| Objective1. This study using Jianpi and Shugan, soothing the liver and invigora ting the spleen intervention of traditional Chinese medicine syndrome of stagnation of liver qi and spleen deficiency diarrhea type irritable bowe 1 syndrome (IBS-D) patients, before treatment and after treatment the cli nical curative effect observation, to analyze the function of "ganzhushux ie" dysfunction of liver stagnation and spleen deficiency diarrhea predom inant IBS, irritable bowel syndrome and to provide clinical basis for mor e. Correlation between cortical treatment intervention of traditional Chin ese medicine.2.Using the method of strengthening spleen and soothing liver, soothi ng liver and invigorating spleen method of liver stagnation and spleen de ficiency diarrhea type irritable bowel syndrome (IBS) were observed befor e and after treatment the serum 5-hydroxytryptamine (5-HT), neuropeptide Y (NPY) and homocysteine (HCY) and adrenal cortex hormone releasing hormo ne (CRH), adrenocorticotropic hormone (ACTH) and glucocorticoid hormone (GC) level changes, to explore traditional Chinese medicine intervention on brain gut axis six indicators of the impact and efficacy and brain gut peptide for further mining of traditional Chinese medicine "liver contro lling dispersion function disorders and physical and chemical indicators provide research foundation.MethodsThe randomized, controlled, double blind research method, takes place during the period October April 2014 to 2015 in the First Affiliated Hos pital of Guangzhou University of traditional Chinese medicine inpatient, outpatient department of patients as the research object collected 120 ca ses with liver stagnation and spleen deficiency diarrhea type irritable b owel syndrome diagnostic criteria and inclusion criteria and signed infor med consent book were included in the study.120 cases of patients were r andomly divided into four groups, including prescription group 30 cases, Shugan decoction group 30 cases, Shugan Jianpi Decoction group (30 cases) and placebo 30 cases. By the research group of experts to make evaluatio n of the efficacy of the scale and standard, a total of five scales, resp ectively for irritable bowel syndrome symptoms questionnaire, the Bristol stool scale, IBS severity score, diarrhea disease (diarrhea type irritab le bowel syndrome) doctors reported outcome scale and TCM syndrome score table. Intervention treatment for 4 weeks, the study physicians and patie nts respectively in the before treatment, after filling in case report ta ble (CRF-Case report form) and observed before and after treatment of fou r groups of patients scale score distribution and to evaluate the clinica 1 efficacy, to analyze the function of "ganzhushuxie" dysfunction of live r stagnation and spleen deficiency diarrhea predominant IBS.Detection of four groups of patients before treatment and after treat ment the serum of 5-hydroxytryptamine (5-HT), neuropeptide Y (NPY) and ho mocysteine (Hey) and promote adrenal cortical hormone is (ACTH), promote adrenal cortical hormone releasing hormone (CRH) and glucocorticoid (GC) a total of six indexes were observed changes in indicators of the level o f patients before treatment and after treatment, to explore the relations hip between traditional Chinese medicine intervention on the brain gut ax is 6 index and its therapeutic effect and brain gut peptide.To establish a database, using SPSS Statisticsl9.0 statistics softwar e to carry on the analysis, measurement data to do first is the normality test, using the Shapiro Wilk test, in line with the positive state of me asurement data with single factor variance analysis to mean soil standard deviation (x±s) said:the homogeneity of variance test for Levene’s t est, variance homogeneous measurement data with the F test was used to co mpare the overall mean with SNK test pairwise comparison of mean variance homogeneous measurement data and non normal measurement data with a non parametric test to R (P25, P50, P75) said:with the Kruskal Wall is test was used to compare the overall average rank and Mann Whitney test for pairwi se comparison the average rank. Count data with non parametric test:the Kruskal-Wallis test is compared with the overall average rank, using Mann-Whitney test to compare the average rank between the two two groups. Are consistent with the measurement data of normal distribution and the line ar trend of correlation analysis with Pearson correlation analysis; do no t meet is normal distribution and linear trend of measurement data and co unt data correlation analysis was carried out by Spearman correlation ana lysis. Test level check 0.05 P≤0.05 for differences have statistical s ignificance, non parameter test group pairwise comparison by Bonferroni a djustment test level=0.05/the number of compare.Results1. The patient’s gender, age, height, body mass index (BMI), weight, disease severity, place of residence, cases, national distribution, marit al status, occupation, education, personal income, physical activity inte nsity, vital signs, to induce the disease aggravating factors such as hav e comparable (P>0.05).2. Main outcome measures:irritable bowel syndrome symptoms questionn aire items abdominal pain to ease the comparison, four groups of patients before treatment with ratio (P>0.05); compared before and after treatmen t in three groups, there were statistically significant (P<0.05); after t reatment among the four groups has statistical significance (P<0.05), com pared with the placebo group, soothing liver and invigorating spleen grou p had statistical significance (P<0.0083); compared with spleen and sooth ing liver group, soothing liver and invigorating spleen group no statisti cal significance (P>0.0083); compared with the group of soothing the live r, soothing liver and invigorating spleen group no statistical significan ce (P>0.0083). Irritable bowel syndrome symptoms questionnaire items dia rrhea to ease the comparison, four groups of patients before treatment wi th ratio (P>0.05); compared before and after treatment in three groups, t here were statistically significant (P<0.05); after treatment among the f our groups has statistical significance (P<0.05), compared with the place bo group, soothing liver and invigorating spleen group had statistical si gnificance (P<0.0083); compared with spleen and soothing liver group, soo thing liver and invigorating spleen group no statistical significance (P> 0.0083); compared with the group of soothing the liver, soothing liver an d invigorating spleen group no statistical significance (P>0.0083). Brist ol stool traits of the four groups of patients before treatment with comp arability (P>0.05); compared with each group before and after treatment, there was statistical significance (P<0.05); after treatment, there was n o statistical significance between the four groups (P>0.05).3. The main secondary outcome measures:irritable bowel syndrome seve rity score comparison, four groups of patients before treatment were comp arable (P>0.05); group comparison before and after treatment were statist ically significant (P<0.05.) After treatment among the four groups was st atistically significant (P<0.05), compared with the placebo group, soothi ng liver and invigorating spleen group have statistical significance (P<0. 0083), compared with in the group of invigorating the spleen, soothing li ver and invigorating spleen group have statistical significance (P>0.008 3); compared with the group of soothing the liver, soothing liver and inv igorating spleen group no statistical significance (P>0.0083). Diarrhea d isease (diarrhea type irritable bowel syndrome) doctors reported outcome scores compared four groups of patients before treatment with ratio (P>0. 05); compared before and after treatment in each group and the placebo gr oup no statistical significance (P>0.05). In the group of invigorating th e spleen, soothing liver group, Shugan Jianpi group had statistical learn ing significance (P<0.05). Compared with the traditional Chinese medicine syndrome, the four groups of patients before treatment with comparabilit y (P>0.05). Diarrhea disease (diarrhea type irritable bowel syndrome) doc tors reported outcome scale score and TCM syndrome curative effect of the treatment between groups comparisons were statistically significant (P<0. 05), compared with the placebo group, in the group of invigorating the sp leen, soothing liver group and Shugan Jianpi group had statistical signif icance (P<0.0083), compared with in the group of invigorating the spleen, soothing liver group, soothing liver and invigorating spleen group no st atistical significance (P>0.0083); compared with the group of soothing th e liver, soothing liver and invigorating spleen group no statistical sign ificance (P>0.0083). Entry abdominal pain score, abdominal distention sco re; abdominal pain frequency, impact of abdominal pain, diarrhea frequenc y, defecation unhappy, pain and diarrhea, vector gas; thin stool pond, ir ritable anxious, mental fatigue were 11 items after treatment among the f our groups compared with statistical significance (P<0.05).4. Neuroendocrine index:four groups of patients 6 nerve endocrine in dexes before treatment with ratio (P>0.05). After treatment, the patients in the four groups of 5-HT compared with statistical significance (P<0.0 5); before and after the treatment group 5-HT compared with the placebo g roup, soothing liver and invigorating spleen group after treatment than b efore treatment decreased, but were statistically significant (P>0.05), i n the group of invigorating the spleen and soothing liver group after tre atment did not decline. After treatment, the patients in the four groups of NPY is no statistical significance (P>0.05), before and after the trea tment group NPY, soothing liver and invigorating spleen group treatment t han before treatment increased, had no statistical significance (P>0.05), in the group of invigorating the spleen and soothing liver group after t reatment did not rise. After treatment, the patients in the four groups o f Hey no statistical significance (P>0.05), soothing liver group, soothin g liver and invigorating spleen group treatment than before treatment dec reased, there was a statistical significance (P<0.05), in the placebo gro up, the group of invigorating the spleen treatment than before treatment decreased, but no statistical significance (P>0.05). After treatment, the patients in the four groups of CRH is no statistical significance (P>0.0 5); compared before and after treatment in three groups and in the placeb o group, in the group of invigorating the spleen and soothing liver group, soothing liver and invigorating spleen group treatment than before treat ment decreased and had no statistical significance (P>0.05). After treatm ent, the patients in the four groups of ACTH was statistically significan t (P<0.05); treatment group before and after ACTH compared placebo group, in the group of invigorating the spleen, invigorating spleen and soothin g liver group treatment than before treatment decreased, but there was no statistical significance (P>0.05), soothing liver group after treatment did not decrease. After treatment, the patients in the four groups of GC is no statistical significance (P>0.05); compared before and after the tr eatment group, placebo group, in the group of invigorating the spleen and soothing liver group, Shugan Jianpi group after treatment did not decrea se.5. Correlation effect and neuroendocrine index:correlation analysis between before and after treatment before and after treatment in the plac ebo group, the curative effect and 5-HT NPY, HCY, CRH, ACTH, GC, IBS and 5-HT scores before and after treatment, NPY, HCY, CRH, ACTH, the differen ce between the positive correlation between before and after the treatmen t of GC the difference is negative correlation, but no statistical signif icance (P>0.05); before and after treatment with 5-HT, NPY, diarrhea scor e HCY, GC difference between the positive correlation between CRH and ACT H before and after treatment, the difference is negative correlation, but no statistical significance (P>0.05); abdominal pain relief and CRH befo re and after treatment the difference positive correlation between, there was statistical significance (P<0.05); abdominal pain before and after t reatment, NPY and HCY, ACTH, GC of the difference between the positive co rrelation between 5-HT and ACTH before and after treatment, the differenc e is negative correlation, but no statistical Significance (P>0.05); diar rhea remission and NPY before and after treatment the difference between the positive correlation was statistically significant (P<0.05); diarrhea remission and before and after the treatment of 5-HT and GC difference b etween the positive correlation between NPY and HCY before and after trea tment, CRH, ACTH difference was negatively correlated, but there was no s tatistically significant (P>0.05); before and after the treatment of stoo 1 and HCY, CRH, GC, the difference between the positive correlation betwe en before and after treatment 5-HT, NPY, ACTH, the difference is negative, but had no statistical significance (P>0.05); treatment of syndrome cura tive effect with 5-HT, NPY and HCY before and after the difference betwee n the positive correlation between before and after ACTH treatment and th e difference is negative correlation, but no statistical significance (P> 0.05), and no correlation between before and after treatment, the differe nee of GC CRH (r=0.000).The correlation analysis of difference before and after treatment bef ore and after treatment the curative effect of invigorating spleen group and 5-HT, NPY, HCY, CRH, ACTH, GC, IBS and NPY scores before and after tr eatment, the difference between HCY positive correlation was statisticall y significant(P<0.05); and ACTH before and after treatment the differenc e between the positive correlation between before and after treatment 5-H T, CRH, GC, the difference is negative, but not statistically significant (P>0.05) between before and after the treatment of diarrhea; as the diff erence between total and 5-HT negative correlation was statistically sign ificant (P<0.05); and NPY, HCY, ACTH before and after treatment, the diff erence between the positive correlation between GC and CRH before and aft er treatment, the difference is negative correlation, but no statistical significance (P>0.05); and HCY before and after the treatment of abdomina 1 pain as the difference between the positive correlation was statistical ly significant (P<0.05); between before and after the treatment of abdomi nal pain NPY difference is positive correlation, and between before and after the treatment of CRH, ACTH, GC difference was negatively correlated, but there was no statistically significant (P>0.05), and no correlation between before and after the treatment of 5-HT (r=0.000); the difference of ACTH before and after treatment of diarrhea remission and the differen ce between the positive correlation was statistically significant (P<0.0 5); diarrhea relief and 5-HT before and after treatment the difference be tween the positive correlation between NPY, HCY and CRH before and after treatment, the difference of GC is negatively related, but had no statist ical significance (P>0.05); before and after the treatment of stool and 5-HT, HCY, CRH, the difference between the positive correlation between be fore and after the treatment of NPY difference is negative correlation, b ut there were no significant meaning (P>0.05) before and after treatment, ACTH, GC and stool difference (r=0.000); there was no correlation betwee n before and after the treatment of 5-HT syndrome curative effect and the difference between the positive correlation was statistically significan t (P<0.05 (the difference between, HCY, CRH, ACTH,, GC and NPY before and after treatment was negatively correlated, but there was no statistical significance (P>0.05).The correlation analysis of difference before and after treatment the curative effect of Shugan group and 5-HT, NPY, HCY, CRH, ACTH, GC treatm ent, IBS scores before and after treatment with 5-HT, HCY, CRH, the diffe rence between the positive correlation was significant between before and after treatment (P<0.05); the total score of IBS and NPY, the difference was negatively related to ACTH, have statistical significance (P<0.05); the total score of IBS and GC before and after treatment the difference b etween the positive correlation, but no statistical significance (P>0.05); before and after treatment with 5-HT, HCY, diarrhea score of GC was posi tively correlated with the difference between before and after treatment, NPY, CRH, ACTH, the difference between the negative correlation, but no statistical significance (P>0.05); abdominal pain before and after CRH tr eatment the difference between the positive correlation was statistically significant (P<0.05); abdominal pain before and after treatment of NPY, HCY and GC, the difference between the positive correlation with 5-HT and ACTH Before and after the treatment, the difference between before and a fter treatment, the difference between before and after treatment, the di fference between before and after treatment, the difference between befor e and after treatment, the difference between before and after treatment, the difference between before and after treatment between the negative c orrelation, but there was no statistical significance (P>0.05); diarrhea relief and 5-HT, Hcy, CRH, GC is positive correlation with NPY, ACTH is n egative correlation, but there was no statistical significance (P>0.05); stool and NPY, Hcy, ACTH and GC is positively correlated with 5-HT, CRH i s negative correlation, but there was no statistical significance (P>0.0 5); syndrome efficacy and NPY, Hcy, CRH is positively correlated with 5-H T, ACTH and GC difference between negative correlation, but there was no statistical significance (P>0.05).The correlation analysis of difference before and after treatment of Shuganjianpi group efficacy and 5-HT, NPY, HCY, CRH, ACTH, GC treatment, IBS scores before and after treatment with HCY, ACTH, GC, the difference between the positive correlation between 5-HT, NPY and CRH before and aft er treatment the difference was negatively correlated, but there was no s tatistically significant (P>0.05); between before and after the diarrhea score and with CRH, ACTH, GC of the treatment difference was statisticall y significant negative correlation (P<0.05) between before and after the treatment of NPY; and the difference was negatively correlated with 5-HT and HCY before and after treatment the difference between the positive co rrelation, but no statistical significance (P>0.05); abdominal pain befor e and after the treatment of NPY, CRH, GC, the difference between the pos itive correlation between 5-HT, HCY and ACTH before and after treatment t he difference was negatively correlated, but had no statistical significa nce (P>0.05); diarrhea relief and treatment of 5-HT and NPY before and af ter the difference Difference before and after treatment with; no, Hcy wa s positively correlated with Hcy, CRH, ACTH and GC before and after treat ment, the difference between the negative correlation, but there was no s tatistical significance (P>0.05); stool and ACTH before and after treatme nt the difference between positive correlation with 5-HT and NPY and CRH before and after treatment, the difference between the negative correlati on, but there was no statistical significance (P>0.05); stool with GC tre atment before and after difference between (r=0.000 syndromes efficacy of GC treatment before and after difference between positive correlation wi th 5-HT and NPY, Hcy, CRH, ACTH is negative correlation, but there were n o statistical significant (P>0.05).Conclusion1. Patient gender, age, height, body mass index (BMI), weight, disease severity, place of residence, cases, national distribution, marital stat us, occupation, education, personal income, physical activity intensity, vital signs, to induce the disease aggravating factors such as have compa rability. The number of patients with a low intensity of physical activit y was higher in patients with more than in urban areas and rural areas.2. The clinical effective outcome measures:single and invigorating t he spleen can significantly relieve and liver alleviates not obvious entr y:diarrhea irritable bowel syndrome) doctors reported outcome scale of p ain influence, abdominal distension and frequency, the frequency of diarr hea; TCM symptom score table irritable anxious, these symptoms may is mor e closely related with spleen, so by the method of invigorating the splee n, relieve symptoms is obvious. Single liver method can be significantly reduced, and single with Shugan alleviates not obvious entries have:irri table bowel syndrome in severe degree score scale abdominal pain score; d iarrhea irritable bowel syndrome) doctors reported outcome scale of abdom inal pain continued time, defecation unhappy, vector gas; TCM symptom sco re scale loss of appetite, mental fatigue, dry mouth, thirst without desi re to drink, these symptoms may is more closely related with liver, so th rough the method of soothing the liver and relieve symptoms more obvious. Single and invigorating the spleen, Shugan symptoms ease as effect of th e method of soothing the liver and strengthening the spleen significant i tems:irritable bowel syndrome, the main symptoms were abdominal pain and diarrhea relieving, irritable bowel syndrome serious degree Rating Scale score, severity of abdominal distention score, pain duration score; diar rhea irritable bowel syndrome) doctors reported outcome scale the frequen cy of abdominal pain, pain diarrhea; TCM symptom scoring table stool thin stools, abdominal pain or discomfort, these symptoms may be related to 1 iver and spleen were more closely, so through the method of soothing the liver and invigorating the spleen, symptom relief effect more obvious. "G anzhushuxie" function disorder and is closely related to the relationship between IBS and through the method of soothing the liver and can signifi cantly improve the stagnation of liver Qi with deficiency of the spleen o f IBS-D patients abdominal pain, bloating, bowel unhappy, vector gas, app etite loss, mental fatigue, dry mouth, thirst without desire to drink and other symptoms. Abdominal pain and diarrhea irritable bowel syndrome) do ctors reported outcome scale effect, abdominal distension and frequency, the frequency of diarrhea; TCM symptom score table irritable anxious thes e symptoms may is more closely related with spleen. Thus, traditional Chi nese medicine for treatment of IBS patients have a certain role, however, to want to further understand the serious impact on the quality of life of patients with psychosomatic disease, achieve better alleviate the pati ent’s symptoms and improve the life quality of the patients still need fu rther clinical studies to validate.3.Neuroendocrine index:through the method of soothing the liver and invigorating the spleen, reducing the possibility of liver stagnation and spleen deficiency type of IBS-D patients serum 5-HT levels, but in the g roup of invigorating the spleen, Shugan group method can not make the dec rease of 5-HT. Through the method of soothing the liver and invigorating the spleen, stagnation of liver Qi with deficiency of the spleen of IBS-D patients serum NPY levels may be increased, but in the group of invigora ting the spleen and soothing liver group method cannot be made NPY increa sed. Through the method of soothing liver and invigorating spleen and soo thing liver, there was a significant decrease in the liver stagnation and spleen deficiency type of IBS-D patients serum Hcy levels may, but with the spleen method does not reduce Hcy effect is not significant. Through the method of soothing liver and invigorating spleen and soothing liver, reducing the level of liver stagnation and spleen deficiency type of IBS- D patients serum CRH, but spleen method cannot decrease CRH. By the metho d of invigorating spleen and soothing liver and invigorating spleen, may reduce liver stagnation and spleen deficiency type of IBS-D patients seru m ACTH level, but liver method cannot ACTH decreased. Through the method of invigorating the spleen, liver, liver and spleen, may not be able to r educe the serum GC level of liver stagnation and spleen deficiency type Ⅰ BS-D. Therefore by using the method of spleen, liver, soothing liver and invigorating spleen could be in serum of patients with brain gut peptide levels produced certain influence, including 5-HT and NPY may with the li ver and spleen were related, Hcy, CRH may be more closely associated with liver and the relationship of ACTH may relationship with spleen more clo sely, using method of invigorating spleen and soothing liver and invigora ting spleen and soothing liver may not be able to reduce the level of liv er stagnation and spleen deficiency diarrhea predominant IBS patients ser um GC. Thus can be inferred from the theory of liver treatment of liver s tagnation and spleen deficiency IBS-D mechanism may be related to regulat ing gastrointestinal motility and improve visceral hypersensitivity, impr oving the state of emotional stress and other factors.4. Efficacy and neuroendocrine index correlation:the use of the metho d of soothing the liver, soothing the liver and invigorating the spleen, not only can improve the curative effect of patients with diarrhea diseas e score, and reducing the levels of 5-HT in serum; by the method of invig orating the spleen and soothe the liver, soothing the liver and invigorat ing the spleen can relieve diarrhea, and a decrease in levels of 5-HT in serum. NPY can inhibit the movement of gastrointestinal tract and the sec retion of water and electrolyte, thereby reducing the occurrence of diarr hea. Use and invigorating the spleen intervention, can improve the patien ts with diarrhea remission and efficacy of stool of curative effect and s yndrome score, serum NPY levels may be elevated; use of liver interventio n can improve patients with diarrhea relief, efficacy of IBS scores and d iarrhea score, elevated serum levels of NPY; use of the method of soothin g the liver and strengthening the spleen can improve the patient’s stool ease, efficacy of IBS scores, diarrhea disease score, syndrome score, and may elevated serum levels of NPY. Using invigorating spleen and soothing liver intervention. IBS-D patients of liver Qi Stagnation with spleen de ficiency type diarrhea disease score improved, serum Hcy decreased; by th e method of invigorating the spleen and by soothing the liver, soothing t he liver and invigorating the spleen intervention IBS-D patients of liver Qi Stagnation with spleen deficiency type IBS scores improved) and low s erum Hcy may drop. Through the spleen, liver method not only can improve the patients’ IBS score, and a decrease in serum CRH levels may. By Jianp i and Shugan Jianpi method not only can improve the efficacy of patients with irritable bowel syndrome (IBS) total score, but also reduce the seru m ACTH level. Through the method of soothing the liver, soothing the live r and invigorating the spleen, in improvement of patients with abdominal pain and efficacy of IBS scores at the same time, may reduce the GC level in serum. Therefore, the use of Jianpi and Shugan, soothing the liver an d invigorating the spleen, can adjust the state of "ganzhushuxie" dysfunc tion, improve the clinical symptoms of liver stagnation and spleen defici ency diarrhea predominant IBS patients at the same time, can also have a certain impact on the brain gut axis, but more exact results need to be f urther testing to verify. |
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