Disease and Condition Overview
Constipation is characterized by the passing of dry, hard stool and infrequent and difficult bowel movements. It can be seen in many acute and chronic illnesses. In Chinese medicine, its location is at the intestines and it is closely associated with dysfunction and irregulations of spleen, stomach, lung, liver and kidney. External pathogenic cold and heat, internal emotional issues and poor diet, yin, yang, qi and blood deficiency may all lead to the blockage and dryness of intestines which cause constipation.
Clinically, there is functional constipation, irritable bowel syndrome and constipation caused by colon and anal diseases, hormonal disturbances or autoimmune diseases.

Pair-point Treatment Combinations

(1) Tianshu (ST26), Shangjuxu (ST37) (Fig 97)
Tianshu (ST26) is the front-mu point of large intestine and Shangjuxu (ST37) is the lower he-sea point of large intestine. This pair point combination unobstructs and regulates large intestine qi and promotes the transportation function of large intestine. This treatment is appropriate for various types of constipation.

Needling techniques:
Tianshu (ST26) perpendicular insertion to a depth of 1.5 cun.
Shangjuxu (ST37) perpendicular insertion to a depth of 1.5 cun.

(2) Zhigou (SJ6), Yanglingquan (GB34) (Fig 105)
Zhigou (SJ6): on the dorsurn of the forearm, on the line connecting Yangchi (SJ4) and the olecranon, 3 cun proximal to the dorsal crease of the wrist, between the radius and the ulna.
Yanglingquan (GB34): on the lateral side of the lower leg, in a depression anterior and inferior to the head of the fibula.
Zhigou (SJ6) is the jing-river point of hand-shaoyang. It primarily clears and harmonizes Sanjiao (upper, middle and lower jiao). Yanglingquan (GB34) is the he-sea point of the foot-shaoyang gallbladder channel. It primarily regulates liver and gallbladder. This pair point combination, one superior and one inferior, both located on the same channel, echoes the effects of one another. Together points have great effect on the qi of that channel, resolve shaoyang and disperse blockage. This treatment is appropriate for constipation caused by blockage and stagnation of qi.

Needling techniques:
In sitting or prone position, perpendicular insertion or upwards oblique insertion Zhigou (SJ6) to a depth of 1 cun.
Yanglingquan (GB34) perpendicular insertion to a depth of 1.5-2 cun.
Manipulate 5 minutes.

(3) Zhigou (SJ6), Zusanli (ST36) (Fig 106)
Zhigou (SJ6): on the dorsum of the forearm, on the line connecting Yangchi (SJ4) and the olecranon, 3 cun proximal to the dorsal crease of the wrist, between the radius and the ulna.
Zusanli (ST36): on the anteriolateral side of the lower leg, 3 cun inferior to Dubi (ST35), one finger breadth (middle finger) lateral to the anterior crest of the tibia.
Zhigou (SJ6) is the jing-river point of the hand-shaoyang. Its main function is to open the qi of the fu organs. Zusanli (ST36) is the lower he-sea point of stomach and its primary function is to lower the turbid of the stomach. This pair point combination opens and dredges, harmonizes shaoyang, regulate spleen and stomach and unobstructs intestine. This treatment is appropriate for constipation caused by qi deficiency.

Needling techniques:
Zhigou (SJ6) perpendicular insertion to a depth of 1 cun reducing method.
Zusanli (ST36) needle to a depth of 1.5-2 cun.
Use tonify method.

(4) Zhigou (SJ6), Zhaohai (KI6) (Fig 107)
Zhigou (SJ6): on the dorsum of the forearm, on the line connecting Yangchi (SJ4) and the olecranon, 3 cun proximal to the dorsal crease of the wrist, between the radius and the ulna.
Zhaohai (KI6): on the medial side of the foot, in the depression below the prominence of the medial malleolus.
Zhigou (SJ6) is the jing-river point of the hand-shaoyang channel. It regulates qi of the Sanjiao (upper, middle and lower jiao). Zhaohai (KI6) is a point on the foot-shaoyin channel and is a yin motility vessel confluence point. It tonifies yin to unobstruct stool. This pair point combination, both clearing and nourishing, works to tonify yin, nourish intestine, reduce heat and unobstruct stool. This treatment is appropriate for constipation caused by yin deficiency and excess fire.

Needling techniques:
Zhigou (SJ6) perpendicular insertion to a depth of 1 cun reducing method.
Zhaohai (KI6) perpendicular insertion to a depth of 1 cun.

Commentaries
Acupuncture treatment of constipation has great results.
Clinically, it is important to differentiate between the excess and deficiency syndromes. Among the deficiency syndromes, qi deficiency and yin deficiency are more common. For qi deficiency, select Zhigou (SJ6), Zusanli (ST36) pair-point combination. For yin deficiency, select Zhigou (SJ6), Zhaohai (KI6) pair-point combination. For excess syndromes most cases are qi stagnations, select Zhigou (SJ6), Yanglingquan (GB34). However, Tianshu (ST26), Shangjuxu (ST37), this combination is appropriate for all types of constipation.