Chinese Herb Academy Logo

Google
Web Chinese Herb Academy

Membership

Forum

Articles

Find a Chinese Herbalist

Public Resources

Featured Links

Help

FAQ
Forum Policies
Contact

Home





photo montage of herbal medicine

Case History: Irritable Bowel Syndrome (IBS)

by Heiko Lade

Western medical diagnosis of IBS has been previously called spastic colon. The 1979 edition of Taber's Medical Dictionary referred to as irritable colon syndrome.

The cause of it is unknown and believed to be hereditary and is common in a modern GP's office. Treatment available apart from suggesting bran and advising stress reduction consists of various drugs which are generally unsuccessful.

Generally there are 2 types.

The first type has abdominal pain with constipation or diarrhea. Commonly in my practice the condition alternates between constipation and diarrhea.

The second type of IBS has painless diarrhea being either intermittent or constant.

Other GIT symptoms may be present such as flatulence, borbygmus, nausea, vomiting and abdominal distension.

Depending on the severity, other more debilitating symptoms manifest including mucous in the stools.

In TCM terms it is a mixture of excess and deficiency. The main contributing factor is liver Qi stagnation. And as a rule is due to an imbalance of the 7 emotions. Anger and all its subcategories such as resentment cause the Qi to stagnate.

Simply observation reveals that the 5 elements are imbalanced. Hence in this case wood attacks the earth. (wood attacks sideways ).

IBS if then further affected by a concurrent deficient spleen. Mental and physical conditions lead to a weakness in the spleen. The mental and physical can be both concurrent or can lead to each other. For instance, excess mental work damages the Spleen Qi and then the appetite may be lost or loose stools result.

A subcategory of Spleen deficiency is Spleen deficiency generating damp. This dampness can then occur in a number of ways or lead to further imbalances. Referring to examples such as cold damp phlegm damp and in particular damp heat. Mucous in the stool is us a direct result of damp.

Damp heat can come from kidney Yin deficiency or lead to kidney Yin deficiency only further complicating IBS. People with IBS can have spells of normal bowel function and it will quickly get aggravated during episodes of an abundance of damp and heat. This is evidenced often in a clinical situation when your patient comes in and says "I only had some Pizza and a piece of cheese cake". The damp and heat combination can also be a demon hard to banish because of our societies diet being excessive in fatty and oily food. Steven Clavey in his Fluid Physiology and Pathology in TCM gives us a simple and cheap solution to resolve damp and heat . "Eat only till 50-60% full". However, to get your patients to do that requires some special kind of hypnotic skills that I donít have. The thick, yellow coat at the base of the tongue is so commonly encountered in my clinical experience, I almost consider it to be normal.

The kidneys often play a role in adding to the complication of IBS. Kidney Yang deficiency can give chronic loose stools or diarrhea. Again, the kidney Yang deficiency can lead to Spleen Yang deficiency.

One can now see how this condition can have a number of TCM pathologies involved. This can be exemplified with the following theoretical example.

A patient constitutionally presents with a kidney Yin deficiency. An imbalance in the sexual sphere further depletes the Yin and leads to empty fire and damp heat is generated in the lower Jiao.

For some time, the patient has been living off junk food, in particular pizza with cold iced drinks. He is a university student who studies hard, stays up late and worries about his exams. He spleen Qi is suffering and damp is accumulating.

While studying his family and romantic life amounted to lots of liver Qi stagnation because of anger and resentment.

Two years after his graduation he presented with IBS.

A situation like this is not all unrealistic and one can see why the average G.P. has an abundance of IBS sufferers.

John McDonald in his Zang Fu Syndromes has provided us with the key symptoms of liver Qi invades spleen. On the emotional front melancholy, depression, irritability & inappropriate anger present themselves with the physical signs of abdominal distention and pain, gas, borborygmus, diarrhea.

Two base formula are Xiao Yao San (Rambling Powder) & Tong Xie Yao Fang (Important Formula for Painful Diarrhea).

Xiao Yao San tends to have a reputation for being for PMT and menstrual pain. In my practice I keep getting patients who have been to a physiotherapist or naturopath and have been prescribed Xiao Yao San. This formula is of course more specialized than that. Its action on dispersing stagnant liver Qi is obvious as Chai Hu being the chief ingredient. However importantly for IBS, is it's effect on harmonizing liver and spleen and nourishing the blood . Zang Fu syndromes lists 27 clinical manifestations appropriate for the formula, of which 3 are appropriate for IBS.

    • Bloating and pain at the umbilicus and abdomen
    • Flatulence
    • Epigastric pain and distension
There are only four references to IBS in Bensky's formula & strategies of which Tong Xie Xao Fang is the most appropriate. Tsang Fu syndromes also confirms its application in irritable bowel syndrome. John McDonald states that liver Qi stagnation invading the spleen has the following symptoms:
    • Borborygmus
    • Diarrhea with PAIN (better after defecation)
    • Recurs at time of stress
    • Diarrhea in small amounts
    • Recurrent abdominal pain
    • Patients is more comfortable after bowel movement

Western medicine has realized the stress component in IBS. In TCM terms, this stress is predominately anger based and in particularly being unable to discharge or express the anger. I have had one patient who always had an attack of diarrhea after any kind of confrontation. The diarrhea phase would last about 1-2 days and then go back to blocked up phase of IBS. Tong Xie Yao Fang is particularly useful in the acute phases of diarrhea and or painful diarrhea. Having said it is most useful for the acute outbursts it is actually used for treating chronic abdominal pain and diarrhea. The Clinical Handbook of Internal Medicine (volume 2) states that if modified, the formula can be taken for months and will gradually restore the damaged intestine.

The formula is straight forward with Bai Zhu, Bai Shao and Chen Pi. All dry fried (Chao) to target spleen tonification. The last ingredient Fang Feng is traditionally not dry fried but my observation and experience working in Sydney's Chinatown reveals that the action of Fang Feng in this scenario is fortified by dry frying with Jing Mi (rice).

Other modern day TCM physicians use a variation of Shu Gan Li Pi Tang (Spread the liver & Regulate the Spleen Decoction) with Tong Xie Yao Fang.

A modern day TCM practice will attract many cases of IBS or border line IBS and these patients will be further complicated by other organ pathologies. The example I have given hopefully will give some insight into the diversity of treating IBS with Chinese herbs .Furthermore the example can exemplify the fact that such a long standing complaint can get quite quick results with one acupuncture treatment and 3 packets of herbs per week.

Case History

Hair dresser ,age 54, Female

Presents with Irritable bowel syndrome of 6 years duration .She sometimes has 3 or 4 days constipation where the stool is dry and hard to pass .Then she may have slight loose stools and sometimes normal bowels .There have been many tests but nothing has been found and only Normacel provides some relieve .As a teenager she had a history of constipation and 18 years ago she went through a traumatic divorce with a lot of anger followed by depression. There are only a few other symptoms present of which the weakness of her memory is most bothersome. The forgetfulness is diagnosed as a kidney deficiency type as she will for example go to the kitchen to get a knife and forget why she went there. Other times she has a heart type memory weakness where she canít recall things from the past. Generally she feels worse for damp weather and this also makes her hips ache. Indigestion in the form of heart burn and acid also bothers her. Sleeping is not good and has tiredness in the day.

At age 39 menopause appeared and she stopped menstruation. Currently she is on HRT as osteoporosis is indicated on a bone scan.(There is a history of early menopause with her mother and sister .)

Tongue: red, with a thin crack to the heart and a redder tip .

Pulse: thin , fine and slow .(She has done a lot of sport throughout her life and is still very fit .)

ANALYSIS OF SIGNS AND SYMPTOMS

There is a clear disturbance with the heart and Shen because of the crack in the tongue and redness in the tip .It is a heart yin deficiency either caused or complicated by a constitutional kidney deficiency which is evidenced by the family history of early menopause. There are no Jing or Yang deficiency signs hence I conclude a kidney Yin weakness is predominant .

Alternating diarrhea and constipation in this case is as a result of liver Qi stasis .Firstly I need to say that this patient is currently in a happy marital relationship ,has relatively few financial troubles and works happily part time .Where does or did the stagnation come from ?Her past marriage break up clearly had a lot of stagnation and one could conclude she is susceptible to accumulation of stuck liver Qi .The weakness in the heart Yin and blood cause the Qi to stagnate. Constitutional kidney weakness led to the heart getting weak .

The heart burn and acid are as a result of the liver Qi stagnation turning to fire and this fire only complicates the heart more ! It was not until later on in treatment that I found out about her panic attacks which only confirm her heart disorder .

The spleen is also weak contributing to blood deficiency . Where did this spleen weakness come from ? Her history of doing lots of exercise put a strain on her muscles (flesh) and thus weakened her spleen in addition to her personality type showing over concern for her family. This subconscious worry depleting spleen Qi.

Of interest is her pulse, which is slow due to the many years of regular exercise. It is thin and fine because of the blood deficiency. It is not wiry because the underlying heart pathology is more pronounced .

DIFFERENTIAL DIAGNOSIS

Liver Qi stasis

Liver Qi stasis leading to fire

Spleen Qi deficiency

Spleen Qi and heart blood deficiency

Kidney Yin deficiency

Heart Yin deficiency

Liver Yin and blood deficiency

In this case all pathologies are present but not always at he same time. Take for example the heart burn which only plays up sometimes ie when the Qi stasis becomes severe to create fire .

TREATMENT PRINCIPLE

I will plan to treat the liver Qi stasis predominately to address the IBS. The resultant fire will not need be treated if the stagnation can be dispersed. The heart and liver Yin and blood will be also targeted in treatment .Mild tonification of the spleen will be attempted as long as it doesnít create more stasis or heat. After this has been treated the kidneys would be targeted and her HRT could be lessened .

BASE HERBAL FORMULA

Xiao Yao San (rambling powder)

Si Ni San (figid extremities Powder)

Gan Mai Da Zao Tang (licorice ,wheat and jujube decotion)

These formula address liver Qi stagnation .

Gui Pi Tang (restore the spleen decoction )

Is a possibility later on after the Qi stasis is better.

LIFE STYLE MODIFICATIONS

In this case there were no major suggestions as she was doing little to aggravate the problem. Her diet was sensible and work load was not causing her undue stress.

PROGNOSIS

Irritable bowel syndrome can take some time to treat .In this case the patient had read a newspaper article about the research from UWS and hence came to me with high expectations .Further more I had shown her the latest copy of the Journal of TCM and in their news section they mentioned that the trial was held over 14 weeks and hence she committed herself to 14 weeks of treatment.

As she had few other major symptoms and a good mental attitude I expected a good result.

1st Treatment:

liv 3 Tai Chong

Co 4 He Gu

Suan Zao Ren ( Semen Ziziphi Spinosae ) 9g

Fu Ling ( Sclerotium Poriae Cocos ) 9g

Gan Cao (Radix Glycyrrhizae Uralensis ) 6g

Long Yan Rou ( Arillus Euphoriae Longanae ) 6g

Shan Yao ( Radix Dioscoreae Oppositae ) 9g

Chai Hu ( Radix Bupleuri ) 6g

Bai Zhu ( Rhizoma Atractylodis Macrocephalae ) 9g

Chuan Lian Zi ( Fructus Meliae Toosendan ) 3g

Bai Shao ( Radix Paeoniae Lactiflorae ) 12g

Ge Geng ( Radix Puerariae ) 9g

2 packets

This formula is based on Si Ni San (Frigid extremities powder) where I substituted Zhi Shi with Chuan Lian Zi because it was more cold. Suan Zao Ren and Long Yan Rou were added to benefit the heart and sleep. Fu Ling , Bai Zhu and Shan Yao were added to tonify the spleen gently without adding too much heat. Ge Geng is cooling to counteract the warmth of Bai Zhu and treats deficient spleen diarrhea .

2nd Treatment :1 week later

The first session had resulted in a couple of good bowel movements and overall felt a bit better. The tongue was the same but closer examination of the pulse showed that the spleen was thin and soft and the liver was not wiry .The strategy of addressing the Qi stasis seemed to be correct and hence I would continue and give 3 packets this time.

St 37 Shangjuxu

Sp 4 Gongsun

Th 6 Zhigou

Liv 3 Taichong

Chai Hu ( Radix Bupleuri ) 6g

Bai Shao ( Radix Paeoniae Lactiflorae ) 9g

Dang Gui ( Radix Angelicae Sinensis ) 9g

Mai Ya ( Fructus Horder Vulgaris Germinantus ) 9g

Bo He ( Herba Menthae ) 3g

Bai Zhu ( Rhizoma Atractylodis Macrocephalae ) 6g

Gan Cao ( Radix Glycyrrhizae Uralensis ) 3g

Ge Geng ( Radix Puerariae ) 9g

Dang Shen ( Radis Codonopsis Pilosulae ) 9g

Chuan Lian Zi ( Fructus Meliae Toosendan ) 3g

3 packages

This time I added Mai Ya not to disperse food stasis but because of its action of dispersing liver Qi. Dang Shen was included to supplement the spleen Qi. By adding Bo He the base formula had become Xiao Yao San with out the fu ling .It was still a very simple prescription but would prove to be powerfully effective .

3rd Treatment: 2 weeks later

Her energy had been quite improved during the week and had not needed to use any medication. The bowels have had a significant improvement.

Tongue: The tip was less red
Pulse: It was still thin and soft .

The tongue had improved because as the liver Qi stasis was being controlled, there was less heat and thus the heart was getting benefit.

Liv 3 Tai Chong

Sp 10 Xue Hai

Sj 6 Zhi Gou

Sang Zhi ( Ramulus Mori Albae ) 9g

Wei Ling Xian ( Radix Clemetidis Chinensis ) 9g

Hong Hua ( Flos Carthami Tinctorii ) 3g

Fu Ling ( Sclerotium Poriae Cocos ) 9g

Gan Cao ( Radix Glycyrrhizae ) 3g

Chai Hu ( Radix Bupleuri ) 3g

Bai Shao ( Radix Paeoniae Lactiflorae ) 9g

Bai Zhu ( Rhizoma Atractylodis ) 6g

Bo He ( Herba Menthae ) 3g

Sheng Jiang ( Rhizoma Zingiberis ) 1 slice

Zhe Ke ( Fructus Citri seu Ponciri ) 6g

Mai Ya ( Fructus Horder Vulgaris ) 9g

3 packets

The formula was now Xiao Yao San plus Si Ni San. Zhe Ke is not as strong as Zhe Shi and as the bowels were working, hence the substitution. There was mild wind and dampness because of the rheumatic hip complaint and as the bowels were improving I could start to address these symptoms with the addition of Sang Zhi and Wei Ling Xian. Hong Hua in a small dose was added more to harmonize the blood than to regulate the blood.

4th treatment :1 week later

The bowels are more normal , she is less tired and sleeping better.

Tongue : It now has less of a red tip .

Pulse : This week it was actually wiry .

Firstly we need to look at the changes in the tongue and pulse. This patient presented with a complexity of organ pathologies. The tongue was showing the deepest constitutional imbalance and the pulse was showing the next pathology of weak spleen and blood. The herbs have always clearly been targeted on liver Qi stasis and even though the problem had existed for 6 years the spleen weakness had preexisted the stasis and hence gave the thin and soft pulse .If I would of prescribed herbs on the pulses alone and gone in there with lots of Qi and blood tonics it would of resulted in more stasis. The heart has improved (ie less heat ) because the Qi stasis has improved and hence is generating less heat. Had I of concentrated on herbs to clear heat in the heart they would possibly have been too cold for the spleen deficiency and diuretics may have depleted the yin.

Liv 3 Tai Chong

St 36 Zu San Li

Co 4 He Gu

Bai Shao ( Radix Paeoniae Lactiflorae) 12g

Bai Zhu ( Rhizoma Atractylodis Macrocephalae) 6g

Ge Geng ( Radix Puerariae ) 9g

Fang Feng ( Radix Ledebouriellae ) 6g

Gan Cao ( Radix Glycyrrhizae) 6g

Mai Ya ( Fructus Horder Vulgaris Germinantus ) 9g

Chai Hu (Radix Bupleuri )6g

Dang Gui ( Radix Anglicae Sinensis ) 9g

Sang Zhi ( Ramulus Mori Albae ) 15g

Mu Dan Pi ( Cortex Moutan Radicis ) 6g

Chuan Xiong ( Radix Ligustici Wallichii ) 6g

Ye Jiao Teng ( Caulis Polygoni Multiflori ) 6g

3 packets

The prescription here is based on Si Ni San with parts of Xiao Yao San. By adding Dan Pi it was fact almost becoming Jia Wei Xiao Yao San ( Augmented Rambling Powder ). I have used Fang Feng here as an envoy to help relieve the over control of spleen by the liver. Chuan Xiong and Ye Jiao Teng are to improve sleep. The former regulates the liver blood hence influencing the ethereal soul of the liver and in combination with Ye Jiao Teng can calm the spirit .

5th Treatment : 1 week later

She now comments that she can cope better and sleeps better. The bowels are now regular and believes it is due to the treatment where as before she thought it was just a good phase she was going through. There is still some aching in her hips due to humid weather and some acid in her stomach. It is of interest to note that she can "cope better" because when she first came there was no emotional stress! Patients can often take some time to admit to their imbalances in the 7 emotions.

St 37 Shangjuxu

Th 6 Zhigou

Ye Jiao Teng ( Caulis Polygoni Multiflori ) 9g

Yuan Zhi ( Radix Polygalae Tenuifoliae ) 3g

Dang Gui ( Radix Anglicae Sinensis ) 9g

Bai Shao ( Radix Paeoniae Lactiflorae) 12g

Chuan Xiong ( Radix Ligustici Wallichii ) 6g

Jing Jie ( Herba seu Flos ) 9g

Chai Hu (Radix Bupleuri ) 6g

Xiang Fu ( Rhizoma Cyperi Rotundi ) 6g

Bai Zhu ( Rhizoma Atractylodis Macrocephalae) 6g

Bo He ( Herba Menthae ) 3g

Fu Ling ( Sclerotium Poriae Cocos ) 9g

Yi Yi Ren ( Semen Coicis Lachryma-jobi ) 12g

Bian Dou ( Semen Dolichoris Lablab ) 9g

Zhe Bei Mu ( Bulbus Fritillariae Thunbergii ) 9g

Wa Leng Zi ( Concha Arcae ) 9g

Gan Cao ( Radix Glycyrrhizae) 3g

3 packets

This is xiao yao san the addition of xiang fu to strengthen the dispersing action. Yi Yi Ren and Bian Dou are to benefit spleen and resolve damp. Zhe Bei Mu and Wa Leng Zi treat acid reflux as a result of liver stasis causing fire possibly due to some extra stress during the week or some hot food or alcohol.

6th Treatment :1 week later

Her bowels are now normal and now can sleep very deeply. There is no heart burn but during the week she was very tired one day after a late night and then had a panic attack. She has had a history of these for many years but I failed to bring it out during other consultations. This symptom only confirms the deep seated heart pathology. There was also a history of heart palpitations . During this week she had also decided to cut back on the HRT. The tongue had changed slightly as did her pulse. Coming off HRT would also put her under more stress mentally and physically but it would give a more true and clear picture of the underlying pathology.

Tongue : it had become a little red again at the tip but not as severe as before.

Pulse : spleen was wiry

Having gone off the HRT was affecting the kidney and heart communication so I would need to address the deficient kidney and resultant heart fire .The spleen was wiry because the wood was attacking the earth .

Sp 6 San Yin Jiao

Liv 3 Tai Chong

Ht 7 Shen Men

Fu Xiao Mai ( Semen Tritici Aestivi Levis ) 18g

Zhi Gan Cao ( Radix Glycyrrhizae ) 3g

Da Zao ( Fructus Ziziphi Jujubae ) 1 piece

Mu Hu Die ( Semen Oroxyli Indici ) 3g

Dan Shen ( Radix Salviae Miltiorrhizae ) 9g

Ye Jiao Teng ( Caulis Polygoni Multiflori ) 9g

Dang Gui ( Radix Anglicae Sinensis ) 9g

Chai Hu (Radix Bupleuri ) 6g

Bai Shao ( Radix Paeoniae Lactiflorae) 12g

Bo He ( Herba Menthae ) 3g

Suan Zao Ren ( Semen Ziziphi Spinosae ) 6g

Fu Ling ( Sclerotium Poriae Cocos ) 9g

Yi Yi Ren ( Semen Coicis Lachryma-jobi ) 12g

Sang Zhi ( Ramulus Mori Albae ) 9g

3 packets

I have now chosen Gan Mai Da Zao Tang (licorice, wheat and jujube decotion)This simple formula can address heart Yin , liver Qi stasis and spleen deficiency .It is also appropriate for women and panic attacks .Mu Hu Die further supplements Dang Gui, Chai Hu and Bai Shao's action in dispersing stagnant liver Qi. Dan Shen will sooth irritability, palpitations and insomnia .

7th Treatment : 1 week later

This week she reported that there were no panic attacks and no flushing and the sleep was still very good . But the bowels had become slightly blocked.

Tongue: The red tip had subsided but there was a bit of a red centre in the stomach region.
Pulse: wiry

What was the reason for the bowels becoming blocked ?

Yi Yi Ren can dry damp and treat loose stools and being in a larger dose and having been used for some weeks have clogged up the bowels . Furthermore, Da Zao aggravates epigrastic distension and bloating and thus I conclude it is not useful for IBS. I would omit Yi Yi Ren and Da Zao in future prescriptions .

Liv 3 Taichong

St 37 Shangjuxu

Sp 6 Sanyinjiao

Th6 Zhigou

Ye Jiao Teng ( Caulis Polygoni Multiflori ) 9g

Long Yan Rou ( Arillus Euphoriae Longanae ) 6g

Bai Zhu ( Rhizoma Atractylodis Macrocephalae ) 6g

Bai Shao ( Radix Paeoniae Lactiflorae) 9g

Chai Hu (Radix Bupleuri ) 6g

Mei Gui Hua ( Flos Rosae Rugosae ) 3g

Gan Cao ( Radix Glycyrrhizae ) 3g

Bo He ( Herba Menthae ) 3g

Ge Geng ( Radix Puerariae ) 9g

Mai Ya ( Fructus Horder Vulgaris Germinantus ) 12g

Sang Zhi ( Ramulus Mori Albae ) 9g

Zhe Bei Mu ( Bulbus Fritillariae Thunbergii ) 9g

6 packets

This prescription is based on Xiao Yao San with Long Yan Rou in place of Dang Gui. I omitted Dang Gui in this case because I had run out of it in clinic and upon reflection thought it was not such a bad idea to replace it with Long Yan Rou .It would be of benefit to her heart and improve her sleep. Mei Gui Hua and Mai Ya strengthen the Qi moving properties of the formula. Another way to see the diversity of TCM and its approach to restoring harmony is depicted in the example of this patient . When one does not sleep well the ethereal soul of the liver will wander and the liver blood will not get benefit . In the case here there is a heart disturbance affecting the sleep and hence in the long term it has upset the liver .When the liver blood is weak it can then stagnate the Qi more easily. There is one school of thought in TCM where it says to treat the Shen first . I believe that her Irritable bowel may of eventually righted itself by just concentrating on the heart and Shen but ultimately she really just wanted to fix her bowels.

8th treatment: 2 weeks later

She has now really cut back on the HRT and is really feeling the pressure. Her heart is often racing and her head feels like it is in a mist and foggy. Her sleep is bad again and she sweats at night. She wakes up at 3am and is restless.

However, the bowels are working normally. She now wishes to treat her hormones naturally.

T: as before

P: liver is thin and wiry
 
 

Sp 6 Sanyinjiao

Ht 7 Shenmen

St 36 Zusanli

Ye Jiao Teng (Caulis Polygoni Multiflori) 30g

Long Yan Rou (Arillus Euphoriae Longanae) 6g

Huang Bai (Cortex Phellodendri) 6g

Zhi Mu (Radix Anemarrhenae Asphodeloides) 3g

Ba Ji (Radix Morindae Officinalis) 6g

Yin Yang Huo (Herba Epimedii) 6g

Shan Zhi Zi (Fructus Gardeniae Jasminoidis) 6g

Long Gu (Os Draconis) 9g

Mai Ya (Fructus Hordei Vulgaris Germinatus) 9g

Shi Chuan Pu (Rhizoma Acori Graminei) 6g

Yuan Zhi (Radix Polygalae Tenuifoliae) 3g

Mai Dong (Tuber Ophiopogonis Japonici) 6g

Mu Hu Die (Semen Oroxyli Indici) 3g

Lu Lu Tong (Fructus Liquidambaris Taiwanianae) 6g

3 packages

Treatment here is based on nourishing heart blood and yin with ye jiao teng and long yan rou and purging empty heat with huang bai and zhi mu .To strenghen kidneys I have used yinyang huo and ba ji and thus the formula is based on er xian tang (two immortal decoction).This combination in fact addresses kidney yin and yang deficiency with upper body deficiency fire .As the insomnia is severe long gu has been added along with yuan zhi . Shan zhi zi clears heat ,and can treat restlessness and insomnia .For the IBS there is a combination of lu lu tong and shi chuan pu which can benefit middle jiao by clearing dampness and mu hu die and mai ya to disperse liver qi stagnation .

9TH Treatment :1 week later

The bowels are still very good and she comments that she is now used to having normal bowels .Her sleep is good and there was no heart racing this week. In fact the HRT has been cut back to one quarter of her prescribed dosage .The quote " I can feel the herbs you added last week are really working" indicates a good prognosis for her menopausal symptoms .

T : normal colour
P : liver is thin and soft

Er xian tang (two immortal decoction) has been a success so This week I would increase the dosages of the formula as I felt confident with the prescription .

Acupuncture was still kept simple with:

St 36 Zusanli

Sp 6 Sanyinjiao

Ht 7 Shenmen

Yintang

Gb 20 Fengshi

Yin yang huo (herba epimedii) 9g

Huang bai (cortex phellodendri) 9g

Ba ji tian (radix morinda officinalis) 9g

Zhi mu (Radix anemarrhenae asphodeloides) 6g

Dang gui (Radix angelica sinensis) 9g

Xu duan (radix dipsaci) 6g

Mu hu die (semen oroxyli indici ) 6g

Mai ya (Fructus hordei vulgaris germinatus ) 15g

Ye jiao teng (Caulis polygoni multiflori) 30g

Ma huang gen (Radix ephedra)15g

Yuan zhi (Radix polygalae tenifoliae) 3g

Dan shen (Radix salviae miliorrhizae) 9g

He huan pi (Cortex albizzia julibrissin) 15 g

Gan cao (Radix Glycyrrhizae uralensis) 18g

I have substituted xian mao with xu duan for 2 reasons .The first being that I didnít have it in stock and secondly because it benefits the bones which is useful for menopausal women. Xu duan also doesnít have any contraindications which makes it easier to prescribe in many cases. Mu hu die and mai ya (with a higher dose) have been retained to address qi stagnation . One common symptom experienced by menopausal women is night sweating ,hence the use of Ma huang gen .I didnít use fu xiao mai as it being wheat may upset the IBS. The trio of he huan pi ,dan shen and ye jiao teng can be useful for insomnia , depression and irritability due to a restless spirit. The large dose of gan cao was administered after having read Lu Yubin's article on insomnia and An mian tang in the journal of Chinese Medicine. In an email communication he quoted to me the following .

"Gan Cao is used here with two purposes ,one is to strengthen the deficient Spleen ,the other is to purge the heart fire , so it's dosage is relatively large."

As this article is about IBS I will finish here and perhaps someone like Jane Lyttleton can give us some case histories on menopause .

CONCLUSION

This case exemplifies the fact that IBS can be effectively treated with TCM. Further more it can be seen that results can be obtained within a relatively short time as in this case 6-8 weeks. It may be premature to conclude that the results would be long lasting but I expect them to curative though some follow up maintenance treatments are obviously recommended to prevent any imbalances from causing future organ disharmonies.


REFERENCES

Bensky, Dan and Gamble ,Andrew .Chinese Herbal Medicine Materia Medica

Eastland Press,Seattle,1986

Bensky, Dan and Barolet, Randell .Formulas and Srategies.

Eastland Press ,Seattle ,1990

McDonald, John and Penner , Joel. Zang Fu Syndromes

Lone Wolf Press ,Toluca Lake ,1994

Clavey ,Steven .Fluid Physiology and Pathology in TCM

Churchill Livingstone ,Melbourne 1995

Maclean , Will and Lyttleton . Clinical Handbook of Internal Medicine.(vol 2)

University of Western Sydney,1999 (Taken from pre release notes)

Pagon ,Andrew .Irritable Bowel Syndrome .

The journal of Chinese medicine ,1998.

Thomas ,Clayton .Taber's Medical Dictionary.

Davis Company ,1979 .

 

[back to top]