| ObjectiveTo summarize Professor Yao Naili’s academic views and clinical experience of the treatment of irritable bowel syndrome with constipation(IBS-C)and the ideas for the diagnosis and treatment of IBS-C in TCM.At the same time,to observe the clinical effect of Professor Yao Naili’s empirical prescription Chaishao Tongfu Decoction in the treatment of liver depression and spleen deficiency IBS-C,so as to provide reference for clinical diagnosis and treatment of IBS-C.MethodsThe ancient and modern literature related to IBS-C disease was studied and sorted out,clinical medical records were collected in the outpatient department from the teachers,and Professor Yao Naili’s clinical experience in diagnosis and treatment of IBS-C was systematically summarized.Randomized controlled trial was used to evaluate the clinical efficacy and safety of Chai Shao Tong Fu decoction in the treatment of IBS-C.A total of 64 patients with liver depression and spleen deficiency IBS-C who were admitted to the Spleen and Stomach Department of Guang’anmen Hospital,China Academy of Chinese Medicine Sciences,and Professor Yao Naili’s clinic from August 2020 to December 2022 were selected.Randomized controlled trial was conducted,and there were 32 cases in the treatment group and there were 32 cases in the control group.The treatment group was treated with Professor Yao Naili’s empirical formula Chai Shao Tong Fu decoction,and the control group was treated with lactulose oral solution.Both groups were treated for 4 weeks.TCM symptom score,IBS-QOL scale,SAS scale and SDS scale were recorded once before treatment and once four weeks after treatment.Safety indexes of patients were recorded once before treatment and once 4 weeks after treatment.Follow-up was performed 4 weeks after drug withdrawal,TCM symptom scores of patients were recorded,and the differences before and after treatment were compared to observe the recurrence situation.Statistical software SPSS26.0 was used for data analysis.Results1.Experience summary:Professor Yao Naili believes that the main causes of IBS-C include exogenous evil,improper diet,emotional disorders and deficiency of old age.The disease is located in the large intestine,which is closely related to the liver and spleen.The basic pathogenesis of IBS-C is "liver depression and spleen deficiency,transport disorder,internal stagnation of turbidness and conduction disorder".It was believed that spleen and stomach weakness and transportation disorder were the basis of the disease,liver loss and relaxation and qi stagnation were the key to the progression of the disease,and turbidness such as heat formation,phlegm and dampness,and food accumulation were the main pathological products.Therefore,Chai Shao Tong Fu decoction was formed with the basic treatment of "soothing the liver and relieving depression,invigorating the spleen and stomach,reducing turbidity and unclog the organs",and according to the patient’s specific conditions with the syndrome.2.Clinical efficacy:A total of 64 IBS-C patients were contained in this study,including 32 patients in the treatment group and 32 patients in the control group,the treatment group was treated with Professor Yao Naili’s empirical formula Chai Shao Tong Fu decoction,and the control group was treated with lactulose oral solution.Including 1 case of loss of follow-up in the treatment group and 1 case of loss of follow-up in the control group.A total of 62 patients,with 31 cases in the treatment group and 31 cases in the control group,were completed clinical observation.(1)In terms of TCM symptom scores:①The total scores of TCM symptoms in both groups were lower after treatment than before treatment(P<0.001),the total score of the treatment group was significantly lower than that of the control group,and the effect of treatment was better than that of the control group(P<0.001).②The scores of each individual symptom of TCM in both groups were lower after treatment than before treatment(P<0.001).In the treatment group,abdominal pain,abdominal distension or abdominal discomfort,fecal traits,frequency of defecation,distension and pain in the chest and hypochondriac,emotional depression or irritability,eat less,frequent belching and fatigue were all lower than those in the control group,and the effect was better than that in the control group(P<0.05).The two groups were equally effective in improving defecation(P>0.05).(2)After treatment with different drugs,the total effective rate of the two groups was 93.5%,with 2 cases of clinical recovery,17 cases of obvious effect,10 cases of effective patients and 2 cases of ineffective patients.The total effective rate of the control group was 74.2%,with 0 cases of clinical recovery,7 cases of obvious effect,16 cases of effective patients and 8 cases of ineffective patients.The effective rate of the treatment group was higher than that of the control group(P<0.05).(3)In terms of quality of life therapy:Both groups improved patients’ quality of life(P<0.001),the therapeutic effect of the treatment group was better than that of the control group in improving restlessness,behavioral disorders,body ideation and health concerns,dietary restriction,social function and sexual behavior(P<0.05).The two groups were equally effective in improving interpersonal relationships(P>0.05).(4)In terms of mental psychology:After treatment,SAS and SDS scores of 2 groups were decreased compared with before(P<0.05):However,the treatment group was better than the control group in improving anxiety,depression and other negative mental states(P<0.05).(5)In terms of recurrence:① After 4 weeks of follow-up,the total scores of TCM symptoms in the treatment group were significantly lower than those in the control group(P<0.05).In terms of individual scores of TCM symptoms,all individual scores in the treatment group were lower than those in the control group at follow-up(P<0.05).There were no significant differences in the symptoms of abdominal pain,distension or abdominal discomfort,fecal characteristics,defecation status,distension and pain in the chest and hypochondriac region,emotional depression or irritability,little food and dormancy,frequent belching,and fatigue in the treatment group compared with the end of treatment(P>0.05).②In terms of recurrence rate,After 4 weeks of drug withdrawal,4 patients in the treatment group relapsed,with a recurrence rate of 13.8%.The recurrence rate of 7 patients in the control group was 30.4%.The recurrence rate in the treatment group was significantly lower than that in the control group.The treatment group had better long-term efficacy and lower recurrence rate than the control group.(6)Safety analysis:No adverse reactions occurred in both groups during medication.ConclusionProfessor Yao Naili has unique insights into the etiology,pathogenesis,diagnosis,treatment and care of IBS-C.Chai Shao Tong Fu decoction is effective and safe in treating IBS-C patients with liver depression and spleen deficiency. |
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