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Journal of Chinese Integrative Medicine ›› 2011, Vol. 9 ›› Issue (11): 1206-1214.doi: 10.3736/jcim20111108

• Original Clinical Research • Previous Articles     Next Articles

Acupuncture combined with Chinese herbal medicine Plantain and Senna Granule in treatment of functional constipation: A randomized, controlled trial

Li-ke Guo1, Chao-xian Zhang2(), Xiao-feng Guo3   

  1. 1. Department of Stomatology, the First Affiliated Hospital of Xinxiang Medical College, Weihui 453100, Henan Province, China
    2. Department of Gastroenterology, the First Affiliated Hospital of Xinxiang Medical College, Weihui 453100, Henan Province, China
    3. Department of Hepatology, the Sixth People's Hospital of Hangzhou, Hangzhou 310014, Zhejiang Province, China
  • Received:2011-05-30 Accepted:2011-07-25 Online:2011-11-20 Published:2011-11-15

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Background: Functional constipation is one of the most common gastrointestinal diseases. Currently, there is no effective Western medical therapy for functional constipation and it significantly impacts the quality of life of the patients. Integrated traditional Chinese and Western medicine therapies were reported to have better therapeutic effects than routine Western medicine therapies.
Objective: To explore the efficacy of acupuncture combined with Chinese herbal medicine Plantain and Senna Granule in the treatment of functional constipation.
Design, setting, participants and interventions: A total of 390 patients with confirmed functional constipation enrolled from the Department of Gastroenterology, the First Affiliated Hospital of Xinxiang Medical College in China from February 2008 to January 2010 were randomly divided into three groups, with 130 cases in each group. Acupuncture group was treated with puncture of point Tianshu (ST25), Shangjuxu (ST37), Zusanli (ST36), Dachangyu (BL25) and Zhigou (SJ6) twice daily for four weeks, while Plantain and Senna Granule group was treated with 5 g of Plantain and Senna Granule once daily, and the combination group was given above-mentioned acupuncture and Plantain and Senna Granule.
Main outcome measures: The defecation cycle, stool property, constipation symptom, accompanying symptoms, gastrointestinal transit time, including total gastrointestinal transit time, mouth-intestine transit time, colonic transit time, right colonic transit time, left colonic transit time and rectosigmoid colonic transit time, and adverse reactions of the three groups were evaluated before treatment, at the end of treatment and 64 weeks after treatment, respectively.
Results: Compared with before treatment, the scores of defecation cycle, stool property, constipation symptoms and accompanying symptoms, and gastrointestinal transit time all decreased significantly at the end of treatment in each group (P<0.01), and the combination group showed better results than the other groups (P<0.05). Compared with the end of treatment, the above-mentioned indexes recurred insignificantly in the combination group and acupuncture group after 64 weeks of follow-up (P>0.05), but all recurred significantly in the Plantain and Senna Granule group (P>0.05). Both short- and long-term total response rates of the combination group showed significant differences compared with those of the other two groups (P<0.05 or P<0.01). No serious adverse reactions occurred in all the three groups.
Conclusion: Acupuncture plus Plantain and Senna Granule can significantly decrease gastrointestinal transit time and defecation cycle in patients with functional constipation; it can also change stool property and alleviate constipation symptom and accompanying symptoms, with good security and tolerance.

Key words: acupuncture, Chinese patent medicine, functional constipation, defecation cycle, stool property, constipation symptom, accompanying symptom, gastrointestinal transit time

Figure 1

Flow diagram of this randomized trial PSG: Plantain and Senna Granule."

Table 1

General characteristics of patients of the three groups"


Item
Acupuncture group (n=125)
PSG group (n=125)
Combination group (n=128)

Gender (Male/female)
62/63
64/61
65/63

Age (x±s, years)
49.7±10.5
51.7±10.3
50.4±12.6

Course of disease (x±s, years)
20.71±5.56
20.67±3.41
20.74±4.81

Degree of disease (n, %)

Mild
36 (28.8)
36 (28.8)
35 (27.3)

Medium
56 (44.8)
55 (44.0)
58 (45.3)

Severe
33 (26.4)
34 (27.2)
35 (27.3)

Table 2

Grades of defecation cycle, stool property, constipation symptom and accompanying symptom of the three groups (x±s, score)"


Group
n
Defecation cycle
Stool property
Constipation
symptom
Accompanying
symptom
Total symptom

Combination
128

Before treatment
2.67±0.52
2.59±0.24
3.84±0.31
7.18±2.54
16.28±4.51

After treatment
0.92±0.26**
0.85±0.44**
1.26±0.24**
3.28±1.74**
7.31±2.39**

64 weeks after treatment
0.93±0.47□■■
0.85±0.53□■■
1.27±0.76□■■
3.31±0.52□■■
7.36±1.25□■■

Acupuncture
125

Before treatment
2.66±1.24
2.60±0.29
3.85±0.64
7.18±4.51
16.29±3.26

After treatment
1.44±0.65**△
1.37±0.39**△
1.79±0.28**△
4.51±1.53**△
9.11±2.42**△

64 weeks after treatment
1.45±0.37
1.37±0.32
1.80±0.18
4.53±2.07
9.15±2.57

PSG
125

Before treatment
2.66±0.34
2.61±1.32
3.84±0.76
7.18±2.08
16.29±5.54

After treatment
1.45±0.68**△
1.38±0.46**△
1.79±0.29**△
4.48±1.26**△
9.10±2.73**△

64 weeks after treatment
2.08±0.1▲
1.92±1.91▲
2.51±0.43▲
5.82±3.05▲
12.33±5.58▲

Table 3

Results of gastrointestinal transit time of the three groups (x±s)"


Group
n
50% TGITT
50% M-ITT
50% CTT
50% RCTT
50% LCTT
50% RSTT

Combination
128

Before treatment
81.8±2.3
21.5±0.4
60.3±1.4
21.5±0.8
12.8±1.7
26.0±2.6

After treatment
21.0±1.6**
8.1±1.2**
12.9±1.5**
6.1±2.1**
2.8±0.3**
4.0±0.4**

64 weeks after treatment
22.5±1.4□■■
8.5±1.7□■■
14.0±0.9▲□■■
6.7±0.3□■■
3.0±1.5□■■
4.3±0.9□■■

Acupuncture
125

Before treatment
81.7±1.5
21.3±0.6
60.4±1.4
21.4±0.8
12.8±0.8
26.2±1.2

After treatment
33.0±2.3**△
11.9±1.4**△
21.1±1.3**△
9.1±1.9**△
5.4±2.4**△
6.6±0.7**△

64 weeks after treatment
37.5±1.3
13.8±2.4
23.7±0.9
10.0±0.3
6.3±1.5
7.4±1.9

PSG
125

Before treatment
81.9±2.4
21.4±0.9
60.5±1.7
21.5±1.5
12.7±2.2
26.3±1.3

After treatment
33.1±1.8**△
12.0±2.2**△
21.1±0.6**△
9.2±1.2**△
5.6±2.4**△
6.3±0.8**△

64 weeks after treatment
57.2±1.5▲
20.9±0.6▲
36.3±0.9▲
15.2±1.8▲
9.7±1.2▲
11.4±1.8▲

Table 4

Results of motolin and residual rate of radiopaque markers of the three groups (x±s)"


Group
n
Motolin (mg/L)
Residual rate of radiopaque markers (%)

Combination
128

Before treatment
326.82±52.73
73.45±8.94

After treatment
504.65±72.64**
25.61±4.82**

64 weeks after treatment
497.95±61.39□■■
27.03±5.74□■■

Acupuncture
125

Before treatment
325.87±41.57
73.43±9.76

After treatment
418.20±26.83**△
37.76±5.43**△

64 weeks after treatment
413.51±56.17
39.85±10.34

PSG
125

Before treatment
327.02±62.44
73.46±4.91

After treatment
420.50±51.43**△
38.50±5.12**△

64 weeks after treatment
368.52±41.36▲
52.93±7.36▲

Table 5

Response rates of the three groups (n, %)"


Group
n
Obviously effective
Effective
Improvement
Ineffective
Total response rate

Combination
128

After treatment
62 (48.44)
39 (30.47)
24 (18.75)
3 (2.34)
125 (97.66)

64 weeks after treatment
60 (46.87)
39 (30.47)
25 (19.53)
4 (3.13)
124 (96.87)△□■■

Acupuncture
125

After treatment
39 (31.20)
29 (23.20)
33 (26.40)
24 (19.20)
101 (80.80)

64 weeks after treatment
38 (30.40)
29 (23.20)
32 (25.60)
26 (20.80)
99 (79.20)△

PSG
125

After treatment
40 (32.00)
28 (22.40)
32 (25.60)
25 (20.00)
100 (80.00)

64 weeks after treatment
31 (24.80)
24 (19.20)
24 (19.20)
46 (36.80)
79 (63.20)△▲
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