1.Typing treatment
Chinese medicine treatment for IBS is still based on the identification and typing treatment, and there are different reports on the identification and typing of IBS, ranging from type 2 to type 7. The Chinese Society of Integrative Medicine and Chinese Medicine (CCM) Committee on Digestive Diseases formulated the “Combined Chinese and Western Medicine Treatment Plan for Irritable Bowel Syndrome (Draft)” in Chongqing in 2003, which divided IBS into five types.
(1) Liver depression and qi stagnation evidence
Main symptoms: constipation, poor desire for stool, difficulty in passing stool; distension and pain in the chest or abdomen; irritability and irritability; stringent pulse.
Secondary symptoms: intestinal tinnitus and yagging; belching and erratic, poor food; posterior weight distress; insomnia and dreaminess; bitter mouth and dry throat, or throat obstruction. Determination of the type of symptoms: 2 items of the main evidence plus 2 items of the secondary evidence, or item 1 of the main evidence plus 3 items of the secondary evidence.
Treatment: Drain the liver and regulate Qi.
Remedies: Liu Mo Tang with added flavor: Shen Xiang (later down), Guang Mu Xiang (later down), Betel nut, Wu Yao, Citrus aurantium, Sheng Da Huang (later down), Yu Jin, Hou Pu; addition and subtraction: Yan Hu Suo and Bai Shao for obvious abdominal pain; Scutellaria baicalensis, Chrysanthemum, Xia Ku Cao for liver stagnation and heat with dry mouth and throat; Fire Ma Ren, Almond, Peach kernel for hard stools.
(2) Liver Qi multiplied by Spleen
Main symptoms: abdominal pain and diarrhea, with pain slowing down after diarrhea (often attacked or aggravated by irritation or nervousness); constriction and urgency in the lower abdomen; distension and pain in the chest and fullness; string or thin pulse.
Secondary symptoms: intestinal tinnitus and yagging; mucus in the stool; depression, good at breathing; impatience and irritability; dullness and abdominal distension. Determination of the type of symptoms: having 2 items of the main evidence plus 2 items of the secondary evidence, or the first item of the main evidence plus 3 items of the secondary evidence.
Treatment: Suppressing the liver and supporting the spleen.
Treatment: Add flavor to the formula for pain and diarrhea: fried Atractylodes macrocephala, raw white peony, antiphlogistic, fried Chen Pi, Chai Hu, simmered mucuna pruriens, fried heliotrope shell, made fragrant herb, raw licorice.
(3) Weakness of spleen and stomach
Main symptoms: frequent diarrhea after meals, loose stools with mucus; poor appetite; abdominal distension after eating, stuffy and uncomfortable; pale tongue, fat tongue with teeth marks, white fur; weak pulse.
Secondary symptoms: abdominal pain and pressure; abdominal distension and intestinal tinnitus; fatigue and laziness, tiredness and fatigue; yellowish complexion. Determination of the type of evidence: having 2 items of the main evidence plus 2 items of the secondary evidence, or item 1 of the main evidence plus 3 items of the secondary evidence.
Treatment: Strengthening the spleen and benefiting Qi.
Treatment formula: Ginseng, Atractylodes Macrocephalae, Poria, Paeonia, Yam, fried lentils, lotus seeds, Coix seeds, sand, fried Chen Pi, Mu Xiang, licorice; addition and subtraction: add Sheng Ma, Chai Hu, Huang Qi if the deficiency of spleen and kidney, add bone marrow, nutmeg if the morning diarrhea; add dry ginger, cinnamon if the abdominal pain likes to press, cold and loose stool; add Atractylodes Macrocephalae, Hou Pu, Huo Xiang, Ze Xie.
(4) Cold and heat mixed evidence
Main symptoms: alternating episodes of diarrhea and constipation; sticky jelly or foam in the stool; abdominal pain before the stool, stopping when the stool is relieved; dark red tongue with white greasy coating; thin or slippery pulse.
Secondary symptoms: abdominal distension and intestinal tinnitus; bitterness in the mouth; anal drop; unpleasant bowel movement. Determination of symptoms: 2 main symptoms plus 2 secondary symptoms, or 3 main symptoms.
Treatment: Calm the cold and heat, and benefit the middle temperature.
Treatment formula: Wu Mei Wan plus or minus: Wu Mei, Huang Lian, Huang Bai, Sichuan pepper, roasted sliced pepper, ginger, Dang Shen, Atractylodes, Poria, angelica, peony, licorice; add or minus: remove Huang Lian, add cumin, lychee kernel; remove Sichuan pepper, ginger, pepper, sliced pepper, add gardenia, Wu Zhu Zhu; add betel nut, thick parker, hawthorn char if the stool is sticky and unpleasant, with urgency and heaviness.
(5) Large intestine dry heat evidence
Main symptoms: constipated stool, one line for several days; feces like a sheep’s vein, wrapped in mucus; lumps in the abdomen, swelling and pain when pressed; red tongue, yellow coating and less fluid; thin pulse.
Secondary symptoms: dizziness and swelling; emaciation; dry mouth or bad breath; insomnia and anxiety. Determination of symptoms: 2 main symptoms plus 2 secondary symptoms.
Treatment: Draining heat and clearing the bowels, moistening the bowels and opening the bowels.
Treatment formula: Ma Zi Ren Wan plus or minus: raw rhubarb (later down), fire hemp, almonds, white peony, hedgehog, white honey (flushed), northern ginseng, maitong, angelica; plus or minus: xuan ginseng, raw earth, raw shouwu in case of heavy constipation; Yan Hu Suo in case of obvious abdominal pain, and white peony in the original formula.
2.Treatment by type identification
(1) Diarrhea-type IBS treatment in Chinese medicine
(1) Liver and spleen disharmony.
Clinical manifestations: often onset or aggravation due to depression, irritation or nervousness; manifestations include constriction and urgency in the abdomen, distension and fullness in the chest, belching and less food; abdominal pain, i.e., diarrhea; pain decreases after diarrhea, intestinal tinnitus and yagging, mucus in the stool, incomplete defecation; light red tongue, thin white coating; string or thin pulse.
Treatment: Diversify the liver and strengthen the spleen
Treatment formula: Painful diarrhea with addition and subtraction.
Composition: Fried Atractylodes Macrocephala, Radix Paeoniae Alba, Fructus Anemarrhenae, Fried Chen Pi
②Spleen deficiency and Qi deficiency.
Clinical manifestations: perennial diarrhea, often due to overthinking; abdominal distension after eating, stuffiness, poor appetite and tiredness, yellow face; often diarrhea immediately after meals, loose stools with mucus, increased stools, abdominal pain, anal swelling; light tongue, thin white fur, fat tongue with teeth marks; weak pulse.
Treatment: Strengthening the spleen and benefiting Qi
Treatment formula: Six Gentlemen’s Tonic plus or minus.
Composition: Mu Xiang, Sha Ren, Fried Atractylodes, Radix Codonopsis, Poria, Licorice
(iii) Damp-heat in the large intestine.
Clinical manifestations: chronic diarrhea, violent diarrhea triggered by emotional factors or dietary indiscretion; chest tightness, thirst, thirst for drinks, spontaneous sweating, short, red urine; diarrhea and abdominal pain, urgent discharge, or unpleasant discharge, yellow and smelly feces, burning anus; yellow and greasy tongue coating; moist pulse or slippery pulse.
Treatment: Clearing heat and draining the bowels
Treatment formula: Radix Scutellariae Scutellariae Tang with reduction.
Composition: Mu Xiang, Huang Lian, Ge Gen, Scutellaria, Poria, Fenugreek
Spleen and kidney Yang deficiency.
Clinical manifestations: diarrhea that does not heal over the years, untreated for a long time, or caused or aggravated by intimidation; cold form and limbs, cold pain in the abdomen, soreness and weakness of the waist and knees, seminal emission and urination; loose stools, mixed with complete grain, or diarrhea at dawn, abdominal pain like warmth and like to press; light and tender tongue with moist coating; sunken or weak pulse.
Treatment: Tonifying the spleen and benefiting the kidney
Treatment formula: Si Shen Wan plus or minus.
Composition: Fuzi, Wu Yu, Nutmeg, Wu Wei Zi
(2) Constipation type of IBS: Chinese medicine evidence-based treatment
(1) Liver-depression and qi-stagnation type.
Clinical manifestations: dry or not very dry stools, difficult and difficult to defecate, less than 3 times a week, or even 1 week, abdominal distension and pain even to both sides, bitterness in the mouth, dizziness, symptoms repeated with emotional fluctuations, light tongue, thin white fur, string pulse.
Treatment: Diversify liver, regulate Qi, and relax stool
Treatment formula: Liu Mo Tang with reduction.
Formulation composition: made of Mu Xiang, Wu Yao, Citrus Aurantium, Betel nut, Rhubarb, Green Peel
② Large intestine dry heat evidence
Clinical manifestations: constipation, one line for several days, feces like a sheep’s vein, covered with mucus, dry mouth or bitter mouth, lumps in the abdomen, painful distension when pressed; red tongue, yellow fur and little fluid; fine pulse.
Treatment: Draining heat and clearing the bowels, moistening the bowels and clearing the stool.
Treatment: Hemp Seed and Nut Pill with addition and subtraction
Composition of the formula: hemp seeds, almonds, white peony, hedgehog, white honey (flushed), northern sage, maitong, angelica.
3.Effective prescriptions and experimental prescriptions collection
(1) Pain and diarrhea formula
Composition: Atractylodes macrocephala, Radix Paeoniae Alba, Radix Bupleuri, Pericarpium Citri Reticulata.
Effects: Clearing the liver and strengthening the spleen.
To stop diarrhea; if sleeplessness is seen at night, add nightshade vine and helianthus bark to nourish the heart and calm the mind. Guangzhou University of Traditional Chinese Medicine, Institute of Spleen and Stomach, Professor Laoxian experience is that the spleen is not healthy, loose stools can be used atractylodes 15-18g, if the spleen is weak stools for several days 1 time and not dry, each dose with atractylodes 30g, warm spleen Yang to pain stools. Combined with modern pharmacological experiments Atractylodes macrocephala has an excitatory effect on the isolated small intestine of rabbits, Professor Lao believes that the two-way effect of Atractylodes macrocephala is closely related to the size of the dosage. When abdominal pain is the main symptom, Bai Shao in the formula is used to ease the pain, and 15-20g of Bai Shao is used heavily with licorice to form Paeoniae and Licorice Soup, which is a classic formula for abdominal pain. Professor Lao’s experience is that it is better to replace it with red peony, because red peony contains higher paeoniflorin than white peony, and its antispasmodic and analgesic effect is stronger than that of white peony. However, red peony and white peony are both sour and cold, and excessive amounts are prone to diarrhea. If the abdominal pain is obvious, in order to achieve the effect of relieving pain more quickly, it is also necessary to add Yuan Hu, Wu Yao, Jiang Huang and other qi-regulating drugs. If the pain has a fixed location, add peach kernel, danpi to invigorate the blood and disperse the knots. If there is pain in both hypochondrium and abdomen, or if the spirit is depressed, add Chai Hu, Yu Jin, and Hefei Pi to strengthen the function of draining the liver and relieving depression. If there is also damp-heat, mucus stools, and urgency, Xiang Lian Wan should be added to treat the condition. It is also possible to clear damp-heat with Fire Tan Mother. For diarrhea with a white, greasy tongue and heavy dampness, combine with Ping Gastric San to treat it. If the spleen is deficient and loose, fatigue can be added with Radix et Rhizoma Ginseng and Huang Jing to strengthen the spleen and benefit the Qi. For prolonged defecation, chebulo and pomegranate skin should be added to stop diarrhea. For those who have constipation and have difficulty in relieving it, use heliotrope, houpu, betel nut, xuan ginseng, Zhi mu, aconite, etc. to break the qi and open the stool and nourish yin and moisten dryness.
(2) Sibei San
Ingredients: Chai Hu, Citrus aurantium, Glycyrrhiza glabra, Bai Shao.
Effects: Clearing the liver and strengthening the spleen.
(3) Xiao Chai Hu Tang
Ingredients: Radix Bupleurum, Scutellaria, Radix Panax, Radix Codonopsis, Ginger.
Effects: Regulating Qi and draining the liver.
Application: adding Radix Aromaticus and Peppermint in case of Qi stagnation; adding Astragalus, Atractylodes and Radix et Rhizoma in case of Spleen deficiency; adding Huang Lian and Poria in case of Damp-Heat; adding Rhizoma Rheum and Phellodendron in case of constipation; adding Chuanxiong and Fructus Herba in case of Blood stasis.
(4) Prosperity San
Ingredients: Radix Bupleurum, Radix Angelicae Sinensis, Radix Paeoniae Alba, Poria, Atractylodes Macrocephala, Peppermint.
Effects: Dredging the liver and strengthening the spleen.
(5) Hanxia Diarrhea Heart Soup
Ingredients: Radix Panax notoginseng, Scutellaria baicalensis, Radix Scutellariae, Radix Codonopsis pilosulae, Radix et Rhizoma ginger.
Effects: Pungent, open and bitter, harmonizing the spleen and stomach.
Application：For severe abdominal pain and diarrhea with pain, use Fang Feng and add Cicadelle; for severe diarrhea, add Horehound; for abdominal distension, add Citrus aurantium shell and Chicken Neijin; for urgency and incomplete defecation, add Mu Xiang and Betel nut; for burning sensation in the anus, use Huang Lian; for watery stool, add Elsholtzia and Pueraria lobata; for mucus stool, add Bupleurum and Diyu; for triggered by mental factors, add Mentha piperita and Chai Hu; for triggered by cold and cold, use Radix et Rhizoma, dry ginger, nutmeg.
(6) Addition of Huangqi Jianzhong Tang
Ingredients: Astragalus, cinnamon stick, jujube, white peony, licorice, ginger, atractylodes, poria.
Effects: Strengthening the spleen and warming the middle.
Applications: for those with Qi stagnation and abdominal distension, add spring sandy sage and lycopodium; for those with cold dampness and loose diarrhea with mucus, add Huo Xiang, Atractylodes, and Perilla; for those with food stagnation and dullness and belching, add Chen Pi Gu Ya, and Chicken Nei Jin; for those with liver stagnation and hypochondriac pain, add Chai Hu and Buddha’s hand; for those with kidney deficiency and weakness of the waist and knees, or five-shift diarrhea, add Shu Shen Zi and Boneset.
(7) Plus flavor tonic for the middle and vital energy soup
Astragalus membranaceus, Radix Codonopsis pilosulae, Rhizoma Atractylodis Macrocephalae, Radix Paeoniae Alba, Pericarpium Citri Reticulatae, Radix et Rhizoma Glycyrrhizae.
Effects: Tonifying the middle and benefiting the qi.
Application: Add Chai Hu, fried Fang Feng and Mu Xiang for liver and spleen deficiency; add fried lentils, fried Coix Seed, Huai Shan and Gorgonian for spleen and stomach weakness; add 7 Mai Dong, Dendrobium and Huai Shan for spleen and stomach yin deficiency; add poppy husk and Chebulus for severe diarrhea; add Bai Shao and Chen Pi for obvious abdominal pain; add white mustard seed and betel nut for mucus in stool; add Citrus aurantium for constipation; use Bai Shao and Bai Zhu for constipation up to 30g, and add fire flax seed 30g, with stagnation, add Lycopodium and Shen Qu.
(8) Radix et Rhizoma Ginseng and Atractylodes Macrocephalae plus or minus formula
Effects: Strengthening the spleen and relieving dampness.
Application: Add Ucimum sanctum and Neem for obvious abdominal pain; reduce lotus seed flesh and Coix seed for constipation, add Citrus aurantium and Hou Pu; add Betel nut and Angelica sinensis for incomplete defecation; add Scutellaria baicalensis and Radix et Rhizoma septicae for dampness and heat; add Ocimum sanctum and Radix etiolatum for diarrhea.
(9) Radix Chai Hu, Gui Zhi and Gan Jiang Tang
Composition: Radix Bupleurum, Scutellaria, Radix Panax, Calcined oyster, Radix Ginger, Radix Cinnamomum, Radix et Rhizoma, Licorice.
Effects: Combining cold and warmth, harmonizing the liver and spleen.
If the stool is sticky and unpleasant and the anus is burning, remove the cinnamon branch, reduce the dry ginger, add Huang Lian and Huang Bai; if the stool is loose and the food is not fragrant, add Poria, Atractylodes and Mu Xiang.
(10) Plus flavor Er Shen Tang
Composition: Bone marrow, nutmeg, wind, white peony, atractylodes, kudzu root, poria, horsetail, Wu Yu, cinnamon, Qin Pi.
Effects: Tonifying the kidneys and warming Yang, strengthening the spleen and promoting clearing, and draining the liver and regulating stagnation.
Application: Add Huang Bai, Yin Chen, remove nutmeg and Wu Yu; add Chebulan and Che Qian Zi for diarrhea; add Wu Ling Li and Pu Huang for abdominal pain and purple tongue with stasis; remove Wu Yu and Cinnamon for Yin deficiency with red tongue and dry coating, add Sheng Di and Angelica Sinensis.
(11) Ginger Diarrhea Heart Soup plus or minus formula
Ingredients: ginger, dry ginger, scutellaria, Fuxianxia, prunus ginseng, Huanglian, fried atractylodes, antiphlogistic, Chen Pi, jujube, roasted licorice.
Effects: Strengthening the spleen and stomach, attacking and tonifying at the same time.
Application: For abdominal pain, add fried white peony; for constipation, add hedgehog, fried betel nut and rhubarb; for abdominal pain and stabbing pain that does not move and astringent pulse, add Salvia miltiorrhiza and Wu Ling Li.
(12) Wanzhi Tang with Allergy Decoction plus reduction
Effects: Supporting earth and suppressing wood, harmonizing liver and spleen.
Applications: Add Yanhuosuo and Xu Changqing for abdominal pain; add Houpao for obvious abdominal distension; add Quan Guaou and Allium for obvious posterior weight; make rhubarb and betel nut for obvious mucous-heat; add Fructus sabdariffa and pomegranate bark for obvious damp-heat; add dry ginger and Wu Zhuyu for obvious cold deficiency; add Sha Yuanzi and Puzzle Nut for kidney deficiency.
(13) Warming Spleen Soup combined with Liang Shen Wan plus or minus formula
Ingredients: Radix Aromaticus, Radix Phellodendron, Radix Ginseng, Radix Ginger, Radix Bupleurum, Rhizoma Atractylodes, Radix Glycyrrhiza Uralensis.
Effects: Strengthening the spleen and warming the stomach.
Application: Add Radix et Rhizoma Guanzhong, Radix et Rhizoma Fructus, Radix Scutellariae; add Radix Astragali for Qi deficiency; add Radix et Rhizoma Yam and Radix et Rhizoma Macrocephala for Yin injury.
(14) Self-designed formula for widening the bowel
Composition: Radix Bupleurum, Radix Paeoniae Alba, Citrus Aurantium, Rhizoma Atractylodes Macrocephalae, Poria, Radix et Rhizoma Gastrodiae.
Effects: Diversifying the liver and strengthening the spleen, clearing heat and relieving dampness.
Application: Add Wu Yao and Mu Xiang for abdominal pain, fried Huai Shan Yao and nutmeg for diarrhea, betel nut and tiger scepter for constipation, Chuan Lian for mucus, and Huo Huo, Su Stem and Cardamom for internal urgency.
(15) Self-designed Qi Qi An intestinal drink
Ingredients: Astragalus, Poria, Yam, Nutmeg, Simmered Cheliput, Boneset, Fructus Schisandrae, Magnolia, Plum, Papaya, and Flax.
Effects: Clearing the liver, strengthening the spleen, clearing heat and relieving dampness.
For superficial symptoms, add Pueraria Mirifica, Fructus Anemarrhea, Perillae and Forsythia.
(16) Self-designed Intestinal Decoction
Ingredients: Pericarpium Citriodora, Poria, Radix et Rhizoma Polygonati, Phyllostachys, Atractylodes Macrocephalae, Radix et Rhizoma Sanguisorba, Paeoniae Alba, Glycyrrhiza Uralensis.
Effects: Completing the intestine, regulating Qi and harmonizing the stomach.
Application：If abdominal pain is very severe, add Yuan Hu and fried neem; if diarrhea is very severe, add Wu Mei and pomegranate peel; if weakness is obvious, add Radix Codonopsis to tonify the qi and strengthen the spleen; if belching is frequent, add Shen Xiang.