Application value of acupuncture combined with central low-frequency repetitive transcranial magnetic stimulation in the elderly with functional constipation of spleen-kidney yang deficiency type

To investigate the application value of acupuncture combined with central low-frequency repetitive transcranial magnetic stimulation (rTMS) in improving the clinical symptoms in elderly patients with functional constipation (FC) of spleen-kidney yang deficiency type.

From January 2023 to January 2024, 128 elderly patients with FC of spleen-kidney yang deficiency type admitted to the Department of Traditional Chinese Medicine of Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine were selected as study subjects. The patients were divided into a control group (prucalopride succinate tablets), an acupuncture group (acupuncture), a rTMS group (central low-frequency rTMS) and a combination group (acupuncture plus central low-frequency rTMS) using random number table method, with 32 patients in each group. Various clinical indicators were collected before treatment and at 4 weeks after treatment, including the patient assessment of constipation symptom (PAC-SYM) score, average weekly spontaneous complete bowel movements (SCBMs), serum intestinal neurotransmitters [nitric oxide (NO), vasoactive intestinal peptide (VIP), 5-hydroxytryptophan (5-HT), substance P (SP)], self-rating anxiety scale (SAS) score, and self-rating depression scale (SDS) score. The patients with SCBMs ≥ 3 times after treatment were followed up for 3 months to observe FC recurrence. Data analysis was performed using SPSS 27.0. Depending on the data type, comparisons between groups were conducted by one-way analysis of variance, Chi-square test, or rank-sum test, and pre- and post-treatment comparisons were performed using the paired-samples t-test.

After treatment, the total PAC-SYM score, serum NO and VIP levels, and SAS and SDS scores in the four groups decreased compared with those before treatment, and the above indicators in the acupuncture group and the rTMS group after treatment were lower than those in the control group, and the above indicators in the combination group were lower than those in the acupuncture group and the rTMS group (all P<0.05). SCBM and levels of serum 5-HT and SP were elevated compared to before treatment, and the above indicators after treatment were higher in acupuncture group and rTMS group than those in control group, and were higher in combined group than those in acupuncture group and rTMS group (all P<0.05). The proportion of patients with SCBM ≥ 3 times increased compared with that of the same group before treatment, and the proportion of patients with SCBM ≥ 3 times in the combination group was higher than that in the other three groups after treatment (P<0.05). A statistical difference was observed in the therapeutic efficacy among the four groups of patients (P<0.05). The follow-up results within 3 months after discontinuation of treatment showed no statistical difference in the recurrence rate of constipation among the control group, acupuncture group, and rTMS group (P>0.05), and the recurrence rate of constipation in the combination group was lower than that in the control group (P<0.05).

Acupuncture combined with central low-frequency rTMS treatment can significantly enhance the therapeutic effect in elderly patients with FC of spleen-kidney yang deficiency type and effectively reduce the recurrence rate of constipation, which may be related to its ability to effectively improve anxiety and depression and to regulate serum intestinal neurotransmitters levels.