Irritable Bowel Syndrome: A TCM Perspective
By Toni Balfour, L.Ac.,
Dipl. Ac. & C.H.
Irritable Bowel Syndrome in Western Medicine
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 aren't
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, Traditional Chinese Medicine 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,
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 Irritable Bowel Syndrome 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,
12 of the Internal Organs correspond to the 12 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) shouldn't be equated with the Western organ.
Irritable
Bowel Syndrome 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 is 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 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 Irritable Bowel Syndrome 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.
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. Journal of the American Medical
Association 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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