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The Efficacy of an Herbal Medicine, Carmint, on the Relief of Abdominal Pain and Bloating in Patients with Irritable Bowel Syndrome: A Pilot Study


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Carmint contains total extracts of Melissa officinalis, Mentha spicata, and Coriandrum sativum, which have antispasmodic, carminative, and sedative effects. As abdominal pain/discomfort and bloating are commonly observed in patients with irritable bowel syndrome, we decided to evaluate the effectiveness of Carmint in relieving these symptoms in irritable bowel syndrome patients. We randomly assigned 32 irritable bowel syndrome patients to receive either Carmint or placebo, plus Loperamide or psyllium (based on their predominant bowel function), for 8 weeks. T-test analysis of the results showed that the severity and frequency of abdominal pain/discomfort were significantly lower in the Carmint group than the placebo group at the end of the treatment (P=0.016 and P=0.001, respectively), as were the severity and frequency of bloating (P=0.02 and P=0.002, respectively). This pilot study suggests that Carmint plus loperamide or Carmint plus psyllium (depending on the irritable bowel syndrome subtype) might be effective in these patients.
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Dig Dis Sci (2006) 51:1501–1507
DOI 10.1007/s10620-006-9079-3
The Efficacy of an Herbal Medicine, Carmint, on the Relief
of Abdominal Pain and Bloating in Patients with Irritable
Bowel Syndrome: A Pilot Study
Reyhaneh Vejdani ·
Hamid Reza Mohaghegh Shalmani ·
Mina Mir-Fattahi · Faranak Sajed-Nia ·
Morteza Abdollahi · Mohammad Reza Zali ·
Amir Houshang Mohammad Alizadeh · Ali Bahari ·
Gholamreza Amin
Received: 13 July 2005 / Accepted: 4 October 2005 / Published online: 26 July 2006
Springer Science+Business Media, Inc. 2006
Abstract Carmint contains total extracts of Melissa offici-
nalis, Mentha spicata, and Coriandrum sativum, which have
antispasmodic, carminative, and sedative effects. As abdom-
inal pain/discomfort and bloating are commonly observed in
patients with irritable bowel syndrome, we decided to eval-
uate the effectiveness of Carmint in relieving these symp-
toms in irritable bowel syndrome patients. We randomly as-
signed 32 irritable bowel syndrome patients to receive either
Carmint or placebo, plus Loperamide or psyllium (based on
their predominant bowel function), for 8 weeks. T-test anal-
ysis of the results showed that the severity and frequency of
abdominal pain/discomfort were significantly lower in the
Carmint group than the placebo group at the end of the treat-
ment (P =0.016 and P =0.001, respectively), as were the
severity and frequency of bloating (P =0.02 and P =0.002,
respectively). This pilot study suggests that Carmint plus
R. Vejdani · H. R. M. Shalmani · M. Mir-Fattahi · F. Sajed-Nia ·
M. Zali · A. H. M. Alizadeh · A. Bahari
The Research Center for Gastroenterology and Liver Diseases
(RCGLD), Shaheed Beheshti University of Medical Sciences,
Tehran, Iran
M. Abdollahi
National Nutrition and Food Technology Research Institute
(NNFTRI), Shaheed Beheshti University of Medical Sciences,
Tehran, Iran
G. Amin
Department of Pharmacognosy, School of Pharmacy, Tehran
University of Medical Sciences,
Tehran, Iran
R. Vejdani (
Number 41, 5th Floor, Entrance Number 4, A3 Block, Phase 1,
Ekbatan, Tehran, Iran, 14437-36143,
loperamide or Carmint plus psyllium (depending on the ir-
ritable bowel syndrome subtype) might be effective in these
Keywords Irritable bowel syndrome
Randomized placebo-controlled trial
Irritable bowel syndrome (IBS) is a condition where patients
experience a variable combination of abdominal pain or dis-
comfort, bloating, and altered bowel function [1]. Its cause
and pathogenesis, however, remain poorly understood [2].
Depending on the bowel habit alteration, patients with IBS
may be grouped according to the predominant symptom: ei-
ther constipation or diarrhea. However, clinical experience
of many clinicians indicates that, often, the predominant
bowel pattern alternates between constipation and diarrhea
over a long period of time [35]. Although IBS is not a life-
threatening condition, it may lead to considerable impair-
ment of health-related quality of life and high health-care
costs [6].
Given the diversity of definitions and diagnostic criteria,
its prevalence has not been firmly established, but it has been
estimated that IBS affects 14–24% of women and 5–15%
of men in Western countries [79]. There are no exact data
on the prevalence of IBS in Iran, but in a study on two
populations its prevalence is reported to be around 4% [10].
Treatment of IBS is largely based on the use of antispas-
modics, antidepressants, and medications that modify bowel
habit, depending on whether constipation or diarrhea is the
predominant problem [11]. Increased dietary fiber or psyl-
lium products are frequently recommended for patients with
1502 Dig Dis Sci (2006) 51:1501–1507
constipation-predominant IBS [12]. There is evidence that
fiber decreases whole-gut transit time, which may alleviate
constipation; fiber also may decrease intracolonic pressures,
which could reduce pain, because it is recognized that wall
tension is one of the factors that contributes to visceral pain
[1315]. Practically, there is a significant improvement in
constipation if sufficient quantities of fiber (20–30 g/day)
are consumed [16, 17].
Diarrhea-predominant IBS is associated with acceleration
of small bowel and proximal colonic transit [16, 18]. Lop-
eramide (2–4 mg up to four times daily), a synthetic opioid,
decreases intestinal transit, enhances intestinal water and ion
absorption, and increases anal sphincter tone at rest. These
physiologic actions seem to explain the improvement in diar-
rhea, urgency,andfecal soiling observed in patients with IBS,
but there is no evidence that it results in pain relief [19, 20].
Carmint is a herbal drop which contains total extracts of
three medicinal plants: Melissa officinalis, Mentha spicata,
and Coriandrum sativum. Melissa officinalis is known to
have mild sedative and carminative, spasmolytic, antibacte-
rial, antiviral, antioxidative, and antihormonal effects. In folk
medicine, Melissa officinalis is used also for lower abdomi-
nal disorders and nervous gastric complaints. Mentha spicata
is used for digestivedisorders, as a remedy for flatulence. The
oil produced from this plant has antispasmodic, carminative,
and stimulant effects. In folk medicine, Coriandrum sativum
is used for digestive and gastric complaints. The essential oil
stimulates the secretion of gastric juices and is carminative
and spasmolitic [2123]. No health hazards or side effects are
known in conjunction with the proper administration of des-
ignated therapeutic dosages of these three medicinal plants,
although Coriandrum sativum possesses a weak potential for
sensitization, as does the volatile oil of Mentha spicata due
to its menthol and L. Carvone content [21].
The aim of this study was to evaluate the effective-
ness of adding the herbal medicine, Carmint, or its placebo
to either loperamide or psyllium in the relief of abdomi-
nal pain/discomfort and bloating in patients with IBS us-
ing a randomized, double-blind, placebo-controlled study
Materials and methods
Thirty-two patients, aged 18–65 years, with IBS (all bowel-
habit subtypes) diagnosed using the Rome II criteria [24],
were recruited from a gastroenterology clinic at a university
hospital in Tehran, Iran, and through two private offices of
two gastroenterologists.
Organic disease was ruled out by a sigmoidoscopic or
colonoscopic examination performed after the appearance
of symptoms and within the previous 5 years. Although
Table 1 Inclusion and exclusion criteria
Inclusion criteria
Age 18–65 years
Colonic evaluation (colonoscopy) within the previous 5 years
Irritable bowel syndrome according to Rome II criteria
Normal liver function test, thyroid tests, complete blood cell
count, chemistry panel, ESR, UA, and stool examination
Exclusion criteria
Pregnancy or breast-feeding
Liver diseases
Nocturnal diarrhea
Respiratory diseases
Diabetes mellitus
Lactose intolerance
Major psychiatric disorder
Other gastrointestinal disorders except dyspepsia
Heart failure or MI
Peripheral neuropathy
Medications: antibiotics, laxatives, anticholinergics, narcotics,
smooth muscle relaxants, antidepressants, iron supplements,
nonsteroidal anti-inflammatory drugs or other analgesics,
treatments for Parkinson’s disease, antipsychotics,
anticonvulsants, any herbal medicine for alleviating abdominal
pain/discomfort or bloating, colchicine, and enema preparations
No consent; uncooperative or unreliable patients
no objective criteria exist for subgroups of IBS, physicians
assessed patients according to predominant bowel-function
pattern on the basis of the patient’s disease history. If diar-
rhea or constipation was present for at least 75% of the time
during which a patient’s IBS was active, the disease was clas-
sified as diarrhea-predominant or constipation-predominant,
respectively; otherwise, the patient was classified as having
alternating IBS. The study was carried out in accordance with
the Helsinki declaration and all patients signed the informed
consent prior to entry into the study. Patients could withdraw
from the study at anytime they wished. The inclusion and
exclusion criteria are listed in Table 1.
Medications affecting gastrointestinal motility and/or vis-
ceral perception, opioids, and analgesics were not permitted
during the study. Antispasmodic agents were not permitted
during the study; however, patients could receive Hyoscine
(40 mg/day) for no more than 3 days if they had bothersome
abdominal pain during the study.
Study design
This was an 8-week, double-blind, randomized, placebo-
controlled, multicenter clinical trial in outpatients with active
symptoms of IBS (or symptomatic IBS).
Patients were randomized to receive 30 drops of either
Carmint (n =14) or placebo (n =18) three times a day, taken
after each meal. Randomization was done using a random
Dig Dis Sci (2006) 51:1501–1507 1503
number table, with odd numbers for Carmint and even num-
bers for placebo.
Patients also received loperamide (2 mg twice a day) if
they had diarrhea-predominant IBS (n =10) or 1 spoonful
of psyllium powder once a day if they had constipation-
predominant or alternating IBS (n =22).
Carmint and its placebo were provided by POUR SINA
pharmaceutical company (Tehran, Iran) as drops and were
comparable in color, odor, and taste. Prior to entry into the
study, a questionnaire about the patients’ demographic infor-
mation and details of their bowel habits was completed for
them and medications in the preceding weeks were recorded.
The patients were provided with weekly treatment follow-
up forms to fill out. The forms included questions regarding
severity and frequency of abdominal pain/discomfort, sever-
ity and frequency of bloating, stool frequency, stool consis-
tency, straining, general improvement, and any new adverse
The symptoms were then rated as follows:
Severity of abdominal pain/discomfort using a 4-point
scale (0 =none, 1 =mild, 2 =moderate, 3 =severe)
Severity of bloating using a 4-point scale (0 =none,
1 =mild, 2 =moderate, 3 =severe)
Frequency of abdominal pain/discomfort
Frequency of bloating
Frequency of hard or loose/watery stool
Number of days without defecation
Number of days with more than three bowel movements
per day
In the weekly questionnaires, patients also were asked if
they had taken their prescribed drugs properly, if they had
taken any other drugs in addition to their prescription in
this study, and if any major physical or emotional stress had
occurred for them each week. Patients had monthly visits
with the enrolling physicians to assess drug compliance and
occurrence of adverse events (AEs). All personnel involved
in the study remained blinded until the study was completed.
The primary efficacy end points in this study were ab-
dominal pain/discomfort and bloating. The secondary effi-
cacy end point was overall relief of IBS symptoms for at
least 1 week per month. The overall relief of IBS symp-
toms question was, In the last 7 days, how much have your
IBS symptoms improved? (The available answers were “no
improvement,” “slightly improved,” “much improved,” and
“absolutely improved.”) In the analysis, because of the small
sample size, the items “no improvement“ and “slightly im-
proved” were classified as one group and the items “much
improved“ and “absolutely improved” as another group.
Statistical analysis
Data were entered into a computer using ACCESS and
were analyzed using SPSS 11.5. Efficacy analysis was
by intention to treat and included all patients random-
ized. Patients’ demographic and baseline characteristics
and clinical information were summarized. T-test and
Mann-Whitney test were used to analyze the sever-
ity and frequency of abdominal pain/discomfort and
Table 2 Patient demographics, baseline characteristics, and clinical
information (n =32)
(N =14)
(N =18)
Sex Male 9 (64.3%) 9 (50%)
Age (yr) Mean (SD) 31 (10.8) 46 (12.0)
Median 34 49
Weight (kg) Mean 64 71
Smoker Yes 3 2
Bowel move-
Mean 10 12
IBS subtype Diarrhea
Alternating 5 5
IBS symptoms Pain severity score 1.8 1.8
Urgent defecation 6 5
Bloating severity
2.1 2.1
Straining for
IBS symptoms
by meal
Yes 5 8
IBS symptoms
by stress
Yes 10 13
Mild 5 8
Moderate 7 6
Severe 2 4
pain relieved
by defecation
Yes 10 12
No 2 4
Unknown 2 2
Bloating None 4 2
Mild 2 2
Moderate 5 11
Severe 3 3
1504 Dig Dis Sci (2006) 51:1501–1507
Table 3 Percentage of patients
with overall improvement of
IBS symptoms per week in the
Carmint and placebo groups
Category 12345678
Carmint Improvement 7.7 30.8 38.5 40 50 40 50 60
Placebo Improvement 14.3 38.5 23 33.3 22.2 11.1 22.2 22.2
Baseline characteristics
Of 32 patients randomized, 28 completed the treatment
follow-up questionnaires: 4 of the patients (1 in the Carmint
group and 3 in the placebo group) withdrew at the begin-
ning of the study because they did not start taking the study
medication or were lost to follow-up.
As summarized in Table 2, the distribution of male and
female patients was similar between the two treatment groups
(P =0.419). The mean age was lower in the Carmint group
than the placebo group (31 and 46 years, respectively). The
average number of bowel movements per week was similar
between the two treatment groups (12 and 10, respectively)
(P =0.76).
Relief of abdominal pain/discomfort
and bloating
A T-test analysis showed that the average abdominal
pain/discomfort severity scores were not significantly dif-
ferent between the Carmint group and the placebo group
at the midpoint of treatment (0.83 and 1.38, respectively;
P =0.13). This difference between the two treatment groups
became statistically significant at the end of the treatment
(0.28 and 1.50, respectively; P =0.016) (Fig. 1). The two
treatment groups had similar pain severity scores at base-
A T-test analysis showed that the average number of days
with abdominal pain/discomfort was lower in the Carmint
group than the placebo group both at the midpoint of treat-
ment (0.66 and 1.92 days, respectively; P =0.02) and in
the last week of treatment (0.42 and 2.25 days, respec-
tively; P =0.001) (Fig. 2). The items which were signif-
icantly different between the two groups by T-test analy-
sis were also significantly different using Mann-Whitney
A T-test analysis showed that the average bloating severity
scores were significantly lower in the Carmint group than
the placebo group both at the midpoint of treatment (2.08
and 2.46, respectively; P =0.005) and in the last week of
treatment (1.71 and 2.5, respectively; P =0.02) (Fig. 3). The
two treatment groups were similar at baseline for bloating
severity scores.
Reductions in the average number of days with bloating
were greater in the Carmint group compared with the placebo
group, both at the midpoint of treatment (1.08 and 1.84 days,
respectively; P< 0.001) and in the last week of treatment
(0.85 and 2.5 days, respectively; P =0.002) (Fig. 4). Mann-
Whitney test showed that Carmint significantly decreased
the average bloating severity score and the average number
of days with bloating at the end of the treatment (P =0.03
and P =006; respectively).
Fig. 1 Change in abdominal pain severity scores by week
Dig Dis Sci (2006) 51:1501–1507 1505
Fig. 2 Average number of days with abdominal pain per week
Fig. 3 Change in bloating severity scores by week
Fig. 4 Average number of days with bloating per week
1506 Dig Dis Sci (2006) 51:1501–1507
Fig. 5 Percentage of patients
with overall relief of IBS
symptoms per week
Overall relief from IBS symptoms
Percentages of patients with overall relief from IBS
symptoms are listed in Table 3. There was not a significant
difference between the two groups in overall relief of
IBS symptoms during the weeks of treatment. However,
during the treatment period, the percentage of patients
with overall relief increased notably in the Carmint group,
while no such improvement was observed in the placebo
group (Fig. 5).
Adverse events
Overall, 21.42% of the patients reported experiencing
AEs. 4 (30.77%) of 13 patients in the Carmint group and
2 (13.33%) of 15 patients in the placebo group reported
at least one AE during the course of the study (Table 4).
There were two discontinuations (7.14%) related to AEs.
Both of these patients were from the placebo group.
The AEs which led to discontinuation were bloating and
IBS is a common health problem, often presenting at pri-
mary care as well as at internal medicine and gastroenterol-
Table 4 Number (%) of patients with adverse events
(whether or not drug related)
Adverse event Carmint group Placebo group
Anal pain before
1 (7.69)
Disurea 1 (6.66)
Malaise 2 (15.38)
1 (7.69)
Palpitation/headache 1(6.66)
Bloating 1(6.66)
ogy outpatient clinics. Therapeutic options are dominated
by drug therapies but there is uncertainty about their effec-
tiveness [25]. One of the major problems in developing a
treatment plan for patients with IBS is that IBS comprises a
group of functional intestinal disorders in which there are no
unique target receptors for pharmacotherapy [26]. Addition-
ally, there is a wide range of symptomatology.
Evidence on the effectiveness of herbal treatment in IBS
is limited, although some previous studies on the efficacy of
herbal medicines with antispasmodic and carminative prop-
erties in patients with IBS have shown good results [27, 28].
Carmint consists of the extracts of three medicinal plants
which are knownto have antispasmodic, carminative, and an-
tibacterial effects [20]. In this multicenter study, for the first
time we evaluated the effectiveness of this herbal medicine in
relieving abdominal pain/discomfort and bloating in patients
with IBS.
The results of our study show that the severity of pain
and severity of bloating started to differ from the beginning
of the second week of treatment, and the difference con-
tinued until the end of treatment. In addition, as the weeks
passed, the average number of days with pain and also the
average number of days with bloating obviously varied be-
tween the two groups; they decreased in the Carmint group.
Overall, in this study, Carmint plus loperamide and Carmint
plus psyllium were safe and well tolerated in patients
with IBS.
The limitation of our study was the small sample size. If
there had been more patients with each IBS subtype in the
trial, we could discuss the efficacy of Carmint with more
confidence. Our pilot study suggests that Carmint and lop-
eramide or Carmint and psyllium (depending on the IBS sub-
type) might be effective for patients with IBS. Larger clinical
trials are needed to prove the efficacy of this prescription in
patients with IBS.
Acknowledgments The authors would likex to thank POUR SINA
pharmaceutical company for providing Carmint and its placebo. This
study originated at The Research Center for Gastroenterology and Liver
Diseases, Shaheed Beheshti University of Medical Sciences, Tehran,
Dig Dis Sci (2006) 51:1501–1507 1507
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... Patients were randomized to receive 30 drops of either Carmint® or placebo three times a day after each meal for 8 weeks. At the end of the treatment, the severity and frequency of abdominal pain and bloating decreased signi cantly in the Carmint® group compared to the placebo group (Vejdani et al. 2006). ...
Coriandrum sativum L. (coriander, cilantro, Chinese parsley) belonging to Apiaceae (Umbelliferae) family is an annual herbaceous aromatic plant widely cultivated and distributed in Asia, Europe, and Northern Africa. Coriander is a well-known culinary herb around the world and has a long history of use as a medicinal plant that dates back to 1500 BC. Dried fruits (usually called seed) and fresh leaves are the most commonly used parts of the plant. Coriander, as well as its essential oil, has been traditionally used to treat various diseases by different civilizations. This chapter covers the botanical properties, traditional uses, chemical composition, pharmacological activities, and the safety profile of coriander.Keywords Coriandrum sativum CorianderApiaceaeEthnomedicineBioactive constituentPharmacological activitySafety
... Carmint was found effective in reducing the severity of pain and bloating and was safe for patients with IBS which support the findings of our study. 46 The beneficial effects in our study may be attributed to different biomedical activities like antioxidant, immunomodulatory, gastro-protective, antispasmodic analgesic, antidiarrheal, antisecretory, anti-colitis, laxative cytoprotective, anti-inflammatory, anxiolytic, antidepressant present in phytochemicals of ingredients of JS. The beneficial effects on overall symptoms of IBS including severity, frequency and consistency of stool as well as the quality of life may be attributed to the "multiple herbs, multiple target" pharmacologic effects phenomenon, also characteristics of Unani Medicine like other traditional medicines and can be a potential treatment option and a drug for an explanation about the effects of JS on IBS. ...
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Background and aim Irritable bowel syndrome (IBS) is one of the most common gastrointestinal disorders characterized by chronic recurrent abdominal pain related to a change in bowel habit or defecation frequency and commonly accompanied by anxiety and depression affecting about 10% population globally. Jawarish Shahi (JS) is a special dosage form prepared for gastrointestinal disorders in Unani medicine containing Phyllanthus emblica L., Terminalia chebula Retz., Coriandrum sativum L., Elettaria cardamomum (L.) Maton and Salix caprea L. Considering the antioxidant, immunomodulatory, antispasmodic analgesic, antidiarrheal, antisecretory, laxative, anti-inflammatory, anxiolytic, and antidepressant properties, the present study was aimed to evaluate the efficacy of JS in IBS. Experimental procedure This single-arm open-labeled clinical trial was conducted on 26 male and female patients of IBS according to Rome IV criteria, aged 18–50 years with moderate symptoms. JS was given 7 g orally twice a day after meal with water for 45 days. IBS Severity Scoring Scale (IBS-SSS) was used for efficacy outcomes and the difference was analyzed from baseline to the subsequent follow-ups. Results Data analysis of subsequent followup showed a significant decrease in IBS-SSS scores except for 2nd followup, scores decreased from 229.50 ± 75.91 to 203.12 ± 71.71 (p < 0.1018), 150.61 ± 55.32 (p < 0.0001), and 123.76 ± 54.81 (p < 0.0001) at 0, 15th, 30th, 45th day of follow up respectively. Conclusion The present study revealed that JS is safe and effective in reducing the overall symptoms of IBS in respect to its severity and impact on quality of life and can be used as an alternate as well as a complementary treatment in IBS.
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Melissa officinalis L, also known as lemon balm, bee balm, honey balm, is a perennial herb. Lemon balm occurs naturally in sandy and scrubby areas but also grown on damp wasteland, at elevations ranging from sea level to the mountains. Melissa officinalis is cost-effective, and compared with the economic indicators of traditional crops grown on fertilized land; this herb provides much higher profits. The leaf of Melissa officinalis contains flavonoids (quercitrin, rhamnocitrin, luteolin), polyphenolic compounds (rosmarinic acid, caffeic acid, and protocatechuic acid), monoterpenoid aldehyde, monoterpene glycosides, triterpenes (ursolic and oleanolic acids), sesquiterpenes, tannins, and essential oils (citral). Antimicrobial activities of the extracts and of rosmarinic acid of this plant were evaluated and were confirmed. The essential oil of Melissa officinalis L was shown to have anti-inflammatory activities, in treating various diseases associated with inflammation and pain. Melissa officinalis L relieves stress-related effects. Extract have the potential to prevent oxidative damage by preventing free radical– mediated oxidative stress. Melissa officinalis showed strong reducing power and exhibited a significant inhibition of deoxyribose degradation. The high phenolic content and radical scavenging activities of extracts of Melissa officinalis L was confirmed.
Ethnopharmacological relevance Functional gastrointestinal disorders (FGIDs) are the most common diagnoses in gastroenterology and represent a group of chronic unexplained gut syndromes. The best-known disorders are irritable bowel syndrome (IBS) and functional dyspepsia (FD). Jawarish Shahi (JS) is used for gastrointestinal disorders in Unani Medicine (UM). Aims of the study: The present review aims to evaluate the FD and IBS in Unani medicine and scientific evidence for the safety and efficacy of JS and its herbal ingredients in the management of FD and IBS. Material and methods Sources of data are from the classical literature of UM, Canon of medicine, Khazainul Advia, Indian Medicinal Plants-An Illustrated Dictionary. Databases, PubMed, Science Direct, Scopus, Google Scholar, were explored for related studies. Results An updated review on the concept of FGIDs in Unani medicine, its pathophysiology, and management is presented. Comprehensive information on JS and its traditional and ethnopharmacological clinical attributes, standardization and toxicity study, biomedical studies of herbs in JS for their efficacies in FD and IBS are presented. Conclusions The outcome of the work clearly indicates that disease conditions similar to FD and IBS and their successful treatment are described in Unani Medicine. JS has been used for disease conditions similar to FD and IBS by the physicians of the medieval period. The herbs in JS are widely researched for pharmacologically active substances and were reported for antioxidant, immunomodulatory, gastroprotective, antispasmodic, analgesic, antidiarrheal, antisecretory, laxative, anti-inflammatory, anxiolytic, and antidepressant properties. Nevertheless, further explorations, particularly well-designed clinical trials are required for efficacy.
The gastrointestinal tract (GIT), one of the essential organs of the human body is susceptible to various diseases. GI disorders such as constipation, diarrhea, GI reflux disease, gastric ulceration, Crohn’s disease, irritable bowel syndrome (IBS), also in addition to some other functional disorders, have become prevalent in a large part of the world population. Majority of the world’s population relies on herbal medicines nowadays for the management and treatment of GI diseases. However, the use of herbal medicines in various manifestations are traditionally derived, and further controlled trials suggest certain benefits of using ginger in nausea and vomiting, extract of licorice in peptic ulcers, Chinese herbal medicine in IBS, opium derivatives in diarrhea, and senna and ispaghula in constipation. The presence of various bioactive components in herbal preparations makes them suitable for potential therapeutic effects in GIT problems. In this chapter, we have discussed a number of single herbal formulations or herbal combinations for the treatment of different types of GIT ailments.
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Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder that causes abdominal pain, distension, change of bowel habit, bloating, constipation, diarrhea, and mucus discharge along with stools. Although the disease causes long-term and agonizing pain, no ideal cure has been found for it so far. This study aimed to investigate the efficacy and compliance of Mentha aquatica L. extract for the treatment of bloating caused by IBS. This double-blind, randomized, placebo-controlled trial study was conducted in Tooba gastroenterology clinic in Sari, Iran, during 2019 (from January to May). A total of 104 patients with IBS in the age range of 20-80 years were randomly divided into two parallel groups of herbal medicine (MAC-330) and placebo. Study period consisted of a 4 weeks of administration, and 2 weeks of follow-up. IBS-associated symptoms including severity of bloating (as primary outcome) and frequency of defecation and abdominal pain were evaluated using a questionnaire before treatment, 1, 2 and 4 weeks after beginning treatment and 2 weeks after stopping treatment. There were no significant differences between the two groups in terms of their baseline characteristics (p > 0.05). The severity of bloating was significantly reduced in the both groups at fourth week (p < 0.030) and 2 weeks after stopping intervention (sixth week) (p < 0.026). The frequency of defecation has increased with the onset of the intervention until the fourth week of the treatment which was not significant. The abdominal pain reduced during the 4 weeks’ intervention, but it was not significant. Based on the obtained results, MAC-330 could not be used as an effective treatment for patients with IBS in short time; however, it reduces the abdominal bloating and pain in these patients, especially in the long-term use.
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Introduction: Dysmenorrhoea is one of the gynaecological pathogenesis commonly observed in the socie-ty in young and adolescent girls. It is associated with painful cramps during menstruation of uterine origin with association of nausea, vomiting, constipation or diarrhoea. Various methods are practiced relieving pain and such symptoms but the search for herbal nutritive formulations to cure this is in search. Methodology: The present clinical study was randomized open labelled clinical trial amongst 150 unmar-ried girls suffering from painful menstruation between age group of 13 to 25. Performa was prepared to analyse data and pain before and after treatment. The population samples were randomly divided into three group with Rajapravartini Vati as control group, another two groups were administered herbal soup and herbal cookies. Results: Percentage relief in pain was 84.9% in cookies, 63.64% in soup group and 45.83% in Ra-japravartni group. 51.35% girls showed complete relief in dysmenorrhoea in cookies group, 40.54% in soup group and 32.43% in Rajapravartini group. Conclusion: Palatability and acceptability of herbal soup and cookies along with effectiveness in relieving painful menstruation was significant.
Lemon balm (Melissa officinalis) is a perennial herb in the mint family. In addition to its anxiolytic and gastro-intestinal effects, it has cognitive, anti-diabetic, and anti-thyroid effects and demonstrates antiviral efficacy against herpes simplex. It may be beneficial for bruxism, benign palpitations, dyslipidemia, diabetes, functional gastrointestinal disorders, premenstrual syndrome, dysmenorrhea, female sexual dysfunction, menopause, agitation of dementia, anxiety, insomnia, depression, attention-deficit/hyperactivity disorder, and HSV. This chapter examines some of the scientific research conducted on lemon balm, both alone and in combination formulas, for treating numerous health conditions. It summarizes results from several human studies of the herb’s use in treating oral and dental, cardiovascular, cardiometabolic, gastrointestinal, genitourinary, neurological, and psychiatric disorders, among others. Finally, the chapter presents a list of lemon balm’s active constituents, different Commonly Used Preparations and Dosage, and a section on “Safety and Precaution” that examines side effects, toxicity, and disease and drug interactions.
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Our objective was to obtain national data of the estimated prevalence, sociodemographic relationships, and health impact of persons with functional gastrointestinal disorders. We surveyed a stratified probability random sample of U.S householders selected from a data base of a national market firm (National Family Opinion, Inc.). Questions were asked about bowel symptoms, sociodemographic associations, work absenteeism, and physician visits. The sampling frame was constructed to be demographically similar to the U.S. householder population based on geographic region, age of householder, population density, household income and household size. Of 8250 mailings, 5430 were returned suitable for analysis (66% response). The survey assessed the prevalence of 20 functional gastrointestinal syndromes based on fulfillment of multinational diagnostic (Rome) criteria. Additional variables studied included: demographic status, work absenteeism, health care use, employment status, family income, geographic area of residence, population density, and number of persons in household. For this sample, 69% reported having at least one of 20 functional gastrointestinal syndromes in the previous three months. The symptoms were attributed to four major anatomic regions: esophageal (42%), gastroduodenal (26%), bowel (44%), and anorectal (26%), with considerable overlap. Females reported greater frequencies of globus, functional dysphagia, irritable bowel syndrome, functional constipation, functional abdominal pain, functional biliary pain and dyschezia; males reported greater frequencies of aerophagia and functional bloating. Symptom reporting, except for incontinence, declines with age, and low income is associated with greater symptom reporting. The rate of work/school absenteeism and physician visits is increased for those having a functional gastrointestinal disorder. Furthermore, the greatest rates are associated with those having gross fecal incontinence and certain more painful functional gastrointestinal disorders such as chronic abdominal pain, biliary pain, functional dyspepsia and IBS. Preliminary information on the prevalence, socio-demographic features and health impact is provided for persons who fulfill diagnostic criteria for functional gastrointestinal disorders.
BACKGROUND: The irritable bowel syndrome (IBS) may lead to considerable impairment of health-related quality of life and high health care costs. It is not clear whether these poor outcomes directly result from severe bowel symptoms or reflect a coexisting psychiatric disorder. OBJECTIVE: To determine whether bowel symptom severity and psychological symptoms directly influence health-related quality of life and health care costs. DESIGN: Cross-sectional survey. SETTING: Secondary and tertiary gastroenterology clinics. PATIENTS: 257 patients with severe IBS who did not respond to usual treatments and were recruited for a trial of psychological treatment. MEASUREMENTS: Predictors were abdominal pain, entries in a diary of 10 IBS symptoms, and measures of psychological symptoms. Outcomes were inability to work, health-related quality of life (measured by Medical Outcomes Survey 36-item short-form questionnaire [SF-36] physical component summary scores), and health care and productivity costs. Predictor and outcome measures were compared by using multiple regression and logistic regression analyses. RESULTS: Abdominal pain occurred on average 24 days per month and activities were restricted on 145 days of the previous 12 months. The mean (±SD) Hamilton depression score was 11.3 ± 6.1. The SF-36 physical component summary score was low (37.7 ± 10.6), and the patients had incurred high health care costs ($1743 ± $2263) over the previous year. Global severity and somatization scores on the Symptom Checklist 90 Revised, abdominal pain, and Hamilton depression scores independently contributed to the physical component score of the SF-36 (adjusted R 2 = 35.2%), but only psychological scores were associated with disability due to ill health. These variables did not accurately predict health care or other costs (adjusted R 2 = 9.3%). History of sexual abuse was not an independent predictor of outcome. CONCLUSIONS: Both abdominal and psychological symptoms are independently associated with impaired health-related quality of life in patients with severe IBS. Optimal treatment is likely to require a holistic approach. Since health care and loss of productivity costs are not clearly associated with these symptoms, alleviation of them will not necessarily lead to reduced costs.
Background & Aims: Disturbed gastric accommodation and sensation contribute to postprandial symptoms in dyspepsia, but the controlling mechanisms are unclear. Nitrergic and α2-adrenergic modulation of gastric sensory and motor function were assessed in this study. Methods: Using a factorial design, we assessed drug effects on gastric sensation during isobaric distentions and fasting and postprandial gastric motor function in 32 healthy volunteers. Each participant received one treatment: placebo; 0.3 or 0.5 μg·kg−1·min−1 intravenous nitroglycerin; 0.0125, 0.025, or 0.1 mg clonidine orally; or combined nitroglycerin plus clonidine. In 16 other healthy subjects, the effects of clonidine and placebo on gastric emptying of solids were evaluated using the 13C-octanoic acid breath test. Results: Clonidine and nitroglycerin increased gastric compliance, but normal postprandial accommodation was still observed despite the induced relaxation. Clonidine but not nitroglycerin reduced aggregate and pain perception averaged over four distention levels. There were no significant drug interactions. No dose effect of clonidine was observed on gastric emptying. Conclusions: Clonidine relaxes the stomach and reduces gastric sensation without inhibiting accommodation or emptying. Nitroglycerin relaxes the stomach without altering perception. Studies of the effects of clonidine on these gastric functions and symptoms in disease are warranted.GASTROENTEROLOGY 1999;116:573-585
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