Volume 39 Issue 8
Aug.  2023
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Article Navigation >  Journal of Nanjing University of traditional Chinese Medicine  > 2023  >  39(8): 775-782
ZHANG Dan, LIU Jia-li, ZHOU Mei-yu, LIU Han-song, QIAN Hai-hua. Effect of Modified Tianwang Buxin Dan on Functional Constipation with Mood Disorder Based on Resting State Functional Magnetic Resonance Imaging[J]. Journal of Nanjing University of traditional Chinese Medicine, 2023, 39(8): 775-782. doi: 10.14148/j.issn.1672-0482.2023.0775
Citation: ZHANG Dan, LIU Jia-li, ZHOU Mei-yu, LIU Han-song, QIAN Hai-hua. Effect of Modified Tianwang Buxin Dan on Functional Constipation with Mood Disorder Based on Resting State Functional Magnetic Resonance Imaging[J]. Journal of Nanjing University of traditional Chinese Medicine, 2023, 39(8): 775-782. doi: 10.14148/j.issn.1672-0482.2023.0775
shu

Effect of Modified Tianwang Buxin Dan on Functional Constipation with Mood Disorder Based on Resting State Functional Magnetic Resonance Imaging

doi: 10.14148/j.issn.1672-0482.2023.0775
  • 1.

    The Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China

  • 2.

    The First Clinical Medical School, Nanjing University of Chinese Medicine, Nanjing 210023, China

  • Received Date: 2022-04-29
    Available Online: 2023-08-17
    Abstract
  •   OBJECTIVE  To investigate the effects of modified Tianwang Buxin Dan on constipation symptoms, mood disorders, serum 5-HT, substance P (SP) and vasoactive intestinal peptide (VIP) levels in patients with functional constipation, and to observe the changes in brain function of patients before and after treatment with resting state functional magnetic resonance imaging (fMRI).  METHODS  A total of 70 functional constipation patients with Yin deficiency and intestinal dryness and treated at the proctology department of Jiangsu Provincial Hospital of Traditional Chinese Medicine from August 2021 to March 2022 were randomly divided into a treatment group and a control group, with 35 cases each (5 cases dropped out of the control group and 6 cases dropped out of the treatment group). The control group was orally treated with polyethylene glycol powder, and the treatment group was orally treated with modified Tianwang Buxin Dan. The course of treatment for both groups was 8 weeks. Before and after treatment, the changes in TCM clinical symptoms and signs (including defecation interval, defecation difficulty level, and faces characteristics) of the two groups of patients were observed, and the Hamilton depression scale (HAMD), Hamilton anxiety scale (HAMA), and symptom checklist-90 (SCL-90) were adopted to evaluate the emotional and psychological state changes of the patients. Forty patients (21 patients in the treatment group and 19 patients in the control group) were randomly selected for brain resting state fMRI to analyze the characteristics of the amplitude of low-frequency fluctuations (ALFF).  RESULTS  After treatment, the TCM clinical symptoms and signs in both groups of patients were significantly improved (P < 0.05, P < 0.01), the HAMD score, HAMA score, and depression and anxiety factors in SCL-90 were significantly improved (P < 0.05), the therapeutic efficacy of the treatment group was superior to the control group (P < 0.05, P < 0.01). The levels of serum 5-HT and SP in both groups were significantly higher than those before treatment (P < 0.05), and the content of serum VIP was significantly reduced (P < 0.05), with the treatment group demonstrating better improvement (P < 0.05). fMRI scanning showed that after treatment, the brain activity of the anterior cingulate gyrus, orbitofrontal gyrus and hippocampus responsible for emotional regulation in the two groups decreased, and the brain activity of the auxiliary motor area responsible for somatic sensation and motor control and the precentral gyrus increased (P < 0.01). In addition, in the treatment group, decreased activity in the medial prefrontal cortex, amygdala, hypothalamus and other brain regions related to the emotional arousal network and hypothalamus pituitary adrenal (HPA) axis was noticed (P < 0.01).  CONCLUSION  The modified Tianwang Buxin Dan can not only alleviate the constipation symptoms of functional constipation patients, but also improve depression and anxiety scores. The mechanism may be related to regulating the activities of brain regions responsible for emotion, somatic sensation and HPA axis.

     

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    • References(35)
  • [1]
    HOSSEINZADEH ST, POORSAADATI S, RADKANI B, et al. Psychological disorders in patients with chronic constipation[J]. Gastroenterol Hepatol Bed Bench, 2011, 4(3): 159-163.
    [2]
    黄业保, 刘春强. 中医药治疗慢传输型便秘的实验研究进展[J]. 中华中医药学刊, 2020, 38(1): 87-89. doi: 10.13193/j.issn.1673-7717.2020.01.020

    HUANG YB, LIU CQ. Experimental research review of Chinese medicine in treatment of slow transit constipation[J]. Chin Arch Tradit Chin Med, 2020, 38(1): 87-89. doi: 10.13193/j.issn.1673-7717.2020.01.020
    [3]
    姜丽芳, 吴洁, 符强, 等. 针刺会阴治疗严重慢性功能性便秘临床疗效观察[J]. 中国针灸, 2023, 43(2): 128-132. doi: 10.13703/j.0255-2930.20220314-k0001

    JIANG LF, WU J, FU Q, et al. Clinical observation of acupuncture at Huiyin(CV 1) for chronic severe functional constipation[J]. Chin Acupunct Moxibust, 2023, 43(2): 128-132. doi: 10.13703/j.0255-2930.20220314-k0001
    [4]
    徐华清, 赵峻, 刘锦成, 等. 基于健脾养血润肠治疗老年慢性功能性便秘的临床效果[J]. 中国医药指南, 2022, 20(35): 129-131.

    XU HQ, ZHAO J, LIU JC, et al. Clinical effect of the treatment of senile chronic functional constipation based on the method of strengthening the spleen, nourishing the blood and moistening the intestines[J]. Guide China Med, 2022, 20(35): 129-131.
    [5]
    肖彦燕. 天王补心丹加减治疗习惯性便秘伴失眠的临床疗效观察[J]. 中医临床研究, 2013, 5(12): 5-6. doi: 10.3969/j.issn.1674-7860.2013.12.002

    XIAO YY. Clinical observation of Tianwang Buxin pill on treating habitual constipation following with insomnia[J]. Clin J Chin Med, 2013, 5(12): 5-6. doi: 10.3969/j.issn.1674-7860.2013.12.002
    [6]
    院建生. 天王补心丹治疗习惯性便秘[J]. 河南中医, 2014, 34(2): 347-348. doi: 10.16367/j.issn.1003-5028.2014.02.058

    YUAN JS. Tianwang Buxin pill in treating habitual constipation[J]. Henan Tradit Chin Med, 2014, 34(2): 347-348. doi: 10.16367/j.issn.1003-5028.2014.02.058
    [7]
    DROSSMAN DA, HASLER WL. Rome Ⅳ-functional GI disorders: Disorders of gut-brain interaction[J]. Gastroenterology, 2016, 150(6): 1257-1261. doi: 10.1053/j.gastro.2016.03.035
    [8]
    刘国华, 张明岛, 施杞, 等. 中医内科疾病治疗常规·诊断依据[M]. 2版. 上海: 上海中医药大学出版社, 2003: 30-31.

    LIU GH, ZHANG MD, SHI Q, et al. TCM Internal Medicine Disease Treatment Routine and Diagnostic Basis[M]. 2nd ed. Shanghai: Shanghai university of traditional Chinese medicine press, 2003: 30-31.
    [9]
    LEWIS SJ, HEATON KW. Stool form scale as a useful guide to intestinal transit time[J]. Scand J Gastroenterol, 1997, 32(9): 920-924. doi: 10.3109/00365529709011203
    [10]
    国家中医药管理局. 中医病证诊断疗效标准: ZY/T001.1-001.9-94[M]. 南京: 南京大学出版社, 1994: 11-12.

    State Administration of Traditional Chinese Medicine. Criteria of Diagnosis and Therapeutic Effect of Diseases and Syndromes in Traditional Chinese Medicine[M]. Nanjing: Nanjing university press, 1994: 11-12.
    [11]
    汤毓华, 张明园. 汉密顿抑郁量表(HAMD)[J]. 上海精神医学, 1984(2): 61-64. https://www.cnki.com.cn/Article/CJFDTOTAL-JSYI198402003.htm

    TANG YH, ZHANG MY. Hamilton depression scale (HAMD)[J]. Shanghai Arch Psychiatry, 1984(2): 61-64. https://www.cnki.com.cn/Article/CJFDTOTAL-JSYI198402003.htm
    [12]
    汤毓华, 张明园. 汉密顿焦虑量表(HAMA)[J]. 上海精神医学, 1984(2): 64-65. https://www.cnki.com.cn/Article/CJFDTOTAL-JSYI198402004.htm

    TANG YH, ZHANG MY. Hamilton anxiety scale (HAMA)[J]. Shanghai Arch Psychiatry, 1984(2): 64-65. https://www.cnki.com.cn/Article/CJFDTOTAL-JSYI198402004.htm
    [13]
    王征宇. 症状自评量表(SCL-90)[J]. 上海精神医学, 1984(2): 68-70. https://www.cnki.com.cn/Article/CJFDTOTAL-JSYI198402006.htm

    WANG ZY. Symptom checklist 90 (SCL-90)[J]. Shanghai Arch Psychiatry, 1984(2): 68-70. https://www.cnki.com.cn/Article/CJFDTOTAL-JSYI198402006.htm
    [14]
    朱丽明, 方秀才, 刘诗, 等. 全国多中心慢性便秘患者情绪和睡眠状况的调查[J]. 中华医学杂志, 2012, 92(32): 2243-2246. doi: 10.3760/cma.j.issn.0376-2491.2012.32.005

    ZHU LM, FANG XC, LIU S, et al. Multi-centered stratified clinical studies for psychological and sleeping status in patients with chronic constipation in China[J]. Natl Med J China, 2012, 92(32): 2243-2246. doi: 10.3760/cma.j.issn.0376-2491.2012.32.005
    [15]
    DING C, GE XL, ZHANG XY, et al. Efficacy of synbiotics in patients with slow transit constipation: A prospective randomized trial[J]. Nutrients, 2016, 8(10): 605. doi: 10.3390/nu8100605
    [16]
    林征, 林琳, 赵志泉, 等. 社会心理行为因素在功能性便秘发病中的作用研究[J]. 基础医学与临床, 2003, 23(S1): 97. https://www.cnki.com.cn/Article/CJFDTOTAL-JCYL2003S1127.htm

    LIN Z, LIN L, ZHAO ZQ, et al. Study on the role of social psychological and behavioral factors in the pathogenesis of functional constipation[J]. Basic Med Sci Clin, 2003, 23(S1): 97. https://www.cnki.com.cn/Article/CJFDTOTAL-JCYL2003S1127.htm
    [17]
    迟玉花, 赵刚. 功能性便秘动力学改变与情志因素的相关性[J]. 世界华人消化杂志, 2012, 20(18): 1685-1689.

    CHI YH, ZHAO G. Correlation of anorectal motility with anxiety and depression in patients with functional constipation[J]. World Chin J Dig, 2012, 20(18): 1685-1689.
    [18]
    叶彬, 陈春晓. 老年住院慢性便秘患者的焦虑抑郁状态和睡眠状况[J]. 中国老年学杂志, 2016, 36(8): 1996-1998. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ201608103.htm

    YE B, CHEN CX. Anxiety, depression and sleep status of elderly inpatients with chronic constipation[J]. Chin J Gerontol, 2016, 36(8): 1996-1998. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ201608103.htm
    [19]
    乔小云, 季洪赞. 4种药物治疗老年功能性便秘的成本-效果比较[J]. 医药导报, 2008, 27(5): 604-605. https://www.cnki.com.cn/Article/CJFDTOTAL-YYDB200805055.htm

    QIAO XY, JI HZ. Cost-effectiveness comparison of four drugs in the treatment of senile functional constipation[J]. Her Med, 2008, 27(5): 604-605. https://www.cnki.com.cn/Article/CJFDTOTAL-YYDB200805055.htm
    [20]
    张介宾. 景岳全书[M]. 北京: 人民卫生出版社, 2017: 763.

    ZHANG JB. Jingyue's Complete Works[M]. Beijing: People's medical publishing House, 2017: 763.
    [21]
    吴瑭. 温病条辨[M]. 北京: 人民卫生出版社, 2019: 96.

    WU T. Detailed Analysis of Epidemic Warm Diseases[M]. Beijing: People's medical publishing House, , 2019: 96.
    [22]
    府明棣, 叶进. 人参不良反应之探析[J]. 辽宁中医杂志, 2015, 42(6): 1214-1215. https://www.cnki.com.cn/Article/CJFDTOTAL-LNZY201506024.htm

    FU MT, YE J. The study of the side effects of ginseng[J]. Liaoning J Tradit Chin Med, 2015, 42(6): 1214-1215. https://www.cnki.com.cn/Article/CJFDTOTAL-LNZY201506024.htm
    [23]
    HOU X, CHEN S, ZHANG Y, et al. Quality of life in patients with Irritable Bowel Syndrome (IBS), assessed using the IBS-Quality of Life (IBS-QOL) measure after 4 and 8 weeks of treatment with mebeverine hydrochloride or pinaverium bromide: Results of an international prospective observational cohort study in Poland, Egypt, Mexico and China[J]. Clin Drug Investig, 2014, 34(11): 783-793.
    [24]
    ZHANG CY, YAO X, SUN G, et al. Close association between abnormal expressed enzymes of energy metabolism and diarrhea-predominant irritable bowel syndrome[J]. Chin Med J, 2019, 132(2): 135-144.
    [25]
    LOPEZ-ALVARENGA JC, SOBRINO-COSSIO S, REMES-TROCHE JM, et al. Polar vectors as a method for evaluating the effectiveness of irritable bowel syndrome treatments: An analysis with pinaverium bromide 100 mg plus simethicone 300 mg po bid[J]. Rev Gastroenterol Mex, 2013, 78(1): 21-27.
    [26]
    MILLER CH, HAMILTON JP, SACCHET MD, et al. Meta-analysis of functional neuroimaging of major depressive disorder in youth[J]. JAMA Psychiatry, 2015, 72(10): 1045-1053.
    [27]
    BLAIR RJ, MORRIS JS, FRITH CD, et al. Dissociable neural responses to facial expressions of sadness and anger[J]. Brain, 1999, 122 (Pt 5): 883-893.
    [28]
    YRONDI A, NEMMI F, BILLOUX S, et al. Significant decrease in hippocampus and amygdala mean diffusivity in treatment-resistant depression patients who respond to electroconvulsive therapy[J]. Front Psychiatry, 2019, 10: 694.
    [29]
    孙继飞, 陈丽梅, 王智, 等. 复发性与首发性抑郁症的静息态脑功能MRI低频振幅初步研究[J]. 国际医学放射学杂志, 2022, 45(4): 385-389, 395. https://www.cnki.com.cn/Article/CJFDTOTAL-GWLC202204003.htm

    SUN JF, CHEN LM, WANG Z, et al. Amplitude of low-frequency fluctuations of resting-state functional MRI in recurrent and first-episode depression[J]. Int J Med Radiol, 2022, 45(4): 385-389, 395. https://www.cnki.com.cn/Article/CJFDTOTAL-GWLC202204003.htm
    [30]
    赵京都, 张皓. 辅助运动区的神经可塑性及临床研究进展[J]. 中国康复, 2022, 37(5): 305-309. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLKF202205012.htm

    ZHAO JD, ZHANG H. Neuroplasticity of auxiliary motor area and its clinical research progress[J]. Chin J Rehabil, 2022, 37(5): 305-309. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLKF202205012.htm
    [31]
    MAYER EA. Gut feelings: The emerging biology of gut-brain communication[J]. Nat Rev Neurosci, 2011, 12(8): 453-466. https://pubmed.ncbi.nlm.nih.gov/21750565/
    [32]
    MAYER EA, NALIBOFF BD, CRAIG AD. Neuroimaging of the brain-gut axis: From basic understanding to treatment of functional GI disorders[J]. Gastroenterology, 2006, 131(6): 1925-1942. https://www.gastrojournal.org/article/S0016-5085(06)02260-8/fulltext
    [33]
    HUBBARD CS, LABUS JS, BUELLER J, et al. Corticotropin-releasing factor receptor 1 antagonist alters regional activation and effective connectivity in an emotional-arousal circuit during expectation of abdominal pain[J]. J Neurosci, 2011, 31(35): 12491-12500. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399687/
    [34]
    TILLISCH K, MAYER EA, LABUS JS. Quantitative meta-analysis identifies brain regions activated during rectal distension in irritable bowel syndrome[J]. Gastroenterology, 2011, 140(1): 91-100. https://www.sciencedirect.com/science/article/pii/S0016508510011510
    [35]
    刘秦浪, 孙林梅, 孙慧, 等. 从脑肠轴探讨功能性便秘伴情绪异常发病机制的研究进展[J]. 世界中医药, 2022, 17(4): 579-582, 589. https://www.cnki.com.cn/Article/CJFDTOTAL-SJZA202204024.htm

    LIU QL, SUN LM, SUN H, et al. Research progress on the pathogenesis of functional constipation with emotional disorders from brain-gut axis perspectives[J]. World Chin Med, 2022, 17(4): 579-582, 589. https://www.cnki.com.cn/Article/CJFDTOTAL-SJZA202204024.htm
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