A Randomized, Double-Blind, and Placebo-Controlled Trial of Chinese Herbal Medicine in the Treatment of Childhood Constipation
| Autor: | Hai-Lan Zhang, Luo-Jia Wang, Yang Wang, Ying Chen, Lei Qiao, Shu-Cheng Zhang |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Male
Modern medicine medicine.medical_specialty Constipation Adolescent medicine.medical_treatment Placebo-controlled study Laxative Decoction Breast milk Gastroenterology Pediatrics Article 03 medical and health sciences 0302 clinical medicine Double-Blind Method Internal medicine medicine Humans Child Defecation business.industry Stomach Functional weakness Intention to Treat Analysis medicine.anatomical_structure Treatment Outcome Patient Satisfaction 030220 oncology & carcinogenesis Child Preschool 030211 gastroenterology & hepatology Female medicine.symptom business Drugs Chinese Herbal |
| Zdroj: | Clinical and Translational Gastroenterology |
| ISSN: | 2155-384X |
| Popis: | Constipation is the most common complaint in childhood, affecting an estimated 20% of children globally (1). The treatment strategies of childhood constipation consist of diet control, behavioral intervention, and oral laxatives (2,3). Given its higher success rate and fewer side effects, the laxative PEG3350 has been considered the first choice (4). However, the effectiveness of PEG3350 laxative does not last, or it does not work after long-term use (5). Therefore, additional treatment interventions are necessary. With an unsatisfactory response to current treatments, many patients seek help from Chinese Herbal Medicine (CHM) (6). For thousands of years, CHM has been the main medical method in China (7,8). Traditional CHM theory holds that the transit of the digestive system depends on Qi. Although the cause of constipation originates from the colon and intestine, it is closely related to the function of the spleen and stomach. Functional weakness in the spleen and stomach leads to food and Qi stagnation. Food stagnation slows gastrointestinal motility, and Qi stagnation disturbs the tone of the stomach and descending movement of the intestine. Food and Qi stagnation further cause heat accumulation in the large intestine, and the pathological heat causes constipation by drying the intestine (7–9). In children, both spleen and stomach functions are very vulnerable because they are still in growth and development. The substantial function has not yet been fully established, and functional weakness of the spleen and stomach is in fact a physiological characteristic. On the other hand, childhood constipation is generally considered as a continuation of infant constipation because most of the childhood constipation has been reported to appear at the onset of babies and infants, although the pathophysiological basis is multifactorial (10). In babies and infants, solid feeding is introduced and the eating behavior coverts from swallowing to chewing. Because breastfeeding contributes to acceptance of a novel dietary and solid feeding introduction, it has been recommended in many guidelines and practices (11–13). However, many mothers would rather formula milk than breast milk; an improper formula-fed duration might increase the risk of eating disorders (12,13). The quantity, quality, and time of food introduction can all place a heavy burden on the baby's digestive system causing food and Qi stagnation (14). Therefore, a physiological weakness of the spleen and stomach in children and a long duration of improper feeding style from the onset of babies and infants are the main sources of childhood constipation; the principles of treatment must pay attention to these pathophysiological bases accordingly. In the documented traditional medicine dictionary (Pi Wei Lun), the prescription XiaojiDaozhi Decoction has been well described. The prescription consists of 12 kinds of CHMs. Through the combined action of these CHMs, XiaojiDaozhi Decoction can wake up gastric and Qi function, eliminate food stagnation, and remove pathological heat accumulation. In the modern medicine, XiaojiDaozhi Decoction has been proven to contain components beneficial to gastrointestinal peristalsis. Pharmacological studies have shown that Fructus Aurantii can alleviate small intestinal spasms (15). Accumulated solid or accumulated shell can increase the rhythm of gastrointestinal contraction (16). Rhubarb mainly contains onion-brewed derivatives, such as emodin formic acid glucoside, rhein-8-glucoside, and a variety of sennosides (17). Cannabis seeds were found to interact with alkaline intestinal liquid to produce fatty acids in the intestine, which stimulated the intestinal wall and enhanced intestinal peristalsis (18). Consequently, the effects of XiaojiDaozhi Decoction may be related to the promotion of bowel motility and digestive secretion, and it can be used in the treatment of constipation. Concerning the pathophysiological basis of childhood constipation and the pharmacological effects, XiaojiDaozhi Decoction was considered for the treatment of childhood constipation, holding the principle of promoting Qi movement, relieving Qi stagnation, and removing pathological heat accumulation (19). However, there is still a lack of evidence-based support for the treatment of childhood constipation by XiaojiDaozhi Decoction. Therefore, we designed a randomized, controlled, double-blind clinical trial to confirm the efficacy and safety of XiaojiDaozhi Decoction in the treatment of childhood constipation. |
| Databáze: | OpenAIRE |
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