Medical Acupuncture and Pain Management Clinic, Brazil

^*Address for Correspondence: Huang WL, Infectious diseases, General Practice, Nutrition, Acupuncture and Pain Management Specialist. Medical Acupuncture and Pain Management Clinic, Rua Homero Pacheco Alves, 1929, Franca, Sao Paulo, 14400-010, Brazil, Phone: +55 16 3721-2437; E-mail: weilingmg@gmail.com

Submission: 22 May, 2020; Accepted: 26 June, 2020; Published: 30 June, 2020

Copyright: © 2020 Huang WL. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Copyright: © 2020 Huang WL. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Urinary incontinence is a common side effect of prostatectomy, affecting 6-8% of men who pass through the surgery. In Traditional Chinese Medicine (TCM), urinary incontinence is caused by Kidney Yang deficiency.

To demonstrate that patients with post-prostatectomy urinary incontinence and sexual dysfunction, have Kidney-Yang energy deficiency and deficiency on the chakras energy meridians. The treatment of these imbalances on the root level are important for the success on the treatment of this pathology.

One case report, patient named J.D.S, 60-year-old male. The patient had prostate cancer and performed the procedure of prostatectomy. Before performing the procedure, the patient had mild sexual dysfuntion. After he developed urinary incontinence (requiring the use of penis diapers) and had total sexual dysfunction. He received the recommendation from his urologist of Duloxetine use for improvement of urinary incontinence, with no improvement. He started treatment with ancient medical tools. They were: Chinese dietary counselling, auricular acupuncture with apex ear bloodletting, systemic acupuncture and moxibustion. The patient also received measurement of the chakras energy centers, and all seven chakras were in the minimum level (1) out of 8. Treatment with homeopathy and crystal-based medication were initiated to replenish the energy of the chakras.

With the use of these tools, the patient presented cure of the urinary incontinence, recovering the control over his bladder, not requiring the use of penis diapers any longer. After the treatment, the patient also reported to have improvement in his sexual performance, as he could not maintain sexual activity before the energy-based treatment.

Based on this case report, patients with urinary incontinence and sexual dysfunction post-cancer prostatectomy have energy imbalances and chakras energy deficiency as the root of the symptoms. The treatment rebalancing these energies and replenishing the chakras energy centers, with high-diluted medications is crucial for the recovery of the symptoms presented after the surgery.

Urinary incontinence; Sexual dysfunction; Postprostatectomy; Traditional Chinese medicine; Acupuncture; Energy; Diet; Moxibustion; Homeopathy; Crystal-Based Medications; Chakras

Urinary incontinence is defined as unintentional loss of urine, being a symptom of a problem on the urinary tract. There are three types of incontinence. Stress incontinence, urge incontinence and overflow incontinence [1-3].

Urinary incontinence is a common side effect of prostatectomy, affecting 6-8% of men who pass through the surgery. As during the surgery, one of the valves is removed, according to Western medicine, Kegel exercises and some medications may recover the well-functioning of the urinary tract [1-3].

Kimberly Hoiland, on the article entitled Post-Radical Prostatectomy Incontinence: Etiology and Prevention, states that prostate cancer is the most common for men over 50 years old, and the associations between urinary incontinence and prostatectomy surgery appear as high as 80% in literature [4].

According to this same article, the majority of patients recover naturally from the urinary incontinence during the period postoperative period, varying from the first weeks after surgery to 12 months [4].

In traditional Chinese medicine, urinary incontinence is associated with Kidney Yang deficiency. It is possible that the patient already had energy deficiencies and Heat retention before the surgery, which lead to the formation of cancer. These energy imbalances would worse with the surgery, the Blood loss and other fluids, leading to the process of urinary incontinence after the surgery. Therefore, treating these energy imbalances is very important for the patient in their post-surgery period, in this case, patients who just had prostatectomy surgery. It is important for the physician to know about these energy imbalances to treat the patient adequately [5].

For the treatment of the pathology presented by this specific patient, the author anchored her reasoning on the treatment in a specific case of a patient the author had in 2006. This patient was a 70-year-old male patient, who reported pain in the legs and was diagnosed with Kidney-Yang deficiency, according to TCM. He received treatment with Chinese dietary counseling, acupuncture and auricular acupuncture associated with apex ear bloodletting [6-9].

With the treatment done, the pain in the legs diminished and the patient was submitted to an interview after the treatment. In this interview, 30 days after the treatment, the patient revealed that his eye pressure had also lowered with the treatment, as his ophthalmologist confirmed. During the treatment, he had not reported to be treating glaucoma in the last 40 years with no improvement of his condition. With the treatment performed, his intraocular pressure lowered from 40 mm Hg to 17 mm Hg [6-9].

This interesting case became the cornerstone of the author studies in the field, trying to comprehend how the treatment based on the root of the problem could treat different diseases and symptoms simultaneously and using the same methods [6-9].

To demonstrate that patients with post-prostatectomy urinary incontinence and sexual dysfunction, have Kidney-Yang energy deficiency and deficiency on the chakras energy meridians. The treatment of these imbalances on the root level are important for the success on the treatment of these pathologies.

The method used in this article was to analyze the literature available in Western and traditional Chinese medicine, along with the use of a case report of a 60- years-old male patient, J.D.S. The patient had symptoms of sexual dysfunction, which worsened after performing radical retropubic prostatectomy surgery due to prostate cancer after the surgery, he developed urinary incontinence. The patient also had used testosterone blockers, to diminish the possibility of acquiring a new cancer and Duloxetine, to control the urinary incontinence. A year after the surgery, he still had the symptoms of urinary incontinence, even with the use of medication.

The background of the patient shown that he already had sexual dysfunction a year before the surgery. Two years before the surgery he had sexual intercourse four times a week, a year before the surgery, he felt his sexual appeal diminish, what worsened after the surgery, with no capacity of having erections.

He went to the urologist, who recommended treatment with Sildenafil. The patient decided not to perform the treatment with this medication, because he had friends who have died from the use of this medication. The urinary incontinence started soon after the surgery. The patient did not want to use diapers or penis diapers, despite having them at home. This situation altered the self-stem of the patient very much, causing symptoms of depression.

He started treatment with the author. At first, he was diagnosed with Kidney-Yang deficiency, Qi deficiency, Blood deficiency and Heat retention according to TCM. After, it was started a treatment for his energy imbalances, first with Chinese dietary counseling, which consisted in avoid dairy products, raw food, cold drinks, sweets. He was also advised to avoid soda, coffee and matte tea. He supposed to avoid fried food, coconut, chocolate, honey, alcoholic beverages, eggs and melted cheese. He was oriented to eat grilled and boiled food, drink lukewarm water. The treatment was accompanied by twice a week sessions of auricular acupuncture, associated with apex ear bloodletting and moxibustion.

The auricular acupuncture points used are described in (Figure 1).

The patient also received measurement of the chakras energy centers through the procedure of radiesthesia. The measurement shown that all patients chakras were at the minimum level (1), considering a scale of 1 to 8.

After the measurement he received homeopathy based on the theory created by the author entitled Constitutional Homeopathy of the Five Elements based on Traditional Chinese Medicine and crystal-based medication to replenish the energy of the chakras.

The homeopathies prescribed were: Sulphur 30CHXX-20 (single dose), Calcarea carbonica 30CHXX-20 (single dose), Silicea 30CHXX-20 (single dose), Natrium muriaticum 30CHXX-20 (single dose), Phosphorus 30CHXX-20. The homeopathies were prescribed to be taken in a single dose with a hiatus of three days between the medications, necessarily on the sequence described.

When this sequence was finished, the same medications were taken on the same sequence but in 200CHXX-20 instead of 30CHXX20, with the same three days’ hiatus.

Two months later, a new sequence of treatment was started, with the same medications taken on the same order, but now with 1000CHXX-20 instead of 200CHXX-20.

Two months later, a new sequence of treatment was started, as the others, with the same medications taken on the same order, now with 10000CHXX-20 instead of 1000CHXX-20.

Two months later, a new sequence of treatment was started, as the others, with the same medications taken on the same order, now with 50000CHXX-20 instead of 10000CHXX-20.

The crystal-based medications used will be described on the discussion section.

After two sessions, the patient started feeling improvement of all his symptoms, feeling more disposition, happiness and energy, and was completely recovered from the urinary incontinence within a month of treatment. Despite the improvement, he continues the treatment to maintain the balance of the energy.

After more than one year of treatment, he received a new chakras energy measurement, he continued to be with the minimum level of energy, even though there was improvement of his symptoms.

The patient reports that when he does not do acupuncture sessions and does not use the medications he feels less disposed, with sadness, negative thinking and with less energy to work. There was a period of time when the patient stopped the use of the medication and had a depressive crisis, even thinking about suicide. After he restarted the treatment he felt great difference in his emotional status, with happiness, less negative thinking, etc.

On the beginning of the treatment, the patient had not described to have sexual dysfunction after the surgery and the doctor was not aware of this symptoms before the treatment. After the treatment he reported an improvement in his sexual capacity, now being able to have intercourse without the use of medications to treat erectile dysfunction.

His urology exams concerning cancer evaluation (Prostatespecific antigen) all appear as normal, until May of 2020.

The urinary incontinence and sexual dysfunction are common side effect of prostatectomy surgery [10,11].

There are three types of urinary incontinence. The first one is Stress Urinary Incontinence (SUI); this type is characterized by the weakness of pelvic muscles. The main way of cure for SUI is exercises in order to fortify the pelvic muscles. These exercises are entitled Kegel exercises [10].

The second type is the Overactive Bladder (OB), also called urgency incontinence. The process of this type of incontinence is miss signal sent by the brain, that understands that the bladder needs to be emptied, when it is not completely full yet. The main consequence is the lack of control of bladder every time the urge to urinate appears [10].

The third type is the mixed incontinence, that happens when the patient has both SUI and OB [10].

In Western medicine, therapy for urinary incontinence includes behavioral therapy, physiotherapy (such as Kegel and other similar exercises), medications and surgery. Duloxetine is the first licensed drug for the treatment of urinary incontinence, with rates of success around 66% [12].

According to literature, prostate cancer is the most common cancer type in male patients over 50 years old. There are different kinds of prostatectomy: The first is open prostatectomy, that can be divided in two types: radical retropubic prostatectomy and laparoscopic prostatectomy, divided in other two types: Laparoscopic radical prostatectomy and robotic-assisted laparoscopic radical prostatectomy [13].

All these different kind of surgeries are associated with postsurgical urinary incontinence. Incontinence rates after prostatectomy vary in the current literature, and can be as high as 80% [1-4].

The treatment can vary from Kegel exercises, to even more conservative measures, such as diminishing or withdrawing caffeine and alcohol, not drinking liquids at night, etc., as demonstrated on the study of Bilal Chughtai, entitled Conservative Treatment for Postprostatectomy Incontinence [14].

Given that the majority of patients recover continence over a period that is variable, and can range from 6 months to 12 months in most cases [10-14].

Sexual dysfunction is also associated with radical retropubic prostatectomy, and the symptoms may start before the surgery. More than 50% of men with prostate cancer are at risk for erectile dysfunction. The biopsy may itself have a detrimental effect [11].

In other studies of the author, the metaphor of the tree was placed to explain better the relation between Western and traditional Chinese medicine, as well as the concepts of leaf-level and root-level developed by the author in several of her studies [6-9].

This metaphor has the objective to link what has already been described in Western and traditional Chinese medicine. In this schematic drawing of the tree, it is possible to visualize the root, trunk, several branches and coming out of each of these branches, many leaves (Figure 2). The leaves represent the symptoms, the branches represent the medical specialties, and the whole tree represent the human body, that is formed by energy. The energy imbalances are represented by Yin and Yang and Five Elements theory and corresponds to the root of the tree. These energy imbalances can influence health of the leaves or development of the disease. The tree is also surrounded by external pathogenic factors (Wind, Cold, Heat, Dryness and Humidity) which will also influence the balance of the energy. There is a communication between the leave-level and the root level, with the energy passing through from the root to all the meridians. When there is an energy imbalance on the root, it can reflect on the whole tree in many organs and systems in different specialties [6-9].

The main idea of this study is to understand how Western and traditional Chinese medicines see the symptoms and signs from two different perspectives. In the treatment of urinary incontinence and sexual dysfunction in post-cancer - prostatectomy surgery as TCM aims to see the patient as a whole, the first important step for treatment is the analysis of the patient history, diet, environment, life style, emotional aspects, etc [15,16].

In the Yellow Emperor’s Classic of Internal Medicine, it is stated that in order to perform a diagnosis of any pathologies, it is important to analyze the symptoms and classify them into Yin and Yang in order to perform the diagnosis. The Bladder, according to the Five Elements Theory is the hollow organ related to the Kidney meridian or massive organ. The Kidney meridian is linked to the Water element and the correspondent emotion is fear. Yang energy is important to maintain the organs up, on their places. When there is a lack of Yang energy, there is a tendency of the internal organs to fall. This is why the person with urinary incontinence cannot maintain the urine inside the Bladder, due to Kidney-Yang deficiency [17].

The Kidney meridian or the second chakra is also associated with the reproduction and sexual function. The formation of cancer is also related to the general lack of energy on the body, when the general energy of all the meridians is treated, as well as the Kidney, all symptoms will improve at the same time. This is why the sexual dysfunction improved, because the root of the tree was treated, what was the cause of all the patients’ symptoms, including the prostate cancer. As the patient already had done the surgery for treating the cancer, the treatment of the lack of energy was important for the patient to maintain a normal level of energy, to avoid the recurrence of the cancer, or its appearance in different organs. According to TCM, the energy of the patient, when balanced, will fight the formation of malign cells, eliminating them without the necessity of using medication [18].

The patient on the case report had Kidney-Yang deficiency, because he felt very cold on the body, especially on the extremities (hands and feet), as Yang energy is responsible for warming the body, the deficiency of the Yang energy can lead to the patient feeling colder, with cold feet and hands. This is why the patient was oriented to eat boiled and grilled food and avoid raw food, which has cold energy, worsening the Yang deficiency. The patient was also oriented to drink lukewarm water, because the energy of the water is naturally cold. Warming the water changes the energy from cold to neutral, improving Yang energy.

As the patient had a Kidney deficiency, the patient was oriented to eat food with black color, such as black beans and black dried grapes, because foods with that color tone the Kidney energy, with the exception of coffee and Coke, which are black but may harm the Kidney energy.

The patient was also oriented to eat pig’s Kidney, to help to improve the Kidney energy that was low. According to the book The Five Elements on the Balanced Diet, written by Ilse Maria Fahmow and Jurgen Fahmow, the consumption of the kidney of other animals can tonify the water element. When there is a need of fortifying this element, other important foods for consumption are different kinds of fish and plums.

The patient on the clinical case report had other deficiencies besides Kidney-Yang deficiency. This happens because the energies inside the body are all interconnected (Figure 1). Treating the imbalance of Yin,Yang,Qi and Blood it is possible to treat several symptoms and diseases at the same time. This was part of a study presented in 2015, at an Acupuncture Research Conference at the Faculty of Medicine of Harvard University in Boston, entitled ACUPUNCTURE VIEWED HOLISTICALLY CAN TREAT ALL THE PATIENT'S DISEASES SIMULTANEOUSLY - A CASE STUDY. The summary of this study states that if we treat the patients’ energy imbalances (Figure 2), we will treat all the patient’s symptoms at the same time; even if the doctor does not know the patient has such a symptom. With this type of reasoning, we will be able to treat all diseases of all specialties at the same time, as we treat in this case, the root of the problems and not only the symptoms [6-9].

When there is deficiency in one of these four energies, there is formation of internal Heat, as showed in (Figure 3).

Cancer, in traditional Chinese medicine, develops when the patient has deficiency of energy and formation of internal Heat. Therefore, the treatment proposed to treat post-cancer prostatectomy urinary incontinence, is treating, at the same time, the energy imbalance that lead to the formation of cancer. A study regarding the treatment of cancer based on chronic energy imbalances would be presented by the author in 3rd Global Summit on Allergy and Immunology, in Paris in March 2020. On this study, three cases of patients with cancer were analyzed, two of them had complete cure of the cancer only using this kind of reasoning without the necessity of radiotherapy, chemotherapy or surgery, and the third patient was in treatment with chemotherapy for Lung cancer, with metastasis, and recovered from the metastasis without relapses. When he was performing treatment for cancer, there was diminution of the metastasis but they would reappear in other organs, on the nervous system, on the abdominal wall, on the cervical glands, having performed surgery to take out the tumor on the nervous system. When the energy-based treatment was associated, the metastasis disappeared and there were no relapses.

In order to make an energy imbalances diagnosis, the patient is submitted to the questions proposed in (Table 1).

* Blood deficiency can be understood as anemia in the energy level. As Blood deficiency may take years to appear in the laboratory exams, the patient with constipation and a normal Complete Blood Count (CBC) can still be considered a patient with Blood deficiency, according to TCM, depending based on the symptoms he/she may present.

The patient in the case report had other energy deficiencies, such as Blood deficiency (no daily bowel movement), Qi deficiency (sweating during the day with no physical activity), Yang deficiency (cold in the extremities) and Heat retention (dry month and itchiness on the skin). To treat the Yang deficiency causing the urinary incontinence and sexual dysfunction all the other energy deficiencies had to be treated, because one energy depends on the other. This was possible through Chinese dietary counseling, to increase nutrient absorption and to improve Blood production. As stated by Hippocrates “make your food your medicine, and your medicine, your food”.

Despite the diet, the treatment was also associated with auricular acupuncture and apex ear bloodletting, because through the apex ear bloodletting procedure it was possible to take out internal Heat, and through auricular acupuncture, it was possible to rebalance Yin,Yang,Qi and Blood.

The auricular acupuncture points used to tone each energy are better described in the article of the author entitled How Do You Treat Back Pain in Your Practice? Part 2, published on the Medical Acupuncture Journal in February of 2018 [19].

The patient also received moxibustion, which is a tool traditional Chinese medicine, centered on burning dried mugwort on particular points on the body. It plays an important role in the traditional medical systems of China, Tibet, Japan, Korea, Vietnam, and Mongolia. In the patients of the author, the moxa used was made of coal warmed on a stove.

In the case of the patient presented on the case report, he had a Kidney-Yang deficiency. Moxibustion was used to tone the energy of the Kidney, improving the Yang energy, and in this way, improving the condition of urinary incontinence and sexual dysfunction presented by the patient.

The patient also received measurement of the chakras energy meridian, because each chakra corresponds to one massive organ of the Five Elements theory, according to the study entitled The Geometry of Emotions: Using Chakra Acupuncture and 5-Phase Theory to Describe Personality Archetypes for Clinical Use as showed in [20] (Figure 4).

As the patient in this case report was diagnosed with no energy on any of the five massive organs or chakras energy centers, all energies from all the organs were treated. The second chakra is correspondent to the Kidney, which is responsible for the Bladder and the sexual function. The Kidney receives energy from the Lung, which receives energy from the Spleen. The Spleen receives energy from the Heart, and the Heart receives energy from the Liver. This scheme is called Generation Cycle and is better shown in (Figure 5).

The treatment the patient received, besides having improved the symptoms he was presenting, also treated the cause of the cancer on the energy level, diminishing the possibilities of the patient acquiring cancer on the future, as well as preventing other diseases such as diabetes, myocardial infarction, hypertension, depression, anxiety, etc, previously described by the author in her studies [6-9].

The patient received treatment to replenish the chakras energy with high-diluted medications. Homeopathy and crystal-based medications were used. The medications chosen are described in (Table 2)

These medications were chosen instead of high-concentrated medication due to the Arndt-Schultz law.

According to the Arndt-Schultz’s law, all drugs in high concentrations cause a reduction of vital energy. This reduction would generate the patient's energy weakness and the formation of internal Heat due to energy imbalances [6-9].

As the patient was already with the energy very weak, diagnosed through radiesthesia, and also had a history of cancer, what shows, indirectly, that the patient had a severe energy deficiency, it was preferred to avoid the use of high-concentrated drugs in any circumstances, because it might worsen the energy of the patient, compromising the treatment of urinary incontinence and sexual dysfunction, that according to the TCM literature is caused by deficiency of Kidney-Yang deficiency. The patient also presented deficiency on the other energies. The worsening of the energy deficiencies of the patient could also be associated with the formation of other chronic diseases in the future or the recurrence of the cancer, or the appearance of other types of cancer in other organs.

According to Hippocrates: “First, do no harm”.

Currently, Western and traditional Chinese medicine are different for most physicians around the world. However, they can be integrated. In (Figure 6), a metaphor of Yin and Yang as the different kinds of medicine was created. For the adequate treatment of urinary incontinence and sexual dysfunction post-cancer prostatectomy surgery, it is important to associate traditional Chinese medicine and Western medicine, so the patient can treat the symptoms and the root of the problem, which are the extreme lack of energy of Yin, Yang, Qi, Blood and Heat retention, associated with severe deficiency of the chakras energy centers [4-14].

According to this case report, patients with urinary incontinence and sexual dysfunction post-cancer prostatectomy surgery have energy imbalances and chakras energy deficiencies as an underlying cause. To have a successful treatment of this kind of patient, the correction of these energy imbalances through Chinese dietary counseling, auricular acupuncture, apex ear bloodletting, moxibustion, and replenishment of the chakras energy deficiency through homeopathy according to Constitutional Homeopathy of the Five Elements based on Traditional Chinese Medicine and crystalbased medication intake are important.

The integral treatment of the patient is significant and not only the localized treatment, focused on symptoms.