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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