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Wednesday, 24 May 2017

How to treat IBS with Chinese herbal medicine and acupuncture?

Tiejun Tang 


Irritable bowel syndrome (IBS) is a common, chronic disease. IBS occurs in 10-20% of the population in the UK, but prevalence is thought to be higher than this as many people with the disorder do not seek medical advice.[1] If you often have unexplained diarrhoea and /or constipation accompanied by abdominal pain and stressed mood,  you may suffer from IBS, and should contact your GP. IBS diagnosis can be confirmed by exclusion using stools test, blood test and colonoscopy results.


Western medicine usually focuses on the symptoms for IBS patients. Antispasmodics can relieve abdominal pain and cramping and antimotility agents can relieve diarrhoea. Laxatives can relieve constipation and anti-depressants can relieve stressed moods. All of these medicines only can release symptoms temporarily. It is difficult to cure the IBS from the root. Many patients have to live with IBS for many years.

According to the philosophy of traditional Chinese medicine depression and stressed mood was due to liver qi stagnation, and diarrhoea and constipation were due to spleen deficiency. If the diarrhoea were triggered by emotional stimulation, the Chinese medicine diagnosis should be “liver restrict spleen” or “disharmonious between liver and spleen”. The treatment principle for this condition must be dispersing the depressed liver and benefiting the spleen. The basic classic formula is Sini San, a prescription which has more than 1700 years history for diarrhoea treatment. Alternatively we also can use modified Senling Baizhu San and Tongxie YaoFang according to patient’s symptoms for individual cases.

In a pharmacological research to investigate the effects of Sini San and fluoxetine on the levels of central and peripheral 5-HT in a rat model of depression, the result showed that after eight weeks Sini San treatment  appeared at least as effective as fluoxetine. It suggested Sini San can replace fluoxetine in the later stages of depression treatment to minimize side effects of this anti-depressant[2].  In another  report from my ex colleague’s research team, it showed Shenling Baizhu San suppresses colitis associated colorectal cancer through inhibition of epithelial-mesenchymal transition and myeloid-derived suppressor infiltration[3]. Baishaoyao (Paeonia lactiflora Pall) is a common ingredient of these three formulas. In in-vitro and in-vivo studies showed it has a beneficial effect of Anti-inflammatory and immunomodulation[4]. With regard to the pathophysiology of IBS a recent report indicated that low-grade mucosal inflammation and immune activation were involved.[5] Based on thousand years clinical experience of Chinese medicine and modern scientific research, we have enough reasons to try Chinese medicine in IBS treatment.

Acupuncture and moxibustion also have good effect on IBS if a good protocol is selected. Although there is much evidence indicating that acupuncture works well on IBS,[6] unfortunately NICE did not recommend acupuncture in their clinical guidance. Maybe their decision based on different treatment protocols.

The advantage of TCM is to combine herbs and needles. The treatment effect of herbs and acupuncture can enhance each other. Chinese medicines tend to cure the disease from the root and not just control the symptoms.

References:
1.   Guidelines on the Irritable Bowel Syndrome: Mechanisms and Practical Management; British Society of Gastroenterology (May 2007)
2. Li Y. Effects of Sini San used alone and in combination with fluoxetine on central and peripheral 5-HT levels in a rat model of depression. J Tradit Chin Med. 2013 Oct;33(5):674-81.
3. Lin X. Shenling Baizhu San supresses colitis associated colorectal cancer through inhibition of epithelial-mesenchymal transition and myeloid-derived suppressor infiltration.BMC Complement Altern Med. 2015 Apr 22;15:126.
4. He DY. Anti-inflammatory and immunomodulatory effects of paeonia lactiflora pall, a traditional Chinese herbal medicine. Front Pharmacol. 2011 Feb 25;2:10
5.  Holtmann GJ . Pathophysiology of irritable bowel syndrome.Lancet Gastroenterol Hepatol. 2016 Oct;1(2):133-146.
6.  Xiao-Peng Ma. Acupuncture-moxibustion in treating irritable bowel syndrome: How does it work? World J Gastroenterol. 2014 May 28; 20(20): 6044–6054.