Herbal Medicine 4, 2010

PHYTOTHERAPY FOR THE DIGESTIVE SYSTEM

DISEASES & CONDITIONS OF THE LOWER GIT

CONTENTS:
Constipation References:
Haemorrhoids Mills and Bone. 2000. Principles and Practice of
Phytotherapy: Herbal Approaches to Systemic
Irritable Bowel Syndrome Dysfunctions.
Spasm

NOTE: herbs listed below under each condition in bold underline are herbs you have
covered so far in Herbal Medicine 4.

Herbalists believe that many chronic diseases begin with poor digestion and that good
upper digestive health is a prerequisite for a healthy digestive system. 1

CONSTIPATION
MEDICAL DEFINITION: Infrequent bowel evacuations and or hard and small faeces, or
where passage of faeces causes difficulty or pain.

SIGNS AND SYMPTOMS:

Large stools (atonic constipation)
Small, hard and dry stools, ribbon-like (spasmodic/ tension)
Haemorrhoids
Lessened urge to defecate
Sensation of incomplete emptying
Flatulence, cramping, griping, wind and bloating
Headaches
Irritability
Sciatica or menstrual pain can be referred pain from spinal pressure due to retained
faeces.

1
Mills and Bone. 2000. Principles and Practice of Phytotherapy: Herbal Approaches to Systemic
Dysfunctions. pp 174-175.
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NATUROPATHIC UNDERSTANDING: (Hoffman 2003, p263; Mills & Bone 2000)
Constipation is not a disease state in its own right, but should be viewed as a symptom of
a deeper metabolic disturbance. Less than one bowel movement daily compromises
healthy elimination.
Acute constipation indicates an abrupt change in bowel habits, and can be an indicator of
the presence of broader organic disease. In chronic constipation there is an ongoing
disturbance in normal bowel movements – an important aim here is to normalise bowel
movement through dietary modification.
Lack of dietary fibre or insufficient fluid intake is a common cause of constipation in
Western societies. However some less common causes of constipation could include:
 Nervous system disorders – including long periods of stress, depression (common)
 Irritable Bowel Syndrome (IBS)
 Diverticular disease
 Infections (eg. appendicitis)
 Painful anal conditions causing fear of opening the bowels
 Obstruction of the bowel – including faecal impaction
 Congenital factors
 Endocrine disorders
 Disease of the large intestine, liver, gallbladder or bowel.
 The bowel may be too tight or atonal (atonicity leads to weaker urge to defecate)
 Drugs or toxins that impact on bowel motility
 Immobility.
Reduced elimination may lead to recirculating toxins which may lead in the long term to
disease.
Transit time of the bowel may be tested using corn kernels swallowed whole (18-24 hours
is ideal).
Any change in bowel habit in people over 50 should be explored for possible malignancy
(especially in men).
Chronic constipation can lead to portal hypertension (back pressure on circulation to and
from liver), and may lead to liver or CV disease, often seen as the cause of varicose veins.

HERBAL TREATMENT STRATEGY:

In otherwise healthy people, laxatives are of secondary importance to a diet high in fibre,
adequate water intake, adequate sleep, regular exercise and other non-pharmacological
forms of maintaining digestive and nervous system health.
Many herbs can alleviate the discomfort of constipation. The most important factor in all cases
is to identify the underlying cause of the constipation, what the constipation is symptomatic of

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or associated with. The herbal actions listed below pertain to the broader metabolic
disturbance the constipation is a reflection of – treat the causative factors.
A number of different types of laxative herbs can be used for constipation:
Bulk laxatives: foods and herbs with a high fibre content are the only safe, long-term
treatment options for constipation. Bulk laxatives act slowly and gently, and they also
modify the bowel flora. The dose is gradually increased each morning and evening until a
softer and bulkier stool is achieved. Be aware that sometimes a systemic cleansing
reaction (such as cold or flu-like symptoms) may be initiated as a person’s bowels start to
move and toxins begin to be eliminated. Explaining this possibility will aid compliance with
treatment.
 Use bulking laxatives for the symptomatic relief of spasmodic constipation (where the
bowel is tense), while treating the cause with nervine/ antispasmodic herbs.
Secretory laxatives (choleretics, cholagogues, hepatics) promote bowel movement
through stimulation of bile production in the liver. They improve liver function and have a
gentle laxative effect.
Stimulating laxatives stimulate peristaltic movement directly via their influence on nerve
ganglia in the gut. They are the anthraquinone-containing herbs.
 In atonal constipation you would use stimulating/ irritant laxatives (BUT ONLY
SHORT TERM; LONG TERM USE OF STIMULATING LAXATIVES MAY LEAD TO
ATONICITY OF THE BOWEL).
Carminatives may be useful in easing the pain/ discomfort associated with constipation.
Bitters stimulate the digestive process and peristalsis.
When stress/ tension or depression is a factor, consider nervine, antispasmodic and
antidepressant herbs.
Lubricate the bowel to improve motility – adequate fluid intake/ mucilage.
Could also employ Nervines as appropriate – sometimes (actually often) constipation may be
due to nervous tension or depression, ie. nervous reflex to the gut/ sympathetic excess
pattern.

ACTIONS HERBS
Bulking laxatives Psyllium
Need to take adequate fluid Guar gum
as these laxatives absorb Linum usitatissimum (Linseed/ Flaxseed)
water and expand.
Oatbran
Ulmus (Slippery Elm) – not too much as can slow
bowel down too much.
Antispasmodics Matricaria (Chamomile)
Valeriana
Humulus

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Stimulating laxatives Cassia (Senna)
Rhamnus purshiana (Cascara)
Aloes (whole leaf containing anthraquinones)
Rumex crispus (Yellow Dock)
Rheum (Rhubarb)
Demulcents/ Lubricants Linseeds (soaked)
Glycyrrhiza
Ulmus
Althea
Aloes (juice – inner leaf only)
Verbascum (Mullein)
Choleretics/ Cholagogues Silybum marianum
Taraxacum radix
Gentiana
Nervines Matricaria
Valeriana
Humulus lupulus (Hops)
Damiana
Passiflora …
Bitters Note: many of the herbs listed above are also bitters
(eg. Gentian, Dandelion, Hops, Aloes, Chamomile …)
Carminatives Matricaria, Melissa, Foeniculum (Fennel), Salvia
(Sage), Zingiber (Ginger), Thymus (Thyme) …

OTHER TREATMENTS:
Lemon juice in warm water upon rising
Increase dietary fibre (slowly and with adequate hydration)
Improve hydration
Bitters before meals
Establish habit and routine around using bowels (sit on toilet at same time each day)
Exercise to improve bowel tone (belly dancing is brilliant)
Abdominal massage
Digestive enzymes, fresh Pineapple or Paw Paw after meals
In long term laxative abuse need to reduce laxatives slowly and retrain the bowel.

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 HAEMORRHOIDS
MEDICAL DEFINTION: Haemorrhoids are caused by increased pressure in the veins of the
anus, resulting in enlargement of the normal spongy blood filled cushions in the wall of the
anus. They are usually a consequence of prolonged constipation or occasionally diarrhoea.
They are also commonly due to pregnancy and childbirth.

SIGNS AN SYMPTOMS:
Pain caused by fissure (usually as a result of bowel movement/straining)
Headaches and irritability
Nausea
May be bright red blood in stool (as opposed to occult)
May accompany varicose veins, broken capillaries, bruising
Internal haemorrhoids occur near the beginning of the anal canal; external haemorrhoids
occur at the anal opening.

NATUROPATHIC UNDERSTANDING:
May be caused by constipation, or anal infection
A common cause is straining during bowel movements
Indicates poor connective tissue strength. It involves both digestive and cardiovascular
system issues.
Vitamin C / bioflavonoid deficiency
Possible liver congestion
A general condition of ‘passive venous congestion’ may be present, producing symptoms
including haemorrhoids, varicosities, abdominal bloating, lower back pain, menstrual
irregularities, constipation, poor circulation to and from the legs sometimes associated with
oedema, cold legs and feet, slow-healing sores and ulcers.

HERBAL TREATMENT STRATEGY:

Blood vessel tonics and lower bowel support
Normalise bowel function to prevent recurrence
Astringe and tone tissue locally
Strengthen connective and vascular tissue systemically (bioflavonoids)
If liver or pelvic congestion is a concern should also employ choleretics and cholagogues.

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 ACTIONS HERBS

Astringents (topically) Ranunculus ficaria (Pilewort) – specific

To strengthen and tone tissue to Hamamelis virginiana (Witchhazel) – specific
reduce pain and bleeding and to Aesculus hippocastanum (Horsechestnut) –
prevent recurrence. specific. Not topically if bleeding.
Collinsonia (Stoneroot) – specific for
haemorrhoids of pregnancy, and generally.
Symphytum (Comfrey)
Calendula

Vascular tonics (contain Ranunculus ficaria (Pilewort) – specific

bioflavonoids) Vaccinum myrtillus (Bilberry)
To strengthen connective and Crataegus (Hawthorn)
vascular tissue).
Aesculus hippocastanum – specific
Ruscus aculaetus (Butchers Broom)
Collinsonia (Stoneroot) – specific
Hamamelis (Witch Hazel) – specific
Quercus alba/ ruber (Oak Bark) – especially in
alcoholics (severe, knotty varicosities).

Bitters Gentian
To assist digestive and eliminative Aesculus (very bitter)
processes and facilitate bowel Taraxacum radix etc
motions.

Laxatives Cassia (Senna)

To promote easier bowel Rhamnus purshiana (Cascara)
movements Aloes
Rumex crispus (Yellow Dock)
Rheum (Rhubarb)

Vulneraries (speed local healing of Millefolium  Plantago (Plantain/ Ribwort)

inflamed tissues) Hydrastis
*Witch Hazel and Calendula sitz bath. Hamamelis

Demulcents/ Emollients Aloes juice

Soothe irritated/ inflamed tissue Ulmus/ Althea
Symphytum

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 IRRITABLE BOWEL SYNDROME (IBS)
MEDICAL DEFINITION: IBS is characterised by troublesome GIT symptoms experienced in
the absence of any organic pathology.
There is no structural pathology, no test is diagnostic and there is no cure.
IBS is the most common diagnosis made in GIT clinics.2

SIGNS AND SYMPTOMS:

Usually presents between 30-40. Can affect very young children and the elderly
Abdominal pain (often cramping) and discomfort (commonly felt in one or both iliac
fossae); gassiness; bloating; changes in bowel habits.
Pain often relieved by defecation or passage of flatus.
A sensation of abdominal distension or bloating
Disordered bowel habit, continuous or intermittent.
May be diarrhoea, constipation or both.
A ‘morning rush’ is common – patients feel an urgent need to defecate several times on
getting up, during and after breakfast.
Sensation of incomplete emptying and passage of mucous
PRESENCE OF BLOOD IN THE STOOL MUST NEVER BE ATTRIBUTED TO IBS, AN
ORGANIC CAUSE MUST BE EXPLORED.

NATUROPATHIC UNDERSTANDING:
There are three basic types of IBS:
1. Functional diarrhoea often without pain
2. Chronic abdominal pain and constipation (spastic colitis)
3. Abdominal pain with disturbed and variable bowel habit (constipation alternating with
diarrhoea)3
Often associated with anxiety and other NS disorders
May be associated with dysfunction of smooth muscle of bowel
May be associated with food intolerance
May be due to poor diet
May be due to indigestion.

Comment: IBS is nearly always associated with anxiety and nervous disorders, or never well
since some kind of stress or trauma, either in the past or ongoing in a person’s life. Consider
the strong link between the central nervous system and the autonomic nervous reflexes of the
2
Oxford handbook of Clinical Medicine 4th Ed
3
Mills and Bone: Principles and Practice of Phytotherapy PP177-179
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gut: when the CNS is disturbed, so is the gut. Hence, when treating IBS we must often take
these factors into primary consideration.

HERBAL TREATMENT STRATEGY:

Treatment should be tailored to individual presentation of the individual.
A basic exclusion diet is often useful
Spasmolytics/ Antispasmodics to reduce spasm and bloating
Nervines to address NS exacerbation of symptoms
Carminatives – to aid in digestion and
Hepatics and Choleretics to improve general liver function
GIT antiseptics to restore normal bowel flora
Mucilage containing herbs, especially in the case of constipation
GIT anti-inflammatories (mucous production indicates irritation )
Constipation should be treated with very gentle laxatives only.

ACTIONS HERBS

Spasmolytics/ Antispasmodics Matricaria

Mentha
Dioscorea (Wild Yam) – specific
Ruta graveolens (Rue) – in low dose

Sedative and Tonic nervines Scutellaria

Valeriana
Melissa

Carminatives Matricaria
Best are those that also have Melissa
antispasmodic/ nervine type Foeniculum (Fennel)
actions.
Salvia (Sage)
Induce relaxation of smooth
muscle; help dispel trapped gas; Zingiber (Ginger)
aid digestive processes. Thymus (Thyme)

Hepatics and Choleretics Silybum marianum

Taraxacum rad (use in low dose with diarrhoea)
Schisandra chinensis

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Mucilage containing herbs ( soothe Ulmus
and slow bowel down) Althea

GIT Antiseptics (to promote healthy Hydrastis

flora) Propolis
Garlic is NOT usually tolerated well Citrus spp
by IBS patients.

GIT Anti-inflammatories Filipendula

Matricaria

Laxatives Rumex crispus (Yellow Dock)

Constipation should be treated with Taraxacum rad (Dandelion Root)
very gentle herbs only

Bitters – promote appropriate See above

digestive secretions, and often
normalise bowel function on their own

Astringents – reverse the diarrhoea Geranium

and reduce any pathological mucous Myrica cerifica (Bayberry)
production
Rhodiola (also adaptogenic)

SPASM
Digestive cramping and colic
May be caused by stress, infection, allergies, indigestion

TREATMENT:
Sedative and relaxant nervines (induce relaxation of CNS)
Carminatives (antispasmodics, induce relaxation of smooth muscle, help dispel trapped
gas)
Anodynes (reduce pain and discomfort).

ACTIONS HERBS

Sedative and relaxant nervines Valeriana

Induce relaxation of CNS. Matricaria
Passiflora

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Carminatives Matricaria
Antispasmodics; induce relaxation Melissa
of smooth muscle; help dispel Foeniculum (Fennel)
trapped gas.
Salvia (Sage)
Zingiber (Ginger)
Thymus (Thyme)
Mentha piperita (Peppermint).

Anodynes Eschscholtzia (Californian Poppy)

Reduce pain and discomfort.

Case Study
A male aged 70 presents with constipation. He is single and retired on a pension. He enjoys
gardening, reading books and has recently taught himself to program computers, “just for
something to do”. He is involved in many different community groups and a church group and
walks daily with his dog. His blood pressure 125/80, and he is not taking any medication. He
has some trouble with his hearing and vision, but aside from that he is generally healthy.
He sleeps 6 hours per night, but wakes after midnight and needs to take a sleeping pill to get
back to sleep. Has been feeling very tired lately however and has not been able to walk quite as
far as usual. Has also been very constipated – no bowel movement for 6 days. Has had the
same thing happen twice previously (within past month) and went to doctor who administered an
enema.
His GP diagnosed him with ‘irritable bowel syndrome’ around 15 years ago. He then started
experiencing abdominal pain which he described as attacks of colicky/ cramping pain with
sustained constipation, with occasional bouts of diarrhoea. Further questioning revealed that
around onset of his symptoms he was retrenched from his job and his marriage also deteriorated
thereafter. From then on he had to work two jobs to pay the bills and rebuild himself financially.
These experiences severely knocked around his confidence, from which he has never really fully
recovered emotionally.
He wants something he can take to induce a bowel movement, relieve the discomfort and stop it
occurring again. His diet is poor – mostly canned foods, sandwiches and foods that do not
require cooking. He craves bread and pasta, and eats very little fruit. He is generally thirstless.
His wife has Alzheimer’s and he is her sole carer.

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