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September 15, 1999

Chinese Herbal Medicine for Irritable Bowel Syndrome—Reply

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor


Copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1999

JAMA. 1999;282(11):1035-1037. doi:10-1001/pubs.JAMA-ISSN-0098-7484-282-11-jac90008

In Reply: Dr Lu provides an interesting perspective on the potential pharmacological basis of action of CHM. It could also be postulated that there is a direct pharmacological action affecting visceral hypersensitivity—1 of the central mechanisms that appears to be dysregulated in IBS. While it is likely that there is a synergism between certain herbs, it is also possible that not all the herbs are efficacious.

The standard formula was devised through the study and collaboration of 2 principal Chinese herbalists. While contained within it are parts of classic formulations, it does not strictly follow previous prescriptions. The placebo was prepared by a pharmaceutical contractor with previous experience in this area. It contained 78.2% calcium hydrogen phosphate, 19.6% soy fiber, 0.3% cosmetic brown, 0.5% cosmetic yellow, 0.01% edicol blue, 0.09% identical licorice dry flavor, and 0.3% bitter flavor. We are reasonably confident that the placebo was completely inert. Patients who received the placebo responded in a predictable fashion overall. The gram proportions of herbal ingredients in the standard formula were converted to the nearest 0.5%.

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