TCM Principles - The Basics of IBS

TCM Principles

The Basics of IBS

Articles appearing under the heading “TCM Principles” are suitable for graduates of the Sun Ten Self Study Course. The articles are ideal to review your studies and further your knowledge in a particular area of TCM.

Although there are different combinations of patterns according to the individual constitution of the patient, the root cause in every IBS patient seems to be a disharmony of the liver and spleen. Thus, even if you are not familiar with single herbs and the fine-tuning of formulas according to complex multiple patterns, you can achieve a certain success by understanding the physiology and pathology of liver and spleen and the use of three harmonising formulas: Tong Xie Yao Fang [Peony & Atractylodes Combination], Ban Xia Xie Xin Tang [Pinellia Combination] and Xiao Chai Hu Tang [Minor Bupleurum Combination].



Disharmony of liver and spleen – how does it happen?


One of the liver’s functions is to govern free coursing. This function ensures free flow of qi and blood, unobstructed mental and emotional activity, the unobstructed secretion of bile, and the smooth function of the spleen’s moving and transformation. Stress (including emotional stress), frustration, and difficult interpersonal relationships, in short, anything that obstructs the free flow of mental and emotional activity, can cause a disturbance of the liver’s free coursing function. This disturbance is called “binding depression of liver qi’ and is the underlying factor of nearly all liver disharmonies. Manifestations include distension and pain in the lesser abdomen.


The spleen governs movement and transformation, which refers to extracting the nutrients from food and moving the extracted essence to relevant parts of the body. In this sense, the spleen participates in the formation of qi and blood. If this function is healthy, the person will enjoy good appetite and digestion, regular bowel movements and good absorption of nutrients.


This function also includes the movement and transformation of fluids. For this reason the spleen must always be treated (together with other bowels and viscera if involved) if there is internal dampness or phlegm. An imbalance of too much thinking and too little action (this may be a character trait or a desk-job with too little physical exercise) and bad eating habits (non-nutritious food, food that is hard to digest, no regularity, or a hectic eating environment) harm the spleen. Examples of possible pathological changes if the spleen is impaired: bad digestion, loose stools, abdominal distension, nutritional disorders, poor appetite and dampness (dampness can manifest as poor appetite, abdominal distension, nausea, vomiting and loose stool, vaginal discharge, feeling of heaviness).


What is the connection between liver and spleen?


The five phases (wood, fire, earth, metal and water) have a restraining relationship to ensure that no phase becomes too dominating and that all phases stay in harmony. According to the five phase relationships within the body wood (liver) restrains earth (spleen). However, if one viscera is imbalanced this may result in an exaggerated restraining relationship, where one phase restrains the other phase beyond control and actually weakens it. As liver qi stagnation is an excess pattern, this liver (wood) repletion is likely to overwhelm the spleen (earth) and interfere with its function of moving and transforming nutrients.


In time, qi stagnation can transform into heat, and dampness can turn into damp heat. Hence many patients also manifest symptoms of heat and damp heat such as tenesmus and burning diarrhoea, poor appetite, nausea, short voidings of scant yellow urine, yellow thick slimy tongue fur on the root of the tongue, rapid pulse.


Formulas used in IBS


For IBS patients with the common liver spleen disharmony pattern with possible concurrent damp heat we can use TCM formulations to manage the symptoms and improve the condition.  Symptoms of an IBS patient with a liver-spleen disharmony pattern include:

  • cramping pain in the lower abdomen, 
  •  bloating and gas, diarrhoea or constipation, or both alternately,
  • rib-side distension or pain,
  • cold hands and feet, 
  •  irritability, 
  •  fatigue, 
  •  menstrual irregularities.

Concurrent damp heat symptoms may be:

  •  tenesmus and burning diarrhoea,
  • poor appetite,
  • nausea,
  • short voidings of scant yellow urine,
  • yellow thick slimy tongue fur on the root of the tongue. 

For these patients, the following formulas are often used in combination but may also be used alone:






Xiao Chai Hu Tang [Minor Bupleurum Combination]

Treats both a liver-spleen and a spleen-stomach and intestine disharmony.

Hepatoprotective, strengthens digestive function

Tong Xie Yao Fang [Peony & Atractylodes Combination]

Eases spasm and stops painful diarrhoea, harmonises liver and spleen.

Antispasmodic, carminative.

Ban Xia Xie Xin Tang [Pinellia Combination]

Treats damp heat in the stomach and intestines.

Digestive stimulant, carminative


The patient should also be made aware that suitable modifications in lifestyle and diet are necessary.


*Reproduced with kind permission from Health World Limited - Australia and New Zealand

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