IBS is the most common functional intestinal disease that is unaccompanied by any substrate abnormality and shows changes in abdominal pain and bowels. Pathogenesis is thought to arise from visceral hypersensitivity, brain–gut interaction, postinfectious primary bowel syndrome, and genetic factors. However, the true cause or pathogenesis of the disease remains unknown [
1,
12]. Previously, intestinal inflammation was perceived as an organic abnormality, but this is no longer understood to be the case unless the inflammation is severe. Recent studies have found that low-grade intestinal inflammation is important in the pathophysiology of intestinal diseases. Therefore, research is underway to locate the biomarkers of IBS [
13]. However, due to the absence of a clear biomarker, the diagnosis is based on the Manning and ROME criteria [
12]. According to the 4
th edition of the revised ROME standard in 2016, symptoms that began 6 months ago should include repeated abdominal pain for ≥1 day/week for ≥1 week in the last 3 months and are classified as IBS when abdominal pain is associated with defecation, stool frequency, and stool appearance. IBS is diagnosed and classified into 4 subtypes, namely constipation, diarrhea, mixed, and nonspecific [
13]. IBS treatment includes psychiatric treatments, such as dietary control, medication for symptoms, and cognitive behavioral therapy, if necessary. The dietary regulation stems from the fermentation of a low-molecular carbohydrate, namely, FODMAP, in the intestines, which aggravates symptoms in patients with IBS. Low FODMAPs Diet is found to be generally effective. However, it is difficult to use Low FODMAP Diet actively as it is not necessary to label ingredients in food in Korea and further research on long-term research, diet composition, and recipes is needed in the future [
14]. Drug treatment is based on the subtypes, namely, constipation, diarrhea, mixed, and nonspecific; depending on the symptoms, treatment is applied accordingly. Constipation type drugs include laxatives, serotonin type 4 receptor agonists, and selective chloride channel activator; for diarrhea type, antidiarrheal drugs and serotonin type 3 receptor antagonists are used. Moreover, to relieve abdominal pain, antispasmodics, and antidepressants, are prescribed. However, this symptomatic drug use in IBS treatment may exacerbate other symptoms, especially where symptoms of constipation and diarrhea coexist [
9]. From a brain–gut interaction perspective, afferent nerves send signals to the central nervous system, and centrifugal signal transduction can cause changes in intestinal motility and intestinal immunity, leading to a variety of gastrointestinal disorders [
12]. The Back-Shu point is an acupuncture point located on both sides of the spine that can be used to diagnose the organ state in the case of changes in the area [
15]. It is closely located to the lateral ganglion in the lower and upper thoracic vertebrae [
8]. In the sympathetic visceral motor innervation, neurons from T10–T12 dominate the small intestine and ascending colon, whereas neurons from L1- L2 dominate the descending colon, sigmoid colon, rectum, and corresponding visceral vessels [
16]. Back-Shu point treatment is based on this sympathetic nervous system innervation, which flows backward from the thoracic lumbar spine [
17]. Therefore, it can be used in the treatment of IBS, a digestive disorder, by checking the convulsions or tenderness of BL20 (T11 Level), BL21 (T12 Level), BL22 (L1 Level), and BL25 (L4 Level), as shown in this study. Acupotomy therapy is effective for treating neurological ataxia caused by soft tissue injuries and may be more effective than conventional acupuncture in tissue restoration [
18]. The acupotomy theory in China explains that soft tissue lesions can cause internal pressure due to mechanical compression of the lesion tissue around the spinal canal and accumulation of inflammatory exudates, which can compress the visceral nerves. This pressure can be removed by acupotomy treatment to restore microcirculation at the lesion site and improve organ malfunction [
18,
19]. The patient has had chronic digestive discomfort for a very long time and complained of abdominal pain with a high NRS score but, the patient refused to consult a gastroenterologist and wanted a quick effect with Korean medicine treatment. If there is problem with a particular organ, an adverse reaction may occur at the corresponding Back-Shu point. Thus, the Back-Shu point can be both a diagnostic point and a treatment point [
9,
16]. The patient complained of severe tenderness at the Back-Shu point, and this tenderness and hypersensitivity could be seen as the action of nociceptive neurons by inflammatory mediators [
9]. In this chronic and severely painful condition, the internal pressure can be caused by excessive inflammatory mediators [
9,
20] Therefore, acupotomy treatment was helpful to release the pressure by removing biomechanical adhesion with thicker needle and more powerful than a standard acupuncture.
Although the use of acupotomy treatment for non-musculoskeletal diseases such as obesity and lymphadenoma is reported [
20], there have been no reports of acupotomy in IBS [
6]. In this study, improvement in the three indicators, namely, NRS, IBS-QOL, and GSRS, suggests that Korean medical therapies, including acupotomy treatment, have a positive effect on IBS treatment. However, the endoscopic examination did not completely exclude organic problems, and it was difficult to distinguish a single effect due to the overlap of several Korean medical interventions. Except for musculoskeletal diseases, acupotomy use in internal diseases is insufficient, and further studies are needed. In the future, well-designed RCT studies on the effects of acupuncture for IBS should be conducted.