Acupuncture for Irritable Bowel Syndrome (IBS)

Irritable Bowel Syndrome (IBS) in TCM is viewed from both zang-fu and fundamental substances (FS) perspective.

Liver Qi Stagnation

Spleen Qi Depletion

Qi and Blood Depletion

Yang Depletion

Yin Depletion

Acupuncture for Irritable Bowel Syndrome (IBS) is a great option. Treatments may be helpful to bring back the underlying imbalanced FS back by adjusting empirical acupuncture points, extraordinary vessels, and channels. 

Herbs in most case is an important part of acupuncture treatments for all types of IBS, herbs is basically a food therapy. The most important part of the change to be made is to get herb ingredients into food to  supplement deficiency yin, yang, Qi, and Blood. 

Get on the right type of food and drinks, and lifestyle considerations on exercises, Taiqi posture (center balanced gravity) and breathing.

Liver energy needs to be smooth and free flowing like a river at the normal time. But at the very unsettled weather, the river can be either in flood, or drought, or alternating between the two.

These are termed as Qi Stagnation and presenting the repletion side of IBS, associated with pain and cramping discomfort, or emotional imbalances.

No matter diarrhea or constipation, as long as the motility is not free-flowing, in TCM Qi stagnation can be identified as the mechanism behind the symptoms.

IBS causing excessive flushing out food intakes, and consequently the body is deprived of food nutrients, resulted in fatigue, bloating, insomnia, anxiety, depression, etc. This is the depletion side of IBS, associated at the first place mostly with Spleen Depletion.

When Spleen Qi Depletion becomes more severe and can involvement Heart, Liver, Lung, Spleen, and Kidney.

In TCM Heart circulates Blood, and Blood houses shen (spiritual activities). Symptoms such as palpitation, insomnia, anxiety, are showing the involvement of TCM Heart. 

When deficiency gets to this level, the two patterns of Liver and Spleen from zang-fu perspective will not be sufficient to be used for forming a treatment strategy. It must be brought into the puzzle to find out the involvements of multiple zang-fu systems and fundamental substances.

Diarrhoea predominated IBS has more yang substances depletion. Zang-fu involved in this pattern: Kidney, Spleen, Lung, and Heart, Small Intestine, Large Intestine, Stomach, Liver, and Spleen.

Constipation predominated IBS has more yin substances depletion. Zang-fu involved in this pattern: Kidney, Liver, and Heart, Large Intestine, Stomach, and Spleen. 

 
Qi and Blood Depletion eventually can affect yin, yang, or mostly likely Jing esseces (both yin and yang can be deplete in chronic cases). 

Every year, many randomised controlled trials (RCTs) have been carried out by researchers on acupuncture for various conditions. RCT is the golden standard for medical research. A P-value < 0.05 generally shows the significance of an intervention. IBS is still in early stage of RCT research, below are current results of studies on acupuncture treatments plus usual care medications and usual care control.

1. A 2012 study: Acupuncture significant reduced IBS      symptoms at 3 months (P = 0.012). The long-lasting effect from 6 to 12      months. (1: p.3,5) Electro-acupuncture (EA), acupuncture-moxibustion(MOX)      and neutral control. 
2. A 2015 study: Both EA and MOX have significant      improved IBS symptoms (P < 0.05). No differences in primary      gastrointestinal symptoms between EA and MOX. Differences between Subtypes      of IBS: EA brings more relief for IBS-C; MOX brings more relief for IBS-D      (2: p.10).

Acupuncture uses needles or mugwort on the channels, which is a network of energy pathways based on yin-yang, zang-fu and Five Phase framework. It can regulate the brain-gut axis, emotions, fundamental substances and internal organs by adding functional energetic forces to acupuncture points.

A patient diagnosed with IBS, when he/she is not in any emergency condition, can seek acupuncture treatments. The treatments can be used as a complementary to his/her usual medications. If his/her intention is to reducing medications, that can be done gradually with IBS symptoms improved, and please keep one's GP informed about it.

The lifestyle and emotion are important factors that he/she can make changes to benefit one's IBS condition. The acupuncturist will help to provide guidelines from TCM holistic perspective.
To make acupuncture treatments work for one's IBS condition, there are 3 parts to make it work:

• The patient can make positive changes in lifestyle and  emotion aspects. Seeking the acupuncturist's advice on food, lifestyle and exercises from the ancient Chinese medicine perspective may be helful.
• A journey with uncertainty: Essentially the  acupuncturist and the patient form a team and need to work together with  patients to make it work. To change a lifelong chronic condition in some  cases takes years and patience with backslashes at times.

References 

1. MacPherson H, Tilbrook H, Bland JM, Bloor K, Brabyn S, Cox H, et al. Acupuncture for irritable bowel syndrome: primary care based pragmatic randomised controlled trial. BMC Gastroenterol [Internet]. 2012;12(1):150. Available from:   http://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-12-150
2. Shi Y, Chen Y-H, Yin X-J, Wang A-Q, Chen X-K, Lu J-H, et al. Electroacupuncture versus Moxibustion for Irritable Bowel Syndrome: A Randomized, Parallel-Controlled Trial. Evid Based Complement Alternat Med [Internet]. 2015 [cited 2017 Oct 13];2015:361786. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26294923 

Crohn's Disease (CD) is a nonspecific granulomatous inflammatory bowel disease (IBD) from an unknown etiology from Western Medicine point of view. The main clinical manifestations are recurrent episodes of abdominal pain, diarrhea, and weight loss and are often complicated with the abdominal mass, anal fistula, and intestinal obstruction(2).

CD can be differentiated from irritable bowel syndrome(IBS) by (1):

CD has structural damages done by long-term inflammation in the gastrointestinal tract including mouth to anus.

IBS has frequent diarrhea but only functional symptoms and discomfort.

• Shang HX et al.      Reported in 2014 with moxibustion combined with acupuncture increases      tight junction protein expression in a controlled study on 60 CD patients,      who were divided into two groups and treated 6 times per week for 12 weeks      consecutively. The herb-partitioned moxibustion and acupuncture (HMA)      group compared to the control group treated with mesalazine. The      results showed both groups have significant improvement in intestinal      morphology and ultrastructure in CD patients. The paper concluded that 'In conclusion, HMA improves      intestinal epithelial barrier repair and reduces inflammation in CD      patients by upregulating the expression of the TJ proteins occludin,      claudin-1, and ZO-1 and their mRNAs' (2).
• Another randomized control trial (RCT) in 2014 was      carried out on 92 patients with herb-partitioned moxibustion combined with      acupuncture compared to placebo on same acupuncture points.The paper      concluded that 'Moxibustion      with acupuncture provided significant therapeutic benefits in patients      with active CD beyond the placebo effect and is, therefore, an effective      and safe treatment for active CD' (3).
• A further study revealed the mechanism of treating CD      with moxibustion and acupuncture. It 'shows      that moxibustion and acupuncture can reduce the number of Th17 cells and      downregulate the expression of Th17-related molecules IL-17 and ROR𝛾t and increase the number of Treg cells      and upregulate the expression of Treg transcription factor FOXP3 in the      intestinal mucosa of CD patients. This suggests that moxibustion and      acupuncture relieve intestinal inflammation in CD patients by restoring      the balance between Th17 and Treg cells, providing the basis for clinical      application of treatment for CD '(4).

The above research revealed the effectiveness and mechanism of using moxibustion and  acupuncture in treating CD may bring back physical changes on the mucosa of the gastrointestinal tract. 

Jason's own clinical experience suggests similar results, with some patients reporting noticeable improvements after 3 - 4 treatments. Acupuncture may be just used as a maintenance for CD patients.

1. IBD or IBS: What’s the Difference? [Internet]. [cited 2017 Jul 31]. Available from: http://www.webmd.com/ibs/guide/ibs-ibd-differences#1

2. Shang H-X, Wang A-Q, Bao C-H, Wu H-G, Chen W-F, Wu L-Y, et al. Moxibustion combined with acupuncture increases tight junction protein expression in Crohn's disease patients. World J Gastroenterol [Internet]. 2015 Apr 28 [cited 2017 Jun 27];21(16):4986. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25945013
3. Bao C-H, Zhao J-M, Liu H-R, Lu Y, Zhu Y-F, Shi Y, et al. Randomized controlled trial: Moxibustion and acupuncture for the treatment of Crohn's disease. World J Gastroenterol [Internet]. 2014 Aug 21 [cited 2017 Jun 27];20(31):11000. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25152604
4. Zhao C, Bao C, Li J, Zhu Y, Wang S, Yang L, et al. Moxibustion and Acupuncture Ameliorate Crohn’s Disease by Regulating the Balance between Th17 and Treg Cells in the Intestinal Mucosa. Evidence-based Complement Altern Med. 2015;2015.