Clinical research of irritable bowel syndrome treated by electroacupuncture on Tianshu (ST 25)

LIU Hui-rong, et al. Clinical Research of Irritable Bowel Syndrome Treated by Electroacupuncture on ST 25
DOI: 10.1007/s11726-007-0091-8

2007 Shanghai Research Institute of Acupuncture and Meridian︱

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Clinical Study

Clinical Research of Irritable Bowel Syndrome Treated by

Electroacupuncture on Tianshu(ST 25)

LIU Hui-rong(刘慧荣)

1, 2

, WU Huan-gan(吴焕淦)

, WANG Xiao-long(王小龙)

, ZUO Chuan-tao(左传涛)

GUAN Yi-hui(管一辉)

, FANG Jian-qiao(方剑乔)

1. Shanghai Research Institute of Acupuncture and Meridian, Shanghai, 200030, P. R. China
2. Shanghai Research Center of Acupuncture and Meridian, Shanghai, 201203, P. R. China
3. Huashan Hospital, Fudan University, Shanghai, 310053, P. R. China
4. Zhejiang University of TCM, Hangzhou, 200030, P. R. China

摘要目的：对电针天枢穴治疗腹泻型肠易激综合征(D-IBS)的临床疗效进行综合评价，促
进电针天枢穴治疗腹泻型肠易激综合征的应用和推广。方法：以随机、对照、单盲的方
法，对就诊的

103 例符合纳入标准的D-IBS患者随机分为电针天枢穴组(n=53)和电针大横

穴组

(n=50)。两个疗程后进行疗效统计，两组之间综合疗效比较采用Radit分析。结果：

D-IBS的腹泻、腹痛、腹胀或腹部不适、肠鸣、排便急迫感、排便不尽感等症状的发生率
分别为

100%、89.3%、71.8%、74.8%、83.5%、78.6%等；综合疗效分析，电针天枢穴

组显效

11 例，好转 34 例，无效 8 例，总有效 45 例，总有效率 84.9%；电针大横穴组显

效

4 例，好转 26 例，无效 20 例，总有效 30 例，总有效率 60.0%。两组疗效差异具有统

计意义

(P<0.05)。结论：电针天枢穴治疗D-IBS临床疗效优于电针大横穴。

关键词：肠易激综合征；穴

, 天枢；电针

Abstract Objectives: By observing and evaluating the clinical curative effect systematically
of electrical acupuncture (EA) on Tianshu (ST 25) on diarrhea-predominant irritable bowel
syndrome (D-IBS), to make it benefit for the application and spread of EA on Tianshu (ST 25)
on D-IBS. Methods: 103 D-IBS matched the involved standards were allocated into treatment
group (EA on ST 25, n=53) and control group (EA on Daheng, SP 15, n=50) in randomized,
controlled and single-blind ways. Curative effect differences were analyzed by Ridit analysis.
Results: The incidence of diarrhea, abdominal pain, abdominal distention or abdominal
discomfort, borborygmus, defecation urgency and defecation incompletion feeling were 100%,
89.3%, 71.8%, 74.8%, 83.5% and 78.6% respectively in D-IBS. Generally, after treatment, 11
cases got excellent results, 34 cases improved and 8 failed in treatment group, totally effective
rate was 84.9%; while in control group, 4 cases got excellent effects, 26 improved and 20 failed,
totally the effective rate was 60.0%. Conclusion: Compared with control group, EA on Tianshu
(ST 25) has a better curative effect on D-IBS.

Key Words: Irritable Bowel Syndrome; Point, ST 25; Electroacupuncture
CLC Number: R246.6
Document Code: A

Foundation item: Supported by State Administration of TCM of

the People's Republic of China(Proj. No. 03XDLZ26; Supported
by Shanghai Leading Academic Discipline Project(Proj. No.
T0302); Supported by Shanghai Commission of Science &
Technology(Proj. No. 03DZ19554-5); The Leading Talents of
Medical Science in Shanghai (Proj. No.LJ06019)

Irritable bowel syndrome (IBS) is one of the most

commonly intermittent or durative gastrointestinal
disorders. Primary symptoms of IBS are chronic
recurrent abdominal pain and alterations in bowel
function. Such alterations can present as diarrhea or
constipation, or alternating of the two. The key signs
of IBS are located in colons but often involved a
psychosomatic condition. With rapid rhythm of social

Journal of Acupuncture and Tuina Science, Volume 5, Number 2, 2007 April

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life, working stress, and life style changes, the
prevalence of IBS is going up. The large-sample
surgery in Europe and U.S.A. in recent years
showed the prevalence of IBS is up to 22%

[1]

While

in China, one third of patients visiting gastrointestinal
section belong to IBS, around 15% in all

[2]

Until now, there is no specific drug that wores for

all the patients. Many IBS patients accept a single
remedy, and most remedies are symptom-oriented and
some measures are not appropriate in terms of health
economics criteria, leading to unsatisfactory
therapeutic efficacy. Therefore, it is necessary to find
a new remedy to cope with both criteria and
effectiveness. Recently, reports at home and abroad
have shown that acupuncture remedy has satisfactory
therapeutic effects on IBS, previous studies of our
research group, from aspects of clinic and mechanism,
have indicated that acupuncture represents potentially
valuable therapeutic remedy for treatment of IBS.

[3-7]

Our research aims to develop a multi-centre,
single-blinded, randomized, controlled clinical trial,
103 patients with diarrhea-predominant irritable
bowel patterns have been screened and grouped.
Efficacy for remedy of diarrhea-predominant IBS
(D-D-IBS) by electric acupuncture (EA) on Tianshu
(ST 25) has been evaluated objectively and
systematically. The remedy based on Tianshu(ST 25)
provides scientific foundation of clinic, and it is also
inclined to promote popularity and utility for
treatment of D-IBS by EA on Tianshu(ST 25).

Clinical Data

1. Diagnostic criteria

As there is no special and objective or physical

criteria for IBS, patients were required to have had
symptoms that fulfilled the classification and
diagnostic criteria of D-IBS from ROME II

[8]

for

functional gastrointestinal disease.

2. Inclusive criteria

a. Diarrhea-predominant bowel pattern;
b. Aged 18 years to 65;
c. Not taking alosetron, Octreotide, herbs and other

remedies to treat IBS at the same time;

d. No severe disease of other organs, such as heart,

brain, liver, kidney, and no psychotic diseases;

e. Willing to join the trial and sign the infored

consent.

3. Exclusive criteria

a. Organic bowel diseases;
b. Women during pregnancy or lactation;
c. Severe disease of other organs, such as heart,

brain, liver, kidney, and no psychotic diseases.

4. Ending and drop-out criteria

According to the criteria to end and drop out partial

included patients, and carefully record the cause of
ending and dropping out, and its relationship with
clinical research. ①failing to keep on the overall
treatment period. ②failing to follow the trial design.
③

presenting severe adverse effects. ④presenting

complication or deterioration during the process of
treatment.

5. Baseline characteristics

Patients with D-IBS, from September in 2003 to

May in 2005, visiting Changqiao community hospital
and Traditional Chinese medical hospital in Putuo
District in Shanghai, China, were screened. 103
patients have been included (62 in Changqiao, 41 in
Putuo, respectively), aged from 19 to 65(MD, 41.3),
with the durations from 6 months to 30 years(MD,
7.5), having family history of diarrhea in 37
cases(35.92%).

6. Grouping

Adopting single randomized method, according to

randomized number chart to make cards and
envelopes, screened patients were subgrouped
according to associated randomized number and
provided treatment. Odd numbers are assigned to
control group, while even numbers are assigned to
treatment group.

Treatment Methods

1. Treatment group

Acupoint: bilateral Tianshu(ST 25).
Operation: routine disinfection, filiform needle

pricking 0.5 cun and stimulating by HAN's instrument,
dense-sparse wave: AM2/100 Hz, impulse width
0.2-0.6 ms, intensity 2-4 mA. 30 min per treatment,
once a day, 6 times for one course, one day off
between two courses, 2 courses in all.

Journal of Acupuncture and Tuina Science, Volume 5, Number 2, 2007 April

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2. Control group

Acupoint: Daheng (SP 15), bilateral, routine

disinfection, filiform needle pricking 0.5 cun and
stimulating by HAN's instrument, dense-sparse wave:
AM2/100 Hz, impulse width 0.2-0.6 ms, intensity 2-4
mA. 30 minutes per treatment, once a day, 6 times for
one course, one day off between two courses, 2
courses in all.

Therapeutic Effects Evaluation

1. Observational Items

Clinical symptoms: including key signs, diarrhea

(stool frequency of a day, consistency, occurrence in a
week), abdominal pain(frequency, extent, period),
abdominal distention or discomfort(frequency, extent,
duration), and other signs, such as rumbling, sensation
of incomplete evacuation, sensation of urgency,
mucous stool, poor appetite, abdominal distention or
pain, fatigue, psychological abnormity etc.

Referencing to diagnostic and therapeutic effect

criteria of gastrointestinal disease for IBS ROME II, and
therapeutic effect criteria of diarrhea, Zhong Yi Bing
Zheng Zhen Liao Chang Gui

[9]

, released by State

Administration of Traditional Chinese Medicine. The
therapeutic effect criteria have been set up eventually.

R=(N score before treatment-N score after

treatment) /N score before treatment×100%

Cure: normal stool, other symptoms primarily

relieve R>=90%

Improvement: frequency reduces remarkably, other

signs improve, 30%<=R<90%;

No effect: no improvement of stool frequency, and

no improvement of other symptoms, R<30%.

2. Statistical analysis

According to proportion of symptoms before

treatment, rank test of two samples for group design
was adopted, Ridit analysis was also used when
therapeutic effects of two groups before and after
treatment were compared.

Results

1. Comparison of clinical data of two groups

The incidence and proportion of key symptoms for

D-IBS (Table 1) By analysis, key symptoms of D-IBS,
such as diarrhea, abdominal pain, sense of urgency
have incidence of over 80%, which are most familiar

signs. Distention or discomfort, rumbling, sense of
incompletion, mucous stool, psychological
abnormality have incidence of 45% to 80%. While
poor appetite, gastro discomfort, fatigue have
incidence of less than 45%. Rank test of two samples
for group design has been used, but there is no
significant difference in key symptoms of two
groups(P>0.05). So the key symptoms of two groups
could be comparative.

2. Overall clinical observation

EA on Tianshu(ST 25) group 11 cases(20.8%)

cured, improvement 34 cases(64.1%), no effect 8
cases(15.1%), effective rate in all 84.9%; EA on
SP-15 4 cases cured(8.0%), improvement 26
cases(52.0%), no effect 20 cases(40.0%), effective
rate 60%(Table 2). By chi-square test, a 24.9% of
significant difference between two groups has been
detected(P<0.05) with 90% power at the α=0.05
significance level, which indicates that efficacy of
EA on ST 25 is superior to one of EA on SP-15.

Table 1. Comparisons of key symptoms incidence(cases)

Clinical signs

ST 25 SP 15 N Incidence

(%)

Diarrhea

103 100.00%

Abdominal pain

92 89.32%

Distention or discomfort

36 38 74

71.84%

Rumbling

77 74.76%

Sense of incompletion

81 78.64%

Sense of urgency

86 83.50%

Mucous stool

53 51.46%

Poor appetite

34 33.01%

Gastro discomfort

46 44.66%

Fatigue

43 41.75%

Psychological abnormality 26

49 47.57%

Table 2. Comparison of symptoms in two groups

Group

Cure Improvement No

effect

ST 25

SP-15 50

4 26

Discussions

To the treatment of IBS, there is no specific method

or drug. Many IBS patients accept a single treatment,
and current measures are symptom-oriented, aimed at
removing inducing factors and correcting the relevant
pathological or physical changes. Recently, reports at

Journal of Acupuncture and Tuina Science, Volume 5, Number 2, 2007 April

●

︱

2007 Shanghai Research Institute of Acupuncture and Meridian

home and abroad have shown that acupuncture

remedy has satisfactory therapeutic effects, previous
studies of our research group, from aspects of clinic
and mechanism, have indicated that acupuncture
represents potentially valuable therapeutic remedy for
treatment of IBS

[7-11]

. However, there is no systematic

research on a single acupoint Tianshu (ST 25), and no
united quality control criteria, and that will affect the
clinical application of treating IBS with Tianshu(ST
25). Therefore, it is greatly necessary in this area.

Global evaluation of symptoms for D-IBS showed

the incidence of key symptoms, such as diarrhea,
abdominal pain, sense of urgency was over 80%, and
so they are familiar symptoms of D-IBS patients.
While distention(71.8%), rumbling(74.8%), sense of
incompletion(78.6%), mucous stool(51.5%), psycho-
abnormality (47.6%), are common symptoms too with
an incidence of 45% to 80%. Since psychological
questionnaires are not involved in this research,
psycho-abnormality here doesn't refer to psychopathic
problem. On the contrary, doctors inquires patients'
psychological stress, personality (whether anxiety, or
nervousness, or sensitivity to dealing with situation,
circumstances stress, relationship of stress and
diarrhea, abdominal pain et al), dealing way, etc. The
sensitivity of patients is called character of sensitivity.
Psycho-abnormality, in fact, refers to inclination of
sensitive personality. This research indicates that
sensitive rate of IBS is 47.6%, This is a pretty high
rate, which is in accordance with opinions of many
scholars.

[10-12]

Therefore, IBS is considered as typical

psychosomatic disease

[10, 12-13]

While poor appetite,

gastric discomfort, fatigue have incidence of less than
45% (33.0%, 44.7%, and 41.8%).

In a word, multiple symptoms of D-IBS could be

improved by EA on Tianshu (ST 25), EA on Tianshu
(ST 25) is superior to EA on Daheng (SP 15). This
research proved the description about treatment of
intestinal problems with Tianshu(ST 25). Tianshu (ST
25) has a function of "dredging intestine, holding on
diarrhea, relieving pain", and therapeutic effect of
Tianshu (ST 25) for treating IBS has been proved.
From clinical aspect, Tianshu (ST 25), as an acupoint
of stomach meridian and the front-Mu acupoint of
Large intestine, is effective and great efficient. So
Tianshu(ST 25) plays a key role in the treatments of
IBS. EA on Tianshu (ST 25) to treat IBS should been

used and popularized. Therefore, this research has
provided scientific clinical data for the remedy based
on Tianshu (ST 25).

References

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Epidemiology. Chinese Journal of Epidemiology, 2003,
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[2] PAN Guo-zong, LU Su-cai, KE Mei-yun, et al.

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[3] ZHAO Chen, LIU Hui-rong, WU Huan-gan, et al. Literature

Research of Treating Irritable Bowel Syndrome by
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[4] CHEN Wen-hua, WU Huan-gan, ZHAO Chen, et al.

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Received date: January 2, 2007