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Acupuncture Management Of Celiac Disease
John L. Stump, DC
ABSTRACT
Background Acupuncture has been shown to be a useful adjunctive technique to treat the pain, abdominal bloating, and other symptoms associated with celiac disease.
Objective To demonstrate the usefulness of acupuncture as an adjunct therapy for diagnosing celiac disease and attenuating and/or eliminating the symptoms.
Design, Setting, and Patient A patient with celiac disease referred by a gastroenterologist was examined to establish an acupuncture diagnosis.
Intervention The patient was needled at 6 bilateral points throughout the treatment schedule 3 times weekly: LI 4, LI 11, LI 20, KI 27, ST 25, and ST 36. In addition, the master point SP 6 was needled bilaterally at each treatment session. The needles were retained for 15-20 minutes each session.
Main Outcome Measures Reduction and control of associated pain and discomfort of celiac disease as reported by the patient on the McGill Pain Questionnaire scale and as determined by acupuncture diagnosis.
Results Initially, the patient rated her pain as a 10 on the McGill scale. She reported a decrease in abdominal pain during the first 3 treatment sessions; her pain was reduced by another 50% after the next 3 sessions. The patient's remaining pain disappeared after the next 4 acupuncture sessions.
Conclusions Acupuncture may be a useful clinical therapeutic method for attenuating or eliminating pain and other symptoms of celiac disease.
KEY WORDS
Acupuncture, Ryodoraku, Pain, Abdominal Bloating, Nausea, Celiac Disease
INTRODUCTION
eliac disease, also known as celiac sprue and non-tropical sprue, is often difficult to diagnose.1 Symptoms can include diarrhea; foul, oily stools; bloating; excessive flatulence; unexplained weight loss; profound fatigue; nausea; vomiting; and abdominal pain. Celiac factors may resemble those of other conditions such as stomach ulcers and irritable bowel syndrome. Thus, the condition is frequently misdiagnosed (Table 1).2
Reactions to gluten may often be misdiagnosed as a simple allergy, fructose intolerance, flatulence problems, or irritable bowel syndrome. Patients may inherit susceptibility to celiac disease;3 those who have immediate family members with the condition have a 10% chance of contracting celiac disease.4 When celiac disease is untreated, fatty acids are eliminated from the body without absorption of vitamins and minerals. For these patients, eating a balanced diet is essential.5,6 The key clinical features of celiac disease in children and adults are listed in Table 2.
In celiac disease, the pulses (Cun, Guan, and Chi) may have a fine, taut, and rapid sensation indicating an involvement of the organs (small intestine, large intestine, etc). The tongue may have a thick, white, greasy coating across the root portion indicating an interior, cold, excess condition. The eyes may have lesions in the colon area of the iris. The auricular points of the colon are usually tender and may show lesion identification areas on the ear.7
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Symptoms or Manifestations
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Factors
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Flatulence
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Carbohydrates, malabsorbed food enters intestines and sugars are broken down into gas
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Diarrhea
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Food and water are not absorbed by the intestines
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Anemia
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Iron-deficiency anemia; iron is not absorbed into the small intestine
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Folic acid deficiency
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Folic acid is not absorbed into the small intestine
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Children
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Adults
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Poor growth
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Diarrhea
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Diarrhea
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Anemia
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Irritability
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Weight loss
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Delayed dentition
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Hypoproteinemia
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Muscle wasting
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Nutritional deficiencies
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Protuberant abdomen
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Bone pain
Tetany
Night blindness
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Ryodoraku examination is also part of the diagnosing process. While trying to measure general skin resistance for an edematous patient with nephritis, Nakatani8 found a line that had a series of points in which electroconductivity was higher than the surrounding areas (some Oriental medicine historians say this phenomenon was similar to the Kidney meridian). He then examined a number of visceral disorders in a similar manner and recognized that this phenomenon held true in all classical meridian lines. The line was then named "Ryodoraku," which was derived as follows: ryo denotes good; do means [electro] conductive; and raku connotes line. Nakatani went on to develop the whole system of diagnosis and treatment which he thought was more objective for analysis than the method used in the classical system.8
Acupuncture has been used as a clinical technique for controlling pain, abdominal bloating, and other symptoms associated with celiac disease. Acupuncture may offer immediate relief of acute or chronic pain. The author has used this technique for treating more than 25 cases of celiac disease in the past 15 years. This case demonstrates the typical procedure.
Case Report
After referral from a gastroenterologist, a 45-year-old woman presented with abdominal pain, distention, and nausea, despite adherence to a gluten-free diet9-11 without considerable deviation for the past 5 years. The patient reported good health over the last 5 years except for celiac disease. Weight and blood pressure had been in the normal range and stable for the prior 3 years; appetite was excellent until 1 year before; caloric intake was appropriate for her weight and physical activity.
The patient's bowel habits were unremarkable. She was well nourished and vital signs were normal (5'3", 129 lb, blood pressure of 128/82 mm Hg). The results of screening blood chemistry studies were normal, including a total protein concentration of 7.6 g/dL and an albumin level of 4.5 g/dL. There were no abnormal physical findings with the exception of her jejunal biopsy, which revealed a flat mucosa, as was the case in a biopsy 2 years earlier.
METHODS
Acupuncture Examination
After the initial standard physical examination and review of the patient's previous records from the referring gastroenterologist and hospital, an acupuncture examination was performed which included pulse, tongue, eye, and ear observations along with a Ryodoraku evaluation.13 Analysis showed a deficiency of energy and malfunction according to the Ryodoraku evaluation of the small intestine, large intestine, and stomach. The tongue had a heavy white coating.
The patient was given a diet questionnaire to record all food and drink consumed daily for a 1-week period to ensure that she had not inadvertently been eating any foods that might cause a problem.
Acupuncture Treatment
The acupuncture points selected were based on a combination of the pulse findings of slow, thin, and forcelessness at the Guan and Chi locations.14 The Ryodoraku instrument examination showed deficiencies in the Small Intestine and Large Intestine meridians, and minor involvement of the Stomach meridian.15
The patient consented to acupuncture treatment and was treated with an acupuncture schedule of 3 treatments per week to alleviate the abdominal pain. Sterile disposable needles (Seirin J type, 3 gauge, 30 mm; Seirin Corp, Tokyo, Japan) with tube inserters (OMS Medical Supplies, Braintree, Mass) were used. The needles were inserted into the skin to approximately 5 mm; needle manipulation was a light, reducing method for 3-5 seconds, and was retained for 15 minutes; the arrival or detection of De Qi was not required.
The patient was needled at 6 bilateral points throughout the treatment schedule: LI 4, LI 11, LI 20, KI 27, ST 25, and ST 36. In addition, the master point SP 6 was treated bilaterally at each treatment session. The needles were retained for 15 minutes from the time the last needle was inserted until the 1st needle was removed. Before each treatment, the patient was asked to rate her pain according to a 10-point scale adapted from the McGill Pain Questionnaire.12
Bloating of the abdominal area around the patient's sigmoid colon reduced immediately after the 1st week of treatment; however, the ileocecal valve had to be evaluated with applied kinesiology opening techniques.16
The patient was treated to balance the deficiencies initially found by pulse and Ryodoraku examination (i.e., as noted above, the Small Intestine, Large Intestine, and Stomach meridians). Ryodoraku evaluation follow-up at the 2nd week noted an approximate 30% improvement in the treated Small Intestine, Large Intestine, and Stomach meridians.
The patient was again given a diet questionnaire to record all food and drink ingested daily for 1 week to verify any discrepancies.
The following points were used for the next 4 office visits: KI 27 (Shufu), ST 25 (Tianshu), LI 4 (Hegu), LI 6 (Pianli), and ST 36 (Zusanle) bilaterally. The Zang/Fu influential point, Ren 12 (Zhongwan), was used singularly. A total of 12 treatments was administered.
Follow-up was scheduled monthly for 3 months; maintenance examinations were conducted quarterly.
RESULTS
Initially, the patient rated her pain as a 10 on the McGill scale. Acupuncture points were clinically selected based on the pulses, tongue, and findings of the Ryodoraku instrument.15 The positive results of the 1st treatments were manifested in the Ryodoraku evaluations and in the patient's manner by the 2nd week, i.e., she became more cheerful and openly discussed her progress. She reported that she slept through the night after the 5th or 6th treatment, and after the 8th treatment, was able to consume her normal gluten-free diet without pain with reduced bloating.
This patient noted a decrease in abdominal pain during the first 3 treatments (1st week). After the next 3 treatments (2nd week), her pain was reduced by another 50%, as noted on the pre- and post-pain scale questionnaire given to her at the beginning of each acupuncture session.
The patient's remaining pain disappeared after the next 4 acupuncture sessions (next 10 days). She had a total of 12 acupuncture sessions before her pulse and Ryodoraku examination showed no deficiencies of the initially involved meridians of the Large Intestine, Small Intestine, and Stomach. Her tongue returned to a normal pink color within 1 month.
DISCUSSION
Acupuncture was the only treatment intervention and change in this patient's routine and schedule; therefore, as with other cases the author has treated over the years, this outcome suggests that acupuncture reduced this patient's pain, abdominal bloating, nausea, and edema of her abdominal area.
An increased understanding of diagnosis and acupuncture treatment of patients with celiac disease may help lead to a reduction in the incidence of delayed treatment for pain involved in such cases. Celiac disease can be devastating and fatal if left untreated.6 The vast majority of cases are diagnosed and treated successfully during childhood or early adulthood. Celiac disease can usually be treated effectively with satisfactory outcomes. However, some cases are non-responsive despite all conventional medical efforts to treat the problem with gluten-free diets and medications.
CONCLUSION
Acupuncture treatment and the Ryodoraku system were valuable techniques in the treatment of this patient with celiac disease. The case reported herein used a traditional acupuncture approach; results demonstrated significant changes in the patient's condition after the 1st week.
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- .Oleson T. International Handbook of Ear Reflex Points. Los Angeles, Calif: Health Care Alternatives; 1997.
- Baldry PE. Acupuncture, Trigger Points and Musculoskeletal Pain: A Scientific Approach to Acupuncture for Use by Doctors and Physiotherapists. 2nd ed. Philadelphia, Pa: Churchill Livingstone; 1993.
- Black ST. Against the grain. CSA/USA Lifeline. Fall 1995:5.
- Sullivan S. How much gluten is too much? CSA/USA Lifeline. May 1990:16.
- Jilin L, Peck G, eds. Chinese Dietary Therapy. New York, NY: Churchill Livingstone; 1991.
- Haas M, Nyiendo J. Diagnostic utility of the McGill Pain Questionnaire and the Oswestry Disability Questionnaire for classification of low back pain syndromes. J Manipulative Physiol Ther. 1992;15:90-98.
- Hseuh CC, Bensky D, O'Connor J, trans-eds. Acupuncture: A Comprehensive Text. Seattle, Wash: Eastland Press; 1981:86-94.
- Korngold E, Beinfield H. Between Heaven and Earth: A Guide to Chinese Medicine. New York, NY: Ballantine Books; 1992.
- Hyodo M. Ryodoraku Treatment. Osaka, Japan: Naniwasha Publishing; 1990.
- Walther DS. Applied Kinesiology: Orthopedic Conditions. Link: http://www.systemsdc.com. Accessed March 2003.
AUTHOR INFORMATION
Dr John L. Stump practices in Fairhope, Alabama, and teaches at the International Academy of Medical Acupuncture in Carefree, Arizona. He is a Diplomate of the National Commission for Certification of Acupuncture and Oriental Medicine, has written several acupuncture teaching manuals, and is a contributing author for several textbooks.
John L. Stump, DC, OMD, EdD*
401 No Section St
Fairhope, AL 36532
Phone: 251-928-5058 • E-mail: bamashogun@aol.com
*Correspondence and reprint requests
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