Journal of Traditional Chinese Medicine ›› 2023, Vol. 43 ›› Issue (2): 397-408.DOI: 10.19852/j.cnki.jtcm.20230105.002
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Effects of acupuncture on functional gastrointestinal disorders: special effects, coeffects, synergistic effects in terms of single or compatible acupoints
ZHAO Jun1, LI Xia1, ZHENG Hui2, YE Kun2, WANG Xin4, WANG Xuefei4, SUN Runquan3(
), LI Zhigang1()
- 1 School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
2 Chengdu University of Traditional Chinese Medicine, Chengdu 610075, China
3 Department of Acupuncture and Moxibustion, The Sixth Medical Center of PLA General Hospital, Beijing 100048, China
4 Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing 100010, China
-
Received:2021-11-19Accepted:2022-04-03Online:2023-04-15Published:2023-03-14 -
Contact:SUN Runquan, Department of Acupuncture and Moxibustion, the Sixth Medical Center of PLA General Hospital, Beijing 100048, China. 470486182@qq.com; LI Zhigang, School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China. lizhigang620@126.com. Telephone: +86-18813199256 -
Supported by:National Key Research and Development Program of China: Study on the Optimization of Clinical Protocol of “Multiacupoint Coeffects and Synergistic Effects”(2019YFC1709004)
Cite this article
ZHAO Jun, LI Xia, ZHENG Hui, YE Kun, WANG Xin, WANG Xuefei, SUN Runquan, LI Zhigang. Effects of acupuncture on functional gastrointestinal disorders: special effects, coeffects, synergistic effects in terms of single or compatible acupoints[J]. Journal of Traditional Chinese Medicine, 2023, 43(2): 397-408.
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Figure 1 Flow diagram of literature search
Figure 1 Flow diagram of literature search
Table 1 Characteristics and categorization of the included literatures for functional dyspepsia
| Study | Sample size | Method/acupoint | Stimulation parameter | Conclusion |
|---|---|---|---|---|
| Xu GX, Liu YB 2005 | 87 | MA at BL20, BL21, CV12, ST25, CV6, PC6, SP4 and ST36 | Twirling reinforcing reducing method, retained 30 min, 5 times per week, 6 weeks | Acupuncture had a significant effect on functional dyspepsia. |
| Park YC et al 2009 | 68 | MA at LI4, LR3, ST36, PC6, SP4 and CV12 | Sterile needles were inserted perpendicularly to a depth of 1 or 2.5 cm (1.0 cm at LI4, LR3, PC6, and SP4; 2. 5cm at ST36 and CV12) and then rotated 90° clockwise three times, retained 15 min, 3 times per week, 2 weeks | Both acupunctures at classical points and nondefined points improved the symptoms of patients with functional dyspepsia. |
| Ma TT et al 2012 | 712 | In group A, EA at ST42, ST40, ST36 and ST34; In group B, EA at ST38, ST35, ST33 and ST32; In group C, EA at BL21 and CV12; In group D, EA at GB40, GB37, GB36 and GB34. | 2/100 Hz, 0.5-1.5 mA, continuous five sessions per week, 30 min, 4 weeks | Acupuncture was effective in the treatment of functional dyspepsia, and was superior to non-acupoint puncture. The benefit of acupuncture relies on acupoint specificity. |
| Zeng F et al 2012 | 72 | EA at ST34, ST36, ST40, and ST42 | 2/100 Hz, 0.1-1.0 mA, five sessions per week, 30 min, 4 weeks | Although acupuncture and sham acupuncture had relatively different clinical efficacy and brain responses, the more remarkable modulation on the homeostatic afferent network, including the insula, anterior cingulate cortex, and hypothalamus, might be the specific mechanism of acupuncture. |
| Fan HZ et al 2012 | 50 | EA at ST36 and PC6 | 25 Hz, 2-10 mA, five sessions per week, 30 min, 4 weeks | EA can significantly improve the short and long-term efficacy of functional dyspepsia. |
| Sun JR 2012 | 50 | Warm acupuncture at CV12, ST25, ST36 | After “Deqi”, warm acupuncture was applied. Once a day, 30 min, 4 weeks | Warm acupuncture was better than Morpholine in improving symptoms of functional dyspepsia, but the overall effect was equivalent. |
| Li DD et al 2014 | 71 | ST36, PC6, LR3 and ST44 were needled in patient differentiated with excess syndrome; ST36, PC6, SP4 and SP9 were needled for patients with deficiency syndrome | 2Hz/100 Hz, 0.1-1 mA, five sessions per week, 30 min, 4 weeks | EA was safe and effective for treating functional dyspepsia, and the effect of acupoint has specificity. |
| Yang M 2014 | 80 | EA at ST42, ST40, ST36 and ST34 | 2Hz/100 Hz, 5 mA, five sessions per week, 30 min, 4 weeks | EA at the specific points of the Stomach Meridian can obviously reduce functional dyspepsia symptom score, improve symptoms and enhance the total effective rate. |
| Geng D et al 2015 | 60 | EA at CV12 and ST36 | 2Hz/100 Hz, 1-2 mA, five sessions per week, 30 min, 4 weeks | It can improve the functional dyspepsia symptoms by using the lower He-sea point and Front-mu point together or using them separately, while the combining use can produce a more significant efficacy. |
| Jin Y et al 2015 | 60 | MA at ST36, KI3, GB41, PC6 and HT7 | Needle insertion was perpendicular with a depth of about 25 mm for Deqi sense-tions and twirling with a frequ-ency of 60-120 times/min was performed, 20-60 min, 4 weeks | Classic acupuncture with manual manipulation could improve dyspeptic symptoms, mental status, and quality of life in patients with functional dyspepsia and is superior to nonclassic acupoint acupuncture without manipulations. |
| Zhang XY et al 2016 | 60 | ST36, PC6, LR3 and ST44 were needled in patient differentiated with excess syndrome; ST36, PC6, SP4 and SP9 were needled for patients with deficiency syndrome | 2Hz/100 Hz, 0.1-1 mA, five sessions per week, 30 min, 5 weeks | EA was an effective approach in treating functional dyspepsia. |
| Zheng H et al 2018 | 200 | ST36, PC6, LR3 and ST44 were needled in patient differentiated with excess syndrome; ST36, PC6, SP4 and SP9 were needled for patients with deficiency syndrome | 2Hz/100 Hz, 0.1-1 mA, five sessions per week, 30 min, 4 weeks | Acupuncture efficaciously improves dyspeptic symptoms in patients with refractory functional dyspepsia. |
Table 1 Characteristics and categorization of the included literatures for functional dyspepsia
| Study | Sample size | Method/acupoint | Stimulation parameter | Conclusion |
|---|---|---|---|---|
| Xu GX, Liu YB 2005 | 87 | MA at BL20, BL21, CV12, ST25, CV6, PC6, SP4 and ST36 | Twirling reinforcing reducing method, retained 30 min, 5 times per week, 6 weeks | Acupuncture had a significant effect on functional dyspepsia. |
| Park YC et al 2009 | 68 | MA at LI4, LR3, ST36, PC6, SP4 and CV12 | Sterile needles were inserted perpendicularly to a depth of 1 or 2.5 cm (1.0 cm at LI4, LR3, PC6, and SP4; 2. 5cm at ST36 and CV12) and then rotated 90° clockwise three times, retained 15 min, 3 times per week, 2 weeks | Both acupunctures at classical points and nondefined points improved the symptoms of patients with functional dyspepsia. |
| Ma TT et al 2012 | 712 | In group A, EA at ST42, ST40, ST36 and ST34; In group B, EA at ST38, ST35, ST33 and ST32; In group C, EA at BL21 and CV12; In group D, EA at GB40, GB37, GB36 and GB34. | 2/100 Hz, 0.5-1.5 mA, continuous five sessions per week, 30 min, 4 weeks | Acupuncture was effective in the treatment of functional dyspepsia, and was superior to non-acupoint puncture. The benefit of acupuncture relies on acupoint specificity. |
| Zeng F et al 2012 | 72 | EA at ST34, ST36, ST40, and ST42 | 2/100 Hz, 0.1-1.0 mA, five sessions per week, 30 min, 4 weeks | Although acupuncture and sham acupuncture had relatively different clinical efficacy and brain responses, the more remarkable modulation on the homeostatic afferent network, including the insula, anterior cingulate cortex, and hypothalamus, might be the specific mechanism of acupuncture. |
| Fan HZ et al 2012 | 50 | EA at ST36 and PC6 | 25 Hz, 2-10 mA, five sessions per week, 30 min, 4 weeks | EA can significantly improve the short and long-term efficacy of functional dyspepsia. |
| Sun JR 2012 | 50 | Warm acupuncture at CV12, ST25, ST36 | After “Deqi”, warm acupuncture was applied. Once a day, 30 min, 4 weeks | Warm acupuncture was better than Morpholine in improving symptoms of functional dyspepsia, but the overall effect was equivalent. |
| Li DD et al 2014 | 71 | ST36, PC6, LR3 and ST44 were needled in patient differentiated with excess syndrome; ST36, PC6, SP4 and SP9 were needled for patients with deficiency syndrome | 2Hz/100 Hz, 0.1-1 mA, five sessions per week, 30 min, 4 weeks | EA was safe and effective for treating functional dyspepsia, and the effect of acupoint has specificity. |
| Yang M 2014 | 80 | EA at ST42, ST40, ST36 and ST34 | 2Hz/100 Hz, 5 mA, five sessions per week, 30 min, 4 weeks | EA at the specific points of the Stomach Meridian can obviously reduce functional dyspepsia symptom score, improve symptoms and enhance the total effective rate. |
| Geng D et al 2015 | 60 | EA at CV12 and ST36 | 2Hz/100 Hz, 1-2 mA, five sessions per week, 30 min, 4 weeks | It can improve the functional dyspepsia symptoms by using the lower He-sea point and Front-mu point together or using them separately, while the combining use can produce a more significant efficacy. |
| Jin Y et al 2015 | 60 | MA at ST36, KI3, GB41, PC6 and HT7 | Needle insertion was perpendicular with a depth of about 25 mm for Deqi sense-tions and twirling with a frequ-ency of 60-120 times/min was performed, 20-60 min, 4 weeks | Classic acupuncture with manual manipulation could improve dyspeptic symptoms, mental status, and quality of life in patients with functional dyspepsia and is superior to nonclassic acupoint acupuncture without manipulations. |
| Zhang XY et al 2016 | 60 | ST36, PC6, LR3 and ST44 were needled in patient differentiated with excess syndrome; ST36, PC6, SP4 and SP9 were needled for patients with deficiency syndrome | 2Hz/100 Hz, 0.1-1 mA, five sessions per week, 30 min, 5 weeks | EA was an effective approach in treating functional dyspepsia. |
| Zheng H et al 2018 | 200 | ST36, PC6, LR3 and ST44 were needled in patient differentiated with excess syndrome; ST36, PC6, SP4 and SP9 were needled for patients with deficiency syndrome | 2Hz/100 Hz, 0.1-1 mA, five sessions per week, 30 min, 4 weeks | Acupuncture efficaciously improves dyspeptic symptoms in patients with refractory functional dyspepsia. |
Table 2 Characteristics and categorization of the included literatures for IBS
| Study | Sample size | Method/acupoint | Stimulation parameter | Conclusion |
|---|---|---|---|---|
| Wang W 2008 | 110 | Warm acupuncture at ST36, CV12, SP6 and ST25 | After “Deqi”, warm acupuncture was applied. Once every other day, 10 times as 1 course, 2 courses | Warm acupuncture can effectively improve the clinical symptoms of IBS-D. |
| Shi XH et al 2010 | 70 | EA at ST25, ST36, BL20, BL21, BL23, BL25 and ST37 | Small equal manipulations involving twirling, lifting, and thrusting were implemented to elicit Deqi. EA therapeutic apparatus, once every other day, 15min, 4week | EA was safe and effective in the treatment of IBS-D, which had the value of further research and promotion. |
| Sun YZ, Song J 2015 | 60 | EA at Jiaji (EX-B2) | After “Deqi”, lifting, inserting and twisting manipulation for 2 min. 60 Hz, five sessions per week, 30 min, 3 weeks | Acupuncture at Jiaji (EX-B2) was an effective approach in treating IBS. |
| Zhang Z 2016 | 60 | Warm acupuncture at Jiaji (EX-B2) | After “Deqi”, warm acupuncture was applied. Six sessions per week, 30 min, 6 weeks | Compared with conventional acupuncture, warm acupuncture at Jiaji (EX-B2) can effectively improve the symptoms of diarrhea and abdominal pain, and improve the quality of life of patients, which was worthy of clinical application. |
| Mao WJ 2019 | 80 | MA at GV20, EX-HN3, LR3, ST36, SP6, ST25 and ST37 | Small equal manipulations involving twirling, lifting, and thrusting were implemented to elicit Deqi, 30 min, 3 times a week for 6 weeks | MA was effective in IBS-D, which can alleviate the clinical symptoms of patients, improve the quality of life, and have a long-term effect. |
| Pei L et al 2020 | 531 | MA at GV20, EX-HN3, LR3, ST36, SP6, ST25 and ST37 | Small equal manipulations involving twirling, lifting, and thrusting were implemented every 10 min to elicit Deqi, once every other day, 30 min, 3 times a week for 6 weeks | Acupuncture may be more effective than PEG 4000 or pinaverium bromide for the treatment of IBS, with effects lasting up to 12 weeks. |
Table 2 Characteristics and categorization of the included literatures for IBS
| Study | Sample size | Method/acupoint | Stimulation parameter | Conclusion |
|---|---|---|---|---|
| Wang W 2008 | 110 | Warm acupuncture at ST36, CV12, SP6 and ST25 | After “Deqi”, warm acupuncture was applied. Once every other day, 10 times as 1 course, 2 courses | Warm acupuncture can effectively improve the clinical symptoms of IBS-D. |
| Shi XH et al 2010 | 70 | EA at ST25, ST36, BL20, BL21, BL23, BL25 and ST37 | Small equal manipulations involving twirling, lifting, and thrusting were implemented to elicit Deqi. EA therapeutic apparatus, once every other day, 15min, 4week | EA was safe and effective in the treatment of IBS-D, which had the value of further research and promotion. |
| Sun YZ, Song J 2015 | 60 | EA at Jiaji (EX-B2) | After “Deqi”, lifting, inserting and twisting manipulation for 2 min. 60 Hz, five sessions per week, 30 min, 3 weeks | Acupuncture at Jiaji (EX-B2) was an effective approach in treating IBS. |
| Zhang Z 2016 | 60 | Warm acupuncture at Jiaji (EX-B2) | After “Deqi”, warm acupuncture was applied. Six sessions per week, 30 min, 6 weeks | Compared with conventional acupuncture, warm acupuncture at Jiaji (EX-B2) can effectively improve the symptoms of diarrhea and abdominal pain, and improve the quality of life of patients, which was worthy of clinical application. |
| Mao WJ 2019 | 80 | MA at GV20, EX-HN3, LR3, ST36, SP6, ST25 and ST37 | Small equal manipulations involving twirling, lifting, and thrusting were implemented to elicit Deqi, 30 min, 3 times a week for 6 weeks | MA was effective in IBS-D, which can alleviate the clinical symptoms of patients, improve the quality of life, and have a long-term effect. |
| Pei L et al 2020 | 531 | MA at GV20, EX-HN3, LR3, ST36, SP6, ST25 and ST37 | Small equal manipulations involving twirling, lifting, and thrusting were implemented every 10 min to elicit Deqi, once every other day, 30 min, 3 times a week for 6 weeks | Acupuncture may be more effective than PEG 4000 or pinaverium bromide for the treatment of IBS, with effects lasting up to 12 weeks. |
Table 3 Characteristics and categorization of the included literatures for FD
| Study | Sample size | Method/acupoint | Stimulation parameter | Conclusion |
|---|---|---|---|---|
| Wang ZD et al 2010 | 80 | EA at ST25, CV9, CV6, ST36 and extra nerve point, i.e. Zhixie | After “Deqi”, twisting, EA therapeutic apparatus, once every other day, 30 min, 4 week | Treatment with EA in patients suffering from chronic functional diarrhoea can significantly improve curative effect. |
| Zhong F et al 2018 | 132 | EA at LI11 and ST37 | 20 Hz, five sessions per week (week 1-2); 3 times a week (week 3-4); 30 min, 4 week | EA at LI11 and ST37 acupoints was effective on regulating bidirectionally functional bowel disorders, and the effect was certainly persistent. |
| Zhao PP et al 2020 | 118 | EA at ST25, BL25 | 20 Hz, six sessions per week (week 1-2); 3 times a week (week 3-4); 30 min, 4 week | Treatment of loperamide hydrochloride capsules and needling on ST25 and BL25 (with EA) was effective in treating functional diarrhoea and the short-term efficacy was equivalent. However, compared with the medicine group, the effect of acupuncture group was more persistent and safer with smaller individual differences. |
Table 3 Characteristics and categorization of the included literatures for FD
| Study | Sample size | Method/acupoint | Stimulation parameter | Conclusion |
|---|---|---|---|---|
| Wang ZD et al 2010 | 80 | EA at ST25, CV9, CV6, ST36 and extra nerve point, i.e. Zhixie | After “Deqi”, twisting, EA therapeutic apparatus, once every other day, 30 min, 4 week | Treatment with EA in patients suffering from chronic functional diarrhoea can significantly improve curative effect. |
| Zhong F et al 2018 | 132 | EA at LI11 and ST37 | 20 Hz, five sessions per week (week 1-2); 3 times a week (week 3-4); 30 min, 4 week | EA at LI11 and ST37 acupoints was effective on regulating bidirectionally functional bowel disorders, and the effect was certainly persistent. |
| Zhao PP et al 2020 | 118 | EA at ST25, BL25 | 20 Hz, six sessions per week (week 1-2); 3 times a week (week 3-4); 30 min, 4 week | Treatment of loperamide hydrochloride capsules and needling on ST25 and BL25 (with EA) was effective in treating functional diarrhoea and the short-term efficacy was equivalent. However, compared with the medicine group, the effect of acupuncture group was more persistent and safer with smaller individual differences. |
Table 4 Characteristics and categorization of the included literatures for FC
| Study | Sample size | Method/acupoint | Stimulation parameter | Conclusion |
|---|---|---|---|---|
| Wang CW et al 2010 | 95 | EA at ST25 | ST25 was punctured deeply to the peritoneum. Once a day, 2/15 Hz, 30 min, 4 weeks | The deep puncture at ST25 with electric stimulation presents similar efficacy on FC as shallow puncture at ST25, but it acted more quickly than shallow puncture at ST25, both of them were more advantageous than medication and the long-term efficacy was better. |
| Wang CW et al 2010 | 95 | EA at ST25 | 2/15 Hz, 1-12 mA, 5 times per week, 30 min, 4 weeks | Deep needling EA of ST25 had a positive effect in improving FC, being faster in the onset of action and stable efficacy in comparison with shallow needling. |
| Geng T, Lin RZ 2011 | 75 | EA at ST25 | 5/10 Hz, 5 times per week, 30 min, 4 weeks | Deep needling at ST25 for FC had a positive effect, which can reduce the use rate of laxatives, and had a certain mid-term curative effect. |
| Cao J 2012 | 41 | EA mainly at ST25, ST36, LI4, ST37, SJ6 and KI6 | 5 times per week, 30 min, 4 weeks | EA had the dual functions of electrical stimulation and strengthening the sense of acupuncture. The density wave can increase metabolism and promote blood circulation, and promote the excretion of stool. |
| Xu J et al 2012 | 64 | MA at SJ6, ST25, ST36 and ST37 | 1/20 Hz, twirling and rotating manipulation wave for 30 min. Once a day, 2 weeks | The therapeutic effect of Hwato neuro and muscle stimulator (SXDZ-100) on chronic functional constipation was superior to that of a regular electronic stimulator (SDZ-II). |
| Zhang C et al 2013 | 60 | EA at ST25, LI4, ST36 and ST37 | Twirling and rotating manipulation wave for 30 s. 5 times per week, 30 min, 4 weeks | EA performed better than prepulsid in the treatment for functional constipation with slow transmission. |
| Hu JW et al 2014 | 49 | EA at ST25, SP14 and ST37 | 15 Hz, 0.1-1.0 mA, 5 times per week, 30 min, 8 weeks | EA treatment had better curative effect on severe FD than sham EA, and the long-term effect was also better. |
| Wang XL et al 2014 | 51 | EA at ST25, SP14, ST37, SJ6 and KI6 | 15 Hz, 0.1-1.0 mA, 3 times per week, 30 min, 4 weeks | EA and general acupuncture were effective for FC, but the EA treatment can improve clinical scores of constipation and quality of life much better than ordinary acupuncture. |
| Xiong F et al 2014 | 92 | EA at LI11 and ST37 | 2/50 Hz, 5 sessions in each of the first 2 weeks, and 3 sessions in each of the remaining 2 weeks. 30 min, 4 weeks | EA therapy can increase stool frequency, improve stool consistency, decrease the patient’s anxiety and depression. |
| Zheng HB et al 2014 | 69 | EA at ST25 and ST37 | 10 Hz, 5 times per week, 30 min, 4 weeks | EA at ST25 combined with He-mu and Shu-mu points were both effective treatments for chronic FC. The long-term effect of the combination of acupoint with He-mu was better than that of Shu-mu. |
| Wu J et al 2014 | 475 | EA at ST25 | 2/15 Hz, 0.1-1 mA, 5 times per week, 30 min, 4 weeks | Deep needling and shallow needling at ST25 can improve intestinal function remarkably and safely. Therapeutic effects of deep needling and shallow needling were not superior to that of lactulose; however, the sustained effects of deep and shallow needling after stopping the acupuncture treatments were superior to the therapeutic effect of lactulose, which might qualify the superiority of deep and shallow needling. |
| Qi LJ et al 2014 | 28 | EA at LI11 and ST37 | 20 Hz, 5 sessions in each of the first 2 weeks, and 3 sessions in each of the remaining 2 weeks. 30 min, 4 weeks | Acupuncture at LI11 and ST37 had therapeutic effect on FC and diarrhea, which were better than medicine. LI11 and ST37 may have two-way regulatory effect on FBDs. |
| Liu J et al 2015 | 70 | EA at ST25 and SP14 | 15 Hz, 0.1-1.0 mA, 5 sessions in each of the first 2 weeks, and 3 sessions in each of the remaining 4 weeks. 30 min, 8 weeks | EA deep needling had a better and more steady effect on severe FC. |
| Da N et al 2015 | 67 | EA at ST25, SP14 and ST37 | 2/15 Hz, 0.1-1.0 mA, 5 sessions in each of the first 2 weeks, and 3 sessions in each of the remaining 6 weeks. 30 min, 8 weeks | It was effective and safe with EA to treat FC. |
| Xue QM et al 2015 | 96 | EA at ST25 | 2/15 Hz, 5 times per week, 30 min, 4 weeks | Using EA at ST25 to treat patients with FC was effectively, and deep needling had more stable effect than shallow needling. |
| Study | Sample size | Method/acupoint | Stimulation parameter | Conclusion |
| Chen L et al 2016 | 63 | EA at ST25, SP14 and ST37 | 15 Hz, 0.1-1.0 mA, 5 sessions in each of the first 2 weeks, and 3 sessions in each of the remaining 6 weeks. 30 min, 8 weeks | Deep needling at ST25 and SP14 plus EA was an effective method in treating severe FC. |
| Shen YF et al 2016 | 70 | EA at ST25, SP14 and ST37 | 15 Hz, 0.1-1.0 mA, 5 sessions in each of the first 2 weeks, and 3 sessions in each of the remaining 6 weeks. 30 min, 8 weeks | EA can improve complete spontaneous bowel movements in severe FC, but it’s insignificantly different from sham acupuncture in improving stool form and defecation difficulty. |
| Liu Z et al 2016 | 1075 | EA at ST25, SP14, and ST37 | 10/50 Hz, 0.1-1.0 mA, 5 sessions in each of the first 2 weeks, and 3 sessions in each of the remaining 6 weeks. 30 min, 8 weeks | 8 weeks of EA increased complete spontaneous bowel movements and was safe for the treatment of chronic severe FC. Additional study was warranted to evaluate a longer-term treatment and follow-up. |
| Wu X et al 2017 | 201 | EA at LI11 and ST37 | 10/50 Hz, 16 sessions of acupuncture treatments, 30 min, 4 weeks | EA was effective and safe at both current intensities for FC; therapeutic effects of low current intensity and high current intensity were not superior to mosapride. EA was superior to mosapride in improving patients’ life quality and satisfaction level of treatment; EA had fewer adverse events than mosapride. |
| Lee HY et al 2018 | 30 | MA at ST25, ST27, BL52 and BL25 | After “deqi”, maintaining them for 30 min. 4 weeks | This study demonstrated that a future clinical trial would be feasible with some modifications to the primary outcome measure and comparator. An additionally finding was that 12 acupuncture sessions over 4 weeks had possible effects of increasing stool consistency and spontaneous complete bowel movement, particularly in participants with severe symptoms. |
| Zheng H et al 2018 | 684 | EA at ST25, BL25, LI11 and ST37 | 15 Hz, 30 min, 4 weeks | Acupuncture was effective to relieve symptoms of patients with functional constipation. Therapeutic effect of He, Shu-mu, and He-shu-mu acupuncture was at least as effective as mosapride; however, non- specific effects of acupuncture may play a relevant role in this trial. Future studies should focus on the non-specific effect of acupuncture by comparing acupuncture with sham acupuncture. |
| Xu XH et al 2020 | 96 | EA at LI11 and ST37 | 2/50 Hz, 0.1-1.0 mA, 30 min, 4 weeks | EA was effective in the improvement of the constipation-related QOL, anxiety and depression, which seems to be better than that by mosapride. However, it seems that the sham acupuncture did not play a crucial role or a supplementary role in treating FC. These findings suggested that EA could be effective in the treatment of FC. |
Table 4 Characteristics and categorization of the included literatures for FC
| Study | Sample size | Method/acupoint | Stimulation parameter | Conclusion |
|---|---|---|---|---|
| Wang CW et al 2010 | 95 | EA at ST25 | ST25 was punctured deeply to the peritoneum. Once a day, 2/15 Hz, 30 min, 4 weeks | The deep puncture at ST25 with electric stimulation presents similar efficacy on FC as shallow puncture at ST25, but it acted more quickly than shallow puncture at ST25, both of them were more advantageous than medication and the long-term efficacy was better. |
| Wang CW et al 2010 | 95 | EA at ST25 | 2/15 Hz, 1-12 mA, 5 times per week, 30 min, 4 weeks | Deep needling EA of ST25 had a positive effect in improving FC, being faster in the onset of action and stable efficacy in comparison with shallow needling. |
| Geng T, Lin RZ 2011 | 75 | EA at ST25 | 5/10 Hz, 5 times per week, 30 min, 4 weeks | Deep needling at ST25 for FC had a positive effect, which can reduce the use rate of laxatives, and had a certain mid-term curative effect. |
| Cao J 2012 | 41 | EA mainly at ST25, ST36, LI4, ST37, SJ6 and KI6 | 5 times per week, 30 min, 4 weeks | EA had the dual functions of electrical stimulation and strengthening the sense of acupuncture. The density wave can increase metabolism and promote blood circulation, and promote the excretion of stool. |
| Xu J et al 2012 | 64 | MA at SJ6, ST25, ST36 and ST37 | 1/20 Hz, twirling and rotating manipulation wave for 30 min. Once a day, 2 weeks | The therapeutic effect of Hwato neuro and muscle stimulator (SXDZ-100) on chronic functional constipation was superior to that of a regular electronic stimulator (SDZ-II). |
| Zhang C et al 2013 | 60 | EA at ST25, LI4, ST36 and ST37 | Twirling and rotating manipulation wave for 30 s. 5 times per week, 30 min, 4 weeks | EA performed better than prepulsid in the treatment for functional constipation with slow transmission. |
| Hu JW et al 2014 | 49 | EA at ST25, SP14 and ST37 | 15 Hz, 0.1-1.0 mA, 5 times per week, 30 min, 8 weeks | EA treatment had better curative effect on severe FD than sham EA, and the long-term effect was also better. |
| Wang XL et al 2014 | 51 | EA at ST25, SP14, ST37, SJ6 and KI6 | 15 Hz, 0.1-1.0 mA, 3 times per week, 30 min, 4 weeks | EA and general acupuncture were effective for FC, but the EA treatment can improve clinical scores of constipation and quality of life much better than ordinary acupuncture. |
| Xiong F et al 2014 | 92 | EA at LI11 and ST37 | 2/50 Hz, 5 sessions in each of the first 2 weeks, and 3 sessions in each of the remaining 2 weeks. 30 min, 4 weeks | EA therapy can increase stool frequency, improve stool consistency, decrease the patient’s anxiety and depression. |
| Zheng HB et al 2014 | 69 | EA at ST25 and ST37 | 10 Hz, 5 times per week, 30 min, 4 weeks | EA at ST25 combined with He-mu and Shu-mu points were both effective treatments for chronic FC. The long-term effect of the combination of acupoint with He-mu was better than that of Shu-mu. |
| Wu J et al 2014 | 475 | EA at ST25 | 2/15 Hz, 0.1-1 mA, 5 times per week, 30 min, 4 weeks | Deep needling and shallow needling at ST25 can improve intestinal function remarkably and safely. Therapeutic effects of deep needling and shallow needling were not superior to that of lactulose; however, the sustained effects of deep and shallow needling after stopping the acupuncture treatments were superior to the therapeutic effect of lactulose, which might qualify the superiority of deep and shallow needling. |
| Qi LJ et al 2014 | 28 | EA at LI11 and ST37 | 20 Hz, 5 sessions in each of the first 2 weeks, and 3 sessions in each of the remaining 2 weeks. 30 min, 4 weeks | Acupuncture at LI11 and ST37 had therapeutic effect on FC and diarrhea, which were better than medicine. LI11 and ST37 may have two-way regulatory effect on FBDs. |
| Liu J et al 2015 | 70 | EA at ST25 and SP14 | 15 Hz, 0.1-1.0 mA, 5 sessions in each of the first 2 weeks, and 3 sessions in each of the remaining 4 weeks. 30 min, 8 weeks | EA deep needling had a better and more steady effect on severe FC. |
| Da N et al 2015 | 67 | EA at ST25, SP14 and ST37 | 2/15 Hz, 0.1-1.0 mA, 5 sessions in each of the first 2 weeks, and 3 sessions in each of the remaining 6 weeks. 30 min, 8 weeks | It was effective and safe with EA to treat FC. |
| Xue QM et al 2015 | 96 | EA at ST25 | 2/15 Hz, 5 times per week, 30 min, 4 weeks | Using EA at ST25 to treat patients with FC was effectively, and deep needling had more stable effect than shallow needling. |
| Study | Sample size | Method/acupoint | Stimulation parameter | Conclusion |
| Chen L et al 2016 | 63 | EA at ST25, SP14 and ST37 | 15 Hz, 0.1-1.0 mA, 5 sessions in each of the first 2 weeks, and 3 sessions in each of the remaining 6 weeks. 30 min, 8 weeks | Deep needling at ST25 and SP14 plus EA was an effective method in treating severe FC. |
| Shen YF et al 2016 | 70 | EA at ST25, SP14 and ST37 | 15 Hz, 0.1-1.0 mA, 5 sessions in each of the first 2 weeks, and 3 sessions in each of the remaining 6 weeks. 30 min, 8 weeks | EA can improve complete spontaneous bowel movements in severe FC, but it’s insignificantly different from sham acupuncture in improving stool form and defecation difficulty. |
| Liu Z et al 2016 | 1075 | EA at ST25, SP14, and ST37 | 10/50 Hz, 0.1-1.0 mA, 5 sessions in each of the first 2 weeks, and 3 sessions in each of the remaining 6 weeks. 30 min, 8 weeks | 8 weeks of EA increased complete spontaneous bowel movements and was safe for the treatment of chronic severe FC. Additional study was warranted to evaluate a longer-term treatment and follow-up. |
| Wu X et al 2017 | 201 | EA at LI11 and ST37 | 10/50 Hz, 16 sessions of acupuncture treatments, 30 min, 4 weeks | EA was effective and safe at both current intensities for FC; therapeutic effects of low current intensity and high current intensity were not superior to mosapride. EA was superior to mosapride in improving patients’ life quality and satisfaction level of treatment; EA had fewer adverse events than mosapride. |
| Lee HY et al 2018 | 30 | MA at ST25, ST27, BL52 and BL25 | After “deqi”, maintaining them for 30 min. 4 weeks | This study demonstrated that a future clinical trial would be feasible with some modifications to the primary outcome measure and comparator. An additionally finding was that 12 acupuncture sessions over 4 weeks had possible effects of increasing stool consistency and spontaneous complete bowel movement, particularly in participants with severe symptoms. |
| Zheng H et al 2018 | 684 | EA at ST25, BL25, LI11 and ST37 | 15 Hz, 30 min, 4 weeks | Acupuncture was effective to relieve symptoms of patients with functional constipation. Therapeutic effect of He, Shu-mu, and He-shu-mu acupuncture was at least as effective as mosapride; however, non- specific effects of acupuncture may play a relevant role in this trial. Future studies should focus on the non-specific effect of acupuncture by comparing acupuncture with sham acupuncture. |
| Xu XH et al 2020 | 96 | EA at LI11 and ST37 | 2/50 Hz, 0.1-1.0 mA, 30 min, 4 weeks | EA was effective in the improvement of the constipation-related QOL, anxiety and depression, which seems to be better than that by mosapride. However, it seems that the sham acupuncture did not play a crucial role or a supplementary role in treating FC. These findings suggested that EA could be effective in the treatment of FC. |
Table 5 Individual acupoint frequency
| Grade | Acupoint | Number |
|---|---|---|
| I | Tianshu (ST25) | 25 |
| II | Zusanli (ST36) | 20 |
| III | Shangjuxu (ST37) | 19 |
| IV | Fujie (SP14) | 7 |
| V | Neiguan (PC6) | 7 |
| VI | Zhongwan (CV12) | 6 |
| VII | Quchi (LI11) | 6 |
| VIII | Taichong (LR3) | 6 |
| IX | Dachangshu (BL25) | 4 |
| X | Gongshu (SP4) | 4 |
Table 5 Individual acupoint frequency
| Grade | Acupoint | Number |
|---|---|---|
| I | Tianshu (ST25) | 25 |
| II | Zusanli (ST36) | 20 |
| III | Shangjuxu (ST37) | 19 |
| IV | Fujie (SP14) | 7 |
| V | Neiguan (PC6) | 7 |
| VI | Zhongwan (CV12) | 6 |
| VII | Quchi (LI11) | 6 |
| VIII | Taichong (LR3) | 6 |
| IX | Dachangshu (BL25) | 4 |
| X | Gongshu (SP4) | 4 |
Figure 2 Venn diagram showing acupoints that were differentially administered across the FD, IBS, functional diarrhea and FC relevant studies FC: functional constipation; FD: functional dyspepsia; IBS: irritable bowel syndrome. BL20: Pishu (BL20); BL21: Weishu (BL21); BL23: Shenshu (BL23); BL25: Dachangshu (BL25); BL52: Zhishi (BL52); CV6: Qihai (CV6); CV9: Shuifen (CV9); CV12: Zhongwan (CV12); EX-HN3: Yintang (EX-HN3); GB34: Yanglingquan (GB34); GB36: Waiqiu (GB36); GB37: Guangming (GB37); GB40: Qiuxu (GB40); GB41: Zulinqi (GB41); GV20: Baihui (GV20); HT7: Shenmen (HT7); EX-B2: Jiaji (EX-B2); KI3: Taixi (KI3); KI6: Zhaohai (KI6); LI4: Hegu (LI4); LI11: Quchi (LI11); LR3: Taichong (LR3); PC6: Neiguan (PC6); SJ6: Zhigou (SJ6); SP4: Gongsun (SP4); SP6: Sanyinjiao (SP6); SP9: Yinlingquan (SP9); SP14: Fujie (SP14); ST25: Tianshu (ST25); ST27: Daju (ST27); ST32: Futu (ST32); ST33: Yinshi (ST33); ST34: Liangqiu (ST34); ST35: Dubi (ST35); ST36: Zusanli (ST36); ST37: Shangjuxu (ST37); ST38: Tiaokou (ST38); ST40: Fenglong (ST40); ST42: Chongyang (ST42); ST44: Neiting (ST44).
Figure 2 Venn diagram showing acupoints that were differentially administered across the FD, IBS, functional diarrhea and FC relevant studies FC: functional constipation; FD: functional dyspepsia; IBS: irritable bowel syndrome. BL20: Pishu (BL20); BL21: Weishu (BL21); BL23: Shenshu (BL23); BL25: Dachangshu (BL25); BL52: Zhishi (BL52); CV6: Qihai (CV6); CV9: Shuifen (CV9); CV12: Zhongwan (CV12); EX-HN3: Yintang (EX-HN3); GB34: Yanglingquan (GB34); GB36: Waiqiu (GB36); GB37: Guangming (GB37); GB40: Qiuxu (GB40); GB41: Zulinqi (GB41); GV20: Baihui (GV20); HT7: Shenmen (HT7); EX-B2: Jiaji (EX-B2); KI3: Taixi (KI3); KI6: Zhaohai (KI6); LI4: Hegu (LI4); LI11: Quchi (LI11); LR3: Taichong (LR3); PC6: Neiguan (PC6); SJ6: Zhigou (SJ6); SP4: Gongsun (SP4); SP6: Sanyinjiao (SP6); SP9: Yinlingquan (SP9); SP14: Fujie (SP14); ST25: Tianshu (ST25); ST27: Daju (ST27); ST32: Futu (ST32); ST33: Yinshi (ST33); ST34: Liangqiu (ST34); ST35: Dubi (ST35); ST36: Zusanli (ST36); ST37: Shangjuxu (ST37); ST38: Tiaokou (ST38); ST40: Fenglong (ST40); ST42: Chongyang (ST42); ST44: Neiting (ST44).
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