Evaluation of Xiaoyao-san for treatment of irritable bowel syndrome: A systematic review and meta-analysis of randomized controlled trials

Introduction Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal disorder, and Xiaoyao-san (XYS) has been prescribed for gastroenterological and neurological diseases in traditional Chinese medicine (TCM). This meta-analysis evaluated the efficacy and safety of XYS on IBS. Methods RCTs were searched for in nine electronic databases to April 30, 2021. RCTs that applied XYS or modified XYS as an experimental intervention and adopted Rome Criteria for IBS diagnosis were included. There were no limits for IBS-subtypes, patient information or publication language. Trials with improper randomization were excluded. The following indices were extracted from each identified trial: efficacy rate, symptom scores, IBS symptom severity score (IBS-SSS), IBS quality of life (IBS-QoL), Short Form Health Survey (SF-36), and adverse effects. Data analysis was conducted using RevMan 5.3, and Cochrane's risk of bias tool was used to assess the risk of bias in each trial. Results Twenty-one RCTs with 1858 patients were included in this review. XYS appeared to be better than conventional therapies in improving the clinical efficacy. Furthermore, XYS significantly reduced abdominal pain, abdominal distention, diarrhea, and IBS-SSS. XYS was also effective on five of the IBS-QoL subscales; dysphoria, interference with activity, body image, food avoidance, and social reaction. In addition, XYS was effective on four of the SF-36 subscales: physical functioning, bodily pain, physical role functioning, and emotional role functioning. Conclusion XYS may have a potential benefit for managing IBS. Moreover, we also recommend future large-scale RCTs with recognised global IBS symptom scales.