What is Irritable Bowel Syndrome (IBS)?
Irritable Bowel Syndrome (IBS) is a functional disorder of the Large Intestine (Colon) intestines that causes diarrhea and/or constipation, abdominal pain and/or cramps, bloating, and gas. Most people with IBS that I have seen in the past 24 years have bloating and pain, and many have constipation and diarrhea that alternates like a see-saw. Others will have diarrhea on a regular basis with occasional constipation, while still others have constant severe constipation with only rare diarrhea. The abdominal pain is often compared to menstrual cramp pain, while some will describe a different kind of stabbing pain.
If there were to be a good thing about IBS, and there is not, it would be that unlike Ulcerative Colitis and Crohn’s Disease, Irritable Bowel Syndrome is not associated with tissue changes, and and does not have any associated risk for colon or rectal cancer.
What is a Syndrome in Western Medicine?
So how can my gut be so miserable when there are no actual changes in the intestines, and no infectious disease, either? That is because as a “syndrome” IBS is a collection of symptoms that are a disease of malfunction, like a misfiring engine that needs the timing chain adjusted, not an engine that is misfiring because it needs brand new valves. Irritable Bowel Syndrome is a functional disorder, that means what it sounds like, there is no infectious cause as in hepatitis, cold, flu, TB, and there is no structural defect, as in gall stones, a clogged artery, or a tumor. Rather, functional disorders are disorders in which your body is rebelling and refusing to function normally.
This is interesting, because, if you read about Irritable Bowel Syndrome on the very reliable Mayo Clinic website, you will see IBS described thusly:
The walls of the intestines are lined with layers of muscle that contract and relax in a coordinated rhythm as they move food from your stomach through your intestinal tract to your rectum. If you have irritable bowel syndrome, the contractions may be stronger and last longer than normal, causing gas, bloating and diarrhea. Or the opposite may occur, with weak intestinal contractions slowing food passage and leading to hard, dry stools.
Abnormalities in your gastrointestinal nervous system also may play a role, causing you to experience greater than normal discomfort when your abdomen stretches from gas or stool. Poorly coordinated signals between the brain and the intestines can make your body overreact to the changes that normally occur in the digestive process. This overreaction can cause pain, diarrhea or constipation.
The question that arises is what causes an individuals intestinal wall muscles to malfunction? And what disrupts the gastrointestinal nervous system to misfire. For more on that topic I would refer anyone interested to research on the Gut-Brain connection, and specifically this book by Dr. Michael Gershon, M.D.
Irritable Bowel Sydrome (IBS) in Ayurveda and Chinese Medicine and Acupuncture Theory
Chinese medicine describes Irritable Bowel Syndrome in very different terms than western biomedicine. Chinese medicine has an extensive theoretical perspective on the function of the internal organs, what we call the Zang-Fu, which is Chinese for the solid and hollow organs, the hollow ones being the bowels and bladders, and the solid ones the heart, live, spleen, etc.
Chinese medicine goes into great detail describing the effect of the nervous system on the gut. Our Chinese theory says, “the Mind leads the Qi.” There are a lot of aspects to this simple expression, but in sum Mind in Asian medicine includes the nervous system. It refers to all levels of cognition, memory, higher mental function, planning, and also all of our emotions and the nervous system states associated with emotions.
We know from science that the fight or flight response is associated with changes in blood pressure, perspiration, bowel motility, heartbeat, pupil dilation and other 100 other functions. Chinese Medicine say that “fear makes the Qi descend.” It differentiates diarrhea type Irritable Bowel Syndrome from constipation type as having more of an anxiety/fear type basis. This DOES NOT mean “its all in your head,” but what it does mean is its how your particular nervous system responds to stressors and conditioning. How you may be internalizing. Ayurveda describes chronic diarrhea as a dysfunction in Aparna Vata, which is the Vata dosha that regulates downward flow of urine, feces, and menstrual discharge. And Vata is the dosha that is most prone to and easily aggravated by fear.
Chronic constipation in Chinese Medicine and Acupuncture medical theory is more a function of “Liver Qi Stagnation” which is more associated with anger, frustration, intensity, irritability, and controlling personality type. This is what is associated with Pitta dosha in Ayurveda, and these patients may also have symptoms of burning such as are seen in GERD or gastritis.
The good news is Chinese Medicine, Acupuncture, and Ayurveda have been proven to treat Irritable Bowel Syndrome safely and effectively, without the harmful side effects associated with the drug therapies of western biomedicine.
The root of Irritable Bowel Syndrome in Chinese Medicine is what is called a “Liver-Spleen Disharmony.” Don’t worry, there is nothing wrong with your physical Liver or Spleen. But the ancient Chinese described harmonious function of the digestive tract in terms of the relationship between the Liver and Gall Bladder and the Pancreas and Stomach, along with the intestines, and the short-hand name for this system is the harmonious function of the Liver and Spleen. When the Liver Qi gets tense it over-controls, and when the Spleen Qi gets weak it fails to do its job. When both happen this is a perfect storm that creates various gut issues, including Irritable Bowel Syndrome.
The Liver Qi in Chinese Medicine and Acupuncture Theory
The Liver in Chinese medicine has the job of maintaining the free flow of Qi through the entire body, and when it fails in this role, due to excessive stress or due to a Pitta personality type, then the energy of the Liver, being aggressive, attacks its neighbor, the Spleen (whose job is intricately involved with extraction of nutrients in the gut) and disrupts it, and the intestinal function. And when the Liver Qi stagnates it leads to tension anywhere in the body, which can weaken intestinal contractions leading to constipation. This is the piece of Irritable Bowel Syndrome that relates to stress, especially associated with frustration or intensity.
The Spleen Qi in Chinese Medicine and Acupuncture Theory
On the other hand anxiety and worry, along with overconsumption of sugars and sweets, fatigue from overwork, can weaken the Spleen Qi directly. And one of the functions of the Spleen Qi is to keep things from falling down. The Spleen is associated with the Zhong Qi/Upright Qi. And if anxiety and fear is consistent or strong enough it will lead to diarrhea, because “fear makes the Qi descend.” This corresponds to the overly strong contractions that lead to diarrhea. Think of it, if someone, God forbid, put a gun to your head you might quickly lose bowel control. Kids pee in their pants when frightened. This is fear causing the Qi to descend; it is also a sudden spike of Vatta dosha.
Diet Therapy for Irritable Bowel Syndrome in a Nutshell
Finally, a diet heavy in sweet, cold, or raw food, and the forceful over drinking of water, can weaken the digestive tract, full stop. This is not the cause of IBS, but can certainly combine with the nervous system piece, and has to be dealt with during treatment. Likewise, regular consumption of alcohol from wine and beer to hard liquor, as well as overconsumption of Spicy Hot, fried, greasy, creamy food or excessive amounts of flesh foods causes Damp Heat in the Intestines and will have to be reduced or eliminated if Damp Heat symptoms like explosive stools are there.
Irritable Bowel Syndrome in Ayurveda: Vata and Pitta
In Ayurveda Irritable Bowel Syndrome is primarily a Vata disorder, because all pain is caused by Vata, and the seat of Vata in the body is the large intestine, and also constipation and bloating are due to Vata elevation. However, IBS-d (diarrhea), all the more so if there is also burning with defecation, or in the upper GI, is a dual Vata-Pitta elevation, because Pitta heat is associated with diarrhea. But because its the colon and a dysfunction of Aparna Vata, it is always a dual elevation. Treatment has to be tailored to the specific symptoms and Prakruti of the individual.
Differentiation of Zang Fu Patterns of Irritable Bowel Syndrome in Acupuncture and Chinese Medicine Theory
In Acupuncture and Chinese medical theory, while the core issue with Irritable Bowel Syndrome is Liver-Spleen disharmony, (above) there are almost always other complicating issues such as “stomach and intestine damp heat” or “heart Qi and blood vacuity”.
Signs and Symptoms
of Spleen Qi Vacuity can include:
fatigue, especially after eating
bloating after eating
postural hypotension (dizzy upon rising)
loose stools or constipation
cold hands and feet
a swollen tongue with teeth marks at the edges
of Stomach and Intestine Damp Heat
foul smelling or explosive diarrhea
diarrhea that is unusually dark or yellow
anal burning after bowel movement or hot, acidic stools
a tongue coating that is slimy and yellow
of Liver Qi Stagnation
lower abdominal distention during menses or premenstrual phase of cycle
any symptoms worse with stress or emotional upset, esp frustration
breast distention or pain with PMS
a pulse that feels like a bowstring
of Heart Qi and Blood Vacuity
swollen tongue with a crack or crease down the center all the way to tip
As you can see from the above there is quite a bit of differential diagnosis to be done during the first and second visits with your acupuncturist or doctor of Chinese medicine when their treatments are classically based.
How Quickly Will My Irritable Bowel Syndrome Improve?
The good news is IBS is actually fairly easy to treat. Over the past 24 years I have treated hundreds and hundreds of cases with extremely good and fairly quick results.
I treat IBS with a combination of Acupuncture, Chinese Herbal Medicine, Ayurvedic Herbal Medicine, and both Chinese and Ayurvedic diet therapy, depending on the case.
I have people come in once a week for three weeks, during which time we can get the treatment started and I can develop a careful and clear understanding of your case. Each case is different, but there are overlapping similarities.
The acupuncture piece of the treatment is designed to “relax the Liver Qi” so that it stops producing damp heat and stops interfering with the healthy “spleen and stomach” function. The acupuncture is not at all painful and is actually very very relaxing and leaves you feeling refreshed, as after a profoundly deep sleep.
I also often use moxibustion to warm and strengthen the acupuncture channels relating to the Spleen and Stomach function and to strengthen the large intestine if weak.
After the first 3 visits, then I like to see you twice a month for 3 months. In severe cases I may need to see you once a week for 4 weeks and then twice a month. Most people have a full recovery back to pain-free, normal bowel movements from anywhere between 6 weeks and 3 months, provided they are conscientious about taking their herbs twice a day, and being careful with their diet. Healing is a process, not a pill. Dealing with the nervous system piece though meditation, therapy, tai qi, or yoga helps a great great deal. Some patients continue with acupuncture treatment once a month or once in 6 weeks for an additional 6 months, both for their Irritable Bowel Syndrome treatment, but also as part of their general health routine, what some patients call a ‘tune-up.”
Your herbal therapy treatment for Irritable Bowel Syndrome may include both Ayurvedic and Chinese Herbal Medicines if constipation, and if diarrhea strictly Chinese medicine. This is based on my clinical experience and what I have found to work best in the fastest time frame. I have a variety of formulas that I use based on your unique gamut of symptoms, ranging from Ginger and Codonopsis to Jia Jian Su He Tang to Triphala and Boswellia.
Diet therapy involves at least three months of a clean and relatively bland diet free of sugar, which includes alcohol beverages, with very little yeasted foods, and lots of cooked vegetables, soups, small amounts of flesh foods, simple light grains like rice, and ample mild digestive spices like fennel, ginger, cumin, cardamon, asafetida, long pepper, and coriander. I also use herbal beverage teas that are great tasting and make a big difference with gas, bloating, and burning.
What I really like is when the patient takes ownership of their dietary changes, and thinks of it as a change in their life rather than some kind of depriving. You don’t have to give up alcohol, spicy hot food, or sweets for the rest of your life. But you do have to ‘fast” from them for 3-6 months, and you may find that you will want to have less of these things once you recover. Usually that is because you have replaced them with other things more satisfying.
For patients interested I like to tailor the diet to the Ayurvedic dosha of the individual, both to the primary and secondary dosha. So even if we use a diet that pacifies Vata or Pitta, we have to adapt it to the individual’s constitution. A Vata elevation in a Kapha type is dealt with differently than in a Pitta type. And a dual Vata-Pitta elevation in a Vata type is different than in a Pitta type.
Feel Free to Contact Me with any questions about how to treat your individual case of Irritable Bowel Syndrome naturally with acupuncture, Ayurveda, or Chinese Herbal Medicine. Thank You!
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