medicine [21• CD Plum kernel or zhiluan-like thing or other abnormal sensation in the throat, becoming main symptoms in case of the emotional fluctuations; ® commonly found in adult, more common in female; @ no organic lesion in inspection of the throat, esophagus and other relevant organs.
Inclusion criteria
CD
Meeting the above diagnostic criteria; ® mental factors (mostly gloomy emotion or worry); @ Informed Consent filled out by candidates.
ELSEVIER
World Journal ofAcupuncture-Moxibustion (WJAM) Vol. 24, No.3, 30th Sep.2014
Exclusion criteria
CD Other diseases of the throat; ® cases who other organic disorders affect throat function; @ cases receiving antibiotics or other methods during treatment. METHODS Patients were subject to bloodletting therapy. The patient was in the prone position with 75% alcohol cotton ball used for regular disinfection in acupoints. Ganshu (Jfftrr BL 18) on both sides was pricked with a three-edged needle, then cupping therapy was applied till bleeding. After 5-10 min, cups were removed. After a dry sterile cotton ball was used to swipe the blood, disinfection was made again using 75% alcohol cotton balls. Zhao's Thunder-fire Moxibustion Stick (Yuyao Guanxie Zi 2005 No.60109121O) was applied. The patient was in the supine position with the moxibustion stick ignited 2-3 cm above the skin. Moxibustion was applied at Zhongwan (~1m CV 12) and Qihai (4.#IJ: CV 6) till red on the skin and hot feeling. Moxibustion time was 15-20 min. Once a day, ten times as a course of treatment. The therapeutic effects were observed after 2 courses.
RESULTS Therapeutic efficacy criteria Judgement criteria developed according to Criteria of Diagnosis and Therapeutic Efficacy in TCM issued by State Administration of Traditional Chinese medicine [2]. Cured: abnormal sensation in the throat disappeared; effective: abnormal sensation in the throat relieved; ineffective: no obvious change of abnormal sensation and the like in the throat.
Results Sixteen cases were cured and 4 cases effective. Cured rate was 80% and effective rate 100%.
Follow-up visit Twenty patients were followed up. 16 cases of cured patients had no recurrence. Symptoms of 4 patients who were effective in treatment had different degrees of improvement.
TYPICAL CASE A female patient, 36 years old, was diagnosed initially in March 2011. She had abnormal sensation in the throat for 6 months. Half a year ago, she quarreled with her colleagues at work and suffered abnormal sensation. It could not be swallowed down or coughed out. In gloomy mood, the symptom
• 55 • worsened. The exam excluded any organic lesion in the nasopharynx, larynx, trachea, esophagus, stomach, cervical spine and etc. No acute or chronic pharyngitis was found. Symptoms included belching, preference for signing, fullness in chest and hypochondrium, mental depression, pale tongue, fat and big tongue body (on whose edge there was a tooth print), small and wiry pulse. Diagnosis: globus hystericus due to liver-qi stagnation. The patient was in the prone position. BLl8 on both sides was pricked with a three-edged needle, respectively and then cupping therapy was applied till bleeding occurred. After 5-10 min, cups were removed. The patient was in supine position, the moxibustion stick of Zhao' Thunder-fire Moxibustion ignited 2-3 em above the skin. Moxibustion was applied at CV 12 and CV 6 to the extent that it is red feeling and hot feeling. Moxibustion time was 15-20 min. One day after treatment, fullness in chest and hypochondrium relieved. After 1 course of treatment, abnormal sensation in the throat was significantly reduced with mental status improved greatly. After 2 courses, abnormal sensation disappeared, and so did the accompanying symptoms.
EXPERIENCES Ren Zhiii Zhi Zhl Fiing (<<1=~][m7J» Renzhai's Direct Guidance on Formulas) published in Song Dynasty pointed out that globus hystericus refers to a thing (which is plum-kernel like) located in the throat and that it may be not out by coughing or down by swallowing. Volume 5 of Wan Bing Hui Chiin ( OJm@]~» Restoration of Health from the Myriad Diseases) pointed out that globus hystericus is mostly due to stagnation of qi in the seven emotions or unhappiness or worry in eating or drinking, and that female patients predominate in this. Therefore, TCM theory holds that this disease is characterized by abnormal seven emotions, gloomy mood, disfunction of liver, even qi movement being not harmonious. Excess wood overcoming earth, liver-qi attacking spleen, deficient spleen producing phlegm, qi-phlegm stagnating in the throat result in this disorder.
Bloodletting as one of pricking methods is to promote the blood circulation and regulate qi. Chapter of blood, qi, body and mind in Sit Wen ( «~l'iiJ» Plain Questions) pointed out, "Bloodletting should be made at the first in treatment." BLl8 belongs to the bladder meridian of foot-taiyang. This acupoint internally correspond to the liver and is located at the infusion and transfusion of the back. The bloodletting by pricking BLl8 in both sides is to sooth the liver,
WorldJournal ofAcupuncture-Moxibustion (WJAM) Vol. 24, No.3, 30th Sep.2014
·56·
regulate qi, relieve pain, dredge meridians and benefit the throat. Moxibustion is one of therapies in TCM. Yf Xue Rit Men ( «~~.An» Introduction to Medicine) pointed out, "Moxibustion should be made where drug or needle does not reach". Zhao s Thunderfire Moxibustion combines the principle of collateral channels and the theory of modem medicine, so being an innovative therapeutic method. Different from the traditional moxibustion stick, it adds aloeswood, pangolin, dried ginger, stem of capillary sagebrush and so forth to a moxa stick. Thunder-fire Moxibustion warms acupoints and is pharmacologic via special plant drug recipe. When compared with the traditional moxibustion, it is more effective and penetrative. Heat from it can stimulate relevant acupoints, activate the meridian qi to let local skin texture open, and enable the drug to reach the corresponding acupoint. At the same time, infrared or near infrared light from its burning penetrates into the deep site of the tissue from the lesion, lesion surrounding, and high drug concentration area, finally providing the following effects: to warm meridians, dispel cold, promote yang qi, promote blood circulation, dredge stagnation, generate diuresis, improve blood circulation in peripheral tissue [3].
the foot and the hand. Huang Di Nei Jing ( «JtWpg ~» The Yellow Emperor's Inner Classic) thought that CV 17 is a place where qi converges in the human body. CV 17 is front-mu point of pericardium and an important place in the abdomen where qi and blood of pericardium meridian infuses. Therefore, addition to smoothening the qi movement and regulating the mood or emotion, CV 12 also known as front-mu point of stomach and a place where conception vessel, taiyang and taiyin in the hand and the foot, can nourish stomach and spleen as well as dispel dampness and have the expectorant effect. In contrast, western medicine has no such therapeutic effect but add economic and mind loads for the patients. By our therapeutic method, clinical effects are satisfactory with root causes and symptoms eliminated.
REFERENCES [1] [2]
[3]
Danzhiing (JIfl ~ CV 17) belongs to Conception vessel, and is associated with taiyin and shaoyin in
ELSEVIER
Wang DJ. Otorhinolaryngology of TCM. Beijing: People's Medical Publishing House; 1987: 244. State Administration of Traditional Chinese Medicine. Criteria of Diagnosis and Therapeutic Efficacy in TCM. Nanjing: Nanjing University Press; 1994: 46. Zhao SB, Zhang LI. Thunder-Fire Moxibustion in TCM. Shanghai: Shanghai Far East Press; 2008: 40-46.
ABSTRACT IN CHINE SE
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·54·
ELSEVIER
Clinical Report Twenty cases of globus hystericus treated by bloodletting combined with thunder-fire moxibustion wu Shuang (~
.)r,
.~.
CHENYi-guo (F*¥,A 00)2
1. Acupuncture Department, Shenyang Municipal Hospital of TCM, Shenyang 110004, Liaoning Province, China; 2. Liaoning University ofTCM ( 1. tt~l:rrP9=l~~ 'ff~f4, :lI?ttlm 110004, 9=l~; 2. :lI?9=l~~
*~) ARTICLE INFO
ABSTRACT
First author: Wu Shuang (1982-), female,
Objective To observe the clinical effect in treatment of globus hystericus with acupoint bloodletting and thunder-tire moxibustion therapy. Methods Twenty patients were subject to bloodletting at Ganshu (JfFtrr BL 18) in both sides and to thunder-tire moxibustion at Danzhong (JlI~ CV 17) and Zh6ngwan (~ Jm CV 12). Once a day, twenty treatments were given. Results Sixteen cases were cured and 4 cases effective; cured rate was 80% and effective rate 100%. Conclusion Bloodletting combined with thunder-fire moxibustion therapy for globus hystericus is better in clinical efficacy, significantly improving the patients' clinical symptoms.
attending physician. Research field: acupuncture in treatment of diseases of the nervous system. E-mail: [email protected] Accepted on March 4, 2014
KEY WORDS: globus hystericus; bloodletting; thunder-tire moxibustion
Globus hystericus refers to a disorder characterized by the abnormal sensation in throat, however, it does not affect the eating. If on the throat, it may be not out by coughing or down by swallowing, thus resulting in the occassional discomfort in the throat. It is called paraesthesia in the throat in western medicine and often diagnosed as neurosis or hysteria in the throat, and globus sensation [1 1• It is more common in adults with female predomination. Clinical manifestations: sensations such as obstruction, itching, urgency, adhesion, and burning; often in the position of throat midline or cricoid cartilage or thyroid cartilage level, secondly, it is in the suprasternal region, less in hyoid bone level, and the minority of it is located uncertainly. Patients with longer duration of this disease often feel nervous and anxious etc. The authors treated 20 cases by bloodletting and thunderfire moxibustion therapy and achieved certain curative effect. The report is as follows.
CLINICAL DATA General data Twenty patients were from the acupuncture clinic
at Shenyang Municipal Hospital of TCM from 20 I0 to 2013, including 18 females and 2 males, ages were from 32 to 70 with an average of 45 years old, the duration of the disease was from I month to 6 years with an average of 3.6 years. The disease was casued by mental factors (mostly gloomly mood or worry). Symptoms worsened due to the mood swings.
Diagnostic criteria In accordance with Criteria of Diagnosis and Therapeutic Efficacy in TCM issued by State Administration of Traditional Chinese Medicine [21• CD Plum kernel or zhiluan-like thing or other abnormal sensation in the throat, becoming main symptoms in case of the emotional fluctuations; ® commonly found in adult, more common in female; @ no organic lesion in inspection of the throat, esophagus and other relevant organs.
Inclusion criteria
CD
Meeting the above diagnostic criteria; ® mental factors (mostly gloomy emotion or worry); @ Informed Consent filled out by candidates.
ELSEVIER
World Journal ofAcupuncture-Moxibustion (WJAM) Vol. 24, No.3, 30th Sep.2014
Exclusion criteria
CD Other diseases of the throat; ® cases who other organic disorders affect throat function; @ cases receiving antibiotics or other methods during treatment. METHODS Patients were subject to bloodletting therapy. The patient was in the prone position with 75% alcohol cotton ball used for regular disinfection in acupoints. Ganshu (Jfftrr BL 18) on both sides was pricked with a three-edged needle, then cupping therapy was applied till bleeding. After 5-10 min, cups were removed. After a dry sterile cotton ball was used to swipe the blood, disinfection was made again using 75% alcohol cotton balls. Zhao's Thunder-fire Moxibustion Stick (Yuyao Guanxie Zi 2005 No.60109121O) was applied. The patient was in the supine position with the moxibustion stick ignited 2-3 cm above the skin. Moxibustion was applied at Zhongwan (~1m CV 12) and Qihai (4.#IJ: CV 6) till red on the skin and hot feeling. Moxibustion time was 15-20 min. Once a day, ten times as a course of treatment. The therapeutic effects were observed after 2 courses.
RESULTS Therapeutic efficacy criteria Judgement criteria developed according to Criteria of Diagnosis and Therapeutic Efficacy in TCM issued by State Administration of Traditional Chinese medicine [2]. Cured: abnormal sensation in the throat disappeared; effective: abnormal sensation in the throat relieved; ineffective: no obvious change of abnormal sensation and the like in the throat.
Results Sixteen cases were cured and 4 cases effective. Cured rate was 80% and effective rate 100%.
Follow-up visit Twenty patients were followed up. 16 cases of cured patients had no recurrence. Symptoms of 4 patients who were effective in treatment had different degrees of improvement.
TYPICAL CASE A female patient, 36 years old, was diagnosed initially in March 2011. She had abnormal sensation in the throat for 6 months. Half a year ago, she quarreled with her colleagues at work and suffered abnormal sensation. It could not be swallowed down or coughed out. In gloomy mood, the symptom
• 55 • worsened. The exam excluded any organic lesion in the nasopharynx, larynx, trachea, esophagus, stomach, cervical spine and etc. No acute or chronic pharyngitis was found. Symptoms included belching, preference for signing, fullness in chest and hypochondrium, mental depression, pale tongue, fat and big tongue body (on whose edge there was a tooth print), small and wiry pulse. Diagnosis: globus hystericus due to liver-qi stagnation. The patient was in the prone position. BLl8 on both sides was pricked with a three-edged needle, respectively and then cupping therapy was applied till bleeding occurred. After 5-10 min, cups were removed. The patient was in supine position, the moxibustion stick of Zhao' Thunder-fire Moxibustion ignited 2-3 em above the skin. Moxibustion was applied at CV 12 and CV 6 to the extent that it is red feeling and hot feeling. Moxibustion time was 15-20 min. One day after treatment, fullness in chest and hypochondrium relieved. After 1 course of treatment, abnormal sensation in the throat was significantly reduced with mental status improved greatly. After 2 courses, abnormal sensation disappeared, and so did the accompanying symptoms.
EXPERIENCES Ren Zhiii Zhi Zhl Fiing (<<1=~][m7J» Renzhai's Direct Guidance on Formulas) published in Song Dynasty pointed out that globus hystericus refers to a thing (which is plum-kernel like) located in the throat and that it may be not out by coughing or down by swallowing. Volume 5 of Wan Bing Hui Chiin ( OJm@]~» Restoration of Health from the Myriad Diseases) pointed out that globus hystericus is mostly due to stagnation of qi in the seven emotions or unhappiness or worry in eating or drinking, and that female patients predominate in this. Therefore, TCM theory holds that this disease is characterized by abnormal seven emotions, gloomy mood, disfunction of liver, even qi movement being not harmonious. Excess wood overcoming earth, liver-qi attacking spleen, deficient spleen producing phlegm, qi-phlegm stagnating in the throat result in this disorder.
Bloodletting as one of pricking methods is to promote the blood circulation and regulate qi. Chapter of blood, qi, body and mind in Sit Wen ( «~l'iiJ» Plain Questions) pointed out, "Bloodletting should be made at the first in treatment." BLl8 belongs to the bladder meridian of foot-taiyang. This acupoint internally correspond to the liver and is located at the infusion and transfusion of the back. The bloodletting by pricking BLl8 in both sides is to sooth the liver,
WorldJournal ofAcupuncture-Moxibustion (WJAM) Vol. 24, No.3, 30th Sep.2014
·56·
regulate qi, relieve pain, dredge meridians and benefit the throat. Moxibustion is one of therapies in TCM. Yf Xue Rit Men ( «~~.An» Introduction to Medicine) pointed out, "Moxibustion should be made where drug or needle does not reach". Zhao s Thunderfire Moxibustion combines the principle of collateral channels and the theory of modem medicine, so being an innovative therapeutic method. Different from the traditional moxibustion stick, it adds aloeswood, pangolin, dried ginger, stem of capillary sagebrush and so forth to a moxa stick. Thunder-fire Moxibustion warms acupoints and is pharmacologic via special plant drug recipe. When compared with the traditional moxibustion, it is more effective and penetrative. Heat from it can stimulate relevant acupoints, activate the meridian qi to let local skin texture open, and enable the drug to reach the corresponding acupoint. At the same time, infrared or near infrared light from its burning penetrates into the deep site of the tissue from the lesion, lesion surrounding, and high drug concentration area, finally providing the following effects: to warm meridians, dispel cold, promote yang qi, promote blood circulation, dredge stagnation, generate diuresis, improve blood circulation in peripheral tissue [3].
the foot and the hand. Huang Di Nei Jing ( «JtWpg ~» The Yellow Emperor's Inner Classic) thought that CV 17 is a place where qi converges in the human body. CV 17 is front-mu point of pericardium and an important place in the abdomen where qi and blood of pericardium meridian infuses. Therefore, addition to smoothening the qi movement and regulating the mood or emotion, CV 12 also known as front-mu point of stomach and a place where conception vessel, taiyang and taiyin in the hand and the foot, can nourish stomach and spleen as well as dispel dampness and have the expectorant effect. In contrast, western medicine has no such therapeutic effect but add economic and mind loads for the patients. By our therapeutic method, clinical effects are satisfactory with root causes and symptoms eliminated.
REFERENCES [1] [2]
[3]
Danzhiing (JIfl ~ CV 17) belongs to Conception vessel, and is associated with taiyin and shaoyin in
ELSEVIER
Wang DJ. Otorhinolaryngology of TCM. Beijing: People's Medical Publishing House; 1987: 244. State Administration of Traditional Chinese Medicine. Criteria of Diagnosis and Therapeutic Efficacy in TCM. Nanjing: Nanjing University Press; 1994: 46. Zhao SB, Zhang LI. Thunder-Fire Moxibustion in TCM. Shanghai: Shanghai Far East Press; 2008: 40-46.
ABSTRACT IN CHINE SE
[!iii
~J
~U~: 5lJt$-R1--z.~k.IJi(.~'t *-~i(; 11:#g:;f$:~ €I!; 11;i;~113ito
h)!:
xt201f~:#g:;f$:~.~:t-;~Uf] ~1Jl~}}f
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