Editor's Note: Part 1 of this article appeared in the September issue.

Western skepticism toward TCM is rife. However, TCM has long been the most common alternative therapy sought by irritable bowel syndrome patients, and has a good track record for safety and tolerability by patients, according to recent research.

What is most impressive is that TCM approaches have multiple targets for the intervention. For example, they may regulate neurotransmitters, balance the hormones of the enteric nervous system, modulate the hypothalamic-pituitary-adrenal axis, reduce inflammation in the intestines, restore gut flora, and modulate smooth muscles in the GI (gastrointestinal) tract that are misfiring and causing either diarrhea or constipation.

TCM Formulations for IBS

Among the well-known TCM formulations for the cluster of symptoms known as IBS are Shen Ling Bai Shu San, Tong Xie Yao Fang, Xiang Sha Yang Wei Wan, and Fu Zi Li Zhong Tang.^4,6 For instance, Tong Xie Yao Fang as an herbal formulation for the treatment of IBS-D was affirmed by Fengbin Liu, et al. (2020),¹ although the authors are uncertain as to the reason for its therapeutic efficacy.

One good explanation may be found in the interaction between the mind (shen) and the spleen, which in TCM includes the common organ of the spleen, and encompasses the way that food is digested and turned into energy for the body. Spleen deficiency is a common TCM diagnosis and is generally seen in constipation or loose bowels, physical fatigue and/or pain in the abdomen. Treatment involves regulation of both spleen and shen – if the patient is suffering from emotional or psychological distress, focusing solely on the spleen is apt to produce only limited benefits.

That IBS has a mind-body connection is apparent from the number of clients who report depression and anxiety compared to the regular population. It is not just that IBS causes situational depression and/or anxiety – it does! – but that studies report significant IBS associated with these two psychological conditions. Therefore, neglect of the shen is at the peril of both patient and practitioner.

Potential Acupoints

To better explore this connection, there is a clinical trial underway⁷ which is using the following acupuncture points to achieve a goal of regulating shen and reinvigorating spleen:

• GV 20 (Bai Hui)
• GV 29 (Yin Tang)
• Bilateral LR 3 (Tai Chong)
• ST 36 (Zu San Li)
• SP 6 (San Yin Jiao)
• ST 25 (Tian Shu)
• ST 37 (Shang Ju Xu)

If the trial produces a good outcome, it will be an example of the safety and effectiveness of using acupuncture in IBS treatment. (The investigators are also noting family history among the participants in an effort to better understand how genetics may affect the development of IBS symptoms.)

That needle acupuncture is a superior approach to helping patients with a wide range of IBS symptoms can be derived from the pairwise meta-analysis conducted by Hoi Lam Wong, et al. (2018),⁸ which compared acupuncture to treatment with trimebutine maleate and pinaverium bromide. Electroacupuncture was also found to be superior to pinaverium bromide, and the combination of needle acupuncture with moxibustion was superior in a study to loperamide when the patients presented with global IBS symptoms.

Practitioners may also find benefits to their patients by combining needle acupuncture with the Ge Shan Xiao Yao formulation of Chinese herbal medicine, as opposed to just Ge Shan Xiao Yao alone. In every study that could be found, there were no serious adverse events associated with TCM and/or acupuncture, making it a strong option for patients who are unsatisfied with Western medical approaches to their IBS, or want to use TCM as a complementary approach.

Clinical Pearls

Irritable bowel syndrome is a common and uncomfortable condition for many patients, for which Western medicine offers only intermittent and unpredictable relief. The constellation of symptoms associated with it may also be the result of health challenges that are far more significant. Once those complicated challenged are ruled out, though, a combination of needle acupuncture and a TCM herbal formula such as Ge Shan Xiao Yao could well bring relief to suffering patients with a wide variety of IBS symptoms.

Given the high prevalence of IBS in Western cultures, TCM practitioners are advised to stay abreast of the latest research and take advantage of the counsel offered in this article to be of most assistance to their patients.

References (Parts 1 & 2)

1. Liu F, et al. Efficacy of Tong-Xie-Yao-Fang granule and its impact on whole transcriptome profiling in diarrhea-predominant irritable bowel syndrome patients: study protocol for a randomized controlled trial. Trials, 2020 Nov 3;21(1):908.
2. Song J, et al. The diagnosis performance of the TCM syndromes of irritable bowel syndrome by gastroenterologists based on modified simple criteria compared to TCM practitioners: a prospective, multicenter preliminary study. Evid-Based Compl Alt Med, 2020;2020:1-8.
3. Camilleri M, Andresen V. Current and novel therapeutic options for irritable bowel syndrome management. Dig Liver Dis, 2009;41(12):854-862.
4. Xiao H-T, et al. Traditional Chinese medicine formulas for irritable bowel syndrome: from ancient wisdoms to scientific understandings. Am J Chin Med, 2015;43(1):1-23.
5. Zhou FS, Cheng H-H. Treatment of irritable bowel syndrome by Chinese medicine: theoretical research and clinical experience. World Chin J Digestol, 2010;18(21):2225.
6. Sung JJ, et al. Agreements among traditional Chinese medicine practitioners in the diagnosis and treatment of irritable bowel syndrome. Aliment Pharmacol Ther, 2004;20(10):1205-1210.
7. Pei Li-x, et al. Acupuncture for irritable bowel syndrome: study protocol for a multicenter randomized controlled trial. Trials, 2018 Oct 1;19(1):529.
8. Wong CHL, et al. IDDF-2018-ABS-0047 acupuncture and related therapies for treating irritable bowel syndrome: overview of systematic reviews and network meta-analysis. Gut, 2018;67(Suppl 2).