柴胡及其复方对腹泻型与便秘型肠易激综合征的同治作用研究进展OA

Objective To provide new ideas for solving the therapeutic dilemma of opposite subtypes of irritable bowel syndrome(IBS).Methods Relevant literature on diarrhea-predominant IBS(IBS-D)and constipation-predominant IBS(IBS-C)in the Web of Science,PubMed,CNKI and Wanfang databases were searched from the inception of databases to January 2026.By integrating the research progress of modern medicine on brain-gut axis,visceral hypersensitivity,intestinal flora and immune inflammation,and combining with the traditional Chinese medicine(TCM)theory of liver qi stagnation,the pathogenesis and commonality were analyzed,and the pharmacological mechanisms and clinical applications of main active components of Bupleuri Radix and its compound preparations in the treatment of two types of IBS were discussed.Results IBS-D and IBS-C have opposite clinical manifestations,but the core pathogenesis of both is failure of the liver to disperse and disharmony of the spleen and stomach,as well as common pathological bases including brain-gut axis dysfunction,visceral hypersensitivity,intestinal flora imbalance and low-grade inflammation,and both are closely related to emotional disorders.The two types of IBS show contradictory differences in the expression of brain-gut peptides[such as motilin(MTL)is significantly increased and gastrin(GAS)is compensatorily elevated in IBS-D patients;while IBS-C patients are the opposite),which increases the difficulty of targeted drug research and development.Guided by the TCM theory,the core pathogenesis of liver qi stagnation governs both types of IBS,laying a theoretical foundation for homotherapy for heteropathy.The main active components of Bupleuri Radix[saikosaponins,flavonoids(kaempferol,quercetin,isorhamnetin)and Bupleuri Radix polysaccharides]exert multi-target effects such as anti-inflammation,antioxidation,barrier repair and flora regulation by regulating the brain-gut-microbiota axis.Classic compound preparations of Bupleuri Radix(Sini Powder,Xiaochaihu Decoction,Chaihu Guizhi Ganjiang Decoction,Chaihu Shugan Powder,Xiaoyao Powder)can alleviate intestinal low-grade inflammation,improve intestinal hypersensitivity,and relieve gastrointestinal symptoms and accompanying anxiety and depression in patients with IBS-D and IBS-C.Conclusion Based on the core pathogenesis of liver qi stagnation,Bupleuri Radix and its compound preparations can realize the homotherapy for heteropathy of IBS-D and IBS-C through the holistic regulation of multi-components and multi-targets.