Matsumoto Jun, et al.. Japanese Acupuncture and Moxibustion, 2008; Vol.4(1): 1-12

Takagi award - winning paper

Effect of Acupuncture and Moxibustion in Patients with Irritable
BowelSyndrome-A series of single case studyMATSUMOTO Jun1,2), ISHIZAKI Naoto3), NAMURA Kenji4),
YAMAMURA Yoshiharu4), YANO Tadashi1)1) Department of Health Promoting Acupuncture and Moxibustion, Meiji University of Oriental Medicine
2) Second Department of Internal Medicine, Gifu University School of Medicine
3) Department of Clinical Acupuncture and Moxibustion, Meiji University of Oriental Medicine
4) Department of Internal Medicine, Meiji University of Oriental Medicine
Abstract[Objective] Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders. Many cases with
IBS often resist conventional treatment and seek alternative therapies to manage the condition. This study investigates the clinical effects of acupuncture and moxibustion treatment in patients with IBS through a series of singlecase study design..
[Subjects & Methods] Four patients who had suffered from IBS for more than four years and had been medicatedfor more than half a year without sufficient recovery were treated with acupuncture and moxibustion according to
the theory of Traditional Chinese Medicine. Ten or twenty sessions of acupuncture and moxibustion therapies were
performed during a treatment period ("period B"), and alternated with a non-treatment period ("period A") (ABAB
design). To evaluate bowel movement disturbance, intensity of abdominal pain or bloating, frequency of defecationand condition of the stool were recorded in bowel diaries. Their psychological state and quality of life (QOL) werealso evaluated.
[Results & Discussion] During period B, three of four patients showed a significant improvement in abdominal
pain, bloating and QOL, and doses of medication were decreased in two patients, while their psychological state
showed inconsistent changes.
The results of this study with periods of treatment or non-treatment indicated that acupuncture and moxibustion
may be effective in improving the condition of patients with IBS, such as abdominal pain and QOL.
Key words: Irritable bowel syndrome, Abdominal pain, Acupuncture and moxibustion, Single case study, Reversal
designⅠ．Introduction
Irritable bowel syndrome (IBS) shows symptoms offunctional chronic bowel movement disturbance withabdominal pain and abdominal discomfort 1-3). Its mor-bidity prevalence rate in advanced countries is about 1015% of general populations and is the highest in gastrointestinal diseases. Declining quality of life (QOL) inpatients with IBS is significant4-6), which is sometimes
reported to be lower than that of dialysis patients6). So-

Corresponding author: Matsumoto Jun
Department of Health Promoting Acupuncture and Moxibustion, Meiji University of Oriental Medicine, Hiyoshi-cho, Nantan-shi,
Kyoto 629-0392, Japan

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cial issues such as high medical cost for the treatment or
eco nomic loss caused by sick leave are also profound sothat patients with IBS are considered to have the mostimportant therapeutic objectives in gastrointestinal diseases in the future1-3).
There are various reports regarding the therapeutic effects of acupuncture treatment to digestive systems7,8)
and a few reports indicated that acupuncture andmoxibustion treatment is clinically effective in patientswith IBS 9,10).

In this study, we performed acupuncture andmoxibustion treatment on four patients with IBS andevaluated the clinical effects of the treatment on abdominal symptoms, psychological state and their QOL
using the method of reversal design11).
Ⅱ．Subjects and Methods
1. Subjects
Subjects were patients in the outpatient department ofTable 1. Characteristics of the patients

Table 2. TCM diagnosis, acupoints used and number of sessions ineach treatment period

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internal medicine in the hospital of Meiji University ofOriental Medicine who were suffered from IBS for morethan one year and had been treated with conventional
medication for more than half a year without any clear
improvement of their symptoms. Diagnosis of IBS wasgiven according to Rome II1,2) criteria, excluding detectable organic diseases based on the findings of colonicendoscopy and blood chemistry data.
Four patients were investigated. Two of them weremales and two were females. Mean (±SD) age of thesubjects was 53±23 years old. The characteristics of thefour patients are shown in Table 1. In terms of disease
duration, three patients had suffered for four years andone had suffered for eight years. Prior to enrollment, thepurpose and procedure of the investigation were explained to all the subjects, and they were informed thatthey should take part in or leave this investigation on
their own volition. Informed consent was obtained inwriting form from all the patients. The protocol of thepresent study was approved from the Ethics Committeeof Meiji University of Oriental Medicine.
2. Acupuncture and moxibustion therapy
In acupuncture and moxibustion treatment, each patient was diagnosed according to the TCM theory33) andacupoints were selected with consideration to the natureof the points. Treatment points and times of treatment
session per intervention period are shown in Table 2.
Needles used for acupuncture were 40 mm #16 (0.16mm
in diameter) disposable stainless steel needles. Needles
were retained for 10 minutes after deqi (dull or numbsensation around the needle) was obtained. No further
stimulating technique such as twisting or tapping was
given. Moxibustion was performed in the presence ofyang deficiency to the meridian points which have aneffect of warming yang on spleen or kidney function33)
and also in which flaccidness and coldness were felt bypalpation. In the moxibustion procedure, rice-grain sizedmoxa cones were lit and removed before they were burntout (about 70% of the way burning) in order to avoid
burn injury and they were applied in a row to treatment
points until patients felt warm on the points. Approximately 10-20 moxa cones were applied at each point.
3. Study protocol
Reversal design11) in which observation period (periodA) and intervention (acupuncture) period (period B)
were alternatively repeated was employed in the present

study (ABAB design). Frequency of acupuncture andmoxibustion treatment was set at once or twice a week
and twenty therapies were used, in principle. For patients
who had some difficulty visiting the hospital often, ten
therapies were set for one period. The non-treatment
period between two treatment periods was basicallylonger than that of treatment periods. However, if a patient requested starting treatment because of aggravationof symptoms during the non-treatment period, the treatment period was started at this point. During the nontreatment period, at least once in two weeks, patientswere given a check such as interview and palpation
without acupuncture and moxibustion treatment. The
conditions for two periods would be almost the same
except for acupuncture and moxibustion treatment. During the observation period the patients were examined bytheir physicians in the same way as that before participation in this study, once in two weeks to one month. A
drug medication regimen for bowel movement disturbance was to be constant during the observation period.
However, if the symptoms of patients were reduced or
exacerbated remarkably, the physicians could change themedication. In both the acupuncture clinic and the internal medicine clinic, patients were not provided with any
guidance about daily life matters such as diet on an outpatient basis.
4. Endpoint(1) Bowel Diary
Patients had to record their bowel conditions. Those
are abdominal pain, bloating, frequency of defecationand condition of the stool every day in our original bowel diaries. Intensity of abdominal pain was expressed infive levels of 0 to 4 (0: no pain, 1: slight, 2: medium, 3:
considerable but endurable pain, 4: very strong and unbearable pain) and degree of bloating was expressed inthree levels of 0 to 2 (0: no bloating, 1: light, 2: strong).
Condition of the stool was expressed in five levels of
liquid stool, loose stool, normal stool, hard and heavystool and scybalum, and was reported after each bowel
movement on the bowel diaries.
Patients were also encouraged to write down special
events, if any, such as their accompanying symptoms,
remarkable changes in their diet, serious events in their
daily lives and so on.

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Figure 1. Changes in abdominal symptoms
Changes in abdominal pain (a) and bloating (b) are shown for all periods. The vertical axis shows the mean values of records inthe bowel diary. The horizontal axis is a time axis, in which periods with or without acupuncture and moxibustion treatment are
shown as Treated or Not treated, respectively.

Figure 2. Changes in stool frequency and condition
Changes in frequency of defecation (a) and condition of the stool; loose to liquid stool (b) are shown for all periods. Frequency
of defecation (a) and percentage (%) of liquid/loose stool in daily defecation (b) are shown on the vertical axis. The horizontal
axis is a time axis, in which periods with or without acupuncture and moxibustion treatment are shown as Treated or Not treated, respectively.

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Figure 3. Changes in QOL
Changes in GSRS on diarrhea (a), constipation (b) and sum of both scales are shown. The vertical axis of the graph is the GSRS
score, the horizontal axis is time, and acupuncture and moxibustion treatment period and non-treatment period are shown as“Treated” and “Not treated”, respectively. Score 1 of GSRS indicates no influence on each digestive symptom on the daily life ofpatients, and score 7 indicates intolerable adverse effects on the daily life of patients.

Figure 4. Changes in psychological state
Changes in POMS on depression (a) and anxiety/tension (b) are shown. The vertical axis on the graph is the T score of POMS,
the horizontal axis is time, and the acupuncture and moxibustion treatment period and non-treatment period are shown as“Treated” and “Not treated”, respectively. A full T score is 85 points, and a T score of 75 points or higher indicates a psychological state in which patients need to consider visiting a specialist.

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(2) QOL
QOL of the patients was evaluated using the Gastrointestinal Symptoms Rating Scale (GSRS)12) designed
to evaluate digestive symptoms. GSRS is a questionnaireon the influence (adverse effect) of digestive symptoms
on 15 items of a patient's daily life in the past week, bywhich QOL of patients can be evaluated in fivesubscales of reflux, (upper) abdominal pain, digestive
disturbance, diarrhea and constipation. In this study,
scales of diarrhea and constipation were selected andevaluated as subscales associated with bowel movement
disturbance. The scale of diarrhea is the average of threesub-subscales, loose stool, frequent bowel movement(diarrhea) and urgent desire of defecation, while thescale of constipa-tion is the average of three subsubscales, constipation, hard stool and feeling of
unsatisfied defecation. Scores of GSRS are made up ofscore 1 to score 7. Score 1 indicates that digestive
symptoms have no effect on the patient's daily life andscore 7 indicates that digestive symptoms have intolerable adverse effect on it.
(3) Psychological state
Two kinds of scales, depression/dejection and anxiety/tension were selected out of five scales in the Japanese version of Profile of Mood States (POMS)13).
5. Evaluation of the effect
The patients recorded data on abdominal pain, bloating, frequency of defecation, and condition of the stool
every day, and the mean values of those scores in a day
were calculated from the data for a week and comparedwith those of the last week. As for GSRS and POMS,
their conditions on the last week were compared withthose of the past week at the start and end of the treatment period. For two periods of acupuncture andmoxibustion treatment, if the values of each evaluation
item decreased, even if not much, and the values foreach item were lower than those of the first visit with
two treatment periods, it was considered that the condition of the item was improved by the acupuncture andmoxibustion treatment and that they had effect on thesymptoms.
Ⅲ．Results
Changes in all treatment and non-treatment periods ofall four cases are shown below.

1. Abdominal pain and bloating
In cases 1, 2 and 3, abdominal pain and bloating weredecreased during all treatment periods, and those in every non-treatment period were increased (Figs. 1a, 1b).
2. Bowel conditions (frequency of defecation, defecation days and condition of the stool)
Changes in frequency of defecation, defecation days
and condition of the stool are shown in Fig. 3. In case 2,
the mean frequency of defecation in two periods oftreatment decreased from 1.6 times a day to 0.9 times a
day and from 1.7 times a day to 1.1 times a day and thatin the non-treatment period was increased, but a patternthat was common to two periods of treatment was notfound in cases 1 and 3 (Fig. 2a). As for the condition of
the stool, the ratio of total frequency of loose stool andliquid stool to overall frequency in one day did notchange, remaining at 100% for cases 1 and 3 (Fig. 2b).
3. QOLIn a scale of GSRS for diarrhea, which consists of liquid/loose stool, frequency of defecation and urgent desire of defecation, values for cases 1 to 4 in the nontreatment period before the treatment period were 6.7,
2.7, 4.3 and 4.0, respectively. However, in cases 1, 2,
and 3, the values decreased for each treatment period
and increased for each non-treatment period (Fig. 3a).
The values for these three cases also changed to 4.3, 1.7,
and 1.0, respectively after two periods of treatment,
which were lower than those at the patient's first visit.
Values for cases 1 to 4 in the constipation scale were 1.3,
4.7, 5.3 and 4.7, respectively during the non-treatment
period before acupuncture and moxibustion treatment.
Cases 2 and 3 decreased for each treatment period and incase 2 increased for each non-treatment period. In cases
1, 2 and 3, they were 1.0, 1.7, 1.3 and 2.7, respectively,
which were lower than those at the patient’s first visit
with two periods of treatment (Fig. 3b). In cases 1, 2 and3, the sum of scales of diarrhea and constipation decreased for each treatment period and increased for each
non-treatment period, showing lower values with twotreatment periods than those of the first visit (Fig. 3c).
The diarrhea scale and sum of scales of diarrhea andconstipation scores in case 4 became worse during thefirst treatment period and improved during the nontreatment period after a dose of medication was increased.

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Table 3. Changes in medication regimen for each patient before andafter the observation period

4. Psychological state
During the two periods of treatment, depression, or
anxiety/tension of POMS was decreased in some patients and it was increased or stayed the same in other
patients (Fig. 4). There was no common tendency during
two periods of treatment. In terms of POMS, patientswith more than and equal to a T score of 75 points,
where the maximum is 85 points, need to see a doctor13).
Depression in case 1 during the second treatment andnon-treatment periods and anxiety/tension in case 4 during the first treatment period showed 85 points, respectively.
5. Changes in medication regimen
After two periods of treatment, the medication dose
was reduced or medication was withdrawn in cases 1
and 3, whereas those in case 4 was increased. (Table 3)
6. Remarks column
Each of case 1, during non-treatment period after the
first treatment period and during the second treatment
period, and case 4, during the first treatment period, had
an unfortunate incident such as a traffic accident andhospitalization of a family member, which caused considerable distress including a sense of uneasiness and asense of irritation. Furthermore, case 4 often complainedof discomfort in the anal region that accompanied theurge to defecate, along with abdominal pain and bloating.
There was no remarkable change in their eating habits.
Ⅳ．Discussion
According to Rome II criteria, IBS is defined to be diagnosed based on at least 12 weeks or more, which neednot be consecutive, in the previous 12 months where
there was abdominal pain and abdominal discomfort that
had two out of three of these features: (a) Relieved withdefecation; and/or (b) Onset associated with a change infrequency of stool; and/or (c) Onset associated with achange in form of stool3). IBS is considered abiopsychosocial disorder resulting from a combinationof 3 interacting mechanisms: pshychosocial factors,
altered motility and transit, and increased sensitivity of
the intestine or colon1,3,14). In a common treatment for
IBS, an anticholinergic agent, regulator of gastrointestinal motility, laxative, antiflatulent, antidepressant or
antianxiety agent is given and if a patient does not respond to the medication, psychotherapy is sometimes
practiced1,3). Recently, new drugs as policarbophil calcium have been used for IBS3), but the treatment has notbeen established. This study was performed in order toinvestigate the efficacy of acupuncture and moxibustion
on IBS patients.

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1. Research design
Many kinds of studies on treatment methods for IBS
show that the placebo response is very variable and high,ranking between 40 and 70%15,16). The placebo effectwas characterized by rapid reaction, sharp change andgradual decreasing of efficacy throughout the administration. Therefore, it is necessary to conduct randomized, double-blind placebo-controlled trial with minimum length of 8-12 weeks, to set up a run-in period andto set up a period for follow-up, in order to minimizing
the placebo effect in IBS patients15,16).
In this study, we found it difficult to have a control
group for the patients or to adopt a double-blinded trial
for our study because there are not many cases of IBS in
our institution. It is difficult to perform placeboacupuncture or a double-blinded trial because of thecharacteristic features of acupuncture and moxibustion
treatment, therefore, we investigated every efficacy ofacupuncture and moxibustion treatment on each casewith a single-case reversal design11). Patients who had
suffered from IBS for a long time and had been treatedwith conventional medicine for more than half a year
without any improvement were selected, and they weretreated for two periods of acupuncture and moxibustion
treatment with a non-treatment period intervening between the two periods. The observation period lasted for6 months to 13 months (average was 8.2 months.)
2. Effects of acupuncture and moxibustion on
IBS patients in this study(1) Abdominal symptoms and bowel movement
The presence of abdominal pain or abdominal discomfort is a precondition of IBS as described above, whichmeans improving these symptoms is important in thetreatment. Many new drugs have been recently developed based on the pathological condition of IBS3). In thepresent study, abdominal pain and bloating were improved in three out of four cases during the first treatment period, which deteriorated with the suspension oftreatment and then improved again during another treatment period. It was suggested that acupuncture andmoxibustion treatment was effective in improving abdominal pain and bloating. There was no common tendency in frequency of defecation during two periods oftreatment.

(2) QOL
It was reported that perceived severity is defined by
the limitations the disease imposes, rather than by thesymptoms in IBS patients5). Furthermore, digestive
symptoms have various affects on common health conditions and social life, and health-related QOL of IBS
patients sometimes is worse than that of patient withdiabetes mellitus and end-stage renal disease. Therefore,
it is considered as significant to evaluate efficacy of IBS
treatment on QOL improvement of IBS patients4,6).
In this study, we selected diarrhea subscale and constipation subscale of GSRS, which can measure QOL
related to digestive symptoms. According to an investigation which was performed for healthy adults in Sweden, it was reported that in the GSRS diarrhea subscale,the mean value (95% confidence interval) was 1.38
(1.35-1.41) and there was no significant difference between ages or sex. In a similar way it was reported thatin the GSRS constipation scale, the mean value (95%
confidence interval) was 1.55 (1.51-1.58) with a slightdifference between ages or sex24).
Before starting acupuncture and moxibustion treatment, all four of our cases showed higher than meanvalues in the diarrhea scale and cases 2, 3 and 4 showeda higher value in the constipation scale. There seemed to
be deterioration of QOL by bowel movement disorders
in all cases. The scores of the diarrhea scale in cases 1, 2
and 3 were decreased in all treatment periods, and it
decreased to 1.0 which was the minimum value at theend of the last treatment in case 3 and decreased to 1.7
which was close to the mean value of healthy people incase 2. Even in case 1, it decreased to 4.3, which was
still higher, but lower compared to that of the first examination. The constipation scale score decreased in cases
2 and 3 during all treatment periods and the score forcase 1 was 1.3 which was lower than the mean value of
healthy people at the beginning of the treatment andremained unchanged during the first treatment period,
but decreased to 1.0 during the second treatment period.
In IBS, because diarrhea alternates with constipation or
diarrhea occurs at almost the same time as constipation,
it is sometimes difficult to distinguish diarrheapredominant from constipation-predominant. That is, it
is considered to be important to evaluate both values as
an overall value of bowel movement disorders in order
to assess QOL of IBS patients, and therefore, we evaluated changes in the total scores of diarrhea and constipation scales. As a result, total scores of the diarrhea and9Matsumoto Jun, et al.. Japanese Acupuncture and Moxibustion, 2008; Vol.4(1): 1-12

constipation subscales decreased in cases 1, 2 and 3 inall treatment periods, and further decreased to a lower
value than that of the first visit at the end of the second
treatment period. For this reason, in this study, it wassuggested that acupuncture and moxibustion treatment iseffective in improving QOL of IBS patients.
In cases 1 and 3, in terms of stool condition, the ratioof loose/liquid stool was not changed, remaining at
100% during the observation period, but in terms of
GSRS diarrhea scores constituted by frequency ofloose/liquid, stool/defecation and an urgent desire todefecate decreased during the treatment period. Because
the GSRS scores consist of items in order to obtain information about disorders on daily life caused by each
item, they are associated with frequency and degree of
symptoms but not necessarily the same frequency ordegree12). In cases 1 and 3, GSRS scores changed withimprovement of (lower) abdominal pain and bloating
described in the bowel diaries. In these cases, there wasa possibility that improvement in abdominal pain andbloating bring about decreased disorders in patients’
daily life in stool condition or frequency of defecationthat patients themselves were aware of and contribute toimprovement of their QOL. However, this is not clear
because there is no endpoint for lower abdominal pain in
items in GSRS. Even if there was no significant change
in stool condition, acupuncture and moxibustion treatment was considered to be effective treatment for IBS
because of an improvement of QOL, which is importantin the treatment of IBS.
As for case 4, although the scores of the constipation
subscale were seen to decrease during all treatment periods, the scores of the diarrhea subscale or the total
scores of diarrhea and constipation scales as an endpoint
for overall disorders of bowel movement was decreased
during the non-treatment period and increased during thetreatment period. For this reason, there is a possibility of
the influences of additional medication administeredduring the non treatment period, an aggravated psychological state described later, aggravated abdominal bloating, or a sense of discomfort in the anal region which
was not estimated in this study. There was not, however,a clear explanation for this progress.
(3) Relationships between psychological state and symptoms of IBS
The gastrointestinal system is easily affected by stressand emotions and the axis of stress, brain, and digestive

apparatus is called brain-gut interaction. This is considered to be important in the pathological condition of
IBS1,3,14). There is experience on a daily basis for digestive symptoms of IBS to be increased along with exacerbation of a psychological state represented by depression
and can be decreased along with an improvement of
psychological state14,28). The development or exacerbation of abdominal pain or bowel movement disordercaused by psychosocial stimulation (stress) is considered
one of the typical distinctive symptoms of IBS14,29,30).
Recent studies reported excess reaction on gastrointestine caused by psychological stress in IBS patients14). It was reported that IBS patients under mental
stress have exaggerated response of duodenum and colonic motility related to abdominal pain31). It was also
reported IBS patients showed excess secretion of adrenocorticotropic hormone (ACTH), and aggravation orabnormality of motility along with abdominal pain by
intravenous administration of corticotrophin-releasing
hormone (CRH)32), which is a common mediator for
stress reaction14). Many IBS patients show depression oranxiety neurosis, which are psychological tendencies14).
Accordingly, changes in psychological state were evaluated using scales of depression/dejection and of tension/anxiety of POMS.
Some of the POMS values in this study decreased during treatment periods, and others did not change or increased. There was no common tendency during two
periods of treatment.
It is not necessarily appropriate to discuss changes in
psychological state, because it may not be a cause ofbowel movement disorders but may be caused by bowel
movement disorders. In cases 1 and 4, however, thepatient or a family member had a traffic accident or disease during the period, while their psychological state
was not good, and they complained about their psychological problems caused by the affairs in their bowel
diaries. It was considered that deterioration of POMS
might be caused by those unhappy affairs rather than thebowel movement disorder itself.
In case 1, during the first acupuncture andmoxibustion treatment period when both degrees ofdepression and tension/anxiety were decreased, abdominal symptoms were greatly improved. After, however, both degrees of depression and tension/anxiety
increased during the non-treatment period and the scoresof the depression scale remained at 85 points which was
highest during the second treatment period. Furthermore,

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before and after the second period there was not as great
an improvement in abdominal pain or GSRS scores as
those of the first period. In case 4, during the first treatment period, both degrees of depression and tension/anxiety became worse and the scores greatly increased to 85 points, well over the 75 points at which
patients need to see a specialist. Although there was no
improvement seen in abdominal pain or frequency ofdefecation and GSRS scores became worse during thisperiod, the values were improved by medication with anantidepressant and antianxiety agent after the first treatment period. Finally, before and after the second acupuncture and moxibustion treatment, POMS scores withtension or anxiety improved to be the value of the firstexamination accompanied by decreased frequency ofdefecation, abdominal pain, etc. In the cases of this study,
these psychological problems may possibly be associated with factors which cause resistance to acupuncture
treatment.
(4) Therapeutic mechanism of acupuncture andmoxibustion treatment
The main pathological mechanism of IBS is thought tobe a vicious circle of brain-gut axis that is formed by agastrointestinal motility disorder not only of the large
intestine but also of the small intestine, an impaired
perception threshold of the intestine or colon, and psychological disturbance14).
The effects of acupuncture and moxibustion treatment
on intestinal movement have been reported in which the
influence of acupuncture treatment or acupuncture electrical stimulation was studied by using human intestinal
sounds or rat intestinal motility as indicators9,17-20).
There have been reports which used the colon transport
time of radiopaque markers or opioid activity in theplasma as indicators21,22). The studies were on the effects
and mechanisms in patients with chronic constipation
after undergoing acupuncture electrical stimulation or
acupuncture treatment for several weeks21,22). However,mechanisms of a long-term effect of acupuncture andmoxibustion treatment has not been thoroughly clarified
in these studies.
With the influences on the perception threshold of theintestine, there are a few reports studying the mechanisms using animal experiments7), one of which showed
suppression of visceral pain by acupuncture stimulation
with rotating needle technique on the face of anesthetized rats. It is said that no change is induced by the mild

stimulation such as retained needle as used in this study.
The therapeutic mechanism of acupuncture was not definitive in the studies of Chan et al9). and Fireman et al10).
regarding the therapeutic effects of acupuncture on IBS,
and no other studies have shown any clear-cut long term
effects and mechanisms on chronic visceral pain of theintestine. Xiang et al24). showed that the rectal perception
threshold was increased by percutaneous electrical stimulation to acupuncture points (TEAS), and not modulated by changes in rectal biomechanics. Xiao et al25). also
reported that percutaneous electrical stimulation to acupuncture points (acupoint TENS) increased, in a shortterm effect, the rectal perception threshold of IBS patients with diarrhea-dominant symptoms. Moreover, thepatients showed a significant increase of the rectal perception threshold and a significant decease of frequency
of defecation and intensity of abdominal pain in a longterm effect after acupoint TENS treatment for twomonths. Although a similar mechanism may be involvedin the acupoint stimulation with acupuncture andmoxibustion, it is not thoroughly clarified. Cases 1 and 3
showed improvement in abdominal pain and bloating,whereas they showed no change in stool condition
known to reflect intestinal transport time26) and exhibitedno clear-cut psychologically common response in two
periods of treatment. Accordingly, it is suggested that
improvement of abdominal pain and bloating in thesecases was induced by increasing the rectal perception
threshold. Further investigation is necessary to understand the therapeutic mechanism of acupuncture treatment, because it could not be clarified by the methods
and results of this study.
As described above, we made comparative examinations at all evaluation points between periods with orwithout acupuncture and moxibustion treatment. Threecases with IBS showed improvement in abdominal pain,
bloating and QOL that are important for treatment of
IBS, during all periods of acupuncture and moxibustion
treatment.
There were lower values of these score after completion of two periods of treatment as compared with that
before treatment. These findings suggested therapeutic
efficacy of acupuncture and moxibustion treatment.
Although more elaborate study is required, acupuncture
treatment is suggested to be an effective therapy for IBS
patients.

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Ⅴ．Conclusion
1) On the basis of single-case reversal design,acupuncture and moxibustion treatment was
performed on four IBS patients who did not show afavorable response to medical pharmacologic
therapy.
2) Improvement in abdominal pain, bloating and QOL
was seen in three of four patients in all acupuncture
and moxibustion treatment periods without dose
escalation, and these symptoms became worse after
ceasing acupuncture and moxibustion treatment.
3) In two patients, the dose requirement of medication
was decreased after two periods of acupuncture andmoxibustion treatment.
4) A possibility is suggested that acupuncture andmoxibustion treatment can be a useful method oftherapy to improve abdominal pain, bloating and
QOL of IBS patients.
※This is an English translation of a paper appeared in
the Journal of the Japan Society of Acupuncture andMoxibustion (JJSAM) vol.55 No.1 issued in 2005.
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