Digestive & Gut Health | Dr. Cai Chun (TCM Gastroenterology) | CMCS Shanghai

About Dr. Cai Chun

Dr. Cai Chun is Chief Physician in TCM Gastroenterology at Shuguang Hospital, affiliated with Shanghai University of Traditional Chinese Medicine — one of China's foremost centres for integrative digestive medicine and a national reference institution for the TCM management of functional gastrointestinal disorders, inflammatory bowel disease, and gut microbiome dysregulation. He is recognised for his expertise in treating irritable bowel syndrome, chronic gastritis, and inflammatory bowel disease through individualised herbal prescription and dietary therapy, with a defining commitment to integrating modern gut microbiome science into classical TCM gastroenterology practice. Dr. Cai's clinical philosophy holds that functional gastrointestinal disorders cannot be resolved by symptom suppression alone — the underlying pattern of organ dysfunction, the quality of the intestinal environment, and the patient's emotional and lifestyle context must all be addressed simultaneously, because IBS is not a disease of the bowel in isolation but a disorder of the entire Liver-Spleen-Intestine axis, in which emotional dysregulation, dietary injury, and microbial imbalance interact to perpetuate the symptom cycle. His department at Shuguang Hospital has established one of Shanghai's most comprehensive integrative gut health programmes, combining classical herbal prescription, dietary therapy, lifestyle modification, and gut microbiome assessment into a unified care pathway for patients with chronic functional gastrointestinal disorders.

Case Overview

Mr. Thomas Reid (pseudonym), a 35-year-old British office worker based in Shanghai, presented with a two-year history of recurrent abdominal pain, bloating, and alternating diarrhoea and constipation, significantly worsened over the preceding three months. Colonoscopy excluded organic pathology. Metagenomic sequencing confirmed gut microbiome dysbiosis — reduced Bifidobacterium and Lactobacillus with increased opportunistic pathogens. TCM diagnosis identified Liver Qi Stagnation with Spleen Deficiency. Dr. Cai Chun designed a comprehensive integrative programme combining classical herbal prescription (Tongxie Yaofang combined with Shen Ling Baizhu San, modified), individualised dietary therapy with probiotic food integration, and structured lifestyle modification. At three-month follow-up, all symptoms had resolved, gut microbiome reassessment showed significant restoration of beneficial flora, and six-month follow-up confirmed no recurrence.

Patient Background

• Name / Nationality: Mr. Thomas Reid (pseudonym) — British; 35-year-old office worker based in Shanghai
• Age / Sex: 35-year-old male
• Chief Complaint: Recurrent abdominal pain and bloating with alternating diarrhoea and constipation for two years, significantly worsened for three months
• History of present illness: Insidious onset of periumbilical dull aching with bloating two years prior; alternating loose stools (3–5 times daily, unformed, occasionally mucoid) and constipation (hard, infrequent stools); symptoms triggered or worsened by emotional stress and dietary indiscretion. Over the preceding three months, pain frequency increased, bloating worsened, and quality of life and work performance were significantly impaired. Self-administered antidiarrhoeals and laxatives with inadequate effect.
• Past medical history: No hypertension, diabetes, or cardiac disease; no abdominal surgery; no drug allergies
• TCM four examinations:
  • Inspection: Slightly sallow complexion; lean build; reduced vitality; pale red tongue with thin white greasy coating and tooth marks on the lateral borders
  • Auscultation/olfaction: Low voice; calm respiration; no abnormal odour
  • Inquiry: Periumbilical dull aching with preference for warmth and pressure; bloating worsened after meals; reduced appetite and food intake; alternating loose and dry stools with mucus; anxiety-prone; poor sleep with frequent dreaming and waking
  • Palpation: Wiry, thready pulse (弦细脉)

Diagnostic Workup

Stool Examination

• No red or white blood cells; small amount of mucus — no evidence of infection or inflammation

Colonoscopy

• No organic pathology identified; mucosa smooth with clear vascular pattern — structural causes excluded

Gut Microbiome Assessment (Metagenomic Sequencing)

• Reduced abundance of beneficial flora: Bifidobacterium and Lactobacillus species significantly decreased
• Increased abundance of opportunistic pathogens: Escherichia coli and Enterococcus species increased
• Conclusion: gut microbiome dysbiosis confirmed, consistent with IBS pathophysiology

Dr. Cai's pre-treatment assessment: The colonoscopy tells us what this is not — it is not Crohn's disease, it is not ulcerative colitis, it is not colorectal cancer. That is important, but it does not tell us what it is or why it has persisted for two years. The microbiome sequencing is more informative: the beneficial flora are depleted and the opportunistic pathogens are overgrown. That is not a coincidence — it is the biological substrate of the symptom pattern. In TCM, the pulse is wiry and thready — wiry indicates Liver Qi stagnation, thready indicates Spleen deficiency. The tongue confirms it: tooth marks on the lateral borders, greasy coating. This patient's bowel is caught between a Liver that is over-controlling and a Spleen that is too weak to resist. Every episode of emotional stress tightens the Liver Qi, which invades the Spleen, which fails to transform and transport, which produces the alternating diarrhoea and constipation. The microbiome dysbiosis is both a consequence and a perpetuating cause of the Spleen deficiency. We need to address both simultaneously.

TCM Diagnosis and Integrative Treatment Strategy

The TCM diagnosis established by Dr. Cai Chun was Diarrhoea — Liver Qi Stagnation with Spleen Deficiency (法法·肝郁脾虚证). The corresponding Western diagnosis was Irritable Bowel Syndrome, mixed type (alternating diarrhoea and constipation).

The treatment principle was: soothe the Liver and strengthen the Spleen; dry Dampness and arrest diarrhoea; harmonise the Stomach and Intestines (疏肝健脾，燥湿止法，调和肠胃).

Herbal prescription — Tongxie Yaofang combined with Shen Ling Baizhu San, modified: Chao Baizhu (dry-fried Atractylodes) 15g, Baishao 15g, Chenpi 10g, Fangfeng 10g, Dangshen 15g, Fuling 15g, Shanyao 15g, Yiyiren 15g, Sharen 6g (added late), Chao Biandou (dry-fried Hyacinth bean) 15g, Zhi Gancao 6g. One decoction daily, taken warm in two divided doses. Rationale: Tongxie Yaofang (Pain-Diarrhoea Essential Formula) is the classical formula for Liver overacting on Spleen — Baizhu and Baishao together soothe the Liver and strengthen the Spleen; Chenpi regulates Qi and dries Dampness; Fangfeng disperses Liver Wind and arrests diarrhoea. Shen Ling Baizhu San augments the Spleen-strengthening and Dampness-resolving effect, directly addressing the depleted Spleen Qi that underlies the microbiome dysbiosis.

Dietary therapy — individualised plan:

• Staple foods: Millet congee, yam congee, and pumpkin congee as primary staples — easily digestible and Spleen-tonifying
• Vegetables: Fibre-rich vegetables (Chinese cabbage, radish, celery, carrot, shiitake mushroom) cooked soft — no raw consumption; carrot and shiitake selected for additional Spleen-supporting properties
• Fruit: No raw cold fruit; apple and banana steamed before consumption to provide vitamins without intestinal irritation
• Protein: Lean meat and fish as primary protein sources; steamed or braised preparation only — no fried or pan-fried cooking
• Probiotic foods: Yoghurt and fermented soy products incorporated daily to increase beneficial flora abundance and support microbiome restoration
• General principle: Small frequent meals; bland and easily digestible; strict avoidance of spicy, cold, raw, and greasy foods

Lifestyle modification: Emotional regulation through music, walking, and yoga to reduce stress-triggered Liver Qi stagnation; aerobic exercise (jogging, Tai Chi) at least three times weekly, 30 minutes per session, to strengthen constitution and promote intestinal motility; regular sleep schedule with consistent bedtime and wake time, avoiding late nights.

Treatment Course and Outcomes

At Two Weeks

• Abdominal pain and bloating significantly reduced; stool frequency decreased; stool consistency improved; mucus reduced
• Sleep quality improved; emotional stability increased

At One Month

• Abdominal pain and bloating essentially resolved; bowel habit normalised — 1–2 formed stools daily
• Appetite markedly improved; energy and mental state good

At Three Months

• All symptoms fully resolved; quality of life significantly improved
• Gut microbiome reassessment: Bifidobacterium and Lactobacillus abundance significantly increased; E. coli and Enterococcus reduced — microbiome dysbiosis substantially corrected

Six-Month Follow-Up

• No recurrence of IBS symptoms; patient maintaining dietary and lifestyle modifications independently

Dr. Cai's clinical reflection: The microbiome data at three months is the most compelling part of this case, because it provides an objective biological correlate for what the patient was already reporting subjectively. The beneficial flora had recovered, the opportunistic pathogens had receded, and the symptoms had resolved — all three simultaneously. That is not a coincidence. The herbal formula was creating the intestinal environment in which the beneficial flora could re-establish themselves: the Spleen-strengthening herbs were improving the mucosal substrate; the Dampness-resolving herbs were reducing the pathological intestinal environment that favoured the opportunistic pathogens; and the probiotic foods were directly replenishing the depleted beneficial species. TCM did not know about Bifidobacterium in the classical period — but the concept of a healthy Spleen producing a clean, well-nourished intestinal environment, and a weak Spleen producing a damp, stagnant one, maps remarkably well onto what we now understand about the relationship between Spleen Qi, intestinal mucosal integrity, and microbiome composition.

Expert Commentary — Dr. Cai Chun

1. The Liver-Spleen Axis in IBS: Classical Theory and Modern Neurogastroenterology

The TCM concept of Liver overacting on Spleen — 肝木克土 — is one of the most clinically important relationships in classical Chinese medicine, and it maps with remarkable precision onto what modern neurogastroenterology has identified as the gut-brain axis. In TCM, the Liver governs the free flow of Qi throughout the body; when emotional stress causes Liver Qi stagnation, the constrained Liver energy invades the Spleen, disrupting its function of transformation and transportation, and producing the characteristic symptom pattern of IBS: abdominal pain triggered by stress, alternating bowel habit, bloating, and mucoid stools. In modern neurogastroenterology, the same phenomenon is described as dysregulation of the brain-gut axis — psychological stress activates the hypothalamic-pituitary-adrenal axis and the autonomic nervous system, altering intestinal motility, visceral sensitivity, and mucosal permeability through corticotropin-releasing factor and serotonin signalling pathways. The classical formula Tongxie Yaofang — designed specifically for the Liver-overacting-on-Spleen pattern — has been shown in modern pharmacological studies to modulate serotonin receptor expression in the intestinal mucosa, reduce visceral hypersensitivity, and normalise intestinal transit time. The classical and modern frameworks are describing the same pathophysiology in different languages.

2. Gut Microbiome Dysbiosis as a TCM Spleen Deficiency Correlate

The relationship between TCM Spleen deficiency and gut microbiome dysbiosis is one of the most productive areas of current integrative medicine research. Multiple studies using metagenomic sequencing have demonstrated that patients with TCM Spleen deficiency patterns — characterised by fatigue, loose stools, reduced appetite, pale swollen tongue with tooth marks, and weak pulse — consistently show reduced abundance of Bifidobacterium and Lactobacillus species and increased abundance of opportunistic pathogens, compared with healthy controls and with patients whose TCM pattern is classified differently. This is not a coincidence of classification — it reflects a genuine biological relationship. The Spleen in TCM governs the transformation and transportation of food essence and the maintenance of the intestinal environment. When Spleen Qi is deficient, the intestinal mucosal barrier is compromised, secretory IgA production is reduced, and the intestinal environment becomes less hospitable to beneficial flora and more hospitable to opportunistic pathogens. Spleen-strengthening herbal formulae — particularly those containing Baizhu, Fuling, Shanyao, and Yiyiren — have been shown to increase Bifidobacterium and Lactobacillus abundance, improve intestinal mucosal integrity, and reduce intestinal permeability in both animal models and clinical trials. The dietary integration of probiotic foods directly replenishes the depleted beneficial species while the herbal formula restores the intestinal environment in which they can survive and proliferate.

3. Why Lifestyle Modification Is Not Optional in IBS: The Emotional Trigger and the Liver Qi Cycle

In clinical practice, the most common reason for IBS treatment failure — whether TCM or Western — is the failure to address the emotional trigger. IBS is not a purely gastrointestinal disorder; it is a disorder of the gut-brain axis in which psychological stress is both a precipitant and a perpetuating factor. In TCM terms, if the Liver Qi stagnation is not resolved, the herbal formula will provide temporary symptomatic relief but will not break the cycle — because every episode of emotional stress will re-trigger the Liver-overacting-on-Spleen pattern and re-produce the symptoms. The lifestyle modifications prescribed in this case — stress reduction through music, walking, and yoga; regular aerobic exercise; consistent sleep schedule — are not supplementary recommendations. They are the interventions that address the Liver Qi stagnation at its source: the emotional and autonomic dysregulation that drives the gut-brain axis dysfunction. Tai Chi is particularly well-suited to this patient population because it combines physical movement with meditative attention and regulated breathing — simultaneously strengthening the Spleen through exercise and soothing the Liver through the calming of the nervous system. The evidence for Tai Chi in IBS symptom reduction is now supported by multiple randomised controlled trials.

How CMCS Shanghai Coordinated This Case

CMCS Shanghai supported Mr. Reid from initial consultation through six-month follow-up, including: priority appointment coordination with Dr. Cai Chun at Shuguang Hospital with bilingual review of prior investigation records; bilingual interpretation throughout all TCM four-examination consultations, herbal prescription discussions, and dietary therapy planning sessions; coordination of colonoscopy and gut microbiome metagenomic sequencing with bilingual results communication and clinical summary for the patient's GP in the UK; bilingual pharmacy support for herbal decoction preparation and daily dosing instructions; monthly symptom tracking with bilingual progress summaries communicated to the patient's gastroenterologist overseas; three-month gut microbiome reassessment coordination with bilingual comparative results report; and six-month follow-up summary provided to the patient's GP for continuity of care documentation.

For international patients with IBS, chronic functional gastrointestinal disorders, or gut microbiome dysbiosis seeking integrative TCM care in Shanghai, Dr. Cai Chun's team at Shuguang Hospital offers a clinically rigorous, evidence-informed approach — combining classical herbal prescription, dietary therapy, and lifestyle modification to address the Liver-Spleen axis dysfunction and intestinal environment that underlie functional gut disorders. CMCS ensures that expertise is accessible: in the patient's language, with overseas physicians informed at every step, from the first consultation through long-term follow-up.

This case report is de-identified and published for educational purposes. All clinical details have been anonymized in accordance with patient privacy standards. CMCS Shanghai is a medical concierge service and does not provide direct medical care.