Traditional Chinese Medicine Offers New Option for IBS Patients

Tiejun Tang

Today, April 19th, is the World IBS Day. Irritable bowel syndrome (IBS) is a very common gastrointestinal disorder that causes chronic abdominal pain, bloating, diarrhea, and constipation. According to a pooled prevalence analysis of 53 studies that used Rome III criteria from 38 countries and involved 395,385 participants, the prevalence of IBS was 9.2%, with a higher prevalence in women than in men (12.0% vs. 8.6%) ^[1].

In 2017, I wrote an article titled "How to Treat IBS with Chinese Herbal Medicine and Acupuncture?" (click to read the full text). Since then, more research progress has been made on this topic. This paper is an update discussing of the the recent advancements in the treatment of IBS with traditional Chinese medicine.

Although Western medicine has made progress in treating IBS for the past years, there are still some challenges. The National Institute for Health and Care Excellence (NICE) recommends dietary changes, symptomatic treatment, tricyclic antidepressants (TCAs), and psychotherapy for IBS treatment. However, TCAs are associated with reported side effects of up to 15 symptoms, including severe symptoms such as headache, epilepsy, sexual dysfunction, and weight gain. As a result, many IBS patients may have to deal with persistent symptoms or suffer from the side effects of TCAs. ^[2]

According to the basic theory of traditional Chinese medicine, IBS is mainly caused by the imbalance of liver and spleen. Liver qi stagnation and spleen deficiency are the primary pathologies of IBS. This dissonance can lead to digestive dysfunction, which leads to the symptoms of IBS ^[3]. TCM offers a holistic approach to treating IBS by addressing underlying imbalances in the body. Common Chinese treatments for IBS include herbs, acupuncture, and moxibustion can ease the conditions.

Tongxie Yaofang, a traditional formula that originated in the Ming Dynasty of China, is a common formula for treating IBS. A research report showed it can effectively improve intestinal permeability and enhance intestinal mucosal barrier function, which may be related to the inhibition of the inflammatory cascade and the NF-κB and Notch signaling pathways^[4]

Wenshen Jianpi Wan is a patent herbal pill which is based on the traditional formula Si Shen Wan. A laboratory research study showed it can reduce visceral hypersensitivity in IBS-D model rats, possibly by down-regulating TNF-α, p-MEK1/2, p-ERK1 in colon tissue and p-ERK2 expression, it also down-regulated the expressions of p-MEK1/2, p-ERK1, and p-ERK2 in the hippocampus^[5].

Acupuncture is also widely used in the treatment of IBS. A multicenter randomized controlled trial study conducted in 7 hospitals in China showed that acupuncture was more effective than western medicine in treating IBS, and the treatment effect could last up to 12 weeks^[6].

A literature study has analyzed the relevant pathophysiological mechanisms and curative effects of acupuncture in the treatment of diarrhea-predominant irritable bowel syndrome (IBS-D). It was found that acupuncture can regulate brain-gut peptides in IBS-D patients, change brain connections and activities, promote neuroendocrine function and mental state, and reduce inflammation and intestinal allergies^[7].

In conclusion, clinical and experimental research reports showed that both Chinese herbal medicine and acupuncture can improve IBS symptoms through different mechanisms, and the combination of herbs and acupuncture may bring better results. TCM therapy can completely avoid the side effects caused by western medicine and bring significant benefits to IBS patients.

Reference:

1.  Oka P. Global prevalence of irritable bowel syndrome according to Rome III or IV criteria: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2020; 5(10):908-917
2. Pierre M Bet . Side effects of antidepressants during long-term use in a naturalistic setting. Eur Neuropsychopharmacol. 2013; 23(11):1443-51
3.  Cheng-Jiao Yao,. Traditional Chinese medicine for irritable bowel syndrome. Medicine (Baltimore). 2020; 99(48): e23394.
4. Qiuke Hou. Tong-Xie-Yao-Fang improves intestinal permeability in diarrhoea-predominant irritable bowel syndrome rats by inhibiting the NF-κB and notch signalling pathways. BMC Complement Altern Med. 2019; 19: 337
5. Tianyuan Jiang.  Wenshen-Jianpi prescription, a Chinese herbal medicine, improves visceral hypersensitivity in a rat model of IBS-D by regulating the MEK/ERK signal pathway. Front Pharmacol. 2022; 13: 955421
6.  Lixia Pei. Effect of Acupuncture in Patients With Irritable Bowel Syndrome: A Randomized Controlled Trial. Mayo Clin Proc. 2020; 95(8):1671-1683.
7. Gezhi Zhang. Effects and Mechanisms of Acupuncture on Diarrhea-Predominant Irritable Bowel Syndrome: A Systematic Review. Front Neurosci. 2022;16:918701.