Professor Yu Hai-bo’s clinical experience in treating acute attack of hemorrhoids with acupuncture-moxibustion

Liu Yong-feng (刘永锋)

Shenzhen Hospital of Chinese Medicine, Guangdong 518033, China

1 Syndrome Differentiation of Acute Hemorrhoids

Prof. Yu Hai-bo considers the main etiology and pathogenesis of hemorrhoids of acute attack are downward flow of damp-heat and qi sinking.

1.1 Damp-heat in lower jiao

Those who usually or recently have improper diet,drinking or eating irregularly, eat greasy or spicy food.Manifestations include large amount of bright bloody stool, swelling mass out of the anus but retractable,burning heat sensation in anus, with local swelling, pain and damp; a red tongue with yellow and greasy coating,and a rapid and string-like pulse.

1.2 Qi sinking

Old people or multiparity, or children with chronic diarrhea or dysentery; overworked or those did long walk with loads, or who have chronic hemorrhoids,leading to slack anus, and have prolapsed hemorrhoids needing reset manually. Manifestations are hematochezia with bright bloody stool, pale complexion,lassitude and fatigue, shortage of qi and no willing to talk, decreased intake and loose stool, a pale tongue with teeth-marks and thin, white coating, and a weak pulse[4].

2 Therapeutic Principles

The general principles in treating hemorrhoids of acute attack are to disperse swelling and relieve pain,control and stop bleeding. However, according to the different physical constitutions, syndrome differentiation should be applied. Clearing heat to detoxify, and inducing dampness to disperse swelling are majorly used for anal swelling and pain, and even purulency; tonifying middle-jiao to replenish qi is used for infantile or aged people who are of weak constitutions or multiparas with sunken qi; regulating intestines and stomach, clearing stagnant and relaxing bowels are often used for those who have constipation.

3 Acupuncture Therapy

The Bladder Meridian (BL) is the barrier of six meridians, and the Governor Vessel (GV) is the sea of yang meridians. Acupoints of BL and GV are often used in treatment of hemorrhoids in acute stage is more often using[5].

Major points: Erbai (EX-UE 2), Kongzui (LU 6),Chengshan (BL 57), Ciliao (BL 32) and Zhibian (BL 54).

Point combination according to syndrome differentiation: For syndrome of damp-heat pouring downward, Dachangshu (BL 25) and Yinlingquan (SP 9)are added; for syndrome of sunken qi caused by deficiency, Pishu (BL 20) and Baihui (GV 20) are added;for constipation, Tianshu (ST 25) and Shangjuxu (ST 37)are added (better to plus electroacupuncture).

3.1 Erbai (EX-UE 2) used alone

Prof. Yu usually acupunctures at Erbai (EX-UE 2) of both sides for hemorrhoids stage Ⅰ, Ⅱ, especially for anal pain and discomfort, itching, and hematochezia.Erbai (EX-UE 2) has always been used for hemorrhoids as the experiential points, located on the palmar side of the forearm, 4 cun above the wrist crease, on both sides of the flexor carpi radialis muscle tendon, one point each side; two points on one arm, a total of four points on both arms.Bian Que Shen Ying Zhen Jiu Yu Long Jing(Bian Que's Jade Dragon Classics of Acupuncture and Moxibustion)[6]states that the disease of hemorrhoids can also be acupunctured, and tenesmus is most difficult to stop, manifested by pain or itching or bleeding, and doctor should seek Erbai(EX-UE 2) back from the palm for treatment.Perpendicular insertion by 15-25 mm and needle manipulation with strong stimulation, in order to obtaining needling qi, effect won’t be achieved until feeling of numbness in both arms and the needle sensation down straight to the fingertips. Acupuncture once every morning and afternoon, alternately treating Erbai (EX-UE 2) on each side of both arms, needle retention for 30 min. Modern medicine believes that acupuncture at Erbai (EX-UE 2) not only can kill pain and disperse swelling, but also has anti-inflammatory and hemostatic effect. It’s easy to apply, with quick and lasting effect[7].

3.2 Upper-lower point combination

This method uses Kongzui (LU 6) and Chengshan(BL 57) for the hemorrhoids caused by blood stasis due to long-term qi stagnation at the end of the colon. The lung and the large intestine are interiorly-exteriorly related, and the lung governs qi, with effect of diffusing qi movement of large intestine. Kongzui (LU 6) is the Xi-Cleft point of the Lung Meridian (LU), effective indiffusing lung qi, also good at treating disease in blood aspect via regulating qi and moving stagnation,activating blood and stopping bleeding, and thus it’s applied for hemorrhoids. This point is punctured with perpendicular insertion by 10-15 mm, with local sensation of sour and heavy, and the needle sensation should disperse towards the forearm.

Chengshan (BL 57) is an acupoint of BL, an important point in selection of distant points for anus diseases,especially for anal pain.Yu Long Ge(Jade Dragon Song)[8]states that various hemorrhoids hurt most, and they have to be treated with acupuncture at Chengshan(BL 57) to get miraculous effect. This point is punctured with oblique insertion with needle tip slightly up by a depth of 25-50 mm, with manipulationto make the needle sensation go upwards. Chengshan (BL 57) area is distributed with medial sural cutaneous nerve, and peroneal nerve in deep layer[9]. The key analgesic mechanism for distal anus pain and discomfort may focus on the brain or spinal cord.

The two acupoints were both treated with strong stimulation and quick twirling method; needles were retained for 30 min and manipulated every 15 min (or replaced by electroacupuncture). However, puncturing Kongzui (LU 6) and Chengshan (BL 57) is only effective for swelling and pain in hemorrhoids, hardly can cure the hemorrhoids.

3.3 Selection of local points

For hemorrhoids of acute attack with severe swelling and pain or itching, Prof. Yu usually selects local acupoints Ciliao (BL 32) and Zhibian (BL 54), two BL acupoints. Needle insertion at Ciliao (BL 32) is usually by an angle of 65° and depth of 15-30 mm, to make sour and distent sensation in lumbosacral region, and the sensation will disperse to external genitalia, anus and rectum with deep insertion by 60 mm[10]. Since the size,depth, and straight or slant shape of posterior sacral foramina are all different, physicians should change the direction of the needle tip to seek the posterior sacral foramina when the needle is blocked by the bone after insertion. The resistance will be relieved when needle enters the second sacral foramina, and easy to push, not only for more successful puncture, but also more obvious needle sensation. When acupuncturing Zhibian(BL 54), the needle tip is tilted back by 70°towards the anus, with deep depth of 15-30 mm and strong stimulation, a contract, causing the anus to contract or distend or a feeling of defecation[11].

4 Other Therapies

4.1 Moxibustion treatment

Prof. Yu usually applies moxibustion to Changqiang(GV 1) in the treatment of hemorrhoids, mainly for syndrome of sunken qi caused by deficiency.Changqiang (GV 1) is the starting point of GV, also the Luo-Connecting point, with function of invigorating yang of the whole body[8]. The area is distributed with coccygeal nerve and anal nerve. Moxibustion at Changqiang (GV 1) can promote contraction of anal sphincter, improve local blood circulation, enhance the support ability of perianal tissue, and benefit the absorption and resolving of hemorrhoids. In treatment,the patient should be in a prone position, with Changqiang (GV 1) exposed. The physician takes a moxa stick of 20 cm in length and 1.8 cm in diameter, ignites and holds it close to the acupoint 2-3 cm away from the skin for mild moxibustion. The treatment should make the skin reddish but not burning, lasting for 15 min every time, performed every other day[12].

4.2 Piercing method

Piercing method is applied to Yinjiao (GV 28). GV originates from anal area at Changqiang (GV 1), ends inside the lips at Yinjiao (GV 28), organically connecting the anus and the mouth. Piercing foreign matter out of Yinjiao (GV 28) is significantly effective in treating hemorrhoids, rectal prolapse, anal fissure, anal fistula abscess, especially hemorrhoids pain and bleeding.Most patients with hemorrhoids may have one or more follicles of miliary size and different colors at Yinjiao(GV 28) or upper labial frenum. In treatment, the physician pinches the patient's upper lip up and back with the left thumb and index finger, with Yinjiao(GV 28) exposed to find the positive reaction point.Meanwhile, the physician uses the right hand to hold a three-edged needle, laterally inserted at one side of the upper labial frenum, pricks the reaction point or the upper labial frenum outwards, and squeezes out 1-2 drops of blood after pricking. The treatment should be finished in 1 min, given once a week, generally 2 to 3 times in total[13].

4.3 Pricking-cupping bloodletting at Ashi point

The Ashi point is the hemorrhoid point, mostly selected on the back in the region of thoracic vertebrae and the lumbar vertebrae, manifested by papules or hairy hemorrhoid point slightly protruding out skin surface, a little reddish, purplish, grayish, or brownish,with different sizes like a sesame and different shapes,unfading when pressed. Pay attention to distinguish the red nevus on skin. After routine disinfection, prick or pierce the Ashi point, and then apply cupping and bloodletting[14-16].

5 Case Study

A female patient, 34 years old.

Chief complaints and current history: Intermittent hematochezia for one year. In mid-February 2016, due to the fried spicy diet during the Spring Festival, the patient suffered from dry stools and a little blood in the stool for a week. The patient felt a foreign matter out of the anus, but not much painful or itching, and eating was normal.

Examination: A reddish tongue with thin and white coating, and a slippery pulse. No reaction point near Yinjiao (GV 28), but a greyish reaction point on the low back of the 9th thoracic vertebra level, and some collaterals on the right side of the 12th thoracic vertebra.

Treatment: Pierced with a three-edged needle at Yinjiao (GV 28) and reaction points on thoracic back, in which, more fibers were pierced out nearby the 9th thoracic vertebra, and squeezed a little blood.Moxibustion was used at Changqiang (GV 1) for 30 min.On the second visit, there was less blood in stools. Then Erbai (EX-UE 2) was punctured, and pricking-cupping bloodletting was used at Dachangshu (BL 25) after acupuncture. On the third visit, deep insertion at Ciliao(BL 32) and Zhibian (BL 54) was applied by needles of 40 mm in length on both sides, to consolidate curative effect, with needle tip towards the affected part and strong stimulation. Symptoms were relieved after about 5 d, there was no recurrence till February 2017.

Explanation: In modern and ancient times, etiology and pathogenesis of hemorrhoids were mostly discussed from aspects of exuberance and debilitation of yin and yang, qi and blood, and normal-reverse transmission and crisscross of viscera and bowels,meridian and collateral, and the interaction of internal and external causes. It’s mainly due to the dysfunction of inner regulation of the body, anatomical and physiological defects, plus the various external precipitating factors such as age, customs, habits,climate, pregnancy, diet, native endowment, and gastrointestinal diseases. It’s been a long history that hemorrhoids were treated with acupuncture.Huang Di Nei Jing(Yellow Emperor’s Classic of Internal Medicine)[17]has stated the experience and acupoints of acupuncture treatment for hemorrhoids.Zhen Jiu Jia Yi Jing(A-B Classic of Acupuncture and Moxibustion) of Jin Dynasty[18]states that hemorrhoid pain, treated by Cuanzhu (BL 2); hemorrhoids, treated by Huiyin (CV 1).After that, ancient doctors recorded lots of acupoints and methods for hemorrhoids treatment. Confirmed by present doctors, acupuncture does have good effect on hemorrhoid bleeding, prolapse, swelling and pain, and anal tenesmus.

6 Conclusion

Based upon the basic TCM theory and theories of various schools, Prof. Yu Hai-bo’s application of acupuncture-moxibustion treatment for hemorrhoids at acute attack has better short-term and long-term efficacy. It’s easy to operate, safe and reliable, and has various methods.

Previous clinical experiences reflected that piercing at Yinjiao (GV 28) had better effect, but Prof. Yu pointed out that it was not necessary to stick to the positive reaction point. Piercing or fire needling at this acupoint for bloodletting could also be used. The manifestation and location of hemorrhoid point on the back are different, carefully checking and distinguishing are needed. In this case, there were some greyish reaction points on her back near the 9th thoracic vertebra, and some collaterals on the right 12th thoracic vertebra.These points were pierced by a three-edged needle and squeezed to bleed a little. Therefore, this is a flexible combination of needling, piercing, moxibustion and cupping. We should select corresponding acupoints to apply manipulation according to different symptoms,different severities, and different courses of the disease.Acupuncture has a remarkable effect in improving symptoms of hemorrhoids, and can help to relieve the symptoms in a severer condition such as hemorrhoids in stage Ⅲ, Ⅳ of acute phase. For recurrent attacks of hemorrhoids which don’t respond well, the treatment can be combined with specific surgery. Acupuncture, as a natural therapy, also can be helpful for anal pain and discomfort after hemorrhoids surgery.

Overall, the essence of Prof. Yu’s academic thoughts lies in inheritance and innovation. The key to inheritance is to build up the TCM syndrome differentiation pattern of thinking, while the key to innovation is to establish a brand new TCM theoretical system not only reflecting the academic essence of TCM,but also meeting the modern therapeutic principles.Therefore, in the field of acupuncture treatment, we should give full play to the characteristics of TCM,follow the law of disease development, and continuously innovate new treatments, in order to bring the academic and technological level of acupuncture and moxibustion up to a new height.

Conflict of Interest

The author declared that there was no potential conflict of interest in this article.

This work was supported by Key Laboratory Project of Shenzhen Science and Technology Research and Development Funds and Platform Construction Planning(深圳市科技研发资金条件与平台建设计划重点实验室项目, No. CXB201111250113A).

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