Irritable Bowel Syndrome (IBS) is an intestinal disorder causing a variety of symptoms, which may include cramping, abdominal pain, gas, bloating, and irregular bowels. Some people with IBS have diarrhea with frequent loose stools, while others have constipation causing infrequent bowel movements that are difficult to pass. Still other IBS patients will suffer from alternating diarrhea and constipation. Symptoms are frequently triggered by stress, emotional factors, or the ingestion of food. IBS is the most common gastrointestinal disease seen by general practitioners and makes up 30-50% of all referrals to GI specialists. Women are affected three times more than men, with the average age of onset being between 20 and 40.
IBS is described as a ‘functional’ illness — the small and large intestines are not functioning appropriately although there is no structural damage found through diagnostic testing. No anatomic defect can be found in IBS patients, and the cause of the illness is not known. What is known is that there is a link between the onset of symptoms and emotional triggers. There are two major clinical types of IBS described in Western medicine: diarrhea-predominant IBS and constipation-predominant IBS. Diarrhea-predominant IBS is characterized by diarrhea, which occurs immediately after waking up or immediately after eating. Other common symptoms include pain, bloating, urgency, and urinary incontinence. Constipation-predominant (or ‘spastic colon’ type) IBS manifests with pain over at least one area of the colon and periodic constipation. This pain may be continuous or it may come in bouts, and is frequently relieved by moving the bowels. There may be constipation alternating with normal stools or constipation alternating with diarrhea. The stool often contains mucus. Associated symptoms include bloating, gas, nausea and dyspepsia. Eating can commonly trigger these symptoms. Western medicine treats IBS with anti-spasmodic or anti-diarrhea medication, diet modification and stress reduction techniques.
Traditional Chinese Medicine (TCM) is a medical system which combines the use of acupuncture, Chinese herbs, and nutrition to bring the body into balance. Whereas Western medicine looks closely at a symptom and tries to find an underlying cause, TCM looks at the body as a whole. Each symptom is looked at in relationship to all other presenting symptoms. The goal of the TCM practitioner is to assess the entire constitution of the patient — considering both physiological and psychological aspects. The practitioner first observes the general characteristics of the patient, and then tries to discern a relationship between symptoms in order to establish what is called a “pattern of disharmony.”
To look at the body as an integrated whole, one also looks at the theory of the ‘Internal Organs.’ The TCM definition of an Internal Organ is very different from the Western concept. In Western medicine, an organ is a material-anatomical structure. In Chinese medicine, each Internal Organ encompasses much more. There can be an anatomical structure, but there is also a corresponding emotion, tissue, sensory organ, color, and element. In addition, twelve of the Internal Organs correspond to the twelve main acupuncture meridians that run through the body. There is energy (Qi) flowing through each meridian. If an Internal Organ is out of balance, the energy of that organ will be damaged. IBS affects the large and small intestines in Western medicine, but in Chinese theory, the Spleen, Liver, Kidney, and Large Intestine can all play a role in the pattern of disharmony.
In TCM, the Spleen is considered to be the key organ to regulate digestion. Keep in mind; this is not the same as the Western spleen. Its functions actually have a closer connection to the Western pancreas. IBS patients with a pattern of Spleen Qi deficiency will suffer from fatigue and diarrhea, which becomes worse when they are overexerting themselves. This is often accompanied by abdominal pain, which may be relieved by exerting pressure over the painful area. Patients may also have gas and bloating. Hemorrhoids are an additional indication of Spleen Qi deficiency. Acupuncture points are chosen which will help nourish the Spleen Qi. There are also specific techniques used in needling that strengthen the body when the patient is deficient. Another important part of treatment is the Chinese herbal formula. In Chinese herbalism, a group of herbs is combined together to specifically address a person’s unique constitution. This is one way in which treatment is very individualized — a master herbalist treats no two patients with the same combination of herbs. Most herbalists use a “classical formula” as a foundation. Many classical formulas written up to 2,000 years ago are still commonly used today. Groups of herbs can be added or taken out of classical formulas on order to customize them for patients. One classical formula used for Spleen Qi deficiency is called Bu Zhong Yi Qi Tang (Ginseng and Astragalus Combination). By adding and subtracting herbs from this formula, it can be individualized to fit the precise needs of the patient.
Another pattern is Spleen Distressed by Dampness. In this pattern the patient may experience symptoms of nausea or heaviness. Bowel movements may feel incomplete, or the patient may even have constipation lined with mucus. This condition is often caused by eating too much fried or greasy food, but may also be caused by emotional factors such as over-thinking or over-worrying. Acupuncture points are chosen to nourish the Spleen and eliminate dampness. The classical herbal formula to address this pattern is called Shen Ling Bai Zhu San (Ginseng, Poria & Atractylodes Powder). Patients are additionally advised to keep a very clean diet. In Chinese medicine, dairy foods and excessive sugar intake create dampness, so these foods should be avoided altogether.
Other patterns include “Cold in the Spleen”, “Spleen and Kidney Yang Deficiency”, “Liver Qi Stagnation”, and “Damp-Heat in the Large Intestine”,
Irritable Bowel Syndrome is clearly a complicated illness in both Western and Chinese medicine. Its many manifestations require very different treatment approaches in Traditional Chinese Medicine. The patterns of disharmony mentioned above may even appear in combination and treatment must be adjusted appropriately. In any severe case of IBS, TCM treatment will be customized for the individual and classical herbal formulas will be modified for the patient.
An Australian study published in 1998 in the Journal of the American Medical Association lends strong scientific support to treating IBS with Chinese herbs. In this double-blind study, 116 patients with IBS were divided into three groups. One group was given a standard Chinese herbal preparation, a second group was given customized herbal formulas individually written for each patient, and a third group was given a placebo. Each patient had regular consultations with both a Chinese herbal-medicine practitioner and a gastroenterologist. Both groups taking the Chinese herbs showed significant improvement over the patients taking the placebo. Positive results were reported by both the patients themselves and the gastroenterologists. Although there was improvement in both groups of patients taking herbs, it is important to note that the positive effects were shown to last longer in the group that was given individualized formulas. This study clearly shows that Chinese herbalism is most effective when each patient is treated not only for their condition, but also for their bodily constitution and other presenting symptoms.
Alan Rivenson, L.Ac., Dipl. Ac.
Affordable Acupuncture
PO Box 298, Canaan, CT 06018
860-824-7727
ARivenson@att.net
www.BerkshireQi.com