Acupuncture and herbs alleviate IBS (irritable bowel syndrome). Two independent studies find Chinese herbal medicine, acupuncture, and moxibustion effective for the relief of irritable bowel syndrome. Both studies feature an integrative approach to patient care. 

The first study, administered at the Hospital of Jiangsu Business College, finds a combination of internal herbs, acupuncture, and moxibustion more effective than montmorillonite clay for the treatment of pain, bloating, and regulation of the daily number of bowel movements. [1] The second study, at the Second Affiliated Hospital of Nanhua University, finds a combination of herbal acupoint applications, acupuncture, and probiotics perform better than any one of these therapies alone. [2] The results indicate that an integrative medicine approach to patient care produces superior patient outcomes.

 

Hospital of Jiangsu Business College
All participants recruited for this study had a diagnosis of IBS according to the Rome III diagnostic criteria, and a TCM (Traditional Chinese Medicine) diagnosis of liver depression and spleen deficiency. For inclusion, participants were required to show at least two of the following: emotional constraint, frequent sighing, abdominal pain relieved by diarrhea, umbilical region pain, bowstring (wiry) or fine pulse, and a thin, white tongue coating. They were also required to show at least one of the following secondary symptoms: indigestion, loss of appetite, loose or sticky stools, weak and fatigued limbs.

The 120 participants were randomly assigned to the control group or the observation group. The control group was comprised of 24 male and 36 female participants, with a mean age of 20.7 years and a mean duration of disease of 1.1 months. The observation group was comprised of 23 male and 37 female participants, with a mean age of 20.5 years and a mean duration of illness of 1.3 months. There were no statistically significant differences in baseline characteristics between the two groups at the onset of the investigation.

 

Treatment Protocols
The control group was treated with montmorillonite clay, one dose daily, with two weeks of treatment making up one course of care. A total of two courses were administered.

The observation group was treated with herbal medicine, acupuncture, and moxibustion. All participants in the group were prescribed Shu Gan Yun Pi Tang made from the following herbs:

  • Jiao Yi Ren 30g
  • Yun Ling 20g
  • Shao Bai Zhu 15g
  • Zhi Xiang Fu 10g
  • Yu Jin 10g
  • Chun Chai Hu 10g
  • Shao Bai Shao 10g
  • Gu Ya 10g
  • Mai Ya 10g
  • Guang Chen Pi 6g
  • Gan Cao 6g

The powdered herbs were mixed with 160ml of warm water and were taken twice a day. Also, acupuncture treatment was administered at the following acupoints:

  • Taichong (LV3)
  • Xingjian (LV2)
  • Ganshu (BL18)
  • Pishu (BL20)
  • Zhongwan (CV12)
  • Zusanli (ST36)
  • Tianshu (ST25)
  • Shangjuxu (ST37)

Following standard disinfection, 0.38 × 40mm needles were inserted. Taichong and Xingjian were needled using a reducing technique, and the remaining points using a reinforcing technique. After the arrival of deqi, the needles were retained for 40 minutes. Moxibustion was applied by suspending a moxa roll 4–5cm above Ganshu, Pishu, Zhongwan, Tianshu, Shangjuxu, and Zusanli. This was ignited and burned so that patients felt a gentle, comfortable warmth and the surrounding skin turned slightly red. Moxibustion was applied for 20 minutes. Acupuncture and moxibustion were administered daily, five days each week. Two weeks made up one course of care, and a total of two courses were administered.

 

Outcomes
Symptoms including umbilical region pain, bloating, and number of bowel movements were assessed before and after treatment. Each symptom was scored from 0–3 with zero being asymptomatic and three being severe. In the clay control group, umbilical pain fell from a mean 2.91 to 1.43, bloating fell from 3.48 to 1.87, and number of bowel movements fell from 3.53 to 2.47. In the TCM observation group, improvements were significantly greater, with umbilical pain falling from a mean 2.83 to 1.02, bloating from 3.45 to 1.53, and number of bowel movements from 3.23 to 1.29.

Patients were classified into one of four groups, based on efficacy. Participants in the cured group showed a complete resolution of umbilical pain and bloating, and had their bowel movements reduced to once daily. Participants in the markedly effective group showed clear improvements in symptoms and had their bowel movements reduced to 2–3 times daily. Participants in the effective group showed some improvements in symptoms and had their bowel movements reduced to 4–5 times daily. Participants in the ineffective group showed no improvement in symptoms and were having six or more bowel movements daily.

In the control group, there were 15 cured cases, 12 markedly effective cases, 17 effective cases, and 18 ineffective cases, producing a total effective rate of 73.3%. In the observation group, there were 18 cured cases, 18 markedly effective cases, 18 effective cases, and 6 ineffective cases, producing a total effective rate of 90.0%.

 

Second Affiliated Hospital of Nanhua University
The participants of this study were assigned to one of four groups: probiotics, herbal application, acupuncture, or combined therapy. The probiotics group was comprised of 29 male and 34 female participants with a mean age of 42.78 years. The mean duration of IBS symptoms was 4.25 years, with an average of 4.03 bowel movements daily. The herbal application group was comprised of 30 male and 33 female participants with a mean age of 42.37 years. The mean duration of IBS symptoms was 4.10 years, with an average of 4.25 bowel movements daily.

The acupuncture group was comprised of 27 male and 36 female participants with a mean age of 42.60 years. The mean duration of IBS symptoms was 4.29 years, with an average of 4.09 bowel movements daily. The combined group was comprised of 31 male and 32 female participants with a mean age of 42.59 years. The mean duration of IBS symptoms was 4.33 years, with an average of 4.21 bowel movements daily.

 

Probiotics
Participants allocated to the probiotics group were treated with an oral bifidobacterium supplement. A dose of 1.5mg was prescribed, taken three times a day, after meals, swallowed with warm water or milk. Treatment was continued for a total of four weeks.

 

Herbal Acupoints
The following herbs were ground to a powder and applied to acupoints in the form of a medicated plaster:

  • Bai Jie Zi
  • Xi Xin
  • Gan Sui
  • Yan Hu Suo
  • Rou Gui

The herbs were applied to the following acupoints:

  • Pishu (BL20)
  • Dachangshu (BL25)
  • Shenshu (BL23)
  • Shenque (CV8)
  • Zusanli (ST36)

The herbs were first applied following enrollment, and once every 10 days thereafter. The herbal plasters remained in situ for 4–6 hours each time, depending on a patient’s individual condition. Participants were warned of potential side effects including skin irritation, pain, and increased body temperature, and monitored closely throughout the treatment period for any changes in symptoms or allergic reactions. Treatment was administered for one month, a total of three applications.

 

Acupuncture
Acupuncture treatment was administered at the following acupoints:

  • Shenque (CV8)
  • Tianshu (ST25)
  • Shangjuxu (ST37)
  • Guanyuan (CV4)
  • Zhongwan (CV12)
  • Zusanli (ST36)

Needles were retained for 30 minutes and acupuncture treatment was applied daily. Seven days of treatments made up one course of care, and a total of three courses were administered with a 2–3 day rest period between courses of care.

 

Combined Therapy
Participants in the combined therapy group were treated with probiotics (bifidobacterium), herbal acupoint applications, and acupuncture, as detailed above.

 

Outcomes
The biomarkers somatostatin (a hormone inhibiting gastric secretion and somatotropin) and vasoactive intestinal peptide (a hormone vasoactive in the intestine that relaxes smooth muscles of the stomach and gallbladder) were measured by way of a fasting blood test taken before and after the treatment period. All groups showed reductions in these markers following treatment, with mean somatostatin levels falling from 49.26pg/mL to 39.69pg/mL in the probiotics group, 49.03pg/mL to 39.07pg/mL in the herbal application group, and 49.32 to 39.13 in the acupuncture group. The greatest reductions were in the combined group, with mean somatostatin levels falling from 49.15pg/mL to 32.54pg/mL.

Vasoactive intestinal peptide levels fell from a mean 70.69pg/mL to 59.23pg/mL in the probiotics group, 70.37pg/mL to 59.01pg/mL in the herbal application group, and 70.54pg/mL to 59.48pg/mL in the acupuncture group. The greatest reductions were in the combined group, with mean vasoactive intestinal peptide levels falling from 70.85pg/mL to 46.21pg/mL.

Clinical symptoms of abdominal pain, bloating, and diarrhea were assessed before and after treatment, with each symptom being scored on a scale of 0–4, with zero representing a complete absence of symptoms. For abdominal pain, mean symptom scores fell from 2.00 to 0.93 in the probiotics group, 2.03 to 0.90 in the herbal application group, 2.10 to 0.95 in the acupuncture group, and 2.08 to 0.48 in the combined group. For bloating, mean symptoms scores fell from 2.10 to 0.71, 2.17 to 0.75, 2.19 to 0.70, and 2.14 to 0.42 in the four groups respectively. For diarrhea, mean symptoms scores fell from 2.68 to 1.23, 2.65 to 1.20, 2.72 to 1.26, and 2.74 to 0.76 respectively. Significantly greater improvements were experienced by participants in the combined group across all symptoms.

The outcomes of the two studies covered in this article indicate that herbal medicine, acupuncture, and moxibustion offer effective relief from the symptoms of IBS, especially when combined with other treatments such as probiotics. Contact your local licensed acupuncturist for more information.

 

References
[1] Yan Xiaoxia (2018) “Clinical efficacy of bifidobacterium capsules, acupoint application and acupuncture combined with moxibustion for treatment of irritable bowel syndrome” Inner Mongolia Journal of Traditional Chinese Medicine Vol.37(8) pp.65-67.

[2] Xie Shujun (2018) “Study on the Effect of Shugan Yunpi Decoction and Acupuncture Therapy in Treating Irritable Bowel Syndrome of Liver Depression and Spleen Deficiency” Contemporary Medical Symposium Vol.16(15) pp.177-179.

 

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