Irritable Bowel Syndrome and Traditional Chinese Medicine

Diagnostic Issues

Irritable bowel syndrome (IBS) is one of the most common gastrointestinal diseases. Most common among the symptoms are abdominal pain, a feeling of intestinal distention or bloating, and either diarrhea or constipation. Patients may have symptoms with stress and an increased sensitivity to bowel distention. In traditional Chinese medicine (TCM), the condition described as IBS by allopathic medicine can be classified into several diagnostic categories.

The physiological model of TCM is different from that of allopathic medicine. The illness is a result of disturbance or imbalance of Yin-Yang in the Zang-Fu organ system or the Channel system (Meridians), which are the two principal systems that regulate the functions of body and mind. The unique diagnosis in TCM is the differentiation of the clinical symptom-complexes, which represent specific pathological conditions that can be adjusted or reversed to physiological conditions by TCM therapeutic techniques such as medicinal herbs, acupuncture and Qi Gong, etc.

The disharmony of the Spleen and Liver system is the most common reason causing the symptoms described in IBS. According to the theory of the Five Phases, Liver (Wood) controls Spleen (Earth). Liver is the organ system that regulates the flow of Qi as well as stores the soul, a part of the spirit, or mental activity. It also controls the secretion of bile. The smooth flow of Qi regulates emotional activities as well as ensures that the digestive processes, which are regulated by Spleen, operate normally. The disharmony of the Spleen and Liver system causes irregular function of spleen and stomach and in turn result in diarrhea or constipation with abdominal pain due to emotional strain or stress, feeling of oppression in the chest and hypochondrium, reddened tongue with thin coating, taut pulse.

The deficiency of the Spleen is another common reason for IBS. Spleen controls digestion and works with stomach coordinately. The Spleen maintains the upward movement of Qi while the stomach sends digested food downward. The deficiency of the Spleen Qi results in persistent loose stools containing undigested food, frequent defecation after intake of greasy food, anorexia, feeling of oppression in the epigastric region, lassitude, pale tongue with white coating, thready and weak pulse.

In addition, IBS is also caused by the disturbance of other organ systems such as the deficiency of the kidney and by other pathogenic factors such as damp heat. The differentiation of symptom-complexes for IBS is to recognize the signature symptoms for each organ system as well as the symptoms for IBS. Proper diagnosis of the condition should be made thorough analyzing the complete history of the patients and all presenting symptoms, followed by checking the tongue and taking pulse.

 

Treatment

The treatment of IBS is a combination of a series of TCM therapies, which is specific to each patient and to each of the diagnostic categories, the symptom-complexes.

Chinese herbal medicine is the most common therapy for IBS. For the disharmony of the Spleen and Liver, the principle of treatment will be strengthening the function of the Spleen, subduing the Liver, and regulating the flow of Qi, the vital energy. The prescription will be based on specific symptoms of each patient as well as the experience of each practitioner. Decoction of Atractylodis macrocephalae and Paeoniae in combination with other herbs is commonly used. For the deficiency of the Spleen, the principle of treatment is to reinforce vital energy of the spleen. The prescription is usually the decoction of Codonopsis, Poria, and Atractylodis with modifications. Patent formula is also available for both cases. Bensoussan et al (JAMA 1998; 280:1585-89) reported that Chinese herbal medicine significantly improved the symptoms of IBS using a randomized, double-blind, placebo-controlled trial. Three groups of patients were tested, individualized Chinese herbal formulation group, standard Chinese herbal formulation group and placebo group. Significant improvement was observed for active treatment groups in symptom scores. Interestingly, on follow-up (14 weeks) only the individualized Chinese herbal formulation group maintained improvement.

Acupuncture is another common therapeutic access to the body through meridians. The stimuli by needle and electricity through acupuncture points on the surface of the body adjust the disharmony in Zang-Fu organ system and Channel system. Tianshu (St 25) and Zusanli (St 36) in combination with other points in the Liver and Spleen Meridians are commonly used. Each acupuncturist may have different combinations and different acupuncture techniques based on their experience and specific symptoms of each IBS patient. Sometimes ear acupuncture is also used to enhance therapeutic efficacy.

Busy lifestyle in the modern society is believed to be one of the causes for IBS and other related illness. The regularity of lifestyle, such as eating and sleeping, is important for IBS patients in addition to the herbal and acupuncture treatment. Regular physical exercise or other calm activities are also necessary. Qi Gong is an ancient Chinese technique to actively promote circulation of Qi in the body and adjust the body inner clock to the natural clock. Tai Ji Quan is another popular exercise in Chinese society, which combines Qi Gong and physical exercise and allows people to practice regularly to relax and adjust the conflict among the organ systems caused by the modern lifestyle. Both Qi Gong and Tai Ji Quan can be very good self-help techniques for TBS.

Diet is considered an important influence of health and illness in TCM. Food is believed to be part of the medicine. Everything a person eats will contribute to the complete treatment plan for the illness. Food can be classified into different groups according to their nature and taste. Fatty and greasy foods, alcohol, or sweets can produce Dampness and Heat, while spicy food also produces Heat. IBS patients should avoid those food items in their diet, especially for those patients diagnosed with the disharmony of Liver and Spleen. On the other hand, diet is believed to complement the nature of each human body, such as the Yin-Yang nature. Consult a TCM practitioner for more information about the diet of each specific case.