Irritable Bowel Syndrome (IBS)

Irritable Bowels Syndrome (IBS) is marked by abdominal pain and cramping, digestive sensitivity with nausea, indigestion, loss of appetite, bloating, flatulence, and alternating constipation and diarrhea. Anxiety and Depression may also be present. Clinically, it is common to divided IBS into those cases with predominant Diarrhea and those with predominant Constipation.

It has become more common in recent decades with incidence of between 5–22% in different countries. Interestingly, in clinical trials up to 40% improvement has been seen with placebo, indicating a possible large psychological aspect in the disease. Although IBS is not mentioned in Traditional Medicine, it overlaps diseases such as Colic, Abdominal Pain and Diarrhea.

Diet has shown to be important in eliminating or reducing IBS. The FODMAP diet eliminates or reduces foods that contain fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. This includes:

Dairy
Vegetables (including onions, garlic, broccoli, cabbage, mushrooms)
Sweeteners (such as honey, sorbitol, high fructose corn syrup)
Wheat
Fruits (such as peaches, apples, pears, apricots, cherries, and blackberries.)

Differential Diagnosis
Diarrhea predominant IBS
1. Liver Qi Stagnation with Spleen Deficiency
Abdominal distention, painful diarrhea aggravated by stress, fatigue, cold hands and feet, premenstrual syndrome
Representative Formula: Tong Xie Yao Fang

2. Spleen deficiency
Fatigue, poor appetite, low energy, bloating and rumbling, diarrhea with undigested food, pale tongue, weak, slow pulse
Representative Formula: Bu Zhong Yi Qi Tang or Xiang Sha Liu Jun Zi Tang

3. Damp-Heat
Abdominal pain, burning diarrhea with a foul odor, yellow greasy tongue coat, slippery rapid pulse
Representative Formula: Huang Lian Su Wan

4. Damp with Qi Stagnation
Abdominal pain, rumbling and gurgling, loose stool or erratic stool, poor appetite, nausea, pale tongue with white greasy tongue fur
Representative Formula: Xiang Sha Yang Wei Wan

Constipation Dominant IBS
1. Liver Qi Stagnation
Abdominal pain, bloating, flatulence, constipation, belching, acid reflux, all aggravated by stress and eating
Representative Formula: Mu Xiang Bing Lang Wan

Other Treatment
Prebiotics and Probiotics are also useful. This includes foods such as Artichokes, Asparagus, Bananas and whole grains. Spleen tonics herbs like Atractylodes Bai Zhu and Astragalus Huang Qi also help improve gut flora.

The use of fermented foods and fermented medicines such as Medicated Leaven (Shen Qu), used in TCM. Sprouted grains such as Malted Barley are very useful due to their enzyme content if the digestion is poor.

Moxa and Cupping on the abdomen is also frequently indicated. Adequate exercise, and stress reduction including Yoga are also beneficial.

Formulas
1. Ginger, Frankincense, Yarrow
2. Triphala
3. Angelica, Balm, Caraway, Peppermint, Celandine, Licorice
4. Zataria, with Triphala, Lesser Cardamon, Fennel, Calamus, Ginger, Long Pepper, Bdellium (as in
Majoon-E-Muqil of Unani)

Electuary of Micleta (Nicholas)
Electuary of Bayberries (Electuarium de Baccis Lauri)
Electuary of Cumin (Diacyminum) Mesue
Powder of Cumin Greater (Nicholas)
Bilwadi Churna (Ayurveda)

Chinese Classification

Simples

Atractylodes Bai Zhu
Citrus Chen Pi
Costus Mu Xiang
Ginger (Gan Jiang)

Paeonia Bai Shao
Amomum Sha Ren
Cyperus Xiang Fu

Formulas

Tong Xie Yao Fang
Xiang Sha Liu Jun Zi Tang
Li Zhong Wan
Bai Zhu Shao Yao San
Huo Xiang Zheng Qi Shui
Mu Xiang Shun Qi Wan
Shen Ling Bai Zhu San
Si Shen Wan
Tao Hua Tang
Zhen Ren Yang Zang Tang

Special Formula

1. Ginger, Yarrow, Frankincense (this has been studied: see below)

BAI ZHU SHAO YAO SAN
    Paeoniae Bai Shao
    Atractylodes Bai Zhu
    Citrus Chen Pi
    Saposhnikovia Fang Feng
This is a classical formula for abdominal pain and diarrhea with Spleen deficiency and Liver stagnation and excess.
If there is Heat, add Coptis Huang Lian, If there is Cold, add Ginger. If theer is indigestion and Food Stagnation, add Hawthorn (Shan Zha)

TANG’S FORMULA
    Astragalus Huang Qi
    Paeoniae Bai Shao
    Atractylodes Bai Zhu
    Citrus Chen Pi
    Coptis Huang Lian
    Dry-fried Ginger (Pao Jiang)
    Costus (Mu Xiang)
    Saposhnikovia Fang Feng
    Nutmeg (Rou Dou Kou)
This is a good representative formula from TCM which has proven efficacy, having 89% effectiveness compared to 37% in the placebo group. (see here)

Research

1. Evaluating the efficacy of mixture of Boswellia carterii, Zingiber officinale, and Achillea millefolium on severity of symptoms, anxiety, and depression in irritable bowel syndrome patients.
2. Traditional Chinese medicine for irritable bowel syndrome
3. Utilization patterns and prescription characteristics of traditional Chinese medicine among patients with irritable bowel syndrome in Taiwan
4. The efficacy of Shugan Jianpi Zhixie therapy for diarrhea-predominant irritable bowel syndrome: a meta-analysis of randomized, double-blind, placebo-controlled trials