[Research on the Angle and Effective Depth of Deep Acupuncture at Baliao Points by Three-dimensional Reconstruction of Computed Tomography].

OBJECTIVE: To explore the needle insertion parameters of deep acupuncture at Baliao points for clinic and teaching. METHODS: A retrospective analysis of 100 cases of prone pelvic CT from January to June 2016 in Nanjing Hospital was carried out. The 3 D images were scanned with continuous 5 mm slice thickness. The optimum needle angle is defined as the angle of the needle along the central axis of sacral anterior and posterior hole, and the angle between the needle body and the skin surface and the center line of the body was observed. The effect needle depth is defined as the thickness of the sacral back soft tissue plus 1/2 sacral depth, to observe the best needle angle of deep acupuncture parameters of Baliao points. RESULTS: For deep acupuncture at Baliao, the oblique thorn method should be used with the needle-point toward the inner bottom. The best insertion angle between needle body and skin surface is: Shangliao(BL 31) (61.04±12.15)°ï¼Œ Ciliao(BL 32) (57.57±10.01)°ï¼Œ Zhongliao(BL 33) (58.25±8.69)°ï¼Œ Xialiao(BL 34) (54.39±10.94)°. The optimum angle of insertion between the needle body and the posterior midline of the human body is: BL 31 (24.54±6.21)°ï¼Œ BL 32 (18.58±7.76)°ï¼Œ BL 33 (17.36±7.90)°ï¼Œ BL 34 (30.73±9.45)°. The effective insertion depth show a decreasing trend: BL 31 (58.16±12.43) mm, BL 32 (44.57±11.55) mm, BL 33 (33.96±10.74) mm, BL 34 (31.13±10.94) mm. The effective depth is positively correlated with BMI, and has no correlation with gender and weight. CONCLUSIONS: The study of the parameters of needle insertion should be taken into account both clinical efficacy and safety, and CT three-dimensional reconstruction can accurately, rationally and scientifically perform acupoint anatomical measurements.

[Variation of Locations of Baliao Acupoints in 290 Volunteer Subjects Analyzed by Using Computed Tomography-aided Three-dimensional Reconstruction Technique].

OBJECTIVE: To observe the variation of sacral vertebrates and foramen involving the bilateral Shangliao (BL 31), Ciliao (BL 32), Zhongliao (BL 33) and Xialiao (BL 34, Baliao acupoints), so as to provide an anatomic basis of acupoint needling in clinical practice. METHODS: A total of 290 patients[161 men and 129 women, mean age and standard devia-tion, (63.6±13.3)years old and (59.5±13.3) years old, respectively] with intact pelvic structure were recruited in the present study. Computed tomography (CT) scans of intact pelves were taken using a SOMATOM Definition AS 128 and the acquired signals were imported into Siemens Syngo Inspace platform for 3 D reconstruction, followed by identification, classification and analysis of the variation of sacral foramen (Baliao acupoint). RESULTS: The total variation rate of posterior sacral foramen (Baliao acupoint) was 20.34%(59/290). The detected three types of variation were sacral vertebrae number variation (4 sacral vertebraes, 6 sacral vertebraes), fusion variant (lumbosacral fusion, sacrococcygeal fusion, lumbosacral & sacrococcygeal fusion, and lumbosacral fusion & S 4 variation) and mixed type. CONCLUSIONS: Variations of sacral vertebrae including the number and fusion exist in the human body, suggesting an increase of the difficulty of acupoint needling. Since posterior iliac spine does not change generally, it is recommended to be used as a reference point for locating the Baliao acupoint.

[Development of Researches on the Underlying Mechanism of Acupuncture Stimulation of Baliao-points for Improving Outlet Obstruction Constipation].

Outlet obstruction constipation (OOC) is a common clinical problem affecting many people's daily life quality nowadays. Acupuncture therapy is effective in easing OOC to reduce patients' sufferings by stimulation of Baliao-points i. e., bilateral Shangliao (BL 31), Ciliao (BL 32), Zhongliao (BL 33) and Xialiao (BL 34), which has been confirmed repeatedly in clinical practice. In the present paper, the authors reviewed development of studies on the underlying mechanisms of acupuncture stimulation of Baliao-points for OOC from: 1) lowering the sensitivity of intraganglionic laminar nerve endings (rIGLEs) to rectal mechanical distension during defecation, 2) raising the level of circulating cholecystokinin (CCK) to improve the sensory threshold of the rectum, 3) lowering the excitability of γ-motor neurons in the spinal anterior horns controlling the slow contraction of the rectal sphincter muscle, 4) inhibiting the excitability of sympathetic output from the spinal lateral horns, 5) easing the tonic contraction of the pelvic muscles to reduce the release of 5-hydroxy tryptamine (5-HT), histamine, and other related chemical mediators due to local ischemia. Moreover, further study on the mechanism of acupuncture stimulation of Baliao-points underlying improving OOC may help up find more specific and effective therapeutic targets and provide more reliable experimental foundation and theoretical basis.

[Observation on effect characteristics of electroacupuncture for different types of functional constipation].

OBJECTIVE: To explore the differences of electroacupuncture (EA) on onset time and symptom improvement for treatment of different types of functional constipation. METHODS: Thirty-eight cases of constipation were selected, including 9 cases of constipation-predominant irritable bowel syndrome (IBS-C), 10 cases of slow transit constipation (STC), 10 cases of pelvic floor dyssynergia (PFD) and 9 cases of inadequate defecatory propulsion (IDP). The electroacupuncture was applied at Tianshu (ST 25), Fujie (SP 14), Shenshu (BL 23), Dachangshu (BL 25) and so on in abdominal and lumbosacral area, 5 times per week, 10 times as a treatment course. The onset time, score of clinical symptoms of constipation and improvement of every symptom in each group were compared. RESULTS: (1) The onset time was (1.78 +/- 0.83) days in IBS-C type, (3.11 +/- 1.90) days in IDP type, (4.10 +/- 1.85) days in STC type and (4.30 +/- 2.00) days in PFD type, indicating statistical differences between IBS-C type and STC type, IBS-C type and PFD type (both P < 0.05). (2) Compared before the treatment, the total scores of symptoms on the onset day in each group were all improved (P < 0.05, P < 0.01), and score of IBS-C type was superior to the rest 3 types (P < 0.05, P < 0.01). (3) EA improved desire to defecate or frequency of defecation in each type (P < 0.05, P < 0.01), in which both were improved in STC type and PFD type, and the improvement of defecation frequency was more significant in STC type (P < 0.01). EA relieved unsmooth defecation or pendant-expansion feeling in each type (all P < 0.05), in which both were improved in IBS-C type (both P < 0.05). EA relieved abdominal distension and pain in IBS-C type, STC type and PFD type (all P < 0.05), while its effects were not obvious on defecation difficulty, defecation time and defecation texture (all P > 0.05). CONCLUSION: The electroacupuncture for treatment of 4 types of constipation is characterized by rapid onset; the improved symptoms are not identical in the electroacupuncture treatment plan for each type of defecation; the main improvement of symptoms are lied on desire to defecate and frequency of defecation, unsmooth defecation or pendant-expansion feeling and abdominal distension and pain. Meanwhile the improvements of defecation texture, defecation difficulty and defecation time were not signi-ficant.

[Study on the measurement and locating of Baliao points (eight sacral foramina)].

OBJECTIVE: To seek the problems of position, measuring and locating methods of Baliao points (posterior sacral foramina) in modern researches. METHODS: Using Baliao (eight sacral foramina), Shangliao(BL 31), Ciliao(BL 32), Zhongliao(BL 33), Xialiao(BL 34), Dihoukong (posterior sacral foramina), Dikong (sacral foramina) and Digu(sacrum) as the key words, literature in the database of the CNKI from 1957 to 2012 were re trieved and analyzed. RESULTS: Problems were found in the past researches including limited numbers of relative literature, disunity of the measurement targets, complicated terms of indices, disunity of the starting and ending point of measurement, unclear weight of indices, deviation of results, lacking of combination with clinical practice and variety of locating methods. CONCLUSION: Position of Baliao points (eight sacral foramina) are clear. However, the locating methods are blurred and vary a lot. Study on living body has more significance for measurement and researches. Factors of gender, body weight, height and childbearing should also be taken into consideration. Therefore, it is necessary to find a more accurate and easier way of locating.

[Clinical study on acupuncture for treatment of chronic functional constipation].

OBJECTIVE: To discuss the effect of acupuncture for treatment of chronic functional constipation (CFC). METHODS: Ninety cases were treated with acupuncture. The following two groups of acupoints were used alternatively once every other day. The acupoints in the first group were Tianshu (ST 25), Qihai (CV 6), Shangjuxu (ST 37) etc., and Zhongliao (BL 33), Xialiao (BL 34), Dachangshu (BL 25) etc. in the second group, electroacupuncture was used at Zhongliao (BL 33), Xialiao (BL 34), Tianshu (ST 25) and Shangjuxu (ST 37), once a day, 10 times constituting one course. The defecation frequency, difficulty degree of defecation, defecation time, endless sensation of defecation, stool quality and awareness of defecation were observed and the Patient Assessment of Constipation Quality of Life (PAC-QOL) was evaluated by constipation patients' diaries. RESULTS: The scores of defecation frequency, difficulty degree of defecation, defecation time, endless sensation of defecation, stool quality, awareness of defecation and PAC-QOL were obviously improved after treatment (all P < 0.01). The total effective rate was 67.7% (61/90). The effect of acupuncture for chronic functional constipation in different dynamic mechanism was different. The effect of slow transit constipation (STC) was better than that of spastic pelvic floor syndrome (SPFS) (P < 0.05), and the effect of constipation caused by irritable bowel syndrome (IBS-C) was better than that of SPFS and relaxant pelvic floor syndrome (RPFS) (both P < 0.05). Fifty-two cases were effectively followed up. Three cases were cured, 6 cases were remarkably effective, 23 cases were effective and 20 cases were ineffective after 1 month of treatment. Three cases were cured, 5 cases were remarkably effective, 16 cases were effective and 28 cases were ineffective after 3 months. CONCLUSION: The effect of acupuncture for CFC with exact etiology, disease location and classification diagnosis is definite, but different dynamic mechanism has different effect. The treatment programs for SPFS and RPFS need to be optimized to improve the therapeutic effect.

[Study on thirty patients with slow-transmission constipation treated by acupuncture and moxibustion].

OBJECTIVE: To assess the therapeutic effects and acting specialty of acupuncture and moxibustion for treatment of slow-transmission constipation (STC). METHODS: A clinical pathway was created and Patient-Reported Outcomes (PROs) method was taken for efficacy evaluation dominantly. Acupuncture and moxibustion were applied to 30 STC patients on two groups of acupoints in alternation, with acupoints of Tianshu (ST25), Daheng (SP15), Fujie (SP14), Qihai (RN6), Guanyuan (RN4), Zusanli (ST36), and Shangjuxu (ST37) as group 1; Dachangshu (BL25), Shenshu (BL23), Baliao (BL31, BL32, BL33, BL34), and Sishencong (Ex-HN1) as group 2. Deep needling was applied on acupoints of abdominal and back region and moxibustion was put on Sishencong, 20 times as one course. The therapeutic effect was assessed based on the Patient Assessment of Constipation Quality of Life Questionnaire (PAC-QOL) method by comparing the Bristol scoring on quality of stool, awareness and frequency of defecation, degree of abdominal fullness sensation, and patients' quality of life (QOL) at different time points, i.e., pre-treatment, after 1, 2 and 3 weeks of treatment. RESULTS: Compared with the condition of pre-treatment, after 1, 2 and 3 weeks of treatment, cases using irritant laxative or glycerin enema reduced, with quality of stool normalized, scores for awareness and frequency of defecation increased, and abdominal fullness sensation lessened (all P < 0.01); both the total score and scores on the 4 domains of QOL (malaise, psychosocial complaint, anxiety and interest related to constipation, and satisfaction) were obviously reduced. No adverse event occurred during the treatment course. Therapeutic effectiveness assessment at the end of treatment showed that 13 patients were cured, 9 improved and 8 treated in vain; the corresponding cases assessed at 1 month after treatment were 10, 7, 13; and those at 3 months after were 7, 8, 15, respectively. CONCLUSION: Establishing a clinical pathway is helpful to patients in their continuous diagnosis and treatment. Using PROs method to evaluate the therapeutic effect could clearly reveal the superiority of acupuncture and moxibustion in improving symptoms and QOL in patients of STC.

[Diagnosis and surgical management of adult Hirschsprung disease].

OBJECTIVE: To investigate the diagnosis and surgical treatment of adult Hirschsprung disease (AHD). METHODS: Clinical data of 10 patients with AHD undergoing operation from May 1985 to May 2005 were analyzed retrospectively. RESULTS: There were 7 males and 3 females with an age ranged from 14 to 40 years. All the cases had constipation, and were diagnosed by barium enema. Aganglionosis was located in distal sigmoid and rectum in 2 cases, in rectum in 7 cases, unknown in one case. Colostomy was performed in one, Ikeda s operation in 6, Rehbein operation in two,modified Swenson operation in one. After radical operation,7 patients had excellent continence function, one had good function, one had poor function. CONCLUSIONS: The diagnosis of adult HD mainly depends on the history of constipation, barium enema and manometry examination. The pull-through procedures are effective surgical treatments for adult HD. The operation type should be selected individually.

Effect of modified Sinisan on anorectal manometry of the constipation predominant type of irritable bowel syndrome.

OBJECTIVE: To explore the mechanism in patients with irritable bowel syndrome (IBS) of the constipation predominant type and observe the therapeutic effects of Sinisan (SNS). METHODS: Forty-seven IBS patients with the constipation predominant type were randomly divided into the treated group (n = 24) and the control group (n = 23). Another group of 22 healthy subjects was set up for healthy control. The treated group was treated with modified SNS, and the control group was treated with Cisapride, the therapeutic course for both groups was 8 weeks. The changes of symptom scoring and anorectal manometry (the anorectal resting pressure, anal tract systolic pressure, anal tract diastolic pressure, rectal threshold feeling, maximal tolerance volume of rectum, and rectum compliance) of these two groups were recorded respectively and compared with each other. RESULTS: Compared with the healthy control group, the rectal threshold feeling, maximal tolerance volume of rectum and rectal compliance of the treated groups got reduced significantly before treatment (P < 0.05). After treatment, the symptom scoring, rectal threshold feeling and maximal tolerance volume of rectum were improved in both groups (P < 0.05), and the improvement of the treated group was more significant than that of the control group (P < 0.01). The total effective rate and recurrence rate of the treated group were superior to those of the control group significantly (P < 0.05, P < 0.01). CONCLUSION: SNS has good effect on IBS of the constipation predominant type.