{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T02:44:12Z","timestamp":1776307452360,"version":"3.50.1"},"reference-count":98,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T00:00:00Z","timestamp":1760054400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Post-stroke constipation (PSC) is a common complication among stroke patients, with a positive correlation to stroke severity. Straining during defecation in constipated patients can increase intracranial pressure, posing a high risk for secondary strokes, negatively impacting prognosis, disease progression, and contributing to the development of depression and anxiety. Non-pharmacological interventions (NPIs), including traditional Chinese medicine (TCM) and rehabilitation approaches, have been explored due to challenges in advancing Western medical treatments. However, the optimal treatment remains unclear, necessitating guidance for clinical practice. This research employs Bayesian network meta-analysis (NMA) to identify the most effective NPIs for improving clinical outcomes and alleviating constipation in post-stroke patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a NMA of randomized controlled trials to evaluate the relative efficacy of eight NPIs for PSC: acupuncture therapy (AT), acupoint catgut embedding (ACE), auricular therapy (ART), moxibustion (MT), abdominal massage (AM), point application (PA), physiotherapy (PT), and cognitive behavioral therapy (CBT). The primary outcome was the clinical effective rate (CER), and the secondary outcome was the Constipation Scoring System (CCS). To establish a comparative hierarchy of interventions, surface under the cumulative ranking curve (SUCRA) values were calculated, representing the probability of relative efficacy across treatments.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A comprehensive literature review identified 53 clinical studies with 5,813 participants to evaluate the relative efficacy of eight NPIs. ACE ranked highest for both CER and CCS (SUCRA\u202f=\u202f94.7, 97.8%), followed by PT (88.4, 81.7%). In contrast, ART and AM ranked lower, indicating relatively less efficacy compared with other interventions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Acupoint catgut-embedding (ACE) may represent a potentially superior non-pharmacological intervention for improving clinical outcomes and reducing constipation severity in post-stroke patients. Physiotherapy (PT) also demonstrated favorable efficacy, ranking second in both clinical outcomes. However, further high-quality, multicenter clinical trials are needed to validate and refine these findings.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fneur.2025.1591620","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:36:45Z","timestamp":1760107005000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Comparative effectiveness of multiple different non-pharmacologic interventions for post-stroke constipation: a Bayesian network meta-analysis"],"prefix":"10.3389","volume":"16","author":[{"given":"Sisi","family":"Feng","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinhui","family":"Wu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xuemei","family":"Dai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhihao","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yi","family":"Luo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,10,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.1161\/STROKEAHA.108.534776","article-title":"New-onset constipation at acute stage after first stroke: incidence, risk factors, and impact on the stroke outcome","volume":"40","author":"Su","year":"2009","journal-title":"Stroke"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1004","DOI":"10.1016\/j.ijnurstu.2012.12.002","article-title":"A systematic review of the effectiveness of bowel management strategies for constipation in adults with stroke","volume":"50","author":"Lim","year":"2013","journal-title":"Int J Nurs Stud"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"142","DOI":"10.13194\/j.issn.1673-842x.2016.05.046","article-title":"Advances in post-stroke constipation research","volume":"18","author":"Gao","year":"2016","journal-title":"J Liaoning Univ Tradit Chin Med"},{"key":"ref4","first-page":"804","article-title":"Clinical observation of lactulose combined with microbial preparation in the treatment of stroke constipation","volume":"22","author":"Lu","year":"2017","journal-title":"Modern Digest Intervent"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"605","DOI":"10.3969\/j.issn.1008-7125.2013.10.007","article-title":"Guidelines for the diagnosis and treatment of chronic constipation in China","volume":"18","year":"2013","journal-title":"Chin J Gastroenterol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"483","DOI":"10.1097\/MCG.0b013e31820fb914","article-title":"World gastroenterology organisation global guideline: constipation--a global perspective","volume":"45","author":"Lindberg","year":"2011","journal-title":"J Clin Gastroenterol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"917","DOI":"10.1111\/j.1365-2036.2008.03806.x","article-title":"A multinational survey of prevalence and patterns of laxative use among adults with self-defined constipation","volume":"28","author":"Wald","year":"2008","journal-title":"Aliment Pharmacol Ther"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref9","first-page":"106","volume-title":"2016 edition of the Chinese guidelines and consensus on the management of cerebrovascular disease","year":"2016"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1481","DOI":"10.1053\/j.gastro.2016.02.014","article-title":"Rome IV diagnostic questionnaires and tables for investigators and clinicians","volume":"150","author":"Palsson","year":"2016","journal-title":"Gastroenterology"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1186\/2046-4053-3-37","article-title":"Evaluation of the Cochrane collaboration's tool for assessing the risk of bias in randomized trials: focus groups, online survey, proposed recommendations and their implementation","volume":"3","author":"Savovi\u0107","year":"2014","journal-title":"Syst Rev"},{"key":"ref12","volume-title":"Bayesian methods in meta-analysis chapter","author":"Mengersen","year":"2006"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1111\/1469-0691.12494","article-title":"The effects of clinical and statistical heterogeneity on the predictive values of results from meta-analyses","volume":"20","author":"Melsen","year":"2014","journal-title":"Clin Microbiol Infect"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"470","DOI":"10.1136\/bmj.316.7129.469","article-title":"Bias in meta-analysis detected by a simple, graphical test. Test had 10% false positive rate","volume":"316","author":"Seagroatt","year":"1998","journal-title":"BMJ"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1002\/jrsm.1037","article-title":"Indirect and mixed-treatment comparison, network, or multiple-treatments meta-analysis: many names, many benefits, many concerns for the next generation evidence synthesis tool","volume":"3","author":"Salanti","year":"2012","journal-title":"Res Synth Methods"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"897","DOI":"10.1136\/bmj.331.7521.897","article-title":"Simultaneous comparison of multiple treatments: combining direct and indirect evidence","volume":"331","author":"Caldwell","year":"2005","journal-title":"BMJ"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"159","DOI":"10.1186\/1741-7015-11-159","article-title":"Is network meta-analysis as valid as standard pairwise meta-analysis? It all depends on the distribution of effect modifiers","volume":"11","author":"Jansen","year":"2013","journal-title":"BMC Med"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1177\/0962280211432219","article-title":"A practical introduction to multivariate meta-analysis","volume":"22","author":"Mavridis","year":"2013","journal-title":"Stat Methods Med Res"},{"key":"ref19","volume-title":"Network meta-analysis using Bayesian methods","author":"Valkenhoef","year":"2015"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1080\/10618600.1998.10474787","article-title":"General methods for monitoring convergence of iterative simulations","volume":"7","author":"Brooks","year":"1998","journal-title":"J Comput Graph Stat"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"e1002028","DOI":"10.1371\/journal.pmed.1002028","article-title":"Epidemiology and reporting characteristics of systematic reviews of biomedical research: a cross-sectional study","volume":"13","author":"Page","year":"2016","journal-title":"PLoS Med"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1002\/jrsm.1167","article-title":"Automated generation of node-splitting models for assessment of inconsistency in network meta-analysis","volume":"7","author":"Van Valkenhoef","year":"2016","journal-title":"Res Synth Methods"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1007\/s10654-010-9491-z","article-title":"Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses","volume":"25","author":"Stang","year":"2010","journal-title":"Eur J Epidemiol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"1056156","DOI":"10.3389\/fneur.2022.1056156","article-title":"EMG biofeedback combined with rehabilitation training may be the best physical therapy for improving upper limb motor function and relieving pain in patients with the post-stroke shoulder-hand syndrome: a Bayesian network meta-analysis","volume":"13","author":"Feng","year":"2023","journal-title":"Front Neurol"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"251","DOI":"10.13460\/j.issn.1005-0957.2023.03.0251","article-title":"Observation on the efficacy of heat-sensitive moxibustion in treating post-stroke constipation with qi deficiency and its effect on serum SP and VIP levels","volume":"42","author":"Ma","year":"2023","journal-title":"Shanghai J Acupunct Moxibustion"},{"key":"ref26","first-page":"1007","article-title":"Clinical observation on bilateral acupoint acupuncture for the treatment of constipation in elderly stroke rehabilitation period","volume":"44","author":"Chen","year":"2022","journal-title":"Hebei J Tradit Chin Med"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1824","DOI":"10.13359\/j.cnki.gzxbtcm.2022.08.020","article-title":"Clinical observation on the treatment of post-stroke constipation by acupuncture and regulating divine formulas","volume":"39","author":"Zhong","year":"2022","journal-title":"J Guangzhou Univ Tradit Chin Med"},{"key":"ref28","first-page":"531","article-title":"Observation on the effect of integrated nursing care of combined Shangluo paste on Shenque acupoint in treating constipation after cerebral hemorrhage","volume":"43","author":"Wang","year":"2022","journal-title":"J Navy Med"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"97","DOI":"10.13424\/j.cnki.jsctcm.2022.02.022","article-title":"Observations on the efficacy of Xiao Yu Zi oil compresses on Shen que acupoints in patients with post-stroke gas constipation","volume":"45","author":"Zhang","year":"2022","journal-title":"J Shaanxi Univ Chin Med"},{"key":"ref30","volume-title":"Clinical efficacy observation of Jin's three-needle therapy in treating post-stroke constipation","author":"Yuan","year":"2022"},{"key":"ref31","volume-title":"Study on the effect of snap-needle therapy on patients with constipation in ischemic stroke with evidence of qi deficiency and blood stasis","author":"Xue","year":"2022"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"119","DOI":"10.13463\/j.cnki.jlzyy.2021.01.032","article-title":"Treatment of post-stroke constipation by needling odd points combined with evidence-based point selection","volume":"41","author":"Wang","year":"2021","journal-title":"Jilin J Tradit Chin Med"},{"key":"ref33","first-page":"110","article-title":"Observation on the efficacy of intermediate frequency therapy on constipation in patients with ischemic stroke","volume":"13","author":"He","year":"2021","journal-title":"Clin J Chin Med"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"37","DOI":"10.19787\/j.issn.1008-1879.2021.12.014","article-title":"Recent efficacy of whole-body vibration training for the treatment of constipation after stroke in the elderly","volume":"12","author":"Huang","year":"2021","journal-title":"Chinese Manipul Rehabil Med"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"63","DOI":"10.19621\/j.cnki.11-3555\/r.2021.0425","article-title":"Clinical observation on the treatment of post-stroke constipation with Chinese medicine acupoint plasters","volume":"29","author":"Song","year":"2021","journal-title":"China's Naturopathy"},{"key":"ref36","volume-title":"Observation on the clinical efficacy of acupuncture point embedding in the treatment of post-stroke constipation with qi deficiency and its effect on serum SP and VIP levels","author":"Gao","year":"2021"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"94","DOI":"10.14164\/j.cnki.cn11-5581\/r.2020.11.043","article-title":"A study of the effect of deep muscle stimulator-assisted treatment of post-stroke constipation","volume":"14","author":"Du","year":"2020","journal-title":"Chin J Mod Drug Appl"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"189","DOI":"10.20047\/j.issn1673-7210.2020.34.048","article-title":"Cognitive-behavioral intervention in stroke patients with constipation","volume":"17","author":"Cong","year":"2020","journal-title":"China Med Herald"},{"key":"ref39","first-page":"79","article-title":"Observation on the nursing effect of abdominal massage method of \"Fuyuan Tongzhi\" on post-stroke constipation","volume":"19","author":"Liang","year":"2020","journal-title":"J Clin Nurs"},{"key":"ref40","volume-title":"Clinical study on the treatment of post-stroke constipation with deficiency evidence by laying moxibustion in the abdomen","author":"Zhang","year":"2022"},{"key":"ref41","volume-title":"Clinical efficacy observation of acupuncture point embedding in the treatment of post-stroke constipation","author":"Sun","year":"2020"},{"key":"ref42","volume-title":"Clinical efficacy observation on the treatment of post-stroke constipation by the method of burying the threads at the matching acupoints of Yuzhu","author":"Guo","year":"2020"},{"key":"ref43","volume-title":"Clinical efficacy of abdominal acupuncture in the treatment of constipation in patients with ischemic stroke","author":"Wu","year":"2020"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"64","DOI":"10.16808\/j.cnki.issn1003-7705.2019.01.030","article-title":"Clinical observation on the treatment of 29 cases of post-stroke constipation of qi deficiency and blood stasis type by burying threads","volume":"35","author":"Deng","year":"2019","journal-title":"Hunan J Tradit Chin Med"},{"key":"ref45","volume-title":"Observations on the clinical efficacy of Baresha point on constipation after stroke","author":"Huang","year":"2019"},{"key":"ref46","volume-title":"Clinical study on the treatment of post-stroke constipation with acupuncture point embedding","author":"Guan","year":"2019"},{"key":"ref47","first-page":"50","article-title":"Study on the effect of burying threads at the Tianshu point combined with the foot transportation sense area of the head on serum SP and VIP levels in patients with post-stroke constipation","volume":"34","author":"Li","year":"2018","journal-title":"J Clin Acupunct Moxibust"},{"key":"ref48","first-page":"60","article-title":"Observation on the recent efficacy and recurrence rate of gastrointestinal intermediate frequency therapeutic instrument-assisted lactulose in the treatment of constipation secondary to cerebral infarction","volume":"17","author":"Li","year":"2018","journal-title":"J Clin Exp Med"},{"key":"ref49","first-page":"585","article-title":"The efficacy of biofeedback in the treatment of post-stroke constipation","volume":"33","author":"Ma","year":"2018","journal-title":"Chin J Rehabil Med"},{"key":"ref50","volume-title":"Clinical study on the prevention of post-stroke constipation after stroke by applying the umbilical cord method with wu juju","author":"Zhao","year":"2018"},{"key":"ref51","first-page":"50","article-title":"Observation on the efficacy of auricular acupuncture point burying beans in the treatment of post-stroke constipation","volume":"36","author":"Long","year":"2017","journal-title":"J Anhui Tradit Chinese Med College"},{"key":"ref52","first-page":"972","article-title":"Observation on the effect of abdominal acupoint massage with electric massager in preventing and treating constipation in patients with cerebral hemorrhage","volume":"31","author":"Li","year":"2017","journal-title":"Chin Nurs Res"},{"key":"ref53","volume-title":"Clinical efficacy observation of Shenque acupoint patch method based on disease mechanism on patients with constipation during stroke recovery period","author":"Yu","year":"2017"},{"key":"ref54","volume-title":"Clinical study on the treatment of post-stroke constipation by the method of \"heavy moxibustion\" with interspersed ginger paste","author":"Liu","year":"2017"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"1181","DOI":"10.13460\/j.issn.1005-0957.2016.10.1181","article-title":"Clinical observation on the treatment of post-stroke constipation by deep stabbing Tianshu point with electroacupuncture","volume":"35","author":"Peng","year":"2016","journal-title":"Shanghai J Acupunct Moxibust"},{"key":"ref56","doi-asserted-by":"publisher","first-page":"276","DOI":"10.13460\/j.issn.1005-0957.2016.03.0276","article-title":"The efficacy of auricular acupressure with basic nursing care in the treatment of solid constipation in the acute phase of stroke","volume":"35","author":"Ji","year":"2016","journal-title":"Shanghai J Acupunct Moxibust"},{"key":"ref57","first-page":"110","article-title":"Analysis of the effect of combined abdominal massage and acupressure care on defecation in elderly stroke patients","volume":"14","author":"Chen","year":"2016","journal-title":"Chin J Geriatr Care"},{"key":"ref58","first-page":"420","article-title":"Effect of cognitive-behavioral intervention on the outcome of stroke patients with constipation","volume":"36","author":"Ma","year":"2016","journal-title":"Chin J Gerontol"},{"key":"ref59","first-page":"220","article-title":"Study on the improvement of symptoms and cognitive ability of patients with constipation after stroke by nursing intervention","volume":"22","author":"Luo","year":"2016","journal-title":"J Colorectal Anal Surg"},{"key":"ref60","first-page":"190","article-title":"Nursing intervention for constipation and cognitive function after stroke","volume":"2","author":"Tu","year":"2016","journal-title":"Chinese J Hygiene Rescue"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"106","DOI":"10.16040\/j.cnki.cn15-1101.2016.13.107","article-title":"Analysis of the efficacy of traditional Chinese medicine acupoint patch in the treatment of post-stroke constipation","volume":"35","author":"Wang","year":"2016","journal-title":"Nei Mongol J Tradit Chin Med"},{"key":"ref62","volume-title":"Clinical observation on the treatment of post-stroke constipation by burying beans in ear acupuncture points","author":"Zhang","year":"2016"},{"key":"ref63","volume-title":"Clinical study of auricular magnetic bead pressing intervention for constipation in stroke patients","author":"Lv","year":"2016"},{"key":"ref64","first-page":"73","article-title":"Clinical observation of thunder fire moxibustion in the treatment of qi deficiency type constipation during post-stroke period","volume":"13","author":"Ma","year":"2015","journal-title":"Chinese Med Modern Distance Educ China"},{"key":"ref65","first-page":"1209","article-title":"Efficacy of navel moxibustion in the treatment of post-stroke constipation","volume":"21","author":"Liu","year":"2015","journal-title":"Chin J Rehabil Theory Pract"},{"key":"ref66","first-page":"175","article-title":"Observation on the nursing effect of auricular burying seeds on constipation in patients with cerebral infarction","volume":"34","author":"Wang","year":"2015","journal-title":"Nei Mongol J Tradit Chin Med"},{"key":"ref67","volume-title":"Clinical study of moxibustion of Shenque acupoints across onion and black onion cakes in the treatment of post-stroke constipation","author":"Zhu","year":"2015"},{"key":"ref68","doi-asserted-by":"publisher","first-page":"3166","DOI":"10.11569\/wcjd.v22.i21.3166","article-title":"Clinical effects of nursing interventions for cognitive function in patients with constipation after stroke","volume":"22","author":"Huang","year":"2014","journal-title":"World Chin J Dig"},{"key":"ref69","doi-asserted-by":"publisher","first-page":"217","DOI":"10.13193\/j.archtcm.2013.01.221.chujm.034","article-title":"Clinical observation on prevention of post-stroke constipation by heat-sensitive moxibustion","volume":"31","author":"Chu","year":"2013","journal-title":"Chin Arch Tradit Chin Med"},{"key":"ref70","doi-asserted-by":"publisher","first-page":"1003","DOI":"10.16448\/j.cjtcm.2013.11.014","article-title":"Observation on the efficacy of auricular pressure bean in the treatment of constipation in stroke","volume":"25","author":"Xu","year":"2013","journal-title":"Clin J Tradit Chin Med"},{"key":"ref71","first-page":"893","article-title":"Treatment of post-stroke constipation with acupuncture by regulating qi and ventilating internal organs","volume":"33","author":"Reng","year":"2013","journal-title":"Chin Acupunct Moxibust"},{"key":"ref72","volume-title":"Observation on the therapeutic effect of Chinese medicine acupoint dressing in treating post-stroke constipation","author":"Zhuang","year":"2012"},{"key":"ref73","first-page":"436","article-title":"Therapeutic efficacy of combining head and body acupuncture in the treatment of constipation after ischemic stroke","volume":"29","author":"Zhao","year":"2010","journal-title":"Shanghai J Acupunct Moxibust"},{"key":"ref74","doi-asserted-by":"publisher","first-page":"1114","DOI":"10.13192\/j.ljtcm.2010.06.159.zhaojl.044.74","article-title":"Clinical observation on the treatment of constipation after ischemic stroke by thermal moxibustion","volume":"37","author":"Zhao","year":"2010","journal-title":"Liaoning J Tradit Chin Med"},{"key":"ref75","volume-title":"Clinical observation on Renmai moxibustion for treatment of post-stroke constipation","author":"Meng","year":"2023"},{"key":"ref76","volume-title":"Clinical observation of acupuncture in the treatment of constipation after stroke of qi deficiency based on the theory of \"circulation of one qi\"","author":"Han","year":"2023"},{"key":"ref77","first-page":"3221","article-title":"Clinical efficacy observation of acupuncture based on the theory of 'regulating pivot and promoting stomach function' on constipation after stroke of blood deficiency and intestinal dryness type","volume":"39","author":"Han","year":"2024","journal-title":"China J Tradit Chin Med Pharm"},{"key":"ref78","doi-asserted-by":"publisher","first-page":"2313","DOI":"10.1002\/sim.1201","article-title":"Network meta-analysis for indirect treatment comparisons","volume":"21","author":"Lumley","year":"2002","journal-title":"Stat Med"},{"key":"ref79","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1097\/MED.0b013e32831e9c8e","article-title":"Serotonin in the gastrointestinal tract","volume":"16","author":"Camilleri","year":"2009","journal-title":"Curr Opin Endocrinol Diabetes Obes"},{"key":"ref80","first-page":"31","article-title":"Advances in clinical and mechanistic studies of acupuncture point embedding therapy","volume":"11","author":"Jiang","year":"2009","journal-title":"J Liaoning Univ Tradit Chin Med"},{"key":"ref81","first-page":"1286","article-title":"Observations on the efficacy of simple acupoint burrowing method in the treatment of habitual constipation","volume":"30","author":"Zhang","year":"2012","journal-title":"Chin Arch Tradit Chin Med"},{"key":"ref82","first-page":"6","volume-title":"Chinese embedded thread therapy guide","author":"Ma","year":"1994"},{"key":"ref83","first-page":"6","article-title":"An experimental study on the integrative effect and therapeutic mechanism of acupoint embedding therapy","volume":"11","author":"Wen","year":"1993","journal-title":"J Shaanxi Univ Chinese Med"},{"key":"ref84","doi-asserted-by":"publisher","first-page":"1251","DOI":"10.13703\/j.0255-2930.2017.11.031","article-title":"Current status of research on the mechanism of action of acupoint buried thread therapy","volume":"37","author":"Huo","year":"2017","journal-title":"Zhongguo Zhen Jiu"},{"key":"ref85","first-page":"493","article-title":"Treatment of post-stroke constipation by acupoint burrowing: a multicenter randomized controlled study","volume":"40","author":"Du","year":"2020","journal-title":"Chin Acupunct Moxibust"},{"key":"ref86","first-page":"1011","article-title":"Net meta-analysis of the efficacy of acupuncture for constipation in stroke patients","volume":"40","author":"Huang","year":"2020","journal-title":"Chin Acupunct Moxibust"},{"key":"ref87","first-page":"193","article-title":"Analysis of reports of adverse reactions to acupuncture point burrowing","volume":"40","author":"Wang","year":"2020","journal-title":"Chin Acupunct Moxibust"},{"key":"ref88","doi-asserted-by":"publisher","first-page":"1038922","DOI":"10.3389\/fnins.2022.1038922","article-title":"Sustained ameliorating effects and autonomic mechanisms of transcutaneous electrical acustimulation at ST36 in patients with chronic constipation","volume":"16","author":"Zhou","year":"2022","journal-title":"Front Neurosci"},{"key":"ref89","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1016\/j.diabres.2009.09.024","article-title":"The effect of mosapride citrate on constipation in patients with diabetes","volume":"87","author":"Ueno","year":"2010","journal-title":"Diabetes Res Clin Pract"},{"key":"ref90","doi-asserted-by":"publisher","first-page":"1486","DOI":"10.1053\/j.gastro.2020.10.066","article-title":"The microbiota-gut-brain Axis: from motility to mood","volume":"160","author":"Margolis","year":"2021","journal-title":"Gastroenterology"},{"key":"ref91","first-page":"1414","article-title":"Effects of moxibustion at Shenque acupoint on clinical symptoms and intestinal flora in patients with post-stroke constipation","volume":"34","author":"Sun","year":"2023","journal-title":"Lishizhen Med Mater Res"},{"key":"ref92","first-page":"897","article-title":"Biophysical properties of moxibustion","volume":"29","author":"Yang","year":"2009","journal-title":"Chin Acupunct Moxibust"},{"key":"ref93","first-page":"865","article-title":"Characteristics and warming effect of moxibustion","volume":"31","author":"Wang","year":"2011","journal-title":"Chin Acupunct Moxibust"},{"key":"ref94","doi-asserted-by":"publisher","first-page":"4355","DOI":"10.3748\/wjg.v13.i32.4355","article-title":"Association of high expression in rat gastric mucosal heat shock protein 70 induced by moxibustion pretreatment with protection against stress injury","volume":"13","author":"Chang","year":"2007","journal-title":"World J Gastroenterol"},{"key":"ref95","first-page":"16","article-title":"Collagen fiber content in acupoint and non-meridian non-acupoint areas","volume":"40","author":"Zhang","year":"2018","journal-title":"J Guiyang College Trad Chinese Med"},{"key":"ref96","first-page":"1111","article-title":"A study of the biophysical properties of skin at acupoints and non-acupoints as affecting the permeation properties of mustardine","volume":"44","author":"Liu","year":"2013","journal-title":"Chin Herbal Med"},{"key":"ref97","doi-asserted-by":"publisher","first-page":"155","DOI":"10.3389\/fnins.2017.00155","article-title":"Modified Mediterranean diet for enrichment of short chain fatty acids: potential adjunctive therapeutic to target immune and metabolic dysfunction in schizophrenia?","volume":"11","author":"Joseph","year":"2017","journal-title":"Front Neurosci"},{"key":"ref98","first-page":"1215","article-title":"A study on the distribution of trace elements in acupoints","volume":"22","author":"Liu","year":"2016","journal-title":"Zhongguo Zhong Yi Ji Chu Yi Xue Za Zhi"}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1591620\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:37:09Z","timestamp":1760107029000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2025.1591620\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,10]]},"references-count":98,"alternative-id":["10.3389\/fneur.2025.1591620"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2025.1591620","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,10]]},"article-number":"1591620"}}