theurethralsyndrome-americantcmsociety美國中醫(yī)

1、Urge Incontinence急迫性尿失禁,,Urge urinary incontinence (UUI) is defined as involuntary loss of urine associated with a sudden, strong desire to void. It happens in both men and women and more in the latter.急迫性尿失禁是指伴有強烈尿意

2、的不自主漏尿。男、女均可發(fā)病，女性多于男性，,,Its incidence increases with age.It comes under the category of enuresis in TCM.發(fā)病率隨年齡增長而增加。屬中醫(yī)學(xué)遺尿范疇。,Overactive bladder & Urge incontinence,,Etiology and PathogenesisUUI can be of neurol

3、ogical or non-neurological origin.The former include stroke, Parkinson's disease, Alzheimer's disease, multiple sclerosis, brain injury and spinal injury. 一.   病因和發(fā)病機理引起急迫性尿失禁的原因可以是神經(jīng)原性或非神經(jīng)原性的。前者多由中風(fēng)

4、、帕金森氏病、老年癡呆、多發(fā)性硬化、腦損傷和脊髓損傷等疾病引起。,,,,Etiology and PathogenesisThe latter include urethral obstruction (chronic prostate hyperplasia), vesical inflammation (calculus, tumor) and stress urinary incontinence.UUI can also b

5、e of idiopathic origin.All the above causes can produce detrusor overactivity to result in urge urinary incontinence.后者由尿道梗阻（慢性前列腺增生）、膀胱炎癥（結(jié)石、腫瘤）、壓力性尿失禁等原因所致，另有些原因不明（特發(fā)性）。上述原因都可引起逼尿肌功能亢進(jìn)，導(dǎo)致急迫性尿失禁。,,Clinical manifestati

6、ons1.  SymptomInvoluntary loss of urine associated with a sudden, strong desire to void.二.   臨床表現(xiàn)1.  癥狀有突然、強烈的尿意時或之后尿液不自主地從尿道口流出。,,Clinical manifestations2.  SignsThe observ

7、ation of involuntary urinary loss from the urethra synchronous with an uncontrollable urge to void. Positive pad test.Perineal anesthesia.Abnormal bulbocavernosus reflex.2.  體征有不能控制的尿急時觀察到尿液不自主地從尿道口流出。護(hù)墊試驗

8、陽性。會陰區(qū)感覺消失、球海綿體肌反射異常。,,Laboratory examination1. Urinalysis, vesicourethral X-ray and endoscopyShowing the non- neurological origins: inflammation, calculus, tumor and urethral obstruction.三.   實驗室檢查1. 

9、  尿液檢查、膀胱尿道X線和內(nèi)窺鏡檢查可發(fā)現(xiàn)急迫性尿失禁的非神經(jīng)原性原因，如炎癥、結(jié)石、腫瘤、尿道梗阻等。,,Laboratory examination2. Urodynamic studyInvoluntary detrusor contraction (detrusor overactivity).A decrease in bladder capacity at the first desire fo

10、r urination.A decrease in maximum bladder capacity (incontinence with an uncontrollable desire to void).Low bladder compliance.2. 尿動力檢查可見無抑制性逼尿肌收縮（逼尿肌功能亢進(jìn)）、初始尿意時膀胱容量減小、最大膀胱容量減少（有不能忍受的強烈尿意時出現(xiàn)尿失禁）、 低順應(yīng)性膀胱。,Overact

11、ive Bladder:Urodynamics,,NormalCystometrogram,Cystometrogram in patient with detrusor instability:AKA Overactive Bladder,Pves(cmH20),Pves(cmH20),Volume (mL),MCC — Maximum Cystometric CapacityMax Pdet — Maximum Detr

12、usor Pressure,Volume (mL),Two nonvoidinvoluntarycontractions that resulted in void,Involuntary contractionsthat resulted in void,Detrusor Leak Point Pressure,,DagnosisBased onThe symptom (history) of urge incotinen

13、cePositive pad test.The results of imaging urodynamic study.四.   診斷根據(jù)：1. 急迫性尿失禁癥狀（病史）。2. 護(hù)墊試驗陽性。3. 尿動力檢查結(jié)果。,,TreatmentAcupuncture treatment1. Therapeutic principleAccording to TCM theory, it is caused

14、 by deficiency of kidney qi and failure of the bladder in restraining the urine discharge, 五. 治療中醫(yī)針刺治療1. 治療原則 中醫(yī)認(rèn)為，尿失禁是由于腎氣不足，膀胱不固引起，,,TreatmentAcupuncture treatment1. Therapeutic principleso the therapeutic princ

15、iple is reinforcing kidney qi and improving vesical restraining function.因此治療原則是補益腎氣，固脬止遺。,,2. Point selectionThe Back-Shu and Front-Mu points of the kidney and bladder are selected as the main acupoints2. 穴位選擇主穴是腎和膀

16、胱的背俞穴和募穴。,,2. Point selectionThe acupoints often selected are Shenshu (B 23), Pangguangshu (B 28), Zhongji (Ren 3), Guanyuan (Ren 4), Mingmen (Du 4), Huiyang (B 35), Sanyinjiao (Sp 6) and Zusanli (S 36).常用穴位有：腎俞，膀胱俞，中極

17、，關(guān)元，命門，會陽，三陰交，足三里。,,2. Point selectionThe kidney is exteriorly-interiorly related to the bladder, so the Back-Shu points of the kidney and bladder are applied. Zhongji (Ren 3) is the Front-Mu points of the bladder. The

18、combined use of the above three acupoints contributes to reinforce kidney qi and improve vesical restraining function. 腎和膀胱相表里，故選腎和膀胱的背俞穴。中極是膀胱的募穴。三穴合用有助于補益腎氣，固脬止遺。,,2. Point selectionGuanyuan (Ren 4) and Mingmen (Du 4

19、) are the sources of primordial qi and acupuncture of them can tonify primordial yang (kidney-yang). Huiyang (B 35) is the acupoint of the foot-taiyang meridian and acupuincture of it can invigorate the meridional qi of

20、the bladder. 關(guān)元、命門是元氣之源，針之能補腎益元。會陽是足太陽經(jīng)穴位，針之能振奮膀胱之經(jīng)氣。,,2. Point selectionSanyinjiao (Sp 6) is the crossing point of the three foot-yin meridians and acupuncture of it can regulate the qi of the three foot-yin meridian

21、s. Zusanli (S 36) belongs to the yangming meridian, which is full of qi and blood, acupuncture of it can tonify qi to stop incontinence.三陰交是足三陰經(jīng)交會穴，針之能調(diào)節(jié)足三陰經(jīng)氣。足三里屬陽明經(jīng)，陽明經(jīng)多氣多血，針之能補氣止遺。,Electroacupuncture neurostimulation

22、電針神經(jīng)刺激療法,A combination of acupuncture in traditional Chinese medicine and electrical nerve stimulation in western medicine (including pudendal nerve stimulation, suprapubic transcutaneous electrical nerse stimulation an

23、d percutaneous tibial nerve stimulation).中醫(yī)針刺療法和西醫(yī)神經(jīng)電刺激療法（陰部神經(jīng)刺激，恥骨上經(jīng)皮神經(jīng)電刺激和經(jīng)皮脛神經(jīng)刺激）的結(jié)合。,,1. Acupoint selectionAccording to TCM theory and modern anatomy in combination with clinical practice, we sift out two groups of

24、 acupoints: (1) Four abdominal points (empirical) and (2) Four sacral points (empirical).1. 穴位選擇根據(jù)中醫(yī)理論和西醫(yī)解剖學(xué)，結(jié)合臨床實踐，篩選出二組穴位：（1）“腹四穴” （經(jīng)驗穴） ；（2） “骶四穴” （經(jīng)驗穴）。,Four sacral points骶四穴,2 Acupuncture methods1) Four sacral p

25、oints(1) The upper two points: located by the two edges of the sacrum on a level with the fourth sacral foramina;2 針刺方法1）骶四穴（1）上兩針刺點：骶骨邊緣旁，平第4骶后孔水平處（雙側(cè)）。,Four sacral points骶四穴,2 Acupuncture methods1) Four sacral po

26、ints(1) The upper two points: use a long needle of 4 cun (100mm); puncture perpendicularly 3~3.5 cun in depth; make the needling sensation reach the urethra or anus.使用4寸長針直刺，針刺深度為3-3.5寸，使針感達(dá)尿道或肛門。,Four sacral points骶四

27、穴,2 Acupuncture methods1) Four sacral points(2) The lower two points: 0.5 cun bilateral to the tip of the coccyx; use a long needle of 4 or 5 cun (100 or 125mm); （2）下兩針刺點： 尾骨旁開0.5寸（雙側(cè)），使用4寸或5寸長針，,Four sacral points骶

28、四穴,2 Acupuncture methods1) Four sacral points(2) The lower two points: puncture obliquely (laterally) towards the ischiorectal fossa, 3~4.5 cun in depth; make the needling sensation reach the urethra.向外側(cè)（坐骨直腸窩）斜刺，3-4

29、.5寸深，使針感達(dá)尿道。,Four abdominal points腹四穴,2 Acupuncture methods2) Four abdominal points(1) The two upper points: 2.5 cun bilateral to Guanyuan (Ren 4); 2 針刺方法2）腹四穴（1）上兩針刺點：關(guān)元旁開2.5寸（雙側(cè)）。,Four abdominal points腹四穴,2 Acup

30、uncture methods2) Four abdominal points(1) The two upper points: use a long needle of 4 cun (100mm); puncture obliquely 1~2 cun in depth; make the needling sensation reach the urethra or vulva. 使用4寸長針，斜刺，1-2寸深，使針感達(dá)尿道或

31、外陰部。,Four abdominal points腹四穴,2 Acupuncture methods2) Four abdominal points(2) The two lower points: 1.5 cun bilateral to Zhongji (Ren 3); （2）下兩針刺點：中極旁開1.5寸（雙側(cè)）。,Four abdominal points腹四穴,2 Acupuncture methods2) Fou

32、r abdominal points(2) The two lower points: use a long needle of 4 cun (100mm); puncture obliquely 1~2 cun in depth; make the needling sensation reach the urethra or vulva.使用4寸長針，斜刺，1-2寸深，使針感達(dá)尿道或外陰部。,,2 Acupuncture met

33、hodsAfter the needling sensation reaches the above positions, an electroacupuncture instrument is connected. Used for electroacupuncture are continuous waves, a frequency of 90~150 times/min and an intensity that the pa

34、tient is adaptable or feels comfortable. It lasts 60 min. The needling sensation must reach the above positions during electroacupuncture. 針感達(dá)上述部位后接電針儀。電針采用連續(xù)波，頻率90~150次/分，強度以患者能適應(yīng)或感到舒適為準(zhǔn)，每次持續(xù)60分鐘。電針期間需保持針感達(dá)上述部位。,,2 Acu