TCM treatment for Ulcerative Colitis

June 8, 2016

 

Definition

Ulcerative colitis (UC) is a chronic medical condition characterized by inflammation of the inner lining of the colon and rectum, which causes ulceration of the surface of the colon, and results in pus, mucus, and bleeding. 

Based on characteristic signs like persistent diarrhea, rectal bleeding, fever, abdominal cramps and weight loss, TCM puts the chronic condition under the categories of "protracted diarrhea", "protracted dysentery", "bloody stools", or "organ intoxication".

Ulcerative colitis is a common and complex clinical condition, TCM treatment has its unique advantage.

 

Causes

The causes of ulcerative colitis remain unknown. The major theories include infection, allergy to food component, genetics, environmental factors, and immune response to bacteria or otherantigens.

In TCM understanding, the problem is closely associated with organ dysfunction, in particular the spleen, that cause a failure to self regulate the intestinal environment. Constitutional weakness, invasion of exogenous pathogens, an unbalanced diet and emotional factors are all contribute to the development of the problem.

 

Symptoms

Major symptoms of ulcerative colitis are diarrhea, rectal bleeding, the passage of mucus, and abdominal pain. Other symptoms include fever, pain and weight loss. Severity of disease is categorized as mild, moderate, or severe according to clinical symptoms.

Mild: diarrhea and rectal bleeding are usually the only symptoms. Patients experience less than four stools daily, with or without blood.

Moderate: typical symptoms are five or six bloody bowel movements per day and bloody diarrhea is often associated with large amount of mucus and pus. Incontinence is often a problem especially when the rectum is severely inflamed. Abdominal pain may also be present in addition to low-grade fever and fatigue.

Severe: patients experience frequent episodes of bloody diarrhea (more than six bloody stools daily) and they may become anorectic and nauseated. In severe attacks, patients may vomit and experience symptoms of anemia such as breathlessness, ankle swelling, and fatigue. Weight loss, fever, fast heartbeat, dizziness, and severe cramping or abdominal pain can also occur with severe cases of the disease.

The disease and its medications may affect other organ systems and result rashes , oral ulcers, mouth, inflammation of the eyes, larger joints (knees, hips, ankles, wrists, and elbow) become hot and swollen, minor elevations in liver enzymes.

TCM identifies ulcerative colitis according to the severity and symptoms exhibited in each individual; these are then allotted into different disharmony patterns or syndromes.

 

Diagnosis

In western medicine, the diagnosis of ulcerative colitis is made from the patient's medical history, a stool examination, sigmoidoscopy findings, and biopsy of specimens from the rectum or colon.

While CM physicians rely on special skills to gather health information from patients so that appropriate therapeutic strategiescan be undertaken. Basically, physicians pay special attention to bowel habits such as frequency, quantity, nature, form, color and smell of the stools, as well as the presence of accompanying physical sensations.

 

Damp-heat in the large intestine 
TCM diagnostic criteria for this type of ulcerative colitis include diarrhea with pus and blood, a burning feeling in the anus, abdominal cramps, fever and scanty yellow urine. On examination, the tongue is red and covered by yellow greasy coating; the pulse isrolling and rapid.

 

Damp-cold in the spleen 
Diagnostic criteria for this type are diarrhea with mucus or watery stools,tenesmus, abdominal cramps, stomach stuffiness, generalized heaviness and clear urine. On examination, the tongue is pale and covered by white greasy coating; the pulse is hesitant and slow.

 

Qi and Blood stagnation 
Diagnostic criteria for this type of ulcerative colitis include diarrhea with mucus or darkish blood, straining for defecation, fixed stabbing pain, distention, belching and a darkish complexion. On examination, the tongue is purple with bleeding spots; the pulse is taut and hesitant.

 

Liver stagnation and spleen weakness 
Diagnostic criteria for this type of ulcerative colitis includes diarrhea triggered by emotional stimulation; attacks usually come after abdominal cramps, chest oppression, belching and frequent passage of gas. On examination, the tongue fur is thin, white and greasy; the pulse is taut.

 

Spleen qi deficiency 
Diagnostic criteria for this type of ulcerative colitis includes loose bowels made worse by poor lifestyle habits or consumption of greasy foods, undigested foods in the stools, lack of appetite, distention, fatigue and sallow complexion. On examination, the tongue is pale and covered by white fur; the pulse is weak and thready.

 

Spleen and kidney deficiencies 
Diagnostic criteria for this pattern are early morning diarrhea that comes after an episode of colic, undigested food in the stools, cold body and extremities, soreness in the lumbar region and knees, and frequent urination at night. On examination, the tongue is pale; the pulse is deep and thready.

 

According to TCM experience, damp-heat in the large intestine, qi and blood stagnation, spleen qi deficiency are the most common types of syndrome patterns; while spleen and kidney deficiencies are usually seen in the late stage of ulcerative colitis .

 

Ulcerative Colitis : Treatment

  The goals of treatment of ulcerative colitis are to induce and maintain remission of symptoms and inflammation of the inner lining of colon. For western medicine, treatment options usually involve medication or surgery, determined according to the extent of the inflammation and the severity of the disease. Medication include 5-Aminosalicylic Acid (5-ASA) , Sulfasalazine, Corticosteroids , Hydrocortisone , Immunosuppressive Agents , Azathioprine and 6-mercaptopurine ,Cyclosporine , Surgery.

 

TCM believes that the major pathologies of ulcerative colitis include spleen and stomach dysfunctions, intestinal turbid accumulations, and blood and qidisturbances. Therefore, TCM treatment strategies are to restore organfunctioning, eliminate turbid accumulations and harmonize the flows of qi and blood.

 

Treatment options include Chinese herbal medicine and acupuncture & moxibustion

 

Prescriptions according to syndrome differentiation

Damp-heat in the large intestine 
Therapeutic aim: Clearing damp-heat, harmonizing blood and qi. 
Sample prescription: Modified Peony Decoction (Shao Yao Tang)

 

Damp-cold in the spleen 
Therapeutic aim: warming and dissolving dampness, harmonizing blood and qi
Sample prescription: Modified Weiling Decoction (Wei Ling Tang)

 

Qi and Blood stagnation 
Therapeutic aim: regulating blood and qi flows to arrest diarrhea and pain. 
Sample prescription : ModifiedDecoction for Removing Blood Stasis in the Lower Abdomen (Shao Fu Zhu Yu Tang)

 

Liver stagnation and spleen weakness
Therapeutic aim: soothing liver, invigorating spleen, expelling dampness, arresting diarrhea. 
Sample prescription: Modified Essential Formula for Diarrhea with Pain (Tong Xie Yao Fang)

 

Spleen qi deficiency 
Therapeutic aim: Replenishing qi, invigorating spleen, consolidating intestines to arrest diarrhea. 
Sample prescription: Modified Powder of Ginseng, Poria & Atractylodes (Shen Ling Bai Shu San)

 

Spleen and kidney deficiencies 
Therapeutic aim: warming and tonifying the spleen and kidney, consolidating the intestine to arrest diarrhea. 
Sample prescription: Modified Immortal Organ-Nourishing Decoction (Zhen Ren Yang Zang Tang)

 

Acupuncture & moxibustion therapies

Acupuncture & moxibustion therapies not only enhance the immune modulation effect, but also mobilize the innate healing power inside the body. For the localized problems like inflammation, ulcers, muscular spasms and sluggish flow, acupuncture and moxibustion are particular effective and thus facilitate structural recovery.

 

Suggested acupuncture methods:
Major points: navel's four-point (one-thumb-width apart from the navel, located in three, six, nine & twelve o'clock), tian-shu, guan-yuan & qi-hai; 
Assist points: da-chang-shu, zhang-qiang, pi-shu, wei-shu, zu-san-li & san-yin-jiao.

 

Moxibustion can also be used to boost the weakened systems, particularly for individuals with chronic symptoms. Below are suggested protocols:
Major points: zhong-wan, tian-shu, guan-yuan & shang-ju-xu;
Assist points: pi-shu, shen-shu, da-chang-shu, zu-san-li, tai-xi, tai-chong, san-yin-jiao & zhong-iv-shu.

 

Chinese medicine works well on Ulcerative Colitis. Acupuncture has been used to treat this disease in many countries. In china, herbs medicine has been more widely used in patients with mild-to-moderate Ulcerative Colitis and combined Chinese and western medicine is the predominance treatment.

 

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