Digestive Disorders

Digestive Disorders & Gastrointestinal Diseases

Irritable bowel syndrome (IBS), Gastrointestinal tract disorders, Type-2 diabetes, Gout, Obesity, Postoperative nausea and vomiting (PONV)

Irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS)

Irritable bowel syndrome (IBS) describes a collection of symptoms, commonly including chronic abdominal pain, bloating, flatulence and altered bowel habits. It is a functional disorder of the intestines, occurring in the absence of visible structural abnormality.

 

IBS affects up to 22% of people in the UK (Maxwell 1997) and is the most common functional digestive disorder seen by GPs. Women are 2-3 times more likely to develop IBS, and often suffer more symptoms during their periods. The condition often begins in adolescence or early adulthood. Predisposing factors may include a low-fibre diet, emotional stress, use of laxatives or a bout of infectious diarrhoea. It is typically a chronic, recurrent disorder, associated with substantial health, social and economic costs. Pain and impairment from IBS can lead to frequent doctor visits, hospitalizations and workplace absenteeism, and can cause depression.

 

The cause of IBS is unclear, but it appears that sensory nerves in the bowel are hypersensitive in people with IBS and may overreact when the bowel wall stretches. Intestinal muscles can be hypo- or hyperactive, causing pain, cramping, flatulence, sudden bouts of diarrhea, and/or constipation. The symptoms are usually triggered by stress or eating. Systematic reviews of the research literature suggest that conventional medications are of limited benefit in IBS (Akehurst 2001).

 

References

Akehurst R, Kaltenthaler E. Treatment of irritable bowel syndrome: a review of randomised controlled trials. Gut. 2001 Feb;48(2):272-82.

Maxwell PR et al. Irritable bowel syndrome. Lancet. 1997 Dec 6;350(9092):1691-5.

How acupuncture can help

Research has shown that acupuncture treatment may benefit IBS symptoms by:

  • Providing pain relief (Pomeranz 1987).
  • Regulating the motility of the digestive tract (Yin 2010, Chen 2008).
  • Raising the sensory threshold of the gut. Various possible mechanisms have been identified, involving spinal nerves and NMDA receptors and a range of neurotransmitters (Xu 2009, Ma 2009, Tian 2008, Tian 2006, Xing 2004). A lowered threshold to bowel pain and distention are hallmarks of IBS.
  • Increasing parasympathetic tone (Schneider 2007b). Stress activates the sympathetic nervous system, which can stimulate colon spasms, resulting in abdominal discomfort. In people with IBS, the colon can be oversensitive to the smallest amount of conflict or stress. Acupuncture activates the opposing parasympathetic nervous system, which initiates the relaxation or ‘rest and digest’ response.
  • Reducing anxiety and depression (Samuels 2008). The distress provoked by IBS symptoms can lead to a vicious cycle of anxiety-pain-anxiety, while the embarrassing nature of the condition can lead to feelings of depression. Acupuncture can alter the brain’s mood chemistry, increases production of serotonin and endorphins (Han 2004), helping to combat these negative affective states.

There is consistent evidence that a course of acupuncture improves IBS symptoms and general wellbeing (Anastasi 2009, Trujillo 2008, Reynolds 2008, Schneider 2007b, Xing 2004, Lu 2000), though there are arguments about the extent to which the effect is placebo-related (Lembo 2009, Schneider 2007a, Lim 2006, Forbes 2005). As yet there is no satisfactory placebo/sham intervention for acupuncture so this is still a matter for conjecture. There are plausible physiological explanations for acupuncture’s effects (see above) and it can promote mechanisms not seen with sham treatments (Schneider 2007b).

 

Acupuncture can be safely and effectively combined with Western biomedicine, and other treatments such as relaxation exercises, herbal medicine and psychotherapy. In addition to offering acupuncture and related therapies, acupuncturists will often make suggestions as to dietary and other lifestyle changes that may be helpful in combating IBS symptoms. Working with a supportive therapist can also help people suffering from IBS to change their negative health beliefs and improve their coping mechanisms, which can have a positive influence on both mood and symptoms.

 

Full details of research studies into traditional acupuncture treatment for IBS can be found overleaf.

Gastrointestinal tract disorders

Gastrointestinal tract disorders

Around 2-4 in 1,000 people in Northern Europe have ulcerative colitis or Crohn’s disease (Rubin 2000). Both are chronic, relapsing, inflammatory disorders of the gastrointestinal tract with several shared clinical features, but with largely distinct risk factors, genetic, immunological, anatomical and histological features, and response to therapy (DTB 2003). Their treatment, which includes medical and surgical approaches, is usually considered in two phases: the induction of remission in an acute attack, and the long-term maintenance of remission (DTB 2003).

Gastritis is an inflammation, irritation, or erosion of the lining of the stomach, which can be acute or chronic. Causes include irritation due to excessive alcohol use, chronic vomiting, stress, or the use of certain drugs (e.g. NSAIDs), Helicobacter pylori infection and pernicious anaemia. Symptoms of gastritis vary among individuals, and many have no symptoms. However, the most common symptoms include nausea, vomiting (possibly with blood), abdominal pain and bloating, indigestion, loss of appetite, and blood in the stools. Treatment usually involves drug therapy.

Gastro-oesophageal reflux is a common (affecting up to 25% of adults) relapsing condition caused by repeated exposure of the lower oesophagus to refluxed gastric contents (Moayyedi 2007). It presents in various ways: some patients just have symptoms, some have endoscopic evidence of mucosal damage (oesophagitis), with or without symptoms, and an important minority have complications such as bleeding, stricture or columnar epithelial (Barrett’s) transformation of the lower oesophageal mucosa which predisposes to adenocarcinoma. Conventional treatment options include drugs and surgery.

About 20% of people in the UK have functional gastrointestinal disorders such as functional dyspepsia and irritable bowel syndrome (Jones 1990; Jones 1992). The latter condition is the subject of another professional information backgrounder, and will not be discussed further here. Functional gastrointestinal disorders are characterised by persisting gastrointestinal symptoms (e.g. pain, bloating) in the absence of any identifiable underlying structural or biochemical explanation (Drossman 2000). They are conventionally treated with drugs or with psychological treatments such as cognitive behavioural therapy, brief psychotherapy and gut-directed hypnotherapy (DTB 2005).

References

Drossman DA (Ed). Diagnostic Criteria for the Functional Gastrointestinal Disorders. Second edition. Kansas: Degnon Associates, 2000: 659-69.

Hypnotherapy for functional gastrointestinal disorders. DTB 2005; 43: 45-8.

Inducing remission in inflammatory bowel disease. DTB 2003; 41: 30-2.

Jones RH et al. Dyspepsia in England and Scotland. Gut 1990; 31: 401-5.

Jones R, Lydeard S. Irritable bowel syndrome in the general population. BMJ 1992; 304: 87-90.

Moayyedi P, Delaney B. GORD in adults. Clinical Evidence. Search date July 2007.

Rubin GP et al. Inflammatory bowel disease: epidemiology and management in an English general practice population. Aliment Pharmacol Ther 2000; 14: 1553-9.

Type-2 diabetes

Type-2 diabetes

Type-2 diabetes (adult-onset or non-insulin-dependent diabetes) is a common metabolic disorder in which the body is unable to regulate the amount of glucose in the blood. The condition affects nearly 1.5 million people in the UK (Diabetes UK, 2004), and may be undiagnosed in as many as a million more. It develops when insufficient insulin is produced by the body, or when the body’s cells no longer respond to insulin (insulin resistance).

 

The four common symptoms of type-2 diabetes are: excessive thirst, passing large amounts of urine, tiredness and weight loss. Over time, the high blood sugar levels caused by type-2 diabetes causes damage to blood vessels. This leads to atheroma, which can cause problems such as poor circulation, angina, heart attacks and stroke. It can result in diabetic complications, including eye disorders, nerve damage, foot problems, kidney disease and impotence.

 

The cause of type-2 diabetes is complex, involving an interplay of genes and environmental factors. It tends to occur in people over 40 and is strongly associated with being overweight. Weight loss (plus increased physical activity) is more effective than drug therapy for preventing or delaying the development of type-2 diabetes (Knowler 2002). Stress hormones such as cortisol cause blood glucose to rise and promote insulin resistance (Purnell 2009). Stress may play a role in the development of the metabolic syndrome (Rosmond 2005), which often precedes diabetes, as well as increasing the risk of developing type-2 diabetes itself (Eriksson et al, 2008), and that it can increase the severity of the condition (Oltmans 2006). Depression may contribute to developing the condition (Carnethon 2007).

References

Carnethon MR et al. Longitudinal association between depressive symptoms and incident type 2 diabetes mellitus in older adults: the cardiovascular health study. Arch Intern Med. 2007 Apr 23;167(8):802-7.

Diabetes UK. Diabetes in the UK 2004. www.diabetes.org.uk/Documents/Reports/in_the_UK_2004.doc

Eriksson AK et al. Psychological distress and risk of pre-diabetes and Type 2 diabetes in a prospective study of Swedish middle-aged men and women. Diabet Med. 2008 Jul;25(7):834-42.

Knowler WC et al. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7;346(6):393-403.

Oltmanns KM et al. Cortisol correlates with metabolic disturbances in a population study of type 2 diabetic patients. Eur J Endocrinol. 2006 Feb;154(2):325-31.

Purnell JQ et al. Enhanced cortisol production rates, free cortisol, and 11beta-HSD-1 expression correlate with visceral fat and insulin resistance in men: effect of weight loss. Am J Physiol Endocrinol Metab. 2009 Feb;296(2):E351-7.

Rosmond R. Role of stress in the pathogenesis of the metabolic syndrome. Psychoneuroendocrinology. 2005 Jan;30(1):1-10.

How acupuncture can help

Chinese medical texts have recognized diabetes as ‘wasting-thirsting’ for thousands of years, relating it to the consumption of too much rich food. Acupuncture therapy is a common approach to treating diabetes in modern China. However, research is scarce and randomized controlled trials almost non-existent. Most clinical studies have focused on peripheral neuropathy, where there is preliminary evidence for an effect (Jiang 2006; Abuaisha 1998). It may help to treat obesity (Cho 2009), which is the primary risk factor for developing type-2 diabetes, and also depression (see BAcC Fact Sheet ‘Acupuncture and Depression’).

 

Studies on physiological mechanisms, both with humans and laboratory animals, indicate that acupuncture may:

  • regulate insulin production (Lin et al, 2004) and blood sugar levels (Lin 2004; Chang 2006; CabioÄŸlu 2006; Jiang 2006)
  • improve the blood lipid profile (CabioÄŸlu 2005; Jiang 2006) (dyslipidaemia is common in patients with type-2 diabetes and may lead to cardiovascular morbidity and mortality).
  • improve blood circulation (Tsuchiya 2007), thus helping to slow the onset and progression of diabetic circulatory complications
  • moderate the stress response (Sakai 2007)

Most people use acupuncture as part of an integrated diabetes treatment plan because they are already using Western medication. Acupuncture can be safely and effectively combined with Western biomedicine and other treatments such as relaxation exercises and herbal medicine. In addition to offering acupuncture and related therapies, acupuncturists will often make suggestions as to dietary and other lifestyle changes that may be beneficial. Eating a healthy balanced diet, taking regular physical exercise, reducing stress and maintaining a healthy body weight can help to prevent or delay the onset of type-2 diabetes and slow the progression of the disease. Working with a supportive therapist can help people commit to these positive lifestyle changes.

 

Full details of research studies into traditional acupuncture treatment for diabetes can be found overleaf.


Gout

Gout

Acute gout is an intensely painful condition, and can reduce patients’ quality of life.(Annemans 2008; Jordan 2007) Around 1.4% of the UK population have gout, the prevalence of which increases with age to around 3% in women and 7% in men aged over 75 years.(Mikuls 2005; Annemans 2008; Jordan 2007) It occurs when serum uric acid concentration rises (hyperuricaemia) and stays above the solubility threshold of monosodium urate, leading to urate crystal formation that causes arthritis, gouty tophi (nodules) in subcutaneous tissues and renal calculi.(Jordan 2007; Roddy 2007; Fels 2008)

Hyperuricaemia may occur if urate is over-produced (e.g. due to excessive dietary purine intake, or during cancer treatments), or, more commonly, if it is under-excreted (e.g. due to renal impairment).(Jordan 2007) Chronic hyperuricaemia is the most important risk factor for the development of gout; others include male gender; obesity; hypertension; renal impairment; consumption of alcohol, red meat, shellfish, fructose-sweetened soft drinks; and the use of loop and thiazide diuretics.(Jordan 2007) The mainstay of treatment for chronic gout is long-term drug treatment with allopurinol or adenuric to prevent attacks, and NSAIDs during an acute attack to reduce inflammation and alleviate pain.

References

Annemans L et al. Gout in the UK and Germany: prevalence, comorbidities and management in general practice 2000–2005. Ann Rheum Dis 2008; 67: 960–6.

Fels E, Sundy JS. Refractory gout: what is it and what to do about it? Curr Opin Rheumatol 2008; 20: 198–202.

Jordan KM et al. British Society for Rheumatology and British Health Professionals in Rheumatology guideline for the management of gout. Rheumatology (Oxford) 2007; 46: 1372–4.

Mikuls TR et al. Gout epidemiology: results from the UK General Practice Research Database, 1990–1999. Ann Rheum Dis 2005; 64: 267–72.

Roddy E et al. Is gout associated with reduced quality of life? A case-control study. Rheumatology (Oxford) 2007; 46: 1441–4.
How acupuncture can help

This Factsheet focuses on the evidence for acupuncture in the treatment of gout.

Overall, very little research has been published on the effects of acupuncture in patients with gout. There are no systematic reviews looking at acupuncture for gout, but there are a few randomised controlled trials. These have found: acupuncture combined with infrared irradiation is more effective in acute gouty arthritis than indomethacin, and provides a significant analgesic effect, while not reducing liver function (Zhou 2011); surround needling therapy is more effective and safer than allopurinol for the treatment of acute gouty arthritis (Xie 2009); electroacupuncture combined with local blocking (Liu 2008) or point-injection (Zou 2007) is an effective method for treating acute gouty arthritis, and can decrease blood uric acid levels; electroacupuncture has a better treatment effect than either allopurinol or probenecid, and there are no harmful effects on renal function in the treatment of patients with gout and renal insufficiency (Xie 2007); electroacupuncture is an effective treatment for acute gouty arthritis, and low frequency (2 Hz) electroacupuncture is more effective than higher frequencies (Zou 2006); and, acupuncture may exert good therapeutic effects on early gout complicated with renal damage (Ma 2004). Thus the evidence so far indicates acupuncture to be more effective than medication and without serious side effects. However, all of the trials are from one country (China) and, with no systematic reviews, the quality of the research has not been closely scrutinised.

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules. The resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress (Hui 2010) It has also be shown to reduce inflammation, by promoting release of vascular and immunomodulatory factors.(Zijlstra 2003; Kavoussi 2007)

Research has shown that acupuncture treatment may help relieve pain and prevent acute attacks of gout by:

Reducing the production of uric acid and promoting its excretion (Xie 2007);
Restoring the various metabolic pathways that are disturbed in individuals with gout.(Wen 2011);
Reducing inflammation, by promoting release of vascular and immunomodulatory factors (Zijlstra 2003; Kavoussi 2007);
Increasing local microcirculation (Komori 2009);
Acting on areas of the brain known to reduce sensitivity to pain and stress, as well as promoting relaxation and deactivating the ‘analytical’ brain, which is responsible for anxiety and worry (Hui 2010; Hui 2009);
Increasing the release of adenosine, which has antinociceptive properties (Goldman 2010).

Obesity

Obesity

Around 60% of adults in England are either overweight or obese (DOH 2011), and 2% are morbidly obese (Body Mass Index (BMI) above 40kg/m2) (Information Centre 2008). In fact, if present trends continue, 60% of all men, 50% of all women, and 25% of all children will be obese by 2050.

Being obese is associated with morbidity (e.g. type 2 diabetes mellitus, certain cancers, cardiovascular and musculoskeletal diseases) and premature death (Maggard 2005; Reeves 2007; Flegal 2007; Renehan 2008). Weight loss can reduce such problems and improve quality of life.

Treatment options include dietary, lifestyle and drug interventions (orlistat) and bariatric surgery (DTB 2007).The National Institute for Health and Clinical Excellence (NICE) advises that lifestyle changes should form the mainstay of management in obesity and that drug treatment should be considered only after lifestyle changes, including behavioural approaches, have been started (NICE 2006).

References

Department of Health 2011 . Healthy lives, healthy people (online) Available www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_130401.

Flegal KM et al. Cause-specific excess deaths associated with underweight, overweight, and obesity. JAMA 2007; 298: 2028–37.

Less weight or more hype with rimonabant? DTB 2007; 45: 41–3.

Maggard MA et al. Meta-analysis: surgical treatment of obesity. Ann Intern Med 2005; 142: 547–59.

National Institute for Health and Clinical Excellence, 2006. Obesity: guidance on the prevention, identification, assessment and management of overweight and obesity in adults and children [online]. Available: http://www.nice.org.uk/nicemedia/pdf/CG43NICEGuideline.pdf

 

Reeves GK et al. Cancer incidence and mortality in relation to body mass index in the Million Women Study: cohort study. BMJ 2007; 335: doi:10.1136/bmj.39367.495995.AE.

Renehan AG et al. Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies. Lancet 2008; 371: 569–78.

The Information Centre, 2008. Health Survey for England 2006: latest trends [online]. Available: http://www.ic.nhs.uk/webfiles/publications/HSE06/Health%20Survey%20for%20England%202006%20Latest%20Trends.pdf

Postoperative nausea and vomiting (PONV)

Postoperative nausea and vomiting (PONV)

Many patients undergoing chemotherapy experience nausea and vomiting (Gralla 1999; Hesketh 1998). The symptoms can be severe, impairing a patient’s quality of life (Osoba 1997), causing emotional distress (Love 1989), and aggravating cancer-related symptoms such as cachexia, lethargy and weakness (Griffin 1996; Roscoe 2000).

Postoperative nausea and vomiting (PONV) are common complaints after general, regional, or local anaesthesia (Watcha 1992). These symptoms can occur in up to 80% of people given an anaesthetic (Sadhasivam 1999).

 

Nausea and vomiting are commonly experienced by women in early pregnancy; the prevalence rates are 50-80% for nausea, and 50% for vomiting and retching (Miller 2002; Woolhouse 2006). The symptoms are most common in the first trimester, between 6 and 12 weeks, but can continue to 20 weeks and last longer than this in up to 20% of women (Jewell 2003; Miller 2002). If vomiting is intractable, it can be associated with weight loss, dehydration and electrolyte imbalances, and may lead to hospitalisation (Miller 2002). The symptoms are thought to be associated with rising levels of human chorionic gonadotrophin (hCG) or oestrogens (Goodwin 2002). Women experiencing nausea and vomiting during pregnancy can suffer considerable physical and psychological effects (Attard 2002; Chou 2003; Chou 2008). The symptoms can affect daily activities and relationships, and result in lost productivity and increased healthcare costs (Attard 2002; Piwko 2007).

 

Drug treatment for nausea and vomiting includes 5-HT3 receptor antagonists, antimuscarinics, antihistamines, dopamine antagonists, corticosteroids and vitamins (i.e. B6 and B12). The teratogenic effects of drugs (such as thalidomide) used in the past to control these symptoms have led to caution about prescribing medications in the first trimester of pregnancy.

 

References

Attard CL et al. The burden of illness of severe nausea and vomiting of pregnancy in the United States. American Journal of Obstetrics and Gynecology 2002; 186: S220-S227.

Chou FH et al. Psychosocial factors related to nausea, vomiting, and fatigue in early pregnancy. Journal of Nursing Scholarship 2003; 35: 119-25.

Chou FH et al. Relationships between nausea and vomiting, perceived stress, social support, pregnancy planning, and psychosocial adaptation in a sample of mothers: a questionnaire survey. International Journal of Nursing Studies 2008; 45: 1185-91.

Goodwin TM. Nausea and vomiting of pregnancy: an obstetric syndrome. American Journal of Obstetrics and Gynecology 2002; 186: S184-S189.

Gralla R et al. Recommendations for the use of antiemetics: Evidence-based, clinical practice guidelines. Journal of Clinical Oncology 1999; 17: 2971-94.

Griffin A et al. On the receiving end: V Patient perceptions of the side effects of chemotherapy in 1993. Annals of Oncology 1996; 7: 189-95.

Hesketh P et al. Methodology of antiemetic trials: response assessment, evaluation of new agents and definition of chemotherapy emotogenecity. Supportive Care Cancer 1998; 6: 221-7.

Jewell D. Nausea and vomiting in early pregnancy. American Family Physician 2003; 68: 143-4.

Love R et al. Side effects and emotional distress during cancer chemotherapy. Cancer 1989; 63: 604-12.

Miller F. Nausea and vomiting in pregnancy: the problem of perception–is it really a disease? American Journal of Obstetrics and Gynecology 2002; 186: S182-S183.

Osoba D et al. Effect of postchemotherapy nausea and vomiting on health-related quality of life. The Quality of Life and Symptom Control Committees of the National Cancer Institute of Canada Clinical Trials Group. Supportive Care Cancer 1997; 5: 307-13

Piwko C et al. The weekly cost of nausea and vomiting of pregnancy for women calling the Toronto Motherisk Program. Current Medical Research and Opinion 2007; 23: 833-40.

Roscoe J et al. Nausea and vomiting remain a significant clinical problem: trends over time in controlling chemotherapy-induced nausea and vomiting in 1413 patients treated in community clinical practices. Journal of Pain and Symptom Management 2000; 20: 113-21.

Sadhasivam S et al. The safety and efficacy of prophylactic ondansetron in patients undergoing modified radical mastectomy. Anesthesia and Analgesia 1999; 89: 1340-5.

Watcha MF, White PF. Postoperative nausea and vomiting: its etiology, treatment and prevention. Anesthesiology 1992; 77: 162-84.

Woolhouse M. Complementary medicine for pregnancy complications. Australian Family Physician 2007; 35: 695.

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How acupuncture can help

The best evidence for acupuncture’s effectiveness is with postoperative nausea and vomiting (PONV) (Ezzo 2006a). The latest systematic review, based on 40 trials and nearly 5,000 patients, found acupuncture to be significantly better than sham treatment and at least as good as anti-emetic drugs, with minimal side-effects (Lee 2009). Trials published since this review gathered its data have also been consistently positive: acupressure at P6 (Soltani 2010), acupoint injection of droperidol at P6 (Zhu 2010), 24-hour acupoint stimulation (Frey 2009), acupuncture at several points (Ayoglu 2009), acupuncture at P6 (Puyang 2009, Frey 2009) and ear acupuncture (Sahmaddini 2008). There is one less consistently favourable review but that looked specifically at caesarean delivery under neuraxial anaesthesia (6 trials only): (Allen 2008).

 

For chemotherapy-induced nausea and vomiting, there is also substantial evidence supporting acupuncture and associated procedures, although it is not as consistent as that for PONV. The latest systematic review (Ezzo 2006b) is now several years old. It found that electro- (but not manual) acupuncture reduced the incidence of acute vomiting and self-administered acupressure appears to have a protective effect for acute nausea and can readily be taught to patients. Subsequent individual trials of acupuncture or electroacupuncture (Yang 2009; You 2009; Sima 2009; Gottschling 2008) have all reported significant benefits, while those for acupressure applied using a wristband have been mixed (Jones 2008; Molassiotis 2007; Shin 2006).

 

For nausea and vomiting in pregnancy, the results have been less convincing, with a mix of positive and equivocal results according to Ezzo et al’s (2006a) systematic review and in subsequent trials (Aghadam 2010; Shin 2007; Heazell 2006). A review covering various treatments, including acupuncture, ginger, vitamin B and medications, concluded that there is a lack of high-quality evidence to support advice on any of them (Matthews 2010).

 

Acupuncture, electroacupuncture or acupressure have been used successfully as treatments for nausea and vomiting arising in various other circumstances, for example opioid-induced (Zheng 2008), radiotherapy-induced (Roscoe 2009; Bridge 2003), and post-myocardial infarction.(Dent 2003).

 

It is characteristic of virtually all the Western trials of acupuncture for nausea and vomiting that they have used just the one point, P6. While this point is certainly strongly indicated for these symptoms, and appears to have a marked specific effect, it is by no means the only candidate; in traditional practice a mixture of different points would usually be employed, related to individual patient characteristics.

 

See Table overleaf for further details of the cited studies.

 

In general, acupuncture is believed to stimulate the nervous system and cause the release of neurochemical messenger molecules (Han 2004; Zhou 2008; Lee 2009). The resulting biochemical changes influence the body’s homeostatic mechanisms, thus promoting physical and emotional well-being (Pomeranz, 1987; Zhao 2008; Samuels 2008; Cheng 2009).. Stimulation of certain acupuncture points has been shown to affect areas of the brain that are known to reduce sensitivity to pain and stress, as well as promoting relaxation (Hui 2010).

 

Acupuncture may help to alleviate nausea and vomiting by:

  • regulating gastric myo-electrical activity (Streitberger 2006)
  • modulating the actions of the vagal nerve and autonomic nervous system (Huang2005)
  • reducing vasopressin-induced nausea and vomiting and suppressing retrograde peristaltic contractions (Tatewaki 2005)
  • regulating vestibular activities in the cerebellum (Streitberger 2006)

J Tradit Chin Med. 2008 Mar;28(1):15-7.
Forty cases of gastrointestinal neurosis treated by acupunture.
Zhao Y1, Ding M, Wang Y.

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