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Irritable Bowel Syndrome
~ From the view of Traditional Chinese Medicine ~
(Professor Bian Zhao Xiang, Director, Clinical Division; Hong Kong Baptist University)
Irritable Bowel Syndrome (IBS) is a functional gastrointestinal disorder whose hallmark is abdominal pain or discomfort associated with a change in the consistency or frequency of stools. It is subcategorized into constipation-predominant, diarrhea-predominant and alternating constipation and diarrhea. Although there is no disease directly corresponding to IBS in the theory of traditional Chinese medicine (TCM), IBS can be classified into disease of “abdominal pain”, “bloating”, “diarrhea” and “constipation”.[1,2]
Causes of IBS
The pathophysiology of IBS is incompletely understood, but accumulated clinical and experimental data showed that it is related with brain-gut disorder, involving the interaction between central nervous system, enteric nervous system and autonomic nervous system. Under the influence of psychological factors, such as stress, and the stimulation of food, bowel motility disturbances and visceral hypersensitivity are as resulted. Amazingly, this biopsychosocial model is closed to the classic theory of TCM in etiology.[3]
Based on TCM theory, each Zang Fu (internal organ) has its physiological and pathological mechanisms, although they have the same denomination with conventional medicine. CM theory believes Spleen transforms the digested food by stomach into essences and helps to transport the essences throughout the body. Liver ensures the smooth flow of Qi, modifies the activity of internal organs (Zang Fu), and is highly related to psychological stage, which takes important role in both physiology and pathology in human health. Based on clinical and experimental data, most of TCM experts agree the weakness of Spleen and Stomach is the basic pathogenesis of IBS. Spleen deficiency is one of main inducement of IBS, causing diarrhea, constipation or alternating constipation and diarrhea. Besides, the negative emotions, like anger, depression and frustration, or other psychological factor, like stress, disturb the movement of Qi and lead to stagnant among Liver and Spleen, which also cause a serious of symptom of IBS. Furthermore, holism of TCM indicates that human body is an integrity while human and natural environment (society) is another integrity. The interactions within these two integrities are compatible and significant for making diagnosis.[4]
Herbal Application for IBS
Chinese herbal medicine (CHM) is the most commonly used in clinical practice, although acupuncture, moxibustion and massage have therapeutic effect on IBS as well. Mostly, a compound formula is prescribed by CM practitioner based on the outcome of differentiation of Syndrome, which is a combined effect of herbs. Due to its multi-target reaction, the homeostasis of patient is retained by tonifying the insufficiency, eliminating the excess, reinforcing the vital energy and removing the evil. The principles of treatment of IBS are regulating the Qi movement among Liver and Spleen, and with the assistance from tonifying the Spleen and warming the Kidney, where Kidney Yang is the foundation of Yang of the whole body. ShenLingBaiZhu San and are typical formulae for Syndrome of weakness of Spleen and Stomach while TongXieYaoFang is for Syndrome of Liver stagnant with weakness of Spleen for IBS[2],. Systematic reviews one IBS with Chinese herbal medicines in general[5] and in specific formula[6] showed that these formulae are effective for IBS, but lack of consolidate evidence to show the effectiveness. Demerits in methodology design, control design, quality control of herbs used in clinical trial and reporting quality are mainly factors which damaged the quality of all studies with CHM.[7-8] Further clinical studies following strict guidance of RCT are necessary in this domain to testify the efficacy of CHM on IBS patients.
As the widely use of complementary and alternative medicine around the world, TCM/CHM studies become more and more popular recently. Some research data showed that CHM do have biomedical evidence to show the reason why these herbs and formulae can help the IBS suffers. For IBS, Bai shao (Radix Paeoniae Lactiflorae), as one of components of TongXieYaoFang, which tastes sour and bitter, cold in nature, is used to ease the Liver, extinguish endogenous wind and relieve spasm and pain according to TCM theory. Current pharmacological study proved that its active ingredient, total Glycosides of Paeony, had function on inhabitation of central nervous system, not only with the effect of tranquilizing, but also relieving pain and releasing spasm of smooth muscle.[9] Our study also showed that paeoniflorin can attenuate the visceral hypersensitivity in rats, and such function may be mediated through, at least partially, the serotonin pathway.
Great Advantage of Chinese Treatment for IBS
IBS is a multi-system related disorder, which is almost impossible to establish a standard and unique treatment strategy for all suffers. TCM as specialized in individual treatment and reestablishment of dynamic balance should make contribution to maintain and improve the human health, especially for functional disorder. More rigorous evidence is a definite impetus for development of TCM/CHM, a science from ancient but with modern scene.
Reference:
1陳文莉. 腸易激綜合症(IBS)的中醫治療五法. 山西中醫學院學報, 2005. 6(2):23-24.
2 危北海, 張萬岱, 陳治水. 中西醫結合消化學, 2003. 北京: 人民衛生出版社. 790-840.
3 Ringel Y, Sperber AD, Drossman DA. Irritable bowel syndrome. Annu Rev Med, 2001. 52:319-338.
4 Lu AP, Jia HW, Xiao C. Theory of traditional Chinese medicine and therapeutic method of diseases. World J Gastroenterol. 2004. 10(13):1854-1856.
5．Liu JP. Yang M. Liu YX. Wei ML. Grimsgaard S. Herbal medicines for treatment of irritable bowel syndrome. Cochrane Database of Systematic Reviews. (1):CD004116, 2006.
6.Bian ZX, Wu TX, Liu L, Miao JX, SONG Lisa, Sung Joseph J Y. Effectiveness of the Chinese Herbal Formula TongXieYaoFang for Irritable Bowel Syndrome: a Systematic review. Journal of complementary and alternative medicine, in press.
7. Bian ZX, Li YP, D. Moher, S. Dagenais, Liu L, Wu TX, Miao JX, Kwan Andrew KL, Song Lisa. Improving the quality of randomized controlled trials with Chinese herbal medicine. Part I. Clinical trial design and methodology. Part II. Control group design. Journal of integrative medicine, Journal of integrative medicine, 2006,4, 122-136.
8. Leung Kelvin SY, Bian ZX, D. Moher, S. Dagenais, Li YP, Liu L, Wu TX, Miao JX, Improving the quality of randomized controlled trials with Chinese herbal medicine. Part III: Quality control of Chinese herbal medicine used in RCT; Part Ⅳ. Applying a revised CONSORT checklist to measure reporting quality. Journal of integrative medicine, 2006,4, 225-242,
9.栾好波. 白芍的現代藥理研究與臨床應用. 中醫臨床醫藥研究雜誌 2005. 135:14653-14654.
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