Electroacupuncture Combined with Chinese Medicine Ironing Therapy for Functional Constipation

Published: July 05, 2024

doi:

Liuying Li, Hui Yan, Jianzhi Cao, Fengya Zhu, Peimin Feng, Xia Zhou

¹Hospital of Chengdu University of Traditional Chinese Medicine, ²Traditional Chinese Medicine Department,Zigong First People’s Hospital

Summary

Electroacupuncture combined with Chinese medicine ironing therapy can effectively improve patients’ constipation symptoms and their quality of life. Here, we present a protocol to describe the treatment process of electroacupuncture combined with Chinese medicine ironing therapy for functional constipation.

Abstract

Functional constipation (FC) is a dysfunctional gastrointestinal disease with the main clinical manifestations of complex bowel movements, incomplete bowel movements, reduced frequency of bowel movements, and dry and hard stools, which seriously affect patients’ quality of life and psychology. Electroacupuncture improves constipation by performing acupuncture on specific points in the body to accelerate intestinal peristalsis. Chinese medicine ironing therapy (CMIT) can warm up the meridians, accelerate local blood circulation, promote gastrointestinal dynamics, and accelerate gastric emptying. This study elaborated on the method and steps of electroacupuncture combined with CMIT for functional constipation, including patient selection, material preparation, operation procedure, postoperative care, and precautions. The therapeutic effect of the method was also evaluated. The results of the study showed that after 4 weeks of treatment, compared with Western medicine alone, electroacupuncture combined with CMIT can improve the frequency of FC patients’ voluntary bowel movements, constipation, and quality of life. There were no obvious adverse reactions.

Introduction

Functional constipation (FC)¹is a chronic digestive disease that seriously affects patients' quality of life, mainly manifested by complex bowel movements, low frequency of bowel movements, hard or lumpy stools, and strained bowel movements². FC significantly impacts the life and psychology of patients³ and is an essential factor in inducing severe diseases such as abdominal pain⁴, sleep disorders⁵, colon cancer⁶, and cardiovascular diseases⁷. Studies show that about 10%-15% of the global population is affected by FC⁸. FC is chronic and poorly treated, with nearly 50% of patients not fully satisfied with conventional treatment⁹, as a substantial public health problem that imposes a significant financial burden on patients¹⁰^,¹¹. Therapeutic measures for FC include general treatment (increased fluid intake, dietary fiber supplementation¹²^,¹³, and exercise¹⁴) and pharmacological treatment (volumetric laxatives¹⁵, osmotic laxatives¹⁶, stimulant laxatives¹⁷, 5-hydroxytryptamine 4 receptor agonist¹⁸, and probiotics¹⁹^,²⁰^,²¹). However, most drugs have adverse effects such as drug dependence, diarrhea, bloating, flatulence, intestinal cramps, and esophageal obstruction. Therefore, the search for an effective treatment for FC with few side effects has attracted the attention of clinicians.

Acupuncture is a form of treatment that originated in ancient China and is often used to treat various digestive disorders. Based on acupuncture, electroacupuncture applies mild and continuous electrical stimulation to strengthen needle feeling and improve clinical efficacy. Electroacupuncture improved weekly complete spontaneous bowel movements (CSBMs)²² and raised the Bristol Stool Form Scale (BSFS) score²³. The mechanism may be related to promoting intestinal motility²⁴ and increasing 5-hydroxytryptamine and tryptophan hydroxylase in the colon²⁵. In general, electroacupuncture can effectively improve the clinical symptoms of FC patients²⁶ and enhance the quality of life and treatment satisfaction of patients²³^,²⁷.

Chinese medicine ironing therapy (CMIT) means heating a Chinese herbal medicine bag (called a reyan bag) and moving it back or rotating it at specific points. CMIT reduces nociceptive nerve excitability, improves blood circulation, promotes intestinal motility, and improves constipation through the physical effects of medicine and temperature²⁸. Foeniculum vulgare Mill, commonly called fennel, has been used in CMIT mainly to bring into play its ability to promote Qi, warm the meridians, regulate the elevation of the spleen and stomach to eliminate stagnation, and pass stools²⁹.

This study combined acupuncture with CMIT and acted on the gastrointestinal acupuncture points of FC patients to improve their constipation symptoms, providing a new and effective method for treating FC patients.

Protocol

The Institutional Review Committee of Zigong First People's Hospital reviewed and approved the clinical program. The treatment process, treatment principles, and adverse reactions were explained to the patients in detail in this study, and the patients were carried out after signing the informed consent form. 1. Patient assessment Inclusion criteria: Include patients who meet the Rome IV diagnostic criteria for functional constipation<sup class="xre…

Representative Results

This study screened and included 60 patients with FC from August 2022 to December 2022 who attended the Zigong First People's Hospital. The random number table method was used to divide the patients into the control group, experimental group A (electroacupuncture group), experimental group B (CMIT group), and group C (electroacupuncture + CMIT group), with 15 cases each. There were no statistical differences in gender, age, and disease duration among the four groups (see Table 1). <p class="jove_…

Discussion

The primary pathophysiological basis of FC is the decrease of intestinal motivity caused by sympathetic nerve tension and parasympathetic nerve excitability⁴². The pathogenesis of FC may be related to intestinal neurotransmitter dysfunction, oxidative stress index balance disruption, aquaporin expression abnormalities, abnormal changes in serum ions, intestinal flora disorders, colorectal sensory and motor function abnormalities, and psychological effects⁴³. Western medicin…

Disclosures

The authors have nothing to disclose.

Acknowledgements

This study was supported by the Key Research and Development Plan (Major Science and Technology Special Project) of the Sichuan Provincial Science and Technology Department (Number: 2022YFS0392) and the Key Discipline Construction Project of the Sichuan Provincial Administration of Traditional Chinese Medicine (Number:202072).

Materials

75% alcohol disinfectant	Shandong Anjie Gaoke Disinfection Technology Co. LTD	Q/371402AAJ008
Absorbent Cotton Swab	Zigong Jisheng Medical Equipment Co. LTD	Chuan machine registration 20162140199
Acupuncture needle (0.25 mm x 50 mm)	Suzhou Medical Supplies Factory Co. LTD	Su machine registration 20162270970
Disposable sterile cloth bag	Zigong first People's Hospital material department	N/A
Disposable sterile gloves	Kefu Medical Technology Co. LTD	Xiang machine registration 20202140410
Fennel	Huazhou Huayi Chinese Medicine slices Co.LTD	Yue 20160614
G91-A type electronic needle therapy instrument and supporting electrode wire	Suzhou Medical Supplies Factory Co. LTD	Su machine registration 20172270675
Lactulose oral solution	Abbott Trading (Shanghai) Co. LTD	H11022318

References

Savarino, E., et al. Functional bowel disorders with diarrhea: Clinical guidelines of the United European Gastroenterology and European Society for Neurogastroenterology and Motility. United European Gastroenterol J. 10 (6), 556-584 (2022).
Bassotti, G., Villanacci, V. A practical approach to diagnosis and management of functional constipation in adults. Intern Emerg Med. 8 (4), 275-282 (2013).
Prichard, D. O., Bharucha, A. E. Recent advances in understanding and managing chronic constipation. F1000Res. 7, (2018).
Wong, M. Y. W., Hebbard, G., Gibson, P. R., Burgell, R. E. Chronic constipation and abdominal pain: Independent or closely interrelated symptoms. J Gastroenterol Hepatol. 35 (8), 1294-1301 (2020).
Moezi, P., et al. Prevalence of chronic constipation and its associated factors in Pars cohort study: A study of 9000 adults in Southern Iran. Middle East J Dig Dis. 10 (2), 75-83 (2018).
Song, E. M., et al. Long-term risks of Parkinson’s disease, surgery, and colorectal cancer in patients with slow-transit constipation. Clin Gastroenterol Hepatol. 19 (12), 2577-2586 (2021).
Sumida, K., et al. Constipation and risk of death and cardiovascular events. Atherosclerosis. 281, 114-120 (2019).
Barberio, B., Judge, C., Savarino, E. V., Ford, A. C. Global prevalence of functional constipation according to the Rome criteria: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 6 (8), 638-648 (2021).
Nelson, A. D., et al. Comparison of efficacy of pharmacological treatments for chronic idiopathic constipation: a systematic review and network meta-analysis. Gut. 66 (9), 1611-1622 (2017).
Han, D., Iragorri, N., Clement, F., Lorenzetti, D., Spackman, E. Cost effectiveness of treatments for chronic constipation: A systematic review. Pharmacoeconomics. 36 (4), 435-449 (2018).
van Mill, M. J., Koppen, I. J. N., Benninga, M. A. Controversies in the management of functional constipation in children. Curr Gastroenterol Rep. 21 (6), 23 (2019).
Suares, N. C., Ford, A. C. Systematic review: the effects of fiber in the management of chronic idiopathic constipation. Aliment Pharmacol Ther. 33 (8), 895-901 (2011).
Lai, H., et al. Effects of dietary fibers or probiotics on functional constipation symptoms and roles of gut microbiota: a double-blinded randomized placebo trial. Gut Microbes. 15 (1), 2197837 (2023).
Gao, R., et al. Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials. Scand J Gastroenterol. 54 (2), 169-177 (2019).
Jalanka, J., et al. The effect of Psyllium husk on intestinal microbiota in constipated patients and healthy controls. Int J Mol Sci. 20 (2), 433 (2019).
Piche, T., Dapoigny, M. Comparative efficacy and safety of lactulose plus paraffin vs polyethylene glycol in functional constipation: a randomized clinical study. United European Gastroenterol J. 8 (8), 923-932 (2020).
Wei, L., et al. Topical therapy with rhubarb navel plasters in patients with chronic constipation: Results from a prospective randomized multicenter study. J Ethnopharmacol. 264, 113096 (2021).
Camilleri, M., et al. Efficacy and safety of Prucalopride in chronic constipation: An integrated analysis of six randomized, controlled clinical trials. Dig Dis Sci. 61 (8), 2357-2372 (2016).
Zhang, C., et al. Meta-analysis of randomized controlled trials of the effects of probiotics on functional constipation in adults. Clin Nutr. 39 (10), 2960-2969 (2020).
Dimidi, E., Mark Scott, S., Whelan, K. Probiotics and constipation: mechanisms of action, evidence for effectiveness and utilization by patients and healthcare professionals. Proc Nutr Soc. 79 (1), 147-157 (2020).
Martoni, C. J., Evans, M., Chow, C. T., Chan, L. S., Leyer, G. Impact of a probiotic product on bowel habits and microbial profile in participants with functional constipation: A randomized controlled trial. J Dig Dis. 20 (9), 435-446 (2019).
Liu, Z., et al. Acupuncture for chronic severe functional constipation: A randomized trial. Ann Intern Med. 165 (11), 761-769 (2016).
Yao, J. P., et al. Effectiveness and safety of acupuncture for treating functional constipation: An overview of systematic reviews. J Integr Med. 20 (1), 13-25 (2022).
Zhang, X., et al. Effect of manual acupuncture, electroacupuncture and moxibustion on intestinal motility and expression of enteric nervous activity related proteins in functional constipation rats. Zhen Ci Yan Jiu. 42 (5), 407-412 (2017).
Zhu, X., et al. The effect and mechanism of electroacupuncture at LI11 and ST37 on constipation in a rat model. Acupunct Med. 34 (3), 194-200 (2016).
Li, P., et al. Efficacy and safety of acupuncture at Tianshu (ST25) for functional constipation: Evidence from 10 randomized controlled trials. Evid Based Complement Alternat Med. 2020, 2171587 (2020).
Wu, X., et al. Electroacupuncture for functional constipation: A multicenter, randomized, control trial. Evid Based Complement Alternat Med. 2017, 1428943 (2017).
Liu, J., et al. Comparative observation on the curative effect of Chinese medicine ironing and ear point pressing after anal fistula operation. Sichuan Chinese Medicine. 39 (10), 205-208 (2021).
Qin, C., et al. Effect of hot cumin compresses on gastrointestinal function recovery after laparoscopic radical colorectal cancer surgery. Chinese Journal of Modern Medicine. 29 (20), 92-95 (2019).
Mearin, F., et al. Bowel disorders. Gastroenterology. 150 (6), 1393-1407.e5 (2016).
Vriesman, M. H., Koppen, I. J. N., Camilleri, M., Di Lorenzo, C., Benninga, M. A. Management of functional constipation in children and adults. Nat Rev Gastroenterol Hepatol. 17 (1), 21-39 (2020).
Li, J., et al. Consensus opinion on the combined diagnosis and treatment of functional constipation in Chinese and Western medicine (2017). Chinese Journal of Integrative Medicine and Digestion. 26 (01), 18-26 (2018).
Lv, Y., et al. Combining Chinese and Western medicine therapy in treating functional constipation in 52 cases is effective. Chinese Journal of Anorectal Diseases. 42 (09), 37-39 (2022).
Zhu, J., et al. Efficacy and safety of vibrating capsule for functional constipation (VICONS): A randomized, double-blind, placebo-controlled, multicenter trial. EClinicalMedicine. 47, 101407 (2022).
Tsai, Y. J., Yang, Y. W., Lan, Y. T. Translation and validation of the traditional Chinese version of the constipation severity instrument. J Chin Med Assoc. 84 (3), 299-302 (2021).
Ibarra, A., Latreille-Barbier, M., Donazzolo, Y., Pelletier, X., Ouwehand, A. C. Effects of 28-day Bifidobacterium animalis subsp. lactis HN019 supplementation on colonic transit time and gastrointestinal symptoms in adults with functional constipation: A double-blind, randomized, placebo-controlled, and dose-ranging trial. Gut Microbes. 9 (3), 236-251 (2018).
Zhong, F., et al. A randomized controlled study on treating functional constipation by electroacupuncture of the large intestine with acupuncture points under the acupuncture points with matching ends. Sichuan TCM. 36 (04), 185-188 (2018).
Park, H. J., et al. A comparison between directional and proportional methods in locating acupuncture points using dual-energy X-ray absorptiometry in Korean women. American Journal of Chinese Medicine. 34 (5), 749-757 (2006).
Shen, X. Y. . Meridians and Acupoints. , (2010).
Godson, D. R., Wardle, J. L. Accuracy and precision in acupuncture point location: A critical systematic review. Journal of Acupuncture and Meridian Studies. 12 (2), 52-66 (2019).
Zhang, H. . Cupping treatment the clinical effect of the treatment of functional constipation and experimental research. , (2019).
Black, C. J., Drossman, D. A., Talley, N. J., Ruddy, J., Ford, A. C. Functional gastrointestinal disorders: advances in understanding and management. Lancet. 396 (10263), 1664-1674 (2020).
An, D. W., et al. Progress in the study of the mechanism of functional constipation. Chinese Modern Physicians. 61 (04), 121-124 (2023).
Hao, Z., et al. Effectiveness of concomitant use of green tea and polyethylene glycol in bowel preparation for colonoscopy: a randomized controlled study. BMC Gastroenterol. 20 (1), 150 (2020).
Wu, S., et al. Assessment of the effectiveness, compliance, and effect on blood electrolytes of polyethylene glycol, mannitol, and magnesium sulfate in bowel preparation before colonoscopy. China Practical Medicine. 14 (30), 88-89 (2019).
Xiao, J. Discovery of a case of pharmacogenetic colonic melanosis and thoughts on pharmacy services. Practical Drugs and Clinics. 26 (03), 237-240 (2023).
Zhang, Z., et al. Progress of research on the effects and mechanisms of anthraquinone-containing herbal medicines on colonic melanosis. Journal of Tianjin University of Traditional Chinese Medicine. 41 (04), 539-544 (2022).
Li, G., et al. Overview of research on the treatment of functional constipation with Chinese medicine specialties. Henan TCM. 43 (01), 146-151 (2023).
Ma, Q., et al. Clinical study on treating Yang deficiency type chronic functional constipation with warm acupuncture and moxibustion at the Eight Shao points. Journal of Guangzhou University of Traditional Chinese Medicine. 40 (02), 363-367 (2023).
Liu, S., et al. Clinical exploration of acupuncture and moxibustion for treating functional constipation in the elderly based on the five viscera Yuanzhen flux theory. Chinese Journal of Basic Chinese Medicine. 28 (11), 1841-1844 (2022).
Wang, Y., et al. Current clinical research on treating functional constipation in the elderly with acupressure points. Massage and Rehabilitation Medicine. 13 (24), 44-46 (2022).
Xia, J., et al. Clinical observation on treating functional constipation by acupuncture point application of Yi Qi intestine moving cream. Chinese Traditional Chinese Medicine Science and Technology. 29 (05), 834-836 (2022).
Hu, Y., et al. The efficacy of using Ziwu Liujiao herbal hot ironing, abdominal massage, and laxative formula to prevent functional constipation. Clinical Research in Chinese Medicine. 12 (22), 18-21 (2020).
Zhang, S., et al. Effect of Chinese herbal enema combined with acupressure in treating elderly patients with functional constipation. Chinese Journal of Drug Abuse Prevention and Control. 28 (12), 1870-1873 (2022).
. Acupuncture: Review and analysis reports on controlled clinical trials Available from: https://iama.edu/wp-content/uploads/2019/10/acupuncture_WHO_full_report.pdf (2019)
Du, Y., et al. Study on the spectrum of acupuncture diseases in the digestive system. Clinical Journal of Acupuncture and Moxibustion. 3, 1-2 (2006).
Liu, L., et al. Evaluation of the safety and efficacy of acupuncture in treating chronic functional constipation. Liaoning Journal of Traditional Chinese Medicine. 48 (03), 159-162 (2021).
Xie, L., et al. Exploring the improvement mechanism of gastrointestinal dynamics of functional constipation by electroacupuncture at Shenqui point based on water channel protein 3 and nuclear transcription factor-κB signaling pathway. Journal of Anhui University of Traditional Chinese Medicine. 40 (05), 64-69 (2021).
Badgujar, S. B., Patel, V. V., Bandivdekar, A. H. Foeniculum vulgare Mill: a review of its botany, phytochemistry, pharmacology, contemporary application, and toxicology. Biomed Res Int. 2014, 842674 (2014).
Rahimi, R., Ardekani, M. R. Medicinal properties of Foeniculum vulgare Mill. in traditional Iranian medicine and modern phytotherapy. Chin J Integr Med. 19 (1), 73-79 (2013).
Li, Y. R. Effect evaluation of Chinese medicine Remai Bao combined with acupoint hot compress nursing intervention in elderly patients with chronic functional constipation. Chronic Epidemiology Magazine. 23 (4), 638-640 (2022).
Wang, Y. Q. Observation on nursing effect of Wuren reyan bag pushing and ironing external application on senile constipation. Hunan Journal of Traditional Chinese Medicine. 36 (11), 111-113 (2020).
Ma, P. H., et al. Theoretical basis and clinical application of "Hezhi inner government". Jilin Province Traditional Chinese medicine. 5 (01), 81-84 (2017).
Wu, J., et al. Comparison of efficacy of different acupuncture points in treating functional constipation: randomized controlled trial. Chinese Journal of Acupuncture and Moxibustion. 34 (06), 521-528 (2014).