Management of Traditional Chinese Medicine on IBS
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Folk remedies, self-medicating, and
CAM around the world
- Management of Traditional
Chinese Medicine on IBS
Meiyun Ke, M.D, Wei Wei*, M.D.Ph.D
Dept. of Gastroenterology, Peking Union Medical College Hospital;
Wang Jing Hospital，Chinese Academy of Chinese Medicine Sciences*，
Beijing, China
What is IBS from TCM view Management of TCM on IBS - eight principles - how response of TCM on IBS
What is IBS from TCM View
IBS belongs to category of diarrhea, constipation,
abdominal pain, melancholia in TCM
Pathogenesis of IBS is associated
with the imbalance of Yin & Yang
Yang
(negative & positive, ) in five Yin
organs ( heart, lung, liver, spleen,
kidney, )
- Symptoms Subtype
- Tongue coating
”Treatment based on
- Pulse condition
syndrome differentiation”Eight Principle is a Key
for treatment based on syndrome differentiation
Eight Principle Pattern Identification
- Exterior & interior
- Cold & heat
- Deficiency & excess
- Yin & YangSix Subtypes of IBS
According to Syndrome of Differentiation
1. gut deficiency
- spleen symptoms with dampness encumbrance
2. extra-gut
- liver qi depressionsymptoms
with spleen deficiency
emotion
3. - spleen and kidney Yang deficiency
4. - dampness-heat in the spleen
5.
tongue
- liver coating
depression with qi stagnation
6. pulses
- large condition
intestine heat bind
Diagnosis consensus of IBS. J of Trad Chi Med and Pharmacy, 2010Eight Principle is a Key
for treatment based on syndrome differentiation
- Exterior & interior
- Cold & heat
- Deficiency & excess
- Yin & Yang
- Interior syndrome
IBS - Cold and heat are the basic state of disease
- Deficiency and excess are the basic reactions
- Yin and Yang is the general guiding principleDeficiency Pattern ( ) Affected by insufficient qi, leading various weak syndromes Symptoms - abdominal discomfort，diarrhea - preferring warm and press - fatigue, cold extremities, lumbar debility Tongue Pulse pale enlarged & teeth-marked vacuous-weak white-slippery or white-slimy fur or sunken-fine
Deficiency Pattern ( ) Treatment strategy: - to fortify the spleen - to replenish qi or - to warm both spleen and kidney To choose: - shenlingbaizu pulvis ( ) - fuzilizhong decoction ( ) - sishen pills ( )
Excess Pattern ( ) Affected by external evil, or disorders of Yin & Yang, qi & blood, as yang, heat, sluggish, closed, etc Symptoms - abdominal pain - lumpy stool with straining during defecation - or loose stool with urgent diarrhea Tongue: Pulse: red slippery or yellow dry or slimy fur slippery-rapid
Excess Pattern ( ) Treatment strategy - to purge heat loosening bowel - to relieve constipation To choose - maziren pills ( ) - gegenqinlian decoction ( )
What is IBS from TCM view Management of TCM on IBS - eight principles - how response of TCM on IBS
A systematic review
Effectiveness and Safety of Herbal Medicines
(HM) in the Treatment of IBS
Methods
- A computer-based & manual literature search
- To review randomized controlled trials of HM
treatment of IBS
J Shi, et al. World J Gastroenterol, 2008Results-1
A total of 22 studies met the inclusion criteria
with 1279 patients and 763 controls
4 studies were of good quality
J Shi, et al. World J Gastroenterol, 2008Results-2
Global improvement of IBS symptoms
8 reports using 9 HMs
Efficacious in IBS-D
4 studies with 3 HMs
Improvement in IBS-C
2 studies with 2 HMs
J Shi, et al. World J Gastroenterol, 2008Results-3
Adverse events
Out of a total of 1279 patients,
15 in 47 subjects were reported with HM
Low incidence of the adverse events
(2.97%, 95% CI: 2.04%-3.90%)
No serious adverse events or
abnormal laboratory tests
J Shi, et al. World J Gastroenterol, 2008Comparison of HM and Placebo on IBS
- Global improvement of IBS symptoms
Favours placebo Favours HM
Jun Shi, World J Gastroenterol 2008Comparison of HM and CM on IBS
- Global improvement of IBS symptoms
Favours CM Favours HM
Jun Shi, World J Gastroenterol 2008Comparison of HM & CM on IBS-D
- Global improvement of IBS-D symptoms
Favours CM Favours HMHM on IBS-C
Global improvement of IBS-C symptoms
Favours placebo Favours HM
Favours CM Favours HMTreatment of IBS with HM
BSS Placebo
scores n=35
at the baseline
Individualized n=38 Standard n=43
- comparable
16 wks of treatment
- BSS score in both treatment groups (P = 0.03)
Follow-up 14 wks
- the individualized CHM group maintained
improvement
Evaluated by herbalist & gastroenterologist
All blinded to each group
Bensoussan A, et al, JAMA, 1998TCM on IBS in Chinese Publication
Total papers in Chinese 1155
Controlled study 310
Well designed study 6
Zhou LK, Wei wei et al, 2008Efficiency of TCM on IBS
- published papers in Chinese
Yi
Ke MY, et al, APDW, 2008TXNG in Treatment of IBS-D
- a randomized double blind placebo controlled multicenter study
IBS-D (Rome III, subtype of “stagnation of the Gan
(liver) Qi attacking the spleen”
N=480,
FAS:Tongxiening Granule (n=329) or placebo (n=113)
PP:Tongxiening Granule (n=320) or placebo (n=108)
Dosage 5g tid, for 3ws
Both diarrhea and abdominal pain scores
significantly decreased compared to placebo group
No obvious AE
Coorperative group of Tongxiening granule. Chin J Dig 2010TCM over CM on IBS-D
a randomized controlled multi-center trial
Rome III and subtype
CHM CM
4 herbal formulas or CM
n=180 n=184
Characteristic
Age ys 41.7±11 41.0±12.5
M/F 103/77 94/86
4.61±4.97 5.05±5.64
Disease course (year)
TSS score
Baseline 267.4±57.8 246.2±71.3
n=180 n=180
* *
2w treatment 180.7±59.0 * 177.1±70.7 *
n=173 n=172
4w treatment 95.8±55.4 ##
124.6±68.5
n=173 n=172
CM=Pinaverium, Vs baseline, *:pConclusion TCM formula has certain advantage under the guidance theory of “treatment based on syndrome differentiation” TCM is safe TCM mainly focuses on adjustment of gut function, balance between Yin & Yang, at multiple targets, multi-level Needs to be further studied
Acknowledgements Dr. Wei wei Dr. Kok-Ann Gwee Dr. Zhou Likun Dr. Zhao wei Dr. Chen Zhimin Dr. Su Jiang Dr. Su Xiaolan Dr. Liu Wei Dr. Zhang jing
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