by Skye Sturgeon, DAOM
Article originally published November, 2025
Sometimes, patients present in clinic with a diagnosis that they have received from a biomedical practitioner and want to know if traditional Chinese medicine (TCM) can treat it. Often, they are dissatisfied with the recommended treatment and seek an alternative. This article will explore a common diagnosis seen in clinics, Irritable Bowel Syndrome.
The good news is that their medical practitioners have likely ruled out more serious inflammatory diseases such as Crohn’s Disease or Inflammatory Bowel Disease. Presumably, the doctor has also eliminated infectious agents such as bacteria, worms, or parasites (such as Giardia). This means that there is no specific disease with a clearly defined cause, or targeted treatments for the patient’s condition, and they are left with a group of symptoms that ‘run together’ without a definable etiology. When confronted repeatedly, biomedicine creates a name for this collection of symptoms called a ‘syndrome’, as opposed to a ‘disease’. There are many examples of this designation including Chronic Fatigue Syndrome (CFS) or Polycystic Ovary Syndrome (PCOS). A patient need not have all the signs or symptoms associated with the syndrome but will usually have enough of them for their condition to be classified as a syndrome. In many cases, the underlying specific disease process and treatment has not yet been determined.
In contrast, a ‘syndrome’ in traditional Chinese medicine (TCM) refers to the result of a diagnostic process, known as pattern differentiation, where, by assessing a patient’s medical history, signs, symptoms, physical examination, and inquiry about their lifestyle, diet, emotional health and other factors, the practitioner identifies patterns or ‘syndromes’ of imbalance or disharmony in the body. This resultant syndrome is then used to develop a treatment plan to restore balance and promote health. Let us take a look at what TCM has to offer, understanding that this collection is not exhaustive in identifying TCM syndromes that address diarrhea or constipation, but rather a diagnosis of ‘irritable bowel syndrome’.
First, what is Irritable Bowel Syndrome?
Irritable bowel syndrome (IBS) is a group of symptoms that occur together, including repeated or episodic pain in the abdomen and changes in bowel movements, which may be diarrhea, constipation, or both. With IBS, one can have these symptoms without any visible signs of damage or disease in the digestive tract. This common condition is estimated to occur in 10-15% of adults in the US with women twice as likely to develop it than men. Other symptoms reported by patients may include abdominal cramps accompanied by an urge to defecate, excess gas, a sensation of bloating, a whitish mucus in the stool, and a feeling like the bowels have not been completely emptied.
Three categories of IBS are defined in biomedicine based on the type of bowel movement disturbance that predominates. When diarrhea or a loose and watery stool predominates, this is designated IBS-D. When constipation or a hard and lumpy stool is the primary condition, it is designated as IBS-C, and when both are present, or alternating, the designation is IBS-M (mixed).
Some researchers classify IBS as a neurogastrointestinal disorder, in which there may be disorders of the gut-brain axis, and suggest dysmotility and visceral hypersensitivity as potential etiologies of the condition. Other causes to be considered include history of a severe infection in the GI tract from bacteria or parasites (like Giardia). A poor diet or any infection that includes a course of antibiotics may cause an alteration in normal flora in the intestines, the imbalance of which may contribute to the symptoms of IBS. Patients that have symptoms of IBS should be investigated for food intolerances such as lactose intolerance, gluten sensitivity, histamines, or FODMAPs, et al. Interestingly, IBS is more common in people who experienced severe stressors in childhood or later in life (e.g. post-traumatic stress disorder/ PTSD). Emotional themes including anxiety, depression, frustration, and anger, which can be contributing factors and sometimes IBS is called ‘nervous stomach’. Some women report that their IBS symptoms worsen predictably according to their menstrual cycle.
Although there are laboratory tests and imaging procedures that are used to rule out more serious conditions, according to biomedicine standard of care, there is no cure for IBS and consequently the focus is on symptom management and changes in diet and lifestyle. Often a dietician or nutritionist will recommend modifications such as increased supplemental fiber, avoiding foods known to cause gas (e.g. legumes, brassica vegetables, or carbonated beverages), limiting dairy products, and avoiding or reducing foods containing gluten or fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs). In addition, a healthcare provider may recommend moderate exercise, relaxation techniques, and regular, adequate sleep. Additionally, cognitive behavior therapy, hypnosis, biofeedback, or other mental health therapies may be employed to address psycho-emotional factors. Medications prescribed to alleviate symptoms include antidepressants, laxatives, antispasmodics, stool softeners, anti-diarrheals, probiotics, and antibiotics, as indicated.
Traditional Chinese Herbal Medicine
There is no traditional condition that is defined as irritable bowel syndrome in Chinese medicine. However, digestive imbalances such as abdominal pain, diarrhea, and constipation can easily be improved with the use of Chinese medicine modalities, especially when emotional factors, stress, and improper diet are also considered. In fact, there are nearly thirty syndromes that may be employed in treating a patient who is having these symptoms. In this article, I will focus on Chinese herb formulas to address IBS by examining the imbalances defined by some of these TCM syndromes.
Careful assessment is necessary. Consideration of Eight Principles (Ba Gang), Five Elements (Wu Xing), and Organs (Zang-fu) in addition to Qi, Xue (Blood), and body fluids (Jin Ye) will prove valuable. After eschewing the possibility of an etiology from an external pathogen, here are some major themes to consider along with suggested classical formulas that address the syndrome’s implied imbalance.
Arguably, the most common etiology will involve the Liver. According to Zang-fu and Wu Xing theories, the Liver provides for the smooth flow of Qi. This Functions can be disrupted by emotional challenges, stress, and on-going irregularities in a woman’s menstrual cycle. When this Functions of the Liver is disrupted, it is termed ‘Liver Qi Stagnation’. Liver Qi Stagnation is an Excess condition. Pain anywhere in the body can usually be attributed, at least in part, to Liver Qi stagnation. In addition, it can engender Heat. The Liver also regulates the Spleen, Stomach, and the entire digestive system. When the Liver is in Excess, one effect is ’overcontrol’ of the organs of the digestive system, resulting in various dysfunctions including pain, diarrhea, and constipation, depending on the patient’s presentation.
Liver Qi stagnation invading (over-controlling) Stomach possibly with Heat and/or Yin deficiency.
Signs and Symptoms
- Spasmodic epigastric pain, distension, and fullness, especially after meals. The pain may radiate to hypochondrium region.
- Alternating constipation (especially when there is Heat) and diarrhea.
- Anxiety, moodiness, irritability, depression.
- Irregular menses, PMS, dysmenorrhea
- Cold fingers and toes
- Pulse (P): wiry (a wiry pulse is keynote for Liver Qi stagnation) and may be rapid (indicting Heat)
- Tongue (T): may be normal, when there is Heat it may be red or with red sides, there may be a dry yellowish tongue coating
Suggested Herbal Formula
Chai Hu Shu Gan Wan 柴胡舒肝丸 (Bupleurum Shu Gan Teapills) (MW# 3372)
- Functions: Soothes Liver Qi, Harmonizes the Liver and Stomach, Clears Heat and Alleviates pain
Liver Qi stagnation invading (over-controlling) the Spleen with Heat or Damp Heat
Signs and Symptoms
- Chronic or recurrent diarrhea with blood a/o mucus, may occur in cycles, may be alternating with constipation.
- Abdominal distension with cramping and pain typically preceding the diarrhea.
- Irritability, easily angered, mood swings, depression.
- Temporal or tension headaches.
- Red, dry, sore eyes, possible red face.
- Patient ‘feels’ hot, may have night sweats.
- Bitter taste in the mouth.
- Pulse (P): Forceful, wiry, rapid
- Tongue (T): Red or with red sides or red spots on edges, with a yellow tongue coating
Suggested Herbal Formulas
Acute phase (i.e., when symptoms are present)
Jia Wei Xiao Yao Wan 加味逍遙丸 (Free & Easy Wanderer Plus) (MW# 3370)
- Functions: Regulates the Liver Qi, harmonizes the Liver and Spleen, Clears Heat or Damp Heat from the Liver and Intestines, Cools the Blood to stop bleeding.
Long Dan Xie Gan Wan 龍膽瀉肝丸 (The Snake & the Dragon Teapills) (MW# 3775) especially when there is Damp Heat
- Functions: Drains Excess Fire from the Liver and Gallbladder, Clears and Drains Damp-Heat from the Lower Jiao
Intermittent phase (i.e., to address underlying pathophysiology)
Chai Hu Shu Gan Wan 柴胡舒肝丸 (Bupleurum Shu Gan Teapills) (MW# 3372)
- Functions: Soothes Liver Qi, Harmonizes the Liver and Stomach, Clears Heat and Alleviates pain
Shu Gan Wan 舒肝丸 (Soothe Liver Teapills) (MW#3677), especially in cases with abdominal pain
- Functions: Regulates the Liver Qi, Dispels Stasis, Relieves pain, Clears Heat
Mu Xiang Shun Qi Wan 木香順氣丸 (MW# 3643) especially in cases with Food stagnation
- Functions: Regulates the Liver Qi, Harmonizes the Liver and Stomach, Descends Stomach Qi, Alleviates Food Stagnation, Strengthens the Spleen and Stomach
Xiao Yao Wan 逍遙丸 (Free & Easy Wanderer Teapills) (MW# 3675) especially in cases with Spleen and Blood deficiency
- Functions: Calms the Liver, Soothes Liver Qi, Strengthens the Spleen, Nourishes the Blood, Harmonizes the Liver and Spleen
Qi Stagnation disrupting the correct movement and descent of the Stomach and Large Intestine Qi resulting in constipation.
Signs and Symptoms
- Constipation with difficulty in passing stool, feelings of incomplete evacuation and sluggishness
- Stools tend to be pebble-like or thin
- Constipation is worse when the patient is stressed
- In women, constipation may be worse during pre-menstrual phase
- Abdominal distension or pain, which is relieved after a bowel movement
- Anxiety, moodiness, irritability, depression
- In women, there may be a history of PMS, irregular menses, breast tenderness
- Poor appetite, belching, flatulence, sighing
- Pulse (P): Wiry, may also be thin in some individuals
- Tongue (T): Normal, thin white coating
Suggested Herbal Formulas
Acute phase (i.e., when symptoms are present)
Tong Xie Yao Fang Wan 痛瀉要方丸 (Calm Wind Teapills) (MW# 3392)
- Functions: Soothes Liver Qi, Harmonizes the Liver and Spleen, moderates stress effect on Intestines, Tonifies the Spleen
Da Huang Jiang Zhi Wan 大黃降脂丸 (Rhubarb Teapills MW# 3118) for acute constipation (should not be used long term}
- Functions: Purges accumulation, unlocks the Bowels, Clears Heat, Invigorates the Blood
Tao Ren Wan 桃仁丸/ Run Chang Wan 潤腸丸 (Peach Kernel Teapills MW#3731)
- Functions: Moistens the Intestines, unblocks the Bowels
Intermittent phase (i.e., to address underlying pathophysiology-- similar to the above)
Shu Gan Wan 舒肝丸 (Soothe Liver Teapills) (MW#3677) especially in cases with abdominal pain
- Functions: Regulates the Liver Qi, Dispels Stasis, relieves pain, Clears Heat
Mu Xiang Shun Qi Wan 木香順氣丸 (MW# 3643) especially in cases with Food stagnation
- Functions: Regulates the Liver Qi, Harmonizes the Liver and Stomach, Descends Stomach Qi, Alleviates Food Stagnation, Strengthens the Spleen and Stomach
Xiao Yao Wan 逍遙丸 (Free & Easy Wanderer Teapills) (MW# 3675) especially with Spleen and Blood deficiency
- Functions: Calms the Liver, Soothes Liver Qi, Strengthens the Spleen, Nourishes the Blood, Harmonizes the Liver and Spleen
Cold Damp or Phlegm Damp in the Intestines
Usually occurs in patients with pre-existing Yang deficiency during colder weather. However, there is a predominance of Cold Damp rather than deficiency. Cold Damp invades the Spleen and Intestines from an on-going consumption of rich, greasy, cold food including iced beverages, fruits, salads, dairy products, sugary foods, and alcohol. The Damp in the Intestines may result in mucus in the stool and the Cold suppresses the Yang Qi and causes spasm and pain.
Signs and Symptoms
- Diarrhea with mucus in stool
- Dull abdominal pain, which is better with warmth and worse with pressure
- Muscle aches
- No thirst or appetite, loss of sense of taste
- Lethargy, listlessness, foggy headedness, feeling of heaviness in the body
- May have chills mixed with mild fever, no sweating
- Pulse (P): soft, soggy, moderate, or slippery (rolling)
- Tongue (T): May be normal or pale with a greasy, white coating
Suggested Herbal Formulas
Ping Wei Wan 平胃丸 (Calm Stomach Teapills) (MW# 3327)
- Functions: Warms the Middle Jiao, Dries and transforms Damp, Regulates and Tonifies Qi
Xiang Sha Liu Jun Zi Wan 香砂六君子散 (Six Gentlemen Plus Teapills) (MW# 3681)
- Functions: Regulates and Tonifies Qi, Harmonizes and Tonifies the Spleen and Stomach, Stops Pain
Fu Zi Li Zhong Wan 附子理中丸 (MW# 3749)
- Functions: Warms Yang, Dispels Cold, Tonifies Qi, Strengthens Spleen
Spleen and Kidney Yang deficiency
Signs and Symptoms
- Chronic diarrhea which is thin and watery, and which may contain mucus and blood
- Incontinence of stool or rectal prolapse possible
- Worse with exposure to cold and cold foods and beverages
- Middle and Lower Jiao may be cold to palpation, Cold intolerance, cold extremities and/or cold lower back with pain,
- Mild persistent abdominal pain, which is better with warmth and pressure
- Loss of appetite, fatigue, listlessness, exhaustion, depression
- Waxy pale or sallow complexion
- Pulse (P): Deep, thready, weak, slow
- Tongue (T): Pale and swollen with a thin white coating
Suggested Herbal Formulas
Fu Zi Li Zhong Wan 附子理中丸 (MW# 3749)
- Functions: Warms Yang, Dispels Cold, Tonifies Qi, Strengthens Spleen
Bu Zhong Yi Qi Wan 補中益氣丸 (Central Qi Teapills) (MW# 3667)
- Functions: Tonifies Qi especially the Middle Jiao Qi, Regulates Qi, Raises sunken Yang, Lifts Spleen Qi and prolapsed organs
Jin Gui Shen Qi Wan 金櫃腎氣丸 (Golden Book Teapills) (MW#3649)
- Functions: Warms and Tonifies Kidney Yang
Spleen and Stomach Qi deficiency
A common pattern in children and in adults who have a diet that is predominately cold in nature, especially from an on-going consumption of rich, greasy, cold food including iced beverages, fruits, salads, dairy products, sugary foods, and alcohol. May also be caused by excess intake of Vitamin C and other drugs such as antibiotics. This type of diarrhea is caused by weak Spleen Qi that is unable to properly transform and transport food resulting in Dampness sinking into the Intestines, which appears as diarrhea.
Signs and Symptoms
- Frequent loose stools or diarrhea possibly with mucus
- The diarrhea may occur with every stool or may be intermittent, may have episodes of constipation.
- Frequent bowel movements, especially soon after a meal
- Weakness and fatigue, which may be worse after eating
- Condition may be aggravated by fatigue and/or overexertion in mind and body
- Certain foods or food combinations may trigger diarrhea
- Pale or sallow complexion and lips
- The patient may be obese, but not necessarily; some patients may experience weight loss and dehydration
- Pulse (P): Weak, thready, deficient
- Tongue (T): Pale with teeth marks and a white coating
Suggested Herbal Formulas
Shen Ling Bai Zhu Pian 參苓白朮片 (MW# 3915)
- Functions: Strengthens the Spleen and Tonifies the Qi, Resolves Dampness, Stops Diarrhea
Xiang Sha Liu Jun Zi Wan 香砂六君子散 (Six Gentlemen Plus Teapills) (MW# 3681)
- Functions: Regulates and Tonifies Qi, Harmonizes and Tonifies the Spleen and Stomach, Stops Pain
Jian Pi Wan 健脾丸 (MW# 3638) When Spleen deficiency is accompanied by Food Stagnation
- Functions: Tonifies Spleen Qi, Eliminates Food Stagnation, Harmonizes the Stomach. Transforms Dampness, Regulates Qi
References
- Treatment Protocols, American Dragon, www.americandragon.com
- Bensky, D. et al., Chinese Herbal Medicine Materia Medica, 3rd Edition, Eastland Press, Seattle, 2004. Maciocia, G., The Foundations of Chinese Medicine: A Comprehensive Text for Acupuncturists and Herbalists, Churchill Livingstone: London 1989.
- Maciocia, G., Diagnosis in Chinese Medicine: A comprehensive guide, Churchill Livingstone: London 2004.
- Maciocia, G., The Practice of Chinese Medicine: The Treatment of Diseases with Acupuncture and Chinese Herbs, Churchill Livingstone: London 1994.
- Maclean, Will, Clinical Handbook of Internal Medicine, University of Western Sydney, 2002
- Maclean, Will, Clinical Manual of Chinese Herbal Patent Medicines, Pangolin Press: 2003
- Wrinkle, A. et al., A Practitioner’s Formula Guide, Elemental Essentials Press: 2008.
