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Clinical trials demonstrate that acupuncture relieves chronic constipation and produces greater long-term patient outcomes than drugs.
Chengdu University of Traditional Chinese Medicine researchers find true acupuncture more effective than sham acupuncture for the relief of constipation. In another study by Yang et al., acupuncture combined with herbal medicine relieves constipation in the elderly and demonstrates superior patient outcomes to pharmaceutical medications. Acupuncture plus herbs produced a high total effective rate and very low relapse rate. Let’s take a look at the results of the investigations.
Zheng et al. (Chengdu University of Traditional Chinese Medicine) conclude that acupuncture is safe and effective for the treatment of functional constipation, often referred to as chronic idiopathic constipation (CIC). This type of constipation does not have a known anatomical or physiological etiology in biomedicine. CIC often involves infrequent defecation, hard stools, straining during bowel movements, and incomplete evacuation of stools. Secondary symptoms include stomach cramping, pain, and abdominal bloating or distention.
The study examines the efficaciousness of front mu (ST25) and back shu (BL25) acupoints of the large intestine meridian. This approach is consistent with Traditional Chinese Medicine (TCM) principles. The large intestine foot-yangming channel is often an integral aspect to treatments for constipation.
The researchers note that functional constipation is classified in the Da Bian Nan (difficulty in bowel movement) category in TCM. They cite prior research indicating that acupuncture effectively treats the root causes of constipation. As a result, acupuncture patients have lower relapse rates than patients having taken mosapride, a medication used to facilitate bowel movements. Although the drug is effective, the research indicates a relatively high relapse rate (54.2%) following discontinuation of the drug. The researchers add that acupuncture is effective without significant adverse effects whereas mosapride may cause loose stools, dizziness, headaches, insomnia, abdominal pain, and borborygmus. Mosapride is a serotonin 5HT₄-receptor agonist and serotonin 5HT₃-receptor antagonist that is a gastroprokinetic agent.
Acupuncture at the large intestine foot-yangming front mu and back shu points was compared with sham acupoint controls to ensure validity of the data. In a prior meta-analysis, acupuncture had a 72.8% total effective rate for the treatment of constipation. In this study, the classic front mu and back shu combination achieved an 82.56% total effective rate.
The active sham control group had a 67.65% total effective rate compared with the 82.56% total effective rate of the true acupuncture group. Notably, the sham points were located and needled 1 cm laterally to the true acupuncture point locations. This active sham control method may have contributed to clinical successes in the sham group. Nonetheless, the true acupuncture group significantly outperformed the sham control group. True acupuncture had better frequency of bowel movement scores, difficulty of bowel movement scores, and a higher total effective rate. The study involved 72 voluntary patients from the gastrointestinal department at Chengdu University of Traditional Chinese Medicine. Inclusion criteria were established and included the following:
Visited the hospital between October 2010 and December 2014
Met the Rome III diagnostic standard for functional constipation
Between 18 – 75 years old
Did not take any stomach or intestinal prokinetic medications within one week prior to the research starting date
Not participating in any other clinical research
Patients who had the following conditions were filtered out of the selection:
Constipation secondary due to biologically identified illness
Unable to describe symptoms due to ambiguous consciousness or psychosis
Progressive malignant tumors or other severe consumptive diseases
Prone to infection and bleeding
Severe primary and concomitant cardiovascular, liver, kidney, digestive or hematopoietic diseases
Pregnant or lactating
Participating in other clinical research
The patients were randomly divided into two groups of 36 patients each: true acupuncture treatment group, sham control group. The average age of participants was 44 years. There were 9 males and 27 females in the treatment group. There were 11 males and 25 females in the control group. The acupoints selected for the treatment group were the following:
Tianshu (ST25) – Large intestine front mu acupoint
Dachangshu (BL25) – Large intestine back shu acupoint
For the control group, body points selected were neither meridian acupoints nor special acupoints. They were located at the following areas:
1 cm to laterally to ST25
1 cm to laterally to to BL25
For both groups, each point was pierced with a disposable 0.3 mm X 50 mm needle (Huatuo brand, Suzhou Medical Equipment Ltd.), adhering to standard piercing depths. For each acupuncture point, the following protocol was observed. After regular disinfection, the needle was inserted into the point and manipulated with pulling, pushing or twisting techniques at a speed of 60 – 90 times per minute. The angle of twist was 90 – 180 degrees and the depth was 0.3 – 0.5 cm. Next, a needle retention time of 30 minutes was observed. Thereafter, the needle was removed and pressure was applied to the point with a dry cotton ball to prevent bleeding.
One 30 minute session was conducted per day. A full treatment cycle consisted of 5 consecutive days. The entire treatment course comprised 4 treatment cycles for a grand total of 20 acupuncture treatments. To evaluate the treatment effective rate, patients were scored before and after the treatments. The constipation signs and symptoms were evaluated for the following:
Frequency of bowel movement
Difficulty in bowel movement
Time taken to bowel movement
Comfort during bowel movement (strain, incomplete bowel movement, bloating, etc.)
Type of Feces
Treatment effective rates were categorized into 4 tiers:
Full recovery: No functional constipation symptoms and physical signs. Improvement rate score ≥90%
Significant improvement: Significant improvement in functional constipation symptoms and physical signs. Improvement rate score ≥70%
Improvement: Moderate improvement in functional constipation symptoms and physical signs. Improvement rate score ≥30%
Ineffective: Little improvement in functional constipation symptoms and physical signs. Improvement rate score <30%
The clinical results of the study by Zheng et al. demonstrate that acupuncture is an effective procedure for the treatment of functional constipation. Compared with prior investigations, the classic front mu and back shu acupoint combination of the large intestine meridian demonstrates excellent rates of positive patient outcomes. Let’s take a look at another study.
Yang et al. (Tianjin and Tongren, China) investigated the effects of acupuncture and traditional herbal medicine on constipation in the elderly. They determined that the combination of both TCM modalities is a more effective constipation in the elderly treatment protocol than a conventional pharmaceutical medication. However, the results were close. TCM yielded a 100% total effective rate and the gastroprokinetic agent cisapride had a 94.83% total effective rate.
In the elderly, constipation is a common complication secondary to other illnesses. Epidemiological studies demonstrate that 60% of the elderly suffer from constipation to varying degrees (Du et al.). The prevention and cure for constipation therefore has a high clinical value and significance. Biomedical etiologies often point to poor peristaltic movement in many cases of constipation in the elderly. This lengthens the stool retention duration and hardens stools due to excess absorption of water.
Constipation may cause acute and chronic stress in the elderly. For elderly patients, exertion during bowel movements may cause a change in coronary and cerebral vascular flow, potentially leading to more threatening conditions including angina, acute myocardial infarction, arrhythmias, high blood pressure, cerebral vascular damage, or death. A common treatment for constipation with medications often employs the purgation method, which is effective in the short-term. However, long-term purgation treatments may result in electrolyte imbalances or varying degrees of stomachaches and diarrhea.
In TCM, chronic constipation in the elderly is often due to a weak liver and kidneys, poor qi and bood circulation, and subsequent malnourishment of the large intestine. TCM also states that long-term consumption of bitter and chilled foods damage the spleen and stomach, slows qi and blood replenishment, and ultimately weakens peristaltic movements thereby affecting the ability to evacuate feces. Professor Han Jing Xuan from Tianjin University of TCM established a protocol using the Sanjiao acupuncture method and the traditional herbal decoction Huang Di San. These two therapeutic approaches have been extensively used in the clinical treatment of a wide range of elderly related diseases including constipation in the elderly.
The acupuncture protocol involves the needling of Zhongwan, Zusanli, and Xuehai to promote spleen and stomach health. Xuehai also promotes blood circulation and minimizes blood stasis. The Waiguan acupoint circulates and nourishes qi in the Sanjiao (triple burner). The study by Yang et al. followed the protocols established by Prof. Han Jing Xuan.
Using the established protocols, acupuncture plus herbs achieved a 100% total effective rate. Cisapride achieved a 94.83% total effective rate. Furthermore, the long-term improvement rate for the Sanjiao acupuncture and Huang Di San protocol was 88.33%. Cisapride had a 46.55% long-term improvement rate.
A total of 118 elderly constipation patients were randomly divided into two groups: treatment group, control group. The control group was given cisapride and the treatment group was given the Sanjiao acupuncture and Huang Di San protocol. Upon starting and throughout the treatment, both groups were given daily activity recommendations: maintain positive emotions, consume high-fiber foods, keep warm. For the Sanjiao acupuncture therapy, the selected primary acupoints were the following:
After standard disinfection, a 0.25 mm disposable needle was swiftly inserted into each acupoint with a high entry speed. The Shanzhong acupoint was needled transverse-obliquely following the path of the Ren meridian for 0.5 – 1 inches. Other acupoints were pierced perpendicularly up to a depth of 0.5 – 1 inches. The Bu (rotate and push) manipulation technique was applied for Shanzhong, Zhongwan, Qihai, and Zusanli for 1 minute. The Xie (rotate and pull) technique was used on Xuehai for 1 minute. A needle retention time of 30 minutes was observed.
One 30 minute acupuncture session was conducted once per day. A full treatment cycle consisted of 10 days. The entire treatment course comprised 2 treatment cycles for a grand total of 20 days. The mandatory ingredients used in the Huang Di San herbal decoction were as follows:
Huang Jing (15 g)
Sheng Di Huang (15 g)
Sha Ren (15 g)
Pei Lan (15 g)
Shou Wu (15 g)
Dang Gui (15 g)
Additional herbs were added according to the nature of constipation. For patients with deficiency the following herbs were added:
Rou Cong Rong (12 g)
Bai Zhu (12 g)
Mai Dong (12 g)
Huang Qi (12 g)
Dang Shen (12 g)
Shan Yao (12 g)
For patients with primary deficiency with secondary excess (Ben Xu Biao Shi) differential diagnostic pattern differentiations, the following herbs were added:
Yu Li Ren (10 g)
Chuan Xiong (10 g)
Chi Shao (10 g)
Tao Ren (10 g)
Dan Zhu Ye (10 g)
The prescribed ingredients were brewed with water to make an herbal decoction. One brew was consumed orally per day in three separate doses throughout the day. One treatment cycle consisted of 10 days and the entire treatment course comprised 2 treatment cycles for a grand total of 20 days. Subjects in the control group took 10 mg of cisapride tablets, 3 times per day, before lunch, dinner, and sleeping. Treatment efficacy was categorized into 4 tiers:
Recovery: Bowel movement within 12 hours. No other symptoms. Scored 0 for interval between bowel movements
Significantly effective: Significant improvement in constipation. Bowel movement within 24 hours. Normal or slightly dry feces. No difficulty in bowel movement. Scored 1 – 9 for interval between bowel movements
Effective: Bowel movement within 72 hours. Moist feces. Slight difficulty in bowel movement. Scored 10 – 18 for interval between bowel movements
Ineffective: No changes in symptoms. Scored 19 – 20 for interval between bowel movements
The results indicate that acupuncture with herbs is more effective than the prescribed medication. Both studies mentioned in this report demonstrate that acupuncture is safe and effective for the treatment of constipation. Important features of TCM protocols is that they produce a high total effective rate, low relapse rate, and no significant adverse effects.
References:Ouyang, H. & Chen, J. Therapeutic roles of acupuncture in functional gastrointestinal disorders [J]. Alimentary pharmacology & therapeutics, 2004, 20(8): 831-841.
Zheng, H. B. & Chen,Y. (2015). A clinical randomized controlled trial of acupuncture at the combination of back shu point and front－mu point of large intestine meridian in the treatment of functional constipation. Practical Journal of Clinical Medicine. 4 (12).
Yang JX, Yu JC & Han JX. (2014). Clinical Study on Treatment of constipation in the elderly with Combination of Acupuncture and Chinese Medicine. World Science and Technology-Modernization of Traditional Chinese Medicine. 16(6).
Du WF, Yu L, Yan XK et al. (2012). Meta-analysis in acupuncture therapy in treating constipation. Journal of Chinese Acupuncture. 32(1): 92-96.
Source: Heath CMI
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