Treating Irritable Bowel Syndrome and Colitis with Acupuncture

Irritable bowel syndrome is a non-inflammatory bowel disease that may effect up to 15% of the population according to one source (Pagon, 1998), and up to 25% according to another (Lewis,1992). It is considered difficult to estimate since many are thought not to seek treatment for IBS.

The symptoms of IBS are varied and can include any of the following:

  • Alternating constipation and diarrhea
  • Cramping and pain in the lower abdomen
  • Pain worse after eating and may be relieved by bowel movements
  • Flatulence, distention, nausea or anorexia
  • Mucus associated with stools, which may be small and round or thin and ribbon shaped. (Pagon,1998)
The cause of IBS is unknown but may be accompanied by mood swings, depression, anxiety, anger, fatigue, or sleep disturbances. There are no organic changes in the structures of the bowel and no inflammation. This ailment does not seem to interfere with absorption of nutrients since there is no malnourishment or weight loss associated with IBS. Some factors, which may be causes of IBS, are stress and tension, irregular eating schedule, eating under stress and food allergies. The diagnosis of IBS may be considered a diagnosis of exclusion, given when other possible diseases are ruled out (Lewis,1992).

Inflammation in the mucous membranes, and submucosal layer, with blood and mucus in the stool characterize chronic ulcerative colitis. The level of diarrhea is much higher sometimes as often as once every two to three hours (Khoe, 1975)). Though onset may occur at any age, colitis is typically seen in ages 20 to 40. Cramping and abdominal pain are seen with the diarrhea, and is associated with anorexia and weight loss. The pain is usually located in the lower abdomen but may be difficult to localize. The pain may refer to the low back and rectum. Other symptoms include bloating, nausea and vomiting (Yves, 1981). The inflammation can lead to structural changes in the bowel, including ulcerations and hemorrhagic areas (Khoe, 1975).

While the etiology of colitis is unknown, it is thought to be multifactoral. Few studies indicate dietary factors as a cause or remedy of colitis, but many factors have been studied such as refined white sugar, lactose, and fast food. Other studies examine the flora in the bowel and have found reduced levels of E. coli, lactobacilli and other good bowel flora and higher levels of gram positive disease causing microorganisms. In Chinese medicine colitis is often seen as a Yang deficiency so dietary management would aim at improving the quantity of warming or Yang supplementing foods. In a paper by Dr. William Khoe, the benefits of adding Yang foods such as meat are negated by the hormones, antibiotics and nitrites found in commercially produced meats in the United States. He recommends no red meat of any type, instead eating fresh fish and naturally raised chicken. (I would suggest organically raised beef, pork and lamb for those needing warming foods without chemicals.) He also recommends no refined sugar, no table salt (sea salt is OK), and no refined white flour or processed grains (Khoe, 1975). Not an easy diet to follow for most Americans.

The pattern of IBS and colitis can vary with acute phases and periods of remission. However with colitis rarely is the mucosal layer of the colon seen to return to normal (Khoe, 1975). Either emotional or psychological upset or an intestinal infection (Yves,1981) frequently sets off acute episodes. In particular with colitis, an acute flare-up needs medical attention to rule out serious complications such as fistulas, lesions or colon cancer, especially if associated with rectal bleeding.

Irritable bowel syndrome and colitis are often associated with emotional stress, both in western medicine and eastern medicine. In TCM, the seven emotions are acknowledged to be a cause of disease. With digestive problems the two organs most associated in TCM with IBS and colitis are the Liver and Spleen. The function of the Liver is to ensure the smooth flow of Qi throughout the body. Anger is the emotion associated with the Liver, and unresolved anger may cause stagnation of Liver QI. Conversely, anger may arise from stagnation of Liver Qi, or excess anger may cause Liver Qi to rise and invade the Spleen. Stagnation of Liver Qi and Liver invading Spleen are both excess conditions in TCM. Deficiency patterns associated with IBS and colitis is deficiency of Spleen Qi or Spleen Yang, or Kidney and Spleen Yang deficiency (Lewis, 1992).

The Spleen in TCM is the major organ of digestion. Its function is to transform food into Qi and to transport that Qi to various organs and to the body in general. Normal functioning of the Spleen enables smooth digestion, sufficient energy production for normal activities, and normal bowel movements. Impaired Spleen function will lead to bloating, gas, anorexia, fatigue and loose stools. The emotion associated with the Spleen is worry or over thinking, which can injure the Qi of the Spleen, leading to a weak or deficient Spleen. A deficient Spleen may not be able to keep the Liver in check, according to Five Phase theory, thereby allowing the Liver to invade the Spleen, and impair its function of transformation and transportation (Lewis,1992). Here is an example of a deficiency of the Spleen leading to an excess of the Liver.

The energy needed for the Spleen to adequately perform its job of transformation and transportation comes from Spleen Yang, which in turn is supported by Kidney Yang. The Kidneys are considered the root of Yin and Yang in the body. Kidney Yang is the basis of the warming function and provides the heat for digestion. A deficiency of Kidney Yang will usually lead to a deficiency of Spleen Yang and an impairment of digestion. Conversely, a long-term impairment of the Spleen will in time deplete the Kidney leading to a deficiency of Kidney Yang. This is a much more serious level of disease in the body (Zhongyin, 1996). The symptoms here will be watery diarrhea is the early morning with undigested food, fatigue, dull aching or cramps which are relieved with warmth or pressure and cold limbs, back or abdomen (Zhongyin, 1996).

The other organs possibly associated with IBS are the Lung and Large Intestine. The emotions associated with the Lung are sadness and grief. Since the Lung is related to the Large Intestine by their Yin-Yang pairing, long term and unresolved sadness and grief can impair the descending function of the Lung which can lead to an impairment of Large Intestine Qi (Lewis, 1992). This pattern is more often associated with constipation rather than diarrhea.

Whether an emotional component is the primary cause of IBS and colitis, a secondary co-factor, or not applicable at all, must be determined on a case-by- case analysis. Since in TCM we treat the whole person any sign of emotional distress is a clue to the total pattern of pathology, and can aid us in choosing a treatment strategy.

The diagnosing of IBS and colitis in TCM are based on the principles of Yin and Yang, excess and deficiency, organ diagnosis, pathogenic factors and the Five Phase cycle and relationships between the elements. By careful differentiation of the signs and symptoms, one may develop a diagnosis and treatment plan.

Acupuncture and moxibustion have been found to be beneficial in the treatment of IBS and colitis, and is seen to surpass the effectiveness of medication in some cases. Treatments will work better and more quickly for those with a shorter clinical course of the disease, however treatments work best when used more frequently during acute episodes. Dietary changes may also benefit, especially avoiding white refined sugar and flour. Supplementing with live cultures of healthy microflora is also beneficial. Since emotional strife such as unresolved anger and worry can may exacerbate the condition, lead to an acute flare-up or have an implication in etiology, the treatment will also include a focus on emotional factors. I have had experience treating IBS and Crohn's disease, a more advanced and debilitating ailment similar to colitis. While acupuncture may not be able to cure Crohn's it can help manage the symptoms and enable people to live a more comfortable life.

Terry Tangredi Lic. Ac. 131 Main Street, Hatfield, MA. 01038 (413) 247-3388