BIRMINGHAM CENTRE FOR CHINESE MEDICINE
245 Alcester Road South, Kings Heath, Birmingham B14 6DT
Tel: 0121-441 2757
CASE HISTORIES - IRRITABLE BOWEL SYNDROME
In orthodox medicine irritable bowel syndrome (IBS) is an umbrella term which covers a variety of conditions involving disturbed bowel function together with abdominal bloating, discomfort or pain. There is very frequently an association with emotional changes. There is no category of IBS in Chinese medicine, but syndromes involving these features are readily diagnosed in accordance with Chinese medicine principles.
In Chinese medicine terms, IBS typically involves (1) 'stagnation of Liver Qi': this can be loosely related to (but not translated into) the nervous system aspect of IBS. Among the functions of the 'Chinese' Liver is to ensure the smooth flow of Qi, which is easily disrupted by anxiety and psychological stress. A 'wiry' (taut) pulse quality and the emotional context are reliable indicators of Qi Stagnation, and one of the many possible consequences is a disruption of digestion. Herbs that 'regulate Qi' or 'soothe the Liver' are used, some of which have specific effects on gastro-intestinal function (2) some Spleen deficiency (in Chinese medicine the Spleen refers to the function of digestion and assimilation of food): together with 'stagnation of Liver Qi' this gives rise to a Disharmony of Liver and Spleen. It requires the use of herbs to 'supplement' the Spleen and possibly, depending on the bowel pattern, herbs which either astringe the stool to prevent diarrhoea, or assist bowel movement. (3) in addition Dampness is also often present. Dampness is a very general term which refers to some form of abnormality in the behaviour of body fluids. In a case of eczema it would refer to weeping or swollen skin lesions. In a digestive disorder Dampness might manifest as diarrhoea, thick and moist or 'greasy' tongue coat, abdominal discomfort and possibly nausea. In such a scenario Dampness would typically be treated with aromatic herbs, though 'draining Damp' (diuretic) and/or bitter-cold herbs might also be used.
CASE
A woman of 32 had suffered attacks of diarrhoea with pain over a period of 18 months. This began after a gastro-intestinal infection on a trip abroad, which at the time was treated with antibiotics. Following that she suffered frequent episodes of diarrhoea, with severe abdominal cramping pain, sometimes accompanied by nausea. The condition was consistently worse during periods of stress and was triggered by emotional upsets; it was also aggravated by a viral infection. Her vitality was low; the tongue body was slightly red, with a somewhat 'greasy' off-white coat; the pulse was a little rapid with a 'wiry' (taut) quality but without much strength. She had been on seroxat (an anti-depressant) for some months and during that time the symptoms had improved. She had come off the medication two months before her first visit. The symptoms had worsened again, but she did not want to depend on seroxat and felt this could not be a long-term solution.
The diagnosis was Liver-Spleen disharmony, the Spleen function having been damaged by an external invasion (which in this case equates to infection). Some Dampness and slight Heat were also present. Herbs were used to 'regulate the Liver' and 'calm the spirit' (Chai Hu [Radix Bupleuri], Bai Shao [Radix Paeoniae Lactiflorae], Zhi Ke[Fructus Citri Auranti]i, Xiang Fu [Rhizoma Cyperi Rotundi], Yuan Zhi [Radix Polygalae]), to supplement the Spleen (Dang Shen [Radix Codonopsitis], dry-fried Bai Zhu [Rhizoma Atractylodis Macrocephalae], dry-fried Shan Yao [Radix Dioscoreae], honey-fried Gan Cao [Radix Glycyrrhizae], to stop diarrhoea and astringe the stool (Ge Gen [Radix Puerariae], Wu Mei [Fructus Pruni Mume], He Zi [Fructus Terminaliae Chebulae]), to fragrantly resolve and drain Dampness (Cang Zhu [Rhizoma Atractylodis], Fu Ling [Sclerotium Poriae Cocos]), and to cool some residual Heat in the intestines (Huang Lian [Rhizoma Coptidis])
Improvement began within one week of treatment and after a month was very marked (bowel movements once a day, far less loose, no abdominal pain or nausea, generally feeling a lot more relaxed). Progress was maintained over the next three to four months, though the symptoms became slightly worse again after an episode of gastroenteritis and when under stress connected with a job move. The patient then became pregnant and treatment was halted. During a brief period of follow-up, the improvement was well sustained without treatment.
Note on diet: In digestive and indeed in many other disorders, dietary advice will form part of the Chinese medicine approach to treatment. Herbal medicine is not food, but the properties of herbs are on a continuum with the properties of foods and the treatment principle behind a herbal prescription can be applied in a directly analogous way to dietary advice. Styles of cooking will also be important. Where there is Spleen Deficiency, foods with a Damp quality (mainly dairy, fatty, sugary foods and some grains) are likely to be problematic, and warm/cooked as opposed to cold/raw will be recommended. Raw/cold foods place greater demands on the digestive energy and tend to damage the Spleen function, while cooked/warm foods are more favourable to it. Following that principle is regularly helpful to patients with certain digestive symptoms. In the case described here, food was not in fact such an important issue, but in many others diet will be very important. However, as in all areas of Chinese medicine there are no rigid rules, since the practitioner will be looking at the individual patient's constitution and needs and will advise accordingly.
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Birmingham Centre for Traditional Chinese Medicine Ltd. Directors: M.R. Ehrenberg BA, PhD, LSSMDip, DipAc, MBAcC, CertAc(Kunming); N. Lampert BA, PhD, DipAc, MBAcC, CertAc(Nanjing) MRCHM; C. Wylde BA, DipAc, MBAcC, CertAc(Nanjing).