The Study On Differentiating Diarrhea-predominant Irritable Bowel Syndrome From The Theory Of TCM Constitution

Diarrhea-predominant Irritable Bowel Syndrome (IBS-D) belongs to the category of "diarrhea" in TCM, which is mostly related to "Dachang xie"(large intestine diarrhea) and "Tong xie"(diarrhea with pain). The author presents a systematic review on ancient and recent TCM literature about etiology, pathogenesis and treatment, and figures out that the factors of IBS-D includes internal injury due to emotional disturbance, deficiency of spleen and stomach, improper diet, exhaustion due to long illness and external invasion. Disharmony between liver and spleen is the key of pathogenesis.According to hyperactivity or depression of liver, deficiency or excess of spleen,the syndromes can be divided into three categories:invasion of the spleen by liver, stagnation of liver-Qi with deficiency of the spleen and liver suppression the weak spleen.They can be treated by calming the liver and strengthening the spleen,dispersing the liver qi and regulating the spleen and restaining the liver by replenishing spleen respectively.According to clinical observation, although all the IBS-D patients have a common pathology of disharmony between liver and spleen, they can manifeste different symptoms.This is because of different constitutions. Different constitutions decide different pathogenesis and syndromes of "diarrhea with pain".Combining the theory of TCM Constitution with clinical experience, the author summarizes 4 basic constitution types of IBS-D, which are constitution of qi stagnation,constitution of qi deficiency,constitution of phlegm and dampness and constitution of yang deficiency. The combination of "pathogenesis differentiation and treatment", "constitution differentiation and treatment " and "disease differentiation and treatment" can improve the clinic effect.