bubble_chart Overview

Irritable Bowel Syndrome (IBS) is the most common functional bowel disorder in clinical practice, characterized by a unique pathophysiological basis and an independent intestinal dysfunction. It is marked by the absence of organic sexually transmitted disease changes in the intestinal wall, but the entire intestine exhibits excessive or abnormal physiological responses to stimuli. Symptoms include abdominal pain, diarrhea, or constipation, or alternating diarrhea and constipation, sometimes with a significant amount of mucus in the stool. According to the CIOMS of WHO, IBS is a motility disorder of the intestine that arises in response to mental stress and stimuli, often with a history of dysentery infection, no organic disease upon examination, and clinical manifestations of abdominal pain, distending pain, diarrhea, and alternating constipation. Therefore, the onset of the disease in patients is often rooted in psychological factors, which play a significant role in the development and progression of the syndrome. In 1982, the NIH Terminology Committee in the United States defined IBS as excluding organic sexually transmitted disease changes, with the following characteristics: ① abdominal pain relieved by defecation; ② occurring at least six times a year; ③ if the aforementioned abdominal pain occurs, it lasts for at least three weeks; ④ excluding painless diarrhea; ⑤ excluding painless constipation. That is, IBS is a hyperactive bowel disease accompanied by diarrhea and abnormal bowel movements.

bubble_chart Epidemiology

IBS can occur at any age, with the majority of cases occurring between the ages of 20 and 50. Women show peaks around the ages of 20 and 50, while men peak around 30. Women are more affected than men, accounting for about three-quarters of cases. According to Thomson, the middle class is more prone to this condition than workers, with a higher incidence among housewives who experience mental stress, loneliness, and emotional distress. Nanda suggests that IBS patients account for about 14-22% of the world's population, making up half of digestive clinic visits. In the so-called healthy populations (non-patient population) in the UK and US, about 30% have gastrointestinal symptoms. Zhang Jinkun found that among 2,950 cadres undergoing physical examinations, 712 had gastrointestinal symptoms (24.1%). Among 256 new medical staff, 55 had gastrointestinal symptoms (21.5%), and more than one-third of patients in his gastrointestinal specialty clinic were diagnosed with IBS or gastrointestinal dysfunction. Li Dingguo believes that IBS affects about 15% of the population, accounting for one-third to one-half of digestive diseases.

bubble_chart Etiology

(1) Psychological factors: The onset and exacerbation of symptoms in IBS patients are closely related to emotional stress. Factors such as severe anxiety, depression, tension, agitation, and fear can affect the regulation of autonomic nervous function, leading to disorders in colonic motility and secretion. Domestic reports indicate that 45% of IBS cases are triggered by emotional stress and similar factors, while some international reports suggest this figure could be as high as 80%.

1. Gastrointestinal disorders in childhood often persist into adulthood, leading to IBS. Apley and Hale followed children with recurrent abdominal pain for 6 to 8 years and found that one-third developed IBS, one-third still had various functional gastrointestinal symptoms, and one-third were asymptomatic. 80% of diarrhea-predominant IBS patients still exhibit hypersensitivity of the gastrocolic reflex from childhood.

2. Among IBS patients, many have a history of acute bacillary dysentery. Repeated fecal pathogen tests cannot confirm chronic bacillary dysentery, and it is believed to be post-dysentery colonic dysfunction, often explained by a "trace reaction."

3. Among so-called "traveler's diarrhea" patients, although some cases are due to infections, many cases of diarrhea caused by travel are actually IBS, resulting from intestinal dysfunction due to emotional factors, lifestyle changes, and dietary changes during travel.

(2) Dietary factors: Improper diet or changes in dietary habits can trigger IBS. For example, excessive consumption of cold or spicy foods, as well as fatty foods, can significantly affect colonic motility. High-protein diets often lead to diarrhea, and excessive fiber intake can cause functional disorders and is associated with IBS. Domestic reports indicate that 11.3% of IBS cases are triggered by improper diet. Regarding food intolerance and IBS, Nanda studied 200 IBS patients and found that most (81.3%) could be confirmed to have one or more food intolerances through food challenge tests. Thomson et al. found that patients with low lactase levels may exhibit some IBS symptoms after consuming excessive lactose.

(3) Infection factors: IBS is not an infectious disease, but intestinal infections can easily trigger colonic dysfunction. For example, infectious intestinal inflammation caused by microorganisms or Chinese Taxillus Herb worms can alter colonic reactivity, inducing or exacerbating IBS, especially after dysentery, which can increase the incidence of IBS.

(4) Intestinal flora imbalance: In healthy individuals, the gut is predominantly anaerobic, with aerobic bacteria mainly consisting of enterobacteria. Changes in diet or excessive consumption of certain foods can disrupt the balance of intestinal flora. Long-term use of oral antibiotics can reduce Gram-negative bacteria in feces. IBS patients have significantly higher levels of aerobic bacteria in their feces compared to healthy individuals.

(5) Genetic factors: Many patients have had IBS since childhood, and some develop it during adolescence, often with a family history. Multiple members of the same family or lineage may suffer from IBS, suggesting a possible genetic link.

(6) Other factors: Certain diseases such as hyperthyroidism, hypothyroidism, carcinoid tumors, diabetes, and hepatobiliary system diseases can also cause IBS. Peptic ulcers and chronic gastritis often coexist with IBS. Additionally, frequent use of laxatives, enemas, and other biological or physical factors, such as menstruation in women, can also trigger IBS.

bubble_chart Pathological Changes

(1) Changes in intestinal motility: High and low motility patterns can be observed in colonic manometry of IBS patients; both constipation and diarrhea can lead to increased motility indices in the sigmoid colon and rectum; IBS patients have poor rectal tolerance; resting sigmoid colon pressure decreases during diarrhea and increases during constipation; balloon distension of various parts of the colon and small intestine can induce IBS-like abdominal pain; the tension type sphincter function of the sigmoid colon segment, when its tension increases, causes proximal dilation and constipation, and when its tension decreases, causes diarrhea; colonic myoelectric activity is characterized by a slow wave of three cycles per minute, and its occurrence rate is more pronounced compared to normal individuals; changes in colonic motility are more sensitive to parasympathomimetic drugs and cholecystokinin. Changes in colonic motility are accompanied by changes in small intestine and esophageal motility.

(2) Changes in intestinal secretion and absorption function: Increased mucus secretion in the colonic mucosa of IBS patients leads to mucous stools, even forming mucous casts; impaired colonic fluid absorption causes excessive fluid retention in the colon, which is also one of the causes of diarrhea.

(3) Changes in immune function: Reports on immune function tests in IBS patients indicate a decrease in CD₈ cells in the peripheral blood T cell population, an increase in the CD₄/CD₈ ratio, and significantly higher serum IgG levels than normal, suggesting immune regulation disorder in IBS.

(4) Hormonal influences: In IBS diarrhea patients, the level of prostaglandin E₂ (PGE₂) in the colonic lumen is increased, and rectal mucosal prostaglandin E₁ (PGE₁) is significantly higher than in non-diarrhea patients and normal individuals. Prostaglandins can promote mucus secretion in the colonic mucosa, leading to large amounts of mucous stools. 5-hydroxytryptamine (5-HT), vasoactive intestinal peptide (VIP), glucagon, somatostatin (SRIF), etc., may directly affect smooth muscle through paracrine mechanisms, causing changes in "slow wave" electrical activity, and cholecystokinin (CCK) can enhance colonic contraction function, leading to abdominal pain. Fukudo et al. found that IBS patients have increased large intestine pressure and elevated Motilin (a gastrointestinal motility hormone) concentration under mental stress. Saria et al. reported that NPY and PYY (both belonging to pancreatic peptide substances) can inhibit the secretion increase caused by PGE₂, suggesting a close relationship with mucous stools, diarrhea, and constipation in IBS. Additionally, abnormal secretion of other gastrointestinal hormones or increased sensitivity of the intestine to these hormones may also be one of the mechanisms of colonic dysfunction. Certain endocrine system disorders such as hyperthyroidism or hypothyroidism, islet cell carcinoma, medullary thyroid carcinoma, etc., can also lead to intestinal dysfunction.

bubble_chart Clinical Manifestations

Classification: There is currently no unified classification standard. The following subtypes are for reference.

(1) Spastic colon type: Mainly characterized by lower abdominal pain, especially left lower abdominal pain and constipation.

(2) Painless diarrhea type: Mainly characterized by diarrhea, accompanied by mucus.

(3) Mixed type: May include abdominal pain, abdominal distension and fullness, and constipation, as well as diarrhea, or alternating between the two.

Bockus proposed three types: spastic colon type, mucous abdominal pain type, and nervous diarrhea type. Chi Jian classified them into three types: unstable type, persistent diarrhea type, and secretory type. Others classify them into four types: diarrhea type, constipation type, alternating diarrhea and constipation type, and mucous type.

Symptoms

(1) Gastrointestinal symptoms:

1. Abdominal pain: Abdominal pain is the most prominent symptom of IBS, usually located in the lower abdomen or left lower abdomen, worsening before defecation and after consuming cold food, often occurring between 4-5 AM. Heaton found that the abdominal pain in IBS patients is six times that of healthy individuals.

2. Diarrhea: Often mucous or watery diarrhea, occurring several times a day, even dozens of times, often accompanied by a feeling of incomplete evacuation.

3. Abdominal distension and fullness: Abdominal distension and fullness is three times that of normal individuals, often accompanied by constipation or diarrhea, worse in the afternoon or evening, and relieved after passing gas or defecation.

4. Constipation: More common in women, with nine times the difficulty in defecation and four times the urgency compared to normal individuals, with less than one bowel movement per week or less than 40g of feces per day. Some IBS patients may have bowel movements only once every ten days, with dry and hard stools. IBS patients often alternate between constipation and diarrhea.

(2) Extragastrointestinal symptoms: About 40-80% of IBS patients have psychological factors, being hypersensitive to external stimuli, manifesting as irritability, anxiety, depression, insomnia, dreamfulness, etc. About 50% of patients experience frequent urination, urgency, and a feeling of incomplete evacuation. Some patients may also experience sexual dysfunction, such as impotence, pain during intercourse, etc.

bubble_chart Auxiliary Examination

(1) General Examination: IBS patients primarily present with intestinal symptoms, with severe cases showing abdominal distension and fullness, and in severe cases, abdominal distension may be visible; those with abdominal pain may have mild tenderness around the navel and lower left abdomen; those with diarrhea may have increased borborygmi; those with constipation may have decreased borborygmi; some patients may have tenderness on the posterior rectal wall during digital rectal examination, while others may show no significant positive signs.

(2) Laboratory Tests: Stool routine examination may show a large amount of mucus or be normal; routine hematuria, stool occult blood bacterial culture (at least 3 times), thyroid function tests, liver, gallbladder, pancreas, and kidney function tests, erythrocyte sedimentation rate, electrolytes, and serum enzymology tests are all normal.

(3) X-ray Examination: X-ray barium enema may show rapid colonic filling and irritability signs, but no significant intestinal structural changes; a full gastrointestinal barium meal may sometimes show rapid passage of the barium through the small intestine, with the barium head reaching the ileocecal region within 0.5 to 1.5 hours. During barium enema examination, warm saline should be used for enema, as soapy water or cold liquid enema can cause colonic spasm and irritability.

(4) Colonoscopy: Visual observation shows no abnormalities in the mucous membrane or only mild congestion, edema, and excessive mucus secretion, with normal colonic mucous membrane biopsy. Some IBS patients may not tolerate the examination due to abdominal pain caused by hyperalgesia, leading to premature termination or inability to perform the examination. Some patients may experience prolonged abdominal pain, distension, and fullness after the examination, which may be related to the stimulation during colonoscopy.

(5) Colonic Motility Function Test: Sigmoid colon pressure decreases in painless diarrhea and increases in constipation; rectal pressure increases in constipation and decreases in diarrhea, with possible anal relaxation; both constipation and diarrhea can lead to increased motility indices in the sigmoid colon and rectum.

bubble_chart Diagnosis

There is currently no unified diagnostic standard or specific diagnostic method for IBS. The following diagnostic criteria can be used as references.

(1) The clinical diagnostic criteria for IBS established at the National Chronic Diarrhea Academic Conference in November 1986 in China are:

1. Main complaints include abdominal pain, abdominal distension and fullness, diarrhea, and constipation, accompanied by systemic neurological Guanneng symptoms.

2. Generally in good health, without weight loss or fever, and systemic examination only reveals abdominal tenderness.

3. Most stool routine and culture tests (at least three times) are negative, and stool occult blood test is negative.

4. X-ray barium enema examination shows no negative findings, or there are signs of colonic irritation.

5. Fiber colonoscopy shows hyperactivity in some patients, with no significant mucosal abnormalities, and histological examination is basically normal.

6. Blood and urine routine tests are normal, and erythrocyte sedimentation rate is normal.

7. No history of dysentery, schistosomiasis, etc., and experimental treatment is ineffective. When selecting cases for clinical research, the course of the disease should exceed two years.

(2) The diagnostic criteria for IBS established at the International Digestive Diseases Conference held in Rome in September 1988 are:

1. Abdominal pain: ① Pain is relieved after defecation; ② Pain is related to the frequency of defecation and stool consistency.

2. Defecation disorders: ① Changes in defecation frequency; ② Stool consistency varies, which can be hard, soft, or watery; ③ Mucus discharge.

3. Often accompanied by abdominal distension and fullness or a sense of bloating.

In addition, there are upper gastrointestinal symptoms, psychiatric symptoms, and other systemic symptoms.

(3) The diagnostic criteria for IBS proposed by Kawakami in Japan in 1989 are:

1. Typical symptoms of IBS: ⑴ History of abdominal pain in childhood; ⑵ Severe abdominal pain requiring emergency treatment; ⑶ Frequent history of abdominal pain; ⑷ Pain relieved by abdominal warmth; ⑸ Pain relieved after defecation; ⑹ Abnormal intestinal function observed; ⑺ Pain induced by defecation; ⑻ Abdominal pain accompanied by diarrhea; ⑼ Alternating diarrhea and constipation; ⑽ History of diarrhea or constipation; ⑾ Rabbit pellet-like stool; ⑿ Rabbit pellet-like stool with abdominal pain; ⒀ Mucus visible in stool.

If six of the above symptoms are present, this syndrome can be suspected.

2. General examination shows no abnormalities, no fever, and red blood cells, white blood cells, hemoglobin, erythrocyte sedimentation rate, etc., are all normal.

3. Stool occult blood test is positive.

4. Large intestine X-ray examination shows no abnormalities, and seasonal epidemic large intestine endoscopy is necessary.

5. Psychosomatically, there are psychiatric abnormalities such as emotional instability, depression, and irritability.

(4) Kruis diagnostic scoring criteria: Kruis proposed a diagnostic scoring criteria for this syndrome based on its symptoms and several simple laboratory tests:

1. Positive symptoms: ① Gastrointestinal bloating 34 points; ② Course of disease over two years 16 points; ③ Severe abdominal pain 23 points; ④ Alternating constipation and diarrhea 14 points.

2. Negative symptoms: ① Other diseases found in physical examination or history minus 47 points; ② Erythrocyte sedimentation rate >20mm/h minus 13 points; ③ White blood cells >10×10⁹/L minus 98 points, hemoglobin <120g/L for females, <140g/L for males minus 98 points; ④ Hematochezia minus 98 points.

After testing with this scoring criteria, the diagnostic rate is 97%, and when the positive symptom score is >43, the diagnostic reliability of this syndrome is 99%. However, this scoring criteria involves few organic sexually transmitted diseases and does not exclude racial differences, so it has its limitations.

bubble_chart Treatment Measures

Due to the inherent disease causes and clinical manifestations varying significantly among individuals, treatment should adhere to the principle of individualization, formulating flexible treatment plans tailored to the patient's condition. The commonly used clinical treatment methods are introduced as follows:

(1) Psychotherapy: Primarily involves helping patients identify the psychological factors causing the condition, guiding them through psychological conflicts and emotional disturbances to achieve therapeutic goals. Doctors should explain the nature and prognosis of the disease to patients with empathy and responsibility, helping them eliminate unnecessary fears and doubts, and building confidence to overcome the disease. In a sense, applying psychotherapy to treat this condition is more important than drug treatment, especially for patients with severe psychiatric symptoms, systematic psychotherapy should be conducted. Guthrie's study on psychotherapy in 102 cases of this condition found that psychotherapy has significant efficacy in eliminating diarrhea and abdominal pain. Thomson believes that even when guiding medicinal treatment is not ideal, psychotherapy can still achieve good results. Some have achieved certain therapeutic effects using hypnotherapy. For example, Whorwell et al. successfully treated 50 severe cases of this condition with hypnotherapy, with 48 cases completely relieved after 18 months of follow-up. Prior et al. observed a significant decrease in rectal sensitivity during hypnosis, with symptoms disappearing accordingly.

(2) Dietary adjustment: Generally focuses on easily digestible, low-fat, and moderate protein foods, eating more fresh vegetables and fruits, avoiding too cold, too hot, high-fat, high-protein, and irritating foods, and limiting certain intolerable diets.

(3) Drug treatment: Drug treatment for this condition should be cautious, avoiding drug abuse. In some patients, no drug may be effective.

1. For patients with severe nervous tension and insomnia, Guanneng syndrome, appropriate treatment with 2.5mg of safety (three times daily) or 5mg orally each night can be considered, or early sleep aids, sodium luminal, etc.; for depression, appropriate use of amitriptyline, imipramine hydrochloride, etc.; and oryzanol 20～50mg, three times daily, to regulate autonomic nerve function.

2. For those mainly suffering from abdominal pain, besides the conventional use of atropine and belladonna, calcium channel blockers such as verapamil or nifedipine 10mg sublingually or orally, three times daily, can be used to alleviate abdominal pain and reduce bowel movements.

3. For those mainly suffering from diarrhea, anticholinergic antagonists such as cimetropin bromide 50mg before meals can be used; or imodin 2mg, three times daily, for severe diarrhea, a small dose of codeine phosphate 15mg, three times daily, or loperamide can be selected.

4. For those mainly suffering from constipation: when stools are dry and hard, paraffin oil 20ml, three times daily, or sesame oil 10～20ml, three times daily, or senna leaf 5～10g soaked in water can be taken; or glycerin suppositories can be inserted into the anus; for long-term constipation but not dry and hard stools, gastrointestinal motility drugs such as domperidone 10mg, three times daily, or cisapride 10mg, three times daily can be used.

5. IBS patients with mucus stools can take indomethacin 25mg, three times daily, to inhibit prostaglandin synthesis and reduce mucus secretion.

6. For those with dysbiosis, probiotics 2.5g, twice daily, or bifidobacterium emulsion, 50ml each time, or Lizhu Chang Le, adults take 1～2 capsules each time, once in the morning and evening, children reduce the dose, severe cases double the dose.

(4) Chinese medicine treatment:

1. Spleen-stomach weakness type: Symptoms include diarrhea immediately after meals, stools that are sometimes loose and sometimes watery, containing mucus, increased frequency of bowel movements, dull abdominal pain, a feeling of heaviness in the anus, discomfort in the epigastric region, poor appetite, fatigue in the limbs, sallow complexion, pale tongue with a white coating, and a weak, slow pulse. Treatment focuses on tonifying the spleen and replenishing qi, harmonizing the stomach, and eliminating dampness. Prescriptions include Ginseng, Poria, and White Atractylodes Powder or a modified version of Seven-Ingredient White Atractylodes Rhizome Decoction.

2. Spleen-kidney yang deficiency type: Symptoms include morning diarrhea, loose stools, undigested food in stool, abdominal pain that does not subside after defecation, soreness and weakness in the lower back and knees, cold limbs, pale and swollen tongue with white coating, and deep, thin, and slow pulse. Treatment involves warming and tonifying the spleen and stomach, and consolidating to stop diarrhea. The prescription is Aconite Middle-Regulating Decoction combined with Four Miracle Pill with modifications.

3. Spleen-stomach yin deficiency type: Symptoms include mild abdominal pain, difficulty in passing stool, sheep-dung-like stool, mucus in stool, infrequent bowel movements, abdominal masses that come and go, distending pain upon pressure, emaciation, hunger without appetite, dry mouth with little desire to drink, frequent and yellow urine, often accompanied by insomnia, anxiety, and palpitations. The tongue is red with little coating, and the pulse is thin and rapid. Treatment involves nourishing yin and moistening the stool. The prescription is Hemp Seed Pill and Fluid-Increasing Decoction with modifications.

4. Liver depression qi stagnation type: Symptoms include abdominal pain and constipation, difficulty in defecation, tenesmus, abdominal distension and fullness, hypochondriac distension and scurrying pain relieved by flatus, easily triggered by anger or worry, belching, hiccups, poor appetite, thin tongue coating, and wiry and thin pulse. Treatment involves regulating qi to relieve stagnation, descending counterflow to promote bowel movement. The prescription is Six Milling Decoction or Bupleurum Soothing Liver Decoction with modifications.

5. Liver-spleen disharmony type: Often triggered or worsened by anger or mental stress. Symptoms include borborygmus and flatus, abdominal pain followed by diarrhea, not much stool, pain relieved after defecation, accompanied by lower abdominal tension, chest and hypochondriac distension, belching, poor appetite, and mucus in stool. The tongue is pale red with thin white coating, and the pulse is wiry and thin. Treatment involves suppressing the liver and reinforcing the spleen, harmonizing qi movement. The prescription is Pain and Diarrhea Vital Formula combined with Cold-Limbs Powder with modifications.

6. Liver-spleen disharmony with mixed cold and heat type: Symptoms include chronic diarrhea, sticky or foamy stool, alternating diarrhea and constipation, abdominal pain and distension before defecation, borborygmus, relieved after defecation but recurring shortly. The tongue coating is white and greasy, and the pulse is thin, wiry, and slippery. Treatment involves draining wood and calming earth, mildly regulating cold and heat. The prescription is Mume Pill.

7. Blood stasis obstructing the intestinal collaterals type: Symptoms include prolonged diarrhea, sticky stool, either dry or loose, incomplete defecation, stabbing abdominal pain with fixed location, pain worsened by pressure, dull complexion. The tongue is dark red or purplish, and the pulse is wiry, thin, and choppy. Treatment involves dispelling stasis to unblock collaterals, harmonizing the nutrient to relieve pain. The prescription is Lesser Abdomen Stasis-Expelling Decoction with modifications.

(5) Physical therapy and acupuncture: Abdominal tuina, hot compress, and ultrashort wave can alleviate symptoms. Acupuncture points include Zusanli (ST36), Guanyuan (CV4), Qihai (CV6), Zhongwan (CV12), Sanyinjiao (SP6), Weishu (BL21), and Dachangshu (BL25). Additionally, qigong therapy has good efficacy for this condition.

Medication according to symptoms: For severe abdominal pain, use Corydalis Tuber or a large dose of Peony Root (30-60g); for pain before defecation, use Saposhnikovia Root and Dried Tangerine Peel; for fixed pain with stasis syndrome, use Sudden Smile Powder. For qi stagnation and abdominal distension, use roasted Aucklandia Root, Dried Tangerine Peel, Submature Bitter Orange, Sichuan Chinaberry, and Green Tangerine Peel; for abdominal distension and difficult defecation, use Silkworm Excrement, Areca Peel, Submature Bitter Orange, and Areca Seed; for severe cold-type borborygmus and abdominal distension, use Cubeb and Fennel; for chest and gastric stuffiness, use Submature Bitter Orange. For excessive mucus in stool, use Chinese Pulsatilla Root, Sargentgloryvine Stem, Patrinia, Dandelion, Atractylodes Rhizome, Neopicrorhiza, and Glabrous Greenbrier; for diarrhea before dawn, use Psoralea and Nutmeg for kidney diarrhea, and Peony Root and fried Saposhnikovia Root for spleen diarrhea; for general diarrhea, use fried White Atractylodes Rhizome and Medicated Leaven, and fried Coix Seed for watery diarrhea; for chronic diarrhea and incessant slippery diarrhea, use roasted Chebula Fruit, roasted Nutmeg, Chinese Gall, Schisandra Fruit, Nutmeg, Red Halloysite, Smoked Plum, Pomegranate Rind, and Limonite, and in severe cases, use Poppy Capsule, but stop once the condition improves. For severe kidney yang deficiency, use Aconite Lateral Root, Cassia Bark, and Epimedium Herb; for severe spleen yang deficiency, use blast-fried Ginger and Cinnamon Twig. For constipation, generally use Trichosanthes Seed, Bush Cherry Seed, fried Hemp Seed, and Areca Seed; for yang deficiency constipation, use Cistanche. For chronic diarrhea damaging yin, use Coastal Glehnia Root, Dendrobium, and Poria, or use raw Peony Root and Smoked Plum; for severe qi deficiency, use Astragalus Root, Tangshen, White Atractylodes Rhizome, and Prepared Liquorice Root; for anal prolapse due to qi deficiency and sinking, use raw Astragalus Root, Cimicifuga Rhizome, and Bupleurum; for anal prolapse and tenesmus, use Aucklandia Root and Areca Seed; for anal heaviness and incomplete defecation, use Immature Bitter Orange; for dampness-heat in the intestines, use Ash Bark, Coptis Rhizome, and Magnolia Bark; for poor appetite and indigestion, use Chicken's Gizzard-Skin, charred Hawthorn Fruit, and Medicated Leaven.

bubble_chart Prognosis

The prognosis for IBS is favorable, and current literature does not report any serious complications or progression to other diseases associated with IBS.

bubble_chart Differentiation

IBS mainly needs to be differentiated from the following diseases:

(1) Malabsorption syndrome: This syndrome often presents with diarrhea, but stool routine examination may reveal fat and undigested food.

(2) Chronic colitis: It also often presents with abdominal pain and diarrhea, but mainly with mucus and bloody stools. Colonoscopy may show colonic mucosal congestion, edema, erosion, or ulcers.

(3) Chronic dysentery: Diarrhea is mainly characterized by purulent and bloody stools. Stool routine examination may show a large number of pus and blood cells, or dysentery bacilli. Stool culture may reveal the growth of dysentery bacilli.

(4) Crohn's disease: It often presents with systemic symptoms such as anemia, fever, and weakness. Colonoscopy may show "linear ulcers" or a "cobblestone" appearance of the intestinal mucosa.

(5) Intestinal tuberculosis: It presents with abdominal pain, diarrhea, and pus and blood in the stool, along with systemic toxic symptoms such as weight loss and low-grade fever, or other subcutaneous nodular lesions.

(6) Intestinal tumors: They may present with diarrhea, but mainly with old bloody stools. Colonoscopy, X-ray barium enema, and rectal examination may show positive signs.

(7) Other diseases: Such as peptic ulcers, hepatobiliary system diseases, etc.

It is worth noting that some patients are abusers or long-term users of laxatives, and a detailed medical history should be taken to avoid misdiagnosis.