Acupuncture plus Chinese Herbal Medicine for Irritable Bowel Syndrome with Diarrhea: A Systematic Review and Meta-Analysis

Abstract

Purpose. To comprehensively evaluate the efficacy and safety of acupuncture combined with Chinese herbal medicine (CHM) in treating irritable bowel syndrome with diarrhea (IBS-D). Methods. Relevant randomized controlled trials (RCTs) were systemically retrieved from electronic databases from inception to March 2018, including the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), Chinese Biological Medical Database (CBM, SinoMed), China Science and Technology Journal Database (VIP), and Wan Fang Data. Meanwhile, pooled estimates, including the 95% confidence interval (CI), were calculated for primary and secondary outcomes of IBS-D patients. Besides, quality of relevant articles was evaluated using the Cochrane Collaboration’s risk of bias tool, and the Review Manager 5.3 and Stata12.0 softwares were employed for analyses. Results. A total of 21 RCTs related to IBS-D were included into this meta-analysis. Specifically, the pooled results indicated that (1) acupuncture combined with CHM might result in more favorable improvements compared with the control group (relative risk [RR] 1.29; 95% CI 1.24–1.35; P =0.03); (2) the combined method could markedly enhance the clinical efficacy in the meantime of remarkably reducing the scores of abdominal pain (standardized mean difference [SMD] –0.45; 95% CI –0.72, –0.17; P = 0.002), abdominal distention/discomfort (SMD –0.36; 95% CI –0.71, –0.01; P = 0.04), diarrhea (SMD –0.97; 95% CI –1.18, –0.75; P < 0.00001), diet condition (SMD –0.73; 95% CI –0.93, –0.52; P<0.00001), physical strength (SMD –1.25; 95% CI –2.32, –0.19; P = 0.02), and sleep quality (SMD –1.02; 95% CI –1.26, –0.77; P < 0.00001) compared with those in the matched groups treated with western medicine, or western medicine combined with CHM. Additionally, a metaregression analysis was constructed according to the name of prescription, acupuncture type, treatment course and publication year, and subgroup analyses stratified based on the names of prescriptions and acupoints location were also carried out, so as to explore the potential heterogeneities; and (3) IBS-D patients treated with the combined method only developed inconspicuous adverse events; more importantly, the combined treatment had displayed promising long-term efficacy. Conclusions. Findings in this study indicate that acupuncture combined with CHM is suggestive of an effective and safe treatment approach for IBS-D patients, which may serve as a promising method to treat IBS-D in practical application. However, more large-scale, multicenter, long-term, and high-quality RCTs are required in the future, given the small size, low quality, and high risk of the studies identified in this meta-analysis.

Standardizing and Optimizing Acupuncture Therapy for Irritable Bowel Syndrome: A Delphi Expert Consensus Study

“…The recommended speci c acupoints in this consensus were Tianshu (ST25), Zusanli (ST36), and Zhongwan (CV12). Of note, this result is concordant with the founding of two SRs that these acupoints were 3 of the top 6 most commonly adopted acupoints [38,42]. Although the 3 speci c acupoints are always taken into consideration for the treatment of gastrointestinal diseases and supported by the Chinese Medicine theory, further clinical trials are still needed to con rm their superiority over other acupoints in treating IBS.…”

Traditional Chinese medicine for irritable bowel syndrome

“…Yan indicates that acupuncture combined with Chinese herbal medicine is an effective and safe treatment approach for IBS-D patients compared with western medicine. [ 25 ] Manheiner has confirmed the effectiveness of acupuncture in relieving the symptoms of IBS. [ 26 ] Chinese patent medicine Shugan Jianpi Zhixie has also been proven to be an effective and safe therapeutic option for patients with IBS-D. [ 27 ] However, no reports of comparisons between different TCM interventions on IBS has been found.…”

Understanding Traditional Chinese Medicine Therapeutics: An Overview of the Basics and Clinical Applications

“…Three articles were excluded because one was a commentary, the other was a protocol, and the last used an animal model. The diversity of pathologies covered by the remaining articles is considerable, with three articles related to cancer (involving 54, 14 and 18 RCTs) [ 33 , 34 , 35 ], three related to hypertension (involving 30, 17 and 39 RCTs) [ 36 , 37 , 38 ], three related to COVID-19 (involving 19, 7 and 18 RCTs) [ 39 , 40 , 41 ], two related to depression (involving 40 and 16 RCTs) [ 42 , 43 ], two related to headache (involving 31 and 30 RCTs) [ 44 , 45 ], and the others related to allergic rhinitis (involving 17 RCTs) [ 46 ], spinal cord injury (involving 26 RCTs) [ 47 ], breast pain (involving 17 RCTs) [ 48 ], primary Raynaud’s phenomenon (involving 8 RCTs) [ 49 ], insomnia (involving 13 RCTs) [ 50 ], erectile dysfunction (involving 11 RCTs) [ 51 ], post-stroke spasticity (involving 35 RCTs) [ 52 ], irritable bowel syndrome with diarrhea (involving 21 RCTs) [ 53 ], diabetic kidney disease (involving 20 RCTs) [ 54 ], and Wilson’s disease (involving 18 RCTs) [ 55 ]. All articles reported the beneficial effects of Chinese herbal medicine when used as a primary treatment or adjunct therapy to Western medicine.…”