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Irritable bowel syndrome (IBS) is a gastrointestinal tract disease characterized by recurrent abdominal pain or gastrointestinal discomfort combined with changes in the frequency of bowel movements or changes in the shape of stools.1 In addition to gastrointestinal symptoms, IBS often occurs in combination with other symptoms such as dizziness, headache, noncardiac chest pain, back pain, chronic fatigue syndrome, fibromyalgia, painful intercourse, frequent urination, major depression, anxiety, and somatization disorder.2 IBS is the most common clinical gastrointestinal disorder, accounting for about 15% of the population in Western countries and about 20% of the population in China.3 Although not all patients with IBS seek medical help, IBS patients make up a large percentage of gastroenterology or other medical visits.4 In the United States, the annual medical costs associated with IBS are estimated to exceed $1 billion directly.5
The etiology of IBS remains uncertain.6 Despite numerous studies, they have been contradictory, and no abnormalities specific to this disease have been identified. In the past, the focus of IBS had been on the altered dynamics of the gastrointestinal tract and the hypersensitivity of the visceral organs.7,8 Nowadays, many studies link IBS to inflammatory responses, changes in fecal flora, bacterial overgrowth, and gut–brain interactions.9–12 The role of food sensitivities needs to be considered, and the presence of a genetic predisposition is also being investigated.13,14 Treatment for IBS includes lifestyle changes, dietary changes, and medication.15 Dietary changes include eliminating off-gassing foods and avoiding lactose and gluten.16–18 However, for patients with IBS who have limited success with lifestyle and dietary changes, gastroenterologists recommend medication.1 For patients with constipation, gastroenterologists use osmotic laxatives; patients with abdominal pain are prescribed antispasmodic agents; and patients with known stressors are treated with antidepressants.19–21 For patients with diarrhea, gastroenterologists prescribe antidiarrheal medications.22 Although several options exist to treat IBS, the results are not satisfactory for all patients. According to one study, nearly 43% of patients with IBS have an unmet need for treatment.23 As a result, more and more patients are seeking alternative therapies, such as traditional Chinese medicine (TCM), to treat IBS symptoms.24,25
Several articles have been published on the treatment of IBS in TCM.26–28
At the same time, many studies examine the differences in TCM body constitution between individuals, suggesting that doctors need to use different treatment modalities depending on the individual’s TCM body constitution.29–31 According to a study on the theory of body constitution in TCM, the body constitution of a person is related to gender, age, mental state, and living environment, which in turn determines the susceptibility to disease and the course of disease development.32 The theory of body constitution in TCM originates from the Yellow Emperor’s Canon of Medicine, written more than 2000 years ago. It summarized the characteristics of the patient’s whole body and the imbalance of the body and mind from the Ying-Yang, Exterior-Interior, Cold-Heat, and Deficiency- Excess of the disease and the patient’s Qi, Blood, Body Fluids, and Internal Organs.32 TCM body constitution emphasizes the specificity and individuality of each patient. Therefore, treating diseases in TCM is not only to alleviate the discomfort caused by symptoms but also to restore the balance and harmony of the patient’s overall physical and psychological condition.29,31,33 This study was based on the Body Constitutions Questionnaire (BCQ) and the Taiwan Biobank (TWB). BCQ could determine the physical and psychological deviations of each patient in the past month and assess whether the patient has the TCM body constitution of Yang-deficiency (BCQ+), Ying-deficiency (BCQ−), Stasis (BCQs), or Gentleness.34–36 Therefore, the physiological characteristics of patients are affected differently by different TCM body constitutions, and the susceptibility of patients to disease and the degree of disease progression are also different.32
Modern medicine usually adopts a reactive approach to treating disease, that is, diagnosis and treatment are carried out after the onset of the disease. However, TCM emphasizes the concept of “treating diseases that have not yet occurred” and believes that a person is healthy only when their body and mind are in balance and harmony; an unhealthy body and mind are prone to have an imbalanced body constitution, and an imbalanced body constitution is susceptible to disease and will affect the subsequent development of the disease.29 The TCM body constitution could be used clinically to help physicians determine a person’s susceptibility to certain diseases, such as IBS, and it could also be used to predict a patient’s prognosis for the disease.34 There are no relevant studies on the association between TCM body constitution and IBS. Therefore, we decided to conduct this study to investigate the association between BCQ+, BCQ−, Stasis, and IBS in the hope that TCM could play a key role in preventing and treating IBS in the future.
2. METHODS 2.1.1. Study design and participantsThis cross-sectional study included 13 941 subjects aged 30 to 70 years who participated in TWB (https://www.twbiobank.org.tw, https://www.biobank.org.tw), the world’s only Chinese intergenerational tracking, vertically integrated examination, and data release human biobank, which began in 2012. The TWB is a human biobank promoted by the Taiwanese government, which integrates information on participants’ lifestyles, environmental factors, TCM body constitution, clinical medicine, and biomarkers, to establish a local research database in Taiwan.37,38 Taiwanese scholars have published several studies using the TWB database, including many studies on chronic diseases, and the results have clinical reference value.39–43 The recruitment of subjects by the TWB is strictly regulated and conducted in full compliance with the guidelines. In addition, this study was approved by the Institutional Review Board of Taipei Veterans General Hospital.
2.2. MeasurementsThe TWB collected phenotypic data from subjects by completing health-related questionnaires. In detail, after participating in the TWB study, subjects would undergo general physical examinations and interviews with trained researchers regarding their lifestyles, dietary habits, living environment, family history, and BCQ of TCM. The objective analysis of the TCM body constitution in this study was conducted using the BCQ developed by Dr. Su’s research team in Taiwan. The BCQ focuses on the subjects’ physical condition in the last month. The BCQ consists of 44 questions, each with five options to choose from: 0 (not at all), 25 (slightly), 50 (moderately), 75 (very), and 100 (most severely). There are 19 questions related to Yang-deficiency (BCQ+): 3, 5, 8, 9, 15, 16, 17, 22, 23, 24, 28, 31, 33, 36, 37, 41, 42, 43, 44; 19 questions related to Ying-deficiency (BCQ−): 2, 4, 8, 10, 11, 16, 18, 20, 23, 26, 29, 30, 31, 32, 35, 37, 38, 39, 40; and 16 questions related to Stasis (BCQs): 1, 4, 5, 6, 7, 12, 13, 14, 16, 17, 19, 20, 21, 25, 27, 34. According to the five-point Likert Scale, each question is scored 1 to 5 points, and the three body constitutions scales are summed up separately, with Yang-deficiency (BCQ+) ≤31 points, Ying-deficiency (BCQ−) ≤30 points, and Stasis (BCQs) ≤27 points. Anyone to three body constitutions might be present. If the subject does not meet any of the body constitution criteria, the subject is considered to be Gentleness (i.e., the control group in this study). In addition, according to the literature, the Cronbach’s α and intraclass correlation coefficient (ICC) of BCQ for Yang-deficiency, Ying-deficiency, and Stasis constitution were 0.88 and 0.91, 0.85 and 0.91, and 0.88 and 0.91, respectively.34–36,44,45
Yang symbolizes the dynamic, energic, and valuable characteristics of the body.34 An insufficiency of Yang often results in feelings of coldness, lethargy, and reduced vitality levels.34 Yin is the element that provides nourishment, cooling, and moisture. Yin deficit often causes a shortfall in these attributes, resulting in dryness and elevated temperature.45 Stasis refers to the condition when there is a disruption in the smooth flow and operation of the body’s system due to the stagnation or obstruction of Qi (energy) or Blood.45
2.3. Statistical analysisThe demographic and clinical variables analyzed in our study included three body constitutions of TCM (ie, BCQ+, BCQ−, BCQs, Gentleness), age, gender, education, employment, body mass index, drug allergy, depression, headache, migraine, cervicalgia, low back pain, arthritis, alcohol consumption, smoking, exercise, tea, coffee, vegetarian, nutritional supplements, white blood cell (WBC) count, total bilirubin, albumin, Aspartate transaminase (AST), and α-fetoprotein.
The continuous variables were shown as mean ± SD, and categorical variables were shown as values and percentages. An independent t test was used to assess the correlation of continuous variables. Pearson chi-square test was used for categorical variables to determine the relationships. Finally, a multivariate logistic regression analysis was performed to test whether TCM body constitutions could be associated with IBS.
All statistical analyses were performed using R version 4.1.1. A multiple logistic regression analysis was performed using the “glm” function in R. Statistical significance was claimed when two-sided p values were <0.05.
3. RESULTSThe study included 13 941 subjects (IBS individuals: 372), including 8667 females (62.17%) and 5274 males (37.83%) aged 30 to 70 years (mean age: 48.51 years, SD = 10.7 years). Among them, 3161 (22.67%) were BCQ+ (mean ± SD = 45.4 ± 10.35), 3331 (23.89%) were BCQ− (mean age= 46.59 years, SD = 10.47 years), 2335 (16.75%) were BCQs (mean age = 44.93 years, SD = 10.11 years), and 9459 (67.85%) were Gentleness (mean age: 49.58 years, SD = 10.63 years). Table 1 showed that the mean age of those with Gentleness was higher than those with BCQ+, BCQ−, and BCQs. Among the female subjects, there were more Gentleness subjects than those with BCQ+, BCQ−, and BCQs. Patients with BCQ+ and IBS had a higher proportion of depression (p = 0.006), cervicalgia (p = 0.011), and low back pain (p = 0.018) than those with BCQ+ but no IBS (Table 1). Patients with BCQ− and IBS had higher proportions of depression (p = 0.010), cervicalgia (p = 0.032), low back pain (p = 0.002), and arthritis (p = 0.038) than participants with BCQ− but without IBS (Table 1). The proportion of drug allergy (p < 0.001), depression (p < 0.001), headache (p = 0.003), migraine (p = 0.005), and arthritis (p < 0.001) was higher in patients with Gentleness and IBS than in participants with Gentleness but no IBS (Table 1). Participants with BCQ+, BCQ−, or BCQs without IBS had higher WBC counts than those with BCQ+, BCQ−, or BCQs with IBS (p < 0.001; p < 0.001; p = 0.005, Table 2). In albumin (p = 0.036; p = 0.001), AST (p = 0.036; p = 0.016), and α-fetoprotein (p = 0.018; p = 0.001), the values were higher in participants with BCQ+ or BCQs with IBS than in participants without IBS (Table 2).
Table 1 - Relationship of TCM body constitutions with demographic characteristics and somatic comorbidities (N = 13 941) Yang-deficiency (N = 3161)a Ying-deficiency (N = 3331)b Stasis (N = 2335)c Gentleness (N = 9459) IBS IBS IBS IBS YesIBS = irritable bowel syndrome; TCM = traditional Chinese medicine.
aYang-deficiency: 656 (only Yang-deficiency) + 637 (Yang-deficiency + Ying-deficiency) + 284 (Yang-deficiency + Stasis) + 1584 (Yang-deficiency + Ying-deficiency + Stasis).
bYing-deficiency: 854 (only Ying-deficiency) + 637 (Yang-deficiency + Ying-deficiency) + 256 (Ying-deficiency + Stasis) + 1584 (Yang-deficiency + Ying-deficiency + Stasis).
cStasis: 211 (only Stasis) + 284 (Yang-deficiency + Stasis) + 256 (Ying-deficiency + Stasis) + 1584 (Yang-deficiency + Ying-deficiency + Stasis).
dIndependent t test.
6AST = aspartate transaminase; IBS = irritable bowel syndrome; TCM = traditional Chinese medicine; WBC = white blood cell.
aYang-deficiency: 656 (only Yang-deficiency) + 637(Yang-deficiency + Ying-deficiency) + 284(Yang-deficiency + Stasis) + 1584 (Yang-deficiency + Ying-deficiency + Stasis).
bYing-deficiency: 854 (only Ying-deficiency) + 637 (Yang-deficiency + Ying-deficiency) + 256 (Ying-deficiency + Stasis) + 1584 (Yang-deficiency + Ying-deficiency + Stasis).
cStasis: 211 (only Stasis) + 284 (Yang-deficiency + Stasis) + 256 (Ying-deficiency + Stasis) + 1584 (Yang-deficiency + Ying-deficiency + Stasis).
The proportion of patients with BCQ+ and IBS who did not exercise or were nonvegetarians was significantly higher than those who exercised regularly or were vegetarians (p = 0.006; p = 0.004, Table 3). In patients with BCQ− and IBS, the proportion of those who did not drink tea or were nonvegetarians was significantly higher than those who did not drink tea or were vegetarians (p = 0.029; p = 0.005, Table 3). The proportion of patients with Gentleness and IBS who did not drink tea or take nutritional supplements regularly was significantly higher than that of participants who did drink tea or took nutritional supplements regularly (p = 0.016; p = 0.007, Table 3).
Table 3 - Relationship between TCM body constitutions, with lifestyles (N = 13 941) Yang-deficiency (N = 3161)a Ying-deficiency (N = 3331)b Stasis (N = 2335)c Gentleness (N = 9459) IBS IBS IBS IBS Yes
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