Herbal medicines for the management of irritable bowel syndrome: A comprehensive review

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.