Table 2.
Combination herbal therapies used for irritable bowel syndrome
| Name of preparation | Composition (part) | Type of study | Model | Concomitant drugs | Duration of study | Results | Ref. |
| Carmint | Mentha piperita (leaf) | Double-blind, randomized, placebo-controlled, multicenter clinical trial | IBS patients | Loperamide or psyllium (based on their predominant bowel function) | 8 wk | Severity and frequency of abdominal pain/discomfort were significantly lower in the Carmint group than the placebo group | [41] |
| Melissa officinalis (leaf) | |||||||
| Coriandrum sativum (fruit) | |||||||
| CHM | Codonopsis pilosulae (root) | Randomized, double-blind, placebo-controlled trial | IBS patients | - | 16 wk | Significant improvement in bowel symptom scores as rated by patients and by gastroenterologists | [42] |
| Agastaches seu pogostemi (whole plant) | Significant global improvement as rated by patients and by gastroenterologists | ||||||
| Ledebouriella sesloidis (root) | Patients reported that treatment significantly ↓ the degree of interference with life caused by IBS symptoms | ||||||
| Coicis lachryma-jobi (seed) | |||||||
| Bupleurum chinensis (whole plant) | |||||||
| Artemisia capillaries (whole plant) | |||||||
| Atractylodis macrocephalae (rhizome) | |||||||
| Magnolia officinalis (bark) | |||||||
| Citrus reticulata (pericarp) | |||||||
| Zingiber officinale (rhizome) | |||||||
| Fraxinus spp. (bark) | |||||||
| Poria cocos (sclerotium) | |||||||
| Angelica dahurica (root) | |||||||
| Plantago spp. (seed) | |||||||
| Phellodendron spp. (bark) | |||||||
| Glycyrrhiza uralensis (root) | |||||||
| Paeonia lactiflora (root) | |||||||
| Saussurea lappa (root) | |||||||
| Coptidis spp. (rhizome) | |||||||
| Schisandra spp. (fruit) | |||||||
| C-IBS formula | Lactulose Ulmus fulva (bark) Glycyrrhiza glabra (root) Avena sativa (bran) | A two arm, open-label, uncontrolled pilot study | Constipation-predominant IBS | - | 2 wk | A 20% increase in bowel movement frequency ↓ in straining, abdominal pain, bloating, and global IBS symptom severity improvements in stool consistency well-tolerated | [54] |
| DA-IBS formula | Vaccinium myrtillus (fruit) | A two arm, open-label, uncontrolled pilot study | Diarrhea-predominant and alternating bowel | - | 2 wk | a small, but significant increase in bowel movement frequency | [54] |
| Ulmus fulva (bark) Cinnamomum zeylanicum (bark) | habit IBS patients | ↓ in straining, abdominal pain, bloating, flatulence, and global IBS symptoms well-tolerated | |||||
| Agrimonia eupatoria (aerial part) | - | ||||||
| Iberogast (STW 5) | Iberis amara (whole plant) | In vitro | Human intestinal mucosa/submucosa preparations | A dose-dependent increase in ion secretion in human tissue and T84 cells evoke an increased spike discharge in 51% of human submucous neurons | [45] | ||
| Chelidonium majus (root) | human epithelial cell line T84 human enteric neurons | ||||||
| Silybum marianum (fruit) | |||||||
| Melissa officinalis (leaf) | |||||||
| Carum carvi (fruit) | |||||||
| Glycyrrhiza glabra (root) | |||||||
| Angelica sinensis (root) | In vivo | Wistar rats | - | Single dose | ↑Afferent discharge to 5-HT and bradykinin dose-dependently | [47] | |
| Matricaria recutita (flower) | |||||||
| Mentha piperita (leaf) | Double-blind, randomized, placebo-controlled, multi-centre trial | IBS patients | - | 4 wk | Significant improvement in IBS symptom scale and abdominal pain scale in STW 5 group compared with placebo | [44] | |
| STW 5-II | Iberis amara (whole plant) Melissa officinalis (leaf) Carum carvi (fruit) | Double-blind, randomized, placebo-controlled, multi-centre trial | IBS patients | - | 4 wk | Significant improvement in IBS symptom scale and abdominal pain scale in STW 5-II group compared with placebo | [44] |
| Glycyrrhiza glabra (root) | |||||||
| Matricaria recutita (flower) | |||||||
| Mentha piperita (leaf) | |||||||
| Padma Lax | Aloe barbadensis A. ferox (extract) | Randomized, double-blind, placebo-controlled trial | Constipation predominant-IBS patients | - | 3 mo | Significant improvement compared to placebo in constipation, severity of abdominal pain, incomplete evacuation, abdominal distension and flatus/flatulence | [43] |
| Jateorhiza palmata (root) | Significantly more Padma Lax patients compared to placebo rated the current treatment superior to previous therapies tried for IBS | ||||||
| Marsdenia condurango (bark), Rhamnus frangula (bark) | Laboratory parameters displayed no clinically significant changes | ||||||
| Gentiana lutea (root) | |||||||
| Inula helenium (rhizome) | |||||||
| Terminalia chebula (fruit) | |||||||
| Piper longum (fruit) Rhamnus purshiana. (bark) | |||||||
| Rheum palmatum (root) | |||||||
| Strychnos nux-vomica (seed) | |||||||
| Zingiber officinale (root) | |||||||
| TXNG | Paeonia lactiflora (root) | Prospective, randomized, double-blind, placebo-controlled trial | Diarrhea predominant-IBS patients | - | 3 wk | ↓IBS-related pain in the TXNG group compared with the placebo | [52] |
| Atractylodes macrocephala (rhizome) | ↓Frequency and the duration of abdominal pain between the TXNG group and the placebo | ||||||
| Citrus reticulate (green unripe exocarp) | Improvement of IBS-related stool in form or appearance in the TXNG group in comparison with the placebo | ||||||
| Allium macrostemon (bulb) | ↓Stool frequency in the TXNG group compared with the placebo | ||||||
| Improvement of stool passage (urgency or | |||||||
| Feeling of incomplete rectal emptying) in the TXNG group compared with the placebo. | |||||||
| Improvement in IBS-related diarrhea in the TXNG group compared to placebo | |||||||
| No statistical difference in either the effective time of IBS-related pain or the effective time of IBS-related diarrhea between the two groups | |||||||
| ↓IBS-related pain alleviation time and the IBS-related diarrhea alleviation time in the TXNG group compared to those in the placebo group | |||||||
| TXYF | Atractylodes macrocephala (rhizome) | In vivo | Maternal separation-induced visceral hypersensitivity rats | - | 2 wk | ↓Pain threshold pressure and abdominal withdrawal reflex scores in a dose-dependent manner | [54] |
| Paeonia lactiflora (root) | ↓ 5-HT levels in serum | ||||||
| Citrus sinensis (dried old peel) | ↓Corticotrophin releasing factor concentrations in the brain | ||||||
| Ledebouriella divaricata (root) | Visceral hypersensitivity alleviation was dependent on the substance P expression in the colon mucosa | ||||||
| Randomized placebo-controlled trial | Diarrhea predominant-IBS patients | Miyarisan | 4 wk | No significant difference between two groups in terms of the total efficacy or the scores of symptoms before and after treatment | [53] | ||
| ↓The number of activated mast cells in the intervention | |||||||
| TCM | Atractylodes macrocephala (rhizome) | Randomized placebo-controlled trial | Diarrhea predominant-IBS patients | - | 16 wk (8 wk drug administration +8 wk follow up) | No significant difference in the proportion of patients with global symptom improvement between the TCM and placebo groups at week 8 and at week 16 | [51] |
| Astragalus membranaceus (root) | No difference in individual symptom scores and the quality-of-life assessment between the two groups at all time points | ||||||
| Paeonia lactiflora (peeled root, fried) | |||||||
| Atractylodes chinensis (rhizome) | |||||||
| Bupleurum chinense (root) | |||||||
| Citrus reticulata (peel) | |||||||
| Saposhnikovia divaricata (root) | |||||||
| Paniculata (twigs) | |||||||
| Punica granatum (rind) | |||||||
| Portulaca oleracea (above-ground parts) | |||||||
| Coptis chinensis (rhizome) |
CHM: Chinese herbal medicine; TXNG: Tong-xie-ning; TXYF: Tong-Xie-Yao-Fang; TCM: Traditional Chinese Medicine; 5-HT: Serotonin; spp.: Schisandra chinensis.