Original Research Chaihu-Guizhi-Ganjiang Decoction is more efficacious in treating irritable bowel syndrome than Dicetel according to metabolomics analysis

Abstract Background Chaihu-Guizhi-Ganjiang Decoction (CGGD) is a traditional Chinese medicine (TCM) prescription used to treat viral influenza in China. There is evidence that CGGD can be used to treat irritable bowel syndrome (IBS) but the potential mechanism of action and metabolites produced upon CGGD treatment are not known. Methods Patients with IBS were treated with pinaverium bromide (Dicetel™) and then CGGD after a washout period of 1 week. Both treatments lasted for 30 days. Efficacy and changes in metabolites in plasma after the two treatments were compared. Plasma samples were acquired before and after each treatment, and untargeted metabolics analysis undertaken. Results Efficacy was measured by two systems: the Rome IV criteria and TCM theory. Irrespective of whether the Rome IV criteria or TCM theory were used, CGGD showed significantly better efficacy than Dicetel against IBS. CGGD also had a greater influence on plasma metabolism than Dicetel. Dicetel treatment led to increased tryptophan metabolism (increased levels of 5-Hydroxyindoleacetaldehyde) and increased protein metabolism (increased levels of L-arginine). CGGD use led to increased carnitine metabolism, with increased levels of L-carnitine and acylcarnitine. Such changes in these metabolites could suppress IBS by improving gastrointestinal motility and suppressing pain, depression, and inflammation. Conclusions CGGD appeared to be more efficacious than Dicetel in treating IBS. Metabolomics analysis helped to reveal the biomolecular basis of this beneficial effect.