The Study Of Efficacy And Mechanism In IBS-D’s Treatment By Changjiling Based On The "Three Blood Organs" Theory

ObjectiveAuthor has the honor of being the fifth country heir old TCM expert’s academic experience, apprentice famous TCM Professor Zhou Fusheng. During the time of follow teacher, the author starting traceability from the the outset of tutorial academic, with irritable bowel syndrome as main direction, system consolidation and mining Mr. Zhou’s academic thoughts and clinical experiences, which including "Three-zang integration" theory, "Heart and Stomach" theory, experience in regulating the liver spleen and application, law of differentiation and treatment of IBS group and medication. In recent years, under the influence of teacher thinking, based on the series study of early IBS-D liver-spleen differentiation systemthe and clinical application, the author committed to the heart-liver-spleen "three blood organs " theory, and used it to the treatment of IBS-D in clinical practice. Furthermore, the author also enrich and validate the theoretical connotation of onset of the disease, for example, the author carried out a series of studies through literature arrangement, laws of syndromes, efficacy, mechanism.Irritable Bowel Syndrome (IBS) is a common clinical functional gastrointestinal disorder, IBS-diarrhea (IBS-D) is a major clinical subtypes of IBS, accounted for about 60% of all IBS, has the characteristic of high incidence and repeat of refractory. The etiology and pathogenesis of IBS is incompletely understood. Generally, IBS may be related to abnormal psychological and visceral hypersensitivity, gastrointestinal disorders and gastro-intestinal infections and other factors, are the result of many factors. So far, there is no drug or monotherapy to patients in full force in the treatment of IBS in Western medicine. Although selective 5-HT agonists or antagonists have a certain effect, its side effects limit its use. With multiple targets, the overall regulation, the traditional Chinese medicine has a good effect on IBS, people are paying more and more attention.This subject is on the basis of previous studies, to experiment randomized trial, controlled trial, blinded trial with placebo to proved whether ChangJiLing has absolute of effectiveness and security in treat of IBS-D. While, through the observation of animal experiment that ChangJiLing’s effect on liver-stagnation and spleen-deficiency type IBS-D anima lmodel’s visceral sensitivity, to explore the deep role mechanism of TCM intervention in the visceral sensitivity of IBS, to provide sufficient evidence for modern pathology and physiological mechanism in IBS-D’s treatment by ChangJiLing. And this research can also provide stronger evidence for the Syndrome differentiation and treatment of IBS under the guide of "three blood organs" theoryMethodThis topic is divided into two parts:clinical and experimental research.Clinical research methods:Meet the inclusion criteria of 60 cases of IBS-D were randomly divided into treatment and control groups by treatment group: control group (1:1), treatment group to give ChangJiLing oral, control group to give placebo oral, used double blind method, to start a randomized comparison and a more Center, big sample of clinical research, and to track follow-up, to evaluate the clinical effect of ChangJiLing through multiple comprehensive index such as clinical symptoms effect index (IBS-SSS), life quality questionnaire (IBS-QOL), and Hamilton anxiety scale. Medication for 4 weeks, and observed a period of six months.Experimental research methods:use of neonatal maternal separation +chronic immobilization method+intragastric administration of Senna method to copy the liver-depression and spleen-deficiency rat model,30 successful model of rats were randomly divided into normal, model group, and the low, medium and high dose groups, the control group. Medicine group give compound decoction of ChangJiLing irrigation stomach by low, medium and high dose, control group give Trimebutine maleate solution irrigation stomach.model group give the same volume normal saline irrigation stomach. These groups were all drug two week. And observe the following indicator before and after treatment:big rat general situation, stool characters, threshold of big rat’s abdominal back shrink reflection (AWR) and the defecation situation of big rats by avoidance water under stress.Results1 Clinical study results1.1 Have a better effect for improved symptoms of bowel movements, abdominal pain, abdominal distension:After 4 weeks of treatment, through the IBS-SSS scale and bowel diary showed that all symptoms were significantly improved in the treatment group, the control group except the mucus out, other symptoms have improved, and the degree of improvement in symptoms in the treatment group than the control group more visible. After 4 weeks of treatment, statistics the two group’s response rate, the results showed that the response rates in the treatment group was significantly higher than the control group, it proved that there have a better effects in the treatment group.1.2 Lower recurrence rate:during the time of IBS-D patients follow-up visit we found that with the extension of follow-up time, the gap between treatment and control groups’symptoms were more pronounced. In the process of follow-up, only part of the symptoms had recurrence in the treatment group, whereasall symptoms in the control group had recurrenced. According to the IBS-SSS score to count the degree of recurrence in patients who had cured after treatment showed the recurrence rate in the treatment group were lower than the control group.1.3 Have a significantly improvement of the quality of life:after 4 weeks of treatment, patients in the treatment group all dimensions of IBS-QOL were significantly improved, while the control group only scores and behavior disorders scores, eating escape scores, social function scores, sexual behavior scores reduced compared with the previousIn the process of follow-up time, patients in the treatment group the dimension points to maintain significantly better than the control group. At the end of the follow up, the treatment group’s total points and the dimension points compared with the 4th week, there were no obvious recurrence, showed that the treatment group can maintainfor the treatment of life, no obvious signs of recurrence. While the control group at the end of follow-up, behavior disorders, body image, sexuality and total points than the 4th week obviously recurrent. To follow up at the end, in addition to self image, social functions, expand external, for maintaining the quality of life in the treatment group were better than the control group.1.4 The drugs are safety and no toxic side-effects:in the course of treatment, there is no adverse reaction in both groups prompt that this drug therapy of IBS-D is a safe and effective treatmentExperimental resultsRats in each group has varying degrees of improvement, the weight relative growth rates of ChangJiLing compound medium and high dose group, are higher than low-dose group, the control group and the model group, which has a statistically significant difference (P<0.05). ChangJiLing medium dose group, high dose group and control group can significantly increased pressure threshold of IBS-D rats’visceral sensitivity (p< 0.05), and reduces visceral sensitivity. In reduce the frequency of defecation after acute water stress, ChangJiLing medium dose group, high dose group have a more effect (p< 0.05).Conelusion1 ChangJiLing compound treatment efficacy in patients with IBS-D compound, can improve the patient’s bowel movements, abdominal pain, bloating and other symptoms, recurrence rates are significantly lower than control group, significantly improving the quality of life in patients with IBS-D, and no side effect2 ChangJiLing compound treatment of IBS-D rats, can reduce IBS-D hypersensitivity in rats, reduced bowel reactions under stress,has the characteristics of the whole regulation for IBS-D rats.Combining the two results, we taking into account that the effect ChangJiLing can reduce the sensitivity of IBS-D patients, and improve symptoms such as abdominal pain, diarrhea, bloating.It also deeper demonstrated that ChangJiLing which create by the guided of the "three blood organs"theory to application in IBS-D patients not only have significantly effect in the near future, but also can reduce the long-term recurrence rate, and it provides stronger evidence for "three blood organs"theory in treating gastrointestinal disease.