Acupuncture Treatment of Variceal Ulcer

First the clinical evaluation of variceal ulcer is very important. This is the evidence in primary attention in the ITALIAN HOSPITAL from Buenos Aires, Unit of Family Medicine and Preventive Medicine (mayjune 2019)

The efficacy in the treatment and prevention from chronic ulcers in inferior limbs is limited. The definition is one skin defect in the inferior limbs that is persistent more than six weeks [1]. First: how is it ¿the skin injury is big or small … The venous insufficiency and risk factor conditions: The conditions that are important for treatment: diabetes, anemia, rheumatoid arthritis, tobacco consumption, hypertension, coronary disease, limp intermittent, infection, eczematous aspect. 

The inspection is necessary, and touch the ulcer, the presence of skin maceration, malignancy disease [2,3]. The evaluation of arterial insufficiency with ecodoppler ankle- arm index, is very important, one determination less 0.8, it is the periphery arteriosclerosis. The compression graduation whit high intensity in this case periphery arteriosclerosis, is wrongly [4,5]. The history of previous ulcer in this patients and the previous treatments, and the time too late for healing, the family history, the previous “deep venous thrombosis”, fracture limb, and surgery. The fever, purulent exudation, clinical infection [6,7].

Patient 1 

CJA; woman, 58 years, with rheumatoid arthritis, diabetes, gout tophus. Two ulcers in right limb in Spleen area Sp (B) and Liver area Liv (H) and two ulcers in left limb in Gall Bladder area GB (VB) and Bladder B (V). After 6 sessions of acupuncture the improve the joint pain and ulcers in a 50%.

Patient 2 

GL ; man, 72 years, ulcer in right limb since 35 years, after abdomen surgery cholecystectomy, 12 days be taken ill with a “deep venous thrombosis” and last a saphenectomy. It was a big ulcer in right limb and a small in the same limb internal, He suffer hypertension and insomnia. After12 sessions of acupuncture ulcers healing in a 100 % (Figures 1 & 2). 

 Figure 1: Patient 2: It was a big ulcer in right limb and a small in the same limb internal. 

 Figure 2: Patient 2: ulcers healing.

Patient 3 

GL; woman, 72 years, variceal ulcer since 9 years, after sclerotherapy treatment, labor, and “deep venous thrombosis”. Intensive pain in right limb, 12 centimeter large, with suppuration, prurigo, pernio erythema. This patient received treatment intermittent 25 sessions, electroacupuncture, ulcer healing in a 50 %.

Patient 4 

BS, woman, 52 years; patient obese, hypertensive and asthmatic, with saphenectomy since 20 years, received trauma in right limb; it was a big ulcer with suppuration and edema. After 15 sessions, ulcer healing in a 50 %.

Patient 5 

PO, man, 25 years, patient with asthma, obese, after use of footwear oppressive, trauma in right limb, he had two variceal ulcers. After 8 sessions of acupuncture he Slim reduce only 3 Kg, 116 kg, and the ulcer is healing in a 100% (Figure 3). 

Figure 3: Patient 5: Periulcerous needles.

Patient 6 

CV; woman, 77 years, asthma, hypertensive, trauma in right limb, phlebitis frequently, she had a variceal ulcer in right limb. After 6 sessions no improvement, with acupuncture, Y study a new ecodoppler and send to specialist, who practice amicrosurgery, she received a phleboplasty. The treatment with acupuncture was negative.

Patient 7 

NR; woman, 58 years, 139 kg, obese , hypertensive, with variceal ulcer in the two limbs, phlebitis frequently, she was febrile, with treatment with victoza( liraglutida).Y suggest suspend the victoza, then remove fever.

After7 sessions of acupuncture the two ulcers healing. Six months letter she had erisipela in left limb and ulcer open. She was treated with penicillin, after 5 sessions of acupuncture ulcer is healing and she had 126 Kg.

The treatment with acupuncture was effective in a 100%, but she has an insufficiency in internal saphenous in left limb and saphenectomy bilateral, and refuse other new surgery (Figures 4-6).

Figure 4: Patient 7: Variceal ulcer in the two limbs. 

Figure 5: Patient 7: Application of periulcerous needles. 
 Figure 6: Patient 7: Ulcers healing.

Variceal ulcer affects the curious vessel Chong mai, on its descendant vessel, (the feet get cold), it is the vessel of vasculopathies of the inferior limb, the key point is Sp 4 Gongsunt hat goes from K 11 Henggu, to St 30 Qichong, to the tree yin of the foot, Spleen, Liver and Kidney. It is a yin process. The Chongmai vessel regulates body temperature, transport of organic liquids to the articular and cellular interstitium. 

The Chong mai, has one ascendant vessel, that goes to the chest; when it sickens it produces precordial pain and dyspnea (note that many of these patients suffer from asthma, coronary disease or hypertension) [8,9]. The Chong mai vessel is the sea of the meridians and secondary vessels, it joins with the Yinweimai that connects the Yin meridians of the body (the key point is Pc 6 Neiguan).

The treatment is based on the application of periulcerous needles to accelerate healing, Y used the Chinese needles size 30 / 25, and in the obese patients, y proffered the Chinese needles size 30/40. The time they were retained in the body was 30 minutes. The acupuncture sessions were with interval of one or two weeks. 

They are inmunodepressed patients and as the Lo group points of the inferior limb Sp 6 Sanyinjiao and superior limb Pc 6 Neiguan are used. The Yang must be lowed with St 36 Zusanli and Yin must be sedated, with Sp 4 Gongsun Lo point, whether passing energy to the Stomach meridian [10,11]. Sp6 Sanyinjiao, the Lo point of the Yin meridians of the foot, or using Lo point of yang meridians of the foot, for example GB 39 Xuanzhong.

From the 7 patients, it is proved that this treatment managed to heal three of the ulcers in a 100%, three others in a 50 %, except for one patient, whose treatment was microsurgery [12-14].

In the variceal ulcer acupuncture proved to be effective as a complementary therapy in the 80% of the cases treated. The limitations of this study is the patients number, were only 7 patients. We need more cases to evaluate this treatment, in the future which could grow out of this research. The varicealulceris a chronic disease, the co morbidities are present : diabetes, anemia, rheumatoid arthritis, tobacco consumption, hypertension, coronary disease, limp intermittent, infection, eczematous aspect, the “deep venous thrombosis”.

With traditional clinical treatment acupuncture may be a complementary medicine.