Volume 8, Number 2 | Summer 2013

Kampo Medicine - Current Research
Irritable Bowel Syndrome

to be ineffective and in case of severe abdominal pain,
or in the presence of strong depressive symptoms,

Shinji Nishida
Department of Psychosomatic Medicine
Japan Red Cross Wakayama Medical Center

antidepressants or anti-anxiety drugs may be added
and psychotherapy administered.
Table1 Irritable Bowel Syndrome (Rome III)

Summary
Abdominal pain or abdominal discomfort occurringin conjunction with bowel movements, but wherecolonoscopy etc. cannot demonstrate any organic
lesions are called irritable bowel syndrome (IBS）.
The Roma III criteria (Table 1) are used as
diagnostic

criteria

forIBS.

Basedonthe

predominant symptoms the condition is further
classified into the four disease types constipation,
diarrhea, mixed and an unclassified varied type1).
Moreover,thedefinitionof"abdominal

paindecreases with bowel movement" is important andconstipation

ofabdominal

pain

diarrheaisnotassociatedclassified

aswithfunctional

constipation or diarrhea, while the independent
symptom of abdominal distension is classified asfunctional

abdominal

distension.

Similartofunctional dyspepsia (FD) IBS too has a highprevalence and is a disease severely impairing theQOL, but society in general often dismisses it.
Similar to FD the three major factors related to thepathology of IBS are anomalies of gastrointestinal
motility, visceral hyperesthesia and psychologicalfactors. Moreover, there are also patients developing
IBS following infections of the intestinal tract, sothat

theinfluenceofminimal

intestinal

inflammation, cytokines and intestinal bacteria arealso considered as etiologic factors.
Western

medicaltherapyofIBS

uses

improving intestinal motility on a foundation ofguidance

anddietaryimprovements.

Depending on the disease type 5HT3 receptor
antagonists,

Lactobacillus

preparations,anticholinergics and cathartics are combined withaforementioned measures. If these measures prove
6

Recurrent abdominal pain or discomfort** atleast 3 days/month in the last 3 months
associated with two or more of the following:
1. Improvement with defecation
2. Onset associated with a change in frequency ofstool
3. Onset associated with a change in form
(appearance) of stool* Criterion fulfilled for the lastmonths withsymptom onset at least 6 months prior todiagnosis**“Discomfort”

means

an

uncomfortablesensation not described as pain.
In pathophysiology research and clinical trials, apain/discomfort frequency of at least 2 days aweek

duringscreening

evaluation

isrecommended for subject eligibility.
IBS classification based on bowel movement
condition
1. Constipational type IBS (IBS-C): hard or
scybala-like stools (a) in more than 25%, soft(mushy) or watery stools (b) in less than 25%, (c)2. Diarrhetic type IBS (IBS-D): soft (mushy) or
watery stools (a) in more than 25%, (b) hard or
scybala-like stools in less than 25%, (c)3. Mixed type IBS (IBS-M): hard or scybala-likemacromolecular polymer preparations and drugs
lifestyle

Diagnostic criterion*stools (a) in more than 25%, soft (mushy) or
watery stools (b) also in more than 25%, (c)4. Unclassified IBS: stool anomalies do not meetthe characteristics of either IBS-C, IBS-D or
IBS-Ma) Bristol Stool Chart 1-2b) Bristol Stool Chart 6-7c) not using any antidiarrheal agents, laxatives

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

Volume 8, Number 2 | Summer 2013

Treatment

EBM

In Chinese medicine diarrhea is called 'fu xie' or 'xie

In Japan the formula keishikashakuyakuto is usedxie (loose stools and diarrhea)', while constipation ismost frequently, but there are also reports about

called 'pi yue' (the restrained spleen, constipation

saireito, keihito, heiisan, daikenchuto etc.2).

due to deficiency of circulatory fluids) or 'da bian nan'

In a DB-RCT Sasaki et al. investigated the effects of(constipation). The causes leading to diarrhea

keishikashakuyakuto3). The study showed that

includeamong the total of 232 patients with IBS (122external

cold,foodincludeddamage,stagnation and sluggishness of liver Qi, Qi deficiency,

patients

Yang

for

constipational type, 53 patients with an alternating

constipation include heat bind, Qi stagnation, Qi

type presenting with diarrhea and 19 patients withdeficiency, Yang deficiency, Blood deficiency, Yinan alternating type presenting with constipation

deficiency etc. In Chinese medicine IBS is often

effects were observed in the normal dose group (1)classified into the subtypes of liver depression andtreated for more than 4 but less than 8 weeks withspleen deficiency, cold-heat complex, intestinal

keishikashakuyakuto and the low dose group (2)liquid depletion, combined with spleen/stomach

receiving 1/20 of the normal dose. These results

deficiency and weakness, but based on the concept

showed that 1) the degree of final improvement (thethat IBS is a disease influenced by mental stress,

ratio of a more than moderate improvement) for all

liver depression and spleen deficiency can be

IBS patients was: (1) 50.9%, 47.9% (n.s.). Classified

considered to be the underlying condition to whichby disease type this ratio was for diarrhetic type: (1)the other factors are added.

54.4%, (2) 48.2% (n.s.), constipational type: (1) 63.6%,

deficiency

etc.,

while

thecauseswithdiarrhetictype,38

patients

57.9% (n.s.), alternating diarrhea type: (1) 39.4%,
Diarrhetic, constipational and mixed types can all be

40.0% (n.s.), alternating constipational type: (1)found within the condition of liver depression and spleen57.1%, (2) 37.5% (n.s.). 2. The degree of improvement

deficiency, for which in China the formula ｔsushayoho

of bowel movements and intestinal organ symptoms:(痛瀉要方 tong xie yao fang) is used for the diarrhetic(n.s.). 3. Improvement classified by disease type

type. In Japan shigyakusan is the first choice, but(ratio of more than moderate improvement) was forkamishoyosan is occasionally used too. Also, viewed asa liver-spleen disharmony keishikashakuyakuto or
keishikashakuyakudaioto as well as shokenchuto

the diarrhetic type: (1) 57.9%, (2) 37.0% (p=0.037). 4．

are used. For cold-heat complex Ubaigan is used inwhereChina, while in Japan hangeshashinto is used. Amovements and intestinal organ symptoms wereconstipational type of IBS is interpreted in China asobserved for the diarrhetic type of IBS.

intestinal

liquiddepletion

andtreated

The usefulness for all IBS patients (ratio of being
more than useful) was: (1) 46.2%, (2) 44.7% (n.s.),significant

improvementsofbowel

withikkansen, while in Japan mashiningan or junchouto
are used. A diarrhetic form of IBS is considered to bekeihito, saireito,
keishikashakuyakuto, heiisan, daikenchuto havea spleen and stomach deficiency and weakness andreportedly been effective.

treated in China with jinryobyakujutsusan, but inRegarding reports from abroad there is the DB-RCT

Japan the similar formula keihito is used. In

by Bensoussan et al.4). In this study 116 IBS patients

particular, for the pathology caused by spleen andwere divided into 3 groups: (1) a group receiving

stomach deficiency and weakness ninjito or shinbuto

individualare used.

identification, (2) a group receiving a standardIn

cumulativeformulacasestudiesprescriptions(Codonopsii

The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)

basedRadix,

onpattern

Pogostemi Herba,7Volume 8, Number 2 | Summer 2013

Saposhnikoviae Radix, Coicis Semen, Bupleuri
Radix, Artemisiae Capillaris Flos, Atractylodis
Rhizoma, Magnoliae Cortex, Citri Unshiu
Pericarpium, Zingiberis Rhizoma Processum,
Fraxini Cortex, Poria, Angelicae Dahuricae Radix,
Plantaginis
Semen,
PhellodendriCortex,
Glycyrrhizae Radix Praeparata, Paeoniae Radix,Saussuerae Radix, Coptidis Rhizoma, SchisandraeFructus) and (3) a placebo group that were alltreated over a period of 16 weeks. After that (1), (2)and (3) were compared to each other and asignificant improvement of the IBS symptoms
observed that continued in group (1) even beyond theend of the administration period. Moreover, thereport by Wai K. et al.5) describes the inclusion of 133
patients with diarrhetic IBS, who were divided intoa (1) regular prescription group (Atractylodis
Rhizoma, Astragali Radix, Angelicae Dahuricae
Radix, Atractylodis Lanceae Rhizoma, Bupleuri
Radix, Citri Unshiu Pericarpium, Saposhnikoviae

Granati Cortex, Murrayae Folium etCacumen, Portulacae Herba, Coptidis Rhizoma) andRadix,References
1) Drossman DA. The functional gastrointestinal
disorders

andtheRomeIII

process.

Gastroenterology. 130:1377-1390. 2006
2) Shinji Nishida and others: Evidence for Kampo
treatment of psychosomatic and stress-relateddiseases, (6) Irritable bowel syndrome; Journal ofJapanese Association of Oriental Psychosomatic
Medicine; 23:90-92, 2008
3) Daisuke Sasaki, Satoru Uehara, Masayoshi
Namiki: Clinical effects of keishikashakuyakuto
in the treatment of irritable bowel syndrome – ajoint multicenter randomized allocation groupcomparison clinical trial – The Japanese Journalof Clinical and Experimental Medicine; 75: 11361152, 1998
4) Bensoussan A, Tally NJ, Hing M,et al.: Treatmentof irritable bowel syndrome with Chinese herbal
medicine: a randomized controlled trial. JAMA.
280:1585-1589,1998
5) Wai K. et al: Treatment of Diarrhea-Predominant(2) a placebo group and treated correspondingly. Yet,

IrritableBowelSyndromewithTraditionalno significant differences between the groups

ChineseHerbalMedicine:

ARandomizedregarding the QOL score regarding the SF36 were

Placebo-Controlled Trial. Am J. Gastroenterology.

observed. Otherwise the pain and diarrhea formula
has frequently been examined in cumulative casestudies.

8The Journal of Kampo, Acupuncture and Integrative Medicine (KAIM)