Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
About the research: It is worth noting that in research, randomised controlled studies (RCT) are the most reliable in terms of quality of evidence, with a systematic review or meta analysis of numerous studies being the best way of seeing the overall picture of the state of the evidence. Below we have a selection of the available research, which does include some larger RCTs, and reviews of the literature alongside smaller studies. The n= figure tells you how many people were participants in the study.
The British Acupuncture Council has a Research digest where they have looked at some more recent studies including on Dyspepsia, including a 2-arm trial where the refractory functional dyspepsia patients were seen to experience improvement in symptoms for up to two months, with no adverse side effects (n=200) (Zheng et al, 2018). An RCT in Korea (n=76) looked at functional dyspepsia as well as other quality of life related measures, finding a significant improvement in FD symptoms for up to 8 weeks in the acupuncture group (Ko et al, 2016).
A meta-analysis of 16 RCTs (n=1436 total) found positive results both for symptoms and quality of life, albeit that the quality of the research was low in many cases in the trails they examined, but further high quality RCT studies are needed to corroborate the trends (Pang et al, 2016).
Mao et al’s meta-analysis (2020; n=853 over 7 RCTs) found Electroacupuncture (EA) to have greater efficacy in alleviating Functional Dyspepsia (FD) symptoms versus placebo (sham-EA). However, with the limitation of small sample size and some low quality, the findings are were cautiously interpreted, calling for further quality, large, multi-centre RCTs to supplement the evidence.
Irritable Bowel Syndrome
The British Acupuncture Council has a Research digest where they examined some recent studies on IBS, such as MacPherson et al (2017; n=116) in a follow up two years after their RCT acupuncture for IBS, finding a favourable result 24 months on. Another RCT for diarrhoea type IBS (Zheng et al, 2016; n=448) found the acupuncture group found a level of improvement in line with that of the group assigned pharmacological (Loperamide) intervention in terms of reducing stool frequency.
Zhu et al (2018a) conducted a network meta-analysis of diarrhoea type IBS, with 29 studies (n=9369) entailed in it, finding that acupuncture may improve symptoms, but that further high quality research was needed to corroborate the overall results. A meta analysis of diarrhoea predominant IBS (Deng et al, 2017) looked at 17 trials (n=1333), finding improvement in clinical symptoms in the acupuncture groups.
Similar trends have been seen in the trials for acupuncture in constipation predominant IBS, in a network meta-analysis, in which the quality of the trials was predominantly of high quality (40 trials n=11032; Zhu et al, 2018b).
The British Acupuncture Council has a Research digest where they examined some recent studies on constipation including an RCT taken in 15 hospitals in China (n=1075) where the acupuncture group was seen to increase the number of weekly spontaneous bowel movements, with the researchers recommending that further studies are needed to see the longer term outcomes (Liu et al, 2016).
Another RCT (Zheng et al, 2018; n=684) similarly showed promise in this area, but was limited somewhat by its design in not having a sham acupuncture control (they only had three different types of verum acupuncture compared with pharmacological intervention), meaning it was difficult to know the magnitude of the effect.
A systematic review and meta-analysis of 33 trials (n=4324 total; Zheng et al, 2019) compared eight different non-drug treatments, finding acupuncture and TENS were the most effective in addressing chronic functional constipation symptoms, but interpreting the results with caution due to small study effects.
Moxibustion is an adjunctive acupuncture technique that involves burning herbs near the skin to stimulate acupuncture points. Wang et al, (2015) examined the effect of moxibustion on a specific pathway in 40 ulcerative colitis (UC) rats divided into 4 groups.
The TLR2/NF- κ B signalling pathway is one of the body’s ways of detecting and fighting pathogens. It helps the body make substances that cause inflammation and attract other fighters to the scene. However, sometimes this pathway can go wrong and cause too much inflammation and harm to the body. This can happen in some diseases, such as ulcerative colitis.
Moxibustion was found to reduce the expression of pro-inflammatory biomarkers (namely, TLR2, IRAK1, IKK-β and NF-κB) in the UC rate; and to increase the expression of anti-inflammatory biomarkers (specifically, IFN- β and IL-10) in the rats’ colonic mucosa.
The researchers suggest that moxibustion can modulate the local immune response in UC, protect the colonic mucosa and promote its repair in UC by inhibiting the TLR2/NF- κ B signalling pathway. The effects of moxibustion were similar to those of salicylazosulfapyridine treatment, a conventional drug for UC, and both treatments were significantly better than the untreated UC group.
Zhao et al’s (2015, n=92) RCT randomised patients with active Crohn’s disease into 2 groups: moxibustion and acupuncture, or sham control. In Crohn’s there is an imbalance between TH17 cells (a type of immune cells that elicit inflammatory response); and Treg cells (which suppress inflammation and protect intestinal mucosa). Acupuncture lowered Th17 levels, and raised Treg cells, to balance their relative levels and dampen inflammation. Crohn’s Disease Activity Index (CDAI) improved with both acupuncture and sham points, but more so with true acupuncture. There were also positive histopathological changes of the intestinal mucosa following acupuncture – such as intact epithelium, reorganised glands and less inflammatory cells. The authors concluded that moxibustion and acupuncture can relieve intestinal inflammation in Crohn’s disease patients by regulating the ratio of Th17 and Treg cells in the intestinal mucosa, and making the lining more intact, the glands more organized, and the inflammatory cells less abundant.
British Acupuncture Council evidence based factsheet about Gastrointestinal & Digestive Tract Disorders including specific research, trials and mechanisms of action for acupuncture in this condition.
British Acupuncture Council IBS Factsheet including specific research, trials and mechanisms of action for acupuncture in this condition.
British Acupuncture Council Research Digest – Constipation (approx halfway down the document)
British Acupuncture Council Research Digest – Dyspepsia (just over halfway down the document)
British Acupuncture Council Research Digest – Irritable Bowel Syndrome (IBS) (approx halfway down the document)
Ko, S.J., Kuo, B., Kim, S.K., Lee, H., Kim, J., Han, G., Kim, J., Kim, S.Y., Jang, S., Son, J. and Kim, M., 2016. Individualized acupuncture for symptom relief in functional dyspepsia: a randomized controlled trial. The Journal of Alternative and Complementary Medicine, 22(12), pp.997-1006.
Mao, X., Guo, S., Ni, W., Zhang, T., Liu, Q., Du, S., Luo, M., Pan, Y., Wu, B., Su, X. and Yang, Y., 2020. Electroacupuncture for the treatment of functional dyspepsia: a systematic review and meta-analysis. Medicine, 99(45).
Pang, B., Jiang, T., Du, Y.H., Li, J., Li, B., Hu, Y.C. and Cai, Q.H., 2016. Acupuncture for functional dyspepsia: what strength does it have? A systematic review and meta-analysis of randomized controlled trials. Evidence-based Complementary and Alternative Medicine, 2016.
Zheng, H., Xu, J., Sun, X., Zeng, F., Li, Y., Wu, X., Li, J., Zhao, L., Chang, X.R., Liu, M. and Gong, B., 2018. Electroacupuncture for patients with refractory functional dyspepsia: a randomized controlled trial. Neurogastroenterology & Motility, 30(7), p.e13316.
Irritable Bowel Syndrome References:
Deng, D., Guo, K., Tan, J., Huang, G., Li, S., Jiang, Q., Xie, J., Xie, H., Zhang, Z., Chen, Y. and Peng, L., 2017. Acupuncture for diarrhea-predominant irritable bowel syndrome: a meta-analysis. Zhongguo zhen jiu= Chinese acupuncture & moxibustion, 37(8), pp.907-912.
MacPherson, H., Tilbrook, H., Agbedjro, D., Buckley, H., Hewitt, C. and Frost, C., 2017. Acupuncture for irritable bowel syndrome: 2-year follow-up of a randomised controlled trial. Acupuncture in Medicine, 35(1), pp.17-23.
Zheng, H., Li, Y., Zhang, W., Zeng, F., Zhou, S.Y., Zheng, H.B., Zhu, W.Z., Jing, X.H., Rong, P.J., Tang, C.Z. and Wang, F.C., 2016. Electroacupuncture for patients with diarrhea-predominant irritable bowel syndrome or functional diarrhea: a randomized controlled trial. Medicine, 95(24).
Zhu, L., Ma, Y., Ye, S. and Shu, Z., 2018a. Acupuncture for diarrhoea-predominant irritable bowel syndrome: a network meta-analysis. Evidence-Based Complementary and Alternative Medicine, 2018.
Zhu, L., Ma, Y. and Deng, X., 2018b. Comparison of acupuncture and other drugs for chronic constipation: A network meta-analysis. PloS one, 13(4), p.e0196128.
Liu, Z., Yan, S., Wu, J., He, L., Li, N., Dong, G., Fang, J., Fu, W., Fu, L., Sun, J. and Wang, L., 2016. Acupuncture for chronic severe functional constipation: a randomized trial. Annals of internal medicine, 165(11), pp.761-769.
Zheng, H., Liu, Z.S., Zhang, W., Chen, M., Zhong, F., Jing, X.H., Rong, P.J., Zhu, W.Z., Wang, F.C., Liu, Z.B. and Tang, C.Z., 2018. Acupuncture for patients with chronic functional constipation: a randomized controlled trial. Neurogastroenterology & Motility, 30(7), p.e13307.
Zheng, H., Chen, Q., Chen, M., Wu, X., She, T.W., Li, J., Huang, D.Q., Yue, L. and Fang, J.Q., 2019. Nonpharmacological conservative treatments for chronic functional constipation: A systematic review and network meta‐analysis. Neurogastroenterology & Motility, 31(1), p.e13441.
Ulcerative Colitis References:
Wang, X., Liu, Y., Dong, H., Wu, L., Feng, X., Zhou, Z., Zhao, C., Liu, H. and Wu, H., 2015. Herb-partitioned moxibustion regulates the TLR2/NF-κB signaling pathway in a rat model of ulcerative colitis. Evidence-Based Complementary and Alternative Medicine, 2015.
Zhao, C., Bao, C., Li, J., Zhu, Y., Wang, S., Yang, L., Shi, Y., Liu, H., Dou, C., Ding, G. and Wang, X., 2015. Moxibustion and acupuncture ameliorate Crohn’s disease by regulating the balance between Th17 and Treg cells in the intestinal mucosa. Evidence-Based Complementary and Alternative Medicine, 2015.