J. Acupunct. Tuina. Sci. 2011, 9 (4): 233-236 DOI: 10.1007/s11726-011-0520-6
Special Topic Study
Treatment of Prostatalgia by Acupuncture: A Randomized Controlled Trial 针刺治疗前列腺痛的随机对照试验 Chen Yunlong (陈云龙)1, Wang Chengrong (王承荣)1, Lin Yanyan (林研研)2 1 No.1 Hospital of Sanming City, Fujian 365000, P. R. China 2 Hospital of Integrative Chinese and Western Medicine of Sanming City, Fujian 365000, P. R. China
【摘要】目的：观察针刺治疗前列腺痛的临床疗效。方法：符合纳入标准的前列腺痛患者 60 例，随机分 成两组，针刺组 30 例采用针刺治疗；药物组 30 例，采用口服中药汤剂治疗。比较两组临床疗效。结果： 针刺组治愈 5 例,显效 12 例,有效 11 例，无效 2 例，总有效率 93.3%；药物组治愈 2 例，显效 8 例，有效 13 例，无效 7 例，总有效率 76.7%。针刺组总有效率优于药物组(P＜0.05),且针刺组在降低美国国立卫生 研究院慢性前列腺炎症状积分指数(National Institutes of Health-Chronic Prostatitis Symptom Index, NIH-CPSI)的总积分和疼痛症状、尿路症状、生活质量亚类评分方面均优于药物组。结论：针刺是治疗前 列腺痛的有效方法。 【关键词】针刺疗法；前列腺；随机对照试验 【中图分类号】R246.2 【文献标志码】A 【Abstract】Objective: To observe the clinical efficacy of acupuncture therapy for prostatalgia. Methods: Sixty subjects were randomized into two groups: an acupuncture group in which 30 cases were treated by acupuncture and a medication group in which the other 30 cases were treated with herbal decoction. The clinical efficacy in these two groups were observed and compared. Results: In the acupuncture group, 5 cases were cured, 12 cases were significantly improved, 11 cases improved and 2 cases failed, and the overall effective rate was 93.3%. In the medication group, 2 cases were cured, 8 cases were significantly improved, 13 cases improved and 7 cases failed, and the overall effective rate was 76.6%; the overall effective rate was higher in the acupuncture group than in the medication group (P<0.05). Moreover, the total score of National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI), and the scores for pain severity, urinary symptoms and quality of life were reduced more significantly in the acupuncture group than in the medication group. Conclusion: Acupuncture is an effective therapy for prostatalgia. 【Key Words】Acupuncture Therapy; Prostate; Randomized Controlled Trial Prostatalgia is a condition characterized by radiating pain primarily along the perineum, penis, sacrum and lower abdomen. It has a strong predilection for men of middle age, especially at the ages ranged from 20 to 45 years. At present, its clinical treatment aims to ease the symptoms, can relieve the pain and urinary abnormalities to some extent. But some cases are difficult to cure or irresponsive of the treatments, susceptible to recur, thus the patients’ life quality is affected. We treated 30 cases of prostatalgia by acupuncture therapy, and compared the effect with those treated by herbal treatment. Now, it is reported as follows. Author: Chen Yunlong, master of medicine, resident physician, 43206772@qq.com
1 Clinical Data 1.1 Diagnosis criteria The diagnosis criteria were stipulated in accordance with the diagnostic criteria by National Institutes of Health (NIH) and in Prostate Surgery[1]. The cardinal symptoms consist of the, micturitionunrelated pelvic pain, such as in the perineum, penis, scrotum, suprapubic and lumbosacral areas, or dripping after urination, difficult urination and urinary irritant signs such as frequent, urgent and painful urination. Anal examination showed tenderness on the bilateral levator ani muscle and the short external rotators of the hip, absence of tenderness on prostate. Liquor prostaticus bacterial culture showed negative,
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leucocyte count over 10 per high-power field, normal or lessened lecithin. The clinical symptoms accumulated over three months in the past six months. 1.2 Inclusion criteria Those with confirmed prostatalgia according to the diagnostic criteria above; those not taking antibiotices within the past month; those not taking medications for chronic prostatitis or affecting urination in recent one week; those willing to undergo acupuncture treatment and survey. 1.3 Exclusion criteria Those taking other medications during this observation; those with abnormal urine routine test, urinary infection and stones; those with organic stricture in the urinary tract; those complicated with prostate hyperplasia, prostate tumors, testicle and epididymis diseases, cirsocele, pubis inflammation, inguinal hernia, and lumbodorsal myofascial inflammation; those with severe gastrointestine, or diseases of heart, lung, liver, kidney, or hematopoietic disease; those with severe neurosis. 1.4 Termination criteria Those unable to persist in treatment; those not undergo the due regimen; those present with severe negative reactions; those present with complications or worsened conditions. To those terminating cases, record the terminating cause and time, and analyze its relationship to this observation. 1.5 Experimental design This experiment was designed in accordance with acupuncture clinical research standards and with randomized, single-blinded controlled trial. The subjects were enrolled in visit sequence and numbered, and then evenly randomized into an acupuncture group and a medication group by random number table. The subjects should sign the informed consent. 1.6 General data Sixty cases of prostatalgia were randomized into an acupuncture group and a medication group, 30 cases in each group. In the acupuncture group, the ages ranged between 19 and 42 years, (26±5) years on average; the shortest duration was 3.1 months, the ●
longest duration was 2 years, (7.83±3.75) months on average. In the medication group, the ages ranged between 19 and 41 years, (26±4) years on average; the shortest duration was 3.2 months, and the longest duration was 2 years, (7.03±3.10) months on average. There was no difference in the age and duration between the two groups (P>0.05), showing comparability between the two groups.
2 Treatment Methods 2.1 Acupuncture group Acupoints: ① Zhongji (CV 3), Guanyuan (CV 4), bilateral Guilai (ST 29), Shuidao (ST 28), Sanyinjiao (SP 6) and Taixi (KI 3). ② Bilateral Shenshu (BL 23), Dachangshu (BL 25), Zhonglvshu (BL 29), Zhibian (BL 49) and Huiyang (BL 35). Operation: One group of acupoints was needled every day, and the two groups of acupoints were needled alternately. The needles were kept for 30 min and TDP instrument was employed to irradiate the acupoints. Thirty days made up one course. 2.2 Medication group Medication group was given Qian Lie Xian Decoction[2], one dose a day and two times divided. Thirty days made up one course.
3 Observation on Therapeutic Effects 3.1 Observational indexes The National Institute of Health-Chronic Prostatitis Symptom Index (NIH-CPSI)[3] was rated to score the symptoms, including the total score and pain or discomfort score, and quality of life score. The indexes were compared between pre-treatment and post-treatment, and between the two groups. 3.2 Statistical methods The collected data were input into the computer and then analyzed by SPSS11.5 software. The measurement data were expressed with ( x ±s) and analyzed by t-test; the enumeration data were analyzed by Chi-square test or rank sum test. P<0.05 was considered as statistically significant. 3.3 Criteria for therapeutic effects The criteria for therapeutic effects were stipulated
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in the light of the Guidance for Diagnosis and Treatment of Chronic Prostatitis by Integrative Medicine[4] and other literature[5, 6]. Cure: NIH-CPSI score was reduced by over 90%. Marked effectiveness: NIH-CPSI score was reduced by 60%-89%. Effectiveness: NIH-CPSI score was reduced by 30%-59%. Failure: The clinical symptoms and signs were improved little; NIH-CPSI score was reduced by less than 30%. 3.4 Comparison of therapeutic effects The overall effective rate was 93.3% in the acupuncture group and 76.7% in the medication group. Chi-square test showed that the overall effective rate was higher in the acupuncture group than in the medication group (P<0.05) (table 1).
Table 1. Comparison of therapeutic effects between the two groups (Cases) Groups n Cure ME Effectiveness Failure TER (%) Acupuncture 30 5 12 11 2 93.31) Medication 30 2 8 13 7 76.7 Note: ME=Marked effectiveness; TER=Total effective rate; compared with the medication group, 1) P<0.05
3.5 Comparison of NIH-CPSI score between the two groups After treatment, the NIH-CPSI scores were significantly reduced in both groups (P<0.05); there were great differences in the total score and symptom scores of NIH-CPSI between the acupuncture group and the medication group (P<0.05), indicating that NIH-CPSI score was reduced more obviously in the acupuncture group (table 2).
Table 2. Comparison of NIH-CPSI score between two groups ( x ±s, points) Acupuncture group NIH score Pre-treatment Post-treatment Pain score 12.13±3.58 3.62±2.441)2) Urinary symptoms 5.66±2.31 1.68±1.291)2) Quality of life 7.26±2.67 2.03±1.621)2) Total score 25.26±6.39 7.13±5.371)2)
Medication group Pre-treatment Post-treatment 11.59±3.85 6.71±3.271) 3.86±2.06 2.23±1.181) 7.21±2.92 3.52±2.811) 22.31±7.23 9.76±6.651) Note: Compared with pre-treatment in the same group, 1) P<0.05; compared with post-treatment in the medication group, 2) P<0.05
3.6 Adverse effects Sixty cases underwent this experiment and all went through this test. No adverse effects were found during the whole procedure.
4 Discussion Acupoints Guanyuan (CV 4), Zhongji (CV 3) and Guilai (ST 29) can activate bladder and qi, disinhibit urine and relieve stranguria. Guanyuan (CV 4), the crossing point of the Conception Vessel and the Three Foot Yin Meridians, can enrich kidney essence and indicate for spermatorrhea, impotence, frequent urination and lower abdominal pain. Zhongji (CV 3), the Front-Mu point of the Bladder Meridian, is indicative of urinary difficulty, impotence and premature ejaculation. Sanyinjiao (SP 6), the crossing point of the Liver, Spleen and Kidney Meridians, can nourish the liver and kidney, move qi and disinhibit urine. Taixi (KI 3), the Yuan-Primary point and Shu-Stream point of the Kidney Meridian, acts to enrich kidney qi. Shenshu (BL 23), Dachangshu
(BL 25), Zhonglvshu (BL 29), Huiyang (BL 35) and Zhibian (BL 49) function to warm kidney yang and unblock meridians and collaterals, and are the essential point for urinary and productive disorders. These points together work to clear dampness heat, activate blood and unblock collaterals, and nourish the spleen and kidney. This study showed that acupuncture could effectively treat prostatalgia and reduce NIH-CPSI score possibly by improving the blood circulation around the prostate. Ji Laixi et al[7] found that acupuncture could accelerate the blood circulation of animal’s prostate; that the pathological lesion could be relieved after acupuncture, specifically, the interstitial edema and inflammatory infiltration were gradually relieved or disappeared; moreover acupuncture could increase the prostate secretion. Liu Tingting et al[8] showed that electroacupuncture could improve the pathological changes of rat’s prostate in prostatitis, and obviously increase the level of serum IL-2 and reduce the level of TNF-α to exert the functions of antiinflammation and immunoregulation. In addition,
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acupuncture could also diminish serum IgG, elevate serum IgA, inhibit the microorganism reproduction, fight against bacteria and virus, and suppress the reproduction and growth of bacteria to eliminate inflammation[9, 10]. To sum up, acupuncture is an effective therapy for prostatalgia, which is worthy of further study.
References [1] Xie T, Wu JP. Prostate Surgery. Beijing: People’s Medical Publishing House, 1983: 136. [2] Jia JM. China Andriatrics of Integrative Chinese and Western Medicine. Beijing: China Medical Science and Technology Press, 2005: 264. [3] Litwin MS, McNaughton-Collins M, Fowler FJ Jr, Nickel JC, Calhoun EA, Pontari MA, Alexander RB, Farrar JT, O'Leary MP. The national institute of health chronic prostatitis syndrome index: development and validation of a new outcome measure. J Urol, 1999, 162(2): 369-375. [4] Zhang MJ, Deng SM. Guidance for diagnosis and treatment of chronic prostatitis by integrative medicine (Tentative Version). Zhong Guo Zhong Xi Yi Jie He Za Zhi, 2007,
27(11): 1052-1056. [5] Jia JM, Xue CM. Efficacy of safety of Qian Lie An Suppository in the treatment of chronic prostatitis. Zhong Hua Nan Ke, 2001, 7(6): 417-419. [6] Li H, Zhang H, Ge JQ. Clinical observation on comprehensive treatment of 80 cases of chronic type Ⅲ prostatitis by elongated needle, microwave and moritatherapy. J Acupunct Tuina Sci, 2005, 3(6): 8-10. [7] Ji LX, Zhai N. Effect of acupuncture at Zhibian (BL 54) point on experimental nonbacterial prostatitis in rats. Zhong Guo Zhen Jiu, 1998, 18(2): 87-90. [8] Liu TT, Jin H, Gao WB. Influences of electroacupuncture on a rat model of chronic abacterial prostatitis. Shang Hai Zhen Jiu Za Zhi, 2007, 26(9): 40-42. [9] Zhao DW, Zhao YQ, Jiang SL, Wu CD. Effect of acupuncture on secretory immunoglobulin-A in chronic prostatitis patients. Zhong Guo Zhen Jiu, 1995, 15(4): 36-37. [10] Chen YL, Sheng PF, Chen GM, Ha LF, Zong L, Wu CL. The Influence of electroacupuncture on pathological changes in the bladder and prostate in rats with unbacteria prostatitis. Shang Hai Zhen Jiu Za Zhi, 2003, 22(2): 6-9. Translator: Xiao Yuanchun (肖元春) Received Date: May 15, 2011
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Proctalgia Fugax, an Evidence-based Management Pathway Purpose: Proctalgia fugax (PF) is a benign anorectal condition which has been described in the literature since the nineteenth century commonly presenting to general surgeons. There is little high level evidence on the subject and its therapeutic modalities. We aimed through this systematic literature review to outline the definition and diagnostic criteria of this condition, the aetiology and differential diagnoses and describe the different treatment modalities that have been attempted and their success. Method: A literature search of Google Scholar and Medline using Pubmed as the search engine was used to identify all studies directly related to the definition, aetiology and treatment options for this condition (latest at 12 August 2008) was performed. Results: The search produced 61 references with three others obtained from the references of these papers. The prevalence of PF in the general population ranges from 4% to 18%. The diagnosis is based on the presence of characteristic symptoms as defined by Rome III guidelines and physical examination. The mainstay of treatment is reassurance and careful counselling with evidence in the literature for warm baths, topical treatment with glyceryl trinitrate or diltiazem and salbutamol inhalation. In persistent cases, local anaesthetic blocks, clonidine or Botox injections can be considered after clarification of risk and benefit. Conclusion: Based on this we suggest that diagnosis should be made through exclusion of common organic causes such as haemorrhoids, anal fissure or anorectal carcinoma and on the fulfillment of Rome III criteria. The main treatment for this benign condition remains reassurance and topical treatment. Selected from Jeyarajah S, Chow A, Ziprin P, Tilney H, Purkayastha S. Proctalgia fugax, an evidence-based management pathway. Int J Colorectal Dis, 2010, 25(9): 1037-1046.
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