Research progress of traditional Chinese medicine in treating diarrhoeal irritable bowel syndrome based on intestinal flora

doi:10.11958/20242298

Abstract

Abstract:

Irritable bowel syndrome (IBS) is a kind of gastrointestinal dysfunction disease characterized by abdominal pain and abnormal defecation accompanied by changes in frequency or fecal character as the main clinical symptoms, and diarrhea-type irritable bowel syndrome (IBS-D) is the most common. It has been found that Chinese medicine therapy has achieved good results in the treatment of IBS-D through multi-component, multi-target and multi-pathway targeted regulation of intestinal flora. Therefore, based on intestinal flora, this paper reviews the relationship between intestinal flora and IBS-D, the understanding of Chinese medicine on IBS-D and intestinal flora, and the role of Chinese medicine therapy on intestinal flora.

Key words: irritable bowel syndrome, diarrhea, gastrointestinal microbiome, therapy of traditional Chinese medicine

CLC Number:

R574.62，R28

References 46

[1]	中华医学会消化病学分会胃肠功能性疾病协作组,中华医学会消化病学分会胃肠动力学组. 2020年中国肠易激综合征专家共识意见[J]. 中华消化杂志, 2020, 40(12):803-818.
	Study Group of Functional Gastrointestinal Disorders,Study Group of Gastrointestinal Motility,Chinese Society of Gastroenterology,Chinese Medical Association. Chinese expert consensus of irritable bowel syndrome in 2020[J]. Chin J Dig, 2020, 40(12):803-818. doi:10.3760/cma.j.cn311367-20201116-00660.
[2]	FAN W, CHEN Y, FANG X, et al. Gender differences in gastrointestinal, biopsychosocial and healthcare-seeking behaviors in Chinese patients with irritable bowel syndrome predominant with diarrhea[J]. BMC Gastroenterol, 2024, 24(1):102. doi:10.1186/s12876-024-03153-7.
[3]	LIU Y L, LIU J S. Irritable bowel syndrome in China:a review on the epidemiology,diagnosis,and management[J]. Chin Med J(Engl), 2021, 134(12):1396-1401. doi:10.1097/CM9.0000000000001550.
[4]	ZHAO Y, ZOU D W. Gut microbiota and irritable bowel syndrome[J]. J Dig Dis, 2023, 24(5):312-320. doi:10.1111/1751-2980.13204.
[5]	李梅梅, 黄玉卓, 马力亚, 等. 中医药治疗腹泻型肠易激综合征的作用机制及相关信号通路研究进展[J]. 中国中西医结合消化杂志, 2024, 32(10):934-938.
	LI M M, HUANG Y Z, MA L Y, et al. Research progress on the mechanism of action and related signaling pathways of Chinese medicine in the treatment of diarrheal irritable bowel syndrome[J]. Chin J Integr Trad West Med Dig, 2024, 32(10):934-938. doi:10.3969/j.issn.1671-038X.2024.10.20.
[6]	MAYER E A, RYU H J, BHATT R R. The neurobiology of irritable bowel syndrome[J]. Mol Psychiatry, 2023, 28(4):1451-1465. doi:10.1038/s41380-023-01972-w.
[7]	CANAKIS A, HAROON M, WEBER H C. Irritable bowel syndrome and gut microbiota[J]. Curr Opin Endocrinol Diabetes Obes, 2020, 27(1):28-35. doi:10.1097/MED.0000000000000523.
[8]	白燕鸥, 刘旭. 肠易激综合征与肠道菌群失调相关性研究进展[J]. 临床军医杂志, 2023, 51(3):327-330.
	BAI Y O, LIU X. Research progress on the correlation between irritable bowel syndrome and intestinal flora disorder[J]. Clin J Med Offic, 2023, 51(3):327-330. doi:10.16680/j.1671-3826.2023.03.31.
[9]	经先振, 王露, 闫倩楠. 肠易激综合征患者肠道菌群改变及其与粪便钙卫蛋白的关系[J]. 国际检验医学杂志, 2023, 44(14):1665-1669,1675.
	JING X Z, WANG L, YAN Q N. Change of intestinal flora and its relationship with fecal calprotectin in patients with irritable bowel syndrome[J]. Int J Lab Med, 2023, 44(14):1665-1669,1675. doi:10.3969/j.issn.1673-4130.2023.14.001.
[10]	马杰, 聂占国, 雷婷, 等. 治疗前肠道菌群多样性与肠易激综合征患者益生菌治疗效果的相关性[J]. 胃肠病学和肝病学杂志, 2024, 33(8):987-992.
	MA J, NIE Z G, LEI T, et al. Correlation between intestinal flora diversity before treatment and the efficacy of probiotics in patients with irritable bowel syndrome[J]. Chin J Gastroenterol Hepatol, 2024, 33(8):987-992. doi:10.3969/j.issn.1006-5709.2024.08.006.
[11]	MENG X, ZHANG G, CAO H, et al. Gut dysbacteriosis and intestinal disease:mechanism and treatment[J]. J Appl Microbiol, 2020, 129(4):787-805. doi:10.1111/jam.14661.
[12]	幸雨, 郭靓, 谢朝菊, 等. 腹泻型肠易激综合征病因病机及脏腑论治[J]. 辽宁中医药大学学报, 2023, 25(10):110-113.
	XIN Y, GUO L, XIE C J, et al. Etiology,pathogenesis and visceral treatment of diarrhea-predominant irritable bowel syndrome[J]. Journal of Liaoning university of TCM, 2023, 25(10):110-113. doi:10.13194/j.issn.1673-842x.2023.10.022.
[13]	贾荣, 唐莉. 杨勤教授从湿论治腹泻型肠易激综合征经验总结[J]. 广西中医药, 2023, 46(1):42-45.
	JIA R, TANG L. Professor Yang Qin's experience in the treatment of diarrhea-predominant irritable bowel syndrome from dampness[J]. Guangxi Journal of Traditional Chinese Medicine, 2023, 46(1):42-45. doi:10.3969/j.issn.1003-0719.2023.01.012.
[14]	郑欢, 吴皓萌, 秦书敏, 等. 黄绍刚辨治腹泻型肠易激综合征经验[J]. 广州中医药大学学报, 2019, 36(9):1448-1451.
	ZHENG H, WU H M, QIN S M, et al. Experience of HUANG Shao-Gang in treating diarrhea-predominant irritable bowel syndrome[J]. Journal of Guangzhou University of Traditional Chinese Medicine, 2019, 36(9):1448-1451. doi:10.13359/j.cnki.gzxbtcm.2019.09.029.
[15]	薛茸丹, 杨文津, 刘迪, 等. 基于“脑-肠轴”探讨腹泻型肠易激综合征病机及针刺取穴思路[J]. 针灸临床杂志, 2023, 39(9):5-9.
	XUE R D, YANG W J, LIU D, et al. Exploring pathogenesis of IBS-D and idea of acupoints selection based on "Brain-Gut Axis"[J]. JCAM, 2023, 39(9):5-9. doi:10.19917/j.cnki.1005-0779.023168.
[16]	韩林延, 周正华. 择时“扶阳抑阴”治疗腹泻型肠易激综合征理论探讨[J]. 山东中医药大学学报, 2016, 40(5):436-438.
	HAN L Y, ZHOU Z H. Timing to strengthen Yang and suppress Yin in treating diarrhea type irritable bowel syndrome[J]. Journal of Shandong University of Traditional Chinese Medicine, 2016, 40(5):436-438. doi:10.16294/j.cnki.1007-659x.2016.05.012.
[17]	钟鹏, 杨婉卿, 吴澎泞, 等. 腹泻型肠易激综合征发病机制及治则探析:基于“血活津门无挡,水出泻止”理论[J]. 亚太传统医药, 2023, 19(9):221-225.
	ZHONG P, YANG W Q, WU P N, et al. Exploring the pathogenesis and treatment of diarrhea-type irritable bowel syndrome based on the theory of“blood activates the jinmen without blockage,water comes out and diarrhea is stopped”[J]. Asia-Pacific Traditional Medicine, 2023, 19(9):221-225. doi:10.11954/ytctyy.202309047.
[18]	史中斐, 郑艺君, 刘平, 等. 从“一气周流”理论探讨腹泻型肠易激综合征的治疗[J]. 中医杂志, 2022, 63(13):1231-1234.
	SHI Z F, ZHENG Y J, LIU P, et al. Discussion on the treatment of diarrheal irritable bowel syndrome from the theory of “Qi Circumfluence”[J]. Journal of Traditional Chinese Medicine, 2022, 63(13):1231-1234. doi:10.13288/j.11-2166/r.2022.13.008.
[19]	李玉丽, 李小雅, 谭周进. 从菌群失调与泄泻的关系论中医的同病异治[J]. 中国微生态学杂志, 2022, 34(7):857-861.
	LI Y L, LI X Y, TAN Z J. Discussion on "treating the same disease with different therapies" based on the correlation between flora imbalance and diarrhea[J]. Chin J Microecol, 2022, 34(7):857-861. doi:10.13381/j.cnki.cjm.202207021.
[20]	WANG Y, WANG M, CHEN J, et al. The gut microbiota reprograms intestinal lipid metabolism through long noncoding RNA Snhg9[J]. Science, 2023, 381(6660):851-857. doi:10.1126/science.ade0522.
[21]	张梁坤, 谷文超, 吴婷婷, 等. 基于脑肠轴探究半夏泻心汤对DSS-UC小鼠肠道菌群及5-HT的影响[J]. 世界科学技术-中医药现代化, 2023, 25(7):2390-2401.
	ZHANG L K, GU W C, WU T T, et al. The effects of Banxia Xiexin Decoction on gut microbiota and 5-HT in DSS-UC mice were investigated based on brain-gut axis[J]. Modernization of Traditional Chinese Medicine and Materia Medica-World Science and Technology, 2023, 25(7):2390-2401. doi:10.11842/wst.20220711008.
[22]	陈文华, 李思琦, 宋佳, 等. 铁皮石斛对抗生素诱导小鼠肠道菌群紊乱的改善作用[J]. 中草药, 2023, 54(19):6362-6369.
	CHEN W H, LI S Q, SONG J, et al. Improvement of Dendrobium officinale on antibiotic-induced intestinal flora disorder in mice[J]. Chinese Traditional and Herbal Drugs, 2023, 54(19):6362-6369. doi:10.7501/j.issn.0253-2670.2023.19.017.
[23]	刘亚丽, 周明月, 宋永贵, 等. 白头翁皂苷对大鼠肠道菌群组成及多样性的影响[J]. 医药导报, 2022, 41(3):287-292.
	LIU Y L, ZHOU M Y, SONG Y G, et al. Effects of Pulchinenosides on the composition and diversity of intestinal flora in rat[J]. Herald of Medicine, 2022, 41(3):287-292. doi:10.3870/j.issn.1004-0781.2022.03.002.
[24]	鄢伟伦, 王帅帅, 任霞. 白术对小鼠肠道菌群调节作用的实验研究[J]. 山东中医杂志, 2011, 30(6):417-419.
	YAN W L, WANG S S, REN X. Experimental study of atractylodes on intestinal microflora in mice[J]. Shandong Journal of Traditional Chinese Medicine, 2011, 30(6):417-419.
[25]	李峙玉, 林岚辉, 郝其源, 等. 枸杞多糖在溃疡性结肠炎小鼠肠道菌群调节中的作用[J]. 肿瘤代谢与营养电子杂志, 2022, 9(2):212-218.
	LI Z Y, LIN L H, HAO Q Y, et al. Effects of lycium barbarum polysaccharide on intestinal microbiota regulation in ulcerative colitis mice[J]. Electron J Metab Nutr Cancer, 2022, 9(2):212-218.
[26]	LIU J, KONG L, SHAO M, et al. Seabuckthorn polysaccharide combined with astragalus polysaccharide ameliorate alcoholic fatty liver by regulating intestinal flora[J]. Front Endocrinol(Lausanne), 2022, 13:1018557. doi:10.3389/fendo.2022.1018557.
[27]	LI J, YANG J, XIA Y, et al. Effects of Astragaloside IV on hearing,inflammatory factors,and intestinal flora in mice exposed to noise[J]. Metabolites, 2024, 14(2):122. doi:10.3390/metabo14020122.
[28]	XU H, WANG S, JIANG Y, et al. Poria cocos polysaccharide ameliorated antibiotic-associated diarrhea in mice via regulating the homeostasis of the gut microbiota and intestinal mucosal barrier[J]. Int J Mol Sci, 2023, 24(2):1423. doi:10.3390/ijms24021423.
[29]	姚思杰, 王栩芮, 张明明. 痛泻要方对肝郁脾虚型IBS-D患者的临床疗效及其机制[J]. 中国实验方剂学杂志, 2020, 26(12):107-113.
	YAO S J, WANG X R, ZHANG M M. Clinical efficacy and mechanism of Tongxie Yaofang on patients with IBS-D of liver depression and spleen deficiency[J]. Chinese Journal of Experimental Traditional Medical Formulae, 2020, 26(12):107-113. doi:10.13422/j.cnki.syfjx.20201221.
[30]	许琰杰, 沈文, 臧海洋, 等. 基于16S rRNA基因测序探讨加味交泰丸对腹泻型肠易激综合征患者肠道菌群的影响[J]. 安徽中医药大学学报, 2023, 42(5):20-26.
	XU Y J, SHEN W, ZANG H Y, et al. Effect of Jiawei Jiaotai Pill on gut microbiota of patients with diarrhea-predominant irritable bowel syndrome:A study based on 16S rRNA sequencing[J]. Journal of Anhui University of Chinese Medicine, 2023, 42(5):20-26. doi:10.3969/j.issn.2095-7246.2023.05.005.
[31]	黄柳向, 旷思敏, 朱楚月. 痛泻安脾汤对腹泻型肠易激综合征大鼠肠道菌群的影响[J]. 中医药导报, 2020, 26(9):1-6.
	HUANG L X, KUANG S M, ZHU C Y. Effects of Tongxie Anpi Decoction(痛泻安脾汤)on intestinal flora of rats with diarrhea-type irritable bowel syndrome[J]. Guiding Journal of Traditional Chinese Medicine and Pharmacology, 2020, 26(9):1-6.
[32]	丁晓洁, 孙喜灵, 于晓飞, 等. 乌梅丸对腹泻型肠易激综合征模型大鼠肠道菌群和炎症因子的影响[J]. 辽宁中医杂志, 2019, 46(6):1296-1299.
	DING X J, SUN X L, YU X F, et al. Effect of Wumei Pill on intestinal flora and inflammatory factors in rats with diarrhea-type irritable bowel syndrome[J]. Liaoning Journal of Traditional Chinese Medicine, 2019, 46(6):1296-1299. doi:10.13192/j.issn.1000-1719.2019.06.056.
[33]	刘佳星, 王彦礼, 李彧, 等. 四神丸对腹泻型肠易激综合征大鼠肠道菌群影响的实验研究[J]. 药学学报, 2019, 54(4):670-677.
	LIU J X, WANG Y L, LI Y, et al. Experimental study on the effect of Sishen Wan on intestinal flora in rats with diarrhea-type irritable bowel syndrome[J]. Acta Pharmaceutica Sinica, 2019, 54(4):670-677. doi:10.16438/j.O513-4870.2018-0920.
[34]	许云姣, 蔡悦青, 姜莉云, 等. 基于肠道菌群探讨四四固本颗粒对IBS-D(脾肾阳虚型)大鼠短链脂肪酸(SCFAs)含量影响[J]. 辽宁中医药大学学报, 2023, 25(2):18-23.
	XU Y J, CAI Y Q, JIANG L Y, et al. Effect of Sisi Guben Granule(四四固本颗粒)on the content of short-chain fatty acids in IBS-D rats based on intestinal flora[J]. Journal of Liaoning university of TCM, 2023, 25(2):18-23. doi:10.13194/j.issn.1673-842x.2023.02.005.
[35]	张志亮, 常廷民. 补脾益肠丸联合复方谷氨酰胺治疗腹泻型肠易激综合征的临床研究[J]. 现代药物与临床, 2019, 34(4):1059-1064.
	ZHANG Z L, CHANG T M. Clinical study on Bupi Yichang Pills combined with compound glutamine in treatment of diarrhea-predominant irritable bowel syndrome[J]. Drugs & Clinic, 2019, 34(4):1059-1064. doi:10.7501/j.issn.1674-5515.2019.04.038.
[36]	郭灵祥, 秦甜甜, 高俊, 等. 参倍固肠胶囊治疗腹泻型肠易激综合征对脑肠菌轴的调节作用研究[J]. 中药材, 2022, 45(10):2502-2506.
	GUO L X, QIN T T, GAO J, et al. Study on regulating effect of Shenbei Guchang capsule in treating diarrheal irritable bowel syndrome on cerebral enterobacterium axis[J]. Journal of Chinese Medicinal Materials, 2022, 45(10):2502-2506. doi:10.13863/j.issn1001-4454.2022.10.040.
[37]	PEI L, GENG H, GUO J, et al. Effect of acupuncture in patients with irritable bowel syndrome:a randomized controlled trial[J]. Mayo Clin Proc, 2020, 95(8):1671-1683. doi:10.1016/j.mayocp.2020.01.042.
[38]	ZHANG G, ZHANG T, CAO Z, et al. Effects and mechanisms of acupuncture on diarrhea-predominant irritable bowel syndrome:A systematic review[J]. Front Neurosci, 2022, 16:918701. doi:10.3389/fnins.2022.918701.
[39]	吴帆, 李佳, 吴松, 等. “标本配穴”针刺法对腹泻型肠易激综合征焦虑模型大鼠焦虑样行为及肠道菌群的影响[J]. 中医杂志, 2023, 64(8):841-847.
	WU F, LI J, WU S, et al. Effect of Biaoben(标本)acupoints combination needling on anxiety-like behavior and gut flora in model rats of irritable bowel syndrome with predominant diarrhea and anxiety[J]. Journal of Traditional Chinese Medicine, 2023, 64(8):841-847. doi:10.13288/j.11-2166/r.2023.08.015.
[40]	郑洁, 董燕, 梁健, 等. 调神健脾针刺疗法配合艾灸对肝郁脾虚证IBS-D患者中医证候积分及肠道微生态的影响[J]. 陕西中医, 2022, 43(10):1477-1480.
	ZHENG J, DONG Y, LIANG J, et al. Influence of regulating shen and strengthening spleen acupuncture combined with moxibustion on TCM syndrome score and intestinal microecology in patients with IBS-D syndrome of liver-stagnation and spleen-deficiency[J]. Shaanxi Journal of Traditional Chinese Medicine, 2022, 43(10):1477-1480. doi:10.3969/j.issn.1000-7369.2022.10.039.
[41]	张军花, 单思, 王沐晨, 等. 基于肠道菌群探讨艾灸“命门”“关元”对健康大鼠免疫功能的影响[J]. 中国针灸, 2023, 43(10):1157-1164.
	ZHANG J H, SHAN S, WANG M C, et al. Effect of moxibustion at"Mingmen"(GV 4)and"Guanyuan"(CV 4)on immune function in healthyrats based on intestinal flora[J]. Chinese Acupuncture&Moxibustion, 2023, 43(10):1157-1164. doi:10.137037/j20220819-k0001.
[42]	孙冉, 张杰, 刘佳琳, 等. 艾灸神阙穴对卒中后便秘患者临床症状及肠道菌群的影响[J]. 时珍国医国药, 2023, 34(6):1414-1416.
	SUN R, ZHANG J, LIU J L, et al. Effect of moxibustion Shenque Point on clinical symptoms and intestinal flora of post-stroke constipation patients[J]. Lishizhen Medicine and Materia Medica Research, 2023, 34(6):1414-1416. doi:10.3969/j.issn.1008-0805.2023.06.36.
[43]	姚雪含, 刘喜平, 朱中博. 艾灸对菌群失调幼鼠结肠黏膜屏障的影响[J]. 中国中医药信息杂志, 2022, 29(8):72-77.
	YAO X H, LIU X P, ZHU Z B. Effect of moxibustion on colonic mucosal barrier in juvenile mice with dysbacteriosis[J]. Chinese Journal of Information on Traditional Chinese Medicine, 2022, 29(8):72-77. doi:10.19879/j.cnki.1005-5304.202110428.
[44]	何婉婷. 穴位贴敷治疗脾肾阳虚型腹泻型肠易激综合征临床疗效观察及对肠道菌群的影响[D]. 南京: 南京中医药大学, 2019.
	HE W T. Observation on the clinical efficacy of acupoint application in treating diarrhea type irritable bowel syndrome with spleen kidney yang deficiency and its impact on intestinal microbiota[D]. Nanjing: Nanjing University of Chinese Medicine, 2019.
[45]	苏冬梅, 李树斌, 王永清. 热奄包热熨神阙穴治疗阳虚型腹泻型肠易激综合征的效果及对肠道菌群的影响[J]. 北京中医药, 2022, 41(10):1145-1148.
	SU D M, LI S B, WANG Y Q. Effect of hot Chinese herbal bag on Shenque(CV8)point on diarrhea-predominant irritable bowel syndrome with Yang deficiency and intestinal flora[J]. Beijing Journal of Traditional Chinese Medicine, 2022, 41(10):1145-1148. doi:10.16025/j.1674-1307.2022.10.014.
[46]	徐瑾, 李玲, 刘军, 等. 耳穴压豆疗法联合逍遥散对腹泻型肠易激综合征患者肠道菌群的影响研究[J]. 中国预防医学杂志, 2020, 21(6):675-679.
	XU J, LI L, LIU J, et al. The effect of auricular point therapy combined with Xiaoyao powder on gut flora in patients with irritable bowel syndrome with diarrhea[J]. China Preventive Medicine, 2020, 21(6):675-679. doi:10.16506/j.1009-6639.2020.06.018.