Complementary and Alternative Therapies for Chronic Constipation

Table 1

Articles of acupuncture or EA for CC.

Reference	Study design (participants)	Acupoints	Implementation of acupuncture	Key efficacy results	Adverse reactions
Wu et al., 2014 [14]	RCT; (); adult	ST25, BL25, LI11, ST37	EA1: ST25, BL25; EA2: LI11, ST37; EA3: ST25, BL25, LI11, ST37; C: Mosapride citrate	Weekly frequency of defecation, defecation difficulty life, and quality score were all improved significantly in the four groups; in follow-up, weekly frequency of defecation of LI11 and ST37 (EA2) was superior to the other three groups	NA
Zhang et al., 2013 [15]	RCT; (); adult	ST25, ST37, ST36, BL25, TE6	EA: 2 Hz/200 Hz; D: Fuzhengliqi mixture; EA + D: both of above; C: Mosapride and Macrogol 4000	All groups decreased the defecation interval, stool property, constipation symptom grade, accompanying symptom grade, and GITT; EA + D was better than others; EA could keep long-term effect	No
Peng et al., 2013 [16]	RCT; (); adult	ST25	EA-deep: 20 to 65 mm in depth; EA-shallow: 5–8 mm depth; D: lactulose oral liquid	All groups increased the weekly defecation frequency; EA-deep could keep long-term effect	No
Chen et al., 2013 [17]	RCT; ( = NA); adult female	ST36, ST37, ST25, ST28, CV4, CV6	EA; Sham-EA	EA improved constipation symptoms and increased autonomic nervous system activities, sham-EA not	NA
Zhou et al., 2012 [18]	RCT; (); elder	AT3, 4i, AT3, AT4, CO7, CO17, AH8, CO18, Constipation Point	AT: according to the pattern/syndrome differentiation; C: solid points	The effective rate: AT 92.0%, C 76.0%	NA
Xu et al., 2012 [19]	RCT; (); adult	TE6, ST25, ST36, ST37	EA: Hwato neuro and muscle stimulator; C: regular electronic stimulator	The effective rate of short term: EA 54.6%, C 29.0%	NA
Anders et al., 2012 [20]	Retrospective case series study; () children	Quchi (LI11)	Fixed indwelling acupuncture needles (0.9 mm in length)	After a median of 3 days of HIC, all children defecated within 2 h. Local constipation therapy was not required	No
L.-J. Wang and L.-L. Wang, 2011 [21]	RCT; (); adult	Group 1: ST25, SP15, CV6, CV4, ST36, ST37, SP6. Group 2: BL33, BL34, BL5, BL23, BL20 Alternatively	HA: punctured by hands; HA + moxibustion: grain-shaped moxibustion was given at CV6, ST36, BL25, BL20, and others with puncture	The total effective rate: HA + moxibustion as 74.0% (37/50) versus 52.0% (26/50)	NA
Guo et al., 2011 [22]	RCT; (); adult	ST25, ST37, ST36, BL25, TE6	EA: 2 Hz/100 Hz; D: Plantain and Senna Granule; EA + D: both of the above	All groups decreased the scores of defecation cycle, stool property, constipation symptom grade, accompanying symptom grade, and GITT; EA + D was better than others; EA and EA + D could keep long-term effect	No
Wang et al., 2010 [23]	RCT; (); adult	ST25	EA-deep: 45 mm in depth; EA-shallow: 5 mm in depth; D: lactulose oral liquid	EA-deep and EA-shadow were significantly superior to D group in increasing number up to 4 and improved CCS. EA-deep worked faster than EA-shadow	NA
Wang et al., 2010 [24]	RCT; (); adult	ST25	EA-deep; EA-shallow; D: Duphalac	EA-deep was similar to EA-shallow in number up to 4 and CCS, and its efficacy remained much longer	NA
Jin et al., 2010 [25]	Before-after study; (); adult	Group 1: ST25, CV6, ST37; Group 2: BL33, BL34, BL25 Alternatively	EA: BL33, BL34, ST25, T37	The scores of defecation frequency, difficulty degree of defecation, defecation time, endless sensation of defecation, stool quality, awareness of defecation, and QoL were obviously improved after treatment. The total effective rate was 67.7% (61/90)	NA
Ding et al., 2009 [26]	Before-after study; (); adult	Group 1: ST25, SP15, SP14, CV6, CV4, ST36, ST37; Group 2: BL25, BL23, BL31, BL32, BL33, BL34, Ex-HN1 Alternatively	Deep needling was applied on acupoints of abdominal and back region and moxibustion was put on Ex-HN1	Reduced laxative, scores for awareness, and QoL. Increased frequency of defecation	No
Zhang et al., 2007 [27]	RCT; EA; SA	TE6	EA: EA at Zhigou; SA: EA at nonacupoint	EA could obviously improve CCS and CTT, decrease cathartics, effective rate of 94.4%	No
Zhu et al., 2003 [28]	Before-after study; (); adult	ST25, ST36, ST37, BL25, BL57	HA	Total effective rate of 100%	NA
Broide et al., 2001 [29]	CCT-self; (); child	NA	Treated by five weekly placebo acupuncture sessions, followed by 10 weekly true acupuncture sessions	The frequency of bowel movements increased only after 10 true acupuncture sessions	NA
Klauser et al., 1993 [30]	CCT-self; (); adult	LI4, ST25, LE3, BL25	EA: 10 Hz	Stool frequencies and CCT were not altered	Two patients dropped out because symptoms worsened

RCT: randomized controlled trial; CCT: controlled clinical trial; HA: hand-acupuncture; EA: EA; AT: auriculotherapy; SA: sham acupuncture; D: drug; HA + D: hand-acupuncture + drug; EA + D: EA + drug; C: control; PE: patient’s endurance; MA: mean age; PO: by mouth; CCS: Cleveland Constipation Score; number up to 4: the number of constipation patients whose defecation was up to 4 times per week; BMs, bowel movements; GITT: gastrointestinal transit time; TGITT: total gastrointestinal transit time; M-ITT: mouth-intestine transit time, CTT: colonic transit time; RCTT: right colonic transit time; LCTT: left colonic transit time; RSTT: rectosigmoid colonic transit time; MTL: motilin; QoL: quality of life; CI: confidence interval; QD, every day; BID: twice per day; TID: triple per day; NA: not acquirable.