[Diarrhea-predominant irritable bowel syndrome of spleen deficiency and damp excess treated with fire needling therapy with filiform needle and acupoint application therapy: a randomized controlled trial].

OBJECTIVE To compare the clinical therapeutic effect on diarrhea-predominant irritable bowel syndrome (IBS-D) of spleen deficiency and damp excess among fire needling therapy with filiform needle combined with acupoint application therapy, simple acupoint application therapy and pinaverium bromide tablets, and explore the mechanism on the improvements in IBS-D. METHODS A total of 150 patients with IBS-D of spleen deficiency and damp excess were randomized into a combined treatment group (50 cases, 14 cases dropped off), an acupoint application group (50 cases, 16 cases dropped off ) and a western medication group (50 cases, 13 cases dropped off ). In the western medication group, pinaverium bromide tablets were prescribed for oral administration, 50 mg per time, three times a day. In the acupoint application group, the herbal plaster of shenling baizhu powder mixed with fresh ginger juice was placed on Shenque (CV 8), once every two days. In the combined treatment group, on the base of the treatment as the acupoint application group, the fire needling therapy with filiform needle was exerted at Tianshu (ST 25), Shangjuxu (ST 37), Yinlingquan (SP 9) and Dachangshu (BL 25), once every two days. The duration of treatment in each group was 4 weeks. Separately, before treatment and after 7 and 28 days of treatment, the score of clinical symptoms and the score of quality of life scale for IBS (IBS-QOL) were observed in each group. Before treatment and after 28 days of treatment, the levels of , and T lymphocytes, and the ratio of / in peripheral blood of patients were detected successively; as well as the expressions of 5-HT3R mRNA and 5-HT4R mRNA in colon mucosal tissues in each group separately. RESULTS Except the score for abdominal pain in the acupoint application group and the scores for abdominal pain and abdominal distention in the western medication group after 7 days of treatment, the scores for abdominal pain, abdominal distention, defecation frequency, stool form and incomplete bowel movement after 7 and 28 days of treatment were all reduced as compared with those before treatment in each group separately (P<0.05). After 7 days of treatment, the scores for abdominal distention, defecation frequency and stool form in the combined treatment group were all lower than those in the western medication group (P<0.05). After 28 days of treatment, the score of each clinical symptom in the combined treatment group was lower than either of the rest two groups respectively (P<0.05); and the scores for abdominal pain, abdominal distention and incomplete bowel movement in the acupoint application group were lower than those in the western medication group separately (P<0.05). After 7 and 28 days of treatment, the score of each item in IBS-QOL was increased as compared with that before treatment in each group (P<0.05). After 7 days of treatment, except the scores for heterosexual relationship and human relations, scores of the other items, other scores of IBS-QOL in the combined treatment group were higher than those in the western medication group separately (P<0.05); while the scores of anxiety and behavior disorder in the acupoint application group were higher than those in the western medication group (P<0.05). After 28 days of treatment, the each score of IBS-QOL in the combined treatment group was higher than the other two groups respectively (P<0.05), while the scores of anxiety, behavior disorder, dietary control, social reaction and human relations in the acupoint application group were all higher than the western medication group (P<0.05). After treatment, the levels of and T lymphocytes and the ratio of /in peripheral blood, as well as the expressions of 5-HT4R mRNA in colon tissue were all increased in each group (P<0.05), but the levels of T lymphocyte and 5-HT3R mRNA expressions in colon tissue were reduced in each group (P<0.05). After treatment, regarding the levels of and T lymphocytes and the ratio of /in peripheral blood, as well as the expressions of 5-HT4R mRNA in colon tissue, the values in the combined treatment group were all higher than either of the rest two groups respectively (P<0.05), while the values in the acupoint application group were higher than the western medication group (P<0.05). Concerning to the level of T lymphocytes and 5-HT3R mRNA expression, the values in the combined treatment group were lower than the rest two groups respectively (P<0.05), and the values in the acupoint application group were lower than the western medication group (P<0.05). CONCLUSION The combined treatment with the fire needling therapy with filiform needle and the acupoint application therapy effectively relieves the clinical symptoms, improves the quality of life and strengthens the immunity in the patients with IBS-D. The therapeutic effect of this combined regimen is better than either simple acupoint application therapy or the oral medication of pinaverium bromide. The mechanism may be related to the regulation of the levels of T lymphocyte subsets and the modulation of the expressions of 5-HT3R and 5-HT4R mRNA in colon tissue.