Acupuncture outperforms medications for the treatment of diarrhea due to irritable bowel syndrome. Termed IBS-D, this type of irritable bowel syndrome presents with chronic diarrhea as one of the primary symptoms. In a protocolized study conducted at the Nanjing University of Chinese Medicine (Pei et al.), researchers determined that acupuncture has a higher treatment effective rate for the relief of IBS-D than pinaverium bromide.

The pharmaceutical medication pinaverium bromide is a spasmolytic agent used for the relief of functional gastrointestinal dysfunction. The antispasmodic action of pinaverium bromide is used to relieve irritable bowel syndrome related diarrhea and abdominal pain. The research team of Pei et al. discovered that acupuncture is significantly more effective than the medication.

The researchers did something very interesting with their investigation model. They studied a specific pattern within the the Traditional Chinese Medicine (TCM) system. They admitted patients to the study meeting the TCM inclusion criteria of liver qi depression combined with spleen qi deficiency. Once the results were tabulated, it was determined that IBS-D patients with liver qi depression and spleen qi deficiency had a 90% total treatment effective rate. The medication achieved an 80% total treatment effective rate.

The researchers note that 65% of all patients with IBS-D suffer from liver qi depression with spleen qi deficiency. Given the diagnostic pattern, this type of IBS-D may be triggered by excess negative emotional activity, including anxiety and depression, and dietary concerns including excess intake of alcohol, oily foods, raw foods, and cold foods. Depression is common among IBS patients. Friedrich et al. determined that 90% of all IBS patients experience depression. Pei et al. note that IBS is often more difficult to treat when depression is present. Allergies or food intolerances directly or indirectly lead to abnormal intestinal bacteria metabolism, which causes a predisposition to IBS. In cases of IBS-D with liver qi depression with spleen qi deficiency, both depression and food intolerances are prominent.

Pei et al. find that acupuncture relieves abdominal pain, bloating, and regulates bowel movements, at least in part, because acupuncture regulates the gut-brain axis (GBA). Carabotti et al. note that the gut-brain axis is the communication link between the central nervous system and the enteric nervous system. The GBA links the brain’s emotional and cognitive areas with functions of the peripheral intestines.

The research of Wang et al. corroborates acupuncture’s ability to regulate the GBA. In a laboratory experiment, Wang et al. determined that acupuncture is effective for "relieving visceral hypersensitivity" in their research entitled Acupoint Specificity on Colorectal Hypersensitivity Alleviated by Acupuncture and the Correlation with the Brain–Gut Axis. The research team measured regulation of the proto-oncogene c-Fos by acupuncture and determined that specific acupuncture points are particularly successful in downregulating c-Fos. This is very important because c-Fos results in the production of AP-1 (Activator Protein-1), which plays a role in the progression of cancer. Given acupuncture’s ability to downregulate c-Fos, additional research on the benefits of acupuncture for cancer patients is warranted.

The work of Pei et al. demonstrates that acupuncture outperforms pinaverium bromide for the treatment of IBS-D. A total of 60 patients from the Acupuncture and Digestion Divisions of the Nanjing University of Chinese Medicine Affiliated Hospital were treated and evaluated in the study. These patients were diagnosed with IBS-D with liver qi depression and spleen qi deficiency between July 2009 and November 2010. They were randomly divided into a treatment group and a control group, with 30 patients in each group. The treatment group received acupuncture therapy and the control group received pinaverium bromide. The primary acupoints selected for the treatment group were the following:

Tianshu (ST25)
Zusanli (ST36)
Shangjuxu (ST37)
Sanyinjiao (SP6)
Taichong (LV3)
Baihui (GV20)
Yintang (MHN3)

Acupuncture therapy commenced with patients in a supine position. Upon disinfection, a 0.30 mm x 40 mm disposable filiform needle was inserted into each acupoint with a high needle entry speed (to a depth of 12 – 25 mm) until a deqi sensation was experienced by the patient. Subsequently, the needles were manipulated with lifting, thrusting, and rotating based on the Ping Bu Ping Xie (tonify and attenuate) principle.

Each needle was manipulated (to achieve the arrival of deqi) until patients felt soreness, swelling, numbness, or a sensation radiating from limb acupoints towards the abdomen. Thereafter, a 30 minute needle retention time was observed, during which the needles were each manipulated once every 10 minutes. One 30 minute acupuncture session was conducted 5 times per week, for a total of 4 consecutive weeks. For the control group, 50 mg of pinaverium bromide was administered orally thrice per day, every day, for a total of 4 consecutive weeks.

Patients were evaluated before and after the treatment course. They were given a score from 0 – 5 in each of the following categories based on the severity of the symptom (0 being normal, and 5 being severe):

stomachache
bowel frequency
bowel incompleteness
bowel moisture
bowel shape
stomach bloating

In the case of bowel moisture, a score of either 1 for the presence of moist bowels or 0 for the absence of moisture was assigned. The scores were totaled to give a sum value indicating the severity of IBS-D for each patient. Treatment efficacy for each patient was measured by calculating the difference in the sum value before and after treatment, with the following formula:

[(Sum value before treatment – sum value after treatment)/sum value before treatment] x 100%

Based on the calculated figure, the treatment efficacy for each patient was categorized into 1 of 3 tiers:

Significantly effective: Symptoms showed drastic improvement. Treatment efficacy value ≥ 70%.

Effective: Symptoms showed improvement. Treatment efficacy value ≥ 30%.
Not effective: Symptoms showed no visible improvement. Treatment efficacy value < 30%.

The total treatment effective rate for each patient group (treatment and control) was derived as the percentage of patients who achieved at least an effective treatment efficacy tier. The clinical results of this study indicate that acupuncture is more effective for the relief of IBS-D symptoms than pinaverium bromide for patients with liver qi depression with spleen qi deficiency.

References:
Pei LX, Sun JH, Xia C, Xu LZ, Geng H, Chen L, Wu XL. (2012). Clinical Evaluation of Acupuncture Treating IBS-D Belonging to Liver Depression and Spleen Deficiency Sydrome. Journal of Nanjing University of Traditional Chinese Medicine. 28(1).

Friedrich M, Grady SE, Wall GC. Effects of antidepressants in patients with irritable bowel syndrome and comorbid depression [J]. ClinTher. 2010, 32(7): 1221-1233.

Carabotti M, Scirocco A, Severi C, Severi C. The gut-brain axis: interactions between enteric microbiota, central and enteric nervous systems. Annals of Gastroenterology. 2015 Mar 27;28(2):203.