Gastro-Intestinal Disorders

by John G. Connor, M.Ac., L.Ac., edited by Barbara Connor, M.Ac., L.Ac.

TABLE OF CONTENTS

1.   Introduction
2.   Chinese Medical Understanding of Digestion
a. Importance of Emotions
b. Main Chinese Medical Patterns of Digestive Disorders
3.   Modern Western Understanding of Digestion
4.   Description and Treatment of Gastrointestinal Disorders
a. Adhesions and Scars
b. Belching
c.   Candidiasis
d.   Constipation
e.   Diarrhea
f. Diverticulitis
g.   Dysbiosis
h. Fat Digestion Difficulties
i. Flatulence and Gas
j. Food Sensitivities
k.   Gallstones
l. Gastritis
m.  Gastro-esophageal Reflux and Heartburn
n.   Gluten Intolerance: Celiac Disease and Sprue
o.   Hemorrhoids
p.   Inflammatory Bowel Disease: Crohn’s Disease and Ulcerative Colitis
q. Intestinal Parasites
r. Irritable Bowel Syndrome
s.   Lactose Intolerance
t. Leaky Gut Syndrome
u.  Pancreatic Insufficiency
v.  Peptic Ulcers: Gastric and Duodenal Ulcers
5.  Dietary, Herbal and Nutritional Support for Digestive Disorders
6. References

1. INTRODUCTION

Barbara and I see many patients with irritable bowel syndrome, gastro-esophageal reflux, diverticulitis and other gastrointestinal complaints. We treat these conditions successfully using a combination of craniosacral acupuncture, gentle hara visceral work, specific herbs and supplements, as well as dietary and lifestyle recommendations. We have written this article in order to explain the basics of the Traditional Chinese Medicine (TCM) approach to digestive health; as well as provide you with the latest alternative herbal and dietary information available on digestive wellness. We hope you will find it helpful. For more information on how acupuncture works and on the fundamentals of craniosacral acupuncture and hara visceral work we invite you to read our articles entitled How Acupuncture Works, What is Craniosacral Acupuncture? and What is Hara Visceral Work? on our web site.

2. CHINESE MEDICAL UNDERSTANDING OF DIGESTIVE DISORDERS
In Traditional Chinese Medicine (TCM) digestion involves dispersion of pure substances to be retained and impure substances to be excreted after these have undergone transformation. In TCM the process of digestion is described mainly in terms of the functions of the Stomach and Spleen. The Stomach and Spleen are a Yin/Yang pair – the Stomach being Yang and the Spleen being Yin. The main function of the Stomach is the rotting and ripening of food, (i.e., transforming and digesting) so that the Spleen can do its job of separating the distilled food essences and transforming and transporting the food and fluids. It becomes the Small Intestine’s function is to reabsorb the pure part of the impure parts of liquids which the Stomach sends down; and it is the Large Intestine’s function is to reabsorb the pure part of the impure foods or solids which the Stomach sends down. Digestion in TCM is however mainly dependent upon the Spleen Qi’s ability to transform and transport foods and fluids.

a. Importance of Emotions

• In TCM emotional problems have a profound influence on stomach disorders; and emotional stress has a deep influence on the circulation of Qi and Blood in the abdomen particularly affecting the Liver and Spleen.

• Chronic worry can affect gastric secretion, irritate the gastric lining and impair efficiency of digestion and absorption. Worry, pensiveness, brooding and excessive mental work can weaken the Spleen and may cause diarrhea. Impatience, irritability, anger, suppressed anger and frustration can all affect the Stomach. These emotions may result in over-secretion of stomach acid and the inflammation of the gastric mucosa, or they may stagnate the stomach function, slowing the passage of food through the stomach into the intestines. Fear also can have an effect on the Stomach.

• Anger (which includes frustration and resentment) may cause stagnation of Liver Qi in the Intestines and thus abdominal pain. Pensiveness and worry both affect the Spleen and Lungs. Since the Spleen is responsible for transforming and moving food essence in the Intestines, while Lung Qi helps the Qi of the Intestines to descend, pensiveness and worry can impair the proper transformation of Spleen Qi and the descent of Lung Qi towards the Intestines. Both of these conditions may cause abdominal pain.

• The liver in TCM is known as the “Sea of Emotions” and is considered interdependent with the psyche. According to Jean-Pierre Barral, D.O., he has found this connection valid in his own work and that in almost every case of nervous depression, the motility of the liver is affected. Motility is the inherent movement of the visceral organs themselves. A visceral restriction occurs when an organ loses part or all of its ability to move. An adhesion is a reduction of motility and can be due to infectious pathologies or surgical interventions.

b. Main Chinese Medical Patterns of Digestive Disorders
i. Spleen Qi Deficiency – manifests as poor or no appetite, a tendency to loose stools, abdominal distention after eating, tiredness, lassitude, sallow complexion, and weakness of the limbs. If Spleen Qi Deficiency gives rise to Dampness there may also be nausea, stuffiness of the chest and epigastrium and a feeling of heaviness. Dampness is heavy and difficult to get rid of. It accumulates in the muscles causing a feeling of heaviness. Nausea is caused by the obstruction of Dampness in the epigastrium preventing the Stomach Qi from descending. Spleen Qi Deficiency can be the cause of nervous diarrhea, gastric or duodenal ulcers, anemia and even hepatitis.

ii. Spleen Yang Deficiency – is basically the same as Spleen Qi Deficiency with the addition of Cold symptoms such as chilliness, cold limbs and edema. Western pathologies such as leucorrhea, edema, gastritis, enteritis, nephritis and colitis may be caused by Spleen Yang Deficiency.

iii. Stagnant Liver Qi – manifests as abdominal distention, constipation, belching, irritability, irregular bowel movements and gastritis aggravated by depression, frustration or anger. When it invades the Intestines it results in colitis. When it invades the Spleen it causes alternating constipation and diarrhea. When it invades the Stomach it causes rebellious Stomach Qi with its attendant nausea, vomiting, belching, epigastric pain and sour regurgitation. Stagnant Liver Qi is also an important prerequisite for the formation of gallstones. Stagnant Liver Qi is a pattern often seen along with Spleen Qi Deficiency in patients with irritable bowel syndrome.

iv. Liver Qi Invading the Stomach – manifests as epigastric distention and pain radiating towards the right or left hypochondrium, belching, sighing and irritability. Pain comes in bouts clearly related to emotional tension. It is usually due to emotional problems such as anger, resentment or frustration. It can result in acid regurgitation and gastric ulceration.

v. Damp Heat in the Intestines – manifests as abdominal pain which is worse with pressure and hot food, a feeling of heaviness and oppression of the chest, loose stools with foul smell, mucus and/or blood in the stools, a burning sensation of the anus, thirst, slight sweating and dark urine. This condition has been diagnosed as Crohn’s disease. Gastroenteritis from a Chinese perspective would correspond to Damp Heat in the Stomach and Intestines

vi. Damp Heat Invading the Spleen – manifests as abdominal pain, loose stools with offensive odor and burning sensation of the anus. This is often seen as traveler’s diarrhea or in cases of food poisoning. If there is the presence of blood in the stools it could be dysentery.

vii. Heat in the Stomach and Large Intestine – manifests as dry stools, infrequent bowel movements, thirst, scanty-dark urine, red face, feeling of heat, abdominal pain, dry mouth and foul breath. It may correspond to gastritis.

viii. Retention of Food – manifests as dull epigastric pain which is worse with pressure, feeling of distention and fullness, belching, sour regurgitation, foul breath, vomiting of undigested food, epigastric pain relieved after vomiting, loose stools or constipation. This condition can be due to over-eating.

ix. Damp Heat in the Liver and Gall Bladder – manifests as pain and fullness of the hypochondrium, bitter and sticky taste, poor appetite, feeling of fullness of the epigastrium, nausea, vomiting, yellow sclera, a sticky-yellow tongue coating and a slippery pulse.

x. Damp Heat in the Stomach – manifests as feeling of oppression of the chest, dull epigastric pain, dry mouth, no desire to drink, a bitter taste, a sticky taste, nausea, vomiting and perhaps frontal headache. This is usually accompanied by Damp Heat in the Spleen as well. It often derives from Spleen Qi Deficiency being unable to transform fluids.

xi. Kidney Yang Deficiency – manifests as early-morning diarrhea, abdominal pain, borborygmi which stop after the bowel movement, weak back and knees.

3. MODERN WESTERN UNDERSTANDING OF DIGESTION

• To get into the body molecules in the lumen of the gut have to cross the apical (lumen-facing) membranes of intestinal lining cells, go through the cytoplasm of these cells, and come out of the membranes at the other end. Absorption thus is a mechanism to take in what we need while at the same time letting nothing critical flow out. Once eaten proteins are reduced first by pepsin and then by pancreatic enzymes to small peptides. Starches and other polysaccharides are broken down to disaccharides. To be absorbed, the small peptides and disaccharides must first be attacked and split by intestinal enzymes, which are not free in the lumen of the gut but are integral components of the apical membranes of intestinal lining cells. The intestinal lining is thus the site where pancreatic enzymes are activated, digestion is completed and absorption occurs.

• The digestion of fats involves pancreatic lipase, which in the small intestine in the presence of bile salts, digests fat into smaller, simpler molecules that can go through the microvillus membranes of absorptive cells. The most abundant fat we eat are the triglycerides. They cannot go through cell membranes because they contain a backbone of glycerol. But lipase cleaves the glycerol from it which allows the fatty acids to diffuse through the microvillus membrane into the villus absorptive cells. They are then reconverted to triglycerides inside the cell and also provided with a coating of protein that helps to keep them suspended in water. Given the complexity of the digestion and absorption of fat, it is no surprise that when the gut becomes sick and unable to perform, it is usually fat absorption that is the first to fail. Fat in the stool is thus one of the earliest and most constant signs of digestive or absorptive trouble.

• All of us harbor in our colons something like 500 species of potentially deadly organisms.

• The strongly acidic fluid of the stomach contributes to defense against microbial invaders by killing them. Parietal cells secrete HCl into the stomach lumen. HCl unfolds proteins in food and stimulates secretion of hormones that promote the flow of bile and pancreatic juice.

• The enzymatic digestion of proteins begins in the stomach through the enzyme pepsin secreted by chief cells. Pepsin breaks certain peptide bonds between the amino acids breaking them down into smaller fragments. It also brings about the clotting and digestion of milk proteins. It is most effective in the very acidic environment of the stomach (pH 2) and becomes inactive at higher pH. The stomach cells are protected from being digested by pepsin by a 1 to 3 mm thick barrier of mucus between it and the gastric juices.

• Other enzymes in pancreatic juice include the carbohydrate-digesting enzyme called pancreatic amylase; several protein-digesting enzymes called trypsin, chymotrypsin and carboxypeptidase.

• Protein digestion starts in the stomach, where proteins are fragmented by the action of pepsin into peptides. Enzymes found in pancreatic juice continue the digestion and it is completed by peptidases in the brush border of the small intestine. Many proteins are absorbed as amino acids by active transport processes that occur mainly in the duodenum and jejunum.

4. DESCRIPTION AND TREATMENT OF GASTRO-INTESTINAL DISORDERS

A.  ADHESIONS AND SCARS
• According to Jean-Pierre Barral, D.O., adhesions can be partial or total and are generally the sequelae of infectious pathologies or surgical interventions. Any surgical intervention of the thorax or abdomen unfortunately necessitates the opening of these cavities. When they are opened air enters which dries the serous membranes which tends to promote restrictions. Visceral restrictions occur when an organ loses part or all of its ability to move.

• A scar creates a permanent state of mechanical irritation by forcing the tissues to rub against each other. This causes a decrease in motion over time because of the large number of movements that an organ makes daily. Neighboring tissues and organs will find their axes modified, which will cause stretching at the level of the mechanoreceptor system and produce both localized and generalized spasms via a reflex route. The circulation of blood and lymph through the organs will be diminished causing stasis. The organs will then become vulnerable to attacks from micro-organisms, varicosities, auto-immune processes, stasis of secretory or excretory liquids, etc. And depending on the location of a scar it may also interfere with the smooth flow of qi through the meridians over which it crosses.

Treatment:  Barbara and I get very good results using a combination of acupuncture and gentle hara visceral work to release restrictions and restore the smooth flow of qi due to adhesions and scars. We may also recommend herbs and nutrients which help dissolve scar tissue.

B.    BELCHING
•   Belching is a symptom of gas in the upper part of the digestive tract. Belching is a safety valve which relieves the pressure of air trapped in the stomach.

• TCM patterns include Retention of Food in the Stomach, Spleen Qi Deficiency with Liver Invading the Spleen, Rebellious Stomach Qi and Liver Invading the Spleen and Stomach.

Treatment: Barbara and I get very good results using a combination of acupuncture, gentle hara visceral work to release upper GI tract restrictions and restore the smooth flow of qi. There are also specific herbs which are helpful. We also recommend eating food more slowly and chewing your food well, avoiding carbonated beverages, stopping smoking, chewing gum or sucking on candy. Fish oil supplements may also be a source of belching.

C. CANDIDIASIS
• The bacteria that reside in your colon are indispensable for good digestive health. Known as probiotics these friendly bacteria are also found in the urinary tract, the mouth and the vagina. In the intestines they do battle with foreign bacteria that might otherwise cause infection; they manufacture some vitamins such as vitamin K and they keep the growth of a fungal yeast called Candida albicans under control.

• Candidiasis is the overgrowth of Candida in the body. Candida colonies produce powerful toxins that are absorbed into the bloodstream and affect our immune system, hormone balance and thought processes. Candida damages the intestinal lining, causing a wide variety of symptoms such as chronic fatigue, mental sluggishness, chronic vaginitis or prostatitis, anal itching, bloating, constipation, diarrhea, bad breath, mucus in the stools, frequent colds, low blood sugar, depression, mood swings, PMS syndrome, ringing in the ears, craving for sweets and yeasted breads and low immunity in general. Those with systemic Candidiasis may suffer from any of the above symptoms and also often exhibit a scattered and unfocused mind, memory loss and in severe cases manic/depression may result. Also common are allergies to many foods and environmental substances.

• The factor that contributes most to Candida proliferation and the degeneration of digestive strength is the use of massive and/or repeated doses of broad-spectrum antibiotics. These drugs kill off all microorganisms in the digestive tract – including the probiotic ones – and prepare a fertile environment for the growth of yeasts and fungi. Low-level ingestion of antibiotics occurs from eating commercial meat, dairy, eggs, and poultry, since most livestock are dosed daily with antibiotics in their feed.

Treatment: In TCM terms Candidiasis is due to Dampness, therefore we treat it using acupuncture points and herbs which drain Dampness. Candida is usually controlled by probiotics, our immune defense system and intestinal pH Bananas are helpful in restoring intestinal flora. They contain beneficial fructooligosaccharides which feed Lactobacillus and Bifidobacteriabut not Candida. Grapefruit seed extract, oleic acid from olive oil, oil of oregano, pau d’arco and raw garlic are all useful in getting rid of Candida. We also recommend going on a strict diet for three weeks and then reintroducing foods one at a time to test for reactions. If you find that you are sensitive to a particular food then avoid it.

D. CONSTIPATION
• Constipation refers to infrequent of difficult defecation. It is caused by decreased motility of the intestines in which feces remain in the colon for prolonged periods of time. It may be caused by improper bowel habits, spasms of the colon, insufficient fiber in the diet, inadequate fluid intake, lack of exercise and emotions.

• TCM patterns include: Heat in the Stomach and Large Intestine, Stagnation of Liver Qi, Qi Deficiency and Blood Deficiency.
To insure regular bowel movements:
♦ Eat at least five fruits and vegetables every day because they are rich in fiber, vitamins, minerals and fluids. If you are not gluten intolerant whole grains like whole wheat berries, oatmeal, millet, amaranth, quinoa, rye berries and brown rice are good. Beans and peas are also a good source of fiber.
♦ Cut back on low-fiber foods, including meats, dairy products, pastries, candy, soft drinks and white bread.
♦ Be cautious of overusing laxatives, even herbal ones, as they cause the bowels to become lazy and the muscles become dependent on laxatives to constrict.
♦ Psyllium seed husks are useful because they add bulk and water to the stools which allows for easy passage. Though not a laxative, psyllium seeds regulate bowel function, are beneficial for both diarrhea and constipation and do not cause harmful dependencies.
♦ Drink at least 6 to 8 glasses of water a day.
♦ If you are able to digest yogurt eating it has a normalizing effect on the bowels and can be helpful for either constipation or diarrhea. Bifidobacteria in yogurt help regulate peristalsis.
♦ Magnesium is also useful to help keep peristalsis working properly. Dosage: 400-900 mg daily.
♦ Be aware that many medications cause constipation such as: pain relievers, antacids containing aluminum, antidepressants, tranquilizers, diuretics and blood pressure medications.

Treatment: In addition to the recommendations listed above Barbara and I get very good results using a combination of acupuncture and gentle hara visceral work to release restrictions and restore the smooth flow of qi. We also get very good results using specific Chinese herbs. For more information we refer you to our article entitled Constipation on our web site.

E. DIARRHEA
• Diarrhea refers to frequent defecation of liquid feces. It is caused by increased motility of and decreased absorption by the intestines. It may be caused by stress, bacterial, fungal, viral or parasitic microbes that irritate the gastrointestinal mucosa, drugs, diverticular disease, foods or beverages that disagree with your system, inflammatory bowel disease, irritable bowel syndrome, malabsorption of fats, lactose intolerance, laxative use and abuse, contaminated water or cancer. The loss of electrolytes which accompanies diarrhea can make you disoriented and weak.

• TCM patterns include: Kidney Yang Deficiency, Damp Heat in the Intestines, Spleen Qi Deficiency, Spleen Yang Deficiency and Damp Heat Invading the Spleen.

Recommended diet for people with diarrhea consists of bananas, rice, apples and toast. These foods are bland and binding. Soda crackers, chicken and eggs can also be eaten. People with diarrhea may also be lactose intolerant so you should avoid milk and dairy products for 2 to 3 weeks to see if the diarrhea stops. If you can tolerate yogurt it is helpful to eat it as it contains beneficial bacteria which help prevent and stop diarrhea. These bacteria ferment fiber which produces short-chained fatty acids to fuel colonic tissue. You can also take probiotic supplements.

Treatment: In addition to the recommendations listed above Barbara and I get very good results using a combination of acupuncture and gentle hara visceral work to restore normal motility and the smooth flow of qi. We also have very good results with specific Chinese herbs. Goldenseal, a Western herb, is known for being highly effective for treatment of acute diarrhea caused by microbial infection.

F. DIVERTICULITIS
• Diverticula are saclike outpouchings of the wall of the colon in places where the muscularis has become weak. The development of diverticula is called diverticulosis. Many people who develop diverticulosis are asymptomatic and experience no complications. About 15% of people with diverticulosis will eventually develop an inflammation within diverticula, a condition known as diverticulitis. Symptoms include fever, lower abdominal pain aggravated by defecation, and signs of peritoneal irritation (muscle spasm, guarding, and rebound tenderness). It often results in constipation with stools of reduced size. The underlying cause of diverticula formation is constipation. Dehydrated stools are difficult to push through the colon and the bowel wall has to work harder. As a result, the muscles in the colon thicken to help this abnormal situation which results in greatly increased pressures within the bowel. Over time, this prolonged pressure can blow out portions of the bowel, causing diverticular pouches. These pouches don’t go away, but a high-fiber diet will help prevent most attacks. Rectal bleeding, usually microscopic, occurs in 25% of cases. Perforation with peritonitis and sepsis can occur, especially in the infirm elderly.

• Diverticula are more likely to form in the sigmoid colon — which has a narrow luminal diameter and a thick layer of smooth muscle — than in the ascending colon, which is wider and has a thinner muscular layer. Diverticulosis is often associated with varicose veins, hemorrhoids, hiatal or inguinal hernias or gallstones. In the cul-de-sac created by the diverticulum, fecal matter stagnates and dries, creating fecaliths.

Recommended Foods, Herbs and Nutrients:
♦ A high fiber diet is of first and foremost importance for preventing the development and recurrence of diverticular disease. Studies have shown that people eating a high-fiber, low-fat diet lower their risks of diverticular disease significantly. Men who eat a high-red meat, low –fiber diet have even higher incidences.
♦ Psyllium fiber can help solidify stools. Dosage: 1-2 teaspoons in at least 8 ounces of water.
♦ Cook vegetables until fairly soft, eat cooked fruits, use easy to digest grains like oatmeal and make vegetable soups with tofu.
♦ Friendly flora can help fight an infection while it is active and can also protect you from future infections.
♦ Gamma-oryzanol is known to have a healing effect on the colon.
♦ Glutamine is regenerative for the colon in general. The digestive tract uses it as a fuel source and for healing.
♦ Evening primrose oil increases the levels of prostaglandin E2 series which promote healing and repair. Dosage:1,000-2,000 mg three times a day.
♦ Aloe vera.
♦ A 3 week intestinal cleansing diet may be helpful.

Foods to Avoid:
♦ Avoid sorbitol, mannitol and xylitol as they are nondigestible sugars and can easily cause diarrhea and bloating.
♦ Avoid foods with seeds like strawberries, poppy seeds, sesame seeds, pumpkin seeds which can catch in your diverticula and cause irritation.

Treatment: In addition to the recommendations above Barbara and I get very good results using a combination of acupuncture and gentle hara visceral work to release intestinal restrictions as well as to restore the smooth flow of qi.

G. DYSBIOSIS
• Dysbiosis is due to an imbalance of intestinal bacteria in the digestive tract. There are ten times more bacteria in our intestinal tract than cells in our body. Antibiotics, stress, and poor dietary habits can destroy this balance. Published research has listed dysbiosis as the cause of arthritis, autoimmune disease, vitamin B12 deficiency, chronic fatigue, cystic acne, the early stages of colon and breast cancer, eczema, food allergy/sensitivity, IBD, IBS and psoriasis. Common dysbiotic bacteria are: Heliobacter, Salmonella and Staphylococcus aureus. Candidais another common dysbiosis culprit. Other causes of dysbiosis are constant high levels of stress, exposure to manufactured chemicals, poor food choices, oral contraceptives, the use of pain killers and surgery.

• The most common cause of dysbiosis is the use of antibiotics which change the balance of intestinal microbes. The microbes that remain in the gut which are resistant to the antibiotics flourish and produce toxins which are poisonous to the cells around them and to the person they inhabit. A wide variety of substances are produced, including amines, ammonia, hydrogen sulfide, indoles, phenols and secondary bile acids. These substances may hurt the intestinal lining directly by damaging the brush border and become absorbed into the bloodstream, causing system-wide effects. Initially our body rushes white blood cells to the injured tissue to eat up the bacteria and carry away the debris via the lymphatic system. Other factors contributing to dysbiosis include poor ileo-cecal valve function and low levels of HCl in the stomach which encourages bacterial overgrowth.

• There are four commonly recognized patterns of dysbiosis:
1) Putrefaction Dysbiosis manifests as bloating, discomfort and indigestion. A high fat, high animal-protein, low fiber diet predisposes people to putrefaction. It causes an increase of bacteroides bacteria which in turn can cause vitamin B 12 deficiency which manifests as depression, diarrhea, fatigue, memory loss, numbness of the hands and feet, sleep disturbances and weakness. Putrefaction dysbiosis can be corrected by increasing high fiber foods, fruits, vegetables and grains in our diet while decreasing meats and fats.

2) Fermentation Dysbiosis manifests as bloating, constipation, diarrhea, fatigue and gas. People with this type of dysbiosis have faulty digestion of carbohydrates. It is often characterized by flora that have been taken over by Candida fungi or other disease-causing microbes. These microbes damage the intestinal brush borders and lead to increased intestinal permeability. People with fermentation dysbiosis need to strictly avoid carbohydrate-containing foods. Use of probiotic supplements are essential and up to 2,000 mg of grapefruit seed extract can be used daily.

3) Deficiency Dysbiosis is often seen in people with IBS and food sensitivities. To restore balance, supplementation with probiotics and fructooligosaccharides is recommended along with increasing high fiber foods, fruits, vegetables and grains while decreasing meats and fats. One may also benefit from taking up to 2,000 mg of grapefruit seed extract daily.

4) Sensitization Dysbiosis occurs when the immune system reacts with abnormal or aggravated responses to the digestive process. Microbes in the gut and foods produce exotoxins that irritate the gut lining. Rheumatoid arthritis, ankylosing spondylitis, eczema and psoriasis are often the result. It appears that specific microbes cause disease only in people with specific gene markers so that what may have originated as a local infection becomes an autoimmune illness. People with sensitization dysbiosis often have food intolerances, leaky gut syndrome and increasing sensitivity to foods and the environment. Symptoms may include acne, bowel or skin problems, connective tissue disease and psoriasis. It may accompany fermentation dysbiosis and similar treatments may be helpful. Taking probiotics may be helpful.

H. FAT DIGESTION DIFFICULTIES
• Undigested fat due to inadequate bile can coat food and nutrients which can cause poor absorption of iron and calcium. Thus inadequate bile can put you at risk for osteoporosis. Bile is alkaline so it neutralizes acid from the stomach and contributes to making the intestinal pH more optimal for digestion. It also helps you have optimal levels of friendly bacteria.

Symptoms of Low Bile Salts includes:
♦ Stools which are persistently pale brown, yellowish or grayish. This does not mean singular events caused by dietary and lifestyle indiscretions.
♦ Discomfort, gas and bloating – especially after fatty meals.
♦ Heartburn.
♦ Vague and intermittent abdominal pains.
♦ Dull, right-sided fullness several hours after eating.
♦ Chronic constipation.
♦ Fat soluble vitamin deficiency signs.

Bile Salts help digest fats, fat-soluble vitamins A, E, D and K and essential oils. CAUTION: Never take bile salts for longer than two months at a time.

I. FLATULENCE AND GAS
• Most of our gas comes from swallowed air. Gas and bloating are also a product of the fermentation of small pieces of undigested foods by the bacteria in our intestines. Cucumbers, celery, apples, carrots, onions and garlic are all commonly known to cause gas. People who are lactose intolerant experience gas when they eat dairy products. Food sensitivities, especially to wheat and grains, can also cause gas.

• Some ways to reduce flatulence and gas include the following:
♦ Chew your food well and eat slowly
♦ Raising fiber levels too rapidly can cause gas so increasing your fiber intake more slowly will help solve this problem. ♦ Taking 2,000 mg of grapefruit seed extract daily may be helpful if you have gas due to Candida.
♦ Many people find that supplementing with digestive enzymes and probiotics helps prevent gas.
♦ Ginger, fennel, basil, oregano, marjoram, parsley, thyme, celery seed, peppermint, spearmint, bayberries, caraway seed, cardamom seed, cloves, coriander, lemon balm, sarsaparilla and anise are useful herbs for reducing gas.

J. FOOD SENSITIVITIES
• Food sensitivities are the result of leaky gut syndrome (see Section T. on Leaky Gut Syndrome below). It’s important to discover the underlying cause, which may be parasites,Candida, bacterial or viral infection, pancreatic insufficiency, medications or poor lifestyle habits. Two types of allergens cause food sensitivity reactions:

♦ Type I or True Food Allergies — are rare, affecting from 1 to 2 percent of adults. An IgE antibody reaction occurs which results in hives, skin rashes, closing of the throat, respiratory distress, runny nose, itching and sometimes asthma and anaphylactic shock. These symptoms can occur within minutes to hours after eating the food. Foods which most often trigger these reactions are: eggs, cow’s milk, nuts, wheat, soy, white fish and shellfish.

♦ Type II – IV or Delayed Hypersensitivity Reactions — are the result of food or environmental factors and cause symptoms which are delayed by several hours to several days. They affect about 24% of adults.

• Symptoms of food and environmental sensitivities can be varied and felt practically anywhere in the body. For a list of about 100 different symptoms which can be caused by food and environmental sensitivities please see Elizabeth Lipski’s book, Digestive Wellness, p.105.

• The offending food molecules enter the bloodstream through damaged mucosal membranes in the gut, the body identifies them as foreign substances or antigens and triggers an immune reaction to try to get rid of them. Prolonged antibody response overwhelms the liver’s ability to eliminate these antigens, so the toxins enter the blood stream and trigger delayed hypersensitivity response, inflammation, cell damage, and disease. Almost any food can cause a reaction, although the foods that provoke 80% of food sensitivity reactions are wheat, beef, dairy products, eggs, pork and citrus.

• There are two types of food sensitivities: Cyclic and Fixed. Cyclic types account for 80 to 90 % of food sensitivities. If you avoid eating the offending food for 4 to 6 months your body will most likely tolerate it again. However, you must also correct the underlying leaky gut syndrome or the problem will reoccur. With the Fixed type sensitivities don’t go away even if you avoid eating the foods for periods of time.

Elimination Diet
• If you think you have food sensitivities, food allergies or need to detox your body an elimination/provocation challenge diet may be helpful. An elimination diet is designed to decrease your toxic burden by providing foods that generally do not cause allergies and are free of preservatives, pesticides, hormones, antibiotics and other toxic elements. After following the elimination diet for two weeks you gradually reintroduce meats, fish and legumes in the third week to see if you are allergic to anything. In addition to foods which you know you are allergic to, some of the common allergens you have eliminated from your diet over the past weeks may cause you problems once you begin to eat them again. Therefore it is important that you introduce no more than one food item at a time and that you allow 3 days before introducing another food item. Each newly introduced food should be eaten during at least 2 of the 3 meals daily for 3 days. If you begin to react before the 3 days is up, stop eating the offending food. If you have no reaction after 3 days, you may introduce another food. However, if you react to an introduced food, it is important to wait until the reaction subsides before introducing another food.

• Eliminate all foods and chemicals that you are sensitive to for 4 to 6 months. If you are sensitive to chemicals use natural household cleaning products. Vitamin C helps flush toxins from our bodies. So take extra vitamin C. Malic acid is useful for stopping or slowing reactions to foods.

• To treat problems connected with leaky gut syndrome see Section T. on Leaky Gut Syndrome.

K. GALLSTONES
• Most gallstones stem from the fusion of crystals of cholesterol in bile. Following their formation, gallstones gradually grow in size and number and may cause minimal, intermittent, or complete obstruction to the flow of bile from the gall bladder into the duct system. If obstruction of the outlet occurs and the gallbladder cannot empty as it normally does after eating, the pressure within it increases and the person may have intense pain or discomfort. Jaundice, due to the inability to secrete bilirubin into the intestine, will accompany complete biliary obstruction.

Dietary recommendations for prevention and treatment of Gallstones:
• Diet plays an important role in the prevention of gallbladder disease.

• Low-fat, low-meat and vegetarian diets are recommended as is a low-sugar, high-fiber intake.

• Avoid coffee as an increase in gallstones has been found in people who were heavy coffee drinkers. Also avoid all fried foods

• A diet high in fiber, especially those fibers capable of binding to deoxycholic acid (predominantly water-soluble fibers found in vegetables and fruits) is extremely important in the prevention as well as reversal of most gallstones.

• In a Lancet study, about half of the people with gallstones had insufficient levels of HCl.

• Milk Thistle extract helps normalize liver function, detoxify the liver and improves the solubility of bile.• Lipotrophic supplements contain substances which help normalize liver and gallbladder function.

• Lecithin (phosphatidyl choline) has been shown to make cholesterol more soluble which reduces formation of gallstones. Dosage: 500 mg daily.• Vitamin C has been shown to prevent formation of gallstones. Dosage: 1 – 3 gm daily.

• Eat breakfast. Fasting more than 14 hours raises your risk of problems due to gallstones.

• Rule out food sensitivities or food allergies. According to Dr. J. C. Breneman ingestion of allergy-causing substances causes swelling of the bile ducts, resulting in impairment of bile flow from the gallbladder.

• Exercise is also important in the prevention of gallstones.

• In TCM understanding gallstones are formed when Liver Qi stagnates and bile is not secreted properly or is secreted insufficiently. This leads to the accumulation of Damp Heat in the Gall Bladder. The steaming action of Heat on Dampness over a long time leads to the formation of stones.

Treatment: In addition to the above recommendations Barbara and I get very good results using a combination of acupuncture, gentle hara visceral work and herbs.

L. GASTRITIS

• Gastritis is a stomach inflammation without an ulcer or sore. It is usually caused by medications, including corticosteroids, NSAIDs, cancer drugs or antibiotics, or by drinking alcohol, or experiencing stress or some trauma. In the elderly poor HCl secretion allows for bacterial growth such as H. pylori and may be another cause of gastritis. A long term effect of gastritis is vitamin B₁₂ deficiency which mimics that of senility.

• TCM Patterns include: Stagnant Liver Qi, Stomach Fire, Liver and Stomach Fire, Deficient Spleen Qi, Liver Invading the Spleen, Spleen Yang Deficiency and Heat in the Stomach and Large Intestine.

Common symptoms of gastritis include: hiccups, loss of appetite, indigestion, dyspepsia, nausea, vomiting or gastric distention after eating, anorexia, vomiting of blood, dark stools and back pain.

Useful Herbs and Nutrients for Gastritis
♦ One simple remedy for gastritis (and ulcers) is to drink huge amounts of water. Drink 4 to 6 glasses of water during the pain.

♦ See under Section 5 for details regarding the following useful herbs and nutrients:
▪ DGL licorice
▪ Aloe vera
▪ Gamma-oryzanol
▪ Glutamine
▪ Slippery elm bark
▪ Evening primrose oil
▪ Flax
▪ Zinc
▪ Vitamin A
▪ Copper, vitamin E and vitamin B-complex.

Treatment: In addition to the above recommendations and Chinese herbs Barbara and I get excellent results using a combination of acupuncture and gentle hara visceral work to release stomach restrictions as well as to restore the smooth flow of qi.

M.   GASTRO-ESOPHAGEAL REFLUX AND HEARTBURN
•   GERD or Gastro-Esophageal Reflux Disease is often an extremely serious problem resulting in the erosion and even destruction of the esophageal lining.
•  TCM pattern: Liver Qi Invading the Stomach

The most common causes of GERD and heartburn are overeating, or too much fat and/or fried food; processed meats with nitrates or nitrites in them; too much sugar, alcohol, chocolate, stress; eating on the run; obesity or pregnancy. Also because fat slows the emptying of the stomach this could also contribute to GERD or heartburn. Some drugs can cause heartburn such as birth control pills, diazepam, nicotine, nitroglycerine, progesterone, provera and theophylline.

• Dr. Acharan Narula believes that GERD is most likely due to the release of histamine by mast cells. Histamine’s major action is to secrete water, i.e., water comes out at the same time it secretes histamine along with bradykinin. It is the histamine which is creating the inflammatory reaction. Dr. Narula believes that heartburn symptoms can be caused by fungal, viral or bacterial infections in the stomach especially by Heliobacter pylori or a variant of it. Persistent inflammation could be due to a certain type of bacteria. He feels berberine alkyloids are very good against bacteria. Bitters such as gentian, dandelion, Oregon grape and goldenseal can be helpful.

• According to Earl Mindell PhD excessive acid production is almost never the reason for heartburn or ulcers. Dr. Jonathan Wright, MD feels that too little stomach acid can be a cause of heartburn. Supplementation with betaine HCl often relieves the symptoms in such cases.

The most common symptoms of GERD and heartburn are a burning sensation above the stomach, belching, regurgitation and a sour taste in the mouth.

The problem with antacids:
People commonly use antacids such as Tums for temporary relief of heartburn. Initially, use of antacids causes the body to produce more HCl (hydrochloric acid) that helps digest food. Parietal cells respond by making more acid. Eventually the parietal cells get exhausted, so over the long term, antacids cause the parietal cells to make less HCl. There are other problems associated with taking antacids. A recent study found that 47% of healthy people who had been using antacids for heartburn/reflux over long periods of time had erosion of the esophagus and 6% had Barrett’s esophagus (a more serious condition). Antacids decrease your stomach’s ability to digest protein by reducing the effectiveness of protease enzymes. Heavy use of antacids may create an overly alkaline environment resulting in imbalances of intestinal flora, stressing the kidneys and setting the stage for possible urinary tract infections.

The ability of the stomach to regulate its own acidity can be frustrating to people who take antacids like Tums or Maalox to counteract heartburn. When the alkaline chemicals neutralize stomach acid, a person’s own G cells (the stomach cells that make the hormone called gastrin, which stimulates parietal cells to produce more acid) can turn rebellious and relight the fires of heartburn. The rebellious G cells sense the decline in stomach acid and secrete gastrin. The secretion of gastrin causes still more acid to be secreted, which defeats the antacid. A vicious cycle can thus occur when the need is felt to take more and more antacid.

The problem with proton pump inhibitors:

Proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RAs) suppress the production of gastric acid and thus may lead to malabsorption of vitamin B12. This study evaluated the association between vitamin B12 deficiency and prior use of acid-suppressing medication using a case-control study within the Kaiser Permanente Northern California population. We compared 25,956 patients having incident diagnoses of vitamin B12 deficiency between January 1997 and June 2011 with 184,199 patients without B12 deficiency. Previous and current gastric acid inhibitor use was significantly associated with the presence of vitamin B12 deficiency. (Lam et al 2013)

Proton pump inhibitors such as Prilosec (omeprazole) absolutely block stomach acid production, which means that no HCl is being produced by your stomach when you use them. But don’t forget that HCl is your body’s first line of defense against disease-causing microbes. Therefore, low HCl levels open you to the possibility of food poisoning. For another serious problem associated with the use of proton pump inhibitors please read the news item entitled: “Study links heartburn drugs to pneumonia risk” dated Oct. 27, 2004.

Adequate HCl is also necessary for the absorption of vitamin B₁₂ from food. Since vitamin B₁₂ is required for the maintenance of many nerve cells of the brain and spinal cord and also for the formation of red blood cells, a deficiency of vitamin B₁₂ is debilitating and ultimately fatal. Several minerals require an acidic environment for absorption, including iron, calcium, magnesium, zinc, copper and most B-complex vitamins. Poor acid content in the stomach causes indigestion. So although antacids and proton pump inhibitors may relieve the symptoms of heartburn and gastro-esophageal reflux temporarily they are not helping your digestion in the long run. And since only 5 to 10% of all GERD sufferers are in fact secreting too much stomach acid it brings into question the appropriateness of using antacids and proton pump inhibitors in the first place.

If you absolutely cannot avoid using proton pump inhibitors bear in mind that they are intended as short-term therapy only. They are generally not recommended to be taken for more than four weeks unless there are special circumstances. They have many side effects and have several drug interactions. Some possible side effects of Prilosec include: headache, dizziness, weakness, diarrhea, abdominal pain, nausea, vomiting, constipation, upper respiratory infection, rash, cough and back pain. Changes in blood cell counts, liver function, hearing and taste are other rarely observed side effects.

The problem with NSAIDs:
In the stomach there are certain molecules called prostaglandins which protect the stomach cells. If you take Ibuprofen (Motrin) or similar compounds these act to prevent prostaglandins from getting made and doing their job which may give you relief from pain but only at the price of putting the stomach in peril. Ibuprofen and similar compounds inhibit the biosynthesis of prostaglandins which stimulate repair. They are a direct cause of leaky gut syndrome, food sensitivities and inflammatory problems like arthritis and eczema. It is now estimated that up to one third of all bleeding ulcers are caused by taking NSAIDs. In many cases the antacids, H2 blockers and proton pump inhibitors given to alleviate the symptoms of stomach pain merely mask the symptoms until the problem becomes life-threatening.

GERD and esophageal lesions due to various medications:
The risks of bisphosphonates, doxycycline, ferrous sulfate, ascorbic acid, aspirin/NSAIDs and chemotherapeutic agents to induce esophageal lesions have been documented in case reports and short series. In addition to direct mucosal injury, many commonly used medications including nitroglycerins, anticholinergics, beta-adrenergic agonists, aminophyllines, and benzodiazepines promote/facilitate gastroesophageal reflux by reducing lower esophageal sphincter pressure. Additional evidence accumulates on the adverse effects of various medications on esophageal motility and perception. (Tutuian et al 2010)

Useful herbs and supplements for treating GERD and heartburn:
♦ Deglycyrrhizinated licorice extract or DGL Dosage: one – two 380 mg wafers before meals.
♦ Fresh papaya or banana
♦ If you have low stomach acid take supplemental HCl in the form of betaine hydrochloride with your meal. (See below for signs of low stomach acid). CAUTION: Do not take HCl on an empty stomach or if you have an ulcer. Never take NSAIDs together with HCl.

Possible signs of low stomach acid:
♦ Burping or abdominal bloating immediately after meals or up to ½ hour after a meal has ended.
♦ Food sitting uncomfortably in the stomach after eating.
♦ Loose stools in the morning.
♦ Chronically coated tongue.
♦ Unexplained bouts of nausea.
♦ Heartburn (it can signal either too little or too much stomach acid.)
♦ Using herbs but not improving from them. (Planta Med 1991; 57:299-304)

Treatment: Barbara and I get very good results treating GERD and heartburn with acupuncture, gentle hara visceral work, dietary and lifestyle changes, and specific herbs and supplements aimed at restoring the natural mechanisms that prevent reflux of gastric acid into the esophagus. Using these natural healing techniques and tools we are able to restore coordination between the lower esophageal sphincter, esophageal motility and backup glands so that GERD or heartburn should not be a problem. By working on the lower esophageal sphincter and the digestive tract as a whole we are able to restore the motility of the upper GI tract so that food and fluids will be moved along smoothly and thus prevent GERD from occurring in the first place.

N. GLUTEN INTOLERANCE, CELIAC DISEASE, SPRUE
• Celiac disease, also called gluten sensitive enteropathy or sprue, is caused by an inability to digest foods containing gluten. Gluten is found in many grains including wheat, oats, rye, barley and spelt. The gliadin fraction in the gluten is believed to be the cause of the problem. In susceptible people, gluten-containing grains damage the lining of the small intestine impairing the assimilation of nutrients from all foods.

• From a TCM perspective the inability to digest food is indicative of Spleen Qi Deficiency and/or Digestive Fire Deficiency. Symptoms of Spleen Qi Deficiency are: no appetite, a tendency to loose stools, abdominal distention after eating, tiredness, lassitude, sallow complexion, and weakness of the limbs. Persons with these symptoms should follow the remedies for tonifying the Spleen Qi by restricting cooling and highly mucus forming foods such as gluten and dairy and adding more warming foods. Non-glutinous grains can be eaten such as rice, corn, millet, buckwheat, quinoa and amaranth.

• Because the villi of the small intestine are damaged in people with untreated celiac disease their bodies can’t manufacture lactase – the enzyme which splits lactose. Therefore about half of people with celiac disease are also lactose intolerant

Common symptoms include recurring attacks of diarrhea or constipation, abdominal cramping, gas, weakness and steatorrhea (gray or tan fatty stools). Less common symptoms include rheumatoid arthritis, bursitis, fatigue, brain-fog, bone pain, schizophrenia, fibromyalgia, depression, epilepsy, “glue ear”, allergies, sinusitis, anemia, insomnia, osteoporosis, spastic colon, diverticulitis, ulcerative colitis and Crohn’s disease.

Treatment consists in avoiding grains which contain gluten. And because of the malnourishment that accompanies celiac disease supplementation of nutrients is necessary. Individuals with celiac disease must avoid gluten-containing foods for life. In addition to the above recommendations Barbara and I get very good results using acupuncture to nourish the Spleen Qi and strengthen the Digestive Fire, and we get very good results using gentle visceral mobilization and craniosacral acupuncture to treat the various symptoms associated with it.

O. HEMORRHOIDS
• Hemorrhoids occur when blood vessels in and around the anus get swollen and stretch under pressure. Straining during bowel movements is a common cause of hemorrhoids. The most common symptom is bright red blood with a bowel movement. They also occur in people with chronic constipation or diarrhea. In most cases they go away in a few days. If you have bleeding that lasts longer, have your doctor examine you to rule out a more serious problem.

Prevention and treatment:
♦ Increase your intake of fruits, vegetables, whole grains and legumes and drink plenty of fluids. You really want to do all you can to prevent the hemorrhoids from forming in the first place so a high-fiber diet is crucial for the maintenance of proper bowel activity..♦ Psyllium seeds add bulk and water to the stool, which allows for easy passage.♦ Acidophilus and bifidobacteria taken two or three times daily help regulate peristalsis. If you are able to digest yogurt, it also has a normalizing effect on the bowel and can be helpful for either constipation or diarrhea.♦ Soothing salves can soothe inflamed tissues. Some soothing salves are vitamin E oil, comfrey, calendula or goldenseal ointment.♦ A warm bath with Epsom salts or healing herbs can be healing and soothing to inflamed tissues.

P. INFLAMMATORY BOWEL DISEASE: CROHN’S DISEASE AND ULCERATIVE COLITIS
Inflammatory Bowel Disease (IBD) exists in two forms: Crohn’s disease and ulcerative colitis. IBD is considered an autoimmune disease.

Causes of IBD: There are four theories as to what causes IBD: 1) infection, 2) a hypersensitivity to antigens in the gut wall, 3) an inflammation of the blood vessels which cause ischemia (a lack of blood supply to the tissues), and 4) food sensitivities. People who eat a lot of sugar and low-fiber diets have a higher incidence of IBD, and there are correlations of IBD with cigarette smoking and eating fast foods. People with bowel disease are especially sensitive to most grains. In various studies the following foods have been implicated in IBD: citrus fruits, pineapple, dairy, coffee, tomatoes, cheese, bananas, sugar, additives, preservatives, spices, beverages other than water and bread. Unfortunately, nearly any food can cause irritation and inflammation. To find out more about the connection between inflammation and IBD we invite you to read our article entitled Inflammation and Its Role in Disease.

1) CROHN’S DISEASE is an inflammation of the GI tract, especially the distal ileum and proximal colon, in which the inflammation may extend through all layers of the intestinal wall — from the mucosa through the serosa layer—as well as the mesentery and regional lymph nodes. (The serosa layer is the outermost layer of most portions of the GI tract and is known as the visceral peritoneum below the diaphragm). It involves shrinking of the lumen, and ulceration of the mucosa with scarring and necrotic areas which may become fistulous. In later stages, it can form abscesses and fistulas, little canals that lead to other organs or form tiny caves. It can disappear for years or progress in jumps. The reactivity of lymphocytes is reduced, posing a risk of inadequate intestinal immune response. Lymphocytes of the small intestine secrete immunoglobulins, particularly the IgA subclass.

Most common signs of Crohn’s disease include abdominal pain (often increasing after meals), fevers which last 24 – 48 hours, canker sores in the mouth, clubbed fingernails, a thickening of the GI lining which may cause constrictions and blockages, poorly-formed stools or diarrhea (usually without blood), fatigue, anorexia and sometimes back pain. When the small intestine is involved there is often right lower quadrant pain that is colicky or cramping in nature and occasionally fistulization.

• In TCM terms Crohn’s disease is classified as Damp Heat in the Intestines.

Research on the benefits of acupuncture treatment of Crohn’s Disease:
A study published in Digestion 2004;69(3):131-9. Epub 2004 Apr 26 by Joos et al entitled “Acupuncture and moxibustion in the treatment of active Crohn’s disease: a randomized controlled study” concluded that apart from a marked placebo effect, traditional acupuncture offers an additional therapeutic benefit in patients with mild to moderately active Crohn’s disease.

2) ULCERATIVE COLITIS is a continuous inflammation of the mucosal lining of the GI tract. It is usually limited to the large intestine and is usually accompanied by rectal bleeding.

Most common signs of ulcerative colitis include fairly sudden appearance of bloody diarrhea, abdominal pain, fever and frequently some weight loss. If the primary site of involvement is the rectum, one may be constipated and complain of tenesmus (spasmodic contractions of the anal sphincter with pain and persistent desire to empty the bowel). Patients also experience joint pain or changes in liver function. This disease carries an increased risk of colonic cancer.

• In TCM terms, most ulcerative intestinal disease is classified as Spleen Deficiency because Spleen Qi is necessary to maintain the health of the intestines. The classical Chinese formula, Ginseng and Astragalus Combination, forms the foundation for the majority of Chinese herbal therapies for Crohn’s disease and ulcerative colitis. Other TCM patterns seen in colitis are Spleen Yang Deficiency and Stagnant Liver Qi.

• The most common restrictions in the colon are due to sequelae from surgery and inflammations. If the cecum is fixed it may pull the right kidney, right ovary or peritoneum to the right, with many associated adverse effects. A restriction of the cecum can lead to a stretched colon or spasm of the ascending colon. Besides affecting the kidney there is also an effect on the anterior of the liver drawing it down inferiorly, with a resultant decrease in liver motility.

The problem with antibiotics:
According to Dr. Gershon taking antibiotics is not without risk. Killing germs in the colon can be a hazardous venture. Antibiotics that kill our colonic friends as well can get us into big trouble very fast. Antibiotic resistance is a fact of bacterial life, and it is a difficulty that the indiscriminate use of antibiotics has made far more serious than it used to be. Since antibiotics are routinely added to chicken feed and other agricultural products, the proportion of resistant organisms increases every year. By killing some bacteria and not others, the administration of an antibiotic may eliminate the competition between germs in the colon so that one strain, which happens to be resistant, achieves domination. The resistant organisms, therefore are likely to cause a rip-roaring florid colitis.

Efficacy of acupuncture in the treatment of colitis:
According to Yang and Yan (1999) acupuncture and moxibustion had a marked curative effect with few side effects in the treatment of 62 patients with chronic colitis.

Dietary and lifestyle recommendations:
♦ People with IBD have an increased level of leukotrienes, produced by neutrophils, which increase pain and inflammation. Therefore omega-3 fatty acids would be useful to reduce such inflammation.♦ Folic acid and zinc supplementation are useful to repair the gut wall.♦ It is good to check to see if you have leaky gut syndrome, microbial infections or parasites as these conditions are prevalent in IBD and would need to be treated if found. ♦ Mold sensitivity and allergies to Candida have also proven to provoke IBD symptoms.♦ Probiotic supplements are highly recommended as friendly flora have been found to be dramatically out of balance in people with IBD.

Secretory IgA:
Secretory IgA is an immunoglobulin antibody found in saliva in the mouth, throughout the digestive tract and in mucous secretions throughout the body. A study examining people with Crohn’s disease and ulcerative colitis found that all of them had low levels of secretory IgA. It concluded that raising secretory IgA levels might eliminate IBD. The following nutrients are all required to maintain healthy secretory IgA levels: choline, essential fatty acids, glutathione, glycine, Phosphatidylcholine, phosphatidylethanolamine, quercetin, vitamin C and zinc.Saccharomyces boulardii, a nontoxic yeast often found in probiotic supplements, has been shown to raise secretory IgA levels.

The Specific Carbohydrate Diet may be helpful for people with Crohn’s disease. According to Elaine Gottschall in her book, Breaking the Vicious Cycle, the presence of undigested and unabsorbed carbohydrates within the small intestine can encourage microbes from the colon to take up residence in the small intestine and to continue to multiply. This in turn may lead to the formation of lactic and acetic acid, in addition to gas, which injure the small intestine. The principle behind this diet is to maximally nourish the individual and minimally nourish the intestinal microbes. Therefore, by specifically eating only mono-saccharides which require minimal digestion and which are absorbed well it theoretically leaves nothing to be used by the microbes to further their growth in the intestines. According to her theory the microbial population will decrease due to lack of food and thus their harmful by-products will also decrease freeing the intestinal surface of injurious substances. No longer needing protection, the mucus-producing cells of the intestine stop producing excessive mucus and carbohydrate digestion is improved.

• On The Specific Carbohydrate Diet you are not allowed to eat sugars, alcohol, grains, dairy products, legumes, potatoes, yams or parsnips. Foods which are allowed on this diet include beef, lamb, poultry, fish, eggs, natural cheeses, homemade yogurt, fruit, nuts, pure fruit juices, weak coffee, weak tea and peppermint and spearmint teas. Also allowed are corn, soy, safflower, sunflower and olive oils.

Treatment: In addition to the recommendations above Barbara and I get very good results treating Crohn’s disease and ulcerative colitis using acupuncture, gentle hara visceral work, dietary and lifestyle changes, and specific herbs and supplements aimed at restoring the natural balance in the colon. We recommend that our patients suffering from colon problems eat lightly in the evening when the colon has more difficulty in the digestion and transit of foodstuffs. Avoid fat, meat and sugar as these are most likely to cause problems. During treatment it is better that you ingest food with long fibers such as leeks, spinach, celery and Swiss chard in order to improve the general function of the colon. Like the small intestine, the large intestine is dependent on the liver and pancreas, therefore it is a good idea to stimulate these organs with olive oil and lemon during the course of treatment. We may also recommend certain herbs you may take for this.

Q. INTESTINAL PARASITES
• Chronic diarrhea is often a sign of a parasitic infection. Other symptoms include pain, constipation, bloating, gas, unexplained weight loss, fatigue, unexplained fever, coughing, itching, rashes, bloody stools, abdominal cramping, joint and muscle aches, irritable bowel syndrome, anemia, allergies, granulomas, nervousness, teeth grinding, chronic fatigue, poor immune response, and sleep disturbances. These symptoms can come and go due to the life cycles of the specific parasite involved.

Useful herbs for parasitic infestations:
♦ Garlic has antiviral, antibacterial and antifungal properties. Allicin, the active ingredient in garlic, has been shown to be effective against E. histolytica and Giardia lamblia.
♦ Goldenseal has been shown to be effective against amebas and Giardia parasites.
♦ Grapefruit Seed Extract – is a general antimicrobial agent with specific antibacterial, antiviral, antiparasitic and anti yeast properties. It is effective against E. Coli, Salmonella typhi, Staph aureus, E. histolytica, Giardia lamblia, herpes simplex type 1 and influenza A virus.
♦ There is also a specific Chinese herbal formula Barbara and I use which is very effective against parasites.

R. IRRITABLE BOWEL SYNDROME

What is Irritable Bowel Syndrome?
• Irritable Bowel Syndrome (IBS) is a disease of the entire GI tract in which persons may react to stress by developing symptoms such as cramping and abdominal pain associated with alternating patterns of diarrhea and constipation. The episodes of diarrhea are often accompanied by crampy abdominal pains or gas which are relieved by a bowel movement. Excessive amounts of mucus may appear in the stools. Other symptoms include flatulence, spasms, bloating, gas, abnormal bowel movements, nausea and loss of appetite. After the diarrhea one may be plagued by long bouts of constipation. One’s stool may also contain mucus because in IBS the colon secretes too much mucus. However, blood mixed with the stools is not IBS but something else. Fever, weight loss or severe pain are not signs of IBS.

• Irritable bowel syndrome affects 10 – 20% of all American adults and is the most common gastrointestinal complaint. After the common cold IBS is the chief cause of absenteeism. About 60% of IBS sufferers report their symptoms first coincided with stressful life events. Many people find that their symptoms persist well beyond the stressful life event and the episodes invade their normal routine.

• There is no single cause of IBS. Some scientists believe a virus or bacterium may play a role. Lifestyle factors such as stress, nervousness and diet are probably common causes. The overuse of antibiotics, antacids or laxatives which disturb the bacterial microflora of the bowel may also be a factor.

• Over 100 different disorders may be linked to the systemic effects of IBS. One disorder that is linked in about 25% of adults with IBS is arthritis which affects the ankles, knees and wrists. IBS has been linked to a higher than normal incidence of colon cancer and diverticulitis. If IBS causes chronic diarrhea, electrolyte and trace mineral deficiencies are likely,• Diagnosis of IBS requires ruling out disorders that can cause similar symptoms such as Crohn’s disease, diverticulitis and ulcerative colitis.

Chinese Medical explanation of IBS:
• From the point of view of Chinese medicine IBS usually corresponds to Stagnant Liver-Qi invading the Spleen. When Liver Qi invades the Spleen there is tiredness with alternation of constipation and diarrhea.

• If diarrhea is the predominant symptom the IBS could also be due to Internal Dampness, Damp Heat, Retention of Food, Deficient Spleen Qi, or Kidney Yang Deficiency. If constipation is the predominant symptom the IBS could also be due to Qi Deficiency, Blood Deficiency or Chronic Interior Heat.

Recommended foods:
• Whole grains, vegetables, legumes and sprouts. In general, consuming a low fat diet rich in complex carbohydrates and dietary fiber is often curative. Eat small meals and chew food well.

• It is beneficial to cook with organic butter or ghee (clarified butter) because butter and ghee supply butyrate to the colon. Butyrate acts as a fuel molecule for the colon. All the energy for the colon cells comes from butyrate.

• A good diet for someone whose GI tract is stressed out is rice and split moong dal beans. Boil the moong dal. Sauté in ghee, organic butter or olive oil, some chopped onions, chopped ginger and coriander, a pinch of cumin seeds, a pinch of turmeric, a pinch of black pepper, and a pinch of cayenne. Once the onions are soft then transfer the mixture to the dal. Then cook them together for 10 mins. Add salt to taste. Cook the rice separately. Use Basmati white rice. Brown rice has too much fiber on it. You can eat any vegetable as long as you cook it. Asparagus, boiled potatoes, carrots and green peas are good, but corn, for example, is hard to digest.

Foods to avoid:

• The most common foods that trigger IBS are wheat, corn and dairy products, coffee, tea, citrus fruits and chocolate. It is also advisable to avoid animal fat, butter which is not organic, all carbonated beverages, candy, fried foods, all junk foods, the additives mannitol and sorbitol, margarine, nuts, pastries, all processed foods, seeds, spicy foods, sugar, and sugar-free chewing gum. These foods encourage the secretion of mucus by the membranes and prevent the uptake of nutrients. Check to see if you have food allergies. They are important factors in this disorder. Food sensitivities are found in one half to two-thirds of people with IBS.

An elimination diet is a good way to check to see if you have food allergies or food sensitivities.• It is better to avoid excess consumption of meat, chicken or fish as the body converts any amino acid (which come from the proteins in the meat, etc.) in the liver into urea. Then the urea goes into the colon and the bacteria in the colon convert it into ammonia. Ammonia is used up in many ways but if an excess is produced then it destroys the mucus of the lining of the large intestine.• Alcohol and tobacco should be avoided as they irritate the linings of the stomach and colon• Monitor your intake of the cabbage family of foods (broccoli, cauliflower and Brussel sprouts) as they can be difficult to digest.

Lifestyle considerations:
• An increase in physical exercise appears helpful for IBS patients suffering from stress. Daily leisurely walks markedly reduce symptoms for many people.

• Chew your food well. Do not overeat or eat in a hurry

• Wait at least one or two hours after eating before going to bed. And eat lightly in the evening.

• Practice deep breathing exercises. Shallow breathing reduces the oxygen available for proper bowel function. IBS is often associated with the emotions of anger, fear, anxiety and worry. These emotions may focus their effect about the Solar Plexus energy center. Meditations linking breathing with concentration on the Dan Tian center (just below the navel) can be effective.

Efficacy of acupuncture in treating IBS:

• According to Chan et al (1997) in a pilot study investigating the potential value of acupuncture in the treatment of irritable bowel syndrome it was found that the patients showed a significant improvement both in general well-being and in symptoms of bloating. It was concluded that acupuncture seems to be effective in the treatment of irritable bowel syndrome and merits further study.

• There was a pilot study presented at the British Medical Acupuncture Society on 24th April 1999 which found that patients with Irritable Bowel Syndrome who were treated with acupuncture for four weeks showed significant improvement in their general well being and a decrease in bloating along with pain reduction.

Efficacy of visceral manipulation in treating IBS:

• According to Jean-Pierre Barral, D.O. irritable bowel syndrome is a good indication for visceral manipulation. Because the intestines are capable of losing their elasticity, of creating adhesions and of going into spasm it is helpful and important to treat them with the appropriate visceral manipulation techniques.

Treatment: In addition to the recommendations above Barbara and I get very good results treating IBS using acupuncture, gentle hara visceral work, and specific herbs and supplements aimed at restoring the natural balance in the colon. We recommend that our patients suffering from IBS eat lightly in the evening when the colon has more difficulty in the digestion and transit of foodstuffs. Avoid fat, meat and sugar as these are most likely to cause problems. During treatment it is better that you ingest food with long fibers such as leeks, spinach, celery and Swiss chard in order to improve the general function of the colon. Like the small intestine, the large intestine is dependent on the liver and pancreas, therefore it is a good idea to stimulate these organs with olive oil and lemon during the course of treatment. We may also recommend certain herbs you may take for this.

S. LACTOSE INTOLERANCE

• Lactose intolerance is the impaired ability to digest lactose – a sugar naturally found in milk products. Individuals with this condition have a deficiency in the enzyme lactase which digests lactose. Symptoms occur when food is consumed containing lactose. These symptoms range from cramps, gas, and diarrhea to acne, bloating, headaches and nausea.

• Although symptoms of lactose intolerance are triggered by the lactose in some dairy products, few lactose-intolerant individuals need to avoid all dairy. Dairy products have varying levels of lactose, which affects how much lactase is required for proper digestion.

How to test for Lactose Intolerance:
There are two ways to test for it — one is a laboratory test and the other is a self-test. To do a self-test you restrict intake of all dairy products for at least ten days. Restricted foods include: milk, yogurt, ice cream, cheese, creamed soups, frozen yogurt, powdered milk, whipped cream, as well as bakery items, cookies, hot dogs, lunchmeats, milk chocolate, nondairy creamers, pancakes, protein powder drinks and ranch dressings. If lactose intolerance is causing your problems you will probably notice your symptoms will disappear significantly. Reintroduction of dairy products will trigger a return of symptoms. However, the results may be inconclusive because you may be sensitive to other foods – in which case your symptoms won’t change. In this case you could either do an elimination diet to find out what other foods you are sensitive to or you could do a laboratory test.

Treatment: Supplementation with the enzyme lactase can be helpful to prevent symptoms of lactose intolerance when consuming lactose-containing dairy products. Because the degree of lactose intolerance varies from individual to individual a greater or lesser amount of lactase may be needed to eliminate the symptoms.

T. LEAKY GUT SYNDROME

• Leaky Gut Syndrome also known as Increased Intestinal Permeability occurs when foods are not digested properly and ferment and rot in our intestines producing toxic by-products that irritate and inflame the intestinal lining causing tiny holes. When the intestinal lining is damaged even more, substances larger than particle size – disease-causing bacteria, potentially toxic molecules, and undigested food particles – are allowed to pass directly through the weakened cell membranes. They go directly into the blood stream activating antibodies and cytokines. The cytokines alert our white blood cells to battle the particles. Oxidants are produced in the battle, causing irritation and inflammation far from the digestive system.

Symptoms associated with Leaky Gut Syndrome include abdominal pain, indigestion, diarrhea, constipation, bloating, gas, chronic joint and muscle pain, confused and fuzzy thinking, poor memory, mood swings, nervousness, anxiety, poor immunity, recurrent vaginal and bladder infections, shortness of breath, fatigue and malaise.

Causes of Leaky Gut Syndrome include chronic stress, dysbiosis, environmental contaminants, GI tract disease, immune system overload, excessive alcohol consumption, low fiber diet, highly processed foods, existence of pathogenic bacteria, parasites and yeasts and prolonged use of NSAIDs, birth control pills, steroid drugs, chemotherapy and radiation therapy

• Leaky gut syndrome is associated with allergies, celiac disease, Crohn’s disease and malabsorption syndromes. It is also linked to autoimmune diseases like ankylosing spondylitis, asthma, bronchitis, eczema, psoriasis, food and environmental sensitivities, rheumatoid arthritis and Sjogren’s syndrome.

Treatment:
♦ Chew your food thoroughly.
♦ If you have food allergies or sensitivities avoid those foods which cause them.
♦ If you have dysbiosis or Candidiasis get appropriate treatment.
♦ Use of antioxidants such as vitamin E, selenium, N-acetyl cysteine, superoxide dismutase, zinc, manganese, copper, Coenzyme Q10, lipoic acid and vitamin C can help quench the flare up of free radicals often produced when there has been damage to the intestinal tract.
♦ Glutamine may be especially helpful in repairing the mucosal lining directly as it is the preferred food of the cells of the small intestine. Dosage: 1 gm to 30 gm daily.
♦ Other useful nutrients and herbs include: gamma-oryzanol, vitamin A, vitamin B5, DGL (deglycyrrhized licorice), folic acid and schizandra.
♦ In addition to the above recommendations Barbara and I get very good results using acupuncture and gentle hara visceral work to restore balance and normal function to the GI tract.

U. PANCREATIC INSUFFICIENCY

• Pancreatic insufficiency is common in people with candidiasis or parasite infections. Pancreatic enzymes help digest protein, fats, carbohydrates and the fat soluble vitamins E, A, K and D.

Symptoms of low pancreatic enzymes and malabsorption
♦ Gas, bloating and indigestion ½ hour to several hours after eating.
♦ Chronic excessive intestinal gas.
♦ Chronic constipation, sometimes mild diarrhea or alternating constipation and diarrhea.
♦ Frequent undigested food in the stools
♦ Floating or bubbling stools (because gas and grease float).
♦ Fat soluble vitamin deficiency signs.
♦ Taking supplements or eating properly and not getting corresponding improvement in health.

Treatment:
♦ Pancreatic enzyme supplements work well as a digestive aid. CAUTION: Do not take pancreatic enzymes if you have ulcers or any kind of inflammatory bowel condition.
♦ Vegetable enzymes work in a much wider range of pH than pancreatic enzymes, enhancing digestion in the stomach as well as in the intestines. And they are less likely to cause food allergy reactions than pancreatic enzymes. Dosage: one to two capsules at the beginning of meals.

V. PEPTIC ULCERS: GASTRIC AND DUODENAL ULCERS

• In the US about 5 to 10% of the population develops peptic ulcers. An ulcer is a craterlike lesion in a membrane. Ulcers that develop in areas of the GI tract exposed to acidic gastric juice are called peptic ulcers. Most occur on the lesser curvature of the stomach where they are called gastric ulcers, or in the pyloric sphincter of first part of the duodenum, where they are called duodenal ulcers. Most peptic ulcers are duodenal.

• The most common symptom is epigastric pain that is burning or gnawing in nature. Typically, the pain occurs 1 ½ to 3 hours after eating and is relieved within a few minutes by ingestion of food.

• According to Elizabeth Lipski in her book, Digestive Wellness, about 10% of stomach and duodenal ulcers are caused by the use of NSAIDs such as aspirin, Tylenol, Motrin and prescription pain relievers. It has been estimated that 107,000 people are hospitalized each year due to NSAID complications, and at least 16,5000 NSAID-related deaths occur each year among arthritis patients alone. It has now been found that 80% of people with duodenal and stomach ulcers and gastritis have a bacteria called Heliobacter pylori (H. pylori). H. pylori is found in about 30% of people, but only 10% will experience ulcers. And 10% of people with ulcers and gastritis do not have H. pylori, nor have they used NSAIDs. What is known, however, is that when H. pylori is eradicated, ulcers heal and don’t recur.

• TCM patterns include: Spleen Qi Deficiency and Liver Qi Invading the Stomach.

Indications for using visceral manipulation in treating ulcers:
According to Jean-Pierre Barral, D.O. all inflammatory symptoms, whether septic or not, present a risk of adhesion or a significant decrease in mobility. For the duodenum, the most important indication for visceral manipulation is an ulcer and its sequelae associated with visceral spasm, which then fixes all surrounding regions. Gastric, biliary and pancreatic transit diminish and the individual cannot eliminate the toxins, which collect in the intestinal tract. The duodenum goes easily into spasm; most treatment is therefore antispasmodic in function.

Treatment:
♦ Quick eradication of H. pylori bacteria is important for healing of ulcers. There are some herbal remedies you can try first if you want to avoid antibiotics.
♦ DGL (deglycyrrhizinated licorice) is a wonderful healing aid for ulcers. It increases the production of protective mucus in the stomach. Numerous studies over the years have found DGL to be an effective anti-ulcer compound. DGL has been shown to be as effective as Tagamet in both short term treatment and maintenance therapy of gastric ulcer. In another study it was as effective as Zantac in the treatment of gastric ulcer. There are no known side effects to using DGL. Dosage: Chew one or two wafers (300 mg each) before meals.
♦ Unripe banana, slippery elm, marshmallow root and raw cabbage juice have anti-ulcer effects.
♦ Avoid tobacco, coffee, alcohol and the use of NSAIDs if you have any type of ulcer.
♦ Avoid refined sugars, fried foods, white-flour products, milled maize, chocolate, soft drinks, desserts, heated or poor quality vegetable oils, red meats, hot spices, vinegar and citrus fruit.
♦ Eat soothing mucilaginous foods and preparations, such as soups, rice congee, avocado, spinach, cucumber, potato, lettuce and soothing herbal teas.
♦ Other remedies used include citrus seed extract, goldenseal, activated charcoal and aloe vera.
♦ One successful dietary approach has been insuring a good intake of vitamin A followed by a high-fiber diet and seven or more servings of fruits and vegetables per day.

5. DIETARY, HERBAL AND NUTRITIONAL SUPPORT FOR DIGESTIVE DISORDERS
Useful herbs and nutrients for optimal digestion:
Chinese herbs have been in use for centuries and Barbara and I have been using them in our practice for over six years with excellent results. We find that our patients suffering from various digestive disorders respond very well to herbs and nutritional supplements in conjunction with the craniosacral acupuncture treatments.

• Acidophilus – is very helpful in replenishing the friendly bacteria in the colon.

•  Alfalfa – contains vitamin K needed to build intestinal flora for proper digestion.

•  Aloe vera – helps soothe and heal the stomach and small intestine lining. It can promote bowel regularity and is an excellent, mild and soothing laxative. Aloe has been approved by the FDA for use in oral ulcers.

.•  Cardamom – is a soothing and warming digestive toner.

•  Cat’s claw – is beneficial to the digestive tract and has been found to relieve swelling and Inflammation relevant to the prevention and treatment of ulcers, colitis, irritable bowel and Crohn’s.

• Chamomile – can have antispasmodic effects. It also possesses a potent anti-inflammatory influence on the intestinal mucosa.

• Copper – is involved in collagen formation, tissue repair and anti-inflammatory processes. Supplementation with copper increases levels of SOD. Dosage: 1 – 2 mg daily in a multivitamin preparation.

• Curcumin – is great for inflammatory conditions, especially inflammation of the colon. It is good for IBS. It is also very good for emptying the bile. Dosage: one 450 mg capsule three times a day with meals. Curcumin is a potent antioxidant which inhibits both the incorporation of arachidonic acid into, and the release of arachidonic acid from, cell membranes. The end result is a reduction of pro-inflammatory prostaglandins, leukotrienes, collagenase, elastase, hyaluronidase, platelet aggregation and tumor necrosis factor.

• DGL (deglycyrrhized licorice) – helps heal the stomach mucus lining by increasing healing prostaglandins that promote mucus secretion and cell proliferation. It enhances the blood flow and health of intestinal tract cells. Dosage: Chew one or two wafers (300 mg. each) before meals. There are no known side effects to deglycrrhizinated licorice.

•  Enteric coated peppermint – may settle an upset stomach, absorb gas, improve digestion, relieve heartburn and colic.

•  Flaxseed oil or primrose oil – supply essential fatty acids needed to protect the intestinal lining. Low dietary intake of the essential fatty acid linolenic acid has been associated with duodenal ulcers. Ground flaxseeds are an excellent source of linolenic acid.

•  Gamma-oryzanol – is useful for gastritis, ulcers and IBS. It acts on the autonomic nervous system to normalize production of gastric juice and has also been shown to be effective in normalizing serum triglycerides and cholesterol. Dosage: 100 mg three times daily for 3 weeks.

•  Ginger – has been found to calm the stomach and improve digestion.

•  Glutamine – is the most popular anti-ulcer drug in Asia today. The digestive tract uses glutamine as a fuel source and for healing. It is effective for healing stomach ulcers, IBS and ulcerative bowel diseases. Dosage: Begin with 8 grams daily for a trial period of 4 weeks

.•  Goldenseal – is soothing to mucus membranes, enhances immune function and has antibiotic and antifungal properties

.•  Multivitamin and mineral complex – supplies those nutrients lost or not absorbed.

•  Oat bran fiber and psyllium seeds – have healing and cleansing effects

• Proteolytic enzymes with pancreatin – aid in protein digestion and in reducing inflammation. Use a formula that is low in HCl and high in pancreatin.

• Slippery Elm – is a remarkably effective GI soother. It has demulcent properties and has been a folk remedy for both heartburn and ulcers.

• Vitamin A – is protective and promotes healing of gastric ulcers. Dosage: 10,000-25,000 IU daily. CAUTION: Pregnant women should not exceed 10,000 IU of vitamin A

• Vitamin B complex – is needed for proper muscle tone in the gastrointestinal tract.

•  Zinc – increases the rate of healing and can prevent damage to the stomach lining. Dosage: 50-100 mg daily.

Broad spectrum anti-microbial herbs
:•   Clove – possesses strong and proven antimicrobial properties against fungus, bacteria and parasites.
•   Echinacea – contains an antibiotic compound with broad spectrum activity.
•   Forsythia – is an outstanding antiviral used for colds and flus.
•   Garlic – has antibacterial, antifungal, antiviral and antiparasitic properties.

• Grapefruit Seed Extract – is a general antimicrobial agent with specific antibacterial, antiviral, antiparasitic and anti yeast properties. It is effective against E. Coli, Salmonella typhi, Staph aureus, E. histolytica, Giardia lamblia, herpes simplex type 1 and influenza A virus.

• Isatis – is one of the best known Chinese antiviral herbs. It is an excellent remedy for any virus. It is mild and can be used for children. It is also a good antibacterial agent.

• Pau d’arco – excels in controlling Candida and yeast overgrowth. It also exhibits antiviral and antibacterial properties.

• Skullcap (Scutellaria baicalensis) – has broad spectrum antimicrobial activity and it suppresses viruses.

Digestive Tea

Digestive tea blend – Take 20 minutes or so after meals (1 part = 1 tsp or 1 TBSP)

Fennel seed ground 1 part

Cardamom seed – ground ¼ part

Ginger ½ part

Orange peel ½ part

Peppermint 1 part

Bring 2 cups of water to a boil and add the above herbs to it. Turn off heat and take off of stove, put on the lid and let simmer for 10 minutes. Strain into a vessel – preferably something that you can pour into a tea cup easily. Pour into your tea cup. Add a little honey for taste.

6. REFERENCES
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Balch, James F., M.D., and Balch, Phyllis A, C.N.C, Prescription for Nutritional Healing, Garden City Park: Avery Publishing Group, 1997
Barral, Jean-Pierre, and Mercier, Pierre, Visceral Manipulation, Seattle: Eastland Press, 1997
Barral, Jean-Pierre, and Mercier, Pierre, Visceral Manipulation II. Seattle; Eastland Press, 1999
Bensky, Dan and Randall Barolet, Chinese Herbal Medicine Formulas and Strategies, Seattle: Eastland Press, 1990
Berkow, Robt.. MD, Editor in Chief, The Merck Manual, Rahway, NJ: Merck Research Laboratories, 1992Berkson, D. Lindsey, Healthy Digestion the Natural Way, New York: John Wiley & Sons, Inc., 2000
Brostoff, Jonathan and Linda Gamlin, Food Allergies and Good Intolerance, Rochester, VT: Healing Arts Press, 2000 Chan, J., Carr, I, Mayberry, J.F., “The role of acupuncture in the treatment of irritable bowel syndrome: a pilot study”, Hepatogastroenterology, 1997 Sept-Oct; 44(17):1328-30
Ciclitira, Paul J., “AGA technical review on celiac sprue”, Gastroenterology, May 2001, Vol 120, No. 6 1526-1540
Dharmananda, Subhuti, Ph.D. The Use of Jianpiling in Treating Ulcerative Colitis, Portland: Institute for Traditional Medicine, May 1997
Dharmananda, Subhuti, Ph.D. Treatment of Irritable Bowel Syndrome with Chinese Herbs. Portland: Institute for Traditional Medicine, Sept. 1997
Dharmananda, Subhuti, Ph.D. A Bag of Pearls. Portland: Institute for Traditional Medicine, 2002
Flaws, Bob, DOM, CMT. Dipl. Ac., Arisal of the Clear, Boulder, CO: Blue Poppy Press, 1991
Flaws, Bob, and Honora Lee Wolfe, Prince Wen Hui’s Cook, Brookline, MA: Paradigm Publications, 1983
Gaeddert, Andrew, Digestive Health Now, Berkeley: North Atlantic Books, 2002
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Kirschmann, Gayla, J., and John D. Kirschmann, Nutrition Almanac, New York: McGraw Hill, 1996
Kritchevsky and Bonfield, Dietary Fiber in Health and Disease, New York: Plenum Press, 1997
Lininger, Schuyler W., Jr., Alan R. Gaby, MD, Steve Austin ND, Donald J. Brown, ND, Jonathan J. Wright, MD, Alice Duncan, DC,CCH, The Natural Pharmacy, Rocklin, CA: Prima Publishing 1999Lipski, Elizabeth, MS, CCN, Digestive Wellness, Los Angeles: Keats Publ. Co. 2000
Lu, Henry C., Chinese System of Food Cures, New York: Sterling Publishing Co., 1986
Maciocia, Giovanni, The Foundations of Chinese Medicine, Edinburgh: Churchill Livingston 1989
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Mindell, Earl, RPh., Ph.D. & Hopkins, Virginia, Prescription Alternatives, New Canaan, CT: Keats Publ, 1998Murray, Michael, ND and Joseph Pizzorno, ND, Encyclopedia of Natural Medicine, Rocklin, CA: Prima Publishing, 1991Narula, Acharan, PhD, Private conversations. July 9 and Sept. 7, 2001
Nichols, Trent W., MD, and Faas, Nancy, MSW, MPH, Optimal Digestion. New Strategies for Achieving Digestive Health, New York: Avon Books, 1999
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Stone, Al; LAc Irritable Bowel Syndrome, http://beyondwellbeing.com/html/herb.htm
Tortora, Gerard J and Sandra R. Grabowski, Principles of Anatomy and Physiology, New York: HarperCollins 1993
Werbach, Melvyn R, M.D., Nutritional Influences on Illness. Tarzana: Third Line Press, 1996
Yang, C. and H. Yan, “Observation of the efficacy of acupuncture and moxibustion in 62 cases of chronic colitis” J. Tradit Chin Med, 1999 Jun;19(2):111-4

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Compassionate Acupuncture and Healing Arts, providing craniosacral acupuncture, herbal and nutritional medicine in Durham, North Carolina. Phone number 919-475-1005.

Compassionate Acupuncture and Healing Arts, providing craniosacral acupuncture, herbal and nutritional medicine in Durham, North Carolina. Phone number 919-475-1005.

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