Predictive value of alarm symptoms in Rome IV irritable bowel syndrome:A multicenter cross-sectional study

BACKGROUND Irritable bowel syndrome(IBS)is a common functional bowel disease that shares features with many organic diseases and cannot be accurately diagnosed by symptom-based criteria.Alarm symptoms have long been applied in the clinical diagnosis of IBS.However,no study has explored the predictive value of alarm symptoms in suspected IBS patients based on the latest Rome IV criteria.AIM To investigate the predictive value of alarm symptoms in suspected IBS patients based on the Rome IV criteria.METHODS In this multicenter cross-sectional study,we collected data from 730 suspected IBS patients evaluated at 3 tertiary care centers from August 2018 to August 2019.Patients with IBS-like symptoms who completed colonoscopy during the study period were initially identified by investigators through medical records.Eligible patients completed questionnaires,underwent laboratory tests,and were assigned to the IBS or organic disease group according to colonoscopy findings and pathology results(if a biopsy was taken).Independent risk factors for organic disease were explored by logistic regression analysis,and the positive predictive value(PPV)and missed diagnosis rate were calculated.RESULTS The incidence of alarm symptoms in suspected IBS patients was 75.34%.Anemia[odds ratio(OR)=2.825,95%confidence interval(CI):1.273-6.267,P=0.011],fecal occult blood[OR=1.940(95%CI:1.041-3.613),P=0.037],unintended weight loss(P=0.009),female sex[OR=0.560(95%CI:0.330-0.949),P=0.031]and marital status(P=0.030)were independently correlated with organic disease.The prevalence of organic disease was 10.41%in suspected IBS patients.The PPV of alarm symptoms for organic disease was highest for anemia(22.92%),fecal occult blood(19.35%)and unintended weight loss(16.48%),and it was 100%when these three factors were combined.The PPV and missed diagnosis rate for diagnosing IBS were 91.67%and 74.77%when all alarm symptoms were combined with Rome IV and 92.09%and 34.10%when only fecal occult blood,unintended weight loss and anemia were combined with Rome IV,respectively.CONCLUSION Anemia,fecal occult blood and unintended weight loss have high predictive value for organic disease in suspected IBS patients and can help identify patients requiring further examination but are not recommended as exclusion criteria for IBS.

Exploring the biological mechanism of qi deficiency syndrome with chronic obstructive pulmonary disease(COPD)based on integrated pharmacology

Objective:To explore the potential biological mechanism of chronic obstructive pulmonary disease(COPD)qi deficiency syndrome,we used the integrated pharmacology network computing platform and carried out experimental verification.Methods:Using an integrated pharmacology strategy to analyze the potential biological targets of COPD qi deficiency syndrome.Based on the established qi deficiency syndrome rat model of COPD,the biological targets of lung and skeletal muscle were detected by electron microscopy,adenosine triphosphate(ATP)content assays,and western blotting.Results:According to the integrated pharmacological results,it was found that the locations of cell components related to COPD qi deficiency syndrome were mainly mitochondria.Electron microscopy results using lung tissue showed that mitochondria in the lipopolysaccharide(LPS group)and pulmonary instillation of LPS combined with cigarette smoke(LPStCS group)were swollen,deformed,and fragmented,with disappearing or broken crista.Results also showed that the total content of ATP in the lung and skeletal muscle of both groups was significantly lower than that in the control group at the 12th week(P<.05).At the 12th week,the expression of dynamin-related protein 1(DRP1)and mitofusin 1(MFN1)protein was significantly difference than that of the control group(P<.05).At the 10th and 14th weeks,changes in fission and fusion proteins in mitochondria of the lung and skeletal muscle were further detected.There was also a significant difference in the expression between the two groups compared to that in the control group at the 10th week and 14th week(P<.05).Conclusion:These findings suggest that the changes in mitochondrial morphology and ATP content and the unbalanced expression of DRP1 and MFN1 might be the key mechanisms underlying qi deficiency syndrome in rats with COPD.

Chronic gastrointestinal symptoms and quality of life in the Korean population

AIM： To evaluate the prevalence of chronic gastroin- testinal symptoms and their impact on health-related quality of life （HRQOL） in the Korean population. METHODS： A cross-sectional survey, using a reliable and valid Rome I] based questionnaire, was per- formed on randomly selected residents, between 18 and 69 years in age. All respondents were interviewed at their homes or offices by a team of interviewers. The impact of chronic gastrointestinal symptoms on HRQOL was assessed using the Korean version of the 36-item Short-Form general health survey （SF-36）. RESULTS： Of the 1807 eligible subjects, 1417 （78.4%： male 762; female 655） were surveyed. Out of the respondents, 18.6% exhibited at least one chronic gastrointestinal symptom. The prevalence of gastro- esophageal reflux disease （GERD）, defined as heart- burn and/or acid regurgitation experienced at least weekly, was 3.5% （95% CI, 2.6-4.5）. The prevalence of uninvestigated dyspepsia, irritable bowel syndrome （IBS） and chronic constipation based on Rome Ⅱ criteria were 11.7% （95% CI, 10.1-13.5）, 2.2% （95% CI, 1.5-3.1）, and 2.6% （95% CI, 1.8-3.5） respectively. Compared with subjects without chronic gastrointesti- nal symptoms （n = 1153）, those with GERD （n = 50）, uninvestigated dyspepsia （n = 166） and IBS （n = 31） had significantly worse scores on most domains of the SF-36 scales. CONCLUSION： The prevalence of GERD, uninvesti- gated dyspepsia and IBS were 3.5%, 11.7% and 2.2% respectively, in the Korean population. The health- related quality of life was significantly impaired in subjects with GERD, uninvestigated dyspepsia and IBS in this community.

Symptoms of spinal dysfunction mimicking systemic diseases(Ogundana Syndrome):a review of 35 cases treated with manual therapy over 30 years

Objective and Method:Symptoms manifesting in other parts of the body signaling the existence of spinal dysfunction(Ogundana Syndrome)in patients(N=35,age range 20-56yrs;mean age 36yrs)diagnosed to have systemic diseases but treated with manual therapy were identified after a 30 year case note review.Results:Incipient parkinsonism(general edema and expressionless mask face),stroke(weakness of one side of the body),tinnitus(headache with noise in one or both ears),breast cancer(breast pain)and dyspnea(difficulty in breathing)were some physician diagnoses and clinical symptoms presented.One percent rate occurrence was noted affecting significantly more females(74%)than males(26%,P<0.001).This involved people with family history of back pain(66%)engaged in low income occupations(farming 40%,trading 25%,artisans 15% and civil servants 20%).Symptoms got better after vertical oscillatory pressure therapy to appropriate spinal regions.Duration of treatment was influenced by duration of spinal dysfunction prior to therapy and age of younger patients.Conclusion:One percent of patients with spinal dysfunction misdiagnosed to have systemic diseases due to misleading symptoms are finally referred for physiotherapy of manifesting symptoms.Manual therapy to the appropriate vertebro-geographic region(s)relieves the symptom(s)without prejudice to existing diagnosis.

Appraisal of treatment outcomes in integrative medicine using metabonomics:Taking non-alcoholic fatty liver disease with spleen deficiency syndrome as an example

Objective:Appraisal of treatment outcomes in integrative medicine is a challenge due to a gap between the concepts of Western medicine(WM)disease and traditional Chinese medicine(TCM)syndrome.This study presents an approach for the appraisal of integrative medicine that is based on targeted metabolomics.We use non-alcoholic fatty liver disease with spleen deficiency syndrome as a test case.Methods:A patient-reported outcome(PRO)scale was developed based on literature review,Delphi consensus survey,and reliability and validity test,to quantitatively evaluate spleen deficiency syndrome.Then,a metabonomic foundation for the treatment of non-alcoholic fatty liver disease with spleen deficiency syndrome was identified via a longitudinal interventional trial and targeted metabolomics.Finally,an integrated appraisal model was established by identifying metabolites that responded in the treatment of WM disease and TCM syndrome as positive outcomes and using other aspects of the metabonomic foundation as independent variables.Results:Ten symptoms and signs were included in the spleen deficiency PRO scale.The internal reliability,content validity,discriminative validity and structural validity of the scale were all qualified.Based on treatment responses to treatments for WM disease(homeostasis model assessment of insulin resistance)or TCM syndrome(spleen deficiency PRO scale score)from a previous randomized controlled trial,two cohorts comprised of 30 participants each were established for targeted metabolomics detection.Twenty-five metabolites were found to be involved in successful treatment outcomes to both WM and TCM,following quantitative comparison and multivariate analysis.Finally,the model of the integrated appraisal system was exploratively established using binary logistic regression;it included 9 core metabolites and had the prediction probability of 83.3%.Conclusion:This study presented a new and comprehensive research route for integrative appraisal of treatment outcomes for WM disease and TCM syndrome.Critical research techniques used in this research included the development of a TCM syndrome assessment tool,a longitudinal interventional trial with verified TCM treatment,identification of homogeneous metabolites,and statistical modeling.

Integrated Prevention and Control Technology for Coffee Leaf Rust in Yunnan Province

This paper investigates the damage symptoms and occurrence regularity related to coffee leaf rust,and proposes a comprehensive prevention and control strategy grounded in the principle of prioritizing prevention and implementing integrated prevention and control.This strategy encompasses the cultivation of rust-resistant varieties,the implementation of agricultural practices,the application of chemical interventions,the utilization of hyperparasitic fungi,and the protection and utilization of natural enemies.The paper further outlines the necessary requirements for effective prevention and control,emphasizing the importance of enhancing responsibility implementation,fostering systematic prevention and control measures,enhancing guidance services,and increasing publicity and guidance.The aim is to offer technical guidance for the integrated prevention and control of coffee leaf rust in Yunnan Province.

The conflict on posttreatment Lyme disease syndrome: a clinical mini review

Is Borrelia burgdorferi responsible for the persistence of symptoms after the standard successful course of antibiotics in Lyme disease patients?This highly controversial issue,concerning the underlying mechanism of posttreatment Lyme disease syndrome(PTLDS),still seems to be a matter of intense conflict of opinion.PTLDS is the manifestation of nonspecific symptoms including fatigue,musculoskeletal pain,dysesthesias,and neurocognitive deterioration after the standard antimicrobial therapy administered to patients suffering from Lyme disease.In this article,we review the conflicting views and published highlights of recent human studies regarding PTLDS.

Neurological complications of hematopoietic cell transplantation in children and adults

Hematopoietic cell transplantation（HCT） is widely performed for neoplastic and non-neoplastic diseases. HCT involves intravenous infusion of hematopoietic progenitor cells from human leukocyte antigen（HLA）-matched donor（allogeneic） or from the patient（autologous）. Before HCT, the patient is prepared with high dose chemotherapy and/or radiotherapy to destroy residual malignant cells and to reduce immunologic resistance. After HCT, chemotherapy is used to prevent graft rejection and graft versus host disease（Gv HD）. Neurological complications are related to the type of HCT, underlying disease, toxicity of the conditioning regimens, immunosuppression caused by conditioning regimens, vascular complications generated by thrombocytopenia and/or coagulopathy, Gv HD and inappropriate immune response. In this review, neurological complications are presented according to time of onset after HCT：（1） early complications（in the first month）-related to harvesting of stem cells, during conditioning（drug toxicity, posterior reversible encephalopathy syndrome）, related to pancytopenia,（2） intermediate phase complications（second to sixth month）-central nervous system infections caused by prolonged neutropenia and progressive multifocal leukoencephalopathy due to JC virus,（3） late phase complications（after sixth month）-neurological complications of Gv HD, second neoplasms and relapses of the original disease.

孙桂芝病证结合辨证在肿瘤治疗中的应用

病证结合是孙桂芝教授治疗肿瘤病学术思想的重要组成部分,把辨证与辨病有机地结合起来,进行综合诊治,既照顾到整体,又注意到局部;辨证为先还是辨病为先在临床诊疗中要根据实际情况而定,二者互补。特别是现代科学技术的发展弥补了中医诊疗方面的不足,辨病治疗成为中医治疗学的重要部分。孙桂芝教授临证始终强调辨证与辨病紧密相连,中西手段并用,诊断疾病现代仪器和中医四诊联合,治疗上病证相参结合,攻补兼施,标本兼治,既要兼顾全局,也要重视细节。

隐源性机化性肺炎的中医临床表现、证候及病位特征的回顾性研究

目的分析隐源性机化性肺炎(COP)患者的中医临床表现、证候及病位特征。方法选择2015年4月—2022年3月首都医科大学附属北京中医医院诊断的COP患者56例,对其中医四诊信息及辨证资料进行回顾性分析。结果56例患者中常规体检时发现的无症状者2例,余首发症状共7种,以咳嗽和喘憋为最常见症状;其次为咳痰,气短和发热。56例患者共涉及21种症状,其中,喘、咳嗽、汗出、咳痰、胸闷和气短为主要症状,出现频率均超过50%。与未合并纤维化患者比较,合并纤维化患者胸闷比例低(P<0.05);与未服用糖皮质激素患者比较,服用糖皮质激素患者汗出、渴而多饮和腰膝酸软比例高(P<0.05,P<0.01)。56例患者中舌淡最多,白苔为最主要舌苔,脉弦和脉滑为最主要脉象,出现频率均超过50%。与未合并纤维化患者比较,合并纤维化患者中脉弦的比例低(P<0.05);与未服用糖皮质激素患者比较,服用糖皮质激素患者中脉弦、脉滑和脉数的比例高(P<0.01,P<0.05)。56例患者中48例为虚实夹杂证,5例为虚证,3例为实证。虚证以气虚为主,其次为阴虚、阳虚。结合脏腑辨证,证候类型出现频率最高的是肺气虚,其次是肾阴虚、脾气虚,出现频率均超过30%。虚证以两证或三证同时出现,主要为肺脾气虚兼夹肾阴虚证和脾气虚兼夹肾阴虚占比较高。实证以寒饮停肺、痰湿阻肺、气郁伤肺和瘀阻肺络为主,出现频率均超过25%。证型组合主要为痰湿阻肺兼夹气郁伤肺和寒饮停肺兼夹瘀阻肺络证。与未合并纤维化患者比较,合并纤维化患者中肾阳虚证、瘀阻肺络证的比例高(P<0.05,P<0.01),气郁伤肺证的比例低(P<0.01);与未服用糖皮质激素的患者比较,服用糖皮质激素的患者肾阴虚证的比例高(P<0.01),肺阳虚证、瘀阻肺络证的比例低(P<0.05)。56例患者病位分布以肺居多,其次为肾、脾和胃。其中,与未服用糖皮质激素患者比较,服用糖皮质激素患者病位在肾、脾的比例高(P<0.05,P<0.01)。结论COP中医临床症状以肺系症状为主,证候类型虚实夹杂,主要病位为肺脏。服用糖皮质激素患者易出现汗出、口渴多饮、腰膝酸软等肾阴亏虚证候,病位在肾、脾比例高;未合并纤维化患者胸闷、脉弦多见,证候类型多见实证。

基于国医大师郭子光“人-症-病-证”体系探析慢性萎缩性胃炎临床辨治路径

慢性萎缩性胃炎(Chronic Atrophic Gastritis,CAG)中常见的肠上皮化生、异型增生属于胃癌前状态。中医在逆转肠上皮化生及异型增生方面具有治疗优势。笔者系国医大师郭子光教授学术传承人,在郭师学术思想指导下,初步提出基于“人-症-病-证”体系慢性萎缩性胃炎临床辨治路径。以病为纲,抓住CAG“脾气胃阴亏虚,湿热瘀阻胃络”的共性核心病机;兼顾个性,结合患者不同证型的个性病机。以“益气养阴,清热燥湿,和胃通络”为基本治则,创制了“益胃复萎”方这一验方,基于此方,分型分期加减论治。病证结合,最大化地优化临床疗效,更能发挥中医特色优势。

中医药治疗糖尿病肾脏病的现状及研究进展

糖尿病肾脏病(DKD)是糖尿病常见的微血管并发症之一,威胁着人类的生命健康。对中医、西医在DKD的发病机理及治疗方面的研究进展进行总结,发现中医和西医在DKD治疗中各有利弊,但中西药联合治疗能明显提高DKD的治疗效果,并能有效干预肾实质病变,延缓病情发展。

穴位贴敷联合中药雾化吸入护理在老年慢性阻塞性肺疾病急性加重期患者中的应用效果

目的:探讨穴位贴敷联合中药雾化吸入护理在老年慢性阻塞性肺疾病急性加重期患者中的应用效果。方法:选取2021年6月~2023年6月北京朝阳医院收治的老年慢性阻塞性肺疾病急性加重期患者100例为研究对象,根据随机数表法分为研究组和对照组,各50例。研究采用穴位贴敷联合中药雾化吸入护理,对照组采用常规护理,比较两组中医症候积分、肺功能指标、炎症反应、免疫功能及生存质量。结果:研究组干预后咳嗽、喘息气短、咳痰、肺湿啰音中医症候积分低于对照组(P<0.05);研究组治疗有效率高于对照组(P<0.05);研究组干预后呼气峰值体积流量(PEF)、用力呼气容积/用力肺活量(FEV1/FVC)、用力呼气容积占预计值百分比(FEV1%pred)、用力肺活量占预计值百分比(FVC%pre)高于对照组(P<0.05);研究组干预后基质金属蛋白酶-9(MMP-9)、白介素-4(IL-4)、肿瘤坏死因子-α(TNF-α)低于对照组,CD4+/CD8+高于对照组(P<0.05)。结论:穴位贴敷联合中药雾化吸入护理可以改善患者临床症状,降低炎症反应,提高患者免疫功能及肺功能,提高临床治疗效果。

加味三味汤治疗帕金森病非运动症状临床疗效

目的:探讨加味三味汤治疗帕金森病患者的非运动症状方面的临床疗效,以期获得更好的治疗效果及临床经验。方法:选取符合标准的50例帕金森病患者,随机分为对照组与实验组,每组各25例,对照组予以多巴丝肼片治疗;实验组在此基础上加用加味三味汤治疗,治疗一疗程后,比较两组患者的新版世界运动障碍学会帕金森病综合量表(MDS-UPDRS)中的日常生活非运动症状与运动症状量表中的震颤、动作迟缓、认知功能、焦虑、抑郁、饮水呛咳、夜尿、失眠、嗜睡、便秘、疲惫感、口角流涎十二项指标的综合评估。结果:在治疗前,两组患者所选取指标的综合评分没有统计学意义(P>0.05);治疗后,实验组患者的综合评分相较于对照组评分减少,有统计学意义(P<0.05)。并且两组患者的评分下降率也有统计学意义(P<0.01)。结论:加味三味汤可改善帕金森病患者的非运动症状,延缓病情进展。

肺系疫病的近现代辨治方法

肺系疫病是中医疫病中传染性最强、发病率最高、危害性最大的一类。总结肺系疫病的近现代辨证论治方法,多继承应用传统的伤寒六经辨证、卫气营血辨证、三焦辨证方法等,或者将2种及2种以上传统方法相结合地创新性应用;分期(型)论治的方法因其简便性、现代临床适用性,应用非常普遍;此外肺系疫病还常根据具体疾病的自身演变特点采取特殊的辨治方法,如辨顺症、逆症治疗与辨常证、变证治疗方法。认为肺系疫病的辨治应当结合辨证、辨病与辨症论治,传承创新,以适应现代临床的特点及需求。

734例慢性阻塞性肺疾病高危人群临床症状及中医证素分布特征

目的:分析慢性阻塞性肺疾病(COPD)高危人群患病特点及中医证素分布特点,为COPD早期干预和诊治提供参考。方法:2022年5月—2022年11月在安徽部分地区对COPD高危人群进行横断面调查,从临床表现提取病位及病性证素。使用SPSS 21.0软件,采用频次分析和聚类分析分别对症状和证素进行分析。结果:共纳入734例COPD高危人群,咳嗽、咳痰、健忘、腰膝酸软、口干口苦、气促、乏力为高频症状,高危人群中患呼吸系统疾病的占34.74%,包括慢性支气管炎、过敏性鼻炎、支气管哮喘、咽炎、肺气肿、肺大疱、肺结节等。对734例COPD高危人群进行证素分析,得到病位证素7个,病性证素10个。病位证素降序排列为肺(49.59%)、肾(28.20%)、脾(26.70%)、肝(17.44%)、卫表(12.81%)、心(神)(7.36%)、胃(6.95%);病性证素降序排列为气虚(53.00%)、痰(26.3%)、湿(13.22%)、阴虚(11.58%)、阳虚(11.44%)、热(10.63%)、血瘀(4.77%)等。聚类分析发现6种组合规律:(1)病位证素肺、脾、胃+病性证素痰、气虚、湿;(2)病位证素肾+病性证素阴虚、阳虚;(3)病位证素血瘀;(4)病位证素肝+病性证素阳亢、热、气滞;(5)病位证素心(神);(6)病位证素卫表。结论:COPD高危人群在发展为COPD前已经有肺气虚的表现,COPD的发展以肺气虚为始,进一步损伤脾、肾,逐步演变为虚实夹杂。

帕金森病伴睡眠障碍的研究进展

帕金森病(PD)是一种与运动和非运动症状相关的大脑退行性疾病,与环境、遗传、神经系统老化等多种因素有关。近年的调查研究显示,中国PD平均患病年龄60岁,在65岁以上人群中,每10万人约1700名患者。睡眠障碍是PD的非运动症状之一,临床表现包括失眠、白天过度嗜睡、不宁腿综合征、快速眼动期睡眠行为障碍以及睡眠呼吸障碍等多种类型。由于存在个体差异,PD伴睡眠障碍疾病治疗过程中应在医生指导下选择最适合患者个体的药物。本文对PD睡眠障碍发病机制和常用药物治疗方案进行综述,希望能够为今后PD伴睡眠障碍的治疗提供新的思路。

从“五辨”思维探讨经方运用思路与方法

李灿东教授提出中医“五辨”思维,即辨症、辨证、辨病、辨人、辨机。本文探讨基于“五辨”模式的经方运用思路与方法。“辨症论治”是经方运用的快捷之法,包括探寻特异性症状或症状群、依据特殊舌象;“辨证论治”是经方运用的常用之法,要辨证之主次兼夹与寒热真假;“辨病论治”是经方运用的固有之义,主要是辨明六经病和专病专方两类;“辨人论治”体现经方运用的个体化差异,须审年龄、性别,辨体质、腹证;“辨机论治”是经方运用的巧妙之法。临证时应坚持“五辨”一体的运用模式,在5个维度综合考量经方,以提高运用的准确性、有效性,揭示和完善经方的学术体系,更好地指导经方的临床运用。

缺血性脑卒中痰热腑实证大鼠模型的建立与评价

背景:中医药在治疗缺血性脑卒中痰热腑实证中具有丰富的经验和独特的优势,为深入挖掘中医药对该病的治疗靶点和治疗机制,建立稳定、可靠的缺血性脑卒中痰热腑实证病证结合动物模型是关键。目的:探讨缺血性脑卒中痰热腑实证大鼠模型的建立方法及评价体系。方法:采用随机数字表法将60只SD大鼠随机分为4组:空白对照组(n=12)、缺血性脑卒中组(n=18)给予普通饲料喂养25 d,病证结合组(n=18)、痰热腑实证组(n=12)给予高脂饲料喂养25 d;第26天,空白对照组、缺血性脑卒中组灌胃给予生理盐水,病证结合组、痰热腑实证组灌胃给予自体粪便混悬液,连续灌胃3 d(灌胃期间继续给予高脂饲料);灌胃结束后,缺血性脑卒中组、病证结合组采用线栓法建立缺血性脑卒中模型,记录各组大鼠饮食量、饮水量、体质量、体温、粪便性状、鼻分泌物、喉中痰鸣、舌象等表征变化。造模结束后24 h,进行神经功能缺损评分、舌象表征、血脂水平检测、脑组织及颈动脉形态学观察以及血清胃动素和生长抑素水平检测。结果与结论:(1)与空白对照组比较,病证结合组大鼠呼吸急促、精神萎靡、烦躁、行动迟缓,鼻周可见大量分泌物、可闻及厚重的喉中痰鸣,饮食量、饮水量下降,体质量、体温及舌下脉络评分升高,粪便粒数、Bristol评分及粪便含水率降低;血清总胆固醇、三酰甘油、低密度脂蛋白胆固醇及生长抑素水平升高,胃动素水平降低,神经功能缺损评分升高,颈动脉发生显著病理改变,脑组织显示明显缺血形态学改变。缺血性脑卒中组仅能造成缺血性脑组织病理改变,不能复制出痰热腑实证的证候特征。痰热腑实证组能复制出典型的中医证候特征,但不能构建出缺血性脑卒中的脑组织病理改变。(2)结果表明,高脂诱导结合线栓法及自体粪便灌胃的多因素复合造模方法,可建立缺血性脑卒中痰热腑实证病证结合动物模型。

Relationship of functional gastrointestinal disorders and psychiatric disorders: Implications for treatment

This article revisits the links between psychopathology and functional gastrointestinal disorders such as irritable bowel syndrome （IBS）, discusses the rational use of antidepressants as well as non-pharmacological approaches to the management of IBS, and suggests guidelines for the treatment of IBS based on an interdisciplinary perspective from the present state of knowledge. Relevant published literature on psychiatric disorders, especially somatization disorder, in the context of [BS, and literature providing direction for management is reviewed, and new directions are provided from findings in the literature. IBS is a heterogeneous syndrome with various potential mechanisms responsible for its clinical presentations. IBS is typically complicated with psychiatric issues, unexplained symptoms, and functional syndromes in other organ systems. Most IBS patients have multiple complaints without demonstrated cause, and that these symptoms can involve systems other than the intestine, e.g. bones and joints （fibromyalgia, temporomandibular joint syndrome）, heart （non-cardiac chest pain）, vascular （post-menopausal syndrome）, and brain （anxiety, depression）. Host IBS patients do not have psychiatric illness per se, but a range of psychoform （psychological complaints in the absence of psychiatric disorder） symptoms that accompany their somatoform （physical symptoms in the absence of medical disorder） complaints. It is not correct to label IBS patients as psychiatric patients （except those more difficult patients with true somatization disorder）. One mode of treatment is unlikely to be universally effective or to resolve most symptoms. The techniques of psychotherapy or cognitive-behavioral therapy can allow IBS patients to cope more readily with their illness. Specific episodes of depressive or anxiety disorders can be managed as appropriate for those conditions. Medications designed to improve anxiety or depression are not uniformly useful for psychiatric complaints in IBS, because the psychoform symptoms that sound similar to those seen in psychiatric disorders may not have the same significance in patients with IBS.