By Antonia Balfour, L.Ac., Dipl. Ac. & C.H.
 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.
What is Traditional Chinese Medicine? Traditional Chinese Medicine (TCM)
is a holistic medical system which combines the use of acupuncture,
Chinese herbs, nutrition, massage, and movement exercises (known as Tai
Chi or Qi Gong) 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." Treatment is aimed at restoring harmony and
bringing the body into balance. The fundamental TCM theory used to
determine the pattern of disharmony is the theory of "Yin and Yang." Yin
and Yang are terms used to describe two polar opposites. Each body part,
each organ, and even each symptom in the body can be described in terms
of Yin and Yang. Levels of Yin and Yang are constantly changing in the
body and there are four possible states of imbalance:
- Excess of Yin
- Excess of Yang
- Deficiency of Yin
- Deficiency of Yang
It is rare for one of these states of
imbalance to exist by itself. Excesses and deficiencies of Yin and Yang
almost always appear in combination. For example, in IBS, the symptom of
loose stools shows an excess of yin, but if the patient feels a burning
sensation along with the loose stools, this indicates an additional
excess of yang. In treating the overall pattern of disharmony, the TCM
practitioner uses acupuncture and Chinese herbs to address all
imbalances of yin and yang. 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 (or channels) that run through the body. There is
qi (or energy) flowing through each meridian. If an Internal Organ is
out of balance, the qi of that organ will be damaged. Therefore, the
Chinese Large Intestine (which is capitalized to distinguish it as the
Chinese organ) should not be equated with the Western organ. IBS affects
the large and small intestines in Western medicine, but in Chinese
medicine, the Spleen, Liver, Kidney, and Large Intestine can all play a
role in the pattern of disharmony.
Common Patterns of Disharmony in Irritable Bowel Syndrome
Spleen Qi Deficiency
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. By adding and subtracting herbs from this formula, it can be
individualized to fit the precise needs of the patient.
Spleen Distressed by Dampness
In this pattern, the patient may experience symptoms of Spleen qi
deficiency along with a feeling 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. 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.
Excess Cold in the Spleen
An excess of cold in the Spleen causes severe pain. The patient may be
"doubling over" in pain; feeling as if curling up will somehow offer
relief. Here the patient cannot tolerate being touched. This pain may be
accompanied by constipation. Acupuncture is given to warm the Spleen,
and the classical formula Da Jian Zhong Tang may be prescribed, although
in severe cases of constipation additional herbs need to be added to
give a laxative effect.
Spleen and Kidney Yang Deficiency
Yang energy provides warmth to the body and a deficiency of Spleen and
Kidney Yang may result in feeling cold or having cold hands and feet.
IBS patients with Spleen and Kidney Yang deficiency will have diarrhea
first thing in the morning, which may contain undigested food particles.
Other symptoms include chronic low back pain, low libido, frequent
urination, or in severe cases, urinary incontinence. Acupuncture
treatment focuses on building up this deficient Yang energy, and the
classical formula, Si Shen Wan, can be used along with additions and
subtractions to suit the exact needs of the patient.
Liver Qi Stagnation
The Chinese Liver is the organ most affected by stress, aggravation, and
anger. The Liver is frequently involved in modern disease, most commonly
when its qi becomes stagnant or stuck. There may be depression,
moodiness, or simply a feeling of being 'wound up.' Women may suffer
from irregular or painful periods. The IBS patient with Liver Qi
Stagnation may have pellet shaped stools and distending pain,
particularly in the area below the ribs. There may also be nausea,
belching, or acid reflux. Symptoms can be triggered or aggravated by
stress. Acupuncture is very effective at restoring the smooth flow of
Liver qi, as are movement exercises such as Tai Chi or Qi Gong. The
classical formula of choice for the IBS patient with Liver Qi Stagnation
is Liu Mo Tang. Liver/Spleen Disharmony Disharmony between the Liver and
Spleen causes irritability along with abdominal distension and pain. The
IBS symptom of alternating constipation and diarrhea is common in a
Liver/Spleen disharmony. Stress, frustration, and anger aggravate the
condition. Xiao Yao Wan is a very commonly used classical formula for
Liver/Spleen disharmony, but does need to be modified in most IBS cases.
Tong Xie Yao Fang is another classical formula used for Liver/Spleen
disharmony and is the best choice when diarrhea is prevalent.
Acupuncture treatment will focus on soothing the Liver and nourishing
the Spleen.
Damp-Heat in the Large Intestine
Abdominal pain and diarrhea with a sense of urgency are key symptoms
indicating damp-heat in the Large Intestine. The diarrhea is commonly
yellow and explosive with a strong odor and a sensation of burning. This
heat indicates that there may be a low-grade infection, although this
type of chronic infection may not show up on lab tests. In addition,
there may be a feeling of heaviness of the body and limbs and stuffiness
in the chest. Acupuncture is used to clear heat and eliminate dampness
and a commonly used classical formula is Ge Gen Huang Qin Huang Lian
Tang.
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.
Research on IBS & Chinese Herbs
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. Only these patients had
maintained improvement on a follow-up consultation 14 weeks after
completing the treatment. 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. According to the principles of Chinese medicine,
each patient must be treated as an individual. Optimal results will be
obtained with both herbs and acupuncture when specific treatments are
customized for each patient.
Antonia Balfour is an acupuncturist and herbalist practicing in
Pacific Palisades, California. For more information, please visit
http://www.balfourhealing.com.
References: Beers, Mark & Berkow, Robert (editors). The Merck Manual of
Diagnosis and Therapy, 17th ed.. Merck Research Laboratories, Whitehouse
Station, N.J. 1999. Bensoussan A, Talley NJ, Hing M, Menzies R, Guo A,
Ngu M. Treatment of irritable bowel syndrome with Chinese herbal
medicine. JAMA 1998; 280(18): 1585-1589. Bensky, Dan & Barolet, Randall.
Chinese Herbal Medicine Formula & Strategies, Eastland Press, Inc.,
Seattle, Washington 1990. Kaptchuk, Ted. The Web That Has No Weaver.
Congdon and Weed, Chicago, Illinois 1983. Maciocia, Giovanni. The
Foundations of Chinese Medicine, Churchill Livingstone, New York 1989.
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