We report the case of a 30-year-old woman with a right adnexal mass resembling an ovarian cyst who declined diagnostic laparoscopy and requested treatment with acupuncture. The patient was treated with Saam acupuncture for 14 weeks. After treatment, transvaginal sonography revealed disappearance of the right adnexal mass. No adverse effects of the Saam acupuncture treatment were reported.
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An adnexal mass is defined as an enlarged structure in the uterine adnexa, usually within the ovary or fallopian tube. Adnexal masses have a variety of causes including physiological or functional cysts, ectopic pregnancies, inflammatory conditions (such as tubo-ovarian abscesses), endometriomas, benign and malignant ovarian neoplasm and non-ovarian tumour.1 Ovarian cysts remain one of the most common diagnoses for an adnexal mass.
An ovarian cyst is any collection of fluid within the ovary. Any ovarian follicle that is larger than 2 cm is termed a cyst. In a woman of reproductive age, follicles smaller than 2 cm form naturally. Surgical removal is indicated for cysts that are larger than 5 cm. Most cysts are not cancerous. However, the risk of cancer is higher in large and persistent cysts. To date, there have been a small number of cases where a reduction in the size (or even complete resolution) of ovarian cysts has been reported with the use of traditional Chinese medical treatment.2 ,3
To the best of our knowledge, this is the first case of the disappearance of an ovarian cyst with Saam (or Sa-Ahm) acupuncture.
A 30-year-old woman visited the Daegu Comprehensive and Integrative Medical clinic in 2012 with a diagnosis of a right adnexal mass which was suspected to be an ovarian cyst. She had undergone laparoscopic adhesiolysis and abscess drainage for the treatment of ruptured bilateral tubo-ovarian abscesses in August 2010 at a local medical centre. At a follow-up transvaginal sonography in December of 2011, she was diagnosed with a right adnexal mass which had mixed components on ultrasonographic examination and was suspected to be an ovarian cyst. The size of the adnexal mass was 25.7×29.6 mm (figure 1). She did not have abdominal pain or vaginal symptoms. Pelvic examination and vital signs showed no significant abnormal findings. She also reported that blood tests performed at that time were normal and malignancy was excluded. In February 2012 a repeat transvaginal sonography revealed an increase in the size of the adnexal mass with mainly cystic components to 47.2×37.2 mm (figure 2).
She had a discussion with her own doctor about further evaluation and follow-up with diagnostic and operative laparoscopy. After this discussion, the patient decided that she did not want a laparoscopy and chose to explore non-operative treatment alternatives. Ultimately she decided to receive Saam acupuncture treatment.
Needle acupuncture was applied bilaterally for 20 min using stainless steel needles of 0.25 mm diameter and 30 mm length (Dongbang Acupuncture, Chungcheongnam-do, Korea). The needles were inserted 10–20 mm deep into the skin and were gently manipulated to obtain de qi. No electrical stimulation or other interventions were used. Based on Saam acupuncture theory, the acupuncture points GB41, SI3, BL66, SI2, KI10, LR8, LU8, LR4, GB43, LI11 and GB44 were used. Acupuncture treatment was continued for 14 weeks (from 21 February to 25 May 2012). No side effects were reported during this treatment. After treatment, follow-up transvaginal sonography was performed on 29 May 2012. Sonographic examination demonstrated normal findings with no signs of the previously documented adnexal mass (figure 3). A second transvaginal sonography confirmed the disappearance of the adnexal mass on 9 June 2012 (figure 4).
The patient was treated with Saam acupuncture, which is an acupuncture technique unique to Korea.4 ,5 The five Shu points have their origins in the characters of Wood, Fire, Earth, Metal and Water for each meridian. Saam acupuncture consists of treating these five Shu points. It is proposed that most illnesses are rooted in the interruptions or imbalances of a network of meridians.6 According to a patient's meridian condition (and their symptoms related to their inner organs), the Saam acupuncture technique diagnoses a patient according to whether a certain organ is experiencing an excess or a deficiency. Organs diagnosed as experiencing an excess require sedation, and deficient organs require tonification.7 Five Shu points may be selected for the purpose of tonification or sedation.
In this patient there were three key organs of focus during her treatment related to Blood and Qi. In order to eliminate Blood Stagnation, the Small Intestine meridian had to be treated. For Qi circulation, the Liver and Gall Bladder meridians (having both Wood and Wind characteristics) were used. Depending on the patient's pulse patterns, the appropriate meridian for acupuncture treatment was chosen. For the Small Intestine meridian, GB41 and SI3 were tonified whereas BL66 and SI2 were sedated. For the Liver meridian, KI10 and LR8 were tonified whereas LU8 and LR4 were sedated. For the Gall Bladder meridian, BL66 and GB43 were tonified whereas LI1 and GB44 were sedated.
Several studies have shown that acupuncture may improve ovarian blood flow and consequently have a beneficial effect on pregnancy rate or polycystic ovary syndrome. This effect may be evoked via modification of autonomic nerve activity as a result, for example, of reflex alteration of ovarian sympathetic nerve activity.8–10
As far as we are aware, this is the first report of a patient treated with Saam acupuncture resulting in the disappearance of an adnexal mass suspected to be an ovarian cyst. Competing theories for the disappearance of the adnexal mass include the passage of time or other diagnoses such as an inclusion cyst. Furthermore, we cannot exclude the possibility of spontaneous resolution of the adnexal mass since about 70% of cysts tend to resolve spontaneously over 2–3 cycles. Modesitt et al11 reported that total cyst resolution occurred within 3 months in 66% of cases of unilocular ovarian cystic tumours less than 10 cm in diameter.
Despite these alternative explanations, we observed the disappearance of an adnexal mass with Saam acupuncture. We think that it is acceptable to try acupuncture for simple cysts of less than 5 cm diameter where malignancy has been excluded and in carefully selected women who are interested in using the procedure. Further controlled prospective studies are required to clarify the efficacy of Saam acupuncture for adnexal masses.
Contributors JCS and Y-JC mainly wrote the paper. O-CK and D-KC designed the protocol. H-JK performed the Saam acupuncture treatment. GHL directed the treatment and paper work overall.
Funding This study was supported by a grant from the Ministry of Health and Welfare, Republic of Korea (Project No 20-12-0-090-091-3000-3033-320).
Competing interests None.
Patient consent Obtained.
Ethics approval The institutional review board at the Daegu Catholic University Hospital approved this study.
Provenance and peer review Not commissioned; externally peer reviewed.
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