By Tai Lahans, DAOM, M.ed., L.Ac.
Irritable Bowel Syndrome - IBS
Irritable bowel syndrome is a gut motility disorder that involves the gastrointestinal tract and creates symptoms in especially the lower gastrointestinal tract. It results in altered bowel habits, abdominal pain, and gas all in the absence of organic pathology.
The differentiation of IBS, colitis, and Crohn’s disease is sometimes not clearly defined. The latest analysis of IBS within the parameters of conventional medicine has arrived at four different types of IBS, as differentiated from colitis and Crohn’s Disease. The four types are:
- alternating diarrhea and constipation
- diarrhea predominant
- constipation predominant
- upper abdominal bloating and discomfort
No anatomical cause is known. It is thought that emotional factors, diet, pharmaceutical drugs, or hormones may aggravate a heightened sensitivity to gastrointestinal motility. The bowel appears to be hyperactive to ingestion of food, to intra-luminal gas, and to parasympathomimetic drugs.
Holistically, IBS is thought to be a disorder of synergistic nature that involves a series of triggers. These include food sensitivities, bowel flora imbalance, and emotional stress. Conventional medical providers treat IBS with spasmolytics, anxiolytics, and antidepressants. They see this disease as a psychosomatic disorder. However, treatment with psychotropic drugs produces very little improvement. No higher levels of anxiety have been found in patients with IBS than in those who suffer from other gut diseases causing similar symptoms.
Symptoms:
- abdominal pain, dull aching discomfort in the left lower quadrant
- abdominal pain and discomfort after meals
- abdominal pain relieved by defecation and flatus
- abdominal pain aggravated by coarse raw foods
- abdominal pain aggravated by stress, anxiety, emotional lability
- disturbed stools with altered frequency and/or constipation alternating with diarrhea
- altered stool form
- altered passage of stool with straining, urgency, incomplete evacuation
- mucus in the stool
- abdominal distention
- distention after meals
- sometimes dyspepsia, nausea, vomiting
IBS affects 1 in 7 people and accounts for 50% of all gastrointestinal outpatient referrals. It is the second most common cause of lost workdays. Twice as many women are afflicted with IBS than are men. The predominant age of onset of IBS is the late 20s.
Risk factors include other family members with IBS implying perhaps a familial syndrome of certain food allergies. Also a history of childhood sexual abuse or sexual or domestic abuse in women is considered a risk factor for IBS. These risk factors from conventional medicine are emblematic of the mind/body connection so elegantly explained in Chinese medicine. The organic nature of the emotions is part of the basic theory of Chinese medicine.
The TCM View
The spleen/pancreas is the center of the body in that it is responsible for the nourishment of qi and blood supplying all of the organs and functions. On the emotional side, the spleen has to do with one’s ability to parent oneself. Women are at higher risk for IBS because the relationship of the spleen to the absorption of nutrition, the production of blood ( menstruation and reproduction ), and care-giving all make women at greater risk for diseases of spleen deficiency. The bowel wall and the absorption that occurs across it is the spleen’s venue. Digestive symptoms that happen below the navel are attributed to the spleen. Symptoms that occur above the navel are considered due to a stomach disharmony.
The liver axis of Chinese medicine is also part of the pathology of IBS. IBS is not a term of Chinese medicine but ” liver invading spleen “ is the internal pattern under which IBS is most commonly placed. Another term for this pattern of abnormal qi flow is
“ transverse rebellion “. A transverse rebellion is most often caused by emotional constraint or distress. The liver is especially susceptible to constraint or qi depression, and this knotting of emotions carries a price. When the spleen/pancreas function is weak the knotted liver qi can “ invade “ or move transversely instead of in its normal direction. The spleen/pancreas is the most common recipient of this abnormal flow and the result is lower abdominal symptoms like interrupted stools, pain, and changes in stool.
When diagnosing IBS many different conditions or diseases have to be ruled out. In fact, IBS is often a diagnosis of exclusion. Those things that need to be ruled out include:
- food allergies
- celiac sprue
- diverticulitis
- lactose intolerance
- parasites
- colon cancer
- pancreatic insufficiency
- hypothyroidism
The key to diagnosis is effective history taking and the patient must be very accurate in giving this history and describing symptoms and when they occur. Diagnosis is based upon characteristic bowel patterns, time and character of pain, physical exam, routine diagnostic procedures that work to rule out other diseases.
Conventional medicine is not always successful in treating IBS instructing patients to eliminate foods that increase gas and fiber, avoid large meals and spicy fried fatty foods and milk products. Anticholinergic agents, tranquilizers, and antidepressants are also used.
Holistic treatment protocols include eliminating aggravating factors like sugar, caffeine, gluten ( wheat, oats, barley, rye ), and avoiding foods to which one is allergic ( usually wheat, corn, and milk ). Healing the GI mucosa is part of the strategy of holistic treatment and Chinese medicine. Glutamine at 500mg daily, cabbage juice, and quercitin all help to heal the mucosal lining of the gut. There are Chinese herbal formulas that help in this process, as well, and eliminating those foods that cause inflammation or to which one has been found to be allergic is very important.
Some of the herbal formulas used include Tong Xie Yao Tang, Wen Pi Tang, Xiang Sha Liu Jun Zi Tang, or possibly Si Shen Tang. Each of these traditional formulas can be used in specific patterns that conventional medicine calls IBS. It is important to be under the care of a practitioner of Chinese medicine so as to be treated for the specific pattern diagnosis in Chinese medicine. Acupuncture is especially helpful in reestablishing the proper qi flows in the abdomen. It can help treat the urgency and pain associated with IBS. When coupled with herbal medicine to treat the underlying deficiencies, acupuncture and the whole system of Chinese medicine is very successful in treating IBS.
Antispasmodics can be used prior to meals in order to inhibit GI smoothe muscle action. Three common antispasmodics are peppermint oil in enteric coated caps, magnesium 200mg daily, and chamomile tea. Increasing fiber with flax meal, psyllium powder, or fenugreek seed crushed and made into a mucilaginous tea also help to calm the bowel wall while healing is taking place. Powdered slippery elm bark is also very helpful. If you would like to purchase any of these products you can call us at the clinic at 828.254.4405.
Decreasing stress through yoga, biofeedback, meditation, and inner work is a valuable means for learning to live within the body rather than from the head up. When living connected to one’s body it becomes more obvious what things one is eating or doing are helping and which are hindering. This knowledge helps us to change our behavior or orientation in life to one that works for us and supports our ability to truly nourish ourselves in every way.
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