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SOUTH BAYLO UNIVERSITY

The Effectiveness of Acupuncture and Moxibustion in the Treatment of Irritable Bowel Syndrome

A Narrative Review

by Dr. John Cassone, DAOM, PhD

A RESEARCH PROJECT SUBMITTED IN PARTIAL FULFILLMENT OF THE

REQUIREMENTS FOR THE DEGREE

Doctor of Acupuncture and Oriental Medicine

ANAHEIM, CALIFORNIA August, 2018

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APPROVED BY RESEARCH PROJECT COMMITTEE

Copyright by Dr. John Cassone 2018

Cassone Wellness

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ACKNOWLEDGEMENTS

I have enjoyed a rich academic experience in my years at South Baylo University completing the Masters program and now the Doctoral program. I am grateful for the high quality professors and doctors that have shaped my understanding of this amazing medicine. In particular, I would like to thank Dr. Sandjaya Trikadibusana for giving me, with patience, many classroom and clinic hours of wisdom. Dr. Trikadibusana has made a tremendous impact on me both personally and professionally. I often keep him in mind as I treat patients in my own clinic.

I would like to thank Dr. Wayne Cheng for the many hours of encouragement and support given during the entire doctoral program at South Baylo University. At the end of the Masters program, he encouraged me to start the Doctoral program and remained a strong student advocate during the entire program. I have spent countless hours in his office and feel grateful for his guidance. He is the reason I kept my sanity and the reason I was able t

Open ABSTRACT

The Efficacy of Acupuncture and Moxibustion in the Treatment of

Irritable Bowel Syndrome – A Narrative Review

John Cassone

SOUTH BAYLO UNIVERSITY at ANAHEIM, 2018 Research Advisor: Sandjaya Trikadibusana, L.Ac., Ph.D., M.D.

ABSTRACT

Diseases and disorders of the gastrointestinal tract are common and increasing in the developed world. Irritable bowel syndrome (IBS) is one of such disorders which comes with a high morbidity rate. Conventional care models are branch treatment focused, meaning they interrupt the disease mechanism but do not address the cause of the disease. They do not treat by improving normal function or identifying factors that disrupt function and are also associated with high costs and undesirable side effects. According to the National Center for Complementary and Integrative Health, acupuncture is considered safe with relatively few complications. The purpose of this study is to review current research on the treatment of IBS, and the related symptoms of visceral hypera

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I. INTRODUCTION

Irritable Bowel Syndrome (IBS) refers to a set of symptoms primarily affecting the gastrointestinal system. According to the National Institute for Diabetes and Digestive and Kidney Diseases, it is estimated that 15% of the population in the developed world suffers IBS. Chronic IBS has affected 26.9% of adults in the United States with an increased economic burden (Sandler, Stuart, and Liberman, 2010). The total cost of IBS is estimated $200 billion worldwide (McFarland, 2008). The general prevalence of IBS around the world is approximately 11% (Hungin, 2003) with the majority being adult females (Lovell and Ford, 2012). The primary symptoms include cramping, pain, gas, constipation alternating with loose stool, sense of urgency to defecate, distention of the lower abdomen, and poor appetite. 

Within the conventional medical care umbrella, the cause of IBS is viewed to be unknown and incurable although the onset is closely related to psychological stress (Drossma, Camerilli, and Ma

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II. Review of Literature

Western Medicine Viewpoint:

Conventional Diagnosis and Treatment

IBS is broken into subcategories based on the prevailing stool pattern: constipation (IBS-C), diarrhea (IBS-D), mixed constipation and diarrhea (IBS-M), or unsubtyped (IBS-U). Gut dysmotility may also be broken down into four sub-groups: spastic colon syndrome, functional diarrhea, diarrhea-predominant spastic colon syndrome, and midgut dysmotility (Cole, Duncan, & Claydon, 2002). Causative factors for IBS are highly variable and complex and a single pathogenesis has not been identified. Most studies indicate that IBS is associated with visceral hypersensitivity, disruption in gut motility, and abnormal function of the gut-brain axis. Visceral hypersensitivity, and visceral hyperalgesia, are terms used to characterize the internal pain of organs (viscera), in this case specifically describing pain within the gastrointestinal tract. Visceral hypersensitivity, as a benchmark for IBS severity, is used to g

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III. MATERIALS AND METHODS

Literature Search Strategy

Four electronic databases were used for literature selection: the Cochrane Central Register of Controlled Trials, PubMed, Alt Health Watch, and EBSCO. A comprehensive search of databases was executed using the keywords “irritable bowel syndrome and acupuncture,” “irritable bowel syndrome and moxibustion,” “visceral hypersensitivity and acupuncture,” and “visceral hypersensitivity and moxibustion.”

The initial search yielded 322 total articles. Many articles that came up in the search had no relevance to acupuncture or moxibustion. From an initial scan on articles and abstracts, 201 were eliminated based on subject relevance. Duplicates were also eliminated. Of the remaining 125 articles, 36 we unavailable in full text. 29 other article were eliminated because they did not involve acupuncture or moxibustion or IBS. Of the remaining 60 articles, 26 were not available in English. Of the remaining 34 articles, 6 were only proposals for future RC

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IV. RESULTS AND DISCUSSION

Sample sizes varied greatly between studies. The majority of the studies had sample sizes with less than 100 subjects and none of the studies had sample sizes greater than 500 subjects. Greater sample sizes produce more robust clinical trials and reviews which is a point for future research efforts to consider. The outcome measurements, which are the most important features to mark treatment success, were also highly variable. Many of the outcome measurements were subjective, which allowed for variability in interpretation. This inconsistency made the summarization of data more challenging. Table 1 shows sample size, study type, treatment, & outcome measurement.

Table 1. Sample Size, Study Type, Treatment, & Outcome Measurement

![Screenshot_2026-05-13_17-32-43.png](/u/screenshot_2026-05-13_17-3

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V. CONCLUSION

Author Opinion

In review of the articles presented in this paper, it was observed that when acupuncture and moxibustion therapies are used in combination they are 30% more effective at treating patients suffering IBS than when each of those therapies are used individually. The combination of the two treatments showed consistent improvements through both objective and subjective outcome measurements. Furthermore, moxibustion treatment showed a 20% improvement over acupuncture when applied to ST25 based on DAI scores, QOL scores, and subjective pain assessments. These subjective improvements indicate changes in the comfort level of the subjects more than functional improvements which leads the author to believe that moxibustion therapy is best applied to treat the visceral hypersensitivity and visceral hyperalgesia aspects of IBS. Although moxibustion is historically used on distal acupoints, in the treatment of IBS, moxibustion therapy is best used on local points including, but not l

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V. REFERENCES

Abdullah, M., Firmansyah, M., (2013). Clinical approach and management of diarrhea. Acta Med Indones, 2013;45:157-65

Anastasi, J., McHahon, D., Kim, G., (2009). Symptom management for irritable bowel syndrome: a pilot randomized controlled trial of acupuncture/moxibustion. Gastroenterol Nurs, 32:243-55

Blackshaw, L., Brookes, S., Grundy, D., Schemann, M., (2007). Sensory transmission in the gastrointestinal tract. Neurogastroenterol Motil, 19(1):1-19

Burnstock, G., Kennedy, C., (2011). P2x receptors in health and disease. Adv Pharmacol, 61:333-372

Burnstock, G., (1997). The past, present and future of purine nucleotides as signaling molecules. Neuropharmacology, 36(9):1127-1139

Camilleri, M., Sellin, J., Barrett, K., (2016). Pathophysiology, evaluation, and management of chronic watery diarrhea. Gastroenterology, doi: 10.1053/j.gastro.2016.10.014

Chao, G., Zhang, S., (2014). Effectiveness of acupuncture to treat irritable bowel syndrome: a meta-analysis. World J Gastroente

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VI. APPENDICES

Appendix A. Bristol Stool Scale

For IBS-D patients, the scores 4=none, 5=slight, 6=moderate, 7=severe

For IBS-C patients, the scores 4=none, 3=slight, 2=moderate, 1=severe

Appendix B. Definition of Terms

Appendix C. List of Abbreviations

Copyright and moral rights for this research project are retained by the author.

A copy can be downloaded for persona