Therapeutic Observation of Warm Needling plus Tuina for Senile Functional Constipation

Community Health Service Center, Huajing Township, Xuhui District, Shanghai, Shanghai 200231, China

CLINICAL STUDY

Therapeutic Observation of Warm Needling plus Tuina for Senile Functional Constipation

Li Ying, Hua Yu, Zhong Ning

Community Health Service Center, Huajing Township, Xuhui District, Shanghai, Shanghai 200231, China

Author:Li Ying, associate general physician of Chinese medicine.

E-mail: ly13636340857@sohu.com

Objective: To observe the clinical efficacy of warm needling plus tuina in treating senile functional constipation.

Methods: Ninety elderly patients with functional constipation were randomized into two groups. Forty-six patients in the treatment group were intervened by warm needling plus tuina; the other forty-four patients in the control group were intervened bySan Huangtablet.

Results: In the treatment group, 19 patients were cured, 24 cases showed improvement, 3 cases failed, and the total effective rate was 93.5%; in the control group, 16 patients were cured, 18 cases showed improvement, 10 cases failed, and the total effective rate was 77.3%. There was a significant difference in comparing the therapeutic efficacy (P＜0.05), and the therapeutic efficacy of the treatment group was higher than that of the control group.

Conclusion: Warm needling plus tuina can produce a higher therapeutic efficacy than takingSan Huangtablet in treating senile functional constipation.

Acupuncture Therapy; Tuina; Massage; Warm Needling Therapy; Moxibustion Therapy; Constipation; Aged

Functional constipation is a common problem in the elderly, manifested by hard or lumpy stools, difficulty defecating or sensation of incomplete evacuation, and decreased defecation times. It often affects more women than man. In China, people over 60 years old has a prevalence rate of 18.0%-23.0%, and the incidence increases with age[1]. Long-term constipation may induce hemorrhoids, cardio-cerebro-vascular diseases, emotional disorders such as anxiety and depression, and increase the risk of intestinal cancer, deeply affecting the mental health and quality of life of the elderly[2]. Therefore, it’s of great significance to adopt positive, accurate, standard, and proper treatment to keep smooth defecation for the old people. In the recent years, we have adopted warm needling plus tuina in treating functional constipation of the elderly. The report is now given as follows.

1 Clinical Materials

1.1 Diagnostic criteria

1.1.1 Diagnostic criteria of traditional Chinese medicine

The traditional Chinese medicine diagnosis referred to the diagnostic criteria of constipation in theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[3]. Elongated defecation interval, once every 3 d, dry and hard stools; difficulty passingstools, lumpy stools, with abdominal distension and pain, lassitude and fatigue, poor appetite; organic intestinal diseases excluded.

1.1.2 Diagnostic criteria of Western medicine

It was according to Rome III diagnostic criteria of functional constipation[4]. (1) Must include at least 2 of the following 6 symptoms: ① straining ≥25% of defecations; ② lumpy or hard stools ≥25% of defecations; ③ sensation of incomplete evacuation≥25% of defecations; ④ sensation of anorectal obstruction or blockage ≥25% of defecations;⑤manual maneuvers to facilitate ≥25% of defecations (e.g. digital evacuation, support of the pelvic floor); ⑥ ＜3 defecations a week. (2) Loose stool rarely present without use of laxatives. (3) Insufficient criteria for irritable bowel syndrome (IBS).

The onset ≥6 months prior to diagnosis, and the symptoms ≥3 months.

1.2 Inclusion criteria

Conforming to the above diagnostic criteria; age over 60 years old; without use of prokinetic agents at least 1 week prior to the recruit to the study.

1.3 Exclusion criteria

Organic intestinal diseases such as inflammatory bowel syndromes, intestinal tuberculosis, colon lumps; with a history of gastrointestinal operation; severe primary diseases or mental disorders; severe heart, liver, or kidney dysfunctions; with a risk of hemorrhage; unwilling to accept the treatment protocol.

1.4 Statistical methods

The SPSS 14.0 version software was used for statistical analyses. The measurement data were expressed as mean ± standard deviationand analyzed by usingt-test; the enumeration data were analyzed by Chi-square test.P＜0.05 indicated a statistical significance.

1.5 General data

The included 90 patients were all from the Department of Traditional Chinese Medicine, Community Health Service Center, Huajing Township, Xuhui District, Shanghai, and its 6 affiliated health states. The subjects were randomized into two groups. There were no significant differences in comparing the gender, age, and disease duration between the two groups (allP＞0.05), indicating the comparability (Table 1).

Table 1. Comparison of general data

2 Treatment Methods

2.1 Treatment group

2.1.1 Warm needling

Major acupoints: Zhongwan (CV 12), Xiawan (CV 10), Guanyuan (CV 4), and Qihai (CV 6).

Adjunct acupoints: Bilateral Tianshu (ST 25), Daheng (SP 15), Shangjuxu (ST 37), and Zhigou (TE 6).

Acupoints selection based on syndrome differentiation: Quchi (LI 11) and Hegu (LI 4) were added for stagnation due to heat; Taichong (LR 3) and Xingjian (LR 2) for qi stagnation; Xuehai (SP 10) and Zusanli (ST 36) for qi-blood deficiency; moxibustion applied to Shenque (CV 8) for yang deficiency.

Operation: The patient took a supine position. Filiform needles of 0.30 mm in diameter and 45-60 mm in length were used to perpendicularly puncture the above acupoints by 15-25 mm (the depth should be adjusted according to individual constitution and the treated location). Mild twirling and slow lifting-thrusting manipulations were applied to produce dull pain or distending feeling in the local area. The major points, Zhongwan (CV 12), Guanyuan (CV 4), and Qihai (CV 6), and the adjunct points, bilateral Tianshu (ST 25) and Daheng (SP 15) were applied with warm needling with moxa sticks of 2 cm in length stuck onto the needle tail. The moxa was lit from the bottom, a segment as one cone. A piece of cardboard could be placed under the needle to prevent burn. Two cones were applied for each point before the needles were removed.

2.1.2 Tuina

The patient took a supine position. The practitioner first applied one-finger Tui-pushing manipulation to Zhongwan (CV 12), Tianshu (ST 25), Daheng (SP 15), and Guanyuan (CV 4), lasting for 1 min (Figure 1). Afterwards, Mo-rubbing manipulation was performed on abdomen clockwise for 10 min (Figure 2); followed by An-pressing and Rou-kneading at Zhongwan (CV 12), Tianshu (ST 25), and Daheng (SP 15) (Figure 3, Figure 4), and Mo-rubbing on the projection zones of transverse colon and sigmoid colon (Figure 5).

The patient then took a prone position. The practitioner conducted one-finger Tui-pushing manipulation along the bilateral Bladder Meridian on the back downward from Ganshu (BL 18) and Pishu (BL 20) for 5 min (Figure 6); followed by An-pressing and Rou-kneading Shenshu (BL 23), Dachangshu (BL 25), and Changqiang (GV 1) for 3 times (Figure 7); finally Ca-scrubbing manipulation was applied to lumbosacral region (Figure 8).

The above treatment was given once a day, 10 times as a treatment course, with a 3-day interval between two courses.

2.2 Control group

Subjects in the control group tookSan Huangtablet (manufactured by Shanghai Yu An Pharmaceutical Co., Ltd.), 1.2 g each time, twice a day.

2.3 Cautions

The patients were asked to have a regular diet: no over-eating, no bias or adephagia; diet should consist of both fine food and roughage; taking more vegetables and fruits. The patients were also asked to form a good defecation habit.

Figure 1. One-finger Tui-pushing abdomen

Figure 2. Mo-rubbing abdomen

Figure 3. An-pressing and Rou-kneading middle abdomen

Figure 4. An-pressing and Rou-kneading Tianshu (ST 25)

Figure 5. Mo-rubbing the projection zones of transverse colon and sigmoid colon

The patient then took a prone position. The practitioner conducted one-finger Tui-pushing manipulation along the bilateral Bladder Meridian on the back downward from Ganshu (BL 18) and Pishu (BL 20) for 5 min (Figure 6); followed by An-pressing and Rou-kneading Shenshu (BL 23), Dachangshu (BL 25), and Changqiang (GV 1) for 3 times (Figure 7); finally Ca-scrubbing manipulation was applied to lumbosacral region (Figure 8).

Figure 6. One-finger Tui-pushing the Bladder Meridian on the back

Figure 7. An-pressing and Rou-kneading the points on back

Figure 8. Ca-scrubbing lumbosacral region

2.4 Treatment duration

The therapeutic efficacies were evaluated after 3 successive treatment courses, as well as a month after the intervention. The intervention had to be deceased if diarrhea occurred, and this subject would be considered as a cured case; while it would be considered as invalid when a 3-day treatment didn’t lead to defecation.

3 Observation of Therapeutic Efficacy

3.1 Criteria of therapeutic efficacy

The criteria of therapeutic efficacy were made according to theCriteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[3].

Recovery: Defecation within 2-day treatment, smooth stools and defecation.

Improvement: Defecation within 3-day treatment, smooth stools but unsmooth defecation.

Invalid: No improvement of constipation symptoms.

3.2 Treatment results

The total effective rate was 93.5% in the treatment group versus 77.3% in the control group, and the difference was statistically significant (P＜0.05). The therapeutic efficacy of the treatment group was significantly higher than that of the control group (Table 2).

Table 2. Comparison of clinical efficacy (case)

A month later, 5 patients got a relapse in the treatment group, and the long-term effective rate was 88.4%; while 14 patients got a relapse in the control group, and the long-term effective rate was 58.8%, and the difference in comparing the long-term effective rate was statistically significant (P＜0.01).

3.3 Adverse events

Patients in the treatment group felt comfortable, without adverse effects like abdominal pain or diarrhea. In the control group, 7 patients suffered diarrhea and abdominal pain, 9 cases had abdominal pain, and the adverse event rate was 36.4%. There was a significant difference in comparing the adverse event rate between the two groups (P＜0.01).

4 Discussion

Traditional Chinese medicine holds that functional constipation of the elderly is mainly caused by function decline of Zang-fu organs, and deficiency of qi, blood, yin and yang. Large intestine is the diseased location, however it’s closely related to the function of lung, spleen, and kidney, mostly presenting deficient syndrome, especially qi and yang deficiency[5]. Therefore, traditional Chinese medicine usually treats this disease by tonifying qi and warming yang, regulating qi to promote defecation, reinforcing yin and moisturizing intestine, nourishing blood and moisturizing dryness[6]. In this study, Zhongwan (CV 12), Xiawan (CV 10), Guanyuan (CV 4), and Qihai (CV 6) were selected as the major points for warm needling treatment. Guanyuan (CV 4) can nourish kidney and improve constitution, tonify qi and yang. Zhongwan (CV 12) and Xiawan (CV 10) both belong to the middle abdomen. Zhongwan (CV 12) is not only the Front-Mu point of the stomach, but also the Influential point of Fu organs. Combining use of Zhongwan (CV 12) and Xiawan (CV 10) can regulate the middle jiao and the qi flow. Qihai (CV 6) works to supplement qi. The above four points together can induce qi to the primary, cultivating the congenital with the post-natal. Tianshu (ST 25), Daheng (SP 15), Shangjuxu (ST 37), and Zhigou (TE 6) were selected asthe adjunct points to reinforce qi and warm yang, regulate and unblock the three jiao. As the Front-Mu point of the large intestine, Tianshu (ST 25) can ascend the clear and descend the turbid, regulate the qi activities, and unblock the three jiao, for dredging the Fu organs[7-9]. Daheng (SP 15) works to dispel dampness and tonify spleen, thus modulating the function of spleen. Shangjuxu (ST 37) is the lower He-Sea point of the large intestine, working to regulate and unblock qi of the large intestine. Zhigou (TE 6) can disperse the qi activities of the three jiao, which guarantees the smooth flow of qi in Fu organs. Meanwhile, warm needling again strengthens the function of tonifying qi and yang, warming and unblocking meridians and collaterals.

By selecting topical meridians and acupoints, tuina treatment combines the anatomical theory and traditional Chinese medicine theories. It promotes the gastrointestinal movement and defecation by manipulations directly worked on abdomen; at the same time, the heat produced by constant manipulations can also enhance the blood circulation in gastrointestinal tract, and subsequently promote defecation[10-12].

Warm needling plus tuina can improve qi flow and unblock stagnation, and moisturize intestine to promote defecation, without bringing pain to patients. Moreover, it’s safe and easy-to-operate, with a content compliance while without adverse effects. This treatment is proper for promotion in the community.

Conflict of Interest

There was no conflict of interest in this article.

Acknowledgments

This work was supported by Special Project for Personnel Training of Traditional Chinese Medicine, Xuhui District, Shanghai (No. ZYKT201227).

Statement of Informed Consent

All of the patients signed the informed consent.

[1] You J, Li ST, Zhang J, Chen ZW. Research progress of traditional Chinese medicine in treating functional constipation. Neimenggu Zhongyiyao, 2007, 26(10): 48-50.

[2] Wu JN, Liu XH, Liu W, Ke MY, Fang XC, Zhao HC, Zhang M, Xie PY, Hao JY, Xu XP, Qian DM, Xu BH, Lan Y, Long JB. Investigation of the mental state and quality of life of the functional constipation patients: a multi-centered clinical investigation. Zhonghua Shiyong Neike Zazhi, 2009, 29(3): 237-239.

[3] State Administration of Traditional Chinese Medicine. Criteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine. Nanjing: Nanjing University Press, 1994: 11.

[4] Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, Moss AJ, Seidman CE, Young JB, American Heart Association; Council on Clinical Cardiology, Heart Failure and Transplantation Committee, Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups, Council on Epidemiology and Prevention. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation, 2006, 113 (14): 1807-1816.

[5] Wang YY. Internal Medicine of Traditional Chinese Medicine. Shanghai: Shanghai Science and Technology Press, 1997: 201.

[6] Cai D, Wang HB. Diagnostic and treatment progress of senile functional constipation. Shijie Zhongxiyi Jiehe Zazhi, 2011, 6(9): 823-825.

[7] Duan JX, Peng WN, Liu ZS, Yang DL, Guo J, Cai HJ. Clinical study on deep insertion at Tianshu (ST 25) for colonic slow transit constipation. J Acupunct Tuina Sci, 2011, 9(1): 46-50.

[8] Sun YZ, Guo Q, Zhu PY. Therapeutic observation of thread-embedding at Back-Shu and Front-Mu points for senile constipation. Shanghai Zhenjiu Zazhi, 2014, 33(3): 222-223.

[9] Zhang W, Sun JH, Pei LX, Wu XL, Chen L, Jiao DY. Systematic review of acupuncture for functional constipation. J Acupunct Tuina Sci, 2014, 12(2): 89-95.

[10] Situ J. Therapeutic observation of moxibustion plus abdominal massage for flatulence and constipation after thoracic and lumbar spine fracture. Shanghai Zhenjiu Zazhi, 2013, 32(12): 1039-1040.

[11] Chen YF. Thirty senile patients with functional constipation treated by abdominal tuina. Zhongyi Waizhi Zazhi, 2011, 20 (5): 42-43.

[12] Ma PY. Therapeutic observation on acupoint application plus abdominal tuina for constipation. Shanghai Zhenjiu Zazhi, 2013, 32(5): 368-369.

Translator:Hong Jue

R246.2

: A

Date:June 15, 2014