Volume 7, Number 3 | Fall 2012

Clinical Report 1 (Acupuncture)
A Case Report on Moxibustion Effectively Used for
Obstruction of the Digestive Tract after Gastrectomy

She had been complaining from before aboutshoulder

Department of Acupuncture,
Morinomiya University of Medical Sciences

Absorption disorder, diarrhea, dumping syndrome
etc. can be sequelae of gastrectomy. We report a casemoxibustion

treatment

wasmarkedly

effective for gastrointestinal passage disorders
occurring in a patient on chemotherapy following
total gastric resection performed for scirrhous
gastric cancer.

Height 150 cm, weight 38 kg; lost 10 kg as compared
to before the development of the scirrhous gastricshoulders

tothesuperior

scapularangle,

interscapular region and next to the spinous
processes of the 4 th and 5th lumbar vertebrae.
[Acupuncture and moxibustion treatment]
Initially we used Seirin type J or Yamasho needles witha diameter between 0.16 mm – 0.20 mm and a lengthof 40 mm – 50 mm in our clinic for the local treatment

insertions,

or

low

frequency

for the complaints of passage disorders. Either moxa

[Chief complaints]
Left neck pain (at first visit), loss of appetite becauseof passage disorder (from January 20XX + 1 year)
In August 20XX a scirrhous gastric cancer wasdiagnosed in hospital O, which then was resected in
September of the same year. Pharmacotherapy
chemotherapeuticfluorouracil)

agents(TS-1,administeredinintervals of 4 weeks followed by 2-week rests. The
chief complaint developed when she started to use ahigh pillow for the night to prevent regurgitation ofduodenal fluid into the esophagus. She also felt
anterior tibial

muscle andexperienced pain of the skin of the scalp. She had
been treated with acupuncture once every 2-3
months for about 10 years and now visited us
following the recommendation by her husband, who
is a patient in the acupuncture and moxibustion
clinic affiliated with our university.
[Anamnesis]
Total gastrectomy in November of 20XX due toscirrhous gastric cancer.

cigars or direct moxibustion (3 to 5 cones, the size of arice grain) was applied next to the spinous processes of
the 7th to 12th thoracic vertebae, from the epigastric to[Present illness]of theshortelectroacupuncture. Moxibustion treatment was added

November 26, 20XX

the hypogastric region and outside the surgical scar weapplied in conjunction with scarcely skin piercing
needle retention warming moxibustion with moxa
cigars and direct moxibustion (5 to 7 cones). About one
year after the first visit the patient underwent aballoon dilatation procedure from the duodenum to theesophageal anastomosis in the same hospital to treat
the passage disorder induced poor appetite. After that,
however, chilling and pain of the epigastric region as
well as a feeling of congestion extending from theepigastric to the umbilical region developed.
September, 20XX+1

Palpation revealed the clear manifestation ofindurations from the epigastric region down to theregions left and right to the umibilicus that tended
to become more marked with increasingly stronger
complaints of passage disorder, so that we gradually
increased the number of moxa cones applied.

[Accessory symptoms]
16

also

[Present illness; finding]single[First visit]

weariness

isdepending on the symptoms either for needle retention,

Y.I.; female, 57 years

methotrexate,

Thereof shoulder and neck stiffness as well as low back pain[Patient]ofstiffness.

cancer. Tenderness in the region from the top of theIntroduction

consistedneck

constipation and low back pain.

Shoko Masuyama and Hitoshi Yamashita

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

Volume 7, Number 3 | Fall 2012

November, 20XX+1

enthusiastically started yoga, facial esthetics, joined

Readmission, after discharge in the following

a painting class and in our clinic also underwent

October we switched to multiple cone direct

cosmetic acupuncture.

moxibustion treatment.
January, 20XX+2[Treatment frequency]

In spite of decreasing tumor marker levels, aOver a period of 25 months from the first visit until

stricture of the small intestines and metastases tothe patient's retirement in December 2 years after

the right ovary were observed 21 months after the20XX the patient visited our clinic in intervals offirst visit (August, 20XX+2), so that she underwent

once every 1-2 months because she was still

surgery in the following month, but because

commuting to work, but over a period of 9 months

peritoneal dissemination and colon metastases wereafter her retirement (December, 20XX+2) she visited

also found,

our clinic once every other week.

anticancer agent was switched in October of theboth ovaries

were resected.

Thesame year to paclitaxel and treatment

Jan. 20XX+1

Apr. 20XX+3

May, 20XX+3

25days later

Jan. 20XX+3

11days later

Jul. 20XX+3

21days laterFig.1 Chronological changes in symptoms and palpable masses[Course] Fig. 1 shows the complaints of abdominal

initiated administering the drug 3 times a weekindurations and the changes over time. One yearfollowed by one week of rest. A port imbedded

after 20XX she started visiting also anothersubcutaneously

acupuncture clinic offering acupuncture treatment

introjection of high caloric infusions, after which her

for cancer patients.

condition improved, so that we recommended to useontherightchest

allowedpaper mounted moxa at home. Application of thispaper mounted moxa during meals provided aJanuary, 20XX+2
Oligophagy

dueto

anticancer agent

dysgeusia.

Thepatientcomplained

inducedfeeling of refreshing relief, resulted in borborygmus

ofand enabled her to eat well.

foodaccumulating in the stomach, the lack of relief of thefullness and a lingering feeling of heaviness. ApartApril, 20XX+3

from the treatment in our clinic the patient started

Suspension of the chemotherapy made food passage

to perform box (warming) moxibustion at home withworse, but application of the paper mounted moxa

a self-made box. During this time the patient

increased intestinal motility.

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

17

Volume 7, Number 3 | Fall 2012

After 2 years and 10 months after the first visit in

The patient relied for the treatment of the cancer on

September, 20XX+3 a total of 47 treatment sessions

Western medicine and chose to combine this withhad been administered. The following month, theacupuncture and moxibustion treatment in our clinic

chemotherapy was discontinued and until she wasfor her complaints of passage disturbance and otherreadmitted three days before her death palliative

symptoms. In particular the moxibustion helpedcare continued at home. She passed away 36 months

ease the ingestion of food per os and conceivably

after treatment begin (on November 17, 20XX).

helped to ease pain and her fears. The stressproblems of oral food ingestion causes patients after[Discussion, conclusions]
BunshiShirotasurgery for cancer and during chemotherapy is a"Basicmajor source of suffering in those patients. Relief

Acupuncture and Moxibustion Treatment" a total of

also helps to spend the remaining time more

40 diseases of the digestive system and 16 among

meaningful. We believe, that moxibustion treatment

these are related to gastric diseases. In that work hefor passage disorders following surgery for gastricdescribes the use of acupuncture points which had

cancer represented for this patient a useful means ofempirically been found to show a high clinicalpalliative care.

usefulness.

listedinFrequently

hiswork

mentioned

pointsfor

digestive system diseases is first of all CV12,
followed by BL17 (Fig. 2). In the present case

Referencetreatment of disturbances of gastrointestinal tract

1) Shirota B. Shinkyu Chiryo Kisogaku. Ido No
Nippon Sha, 1940.

passage with moxibustion on the abdomen was more
effective than the use of points on the back or legs forrelieving the symptoms. CV12 is an acupoint used
not only for the treatment of postsurgical gastriccancer, but frequently also for the treatment ofdigestive system disorders.

Frequency of appearance

25

20

2315

1310

12129958

70CV12BL17BL20

ST21

ST34

ST36

BL21Fig.2 Frequently used acupoints by Bunshi Shirota

18

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

BL50