Physiologic Characteristics of Traditional Chinese Medicine Based IBS Subgroups

描述（申请人提供）：背景：肠易激综合征（IBS）是一种常见的慢性胃肠道（GI）疾病，其定义为在没有可检测的器质性原因的情况下，与排便习惯改变相关的腹痛或不适的复发症状。虽然许多IBS患者有肠外症状，但这些症状通常不会在传统范式下被考虑。部分由于缺乏有效的治疗方法，30- 40%的IBS患者转向补充和替代医学（CAM）治疗，而不是或除了常规治疗之外。与西方方法不同，传统中医（TCM）将IBS患者视为异质群体，其GI症状是由更广泛的潜在多系统失调引起的许多表现之一。在失调的中医模式中，将患者分为包含GI和肠外症状的亚组。中医疗法，如针灸和草药，针对这些特定的模式。此外，中医模式显示出惊人的相似性，以常见的介绍IBS和新兴的概念，应激神经生物学，特别是变稳态和变稳态负荷。尽管它在中医范式中的核心作用，很少有研究探讨失调模式的本质。目的：基于广泛的初步数据，该提案试图通过测试以下假设来科学地验证中医模式：1）中医模式可以通过与应激反应的特定改变相关的不同病理生理模式来表征，以及2）中医模式可以通过选择症状项来区分。研究方法：在目标1中，我们将评估情感，疼痛，自主神经和神经内分泌反应内脏和躯体疼痛刺激，以确定两种不同的模式（过度和不足）反映改变的应激反应（分别为非稳态和非稳态负荷）。目的二：评估患者症状自评与中医专家诊断的相关性。结论：如果这些假设是正确的，它有力地验证了IBS失调的中医模式的存在，支持IBS是一种异质性，多系统疾病，与目前的特征相反，并提供了新的诊断和治疗方法的基础。鉴于传统方法治疗IBS等多系统功能性疾病的结果令人失望，这可能为这些具有挑战性的疾病的分类和治疗提供令人兴奋的见解和贡献。

DESCRIPTION (provided by applicant): Background: Irritable Bowel Syndrome (IBS) is a common chronic gastrointestinal (Gl) disorder defined by recurrent symptoms of abdominal pain or discomfort associated with alterations in bowel habits, in the absence of a detectable organic cause. Though many IBS patients have extraintestinal symptoms, these are generally not considered under the conventional paradigm. Partly from the lack of effective therapies, 30- 40% of IBS patients turn to complementary and alternative medical (CAM) therapies instead of, or in addition to, conventional treatment. Unlike the western approach, Traditional Chinese Medicine (TCM) views IBS patients as a heterogeneous population whose Gl symptoms are one of many manifestations resulting from a broader underlying multisystemic dysregulation. In TCM patterns of dysregulation, patients are classified into subgroups incorporating both Gl and extraintestinal symptoms. TCM therapies like acupuncture and herbs target these specific patterns. Further, TCM patterns show striking similarity to common presentations of IBS and to emerging concepts of stress neurobiology, particularly allostasis and allostatic load. Despite its core role in the TCM paradigm, few studies explore the nature of patterns of dysregulation. Aims: Building on extensive preliminary data, this proposal seeks to scientifically validate TCM patterns by testing the following hypotheses: 1) TCM patterns can be characterized by distinct pathophysiologic patterns related to specific alterations in stress responsiveness, and 2) TCM patterns can be distinguished by select symptom items. Methods: In Aim 1, we will assess affective, pain, autonomic and neuroendocrine responses to visceral and somatic pain stimuli to identify two distinct patterns (EXCESS and DEFICIENCY) reflecting altered stress responsiveness (allostasis and allostatic load, respectively). In Aim 2, we will assess correlation between patient self-report of select symptom items and TCM expert diagnosis of patients to specific TCM patterns. Conclusions: If these hypotheses are correct, it strongly validates the existence of TCM patterns of dysregulation in IBS, supports that IBS is a heterogeneous, multisystemic disorder contrary to current characterizations, and provides the basis for novel diagnostic and treatment approaches. Given the disappointing results with conventional approaches to multisystemic functional disorders like IBS, this may provide exciting insights and contributions to the classification and treatment of these challenging disorders.