Blue Poppy: Irritable Bowel Syndrome (IBS)

abstracted & translated by

Bob Flaws, Lic. Ac., FNAAOM (USA), FRCHM (UK)

Keywords: Chinese medicine, Chinese herbal medicine, gastroenterology, irritable bowel syndrome (IBS)

On pages 21-22 of issue 6, 2004 of Hei Long Jiang Zhong Yi Yao (Heilongjiang Chinese Medicine & Medicinals), Liu Xiang-wen of the Zhao-tong Municipal Chinese Medical Hospital in Yunnan published an article titled, "The Treatment of 56 Cases of Irritable Bowel Syndrome with Modified Pu Lian Liu Jun Zi Tang (Taraxicum & Coptis Six Gentlemen Decoction). Because this is such a commonly seen condition, a summary of this article is presented below.

Cohort description:

Among the 56 patients treated with this protocol beginning in 1986, there were 34 males and 22 females aged 14-72 years, with an average age of 39. The shortest history of disease was six months and the longest was 21 years, with an average disease duration of approximately six years. In 49 cases, there was accompanying emotional dysphoria, anxiety, and insomnia. In 21 cases, there was accompanying gastrointestinal tract disease. There were loose stools in 31 patients, alternating constipation and loose stools in 15 patients, constipation and abdominal distention in 10 patients, and borborygmus in 29 patients.

Treatment method:

Modified Pu Lian Liu Jun Zi Tang consisted of:

Pu Gong Ying (Herba Taraxici Mongolici Cum Radice), 30g

Huang Lian (Rhizoma Coptidis Chinensis), 10g

Tai Zi Shen (Radix Pseudostellariae Heterophyllae), 20g

Bai Zhu (Rhizoma Atractylodis Macrocephalae), 20g

Fu Ling (Sclerotium Poriae Cocos), 30g

mix-fried Gan Cao (Radix Glycyrrhizae Uralensis), 6g

Chen Pi (Pericarpium Citri Reticulatae), 10g

Ban Xia (Rhizoma Pinelliae Ternatae), 15g

If there was abdominal pain and severe tenesmus, 10 grams each of Mu Xiang (Radix Auklandiae Lappae), Bin Lan (Semen Arecae Catechu), and Yan Hu Suo (Rhizoma Corydalis Yanhusuo) were added.

If there was borborygmus and abdominal distention, 15 grams each of Da Fu Pi (Pericarpium

Arecae Catechu) and Hou Po (Cortex Magnoliae Officinalis) were added.

If the stools were loose and watery and accompanied by a foul smell, 10 grams each of Lian Qiao (Fructus Forsythiae Suspensae) and Ku Shen (Radix Sophorae Flavescentis) and 15 grams of Huang Qin (Radix Scutellariae Baicalensis) were added.

If the stools were simply loose and watery, six grams of Rou Gui (Cortex Cinnamomi Cassiae), 30 grams of Che Qian Zi (Semen Plantaginis), and 10 grams of Gan Jiang (dry Rhizoma Zingiberis Officinalis) were added.

If there was rib-side pain and a bitter taste in the mouth, 10 grams each of Chai Hu (Radix Bupleuri) and Xiang Fu (Rhizoma Cyperi Rotundi) and 20 grams of Bai Shao (Radix Albus Paeoniae Lactiflorae) were added.

If there was five-colored diarrhea, Si Shen Wan (Four Spirits Pills) were added.

If there was constipation with abdominal distention, 30 grams of Ma Zi Ren (Semen Lini Usitatissimi), 15 grams of Rou Cong Rong (Herba Cistanchis Deserticolae), and 10 grams of Zhi Shi (Fructus Immaturus Citri Aurantii) were added.

One packet of these medicinals was decocted in water and administered orally per day. One week equaled one course of treatment.

Study outcomes:

Cure was defined as complete disappearance of all symptoms, normalization of intestinal tract function, and no recurrence on follow-up. Improvement meant that the symptoms improved, the number of bowel movements decreased, and the shape of the stools was almost normal or constipation was less. No effect meant that there was no improvement in symptoms, number of bowel movements, shape of the stools, or constipation. Based on these criteria, 38 patients were judged cured after two courses of treatment, 14 improved, and only four cases got no effect, for a total effectiveness rate of 92%.

Discussion:

According to Dr. Liu, the onset of this condition is closely associated to psycho-emotional factors, faulty diet, excessive taxation and fatigue, and external contraction of evils. In terms of the viscera and bowels, he mostly thinks it is associated with the spleen, stomach, large and small intestines, kidneys, and life-gate fire. Due to long-term spleen vacuity lack of movement, unregulated diet, and/or external contraction of damp evils, there is damage to spleen and/or kidney yang with resulting vacuity weakness. If dampness accumulates, it produces rheum which may then lodge in the stomach and intestines. Hence, there are the symptoms of loose stools, constipation, abdominal distention, and borborygmus. If rheum and evils join together, they become insidious and difficut to cure, and new rheum gathers more and more. Therefore, Dr. Liu thinks that the root of this disease is vacuity and its branch or tip is repletion. Thus it is a mixed vacuity-repletion condition. Its disease mechanisms are mostly spleen or kidney yang vacuity and water rheum collection and accumulation. When it comes to treatment, Dr. Liu believes this should be divided into two phases or stages, the acute attack stage and the remission stage. During the acute phase, the treatment principles should be to fortify the spleen and dry dampness, dispel evils and expel rheum. This is what Dr. Liu thinks his self-composed modified Pu Lian Liu Jun Zi Tang does. During the remission stage, he says that the treatment principles should be to mainly fortify the spleen and supplement the kidneys. According to Dr. Liu, the ingredients in Liu Jun Zi Tang fortify the spleen and dry dampness, boost the qi and supplement the center. Pu Gong Ying, which is bitter is flavor, fortifies the spleen and stomach. Huang Lian thickens the intestines and stomach and stops diarrhea. Readers should note that this is a somewhat different interpretation of the disease mechanisms of IBS and of the functions of Pu Gong Ying and Huang Lian than found in most contemporary Chinese sources.

For more information of the Chinese medical treatment of IBS, see Bob Flaws & Philippe Sionneau’s The Treatment of Modern Western Medical Diseases with Chinese Medicine available from Blue Poppy Press.