Dr Matt Boyle | Chinese Medicine

Chinese Medicine and Acupuncture for IBS

Chinese medicine
and acupuncture
for IBS

Written by Matt Boyle • Melbourne, Australia • Decemember 12, 2024

Western medicine and IBS

What is IBS?

Characterised by abdominal discomfort and disturbed bowel habits, irritable bowel syndrome (IBS) is one of the most well recognised functional gastrointestinal disorders.1 It is regarded as a disorder of the gut-brain axis which affects the sensitivity and reactivity of the gut.2 IBS isn’t life-threatening and it doesn’t increase the likelihood of the development of colon conditions such as ulcerative colitis, Crohn’s disease, or bowel cancer.

How common is IBS?

IBS is estimated to affect about 10-15% of people in industrialised countries.3 It typically affects women more than men (with Asian countries tending more towards parity),4 and occurs predominantly in patients younger than 45.5

Signs and symptoms of IBS

Some of the key symptoms of IBS include:

  • Abdominal pain or discomfort.
  • Abdominal bloating (where the abdomen feels full or distended) or distension (a visible increase in the size of the abdomen).
  • Flatulence.
  • Constipation and/or diarrhoea.
  • Mucous in the stool.
  • Rectal urgency or a feeling of incomplete evacuation.
  • Nausea.
  • It is quite common for the those with IBS to also suffer from other comorbidities such as: anxiety and depression,6 fibromyalgia, chronic fatigue syndrome, and obsessive compulsive disorder.

The symptoms of IBS can be frustratingly unpredictable, sometimes with obvious connections to food or emotional states, and at other times with seemingly no causative factors at all. Symptoms can range from being a minor nuisance to significantly impacting one’s quality of life.

Causes of IBS

IBS is generally not well understood from a Western medical perspective. Some of the proposed mechanisms involved include:

  • Infection: IBS may develop after an episode of gastroenteritis.
  • Bacterial: an imbalance of the microbiotica in the gut (dysbiosis).
  • Visceral hypersensitivity: oversensitivity of the nerves in the gastrointestinal tract.
  • Gut motility: intestinal muscle contractions may cause movement through the digestive system to be unusually fast (diarrhoea) or slow (constipation).
  • Food intolerances: foods that trigger IBS symptoms vary from person to person.
  • High levels of emotional stress.
  • Medications: certain types of medications (antibiotics, pain killers, etc) may lead to constipation or diarrhoea.

Diagnosing IBS

In cases of IBS, the digestive system appears normal on routine investigate tests. It is for this reason that IBS is deemed a functional gastrointestinal disorder (a functional disorder is one where there is no known structural (anatomical), biochemical, or infectious cause).

There is no specific test for IBS. The symptoms of IBS can mimic a number of other conditions, and as such investigations are performed to rule out other diseases that could be leading to the symptoms. Conditions that could be confused with IBS include lactose intolerance, coeliac disease, inflammatory bowel disease (ulcerative colitis or Crohn’s disease), bacterial or parasitic infection, or bowel cancer.

Tests that may be performed before diagnosing IBS include:

  • Stool tests: to exclude infectious conditions and inflammatory bowel disease.
  • Blood tests: to exclude coeliac disease.
  • Gastroscopy/colonoscopy: to exclude peptic ulcer disease, coeliac disease, inflammatory bowel disease, and bowel cancer.

Irritable bowel syndrome is categorised into four major categories:

  • Constipation-predominant (IBS-C).
  • Diarrhoea-predominant (IBS-D).
  • Mixed (IBS-M); alternating constipation and diarrhoea.
  • Unsubtyped (IBS-U): for those who don’t fall into the above categories.

Research indicates a relatively even distribution among these 4 sub-types; IBS-C 22.0%, IBS-D 23.4%, IBS-M 24.0%, and IBS-U 22.2%.7

While there is no test for IBS as such, a diagnosis can be made (after excluding other abnormal pathology) by utilising a diagnostic tool based on a patient’s symptom profile known as the Rome IV criteria.

Given the often vague and variable nature of symptoms of IBS, and the often perceived embarrassment of talking about bowel habits, it is not uncommon for people to just ‘learn to live with it’ and never seek help. To make matters worse, in the past it was quite common for patients to be dismissed as psychosomatic cases. It has only been the past 15 or so years that the medical community has started taking IBS seriously.8 Only around 50% of IBS patients worldwide consult with a physician about their symptoms.9

Chinese medicine and IBS

Diagnosis of IBS in Chinese medicine

Irritable bowel syndrome as a disease entity has traditionally not existed in Chinese medicine (the label being a more recent development). Chinese medicine has however been treating digestive issues, and all the accompanying symptoms of IBS, for thousands of years. In Chinese medical texts, what we would now call IBS was categorised according to the patient’s primary symptom: be it diarrhoea, constipation, or abdominal distension.

The successful treatment of IBS in Chinese medicine relies on making an accurate Chinese medical diagnosis. To do this we carefully analyse a person’s bowel habits, as well as their broader digestive symptoms, in combination with an assessment of the health of all other organ systems in their body. Taken as a whole this information paints a picture of the pathomechanism involved in each individual case of IBS.

Causes of IBS in Chinese medicine

While in some cases there is a clear and obvious causative agent at the root of the development of IBS, in most cases IBS is less clear cut and multi-faceted, with a combination of factors playing a role in compromising digestive strength. After a sufficient level of damage to the digestive system has been sustained a threshold is reached where symptoms begin to emerge. From a Chinese medicine perspective, some of the more common factors that damage the digestive system (and initiate IBS) include:

  • Infections: it is quite common for people to report that ever since travelling in a foreign country and experiencing a bout of food poisoning/gastroenteritis that their digestive system has never been the same. In this case the acute episode significantly undermines the integrity of their gut health, leading to long-term digestive maladies.
  • Medications: certain medications can deleteriously affect the digestive system. Many people for example have observed a direct relationship between antibiotic use and digestive distress.
  • Diet:
    • Unhealthy diet: this includes obvious unhealthy foods and drinks like processed/refined (junk) foods and foods with artificial chemicals.
    • Food sensitivities/intolerances: dairy, sugar, and potentially wheat (or gluten) can often be problematic for the digestive system (though in many cases this can be related to the way these foods are now prepared compared to how they were prepared in ancient cultures).
      • Sugars in general often present digestive challenges to IBS suffers and it is from this premise that Monash University in Melbourne developed the FODMAP diet (which seeks to reduce the symptoms of IBS by keeping certain difficult to digest carbohydrates under a threshold level that keeps symptoms at bay).10
    • Cold and raw foods: the Chinese medical tradition (as well as the Ayurvedic tradition in India) assert that more digestive resources are required to adequately digest and assimilate cold/raw foods. Warm and cooked foods are considered to be more gentle and less of a shock to the digestive system.
    • Eating habits: eating too quickly, eating while stressed, not chewing food thoroughly, and over-eating can all put extra strain on the digestive system.
  • Emotions:
    • Excess stress: an extremely common denominator in IBS, stress impedes the free flow of Liver qi in Chinese medicine. Such persons typically notice that their IBS symptoms get worse during periods of heightened stress.
    • Excess worry/thinking/obsessing: such mental faculties are the domain of the Spleen in Chinese medicine, and engaging in excess mental thought can therefore deplete the Spleen (the central organ involved in digestion in Chinese medicine).
      • It is particularly interesting to note that obsessive compulsive disorder or OCD (an anxiety disorder associated with obsessive thoughts and compulsive behaviours) has been found to be highly prevalent in patients with IBS.11 From a Chinese medicine perspective there are strong links to the Spleen in both of these disorders.
  • Physical activity:
    • Lack of physical activity: lack of movement/exercise can lead to qi becoming stagnant (both systemically and in the bowels; potentially leading to constipation).
    • Excess physical activity: conversely, too much physical exertion can deplete a person’s qi and blood (particularly if their constitution is on the deficient side), which in an IBS context could lead to deficient pathologies of the Spleen.

Treating IBS with Chinese medicine

Chinese herbal medicine for ibs

As the primary treatment modality of choice for treating internal conditions in the body in Chinese medicine, Chinese herbal medicine is pivotal in managing IBS. Herbal formulas are quite sophisticated and devised to address a person’s specific underlying pathology and presenting symptoms. Some of the common categories of herbs used in cases of IBS include herbs to:

  • Moisten and lubricate the intestines (to address constipation).
  • Astringe and bind the intestines (for diarrhoea).
  • Regulate qi and restore the qi dynamic (for abdominal bloating, distension, and pain).
  • Harmonise the Stomach and direct Stomach qi downward (to alleviate nausea, belching, and hiccups).
  • Tonify the qi (to strengthen organ systems that have become weakened).

Acupuncture for ibs

  • Acupuncture excels at moving qi and blood in the body, and is thus particularly effective at treating IBS of a qi stagnation (or Liver/Spleen disharmony) type in Chinese medicine. As a short-hand, this is often the type connected to stress, and is incidentally one of the most common types of IBS.
  • The warming practise of moxibustion (see here for details) is particularly appropriate in IBS cases characterised by cold and yang deficiency (such cases will more often than not be associated with diarrhoea or loose stools and low energy).

Chinese dietary therapy for ibs

  • An important component of IBS treatment, Chinese dietary therapy consists of some generalised principles for digestive health, coupled with specific advice for the particular disharmony a person presents with. Internally warming foods for example can be very good for some people with IBS but detrimental to those with conditions characterised by internal heat.
  • The focus in Chinese medicine is not just about what you eat but also how you eat (which can be just as important).

IBS consultations in Melbourne and Australia wide

I treat people with irritable bowel syndrome (IBS) Australia wide through private telehealth consultations (with Chinese herbal medicine and dietary therapy) and in person in Melbourne with herbal medicine and acupuncture. Follow the links to find out more about: Chinese herbal medicine, acupuncture, and Chinese dietary therapy. To make an enquiry or book a session, click here.

References

1. Linedale, E. C., & Andrews, J. M. (2017). Diagnosis and management of irritable bowel syndrome: a guide for the generalist. The Medical journal of Australia, 207(7), 309–315. https://doi.org/10.5694/mja17.00457

2. Manning, L. P., Tuck, C. J., & Biesiekierski, J. R. (2022). The lived experience of irritable bowel syndrome: A focus on dietary management. Australian journal of general practice, 51(6), 395–400. https://doi.org/10.31128/AJGP-07-21-6080

3. Maxion-Bergemann, S., Thielecke, F., Abel, F., & Bergemann, R. (2006). Costs of irritable bowel syndrome in the UK and US. PharmacoEconomics, 24(1), 21–37. https://doi.org/10.2165/00019053-200624010-00002

4. Chey, W. D., Kurlander, J., & Eswaran, S. (2015). Irritable bowel syndrome: a clinical review. JAMA, 313(9), 949–958. https://doi.org/10.1001/jama.2015.0954

5. Grundmann, O., & Yoon, S. L. (2010). Irritable bowel syndrome: epidemiology, diagnosis and treatment: an update for health-care practitioners. Journal of gastroenterology and hepatology, 25(4), 691–699. https://doi.org/10.1111/j.1440-1746.2009.06120.x

6. Tack, J., Fried, M., Houghton, L. A., Spicak, J., & Fisher, G. (2006). Systematic review: the efficacy of treatments for irritable bowel syndrome–a European perspective. Alimentary pharmacology & therapeutics, 24(2), 183–205. https://doi.org/10.1111/j.1365-2036.2006.02938.x

7. Lovell, R. M., & Ford, A. C. (2012). Global prevalence of and risk factors for irritable bowel syndrome: a meta-analysis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 10(7), 712–721.e4. https://doi.org/10.1016/j.cgh.2012.02.029

8. Hunter Medical Research Institute. (2024, April 4). Solving the enigmatic condition of Irritable Bowel Syndrome (IBS). https://hmri.org.au/news-and-stories/solving-enigmatic-condition-irritable-bowel-syndrome-ibs

9. Cremonini, F., & Talley, N. J. (2005). Irritable bowel syndrome: epidemiology, natural history, health care seeking and emerging risk factors. Gastroenterology clinics of North America, 34(2), 189–204. https://doi.org/10.1016/j.gtc.2005.02.008

10. Monash University. (n.d.). FODMAPs and Irritable Bowel Syndrome. https://www.monashfodmap.com/about-fodmap-and-ibs/

11. Davarinejad, O., RostamiParsa, F., Radmehr, F., Farnia, V., & Alikhani, M. (2021). The prevalence of obsessive-compulsive disorder in patients with irritable bowel syndrome: A cross-sectional study. Journal of education and health promotion, 10, 50. https://doi.org/10.4103/jehp.jehp_812_20