Januarys blog article no.2!! IBS - Irritable bowel syndrome and TCM approach Irritable bowel syndrome is the commonest functional gastrointestinal disorder affecting almost one quarter of the general population. It may be loosely defined as abdominal pain and disturbed bowel habit with no evidence of organic disease, and has conventionally been a diagnosis of exclusion. However, a positive diagnosis can usually be made on the basis of characteristic symptoms and signs, without the need for extensive investigations. It does not cause inflammation and should not be confused with other disorders, such as ulcerative colitis and Crohn’s disease. IBS causes a great deal of discomfort and distress. It has often been thought to be caused by emotional conflict or stress and seems to be more common in those who have a colon that is more sensitive and reactive than usual, so it responds strongly to stimuli that would not bother most people. In the IBS sufferer, ordinary events such as eating and the presence of abdominal gas or other material in the colon can cause the colon to overreact. Certain foods may trigger spasms in some people. Although there is no especially effective treatment in Western medicine, acupuncture can offer significant improvement. The clinical manifestations of irritable bowel syndrome include: • Abdominal pain, often eased after bowel movements • Looser and more frequent bowel movements • Visible abdominal distention • Feeling of distention • Mucus per rectum • Feeling of incomplete emptying of rectum • Constipation In addition, dyspeptic symptoms are reported by over 90% of patients with irritable bowel syndrome, suggesting an overlap with non-ulcer dyspepsia. Associated non-gastrointestinal symptoms include migraine, flushing, palpitations, tiredness, urinary symptoms and dysmenorrhoea. Symptoms of irritable bowel syndrome are commonly related to emotional factors. In Traditional Chinese Medicine (TCM) there are considered to be seven emotional factors which can cause disease, each of which affects a specific internal organ and has a particular effect on the flow of Qi. The Liver and Spleen may often be affected by emotional factors, resulting in gastrointestinal dysfunction and symptoms consistent with a diagnosis of irritable bowel syndrome. Anger injures the Liver (resulting in stagnation of Liver Qi) and causes Qi to rise up, whilst worry injures the Spleen (impairing its function of transformation and transportation) and causes Qi to stagnate. Sadness can indirectly lead to bowel dysfunction, as it injures the Lungs, which are in TCM terms exteriorly-interiorly related to the Large Intestine. Three basic TCM patterns of disharmony can be differentiated: 1. Excess pattern: stagnation of Qi in the Liver and Intestines 2. Deficiency pattern: Deficiency of Spleen Qi 3. Mixed Deficiency/Excess patterns: i. Liver invading the Spleen - combined pattern of Liver Excess (Stagnation of Liver Qi) and Spleen Deficiency, the Liver may be primarily in excess, actively invading the Spleen and impairing its function, or the Spleen may be primarily deficient, allowing itself to be invaded by the Liver. ii. Deficiency of Lung Qi with stagnation of Qi in the Large Intestine - If the Lung Qi is Deficient, it fails to descend and help the function of the Large Intestine. This results in stagnation of Qi in the Large Intestine. DIFFERENTIATION: Excess Pattern • Spastic abdominal pain, aggravated by pressure • Constipation • Abdominal distention (may be quite marked) • Feeling of incomplete emptying of the rectum Deficiency Pattern • Loss of appetite • Lassitude and tiredness • Abdominal distention after eating • Diarrhoea • Slight abdominal pain, relieved by pressure • Mucus per rectum Mixed Deficiency/Excess Pattern • Symptoms of Excess and Deficiency may occur together or alternately. The predominant symptoms depend on whether the pattern is primarily excess or deficient. For example, constipation may alternate with diarrhoea, but constipation will predominate if the Liver is primarily in excess, and diarrhoea if the Spleen is primarily deficient. Emotional factors play an important role in the pathogenesis of irritable bowel syndrome, with symptoms largely a result of Liver Qi stagnation and/or Spleen Qi Deficiency. The correct selection of acupuncture points in the treatment of this condition depends on identification of the particular TCM pattern of disharmony, determined by analysis of the patient’s symptoms and signs. Education of the patient in understanding the originating factors of the disorder, and helping him or her to change or reduce these, will also assist in relieving the disharmony and lessen the chance of recurrence. IBS is not easy to treat. The preliminary course of treatment is twice a week for one month. Although some patients may subsequently need more than these. Dietary therapy is very important too. The patient should avoid any food that may make the condition worse. Generally, patients suffering from IBS should avoid hot spicy food, greasy, rich and fried foods, dairy products, cold or icy foods and beverages, and raw fruits and vegetables. Instead, a clear, bland diet that is easy to digest such as congee (a type of rice porridge or gruel popular in many Asian countries- definitionally a thick porridge of rice largely disintegrated after prolonged cooking in water) or soup. Develop better bowel habits, i.e. going to the bathroom after breakfast every day, to take more exercise such as jogging, walking, light yoga, qi-gong and proper meditation will help as well. Sources and referencing: - JOURNAL OF CHINESE MEDICINE NUMBER 40 SEPTEMBER 1992 - JOURNAL OF CHINESE MEDICINE • NUMBER 74 • FEBRUARY 2004
Posted on: Mon, 26 Jan 2015 22:14:30 +0000
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