Efficacy and Mechanisms of Acupuncture at Back-Shu and Front-Mu Points of the Large and Small Intestines Plus ST36 for Slow-Transit Constipation

Abstract

Objective: This study aimed to assess the efficacy, safety, and mechanisms of acupuncture at Back-Shu and Front-Mu points of the large intestine and small intestine plus ST36 for slow-transit constipation (STC). Methods: In this trial, 300 STC patients were assigned to an acupuncture group (n = 150, 20 sessions over 4 weeks) or a control group (n = 150, Congrong Shujiang oral liquid) using a computer-generated randomization sequence. Primary outcomes were weekly spontaneous bowel movements (SBMs) and colonic transit time. Results: The acupuncture group showed significantly greater improvements in weekly SBMs (1.8 ± 0.7–4.5 ± 1.2 vs. 1.9 ± 0.6–3.8 ± 1.1) and colonic transit time (78.5 ± 15.3–45.6 ± 12.8 h vs. 76.9 ± 16.2–52.3 ± 13.5 h) versus control (all P < 0.05), sustained at follow-up. Acupuncture also superiorly improved PAC-SYM, PAC-QOL, anorectal function, and gastrointestinal hormones (all P < 0.05), with a higher clinical efficacy (93.3% vs. 74.7%, χ² = 18.52, P < 0.01; difference 18.6%, 95% CI 10.5%–26.7%). Conclusion: Acupuncture at Back-Shu and Front-Mu points of the large intestine and small intestine plus ST36 is an effective, safe, multi-targeted therapy for STC, improving symptoms, function, and neuroendocrine levels via the brain–gut axis.

Trial registration: International Traditional Medicine Clinical Trial Registry, ITMCTR2026000328.