Analysis of Thinking of Diagnosis and Treatment of Ulcerative Colitis by TCM
——Clinical analysis of 63 cases of ulcerative colitis
Abstract: It discusses the diagnosis and treatment of ulcerative colitis by TCM from the perspective of symptom standards, data analysis, and diagnosis and treatment ideas. It is pointed out that the pathogenesis of ulcerative colitis is complicated, and it is mostly syndromes of mixed deficiency and excess, and mixed cold and heat. Combination of treatment and disease differentiation and dialectics, and treatment by stages. On the basis of supporting righteous qi, strengthening the spleen and stopping diarrhea, properly add blood-activating and removing blood stasis products, so as to heal the ulcer early and improve the quality of life.
Keywords: ulcerative colitis; TCM syndrome differentiation; analysis of diagnosis and treatment thinking.
Abstract: Ucerative Colitis is a kind of chronic non-specificity inflammation bowel disease which cause is complex. It has varied manifestation, easily to relapse and usually last a very long period. According to its clinical manifestation, colitis should belong to the diseases as the continued or intermittent chronic dysentery. In spite of traditional Chinese medicine and western medicine were useful for the treatment of ucerative Colitis, but each has it's shortage. If combine with this two treatment means it would remit symptoms, decrease recrudesce and reduce the take place of side effect.
Keyword: Ucerative Colitis; differentiation of symptoms and signs of Chinese medicine; analysis of diagnosis and treatment.
Ulcerative colitis (UC) is a chronic non-specific intestinal inflammatory disease whose etiology is not very clear. It mainly involves the rectum, colon mucosa, and submucosa. The clinical symptoms include diarrhea, mucus pus and blood in the stool, abdominal pain, and tenesmus. The main symptoms, which can be accompanied by varying degrees of systemic symptoms and extraintestinal manifestations , are a disease with complex etiology, variable conditions, long course of disease, and difficult to heal. It is difficult to cure and has a high recurrence rate. The cancer rate is listed as one of the modern intractable diseases by the World Health Organization.
The author began to accumulate cases for observation in 2003. From September 2009 to September 2010, as a visiting scholar of "Western Light", went to the Department of Gastroenterology, Peking Union Medical College Hospital to study, under the tutelage of Qian Jiaming, a well-known Chinese expert in inflammatory bowel disease. Professor, observe a large number of related patients, refer to the consensus on the diagnosis and treatment of ulcerative colitis (2009) formulated by the Spleen and Stomach Disease Branch of the Chinese Society of Chinese Medicine (2009), and the consensus on the diagnosis and treatment of Chinese inflammatory bowel disease revised by the Chinese Society of Digestive Diseases (2007), Developed a UC Chinese and Western medicine questionnaire, and used questionnaires, registered biochemistry, colonoscopy, pathology results, and full-time TCM doctors to observe the tongue and pulse to fill in the form for patients with confirmed UC. A total of 63 cases are reported. The results are reported as follows:
According to the characteristics of the clinical manifestations of this disease, it can be classified as "rest dysentery", "long dysentery" and "intestinal dysentery" in traditional Chinese medicine. The Consensus of TCM Diagnosis and Treatment of Ulcerative Colitis (2009) Syndrome Classification Criteria  (1) Large Intestine Damp-heat Syndrome established by the Spleen and Stomach Disease Branch of the Chinese Society of Chinese Medicine. Main symptoms: ①Abdominal pain, diarrhea, mucus, pus and blood under the stool; ②Red tongue, yellow and greasy fur. Secondary symptoms: ① burning anus; ② tenesmus; ③ hot body, short red urine; ④ dry mouth, bitter mouth, bad breath; ⑤ slippery pulse. (2) Spleen deficiency and dampness syndrome.Main symptoms: ①Loose stools, more white mucus, less redness, or white freezing; ②The tongue is pale red, with tooth marks on the sides, and the fur is white and greasy. Secondary symptoms: ① faint abdominal pain; ② full abdominal distension, poor appetite and poor appetite; ③ fatigue of limbs, mental fatigue and lazy speech; ④ weak or slippery pulse. (3) Miscellaneous syndromes of cold and heat. Main symptoms: ① Thin diarrhea, with sticky cold, repeated attacks; ② Red tongue, or pale red tongue, thin yellow coating. Secondary symptoms: ① Abdominal pain is continuous; ② Limbs are not warm; ③ Burning sensation in the abdomen, polydipsia; ④ Pulse string, or thin string. (4) Liver depression and spleen deficiency syndrome. Main symptoms: ①Abdominal pain is diarrhea, and the pain decreases after diarrhea; ②The frequency of stool is often increased due to emotional or dietary factors; Secondary symptoms: ①Loose stools, or mucous stools; ②Depression or anxiety; ③Unhappy belching, eating Less abdominal distension; ④The tongue is pale red and the coating is thin and white; ⑤The pulse is stringy or thin. (5) Syndrome of spleen and kidney yang deficiency. Main symptoms: ① chronic diarrhea is not stopped, there is white freezing, and even the grain will not be melted, slipping can not help; ② cold limbs. Secondary symptoms: ① Abdominal pain likes warmth and press; ② Abdominal distension, poor appetite and poor appetite; ③ Sore back and soft knees; ④ Pale tongue, or tooth marks, thin white moss; ⑤ Deep and thin pulse. (6) Yin and blood deficiency syndrome. Main symptoms: ①Difficulty defecation, a small amount of mucus, pus and blood in the stool; ②Red tongue, little fluid, little or no coating. Secondary symptoms: ① faint burning pain in the abdomen; ② low-grade fever in the afternoon, night sweats; ③ dry mouth and dry throat; ④ dizziness, upset and restless; ⑤ pulse count. The above-mentioned syndromes are confirmed: the main symptom is necessary, and it can be diagnosed by adding more than 2 secondary symptoms.
A total of 63 patients were investigated, including 38 males and 25 females; their age was 44.5±22.5 years. 4 cases (6.3%) of primary type, 32 cases (50.8%) of chronic prolonged type, 26 cases of chronic relapse type (41.3%); 9 cases of rectal type (14.3%), 18 cases of rectal type (28.6%), left 16 cases (25.4%) of semicolon type (splenic flexure), 5 cases (7.9%) of extensive colon type (splenic flexure), and 15 cases (23.8%) of total colon type. 6 cases of large intestine damp-heat syndrome (9.5%), 12 cases of spleen deficiency and dampness syndrome (19.0%), 13 cases of cold-heat complex syndrome (20.6%), 23 cases of liver stagnation and spleen deficiency syndrome (36.5%), 5 cases of spleen and kidney yang deficiency ( 7.9%), 4 cases (6.3%) of Yin-blood deficiency syndrome. According to statistics, only those with the most prominent symptoms were selected as the dialectical type. Among them, 57 cases (90.5%) had blood stasis, such as dark red tongue, ecchymosis on the tongue, tortuous veins on the tongue, etc., 53 cases (84.1%) had both Dampness manifestations, such as thick white tongue coating or yellow coating, pulse or slippery; rare manifestations of a single syndrome.
Diagnosis and treatment ideas
The etiology of UC is not yet clear. Modern medicine believes that the onset of UC is generally related to environmental, genetic, infection, autoimmune, mental and allergic factors [4, 5]. According to the clinical manifestations of UC, the disease is mostly classified into the categories of "diarrhea", "dysentery", "abdominal pain", "intestinal wind", "dirty poison" and "intestinal dysfunction" in traditional Chinese medicine. Jiao Liangjun and others classified UC as "internal carbuncle" (intestinal carbuncle) differentiation and treatment , very insightful. Modern Chinese medicine studies believe that the disease is mostly caused by external factors, improper diet (clean), emotional internal injury, and insufficient body spleen and kidney. The basic pathological factors include stagnation of qi, damp heat, blood stasis, and turbid phlegm. The disease is located in the large intestine, involving the spleen, liver, kidney, and lungs. Damp-heat accumulates intestines, stagnation of qi and collaterals and blood stasis are the basic pathogenesis, spleen deficiency and insufficiency is the main morbidity basis, and unbalanced diet and moodiness are the main triggers. This disease is mostly a syndrome of deficiency and excess. The active period is mainly based on the deficiency of the intestines, mainly due to damp heat accumulating intestines, and imbalance of qi and blood. And most of the original deficiency is spleen deficiency, and there are also kidney deficiency. The Spleen and Stomach Disease Branch of the Chinese Society of Traditional Chinese Medicine will classify UC into six types for differentiation and treatment, and formulate the classification criteria for symptoms in a very detailed way, which has a good clinical significance. However, UC is a disease with a very complicated pathogenesis after all. The symptoms are often superimposed on each other, and they will transform into each other in different periods. It is often not perfect to use points to apply the method of syndrome differentiation. The author has realized in the clinic that the disease is often misdiagnosed as acute enteritis, bacillary dysentery, hemorrhoids, etc., with a high rate of mistreatment, and most patients have a slow onset and insidious. Studies have shown that the average interval from the onset of symptoms to diagnosis is about 9 months, and the treatment cannot be accurate and timely . Therefore, most of the patients are already chronically prolonged or chronically relapsed when they are truly diagnosed. At present, western medicines for the treatment of UC include aminosalicylic acid preparations, glucocorticoids, immunosuppressants, and newly developed biological preparations. The advantage of western medicine treatment is that it can control inflammation as soon as possible, relieve symptoms, and target UC active periods, severe UC or UC outbreaks. Type patients can achieve satisfactory results. However, in addition to probiotics, there are many adverse reactions to long-term use of immunosuppressants or drugs related to immune function.The advantage of traditional Chinese medicine treatment is to maintain remission and prevent recurrence, but it can still be used for patients who are ineffective in salicylic acid preparations and immunosuppressive therapy, as well as refractory cases of glucocorticoid resistance or dependence, or those who are intolerant to western medicine. Traditional Chinese medicine treatment has achieved satisfactory results . Traditional Chinese medicine has many functions such as anti-inflammatory, regulating immune response, adjusting colon movement, mucosal protection, and improving the body environment. As an important part of the treatment of ulcerative colitis, it cannot be ignored. Chinese medicine believes that "long-term illnesses are often deficient", and "long-term illnesses are often stasis". In this case investigation, it was found that whether the disease is in the active or remission period, the essence of the disease is characterized by the deficiency of the essence and the deficiency of the spleen. On this basis, because of different emphasis on performance, there may be pathological changes such as kidney deficiency, blood deficiency, dampness, and blood stasis. The active period is mainly based on the standard and the real, mainly due to the deficiency of the spleen, the stagnation of water and dampness, the stagnation of heat, the damp heat accumulates the intestines, the injury of the lipid membrane and the blood network, the imbalance of Qi and blood, and the loss of conduction in the large intestine; , Mainly because of righteous deficiency and evil love, loss of health in movement and transformation, mainly due to spleen deficiency, and some patients with kidney deficiency. The 63 patients surveyed all received Western medicine treatment for at least 3 months, because Western medicine treatment is aminosalicylic acid preparations, glucocorticoids, immunosuppressants, etc., which are equivalent to the products of traditional Chinese medicine. Long-term use may cause the patient’s liver. Side effects such as impaired function, fragile bone, bone marrow suppression, and low immunity, and physical wastage appear, so most of them are manifested as a deficiency syndrome or a syndrome of the original deficiency and the original deficiency. "Yi Lin Gai Cuo" said: "The vitality is weak, it must not reach the blood vessels, and the blood vessels have no qi, and must stay and stasis." Chronic illness and blood stasis play an important role in the pathogenesis of ulcerative colitis (UC) . This phenomenon is fully reflected in clinical observation. Macroscopically, almost all types of syndromes have blood stasis to varying degrees; microscopically, there are changes in blood rheology. Modern studies have shown that the blood circulation and microcirculation disorders shared by various blood stasis syndromes are caused on the basis of abnormal blood viscosity and hemorheology. Studies have shown that during the active phase of the disease, patients not only have an inflammatory reaction, but also a hypercoagulable state, which is at risk of thrombosis. Once microthrombosis is formed, blood vessels are partially or completely blocked, which further affects tissue regeneration, and even causes tissue necrosis, and can prevent anti-inflammatory drugs from reaching the diseased site, making the disease repeated and clinically difficult to cure. This is also in line with the TCM theory of chronic illness and multiple blood stasis, Qi deficiency syndrome is the cause of blood stasis syndrome, and blood stasis syndrome is the pathological result of Qi deficiency syndrome. Traditional Chinese medicine can effectively alleviate the symptoms of blood stasis in UC from the macroscopic view, and can change the hypercoagulable state of the blood in the microscopic view. Therefore, if there is blood in the stool and blood stasis syndrome, it is not possible to stop the bleeding alone. It is necessary to add an agent for replenishing qi and activating blood to cool the blood to achieve qi flow and blood flow and bleeding can stop. In this survey, 33 cases had been treated with traditional Chinese medicine, including oral decoction and Chinese medicine enema treatment. 9 cases had blood in the stool worsened after the medicine. Most of the prescriptions were high-dose products for clearing away heat, detoxifying, and reducing astringency. Excessive cold products damage the spleen and stomach, make it more insufficiency, cannot take blood, and blood spills out of the veins. The author understands that the treatment of UC should be based on strengthening the spleen and strengthening the foundation, combined with the emphasis on both syndromes, and adding or subtracting medication according to the syndrome. The author often uses self-made Changfukang preparations in clinical treatment. The prescriptions are Astragalus 20g, Barley 30g, Codonopsis, Atractylodes, Hawthorn, Poria, Beibei sauce each 15g, Muxiang, Dried ginger, Magnolia officinalis each 9g, Tangerine peel, Piper longum longum , Ligusticum chuanxiong, licorice each 6g co-decocted, one dose a day, taken once in the morning and evening, to invigorate the spleen and qi, detoxify and relieve diarrhea. The prescription drug is gentle in nature, reflecting the idea that the treatment of the disease can only be delayed but not urgently. It is by no means a simple treatment of astringent to stop diarrhea. Astragalus, Codonopsis, Atractylodes, Poria, Tangerine Peel, Coix Seed to invigorate the spleen and nourish qi, weaken the dampness, wood incense, dried ginger warms the stomach, Hawthorn, Magnolia officinalis promote stagnation, play the role of systemic conditioning, nourishing qi and nourishing deficiency; Ligusticum chuanxiong is the "qi medicine in blood, blood medicine in qi", which has the effect of regulating qi and activating blood; combined use of Beibaijiang and Piper longum tuberosum, one cold and one warm, one clear and one congestion, syndrome differentiation plus disease differentiation medication, detoxification Warm, calmly stop leaking. If it is rectal type or straight type B, decoct with Chinese medicine Bletilla striata, Panax notoginseng powder, Sophora flavescens and Indigo Naturalis, take 100ml of thick juice, keep the enema, and straighten the disease to achieve the effect of clearing heat, promoting blood circulation, removing rot and promoting muscle.
In short, the pathogenesis of UC patients is complicated, mostly due to a mixture of deficiency and excess, mixed cold and heat, or upper heat and lower cold, or stomach heat and cold spleen, or spleen and kidney yang deficiency, and large intestine damp-heat. Different patients have different cold and heat levels, as well as the severity of deficiency and excess. ; The same patient's symptoms change in different periods; treatment should be combined with disease differentiation and syndrome differentiation, and treatment should be treated by stages. On the basis of supporting righteous qi, strengthening the spleen and stopping diarrhea, the proper addition of blood-activating and stasis-removing products can effectively improve the blood supply of the intestinal mucosa and change the immune status of the body, so that ulcers heal early and improve the quality of life. If combined with Chinese medicine rectal enema, the effect is better.
(Received on August 12, 2010)
Published in Volume 25, Issue 4, Journal of Practical Chinese Medicine, 2011