Acupuncture and Moxibustion: Warm Needle method in the Treatment of Post-Cervical-Cancer Bladder Numbness after Radical Surgery - New Column

Townsend Letter for Doctors and Patients, Jan, 2003 by Honora Lee Wolfe

Keywords: Chinese medicine, acupuncture, warm needle, post cervical cancer radical surgery bladder numbness

Warm needle therapy is an acupuncture technique in which dried and pounded Folium Artemisiae Argyii (Ai Ye, or mugwort) is attached to the handle of the acupuncture needle after the needle has been inserted in an acupuncture point. Then the mugwort is lit and allowed to burn. This technique is described in the Chinese literature as combining the effects of acupuncture and moxibustion in a single treatment. Typically, there is about an inch between the surface of the skin and the ball of burning mugwort, and warmth is thus conducted from the handle of the needle to the needle itself and the surrounding tissue. According to Nigel Wiseman and Feng Ye, authors of A Practical Dictionary of Chinese Medicine, this method is primarily appropriate for vacuity cold diseases and wind damp impediment (i.e., joint pain) conditions. (1) While I don't use this technique as often as some other moxa methods, it can be a useful tool in the therapeutic toolbox and is especially nice as an introduction to moxa when you have pati ents who have had needle treatments in the past but never any moxa therapy, or when fine needle acupuncture (2) alone is not adequate.

Approximately one in 63 women develop invasive cancer of the cervix at some time during their life. In 1988, there were approximately 13,000 new cases of invasive cancer of the cervix in the US with approximately 7,000 deaths. (3) Women at high risk for developing cervical cancer include those starting intercourse in their teens, having multiple sexual partners, having many children, and those from low socioeconomic groups. Infection by human papilloma virus (HPV) is believed to be one of the main causes of cervical cancer. Radical hysterectomy with or without radiation is considered to be the standard of care for invasive cervical cancer. However, the complications of radical hysterectomy include fistula formation, sepsis, brachial palsy, loss of enervation of the bladder or colon, and the possibility of residual tumor. In particular, radical hysterectomy for cervical cancer can damage the nerves associated with the bladder. If this happens, it can lead to post-operative bladder numbness and urinary retentio n. While not usually a life-threatening condition, this may be extremely inconvenient and embarrassing for the patient if she has lost total control over her urination. In many cases, catheterization may be necessary, which is more than merely an inconvenience.

Recently, Xie Ying published an article titled, "A Clinical Audit of the Treatment of 136 Cases of Post-Cervical Cancer Radical Surgery Bladder Numbness with Warm Needle Moxibustion," in issue #4, 2002 of Zhong Yi Za Zhi (Journal of Chinese Medicine) on page 267. Because of the positive outcomes of this study, a precis of this article appears below.

Cohort description:

One hundred thirty-six women with post-operative cervical cancer bladder numbness were divided into three groups. The warm needle treatment group was comprised of 49 women aged 24-69 years with an average age of 31.51 years. Twentyfive of the women had stage Ia cervical cancer, 16 had IIa, and eight had IIb stage cervical cancer. The acupuncture comparison group was comprised of 46 women, 25-66 years of age, with an average age of 34.46 years. Twenty-six of these women had stage Ia cervical cancer, 14 had Ib, and six had IIb. The other 41 women were assigned to the "corpus vesicae procedure" comparison group. This group was 23-68 years of age, with an average age of 32 years. Twenty-five of these women had stage Ia cervical cancer, 10 had IIa, and six had IIb. Therefore, there was no significant statistical differences between these three groups in terms of age or stage of disease.

Treatment method:

The members of the warm needle treatment group were first needled at Guan Yuan (CV 4), Zhong Ji (CV 3), and Qi Hai (CV 6) with heads of the needles pointing to the perineum and then manipulated until a numb, distended feeling was propagated to that area. Then Zu San Li (St 36), San Yin Jiao (Sp 6), and Yin Ling Quan (Sp 9) were needled with supplementing hand technique. All these needles were retained for 30 minutes. During this time, two 2cm sections of moxa rolls were burned on each of the handles of these needles. This treatment was done once per day.

The members of the acupuncture comparison group were needled at the same points but no moxibustion was burned. The needles were retained for 30 minutes each time, once per day.

The members of the corpus vesica procedure comparison group were urged to empty their bladders. Then an intravenous drip of 300-500m1 of saline solution was administered. When the patient felt like her bladder was full, it was emptied by a catheter and another 500m1 of saline solution was administered by intravenous drip. Again she emptied her bladder by catheter. This was done two times per day.

All three groups were treated for one week, after which treatment outcomes were tabulated.