Irritable Bowel Syndrome (IBS) and Oriental Medicine
Irritable Bowel Syndrome (IBS), also known as spastic colitis, is the most frequent gastrointestinal (GI) disorder and accounts of 30 -50% of all referrals to gastroenterologists. In 10-20% of European and American populations it starts in late teens to early twenties occurring more often in women.
IBS is not classified as a disease, but as a syndrome. It is considered a functional GI disorder characterized by a variable combination of chronic and recurrent intestinal symptoms that are not explained by structural or biochemical abnormalities.
Symptoms may occur alone or in combination: abdominal pain or discomfort with altered bowel function; abnormal frequency of bowel movements (BM); typically diarrhea, constipation or both; flatulence, bloating, loss of appetite, nausea, increased mucous production, painful BMs. Cramping, intermittent, lower abdominal pain does not usually occur at night nor interfere with sleep and most symptoms are commonly relieved by defecation.
Additional non-bowel symptoms may include heartburn, chest pain, headaches, fatigue, muscle pain, urologic dysfunction and gynecological symptoms, and often coincide with chronic fatigue syndrome. There is a Mind-Gut interaction where anxiety and/or depression frequently accompany IBS symptoms in varying degrees.
The cause of IBS is not clear. It is felt to be a “dysregulation” of intestinal motor and sensory functions of central nervous system (CNS) origin – thus the psychogenic component. The gut produces 95% of serotonin in the body. If the gut is not functioning optimally this affects mood, thought processes and clarity of mind. There is strong evidence for disruption of balance between non-pathogenic flora and the immune system, while GI infections treated by antibiotics result in a higher chance of acquiring IBS.
Diagnosis follows the Rome III Criteria, which includes abdominal pain for at least three days per month for three months and is characterized by two out of the three following symptoms: pain relieved with a BM; change in frequency of BM; and change in the consistency of BM.
Other causes should be ruled out such as lactose intolerance, drug-induced diarrhea, parasites, food sensitivity (may depend on combination) and food allergies.
Medications include the possible use of tricyclic antidepressants and symptomatic treatment for spasms, constipation and diarrhea. Antibiotics are often improperly prescribed because diarrhea is confused with infection. This leads to other gut problems such as poor gut flora.
Lifestyle: Eliminate offending foods such as common allergens: wheat, dairy, corn and soy. Avoid gas-producing and diarrhea-producing foods: beans, fermentable carbs, sweeteners, hydrogenated fats, brussel sprouts, cabbage, cauliflower, raw onions, grapes, plums, raisins, coffee, garlic, red wine and beer. Increase dietary fiber from non-wheat plant sources for constipation and foods that promote healthy flora in the gut such as beet fiber.
TRADITIONAL CHINESE MEDICINE (TCM) cannot be simplified without losing its essence. It seeks to find and understand the cause. TCM’s advantage in treating functional disease is holism and emphasis on various exterior functional activities of the human body.
TCM can’t live without the Spleen (SP); biomedicine does not consider its importance. In TCM the SP and Stomach (ST) energetic systems are paired. Together they receive food, assimilate it and send it to the rest of the organs and the body to be further processed. The SP ascends energetically while the ST descends. SP dysfunction may result in diarrhea, while ST dysfunction may result in nausea or vomiting.
The Small Intestine (SI) separates pure substances from the un-pure. It has the ability to absorb and distribute nutrients. There are few specific SI syndromes and SI qi deficiency can result in chronic diarrhea. Most SI diseases are referred to as SP problems. The Large Intestine (LI) has the ability to eliminate waste and its dysfunction is constipation.
Causes of IBS in TCM include: irregular diet; emotional stress leading to qi stagnation and affecting the SP and ST; SP deficiency causing anxiety, depression and sleep disturbances; Qi, Blood, Yin or Yang deficiency after chronic disease or after delivery; or overuse of laxatives or purging supplements.
Differentiation follows the basic presentations such as diarrhea-predominant IBS, constipation-predominant IBS with abdominal pain and flatulence, abdominal pain-predominant and alternating between diarrhea and constipation. Subcategories go into further detail and include but are not limited to:
- Excess presenting with abdominal distension and/or pain, red face, scanty and/or red urine, dry smelly mouth; may occur in heavier kids with less BMs due to lack of exercise.
- Deficiency in older patients and weaker constitutions with diminished Yin essence from over-consumption of spicy food and irregular toilet habits. There may be weakness, no power to pass stool, might not be dry, may even be soft; sweaty, pale complexion, shortness of breath and/or fatigue. This is also common in women after giving birth due to blood loss.
- Cold, in chronic conditions and older patients. Stools may not be dry, but difficult to pass or the patient may have no power to pass stool and present with a sallow or pale complexion, cold in the four limbs and lower abdomen and an aversion to cold with clear urine.
Acupuncture and Herbs seek to alleviate symptoms, address the cause and restore balance to the entire person by being highly modifiable based on patient presentation. Some acupuncture points are near areas of discomfort while others are found on distal aspects of the body. Herbs are a way to safely treat the body internally.
Nutritional considerations follow an energetic standpoint that is synonymous with the TCM diagnosis. Foods are recommended that nourish and balance the body without aggravating the gut.
Both Western and Eastern medicine agree it is necessary to address the whole body to alleviate the IBS presentation. After being diagnosed it is imperative that consistent lifestyle changes are made to maintain and prevent reoccurrence of symptoms.