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MEDICAL ACUPUNCTUREVolume 20, Number 1, 2008 Mary Ann Liebert, Inc.DOI: 10.1089/acu.2007.0557

Acupuncture for the Treatment of Irritable Bowel Syndrome

Nelson P. Trujillo, MD

ABSTRACT

Background: Irritable bowel syndrome (IBS) is a disorder characterized by lower abdominal pain or discom-

fort, diarrhea, constipation (or alternating diarrhea/constipation), gas, and bloating.

Objective: To describe the treatment of IBS from the viewpoint of a gastroenterologist/acupuncturist.

Design, Setting, and Patients: Over the past 5 years, 149 patients were diagnosed as having IBS following

the Rome II criteria. An additional 35 patients presented with persistent (6 months) history of localized un-

diagnosed abdominal quadrant pain. The patients treated with acupuncture were selected on the basis of non-

response to standard medical treatment.

Interventions: Acupuncture Energetics method using an N-N1 circuit on the Yang MingTai Yin meridi-

ans. Occasionally, a Shao YangJue Jin circuit was used, especially if there was evidence of significant anxi-

ety. Usually, microcurrent at 2 Hz was applied between 2 points, bilaterally. For the Balance Method, acupunc-

ture points were needled only on 1 side, balancing Yin and Yang points. An example of a circuit would be

SP 9, LR 8, TE 5, LI 4 on the right side, and PC 6, LU 7, ST 36, and GB 34 on the left side. The needles were

inserted to 1.52.5 cun. De Qi was obtained on insertion. The needles were usually retained 3040 minutes.

The patients were treated once a week.Main Outcome Measure: Response to treatment.

Results: Overall, there was 80% improvement with acupuncture treatments in both groups of patients. The

Acupuncture Energetics method and Balance Method were equally effective in the treatment of these patients.

However, the Balance Method was applied more quickly to patients than the Acupuncture Energetics method.

Conclusions: Acupuncture is an effective treatment for patients with IBS and patients with localized abdomi-

nal quadrant pain. Further studies are warranted to test the generalizability of these findings.

Key Words: Irritable Bowel Syndrome, IBS, Abdominal Pain, Acupuncture, Acupuncture Energetics Method, Balance Method

INTRODUCTION

IRRITABLE BOWEL SYNDROME (IBS) IS a disorder charac-terized by lower abdominal pain or discomfort, diarrhea,constipation (or alternating diarrhea/constipation), gas, and

bloating.1 As a board-certified gastroenterologist and li-

censed acupuncturist, herein I review all the cases I have

seen of IBS and persistent localized abdominal pain treated

with acupuncture in the last 5 years.

METHODS

In 149 patients, a diagnosis of IBS was made according

to Rome II criteria.2 An additional 35 patients presented with

persistent (6 months) history of localized abdominal quad-

rant pain undiagnosed after physical examination and com-

puted tomography with contrast of the abdomen and pelvis.

IBS patients had undergone these diagnostic tests as well.

Those treated with acupuncture were selected on the basis

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George Washington University, Washington, DC.


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of nonresponse to standard medical treatment,3 which in-

cluded dietary and lifestyle modifications, consumption of

3040 g/d of dietary fiber, probiotics, anticholinergics, low

doses of amitriptyline (25 mg/d), and occasionally, pain

medication. This group of nonresponders was then offered

the opportunity to receive acupuncture for treatment of their

IBS or localized abdominal quadrant pain. The patients had

to commit to receive 3 weekly treatments before decidingwhether treatments were beneficial. IBS patients with only

constipation were excluded.

A total of 184 patients fulfilled these criteria; 23 of these

patients had been referred for acupuncture by another gas-

troenterologist. Of the 184 patients, 75 were excluded from

consideration because they did not complete 3 treatments. Only

1 of the patients referred by the gastroenterologist had to be

excluded. IBS patients numbered 94, and 15 patients were

treated for abdominal quadrant pain. There were 78 women

and 31 men; the median age was 53 years. The youngest pa-

tient treated was 11-years-old and the oldest was 91 years.

The severity of symptoms was assessed using a Health

Distress Index visual analog scale from 1 to 100: 125 wasconsidered no improvement, 2550 was slight improvement,

5075 was significant improvement, and 75100 was con-

sidered improvement. I ascertained the patients condition 3

months after the conclusion of the acupuncture treatments

for all improved patients (although a Health Distress Index

was not done). Information on all but 2 is available.

During the first 2 years of acupuncture practice, I used

the Acupuncture Energetics method of acupuncture.4 For the

remaining 3 years, the Balance Method was predominantly

used.5 Occasionally, Kiko Matsumotos style of acupunc-

ture was used.6 For the Acupuncture Energetics method, an

N-N1 circuit was used on the Yang MingTai Yin merid-

ians. Occasionally, a Shao YangJue Jin circuit was used,especially if there was evidence of significant anxiety. In

this method of acupuncture, points were needled bilaterally.4

An example of a circuit would be SP 6, SP 9, LI 4,

ST 36, and ST 40. Usually, microcurrent at 2 Hz was ap-

plied between 2 points, bilaterally, utilizing an Electrostim-

ulator 8c Pro (Pantheon Research, CA).

For the Balance Method, acupuncture points were needled

only on 1 side, balancing Yin and Yang points. An example

of a circuit would be SP 9, LR 8, TE 5, LI 4 on the right side,

and PC 6, LU 7, ST 36, and GB 34 on the left side. 5

The needles used were Spring Ten Handle 0.18 15, and

0.20 30 (Llhasa, OMS Inc, Weymouth, MA). They were

inserted to 1.52.5 cun. De Qi was obtained on insertion.

The needles were usually retained 3040 minutes. The pa-

tients were treated once a week.

RESULTS

Of the 94 IBS patients, 33 were treated with the Acupunc-

ture Energetics Method; of these, 26 improved and 7 showed

no improvement. The Balance Method was used on 59 pa-

tients; of these, 11 showed no improvement, 3 had slight

improvement, 3 had significant improvement, and 42 were

improved. The remaining 2 patients were treated by the

other method and reported improvement.

Improvement in the IBS patients treated with the

Acupuncture Energetics method was 79%; improvement in

the IBS patients treated with the Balance Method was 81%.Of the 15 patients treated for abdominal pain, 10 were

improved, 2 had slight improvement, and 3 were not im-

proved. Three of the improved patients were treated with

the Balance Method; the remainder by the Acupuncture En-

ergetics Method. Overall, there was 80% improvement in

both groups of patients. This improvement was maintained

for at least 3 months for all patients (2 patients, 1 in each

category, were lost to follow-up).

The median number of treatments for the IBS patients

who were not excluded was 7, and a similar number of treat-

ments for those with localized abdominal quadrant pain.

The Balance Method treatment used fewer needles and

was faster to set up than the Acupuncture Energetics treat-ment. Usually, no electrostimulation was applied with the

Balance Method acupuncture.

DISCUSSION

The large number of exclusions for noncompletion, de-

spite the patients previously agreeing to 3 acupuncture treat-

ments, is worthy of note. Anecdotally, primary reasons given

for not completing the course of 3 treatments were no im-

provement after the first treatment, significant or complete

improvement after the first treatment and therefore, not

needing any more treatments, and other circumstances not

related to the outcome of the treatment such as cost or a re-

action to the experience.

The discrepancy of the small numbers of exclusions in

those patients specifically referred for acupuncture vs the

large numbers in those in which acupuncture was offered as

a last recourse of treatment is puzzling. Most of the patients

included in this study had never received acupuncture treat-

ments. Perhaps there was a perception problem as to what

to expect of an acupuncture treatment. I do not advertise that

I perform acupuncture. When I tell patients that I have no

additional medical treatments to improve their condition and

suggest that they undergo acupuncture treatment, many askif I can recommend an acupuncturist. I am suggesting that

the setting where the patient is and the reason for being there

affect the patients perception and expectation of an

acupuncture treatment. My patients expect medical treat-

ment, and not acupuncture, from me. This, in turn, may af-

fect their willingness to continue with the treatments.

Unexpected results delineated the high percentage of re-

sponders in the treated patients. They are a highly selected

group of patients. If I would add those patients who were

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excluded to the total to perform an analysis, there would be

a significant decrease in the percent of improvement. De-

spite this, these groups of patients with medical treatment

failures and their response to acupuncture was impressive

and encouraging.

It has been suggested that favorable responses to acupunc-

ture, both therapeutic and sham, are similar and may repre-

sent a placebo effect; however, they do occur.

7

I did nothave a control of sham acupuncture treatment in my patients.

However, I did use 3 different methods of acupuncture and

the results were similar. Although a recent Cochrane review

was indecisive in whether acupuncture was more effective

than sham acupuncture in the treatment of IBS,8 many in-

vestigators have reported improvement of IBS following

treatment with acupuncture.9,10 I suggest that if both sham

and regular acupuncture produce an improvement in patients

who otherwise would remain sick, then the acupuncture

treatment, whether sham or real, has had a favorable and

beneficial therapeutic effect.

My reasons for switching from Acupuncture Energetics

to the Balance Method were based on the presumption thatthe treatment results would be similar and it would conserve

my time. Certainly, I use fewer needles with the Balance

Method and can set up the treatment in much less time; also,

I usually do not use microcurrent in the Balance Method.

This retrospective review confirms the therapeutic similar-

ity of both methods in the treatment of IBS and abdominal

quadrant pain.

CONCLUSIONS

Acupuncture is an effective treatment for patients with

IBS and patients with localized abdominal quadrant pain.

The Acupuncture Energetics method and Balance Method

are equally effective in the treatment of these patients. It ap-

pears that knowledge and expectation of an acupuncture

treatment may affect the patients willingness to complete a

course of treatment.

REFERENCES

1. Irritable bowel syndrome. http://digestive.niddk.nih.gov/ddis-

eases/pubs/ibs/. Accessed April 1, 2007.2. Rome II. http://www.romecriteria.org/rome12biblio.html. Ac-

cessed April 1, 2007.

3. Podovei M, Kuo B. Irritable bowel syndrome: a practical re-

view. South Med J. 2006;99(11):12351242.

4. Helms JM.Acupuncture Energetics: A Clinical Approach for

Physicians. Berkeley, CA: Medical Acupuncture Publishers;

1997.

5. Tan R. Dr. Tans Strategy of Twelve Magical Points. San

Diego, CA: Advanced Principles and Techniques in Acupunc-

ture; 2002.

6. Matsumoto K, Euler D. Kiko Matsumotos Clinical Strategies.

Natick, MA: Kiko Matsumoto International; 2002.

7. Schneider A, Enck P, Streitberger K, et al. Acupuncture treat-

ment in irritable bowel syndrome. Gut. 2006;55:649654.8. Lim B, Manheimer E, Lao L, et al. Acupuncture for treatment

of irritable bowel syndrome. Cochrane Database Syst Rev.

2006;(4):CD005111.

9. Forbes A, Jackson S, Walter C, Quraishi S, Jacyna M, Pitcher

M. Acupuncture for irritable bowel syndrome: a blinded

placebo-controlled trial. World J Gastroenterol. 2005;11(26):

40404044.

10. Fireman Z, Segal A, Kopelman Y, Sternberg A, Carasso R.

Acupuncture treatment for irritable bowel syndrome: a double

blind controlled study.Digestion. 2001;64:100103.

Address correspondence to:

Nelson P. Trujillo, MD, LAc, FACG, FAAMA

2021 K Street NW, Suite T-110

Washington, DC 20006

E-mail: [email protected]

IRRITABLE BOWEL SYNDROME 49

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