The Treatment of Irritable Bowel Syndrome
The digestive tract is often first to be affected by stress and we all know how prevalent the 'S' word is today. Hardly surprising then that most weeks somebody, actually twice as many women as men, consults me about their irritable bowel. In the twenty years that I have practised as a medical herbalist my approach to their treatment using diet and herbs has varied somewhat.
Initially I was interested by the relationship between IBS and food intolerance. If offending substances like wheat and dairy, citrus fruits and caffeine were avoided, symptoms could improve dramatically. However it was often difficult to return patients to their former diet without repercussions, so it was important to understand and address the underlying causes of the digestive disturbance. Emotional upset, pressure at work, worries about children, money etc. were all there, combined with poor diet and irregular eating habits.
Avoiding caffeine certainly reduces the stress symptoms, and relaxing herbs such as chamomile, lemon balm, hops and lavender calm the nerves and soothe stress-related digestive symptoms. Aromatic herbs and spices such as caraway, aniseed, fennel, ginger and cardamom are helpful, enlivening digestion, enhancing secretion of digestive juices, relieving gut tension and spasm and clearing toxins from the gut. Bitter herbs like Dandelion root, (Taraxacum rad), Gentian (Gentiana lutea) and Milk thistle (Cardus/Silybum marianus) will enhance secretion of digestive enzymes, stimulate liver, gallbladder and pancreatic function. With constipation, antispasmodics like peppermint and wild yam (Dioscorea villosa) and mild laxatives like licorice, linseed and psyllium seeds are recommended, while astringents like tormentil (Potentilla erecta), rose and agrimony (Agrimonia eupatoria) tone the bowel in diarrhoea.
Ten years ago I started studying Ayurvedic medicine. Inspired by the great wisdom of this ancient system and impressed by how all I have learned has helped my practice, I have been studying it ever since and particularly intensively in the last three years. In Ayurveda IBS falls into the category of Grahani, disturbed function of the intestine. Disruption of the digestive fire (Agni) alters the function of Pachaka Pitta and Samana vata in the digestive tract and the consequent symptoms vary in each individual according to the specific imbalance of the doshas, Vata, Pitta and Kapha.
Digestion can be disturbed by many different factors including: irregular eating, incompatible or indigestible foods, over- eating, anxiety, debility due to other illness, suppression of natural urges like evacuating the bowels, doing too much and never resting and eventually leads to low digestive fire (manda agni), the root cause of Grahani. It is also linked to a history of acute diarrhoea when the digestive fire, Pachaka Pitta, is taken from the intestine by excess Vata leading to low Agni.
Low Agni means that food is poorly broken down, digested and absorbed. Partially digested and undigested food particles lead to accumulation of toxins (ama) in the gut which combine with food causing the foul smelling stools, often with undigested food, cramping pain, debility and malaise. Depending on the specific disturbance of Agni and the intestine, the other symptoms of IBS will develop.
There are 4 different types of Grahani, Vata type, Pitta type, Kapha type and a type where all 3 doshas are involved.
Vata type: people suffer from dryness, dry skin, mouth or throat, constipation or alternating constipation and diarrhoea, thirst, bloating, wind, and feeling cold. They could have back or groin pain, weight loss, debility, anal fissures, insomnia, and anxiety.
Pitta type: there can be heartburn, thirst, feeling hot, irritable or angry, heat symptoms like inflammation, sweating and fever, liquid and foul smelling stools and eructations.
Kapha type: there can be nausea, phlegm, heaviness in the chest and abdomen, bad smelling eructations, lethargy, sluggish bowels and mucus in the stools.
When treating IBS the diet should be light; indigestible foods including bread, cheese, red meat, cold, hard, and raw foods should be avoided. A light fast can be helpful taking only vegetable soups and a little basmati rice and mung beans, (kitcharee). Herbs to raise Agni like ginger, fennel and cumin will improve digestion and absorption and clear ama from the digestive tract.
The Ayurvedic framework of the doshas is so helpful because it provides an understanding of the symptoms and how they vary from one constitutional type to another. It also provides a system of treatment specific to that particular constitutional imbalance utilizing not only diet and herbs but also lifestyle advice so that treatment of IBS can be less general and more specific and therefore more successful.
Vata type: Ginger, clove, fennel, cumin, cardamon and a little cinnamon will all raise digestive fire. Haritaki (Terminalia chebula) clears excess Vata from the bowel. Triphala, a mixture of Haritaki, Amalaki (Emblica Officinalis) and Bibhitaki (Terminalia belerica) is a gentle bowel tonic excellent for chronic constipation and IBS, for clearing toxins from the bowel and balancing the doshas. It can be taken in powder or capsule form before retiring to bed. Shatavari (Asparagus racemosus) and Ashwagandha (Withania somnifera) both calm Vata as does sesame oil. This is often given as an enema but can also be massaged over the body and particularly over the abdomen 5 minutes before soaking in a warm bath. Sweet, sour and salty foods are best.
Pitta Type: Amalaki (Emblica officinalis) is a rejuvenative tonic and renowned remedy for Pitta problems which balances the doshas.
Coriander water cools Pitta, as does sandalwood powder prepared in ghee which is often mixed with fennel, long pepper, black pepper, and cloves. Nutgrass (Cyperus rotundus) known in India as Musta, improves intestinal absorption and stops diarrhoea.
Aloe vera juice, turmeric, Manjista (Rubia cordifolia) Guduchi, (Tinospora cordifolia) and Shatavari. (Asparagus racemosus) are all excellent for calming Pitta. Sweet, bitter and astringent foods are best.
Kapha type: ginger, lime juice and honey are excellent. Trikatu, a compound containing black pepper, long pepper, and ginger is specific for low agni and high ama. Turmeric, cardamom, cinnamon, cloves, sandalwood, cumin, nutmeg, rock salt, and pippali (Long pepper: Piper longum) raise digestive fire and clear Kapha. 1/2 teaspoon of Hingwastaka, a mixture of asafoetida, ginger, black pepper, and rock salt, taken in a little warm water 1 to 2 hours before lunch and supper, increases agni and clears ama. Pungent, bitter and astringent tasting foods are best.
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