Hemorrhoidal disease is one of the most common benign anorectal conditions, with a prevalence of up to 40% in the general population, with a higher incidence in people between 45 and 65 years of age.1 Currently defined as distal displacement or pathological hypertrophy of the anal pads, the main associated factors that trigger the disease include constipation, dry stools, prolonged evacuation, pregnancy and childbirth.2 Therefore, there are complementary alternative treatments to relieve symptoms, such as the use of Chinese Herbs to reduce bleeding and Acupuncture on pain control and support on strengthen of anal structural tissue.
Hemorrhoids develop from structural changes in the supporting connective tissue of anal pads, which are made of fibroelastic tissue, muscle fibers, and arteriovenous vascular plexuses, as well as from exacerbated dilation and distortion of the anorectal vascular framework, knowing that both conditions can coexist.1,3,4
Thus, they are categorized as internal or external, according to their connection with the pectineal line, commonly communicating. In this sense, they can be classified into degrees, ranging from visible to the proctoscope and without hemorrhoidal prolapse (first degree) to permanent and irreducible prolapse (fourth degree).5
Depending on the degree of involvement, it is worth highlighting the acceptance of nonsurgical treatments for some grades of the disease, while for others surgical intervention is recommended. Of the surgical procedures, there are currently outpatient options (infrared coagulation, rubber band ligation, injection sclerotherapy), invasive ones (open Milligan and Morgan ligation, excisional hemorrhoidectomy, stapled hemorrhoidepexy), in addition to minimally invasive ones (Doppler guided hemorrhoid artery ligation, endovascular embolization of the superior rectal arteries).3 Nonsurgical therapies include the implementation of a fiber rich diet and liquids, physical activity, better ergonomics and shorter bowel movements, topical therapies (phlebotonics), sitz bath, as well as the use of acupuncture. Literature mentions that acupoint application can improve the overall efficiency, reduce pain scores, and relieve the degree of postoperative pain in mixed hemorrhoids.6
In our clinical practice, the management of hemorrhoids typically initiates with distal analgesic points such as Hegu (LI4), the Yuan-Source point on the Large Intestine meridian, Bai Hui (DM20), the Hui-Meeting point of the Governing Vessel, and Zusanli (ST36), the He-Sea point on the Stomach meridian.7–8
According to traditional Chinese medicine, the Spleen is crucial for regulating blood within the vessels. Therefore, Taibai (SP3), the Shu and Yuan point on the Spleen meridian, is used to reinforce Spleen function, essential for fluid transformation and transportation. Gongsun (SP4), the Luo-Connecting point on the Spleen meridian, supports Spleen function and regulates the Chong Mai, influencing systemic blood flow. SP4 is particularly effective in relieving Qi and Blood stagnation, which are involved in hemorrhoids.8–9
Pishu (BL20), located 1,5 cun lateral to the lower border of the spinous process of the 11th thoracic vertebra, strengthens the Spleen, particularly in conditions of Spleen deficiency.9 Chengshan (BL57), located on the posterior midline of the leg, regulates Qi and Blood in the lower extremities and provides relief from pain and edema in the anorectal area.
The integration of these acupuncture points into a targeted treatment protocol offers an effective approach to managing hemorrhoids by symptomatic relief and underlying pathophysiological factor.
REFERENCES
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