Volume 11, Number 2 | Summer 2016

Clinical Report 1 (Acupuncture)
Chinese Acupuncture and Moxibustion in Japan Constipation
Masanori Takashi1) and Katsuhiko Arai2)
1) Tokai University Oiso Hospital
2) Tokai University School of Medicine

Constipation is among adults not a particularly rarecomplaint, but as the author has stated during around-table discussion held by the “The Journal ofKampo Medicine” (Japanese Version), this complaint
is rather rare among patients visiting acupuncture
moxibustion

clinics

withgastrointestinal

symptoms and its presence is often discovered firstduring anamnesis or the course of the treatment
when confirming symptoms, subsequently leading to
its treatment1).
On this occasion the patient visited our clinic with achief complaint of low back pain, but since shecomplained during treatment also of constipation, I
administeredacupuncture

andmoxibustion

treatment and report its effectiveness here.

37-year-old woman, office work

[Chief complaint] Constipation

fluctuating in intensity. Treatment based on mypattern

identification

asliverQi

stagnation

decreased the VAS value from 80 to 45 mm. Afterfocused mainly on the constipation.
Otherwise the patient complained of shallow sleep
with much dreaming, lack of appetite, a feeling of a
blocked throat, easy fatigability, irregular, shortintervalmenstruation,tenderness

andpremenstrual

menorrhalgia,

whichbreastwasparticularly strong during the first half of themenstruation.
[Past history]
Eczema (at age 20), duodenal ulcer (at age 33), lowback pain (at age 35)[Present status]
Height: 145 cm; weight: 37 kg; pulse: deep, wiry;
tongue: red with cracks, white coat; abdomen showsmuch gas and is generally distended, but fecal
masses could not be palpated. The extremities[TCM diagnosis]
Liver Qi stagnation[Therapeutic principle] Promote orderly Qi flow and[Present illness]
She tended to have constipation since her twenties,
but did not consult any medical institution andinstead relied on dietetics and a combination ofcommercial laxatives and enemas to control thecondition. She regularly visited our clinic since one
year earlier for the treatment of low back pain, but
at that point did not complain about constipation.
However, three months after treatment begin thetendency towards constipation increased, so that thepatient requested treatment, because she had not
had any bowel movements for several days. She hadbowel movements only once every 3-4 days, whichwere thin and short and did not really bring her
relief. Also, a feeling of abdominal distension rated
as high as 75 mm on a VAS tended to be relieved by12

towards the flank(s) and changed location while

showed reversal cold.

Case[Case]a painful tension extending from the low backthat the acupuncture and moxibustion treatment

Introduction

andpassing winds and belching. The low back pain wasrelieve stagnation[Acupoint selection]
ST-25, SJ-6, St-37, BL-25, LIV-3, BL-18, BL-23(Figure)Used needles:
Disposable sterilized Seirin needles, length: 1 cun 6fen, No.1 and No.3
[Explanation]
I used reduction by twirling the needles at BL-18 and
LIV-3 to disperse stagnated liver-energy andregulate energy2). Application of reducing techniques
to the back shu point of the large intestine channel
BL-25 and the alarm point ST-25 was intended tofree the Qi movement of the large intestines, relax
the bowels and regulate congestion3).

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 11, Number 2 | Summer 2016

had increased. For that reason I applied a somewhat
stronger reducing
stimulation using
twirling at BL-25.
Third and fourth session:
Bowel movements
occurred after thetreatment andsubsequently in intervalsof once every 3 days. Thethickness of the stool
increased from pencil tosmall banana size andthe patient reported thebowel movements now
being comfortable.

Fifth session:

FigureThe patient had now bowel movements everyAlso, since the lower sea point ST-37 of the large

other day. Expression of the abdominal distension onintestines is a place where the channel Qi of the six

the VAS was now 40 mm. For the low back pain Ibowels meet, reactions to diseases of the six bowels

combined the treatment with cupping at BL-25 andappear here. Since the chapter 4 of the Ling-Shu

BL-24.

"Visceral Diseases Caused by Evil Qi" states: "the He

Sixth session:

points are for treating the viscera"4), I chose ST-37

Expression of the low back pain on the VAS was 15and ST-25 and used a reducing method to free themm and did not bother the patient any longer.

bowels and regulate Qi5). Since the low back is theEighth session:

house of the kidneys, I used BL-23 for neutral

Expression of the feeling of distension on the VAS

supplementation and drainage6) to treat the low backwas 20 mm. To regulate abdominal Qi movement Ipain.

added Zu Sanli to the treatment.

[Course] Treatments were administered once a week.

Tenth session:

First session:

Since the low back pain had been alleviated and theFollowing the treatment an urge to defecatepatient had bowel movements every other day

developed and while the bowel movement was small,without discomfort the treatment was ended.

she could pass it by herself and it decreased thefeeling of abdominal distension. At this point she
discontinued the OTC laxative.

Discussion
Constipation is classified according to its causes

Second session:
Because the patient had no bowel movements on theinto idiopathic simple constipation and secondary

day prior to the treatment session, the low back pain

constipation.

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

13

Volume 11, Number 2 | Summer 2016

The condition can be classified into idiopathic
simple constipation, referring to temporary simple
constipation

caused byenvironmental

effects of opioids like in this case are also goodindications.

factors,

dietary changes as well as stress and similar mental

Referencefactors. Little food intake may result in a lack of1) The Journal of Kampo Medicine (Japanese Version),stimulation of the intestinal mucosa, decreasing

Vol.54 No.12, P1839-1863, 2007 (in Japanese)

peristaltic movements and thus cause atonic2) LI Shi-zhen 李 世 珍 : Clinical Elaboration of theconstipation, or else the sensitivity of the wall of theCommon Shu Points 常用腧穴臨床発揮, P430-439,

rectum may decrease and thereby decrease thePeople’s Medical Publishing House Co., LTD 人民衛

defecation reflex in rectal constipation. In spastic

生出版, 1991 (in Chinese)

constipation the feces do not move forward to theanus when the sigmoid colon is spastic.

Common Shu Points 常用腧穴臨床発揮, P472-482,

Moreover, secondary constipation may be further
classified into obstruction constipation due to colon
tumors obstructing the intestinal lumen. A variety ofendocrineorsystemic

disorders3) LI Shi-zhen 李 世 珍 : Clinical Elaboration of thecanPeople’s Medical Publishing House Co., LTD 人民衛
生出版, 1991 (in Chinese)4) The Inner Classic of the Yellow Emperor (Huangdicause

Neijing Ling shu 黄 帝 内 経 霊 枢 ) Chapter 4: The

constipation, as well as relaxation of smooth muscles

Visceral Diseases Caused by Evil Energy 邪気蔵府病

induced by antipsychotic agents or muscle relaxants,

形編 (in Chinese)

resulting in drug induced constipation7).
While the cause is not clear in this case, I
presumed it to be idiopathic simple constipation.
In the second volume of the "Textbook of5) LI Shi-zhen 李 世 珍 : Clinical Elaboration of theCommon Shu Points 常用腧穴臨床発揮, P198-209,
People’s Medical Publishing House Co., LTD 人民衛
生出版, 1985 (in Chinese)

Acupuncture and Moxibustion" constipation is6) The Inner Classic of the Yellow Emperor (Huangdi

classified into the four forms of heat constipation

Neijing Su wen 黄 帝 内 経 素 問 ) Chapter 17 The

caused by dryness-heat of stomach and bowels, Qi

Essentials

constipation caused by liver depression and Qi

Palpation 脈要精微論 (in Chinese)

stagnation, constipation due to both Qi and Blooddeficiency as well as cold constipation due to kidney

andFundamentalsofDiagnostic7) Internal Medicine, Ver. 8, P1016-1019, Asakura
Publishing Co,. Ltd. 2003 (in Japanese)yang deficiency. For the treatment I used ST-25 and8) Textbook of Acupuncture and Moxibustion 鍼灸学

SJ-6. To the basic treatment point ST-37 LI-11 and(Part2), P162-165, zhongyigujichubanshe 中医古籍

LU-5 were added for heat constipation, LIV-3 and出版, 1986 (in Chinese)

GB-34 for Qi constipation, ST-36, BL-20 and SP-6 fordeficiency type constipation and for cold constipation
BL-23 and BL-248).

* This report was published in the "The Journal ofKampo Medicine" (Japanese edition) Vol. 55; No.12

I considered the condition in this case to be aand has been translated after slight modifications.

constipation caused by liver depression and Qi
stagnation. That is why LIV-3 among the above
mentioned basic treatment points was effective.
There is a tendency to consider pain caused bydiseases of the locomotor system to be an indication
for acupuncture and moxibustion treatment, but
idiopathic or secondary constipation due to the side14The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)