王燾，唐代醫學家，著有《外台秘要》曰: "故湯藥攻其內, 以灸攻其外, 則病無所逃, 方知火艾之功, 過半於湯葯矣, 此之一法, 醫之大法, 宜深體之, 要中之要, 無過此術."

In the book written by Wang Bin of Tang Dynasty called 《Outside the Secret》 mentioned: Hence, the disease has no place to escape, if we attack it internally with decocted soup and externally by applying moxibustion. The power of fire (moxibustion) has been widely known and its ability excels far more than that of decocted soup. It is important and should be understood deeply that this is the best method in medication with comparative advantage.

追求中醫藥的現代化並不再是一個意識。事實上已經正在發展。在黨中央的大力支持下, 現在中醫藥已經是處在一個新的時代, 前所未有。 中醫藥的發展已經超越了西方醫學理論範圍，突破了傳统中醫藥的框架。哪有誰真正知道和瞭解我們所取得的成績？

The quest for modernization of Traditional Chinese Medicine is not anymore an ideology. It has already come into existence. In fact, we are now in a new era of Modern Chinese Medicine under the tireless support from the Chinese Communist Party (CCP). Development of Traditional Chinese Medicine has paved its way and transformed into Chinese Medical Sciences which has gone beyond the scope of western medical theories and breakthrough the framework of Traditional Chinese Medicine.  Does anyone know how far we have achieved?

以下為一項臨床觀察給大家分享：

Herewith below a clinical observation we would like to share.

強腎灸配合中藥治療女性壓力性尿失禁30例臨床觀察

Title: Clinical Observation on 30 Cases of Female Stress Urinary Incontinence Treated with Strong Kidney Moxibustion and Chinese Herbal Decoction

作者: 楊敏 單位：廣西壯族自治區南溪山醫院，廣西 溪山 541002

By: Yang Min of Nansishan Hospital of Guangxi Zhuang Autonomous Region, Xishan, Guangxi, China 541002

【摘要】 

【Abstract】

目的：觀察強腎灸（中國灸系列產品）加中藥治療女性壓力性尿失禁的臨床療效。

Objective: to observe the clinical efficacy of combining the usage of Strong Kidney Moxibustion (a therapeutic product of the China Moxibustion series) with intake of Chinese herbal decoction in the treatment of female stress urinary incontinence.

方法：將60例女性壓力性尿失禁患者隨機分為強腎灸加中藥組和單純中藥組進行對比觀察治療。

Methods: Sixty women who suffer from stress urinary incontinence were randomly divided into two groups then observe the performance comparatively after treatments. The Strong Kidney Moxibustion with oral administration of Chinese herbal decoction group and the group purely took Chinese herbal decoction.

結果:強腎灸加中藥組總有效率90%，單純中藥組總有效率80%，兩組總有效率經統計學處理，差異有顯著性意義(p<0.05)。

Results: The total effective rate was 90% in the Strong Kidney Moxibustion plus oral administration of Chinese herbal decoction group and 80% in the group purely took Chinese herbal decoction respectively. The total effective rate achieved of these two groups through statistical analysis concluded that a significant difference does exist (p <0.05).

結論：強腎灸加中藥組療效優於單純中藥組。

Conclusion: The effectiveness of applying Strong Kidney Moxibustion with oral administration of Chinese herbal decoction group is better than the group purely took Chinese herbal decoction

【關鍵字】  壓力性尿失禁 中國灸 強腎灸 穴位貼敷 中藥療法

【Keywords】 stress urinary incontinence, China Moxibustion, Strong Kidney Moxibustion, acupuncture points plastering , Chinese herbal medicine therapy

壓力性尿失禁是婦女常見疾患。本病臨床上主要表現為在休息或輕微活動下無尿失禁，而在腹壓增加時出現難以控制的溢尿。自2006—03～2008—05筆者用中國灸系列產品之強腎灸（中國灸法研究中心研製，武漢國灸科技開發有限公司出品）穴位貼敷加內服中藥治療本病取得了滿意的療效，現報導如下。Stress urinary incontinence is a common disease of women. Clinical manifestation happens when there is an increase in abdominal pressure (stress) causing the accidental release of urine. It will not happen while at rest or during minor activities. From March 2006 to May 2008, the author applied the Strong Kidney Moxibustion of the China Moxibustion product series (researched and developed by China Moxibustion Institute which produced by Wuhan Chinese Moxibustion Technology Development Co. Ltd.) on acupuncture points of patients in addition to oral administration of Chinese herbal decoction to treat this disease that had achieved satisfactory results.

1     資料與方法

Reports are as follows:

1．1 一般資料

1.1 General information　

對符合納入標準的60例門診患者隨機分為治療組和對照組。其中治療組年齡36～74歲，平均52歲；病程最短1年，最長12年；全部為已婚婦女，生育1～2胎者6例，生育3胎以上者16例，絕經後的患者8例。對照組年齡34～72歲，平均50歲；病程最短1年，最長10年；全部為已婚婦女，生育1～2胎者7例，生育3胎以上者14例，絕經後的患者9例。兩組病程、年齡、生育情況經統計學處理具有可比性(p>0.05)。

60 outpatients were randomly divided into treatment group and control group. Age range of the treatment group was from 36 to 74 years old, with an average of 52 years old. The shortest course of disease was 1 year, and the longest was 12 years; all married women. 6 cases had given 1 to 2 births, 3 or more in 16 cases, and 8 cases postmenopausal patients. While the age range of the control group was from 34 to 72 years old, and the mean was 50 years old. The shortest course of disease was1 year and the longest 10 years; all married women. 7 cases had given 1 to 2 births, 3 or more births in 14 cases, 9 cases of postmenopausal patients. The course of disease, age and fertility situation of these two groups was statistically significant (p> 0.05).

1.2 診斷及納入標準［1］

1.2 Diagnostic and inclusion criteria [1]

(1)病人主訴腹壓增加時(如咳嗽、大笑、打噴嚏、搬重物)不自主漏尿。(2)護墊試驗陽性者(即讓病人事先帶上無菌尿布，大量飲水後進行爬樓梯、搬重物等活動，30～60min後檢查無菌尿布是否有漏尿而潮濕)。(3)b超檢查：經會陰b超檢查以下三項指標有兩項以上符合：①休息狀態的膀胱角≥95°; ②膀胱頸的活動度≥20°; ③膀胱角與恥骨弓距離≥2.3cm。

(1) Patients complained of having involuntary leakage of urine when there is increased in abdominal pressure (such as coughing, laughing, sneezing, moving heavy object). (2) positive pad test (that is, patients have to drink a lot of water and wear a sterile diaper in advance, then have to climb the stairs, lift and move heavy object, then check the sterile diaper whether there is moisture due to leakage after 30 ~ 60 minutes). (3) ultrasound diagnosis: ultrasound exam at the perineum area if the following three indicators exist or at least two: (a) the bladder angle is ≥ 95 ° while at resting state; (b) bladder neck activity is ≥ 20 °;  (c) bladder angle and pubic arch distance is ≥ 2.3 cm.

1.3     排出標準

1..3 Discharge criteria　
(1)神經源性膀胱、心理性尿失禁以及需要外科手術治療的尿道括約肌閉鎖不全、異位輸尿管等引起的尿失禁。(2)未按規定堅持治療或自行服用其它藥物者。

(1) neurogenic bladder, psychological urinary incontinence and the need for surgical treatment of urethral sphincter insufficiency, ectopic ureter caused by urinary incontinence. (2) Those that do not adhere to the prescribed treatment or take other drugs on their own.

1.4 治療方法

1.4 Treatments

①  治療組：用強腎灸貼敷中極、關元、命門穴，每日2貼（中級、關元兩穴合用1貼），每天使用12h；同時用固脬湯加減治療，基本方：熟地12g,山藥15g,附片6g,補骨脂10g, 菟絲子15g,金櫻子15g,桑螵蛸12g,益智仁10g,黃芪30g,黨參30g,焦白術15g,烏藥10g,枳殼15g。treatment group: with Strong Kidney Moxibustion applied on the following acupoints, ZhongJi (CV3), GuanYuan (CV4), and MingMen (GV4), 2 patches daily for 12 hours, (one patch at MingMen (GV4) alone, another patch used for 2 acupoints interchangeably at ZhongJi (CV3) and GuanYuan(CV4)). at thesame time take Reformulated GuPao Decoction Soup, the basic ingredients are: RADIX REHMANNIAE PRAEPARATA (ShuDìHuánɡ) 12g, RHIZOMA DIOSCOREAE (ShanYao) 15g, RADIX ACONITI LATERALIS PREPARATA (FuPian) 6g, FRUCTUS PSORALEAE (BuGuZhi ) 10g, SEMEN CUSCUTAE (TuSiZi) 15g, FRUCTUS ROSAE LAEVIGATAE (JinYingZi) 15g, OVUM OF MANTIS (SangPiaoXiao) 12g, (FRUCTUS ALPINIAE OXYPHYLLAEE (YiZhiRen) 10g, RADIX ASTRAGALI (HuangQi) 30g, RADIX CODONOPSIS (DangShen) 30g, BURNT RHIZOMA ATRACTYLODIS MACROCEPHALAE (JiaoBaiZhu)15g, RADIX LINDERAE (WuYao) 10g, FRUCTUS AURANTII (ZhiQiao) 10g。

隨症加減:少腹下墜者加升麻10g 柴胡6g；少腹冷痛者加肉桂6g；腰痛者加杜仲10g；納差者加焦三仙各15g。每日1劑，水煎服。10d為一療程，連用3個療程。②對照組：單純用固脬湯加減治療，基本方及隨症加減同治療組，每日1劑，水煎服。10d為1療程，連用3個療程。

Adjustment of the formula based on patients’ conditions: heaviness or dragging at the lower abdomen, add RHIZOMA CIMICIFUGAE (ShengMa) 10g and RADIX BUPLEURI (ChaiHu) 6g; coldness with pain at the lower abdomen, add CORTEX CINNAMOMI (RouGui) 6g; lumbar pain add CORTES EUCOMMIAE (DuZhong) 10g; poor appetite or anorexia add BURNT FRUCTUS CRATAEGI  (JiaoShanZha) 15g, BURNT FRUCTUS HORDEI GERMINATUS (JiaomaiYa) 15g and BURNT MEDICATED LEAVEN (JiaoShenQu) 15g。One set per day cook as decocted soup, 10 days is one course of treatment, continue the treatments for 3 courses. ②for the control group: purely the basic soup decoction with adjustment, procedures same as the treatment group which was 10 days considered as one course of treatment, continue the treatments for 3 courses.  

1.4     療效標準

1.4  Efficacy Standards
    　

參照標準［2］制定。痊癒：不自主漏尿消失，護墊試驗轉陰性。好轉：不自主漏尿次數明顯減少，護墊試驗連續3次以上轉陰性。無效：不自主漏尿次數無好轉，護墊試驗陽性。

Standard reference [2] policy. Healed: involuntary leakage of urine disappeared, pad test negative. Improved: the number of involuntary leakage significantly reduced, pad test negative for more than 3 times consecutively. Invalid: the number of involuntary leakage did not improve, pad test positive.

2  結果

2  Results

表1  兩組臨床療效比較［n=30,（%)］

Table 1: Clinical Efficacy Comparison between the two groups [n = 30, (%)]

兩組療效經ridit分析，差異有顯著性意義(p<0.05)。治療組療效優於對照組。The efficacy between these two groups was applied using Ridit analysis. There was a significant difference between the two groups (p <0.05). The treatment group was better than the control group.

３  討論:

2     Discussion

壓力性尿失禁患者以中年經產婦居多, 其病位在膀胱，涉及肺、脾、腎及肝，本病多因稟賦不足，脾肺虛弱，不能通調水道，或元氣素虛，產時複傷氣血，以致腎氣不固，或因天癸將竭，肝腎虧虛，命門火衰，不能溫煦膀胱，則膀胱氣化無權，膀胱不能固攝所致。治療上筆者採用強腎灸穴位貼敷中極、關元、命門穴加內服固脬湯加減治療。

Stress urinary incontinence is more common in middle-aged adult women who had given birth. Disease location is in the bladder, involving the lung, spleen, kidney and liver. It cause is due to congenital deficiencies, weakness of the lungs and spleen in clearing and regulating body fluids, virtual element used to be weak, exhaustion of qi and blood during labor without replenishing leadingthe kidney qi becomes unsecured or depletion of reproductive essence,liver and kidney deficiency, weakness of kidney fire that cannot warm the bladder that makes the bladder’s gasification function becomes weak and cannot get regulated and controlled. Theauthor used the Strong KidneyMoxibustion applied on ZhongJi (CV3), GuanYuan (CV4) and MingMen (GV4) acupoints plus oral administration of Reformulated GuPao Decoction Soup.

灸法是我國古代最重要的治病方法之一，中國灸是秉承古老灸法治病求本的原理，通過運用現代高科技手段研製成功的。強腎灸由自動發熱體和熱熔藥膏組成，其主要藥物成份有：制附子、仙茅、仙靈脾等，有溫補腎陽、填精益髓之功效。中極乃膀胱募穴，有約束膀胱之作用；關元是足三陰經和任脈的交會穴，能培補元氣，振奮膀胱之氣機；命門可強腎固本，溫腎壯陽，培補人體的元氣。

Moxibustion is one of the most important medical treatment methods in ancient China. China Moxibustion is a product that adopts modern technique in manufacturing by following the therapeutic principle of traditional moxibustion. Strong Kidney Moxiustion is equipped with an automatic heating element with composition of herbal medicine. Main ingredients are: PROCESSED RADIX ACONITI LATERALIS PRAEPARATA (ZhiFuZi), RHIZOMA CURCULIGNIS (XianMao) , HERBA EPIMEDII (YinYangHuo) and etc.having the functions of reinforcing and warming the kidney yang, replenishing essence, and benefiting marrow. ZhongJi (CV3) is the Mu (collecting) acupoint of urinary bladder meridian which has the role of constraining the bladder. GuanYuan (CV4) is the intersection point of the leg’s 3 Yin meridians and Conception Vessel meridian that could reinforce the vital energy and boost the gasification function of the bladder. MingMen (GV4) could maintain and strengthen the kidney function, warming the kidney and become potent, maintain and foster one’s vitality.

 中藥方中熟地，山藥滋腎補精;附片溫腎助陽化氣；補骨脂、菟絲子溫補腎陽；金櫻子、桑螵蛸、益智仁補腎固澀而縮小便；黃芪、黨參、焦白術健脾益氣；烏藥溫腎散寒、除膀胱冷氣；枳殼能使內臟平滑肌收縮有力。現代藥理研究表明，黃芪、補骨脂均有雌激素樣作用［3，4］。補腎益氣中藥可升高雌激素水準而增加雌激素與尿道、膀胱組織中激素受體的親和力［5］。

In the formula, RADIX REHMANNIAE PRAEPARATA (ShuDìHuánɡ) and RHIZOMA DIOSCOREAE (ShanYao) have the effect of nourishing kidneyy and replenishing essence. RADIX ACONITI LATERALIS PREPARATA (FuPian) to warmth the kidney yang and helps in gasification.FRUCTUS PSORALEAE (BuGuZhi) and SEMEN CUSCUTAE (TuSiZi) to nourish and warmth the kidney yang. FRUCTUS ROSAE LAEVIGATAE (JinYingZi), OVUM OF MANTIS (SangPiaoXiao) and (FRUCTUS ALPINIAE OXYPHYLLAEE (YiZhiRen) help to nourish the kidney and enable to regulate and control its functions in order lessen the frequency of urination. RADIX ASTRAGALI (HuangQi), RADIX CODONOPSIS (DangShen) and BURNT RHIZOMA ATRACTYLODIS MACROCEPHALAE for strengthening the spleen and replenishing qi. RADIX LINDERAE (WuYao) for warming the kidney to dispel cold and eliminating the coldness at the bladder. FRUCTUS AURANTII (ZhiQiao) has the effect of strengthening the contraction ability of smooth (visceral) muscle. Modern pharmacological studies have shown that RADIX ASTRAGALI (HuangQi) and FRUCTUS PSORALEAE (BuGuZhi), both have estrogen-like effects [3,4]. Chinese medicine that uses for nourishing kidney invigorating vital energy have the effect of increasing the estrogen level and also increase the affinity interactions of the estrogen with hormone receptors at the urinary tract and bladder tissue [5].

用強腎灸合固脬湯加減治療壓力性尿失禁，一是通過強腎灸灸熱作用於經穴，啟動神經內分泌免疫系統產生大量的內源性藥物，二是灸法中穴位與灸藥結合，發揮了穴位和局部外源性灸藥各自的功效，三是固脬湯加減增強了補腎健脾、益氣固攝等功效。通過多方面的綜和調節作用，起到了疏通經氣運行，溫腎壯陽，增強臟腑功能，提高了局部肌肉、神經的協調性，從而提高了治療效果。

With the Strong Kidney Moxibustion combined with Reformulated GuPao Decoction Soup to treat stress urinary incontinence, first through the moxibustionheat stimulating the acupoints and meridians could activate the body neuroendocrine immune system to producealarge number of endogenous drugs, second is the combining effects of herbal medicine on acupuncture points that produces exogenous treatment effect of its own. Third, the Reformulated GuPao Decoction Soup has the effect of enhancing the kidney and spleen functions, improving the regulating and controlling functions of qi and other effects. Through a wide range of comprehensive treatment methods, have achieved in clearing and regulating the normal flow of qi in the meridians, warming and strengthening the kidney Yang. It has enhanced the function of organs; improved the homeostasis of local muscles and the nerves condition, therefore enhancing the treatment effectively.   

【參考文獻】

【References】
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