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Expert Advice-Treatment of Irritable Bowel Syndrome in Traditional Chinese Medicine(TCM):

Irritable Bowel Syndrome and Chinese Medicine

At least fifteen percent of the U.S. population is affected by irritable bowel syndrome. It is a very common cause of chronic abdominal and pelvic pain in women. Irritable bowel syndrome is a term used in all cases of abdominal pain with alternation of diarrhea and constipation for which no structural abnormality can be found. Different names such as irritable colon, unstable colon, spastic colon or nervous colon are given to irritable bowel syndrome. Because irritable bowel syndrome is not an inflammatory process, the names of mucous colitis or nervous colitis for irritable bowel syndrome are not appropriate.

Three typical symptoms are associated with irritable bowel syndrome: abdominal pain, constipation, and diarrhea. Irritable bowel syndrome is a disorder of the motility of the entire gastrointestinal tract. Irritable bowel syndrome is closely related to intestinal contractions. There are two types of intestinal contractions: segmenting contractions and propulsive contractions. Segmenting contractions keep waste products from moving down toward the rectum and anus, while propulsive contractions force the contents forward. Constipation results from excessive segmenting contractions, while diarrhea results from excessive propulsive contractions. In irritable bowel syndrome, the gastrointestinal tract is very sensitive to many stimuli such as emotional stress, anxiety, depression, diet, alcohol, drugs, and hormones. The treatment of irritable bowel syndrome by conventional medicine can be a distressing and frustrating experience for both patients and doctors. Traditional Chinese medicine can provide an effective alternative approach to treating this syndrome, which is seen as a functional disorder related to emotions and diet.

Irritable Bowel Syndrome in Chinese Medicine
A variety of names are given to both diarrhea and constipation in Chinese medicine. Some names are associated with dysfunction of particular organs, such as Stomach diarrhea, Spleen diarrhea, Large Intestine diarrhea, or Kidney diarrhea. Some names are associated with the cause of the problem, such as food diarrhea, Chi diarrhea, Cold constipation, Heat constipation, Chi constipation, Excess constipation, or Deficiency constipation. From the earliest classics such as the Yellow Emperorís Classic of Internal Medicine, and the Classic of Difficulties, both of which were written more than two thousand years ago, to modern medical literature, constipation and diarrhea are seen as conditions which are effectively treated by traditional Chinese medicine. In the traditional medical literature, irritable bowel syndrome is not classified as a disease, per se. The specific symptoms that are presented by the patient are differentiated into a particular pattern (e.g. Spleen diarrhea, Cold constipation, etc.) and treated accordingly. This provides a practical and effective way to address this syndrome. So far, in this country, I have treated over one hundred cases of irritable bowel syndrome with acupuncture and herbal medicine. My patients have had excellent results from these ancient healing techniques.

Patterns and Treatments of Irritable Bowel Syndrome
In the following section, five patterns of irritable bowel syndrome are differentiated according to Chinese medical theory. The name of each pattern is based either on the cause of the problem (example: Chi Stagnation), or the internal organs affected (example: Spleen and Liver Disharmony). Diagnosis is based on the individualís symptoms, specifically the nature of his or her abdominal pain, diarrhea, and constipation, plus the readings of the tongue and pulse. Clinical manifestations, commonly-used herbs and herbal formulas for each pattern are discussed.

Disharmony of Spleen and Liver. This disharmony pattern originates in emotional stress and inappropriate diet. Clinical manifestations include: diarrhea; abdominal pain; constipation; chest congestion; hypochondriac (under the rib cage) pain; noisy belching of gas from the stomach; poor appetite; episodes of diarrhea brought on by anger or emotional stress; thin, mucous tongue coating or pale-red tongue; and a wiry pulse. An essential formula, Tong Xie Yao Fang, which includes ledebouriella (fang feng), poria (bai shao), tangerine peel (chen pi), and atractylodes (bai zhu) is the basic formula for this pattern.

Deficiency of Spleen and Kidney Yang. Constitutional weakness, general weakness from aging, chronic illness, or slow recovery from surgery or childbearing are the principal causes of this pattern. Clinical manifestations include: diarrhea; abdominal pain that seems to move around; constipation; relief of pain with bowel movements; cold limbs; sore knees and back; pale tongue; and a deep, thin pulse. Time-tested formulas such as Si Shen Wan, which includes psoralea (bu gu zhi), evodia (wu zhu yu), nutmeg (rou dou kou), and schizandra (wu wei zi); and Fu Zi Li Zhong Tang, which includes aconite (fu zi), ginseng (ren shen), ginger (gan jiang), licorice (gan cao), and atractylodes (bai zhu) are the basic formulas for this pattern.

Spleen Yang Defiency. The habitual consumption of cold foods, chronic indigestion, or long-standing exposure to cold temperatures are considered to be the origins of this pattern. Clinical manifestations include: watery diarrhea; abdominal pain that is relieved by heat; difficult bowel movements; rumbling noise in the intestines with abdominal pain; chest congestion; poor appetite; aversion to cold; cold limbs; tongue coated with whitish mucus; and a slow, "soggy" pulse. Formulas such as GI Strength (Xiang Sha Liu Jun Zi Tang), which includes ginseng (ren shen), atractylodis (bai zhu), poria (fu ling), licorice (gan cao), Tangerine peel (chen pi), pinella (ban xia), amomum (sha ren), and saussurea (mu xiang); and Wen Pi Tang, which includes aconite (fu zi), ginger (gan jiang), codonopsis (dan shen), rhubarb (dai huang), and licorice (gan cao), are classical herbal combinations for this pattern.

Damp Heat in the Middle Burner. The most common precipitators of this pattern are the habitual consumption of hot, spicy, or greasy foods, and/or chronic infections. Clinical manifestations include: diarrhea; abdominal pain with bloating; constipation with dry, hard stools; urgent diarrhea; diarrhea with abdominal pain; burning sensation of the anus; darker, foul-smelling stools and urine; dry mouth with bad breath; yellow tongue coating; and a rapid pulse that feels "soggy" or "slippery." Formulas such as Ge Gan Qin Lian Tang, which includes kudzu (ge gan), licorice (gan cao), skullcap (huang qin), and coptis (huang lian); and Ma Zi Ren Wan, which includes cannabis (ma zi ren), red peony (shao yao), aurantium (zhi shi), rhubarb (dai huang), magnolia (hou bu), and armenica (xing ren) are commonly-used prescriptions for this condition.

Chi Stagnation and Blood Stasis. Emotional trauma or internal injury are considered to be the origins of this pattern. Clinical manifestations include: diarrhea; sharp abdominal pains that seem to move around; constipation; anxiety; chest congestion; aversion to pressure in hypochondriac areas; sharp hypochondriac pain; purple-appearing tongue; and a choppy pulse. Ge Xia Zhu Yu Tang, which includes bat dung ( wu ling zhi), angelica (dang gui), cnidium (chuan qiong), persica seed (tao ren), peony bark (dan pi), red peony (chi shao), lindera (wu yao), corydalis (yan hu), licorice (gan cao), cyperus (xiang fu), safflower (hong hua), and aurantium (zhi ke) is a leading herbal formula for this combined pattern of irritable bowel syndrome.

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