Researchers document that acupuncture combined with moxibustion and herbal medicine enhance the effectiveness of drug therapy for patients with cirrhotic ascites (CA). Patient benefits include reduced fluid retention, improved liver function, and lower relapse rates. In addition, hospitalization durations are significantly reduced. Let’s take a look at the results and how they are achieved.

Acupuncture plus moxibustion is a potent modality of therapeutic care for the alleviation of cirrhotic ascites. Researchers tested the efficacy of the Traditional Chinese Medicine (TCM) approach to care and discovered that it significantly reduced hospitalization times, lowered relapse rates, and alleviated symptoms. In a study entitled Clinical Observation of 135 Cases of Cirrhotic Ascites Treated with Acupuncture and Medicine, Dr. Du documents an 80% total treatment effective rate for patients receiving acupuncture plus moxibustion in addition to conventional medications. Patients receiving TCM herbal medicine in addition to standard care had a 77.8% total effective rate and patients receiving only standard medications had a 66.7% total effective rate.

Cirrhotic ascites is the build-up of fluid in the peritoneal cavity due to cirrhosis of the liver. The peritoneal cavity is the serous membrane encircling the internal organs of the abdomen. Cirrhosis imbalances perfusion pressures due to the development of portal hypertension, which is the increase in blood pressure in the portal venous system. This leads to sodium and water retention as the body releases biochemicals in an attempt to normalize perfusion pressures.

The clinical results are significant and the addition of TCM modalities improves hospitalization outcomes. For patients receiving acupuncture combined with moxibustion, 57.78% were hospitalized for four weeks, 13.33% for two weeks, and the remaining 28.89% patients for six weeks or more. These outcomes were significant improvements over patients receiving only medications: 42.22% were hospitalized for four weeks, 11.11% for two weeks, and the remaining 46.67% for six weeks or more.

A one year follow-up on the relapse rates for ascites demonstrates that acupuncture combined with moxibustion produces significant outcome measures. Acupuncture plus moxibustion patients had a relapse rate of 15.56% of three times or more, and a total recurrence rate (at least once) of 64.44%. For patients receiving TCM herbal medicine, there was a 22.22% relapse rate of 3 times or more, and a total recurrence rate of 68.89%. For patients receiving only medications, patients had a relapse rate of 42.22% of three times or more, and a total recurrence rate of 84.44%. These are important outcome measures demonstrating significantly lower relapse rates for patients receiving the benefit of acupuncture with moxibustion or herbal medicine.

Dr. Du’s investigation reveals that drug therapy as a standalone treatment option produces significantly lower positive patient outcomes than an integrative medicine approach to care using acupuncture or herbal medicine. A total of 135 patients were randomly divided into three equal groups: acupuncture plus moxibustion, herbal medicine, medication only. The acupuncture group received needling of a protocolized acupuncture point prescription. The herbal medicine group ingested a modification of the classic herbal formula Zhen Wu Tang. All three groups received identical drug therapy. The acupuncture-moxibustion group received bilateral needling of the following acupoints:
Shuifen (CV9)
Qihai (CV6)
Guanyuan (CV4)
Zhongji (CV3)
Zusanli (ST36)
Taichong (LV3)
Fuliu (KD7)
Shenshu (BL23)
Gongsun (SP4)
Pishu (BL20)
Sanyinjiao (SP6)
Yinlingquan (SP9)

Acupuncture-moxibustion treatment commenced with the patient in a prone position. First, a standard acupuncture needle was inserted into Pishu and Shenshu, thereafter manipulated with the Bu (reinforcement) technique. Only acupuncture (no moxibustion) was administered to these two acupoints. Next, the patient shifted to a supine position, and a standard acupuncture needle was inserted into the remaining acupoints. The Ping Bu Ping Xie manipulation technique was applied for acupoints on the upper abdomen and foot.

A 2 cm cylindrical moxa cigar cutting was attached to the acupuncture needles on Shuifen, Qihai, Guanyuan, Zhongji, and Zusanli. The surrounding skin was covered with a protective sleeve to prevent burning from falling moxa cigar ash. The moxa cigar was lit and burnt for approximately 20 minutes, until the surrounding skin felt warm and was flushed. One treatment session was conducted 30 minutes before lunch every day, for 2 weeks, as one treatment cycle. Up to 6 treatment cycles were administered, dependent upon the individual patient’s condition.

In acupuncture, a number of acupoints have known cirrhotic ascites related effects. The Shuifen acupoint, located along the Ren meridian, is one crucial acupoint selected in cirrhotic ascites (CA) treatment. Qihai, Guanyuan, and Zhongji, also found along the Ren meridian; all reinforce the body’s yuan qi and yang, improve qi circulation, and have a diuretic effect that removes water retention due to ascites. The Zusanli acupoint, which is part of the stomach meridian, is a signature acupoint used extensively in diverse situations to promote overall health, regulate the stomach and intestines, reduce bloating, and improve qi circulation.

Taichong is known to treat depression and improve liver health. Fuliu and Shenshu improve kidney health, nourish the yang, and eliminate ascites. Lastly, the pairing of Gongsun and Pishu improves general spleen health, regulates qi circulation, and removes ascites water build-up. Gao (2007) notes that acupuncture at Guanyuan, Zhongji, and Shuidao may be implemented to contract the detrusor (urination bladder muscle). Acupuncture at Sanyinjiao and Yinlingquan can be implemented to relax the external urethral sphincter; therefore promoting urination. A modified version of Zhen Wu Tang contained the following ingredients:
Fu Zi (12 g)
Bai Zhu (10 g)
Fu Ling (15 g)
Sheng Jiang (10 g)
Bai Shao Yao (10 g)
Da Fu Pi (15 g)
Gui Zhi (10 g)
Sheng Huang Qi (15 g)
Yin Chen Hao (15 g)
Da Huang (6 g)

The prescription was brewed with water to yield a 150 ml decoction, served in three portions per day; 50 ml each time. The decoction was taken every day for 2 weeks, as one treatment cycle. Up to 6 treatment cycles were administered, dependent upon the individual patient’s condition. The following pharmaceutical medications were administered for all patients in all groups:

Glutathione (1.2 mg), once per day. (hepatoprotective)
Octreotide acetate (0.2 mg), twice per day. (portal hypertension drug)
Spironolactone (60 mg), once per day. (diuretic)
Furosemide (40 mg), once per day. (diuretic)
In cases where human blood albumin fell below 28 g/L:

20% albumin (10 g), twice per week
The medications were administered every day via intravenous infusion for 2 weeks, for one treatment cycle. Up to 6 treatment cycles were administered, dependent upon the individual patient’s condition. Treatment efficacy was evaluated and categorized into 3 tiers:

Significantly effective: no symptoms, hepatosplenomegaly was stable, no tenderness and pain upon percussion, no ascites, normal liver function restored

Improvement: no major symptoms or significant reduction in symptoms, hepatosplenomegaly was stable, no significant tenderness and pain upon percussion, ≥50% reduction in ascites, liver function improved by ≥50% but not completely restored.

Ineffective: insufficient recovery to be categorized as improvement.

Based on the clinical data of Dr. Du’s study, it can be affirmed that both TCM modalities (herbal medication and acupuncture) benefit patients with cirrhotic ascites. Patients demonstrate improvements in symptoms, shorter hospitalization times, and a significantly lower relapse rate. The data indicates the an integrative medical protocol yields superior patient outcomes for patients with cirrhotic ascites.

Continuing Education Credit
To learn more about the treatment of liver cirrhosis and ascites with acupuncture and herbal medicine, visit the Healthcare Medicine Institute’s acupuncture continuing education course entitled Cirrhosis Treatments. This online class provides license renewal credit for licensed acupuncturists and presents important treatment protocols for patients with liver cirrhosis. The course focuses on herbal medicines and TCM theoretical principles used to achieve optimal patient outcomes.

References:
Du XD. (2015). Clinical Observation of 135 Cases of cirrhotic ascites Treated with Acupuncture and Medicine. Medical Information. 28(34).

Gao WB. (2007). 6 modern techniques of acupuncture-moxibustion in treating neuropathy. Beijing, Chinese Medical Science and Technology Publisher. 249