Irritable Bowel Syndrome (IBS)

Irritable bowel syndrome (IBS) is a frequently treated digestive disorder at our Williamstown clinic. Every week we would see quite a few new clients who complain of distressing digestive symptoms that fall under the umbrella of IBS. For some of these clients, the intervals between their IBS flare-ups are very short and the acute symptoms are severe, to the extent that their social and work lives are affected. Most clients have continuous digestive discomfort between IBS flare ups which increases their stress and anxiety levels, both dominant emotional triggers for an acute episode of IBS symptoms.

Chinese medicine acupuncture and herbal formulas have a long history of effectively relieving symptoms that pertain directly to IBS. These symptoms include abdominal pain, cramps, diarrhea and constipation. Research studies found that acupuncture can calm nervous tension to reduce stress and anxiety.

FAQ: How do I know if I have irritable bowel syndrome (IBS)?

IBS is a common intestinal disorder which affects approximately one in every five Australians. People with IBS has sensitive or dysfunctional intestines which are easily upset, producing unpleasant symptoms of abdominal pain or cramping, mucus in the stools, and alternating diarrhea and constipation.

IBS is a functional intestinal disorder and does not cause permanent damage to the intestines or lead to serious diseases like bowel cancer. The condition is not infectious in nature and there is no structural damage or anatomical changes presenting at the intestines. Women are affected about 2 to 3 times more than men, with the average age of onset around late teens and early twenties.

Signs and symptoms of IBS

The main symptom of IBS is recurrent abdominal pain or cramps that are relieved by the passing of wind or a bowel movement. The pain and cramps symptoms differ from person to person. Some of our IBS clients complain about stomach cramps after eating, but indicate that the pain area actually covers both the upper and lower abdomen.

A dominant feature of IBS is the change in bowel habits, such as diarrhea or constipation, for 3 months or more. Some clients have diarrhea, others have constipation. Most of the time we treat IBS clients who present with alternating diarrhea and constipation.

The signs and symptoms of IBS include:

• Pain and cramps in the abdomen
• Bloated or swollen abdomen
• Diarrhea – frequent loose stools
• Constipation – infrequent bowel movement with hard and dry stools
• Alternating between diarrhea and constipation
• Bowel movements that do not feel complete
• Mucus in stools
• Wind or rumbling noises from abdomen
• Pain and nauseous sensation in the upper abdomen area indicating the stomach
• Neurasthenia symptoms including insomnia, lethargy, palpitation and headache

The cause of irritable bowel syndrome (IBS)

The cause of IBS is unknown. There is currently no Western medication or special diet which cures IBS. Conventional treatments focus on preventative measures aiming to avoid triggers in susceptible individuals. The neurotransmitter serotonin has been linked to the development of IBS in susceptible individuals. It was found that impaired serotonin levels altered the functioning of nerve cells in the bowels, causing changes in pain sensation and bowels functioning. Serotonin is also commonly regarded as a biochemical that is responsible for maintaining mood balance.

Chinese medicine sees unregulated emotions as causative factor for IBS

The Chinese medicine diagnostics view the body as an integrated whole. From a Chinese Internal Organ Theory perspective, patterns of disharmony in IBS patients can involve the Liver, Spleen, Kidney and Large Intestine. A majority of Chinese medicine patterns of disharmony identified in IBS patients are linked to unregulated emotional stimuli or prolonged negative feelings.

FAQ: What are the common triggers for IBS flare ups?

Widely recognised triggers are environmental factors such as changes in routine, strong emotions especially stress and anxiety, past gastroenteritis episodes for example food poisoning or gastrointestinal infection, and intolerance to certain types of sugar and carbohydrates in the diet. Those who have family members with IBS are more susceptible to developing the condition. Some of our female clients routinely get an acute IBS flare up during a particular part of their menstrual cycle.

From our experience, clients who suffer from IBS should avoid the following risk factors, which can trigger an onset of IBS flare up:

• Stress, anxiety and emotional upset
• Certain food and drinks that trigger their acute IBS episode, for example alcohol and caffeine
• Milk and dairy products containing lactose
• Eating too much at one time or eating too quickly

Chinese medicine acupuncture and herbal formulas treat symptoms of irritable bowel syndrome (IBS)

Various research evidences have confirmed the efficacy of acupuncture and Chinese herbal formulas in treating IBS symptoms. Our experience finds that the diagnostic process is the key element in overcoming complex modern diseases such as IBS.

Chinese medicine diagnostic process for IBS

The Chinese medicine principles of health state that if the body is in balance, both internally and in harmony with the external environment, there will be no disease. The concepts of Yin and Yang, Excess and Deficiency are the foundation of diagnosis and treatment in Chinese medicine. When our clients first present at the clinic to have their IBS condition assessed, we conduct a detailed consultation to diagnose the 4 possible states of imbalances, namely Excess of Yin, Excess of Yang, Deficiency of Yin and Deficiency of Yang.

In Chinese medicine theory, each organ involved in the pathology, and each presenting symptom can be described in terms of Yin, Yang, Excess and Deficiency. For example, the symptom of loose stools in a client with diarrhea predominant IBS indicate an Excess of Yin. On the other hand, if the same client gets diarrhea first thing in the morning, with undigested food particles in the stools, then there is co-existence of Deficiency of Yang in the pathology.

In our diagnostic process, we assess each IBS symptom in relationship to all other presenting symptoms, and arrive at a pattern of disharmony for each individual client. In addition to the IBS symptoms, we also assess the entire constitution of the client, taking into consideration the physiological and psychological factors of IBS development in this particular client. The main Chinese medicine diagnostic tools are used, including tongue observation, pulse palpation, observation of signs and inquiring of symptoms, emotions, past medical histories, lifestyle and dietary issues.

Chinese herbal medicine treats the underlying cause of IBS

At Joanne Vidich Chinese Medicine, herbal medicine is an integral part of our IBS treatment program. We use the following foundation herbal formulas in the treatment of IBS:

• Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction)
• Tong Xie Yao Fang (Important Formula for Painful Diarrhea)
• Shen Ling Bai Zhu San (Ginseng, Poria and Atractylodes Powder)
• Liu Mo Tang (Six Milled Herbs Decoction)
• Si Shen Wan (Four Miracle Pill)
• Xiao Yao Wan (Free and Easy Wanderer Pill)

There are many classical and contemporary Chinese herbal formulas commonly used in treating IBS patterns. To address individual constitution, symptom group and emotional disharmonies, we subtract from or add herbs into the foundation formulas to form a customised treatment for each client.

An Australian study published in 1998 in the Journal of the American Medical Association lends support to the use of Chinese herbal medicine in treating patients with IBS. In the double-blind randomised study involving 116 patients, patients treated by Chinese herbs showed significant improvement over the patients taking the placebo. Within the Chinese medicine group, those treated using herbal formulas customised for individual patient showed longer lasting improvement to their IBS symptoms, compared to those taking a standard Chinese herbal preparation.

FAQ: Are the Chinese herbal formulas effective for IBS abdominal bloating?

All of our foundation formulas contain herbal ingredients that address the symptoms of abdominal bloating in IBS. Amongst the commonly seen patterns of disharmony in IBS, deficiency in Spleen Qi with dampness encumbering the middle burner, stagnation in the flow of Liver Qi, and a combination of both patterns, are the main factors causing abdominal bloating in our female clients.

FAQ: Can acupuncture treat IBS?

Acupuncture sessions are important in supporting herbal medicine treatment for our IBS clients. By regulating the flow of qi in the meridians, acupuncture rectifies organ malfunctioning, relieve stress to promote a calm mental state, and relieve symptoms of pain and cramps.

We find acupuncture to be instrumental in conditioning the clients to become increasingly resilient when encountering risk factors that often trigger their IBS flare ups. These risk factors include stress, anxiety, nervous tension, gastrointestinal upset, and especially in female clients during an episode of premenstrual syndrome (PMS) and while having menstrual cramps.

FAQ: Can acupuncture help with constipation in IBS?

Acupuncture treats constipation in IBS by moving the Qi in the intestines to regulate peristalsis of the digestive tract. The antispasmodic effect of acupuncture also helps to relax the intestines and in the emptying of the bowels. The combination of these two actions restore regular bowel movements in our IBS clients, at the same time reduce the formation of hard and pellety stools which are difficult to pass.

We also use acupuncture protocol to harmonise the energy of the Liver and Spleen organs, and found success in relieving the symptoms of alternating constipation and diarrhea in many of our IBS clients.

Treatment outcome for irritable bowel syndrome (IBS)

The desired treatment outcomes for our IBS clients are an improvement in the frequency of bowel movements and ease in passing stools for those presenting with constipation predominant IBS, and the passing of solid and formed stools for those presenting with diarrhea predominant IBS.  For both groups of clients, and those who present with alternating episodes of constipation and diarrhea, the reduction of abdominal pain intensity is the secondary measure of treatment outcome.

Chinese medicine treatment plan for IBS

IBS is a complicated digestive disorder, with many manifestations that correspond to different patterns of disharmony, and require ongoing adjustment in treatment methods.

Depending on the severity of symptoms and the chronicity of the condition, we generally put our clients on herbal medicine treatment for a period of between three to six months. To achieve optimal results, the herbal treatment course needs to be supported by gradual dietary and lifestyle changes. Stress management techniques are important in promoting recovery and preventing relapse once the IBS condition is under control.

FAQ: How many sessions of acupuncture are needed for IBS?

During an active course of treatment, in addition to taking of herbal medicine, IBS clients are encouraged to have acupuncture sessions once or twice per week. Once the IBS condition is under control, an acupuncture session every 2 week is recommended for the purpose of maintaining digestion system physiology and assisting the patients to cope better in stressful situations.

We have many IBS clients who come in for maintenance acupuncture sessions once every 4 to 6 weeks to keep their body and mind in balance. These clients may not have IBS symptoms anymore or only get mild flare ups once in a while. Maintenance acupuncture sessions for these clients focus on treating the internal imbalances which make them susceptible to developing IBS. We strengthen the functioning of the digestion system, reduce food cravings, and regulate the menstrual cycles and treat the symptoms of premenstrual syndrome (PMS). We also find that applying esoteric concepts to acupuncture protocols helps IBS clients who suffer from stress, anxiety and nervous tension in a profound way.

When the overall physical and emotional wellbeing of the IBS clients is being maintained, they can overcome the disease mechanism of IBS and be in control of their digestive health.

References:

1. Moleski S 2013, ‘Irritable bowel syndrome (IBS)’, The Merck Manual of Diagnosis and Therapy, Merck & Co.
2. Bensoussan A, Talley NJ, Hing M, Menzies R, Guo A, Ngu M. Treatment of irritable bowel syndrome with Chinese herbal medicine. Journal of the American Medical Association 1998; 280(18): 1585-1589.

Useful links:

1. GESA (Gastroenterological Society of Australia), www.gesa.gov.au