The Study On The Curative Effect Of Lai’s Tong-yuan Therapy In Diarrhea-Predominant Irritable Bowel Syndrome Caused By Liver Stagnation And Spleen Deficiency

Objective:Irritable bowel syndrome (IBS) is a common disease characterize by repeating, long term abdominal pain, distention and altered bowel habits. It is a series of symptoms caused by malfunction of smooth muscle in gastrointestinal tract. IBS is gaining social attention in recent years. The pathophysiology of IBS is not clear, many theories have been put forward, but the exact cause of IBS is still uncertain.There are no effective medications for IBS. Symptomatic treatment such as antidiarrheal, improve gastrointestinal motility, anti-depression together with psychological management and dietary modifications are commonly used, but these treatment have unsatisfactory and short-lasting effect. Chinese medical have long history in treating Irritable bowel syndrome. Using acupuncture to treat IBS can relieve the burden on gastrointestinal tract, while having fast and long lasting effects with no side effects. Using acupuncture to treat IBS has a great prospect and worth clinical recommendation.Lai’s tong-yuan therapy is invented by Professor Lai Xin Sheng, which is constituted of his years of clinical experience and a mature theories basis. Lai’s tong-yuan therapy is effective and easy to operate. It can be apply to a wide spectrum of disease. Professor Lai’s years of experiences prove that Lai’s tong-yuan therapy can treat IBS effectively. This study is a randomized clinical trial. The clinical value of Tong-yuan method and should Tong-yuan method be promoted will be evaluated by comparing and observing the effectiveness of Tong-yuan warming needle moxibustion method, Tong-yuan acupuncture method and conventional acupuncture treatment in treatingDiarrhea-Predominant Irritable Bowel Syndrome caused by liver stagnation and spleen deficiency’s clinical effect. We expect this research could provide a clinical reference data so that a better treatment method can be chosen for the clinical practice afterwards.Methods:This study enrolled patients from the Chinese Medicine Teaching Clinic of The Chinese University of Hong Kong and the general public.90 patients who meet the choosing criteria and standard are randomly allocated into Tong-yuan warming needle moxibustion group, Tong-yuan acupuncture group and conventional acupuncture group. The demography data are collected and compared among different groups before receiving the treatment. The acupuncture points used for Tong-yuan warming needle moxibustion group are Tianshu (ST25), Guanyuan (CV4), Qihai (CV6), Guilai (ST29), Sanyinjiao (SP6),Ganshu (BL18),Pishu (BL20), Dachangshu (BL25), Zusanli (ST36), Shangjuxu (ST37)and Taichong (LR3)> warming needle moxibustion are applied to Tianshu (ST25), Guanyuan (CV4), Qihai (CV6), Guilai (ST29); Tong-yuan acupuncture group has the same acupuncture point as Tong-yuan warming needle moxibustion group, but do not receive moxibustion. Acupuncture points of conventional acupuncture group are Pishu (BL20), Tianshu (ST25), Zusanli (ST36), Sanyinjiao (SP6) and Taichong (LR3). The treatment last for 30 minutes after manipulation of needle in all 3 groups. A treatment cycle last for 4 weeks while patient will receive2 times of acupuncture each week, clinical assessment is done after the treatment.The effectiveness of the intervention is primarily assessed by the Irritable bowel syndrome severity scoring system (IBS-SSS), IBS-SSS assess five aspects such as abdominal pain and distension, bowel habit. The secondary indicators include IBS quality of life questionnaires (IBS-QOL), anxiety and depression questionnaires (HAD) and Chinese Medical Syndrome Scores. The effectiveness of the treatment is assessed by difference in IBS-SSS questionnaire’s score before and after receiving the treatment. SPSS20.0 is used to conduct the data analysis.Results:This study recruited 90 medical cases. There are 30 patients in Tong-yuan warming needle moxibustion group, Tong-yuan acupuncture group and conventional acupuncture group respectively. The sex, ages, medical history,BMI and education level of the patients in these three groups are comparable. During the treatment, there are no dropout cases. Statistical analysis shows that sex, medical history, BMI, education level and age have insignificant impact on IBS-SSS initial score, we can consider these factors are not correlated with Irritable bowel syndrome.Before treatment, the difference in IBS-SSS score, IBS-QOL total score and score in each aspect, HAD score, Chinese Medical Syndrome Scores of three groups have no statistical significance, they are comparable.(1) IBS-SSSAll 3 groups shown significant statistical difference in reducing IBS-SSS score. The Tong-yuan warming needle moxibustion group shown statistical significant difference in reducing IBS-SSS score when compared to conventional acupuncture, while Tong-yuan acupuncture and conventional acupuncture do not have significant statistical difference in improving IBS-SSS scoring. All 3 groups have stable long term medical effect.(2) IBS-QOL scoreAccording to the changes in IBS-QOL score, acupuncture can improve IBS patient in the aspects of dysphoria, interference with activity, health worry, food avoidance, while Tong-yuan warming needle moxibustion method have unique effect in improving sexual behavior and social reaction of IBS patients.Acupuncture have improving long term effect in interference with activity, health worry, food avoidance three aspects, while Tong-yuan warming needle moxibustion method have unique improving long term effects in psychological changes and sexual behavior two aspects.After treatment, the IBS-QOL scoring difference in the 3 groups in the aspect of dysphoria, interference with activity, body image and food avoidance shown statistical significance, the effect of Tong-yuan warming needle moxibustion group is better than the other 2 groups.The difference of scoring of IBS-QOL in follow-up of the three groups in the aspects of dysphoria, interference with activity, body image, health worry, food avoidance and social reaction shown statistical significance, the effect of Tong-yuan warming needle moxibustion group is better than Tong-yuan acupuncture group, which the effect of Tong-yuan acupuncture group is better than conventional acupuncture group.The research proves that acupuncture could improve IBS patient’s life quality, especially in the aspect of dysphoria, interference with activity, health worry, and food avoidance four aspects, while Tong-yuan warming needle moxibustion have better long term effect. (3) HADThe average of anxiety and depression scoring before the treatment is larger than 8, which imply anxiety and depression index are comparatively high in the recruited patients. The scoring in depression shown statistical significance change after in Tong-yuan warming needle moxibustion group and Tong-yuan acupuncture group, which imply the treatment is effective. The scoring in HAD questionnaire shown no statistical significance in conventional acupuncture group, which imply conventional acupuncture have no significant effect in improving patient anxiety and depression. Compare after treatment and follow-up of these 3 group, P>0.05, the difference have no statistical significance, which imply they have stable long term effect after treatment.(4) Chinese Medical Syndrome ScoresThe study proves that, Tong-yuan warming needle moxibustion method, Tong-yuan acupuncture method and conventional acupuncture method shown significant statistical difference in reducing Chinese Medical Syndrome Scores. Tong-yuan warming needle moxibustion method has the most outstanding effects in improving Chinese Medical Syndrome score, while Tong-yuan acupuncture method is better than conventional acupuncture method.The study prove that acupuncture can improve patient abdominal distension and pain, diarrhea, chest pain and distension, belch, decreased appetite and fatigue, which Tong-yuan warming needle moxibustion method have unique curative effect in treating depression. Follow-up shows that, Tong-yuan warming needle moxibustion group and Tong-yuan acupuncture group have statistically significant long term medical effect in the aspects of improving diarrhea. The differences in total score between after treatment and follow up of all 3 groups shown no statistical significance, which imply the treatment have stable long term effect.(5)Treatment efficacy evaluationAccording to the treatment efficacy evaluation system, Tong-yuan warming needle moxibustion group have 12 full recovery cases,13 good recovery cases, 5 modest recovery cases,0 no recovery cases, effective rate are 100%; Tong-yuan acupuncture group have 5 full recovery cases,17 good recovery cases,6 modest recovery cases,2 no recovery cases, effective rate are 93.33%. Conventional acupuncture group have 6 full recovery cases,9 good recovery cases,11 modest recovery cases,4 no recovery cases, effective rate are 86.67%. Comparing the three types of treatment method as a whole, the efficacy of three groups can be viewed to be not identical, Tong-yuan warming needle moxibustion group’s effective rate is higher than Tong-yuan acupuncture group, Tong-yuan acupuncture group’s effective rate is higher than conventional acupuncture group。Conelusion:Tong-yuan acupuncture method is more effective than conventional acupuncture in curing Diarrhea-Predominant Irritable Bowel Syndrome. Tong-yuan warming needle moxibustion method’s treatment have better effect than Tong-yuan acupuncture method, while Tong-yuan acupuncture method’s treatment have better effect than conventional acupuncture method. Lai’s tong-yuan acupuncture therapy is safe and more effective in curing Diarrhea-Predominant Irritable Bowel Syndrome. This method deserves a full scale promotion in clinical practice. However, the curing mechanism of Lai’s Tong-yuan acupuncture methods needs a more in-death research.