Acupuncture Department of Kunshan Bacheng People’s Hospital, Jiangsu 215311, China

CLINICAL STUDY

Moxibustion on Shenque (CV 8) Improves Effect of Acupuncture for Diarrhea-predominant Irritable Bowel Syndrome

Liu Xiao-xia

Acupuncture Department of Kunshan Bacheng People’s Hospital, Jiangsu 215311, China

Author:Liu Xiao-xia, attending physician.

E-mail: jingyue8698@163.com

Objective: To observe the clinical effect of acupuncture and moxibustion on diarrhea-predominant irritable bowel syndrome (IBS-D).

Methods: A total of 60 IBS-D patients were randomly allocated into a treatment group and a control group, 30 in each group. Patients in the treatment group were treated with acupuncture combined with ginger and salt-partitioned moxibustion on Shenque (CV 8), whereas patients in the control group only received acupuncture treatment. Six days made up a course of treatment, and the clinical effects were statistically analyzed after 4 courses.

Results: The overall response rate in the treatment group was 96.7%, versus 76.7% in the control group, showing a statistical significance (P＜0.05). In the intra-group comparison of the symptom scores after treatment, there were statistical differences in both groups (bothP＜0.01), and in the inter-group comparison, the difference was statistically significant (P＜0.05).

Conclusion: Acupuncture combined with ginger and salt-partitioned moxibustion on Shenque (CV 8) can obtain better effect for ISB-D than acupuncture alone.

Acupuncture Therapy; Acupuncture-moxibustion Therapy; Indirect Moxibustion; Diarrhea; Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder and associated with abnormal intestinal motility and abnormalities in the gastrointestinal nervous system. With its high incidence, persistent/ intermittent IBS can greatly affect patients’ work and quality of life. Clinically IBS can be classified as diarrhea predominant (IBS-D), constipation predominant (IBS-C), or with alternating stool pattern (IBS-A). The IBS-D is more common than the other two types. Over the recent years, we’ve treated IBS-D with acupuncture plus ginger and salt-partitioned moxibustion. The results are now summarized as follows.

1 Clinical Materials

1.1 Diagnostic criteria

1.1.1 Diagnosis in Western medicine

IBS can be diagnosed according to the Rome II criteria[1]: at least 12 weeks (unnecessarily consecutive) in the preceding 12 months, ofabdominal discomfort or pain that has two out of the three features: relieved with defecation; and/or onset associated with a change in frequency of stool; and/or onset associated with a change in form (appearance) of stool (hard, loose or watery stools).

IBS-D can be further diagnosed with at least one of the following features: more than 3 bowel movements a day; loose (lumpy or watery) stools; urgency of bowel movements.

1.1.2 Diagnosis in Chinese medicine

IBS can be differentiated into three patterns according to theDiagnosis and Treatment Protocol of Integrative Chinese and Western Medicine for Irritable Bowel Syndrome[2].

Liver-qi stagnation with spleen deficiency: Major symptoms include diarrhea (often triggered by emotional disturbance) upon abdominal pain, pain relieved after defecation and cramp of the lower abdomen. Associated symptoms include bowel sounds, flatus, mucus in the stools, depression, frequent sighing, irritability, a poor appetite, abdominal distension, a thin and white tongue coating and a wiry pulse.

Weakness of the spleen and stomach: Major symptoms include diarrhea after meals, mucus in loose/watery stools, a poor appetite, abdominal distension after eating food, and gastric fullness and discomfort. Associated symptoms include dull abdominal pain that can be relieved by pressure, bloating, bowel sounds, mental fatigue, reluctant to talk, lassitude, a sallow complexion, a pale swollen tongue with teeth marks and a white coating and a thready weak pulse.

Yang deficiency of the spleen and kidney: Major symptoms include diarrhea in the early morning, stools containing undigested food and abdominal pain with a cold sensation. Associated symptoms include cold limbs, soreness and weakness in the low back and knee joints, a pale swollen tongue with a white slippery coating and a deep thready pulse.

1.2 Inclusion criteria

Those who met the above diagnostic criteria in Chinese and Western medicine; having a duration of more than 6 months; aged between 18 and 65; having excluded other conditions and signed the informed consent.

1.3 Exclusion criteria

Those with organic intestinal problems; having taken medications that may affect efficacy evaluation; having mental illnesses or severe primary conditions or complications involving the cardio-cerebrovascular, liver, kidney and hemopoietic systems; women during pregnancy or lactation; and those who failed to follow the treatment protocol or dropped out.

1.4 Statistical method

The SPSS 13.0 version software was used for data processing, mean ± standard deviationfor expression of measurement data,t-test for intergroup and intra-group comparison, and Chi-square test for enumeration data. APvalue of less than 0.05 indicates a statistical significance.

1.5 General data

A total of 60 IBS cases treated in the Acupuncture Department of Kunshan Bacheng People’s Hospital between July 2009 and July 2013 were randomly allocated into a treatment group and a control group, 30 in each group. Organic intestinal conditions were excluded in all patients by routine stool test, fungal smear and colonscopy. There were no between-group significant differences in age, gender and duration (P＞0.05), indicating that the two groups were comparable (Table 1).

Table 1. Between-group comparison of general data

2 Treatment Methods

2.1 Treatment group

2.1.1 Acupuncture

Major acupoints: Zhongwan (CV 12), Guanyuan (CV 4), and bilateral Tianshu (ST 25), Zusanli (ST 36), Shangjuxu (ST 37), Pishu (BL 20) and Dachangshu (BL 25).

Adjunct acupoints: Weishu (BL 21) for weakness of the spleen and stomach; Ganshu (BL 18) and Xingjian (LR 2) for liver-qi stagnation with spleen deficiency; and Shenshu (BL 23) for yang deficiency of the spleen and kidney.

Method: Ask the patient to take a prone lying position. Apply needles to Pishu (BL 20), Dachangshu (BL 25), Weishu (BL 21), Ganshu (BL 18) and Shenshu (BL 23) and remove needles upon arrival of qi. Then ask the patient to take a supine lying position. Needle the rest acupoints 1-1.5 cun perpendicularly and use even reinforcing-reducing manipulation by lifting and thrusting until appearance of local soreness, distension, numbness or/and sensation radiating towards the abdomen. Then manipulate once every 10 min, retain the needles for 30 min and combine with abdominal TDP irradiation.

2.1.2 Moxibustion

Acupoint: Shenque (CV 8).

Method: Ask the patient to take a supine lying position. Fill up the umbilicus with salt. Cut a fresh ginger into 0.7-0.8 cm pieces (no less than 4 cm in diameter). Prick a couple of holes with a toothpick. Make moxa cones of 3 cm in diameter and 3 cm in height. Place the moxa cones onto the ginger piece. Then put the ginger piece and moxa cone on Shenque (CV 8) that is filled up with salt. Ignite the moxa cone and replace once until it’s burnt.

Acupuncture and moxibustion were done once a day, 6 times made up a course of treatment. There was a 1-day interval between two courses. The patients were treated for a total of 4 courses.

2.2 Control group

During treatment, patients in both groups are not allowed to take medications that may affect gastrointestinal functions. They were also reminded to maintain a peaceful mind and stay away for pungent food. After treatment, therapeutic efficacies in two groups were statistically analyzed.

3 Therapeutic Efficacy Observation

3.1 Observation indexes

Symptoms including abdominal pain and diarrhea were graded and scored according to relevant literature[3].

Grade 0: Asymptomatic.

Grade 1: Mild symptoms that have no effect on daily living.

Grade 2: Moderate symptoms that have effects on daily living.

Grade 3: Severe symptoms that greatly affect daily living.

3.2 Criteria for therapeutic efficacy evaluation

Marked effect: Asymptomatic, normal frequency of bowel movements, normal stools and no relapse after 3 months.

Improvement: Almost asymptomatic, relapse within 3 months but mild in both severity and symptoms.

Failure: Symptoms remain unchanged.

3.3 Treatment results

3.3.1 Comparison of clinical effects

The difference between-group in clinical effects was statistically significant (P＜0.05), indicating a better effect in the treatment group (Table 2).

3.3.2 Comparison of clinical symptom scores

After treatment, there were intra-group significant differences in both groups (P＜0.01), coupled with a between-group statistical significance in symptom scores (P＜0.05). This indicates that symptoms of patients in both groups were improved; however, patients in the treatment group obtained a better result than those in the control group (Table 3).

Table 2. Between-group comparison of clinical effects (case)

Table 3. Between-group comparison of symptom scores before and after treatment (, point)

Table 3. Between-group comparison of symptom scores before and after treatment (, point)

Note: Intra-group comparison before and after treatment, 1) P＜0.01; compared with the control group after treatment, 2) P＜0.05

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4 Discussion

To date, the precise etiology of IBS still remains unknown. Studies have suggested that IBS is not only limited to abnormalities in the gastrointestinal nervous system, but also associated with a disruption of the brain-gut axis[4]. It has been reported that endocrine disorder, abnormal gut flora, poor digestion and absorption and mental stress may contribute to or aggravate gastrointestinal symptoms in IBS patients[5]. In modern medicine, there are no specific drugs or therapies for IBS. By conducting signals through stimulating acupoints, acupuncture can induce a dual-directional regulation on physiological functions of the body, restore normal intestinal motility and thus alleviate IBS[6]. Some researchers have found acupuncture can substantially regulate gastrointestinal hormones such as gastrin and motilin[7-8]. It’s believed that acupuncture can not only alleviate clinical signs and symptoms of IBS(abdominal pain, bloating and abnormal stools), but also reduce the visceral hypersensitivity[9-10].

In Chinese medicine, IBS-D falls under the category of ‘chronic diarrhea’. This condition is located in the large intestine and closely associated with the liver, spleen and kidney. Disorder in transportation and transformation of the spleen and stomach is considered as the major cause. Inducing factors may include exogenous pathogenic factors, improper diet and emotional disturbance. Over time, IBS-D may affect the kidney and result in yang deficiency of the spleen and kidney. There are three patterns of IBS-D in Chinese medicine: weakness of the spleen and stomach, liver-qi stagnation with spleen deficiency and yang deficiency of the spleen and kidney. The principles of treatment are to strengthen the spleen, warm the kidney, regulate the liver and spleen, and astringe the intestine and arrest diarrhea.

Since the spleen and stomach are considered as the postnatal base and source of qi and blood generation, acupoints of the Stomach Meridian are mainly selected for treatment. Because the Front-Mu points are located at the chest and abdomen, where the qi of the Zang-fu organs is infused, Zhongwan (CV 12), the Front-Mu point of the Stomach, Tianshu (ST 25), the Front-Mu point of the large intestine, and Guanyuan (CV 4), the Front-Mu point of the small intestine were selected to regulate gastrointestinal qi activities. Zusanli (ST 36), the lower He-Sea point of the Stomach Meridian and a key point for abdominal pain, was selected to regulate the spleen and stomach and boost the immune system. Shangjuxu (ST 37), the lower He-Sea point of Large Intestine Meridian, was combined to enhance the effect of strengthening the spleen. Xingjian (LR 2) and Ganshu (BL 18) were combined to regulate liver qi and relieve stagnation. In addition, Pishu (BL 20), Weishu (BL 21), Shenshu (BL 23) and Dachangshu (BL 25) were combined to regulate corresponding Zang-fu organs.

Shenque (CV 8) is located within the umbilicus and characterized by thin skin, high sensitivity, numerous capillaries, strong permeation and fast absorption. Also, this acupoint connects with the true yang of the life gate, especially with the spleen, stomach and kidney. Moxibustion on Shenque (CV 8) can regulate meridians and Zang-fu organs, supplement healthy qi and harmonize yin and yang. What’s more, the salty flavor enters the Kidney Meridian and acts to astringe; and pungent in favor and warm in nature, ginger can warm the spleen and stomach and remove cold. So, ginger and salt-partitioned moxibustion on Shenque (CV 8) can regulate the stomach and intestines, warm the kidney, strengthen the spleen, balance yin and yang and alleviate pain and diarrhea. With its fast effect and longer after-effect time, acupuncture is a good option for IBS-D.

In summary, acupuncture combined with ginger and salt-partitioned moxibustion can obtain a remarkable effect for IBS-D. This integrative therapy is simple and convenient.

Conflict of Interest

There was no potential conflict of interest.

Acknowledgments

This work was supported by Kunshan Bacheng People’s Hospital.

Statement of Informed Consent

All of the patients signed the informed consent.

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Translator:Han Chou-ping

Received Date: June 16, 2014

R246.1

: A

in the control group only

same acupuncture method (same acupoints, method and courses) as the treatment group. Abdominal TDP irradiation was combined after acupuncture.