---
title: "Zusanli (ST36) acupuncture modulates brain-gut neuro-immune axis in IBS-D"
id: "pubmed-42908452"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42908452"
content_type: "clinical_feed_article"
specialty: "Pharmacology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42908452/"
doi: "10.13702/j.1000-0607.20260206"
published_at: "2026-10-25T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Zusanli (ST36) acupuncture modulates brain-gut neuro-immune axis in IBS-D
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42908452
- **Specialty:** [Pharmacology](https://medichelpline.com/clinical-feed/pharmacology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42908452/)
- **DOI:** [10.13702/j.1000-0607.20260206](https://doi.org/10.13702%2Fj.1000-0607.20260206)
- **Published At:** 2026-10-25T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- This article is a review focused on acupuncture at **Zusanli (ST36)** for diarrhea-predominant irritable bowel syndrome (**IBS-D**), synthesizing modern mechanistic evidence rather than reporting a single trial. - Investigators reported that core pathological features of IBS-D include **visceral hypersensitivity**, low-grade mucosal inflammation, impaired intestinal barrier function, gut microbiota dysbiosis, and autonomic nervous system imbalance. - The review summarizes data indicating ST36 stimulation remodels vagal–sympathetic balance through a peripheral afferent → central integration → autonomic efferent circuit, according to the authors. - Study teams observed ST36 acupuncture modulates central nociceptive and emotional processing; the article links these central changes to downstream effects on gut function and symptoms. - Data indicated acupuncture influences brain-gut peptide signaling such as **5-hydroxytryptamine**, suppresses immune activation and inflammatory mediator release, and improves tight-junction protein expression and mucosal permeability. - Authors noted effects on microbiota-related metabolic pathways, proposing modulation of microbiota–metabolite interactions as a mechanism for symptom relief. - The review emphasizes attenuation of a putative “stress–inflammation–pain amplification” neuro-immune feedback loop as a unifying mechanism for reductions in abdominal pain and diarrhea. - Limitations documented by the authors include insufficient circuit-level verification, unclear stimulus parameter–effect relationships, and a lack of standardized clinical protocols; the review did not provide new trial endpoints or quantitative outcome data. - The paper signals the need for standardized stimulation parameters and mechanistic verification to translate experimental findings into reproducible clinical protocols. - Keywords listed by the authors include Acupuncture, Autonomic nerve, Brain-gut axis, Diarrhea-predominant irritable bowel syndrome, and **Zusanli (ST36)**.
## Clinical Analysis & Structured Key Points
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Affiliations Expand ### Affiliations * 1 Institute of Acupuncture-Moxibustion, Shandong University of Traditional Chinese Medicine, Jinan 250355, China. * 2 Institute of Acupuncture-Moxibustion, Shandong University of Traditional Chinese Medicine, Jinan 250355, China. xiayucen@sdutcm.edu.cn. * PMID: **42908452** * DOI: [ 10.13702/j.1000-0607.20260206 ](https://doi.org/10.13702/j.1000-0607.20260206) Item in Clipboard Review # [Explanation on modern mechanism of "for abdominal-diseases, Zusanli is indicated": acupuncture at Zusanli (ST36) regulates the brain-gut "neuro-immune axis" for the treatment of diarrhea-predominant irritable bowel syndrome] [Article in Chinese] Jiachen Ma et al. Zhen Ci Yan Jiu. 2026. Show details Display options Display options Format Abstract PubMed PMID Zhen Ci Yan Jiu Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Zhen+Ci+Yan+Jiu%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Zhen+Ci+Yan+Jiu%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42908452/) . 2026 Oct 25;51(10):1367-1375. doi: 10.13702/j.1000-0607.20260206. ### Authors [Jiachen Ma](https://pubmed.ncbi.nlm.nih.gov/?term=Ma+J&cauthor_id=42908452)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42908452/#short-view-affiliation-1 "Institute of Acupuncture-Moxibustion, Shandong University of Traditional Chinese Medicine, Jinan 250355, China."), [Yongjun Chen](https://pubmed.ncbi.nlm.nih.gov/?term=Chen+Y&cauthor_id=42908452)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42908452/#short-view-affiliation-1 "Institute of Acupuncture-Moxibustion, Shandong University of Traditional Chinese Medicine, Jinan 250355, China."), [Yucen Xia](https://pubmed.ncbi.nlm.nih.gov/?term=Xia+Y&cauthor_id=42908452)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42908452/#short-view-affiliation-2 "Institute of Acupuncture-Moxibustion, Shandong University of Traditional Chinese Medicine, Jinan 250355, China. xiayucen@sdutcm.edu.cn.") ### Affiliations * 1 Institute of Acupuncture-Moxibustion, Shandong University of Traditional Chinese Medicine, Jinan 250355, China. * 2 Institute of Acupuncture-Moxibustion, Shandong University of Traditional Chinese Medicine, Jinan 250355, China. xiayucen@sdutcm.edu.cn. * PMID: **42908452** * DOI: [ 10.13702/j.1000-0607.20260206 ](https://doi.org/10.13702/j.1000-0607.20260206) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract in [ English, ](https://pubmed.ncbi.nlm.nih.gov/42908452/#eng-abstract) [ Chinese ](https://pubmed.ncbi.nlm.nih.gov/42908452/#zho-abstract) Diarrhea-predominant irritable bowel syndrome (IBS-D) is a functional intestinal disorder characterized by recurrent abdominal pain, diarrhea and altered defecation habits. It is frequently comorbid with psychological disorders such as anxiety and depression, which greatly impair the quality of life. Accumulating evidence demonstrates that the core pathological links of IBS-D involve disrupted brain-gut interaction and dysregulation of the brain-gut "neuro-immune axis", including visceral hypersensitivity, low-grade mucosal inflammation, impaired intestinal barrier function, gut microbiota dysbiosis and abnormal autonomic nerve modulation. Zusanli (ST36) is an essential acupoint for digestive disorders, and the ancient maxim "for abdominal-diseases, Zusanli is indicated" summarizes its prominent clinical value in abdominal ailments. Modern studies have verified that acupuncture at ST36 can remodel vagal-sympathetic balance via the peripheral afferent-central integration-autonomic efferent circuit, modulate central nociceptive and emotional processing, and exert regulatory effects on brain-gut peptide signals such as 5-hydroxytryptamine, suppress immune activation and release of inflammatory mediators, improve the expression of tight-junction proteins and intestinal mucosal permeability, as well as modulate microbiota-metabolite-related pathways. Thereby, it attenuates the neuro-immune feedback of "stress-inflammation-pain amplification", alleviates visceral hypersensitivity and relieves symptoms including abdominal pain and diarrhea. Taking the classical maxim "for abdominal-diseases, Zusanli is indicated" as a clue, this paper reviews research advances regarding acupuncture at ST36 in treating IBS-D by regulating the brain-gut "neuro-immune axis". Limitations of current evidence are also pointed out, including insufficient circuit verification, unclear stimulus parameter-effect relationship and non-standardized clinical protocols, so as to provide references for standardized application and mechanistic exploration of acupuncture at ST36 in treating functional gastrointestinal disorders. 腹泻型肠易激综合征（IBS-D）是以反复腹痛、腹泻及排便习惯异常为特征的功能性肠病，常伴焦虑、抑郁等心理共病，严重影响患者生活质量。现有证据表明，IBS-D的核心病理环节涉及脑-肠互作障碍及脑-肠“神经免疫轴”失衡，包括内脏高敏、黏膜低度炎性反应、屏障功能受损、肠道微生态紊乱及自主神经调控异常等。足三里为消化系统病证常用要穴，“肚腹三里留”概括了其在腹部疾患中的突出临床价值。现代研究证实，针刺“足三里”可通过外周感觉传入-中枢整合-自主神经输出的环路机制，重塑迷走与交感平衡，调控中枢痛觉与情绪加工，并通过影响5-羟色胺等脑肠肽信号、抑制免疫激活与炎性介质释放、改善紧密连接蛋白表达及肠黏膜通透性、调节菌群-代谢物相关通路，从而削弱“应激-炎性反应-痛觉放大”的神经免疫反馈，降低内脏高敏并缓解腹痛腹泻等症状。本文以“肚腹三里留”为线索，综述针刺足三里调控脑-肠“神经免疫轴”治疗IBS-D的研究进展，并指出现有证据在环路验证、刺激参数-效应关系及临床方案标准化等方面的不足，以期为针刺足三里治疗功能性胃肠病的规范应用及机制研究提供参考。. **Keywords:** Acupuncture; Autonomic nerve; Brain-gut axis; Diarrhea-predominant irritable bowel syndrome; Zusanli (ST36). [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement All authors declare that there is no conflict of interest. ## References 1. 1. Ford A C, Sperber A D, Corsetti M, et al. Irritable bowel syndrome[J]. Lancet, 2020, 396(10263):1675-1688. 2. 1. Sperber A D, Bangdiwala S I, Drossman D A, et al. Worldwide prevalence and burden of functional gastrointestinal disorders, results of Rome foundation global study[J]. Gastroenterology, 2021, 160(1):99-114. 3. 1. Zhang F, Xiang W, Li C Y, et al. Economic burden of irritable bowel syndrome in China[J]. World J Gastroenterol, 2016, 22(47):10450-10460. 4. 1. Piovezani Ramos G, Camilleri M. Current and future therapeutic options for irritable bowel syndrome with diarrhea and functional diarrhea[J]. Dig Dis Sci, 2023, 68(5):1677-1690. 5. 1. Lacy B E, Pimentel M, Brenner D M, et al. ACG clinical guideline:management of irritable bowel syndrome[J]. Am J Gastroenterol, 2021, 116(1):17-44. 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