Integrating Acupuncture and Diet Therapy in the Management of Slow-Transit Constipation with Liver-Qi Stagnation: A Case Study

Journal of Complementary Therapies in Health ISSN 2975-9323 |eISSN 2975-9552 Journal of Complementary Therapies in Health 2025:3(3). doi:10.5281/zenodo.17599147 institutoptc.com/journal-complementary-therapies Clinical case study Integrating Acupuncture and Diet Therapy in the Management of Slow-Transit Constipation with Liver-Qi Stagnation: A Case Study. Filipe Antunes1* , Sara Santos1, Manuela Pereira1, and Leandro Araújo1. 1 IPN – Portuguese Institute of Naturology, Porto, Portugal. * Correspondence: [email protected] Abstract Slow transit constipation is a pathological condition characterised by an irregular bowel pattern, abdominal discomfort, sensation of incomplete evacuation, and dry stools. In Traditional Chinese Medicine (TCM), these symptoms can be correlated with the imbalance of Liver-Qi stagnation. This case study describes the application of a TCM treatment protocol, combining acupuncture and diet therapy, in a 31-year-old woman with Liver-Qi stagnation and slow transit constipation. The aim was to demonstrate the effectiveness of a personalised TCM's approach in solving the problem and promoting greater body awareness. Ten sessions were conducted over three months combining acupuncture and individualised diet therapy. The results show the resolution of the constipation, sleep pattern improvement, and reduction of abdominal distension, evidencing TCM´s ability to treat the underlying cause and not just the symptoms. This case highlights TCM’s potential as an adjunctive therapy for functional bowel disorders. Keywords: TCM; Acupuncture; Constipation; Slow-Traffic Constipation; Liver-Qi Stagnation. 1. Introduction Constipation is a common condition that affects approximately 18% of the population in Portugal 1, with prevalence increasing with age 1,2. Western medicine defines slowtransit constipation as having fewer than three spontaneous bowel movements per week, accompanied by abdominal distension and pain/discomfort, common in young women, due to a deficit of cells that promote a delayed colonic transit 3,4. The diagnosis is complemented by anamnesis and additional tests such as rectal examination, abdominal X-ray and CT scan 4-6. The causes can be multifactorial, including inadequate diet, a sedentary lifestyle, and use of certain medications 1-3,7. For diagnosis, criteria is mainly based on the use of two scales: the Rome IV Scale, which requires the presence of symptoms in the last three months, with a minimum evolution of six months and at least two clinical criteria, and the Bristol Scale, which classifies the type of stool, allowing inferences related to the individual's diet and hydration status 3,4. Western treatment begins with lifestyle modifications, such as physical exercise, fibre and water intake, and may resort to laxatives or, as a last resort, surgery 3,4,7. TCM offers a holistic perspective, looking at the body, and mind and spirit as interdependent parts. Pathologies are often associated with imbalances of Qi flow, which is the body's "vital energy". It uses practices such as phytotherapy, acupuncture, massage therapy, qigong, and diet therapy 8. In the context of constipation, TCM is distinguished by its individualised approach and efficacy 9. In addition to the anamnesis and the tests Citation: Antunes F., Santos S., Pereira M. Araújo L. Integrating Acupuncture and Diet Therapy in the Management of Slow-Transit Constipation with Liver-Qi Stagnation: A Case Study. Journal of Complementary Therapies in Health. 2025;3(3) 10.5281/zenodo.17599147 Academic Editor: Jorge Rodrigues Received: 30 October 2025 Reviewed: 8 November 2025 Revised: 11 November 2025 Accepted: 12 November 2025 Published: 13 November 2025 Publisher’s Note: IPTC stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Copyright: ©2025 by the authors. Submitted for open access publication under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Journal of Complementary Therapies in Health 2025: 3(3). 2 of 7 Antunes F., Santos S., Pereira M. Araújo L. Integrating Acupuncture and Diet Therapy in the Management of Slow-Transit Constipation with Liver-Qi Stagnation: A Case Study doi:10.5281/zenodo.1759914 performed, the diagnosis involves observation of the tongue and palpation of the pulse, which helps to confirm symptoms and identify underlying energy patterns. As in Western medicine, the Bristol Scale can also be used, since the characteristics of the stool reflect the energetic and functional state of the organs. After identifying the particularities of constipation, the energetic diagnosis of TCM aims to determine which organs or viscera are affected and the associated syndromes, in order to outline the most appropriate therapeutic strategy. In the case under study, there is stagnation of Liver-Qi, corroborated by a pink tongue with coating, presence of petechiae on the edges and distended sublingual veins, a tense pulse in the liver, insomnia at one in the morning and the presence of irritability and repression of this emotion 10. As the liver is the organ responsible for the smooth circulation of Qi in the body, when it stagnates, it affects the Qi of other organs, such as the spleen and stomach, interfering with digestion 11,12. The disturbance in the stomach's Qi leads to slow digestion, which makes it difficult to send food to the small intestine, resulting in bloating. Stagnation also impairs the downward movement of Qi, delaying faecal elimination, undigested food particles, and difficulty to excrete. Once the diagnosis is concluded, the treatment of constipation in TCM may involve several therapeutic techniques, chosen according to the identified energy imbalance and the patient's global condition. This personalised approach, centred on the individual and not just on the pathology, distinguishes TCM from Western Medicine, often more standardised in its therapeutic protocols 13,14 The present case study explores the application and ability of two principles of TCM, diet therapy and acupuncture, in the treatment of slow transit constipation, specifically when associated with Liver-Qi stagnation. 2. Methodology A case study was conducted with a young female nurse by profession, 31 years old, with no known health problems other than the daily use of the contraceptive pill. The patient consented to her participation and sharing of the case. The study lasted ten consultations, distributed weekly in the first seven, fortnightly in the following two, and monthly in the last. In the first consultation, the absence of an intestinal pattern was presented by the patient as her main complaint, also stating that she had a bowel movement every five days, sometimes forgetting the last bowel movement. Stools were consistently dry, hard, and bally, with severe colic prior to bowel movement but no lower back pain afterwards. Other symptoms included bloating and abdominal discomfort at the end of the day and after meals. The sleep pattern was irregular, she went to bed at midnight, fell asleep at one in the morning, and woke up at six in the morning, feeling tired. Emotionally, the patient was easily irritable, a perfectionist, and kept frustrations and irritability to herself. Eating habits included an irregular breakfast, sometimes omitted (bread with cheese and yogurt), lunches and dinners of fish or meat with pasta and/or vegetables (carrots, broccoli, zucchini, cauliflower, eggplant), with special emphasis on the almost daily consumption of broccoli. Dinner times were irregular due to shift work. Hydration was approximately 1.5 L of water per day. After collecting the clinical data, the pulse and tongue were evaluated: • Pulse: Low overall vitality. Weak heart, tense liver, spleen and stomach, fast lung (associated with recent constipation), weak Yin kidney and Yang kidney present. • Tongue: Pink with white coating on the edges, dental marks, petechiae on the sides and red at the tip with petechiae. Slightly distended sublingual veins. These signs and symptoms were consistent with a diagnosis of Liver-Qi stagnation. After reaching the diagnosis, a treatment protocol was defined: The treatment consisted Journal of Complementary Therapies in Health 2025: 3(3). 3 of 7 Antunes F., Santos S., Pereira M. Araújo L. Integrating Acupuncture and Diet Therapy in the Management of Slow-Transit Constipation with Liver-Qi Stagnation: A Case Study doi:10.5281/zenodo.1759914 of acupuncture and dietary modifications. In terms of acupuncture points, a standardised protocol was applied, which included the points shown in Table 1. Table 1. Acupuncture points The needles (0.25x0.25mm and 0.30x0.40mm) were inserted perpendicularly (except L3) with a top-down orientation, and kept for 20 to 30 minutes. The locations are shown in Figure 1. Figure 1. Location of the points. In terms of diet therapy, the following recommendations were implemented: • Always consume the first meal when you wake up (considered breakfast). • Replace cheese with fresh cheese or yogurt with probiotic and fruit at breakfast. • Initially, avoid the consumption of dark green vegetables (especially broccoli). • Introduce vegetables such as garlic, leeks, pumpkin, and carrots. • Ingest 20-30 g of ground flaxseed in 200 mL of water, soaked for 6-9 hours, drinking only the liquid in the morning and evening. • Drink peppermint tea 30 minutes after main meals (initially). • Avoid spicy, warm or hot foods in excess, fatty and processed foods, raw foods, excess salt and liquids during meals. Avoid acidic and astringent fruits at an early stage. This case study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The patient provided written informed consent to participate in the study and to have her clinical information published anonymously for educational and scientific purposes. All personal identifiers were removed to ensure confidentiality Acupuncture Point Function ST28 (Shuidao) ST29 (Guilai) It helps to clear heat and promote bowel movements. Waishudao and Waiguilai It reinforces the action of elimination and energy circulation. It acts on the descending colon to promote the descent of Qi. L3 (Taichong) Yuan point, promoting, a smooth circulation of Qi, LI4 (Hegu) It unclogs Qi, facilitates the descent of food into the intestine and helps in the elimination of heat. ST37 (Shangjuxu) It is an inferior sea point of the large intestine. It stimulates the circulation of Qi in the intestines, and promotes the descent of energy. ST39 (Xiajuxu) It is a lower sea point of the small intestine. It harmonises the Qi of the gut, and regulates the Qi in rebellion. Journal of Complementary Therapies in Health 2025: 3(3). 4 of 7 Antunes F., Santos S., Pereira M. Araújo L. Integrating Acupuncture and Diet Therapy in the Management of Slow-Transit Constipation with Liver-Qi Stagnation: A Case Study doi:10.5281/zenodo.1759914 and privacy. Ethical approval was not required, as this study describes a single clinical case with non-experimental therapeutic interventions within standard Traditional Chinese Medicine practice 3. Results The treatment showed a clear improvement in the clinical picture, showing an upward trend in the number of stools per week since the first consultation (Table 2). Table 2. Comparison of the evolution of symptoms during the consultations The main improvements observed were the resolution of abdominal distension, which disappeared after the fourth consultation; Improvement in sleep pattern, as the patient started to wake up with more energy and stopped reporting 1 am insomnia, associating it with the establishment of an earlier bedtime (between 10 pm and 11 pm); Resolution of constipation due to slow transit, which was the main problem, solved with the establishment of a defined intestinal pattern after the fifth consultation; Increased body awareness, as greater awareness of body and its signals have been developed. Improvements in TCM indicators, namely in the pulse in the position of the spleen that was no longer tense, the petechiae on the lateral edges of the tongue disappeared, the sublingual veins became progressively less distended, and the pulse in general showed more vitality on rest days. 4. Discussion The initial anamnesis data (sleep pattern, bowel pattern, slow digestion, abdominal distension, tongue with lateral petechiae, tense pulse in the liver, spleen and stomach, irritability, excessive consumption of dark green vegetables) were crucial to confirm the diagnosis of Liver-Qi stagnation. The liver, in TCM, is responsible for the smooth flow of Qi and Xue (blood), influencing emotions, digestion, and the menstrual cycle. When Liver-Qi stagnates, it affects the Qi of other digestive organs, such as the spleen and stomach, preventing the effective descent of food, causing lengthy digestion and bloating 15-17. This stagnation also compromises the peristaltic movements of the large intestine, drying out fluids and resulting in hard, blistering stools that are difficult to excrete. Therefore, identifying foods that may promote Liver-Qi stagnation is clinically useful: in early stages dietary change can produce substantial benefits, whereas in chronic stages diet alone may be less effective. In any case, treatment should aim to nourish the Blood, disperse stagnation, improve circulation in the lower burner (lower heater), and Symptom First Consultation Third Consultation Seventh Consultation Tenth Consultation Bowel Pattern Absence of bowel pattern Four stools in the week Five droppings in the week Between four and five stools per week Bloating Feeling of abdominal bloating Feeling of abdominal bloating Not mentioned Had no abdominal distension Pain/Colic Very severe cramping before defecation No cramps No Mentioned No Mentioned Sleep Pattern Irregular due to shifts Not mentioned Without the 1 am insomnia Without the 1 am insomnia Emotional State He was easily irritated Not mentioned angry at work No Mentioned Journal of Complementary Therapies in Health 2025: 3(3). 5 of 7 Antunes F., Santos S., Pereira M. Araújo L. Integrating Acupuncture and Diet Therapy in the Management of Slow-Transit Constipation with Liver-Qi Stagnation: A Case Study doi:10.5281/zenodo.1759914 avoid foods that exacerbate Liver dysfunction, since the Liver in TCM governs the smooth movement of Qi and thus the circulation of Blood 13. Dietary measures are therefore complementary to therapies that move Qi (for example acupuncture and gentle dispersing foods) and help re-establish free flow before further support of the affected organs is attempted 18. In addition to improving the circulation of Qi, it is also important to support organs that may have been affected by Liver-Qi stagnation, such as the spleen-pancreas and stomach 19,20. Therefore, the combination of acupuncture and diet therapy is essential. Acupuncture points were selected to unclog the flow of Qi, drain the Liver, regulate the circulation of Qi, and remove the heat generated by stagnation. For example, L3 and LI4 (the Si Guan pair) are powerful for regulating Qi circulation, and the ST28, ST29, Waishudao, and Waiguilai abdominal points in the left quadrant of the abdomen act directly on the descending colon to promote evacuation . Diet therapy complemented the action of acupuncture, with the objective of toning affected organs (spleen-pancreas and stomach), regularising peristalsis, hydrating faeces, and avoiding foods that aggravated stagnation. The initial removal of dark green vegetables, such as broccoli, although healthy, was strategic because, in the event of excess liver, its supporting function could aggravate stagnation, with dispersion being a priority. Peppermint tea (fresh, spicy) was advised, in therapeutic quantity, so as not to cause dryness of the fluids and hardening of the stool. The consumption of ground flaxseed in the morning and at night to lubricate the faeces and facilitate evacuation. These two indications served as initial "crutches" to hydrate the stool and speed up digestion, and were later removed as the bowel pattern became established. Throughout the treatment, the evolution and improvements observed were noticeable, namely significant changes in the patient's tongue and pulse, which indicated a clear improvement in her energy status. The pulse in the spleen position ceased to be tense as the patient's digestion regularised, the petechiae on the lateral edges of the tongue disappeared, the sublingual veins became progressively less distended, the insomnia of one in the morning disappeared, and an intestinal pattern began to be outlined. Additionally, in the few sessions in which the patient attended without having worked at night, her pulse showed more vitality than in the first consultation, which demonstrates a positive evolution in the production and circulation of energy in the body. Improvements found in this clinical case are supported by previous studies 21-25. Moreover, it was noticed that, in addition to the improvement of constipation that the patient initially presented, other problems were also improved, especially the sleep pattern, digestion, and abdominal distension, which is supported by the literature 10-12. 5. Conclusion This case study highlights the effectiveness of a Traditional Chinese Medicine (TCM) approach, combining acupuncture and diet therapy, in the management of slow transit constipation associated with Liver-Qi stagnation. The individualised treatment not only resolved the patient’s constipation but also improved related symptoms, including sleep quality, abdominal distension, and emotional irritability. These outcomes illustrate TCM’s distinctive strength in addressing the underlying energetic imbalance rather than focusing solely on symptomatic relief. By restoring the smooth flow of Qi and harmonising the functions of the Liver, Spleen, and Stomach, the applied protocol promoted physiological and emotional equilibrium. Furthermore, the patient’s increased body awareness and ability to recognise the connection between diet, emotions, and bowel function suggest that TCM can foster selfregulation and sustained therapeutic results. Although this is a single case, it reinforces the clinical relevance of integrating acupuncture and dietary adjustment in functional bowel disorders, particularly when conventional approaches yield limited results. The growing understanding of the gut–brain Journal of Complementary Therapies in Health 2025: 3(3). 6 of 7 Antunes F., Santos S., Pereira M. Araújo L. Integrating Acupuncture and Diet Therapy in the Management of Slow-Transit Constipation with Liver-Qi Stagnation: A Case Study doi:10.5281/zenodo.1759914 axis and intestinal microbiota in contemporary research supports TCM’s holistic perspective, in which digestive health is closely linked to emotional and systemic balance. Future studies with larger sample sizes and controlled designs are warranted to further substantiate these findings and clarify the mechanisms underlying the TCM approach to slow transit constipation. Credit author statement: Conceptualisation, F.A.; Methodology, F.A.; Validation, S.S., M.P.; Formal analysis, F.A. and S.S.; Investigation, F.A., S.S., M.P., and L.A.; Writing – Original Draft, F.A. and S.S.; Writing – Review & Editing, F.A., S.S., M.P., and L.A.; Visualisation, F.A.; Project administration, F.A. All authors have read and agreed to the published version of the manuscript. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Conflict of Interest: The authors declare that there are no conflicts of interest. Institutional Review Board Statement: Not applicable. Informed Consent Statement: An informed consent statement was signed by the patient. Data Availability Statement: The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author. References 1. Caetano AC, Costa D, Silva-Mendes S, Correia-Pinto J, Rolanda C. Constipation: Prevalence in the Portuguese community using Rome IV-Associated factors, toilet behaviours and healthcare seeking. United European Gastroenterol J. 2022;10(4):376-84. doi: https://doi.org/10.1002/ueg2.12221 2. Ribeiro A, Freire G, Alves M. A Long History of Constipation. GE Port J Gastroenterol. 2020;27(2):144-6. doi: https://doi.org/10.1159/000501804 3. 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