Acupuncture Continuing Education

Acupuncture Relieves Constipation, Antiquity Meets Science

Researchers find acupuncture effective for the alleviation of constipation. Zhejiang Tongde Hospital researchers tested the validity of an ancient acupuncture point prescription used for the treatment of constipation with a controlled scientific clinical experiment. The researchers find acupuncture “increases the contractile activity of intestinal smooth muscle and benefits bowel movements.” The researchers add that acupuncture “significantly improves CSBMs [complete spontaneous bowel movements] for patients with severe functional constipation.” The Zhejiang Tongde Hospital findings were published in research entitled Electroacupuncture in Treating Severe Functional Constipation: A Randomized Controlled Trial.

 

Acupuncturist needling acupoint ST25 (Tianshu)Acupuncturist needling ST25 (Tianshu) 

Seventy humans participated in the study. All participants suffered from functional constipation. This is a form of constipation without a known organic etiology. Functional constipation is characterized by two or less defecations per week, fecal incontinence, painful or hard bowel movements, large diameter stools, or volitional stool retention. 

The hospital researchers tested a time honored acupuncture treatment used for regulating peristalsis (intestinal constriction and relaxation that creates wavelike movements, which pushes stools through the intestine) and digestion. The research definitively proves that acupuncture promotes healthy peristaltic movements and subsequently alleviates constipation. Patient outcomes were evaluated using modern scientific methodologies. For control and accuracy study design purposes, true acupuncture (verum acupuncture) was compared with fake acupuncture (sham acupuncture). Using this approach to the study design, the researchers determined that acupuncture produces significant positive patient outcomes for patients with functional constipation.

Inclusion criteria were as follows. All participants were diagnosed with severe functional constipation. The patients were randomly divided into two groups: true acupuncture group, sham control group. There were 35 patients in each group. Patients participating in the study met the following inclusion criteria:

  • Rome III diagnostic standard for functional constipation
  • Diagnosed with severe constipation, with complete spontaneous bowel movements (CSBMs) ≤2 times per week for no less than three consecutive months
  • Between 18—75 years of age
  • Did not take any anti-constipation drugs within at least 2 weeks prior to the research start date
  • Did not participate in other clinical research

Exclusion criteria were applied. This assured that patient participating in the study suffered from functional constipation and not constipation secondary to a separate, known etiology. Patients who had the following conditions did not participate in the study:

  • Constipation secondary due to biologically identified illnesses
  • Severe primary and concomitant cardiovascular, liver, kidney, digestive, or hematopoietic diseases
  • Unable to follow instructions from researchers due to ambiguous consciousness or psychosis
  • Pregnant or lactating
  • Progressive malignant tumors or other severe consumptive diseases
  • Prone to infection and bleeding or taking anticoagulant drugs
  • Uses a heart pacemaker

Let’s take a close look at the acupuncture point prescription. The acupoints selected for the treatment group were the following:

  • ST25 (Stomach 25, Tianshu)
  • SP14 (Spleen 14, Fujie)
  • ST37 (Stomach 37, Shangjuxu)

These are acupoints used in classic acupuncture point prescriptions within the Traditional Chinese Medicine (TCM) system. According to TCM principles, Tianshu (translated as heaven’s pivot or celestial pivot) is the front-mu point of the large intestine. In the USA, the numerical designation of ST25 is typically used to refer to this acupoint, which is located 2 cun lateral to the navel, bilaterally. As the front-mu point of the large intestine, this acupoint is an important center wherein the qi of the large intestine coalesces. In biomedical terms, the application of acupuncture needles to this acupoint has an immediate stimulatory and regulatory effect on peristalsis. This acupoint exerts a homeostatic effect on the large intestine and is therefore traditionally indicated for the treatment of both diarrhea and constipation. The focus of the Zhejiang Tongde Hospital research was to scrutinize Tianshu’s ability to alleviate constipation.

The study stresses the importance of the acupoint Fujie (translated as abdomen knot) in the acupuncture point prescription protocol. Numerically designated as SP14, this acupoint is 4 cun lateral to the navel and 1.3 cun inferior to the level of the navel. This acupoint may be located using palpation;it is located on the lateral border of the rectus abdominis muscle. The researchers comment that according to the Zhen Jiu Jia Yi Jing (Classic of Acupuncture and Moxibustion), a textbook written during the Jin Dynasty, SP14 is effective for the treatment of constipation. This classic work, written by Huang-fu Mi, was originally published in 282 CE. The earliest extant version is dated 1601. The researchers endeavored to test the efficacy of this ancient acupuncture point indication using a scientific study design.

ST25 and SP14 are both local to the large intestine. The third acupoint implemented in the acupuncture point prescription protocol is distal to the large intestine. ST37 (Shangjuxu) is located on the lower leg, 6 cun inferior to the tibofemoral joint line and in the depression lateral to the anterior crest of the tibia. Licensed acupuncturists often locate this acupoint 3 cun inferior to ST36 and 10 cun superior to the prominence of the lateral malleolus. ST37 (translated as upper great void) is the lower he-sea of the large intestine and is the point of the sea of blood.

The lower he-sea designation to ST37 makes it particularly important within the TCM system for the treatment of large intestine related disorders. There are only three acupoints given the lower he-sea designation: ST37 (large intestine lower he-sea), ST39 (small intestine lower he-sea), BL39 (Sanjiao lower he-sea). ST37’s designation as the large intestine lower he-sea was originally delineated in the Yellow Emperor’s Inner Classic (Huangdi Neijing), written approximately 2,000 years ago. Scholars tend to agree that the first publication of this classic TCM work was between 475 – 200 BCE. From a modern medical perspective, it is interesting that researchers continue to validate the accuracy of this ancient work.

The acupuncture point prescription was administered with both manual and electroacupuncture techniques. ST25 and SP14 were needled with 0.3 mm diameter needles (Chinese gauge 30, Japanese gauge 8) to standard depths. Deep needling is contraindicated, especially in thin patients. Electroacupuncture was applied to the acupoints (0.1—1.0 mA, 15 Hz). ST37 was needled with 0.3 mm X 40 mm needles to standard needling depths. After achieving a deqi sensation at ST37, the needles were rotated, lifted, and thrust every 10 minutes. For both the treatment group and the control group, one 30 minute acupuncture session was conducted per day. A full course of treatment lasted for 8 consecutive weeks. To evaluate the treatment effective rate, patients were scored before and after the treatments.

Sham acupuncture was applied to participants in the control group. The method chosen for the study design was active sham non-acupoint stimulation. The locations for the sham points were as follows:

  • 1 inch lateral to ST25
  • 1 inch lateral to SP14
  • 1 inch lateral to BL25

The following protocol was observed. Each acupoint was pierced with a 0.3 mm X 40 mm filiform acupuncture needle to a shallow depth of 2 mm. Next, an electroacupuncture device was connected to the acupoints. The device was powered off but the patients were informed that electricity was set to 0.5 mA, at 15 Hz.

This represents a slightly controversial study design because shallow needling of non-acupoints for sham controls may exert potential therapeutic benefits associated with Ahshi acupoints. Nevertheless, the data indicates that true acupuncture alleviated functional constipation and sham acupuncture did not. Only true acupuncture regulated peristalsis. The researchers note of true acupuncture, “electroacupuncture increases the contractile activity of intestinal smooth muscle and benefits bowel movements.” They add that only true acupuncture resulted in “significantly improved complete spontaneous bowel movements (CSBMs) in patients with severe functional constipation.”

The researchers measured positive patient outcomes and determined that acupuncture is effective for the alleviation of functional constipation. Sham controls eliminated outcome measures produced by the placebo effect. Further, the researchers tested the validity of ancient acupuncture point prescription protocols and validated their efficacy. In a modernization of ancient acupuncture, electroacupuncture was added to the treatment protocol. The results indicate that acupuncture is both safe and effective for the treatment of functional constipation.

 

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References
Shen YF, Fang JQ, Chen LF et al. Electroacupuncture in Treating Severe Functional Constipation: A Randomized Controlled Tria [J]. Shanghai Journal of Acupuncture and Moxibustion, 2016, 35(12).

Longstreth GF, Thompson WG, Chey WD, et al. Functional Bowel Disorders [J]. Gastroenterology, 2006, 130(5):1480-1491.

Guo R. Analysis of Mood and Sleep in Patients with Function Constipation [J]. China Modern Medicine, 2013, 20 (26):29-30.

Du WF, Yu L, Yan XK et al. Meta-analysis on Randomized Controlled Clinical Trials of Acupuncture and Moxibustion on Constipation, 2012, 32(1):92-96.

 


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