by Honora Lee Wolfe, Dipl.Ac.

A few years ago, I had a 70-year-old woman come to see me for stress incontinence. We tried several treatment strategies over a period of two months, none of which were successful. Her pattern diagnosis was complex and she was not interested in taking internal medicine, which may have given her a better result. While this particular treatment would not necessarily have given my particular patient relief of her symptoms, I felt so frustrated at not being able at help her that, since that time, I have kept my eyes open for any information about incontinence of urine. The following research report and case study may be helpful to others trying to treat this condition.

(From “The Acupuncture-moxibustion Treatment of 50 Cases of Stress Incontinence” by Ma Xing & Ma Hou-zhi, Si Chuan Zhong Yi [Sichuan Chinese Medicine], #3, 1998, p. 51)

Stress incontinence is a commonly seen condition in middle-aged and older patients, mostly appearing in women. From January 1990 to December 1993, the authors of this article treated 50 cases of stress incontinence with acupuncture-moxibustion with satisfactory treatment efficacy as described below.

Cohort description

All 50 of the patients included in this study were middle-aged and elderly women. The oldest was 69 and the youngest was 48 years old. The shortest course of disease was two months and the longest was six years. During treatment, any other treatment methods were discontinued. The diagnostic criteria included that all the patients were middle-aged and elderly women who experienced urinary incontinence whenever abdominal pressure was increased.

Treatment method

1. Guan Yuan (CV 4), Qi Hai (CV 6), San Jiao Jiu (extrachannel points located at the two bases of an equilateral triangle whose width is the same as the patient’s mouth and whose apex is centered on the navel)

2. Ming Men (GV 4), Shen Shu (Bl 23), Da Chang Shu (Bl 25)

These two groups of points were used alternately. A two cun 30 gauge fine needle was used to needle the above points perpendicularly so that a sore, distended sensation was produced around the area needled. Sparrow-pecking moxibustion was also used. Each time the needles were retained for 30 minutes. Each 15 minutes, the needles were twisted and rotated one time. One course of treatment lasted a half month. A three day pause was observed between each successive course of treatment.

Treatment outcomes

Of the 50 cases so treated, 38 cases were deemed cured. This was defined as the ability to control one’s urination and the disappearance of urinary incontinence. Thus 76% of the cases were cured. Improvement meant that the incontinence was decreased. However, one was still not able to control the flow of urine. Ten cases or another 20% were judged improved. Two cases or 4% experienced no effect. After two courses of treatment there was no change in urinary incontinence. Thus the total amelioration rate was 96%.

Representative case history

Female, 49 years old. Her initial examination occurred on Mar. 25, 1992. For the past two years, the patient had had no self-control over the flow of her urine. Whenever she became fatigued, coughed, or sneezed, she would experience urinary incontinence. She had previously been diagnosed as suffering from stress incontinence and had been administered Liu Wei Di Huang Wan (Six Flavors Rehmannia Pills), Bu Zhong Yi Qi Wan (Supplement the Center & Boost the Qi Pills), and vitamins without any apparent improvement in her condition. In the last half-year her symptoms had gotten worse. So she decided to try acupuncture.

In addition to the afore-mentioned symptoms characteristic of stress incontinence, the patient experienced bodily fatigue, loss of strength, dread of cold, chilled limbs, a slightly fat body, and difficulty falling asleep at night. Her tongue fur was thin and white, and her pulse was sunken and fine. The patient was treated with the above acupuncture-moxibustion protocol for five times and the number of times she experienced urinary incontinence was markedly decreased. She was able to control her urine even when she coughed, laughed, and sneezed. After 20 treatments, all her symptoms were eliminated and she was judged cured. On follow-up (i.e., one year later), there had been no recurrence.

Discussion

According to the authors, stress incontinence is a commonly seen type of urinary incontinence in middle-aged and elderly females. In modern (Western) medicine, it is also called female incontinence. It is due to shortening of the urethra and loss of the normal posterior urethrovesical angle resulting from pelvic relaxation (cystocele) that characteristically occurs with aging or multiparity. Coughing, sneezing, or anything which increases the intra-abdominal pressure thus causes a loss of self-control over the discharge of urine.

In terms of Chinese medicine, this disease is produced by spleen-kidney yang vacuity. Thus the urinary bladder lacks the strength to restrain the urine, qi transformation loses its duty, and opening and closing are not secure (or do not secure). Treatment of this disease should, therefore, warm and supplement the spleen and kidneys. Guan Yuan, Qi Hai, and San Jiao Jiu are all located on the lower abdomen in the vicinity of the bladder. Needling and later moxaing these points has the effect of warming and moving spleen yang, banking and supplementing the original qi. Shen Shu, Ming Men, and Da Chang Shu are able to warm the kidneys and strengthen yang, free the flow of yang and transform the qi. When these two groups of points are combined and used together, they achieve the function of warming and supplementing the spleen and kidneys, thus promoting the qi transformation’s obtaint of regulation. Opening and closing have their (proper) degree, and thus the effects are fully satisfactory.

Translator’s Commentary

It doesn’t take too many years of practice to know that conditions where the pattern is predominantly yang vacuity frequently respond well to treatment by moxibustion therapy. In fact, when and if I determine that yang vacuity is the main “ingredient” in a particular patient’s pattern configuration, I am usually quite happy to treat them, because I am relatively certain of at least some degree of success.

While I might go about the treatment slightly differently, using more moxibustion and fewer needles, there is certainly nothing wrong with the protocol the authors have designed.

This protocol does not take into consideration, however, that incontinence may be caused by other disease mechanisms than spleen-kidney yang vacuity. These could include kidney qi or yin vacuity, qi desertion, and damp heat or stomach heat. Heat patterns must always be considered when the patient is relatively younger. If any of these patterns were present separate from or in addition to spleen-kidney yang vacuity, other points and other treatment styles would be required to treat the condition successfully.

For more insight into this condition, I suggest Sionneau and Lu’s, Treatment of Disease in Chinese Medicine, Volume 6.