Stress e colon irritabile in MTC

Autore: Vito Marino

Responsabile Ambulatorio di Agopuntura, Osp. Buccheri La Ferla Fatebenefratelli, Palermo
Direttore Scuola di Agopuntura e M!, Fonda"ione #nterna"ionale Fatebenefratelli, sede di Palermo
Docente al Master $Agopuntura nelle sindromi stress%correlate&, 'ni(ersit) di Palermo
Docente presso la Scuola ao, Scuola per le Arti Mediche Orientali, di Bologna
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Eziopatogenesi del Colon Irritabile in MTC
Secondo la M! il *ingshen del fegato, lo +un, , correlato alla creati(it) e alla capacit) di
$programma"ione strategica& e di pre(isione, i suoi disturbi si manifestano con la collera,
l-irritabilit), l-aggressi(it) repressa per impossibilit) di $lotta o fuga&, come detto in preceden"a.
#l *ingshen della mil"a, lo .#, , correlato con l-intelligen"a logica, il pensiero ra"ionale, la
riflessione, i sui disturbi si manifestano con preoccupa"ioni, pensieri ossessi(i e ripetiti(i,
rimugina"ione.
#l *ingshen del polmone, il Po, , la sede degli istinti di conser(a"ione dell-indi(iduo e della specie,
/uello che secondo McLean , il $cer(ello rettiliano&, e della sensibilit), le sue altera"ioni si
manifestano con triste""a, depressione.
#l *ingshen del cuore, lo Shen, regge la globalit) di tutte le atti(it) mentali, la coscien"a e la
coscien"a del s0, i suoi disturbi si manifestano con riso immoti(ato e gioia eccessi(a.
!uore e cer(ello sono nell-essere umano le sedi dell1intelligen"a in /uanto alloggiano lo Shen2 in
particolare, il cuore regge l-intelligen"a immediata ed intuiti(a delle cose, il cer(ello regge
l1intelligen"a ra"ionale in collabora"ione con gli organi di senso che raccolgono le informa"ioni
pro(enienti dall1esterno.
Recenti ricerche hanno dimostrato che la rete ner(osa delle pareti interne del tratto gastro%enterico ,
sia collegata al cer(ello attra(erso il sistema ner(oso autonomo, sia con il sistema endocrino,
immunitario e linfatico. #l colon /uindi potrebbe essere (isto come un complesso neuro%endocrino%
immunologico in rela"ione continua con l1esterno attra(erso il cibo, e con l1interno per la sua
rela"ione con il cer(ello, le emo"ioni e i neurotrasmettitori, che poi sono i mediatori in causa nella
patogenesi del colon irritabile. !er(ello e colon possono /uindi essere considerati i due $cer(elli&
connessi attra(erso il sistema ner(oso autonomo.
Colon irritabile come Disarmonia tra Cuore e Vescica Biliare e Disarmonia tra Fegato e Milza
Principali manifesta"ioni3 Dolore addominale distensi(o in rela"ione a stimoli emoti(i,
borborigmi, defeca"ione impellente, il dolore addominale si attenua dopo la defeca"ione, feci
mucose, sensa"ione di piene""a e tensione al torace e agli ipocondri, erutta"ioni fre/uenti,
flatulen"e fre/uenti. Patina linguale sottile e bianca, polso teso a corda.
rattamento. 4B567.angling/uan, 897:aiguan e 8;7<higou in puntura $transfissiante&
=corrispondente alla $"onula& :A'9 dell1Agopuntura di Polso%!a(iglia>, S?97ianshu,
!@;7Ai+ai, S5;7<usanli.

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!ochrane Database SBst Re(. ?CC; Oct DE2=6>3!DCC9DDD.
Acupuncture for treatment of irritable boel s!ndrome"
Lim B , Manheimer 8, Lao L, <iea 8, :isnieFsGi *, Liu *, Berman B.
'ni(ersitB of MarBland School of Medicine, !enter for #ntegrati(e Medicine, Hernan +ospital
Mansion, ??CC Hernan Dri(e, Baltimore, MarBland ?D?CI%;;JI, 'SA.
BA!H4RO'KD3 #rritable boFel sBndrome =#BS>, a disorder of altered boFel habits associated
Fith abdominal pain or discomfort. he pain, discomfort, and impairment from #BS often lead to
healthcare medical consultation =alleB DJJI> and ForGplace absenteeism, and associated economic
costs =Leong ?CC5>. A recent randomi"ed controlled trial shoFs (ariable results but no clear
e(idence in support of acupuncture as an effecti(e treatment for #BS =Fireman ?CCD>.
OB*8!#@8S3 he obLecti(e of this sBstematic re(ieF is to determine Fhether acupuncture is more
effecti(e than no treatment, more effecti(e than 1sham1 =placebo> acupuncture, and as effecti(e as
other inter(entions used to treat irritable boFel sBndrome. Ad(erse e(ents associated Fith
acupuncture Fere also assessed. S8AR!+ SRA84.3 he folloFing electronic bibliographic
databases Fere searched irrespecti(e of language, date of publication, and publication status3
M8DL#K8, the !ochrane !entral Register of !ontrolled rials =!8KRAL> on he !ochrane
LibrarB, 8MBAS8, the !hinese Biomedical Database, the !umulati(e #ndeM to Kursing and Allied
+ealth =!#KA+L>, and the Allied and !omplementarB Medicine Database =AM8D>. References in
rele(ant re(ieFs and R!s Fere screened bB hand. he last date for searching for studies Fas I
FebruarB ?CC;. S8L8!#OK !R#8R#A3 Published reports of randomi"ed controlled trials =R!s>
and /uasi%randomised trials of acupuncture therapB for #BS. DAA !OLL8!#OK AKD
AKAL.S#S3 All eligible records identified Fere duallB e(aluated for eligibilitB and duallB
abstracted. Methodological /ualitB Fas assessed using the *adad scale and the Linde #nternal
@aliditB Scale. Data from indi(idual trials Fere combined for meta%analBsis Fhen the inter(entions
Fere sufficientlB similar. +eterogeneitB Fas assessed using the # s/uared statistic. MA#K
R8S'LS3 SiM trials Fere included. he proportion of responders, as assessed bB either the global
sBmptom score or the patient%determined treatment success rate, did not shoF a significant
difference betFeen the acupuncture and the sham acupuncture group Fith a pooled relati(e risG of
D.?E =J9N !# C.E5 to D.JE2 nODCJ>. Acupuncture treatment Fas also not significantlB more effecti(e
than sham acupuncture for o(erall general Fell%being, indi(idual sBmptoms =e.g., abdominal pain,
defecation difficulties, diarrhea, and bloating>, the number of impro(ed patients assessed bB blinded
clinician, or the 8uroAol score. For tFo of the studies Fithout a sham control, acupuncture Fas
more effecti(e than control treatment for the impro(ement of sBmptoms3 acupuncture (ersus herbal
medication Fith a RR of D.D6=J9N !# D.CC to D.5D2 nOD5?>2 acupuncture plus psBchotherapB (ersus
psBchotherapB alone Fith a RR of D.?C =J9N !# D.C5 to D.5J2 nODCC>. :hen the effect of ear
acupuncture treatment Fas compared to an unclearlB specified combination of one or more of the
drugs dia"epam, perphena"ine or domperidone, the difference Fas not statisticallB significant Fith a
RR of D.6J=J9N !# C.J6 to ?.562 nO6E>. A'+ORS1 !OK!L'S#OKS3 Most of the trials included
in this re(ieF Fere of poor /ualitB and Fere heterogeneous in terms of inter(entions, controls, and
outcomes measured. :ith the eMception of one outcome in common betFeen tFo trials, data Fere
not combined. herefore, it is still inconclusi(e Fhether acupuncture is more effecti(e than sham
acupuncture or other inter(entions for treating #BS.
* 4astroenterol. ?CC; MaB26D=9>36CE%DI.
Acupuncture for functional gastrointestinal disorders"
aGahashi .
Department of SurgerB, DuGe 'ni(ersitB Medical !enter, Durham, K! ?IIC9, 'SA.
Functional gastrointestinal =4#> sBmptoms are common in the general population. 8speciallB, motor
dBsfunction of the 4# tract and (isceral hBpersensiti(itB are important. Acupuncture has been used
to treat 4# sBmptoms in !hina for thousands of Bears. #t is concei(able that acupuncture maB be
effecti(e in patients Fith functional 4# disorders because it has been shoFn to alter acid secretion,
4# motilitB, and (isceral pain. Acupuncture at the loFer limbs =S%5;> causes muscle contractions
(ia the somatoparasBmpathetic pathFaB, Fhile at the upper abdomen =!@%D?> it causes muscle
relaMation (ia the somatosBmpathetic pathFaB. #n some patients Fith gastroesophageal refluM
disease =48RD> and functional dBspepsia =FD>, peristalsis and gastric motilitB are impaired. he
stimulatorB effects of acupuncture at S%5; on 4# motilitB maB be beneficial to patients Fith 48RD
or FD, as Fell as to those Fith constipation%predominant irritable boFel sBndrome =#BS>, Fho shoF
delaBed colonic transit. #n contrast, the inhibitorB effects of acupuncture at !@%D? on 4# motilitB
maB be beneficial to patients Fith diarrhea%predominant #BS, because enhanced colonic motilitB
and accelerated colonic transit are reported in such patients. Acupuncture at !@%D? maB inhibit
gastric acid secretion (ia the somatosBmpathetic pathFaB. hus, acupuncture maB be beneficial to
48RD patients. he antiemetic effects of acupuncture at P!%; =Frist> maB be beneficial to patients
Fith FD, Fhereas the antinocicepti(e effects of acupuncture at P!%; and S%5; maB be beneficial to
patients Fith (isceral hBpersensiti(itB. #n the future, it is eMpected that acupuncture Fill be used in
the treatment of patients Fith functional 4# disorders.
4ut. ?CC; MaB299=9>3;6J%96. 8pub ?CC9 Sep E.
!omment in3
4ut. ?CC; MaB299=9>3I65%62 author replB I66.
Acupuncture treatment in irritable boel s!ndrome"
Schneider A , 8ncG P, Streitberger H, :eiland !, Bagheri S, :itte S, Friederich +!, +er"og
:, <ipfel S.

Department of 4eneral Practice and +ealth Ser(ices Research, 'ni(ersitB Medical +ospital,
'ni(ersitB of +eidelberg, @ossstrasse ?, ;JD?C +eidelberg, 4ermanB.
antonius.schneiderPmed.uni%heidelberg.de
BA!H4RO'KD AKD A#MS3 Despite occasional positi(e reports on the efficacB of acupuncture
=A!> on functions of the gastrointestinal tract, there is no conclusi(e e(idence that A! is effecti(e
in the treatment of irritable boFel sBndrome =#BS>. PA#8KS AKD M8+ODS3 FortB three
patients Fith #BS according to the Rome ## criteria Fere randomlB assigned to recei(e either A! =n
O ??> or sham acupuncture =SA!> =n O ?D> using the so%called QStreitberger needleQ. reatment
duration Fas DC sessions Fith an a(erage of tFo A! sessions per FeeG. he primarB end point Fas
impro(ement in /ualitB of life =AOL> using the functional digesti(e diseases /ualitB of life
/uestionnaire =FDDAL> and a general /ualitB of life /uestionnaire =SF%5;>, compared Fith baseline
assessments. AOL measurements Fere repeated three months after treatment. R8S'LS3 Both the
A! and SA! groups impro(ed significantlB in global AOL, as assessed bB the FDDAL, at the end
of treatment =p O C.C??>, Fith no differences betFeen the groups. SF%5; Fas insensiti(e to these
changes =eMcept for pain>. his effect Fas partiallB re(ersed three months later. Post hoc
comparison of responders and non%responders in both groups combined re(ealed a significant
prediction of the placebo response bB tFo subscales of the FDDAL =sleep, coping> =F O ;.I6;, p O
C.CC5> in a stepFise regression model. !OK!L'S#OKS3 Acupuncture in #BS is primarilB a placebo
response. Based on the small differences found betFeen the A! and SA! groups, a studB including
9;; patients Fould be necessarB to pro(e the efficacB of A! o(er SA!. he placebo response maB
be predicted bB high coping capacitB and loF sleep /ualitB in indi(idual patients.
:orld * 4astroenterol. ?CC9 *ul D62DD=?;>36C6C%6.
Acupuncture for irritable boel s!ndrome: a blinded placebo#
controlled trial"
Forbes A , *acGson S, :alter !, Auraishi S, *acBna M, Pitcher M.
St MarG1s +ospital, :atford Road, +arroF +AD 5'*, 'nited Hingdom. lastair.forbesPic.ac.uG
A#M3 #rritable boFel sBndrome =#BS> is a common disorder and manB patients fail to find ade/uate
relief from con(entional therapies for their sBmptoms. his studB tests the claim that acupuncture is
effecti(e for a maLoritB of these patients. M8+ODS3 A prospecti(e, blinded, sham acupuncture%
controlled trial of traditional !hinese acupuncture Fas performed at a single postgraduate teaching
hospital in 8urope. SiMtB patients Fith Fell%established #BS Fere recruited. he blinded comparator
Fas sham acupuncture administered bB the second of tFo acupuncturists Fho alone Fas aFare of
the randomi"ation, and Fho otherFise folloFed the prescription of the first. he primarB end%point
Fas a defined fall in the sBmptom score at D5 FG =bB intention to treat>. he prior eMpectation Fas a
5CN placebo response, and a response rate of ICN from acupuncture, for Fhich the studB Fas
ade/uatelB poFered. R8S'LS3 Patients in treated and sham groups impro(ed significantlB during
the studB%mean impro(ement in scores being e/ual =minus D.J> and significant for both =PRC.C92
one%tailed t test>. here Fas a small numeric but non%significant difference betFeen the response
rate in patients recei(ing acupuncture =6C.IN> and sham treatment =5D.?N>. Se(eral secondarB end%
points marginallB fa(ored acti(e treatment, but an impro(ed sBmptom score of anB degree of
magnitude occurred more often Fith sham therapB =;9.;N (s 9J.?N>. For no criterion Fas
statistical significance approached. !OK!L'S#OK3 raditional !hinese acupuncture is relati(elB
ineffecti(e in #BS in the 8uropean hospital setting, and the magnitude of anB effect appears
insufficient to Farrant in(estment in acupuncture ser(ices.