Systematic Reviews Of Traditional Chinese Medicine In The Treatment Of Diarrhea-Predominant Irritable Bowel Syndrome

Irritable bowel syndrome(IBS)is one of the most common functional gastrointestinal diseases all over the world.Epidemiologic data suggest that the prevalence of IBS is as high as 15% of the global population,along with its long-lasting abdominal pain,diarrhea,constipation and other symptoms,causing more and more medical workers attention.According to the difference of clinical manifestations,IBS can be divided into constipation,diarrhea,mixed,and unstable IBS,among which IBS-D is the most common type.For the treatment of IBS-D,the main treatment of modern medicine is reducing symptoms and improving mental health,the representative drugs for IBS-D are Pinaverium Bromide,Trimebutine Maleate,Montmorillonite and so on,but it is difficult to cure,there is still lack of efficacy treatment program.In Traditional Chinese Medicine(TCM),IBS-D is considered as “diarrhea”,“abdominal pain”,etc.TCM believes that the main pathogenesis of this disease are congenital deficiency,exogenous disorders,spleen and stomach weakness,emotional disorders and diet injuries,etc.Among them,Liver flourishing by spleen,Spleen soil cutting is the basic pathogenesis of the disease,"Pain caused by liver,Diarrhea caused by spleen," means that the disease is caused by Liver flourishing and spleen deficiency,and is treated by liver-spleen-harmonizing therapy.A large number of clinical studies have shown that TCM has good treatment response at treating IBS-D,which is one of the preponderant illness for TCM.In internal treatment syndrome differentiation system,the overwhelming majority of literature studied on the treatment of liver and spleen.In external treatment system,the external treatment mainly including Acupuncture Therapy,Acupoint Application,Auricular Therapy,Enema Therapy and so on.Clinical application prospects show a promising prospect.The dialectical treatment of IBS-D from Liver and Spleen generally is accepted.While we still cannot confirm its therapeutic effects by evidence-based medicine,whether it will be able to use for a long-term or not,and is it safe or not,are inconclusive.In addition,the external treatment of TCM doesn't get enough attention.There are still some problems in the therapeutic process which need confirming further,such as the standard of acupoint application during the treatment,the choice of external remedy,etc.Therefore,this study use evidence-based medicine methods to collect clinical randomized/semi-randomized controlled trials about IBS-D in the medicine database of Pub Med,CNKI,etc from databases setting up to December 2016,respectively,making a systematic review for the clinical curative effect,recurrence rate,safety and therapeutic characteristics in exterior and interior different TCM treatment methods,in order to objectively evaluate the status quo of TCM therapy of IBS-D and to guide clinical practice better.Part one A systematic review of Dialectical Treatment of Diarrhea-Predominant Irritable Bowel Syndrome from Liver and Spleen1.Purpose Systemically review the effectiveness and safety of the internal treatment of Chinese medicine of dialectical treatment of IBS-D from Liver and Spleen.2.Research method 1)Set down strict inclusion and exclusion criteria.2)Retrieve the medicine database of Pub Med,SCI,Embase,Cochrane,China National Knowledge Infrastructure(CNKI),China Biology Medicine disc(CBM),VIP,etc,and manual search relevant literature.The retrieval period is from database setting up —December 2016.3)2 researchers conduct the preliminary screening from all documents according to the inclusion and exclusion criteria,read the full text of the literature,and finnaly collect the randomized and quasi-randomized controlled clinical trials consistent with dialectical treatment of IBS-D from liver and spleen.4)Extract the basic information of the final included studies,and evaluat the quality of the included studies according to the criteria of Cochrane Evaluation Handbook.5)Rev Man5.3 software is used to analyze the effect of each index,and evaluate the effectiveness and safety of dialectical treatment of IBS-D from Liver and Spleen.3.Results 1)A total of 748 articles were collected.Among them,719 were Chinese language literature,29 were English literature.Finally 22 were included according to inclusion and exclusion criteria,2045 patients in total,including 1061 cases in the treatment group,984 cases in the control group(the pinaverium group).2)Among 22 studies,each literature quality score were more than 3 points,which are a high quality literature.3)Using Rev Man 5.3 software analyzed: the combined odds ratio(OR)[95% CI] of the clinical total effective rate,the Chinese clinical effective rate,the recurrence rate and the adverse effect rate were 3.34 [2.54,3.76 4.38],[2.40,5.87],[0.15 0.26,0.48] 0.10,[0.03.0.32] respectively,a statistically significant difference(P<0.05).Chinese medicine of dialectical treatment of IBS-D from Liver and Spleen could improve the clinical total efficiency and efficiency of TCM syndrome,its curative effect was better than the pinaverium group.What's more,it had lower recurrence rate and better security.4.Conclusion 1)In terms of effectiveness,dialectical treatment of IBS-D from Liver and Spleen with TCM was superior to the pinaverium group in the total effective and the efficacy of TCM Syndrome,which showed dialectical treatment from Liver and Spleen playing a unique advantage in the treatment of IBS-D,and the recurrence rate was low.2)In terms of security,the recurrence rate of the treatment group was significantly lower than that of the pinaverium group,which suggested that the TCM compound has good safety.However,due to the non-standarded study design,the possible presence of publication bias and other reasons,the security still needed more high-quality,large sample,multi center clinical studies confirmed.Part two A systematic review of IBS-D with the treatment of Chinese medicine external treatment1.Purpose Analyze the clinical efficacy and application characteristics of IBS-D in the treatment of Chinese medicine external treatment.2.Research method 1)Set down inclusion and exclusion criteria separately.2)Retrieve the database of Pub Med,SCI,Embase,Cochrane,CNKI,CBM,VIP,etc for searching relevant literature from database setting up to December 2016.And screen literatures respectively according to inclusion and excluding criteria by different kinds of Chinese medicine external treatment of IBS-D.3)Use Rev Man5.3 software to analyze the effect of each index,and to evaluate the clinical efficacy of Chinese medicine external treatment of IBS-D.4)The data were extracted from the literatures,and the database about external treatment of IBS-D was established.The variable name was composed of search terms,serial number,title,treatment,etc.We classified and sorted literatures from the frequency of medication and the frequency of acupoints perspective.SPSS19.0 software was used to analyze and evaluate the characteristics of the TCM treatment of IBS-D.3.Results Of the 327 literatures on Chinese medicine external treatment(including Acupuncture Therapy,Acupoint Application,Auricular Therapy)of IBS-D enrolled,257 were Acupuncture Therapy,36 were included according to the inclusion and exclusion criteria;63 were Acupoint Application,31 were finally included;7 were Auricular Therapy,6 were finally included.Meta-analysis results showed that: the combined odds ratio(OR)[95% CI] of the clinical total effective rate of Chinese medicine external treatment of Acupuncture Therapy,Acupoint Application and Auricular Therapy are 2.53 [1.40,4.60]?3.29 [2.25,4.82]?3.45 [1.46,8.17],which shows a statistically significant difference(P<0.05).This indicated that the effect of Acupuncture Therapy,Acupoint Application and Auricular Therapy are better than the western medicine control group in the treatment of IBS-D patients.The characteristics analysis showed that the clinical use of high-frequency acupoint in Acupuncture Therapy of the treatment of IBS-D are: Tianshu,Zusanli,Zhongwan,Taichong,Shangjuxu,Guanyuan,Sanyinjiao,Spleenshu,Qihai and Yinlingquan;High-frequency acupoint of Acupoint Application are: Shenque,Tianshu,Spleenshu,Zusanli and Livershu.And the high-frequency medicines of Acupoint Application are: cinnamon,cloves,Evodiae,Radix Paeoniae Alba and rhizoma corydalis.Finally,the used frequency of the top five points for Auricular Therapy,in order,were large intestine,endocrine,liver,spleen,stomach.4.Conclusion There are various methods of Chinese medicine external treatment of IBS-D,Each with its own characteristics and excellent results.The acupoint of Acupuncture Therapy in treatment of IBS-D belongs to the Stomach Meridian,the most widely used acupoint are Tianshu and Zusanli.The acupoint of Acupoint Application for IBS-D belongs to Stomach Meridian and Bladder Meridian,the rest belong to Ren Meridian.With a focus on selecting the Shenque point of Ren Meridian,the Zusanli,Tianshu,Spleen shu and Liver shu points of Bladder Meridian.The application of the medicine is concentrated on cinnamon and cloves,most of them are warm,spicy,bitter.Finally,the frequent use of the top five points for Auricular Therapy were followed by large intestine,endocrine,liver,spleen,stomach.Chinese medicine external treatment can improve the clinical efficacy of IBD-D.But due to the low quality of domestic literatures,more high quality multi center,large sample randomized controlled trials still needed.