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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.

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Modern Feet

From bare foot times when we relied on agility and endurance for survival, to the present day when our command of language is what makes or breaks us, there have been few times in history during which our feet – or someone else’s – did not carry us.

High Heels

Foot Photo by Matilde Aamodt

Even though our feet are normally reliable and loyal we have a knack for ignoring and even abusing them. The brutal practice of foot binding, for example, created a deformity that certain cultures viewed as a mark of beauty. While foot binding died off with a refusal to tolerate the lifelong disabilities it caused, today’s high heels with their narrow toe boxes and sharp points might be considered just as punishing.

Consider this:  for every two inches of heel height the ankle must rotate by ~23.5 degrees, while it undergoes a 45-degree change in four-inch heels.

Feet are the foundation from which we move; problems in the feet can lead to compensatory patterns in the rest of the body. Structural changes can occur in the knee, hip or spine, and head placement and gait may be altered. This commonly results in ankle, knee, hip, low back and even neck pain. In heeled shoes, structures in the calf like the soleus and achilles shorten, the calcaneus bone lifts and the talonavicular (TN) joint drops. Over time, the mid-foot may even collapse. Ouch!

We began wearing shoes as necessary protection, but over time most shoes have decreased our proprioceptive awareness and changed the way we move – and not for the better. Technology provides arch support, motion control, attractive design and cushioning. Running shoes are purchased as slightly larger shoes assuming that the foot will eventually deform and fit them. Flip-flops allow us more freedom, but the foot tightens up in dorsiflexion and then slaps the ground as we move along and for some this lead to imbalance.

Common Foot Conditions Resulting From Modern Footwear

    • Plantar fasciitis
    • Bunions
    • Achilles tendonitis
    • Ankle sprains
    • Bone spurs
    • Excess pronation or supination

… all leading to compensation in the kinetic chain

Oriental medicine (OM) includes acupuncture and bodywork – including acupressure and reflexology – in its view of the foot as one of many microsystems representative of the rest of the body. It prevents and treats diseases by stimulating points (zones) on the foot to regulate zang-fu (yin-yang) organ function and soothe qi and blood in the channels.

There are 33 points found on the six basic meridians of each foot. Perhaps not-so-coincidentally there are 33 joints in each foot. All acupuncture/acupressure points on the feet can be used to treat local conditions, while many of them are the most powerful points for treating conditions affecting organ systems or pain in opposite limbs. The most distal (farthest away) points on a channel affect emotions, regulate temperature, strengthen the body and can relieve heaviness in the limbs and joint pain. The feet in particular can help with head and face conditions.

In the cortical homunculus, a sensory map, our brain views the feet, hands and mouth as being proportionally larger sense organs than the rest of the body. But allopathic medicine tends to use orthotics such as boots, arch supports, cortisone injections and surgery – all which serve to numb or restrict movement – as answers to every problem.

With so much potential, it is a wonder that we have come so far in desensitizing our feet.

There has been a recent movement to return to our barefoot nature with the introduction of the Vibram 5-Fingers and similar minimal concept shoes. More research and education about the benefits of going barefoot are giving us a greater understanding of how having healthy, functional feet affects the rest of our bodies.

When I attended the 2012 SCW Dallas Mania in August, I found Vibram Five Fingers fitness advisor Stacey Lei Krauss to be the highlight. She brought together years of experience and training working with and improving foot function. Her knowledge base and presentation skills made for informative and enjoyable seminars.

Krauss says that bare feet tend to have improved blood circulation and nerve reflex action, and that going barefoot or minimal will “wake up your feet.” Because “minimal” does not imply extra cushioning or support, Krauss suggests going barefoot on concrete first since we are less apt to stomp or run quickly over a hard surface. There is more reaction or proprioceptive awareness required of the feet on soft uneven surfaces such as sand and grass so these surfaces should be approached over time. Important points to remember for maximizing minimal shoes like Five Fingers as you re-learn how to run include foot strike, compliance (allowing the feet to relax), tempo, and posture.

Kraus offered a few starter protocols for care and strengthening of newly bare feet.

I. Self-Care
The feet house 250 sweat glands and can sweat up to one pint daily! Bacteria live better in your shoes than on a studio floor, so it’s essential that you clean and maintain your feet. Krauss says feet have the same stigma as other “private parts” but we tend to spend more time maintaining those parts than we do our feet. “It’s not enough to splash – wash!”

Self-Massage Sequence Before or after workouts and on non-workout days. ~3 minutes.

  • Apply oil or lotion.
  • Rub each toe, lengthen, split (forward, back and wide), toe fan.
  • Slide fingers between toes and move forward, back, sides and figure eights.
  • Thumbs on transverse arch (landing pad). Try to feel each metatarsal head.
  • Rub an elbow or knuckle along the arch (and plantar fascia).
  • Knuckle thump around heel.
  • With your thumb and first two fingers rub the achilles tendon up, down, across and around.
  • Use both hands to friction-rub  the ankle in a twisting motion.

I would recommend soaking feet in warm soapy water, or a warm herbal soak, for 10 minutes before following the sequence. Make sure water is deep enough to reach your ankle bones.

General Foot Strengthening and Lengthening  
Do this protocol for a minimum of two weeks to one month. Can be done pre- and post-run or workouts. Do each exercise a few times.

  • While standing barefoot raise the toes up, spread the toes.
  • With the toes up try thumb taps, pinky taps, back and forth.
  • Eversion (roll the foot out), inversion (roll in).
  • Grip the ground with toes, hold and release.
  • 1 heel up ankle circles.
  • 1 foot up dorsiflex (toes down), plantarflex (toes up). Grip floor with the other foot.
  • Split stance calf stretches – gastrocnemius (straight leg) and soleus (knee slightly bent).

Krauss says to start jogging at about 10 minutes max. Bring your regular running shoes with you and change before the long part of your run. Your feet (and ankles, and calves) will thank you. After reaching 10% of maximum weekly distance progress at no more than a 10% increase at each week. Expect tight calves and achilles complex at first. Always allow time for a foot-specific warm up and cool down.

Starting tempo runs at about 180 beats per minute is recommended for beginners. This sounds fast but it actually decreases the load and distance between each step.

Having done post-race massage for runners, I have met runners who used their minimal shoes for the first time during a race. A three-mile run in new minimalist shoes can create major tightness and discomfort post-run for the uninitiated. Remember you are waking up muscles and joints that have been lulled to sleep by restrictive and cushiony footwear for a long time. It’s going to take a while to re-educate these structures, but your patience will certainly pay off in less ankle, knee, hip and back pain overall.

Consider the information I have provided and continue to learn by utilizing good resources such as Vibrams’ website.

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