The acupuncture treatment of irritable bowel syndrome

Townsend Letter for Doctors and Patients,  July, 2004  by Honora Lee Wolfe

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Keywords: Acupuncture, irritable bowel syndrome (IBS), diarrhea, constipation

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In Chinese medicine, what is referred to in the West as irritable bowel syndrome is mostly categorized as xie tong, painful diarrhea. If this is accompanied by abdominal distention, this is categorized as fu zhang, while constipation is bian bi. The modern Chinese medical literature is unanimous in saying that the root cause of IBS is always a disharmony between the liver and spleen. Due to emotional stress and frustration, the liver may become depressed and the qi become stagnant. Qi stagnation then results in abdominal distention and pain. Due to worry, lack of exercise, over-fatigue, improper diet, or over or prolonged use of antibiotics, the spleen may become vacuous and weak. Spleen qi vacuity results in fatigue, lack of strength, and downward diarrhea. In addition, these two disease mechanism mutually engender each other. When the liver becomes depressed, it commonly counterflows horizontally to attack the spleen, thus causing or worsening spleen vacuity weakness. Conversely, if the spleen is vacuous and weak, this may cause or worsen liver depression. This is because weakness of the spleen qi may lead to blood vacuity or insufficiency, and the liver can only function when it receives an adequate supply of blood to nourish it. Hence, liver depression, qi stagnation, and spleen vacuity weakness typically go hand in hand in clinical practice. In addition, because of their monthly loss of blood, women's spleens must work harder at producing blood than men's spleens must. This also predisposes women in particular to spleen vacuity and explains why three times as many women as men suffer from IBS.

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If the liver becomes depressed and the qi becomes stagnant, this stagnation may eventually transform into depressive heat. Over time, this pathological heat will damage and consume the blood, body fluids, and ultimately kidney yin. Spleen vacuity may also lead to blood and, therefore, yin vacuity because the spleen is the root of blood engenderment and the blood and essence share a common source. Since yin is supposed to control yang, if kidney yin becomes vacuous and weak, liver yang may become hyperactive. Since fire burns upward and the heart and lungs are located above the liver, this pathological heat may also accumulate in the heart and/or lungs, disturbing either or both heart and lung function.

Because the spleen is also in charge of moving and transforming liquids, if the spleen becomes weak, water dampness may accumulate in various parts of the body. Dampness (which is a yin evil), being thick, heavy and turbid, tends to percolate downward and may further block the free flow of qi which is yang, thus aggravating liver depression qi stagnation. Dampness may also give rise to depressive heat which then may cause the dampness to become damp heat. It is also possible for liver depression/transformative heat to stew the body's juices and give rise to damp heat.

In addition, if qi becomes stagnant and the spleen becomes weak, food stagnation is easily engendered. Food stagnation means food which sits in the stomach undigested. Such food stagnation may also transform into depressive heat.

If qi stagnation fails to move the blood, the blood will stop and become static. Thus, if liver depression is bad enough or lasts long enough, it may give rise to blood stasis. Blood stasis is mainly associated with pain, such as abdominal pain, headache, or other relatively severe aches and pains which are fixed in location and tend to be sharp or piercing in nature.

If spleen vacuity endures, it may eventually reach the kidneys, thus resulting in spleen qi and kidney yang vacuity. This commonly occurs in perimenopausal women and then again later in life in both men and women. Because kidney yang warms and steams the liver, kidney yang vacuity tends to aggravate liver depression. Because kidney yang also warms and steams (i.e., evaporates) body fluids, kidney yang vacuity also aggravates any accumulation of evil dampness. Further, because yang vacuity causes vacuity cold and cold's nature is to contract and constrict, kidney yang vacuity tends to cause or aggravate blood stasis.

Treating Irritable Bowel Syndrome with Acupuncture

As we said earlier, a liver spleen disharmony is at the heart of irritable bowel symptomology. Looking at the disease mechanisms we have just described above, acupuncture is known to have a positive impact on many of these, especially in the case of relaxing the liver and moving the qi. That being said, let's look at the specific points/treatment methods that might be chosen for patients with this condition.

Liver-spleen disharmony pattern

Main symptoms: Abdominal distention and painful diarrhea which are worse with stress or emotional upset, chest, breast, and rib-side distention and pain, irritability, fatigue, lack of strength, cold hands and feet, orthostatic hypotension, easy bruising, menstrual irregularities in women, a pale but dark, possibly swollen tongue with thin, white fur, and a fine, bowstring pulse