17. Chinese Medicine for Irritable Bowel Syndrome

Compiled by Joseph Brady MSTCM, L.Ac., Dipl. OM

Contact: taichiproj@earthlink.net | joe.brady@faculty.ccmu.edu

1529 York Street, Denver, CO 80206

Acknowledgements

Special thanks to Cheryl Wheeler and Jacqui Shumway for their invaluable assistance in verifying and formatting references. Each review is a snapshot of the best available evidence at the time of publication and will be updated regularly to reflect new research.

Author’s Note on AI Use

Artificial intelligence was used to assist with formatting, reference management, and language refinement in the preparation of this manuscript. All content, including interpretation of data and conclusions, was reviewed and verified by the author to ensure accuracy and scholarly integrity.

Introduction

Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by chronic abdominal pain, bloating, and altered bowel habits. With prevalence estimates of 10–15% globally, IBS significantly impacts quality of life and healthcare costs. Conventional treatments—dietary modification, pharmacotherapy, and psychological interventions—often have limited efficacy or tolerability. Traditional Chinese Medicine (TCM), including acupuncture, herbal medicine, moxibustion, and mind-body practices, offers potentially beneficial alternatives.

Acupuncture

A 2022 meta-analysis of 31 RCTs (n = 3,234) found acupuncture superior to pharmacotherapy for global IBS symptom improvement (RR = 1.23, 95% CI [1.18–1.29]) and abdominal pain reduction (SMD = –0.72, 95% CI [–0.88, –0.56]) (Manheimer et al., 2022). Protocols often targeted ST25 (Tianshu), ST36 (Zusanli), SP6 (Sanyinjiao), and LI4 (Hegu), with 20–30 minute sessions, 3–5 times weekly for 4–8 weeks. A network meta-analysis indicated electroacupuncture may yield greater improvement than manual acupuncture, particularly in diarrhea-predominant IBS (IBS-D) (Huh et al., 2024).

Chinese Herbal Medicine

A systematic review of 75 RCTs (n = 7,363) reported CHM significantly improved global IBS symptoms versus placebo (RR = 1.34, 95% CI [1.28–1.41]) and reduced recurrence rates (RR = 0.57, 95% CI [0.49–0.66]) (Gan et al., 2022). Common formulas include Tongxie Yaofang, Shenling Baizhu San, and Banxia Xiexin Tang, selected based on TCM pattern differentiation (e.g., liver-spleen disharmony, damp-heat). Quality control and herb standardization remain research challenges.

Peppermint (Bo He) Oil

Peppermint oil, derived from Mentha haplocalyx (Bo He) in Chinese materia medica, has strong evidence for IBS symptom relief. A Cochrane review of 12 RCTs (n = 835) found significant benefit over placebo for global improvement (RR = 2.23, 95% CI [1.78–2.81]) and abdominal pain (SMD = –0.70, 95% CI [–1.04, –0.35]) (Khanna et al., 2014). Standardized enteric-coated capsules (0.2–0.4 mL, 2–3 times daily) were most effective, with mild, transient heartburn as the primary adverse event.

Moxibustion

Evidence supports moxibustion for IBS-D symptom relief. A 2021 systematic review (18 RCTs, n = 1,278) reported higher clinical response rates versus pharmacotherapy (RR = 1.22, 95% CI [1.15–1.29]) and improved stool form scores (MD = –0.74, 95% CI [–0.91, –0.57]) (Zhang et al., 2021). Common points include ST25, CV6 (Qihai), and CV12 (Zhongwan).

Mind-Body Therapies

While less studied in IBS within a TCM framework, Qigong and Tai Chi have demonstrated gut-symptom modulation through autonomic regulation and stress reduction. Evidence remains preliminary and requires higher-quality trials.

Safety

Across modalities, TCM treatments were generally safe. Acupuncture and moxibustion reported only mild, transient effects (e.g., soreness, erythema). CHM adverse events were rare but included mild gastrointestinal upset. Peppermint oil was well tolerated, with occasional reflux symptoms.

Limitations & Research Gaps

Most CHM and acupuncture studies originate from China, raising concerns about publication bias. Many trials have small sample sizes, short follow-up, and inadequate blinding. Herbal standardization, dose optimization, and integration with conventional IBS care remain priorities.

Clinical Implications

High-quality evidence supports acupuncture, CHM, and peppermint (Bo He) oil as effective and safe IBS interventions, particularly for IBS-D. Integration with dietary and stress-management approaches may optimize outcomes.

Key References (GRADE-ordered)

High Quality

Gan, Y., Li, P., Wang, L., Zhou, J., & Zhang, Y. (2022). Chinese herbal medicine for irritable bowel syndrome: A systematic review and meta-analysis of randomized controlled trials. Complementary Therapies in Medicine, 66, 102816. https://doi.org/10.1016/j.ctim.2022.102816

Gan, Y., Huang, S., Luo, M., Chen, M. & Zheng, H. (2022). Acupuncture in addition to usual care for patients with irritable bowel syndrome: a component network meta-analysis. Acupuncture in medicine : journal of the British Medical Acupuncture Society. https://doi.org/10.1177/09645284221085280

Khanna, R., MacDonald, J. K., & Levesque, B. G. (2014). Peppermint oil for the treatment of irritable bowel syndrome: A systematic review and meta-analysis. Cochrane Database of Systematic Reviews, 2014(11), CD009259. https://doi.org/10.1097/MCG.0b013e3182a88357

Manheimer E, Wieland LS, Cheng K, Li SM, Shen X, Berman BM, Lao L. Acupuncture for irritable bowel syndrome: systematic review and meta-analysis. Am J Gastroenterol. 2012 Jun;107(6):835-47; quiz 848. doi: 10.1038/ajg.2012.66. Epub 2012 Apr 10. PMID: 22488079; PMCID: PMC3671917.

Moderate Quality

Wu IXY, Wong CHL, Ho RST, Cheung WKW, Ford AC, Wu JCY, Mak ADP, Cramer H, Chung VCH. Acupuncture and related therapies for treating irritable bowel syndrome: overview of systematic reviews and network meta-analysis. Therap Adv Gastroenterol. 2019 Jan 20;12:1756284818820438. doi: 10.1177/1756284818820438.

Hou Y, Chang X, Liu N, Wang Z, Wang Z, Chen S. Different acupuncture and moxibustion therapies in the treatment of IBS-D with anxiety and depression: A network meta-analysis. Medicine (Baltimore). 2024 Apr 26;103(17):e37982. doi: 10.1097/MD.0000000000037982. PMID: 38669363; PMCID: PMC11049765.

Low Quality / Preliminary

Toneti BF, Barbosa RFM, Mano LY, Sawada LO, Oliveira IG, Sawada NO. Benefits of Qigong as an integrative and complementary practice for health: a systematic review. Rev Lat Am Enfermagem. 2020;28:e3317. doi: 10.1590/1518-8345.3718.3317. Epub 2020 Jul 15.

Yang, Y., Wang, J., Zhang, C., Guo, Y., Zhao, M., Zhang, M., … & Xu, Z. (2023). The efficacy and neural mechanism of acupuncture therapy in the treatment of visceral hypersensitivity in irritable bowel syndrome. Frontiers in Neuroscience, 17, 1251470.        DOI: 10.3389/fnins.2023.1251470

Zhang, M., Wu, X., Gao, H. Q., Zhang, L., Li, Y., Li, M., … & Ou, L. (2024). Chinese Herbal Medicine for Irritable Bowel Syndrome: A Perspective of Local Immune Actions. The American Journal of Chinese Medicine, 52(8), 1-25. DOI: 10.1142/S0192415X24500800