Effectiveness and Safety of Moxibustion on Constipation: A Systematic Review and Meta-Analysis

Constipation is an extremely common condition in clinical practice, characterized by prolonged stool retention in the intestine, reduction in the number of bowel movements to fewer than three times per week, and dry, hard-to-pass stools. This problem causes physical and emotional suffering to patients and can lead to symptoms such as abdominal pain, bloating, loss of appetite, and reduced sleep quality, as well as more serious complications such as heart failure and even sudden death. Constipation is particularly common in bedridden patients, older adults, individuals with reduced mobility, patients undergoing chemotherapy, and those with certain neurologic conditions such as stroke. Conventional Western treatment, based on oral laxatives, suppositories, and enemas, provides temporary symptomatic relief but does not fundamentally resolve the problem of bowel function, and may also increase the risk of constipation over the long term.

This study aimed to evaluate the efficacy and safety of moxibustion for the treatment of constipation through a systematic review and meta-analysis. Moxibustion is a Traditional Chinese Medicine technique that uses moxa sticks (Artemisia vulgaris) which, when lit and applied to specific body points, produce therapeutic heat. The investigators conducted a comprehensive search of various English- and Chinese-language medical databases, including PubMed, EMBASE, Cochrane Library, and others, looking for studies published through November 2019. Only randomized controlled trials comparing moxibustion alone with conventional Western treatments or other Traditional Chinese Medicine methods in patients diagnosed with constipation were selected.

The methodologic quality of the studies was assessed using specific criteria, and the data were analyzed statistically to determine treatment efficacy.

The analysis included ten randomized clinical trials involving 760 patients, of whom 379 received moxibustion and 381 received control treatments. Results showed that moxibustion had a significantly higher clinical efficacy rate compared with conventional treatments, with 30% greater odds of symptom improvement. Patients treated with moxibustion also had shorter time to first bowel movement after treatment initiation, lower clinical symptom scores (indicating less discomfort), and better stool consistency on the Bristol scale, which classifies stool form and texture. Interestingly, the benefits of moxibustion were consistent regardless of the type of treatment used in the control group, the duration of treatment (which ranged from 7 to 56 days), or the specific moxibustion method used.

The studies tested different techniques, including heat-sensitive moxibustion, thunder-fire moxibustion, and small-cone moxibustion.

The clinical implications of these findings are promising for patients and clinicians. Moxibustion offers a safe and effective alternative to conventional treatments for constipation, particularly valuable for its ease of application, lack of toxicity, and minimal side effects. The technique may be especially beneficial for patients who do not respond adequately to laxatives or who experience adverse effects from conventional medications. For practitioners, these results suggest that moxibustion can be integrated as part of a broader therapeutic approach to constipation management.

The study also identified that specific body points are more frequently used, such as those related to the stomach meridian and points of the Conception Vessel, providing practical guidance for the application of the technique.

However, the study has important limitations that should be considered. The methodologic quality of the included studies was generally low, with only one of the ten studies receiving an A rating (high quality) and the remainder a B rating (moderate quality). Most studies did not use adequate methods of randomization, allocation concealment, or blinding, which may have introduced bias into the results. In addition, only four studies observed adverse effects during treatment, and although there was no significant difference in safety between moxibustion and control treatments, the data were insufficient to draw definitive conclusions about the safety of the technique.

The sample sizes of many studies were small, and there was considerable variability in application methods, treatment duration, and acupoints used. The analysis also detected some publication bias, suggesting that studies with negative results may not have been published. Finally, most studies were conducted in China, limiting the generalizability of results to other populations. The authors conclude that, although moxibustion demonstrates a beneficial effect in the treatment of constipation, more rigorous future studies with larger samples and better methodologic quality are needed to definitively confirm its efficacy and establish standardized treatment protocols.