Abstract: In modern civilized society, mental stress and strain has become a matter of prime concern. Much importance is being given to diseases which have been found to have a relation with the mental conflicts of the individual for their development; and on this basis, Heinroth in 1888 coined the term Psychosomatic Disorders and Franz Alexander (Father of Psychosomatic Medicine) formed a list of seven psychosomatic illnesses. However at present, this list has increased by leaps and bounds, mainly because of the increasing awareness of people regarding the effect of mind on the physical body which had been so lucidly explained more than 200 years ago by Dr Samuel Hahnemann. Irritable bowel syndrome or IBS is one such psychosomatic disorder which was not present in the previous list, and for it’s treatment we have to rely on the individualizing features of the patient just like any other case.
Osler coined the term ‘mucus colitis’ in 1892 when he wrote of a disorder of mucorrhea and abdominal colic with a high incidence in patients with coincident psycho-pathology. Since that time, the syndrome has been referred to by sundry terms, including spastic colon, irritable colon and nervous colon. One of the first references to the concept of an ‘irritable bowel’ appeared in the Rocky Mountain Medical Journal in 1950. The term was used to categorize patients who developed symptoms of diarrhea, abdominal pain, constipation, but where no well recognized infective cause could be found.
Today, irritable bowel syndrome is considered as the commonest functional
gastrointestinal disorder. According to Dorland’s Medical Dictionary, irritable bowel syndrome is defined as ‘a chronic non-inflammatory disease, characterized by excessive secretion of mucus and disordered colonic motility with consequent colic , constipation and / or diarrhea with the passage of mucus ; it is a common disorder with a psycho-physiologic
basis , also called spastic or irritable colon syndrome.’
Thus, irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by abdominal pain and altered bowel habits in the
absence of specific and unique organic pathology.
FGID or Functional Gastrointestinal Disorder, comprises of the following chronic gastrointestinal symptoms :
• Nausea alone
• Vomiting alone
• Belching
• Chest pain unrelated to exercise
• Postprandial fullness
• Abdominal bloating
• Abdominal discomfort / Pain (right or left iliac fossae)
• Passage of mucus per rectum
• Frequent bowel actions with urgency first thing in the morning
Common functional gastrointestinal disorders:
A. Functional esophageal disorders:
? Globus
? Ruminating syndrome
Chest pain of presumed esophageal origin
B. Functional gastroduodenal disorders:
? Functional dyspepsia
? Aerophagia
? Vomiting
C. Functional bowel disorders:
? Irritable bowel syndrome
? Pain / Gas / Bloat syndrome
? Diarrhea
A Short Recapitulation of the Anatomy and Physiology of the Large
Intestines Musculature of large intestine
The large intestine have aggregated longitudinal muscle coats called Taenia coli and in between them, the wall of the gut is puckered, as the length of the taenia is shorter than the actual length of the gut and the longitudinal muscle here is thin and of half the thickness of the circular muscle coat. These puckered regions appear as sacculations when distended.
Arterial supply of large intestine
The arterial supply is via Right colic, Ileocolic and Middle colic branches
of the Superior mesenteric artery and also via, Superior left colic, Inferior left colic and Superior rectal arteries of the Inferior mesenteric artery.
Nerve supply of large intestine
1. Upto the right two–thirds of the transverse colon:
? Sympathetic supply is from the Thoracic splanchnic nerve via the Celiac plexus and it’s branches
? Parasympathetic supply is from the Vagus reaching the Celiac plexus via the Posterior gastric nerve
2. From the left one–third of the transverse colon upto the rectum:
? Sympathetic supply is from the Thoracic splanchnic nerve via the
Inferior mesenteric plexus
? Parasympathetic supply is from the Pelvic splanchnic nerve (S2, S3, S4)
Neural control of the gut wall shows that the myentric and the submucosal
plexuses are extrinsically controlled by the sympathetic and parasympathetic nervous systems and the sensory fi bers pass from the
luminal epithelium and gut wall to the enteric plexuses and from there to
the prevertebral ganglion of the spinal cord and directly to the spinal cord
and brain stem.
Movements of the large intestine.
The principal functions of the colon are:
1. Absorption of water and electrolytes from the chyme to form solid feces.
2. Storage of fecal matter until it can be expelled.
The movements of the colon are sluggish as the function of the proximal
part is absorption and that of the distal part is storage of feces – both of
which do not require intense movements. This movement is again of two types:
A. Mixing or haustration
About one inch of the circular muscles and the longitudinal muscles called
the teniae coli, contract at a time; causing the unstimulated portion to bulge
out like a bag, called haustration.These haustrations reach the peak in about thirty seconds and disappear within one minute, to again reappear
within a few minutes. These contractions move towards the anus, so the fecal matter is gradually exposed to the surface of the large intestines while fluid and dissolved substances are progressively absorbed.Thus, the chyme becomes semisolid within the transverse colon.
B. Propulsive movements
Mass movement causes the propulsion from the beginning of the transverse colon to the sigmoid colon. These movements occur one to three times each day. In ‘mass movements’ first, a constrictive ring appears in response to a distended or irritated point in the colon – usually the transverse colon. Then rapidly thereafter, twenty or more centimetres of colon, distal to the constriction, lose their haustrations and contract as a unit forcing the fecal matter in this segment en mass further down the colon. The appearance of mass movement is facilitated by gastrocolic and
duodenocolic refl exes which again results from distention of the stomach
and duodenum. Here the autonomic nervous system is responsible for the
initiation of the reflex. Irritation of the colon also initiates intense mass movements.
The vagus nerve supply is the parasympathetic supply to the proximal
half of the colon, whilst defecation is stimulated by parasympathetic
defecation refl ex involving the sacral segments of the spinal cord.
Parasympathetic stimulation increases the overall degree of activity of the gastrointestinal tract, by promoting peristalsis and relaxing the sphincter.
Strong sympathetic stimulation inhibits peristalsis and increases the tone of the sphincter, resulting in slow propulsion and decreased secretion causing severe constipation.
Secretions of the large intestines Whenever a segment of the large intestine becomes intensely irritated, the mucosa secretes large quantities of water and electrolytes in addition to the normal viscid solution of alkaline
mucus. This causes rapid movement of feces towards the anus, resulting in diarrhea.
Diarrhea accompanying periods of nervous tension is caused by excessive
stimulation of the parasympathetic nervous system , which greatly excites both –motility and secretion of mucus in the distal colon. These two
effects added together causes marked diarrhea.
Constipation can result from spasm of a small segment of the sigmoid
colon . Motility, even normally is weak in the large intestines. Thus, even
a slight degree of spasm is sufficient to cause serious constipation. After the constipation has continued for several days, and excessive accumulation of feces and excessive colonic secretions above the spastic colon leads to a day or so of diarrhea . Aft er this, the cycle begins again with repeated bouts of alternating constipation and diarrhea.
Etiology
Patients with functional gastrointestinal disorder have been shown to have
abnormalities in visceral sensation and have a lower pain threshold when
tested with balloon distention (visceral hyperalgesia). Visceral hypersensitivity possibly relates to:
? Altered receptor sensitivity at the viscus itself
? Increased excitability of the spinal cord dorsal horn neurons
? Altered central modulation of sensations
Symptoms are likely to be generated as a consequence of disturbed
gastrointestinal motility that leads to distention with visceral hyperalgesia
accentuating the pain. Patients who develop irritable bowel syndrome following an acute enteric infection, demonstrate micro-inflammatory changes in the enteric mucosa or neural plexus.
These also contribute to symptom development. The brain-gut axis describes a combination of intestinal motor, sensory and CNS activities. A bio-psychosocial conceptualization of the pathogenesis and clinical expression of irritable bowel syndrome shows how genetic, environmental and psychological factors interact to cause dysregulation of brain-gut function.
Early in life, genetics and environmental influences (for example, family
att itude towards bowel training, verbal or sexual abuse, exposure to an infection) may affect one’s psychosocial development (susceptibility to stress, psychological state, coping skills, development of social support, etc.) or the development of gut dysfunction (abnormal motility or visceral hypersensitivity).
Functional gastrointestinal disorder should be regarded as a dysregulation
of the brain-gut function. The brain-gut axis describes a combination of intestinal motor , sensory and CNS activities. Thus, extrinsic (for example, vision, smell, etc.) and intrinsic (for example, emotions, thoughts, etc.) informations can affect gastrointestinal sensations due to the neural connections from high centers.
Conversely, viscerotropic events can affect central pain perception, mood
and behavior. Psychological stress can exacerbate gastrointestinal symptoms and psychological disturbances are more common in patients with irritable bowel syndrome. They alter the attitude to illness, promoting a healthcare seeking attitude, often leading to a poor clinical outcome with psychosocial consequences and poor quality of life at home and work.
Publications suggesting the role of the brain-gut ‘axis’ appeared in the
1990s, such as, a study entitled ‘Braingut Response to Stress and Cholinergic Stimulation in IBS’ published in the Journal of Clinical Gastroenterology in 1993. A 1997 study published in Gut magazine suggested that irritable bowel syndrome was associated with
a ‘derailing of the brain-gut axis.’ Psychological factors are still thought to
be important in the etiology of irritable bowel syndrome, and the symptoms defining the condition are referred to, by some doctors, as medically unexplained symptoms, a term some psychiatrists
consider synonymous with psychosomatic illness.
Beginning from the seven classical psychosomatic illnesses of Franz
Alexander, the Father of Psychosomatic Medicine, the number of these
illnesses has continued to increase by leaps and bounds.
Factors that can trigger the onset of IBS
? Pelvic surgery
? Psychological stress
? Sexual , physical , verbal abuse
? Mood disturbances
? Anxiety, depression
? Eating disorders
? Food intolerance
A biopsychosocial model for psychosomatic illness has been described
by George Engel, in 1977 as follows:
Pathophysiology
Traditional theories regarding pathophysiology may be visualized
as a 3-part complex of altered gastrointestinal motility, visceral hyperalgesia and psychopathology. A unifying mechanism is still unproven.
1. Altered gastrointestinal motility includes distinct aberrations in
small and large bowel motility.
a. The myoelectric activity of the colon is composed of background slow waves with superimposedspike potentials. Colonic dysmotility in irritable bowel syndrome manifests as variations in slow wave frequency and a blunted, late-peaking, post-prandial response of spike potentials. Patients who are prone to diarrhea demonstrate this disparity to a greater degree than patients who are prone to constipation.
b. Small bowel dysmotility manifests in delayed meal transit in patients prone to constipation and in accelerated meal transit in patients prone to diarrhea. In addition, patients exhibit shorter intervals between migratory motor complexes (the predominant interdigestive small bowel motor patterns).
2. Visceral hyperalgesia is the second part of the traditional 3-part complex that characterizes the irritable bowel syndrome.
a. Enhanced perception of normal motility and visceral pain characterizes
irritable bowel syndrome. Rectosigmoid and small bowel balloon inflation produces pain at lower volumes in patients. Notably, hypersensitivity appears with rapid but not gradual distention.
b. Patients who are aff ected describe widened dermatomal distributions of referred pain.
c. Sensitization of the intestinal afferent nociceptive pathways that synapse in the dorsal horn of the spinal cord provides a unifying mechanism.
3. Psychopathology is the third aspect. Personality factors:
a.Patients with psychological disturbances relate more frequent and debilitating illnesses than control populations.
b. Patients who seek medical care have a higher incidence of panic
disorder, major depression, anxiety and hypochondriasis than control populations.
c. A higher prevalence of physical and sexual abuse has been demonstrated in patients with irritable
bowel syndrome.
d. Whether psychopathology incites development of irritable bowel
syndrome or vice versa remains unclear.
Frequency
In western populations, up to 1 in 5 people report symptoms consistent
with irritable bowel syndrome. Only fifty per cent (approximately) consult
their doctors and among them, only thirty per cent are referred to the hospital specialists. Up to forty per cent of all patients seen in the specialist
gastroenterology clinics have irritable bowel syndrome. Irritable bowel syndrome patients lose time off work for periods ranging from 7 -13 days each year. Those who consult their doctors for irritable bowel syndrome, perceive that their symptoms are more severe than non-consulters and consulting behavior is determined by the number of presenting symptoms. Females out number male as they are more prone to anxiety and depression.
Clinical Features and Diagnosis
The ‘Rome process’ is an international effort to define and categorize the
functional gastrointestinal disorders, (of unknown cause), such as irritable
bowel syndrome and functional dyspepsia. This approach represents a
substantial change in thinking given that doctors have usually relied on
basic science and palpable ‘evidence’ to diagnose all kinds of ailments. More than half of the gut disorders encountered by physicians are functional (that is, disorders of gut function) and there is no structural or biochemical explanation for them, so it was necessary to develop alternate methods to identify them. This process is akin to that followed by psychiatrists to categorize and diagnose psychiatric entities,
which culminated in the DSM-IV criteria. These should not be ‘diagnoses
of exclusion’; they demand a more positive approach.
The Rome criteria has been evolving from the first set of criteria issued
in 1989 (the Rome Guidelines for IBS) through the Rome Classifi cation System for FGIDs (1990), or Rome-1, the Rome I Criteria for IBS (1992) and the FGIDs (1994), the Rome II Criteria for IBS (1999) and the FGIDs (1999) to the recent Rome III Criteria (2006). ‘Rome II’ and ‘Rome III’ incorporated pediatric criteria to the consensus.
According to the Rome II committees and the Functional Braingut Research Group, irritable bowel syndrome can be diagnosed based
on atleast twelve weeks, which need not be consecutive, of the preceding
twelve months there was abdominal discomfort or pain that had two out of
three of these features:
1. Relieved with defecation; and/or
2. Onset associated with a change in frequency of stool; and/or
3. Onset associated with a change in form (appearance) of stool.
Symptoms that cumulatively support the diagnosis of irritable bowel syndrome:
1. Abnormal stool frequency (for research purposes, ‘abnormal’ may
be defined as greater than three bowel movements per day and less than three bowel movements per week).
2. Abnormal stool form (lumpy/ hard or loose/watery stool).
3. Abnormal stool passage (straining, urgency or feeling of incomplete
evacuation).
4. Bloating or feeling of abdominal distention.
Supportive symptoms of irritable bowel syndrome:
1. Fewer than three bowel movements a week.
2. More than three bowel movements a day.
3. Hard or lumpy stools.
4. Loose (mushy) or watery stools.
5. Straining during a bowel movement.
6. Urgency (having to rush to have a bowel movement).
7. Feeling of incomplete bowel movement.
8. Passing mucus (white material) during a bowel movement.
9. Abdominal fullness, bloating or swelling.
Diarrhea-predominant: At least 1 of B,D, F and none of A, C, E; or at least 2 of B, D, F and one of A or E.
Constipation-predominant: At least 1 of A, C, E and none of B, D, F; or atleast 2 of A, C, E and one of B, D, F.
Red flag symptoms which are not typical of irritable bowel syndrome:
? Pain that awakens/interferes with sleep
? Diarrhea that awakens/interferes with sleep
? Blood in the stool (visible or occult)
? Weight loss
? Fever
? Abnormal physical examination
Rome III Classification
For adults
In the Rome III classification, the functional gastrointestinal disorders are
classified into six major domains for adults:
1. Esophageal (category A)
2. Gastroduodenal (category B)
3. Bowel (category C)
4. Functional abdominal pain syndrome (category D)
5. Biliary (category E)
6. Anorectal (category F)
The functional bowel disorders (category C) include: Irritable bowel
syndrome (C1); functional bloating (C2); functional constipation (C3) and
functional diarrhea (C4). Irritable bowel syndrome (C1) is
more specifically defined as pain associated with change in bowel habit,
which is different from functional diarrhea.
For children (Category H)
H1. Vomiting and aerophagia:
H1a. Adolescent rumination syndrome
H1b. Cyclic vomiting syndrome
H1c. Aerophagia
H2. Abdominal pain-related FGIDs:
H2a. Functional dyspepsia
H2b. Irritable bowel syndrome
H2c. Abdominal migraine
H2d. Childhood functional abdominal pain
H3. Constipation and incontinence:
H3a. Functional constipation
H3b. Non-retentive fecal incontinence
The Rome III criteria (May 2006) for the diagnosis of irritable bowel
syndrome requires that patients must have recurrent abdominal pain or discomfort at least three days per month during the previous three months that is associated with two or more of the following:
1. Relieved by defecation.
2. Onset associated with a change in stool frequency.
3. Onset associated with a change in stool form or appearance.
Supporting symptoms include the following:
? Altered stool frequency
? Altered stool form
? Stool passage (straining and/or urgency)
? Mucorrhea
? Abdominal bloating or subjective distention
Manning and associates established six criteria to distinguish irritable
bowel syndrome from organic bowel disease. Although historically
important, these criteria are insensitive (fifty eight percent), non-specific
(seventy four per cent), and less reliable in men. The Manning criteria to
distinguish irritable bowel syndrome from organic disease are as follows:
? Onset of pain associated with more frequent bowel movements
? Onset of pain associated with looser bowel movements
? Pain relieved by defecation
? Visible abdominal bloating
? Subjective sensation of incompleteevacuation more than twenty five per cent of the time
? Mucorrhea more than twenty five percent of the time
In the past, it was thought that the diagnosis of irritable bowel syndrome
relied on a diagnosis of exclusion; that is, if one cannot find a cause then irritable bowel syndrome is the diagnosis.
Currently the diagnosis of irritable bowel syndrome relies on meeting
Rome II inclusion criteria (updated by Rome III criteria) and excluding other
illnesses based on history, physical examination and laboratory testing.
Although the Rome II and III criteria were not designed to be a management guideline, it is currently a ‘gold standard’ for the diagnosis of irritable bowel syndrome.
Irritable bowel syndrome is a multisystem disorder, and the nongastrointestinal features are:
1. Gynecological symptoms:
? Dysmenorrheal
? Dysparunia
? Pre-menstrual tension
2. Urinary symptoms:
? Increased frequency
? Urgency
? Nocturia
? Incomplete emptying of the bladder
3. Others:
? Back pain
? Headache
? Bad breath
? Unpleasent taste
? Insomnia
? Fatigue
Investigations
Investigations are normal. A positive diagnosis can be confidently made
in patients below forty years of age, without resorting to complicated tests
.
Routine tests include :
? Full blood count
? ESR
? Sigmoidoscopy
Barium enema and colonoscopy are undertaken in elderly patients to
exclude colorectal cancer. Pointers for the need of a thorough investigation
are the presence of the above symptoms in association with rectal bleeding, nocturnal pain, fever and weight loss.
Differential Diagnosis
Diarrhea predominant patients justify investigations to exclude :
1. Microscopic colitis: Histological examination of biopsy shows
presence of a thick submucosal band of collagen.
2. Lactose intolerance: Irritable bowel syndrome is very oft en suspected,
but the diagnosis is suggested by clinical improvement
on lactose withdrawal.
3. Celiac disease: Presents at any age and features of malnutrition
predominate. Diagnosis by endoscopic small bowel biopsy which
shows villous atrophy. Celiac diseases is associated with other HLA
linked autoimmune disorders.
4. Inflammatory bowel disease: Inflammatory bowel disease and
irritable bowel syndrome are heterogenous disorders of the gastrointestinal tract and canprofoundly affect the quality of life . Because many symptoms of inflammatory bowel disease are similar to those of irritable bowel
syndrome, the former may be misdiagnosed.
The two major forms of inflammatory bowel disease
Ulcerative colitis and Crohn’s disease also have overlapping non-specific, pathological features. Though colonoscopy may show active inflammation with pseudopolyps or a complicating carcinoma – rectal scarring , perianal
disease and discrete ulcers suggest Crohn’s disease, whereas
in Ulcerative colitis, the histological abnormalities show confl uent
ulcers most severe in the distal colon and rectum.
Other commoner causes of chronic constipation are as follows:
1. Organic obstructions, for example, carcinoma of the colon or diverticular disease.
2. Painful anal conditions, like, fissure in ano or prolapsed piles.
3. Adynamic bowel, as may occur in Hirschsprung’s disease, senility,
spinal cord injuries and diseases, Parkinson’s disease and myxedema.
4. Drugs which decrease the peristaltic activity of the bowel and
ganglion blocking agents.
5. Habit and diet, for example, dehydration, starvation, lack of suitable
bulk in the diet and dyschezia (difficult and painful evacuation
of feces). Other flatulence predominate conditions simulating irritable bowel syndrome are :
Recurrent, prolonged episodes of flatulence are nearly always caused by
the acquired habit of air swallowing, of which the patient is usually unaware
and denies. Chronic obstruction of the esophagogastric junction (achalasia, pseudo-achalasia), gastric outlet (peptic
ulcer disease, tumor) with proximal viscous dilatation or gastroparesis
(diabetes, sepsis, viral infection and retroperitoneal cancer) may oft en be
associated with belching.
Abdominal day time bloating is a feature of irritable bowel syndrome
but there is no demonstrable pathologies unlike in the above conditions.
Management
1. Patient hearing of all the complaints, followed by careful examination
and cost efficient investigations.
2. Reassurance and educating the patient regarding the symptoms
and prognosis of the disease .
3. Increasing dietary ‘fiber’ intake may cure constipation, but many
patients have already tried this before consulting the doctor. Alternatively,
and perhaps more commonly, there is an excessive intake of non-starch polysaccharide (NSP) or unabsorbable mono-, di- and tetrasaccharides, such as sorbitol, mannitol (found in fruits and chewing gum), lactose
(found in milk, chocolate, cream, cheese and yoghurt) and scodarose
(found in onions), which can all cause diarrhea, abdominal
pain and excessive flatulence. Excessive consumption of caff einecontaining drinks may also be responsible for diarrhea through
their direct stimulatory eff ect on the colon. Wheat fiber (bran) is one of the most effective dietary laxatives and excessive amounts
of wholemeal bread or wholemeal cereals may be responsible for diarrhea.
Other common offending items include citrus fruits, onions and nuts.
4. Change in eating habits like having a heavy meal at a time can
quickly overload and overstretch the bowel. Hence, time should be
allotted for enjoying small meals frequently.
5. Regular bowel habits should be encouraged and usual defecation
in the morning , after breakfast, when the gastrocolic and duodenocolic
reflexes cause mass movements in the large intestine.
This prevents the development of constipation later in life.
6. Lastly, but most importantly, avoid stressful events, occupational
dissatisfaction and diffi culties in interpersonal relationships. If these circumstances cannot be avoided, the individual has to
learn to combat them by strengthening his / her stamina which can
be achived to a certain extent, by following regular physical activities
and exercises.
Prognosis
Patients suffering from irritable bowel syndrome seldom turn out to have
any organic disease even later in life. Hence the prognosis is good , but it is quite difficult to get rid of the annoying symptoms of the disease.
Homeopathic Approach of Treatment
In aphorism 210 of the Organon, sixth edition, Master Hahnemann says, ‘…the disposition and mind is always altered; and in all cases of disease we are called on to cure, the state of the patient’s disposition is to be particularly noted…’ With these words Hahnemann, a hundred years ago has clearly and simply stated facts which represent today the most recent discovery of medicine, concerning the interrelationship between mind and body, involving the problem of the psychic origin of many pathological conditions. The vegetative nervous system functions as the pathway between psyche and soma. The emotional reaction is mediated through the thalamus and the vegetative nervous system centers in the diencephalon and reaches the organ by means of the sympathetic and parasympathetic fibers, expressing in the language of the organ, that
is, its particular disturbances in function.
Miasmatic approach
Internal psora, according to Dr Hahnemann, when aroused, produces excessive sensitiveness and irritability from weakness. Thus, all physical and psychical impressions, even the weaker and the weakest, cause a morbid excitement, often in a high degree.
The abdomen feels full and distended with a painful sensation, after
eating. These symptoms are worse in the morning. There is an empty gone feeling in the abdomen after eating or a stuffy, full feeling preventing eating.
There may be constricting sensations in the abdomen, pressure in the lower region of the liver, audible rumblings in the bowel and a heavy dragging down sensation as if diarrhea would set in aggravated soon aft er eating or drinking. All abdominal pains of psora are ameliorated by heat and gentle pressure. Diarrhea of psoric patients comes on from exposure to cold. The constipation of psora is very stubborn and there may be remote pains like headache, liver pain or drowsiness with sleepiness, stupor and no desire to work.
True colic is found in sycotic taints. Often the simplest kind of foods, especially fruits, produce colic or pain throughout the intestinal tract and it is ameliorated by bending double , motion or hard pressure. The colics are
accompanied by a slimy mucus stools.
Sycotic troubles make the patient highly irritable and cross. The stools
are greenish-yellow, mucoid and very changeable. It is sour smelling and is
forcibly ejected from the rectum. The diarrhea of sycotic subjects comes on
from getting wet.
Syphilitic patients are worse at night; they are driven out of bed at
night and this is accompanied by profuse, warm / cold perspiration, which
is very exhausting and debilitating. The face is pale and earthy, eyes are sunken with dark rings, lips are bluish and there is loss of appetite accompanied by much thirst.
In tubercular diathesis , the patients have diarrhea from the least
error in diet or exposure to cold. The stools are ashy or grayish in color.
There is marked nausea and vomiting, soon after eating or drinking. The
tubercular diarrhea is aggravated by taking milk, potatoes, meat and on
any motion or any movement. The patients want to be alone due to marked prostration from every evacuation.
Homeopathic treatment is based on individualizing symptoms of an
individual patient and not on the common symptoms of the disease. However, the following rubrics may be taken into consideration , during the
treatment of irritable bowel syndrome (as in REPERTORY OF HOMOEOPATHIC MATERIA MEDICA, by J.T. KENT) :
There are many more rubrics and subrubrics which correspond to the
symptoms of irritable bowel syndrome in the chapters ABDOMEN and RECTUM alone of REPERTORY OF THE HOMOEOPATHIC MATERIA MEDICA by J.T. KENT. As irritable bowel syndrome is a multisystem disorder, the rubrics are scatt ered throughout the repertory and no particular chapter or rubric can be segregated as the only chapter , helpful for the selection of the medicine for individuals suffering from irritable bowel syndrome. However, the medicine can only be selected after a thorough case taking and determined the characteristic picture of the individual.
In BOENNINGHAUSEN’S CHARACTERISTICS and REPERTORY,
translated by C.M. BOGER, the following rubrics may be taken into account:
NAUSEA AND VOMITING
Nausea
Anxiety, with
Aggravation
Anger , vexation, etc.
Emotions
Exertion, mental
Fright, aft er
Concomitants
Headache
Earache
Eye pains
ABDOMEN
Anxiety, anguish, etc. in
Colic
Cramps
Diarrhea , pain like that of
Distended, here and there
Distensive pain
Emptiness, sense of
STOOL
Diarrhea
Alternating with constipation
Chronic
Painful
Constipation
On alternate days
Concomitants, before stool
Abdomen rumbling, etc. in
Angriness
Anxiety, fear
Irritability
FLATULENCE
Aggravation
Anxiety with
In SYNTHESIS REPERTORY by
DR FREDERIK SCHROYENS, the following
rubrics may be sought for:
ABDOMEN
Pain
cramping
Diarrhea
before
vexation, aft er
Distention
grief, from
mental exertion from
mortifi cation , aft er
anxiety, in
RECTUM
Diarrhea
accompanied by urination ; urgency
to urinate
anger; aft er
anticipation; aft er
bad news; aft er
domestic cares ; from
excitement; aggravates
exertion; aft er
aggravates
during
nervous; emotions aggravates
constipation
vexation; after.
These are a few of the rubrics which may be taken into account while treating a patient suffering from irritable bowel syndrome, but it should always be remembered that, irritable bowel syndrome is a multisystem
disease and homeopathy is also based on the individualizing features
of the patient , hence , any and every rubric may be helpful throughout the
repertory.
Cases for Reference
Case 1
Mr X, forty five years of age, an officer in a Rubber Board, reported on
28.9.2001 with the following symptoms of twenty five years duration:
Burning sensation in rectum, with pain, heaviness and fl atulent distention
of the abdomen. He has early morning urging for stool. Sometimes
there is constipation, with frequent ineffectual urging and sometimes loose
indigestible stools. He has headache and is tense when constipated. All his
symptoms are increased during morning hours; aft er eating, especially spicy food, baked items, sweets, meats, oily food; and mental tension. He feels better after stool, when engaged and when he goes without regular meals.
On the basis of characteristics, Nux vomica 200, 2 doses was prescribed.
14.10.01
He reported relief of abdominal distention, pain in abdomen, headache,
eructations, constipation, etc. but loose stool, burning in anus, frequent
morning urging, etc. still persisted. Sulphur 200, 2 doses was prescribed.
15.11.01
Rumbling in abdomen, frequent urging in morning persisting. Sulphur
200, 1 dose was prescribed .
9.12.01
Patient reported relief from all symptoms.
Case 2
A patient reported gripping pain in the abdomen and nausea with passage
of foul flatus, worse in the morning,evening; bett er aft er stool. There was
also itching and pricking in the rectum with internal piles. Sensation of constant pressure at the rectum, with generalized weakness and perspiration of soles and palms. Recurrent cold and
cough with throat infection. Stiffness of the back. Patient felt depressed and is afraid of being alone; very sad on waking up in the morning; is melancholic. He had desire for sweets and an aversion to bread.
10.2.2004
Aloe socotrina 200, 2 doses was administered.
25.2. 2004
He reported slight improvement gradually and was put on Placebo for
one month.
2.4.2004
Lycopodium clavatum 1M, 1 dose was given, after which she reported
steady improvement.
Bibliography
1. CLINICAL MEDICINE by KUMAR and CLARK (fi ft h edition).
2. DAVIDSON’S PRINCIPLES and PRACTICE OF MEDICINE (nineteenth
edition).
3. HARRISON’S PRINCIPLES OF INTERNAL MEDICINE (sixteenth
edition).
4. ROBBINS BASIC PATHOLOGY ( seventh edition).
5. THE CHRONIC MIASMA by J . HENRY ALLEN.
6. KENT’S REPERTORY OF HOMOEOPATHIC MATERIA MEDICA.
7. SYNTHESIS REPERTORY.
8. BRITISH MEDICAL JOURNAL FROM INTERNET.
Authors:
- Dr Ambika Kundu
- Dr Amit Bikram Basu
Source:
The Homoeopathic Heritage, January 2010.
