Discussions On TCM Syndromes Of The Overlap Between Functional Dyspepsia And Irritable Bowel Syndrome

Objective:Exploring the characteristics of TCM syndromes of the overlap of functional dyspepsia and irritable bowel syndrome to guide the clinical treatment better.Methods:62 patients with the overlapp of FD and IBS,60 patients with FD and 60 patients with IBS in the digestive clinic of Jiangsu Provincial Hospital of traditional Chinese Medicine were selected,all patients were classified according to the experts’consensus of TCM diagnosis and treatment on functional dyspepsia and irritable bowel syndrome in 2017.The collection table of clinical case information was used to collect the datum.the general datum,symptoms,tongue coating,pulse,diagnosis,syndrome differentiations and subtype combinations were entered into the EXCEL forms,and the relevant datum in the case data were imported into SPSS software.Frequency analysis,independent sample T test and X2 test were used to compare the relationship and differences between overlapping group,FD group and IBS group in general datum,subtype compositions and syndrome type distribution.Summarizing the symptoms,tongue coating,pulse,and syndrome types of the overlap of FD and IBS,and exploring the inducing factors and pathogenesis of the overlap of FD and IBS.Results:(1)General datum:Among the 62 patients with the overlap of FD and IBS,30(48.4%)were male,32(51.6%)were female,52(83.9%)were married,10(16.1%)were unmarried,and the youngest was 15 years old.The maximum age was 64 years old,the average age was 40.66 years old,and 30-44 years old was the peak of the disease.The average course of the disease was 57.16±51.85(months),BMI was21.34±2.62(Kg/m2),12 smokers(19.4%),11 drinkers(17.7%),and 37 cases with the highest frequency of college or university education and above.The occupational distribution was mainly staff(41.9%).The patients with light,medium and large working pressure accounted for 41.9%,40.3%and 17.7%respectively.There was no significant difference in sex composition,marriage,age,BMI,smoking and drinking between overlap group and FD group.The average course was longer than that in FD group,and the educational level was higher than that in FD group,the difference was statistically significant(p<0.05),but there was no significant difference between overlap group and IBS group in the above aspects.(2)The differences of subtype compositions among the three groups:the highest proportion of the overlap group was PDS+EPS,accouting for 64.52%,PDS and EPS was 27.42%and 8.06%respectively,the proportion of PDS was the highest in FD group(51.67%),followed by PDS+EPS(41.67%),and the lowest frequency was EPS(6.67%).There were differences in subtype compositions between overlap group and FD(p<0.05).PDS+EPS was the most likely to overlap IBS than PDS and EPS.IBS-D,IBS-C and IBS-M accounted for 75.81%,19.35%and 4.84%respectively in overlap group,86.67%,8.33%and 5%respectively in IBS group.IBS-D was the main subtype in overlap and IBS group.(3)CnThe main symptoms of overlap between FD and diarrhea IBS were epigastric distension(67.74%),pain(45.16%),belching(46.77%),abdominal pain(75.81%),intestinal wheezing(56.45%)and anorexia(41.94%).Fatigue(38.71%),irritability(38.71%),loose stool(75.81%),the inducing factors of symptoms were irregular diet(53.23%),eating(50%)and feeling external evil(38.71%).The tongue was light red(43.55%),the edge had tooth marks(69.35%),the moss was thin and white(37.10%),and the pulse was fine string(41.94%).②When FD and IBS-C overlapped,the main TCM symptoms were epigastric distension(19.35%),belching(19.35%),abdominal distension(12.90%),abdominal pain(19.35%),dry mouth(12.90%)and defecation difficulty(19.35%),the inducing factors of symptoms were eating(19.35%)and emotional disturbance(16.13%).Tongue red(11.29%),fur thin white(8.06%)or thin white(8.06%),pulse fine string(12.90%).(4)The combination of syndrome types of overlapping FD and IBS:there were 11 types of combinations,and the most common syndrome was spleen deficiency and qi stagnation combined with liver depression and spleen deficiency.It accounted for 33.87%,followed by spleen deficiency qi stagnation syndrome combined with spleen deficiency dampness syndrome(19.35%),spleen deficiency qi stagnation syndrome combined with liver depression and spleen deficiency syndrome combined with cold and heat syndrome(11.29%).The combination of the above syndrome types was the overlap of FD and diarrhea IBS,which was the main syndrome type combination.The disharmony between liver and stomach combined with liver depression and qi stagnation syndrome(11.29%)was the main syndrome type combination when FD and IBS-C overlapped,while the other syndrome types were less than 10%.(5)The distribution of syndrome types in FD and IBS groups:the distribution of FD syndrome was spleen deficiency qi stagnation syndrome(50%),liver and stomach disharmony syndrome(35%),spleen and stomach deficiency cold syndrome(6.67%),cold and heat error syndrome(6.67%),spleen and stomach dampness-heat syndrome(1.67%).The distribution of IBS syndrome types were liver depression and spleen deficiency syndrome(43.33%),spleen deficiency and dampness syndrome(33.33%),spleen and kidney yang deficiency syndrome(10%),liver stagnation and qi stagnation syndrome(5%),cold and heat syndrome(3.33%),spleen and stomach dampness-heat syndrome(1.67%),yin deficiency intestinal dryness syndrome(3.33%).(6)There are 78 Chinese herbs involved in the overlap of FD and IBS.The herbs with high frequency of use are:fried Atractylodes macrocephala,tangerine peel,Poria cocos,Jiao six Shenqu,roasted licor:ice,fried malt,Codonopsis pilosula,fried Coix seed,fairy crane grass,fried rice sprouts,broad wood incense,fried yam,fried peony and so on.Conclusion:FD and IBS not only have overlapping symptoms,but also overlap between TCM syndromes.The key to overlapping pathogenesis is spleen deficiency and liver depression,spleen deficiency and dampness,and the disease is dominated by deficiency and excess.The treatment should be based on the spleen and stomach,the treatment of the liver and invigorating the spleen should be emphasized.Pay attention to gasification stagnation,flat adjustment of cold and heat,the treatment has a certain particularity.