Irritable bowel syndrome
History taking】
Mainly describe abdominal pain, diarrhea, constipation, abdominal distension, etc. Also, describe the patient’s sleep, mental status, psychological status and previous history of intestinal tract.
Physical examination
Physical examination focuses on the abdomen.
Auxiliary examinations
1.Blood, urine, stool routine, blood sedimentation, liver and kidney function, electrolytes, etc.
2, chest X-ray, hepatobiliary, pancreatic, spleen, kidney and gynecological ultrasound.
3.Barium meal, colonoscopy.
Diagnostic points】
1.Abdominal pain, bloating, diarrhea and constipation as the main complaints, accompanied by systemic neurological symptoms.
2.Good general condition, no wasting and fever, etc. Physical examination revealed abdominal pressure pain.
3, repeatedly negative fecal routine and culture (not less than 3 times), negative fecal occult blood test.
4. No positive findings on barium enema X-ray examination, or irritable signs in the small intestine and colon.
5.Colonoscopy showed hypermotility or spasm in some patients without obvious mucosal abnormalities.
6.Blood and urine routine and blood sedimentation are normal.
7.Intestinal tract and other organic diseases that may cause the above symptoms must be excluded.
Differential diagnosis
1, malabsorption syndrome.
2.Schistosomiasis.
3.Intestinal tumor.
4, inflammatory bowel disease.
5, lactase deficiency.
6, intestinal tuberculosis.
7, can cause intestinal irritation symptoms of other systemic diseases such as hyperthyroidism.
Treatment principles
1, Chinese medicine identification treatment: cold and dampness, damp-heat injury, liver qi multiplied by the spleen, food stagnation of the stomach, spleen and stomach weakness, spleen and kidney Yang deficiency, etc., and the spleen deficiency and dampness is the main treatment to strengthen the spleen to resolve dampness, to collect astringent diarrhea, long-standing disease and kidney to give warm kidney diarrhea products.
Cold and damp type
Symptoms: diarrhea as thin as water, abdominal pain and intestinal tinnitus, stuffy stomach with little food, or with wind-cold symptoms. Tongue coating is white and greasy, pulse is moist and slow.
Treatment: Dispersing cold and aromatizing dampness.
Main formula: Huo Xiang Zheng Qi San plus reduction
Prescription: Patchouli 12g, Perilla frutescens 10g, Angelica dahurica 9g, Houpao 10g, Daji Pi 9g, Fuxianxia 12g, Chen Pi 6g, Poria 12g, Licorice 6g. Take with water decoction.
If the dampness is heavy, add 12 grams of Atractylodes macrocephala, 20 grams of Coix seeds and 12 grams of Zedoary.
Chinese patent medicine: Huo Xiang Zheng Qi Wan, 1 bottle each time, 3 times a day.
Damp-heat type
Symptoms: Diarrhea with abdominal pain, urgent diarrhea, like water injection, burning in the anus, thirst, short yellow urine. The tongue is yellowish and greasy, the pulse is moist and counted.
Treatment: Clearing heat and relieving dampness.
Main formula: Radix et Rhizoma Puerariae Scutellariae Tang (Zhang Zhongjing’s Treatise on Typhoid) with reduction
Prescription: Pueraria Mirifica 20g, Scutellaria Baicalensis 12g, Rhizoma Huanglian 10g, Radix et Rhizoma Polygonatum 15g, Poria Cocos 12g, Radix et Rhizoma Mianxian 15g, Radix patchouli 12g, Radix carthamus tinctorius 15g, Radix mucuna pruriens 6g, Radix et Rhizoma Glycyrrhiza Glabra 6g. Take with water decoction.
Proprietary Chinese medicine: Huang Lian Su tablets, 2 tablets each time, 3 times a day. Gastroenterology 1 pack 3/day.
Injured food type
Evidence: Abdominal pain and intestinal tinnitus, diarrhea with fecal matter smelling like defeated eggs, warm rot and sour odor, not thinking of eating. Thick and greasy tongue coating, slippery pulse.
Treatment: Eliminating food and inducing stagnation.
Formula: Main formula Baohe Wan (Zhu Danxi, “Danxi Xinfa”) plus reduction
Prescription: Shanzha 15g, Shenqu 12g, Fuxianxia 10g, Fu Ling 15g, Chen Pi 6g, Lianxiao 12g, Bujian Ye 15g, Maiyao 15g, Licorice 6g. Take with water decoction.
Chinese patent medicine Wang’s Bao Chi Wan, 1 bottle each time, 3 times daily.
Liver-depression type
Evidence: Episodes of diarrhea related to emotion, distension and stuffiness in the epigastrium, belching and less food, abdominal pain and intestinal tinnitus, diarrhea immediately after abdominal pain and pain relieved after diarrhea. Thin white tongue coating and thin string pulse.
Treatment: Suppressing the liver and supporting the spleen.
Main formula: Painful diarrhea (Zhang Jiebin’s “Jing Yue Quan Shu”) plus and minus
Prescription: Bai Shao 15g, Bai Zhu 12g, Fang Feng 10g, Chen Pi 6g, Fu Ling 12g, Chai Hu 10g, Hovenia 10g, Fructus 12g, Licorice 6g. Take with water decoction.
Proprietary Chinese medicine, 10 to 15 grams each time, 3 times a day.
Spleen deficiency type
Symptoms: loose stools with occasional diarrhea, incomplete transformation of grain, little food and distention, withered face and tired limbs. Pale tongue, weak pulse.
Treatment: Strengthen the spleen and benefit the stomach.
Main formula: Ginseng, Ling and Atractylodes (Chen Shiwen, etc., “Taiping Huimin and Pharmaceutical Bureau Formula”)
Prescription: Radix Codonopsis Pilosulae 18g, Atractylodes Macrocephala 15g, Poria Cocos 12g, Rhizoma Polygonati 15g, Lentils 12g, Chen Pi 6g, Sharen 6g (later), Semen Coix 15g, Radix Chrysanthemi 10g, Astragalus Astragali 12g, Shen Qu 10g, Roasted Licorice 6g. Take with water decoction.
Chinese patent medicine Xiang Sha Liu Jun Wan, 6 grams each time, 3 times a day.
Kidney deficiency type
Indications: Abdominal pain before dawn, diarrhea with intestinal tinnitus, and after diarrhea, peace, cold form and limbs, soreness and weakness of waist and legs. Pale tongue, sunken and thin pulse.
Treatment: Warming the kidney and strengthening the spleen, consolidating astringency and stopping diarrhea.
Main formula: Si Shen Wan (Xue Nei Zhai, “Summary of Internal Medicine”) with added flavor
Prescription: 12 grams of bone marrow, 10 grams of Cornus officinalis, 6 grams of nutmeg, 6 grams of Wu Wei Zi, 10 grams of Radix et Rhizoma Polygonati, 9 grams of ginger, 15 grams of Radix Codonopsis pilosulae, 12 grams of Atractylodes Macrocephala, 6 grams of roasted licorice. Take with water decoction.
Chinese patent medicine supplementing spleen and intestine pill, 6 grams each time, 3 times a day.
2.Supplement the normal intestinal flora.
3.Must pay attention to psychological treatment and remove the causative factors.
Therapeutic criteria]
Patients with IBS can generally be treated without hospitalization.