| BackgroundChinese medicine in treating with irritable bowel syndrome has accumulated a large amount of clinical experience. Because of its obvious effect, less adverse reaction, low recurrence rate, many clinicians respect it. There are more and more researches of TCM in preventing and treating IBS. About Tongxieyaofang Decoction treating IBS, there are two sides of problems needed to pay attention. One is about the indication. Compare with liver stagnation and spleen deficiency syndrome, whether the therapeutic effect of Tongxieyaofang on other syndromes is different. In addition, whether different of the classifications and individual factors of IBS leads to differences in efficacy. It is expected to achieve indication optimization and improve the curative effect by studying this question. The other is the consistency of efficacy evaluation in clinicians’and patients’point of view. Generally, clinicians think that could get good curative effect if the treatment basing on syndrome differentiation, but that would not really on patients actually. Therefore, it is necessary to carry out the evaluation of curative effect on patients’point of view and especially about long-term effects.ObjectiveFollow up study:To conduct the follow-up study of curative effect on patients’point of view, and in a certain extent, evaluate the actual effect of Tongxieyaofang Decoction in treating IBS objectively.Case-series study:To carry out the clinical observation of using Tongxieyaofang Decoction to treat IBS that embedded "different classifications and individual factors", analysis the overall and individual effect, so as to provide the preliminary basis for the indications optimization of this prescription in treating IBS.Methods Follow up study:retrieval IBS patients from the outpatients system of Guangdong Province Traditional Chinese Medical Hospital, researcher used follow-up questionnaires to record the medication, short-term and long-term effect, induced or exacerbating factors about the patients, and used PASW Statistical18.0software for statistical analysis.Case-series study:the patients who met the inclusion criteria but did not meet the exclusion criteria received the treatment of Tongxieyaofang Decoction. They took the medicine twice a day. The treatment courses were4weeks. At the same time, we took the health propaganda to the patients. We design different classifications and individual factors and make prospective observation, evaluate the curative effect of Tongxieyaofang Decoction in treating IBS, collect patients’data, and establish the database. On the basics of summarizing the curative effect analysis, we analysis the correlation between effect and different syndromes, main symptoms, disease subtypes.Results1. The follow-up study of Tongxieyaofang Decoction in the treatment of irritable bowel syndrome.There were118IBS cases conformed to the inclusion criteria after screening, and83cases accepted the follow-up.In the overall evaluation of curative effect, there were90.36%patients thought it effective.6patients evaluated it invalid.85.96%increased frequency of defecation of patients showed improvement.75.68%patients of abnormal stool forming,63.46%patients of abdominal pain or discomfort could be lightened. There were4cases alleviated among5with abdominal distension.5people in12of defecation paresthesia could be reduced. And4cases in22with bowel could be improved. On the long-term effect,12.2%patients without recurrence,67.07%patients still relapse, but the frequency is reduced, the symptoms such as abdominal pain, diarrhea and quality of life improved.2. Case-series study embedded different classifications and individual factorsThere were13patients involved in this study,4patients withdraw from the study at last. The results were as follow.Overall, the score of IBS symptom severity scale (IBS-SSS) and IBS quality of life scale (IBS-QOL) decreased in different degree after the treatment. 7patients responded to IBS-SSS (53.85%). The responder rate of AR was46.15%(6/13). And2patients responded to IBS-QOL (15.4%). the anxiety subscale score of Hospital Anxiety and Depression Scale (HAD) had no obvious change after treatment. The score of depression subscale decreased slightly.Except to the syndrome of "liver stagnation and spleen deficiency" Tongxieyaofang can also play a good effect on the treatment of "disharmony between liver and spleen" and "damp abundance due to spleen asthenia". It prompts that this prescription can treat other syndromes. Compared to "weakness of the spleen and stomach","stagnation of liver Qi, dysfunction of intestine transition", the curative effect of Tongxieyaofang Decoction showed differences in "liver stagnation and spleen deficiency","disharmony between liver and spleen","damp abundance due to spleen asthenia"In this study, Tongxieyaofang can relieve abdominal distention, reduce defecate frequency, and improve patients’stool obviously. And it has curative effect on suspected constipation-predominant IBS. But it lacked in relieve abdominal pain. So we should adjust the prescription according to the symptom in clinical practice (such as adding Cortex Fraxini, Radix Linderae aggregata, ect).The anxiety state can influence the curative effect of Tongxieyaofang. So we should strengthen psychological counseling or combine with psychological therapy when treating patients with mental disorders.Conclusion1. According to the follow-up study, we found that Tongxieyaofang Decoction had good curative effect in treating IBS. The efficacy evaluation was coincident in both clinicians’ and patients’ point of view. This prescription could improve several IBS symptoms. According to the degree of improvement, these symptoms were defecate frequency, stool forming, abdominal pain or discomfort, abdominal distention and bowel feeling in turn. In long-term, it could reduce the recurrence frequency.2. The result of the clinical observation showed that there were7and6patients responded to IBS-SSS and AR respectively. By anglicizing the correlation between effect and different classifications or individual factors, we knew:besides to syndrome differentiation, curative effect was associated with different "symptoms","mentality", and "disease condition". Tongxieyaofang Decoction in treating IBS showed different effect in different "syndromes","symptoms", and "mentality". This prescription improved diarrhea significantly, but poor in abdominal pain. It prompted that we should modify the formula of the prescription for pain in clinical practice. |
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