Diverticulosis refers to the diverticula in the intestines, small pouches or sacs that represent herniations of mucosa and sub mucosa in the muscular layer of the colon (Thaha & Williams, 2012). Diverticular disease is classified as ranging from: asymptomatic; symptomatic, uncomplicated diverticular disease; and complicated diverticular disease. The latter includes diverticulitis which can lead to abscess or perforation of the bowel. Other complications include haemorrhage, segmental colitis, peritonitis and fistula.
Between 40-60% of people over 70 years have diverticulosis (Martel & Raskin, 2008) and in older adults there is a female predominance (Thaha & Williams, 2012).
In WM, diet recommendations are made for an uncomplicated presentation of diverticulosis and bulking agents like Normacol are prescribed for associated constipation. With complications including diverticulitis, antibiotics or anti-inflammatory medication are prescribed. New research is emerging about probiotic use.
Prevention is recommended by increasing dietary fibre with fruits and vegetables, limiting red meat and salt and regular physical activity (Thaha & Williams, 2012). In the past, people with diverticulosis were advised to avoid nuts, popcorn, and seeds to reduce the risk of diverticulitis yet this restriction is not evidence-based (Beitz, 2004).
Normacol is prescribed as a laxative yet precautions are necessary in the elderly with prolonged use and abdominal cramp or distention could result (Mims, 2013).
Due to a lack of TCM research under diverticular disease or diverticulosis (appendix 1 for search strategy), the search was widened to include TCM treatment of individual symptoms including; constipation, diarrhoea, bloating and abdominal pain. The research seen as the most relevant to this case was about colon motility and constipation due to its involvement in diverticular disease.
St-36 zusanli has been found to accelerate colonic transit and stimulate distal colonic motility using electro-acupuncture (EA) (Diehl, 1999; Iwa et al., 2006; Takahashi, 2006).
In a systematic review of TCM’s treatment of constipation, significantly positive results were found in 15 of 21 studies (Lin et al., 2009). Of the 21 studies, 18 were Chinese herbal medicine and 3 acupuncture. The results ‘should be interpreted cautiously’ due to the heterogeneity in diagnostic procedures and interventions and differing outcome measures.
In a review of trials using auricular therapy for constipation it was effective in managing constipation(Li, Lee, & Suen, 2010). Generalisation of this result was difficult due to the inconsistent intervention protocols and uncertainty regarding point location accuracy and subject compliance.
After six treatments, a 78 year old patient was able to reduce her use of normacol (under GP guidance) and had a bowel motion almost daily. After twelve treatments she said that with occasional pain she ‘did not let it get me down’ and would think ‘I can make it’ whether she had pain or not. She resumed all her activities and was confident to plan a holiday. She continued to have treatment every 2-3 weeks for the rest of the year with occasional bouts of abdominal pain and stool irregularity. Now, five years later when asked her about diverticulosis, she replied ‘I don’t even think about it’.