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Chinese herbal medicine effective in IBS

An Australian study recently published in the Journal of the American Medical Association lends strong scientific support to the traditional use of Chinese herbs in the treatment of irritable bowel syndrome (IBS). The authors believe theirs is the first clinical study to rigorously document the effectiveness of Chinese herbal medicine in the treatment of IBS - and the first to incorporate traditional Chinese diagnosis and treatment methods for IBS into a strictly controlled, conventional study model [Bensoussan et al., 1998].

The randomized, placebo-controlled, double-blind study involved 116 people with active IBS recruited from hospitals and private gastroenterology practices in Sydney, Australia. Patients were diagnosed first by gastroenterologists using standard western diagnostic methods, and then by Chinese herbalists according to the principles of Chinese medicine.

Forty-three subjects were randomized to receive a standard Chinese herbal formula "considered to regulate and strengthen bowel function," 38 took individualized herbal formulas, and 35 received a placebo deemed to be indistinguishable from the herbal treatments. Treatments were administered by capsule. Individualized treatments were custom-designed by the Chinese herbalists, who also supervised treatment during the course of the trial. Each subject worked with only one herbalist for the duration of the study. Results were evaluated by gastroenterologists after eight weeks and again at the end of the 16-week treatment period.

Both the standard herbal formula and the individualized treatments were significantly more effective than placebo in relieving IBS symptoms. Not only did Chinese herbal therapy prove superior to placebo, the researchers concluded that treatment benefits were more sustained in patients who took individualized formulas than in those who took the standard formula. Patients receiving the herbal formulas had significantly better scores in four out of five key outcome measures. Those taking the standard formula improved by 44 percent (according to patient assessments) and 59 percent (according to physician assessments) and those receiving individualized treatments improved by 42 percent and 40 percent, compared to 22 percent and 19 percent improvements in subjects taking placebo.

The standard formula used in the trial, consisting of 20 Chinese herbs, was not identified by name in the paper, nor were the individualized formulas described. The herbs included in the highest proportions in the standard formula were yin chen at 13 percent (Artemisia capillaris Thunb., Asteraceae), bai zhu at 9 percent (Atractylodes macrocephala Koidz., Asteraceae), dang shen at 7 percent (Codonopsis pilosula [Franch.] Nannfeldt., Campanulaceae), yi yi ren (Job's tears) at 7 percent (Coix lacryma-jobi L., Poaceae), and wu wei zi (schizandra) at 7 percent (Schisandra chinensis [Turcz.] Baill., Schisandraceae).

Two patients withdrew from the study because of adverse effects related to the herbal treatment (gastrointestinal discomfort and headache). No other major adverse effects were reported.

As many as 10 to 20 percent of Americans and Australians may be afflicted with IBS, a chronic gastrointestinal disorder marked by abdominal pain, bloating, and disturbances in bowel function alternating from constipation to diarrhea. According to the authors of the study, no single medical treatment provides reliable relief or resolution of the condition. According to physician assessments in this study, 78 percent of patients taking the standard Chinese herbal formula and 50 percent of those receiving individualized formulas improved during treatment, compared with 30 percent of those taking placebo. - Evelyn Leigh (HRF)

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[Bensoussan A, Talley NJ, Hing M, Menzies R, Guo A, Ngu M. Treatment of irritable bowel syndrome with Chinese herbal medicine. JAMA 1998; 280(18): 1585-1589.]

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