Common Patterns of Disharmony in Irritable Bowel Syndrome
Spleen Qi Deficiency
In TCM the Spleen is considered to be the key organ to regulate digestion. Keep in mind, this is not the same as the Western spleen. Its functions actually have a closer connection to the Western pancreas.
IBS patients with a pattern of Spleen qi deficiency will suffer from fatigue and diarrhea which is worse when they are overexerting themselves. This is often accompanied by abdominal pain which may be relieved by exerting pressure over the painful area. Patients may also have gas and bloating. Hemorrhoids are an additional indication of Spleen qi deficiency.
Acupuncture points are chosen which will help nourish the Spleen qi. There are also specific techniques used in needling that strengthen the body when the patient is deficient.
Another important part of treatment is the Chinese herbal formula. In Chinese herbalism, a group of herbs is combined together to specifically address a person's unique constitution. This is one way in which treatment is very individualized -- a master herbalist treats no two patients with the same combination of herbs.
Most herbalists use a "classical formula" as a foundation. Many classical formulas written up to 2,000 years ago are still commonly used today. Groups of herbs can be added or taken out of classical formulas to customize them for patients.
One classical formula used for Spleen qi deficiency is called Bu Zhong Yi Qi Tang. By adding and subtracting herbs from this formula, it can be individualized to fit the precise needs of the patient.
Spleen Distressed by Dampness
In this pattern, the patient may experience symptoms of Spleen qi deficiency along with a feeling of nausea or heaviness. Bowel movements may feel incomplete, or the patient may even have constipation lined with mucus.
This condition is often caused by eating too much fried or greasy food, but may also be caused by emotional factors such as over-thinking or over-worrying.
Acupuncture points are chosen to nourish the Spleen and eliminate dampness. The classical herbal formula to address this pattern is called Shen Ling Bai Zhu San.
Patients are additionally advised to keep a very clean diet. In Chinese medicine dairy foods and excessive sugar intake create dampness, so these foods should be avoided altogether.
Excess Cold in the Spleen
An excess of cold in the Spleen causes severe pain. The patient may be "doubling over" in pain, feeling as if curling up will somehow offer relief. Here the patient cannot tolerate being touched. This pain may be accompanied by constipation.
Acupuncture is given to warm the Spleen, and the classical formula Da Jian Zhong Tang may be prescribed, although in severe cases of constipation additional herbs need to be added to give a laxative effect.
Spleen and Kidney Yang Deficiency
Yang energy provides warmth to the body and a deficiency of Spleen and Kidney Yang may result in feeling cold or having cold hands and feet. IBS patients with Spleen and Kidney Yang deficiency will have diarrhea first thing in the morning which may contain undigested food particles. Other symptoms include chronic low back pain, low libido, frequent urination, or in severe cases, urinary incontinence.
Acupuncture treatment focuses on building up this deficient Yang energy, and the classical formula Si Shen Wan can be used along with additions and subtractions to suit the exact needs of the patient.
Liver Qi Stagnation
The Chinese Liver is the organ most affected by stress, aggravation, and anger. The Liver is frequently involved in modern disease, most commonly when its qi becomes stagnant or stuck. There may be depression, moodiness, or simply a feeling of being 'wound up'. Women may suffer from irregular or painful periods.
The IBS patient with Liver Qi Stagnation may have pellet shaped stools and distending pain, particularly in the area below the ribs. There may also be nausea, belching, or acid reflux. Symptoms can be triggered or aggravated by stress.
Acupuncture is very effective at restoring the smooth flow of Liver qi, as are movement exercises such as Tai Chi or Qi Gong. The classical formula of choice for the IBS patient with Liver Qi Stagnation is Liu Mo Tang.
Liver/Spleen Disharmony
Disharmony between the Liver and Spleen causes irritability along with abdominal distension and pain. The IBS symptom of alternating constipation and diarrhea is common in a Liver/Spleen disharmony. Stress, frustration, and anger aggravate the condition.
Xiao Yao Wan is a very commonly used classical formula for Liver/Spleen disharmony, but does need to be modified in most IBS cases. Tong Xie Yao Fang is another classical formula used for Liver/Spleen disharmony and is the best choice when diarrhea is prevalent.
Acupuncture treatment will focus on soothing the Liver and nourishing the Spleen.
Damp-Heat in the Large Intestine
Abdominal pain and diarrhea with a sense of urgency are key symptoms indicating damp-heat in the Large Intestine. The diarrhea is commonly yellow and explosive with a strong odor and a sensation of burning. This heat indicates that there may be a low grade infection, although this type of chronic infection may not show up on lab tests. In addition, there may be a feeling of heaviness of the body and limbs and stuffiness in the chest.
Acupuncture is used to clear heat and eliminate dampness and a commonly used classical formula is Ge Gen Huang Qin Huang Lian Tang.
Irritable Bowel Syndrome is clearly a complicated illness in both Western and Chinese medicine. Its many manifestations require very different treatment approaches in Traditional Chinese Medicine. The patterns of disharmony mentioned above may even appear in combination and treatment must be adjusted appropriately. In any severe case of IBS, TCM treatment will be customized for the individual and classical herbal formulas will be modified for the patient.