Systematic Review of Randomized Controlled Trials of Tongxie Yaofang and Its Modified Prescriptions for the Treatment of Irritable Bowel Syndrome / 广州中医药大学学报

ABSTRACT

Objective To assess the effectiveness of the Chinese herbal formula Tongxie Yaofang(TY) or its modified prescriptions in the management of irritable bowl syndrome(IBS).Methods A systematic review was carried out according to the Cochrane standards.A computerized literature search was carried out in main Chinese and English databases including CNKI,CBMdisc,Database of Chinese Doctorate Dissertation,Database of excellent Chinese Master Dissertation,MEDLINE and Cochrane Library.Studies were retrieved when they were randomized controlled trials(RCTs) whose interventions for IBS patients were TY or modified prescriptions of TY with placebos or conventional medicine as controls.Outcome measurement included the alleviation of main symptoms such as abdominal pain,diarrhea frequency,and(or) comprehensive effectiveness and quality of life(QOL).Meta-analysis was performed after evaluating the quality of included studies.Subgroup analysis was done between subgroups of diarrhea-predominant IBS and subtype-regardless IBS,and was also done between diarrhea-predominant IBS treated with TCM syndrome differentiation and that without TCM syndrome differentiation.Funnel plot analysis was used to analyze the publication bias.Results Forty-six studies met the inclusion criteria,and 4155 participants were included in the meta-analysis.The results showed that the effectiveness of TY or modified prescriptions of TY was better than that of conventional medicine or placebos[OR= 5.30,95%CI(4.38,6.41)].Subgroup analysis showed that the OR of TY or modified prescriptions of TY in the diarrhea-predominant groups[OR=5.61,95%CI(4.33,7.25)]was higher than that of subtype-regardless groups[OR=4.95,95%CI(3.74,6.55)],and OR of TY or modified prescriptions of TY in the studies of diarrhea-predominant IBS treated based on TCM syndrome differentiation [OR=6.50,95%CI(3.78,11.20)] was higher than that of the studies without TCM syndrome differentiation[OR=5.37,95%CI(4.01,7.19)],but the difference was insignificant.Funnel plot showed certain publication bias.Conclusion The effectiveness of TY or modified prescriptions of TY for IBS patients is better than that of western medicine and placebo.But their effectiveness for diarrhea-predominant IBS or with TCM syndrome differentiation was not proved to be better than those for other subtypes or without TCM syndrome differentiation.Biases may exist for overall quality of the studies is low;negative results in some high quality studies need further discussion.