[Efficacy and mechanism of acupuncture combined with Tongxieyaofang for diarrhea-type irritable bowel syndrome of liver depression and spleen deficiency].

To observe the clinical effect of acupuncture at lower-he acupoints and front-mu acupoints combined with Tongxieyaofang (TXYF) for diarrhea-type irritable bowel syndrome (IBS-D) of liver depression and spleen deficiency, and to explore its possible mechanism.A total of 123 IBS-D patients with syndrome of liver depression and spleen deficiency were randomly divided into an acupuncture+TXYF group, a TXYF group and a medication group, 41 cases in each group. The patients in TXYF group were treated with oral administration of TXYF, three times a day. The patients in acupuncture+TXYF group were treated with oral administration of TXYF and routine acupuncture at Shangjuxu (ST 37), Tianshu (ST 25), Taichong (LR 3), Sanyinjiao (SP 6) and Zusanli (ST 36), once a day. The patients in medication group were treated with oral administration of pinaverium bromide, 50 mg, three times a day. All the treatment was given for four weeks. The total score of TCM syndrome scale, self-rating anxiety scale (SAS), self-rating depression scale (SDS) scores as well as the expression of calcitonin gene-related peptide (CGRP), vasoactive peptide (VIP) and MAPK signal pathway indicators of ERK1 mRNA and ERK2 mRNA were compared before and after treatment; the clinical effect was also compared.After treatment, the total score of TCM syndrome scale and SAS and SDS scores in each group were significantly reduced (P<0.05), and the scores in the acupuncture+TXYF group were lower than those in TXYF group and medication group (P<0.05). The total effective rate was 87.8% (36/41) in the acupuncture+TXYF group, which was higher than 78.0% (32/41) in the TXYF group and 68.3% (28/41) in the medication group (P<0.05). After treatment, the levels of CGRP and VIP in each group were decreased (P<0.05), and the levels in the acupuncture+TXYF group were lower than those in the TXYF group and the medication group (P<0.05). After treatment, the levels of ERK1 mRNA and ERK2 mRNA in each group were decreased (P<0.05), and the levels in acupuncture+TXYF group were lower than those in medication group (P<0.05).The acupuncture at lower-he acupoints and front-mu acupoints combined with TXYF could effectively alleviate the clinical symptoms, improve anxiety and depression in IBS-D patients with syndrome of liver depression and spleen deficiency, and its mechanism may be related to regulating the expression of ERK1 mRNA and ERK2 mRNA in MAPK signaling pathway, and reducing the serum levels of CGRP and VIP.