HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 1, NUMBER 3

2014

Acupuncture and Moxibustion Treatment Relieves Lower Urinary
Tract Dysfunction
Nobuyuki Otsuka
Hotal Ancient Medicine Research Institute (HARI)
3-2-1 Hotarugaike-nakamachi, Toyonaka, Osaka, 560-0033 Japan
E-mail: nj00ot@kmj.biglobe.ne.jp
Keywords: Lower urinary tract dysfunction, overactive bladder, frequent urination,
urinary urgency, urinary incontinence, oriental medicine,
acupuncture and moxibustion treatment

Patients complaining of urinary
symptoms in Japan rapidly increase withage. According to the sample survey, thenumber of patient suffering fromoveractive bladder is estimated to bearound 8.4 million in Japan. In the 40's it
is about 5%, it is 13% in the 60's, 24% in
the 70's and 37% in the 80's. It tends tobe noticeable in the 70's years old.
Women are two to five points less thanmen, but they have a similar tendency.
The classification of symptoms is the mostfrequent at about 60% in nocturia, 50% inintermediate
frequency
urination,
following the urination lowering and the
feeling of urination continued. Thesediseases are more male than women.
Urge incontinence and stress urinary
incontinence are more common among
women.

interview. As a result of crosstabulation,
patients who go to the toilet several times
at bedtime may also have urinary urgency
and residual feeling. About half ofpatients have no urine leakage, but theother half have urinary incontinence.

As a result of examining urination
symptoms of patients visiting anacupuncture and moxibustion treatment
facility, there are many females, andpeaks are in their 60s. The patient
consulted the main complaint as a motor
system disease, but about 40% of thepatients had dysuria owing to the

LUTD includes urinary symptoms(there is a problem when saving), voiding
symptoms (there is a problem inurination), urination symptoms (there is aproblemafter
urination[1].
Representative
diseases
includeoveractive bladder (OAB), benign
prostatic hyperplasia, low active bladder,andabdominal
stressurinary

In the case of frequent urination,some patients need to go to thebathroom during treatment. Somepatients do not have an hour as a generaltreatment time. Therefore, for a patient
who goes to the toilet more than once oninterview, it is necessary to hear more
about urinary urgency and residual
feeling. Lower Urinary Tract Dysfunction(LUTD) such as voiding symptoms become
increasingly important in the future as theaging progresses. The acupuncture andmoxibustion effect on LUTD are reported.

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incontinence.
OAB is urine syndrome caused byexcessdetrusor
muscleactivity.
International Continence Society (ICS2001) defined OAB as "Symptom
syndrome with urinary urgency as a main
symptom, usually accompanied bydaytime frequent urination and nocturia,
and in some cases urgency urinary
incontinence". Regardless of the presenceor absence of urge incontinence, it is a
syndrome characterized by urinary
urgency accompanied by frequenturination and nocturia. OAB may haveurinary urgency. Urinary incontinence is
not required. OAB is related to a wide
range of dysuria.
OAB is divided into neurogenic OAB
caused by nerve and nonneuropathic OAB
not caused by nerve. Neurogenic OAB iscaused by cerebrovascular accidents andspinal cord injury. Causes of nonneurogenic OAB are classified as
idiopathic OAB of unknown cause,
bladder outlet obstruction (BOO), aging,female pelvic floor disorder. Idiopathic
OAB is the most frequent, and applicationof acupuncture and moxibustion is
expected. Diagnosis of OAB is based on
subjective symptoms. It is necessary toproperly interrogate "feeling of urgency as
the main symptom" and "presence orabsence of urinary symptoms such as
frequent urination". Upon diagnosis, it isnecessary to exclude bladder cancer,
cystitis, bladder stone, prostate cancer
and other diseases.
Treatment of dysuria was commonlyprescribed anticholinergic as a drug tosuppress bladder contraction. Oxybutynin
is the first choice as an anticholinergic

2014

agent with relaxing action of smoothmuscle of bladder. In addition to
oxybutynin,
Propiverine
havingantimuscarinic action and calcium
antagonistic action, Tolterodine ofmuscarinic receptor antagonist, Trospiumand Propanthelin having antimuscarinic
action are prescribed as anticholinergic
agents. These therapeutic agents sufferedfrom side effects such as dry mouth.
In addition to anticholinergic drugs,
There are Flavoxate with relaxing actionof smooth muscle, Imipramine of systemic
antidepressant antidepressant, Capsaicin
and Resiniferatoxin producing state notresponsive to irritation, Botulinum toxin
which suppresses contraction of the
bladder. Recently developed beta 3
receptor stimulant Betanisu and M3
receptor blocker Vesicare can positively
suppress bladder contraction and makerelaxed bladder. Traditional Chinese
medicine is also used for treatment.
Hatimi-ziogan,gosya-zinkigan, Hochuekki-to, and shokenchu-to are used.
Quantification is necessary to verifytheeffectofacupunctureandmoxibustion treatment. A commonly
known evaluation method is International
Prostate Symptom Score (IPSS). The meritis that severity can be judged. The
subjects we conducted this time were 7
or more of the mean moderate symptoms
and 3 or more times of nighttime
urination. OverActive Bladder Symptom
Score (OABSS) is used as a simple
questionnaire to evaluate the effect ofacupuncture and moxibustion treatment
on overactive bladder.
Acupuncture effect of BL33 in OAB
has been reported [2-6]. Acupuncture was

Hotal Traditional Oriental Medicine Letters, Vol.1, No.3, pp.1-6, 2014(C) 2014 HARI2HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 1, NUMBER 3
performed on the left and right BL33 in 9
males and 2 females who had overactive
bladder (51 years old to 82 years old,
average age 71 years). The main
complaint was urge incontinence 9,
urinary urgency 2 people. Evaluation ofsubjective symptoms before and after
acupuncture, and urodynamic dynamics
examination were carried out to judge theeffect of acupuncture. Disposable
acupuncture with a diameter of 0.3 mm
was inserted between 50 and 60 mm andstimulation by hand was performed for 10
minutes. The number of acupuncture
treatments was 4 to 12 (average 7).
In subjective symptoms, urinary
incontinence was markedly improved in 5of 9 patients with urinary incontinence
disappeared. The number of urinary
incontinence and amount decreased in 2
patients
andimprovement
wasconfirmed. In addition, the urinary
symptoms of two who chiefly complainedof urinary urgency became normalized.
The improvement rate of subjective
symptoms was 82%. The uninhibited
contractions observed in all 11 patients inthe urinary flow dynamics examination
before treatment disappeared in 6
subjects after treatment. In comparison
before and after treatment, a significant
increase in maximum bladder capacityand bladder compliance was observed,
and improvements were also observed in
the urodynamic test. Acupuncture
treatment using BL33 has been shown to
be useful for urge incontinence andurinary urgency associated with OAB.
Acupuncture treatment to BL33
returns to original after stopping
treatment. In order to continue the effect,2014

it is necessary to perform acupuncture
treatment at least once every three
weeks.
There is a report on the effect ofmoxibustion treatment by self care thatenables continuous treatment even at
home. The effectiveness of moxibustion
treatment on nocturia was studied [7].
Thirty-four patients with nocturia andresistance to drug therapy (31 men, 3
women, average age 73 years) were
included. Two groups were randomly
assigned: 20 people in the moxibustion
group and 16 people in the Sham
moxibustion group that did not raise thetemperature. For treatment, the patient
himself tried 3 times moxibustion every
day to the CV3 of the lower abdomen at
home. Evaluation was made on changes
in the cumulative number of average
nocturnal urination frequency during 1
week before treatment and 1 week during
treatment. The results showed that the
average nocturnal urination frequency
per day was 21.6 times before treatment
and 16.8 times during treatment in themoxibustion group, a significant decrease
before and after treatment (p <0.05). In
the Sham group, no significant difference
was found between 19.9 before
treatment and 18.4 during treatment.
Effective examples were 10 in 20 (50%) in
the moxibustion group, 4 in 14 (29%) in
the Sham group. The moxibustion to CV3
has reduced the number of urination
during the average nightly sleep of one
week, and moxibustion treatment to CV3
is an effective treatment method for
nocturia.
Results of acupuncture treatment for
20 female patients complaining of

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HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 1, NUMBER 3
idiopathic unstable bladder symptoms(frequent urination, urinary urgency, urge
urinary incontinence) have been reported[8]. Acupuncture sites are SP6, BL23,
BL28, BL32, GV4, CV4, CV6. As anevaluation, symptoms and urodynamics
examination were conducted. As a result,improvement of symptoms was observedin 77% of 15 patients. There was only one
patient who did not see improvement.
Patients with improved symptoms
confirmed an increase in bladder capacity
by urodynamic examinations.
The voiding disorder targeted by
Chinese medicine has a statement on
urination that is difficult to urinate, butthere is no direct description on OAB. Thismay be because OAB is not serious as adisease. On the other hand, OAB andurinary incontinence markedly lower
quality of life (QOL), it is one of thediseases for which remission of symptoms
is desired. Especially, in case of idiopathy,
elucidation of the mechanism in Western
medicine is awaited, and expectation for
acupunctureandmoxibustionisconsidered high.
In discussion, it is important toevaluate how the contents reported thistime are concerned in acupuncture. BL33
have been reported as treatment holes
for overactive bladder. In this case, theacupuncture technique is to take a hole in
the third posterior sacral hole, connect
the upper iliac spine and the sacral
osteotomy to the center on that line. The
insertion angle of the acupuncture
towards the head 45 ° Insert 40 mm witha scantile so that the acupuncture follows
the bone on the back of the sacrum. As aresult, the tip of the acupuncture point is2014

likely to reach the position of BL32 orBL31. In addition, it is thought that BL27
traveling in the proximity part, BL28 isalso stimulating. Since it is indicated thatbaliao points (eight sacral foramina) are
effective for urinary leakage, thetherapeutic effect on overactive bladder isconsidered. From the above, there arebaliao points and BL27 for acupuncture
points related to urinary leakage, andacupuncture points concerning urinary
frequency have BL28. It is thought that
acupuncture inserted from BL33 stimultes
not only baliao points but also BL27 andBL28, thereby reducing overactive bladder
symptoms such as urinary frequency,
urgencyurgencyandurinaryincontinence.
CV3 means that it is located in the
middle (top and bottom,and right andleft) of the body. There are uterus andtesticle inside, and it is in the deep part ofthe body. CV3 chiefly refers to itching,reproductive disease, urinary retention,
menstrual irregularity, rupture, infertility,and genital itching. The effect of mild
moxibustion at CV3 has been reported,
but acupuncture does not explicitly
mention frequent urination or urinaryleakage. Although the effect due toacupuncture stimulation to the SP6 has
been reported, acupuncture academics
do not explicitly mention frequenturination or urinary leakage [9-12].
On the other hand, overactive
bladder is thought to be the kidney
deficiency and spleen-kidney deficiency.
In the case of kidney yang deficiency, theextent of kidney deficiency progressed,and cold-sho (deficiency-sho) due to a
decline in warming effect appeared. Also,

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HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 1, NUMBER 3
in elderly people and weakness due tochronic diseases, the yang-qi of the
kideny are empty, the bladder can notconstrain the liquid and the amount ofurine is increased by the frequency in thenight. It is also thought to be a disease
due to attenuation of anabolism,
circulation failure, decreased excitabilityof the brain, etc. due to a decline inendocrine function.
The symptoms of yang deficiency ofkidney are renal imperfections, inaddition to kidney deficiency, cold oflimbs, cold of waist and belly, frequenturination, nocturia, night polyuria,
excessive urine, extra bitumen afterurination, urinary incontinence orenuresis. Since it is a disease of thekidney, the accompanying symptoms are
tinnitus, hearing loss, waist back dullness,
slimming,prematureejaculation.
Representative holes are SP6, CV3, BL23,
GV4, CV6, CV4, BL28.
As described above, in the case ofkidney yang deficiency, it is known that
overactive bladder symptoms such as
urinary frequency, urinary urgency andurinary incontinence are known to occur,and since there are SP6 and BL33 astreatment holes, The effect of BL33 isthought to be indicated not through asingle acupuncture point but throughremission of kidney yang deficiency.
In conclusion, in Japan where theaging of the population is progressing,patients who complain of lower urinary
tract dysfunction including overactive
bladder are considered to rapidly increasein the future, especially in the elderly.
Western medicine treatment methods forlower urinary tract dysfunction are being

2014

promoted with the development ofeffective drugs by elucidating themechanism of smooth muscle receptors
and the effectiveness has been shown. On
the other hand, these drugs have side
effects such as dry mouth, and there arecases where it is difficult to administer tothe elderly. There are also idiopathic
diseases and cases where Western
medical treatment is difficult to apply. As
a result, expectations for oriental
medicine approaches are increasing.
In acupuncture treatment, the effectof BL33 is reported, and in warm
moxibustion the effect of CV3 is reported.
In the acupuncture to the SP6, a random
comparison test was conducted, and theeffectiveness of acupuncture wasconfirmed. The main symptom of
acupuncture points of baliao points
including BL33, and BL27 and BL28 those
close to baliao points, are frequenturination, nocturia, urinary leakage. The
effect is evident from ancient times has
been done. SP6 and CV3 can be explained
as treatment hole of kidney yangdeficiency.

[1] Nobuo Nara, Toyo Therapy Association edited Textbook Clinical
Medicine Detailed Exposition 2nd edition.
[2] Hiroshi Kitakoji et al. “The Survey of The Urinary Complaints of The
Outpatients in Acupuncture Clinics”, Journal of the Japan Society of
Acupuncture and Moxibustion, 43, pp. 99-108 ,1993.
[3] Hiroshi Kitakoji et al. “Effect of acupuncture on the overactive
bladder”, The Japanese Journal of Urology 86(10), pp. 1514-1519,
1995.
[4] Hiroshi Kitakoji et al. “Efficacy of acupuncture and moxibustion
treatment regarding the field of Urology and its fact: - Focusing on
pollakisuria and urinary urgency-", Journal of the Japan Society of
Acupuncture and Moxibustion 65, pp.158-169, 2015.

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HOTAL TRADITIONAL ORIENTAL MEDICINE LETTERS, VOLUME 1, NUMBER 3

2014[5] Hisashi Honjo et al., "Acupuncture Treatment for A Overactive Type
Neurogenic Bladder with Detrusor Sphincter Dyssnergia Patient: A(Received 30 September 2014)

Case Report", Journal of the Japan Society of Acupuncture andMoxibustion 43, pp.115-119, 1993.
[6] Hisashi Honjo et al., "Analysis of bladder diary with urinary
perception to assess overactive bladder symptoms in community‐dwelling women", Neurourology and Urodynamics 28, pp.982-985,
2009.
[7] Kenichi Tomita, “Effect of moxibustion treatment for nocturia: arandomized controlled trial”, Journal of the Japan Society of

Dr. Nobuyuki Otsuka

Acupuncture and Moxibustion 59, pp.116-124, 2009.

He graduated from Tohoku University in 1985 and completed the first[8] T. Philp et.al., Acupuncture in the treatment of bladder instability., Br
J Urol. 61(6), pp. 490-3, 1988.

harf term of doctor course of Tohoku University graduate school in
1987. He was awarded doctor degree in 1997 from Tohoku University.

[9] H.C. Klingler et.al., Use of peripheral neuromodulation of the S3

He established Hotal Ancient medicine research Institute (HARI) in 1999.

region for treatment of detrusor overactivity: a urodynamic-based

Now, he is enrolled at Meiji school of oriental medicine from 2014. He isstudy., Urology. 56(5), pp.766-71, 2000.

engaged in research on oriental medicine such as traditional Chinese[10] V. Vandoninck et.al., Posterior tibial nerve stimulation in the

medicine, acupuncture and moxibustion, qigong etc.

treatment of urge incontinence., Neurourol Urodyn, 22, pp.17-23,
2003.
[11] P.L. Chang, Urodynamic studies in acupuncture for women withfrequency, urgency and dysuria., J Urol. 140(3), pp. 563-6, 1988.
[12] S.L Emmons et.al., Acupuncture for overactive bladder: arandomized controlled trial., Obstet Gynecol. 106(1), pp. 138-43,
2005.

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