SOOTHING AN IRRITABLE BOWEL
Dr Douglas Drossman was waiting for his patient to arrive. Three times the man had cancelled, but this time he had promised to keep his appointment.
As an international expert on irritable bowel syndrome, Dr Drossman understood the reason for the cancellations.
The man, a mid-40s property tycoon, was suffering so badly from an irritable bowel that he was afraid to leave his home in the US Midwest and fly to Dr Drossman at the University of North Carolina.
At one time the man had travelled around the country on business, enduring the bloating, abdominal cramps and diarrhoea that commonly accompany the syndrome. But unexpectedly, at a very public moment, he’d had an episode of incontinence. He’d survived the embarrassment, but when it had happened again he’d made a decision to retreat to his home and conduct all his business from there.
For 2 years he’d hardly ventured out and had eaten as little as possible. His numerous attempts to have his diarrhoea treated had failed.
To Dr Drossman, who has psychiatric as well as gastroenterological training, this man’s condition had a large psychological component. His anxiety about not being able to control his diarrhoea in public had become a problem in its own right. He had ‘catastrophised’ his condition and believed he was helpless to remedy it.
Not only did the anxiety keep him at home, but it also perpetuated the diarrhoea. The man was caught in a vicious cycle. He did, however, manage to keep the appointment with Dr Drossman and explain that once the cramping began he could not control himself for more than 2 minutes.
Dr Drossman look a behavioural approach. lie sent the man to the cinema with instructions that he sit within a 2-minute walk of the bathroom.
With reluctance, the man agreed, and was surprised to find that the proximity of the bathroom reduced his anxiety. He watched a full-length film without experiencing a single cramp. As this type of exercise was repealed and expanded, he gradually regained confidence. Eventually he gained 20 kg and was back travelling.
Irritable bowel syndrome, which has also been known as spastic colon, mucous colitis and nervous bowel, affects about 10 per cent of adult Australians. It can last for years and is notoriously difficult to treat because of its wide range of symptoms. While it may cause uncontrollable diarrhoea, it may also cause painful constipation. Some men seek help because their bloating and gas are affecting their work. To avoid embarrassment, they frequently have to leave meetings to relieve themselves.
While there is no universal treatment, a combination of diet modification, stress management and medication is usually used.
In China, herbal medicines have been used as a remedy for this condition for centuries. When the herbal remedies were tried on patients in Sydney, the outcome was striking. Those who received the 20-herb combination did two to three times better than those who were given a placebo.
This trial was the first placebo-controlled trial in the use of Chinese herbal medicine for the treatment of irritable bowel syndrome in the world. Previous studies in China had not been performed to the same rigorous standards.
During the trial, 116 patients received treatment for 16 weeks. While 33 per cent of those on the placebo reported an improvement in their symptoms, more than 70 per cent of those receiving the herbs said they felt better.
The principles of Chinese medicine are different from those of Western pharmacology. Western practice typically involves looking for a single active ingredient, extracting it and using it as a drug. Chinese practice involves looking for the synergy among a number of ingredients. While some herbs in a combination may not act directly on the body, they may boost the function of other herbs being used.
The 20 herbs used in this instance are not easily identifiable in the West. One, for example, is the root of the white peony flower, which contains chemicals that relax smooth muscle.
There are plans for the commercial production of this 20-herb preparation.
*34\105\2*
