IBS formula/JAMA research

[Guest guest]

For the group:

 

For anyone who is interested, here is the original study on IBS reported in

JAMA in 1998. A fairly well-done study, I think.

 

For the record, I was asked some time ago to research one of the formulas

used in the study, for possible use in mainstream settings. I must say, I

thought the formula was fairly well-done, basically a combination of two or

three classical prescriptions, and I had no problem with it whatsoever.

 

In a previous post, I mentioned about the formula being 'thrown together'.

I should have said not that the prescription itself was thrown together, but

that there was a potential problem of using a prescription designed for a

complex pattern for all patterns that may come up in an IBS patient. In

essence, that we don't give prescriptions to patients without diagnosing

them properly first.

 

My problem was not with the formula, but the potential of calling it the

" IBS formula " , and the profession applying it indiscriminately to patients

without pattern diagnosis. It goes without saying, that IBS is a complex

condition from either a biomedical or Chinese medical viewpoint, with many

stages, possibilities of symptoms or pattern. No one prescription could

possibly cover all of the patterns. Also, many patients are undergoing

biomedical treatment with sulfa drugs or steroids, among others, and

possible interactions must be taken into account, as well as the lessening

of therapeutic efficacy with herbal medicine if trying to address the

condition directly.

 

In these situations, I am concerned that we don't make too big of a case for

a single prescription in the treatment of a complex western disease, even if

well-done. The " IBS formula " is not PC-SPECS. . . . .but in the eyes of

the public, it would or will be looked on as a 'cure'. We should be careful

about expectations.

 

 

 

 

 

Bensoussan A, Talley NJ, Hing M, Menzies R, Guo A, Ngu M. Treatment of

irritable bowel syndrome with Chinese herbal medicine: a randomized

controlled trial. JAMA 1998 Nov 11;280(18):1585-1589.

Abstract: CONTEXT: Irritable bowel syndrome (IBS) is a common functional

bowel disorder for which there is no reliable medical treatment. OBJECTIVE:

To determine whether Chinese herbal medicine (CHM) is of any benefit in the

treatment of IBS. DESIGN: Randomized, double-blind, placebo-controlled trial

conducted during 1996 through 1997. SETTING: Patients were recruited through

2 teaching hospitals and 5 private practices of gastroenterologists, and

received CHM in 3 Chinese herbal clinics. PATIENTS: A total of 116 patients

who fulfilled the Rome criteria, an established standard for diagnosis of

IBS. INTERVENTION: Patients were randomly allocated to 1 of 3 treatment

groups: individualized Chinese herbal formulations (n = 38), a standard

Chinese herbal formulation (n = 43), or placebo (n = 35). Patients received

5 capsules 3 times daily for 16 weeks and were evaluated regularly by a

traditional Chinese herbalist and by a gastroenterologist. Patients,

gastroenterologists, and herbalists were all blinded to treatment group.

MAIN OUTCOME MEASURES: Change in total bowel symptom scale scores and global

improvement assessed by patients and gastroenterologists and change in the

degree of interference in life caused by IBS symptoms assessed by patients.

RESULTS: Compared with patients in the placebo group, patients in the active

treatment groups (standard and individualized CHM) had significant

improvement in bowel symptom scores as rated by patients (P=.03) and by

gastroenterologists (P=.001), and significant global improvement as rated by

patients (P=.007) and by gastroenterologists (P=.002). Patients reported

that treatment significantly reduced the degree of interference with life

caused by IBS symptoms (P=.03). Chinese herbal formulations individually

tailored to the patient proved no more effective than standard CHM

treatment. On follow-up 14 weeks after completion of treatment, only the

individualized CHM treatment group maintained improvement. CONCLUSION:

Chinese herbal formulations appear to offer improvement in symptoms for some

patients with IBS.