Recalcitrant Constipation & Acupuncture

abstracted & translated by

Honora Lee Wolfe, Lic. Ac., Dipl. Ac., FNAAOM (USA)

In issue #7, 2003 of Gan Su Zhong Yi (Gansu Chinese Medicine) , Wu Luan-ling published an article titled, "A Report on the Treatment of 35 Cases of Recalcitrant Constipation with Acupuncture." This article appeared on pages 32-33 of that journal. Because constipation is such a common problem in clinical practice, a summary of this article's main points is given below.

Keywords: Chinese medicine, acupuncture, constipation

Cohort description

All 35 patients described in this study were seen as out-patients at the author's hospital in Guangdong province. They ranged in age from 30-70 years. The shortest course of disease was half a year, while the longest was 20 years. The shortest interval between bowel movements was three days, the longest was 10 days, and the average was five days. In terms of Chinese medical pattern discrimination, eight cases presented intestine and stomach accumulation and heat, seven cases presented qi mechanism depression and stagnation, 10 presented qi and blood depletion and vacuity, and five cases presented kidney yang vacuity. During acupuncture treatment, all other medications and treatments for constipation were suspended.

Treatment method

The main acupuncture points treated in this protocol were Tian Shu (St 25), Da Chang Shu (Bl 25), and Shang Ju Xu (St 37). If there was intestine and stomach accumulation and heat, Qu Chi (LI 11) and Nei Ting (St 44) were added. For qi mechanism depression and stagnation, Zhi Gou (TB 6) and Tai Chong (Liv 3) were added. For qi and blood depletion and vacuity, Pi Shu (Bl 20), Wei Shu (Bl 21), Zu San Li (St 36), and San Yin Jiao (Sp 6) were added. And for kidney yang vacuity, Guan Yuan (CV 4) and Shen Shu (Bl 23) were added. Thirty gauge needles were inserted relatively deeply at these points with a definite sensation of obtaint of the qi. The three main points were treated with even supplementing-even draining hand technique. Qu Chi, Nei Ting, Zhi Gou , and Tai Chong were treated with draining technique, strong stimulation, and no moxibustion. Pi Shu, Wei Shu, Shen Shu, Zu San Li, Guan Yuan , and San Yin Jiao were treated with supplementing hand technique and two cones of moxa were burned on the top of each needle. The needles were retained for 30 minutes each time, and treatment was administered once per day. Five days equaled one course of treatment, and a two day rest was allowed between each successive course.

Treatment outcomes

Outcomes were tabulated and assessed after 1-2 courses of treatment. Cure was defined as one bowel movement per day with soft, moist stools and no discomfort during defecation. Improvement meant that defecation was daily or every other day, the stools were soft and moist, and defecation was easy. Based on these criteria, 24 cases or 68.6% were cured, nine cases or 25.7% improved, and two cases (5.7%) got no effect.

Discussion

When I was studying acupuncture with Dr. (Eric) Tao Xi-yu in Denver, CO, Dr. Tao started his students off with a repertoire of empirical formulas for commonly seen diseases and conditions, such as constipation. Dr. Tao believed that treatment based on pattern discrimination was something that had to be learned over time through clinical experience. He also understood that real patients with chronic conditions do not commonly present a, single, nice, neat textbook pattern. Instead, disease mechanisms are mutually engendering and, therefore, it is more common to see patients presenting with three, four, and even five patterns simultaneously. Rather than making the practice more difficult for beginners, in an ironic sort of way, it actually makes practice easier. Because many patients present similar constellations of disease mechanisms, it is possible to create and use basic formulas that treat the majority of cases of a particular condition, constipation being, I find, a case in point.

Dr. Tao's acupuncture formula for chronic constipation is quite similar to the above protocol if one also takes into account Dr. Wu's auxiliary points. It consists of: Tian Shu (St 25), Da Chang Shu (Bl 25), Zu San Li (ST 36), Yang Ling Quan (GB 34), Zhi Gou (TB 6), Nei Ting (St 44), He Gu (LI 4), and Zhao Hai (Ki 6). Dr. Wu and Dr. Tao have both selected Tian Shu and Da Chang Shu as two of their three main points. Tian Shu and Da Chang Shu are the front alarm and back transport points of the large intestine and have a direct connection to that bowel. Thus they can be used for any large intestine affection when combined with other appropriate points and stimulated with appropriate hand technique. In explaining his choice of Shang Ju Xu , Dr. Wu quotes the saying from the Nei Jing (Inner Classic) , "The uniting [points] treat the internal viscera." Zu San Li is also a uniting point. Dr. Tao preferred to use it for all digestive tract conditions since its therapeutic effects are so reliable. Dr. Tao tended to reserve the lower uniting points for acute replete conditions as opposed to chronic ones and especially vacuities. Likewise, Dr. Tao preferred to use Yang Ling Quan and Zhi Gou for the treatment of liver depression causing stagnation to the qi mechanism resulting in constipation. I personally think this was because Yang Ling Quan is a point on the paired foot yang channel and, therefore, is good for stimulating qi or function which is yang. It may also have been because Zhi Gou is on the hand shao yang and the hand and foot shao yang are a unit. He included these two points in his basic formula because qi stagnation due to liver depression plays such a common role in chronic constipation. While Dr. Wu only suggests Nei Ting if there is replete accumulate and heat, Dr. Tao also included Nei Ting in his basic formula. This is because of the tendency for the liver and stomach to transform heat when the liver becomes depressed and the qi becomes stagnant. Instead of pairing Nei Ting with Qu Chi , Dr. Tao preferred He Gu . I think this is because the combination of Zu San Li and He Gu also regulates and rectifies the upbearing and downbearing of the entire qi mechanism and especially of the stomach and intestines. And finally, Dr. Tao routinely added Zhao Hai in his treatment of chronic or habitual constipation. This is because he believed this point is able to supplement yin fluids and, therefore, moisten the intestines, particularly when combined with Nei Ting, the water point of the foot yang ming. Due to enduring depressive heat, intestinal fluids are often damaged and there is insufficient water to "float the boat."

Long before I really understood the interrelationships between the disease mechanisms of constipation or the rationale behind the selection of these points, I routinely used this formula for the treatment of chronic constipation to good clinical effect. It is nice to see a controlled clinical trial confirm the efficacy of such a similar combination of points.

Copyright © Blue Poppy Press, 2004. All rights reserved.