IRRITABLE BOWEL

SYNDROME(IBS)
DEFINITION-
• Irritable Bowel Syndrome (IBS) -Irritable Bowel
Syndrome (IBS) is a common functional gastrointestinal
disorder characterized by a combination of symptoms,
including abdominal pain or discomfort, bloating, and
altered bowel habits (diarrhea, constipation, or
alternating between the two). IBS does not cause
visible damage to the gastrointestinal tract but affects
the functioning of the gut. It is considered a
"functional" disorder, meaning there is no identifiable
structural or biochemical abnormality, but there is
abnormal bowel function.
• Types of IBS
• IBS is typically classified based on the
predominant symptoms and bowel habits:
• IBS with Diarrhea (IBS-D):
– Characterized mainly by frequent, urgent diarrhea,
often associated with abdominal pain and bloating.
– Stools are typically loose or watery, and urgency is a
common complaint.
• IBS with Constipation (IBS-C):
– Characterized by infrequent, hard, and difficult-to-
pass stools.
– People with IBS-C may experience straining,
incomplete evacuation, and abdominal bloating.
• IBS Mixed (IBS-M):
– A combination of diarrhea and constipation, with
symptoms alternating between the two. This can
make diagnosis and management more
challenging.
• IBS Unclassified (IBS-U):
– When symptoms don’t fit into any of the above
categories or when bowel habits change over time.
ETIOLOGY-
• The exact etiology of Irritable Bowel Syndrome (IBS) remains unclear, but
multiple factors are believed to contribute to its development. These factors
are often interconnected, and IBS may result from a combination of genetic,
environmental, physiological, and psychosocial elements. The main factors
contributing to IBS are:
• 1. Gut Motility Disorders Altered Gastrointestinal Motility: Abnormalities in
the contractions of the smooth muscles in the intestines can lead to the
primary symptoms of IBS, such as diarrhea, constipation, or alternating bowel
movements . IBS-D (diarrhea predominant): Involves faster-than-normal gut
motility or rapid transit through the intestines, leading to loose stools .IBS-C
(constipation predominant): Involves slow motility or delayed transit, leading
to constipation and difficulty passing stools . IBS-M (mixed type): A
combination of both slowed and accelerated motility.
• 2. Visceral Hypersensitivity Increased Sensitivity to Normal
Bowel Movements: People with IBS may experience
heightened sensitivity to distension (stretching) of the
intestines or normal contractions. This leads to pain and
discomfort even in the absence of any structural abnormality
in the gastrointestinal tract . Pain Perception: A person with
IBS may perceive pain or discomfort from stimuli (like the
normal passage of food or gas through the gut) that others
might not experience or would not find painful.
• 3. Gut-Brain Axis DysfunctionPsychosocial Factors: The gut-brain
axis refers to the bidirectional communication between the
gastrointestinal system and the central nervous system (CNS).
This pathway can be altered in IBS, leading to heightened pain
sensitivity (visceral hypersensitivity) and altered gut
function.Stress and Anxiety: Psychological stress is a well-known
trigger for IBS flare-ups, and emotional stress can influence
gastrointestinal motility, gut microbiota, and pain perception.
Many IBS patients report that symptoms worsen during periods
of stress or anxiety.Depression: There is a strong association
between IBS and mental health conditions, especially depression.
The interaction between the gut and the brain can exacerbate the
gastrointestinal symptoms of IBS.
• 4. Microbial Imbalance (Dysbiosis)Gut Microbiota: The
balance of gut microbiota (the trillions of
microorganisms in the intestines) is thought to play a
role in IBS. Dysbiosis refers to an imbalance of these
microorganisms, which can lead to changes in bowel
function and inflammation.IBS-D: Overgrowth of certain
bacteria or a shift in microbial composition may
contribute to diarrhea by altering fermentation patterns
and producing gas or by directly affecting gut
motility.IBS-C: Changes in the microbial environment
may affect the breakdown and fermentation of fiber,
contributing to constipation in some individuals.
• 5. Infections and Post-Infectious IBS (PI-IBS)
• Gastrointestinal Infections: Some individuals develop IBS after a
bout of gastroenteritis or a gastrointestinal infection, often
referred to as post-infectious IBS (PI-IBS). It is believed that an
infection can trigger long-lasting changes in the gut, leading to
persistent symptoms like diarrhea and abdominal pain.
• Inflammatory Changes: In some cases, infection may lead to low-
grade inflammation or changes in gut permeability (leaky gut),
which could contribute to ongoing gut dysfunction.
• 6. Intestinal Inflammation
• Low-Grade Inflammation: Some research has
suggested that people with IBS, particularly IBS-D, may
have subtle low-grade inflammation in the gut. This
inflammation could contribute to abnormal motility,
hypersensitivity, and alterations in gut barrier function.
• Immune System Activation: IBS patients may have an
abnormal immune response in the gut, where immune
cells such as mast cells are activated in response to
stimuli, leading to symptoms of pain and discomfort.
• 7. Genetic Predisposition
• Family History: There is evidence to suggest that genetics play a
role in the development of IBS. IBS tends to cluster in families, and
individuals with a first-degree relative with IBS may be at a higher
risk.
• Genetic Mutations: Certain genetic factors affecting gut motility,
immune function, and the gut microbiota may contribute to the risk
of developing IBS.
• 8. Dietary Factors
• Food Sensitivities and Triggers: While no specific "cause" has been
identified, certain foods can act as triggers for IBS symptoms.
Common dietary triggers include:
– High FODMAP foods (Fermentable Oligosaccharides,
Disaccharides, Monosaccharides, and Polyols): These are
types of fermentable carbohydrates found in foods such
as wheat, onions, garlic, and certain fruits and
vegetables. They can be poorly absorbed in the small
intestine, leading to gas production, bloating, and
diarrhea.
– Fatty Foods: High-fat meals can exacerbate symptoms in
some individuals, especially in IBS-D.
– Dairy: Lactose intolerance is common in people with IBS,
and dairy products can worsen symptoms like bloating
and diarrhea in sensitive individuals.
• 9. Hormonal Factors
• Gender and Hormonal Changes: IBS is more
common in women, and its symptoms often
fluctuate with the menstrual cycle, suggesting a
hormonal influence. Many women report that IBS
symptoms worsen during menstruation, which
could be related to estrogen and progesterone
levels influencing gut motility, sensitivity, or
inflammation.
• 10. Psychosocial and Environmental Factors
• Stress and Trauma: Emotional stress and prior
traumatic events (such as abuse or significant life
changes) can contribute to the development of IBS or
exacerbate existing symptoms. Chronic stress can
influence the gut-brain axis, leading to changes in
bowel function.
• Cultural and Psychological Factors: Cultural perceptions
of health, the doctor-patient relationship, and
psychosocial factors like coping mechanisms can
influence the severity and reporting of IBS symptoms.
• Pathophysiology of IBS
• The exact cause of IBS is not fully understood, but several factors
are believed to contribute to its development:
• Gut Motility Dysfunction:
– Altered motility of the intestines, which can lead to diarrhea (due to fast
transit time) or constipation (due to slow transit time). This may result from
abnormal smooth muscle contractions or disturbances in the enteric nervous
system.
• Visceral Hypersensitivity:
– Increased sensitivity of the gut to normal stimuli. This heightened pain
response in the intestines is thought to arise from an overreaction to normal
digestive processes, causing discomfort or pain.
• Gut-Brain Axis Dysfunction:
– A disrupted communication pathway between the gut and the brain
can influence the motility and sensation of the intestines. This is likely
related to stress, anxiety, and other psychological factors, which can
trigger or worsen IBS symptoms.
• Microbial Dysbiosis:
– An imbalance in the gut microbiota has been implicated in IBS. Some
studies suggest that alterations in the types and numbers of gut
bacteria may influence IBS symptoms, particularly in those with IBS-D
(diarrhea predominant) and IBS-M (mixed type).
• Inflammation:
– Low-grade inflammation in the intestines has been observed
in some IBS patients, particularly in those with IBS-D. This
inflammation might contribute to altered motility and
hypersensitivity.
• Infection or Gastrointestinal Illness:
– Some people develop IBS after a gastrointestinal infection
(post-infectious IBS), suggesting that infections can trigger
long-term gut dysfunction.
• Psychosocial Factors:
– Stress, anxiety, and depression are known to exacerbate or
even trigger IBS symptoms, possibly through the gut-brain
axis. These psychological factors can also alter gut motility and
increase sensitivity to pain.
• Management of IBS
• There is no cure for IBS, but symptoms can often
be managed with lifestyle modifications, dietary
changes, medications, and psychological
therapies. Common management strategies
include:
• Dietary Changes: The low FODMAP diet is a
common recommendation for IBS, as certain
fermentable carbohydrates can exacerbate
symptoms. Fiber intake may be adjusted based on
whether the individual has IBS-C or IBS-D.
• Medications: Depending on the predominant
symptoms, options may include:
– Antispasmodics (e.g., hyoscine) for abdominal cramping.
– Laxatives or fiber supplements for IBS-C.
– Anti-diarrheal medications (e.g., loperamide) for IBS-D.
– Antidepressants or antianxiety medications for managing the
gut-brain connection.
– Probiotics or antibiotics (e.g., rifaximin) for microbial
dysbiosis.
• Psychological Therapies: Cognitive-behavioral therapy
(CBT), hypnotherapy, or relaxation techniques to reduce
stress and improve symptom management.
• Regular Exercise: Exercise can help manage stress and
regulate bowel movements.
 TCM VIEW OF IBS-
• Irritable Bowel Syndrome (IBS) in Traditional Chinese Medicine (TCM)
• In Traditional Chinese Medicine (TCM), Irritable Bowel Syndrome (IBS) is
considered a complex disorder that reflects an imbalance in the body's
internal environment, particularly the digestive system. Unlike Western
medicine, which views IBS primarily in terms of gastrointestinal motility,
inflammation, and microbial dysbiosis, TCM diagnoses IBS through a
holistic approach, considering not only the physical symptoms but also
the emotional and environmental factors contributing to the condition.
• In TCM, IBS is often viewed as a manifestation of disharmony between
the Spleen, Stomach, Liver, and Kidney systems, as well as imbalances in
Qi (vital energy), Blood, and Yin/Yang. The symptoms of IBS, including
abdominal pain, bloating, diarrhea, constipation, and irregular bowel
habits, are seen as signs of underlying imbalances within these systems.
• TCM Pathophysiology of IBS
• The pathophysiology of IBS in TCM is primarily based on
the concept of Qi stagnation, Blood deficiency, and Yin
deficiency, along with the imbalance of Hot and Cold
conditions. The major contributing factors in TCM are:
• Spleen Qi Deficiency
– The Spleen in TCM is the organ responsible for transforming
food into Qi and Blood, and for maintaining proper digestion.
When the Spleen is weak (Spleen Qi deficiency), it cannot
effectively transport and transform food, leading to digestive
problems such as bloating, diarrhea, and fatigue.
– Symptoms: Loose stools, bloating, fatigue, lack of appetite, and
a feeling of heaviness.
• Liver Qi Stagnation
• The Liver plays a crucial role in the smooth flow of Qi
throughout the body, including the digestive system.
Liver Qi stagnation is a common cause of IBS, especially
in individuals who experience stress or emotional
turmoil. Stagnation of Liver Qi can obstruct the Spleen’s
function, leading to digestive issues.
• Symptoms: Abdominal pain or discomfort that is relieved
by passing gas or bowel movements, irritability, mood
swings, and bloating, especially after meals.
• Dampness and Phlegm
• Dampness (excess moisture or internal "fluid
accumulation") can accumulate in the body due to a
weak Spleen and cause digestive disturbances. This is
often associated with Damp-Heat or Cold-Damp
patterns in IBS.
• Dampness can obstruct the normal flow of Qi and lead
to symptoms like bloating, diarrhea, a feeling of fullness,
and loose stools.
• Symptoms: Heaviness, excessive mucus in stools, a
greasy coating on the tongue, and sluggish digestion.
• Heat in the Stomach and Large Intestine
• Stomach Fire or Large Intestine Heat can
manifest as IBS with symptoms like diarrhea,
urgency, or inflammatory-like symptoms such as
abdominal pain with a feeling of heat or
burning. This is often linked with dietary factors
such as the consumption of spicy foods,
alcohol, or a high-fat diet.
• Symptoms: Diarrhea with a sense of urgency,
foul-smelling stools, abdominal pain, and
irritability.
• Blood Deficiency
• Blood deficiency (often involving the Spleen or Heart) can
lead to inadequate nourishment for the digestive organs,
resulting in constipation, dryness, and difficulty passing
stools.
• Symptoms: Dry stools, fatigue, dizziness, pale complexion,
and a feeling of emptiness or weakness in the abdomen.
• Kidney Yin Deficiency
• Kidney Yin is essential for nourishing the Spleen and
maintaining fluid balance in the body. A deficiency of
Kidney Yin can result in dryness and constipation, as well as
the disruption of the body's internal balance.
• Symptoms: Constipation, dry skin, dry stools, lower back
pain, and feeling of heat at night
• Qi and Blood Deficiency
• When the body's Qi and Blood are weak, it can
impair the function of the digestive system,
leading to symptoms like fatigue, abdominal
distention, constipation, or diarrhea.
• Symptoms: Fatigue, lack of energy, weak
digestion, bloating, and irregular bowel
movements.
• Common Patterns of IBS in TCM
• Liver Qi Stagnation with Spleen Qi Deficiency
– This is one of the most common patterns seen in IBS.
Liver Qi stagnation leads to emotional stress, which
then affects the Spleen and causes digestive issues.
The Spleen Qi deficiency leads to bloating, irregular
bowel movements, and fatigue.
– Symptoms: Abdominal bloating, irritability, alternating
diarrhea and constipation, a feeling of fullness in the
abdomen, and fatigue.
– Tongue: Pale, with a thin white coating.
– Pulse: Wiry (due to Liver Qi stagnation), weak (due to
Spleen Qi deficiency).
• Spleen Qi Deficiency with Dampness
– When the Spleen is weak and unable to properly transform food
and fluids, it leads to the accumulation of Dampness in the body,
which can affect the digestive system.
– Symptoms: Abdominal bloating, loose stools or diarrhea, nausea,
lack of appetite, and a feeling of heaviness in the body.
– Tongue: Pale with a thick, greasy coating.
– Pulse: Slippery or weak.
• Heat in the Large Intestine or Stomach
– This pattern is often linked to IBS-D (diarrhea predominant) with a
fiery or inflammatory component. Overconsumption of spicy
foods, alcohol, or stress can lead to this pattern.
– Symptoms: Diarrhea, urgency, abdominal pain, and a burning
sensation, often accompanied by foul-smelling stools.
– Tongue: Red, with a yellow coating.
– Pulse: Rapid and full.
• Kidney Yin Deficiency with Dryness
– This pattern involves a deficiency of Kidney Yin,
leading to a lack of nourishment for the intestines,
resulting in constipation and dryness.
– Symptoms: Constipation, dry stools, dry skin, back
pain, dizziness, and a feeling of heat, especially at
night.
– Tongue: Red with little coating, dry appearance.
– Pulse: Thin and rapid.
• Liver Overacting on Spleen (Liver Qi Stagnation
Affecting Spleen) in IBS - TCM Perspective
• In Traditional Chinese Medicine (TCM), the concept of
Liver Overacting on Spleen is a common pattern seen
in digestive disorders, including Irritable Bowel
Syndrome (IBS). This pattern arises when Liver Qi
stagnation (typically caused by emotional stress,
frustration, or anger) interferes with the normal
functioning of the Spleen (which is responsible for
transforming food and fluids into Qi and Blood).
• The imbalance between the Liver and Spleen can
manifest in a variety of IBS-related symptoms, including
bloating, alternating diarrhea and constipation, and
abdominal discomfort.
• Pathophysiology of Liver Overacting on Spleen
• Liver Qi Stagnation:
– The Liver in TCM is responsible for the smooth flow of Qi throughout the body,
including the digestive system. When Liver Qi becomes stagnant (often due to
stress, emotional upset, or frustration), it fails to move freely, which can create
internal tension and disruption in the digestive system.
– Stagnant Liver Qi can lead to a buildup of heat, phlegm, and dampness, and can
also disrupt the normal function of the Spleen.
• Spleen Qi Deficiency:
– The Spleen in TCM is responsible for the transformation and transportation of
food and fluids. When the Liver Qi stagnates, it creates a kind of "pressure" or
blockage on the Spleen, preventing it from properly performing its function.
– This results in Spleen Qi deficiency, which impairs the Spleen’s ability to
transform food into Qi and Blood, leading to digestive problems like bloating,
diarrhea, constipation, fatigue, and poor appetite.
• Liver Overacting on Spleen:
– The Liver Qi's stagnation "overacts" or "invades" the Spleen, disrupting the
smooth flow of digestion and creating symptoms of both Spleen Qi deficiency
and Liver Qi stagnation. This can cause a variety of digestive symptoms,
including alternating bowel movements (diarrhea and constipation), abdominal
bloating, and discomfort.
• Key Symptoms of Liver Overacting on Spleen in IBS
• When Liver overacts on Spleen, the individual may
experience a combination of symptoms related to both
the Liver and Spleen:
• Abdominal Distension and Bloating:
– A feeling of fullness or bloating, particularly after eating, due
to the impaired digestion and the stagnation of Liver Qi.
• Alternating Diarrhea and Constipation (IBS-Mixed):
– A hallmark symptom of this pattern is alternating diarrhea
and constipation, reflecting the interaction between Liver Qi
stagnation (leading to constipation) and Spleen Qi deficiency
(leading to loose stools or diarrhea).
– Diarrhea may be loose and frequent, often with a sense of
urgency, while constipation is characterized by dry stools and
difficulty passing them.
• Abdominal Pain or Discomfort:
• This pain is often sharp, crampy, or spasmodic, and it may
be relieved by passing gas, having a bowel movement, or
engaging in activities that relieve stress.
• The pain can be triggered or exacerbated by emotional
stress, frustration, or anger, which are common causes of
Liver Qi stagnation.
• Fatigue and Low Energy:
• Spleen Qi deficiency often leads to fatigue, a lack of energy,
and a feeling of heaviness or sluggishness in the body.
Patients may feel tired after eating, or have difficulty getting
up in the morning.
• Poor Appetite and Digestive Discomfort:
• People with this pattern may experience loss of appetite,
nausea, or a sensation of a "lump" in the stomach, which is
a result of the Liver Qi interfering with the Spleen's ability
to properly digest food.
• Irritability, Mood Swings, and Emotional Stress:
• Because the Liver governs the flow of emotions, Liver Qi
stagnation often leads to irritability, mood swings, and
stress. These emotional factors can worsen the digestive
symptoms, creating a vicious cycle of pain and discomfort.
• Tongue and Pulse Diagnosis:
• Tongue: The tongue in this pattern is typically pale, with a
thin white coating (indicating Spleen Qi deficiency). There
may be slight red edges or a purple tongue (suggesting
Liver Qi stagnation or Blood stasis), especially along the
sides of the tongue.
• Pulse: The pulse is typically wiry (indicating Liver Qi
stagnation) and weak or empty (indicating Spleen Qi
deficiency).
• Treatment Principles for Liver Overacting on
Spleen in IBS (TCM Approach)
• In TCM, the treatment strategy for Liver
overacting on Spleen focuses on:
• Smoothing Liver Qi to resolve the stagnation.
• Tonifying Spleen Qi to strengthen digestion
and promote proper transformation of food.
• Clearing heat (if present) and resolving
dampness to support digestive function.
• COMMON ACUPUNCTURE POINTS-
• ST25
• SP6
• ST36
• LI4 & LV3
• ST40 , SP9 , REN9
• ST44, LI11
• Herbal Medicine
• Herbal formulas are commonly used to address this pattern of
disharmony. Common formulas might include:
• Xiao Yao San (Free and Easy Wanderer): A classic formula for
Liver Qi stagnation with Spleen Qi deficiency. It helps soothe
Liver Qi, strengthen the Spleen, and regulate digestion. This
formula is often used when emotional stress is a key factor.
• Chai Hu Shu Gan San: This formula is used to promote the free
flow of Liver Qi and relieve stagnation. It is often combined
with other formulas to strengthen the Spleen.
• Bu Zhong Yi Qi Tang: This formula is used when there is Spleen
Qi deficiency with Liver Qi stagnation. It tonifies the Spleen
and enhances the digestive function.
• Xiang Sha Liu Jun Zi Tang: A modified version of the Liu Jun Zi
Tang (Six Gentlemen Decoction) that helps tonify the Spleen,
resolve Dampness, and move Liver Qi.
• THANK YOU- DR KAMALESH ARYA , JINGWELL
ACADEMY
• REFERENCE- MAYO CLINIC
• ATTACHED TCM RESEARCH PAPERS-
PUBMED , GOOGLE SCHOLAR

• DR POOJA UC