Modern Western medicine According to modern Western medicine, irritable bowel syndrome (IBS, also known as spastic colon, functional or nervous diarrhoea, colon or vegetative neurosis, or mucus colitis), is an non-inflammatory bowel disease.
Aetiology The causes of IBS are not entirely clear. Apart from motor-secretory activity of the colon due to excessive parasympathetic stimulation, there is no evidence that any structural defects of the bowel are associated with IBS. However a variety of factors have been identified as possible causes: ¥ psychological such as family, marital or work problems, tension and stress. ¥ irregular diet such as a low-fibre diet. ¥ food allergies such as intolerance to wheat, corn, dairy products, citrus fruit, tea, coffee, apples, pears and salads.
Incidence IBS is the most common gastrointestinal disorder reported to GPs in Western industrialised societies; 30-50 % of all patients referred to gastroenterologists suffer from the condition. However it is almost impossible to determine the exact number of sufferers as many do not seek medical attention. Some estimates suggest that approximately 15% of the population have suffered from IBS, and that there are twice as many women sufferers (in the 20-40 age group) as men, although it is more likely that the number is equal, with men not reporting the symptoms as often.
Clinical manifestations Characteristic symptoms of IBS include any of the following: ¥ intermittent alternation of constipation and diarrhoea which is frequently related to mood changes. ¥ cramping pain in the lower abdomen which may be focused in the left or right iliac fossa. ¥ location of pain may vary from site to site and attacks tend to be episodic and may be severe (spastic). ¥ hypersecretion of colonic mucus (mucus in the stools). ¥ more frequent bowel movements accompanied by pain. ¥ sometimes relief of pain with bowel movements. ¥ pain worse for eating. ¥ flatulence and distention. ¥ nausea and anorexia. ¥ stools are often small and round and may have the appearance of rabbit droppings or be thin or ribbonlike or cigar-shaped. ¥ varying degrees of anxiety, depression, hostile feelings, fatigue and sleep disturbances which may also worsen the condition.
Diagnosis Diagnosis can be quite difficult and is mainly made by excluding other conditions such as acute bowel infection, bowel parasites (tapeworms, threadworms, amoeba etc.), overgrowth of bowel flora, spinal maladjustment, candidiasis, excessive use of laxatives etc. A full clinical picture with a detailed history and physical examination are crucial for accurate diagnosis. The muscular contraction in the colon and ileum is found to be uncoordinated and spasmodic, althoughthere is no apparent reason which can be detected by X-rays or endoscope. In other words, in contrast to other severe lower gastrointestinal disorders, there is no abnormality in intestinal structure and people with this disease neither lose weight nor become malnourished. Biomedical investigation Colonoscopy, sigmoidoscopy, barium enema etc. may be performed if the above mentioned conditions are suspected. Biomedical treatment ¥ Diet regimen: high fibre diet, rich in cooked vegetables; avoidance of aggravating foods and any food sensitivities. ¥ Psychotherapy: stress reduction techniques such as biofeedback, counselling or hypnosis. ¥ Medication: bulking agents and adsorbents such as methyllcellulose to regulate the consistency of the bowel contents; antispasmodics such as mebeverine or
anticholinergics such as dicyclomine; codeine or its derivatives for the treatment of diarrhoea; tricyclic antidepressants such as amitriptyline. Note: tricyclic antidepressants in overdose can produce severe side-effects such as coma, fits and dangerously abnormal heart rhythms. Traditional Oriental Medicine According to traditional Oriental medicine, IBS is caused by a combination of the following:
1. Long standing bottled-up emotions such as anger, hatred, resentment, grudges, irritability, frustration, stress, tension, indignation, bitterness, hostility, unhappiness, depression and general fluctuations in mental state will particularly injure the Liver qi. The Liver's free-going function is especially important in harmonising the emotions and digestion (assisting the Spleen's function of transforming food), and stagnant Liver qi will readily invade the Stomach, Spleen and intestines causing abdominal distention and pain (which may be worse around menstruation), constipation or diarrhoea or alteration of constipation and diarrhoea, flatulence, sour belching, nausea and vomiting and tiredness. Furthermore the Liver houses the ethereal soul (hun) and stagnation of Liver qi will tend to consume the blood and yin and distress the ethereal soul resulting in mental confusion, and lack of direction and resoluteness.
2. Sustained periods of pensiveness, melancholy, worry, brooding, overthinking, excessive mental work or studying, and thinking intensely about life rather then living it, will knot the qi and particularly weaken the Spleen giving rise to tiredness, loss of appetite and loose stools. The Spleen is the residence of thought (yi) and weakness of the Spleen will affect this function of the Spleen and result in slack concentration, poor memory and difficulty in focusing.
3. Irregular eating habits, for example eating too little (especially a protein-deficient diet) or following a strict dietary regimen, or excessive eating, or over-consumption of damp and cold food such as dairy products, raw vegetables and fruits, will weaken and impair the function of the Spleen resulting in poor appetite, bad digestion, lethargy, abdominal distention and loose stools. Furthermore, overconsumption of poor quality food due to farming techniques (pesticides and herbicides), food processing methods (canning, pre-cooking, freezing etc.) and cooking techniques (e.g. microwaves) will definitely further weaken the Spleen and cause deterioration in overall health.
4. Overuse of antibiotics in the treatment of various respiratory and infectious diseases. Most antibiotics are cold and damp in nature and lead to depletion of Spleen qi and accumulation of dampness in the Spleen and Stomach, consequently affecting the digestive system and resulting in diarrhoea, candida infections and stomach upsets as well as tiredness, weakness, poor weight gain etc. They also weaken the immune system and result in depletion of the Lung and Kidneys.
5. As well as food pollution, air may also be polluted. City
dwellers who breathe in stale air heavily contaminated with car fumes are more prone to Lung diseases. This will cause clogging of the Lung and result in Lung qi deficiency manifesting as cough, propensity to catch colds and especially tiredness. As the Lung rules the descending of qi and is internally-externally related to the Large Intestine, this will eventually affect the bowel movement and cause constipation. The relationship between the Lung and Large Intestine also explains how additional emotions such as sadness, grief and loss which dissolve the qi and distress the corporeal soul (po, the mental-emotional aspect of the Lung), will also affect bowel movement.
6. The Kidneys are the root of pre-heaven essence and control thre two lower orifices. Deficiency of Kidney qi and/or Kidney yang may result in chronic diarrhoea, physical weakness, tiredness after bowel movements and a liking for having the abdomen massaged. Furthermore the Kidneys house the will (zhi), a person's inner drive, stability and integrity, and Kidney deficiency may give rise to symptoms such as mental depression, anxiety, insecurity, nervousness, lack of grounding and a feeling of 'butterflies' in the abdomen. Differentiation of Patterns From the above it is very clear that IBS corresponds to a mixed pattern of excess and deficiency. The primary excess pattern is the stagnation of Liver qi which invades the Spleen, Stomach and intestines, and the primary deficiency pattern is the deficiency of Spleen and Stomach qi. If the weakness of the Spleen and Stomach is more pronounced, loose stools, slight abdominal distention, tiredness, pale tongue and empty pulse will predominate and there will usually be signs of the kind of emotional states described above as well as dietary irregularity. If stagnation of Liver qi invading the Spleen, Stomach and intestines is more evident, there will be more severe abdominal distention, and nausea, vomiting, dry and bitty and sometimes loose stools, a darkish or purplish tongue or one that is red only on the sides, and a wiry pulse as well as signs of long-standing bottled-up emotional states. The secondary deficiency pattern affects the Lung and/ or Kidneys. This would manifest as a history of diarrhoea and/or constipation since childhood, constant weariness, and physical, emotional and mental fragility. The Kidney and Lung pulses will often be deep and weak. Traditional Oriental Medical treatment Acupuncture and moxibustion For stagnation of Liver qi which invades the Spleen, Stomach and intestines use the following points with even or reducing needling method depending on severity of the case: Taichong LIV-3 with Hegu L.I.-4 Neiguan P-6 with Gongsun SP-4 Yanglingquan GB-34
Zhangmen LIV-13 Qimen LIV-14 To root the ethereal soul and settle the emotions add: Shenting DU-24 Benshen GB-13 Hunmen BL-47 Geshu BL-17 For deficiency of Spleen and Stomach qi use the following points with even or tonifying needling method or moxibustion depending on the condition: Zusanli ST-36 Shangjuxu ST-37 Xiajuxu ST-39 Zhongwan REN-12 Shangwan REN-13 Xiawan REN-10 Pishu BL-20 Weishu BL-21 Dachangshu BL-25 Jizhong DU-6 Sanyinjiao SP-6 Taibai SP-3 To strengthen the Spleen's function of housing the thought add: Tianshu ST-25 and Yishe BL-49. To tonify the Kidneys and Lung, and strengthen the will and the corporeal soul add: Huangshu KID-16 Gaohuangshu BL-43 Qihai REN-6 Yindu KID-19 Zhishi BL-52 Shenshu BL-23 Guanyuan REN-4 Feishu BL-13 Pohu BL-42 Traditional Oriental Medication Prescription Modified Spread the Liver and regulate the Spleen Decoction (Shu Gan Li Pi Tang Jia Jian) from New Explanations of Medical Formulas (Yi Fang Xin Jie) by Ma You Du, 1980 AD, and Formula for Painful Diarrhoea (Tong Xie Yao Fang) from Collected Treatises of (Zhang) Jing Yue (Ding Yue Quan Shu) by (Zhang) Jing Jue (Jie Bing), 1624 AD. Ingredients ¥ Chai Hu (Radix Bupleuri) 9-12 g to relive depression of Liver qi. ¥ Xiang Fu (Rhizoma Cyperi Rotundi) 9-12 g to soothe the Liver and regulate the circulation of qi, and to relieve pain and normalise menstruation. ¥ Qing Pi (Pericarpium Citri Reticulatae Viride) 3-6g to facilitate the flow of Liver qi and remove stagnation of qi and blood.
¥ Fang Feng (Radix Ledebouriellae Sesloidis) 3g to alleviate pain. ¥ Chao Bai Zhu (Parched Rhizoma Atractylodis Macrocephalae) 9-12 g to stop diarrhoea, reinforce the Spleen and replenish qi. ¥ Chao Bai Shao (Parched Radix Paeoniae Lactiflorae) 9-15g to soothe the Liver and alleviate pain. ¥ Chao Chen Pi (Parched Pericarpium Citri Reticulatae) 6-9 g to promote circulation of qi and aid digestion. ¥ Shan Yao (Radix Dioscoreae Oppositae) 6-9g to strengthen the Spleen, tonify the Lung and stabilise the essence. ¥ • Zhi Gan Cao (Radix Glycyrrhizae Praeparatae) 6g to tonify the Stomach and Spleen, replenish the qi and relieve spasm and pain.
To reinforce the function of the Spleen and calm the mind add: ¥ Fu Shen (Poriae Cocos Pararadicis Sclerotium) 9g To relieve depression of the Liver add: ¥ Mu Hu Die (Semen Oroxyli Indici) 6-9g to facilitate the flow of the Liver qi and regulate the function of the Stomach. ¥ Mei Gui Hua (Flos Rosae Rugosae) 6-9g to normalise the flow of qi and nourish Liver blood. ¥ Xiang Yuan (Fructus Citri) 4-6g regulate the circulation of qi and strengthen the Spleen. ¥ • Yu Jin (Tuber Curcumae) 6g-to promote the
circulation of qi and relieve depression. To nourish the Heart and calm the mind add: ¥ Long Yan Rou (Arillus Euphoriae Longanae) 9g to tonify the Heart and calm the mind, nourish the blood and benefit the Spleen. ¥ Lian Zi Rou (Semen Nelumbinis Nuciferae) 6g to calm the mind, strengthen the Kidneys and regulate the Stomach. ¥ Yuan Zhi (Radix Polygalae Tenuifoliae) 6g to calm the mind. ¥ Suan Zao Ren (Semen Ziziphi Spinosae) 6g to calm the mind and benefit the Liver. ¥ • Bai Zi Ren (Semen Biotae Orientalis) 9g to nourish the
Heart, calm the mind and moisten the intestines. If Liver qi stagnation has transformed into Liver Fire add: ¥ Zhi Zi (Fructus Gardeniae Jasminoidis) 9-12 g to drain the fire. ¥ • Mu Dan Pi (Cortex Moutan Radicis to remove heat, especially pathogenic heat from the blood, to activate the blood flow and remove blood stagnation.
If stagnation of Liver qi is severe add: ¥ Chuan Lian Zi (Fructus Meliae Toosendan) 6-9g to promote the circulation of qi and alleviate pain. ¥ Wu Yao (Radix Linderae Strychnifoliae) 3g to promote circulation of qi and alleviate pain. ¥ • Bing Lang (Semen Arecae Catechu) 3g to promote
digestion and circulation of qi. For nausea and vomiting add: ¥ Wu Zhu Yu (Fructus Evodiae Rutaecarpae) 3-6g to
soothe the Liver and direct the rebellious qi downward. For severe spastic pain add: ¥ Mu Yao Zi (Semen Entadae Phaseolodes) 9g. If Spleen deficiency is severe add: ¥ Ren Shen (Radix Ginseng) 9-12g to reinforce qi, tonify the Lung and the Spleen and calm the mind. ¥ Sheng Ma (Rhizoma Cimicifugae) 6-9g to raise the sunken yang qi. ¥ • Huang Qi (Radix Astragali) 9-12g to replenish qi and
assist in the ascent of yang. To regulate the Stomach add: ¥ Shan Zha (Fructus Crataegi) 6-9g ¥ Mai Ya (Fructus Hordei Vulgaris Germinantus) 6-9g ¥ Gu Ya (Fructus Oryzae Sativae Germinantus) 6-9g For Kidney deficiency add: ¥ Bu Gu Zhi (Fructus Psoraleae Corylifoliae) 9-12g to invigorate Kidney yang, warm the Spleen and treat diarrhoea. ¥ Du Zhong (Cortex Eucommiae Ulmoidis) 9-12g to tonify the Liver and Kidneys. ¥ Shu Di Huang (Radix Rehmanniae Glutinosae Conquitae) 9-12g to noursih the blood.
Prognosis This disease responds very well to traditional Oriental medical treatment which is probably therefore the medical treatment of choice, taking into consideration the side-effects of modem Western drugs and the fact that there is no effective treatment in most cases by modern Western biomedicine (which will neither relieve the symptoms on a long term basis nor eradicate the disease). Patients should be encouraged to actively and willingly participate in the healing process by re-harmonising their diet, emotions and life-style. Case history Very recently a 20-year old woman, diagnosed with IBS, complained of alternation of more pronounced constipation (like 'sheep droppings') and only occasionally slight diarrhoea, severe distention and pain in the abdomen and lower back which was worse when stressed, lethargy, a heavy sensation in the body, a "muffled" feeling in the head, irritability, anger and resentment due to a long unfruitful former relationship, heavy periods, frequent occipital headaches, a bitter taste in the mouth, halitosis, disinterest, wanting to sleep a lot, dream-disturbed sleep and constant hunger. Her tongue had a yellow greasy coating and was red with red spots at the tip . The pulse on the right side was slippery-wiry, and on the left thready-weak. On further interrogation it was revealed that she was treated with corticosteroids for low blood platelets for a few years, had received antibiotics for a tooth abscess, a TB-immunisation 6 years ago (her left arm is scarred and still keeps blistering), was on the contraceptive pill until recently due to irregular, heavy and prolonged periods, suffered German measles (rubella) at age 7, glandular fever (infectious mononucleosis) at age 15, and chickenpox (varicella) at age 12. The glands in her neck are often painful and swollen and have been treated by antibiotics. This case is very complex. The above clinical manifestation point to Liver qi and Liver Fire invading the Stomach and Intestines, as well as some Heart and Stomach Fire, and Spleen qi and Kidney and Lung yin deficiency. She is being treated with acupuncture and has taken a herbal prescription in line with that described above. The treatment is in progress and her condition is improving. She has very little pain, much less distention and constipation, and emotionally and mentally feels better. As she has been on steroid, antibiotic and vaccination treatment for long periods of time which has obviously changed the nature of her tongue and pulse, and weakened her overall condition, the treatment course will be protracted. Dr Andrew Pagon MB ChB (P.R.China) MBAcC MRCHM has studied traditional Oriental medicine in Denmark, the UK and China since 1987. He graduated in both modern Western and traditional Chinese medicine from Tianjin International University of TCM in 1996 and subsequently obtained the license of a doctor specialising in TCM.