Explore the mechanism and treatment analysis of Acupuncture and Moxibustion for Constipation after Stroke

Shu-Meng He ,Rui Song ,Tong-Sheng Su＊

1Shaanxi University of Chinese Medicine,Xianyang City,Shaanxi,China.2Shaanxi Province Chinese Medicine Hospital,Xi'an,Shaanxi,China.

Modern research has shown that there is a special brain-gut axis between the brain and the gut,which can regulate and maintain the stable function of the body.Many studies have also proved that acupuncture at certain acupoints can affect the level of brain-gut peptide,an important material basis in the brain-gut axis,thereby improving the symptoms of constipation in patients after stroke.Through the angle of traditional Chinese medicine and meridian,it can prove the rationality of acupuncture at certain acupoints for the treatment of post-stroke constipation,and it is helpful for the selection of acupoints in the clinical treatment of post-stroke constipation.

Key words:Brain-gut axis,Brain-gut peptide,Stroke,Constipation,Acupuncture

Background

Stroke is a common clinical disease,including ischemic stroke and hemorrhagic stroke.It has the characteristics of high morbidity,disability,and mortality.Stroke is one of the most serious public health problems in our country.In recent years,it has become the most disabling and fatal disease in our country [1].Post-stroke constipation is a common and frequent complication in post-stroke patients,and its incidence can be as high as 48% [2].More serious patients can only rely on drugs to defecate,such as caoxilou,which seriously reduces the quality of life of patients,but also brings a heavy burden to the family life of many patients.In recent years,a large number of studies have shown that there is a very complex neuro-endocrine system between the brain and the gut.This system can connect the brain and the gastrointestinal system,which called the brain-gut axis.After stroke,the brain and intestine axis system of the patient was changed,and the neuro-endocrine-immune function was disordered,which led to the symptoms of constipation in many patients.The treatment of constipation has always been one of the dominant diseases of acupuncture therapy.Since the discovery of the brain-gut axis system,many studies and theories have explained the mechanism of acupuncture for post-stroke constipation from the perspective of the brain-gut axis system[3?5].

Brain gut axis theory

The brain-gut axis was first proposed by Professor Mike Gelsson of Columbia University.It is a system composed of gut microbiota,intestines,and nervous system (including central nervous system and enteric nerve),and is also called Brain-gut-microbe axis.The core of the brain-gut axis is the interaction between the central nervous system of the brain and the intestinal flora located in the gastrointestinal tract[6].In the past,the intestinal tract has long been regarded as controlled by the central nervous organ,but after further study found that the intestinal function is not controlled by the central nervous,but by the enteric nerve in the wall of the gastrointestinal tract.The enteric nerve is a complete network system independent of the brain.It is called the human body’s“second brain”It is different from the sympathetic nerve and parasympathetic nerve in structure,and is similar to the central nerve.The number of neurons is equivalent to that of the spinal cord.Its main function is to control the movement and secretion of the gastrointestinal tract.Intestinal microbes can communicate with the central nervous system through the vagus nerve channel,the immune system channel and the circulatory system channel[7].The material basis for the operation of the brain-gut axis pathways is the brain-gut peptide,which is a small molecule secreted by secretory cells in the enteric nerve,central nerve and gastrointestinal tract,and is also the main target of the brain-gut axis.The main way that brain-gut peptide participates in the brain-gut interaction is to regulate the movement and secretion of the body's gastrointestinal tract by participating in the transmission of information between the enteric nerve,central nerve and gastrointestinal effector cells.Brain-gut peptide can not only transmit neurotransmitters,but also secrete hormones,such as motilin,gastrin,ghrelin,vasoactin,5-hydroxytryptophan,Substance P,cholecystokinin,etc.[8].The main function of motilin is to make the stomach body and antrum contract and promote the emptying of food in the gastrointestinal tract.Gastrin can enhance the sphincter tension and promote gastrointestinal motility.Ghrelin participates in the body's energy metabolism and enhances Myocardial contractility,protection of gastric mucosa,etc.,in addition to stimulating gastrointestinal motility.Vasoactive peptides are inhibitory brain-gut peptides,which are mainly distributed in the central nervous system,gastrointestinal tract,and colon to stabilize and protect the intestinal nerve;P The substance belongs to the excitatory brain-gut peptide,which can contract the smooth muscle of the gastrointestinal tract,enhance gastrointestinal motility,and promote gastrointestinal emptying [9].5-hydroxytryptamine can promote gastrointestinal motility,and can also participate in regulating the body’s mood and recognition.Know and sleep[10].Cholecystokinin is mainly distributed in the gastrointestinal tract and central nervous system,and it mainly delays the emptying of the gastrointestinal tract by inhibiting the movement speed of the gastric antrum.

Brain-gut connection in Chinese medicine

The concept of holism is the main feature of the theoretical system of traditional Chinese medicine.The viscera and viscera are based on Qi,blood and body fluid,and through the meridian system,the viscera and viscera are connected into an organic whole."Su Wen":The heart is the foundation of life,and the change of the spirit.The heart in the concept of Chinese medicine refers to the "system heart".Traditional Chinese medicine believes that the main function of the heart is to preside over the blood and at the same time to preside over the spirit.The relationship between the heart and the small intestine is one outside and the other inside.This is an extension of the system heart function.In TCM theory,"Spirit" is the fundamental factor that governs the movement,change,rise and fall of things[11].In terms of the structure of the meridian,the "Lingshu" contains:"The small intestine is the pulse of the sun ...swallowing,lowering the diaphragm,reaching the stomach,reaching the small intestine ...the spleen is the pulse of the moon ...returning from the stomach to the upper diaphragm and filling the heart.Intestine and spleen Interconnected.From a functional point of view,the spleen and stomach are the foundation of acquired nature and the hub for the lifting and lowering of the Qi machine.The spleen controls the transportation and transformation of the human body.The spleen converts the food consumed by the human body into the essential water and grains of the human body,and absorbs and transmits it to the whole body,the viscera.The diet enters the stomach,after the spleen and stomach are decomposed,the water is passed down to the small intestine and the large intestine.The large intestine is the organ of passivation.The feces are excreted from the body,and the absorption of dross and body fluid depends on the promotion and stimulation of the temper.”"Su Wen" records:Soul door is the five internal organs,the water valley should not be hidden for long.The brain is the primordial organs,dominating the daily life activities of the human body,and all the internal organs coordinate and cooperate to maintain the body under the control and regulation of the brain.The stability of the Soul door is also regulated by the brain.

Treatment of constipation after stroke

Regarding the treatment of post-stroke constipation,western medicine mainly uses laxatives,prokinetic drugs,secretagogues,enemas and suppositories.Laxatives mainly include volumetric laxatives and osmotic laxatives.The mechanism of volumetric laxatives is to increase the water content of feces,thereby increasing the volume of feces and improving the symptoms of constipation,such as Psyllium,Ethylene glycol,lactulose and Salt laxatives.Prokinetic drugs can increase gastrointestinal motility,and directly act on intestinal smooth muscle.It can improve constipation better.Secretagogues can stimulate the secretion of intestinal fluid in the body,thereby Promote defecation.Enema and suppositories generally lubricate the intestinal wall and soften feces,making it easier to discharge,generally used in the intestinal administration,better results.Most of these have strong side effects.For example,excessive use of magnesium sulfate is prone to electrolyte disturbances,long-term use of more irritating laxatives is likely to cause a certain degree of enteric nerve damage,and excessive use of volumetric laxatives may cause blackening of the colon.Long-term use of enema Drugs and suppositories will have a greater dependence and so on[12].

Many ancient documents and modern studies have proved that acupuncture has a good effect on constipation,and has a two-way regulation effect.It has good effects on various gastrointestinal diseases such as diarrhea and loose stools.Long-term acupuncture treatment can help stroke Recovery of the patient's gastrointestinal function.Table 1 shows the frequency of use of acupoints for the treatment of post-stroke constipation.

Table 1 Acupoint frequency table

Tianshu point belongs to the foot-Yangming stomach meridian.It is the recruiting point of the large intestine and the place where the gas of the large intestine gathers.Tianshu is the key point for improving the function of the gastrointestinal tract and treating large intestinal diseases.Various other diseases of the intestinal tract such as diarrhea and loose stools have good curative effects.At the same time,it can treat patients with loss of appetite,fatigue and fatigue caused by spleen deficiency,loose stools and diarrhea.Modern studies have shown that acupuncture at Tianshu point acts on rats with atrophy of the intestinal mucosa and a small number of acinars,so that the smooth muscle thickness and cell morphology of the intestinal mucosa gradually become normal [12].In addition,acupuncture at Tianshu acupoint in rats can significantly reduce the neuropeptide Y content in rat thalamus and colon tissue [13].Zusanli belongs to the Foot-Yangming Stomach Meridian,and the"Lingshu" has records:if evil is in the spleen and stomach,the disease will cause muscle pain,the excess of yang,and the lack of yin,the heat will be good;the lack of yang,the excess of yin,the cold in the intestine Ming abdominal pain.The Zusanli point,which stimulates the stomach meridian,can effectively regulate the gastrointestinal function.Studies have shown that acupuncture at Zusanli may regulate the gastrointestinal function by regulating brain-gut peptide hormones.The content of cholecystokinin in paralyzed rats has a significant regulatory effect;at the same time,acupuncture at Zusanli can also regulate the body's gastrin,improve gastric mucosal blood flow,regulate gastric acid,and protect gastric mucosa.Cholecystokinin and gastrin are a kind of brain-gut peptides,which participate in the brain-gut axis of the body [14].The upper Juxu and Lower Juxu points belong to the Stomach Meridian of Foot-Yangming,which are the lower acupoints of the Large and Small Intestine Meridians,respectively.They have always been one of the commonly used acupoints for the treatment of gastrointestinal diseases.Studies have reported that acupuncture at the Shangjuxu acupoint can reduce the expression of serotonin transporter in the colonic mucosa of constipated rats.The mechanism of action may be to reduce the transcription efficiency and gene expression of the serotonin transporter genotype in the colonic mucosa of rats,which significantly reduces the reuptake rate of serotonin transporter,thereby enhancing intestinal motility and peristalsis,and alleviating symptoms of constipation [15].Both Qihai and Guanyuan points belong to the Ren Channel.Modern anatomical studies have shown that there is the medial cutaneous branch of the anterior branch of the eleventh intercostal nerve in the depths of Qihai point,and the small intestine is inside[16];the deep part of point Guanyuan is also the small intestine,and the twelfth intercostal nerve is distributed in the depth.The medial branch of the anterior cutaneous branch[17].Zhongwan and Xiawan acupoints were first seen in the "A and B Classic of Acupuncture and Moxibustion".Studies have shown that acupuncture at Zhongwan point can increase the body'sserumgastrin,motilin,plasma cholecystokinin,neuropeptide Y levels [18?20],shorten the body's gastric emptying time,and enhance gastric motility.According to the nerve segment theory,the sympathetic afferent neurons of the stomach (chest 6?9) and the sympathetic afferent neurons of the Zhongwan point (chest 7-waist 2) cross.Therefore,the Zhongwan and Xiawan points have an impact on the gastric function.Regulation has a good effect.

The brain-gut axis mainly regulates intestinal function through the pathway of intestinal microbes and central nervous system,and the brain-gut peptide secreted by the enteric nerve,central nervous system and gastrointestinal endocrine cells.Brain-gut peptides mainly include motilin,gastrin,ghrelin,vasoactive hormone,serotonin,substance P,cholecystokinin and so on.From the above studies,it can be found that acupuncture at certain acupoints can regulate intestinal function by regulating the secretion of brain-gut peptides and the distribution of intestinal microbes,thereby alleviating the symptoms of constipation in patients with post-stroke constipation.Among them,Tianshu,Zusanli,Shangjuxu,and Qihai are frequently used.We can also use these acupoints for treatment of post-stroke constipation in our clinic.However,because there are few studies on this aspect,we can further study this in the future and explore more acupoints that can interfere with the brain-gut axis,which will be more beneficial to the treatment of post-stroke constipation.