Pathogenesis and therapeutic strategies for irritable bowel syndrome: an integrated perspective from dynamic balance theory of Chinese medicine

Abstract

Background Irritable bowel syndrome (IBS) is a common disorder of gut-brain interaction characterized by recurrent abdominal pain and altered bowel habits, resulting in a substantial impact on quality of life. Owing to the multifactorial nature of IBS and the limitations of current treatment options, Traditional Chinese Medicine (TCM) has increasingly been investigated as a complementary therapeutic approach. Aim This narrative review examines the pathogenesis of IBS from the perspective of TCM, with particular emphasis on the interrelationships among the heart, liver, and spleen within the framework of interpromotion and interrestraint theory. It also summarizes representative TCM-based intervention strategies and discusses their potential conceptual links to contemporary biomedical mechanisms. Methods A narrative review approach was adopted. Relevant literature concerning IBS pathogenesis, TCM theories, and TCM-based interventions was identified through searches of major scientific databases. Findings from experimental and clinical studies were synthesized qualitatively to provide an overview of current evidence and research trends. Results Current evidence suggests that TCM interventions may influence multiple biological processes implicated in IBS, including brain-gut axis signaling, gastrointestinal motility, gut microbiota composition, intestinal barrier function, immune regulation, and visceral sensitivity. Emerging studies also suggest potential conceptual associations between traditional TCM concepts and modern pathophysiological mechanisms; however, these relationships remain hypothesis-generating and require further experimental validation. However, interpretation of the evidence is limited by heterogeneity in study design, syndrome differentiation, intervention protocols, and outcome assessment. Conclusion TCM provides a complementary framework for understanding and managing IBS and may offer therapeutic benefits through multidimensional regulatory effects. Nevertheless, the overall quality of available evidence remains variable, and many mechanistic findings are derived primarily from preclinical studies. Further high-quality clinical research, standardized outcome measures, and biomarker-based investigations are needed to clarify the clinical value and biological basis of TCM interventions in IBS.