A glimpse on recent researches on irritable bowel syndrome with homeopathic intervention

Gastroenterological problems are some of the most common conditions treated by homeopaths. Among them Irritable bowel syndrome (IBS) is increasing in the last few decades. As per a recent survey, IBS hasaffected approximately 20% of Indian population.[1]Increased psychological stress[2] and westernisation of food like fast food[3] and preserved food are majorly considered among probable causes.

It is a known fact that conventional approach mainly focusses on the symptomatic management. Rather than focussing to cure the disease as a whole, different medications are given for each individual’s symptoms, that too with adverse effects. On the other hand, homeopathy treats the patient as a whole, which aims to provide everlasting solace. Moreover, the efficacy of homeopathy is scientifically proven & published. For instance, American Gastroenterological Association reviewed randomised controlled trails (RCTs) of homeopathy and other alternative treatment focusing on gastrointestinal disorders including IBS. Overall, results of this review were in favour of homeopathy.[4] This article gives a glimpse on some of the researches on IBS with homeopathic intervention and its therapeutics.

Diagnosing the condition

Usually, when a patient with colic & irregular bowel movement comes, IBS is confirmed by the characteristic symptoms after ruling out other conditions by pathological tests. However, sometimes it used to be challenging. This difficultly in diagnosis has been made more systematic by Rome criteria, based on the presence of alarming symptoms such asgastrointestinal bleeding, weight loss, anaemia, or frequent nocturnal symptoms as starting points. IBS can be differentiated in three groups viz. IBS with constipation (IBS-C), IBS with diarrhoea (IBS-D), and IBS alternating diarrhoea and constipation (IBS-A).

Recent researches on IBS with homeopathic intervention

As stated above, there have been research studies showing the efficacy of homeopathy in IBS. Some of them are listed below:

1. It was a three-armed trial comparing (i) usual care, (ii) homeopathic treatment plus usual care and (iii) supportive listening plus usual care. The primary outcome was change in irritable bowel symptom severity score between baseline and 26 weeks, calculated using ANCOVA. An interim ANCOVA adjusted for baseline IBS severity, age and employment status found no statistically significant difference between the three arms. However, a post-hoc test comparing homeopathic treatment plus usual care to usual care alone found a statistically significant difference in favour of homeopathic treatment. In addition, 62.5 percent of patients in the homeopathic treatment arm (compared to 25.0 percent of those in the usual care arm), achieved a clinically relevant change in irritable bowel symptom severity score, which indicates a promising effect for homeopathic treatment, though these results should be interpreted with caution due to the low number of participants in the study.[5]

 

2. In this study 14 practicing homeopathic physicians collected clinical and outcomes data over a 6-month in their clinic.A unique excel spreadsheet for successive clinical appointments had been designed for record facilitated with date, patient identity, age and gender, medical condition/complaint treated, whether chronic or acute, new or follow-up case, patient-assessed outcome (7-point Likert scale: −3 to +3) compared with first appointment, homeopathic medicine/s prescribed, whether any other medication/s being taken for the condition. Physicians punctually and regularly submitted their data cells were completed as required, enabling substantial data analysis. 75.9% positive, 4.6% negative, 14.7% no change; 4.8% outcome not recorded in 961 cases having two or more homeopathic appointments per patient. Significant positive outcome noted mostly in the frequently treated conditions of anxiety, depression, and irritable bowel syndrome. Specifically in cases of IBS, 73.9% of patients have reported moderate to major improvement.[6]

 

3. National Health Service Trust, Bristol, United Kingdom has conducted a observational study in225 patients. 71% IBS patients reported either slightly, moderately or much better. Among them 55% of patients showed significant positive changes in their symptoms. 26% of patients showed no improvement and only 1% had worse condition. It clearly shows that homeopathy, unlike other systems,is not only effective, but also without any adverse effect.[7]

 

4. D.Y. PatilHomeopathic Medical College & Research Centre, Pune recently conducted a clinical trial to assess the efficacy of homeopathy in treatment of IBS. Inclusion criteria was to select all the cases fit to Manning‘s criteria and Rome‘s criteria.Cases with abnormalities in lab investigations, symptoms for less than 12 weeks and doesn‘t fit into Manning‘s and Rome‘s criteria were excluded. The method of selection of homeopathic medicines was on the availability of unique symptoms, physical and mental symptoms. Synthesis Repertory RADAR 10 was used for repertorization. Criteria for assessment were improvement of symptoms, Patient in general, reduction in duration of attack, relief from reoccurrence. After completion of  the  study,  the  post  treatment  disease scores  were  compared  with  the  pre-treatment  disease intensity scores and statistically evaluated using the t-test. Homeopathy is significantly found useful in cases of IBS. Out of 30 cases 24 got significant relief and reduction in duration and frequency of attack. [8]

 

 

5. This study was conducted by Tunbridge Wells Homeopathic Hospital to assess the effectiveness of Homeopathic medicines in chronic diseases like IBS, arthritis, depression, eczema, menopause, CFS and migraine. 4571 patients are treated in which 77% reported positive health changes.[9]

Different approaches of homeopathic intervention in  cases of IBS

Prescribing trend of homeopathic medicine may vary from physician to physician. There are several methods in selecting the remedy like on the basis of physical or mental general, uncommon peculiar symptom, and miasmatic/constitutional approach, specific symptomatic analysis, condition specific drugs, etc. But the core intension is to select similimum to the present case. Many a times in chronic cases, acute phase arrives during the course of treatment. Such conditions are usually managed by the remedies which are in relation to the previous remedy either in lower potency or in mother tincture form. If well selected remedy fails to improve or stopped to improve, anti-miasmatic remedies are usually considered. Here we present some of the homeopathic drugs useful in cases of IBS.[10]

Remedies	Indication
Arsenicum album	Pain in the abdomen, with unbearable anxiety and restlessness; suitable for office goers, those who are perfectionists; burning in the abdomen, with heat and thirst; tenesmus as in dysentery, constant burning and pressure in the rectum and anus; ineffectual urging to stool; frequent diarrhoea, with violent tearing cutting pains in the intestines; while fully conscious, sometimes discharges of faeces and urine unaware. Great exhaustion after the slightest exertion.Among these the all-prevailing debility, exhaustion, and restlessness, with nightly aggravation, are most important. Stools are very offensive. Cannot bear the sight or smell of food. Great thirst; drinks much, but little at a time. Ill effects of vegetable diet, melons, and watery fruits generally.
Belladonna	Dr. William Boericke says Belladonna always is associated with hot, red skin, flushed face, glaring eyes, throbbing carotids, excited mental state, hyperaesthesia of all senses, delirium, restless sleep, dryness of mouth and throat with aversion to water, neuralgic pains that come and go suddenly. Melancholy with grief and discouragement; nervous anxiety and restlessness; dread of all exertion and motion; violent colic with constipation, which allows no rest; shootings in left side of the abdomen, on coughing, on sneezing, and on being touched; painful distended abdomen, very sensitive to the touch; diarrhoea with stools of mucus; evacuations whitish like chalk, or greenish; thin, green stools, with frequent micturition and perspiration.
Colocynthis	Suitable for irritable persons who easily angered; Ailment from indignation, or anger. Colic causing patient to bend double, sometimes with nausea and vomiting, sometimes with diarrhoea, sometimes with passing great quantities of gas; pains often extend into chest and pelvis; sensation as if stones were being ground together in the abdomen. Pain in abdomen relief by warm application, bending double and pressure. Patient becomes angry or irritably replies when questioned.
Bryonia alba	Stitching,tearing pain in abdomen. Dryness of mucous membrane. Constipation, stools brown, hard, dry, dark, bloody; worse in morning, from moving, in hot weather, after being heated, from cold drinks, every spell of hot weather. Excessive thirst with dryness of mouth, tongue, and throat. Dyspeptic ailments during summer heat. Sensation as if stone lied in stomach. Pain in abdomen worse from motion, eating after, and relief by pressure, cold things and lying on painful side.
Iris versicolor	Low-spirited, discouraged and easily vexed persons; great depression with headache; fear of an approaching illness. Periodical night diarrhoea, with pain and green discharges. Burning sensation in whole alimentary canal.  colic worse by bending forward and better by discharge of flatulence; cutting pain in the lower part of abdomen; liver sore to touch, fetid flatulence; sharp griping pains in the bowels.
Natrum phosphoricum	Fears of bad news and on waking; irritable; sharp cutting in hypochondria and left iliac region; flatulence worse after eating; colic as from wind pressing on bladder, causing frequent inclination and urging to stool; colicky pains worse walking; diarrhoea with colic; fears to pass flatus as faeces would escape; after coitus (man) urging to stool and urination. Yellow, creamy coating at the back of the roof of mouth and tongue. Flatulence, with sour risings.
Lycopodium	Patients fear to be alone, aversion to undertake anything new. Haughty and obstinate when sick. Craves sweet, hot food, tea, etc. Incomplete burning eructation rise only to pharynx there burn for hours.Abdominal flatulence with much rumbling and gurgling with pains of various sorts; IBS with chronic inflammation and enlargement of the liver; abdomen is full and bloated especially after meal; stool hard and difficult, small quantity; abdominal complaints worse between 4-8pm.
Calcareacarbonica	Patients have fear of contagious disease, delusion of incurable disease, obstinate metal personality; laziness, etc. are the common mental general of Calcareacarbonica patient. Abdomen very much distended and hard; tension in the abdomen with distension without sensation of flatus, which disappears after passing wind; cramp in the intestinal canal especially in the evening and at night with coldness in the thighs; feeling of heaviness in the lower portion of the rectum; burning in the rectum after a copious stool especially in the morning; crawling in the rectum as from worms; frequent passage of stool, at first hard, then pasty, then liquid; in most cases stool is perfectly white and offensive like bad eggs. Icy coldness in, and on the head, much perspiration, wets the pillow.
Nux vomica	Very useful in effects of mental strain at night, especially when it results in irritability and great nervous sensitiveness; suitable to persons who becomes angry easily, of sedentary habits, or those who sit up late at night; indescribable anxiety with nausea, vomiting and trembling; colic with pressure upward causing shortness of breath, and downward causing desire for stool; colic, with constipation and frequent desire for stool; indicated in constipation when there is repeated ineffectual urging to stool; diarrhoea consisting of frequent small evacuations; constant feeling as if there were more to be evacuated; dysentery, especially after the administration of allopathic remedies, with disordered stomach, morning aggravation and discharge of bloody mucus
Pulsatilla	Suitable for women of weeping tendency; likes sympathy; Timid, fears in evening to be alone, dark, ghost. spasmodic pain at bottom of hypogastrium or around the navel with pressure on rectum penetrating into pelvis; colic and labour-like pains in pregnant women; colic with chilliness, while the menstruation is suppressed; hard distension of abdomen especially in epigastrium. Patients desire cold food and drinks, ice-cream, pastry, fatty food. Pain and gastric complaints are worse by fatty food and pastry. Thirstlessness is associated with almost every complaints.

Cinchona officinalis

Colic in the region of the umbilicus with shivering immediately after eating a moderate supper with good appetite; distension of abdomen as from much drinking and from flatulent food; fermentation in the abdomen from eating fruit; great rumbling and moving of much offensive flatus in the abdomen; diarrhoea; faeces contains undigested food, passed in several pieces

 

Aegle marmelos	Abdominal colic with indigestion and constipation; no desire for food; wind comes out with loud noise, worse in the afternoon; associated amoebic and bacillary dysentery may or may not be present
Aloe socotrina	Distension with periodic motion of flatus; worse morning; cutting pain in the stomach worse morning after rising with diarrhoea; pain as if another stool would follow after a stool; sensation of a plug between symphysis pubis and coccyx with urging to stool; abdominal symptoms are associated with pressure and fullness in the region of the liver; great accumulation of flatus, which presses downward; heat with diarrhoea when faeces pass; fear of least stool would escape with flatus or on passing urine
Mercurioussolubilis	The stools always contain mucus, and there is usually tenesmus; colic pain extending up the colon; green mucous stools are preceded by chilliness and followed by tenesmus and burning; dysentery of blood and mucus; with fever and easy sweat worse at night
Natrum muriaticum	Dry and hard stools, with fissure in the anus, cause bleeding; constipation, with feeling of constriction of the anus, stool is difficult to expel and causes fissure, bleeding and soreness; chronic diarrhoea with burning in anus during the passage; constrictive cramp in the stomach in the evening with a feeling of coldness in the back and stomach; pressure in the pit of the stomach, with sensitiveness to touch; sensation as if a foreign body were sticking in the orifice of the stomach; pinching pain in the right side of the abdomen; worse lying on left side
Phosphorus	Weak and all gone sensation in the whole abdomen; desire for stool whenever lies on left side; chronic diarrhoea, painless, worse in hot weather; stools involuntary, undigested, fetid or containing particles like grains of tallow; great weakness after stool
Sulphur	Dysentery subacute, persistent with burning and tenesmus; diarrhoea generally thin, watery, sometimes with mucous,  undigested and generally very fetid, worse in the early morning in bed with the necessity of urgent and frequently, without pain; persons having chronic diarrhoea with aversion to meat, tendency to stupor, with cold sweat; disagreeable odour of the body, with aversion to washing; habitual constipation, especially when the rectum is irritable and dry; frequent ineffectual desire for stool in the rectum with burning in the anus
Veratrum album	Diarrhoea from eating fruits at night associated with terrible colic; stools very profuse and watery, sometimes blackish, followed by great emptiness and weakness in the abdomen; evacuation are often accompanied by violent vomiting

 

References:

[1] Talley NJ, Zinsmeister AR, Van Dyke C, Melton LJ 3rd. Epidemiology of colonic symptoms and the irritable bowel syndrome. Gastroenterology. 1991;101:927–34.

[2]Emeran A. Mayer, Bruce D. Naliboff, Lin Chang, And Santosh V.Coutinho Stress and the Gastrointestinal Tract

2001. Stress and irritable bowel syndrome Am J PhysiolGastrointest Liver Physiol 280: G519–G524, 2001.

[3] Richard P. MacDermott, Treatment of irritable bowel syndrome in outpatients with inflammatory bowel disease using a food and beverage intolerance, food and beverage avoidance diet, Inflammatory Bowel Diseases, Volume 13, Issue 1, January 2007, Pages 91–96

[4] Ronald L. Koretz, Michael Rotblatt, Complementary and alternative medicine in gastroenterology: The good, the bad, and the ugly, American Gastroenterological Association. Published by Elsevier Inc.November 2004Volume 2, Issue 11, Pages 957–967

[5] Emily J.Peckham, ClareRelton, Jackie Raw, ClareWalters, Kate Thomas, Christine Smith, KapiKapur, Elmuhtady Said.Interim results of a randomised controlled trial of homeopathic treatment for irritable bowel syndrome, Homeopathy. Volume 103, Issue 3, July 2014, Pages 172-177

[6]R.T.Mathie, T.W.Robinson, Outcomes from homeopathic prescribing in medical practice: A prospective, research-targeted, pilot study, Homeopathy Journal, Volume 95, Issue 4, October 2006, Pages 199-205.

[7] David S. Spence,Elizabeth A. Thompson, S.J. Barron. Homeopathic Treatment for Chronic Disease: A 6-Year, University-Hospital Outpatient Observational Study, The Journal of Alternative and Complementary Medicine.Volume: 11 Issue 5: November 18, 2005

[8]Dr.ParthAphale, Dr.AtulRajgurav, To Study the Efficacy of Homeopathy in Management of Irritable Bowel Syndrome (IBS), Saudi Journal of Medical and Pharmaceutical Sciences, Scholars Middle East Publishers, Dubai, United Arab Emirates.

[9]H.Roniger, Tunbridge Wells Homeopathic Hospital outcome study, European Journal of Integrative Medicine, Volume 1, Supplement 1, November 2008, Page 40

[10] W. Boericke, New Manual of Homeopathic Materia Medica& Repertory [with Relationship of Remedies], Second Re-Augmented & Revised Edition Based on Ninth Edition, Reprint Edition 2002, B. Jain Publishers, New Delhi.

A glimpse on recent researches on irritable bowel syndrome with homeopathic intervention

Gastroenterological problems are some of the most common conditions treated by homeopaths. Among them Irritable bowel syndrome (IBS) is increasing in the last few decades. As per a recent survey, IBS hasaffected approximately 20% of Indian population.[1]Increased psychological stress[2] and westernisation of food like fast food[3] and preserved food are majorly considered among probable causes.

It is a known fact that conventional approach mainly focusses on the symptomatic management. Rather than focussing to cure the disease as a whole, different medications are given for each individual’s symptoms, that too with adverse effects. On the other hand, homeopathy treats the patient as a whole, which aims to provide everlasting solace. Moreover, the efficacy of homeopathy is scientifically proven & published. For instance, American Gastroenterological Association reviewed randomised controlled trails (RCTs) of homeopathy and other alternative treatment focusing on gastrointestinal disorders including IBS. Overall, results of this review were in favour of homeopathy.[4] This article gives a glimpse on some of the researches on IBS with homeopathic intervention and its therapeutics.

Diagnosing the condition

Usually, when a patient with colic & irregular bowel movement comes, IBS is confirmed by the characteristic symptoms after ruling out other conditions by pathological tests. However, sometimes it used to be challenging. This difficultly in diagnosis has been made more systematic by Rome criteria, based on the presence of alarming symptoms such asgastrointestinal bleeding, weight loss, anaemia, or frequent nocturnal symptoms as starting points. IBS can be differentiated in three groups viz. IBS with constipation (IBS-C), IBS with diarrhoea (IBS-D), and IBS alternating diarrhoea and constipation (IBS-A).

Recent researches on IBS with homeopathic intervention

As stated above, there have been research studies showing the efficacy of homeopathy in IBS. Some of them are listed below:

1. It was a three-armed trial comparing (i) usual care, (ii) homeopathic treatment plus usual care and (iii) supportive listening plus usual care. The primary outcome was change in irritable bowel symptom severity score between baseline and 26 weeks, calculated using ANCOVA. An interim ANCOVA adjusted for baseline IBS severity, age and employment status found no statistically significant difference between the three arms. However, a post-hoc test comparing homeopathic treatment plus usual care to usual care alone found a statistically significant difference in favour of homeopathic treatment. In addition, 62.5 percent of patients in the homeopathic treatment arm (compared to 25.0 percent of those in the usual care arm), achieved a clinically relevant change in irritable bowel symptom severity score, which indicates a promising effect for homeopathic treatment, though these results should be interpreted with caution due to the low number of participants in the study.[5]

 

2. In this study 14 practicing homeopathic physicians collected clinical and outcomes data over a 6-month in their clinic.A unique excel spreadsheet for successive clinical appointments had been designed for record facilitated with date, patient identity, age and gender, medical condition/complaint treated, whether chronic or acute, new or follow-up case, patient-assessed outcome (7-point Likert scale: −3 to +3) compared with first appointment, homeopathic medicine/s prescribed, whether any other medication/s being taken for the condition. Physicians punctually and regularly submitted their data cells were completed as required, enabling substantial data analysis. 75.9% positive, 4.6% negative, 14.7% no change; 4.8% outcome not recorded in 961 cases having two or more homeopathic appointments per patient. Significant positive outcome noted mostly in the frequently treated conditions of anxiety, depression, and irritable bowel syndrome. Specifically in cases of IBS, 73.9% of patients have reported moderate to major improvement.[6]

 

3. National Health Service Trust, Bristol, United Kingdom has conducted a observational study in225 patients. 71% IBS patients reported either slightly, moderately or much better. Among them 55% of patients showed significant positive changes in their symptoms. 26% of patients showed no improvement and only 1% had worse condition. It clearly shows that homeopathy, unlike other systems,is not only effective, but also without any adverse effect.[7]

 

4. D.Y. PatilHomeopathic Medical College & Research Centre, Pune recently conducted a clinical trial to assess the efficacy of homeopathy in treatment of IBS. Inclusion criteria was to select all the cases fit to Manning‘s criteria and Rome‘s criteria.Cases with abnormalities in lab investigations, symptoms for less than 12 weeks and doesn‘t fit into Manning‘s and Rome‘s criteria were excluded. The method of selection of homeopathic medicines was on the availability of unique symptoms, physical and mental symptoms. Synthesis Repertory RADAR 10 was used for repertorization. Criteria for assessment were improvement of symptoms, Patient in general, reduction in duration of attack, relief from reoccurrence. After completion of  the  study,  the  post  treatment  disease scores  were  compared  with  the  pre-treatment  disease intensity scores and statistically evaluated using the t-test. Homeopathy is significantly found useful in cases of IBS. Out of 30 cases 24 got significant relief and reduction in duration and frequency of attack. [8]

 

 

5. This study was conducted by Tunbridge Wells Homeopathic Hospital to assess the effectiveness of Homeopathic medicines in chronic diseases like IBS, arthritis, depression, eczema, menopause, CFS and migraine. 4571 patients are treated in which 77% reported positive health changes.[9]

Different approaches of homeopathic intervention in  cases of IBS

Prescribing trend of homeopathic medicine may vary from physician to physician. There are several methods in selecting the remedy like on the basis of physical or mental general, uncommon peculiar symptom, and miasmatic/constitutional approach, specific symptomatic analysis, condition specific drugs, etc. But the core intension is to select similimum to the present case. Many a times in chronic cases, acute phase arrives during the course of treatment. Such conditions are usually managed by the remedies which are in relation to the previous remedy either in lower potency or in mother tincture form. If well selected remedy fails to improve or stopped to improve, anti-miasmatic remedies are usually considered. Here we present some of the homeopathic drugs useful in cases of IBS.[10]

Remedies	Indication
Arsenicum album	Pain in the abdomen, with unbearable anxiety and restlessness; suitable for office goers, those who are perfectionists; burning in the abdomen, with heat and thirst; tenesmus as in dysentery, constant burning and pressure in the rectum and anus; ineffectual urging to stool; frequent diarrhoea, with violent tearing cutting pains in the intestines; while fully conscious, sometimes discharges of faeces and urine unaware. Great exhaustion after the slightest exertion.Among these the all-prevailing debility, exhaustion, and restlessness, with nightly aggravation, are most important. Stools are very offensive. Cannot bear the sight or smell of food. Great thirst; drinks much, but little at a time. Ill effects of vegetable diet, melons, and watery fruits generally.
Belladonna	Dr. William Boericke says Belladonna always is associated with hot, red skin, flushed face, glaring eyes, throbbing carotids, excited mental state, hyperaesthesia of all senses, delirium, restless sleep, dryness of mouth and throat with aversion to water, neuralgic pains that come and go suddenly. Melancholy with grief and discouragement; nervous anxiety and restlessness; dread of all exertion and motion; violent colic with constipation, which allows no rest; shootings in left side of the abdomen, on coughing, on sneezing, and on being touched; painful distended abdomen, very sensitive to the touch; diarrhoea with stools of mucus; evacuations whitish like chalk, or greenish; thin, green stools, with frequent micturition and perspiration.
Colocynthis	Suitable for irritable persons who easily angered; Ailment from indignation, or anger. Colic causing patient to bend double, sometimes with nausea and vomiting, sometimes with diarrhoea, sometimes with passing great quantities of gas; pains often extend into chest and pelvis; sensation as if stones were being ground together in the abdomen. Pain in abdomen relief by warm application, bending double and pressure. Patient becomes angry or irritably replies when questioned.
Bryonia alba	Stitching,tearing pain in abdomen. Dryness of mucous membrane. Constipation, stools brown, hard, dry, dark, bloody; worse in morning, from moving, in hot weather, after being heated, from cold drinks, every spell of hot weather. Excessive thirst with dryness of mouth, tongue, and throat. Dyspeptic ailments during summer heat. Sensation as if stone lied in stomach. Pain in abdomen worse from motion, eating after, and relief by pressure, cold things and lying on painful side.
Iris versicolor	Low-spirited, discouraged and easily vexed persons; great depression with headache; fear of an approaching illness. Periodical night diarrhoea, with pain and green discharges. Burning sensation in whole alimentary canal.  colic worse by bending forward and better by discharge of flatulence; cutting pain in the lower part of abdomen; liver sore to touch, fetid flatulence; sharp griping pains in the bowels.
Natrum phosphoricum	Fears of bad news and on waking; irritable; sharp cutting in hypochondria and left iliac region; flatulence worse after eating; colic as from wind pressing on bladder, causing frequent inclination and urging to stool; colicky pains worse walking; diarrhoea with colic; fears to pass flatus as faeces would escape; after coitus (man) urging to stool and urination. Yellow, creamy coating at the back of the roof of mouth and tongue. Flatulence, with sour risings.
Lycopodium	Patients fear to be alone, aversion to undertake anything new. Haughty and obstinate when sick. Craves sweet, hot food, tea, etc. Incomplete burning eructation rise only to pharynx there burn for hours.Abdominal flatulence with much rumbling and gurgling with pains of various sorts; IBS with chronic inflammation and enlargement of the liver; abdomen is full and bloated especially after meal; stool hard and difficult, small quantity; abdominal complaints worse between 4-8pm.
Calcareacarbonica	Patients have fear of contagious disease, delusion of incurable disease, obstinate metal personality; laziness, etc. are the common mental general of Calcareacarbonica patient. Abdomen very much distended and hard; tension in the abdomen with distension without sensation of flatus, which disappears after passing wind; cramp in the intestinal canal especially in the evening and at night with coldness in the thighs; feeling of heaviness in the lower portion of the rectum; burning in the rectum after a copious stool especially in the morning; crawling in the rectum as from worms; frequent passage of stool, at first hard, then pasty, then liquid; in most cases stool is perfectly white and offensive like bad eggs. Icy coldness in, and on the head, much perspiration, wets the pillow.
Nux vomica	Very useful in effects of mental strain at night, especially when it results in irritability and great nervous sensitiveness; suitable to persons who becomes angry easily, of sedentary habits, or those who sit up late at night; indescribable anxiety with nausea, vomiting and trembling; colic with pressure upward causing shortness of breath, and downward causing desire for stool; colic, with constipation and frequent desire for stool; indicated in constipation when there is repeated ineffectual urging to stool; diarrhoea consisting of frequent small evacuations; constant feeling as if there were more to be evacuated; dysentery, especially after the administration of allopathic remedies, with disordered stomach, morning aggravation and discharge of bloody mucus
Pulsatilla	Suitable for women of weeping tendency; likes sympathy; Timid, fears in evening to be alone, dark, ghost. spasmodic pain at bottom of hypogastrium or around the navel with pressure on rectum penetrating into pelvis; colic and labour-like pains in pregnant women; colic with chilliness, while the menstruation is suppressed; hard distension of abdomen especially in epigastrium. Patients desire cold food and drinks, ice-cream, pastry, fatty food. Pain and gastric complaints are worse by fatty food and pastry. Thirstlessness is associated with almost every complaints.

Cinchona officinalis

Colic in the region of the umbilicus with shivering immediately after eating a moderate supper with good appetite; distension of abdomen as from much drinking and from flatulent food; fermentation in the abdomen from eating fruit; great rumbling and moving of much offensive flatus in the abdomen; diarrhoea; faeces contains undigested food, passed in several pieces

 

Aegle marmelos	Abdominal colic with indigestion and constipation; no desire for food; wind comes out with loud noise, worse in the afternoon; associated amoebic and bacillary dysentery may or may not be present
Aloe socotrina	Distension with periodic motion of flatus; worse morning; cutting pain in the stomach worse morning after rising with diarrhoea; pain as if another stool would follow after a stool; sensation of a plug between symphysis pubis and coccyx with urging to stool; abdominal symptoms are associated with pressure and fullness in the region of the liver; great accumulation of flatus, which presses downward; heat with diarrhoea when faeces pass; fear of least stool would escape with flatus or on passing urine
Mercurioussolubilis	The stools always contain mucus, and there is usually tenesmus; colic pain extending up the colon; green mucous stools are preceded by chilliness and followed by tenesmus and burning; dysentery of blood and mucus; with fever and easy sweat worse at night
Natrum muriaticum	Dry and hard stools, with fissure in the anus, cause bleeding; constipation, with feeling of constriction of the anus, stool is difficult to expel and causes fissure, bleeding and soreness; chronic diarrhoea with burning in anus during the passage; constrictive cramp in the stomach in the evening with a feeling of coldness in the back and stomach; pressure in the pit of the stomach, with sensitiveness to touch; sensation as if a foreign body were sticking in the orifice of the stomach; pinching pain in the right side of the abdomen; worse lying on left side
Phosphorus	Weak and all gone sensation in the whole abdomen; desire for stool whenever lies on left side; chronic diarrhoea, painless, worse in hot weather; stools involuntary, undigested, fetid or containing particles like grains of tallow; great weakness after stool
Sulphur	Dysentery subacute, persistent with burning and tenesmus; diarrhoea generally thin, watery, sometimes with mucous,  undigested and generally very fetid, worse in the early morning in bed with the necessity of urgent and frequently, without pain; persons having chronic diarrhoea with aversion to meat, tendency to stupor, with cold sweat; disagreeable odour of the body, with aversion to washing; habitual constipation, especially when the rectum is irritable and dry; frequent ineffectual desire for stool in the rectum with burning in the anus
Veratrum album	Diarrhoea from eating fruits at night associated with terrible colic; stools very profuse and watery, sometimes blackish, followed by great emptiness and weakness in the abdomen; evacuation are often accompanied by violent vomiting

 

References:

[1] Talley NJ, Zinsmeister AR, Van Dyke C, Melton LJ 3rd. Epidemiology of colonic symptoms and the irritable bowel syndrome. Gastroenterology. 1991;101:927–34.

[2]Emeran A. Mayer, Bruce D. Naliboff, Lin Chang, And Santosh V.Coutinho Stress and the Gastrointestinal Tract

2001. Stress and irritable bowel syndrome Am J PhysiolGastrointest Liver Physiol 280: G519–G524, 2001.

[3] Richard P. MacDermott, Treatment of irritable bowel syndrome in outpatients with inflammatory bowel disease using a food and beverage intolerance, food and beverage avoidance diet, Inflammatory Bowel Diseases, Volume 13, Issue 1, January 2007, Pages 91–96

[4] Ronald L. Koretz, Michael Rotblatt, Complementary and alternative medicine in gastroenterology: The good, the bad, and the ugly, American Gastroenterological Association. Published by Elsevier Inc.November 2004Volume 2, Issue 11, Pages 957–967

[5] Emily J.Peckham, ClareRelton, Jackie Raw, ClareWalters, Kate Thomas, Christine Smith, KapiKapur, Elmuhtady Said.Interim results of a randomised controlled trial of homeopathic treatment for irritable bowel syndrome, Homeopathy. Volume 103, Issue 3, July 2014, Pages 172-177

[6]R.T.Mathie, T.W.Robinson, Outcomes from homeopathic prescribing in medical practice: A prospective, research-targeted, pilot study, Homeopathy Journal, Volume 95, Issue 4, October 2006, Pages 199-205.

[7] David S. Spence,Elizabeth A. Thompson, S.J. Barron. Homeopathic Treatment for Chronic Disease: A 6-Year, University-Hospital Outpatient Observational Study, The Journal of Alternative and Complementary Medicine.Volume: 11 Issue 5: November 18, 2005

[8]Dr.ParthAphale, Dr.AtulRajgurav, To Study the Efficacy of Homeopathy in Management of Irritable Bowel Syndrome (IBS), Saudi Journal of Medical and Pharmaceutical Sciences, Scholars Middle East Publishers, Dubai, United Arab Emirates.

[9]H.Roniger, Tunbridge Wells Homeopathic Hospital outcome study, European Journal of Integrative Medicine, Volume 1, Supplement 1, November 2008, Page 40

[10] W. Boericke, New Manual of Homeopathic Materia Medica& Repertory [with Relationship of Remedies], Second Re-Augmented & Revised Edition Based on Ninth Edition, Reprint Edition 2002, B. Jain Publishers, New Delhi.