Ten per cent of the population consults for digestive troubles that resemble everything except an identifiable disease: pain, bloating, alternating transit, normal investigations. Irritable bowel syndrome (IBS) is that condition: common, real, often minimised, and now defined by positive criteria rather than by elimination.
IBS: a positive diagnosis, not a diagnosis of exclusion
IBS was long a “diagnosis by exclusion”: everything was searched, nothing was found, “irritable colon” was concluded. That is no longer the case. IBS is now an entity diagnosed positively on precise criteria, and the presence of those criteria suffices to make the diagnosis without first eliminating every other cause.
This change has an important consequence: IBS is a recognised pathology, with identified mechanisms (visceral hypersensitivity, dysbiosis, gut-brain axis), not a “nothing” conceded to an exhausted patient.
The Rome IV criteria and the 3 subtypes
The Rome IV criteria (2016) define IBS: recurrent abdominal pain on average at least once a week over the last three months, associated with at least two of these three features: relation to defecation, change in stool frequency, change in stool form. All present for at least six months.
Three subtypes according to dominant transit:
- IBS-D: predominant diarrhoea (frequent loose or liquid stools)
- IBS-C: predominant constipation (hard or infrequent stools)
- IBS-M: mixed (alternating between the two)
The subtype orients treatment: the protocol and the TCM reading differ depending on whether the dominant problem is urgency or stagnation.
Stress, dysbiosis, hyperpermeability: the three mechanisms
IBS is not a “psychosomatic” disorder in the usual sense: it has documented physical mechanisms.
Visceral hypersensitivity: the IBS intestinal nervous system perceives as painful stimuli that a normal intestine does not notice. Normal bloating is pain in IBS.
Dysbiosis and low-grade inflammation: the IBS microbiome is often disturbed, with mild mucosal inflammation that maintains hypersensitivity. The gut-brain axis is at the heart of the mechanism: stress deregulates the gut, the gut deregulates stress.
Hyperpermeability: the IBS intestinal barrier is often more permeable, letting through fragments that activate the mucosal immune system and maintain the loop. The article on leaky gut covers this mechanism.
The TCM reading: Liver attacking the Spleen, Spleen deficiency
The TCM reading of IBS is one of the clearest: the picture corresponds almost exactly to the Liver invading the Spleen syndrome (肝郁脾虚). The Liver (which manages the flow of Qi and the emotions) blocks under stress, and instead of smoothing the flow, it “attacks” the Spleen (digestion): stress translates into pain, bloating and alternating transit.
The second picture is Spleen deficiency producing Dampness: the tired Spleen no longer transforms, produces the substance that obstructs, and transit deregulates. Liver Qi stagnation on a background of Spleen deficiency is the classic IBS profile in TCM.
Diet: FODMAPs then reintroduction, TCM in support
The best-documented dietary protocol is FODMAP restriction (fermentable carbohydrates) for 4-6 weeks, then gradual reintroduction to identify the personal culprits. This protocol relieves symptoms in a majority of IBS patients; the article on FODMAPs and Spleen Dampness details the method.
TCM adds the terrain work that restriction does not do: supporting the Spleen (warm, regular meals, digestive disorders in TCM), smoothing the Liver (movement, stress management, flavours that mobilise without irritating), and treating the emotional component that the FODMAP protocol ignores. IBS is a pathology where the integrative approach is more complete than either alone.
| Subtype | Dominant sign | Dominant TCM reading | Dietary axis |
|---|---|---|---|
FAQ: IBS
Is IBS a real disease?
Yes: it is an entity diagnosed by positive criteria (Rome IV), with documented physical mechanisms (visceral hypersensitivity, dysbiosis, hyperpermeability). It is neither “nothing” nor a diagnosis of exclusion.
What is the difference between IBS and dysbiosis?
Dysbiosis is an imbalance of the microbiome; IBS is a functional syndrome of which dysbiosis is one possible mechanism. IBS can exist with a little-disturbed microbiome, and dysbiosis can exist without IBS.
Should FODMAPs be avoided for life?
No: restriction is an identification phase (4-6 weeks), not a permanent diet. Reintroduction identifies the personal culprits; the long-term diet is as varied as possible, minus the FODMAPs that genuinely trigger symptoms.
Does stress cause IBS?
It does not cause it alone, but it modulates it strongly via the gut-brain axis. Stress triggers or worsens flares; stress management is part of the treatment, not an alternative to it.
IBS, the digestive disorder we can finally name
IBS is the pathology that has come furthest: from catch-all “irritable colon” to an entity diagnosed by positive criteria, with identified mechanisms and management that works. FODMAP restriction relieves, TCM terrain work treats the foundation, and stress management stabilises. To locate your digestive terrain: the Yin Shi energy test maps your profile in a few minutes.
To go further
Yin Shi ecosystem resources directly related to this article.
Which TCM organ carries your IBS?
The five-organ test locates the Zang-Fu system behind the functional trouble.
Take the test →IBS: criteria, subtypes, pathophysiology
The lesson lays down the Rome IV criteria and the subtypes of irritable bowel syndrome.
Take the lesson →Digestion: where TCM meets science
The book devotes a section to irritable bowel syndrome and permeability.
Discover the book →