Editorial
Copyright ©2012 Baishideng Publishing Group Co.
World J Gastroenterol. Feb 21, 2012; 18(7): 589-600
Published online Feb 21, 2012. doi: 10.3748/wjg.v18.i7.589
Table 1 Single herbs used for treatment of irritable bowel syndrome
Scientific namePartType of studyModelConcomitant drugsDuration of studyResultsRef.
Aloe veraGelPlacebo-controlled double-blind trialIBS patients-1 moNo difference between treatment and placebo groups in response to treatment at 1 mo diarrhea-predominant patients showed a trend towards a response to treatment at 1 mo[17]
Curcuma longaRhizomePartially blinded, randomized, two-dose, pilot studyIBS patients-8 wk↓Abdominal pain/discomfort score Significant improvements in IBS QOL scales Approximately two thirds of all subjects reported an improvement in symptoms after treatment[18]
Curcuma xanthorrhizaRhizomeRandomized, double-blind, placebo-controlled trialIBS patients-18 wk↑IBS-related pain ↓IBS-related distension but more decrease was seen in placebo The global assessment of changes in IBS symptoms and psychological stress due to IBS did not differ significantly among groups[19]
Cynara scolymusAqueous-alcohol extract of leafPostmarketing surveillance studyIBS patients-6 wk↓Severity of symptoms reported by both physicians and patients 96% of patients rated this drug as better than or at least equal to previous therapies Very good tolerability[24]
Aqueous extract of leafDose-ranging, open, postal studyIBS patients-2 mo↓IBS incidence by 26.4% A significant shift in self-reported usual bowel pattern away from “alternating constipation/diarrhea” toward “normal”↓NDI total symptom score by 41% 20% improvement in the NDI total QOL score[23]
Fumaria officinalisWhole plantRandomized, double-blind, placebo-controlled trialIBS patients-18 wk↓IBS-related pain ↑IBS-related distension The global assessment of changes in IBS symptoms and psychological stress due to IBS did not differ significantly among group[19]
Hypericum perforatumAerial partsRandomized, double-blind, placebo-controlled trialIBS patients-12 wk↓Overall BSS in both groups with the placebo arm having significantly lower scores at 12 wk compared with Hypericum group A similar proportion of subjects in each treatment group believed that the study drug they received decreased IBS life interferences[28]
Open-label, uncontrolled trialIBS women-8 wk↓autonomic nervous system to different stressor Improvement of Gastrointestinal symptoms of IBS[29]
Iberis amaraWhole plant extractDouble-blind, randomized, placebo-controlled, multi-centre trialIBS patients-4 wkSignificant improvement in IBS symptom scale and abdominal pain scale in Iberis group compared with placebo[44]
Maranta arundinaceaRootUncontrolledDiarrhea predominant- IBS patients-1 mo↓Diarrhoea ↓Abdominal pain[30]
Menthe piperitaEssenceProspective double blind placebo-controlled randomized trialIBS patients-4 wk75% of the patients in the treatment group showed a > 50% reduction of basal total IBS symptoms score compared with 38% in the placebo group (P < 0.009) a statistically significant reduction of the total IBS symptoms score in treatment group compared with T (0), while no change was found with the placebo[34]
Randomized double-blind placebo-controlled studyIBS patients-8 wkThe number of subjects free from abdominal pain or discomfort changed from 0 at wk 0 to 14 at wk 8 in the treatment group and from 0 to 6 in controls (P < 0.001). ↓Severity of abdominal pain significantly in the drug group as compared to controls Improvement in the QOL in the treatment group There was no significant adverse reaction[33]
Randomized, double-blind controlled trialIBS patients-2 wk76% of the patients receiving peppermint oil reported changes in the severity of symptom scale at the end of trial compared with 19% receiving placebo[35]
Improvements in the change of symptom scale in 71% of the patients receiving peppermint oil compared with 43% receiving placebo
No significant differences between groups in the Gastrointestinal Symptom Rating Scale
No changes in symptoms such as abdominal rumbling, abdominal distention, belching, gas, and heartburn in treatment group compared with placebo
Mean severity of pain symptoms in the treatment group was significantly lower than that in the placebo
IBS patients-1 moSignificant reduction in the abdominal pain, abdominal distension, stool frequency, borborygmi, flatulence in the treatment group compared to placebo[32]
Symptom improvements after essence therapy were significantly better than after placebo
No significant changes in liver function test results.
Paeonia lactifloraPaeoniflorin; Active principle of rootIn vivoNeonatal maternal separation-induced visceral hyperalgesia in rats-Single doseA dose-dependent analgesic effect Blockage of analgesic effect of Paeoniflorin by nor-binaltorphimine, dl-α-methyltyrosine, and yohimbine. Analgesic effect may be mediated by kappa-opioid receptors and α(2)-adrenoceptors in the central nervous system[39]
Plantago psylliumSeedRandomized placebo controlled trialIBs patients-12 wkSignificantly greater proportion of responders in the psyllium group than in the placebo group[40]
↓Symptom severity significantly in the psyllium group compared with the placebo
No differences in QOL
Table 2 Combination herbal therapies used for irritable bowel syndrome
Name of preparationComposition (part)Type of studyModelConcomitant drugsDuration of studyResultsRef.
CarmintMentha piperita (leaf)Double-blind, randomized, placebo-controlled, multicenter clinical trialIBS patientsLoperamide or psyllium (based on their predominant bowel function)8 wkSeverity and frequency of abdominal pain/discomfort were significantly lower in the Carmint group than the placebo group[41]
Melissa officinalis (leaf)
Coriandrum sativum (fruit)
CHMCodonopsis pilosulae (root)Randomized, double-blind, placebo-controlled trialIBS patients-16 wkSignificant 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 formulaLactulose Ulmus fulva (bark) Glycyrrhiza glabra (root) Avena sativa (bran)A two arm, open-label, uncontrolled pilot studyConstipation-predominant IBS-2 wkA 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 formulaVaccinium myrtillus (fruit)A two arm, open-label, uncontrolled pilot studyDiarrhea-predominant and alternating bowel-2 wka 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 vitroHuman intestinal mucosa/submucosa preparationsA 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 vivoWistar 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 trialIBS patients-4 wkSignificant improvement in IBS symptom scale and abdominal pain scale in STW 5 group compared with placebo[44]
STW 5-IIIberis amara (whole plant) Melissa officinalis (leaf) Carum carvi (fruit)Double-blind, randomized, placebo-controlled, multi-centre trialIBS patients-4 wkSignificant 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 LaxAloe barbadensis A. ferox (extract)Randomized, double-blind, placebo-controlled trialConstipation predominant-IBS patients-3 moSignificant 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)
TXNGPaeonia lactiflora (root)Prospective, randomized, double-blind, placebo-controlled trialDiarrhea 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
TXYFAtractylodes macrocephala (rhizome)In vivoMaternal 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 trialDiarrhea predominant-IBS patientsMiyarisan4 wkNo 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
TCMAtractylodes macrocephala (rhizome)Randomized placebo-controlled trialDiarrhea 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)