Promising research with growing clinical support from multiple studies
Irritable Bowel Syndrome (IBS)
Irritable bowel syndrome (IBS) is a chronic disorder of gut–brain interaction characterized by recurrent abdominal pain and altered bowel habits without structural disease. Under the Rome IV criteria, IBS is defined by abdominal pain, on average, at least one day per week in the last three months, associated with two or more of the following: related to defecation, change in stool frequency, or change in stool form; symptoms start at least six months before diagnosis. Subtypes are based on predominant stool pattern: IBS with diarrhea (IBS-D), IBS with constipation (IBS-C), mixed (IBS-M), or unclassified. Western medicine frames IBS as a multifactorial condition involving disordered gut–brain signaling, visceral hypersensitivity, altered motility, immune activation, psychosocial stressors, and microbiome perturbations. Evidence-based care is individualized and multimodal. Diet is foundational: the low-FODMAP diet—developed and validated by Monash University—has strong evidence for improving global IBS symptoms when delivered in a structured, three-phase format (short-term elimination, personalized reintroduction, and long-term adaptation). Pharmacotherapies target stool form and pain: antispasmodics (e.g., hyoscine, dicyclomine) can reduce cramping; rifaximin is effective for IBS-D; and secretagogues such as linaclotide and plecanatide are effective for IBS-C. Low-dose tricyclic antidepressants (TCAs) and, in selected cases, SSRIs modulate the gut–brain axis to reduce pain and normalize bowel habits. Psychological therapies—especially gut-directed cognitive behavioral therapy (CBT)—have strong support for improving global symptoms and quality of life. Emerging approaches include selective probiotics, postbiotics, and microbiome-directed therapies; evidence is mixed and evolving, and current guidelines are cautious about routine probiotic use for global IBS symptoms due to heterogeneity. Eastern and traditional systems conceptualize IBS through functional patterns.
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication regimen.
Western Medicine
Diagnosis
Rome IV: recurrent abdominal pain, on average, at least 1 day/week in the last 3 months, associated with ≥2 of: related to defecation, change in stool frequency, change in stool form; symptom onset ≥6 months prior. Subtype by stool pattern (IBS-D, IBS-C, IBS-M) using Bristol Stool Form Scale on abnormal days; exclude alarm features and structural disease as indicated.
Treatments
- Low-FODMAP diet with structured reintroduction
- Targeted fiber strategy (e.g., soluble fiber such as psyllium)
- Antispasmodics for pain/cramping
- Gut-brain axis modulators (low-dose TCAs; SSRIs selectively)
- CBT and other gut-directed psychotherapies
- Rifaximin for IBS-D
- Linaclotide or plecanatide for IBS-C
- Lifestyle: regular meals, sleep, physical activity
- Emerging microbiome therapies (select probiotics, postbiotics, FMT in research settings)
Medications
- Antispasmodics: hyoscine (scopolamine butylbromide), dicyclomine, otilonium
- Rifaximin (for IBS-D)
- Bile acid binders (for bile acid diarrhea when suspected)
- TCAs (e.g., amitriptyline, nortriptyline) at low dose
- SSRIs (e.g., sertraline, citalopram) in selected patients
- Linaclotide; plecanatide (for IBS-C)
- Osmotic laxatives (e.g., PEG) as adjuncts in IBS-C
- Peppermint oil (enteric-coated) for pain/bloating
Limitations
No single therapy works for all patients; responses vary by subtype and individual factors. Low-FODMAP requires dietitian guidance to avoid over-restriction and potential nutritional/microbiome impacts. Antispasmodic and antidepressant side effects can limit use. Antibiotics (rifaximin) have finite benefit windows and retreatment considerations. Evidence for routine probiotics and fecal microbiota transplant remains inconsistent; guideline recommendations are cautious.
Sources
- Lacy BE et al. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. Am J Gastroenterol. 2021.
- Drossman DA, Hasler WL. Rome IV—functional GI disorders: disorders of gut–brain interaction. Gastroenterology. 2016.
- Halmos EP et al. A diet low in FODMAPs reduces IBS symptoms: a randomized controlled trial. Gastroenterology. 2014.
- Monash University FODMAP Program (clinical resources and validation studies).
- Pimentel M et al. Rifaximin therapy for IBS without constipation. N Engl J Med. 2011.
- Chey WD et al. Linaclotide for IBS-C: randomized trials. Am J Gastroenterol. 2012.
- Johnston JM et al.; Plecanatide for IBS-C: randomized controlled trials. Am J Gastroenterol. 2018.
- Ford AC et al. Antidepressants and psychological therapies in IBS: systematic review/meta-analysis. Gut. 2019.
- Lackner JM et al. CBT for IBS (IBSOS). JAMA. 2018.
Eastern & Traditional Medicine
Traditional Chinese Medicine (TCM) – pattern differentiation
IBS often reflects liver qi stagnation invading the spleen (stress-triggered pain, bloating, irregular stools) and/or spleen qi deficiency with dampness (fatigue, loose stools, worse with cold/raw foods). Treatment soothes the liver, strengthens spleen, transforms dampness, and harmonizes the intestines.
Techniques
- Herbal formulas individualized to pattern (e.g., Tong Xie Yao Fang; Xiao Yao San variants; Shen Ling Bai Zhu San)
- Dietary therapy: warm, cooked, easily digestible foods; avoid greasy/cold/raw; ginger/congee
- Acupuncture at points such as ST25, ST36, SP6, LV3, LI4; moxibustion for cold-damp
Acupuncture
Modulates autonomic tone, visceral sensitivity, and motility within a gut–brain framework; selected for pattern (e.g., moving liver qi, strengthening spleen) and symptom targets (pain, bloating, bowel frequency).
Techniques
- Body acupuncture (e.g., ST25, ST36, SP6, LI4, LV3, CV12, CV6)
- Electroacupuncture in some protocols
- Adjunct moxibustion for cold patterns
Herbal/phytomedicine – STW 5 (Iberogast) and traditional formulas
Multi-herb combinations target motility, spasm, and visceral hypersensitivity; selected per TCM patterns or as standardized phytomedicine.
Techniques
- STW 5 (Iberogast): standardized liquid combining nine herbs
- Pattern-based TCM formulas (e.g., Tong Xie Yao Fang; Xiao Yao San; Shen Ling Bai Zhu San) with modification by presentation
Ayurveda
IBS maps to grahani with impaired agni (digestive fire) and vata imbalance leading to irregular motility and pain. Therapy aims to rekindle agni, pacify vata, and restore gut integrity through diet, herbs, and routines.
Techniques
- Dietary regulation (light, warm, spiced foods; buttermilk/ginger; routine meals)
- Herbs/formulas: Triphala (constipation), ginger, ajwain; bael (Aegle marmelos) or Kutaja for diarrhea patterns
- Lifestyle: abhyanga (oil massage), yoga, pranayama
Sources
- Manheimer E et al. Acupuncture for IBS. Cochrane Database Syst Rev. 2012.
- Zhang H et al. Tong Xie Yao Fang for IBS-D: systematic review/meta-analysis. Evid Based Complement Alternat Med. 2015.
- Holtmann G et al. STW 5 (Iberogast) in functional dyspepsia and IBS: systematic review. Phytomedicine. 2019.
- Manheimer E et al. Acupuncture for IBS. Cochrane Database Syst Rev. 2012 (moderate-certainty benefit vs usual care; uncertain vs sham).
- Zhao J et al. Acupuncture for IBS: systematic review/meta-analysis. Medicine (Baltimore). 2019.
- Zhang CS et al. Acupuncture for functional GI disorders: systematic review. Aliment Pharmacol Ther. 2017.
- Holtmann G et al. Phytomedicine. 2019 (systematic review showing benefits in FD and IBS subsets).
- Madisch A et al. STW 5 in functional GI disorders: randomized trials. Aliment Pharmacol Ther. 2001–2004.
- Zhang H et al. Tong Xie Yao Fang meta-analysis. Evid Based Complement Alternat Med. 2015.
- Rastogi S. Ayurvedic approach to IBS (grahani). AYU. 2011.
- Sharma P et al. Triphala in functional constipation: randomized trial. J Altern Complement Med. 2017.
- Sathyanarayana T et al. Aegle marmelos for diarrhea-predominant disorders: clinical data. Pharmacogn Rev. 2010.
Integrative Perspective
A practical integrative plan pairs a structured low-FODMAP diet (2–6 week elimination, systematic reintroduction, and personalization) with TCM-informed dietary principles—favoring warm, cooked, easy-to-digest meals (e.g., rice congee, gently cooked low-FODMAP vegetables) and culinary herbs like ginger to support ‘spleen qi.’ This reduces fermentable triggers while aligning with East Asian emphasis on digestive warmth and regularity. Layer symptom-directed tools: enteric-coated peppermint oil for pain/bloating (a traditional remedy now guideline-endorsed), antispasmodics or low-dose TCAs for refractory pain, and acupuncture to modulate visceral sensitivity. Combine gut-directed CBT with mindfulness-based stress reduction to address the gut–brain axis from both Western and contemplative perspectives. When using multi-herb formulas (e.g., STW 5 or TCM prescriptions), review drug–herb interactions, pregnancy status, and liver history (rare hepatotoxicity has been reported with some multi-herb products). Coordinate care among a gastroenterologist, dietitian trained in low-FODMAP, and qualified TCM/Ayurvedic practitioners to avoid duplicative or restrictive therapies and to ensure phased liberalization of diet for nutritional adequacy and microbiome diversity.
Sources
- Lacy BE et al. ACG Clinical Guideline: Management of Irritable Bowel Syndrome. Am J Gastroenterol. 2021.
- Drossman DA, Hasler WL. Rome IV criteria. Gastroenterology. 2016.
- Halmos EP et al. Low-FODMAP RCT. Gastroenterology. 2014.
- Monash University FODMAP Program.
- Pimentel M et al. Rifaximin in IBS-D. N Engl J Med. 2011.
- Chey WD et al. Linaclotide for IBS-C. Am J Gastroenterol. 2012.
- Johnston JM et al. Plecanatide for IBS-C. Am J Gastroenterol. 2018.
- Ford AC et al. Antidepressants and psychotherapies in IBS. Gut. 2019.
- Lackner JM et al. CBT for IBS (IBSOS). JAMA. 2018.
- Manheimer E et al. Acupuncture for IBS. Cochrane Database Syst Rev. 2012.
- Holtmann G et al. STW 5 (Iberogast) review. Phytomedicine. 2019.
- Khanna R et al. Peppermint oil for IBS: meta-analysis. J Clin Gastroenterol. 2014.
- Gaylord SA et al. Mindfulness for IBS: RCT. Am J Gastroenterol. 2011.
Health Disclaimer
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication regimen.