Digestive Disorders

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What do we treat?

The team at the Rozelle Acupuncture and Chinese Medicine Centre (RACM) Sydney offers Chinese Medicine (CM) treatment for a range of conditions that have shown promising results through CM clinical trials.

Our team also advises on best evidence laboratories for food allergy and intolerance testing, as well as testing for gut pathogens, bacteria, and parasites.

The Gut-Brain Connection

The digestive system may influence hormone balance, stress levels, memory, cognition, mood, immune response, and inflammatory processes, because most of the chemicals controlling the brain are also located in the gut. These include hormones and neurotransmitters such as Serotonin, Norepinephrine, Dopamine, Glutamate, GABA (gamma-Aminobutyric acid), native benzodiazepines, small brain proteins, and natural opiates (Carabotti et al 2015).

The gastrointestinal system or enteric nervous system (ENS) and the brain or central nervous system (CNS) communicate through a bi-directional communication link, called the Gut-Brain Axis (GBA). In this axis there is a constant exchange of chemical messages and neurotransmissions linking the CNS and the ENS by means of neural and humoral (hypothalamus-pituitary-adrenal axis) mechanisms.

Neural mechanisms of communication in the GBA involve the CNS, autonomic nervous system and the ENS. The CNS comprises the brain and spinal cord, the autonomic nervous system and includes the sympathetic and the parasympathetic nerves, and the vagus nerve which is of particular importance in the GBA.

The limbic system is also part of the autonomic nervous system and is responsible for fear and arousal. It connects to other areas of the brain that direct behavioural responses, creating the link between a strong emotional experience to a physical response in the digestive system. ‘Butterflies’ in the stomach, or irritable bowel syndrome and gut pain when anxious or angry, are examples of limbic system action.

Humoral mechanisms (antibodies delivered via body fluids) of communication in the GBA include the enteroendocrine system which produces hormones and the HPA (hypothalamus-pituitary-adrenal) axis, which influences our response to stress (Collins et al 2012).

The science of the GBA explains how digestive health and what we eat, potentially impacts the health of every other system in the body. The ENS is found in the lining and tissues of the oesophagus, stomach, colon, and small intestine and contains over 100 million neurones. It is often referred to as ‘the second brain’, because it can act independently of the brain, but its main functions are to maintain proper digestive function, regulate brain chemistry, and influence neuroendocrine and neuroimmune systems.

The ENS ‘talks’ with the brain and CNS via the GBA, and because the GBA links emotional and cognitive centres in the brain with the ENS, emotional well being and mental health may influence the digestive system, and the digestive system may also influence mental health.

Emotional wellbeing and digestive health may influence the immune system as well (how well we respond to colds, flus and bacterial infections, or whether we instead develop a hyper-vigilant immune response, such as allergies or autoimmune disease), because there are immune cells in the gut, and most immune cells have receptors to neurotransmitters.

In order to be healthy the gastrointestinal system requires over 400 strains of good bacteria. The GBA links bi-directional communication from the gut bacteria to the brain, and the brain to the gut bacteria, allowing unhealthy gut bacteria to potentially influence hormone balance, anxiety, stress, memory, cognition, mood, and immune response.

For example, when the gut bacteria is healthy, the immune system responds quickly to colds and flus and infection. When the gut bacteria are not healthy, chronic chest infections may occur, as well as depression, anxiety, insomnia, and autoimmune diseases such as Coeliac, rheumatoid arthritis, Hashimoto’s, and elevated Natural Killer (NK) cells.

On the other hand, the CNS influences the digestive system in an unhealthy way when stress and anxiety promote the development of pathogenic types of gut bacteria. Stress can also lead to changes in the permeability of the lining of the intestines, allowing minute particles of food to leak through into the blood stream, which in turn stimulate unhealthy immune responses that may lead to allergies, food intolerances, and skin and autoimmune diseases.

Over two millennia ago the ancient Chinese medicine (CM) practitioners understood the gut-brain connection at a level that science is only now able to appreciate and explain. Consequently, science provides good evidence for the rationale behind key CM theories of the cause of disease and treatment protocols for digestive disorders. This is why a whole body holistic assessment is a good medical model; to identify all possible factors contributing to any given disease, whether it be digestive, mental health or immune related.

For this reason the practitioners at the Rozelle Acupuncture and Chinese Medicine Centre Sydney take the time to make an holistic assessment (see About Us, Chinese Medicine, Acupuncture, and Chinese Herbal Medicine).

Further reading could be on: Serotonin, GABA, Glutathione and brain intestinal-microbe connection. Serotonin is a chemical and neurotransmitter, manufactured in the brain and intestines. 90% is found in the intestines, and the brain uses the serotonin it produces: http://www.pointofreturn.com/serotonin.html.

GABA (gamma-Aminobutyric acid) is an amino acid that acts as the principal calming neurotransmitter in the human central nervous system (CNS). A useful link for a more detailed explanation is: http://www.pointofreturn.com/gaba.html.

Glutathione is an amino acid, essential for cellular health and DNA synthesis and repair, good immunity and detoxification pathways. It is also an important anti-oxidant and anti-inflammatory: http://www.pointofreturn.com/glutathione.html.

Stephen M. Collins, Michael Surette and Premysl Bercik, The interplay between the intestinal microbiota and the brain: Nature Reviews Microbiology 10, 735-742 (November 2012). doi:10.1038/nrmicro2876.

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Gut Bacteria and Parasite Infections

Our CM team treats various digestive disorders involving pathogenic organisms such as: Candida Albicans, Blastocyst Hominis, Cryptosperidian, Helicobactor Pylori, worms, amoebas, protozoa, pathogenic bacteria, fungal, viral, and yeast infections. Gut pathogens increase risk of reflux, constipation, pain and diarrhoea, nausea, vomiting, heart burn, Crohn’s Disease, Coeliac Disease, allergies, food intolerances, and irritable bowel syndrome (IBS).

If not diagnosed or properly treated, chronic gut pathogens may cause hormonal imbalance, menstrual irregularities, infertility, insomnia, malabsorption, fatigue, weight gain, weight loss, anxiety, depression, skin diseases, thyroid conditions, autoimmune disease, systemic inflammation, and liver damage.

If a gut pathogen is suspected, our CM team provides the following:

  • Recommendation for best evidence laboratory testing to exclude pathogenic gut parasite or bacteria,
  • CM support during and after antibiotic treatment,
  • Acupuncture and CM herbal treatment of parasite and bacterial infestation,
  • Discussion on best pre- and pro-biotic for gut recovery,
  • Nutrition and dietary guidance.

Practitioners of Chinese medicine have written many manuscripts and treatises on the diagnosis, recovery, and treatment of gut pathogens and, in particular, have a long history of treating both bacterial and parasitic infestations. Of note, in 2015, a Nobel prize in medicine was awarded to CM researcher Tu Youyou who showed good evidence for the clinical effectiveness of Artemisia annual (Qing huo) in treating malarial parasites. Reference to the herb was found in a 1,600 year old (400 AD) text.

Early Chinese documents referred to parasitic toxins or antigens as Gu Zheng and Gu Du, which may be loosely translated as ‘parasitic syndrome’ and this term is still found in Chinese medical texts. Starting from 500 BC with the Shen Nong Ben Cao Jing (a comprehensive CM herbal text), a large body of work has been devoted to the treatment of Gu Zheng and Gu Du.

Reller (2016), on his website, provides a substantial list of significant CM research for the treatment of parasites and bacterial and pathogenic organisms of the gut, based on the chemical analysis of formulas and herbs used for many centuries throughout Asia. Promising research on clinical trials in Chinese herbal medicine and acupuncture is also discussed. Below is a summary of this review.

Research (2012) found that one of the chemicals in the Chinese herb Dichroa febrifuga (Shu qi leaves or Chang shan root) has a dose-dependent curative rate of 50-100% for malaria and the protozoa Plasmodium falciparum parasite: https://www.ncbi.nlm.nih.gov/pubmed/22182577.

A study in Japan (2015) found that 2 active chemicals in the Chinese herbs Qing hao, or Artemesia annua, Artemesinin, and Artemether, showed great potential in vitro studies to inhibit growth of Babesia gibsoni, a parasite that infects dogs: https://www.ncbi.nlm.nih.gov/pubmed/25523292.

In a study in France (2011) found that E zhu, Yu jin and Jiang huang have a broad anti-parasitic effect on Candida, Giardia, Pasmodium (malaria), leishmania, Babesia, Sarcoptes and Nematodes: https://www.ncbi.nlm.nih.gov/pubmed/21104602.

A study of herbal treatment for the parasitic disease Schistosomiasis (2001), found that Mo yao produced a 98% cure rate after two weeks. Twenty cases followed up with biopsy specimens at 6 months revealed no living ova: https://www.ncbi.nlm.nih.gov/pubmed/11791960.

An Australian a review (2003) of the treatment of parasitic disease, found evidence of significant benefit treating Giardia, especially with the Chinese herbs Huang lian, Gou mei, aged garlic and the Ayurvedic formula Piper longum and Bi ba: https://www.ncbi.nlm.nih.gov/pubmed/21104602.

Another study (2002) found that the herbs Qing hao, He huan pi and Xuan fu hua or Jin fei cao were anti parasitic for Ascaris lumbridoides: https://www.ncbi.nlm.nih.gov/pubmed/12512821.

A study (2015) in Germany and Switzerland noted that protozoal diseases are now found to be common and classified as "Neglected Diseases" by the World Health Organisation (WHO), but that a number of common herbs have chemicals that are proven to be potent antiprotozoal medicines. The highest activity was found in the Chinese herbs Dan shen, E zhu, and Valerian, Hypericum, Arnica and Silymarin out of 58 extracts studied: https://www.ncbi.nlm.nih.gov/pubmed/26248069.

An Indian study (2011) revealed that churchmen, a chemical found in the Chinese herbs E zhu, Yu jin, and Jiang huang, may be more effective than antibiotics to counter Clostridium difficile, the most prevalent cause of gastroenteritis. Antibiotic therapy was found to increase the risks of acquiring this infection by 7-10 times: https://www.ncbi.nlm.nih.gov/pubmed?term=clostridium gastroenteritis herbal.

A study in China (2015), showed that the Chinese herb, Bing Lang, contains about 50 active chemicals that have broad anti-parasitic and antioxidant effects, as well as activities that treat chronic fatigue, depression, allergies, chronic inflammation, and digestive dysfunction. Bing lang may also help regulate blood glucose, lipids, and platelets: https://www.ncbi.nlm.nih.gov/pubmed/25681543.

A study (2011) in India, of the effects of various herbs used traditionally to treat parasitic infections, showed that Annona squamosa, Han lan cao, Long kui, He zi, and Catharanthus roseus extracts showed complete inhibition (100%) at the maximum concentration tested (50 mg/ml): https://www.ncbi.nlm.nih.gov/pubmed/20980034.

A review of the treatment of parasitic disease in Belgium, (2008) found that a variety of classes of herbal and nutrient chemicals are effective in viral parasitic diseases, such as HIV infection. These include flavonoids, lignans, coumarins, xanthones, tannins, and terpenes, which are the active chemicals in many Chinese herbs and modern nutrient medicines: https://www.ncbi.nlm.nih.gov/pubmed/18671200.

A review of the treatment of childhood viral intestinal parasitic disease in South Korea (2000), found that of the 34 traditional Chinese herbs investigated to treat rotavirus and infant diarrhoea, Zhi shi had the most potent effect. Also effective in the treatment of shock, by inhibiting excess histamine release, and improving blood circulation.

A study in China (2012), revealed that Wu wei zi and pomegranate extract significantly inhibited Norovirus gastroenteritis: https://www.ncbi.nlm.nih.gov/pubmed?term=norovirus gastroenteritis.

Chinese herbs

Two large long-term studies of the parasitic disease Clostridium difficile (2013) found that common antidepressant medications, and a diagnosis of depression, were highly associated with the most common parasitic disease in older hospitalised patients. The antidepressants associated with the increased risk were Prozac, Remeron and Trazodone, all of which affect the serotonin and 5HT neurotransmitters and receptors, most of which are located in the gastrointestinal system, not the brain.

Acid-inhibiting drugs, such as proton pump inhibitors and histamine H1 antagonists, also dramatically increase the risk of hospital-acquired infections such as Clostridium in the GI, and various pneumonias, many of which are antibiotic resistant: http://www.biomedcentral.com/1741-7015/11/121/abstract.

In China (2007), researchers found that an alcohol tincture of Pu gong ying and Stemona root was very effective in decreasing the Demondex follicularum mite growth: http://www.ncbi.nlm.nih.gov/pubmed/17633825. A (2006) study, found that Demodex follicularum, treated with Huang bai), Xian he cao and Pu gong ying was effective to inhibit overgrowth of skin mites: http://www.ncbi.nlm.nih.gov/pubmed/17326398.

A review of the treatment of herpes and varicella viral parasitic diseases (2001), found that Da huang, Mu dan pi, and Chuan lian zi, and water decoction of Ku shen, had a significant effect: http://www.ncbi.nlm.nih.gov/pubmed/11789588.

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FOOD ALLERGIES

Food allergies and intolerances occur when the lining or mucus membrane of the digestive tract becomes damaged (as a result of stress, the side effects of medications, unhealthy diet, gut pathogens, recreational drug use, and excess alcohol). When the gut mucus membrane is damaged, minute particles of food literally leak through this important barrier, and then pass into the blood stream. In response, the body produces antigens, mounting an immune attack when sensitive foods are eaten. Severe gut inflammation, food intolerances, and food allergies develop over time, which may gradually involve a greater number of foods.

When food allergies are present, robust testing of immune factors such as elevated IgE, IgG, or IgA against common foods is useful to ascertain positive or negative response. We refer our clients to labs that carry out IgG testing on foods, pollens, and chemicals because this is often more sensitive than IgE testing.

IgE testing of foods often gives false negative reports (when a food comes up negative, despite the client having a known highly allergic response). Our team has a great deal of experience interpreting these reports and using this information to complement our Chinese medicine treatments. We have found that a robust testing lab is essential for reliable assessment.

Some very promising results have been documented using acupuncture and Chinese herbal medicine in reducing food allergy symptoms, including digestive disturbances accompanied by respiratory complaints, such as asthma and hay fever. Below is a list of clinical studies.

20 participants (Zhang Xin-Cheng et al., 2001) with food allergies and bloating, pain and discomfort after eating certain foods were given a CM herbal formula containing Huang Qi, Bai Jiang Cap, Ma Chi Xian, Di Ku Dan, stir-fried Shan Zha, Bai Zhu, Fu Ling, Huang Qin, Hou Po, Huang Lian and Huo Xiang with some modifications based on each individual’s symptoms. Researchers claimed 95% efficacy (disappearance of symptoms, a lowering of IgE levels to normal, and the ability to eat the offending foods without presenting symptoms for up to one year).

Wang and Li (2012) reported a significant reduction to peanut allergy in participants given CM herbal medicine (the formula was not disclosed). Several studies in China (Wang et al., 2009), (Brown, 2011), showed that electro-acupuncture stimulation regulates the balance of Th1 and Th2 T helper cell cytokines, affecting a number of inflammatory pathways, as well as boosting the immune system and calming allergies. Th1 T helper cells are low and Th2 T helper cells are high when allergies persist. A study in China showed that Ju hua significantly relieved allergy induced asthma by switching the immune response from a Th-2 dominance towards a Th-1 effect (Brown, 2011).

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IRRITABLE BOWEL SYNDROME (IBS)

Irritable bowel syndrome (IBS) is one of the most common conditions we see in our clinic and our anecdotal evidence suggests promising results using acupuncture, CM diet therapy, and Chinese herbal medicine.

A recent systematic review by Bahrami and colleagues (2016) concluded that evidence was promising for the use of various herbal remedies to relieve the symptoms of IBS. Researchers also found that a formula of herbs appeared to work better than the use of a single herb.

Earlier in Australia, Bensoussan and colleagues (1998) conducted a randomised clinical trial on 116 patients with IBS. Clinically and statistically improved outcomes for the treatment group receiving Chinese herbal medicine were observed compared to the non-treatment group. Once intervention had stopped those participants who received a tailored CM herbal formula were found to have more stable IBS symptoms compared to those who had a standardised CM herbal formula.

REFLUX AND HEARTBURN

Reflux and heartburn are a common form of digestive complaint that our team often treats with Chinese medicine (CM). When experienced, Helicobacter pylori should always be excluded as a factor however, even after identification and medical treatment, reflux often does not clear entirely.

Our team has anecdotal evidence to suggest that antibiotic treatment for H. pylori followed by a CM treatment that strengthens digestive function and normalises gut biome, encourages positive long term results and gut health after H. pylori diagnosis and treatment. There have been some promising research to date in CM on the treatment of heartburn with acupuncture and Chinese herbal medicine.

One study revealed that acupuncture was more effective compared to treatment with a proton pump inhibitor (Dickman et al., 2007). Of interest was a study published in the Journal of the American Medical Association (JAMA) showing that the rise in Clostridium difficile-related diarrhoea were linked to acid reflux drugs (Kuehn, 2012). Therefore, a search for alternative methods was recommended.

Research by Zhang (2008) and (2010) in the Journal of the National Medical Association, showed promising results using acupuncture for heartburn compared to medication. On the British Acupuncture Council website is an informative list of research projects investigating the science behind how acupuncture influences gastro-intestinal disorders.

Acupuncture works by:

  • Inhibiting gastric and duodenal motility by activating sympathetic nerves via spinal reflexes, and increasing motility via the vagus nerve and supraspinal reflexes (Chang 2001; Takahashi 2006; Sehn 2006; Yao 2006; Noguchi 2008),
  • Altering acid secretion, and visceral pain (Takahashi 2006),
  • Improving delayed gastric emptying (Xu 2006),
  • Reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003),
  • Stimulating areas in the brain that are involved in gastric perception (Zeng 2009),
  • Inhibiting stress-induced pro-opiomelanocortin expression in the hypothalamus (Sun 2008),
  • Increasing vasoactive intestinal peptide and nitric oxide in plasma, gastric mucosal and bulb tissues, and elevating expression of vasoactive intestinal peptide in antral smooth muscle (Shen 2006),
  • Decreasing permeability of intestinal mucosa in patients with acute pancreatitis, and reducing accumulation of endogenous inflammatory mediators and vascular active substance in intestinal mucosa (Wang 2007).

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CROHN’S DISEASE

Crohn’s disease is a chronic inflammatory disease that can lead to inflammation and ulceration anywhere along the digestive tract from the mouth to the rectum, causing abdominal pain and chronic loose stools or diarrhoea.

Our team has significant experience treating in particular, women, with Crohn’s disease who are unable to fall pregnant due to irregular cycles, poor hormone levels, poor lining of the uterus, and recurrent miscarriage.

The team has collected good anecdotal evidence to show that acupuncture and Chinese herbal medicine improves digestion and absorption while decreasing the incidence of watery diarrhoea in Crohn’s disease, positively impacting hormone balance, uterine lining, and reducing miscarriage.

There has also been extensive research on Crohn’s disease in CM, and several studies have shown good outcomes for the use of acupuncture and Chinese herbal medicine. For example, a recent study (Bao et al., 2014) showed that acupuncture and moxibustion (a herb used to warm the needles during acupuncture) was effective in reducing the symptoms of Crohn’s disease compared to no acupuncture.

Shang and colleagues (2015) showed that moxibustion combined with acupuncture increased tight junction protein expression in Crohn’s disease patients.

The British Acupuncture Council web site cites two good studies that show how acupuncture has been found superior to sham acupuncture for disease activity scores in Crohn’s disease and Ulcerative Colitis (Joos 2006; Joos 2006; Schneider 2007).

Earlier in 2011, Bao and his team showed that moxibustion down-regulates colonic epithelial cell apoptosis and repairs tight junctions in rats with Crohn’s disease.

Zhao and colleagues (2015) investigated how acupuncture and moxibustion relieved Crohn’s disease and found a regulatory effect of the balance between Th 17 and Treg Cells in the intestinal mucosa. Numerous other studies support these investigations including Wang and colleagues (2012), and Bao and colleagues (2012), Zhao and colleagues (2015) who investigated the brain gut function in patients with diarrhoea-dominant irritable bowel syndrome and the impact of electro acupuncture.

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COELIAC DISEASE

(see also Malabsorption below)

Coeliac disease is an inflammatory and autoimmune disease where the body identifies gluten as a pathogen or allergen, causing abdominal pain, bloating, vomiting, diarrhoea, and loose stools. Fatigue, depression, and anxiety are also common symptoms presenting with this condition. Our team of CM practitioners has found that acupuncture and Chinese herbal medicine in combination with diet modification and a process of encouraging a healthy gut biome (environment) significantly improves energy levels and quality of life, due to a reduction in symptoms.

Our team has a lot of experience treating men, women, and children with Coeliac disease and several clinical trials also support the use of CM in the treatment of Coeliac disease.

For example Huang qin was found to significantly inhibit IL-8, and other inflammatory cytokines that may be associated with Coeliac disease: http://www.ncbi.nlm.nih.gov/pubmed/18039391.

Research in South Korea (2010), found that Dracona Reina inhibited IL-8, along with other inflammatory cytokines that may be integral to the pathology in Coeliac disease: https://www.ncbi.nlm.nih.gov/pubmed/19577610.

Research in Shanghai (2010), found that Qing Yi Hua Ji, containing bai hua she she cao, ban zhi lian, mo yu, jiao gu lan and bail dou kou, significantly lowered serum levels of IL-8 and other inflammatory cytokines associated with Coeliac disease pathogenesis: https://www.ncbi.nlm.nih.gov/pubmed/20619142.

Testing for Coeliac Disease

Antibody tests for Coeliac disease show low sensitivity and low specificity, and so a combination of antibody tests including tTG IgA and DGP IgG which show the highest sensitivity are recommended. These tests may still provide a false negative result, and in this case a biopsy can be taken, or in Australia, gene testing is now covered by Medicare for Coeliac.

There are numerous applications to be made to receive free gene testing, however if a positive identification is made, free access to essential resources such as the Coeliac Society, and free screening of children is then offered.

Further research and discussion on Coeliac disease

Paul L. Reller (2016), compiled a review of research covering a wide range of issues related to Coeliac disease that both practitioners and patients might find helpful. Below is a summary of his review with useful links to the full papers.

A 2013 study at Sahlgrenska University Department of Clinical Nutrition, Goteborg, Sweden, found that Vitamin D deficiency and subsequent osteoporosis was highly associated with Intestinal Failure (IF), (temporary or permanent intestinal malabsorption and gastrointestinal dysfunction). In adults, the most prevalent causes of IF are Inflammatory Bowel disease, bacterial overgrowth, anti-thrombin or Vitamin K deficiency, surgical complications, cancer, and radiation enteritis. Common malabsorption nutritional deficiencies linked to these disorders include Vitamins B12, A, D, E, K, iron, selenium, zinc, and others: https://www.ncbi.nlm.nih.gov/pubmed/23481225.

A study in Finland (2014), showed that a significant percentage of patients diagnosed with Coeliac disease and put on a gluten-free diet for more than 6 months still had an imbalance in their Biome, with a predominance of Proteobacteria species and a deficiency of Bacteroidetes and Firmicute species, showing that persistent dysbiosis is a problem in Coeliac disease that may not be addressed by standard treatment protocol: https://www.ncbi.nlm.nih.gov/pubmed/25403367.

A review of the tests for Coeliac disease in Denmark (2013) revealed that, while a majority of patients show an inherited Major Histocompatability Complex (MHC) Human Leukocyte Antigen (HLA) type DQ2 or DQ8, that this does not explain the disease, and that more genetic loci of propensity to Coeliac disease are being discovered each year.

Coeliac disease is sometimes associated with liver dysfunction or autoimmune hepatitis: https://www.ncbi.nlm.nih.gov/pubmed/18496773. A review of Coeliac disease and gluten sensitivity in the US (2013) revealed glyphosate herbicides such as RoundUp, which inhibit the P450 enzyme pathway in the liver, strongly chelate important minerals causing mineral deficiencies while depleting important amino acids, such as tyrosine, tryptophan, methionine, and selenomethionine, which are linked to Coeliac disease.

The researchers also noted that a number of corporate farming methods increase the accumulation of glyphosate in the environment, and research suggesting that these chemicals break down quickly have been proven wrong, with enormous accumulation in the environment linked to gluten sensitivity, Coeliac disease, and a host of serious health problems: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945755.

In 2015, a review of non-Coeliac gluten sensitivity in the United Kingdom, and Italy noted that to date there were no diagnostic markers for this disorder and, hence, self-reporting was the standard for diagnosis, confirmed by the effects of dietary elimination and rechallenges: https://www.ncbi.nlm.nih.gov/pubmed/26147528.

In 2012, experts at Harvard Medical College, the Johannes Guttenberg University School of Medicine, and the University of Helsinki, outlined how proteins in wheat that are found to be much higher in concentration in newer hybrids, called amylase trypsin inhibitors (ATIs), evolved as an immune protection in the plant, may be responsible for reactivity to wheat and inflammatory reaction in the intestines. Reactions to larger concentrations of ATIs in gluten resulted in inflammatory imbalances similar to those seen with low-grade bacterial endotoxins and LPS, increasing TNF-alpha and a TH1/TH2 imbalance seen in many autoimmune disorders.

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CONSTIPATION

One of the most common observations of our team is the significant impact chronic constipation has on hormones, miscarriage, and a woman’s ability to conceive and go full term. Conversely, once constipation is resolved, we find hormone levels improve remarkably quickly.

Similarly, other health problems can be caused by chronic constipation, (haemorrhoids, piles, and anal fissures) and these conditions may impact all age groups. Our team have observed good anecdotal evidence to support the use of acupuncture and Chinese herbal medicine in the treatment of constipation in conjunction with a good diet. There are also some encouraging studies in Chinese medicine.

Recently, a large systematic review and meta-analysis of 15 clinical trials assessed the clinical evidence for the use of ear acupuncture for constipation. The review showed a moderate and significant effect of ear acupuncture on constipation in the treatment group compared to the controls or non treatment group (Yang et al., 2014). The review recommended that further research was warranted.

Diarrhoea and Ulcerative Colitis (UC)

Ulcerative colitis (UC) is a chronic condition causing pain and diarrhoea, and is due to inflammation and ulcers in the colon and rectum. Often there is blood in the stools and anaemia, as well as severe fatigue, low grade fevers, and weight loss. UC often develops slowly and symptoms can range from mild to severe, with periodic flare ups and worsening of the condition. Inflammation of the joints, eyes, and liver are also common in patients with UC. Similar to Crohn’s disease, UC is predominantly an inflammatory bowel disease and diagnosis is made by a colonoscopy.

Our team's anecdotal evidence suggests good response when treatment combines acupuncture and Chinese herbal medicine. However, most systematic reviews of acupuncture or Chinese herbal medicine agree that more rigorous studies aree needed because many of the past studies have been poorly designed (Schneider 2007; Lee 2009). However, there have been several promising studies on UC and inflammatory bowel disease where diarrhoea and pain are the main symptoms being addressed and CM treatment has provided significant benefit.

Mu (2007) and Lee (2009) found good results using acupuncture to treat UC. Patients with inflammatory bowel symptoms including pain and diarrhoea were randomly allocated to the electro-acupuncture group or the group receiving loperamide (immodium). Both loperamide and electro-acupuncture significantly reduced the mean score of the Bristol scale and increased the weekly average number of days with normal bowel movements. Researches suggested that a cost analysis of one treatment over the other should be conducted in light of the side-effects of long term loperamide use (Zheng et al 2016).

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NAUSEA AND VOMITING

One of the main areas that acupuncture has been used to reduce nausea and vomiting is chemo-therapy induced nausea and vomiting. While this is not the only application, it has been accepted for many years that acupuncture is an effective treatment for chemo-therapy induced nausea and vomiting. There is a significant body of evidence to support this claim (Gao et al., 2016).

Our team also treats pregnant women in the first trimester who experience vomiting and nausea, as well as pregnant women suffering vomiting and nausea beyond the first trimester. Our team's anecdotal evidence suggests particularly good results in second and third trimester relief of nausea and vomiting.

HAEMORRHOIDS

Painful haemorrhoids are often treated and relieved with acupuncture by our team and we have good anecdotal evidence to support the use of acupuncture for painful haemorrhoids during pregnancy, as well as at other times.

Several studies have shown promising pain relief as well as wound healing, anti itch, anti ulcer, anti-inflammatory, antimicrobial, and immune-modulation, after acupuncture and Chinese herbal medicine treatment, with some detailed research isolating the active chemicals responsible for herbal efficacy.

He and colleagues' (2016) review of research on the herb Bletilla strata used in Mongolia, Korea, Japan, and China showed resultant pharmacological activities which included: wound healing, anti-ulcer, cytotoxicity, antimicrobial, anti-inflammatory, anti-oxidation, anti-fibrosis, and anti-itch in the treatment of haemorrhoids.

Ma and colleagues (2016) conducted a phytochemical investigation of Houttuynia cordata, used for its heat-clearing, swelling, and pus removing effects, first recorded for the treatment of haemorrhoids by Shizhen Li. It was also shown to be hepato-protective.

Wang and Hua (2015) conducted research on 315 patients evaluating the use of a Chinese herbal medicine haemorrhoid lotion against standard therapy post haemorrhoid surgery pain scores. They found clinical and statistical difference in the pain score with significant benefit to the Chinese herbal treatment group, as well as faster wound healing and less blood in stools.

Earlier, He and colleagues (July 2016) reviewed the ethnopharmacological relevance of Sophia Japonica used for treating haemorrhoids in China, Japan, Korea, and Vietnam. The review also highlighted the phytochemistry, biological activities and toxicology of 6 decades of published work on this plant, showing 153 chemical compounds. Several flavonoids and iso-flavonoids comprise the active constituents that exhibit anti-inflammatory, antibacterial, antiviral, antiosteoporotic, antioxidant, radical scavenging, antihyperglycemic, antiobesity, antitumor, and hemostatic effects.

Sun and colleagues (2011) used electroacupuncture on acupuncture point BL 57. Greater clinical and statistical improvements were seen in pain and post operative haemorrhoid healing in the electroacupuncture group compared to the medicated group.

Earlier, Li and colleagues (2008) conducted the same research on 120 participants using acupuncture points BL 57 and GV 1. Results showed better outcomes for pain and healing rates in the electroacupuncture group compared to the medicated group that used a non steroid anti-inflammatory.

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MALABSORPTION AND POOR DIGESTION

(see Coeliac Disease above)

Differentiating malabsorption syndromes from true Coeliac disease is frequently difficult. The most common malabsorption issues besides Coeliac include lactose, vitamin B12 and folic acid, iron, and protein, especially dairy (lactose intolerance), Vitamins K, D, E,C, A, zinc, iodine, and selenium.

Importantly, there are still no biomarkers for non-Coeliac gluten sensitivity. A true test involves a 6 week avoidance of glutens, and then a number of challenges with gluten in the diet to record any potential symptoms. Causes of malabsorption are complex because many factors may be involved.

Our practitioners are trained to investigate all factors that may determine whether the complaint is malabsorption or food intolerance, or even a bit of both. There are different laboratories that may assist with diagnosis that we have used for many years. A diagnosis of unformed stools or diarrhoea in particular with undigested food in the stools classically suggests malabsorption in CM.

CM has a whole portfolio of diagnostic categories related to assessing malabsorption. One main cause is spleen qi vacuity. This is commonly seen in people who experience fatigue and exhaustion. Undigested food in the stool sample is a major indicator. The treatment principle is to use acupuncture and Chinese herbal medicine to strengthen the spleen qi to aid digestion.

Some known causes of malabsorption include the side-effects of certain medications that influence uptake of essential vitamins and minerals. These may include: the contraceptive pill impacting zinc and vitamin C levels, Metformin prescribed for polycystic ovarian syndrome (PCOS), and blood sugar regulation, may cause loose stools and diarrhoea leading to anaemia and many other vitamin deficiencies.

Prilosec and Nexium, that lower stomach acid, are linked to malabsorption of B12 and various other minerals. Heavy metals in the blood stream such as lead and mercury may block uptake of iron, magnesium, potassium, calcium, and zinc. When malabsorption is suspected one initial test that may be performed is the anti-gliadin antibody test. If it comes back negative this still does not exclude malabsorption, especially if the symptoms persist. For more information see Paul Reller's website: Malabsorption Syndromes and Celiac Disease.

REFERENCES

  1. Du Q, Gu X, Cai J, Huang M, Su M. Chrysin attenuates allergic airway inflammation by modulating the transcription factors T-bet and BATA-3 in mice. Mol Med Rep. 2012 Jul; 6(1): 100-4. doi: 10.3892/mmr. 2012.893.Epub 2012 Apr 26.
  2. Bensoussan, A et al 1998, “Treatment of Irritable Bowel Syndrome with Chinese Herbal Medicine - A Randomized Controlled Trial”. JAMA, 280(18): 1585-1589.
  3. Brown, L. Efficacy and mechanisms of action of traditional Chinese medicines for treating asthma and allergy. Sinai J Med 2011 Sep-Oct;7895): 697-716.doi: 10.1002/msi.20294.
  4. Dundee, JW et al 1988, “PC 6 acupressure reduces morning sickness”, Journal of the Royal Society of Medicine, 81(8): 456–457.
  5. Dundee, JW et al 1987, “Acupuncture to prevent cisplatin-associated vomiting”, Lancet, 1:1083.
  6. Dundee, JW et al 1986, “Traditional Chinese acupuncture: a potentially useful antiemetic?” British Medical Journal, 293:383–384. J Allergy Clin Immunol. 2009 Feb;123(2): 297-306; quiz 307-8. Treatment of asthma and food allergy with herbal interventions from traditional chinese medicine. Department of Paediatric allergy and immunology, Mt Sinai J of Med 2011 Sep-Oct; 78(5): 697-716.dol: 10.1002/msj.20294.
  7. Wang K, Wu H, Wang G, Li M, Zhang Z, Gu G. The effects of electroacupuncture on TH1/TH2 cytokine mRNA expression and mitogen-activated protein kinase signalling pathways in the splenic T cells of traumatised rats. Anesth Analg. 2009 Nov; 109(5): 1666-73.
  8. Yin WX, Yin KW. Antiemetic effects of Panax notoginseng on vomiting caused by brain concussion. Zhong Yi Za Zhi 1994;35:135.
  9. Zhang, et al. Food allergies and Chinese Medicine Xin Zhong Yi. #9 pp. 59-60. (2002).
  10. Zhang ZX. Analysis on 30 case of liver-based treatments for vomiting. Gan Su Zhong Yi 2006;19:30.
  11. Reller PL. Last Updated: June 15, (2016) Parasites and Parasitic diseases.
  12. Dickman R, Schiff E, Holland A, Wright C, Sarela SR, Han B, Fass R. Clinical trial:acupuncture vs. doubling the proton pump inhibitor dose in refractory hearburn. Aliment Pharmacol Ther. 2007 Nov 15; 26(10): 1333-44. Epub 2007 Sep 17.
  13. Kuehn BM. Reflux drugs linked to C. difficile-related diarrhoea. JAMA. 2012 Mar 14; 307(10):1014. doi: 10.1001/jama.2012.233.
  14. Bao CH, Zhao JM, Liu HR, Lu Y, Zhu YF, Shi Y, Weng ZJ, Feng H, Guan X, Li J, Chen WF, Wu LY, Jin XM, Dou CZ, Wu HG. Randomized controlled trial: moxibustion and acupuncture for the treatment of Crohn's disease. World J Gastroenterol. 2014 Aug 21;20(31): 11000-11.
  15. Shang HX, Wang AQ, Bao CH, Wu HG, Chen WF, Wu LY, Ji R, Zhao JM, Shi Y. Moxibustion combined with acupuncture increases tight junction protein expression in Crohns disease patients. World J Gastroenterol. 2015 Apr 28;21(16):4986-96. doi: 10.3748/wjg.v21.i16.4986.
  16. Bao CH, Wu LY, Shi Y, Wu HG, Liu HR, Zhang R, Yu LQ, Wang JH. Moxibustion down regulates colonic epithelial cell apoptosis and repairs tight junctions in rats with Crohn disease. World J Gastroenterol. 2011 Dec 7;17(45):4960-70. doi: 10.3748/wjg.v17.i45.4960.
  17. Li N, He HB, Wang CW, Yang CM. Observation on therapeutic effect of electroacupuncture at Chengshan (BL 57) and Changing (GV 1) on hemorrhoidal pain. Zhongguo Zhen Jiu. 2008 Nov; 28(11): 792-4.
  18. Sun PL, YanG W, Zhang LC. Effect of electroacupuncture at Chengshan (BL 57 on postoperative pain of mixed haemorrhoids. Zhongguo Zhen Jiu. 2011 May; 31(5): 413-5.
  19. Wang XM, Lu Y, Wu LY, Yu SG, Zhao BX, Hu HY, Wu HG, Bao CH, Liu HR, Wang JH, Yao Y, Hua XG, Guo HY, Shen LR. Moxibustion inhibits interleukin-12 and tumor necrosis factor alpha and modulates intestinal flora in rat with ulcerative colitis. World J Gastroenterol. 2012 Dec 14;18(46):6819-28.
  20. Zhao C, Bao C, Li J, Zhu Y, Wang S, Yang L, Shi Y, Liu H, Dou C, Ding G, Wang X, Wu H. Moxibustion and Acupuncture ameliorate Crohn disease by regulating the balance between Th17 and Treg cells in the intestinal mucosa Evid Based Complement Alternat Med. 2015; 2015:938054.
  21. Ji R, Wang A, Shang H, Chen L, Bao C, Wu L, Wu H, Shi Y. Herb-partitioned moxibustion upregulated the expression of colonic epithelial tight junction related proteins in Crohn disease model rats. Chin Med. 2016 Apr 26; 11:20.
  22. Bahraini H, Hamedi S, Salari R, Noras M. Herbal Medicines for the Management of Irritable Bowel Syndrome: A Systematic Review. Electron Physician. 2016 Aug; 8(8): 2719–2725. Published online 2016 Aug 25.
  23. Gao L, Chen B, Zhang Q, Zhao T, Li B, Sha T, Zou J, Guo Y, Pan X, Guo Y. Acupuncture with different acupoint combinations for chemotherapy-induced nausea and vomiting: study protocol for a randomised controlled trial. BMC Complement Altern Med. 2016 Nov 8; 16(1): 441.
  24. Yang LH1, Duan PB, Du SZ, Sun JF, Mei SJ, Wang XQ, Zhang YY. Efficacy of auriculotherapy for constipation in adults: a systematic review and meta- analysis of randomized controlled trials. J Altern Complement Med. 2014 Aug;20(8):590-605.
  25. Zheng H, Li Y, Zhang W, Zeng F, Zhou SY, Zheng HB, Zhu WZ et al,. Electroacupuncture for patients with diarrhoea predominant irritable bowel syndrome or functional diarrhoea: A randomised controlled trial.Medicine (Baltimore). 2016 Jun; 95(24):e3884.
  26. He X, Fang J, Wang X, Zhao Z, Chang Y, Guo H, Huang L. Bletilla striata: Medicinal uses phytochemistry and pharmacological activities. J Ethnopharmacol. 2016 Nov 16. pii: S0378-8741(16)31877-3.
  27. Ma Q, Wei R, Wang Z, Liu W, Sang Z, Li Y, Huang H. Bioactive alkaloids from the aerial parts of Houttuynia cordata. J Ethnopharmacol. 2016 Nov 11. pii: S0378-8741(16)31738-X.
  28. Wang YJ, Hua GH. Observation of curative effect of haemorrhoid lotion on pain, deem and bleeding after anorectal surgery. Zhongguo Zhong Yao Za Zhi. 2015 Nov; 40(22): 4497-500.
  29. He X, Bai Y, Zhao Z, Wang X, Fang J, Huang L, Zeng M, Zhang Q, Zhang Y, Zheng X. Local and traditional uses, phytochemistry, and pharmacology of Sophora japonica L: A review. J Ethnopharmacol. 2016 Jul 1; 187:160-82.
  30. Carabotti M, Scirocco A, Maselle MA, Severia C. The gut-brain axis:interactions between enteric macrobiotic, central and enteric nervous systems. Ann Gastroenterol. 2015 April-Jun; 28(2): 203-209.
  31. Collins SM, Surette M, Bercik P. The interplay between the intestinal microbiota and the brain. Nature Reviews Microbiology 10, 735-742 (November 2012).

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