Volume 6, Number 4 | Winter 2011

Clinical Report 1 (Acupuncture)
The Cases of Acupuncture and Moxibustion Treatment for
Pollakisuria and Nocturia during Pregnancy Thought to beEffectiveNaokoMaeda1),,Shuichi

59 kg before pregnancy).
The present illness started in the 21st gestational
week, when she was diagnosed during a pregnancy

Katai2)checkup with gestational diabetes because of urinary

1) Ayumi Acupuncture and Moxibustion Clinic2) Department of Health Science,
Tsukuba University of Techonology

sugar (3+). The condition could later be controlled

Women undergo various physical and mentalassociatedwithpregnancy. Indefinite

complaints classified as minor trouble are associatedwith suffering and pain that decrease the quality oflife of the women during pregnancy. Yet, many of theindefinite complaints improve after the pregnancy
and are mostly not actively treated with western
medicine based on

considerations

ofpossible

influences on the fetus. For those reasons folk
medicines are adopted in the care for pregnant
women, but currently the expecting mothers often
endure these conditions until delivery. Here we
report two cases in which the acupuncture andmoxibustionthrough diet and urinary sugar (+) was later foundonly once during a pregnancy checkup in the 39th
gestational[Introduction]changes

cm, weight 64 kg (weight increased by 5 kg from thetreatment

wasconsidered

tobemarkedly effective in pregnant women visiting aclinic for acupuncture and moxibustion treatment,
who were particularly aware of pollakisuria andnocturia among indefinite complaints.
Further, in this manuscript we followed thetreatment guidelines1) for overactive bladder of theNeurologic Bladder Society and classified thecomplaints of patients with a too high frequency ofmicturitions during the daytime as pollakisuria, andcomplaints about getting up more than once during
the night to void as nocturia.
The patients consented to the publication of thiscase report after receiving oral explanations.

week.

Otherwise

thepregnancy

proceeded uneventful.
Complaints during the first visit were low backpain and shoulder stiffness. The fetus was incephalic presentation. There was no chilling, but
over a distance of about 8 cm above the ankles a ringlike edematous region was observed. Micturition
frequency was once every 30 minutes to 1 hour andabout 2-3 times per night. Both the pollakisuria andnocturia developed around the time morning
sickness resolved by the 14th gestational week.
Five acupuncture and moxibustion treatments
were administered in intervals of approximately 4weeks. The basic treatment was bilateral moxaneedling of SP6 with 3 cones of moxa and a selectionof appropriate acupoints for the complaints made ateach visit (Table 1).
The pregnant woman assumed a semi-Fowler
position during the acupuncture and moxibustion
treatment to prevent the development of supine
hypotension syndrome and the moxa-needlingtreatment was performed in the flexed knees
position.
Moreover, we instructed the patient to treat
herself with moxibustion daily on the left and rightSP6 for 5 minutes each using stick moxa. The patientreported to have performed the self-moxibustion
daily.
At the fourth treatment the region around the left
and right SP9 was slightly depressed, representing[Patient No. 1]
A 36-year old woman, primapara, housewife.
She visited our clinic in order to prepare herself
physically for the delivery. During the first visit thea state of deficiency, so that daily self-moxibustion
treatment with stick moxa on the left and right SP9
for 5 minutes each was added.

gestational age was 22 weeks and 6 days, height 165
The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

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Volume 6, Number 4 | Winter 2011

For the moxa-needling we used 50 mm Seirin L-

correction of the breech presentation. Before thetype needles with a diameter of 0.20 mm and 0.769

second treatment abdominal palpation showed ag portions of Kamaya moxa for moxa-needling

cephalic presentation of the fetus, but because theformed into spheres with a diameter of 20 mm, thatpatientwere then attached to the needle heads and burned.

moxibustion treatment until delivery for the sake of

For retaining needles we used J-type Seirin needles

physical conditioning, a basic treatment of bilateralwith a length of 40 mm and a diameter of 0.16 mm.

moxa-needling at SP6 with 3 cones of moxa andThe indefinite complaints were evaluated using
the entries in a 5-stage, 40-item (Table 2) evaluationindefinite complaints questionnaire with numbers
from 0 to 4 made by the patient herself before eachacupuncture and moxibustion treatment.
The course showed that following the first visit
the nocturia improved and the pollakisuria improvedto achieve micturition intervals of 2 hours. After thatthe pollakisuria and nocturia did not recur during
the pregnancy until delivery (see Figures 1-3).
Delivery was a natural childbirth and although
there was copious bleeding during delivery, no iron
medication was used and the patient was not unwell.

continued

acupunctureandneedles retained in a selection of appropriate
acupoints for the complaints at that particular visit(see Table 3) was administered.
The same types of needles and moxa as used forpatient No. 1 were employed and for the directmoxibustion the Yamasho moxa "Nippon Ichi
Ogonzan" was used.
The indefinite complaints were evaluated like forpatient No.1 during each treatment.
The course showed that micturition intervals had
lengthened to 2-3 hours and rising during the nightfor micturition occurred only once during the 3-day
period from the first to the second treatment. Fromthe second treatment the course preceded without[Patient No. 2]
16-year old woman, primapara, senior high school
student.
Chiefrequestedcomplaint

wascorrection

ofbreechpollakisuria and nocturia (see Figures 1-3).
Delivery was a natural childbirth and thepostpartum course was uneventful.

presentation. The gestational age at the first visit
was 29 weeks and 3 days. Height was 153 cm, weight[Discussion]

was 59 kg (weight increased by 7 kg from the 52 kg

During the individual stages of pregnancy various

before pregnancy). The pregnancy had proceeded inindefinite complaints may develop in pregnant

breech presentation since the 25th gestational week.

women and tend to change in conjunction withThe pregnancy was otherwise uneventful.

alterations in physical condition. Common self-careDuring the first visit, chilling of the feet andof indefinite complaints include aerobics, swimming,edematous over a distance of about 7-8 cm above theyoga and similar exercises, while belts are used foranklessplinting the pelvis in case of low back pain1).

ina

ring-likeregion

wereobserved.

Micturition frequency was once every hour and on 3-Both pollakisuria and nocturia are classified as

4 nights per week about 1-2 times per night.

indefinite complaints and according to Shimada etTreatment frequency until correction of the breechal.3) report, pollakisuria and nocturia are ranked top

presentation was twice a week and after that once aamong indefinite complaints developing during theweek.

first and second trimester, while ranking top during

During the first visit, left and right SP6 werelate gestation with an incidence of 95.4%. Thus,

treated with moxa-needling and direct moxibustion

almost all pregnant women experience pollakisuria

with half-rice grain sized cones on BL67 for the16

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 6, Number 4 | Winter 2011

and nocturia (see Table 4). That report, however,moxibustion treatment for pollakisuria and nocturia

does not mention nocturia.

in pregnant women, but among the reports about

Regarding the reason for the easy development oflower urinary tract disorders, Tomita et al.7) noted

pollakisuria is considered to be that the "enlarging

that "according to RTCs warming moxibustion

uterusduringtreatment for nocturia led to a significantly

pregnancy presses on the bladder and flattens it indecreased number of nocturnal micturitions." Again,anteroposterior direction. That is why a micturition

the mechanisms behind the marked effectiveness ofdesire occurs so easily." 4) Also, regarding kidney

the acupuncture and moxibustion treatment are notfunction4) "the glomerular filtration and blood

clear, but careful inspection of the abdomen of theplasma flow increase during pregnancy, so that thepregnant

glomerular filtration reaches by the 16th gestational

moxibustion treatment shows marked changes

week a peak that is about 1.5 times higher than in(Figure 4-1, Figure 4-2). The entire abdomen seems

the non-pregnant state, subsequently maintaining

to be becoming firmer, the position of the protruding

this high value until late gestation. The kidney blood

uterus comes to lie higher and the bulge above theplasma flow reaches a peak by the 15-16th week too,inguinal and suprapubic regions decreases. Thesebut there is no agreement among reporters, sincefindings suggest that acupuncture and moxibustionsome reports describe a decrease towards latetreatment exerts some influence that is mediated via

gestation, while other reports state the level isthe autonomous nervous system, causing changes inmaintained."

the position of the uterus and bladder, leading toamong

Incidentally,

thephysicalHirose5)changesnotedregardingthecorrelation between pollakisuria and sleep disorders

woman

after

an

acupuncture

andvariations in the bladder capacity, surmised to cause
the alleviation of the pollakisuria.

in the various pregnancy periods that "the frequency

Collecting data pertaining to improvements ofof nocturnal urination had markedly increased inpollakisuria and nocturia in pregnant womenpatients with sleep disorders during the first, secondthrough acupuncture and moxibustion treatment

and third trimester of the pregnancy. (omission)

represents a task for the future. The clarification of

Nocturia

sleepchanges in uterine position and size as well as

maintenance disorders." Sleep disorders during late

bladder capacity before and after acupuncture andgestation may cause accumulation of fatigue andmoxibustion treatment represents yet another task.

isa

conceivablecauseforcould thereby possibly influence delivery. Regarding
fatigue during gestational periods Yano6) pointed out,

[Conclusions]that this fatigue might be a non-obstetrical etiologic

Thefactor for uterine inertia. Moreover, uterine inertia

moxibustion treatment is effective for pollakisuria

may easily develop into protracted labor andand nocturia in pregnant women.

results

indicatedthat

acupuncture

andinvasive measures at the time of delivery could affectthe pueperal period. Thus, pollakisuria and nocturia
during pregnancy may affect the QOL during
pregnancy and the delivery, therefore representing
important symptoms for the expecting mothers thatshould be alleviated.
On the other hand, there seem to be no reports
abouttheeffectivenessofacupunctureandThe Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

17

Volume 6, Number 4 | Winter 2011

≪References≫
1.

Treatment Guidelines for Overactive Bladder,
Neurologic Bladder Society: 20092.

Midwife skills for gestation periods, support ofminor troubles, Perinatal Care, Summer Special
Edition 2010: 54-58

3.

Mieko Shimada, Haruko Niikawa: Current
situation about minor troubles in pregnant
women; Midwife 2011; 65 (3): 42-45

4.

TakeshiMaruo,Takashi

Okai:

Standard

Obstetrics and Gynecology; Tokyo, Igaku Shoin,
2008: 312-313
5.

Kazuhiro Hirose, Shinichi Hoshi, Shuichiro
Shirakawa: Longitudinal study about sleep
disorders in pregnant and parturient women;
Acta Obstetrica et Gynaecologica Japonica,
2002; 53 (2): 527

6.

Tadashi Yano: Inertia Uteri; Tadashi Yano
Edition of the Illustrated Guide to AcupunctureandMoxibustion

Techniques;Tokyo;KOBUNDO Co.,Ltd.; 2012:344-350
7.

Kenichi Tomita, Hiroshi Kitakouji, Hisashi
Honjou,Masahiro

Nakao:

The

effectsofwarming moxa on nocturia - investigation of arandomized controlled study; Journal of theJapan Society of Acupuncture and Moxibustion,
2009, 59 (2): 116-124

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The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)