Efficacy of MaZiRenWan, a Chinese Herbal Medicine, in Patients With Functional Constipation in a Randomized Controlled Trial

Zhong, Linda L. D.; Cheng, Chung Wah; Kun, Wai; Dai, Liang; Hu, Dong-Dong; Ning, Ziwan; Xiao, Haitao; Lin, Chengyuan; Zhao, Ling; Huang, Tao; Tian, Ke; Chan, King-hong; Lam, Ting Wa; Chen, Xiaorui; Wong, Chi-tak; Li, Min; Lü, Aiping; Wu, Justin C.Y.; Bian, Zhaoxiang

doi:10.1016/j.cgh.2018.04.005

Cited by 36 publications

(58 citation statements)

References 21 publications

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“…The studies published between 1991 and 2019 were included. Patients had FD, [15][16][17][18][19][20][21][22]13,14,[23][24][25][26][27][28][29][30][31][32] and constipation [56][57][58][59][60][61][62] in 19, 23 and 7 trials respectively. More than 33 different kinds of herbal formulae were tested in the included trials.…”

Section: Resultsmentioning

confidence: 99%

“…Herbal medicines versus conventional pharmacotherapy for FGIDs. Five trials 54,24,20,62,59 compared the effective rate of HMs versus conventional pharmacotherapy for FGIDs (n = 1284). The risk ratio for improvement of symptom for HMs treated versus conventional pharmacotherapy treated was 1.10 (95% CI 1.03-1.18), which indicated that HMs were non-inferior to conventional pharmacological drugs such as Cisapride in FD, Pinaverium in IBS and Senna or Lactulose in FC ( Fig.…”

Section: Resultsmentioning

confidence: 99%

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Herbal medicine in the treatment of functional gastrointestinal disorders: A systematic review with meta‐analysis

Tan

Gwee

Tack

et al. 2019

J of Gastro and Hepatol

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Background and Aims The efficacy of herbal medicines (HMs) for functional gastrointestinal disorders (FGIDs) including irritable bowel syndrome (IBS), functional dyspepsia (FD) and functional constipation (FC) is controversial. A systematic review with meta‐analysis was conducted to determine their effectiveness for FGIDs. Methods We searched the following electronic databases till July 2019 with English language restriction: The Cochrane Library, EMBASE and PUBMED. Randomized double‐blind controlled trials of HMs compared with placebo or conventional pharmacological drugs for adult FGIDs patients were included. Results In total, 49 trials involving 7396 participants with FGIDs were included. The risk of bias was low in 9, unclear in 36, and high in 4 trials. More than 33 different herbal formulae were tested. HMs demonstrated statistically significant benefits for symptom improvement compared with placebo in 46 trials (RR = 1.67, 95% CI 1.48–1.88). When compared with conventional pharmacological therapy in 5 trials, HMs were found to be non‐inferior (RR = 1.10, 95% CI 1.03–1.18). The number of trials with regards to FD, IBS and FC were 19, 23 and 7 respectively. Subgroup analysis found that HMs were better than placebo in alleviating symptoms for FD (RR = 1.50, 95% CI 1.32–1.69), IBS (RR = 1.62, 95% CI 1.32–1.97) and FC (RR = 3.83, 95% CI 2.26–6.50). HMs tended to have more patients with adverse events than placebo, but similar to conventional pharmacological drugs. Conclusions Our findings provide a positive signal for HMs as a potentially well‐tolerated and effective treatment for FGIDs, deserving further examination in high‐quality trials.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Herbal medicine in the treatment of functional gastrointestinal disorders: A systematic review with meta‐analysis

Tan

Gwee

Tack

et al. 2019

J of Gastro and Hepatol

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“…Participants were eligible as per the published protocol (Zhong et al, 2013) and clinical study (Zhong et al, 2019). In brief, subjects were included if the following requirements were met: 1) diagnosed with FC according to Rome III; 2) diagnosed with excessive pattern according to TCM; 3) 18-65 years old; 4) complete spontaneous bowel movement (CSBM) ≤ 2times/ week; 5) severity of constipation ≥ 3 points (on a 7-point scale) (Ford and Suares, 2011); 6) total symptom score ≥ 8 points (on a 7-point scale for constipation-related symptoms); 7) normal colonic examination (barium enema or colonoscopy) within five years; 8) normal liver and renal function in blood test within 3 months.…”

Section: Participantsmentioning

confidence: 99%

“…Details on MZRW preparation for FC patients have been documented in a previously published clinical study (Zhong et al, 2019). In brief, a dose of 15 g per day (7.5 g, twice a day) of MZRW granules was selected.…”

Section: Preparation Of Mzrw Granules For Fc Patient's Interventionmentioning

confidence: 99%

“…These compounds have been shown to stimulate the contractions of colonic smooth muscle through multiple signaling pathways, such as the acetylcholine-, estrogen-, prostaglandin-, cannabinoid-, and purine pathways (Huang et al, 2018). Recently, in a three-armed, randomized, and controlled clinical study with 291 FC patients (Zhong et al, 2019), MZRW demonstrated comparable efficacy with Senna (a first-line laxative commonly used in Hong Kong) during the treatment period. Both were better than a placebo.…”

Section: Introductionmentioning

confidence: 99%

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Chinese Herbal Medicine (MaZiRenWan) Improves Bowel Movement in Functional Constipation Through Down-Regulating Oleamide

et al. 2020

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In a prospective, randomized, three-arms, controlled clinical study, Chinese Herbal Medicine MaZiRenWan (MZRW, also known as Hemp Seed Pill) demonstrates comparable efficacy with Senna for functional constipation (FC) during an 8-week treatment period. Both MZRW and Senna are better than a placebo; relative to Senna and a placebo, MZRW displayed a more sustained effect during the 8-week follow-up period. The characteristic pharmacological mechanism responsible for this observation is still unclear. To explore this, we collected pre-and post-treatment serum samples of 85 FC patients from MZRW/Senna/placebo treatment groups for pharmacometabolomic analysis. An ultrahigh-performance liquid chromatography-mass spectrometer (UPLC-MS) was used for metabolic profiling and quantification. In vivo studies were conducted in constipated C57BL/6J mice to verify the effects and corresponding mechanism(s) of the action of MZRW. Pearson correlation analysis, paired t-test, one-way ANOVA analysis, c2 test, and Student t-test were used to interpret the clinical and preclinical data. Changes in levels of circulating oleamide and its derivatives negatively correlate with improvement in complete spontaneous bowel movement (CSBM) in the MZRW group (Pearson r =-0.59, p = 0.00057). The same did not hold true for either Senna or placebo groups. Oleamide is a known regulator of intestinal motility. MZRW treatment resulted in reduced levels of circulating oleamide in FC patients. Experimental verification showed that MZRW attenuated oleamide-induced slow intestinal motility in mice. MZRW decreased oleamide levels in serum, ileum, and colon in normal mice, but increased expression of colonic fatty acid amide hydrolase (FAAH). In conclusion, MZRW improved bowel movement in FC by down-regulating oleamide, possibly by enhancing FAAH-mediated degradation. Our findings suggest a novel therapeutic strategy for FC.

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Consumption of Wheat Peptides Improves Functional Constipation: A Translational Study in Humans and Mice

Wang

Shen

Zhang

et al. 2022

Molecular Nutrition Food Res

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Scope: Wheat peptides (WP) are rich in glutamic acid, glutamine, and other bioactive compounds that may benefit gut function and health. This study aims to evaluate the effects of regular consumption of WP on constipation-induced complications and gut microbiota in humans and mice. Methods and results: A randomized trial of 49 functional constipation participants is conducted. The weekly amount of spontaneous bowel movements (SBM) increases by 2.09 per week after WP treatment, and by 0.40 per week among the placebo group (PL). Concomitantly, the secondary outcomes show significant improvements in the quality of life-related to constipation (PAC-QOL), constipation severity, and satisfaction with the intervention. In the animal study, WP effectively alleviates constipation symptoms and affects the secretion of intestinal mobility-related neurotransmitters and gastrointestinal hormones in loperamide-induced constipation mice. Additionally, WP regulates the gene and protein expression levels of water-electrolyte metabolism and intestinal mobility. Furthermore, WP treatment decreases the abundance of several gut microbiota positively correlated to constipation (Turicibacter, Bacteroides_f_Bacteroidaceae, and Streptococcus) in mice. Conclusion: WP ameliorates constipation in humans and mice, which could be partly explained by improving water-electrolyte metabolism, boosting intestinal motility, and reshaping gut microbiota.

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Efficacy of MaZiRenWan, a Chinese Herbal Medicine, in Patients With Functional Constipation in a Randomized Controlled Trial

Cited by 36 publications

References 21 publications

Herbal medicine in the treatment of functional gastrointestinal disorders: A systematic review with meta‐analysis

Herbal medicine in the treatment of functional gastrointestinal disorders: A systematic review with meta‐analysis

Chinese Herbal Medicine (MaZiRenWan) Improves Bowel Movement in Functional Constipation Through Down-Regulating Oleamide

Consumption of Wheat Peptides Improves Functional Constipation: A Translational Study in Humans and Mice

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