Ulcerative colitis (“UC”) is an intestinal disease with unknown cause, characterized by recurrent ulcers in the intestines. Patients usually have diarrhoea, bloody mucus and abdominal pain. Western medicine treatment of UC currently has low effective rate but significant side effects, while acupuncture & Chinese medicine offer better treatments for ulcerative colitis, which is safer with less side effects.
Recently I have treated another patient of ulcerative colitis (referred to as “UC”). Here I will talk about the UC in terms of the cause, pathology and commonly-seen symptoms & signs, and give a brief introduction to the modern research in recent years on treatment of UC with Chinese medicine and acupuncture, as well as prevention & dietary advice on Ulcerative Colitis.
Brief introduction of Ulcerative Colitis
Ulcerative colitis is a form of colitis, a disease of the colon (the largest portion of the large intestine), that includes characteristic ulcers, or open sores. It is an inflammatory process limited in colonic mucosa and submucosa. Lesions were located in the sigmoid colon and rectum, can also be extended to the descending colon, or even the entire colon. It often has long duration, and often recurs repeatedly. UC can be seen at any age, but most common in 20-30 years.
Cause of Disease
The cause of ulcerative colitis is still not clear in Western medicine. It is thought that the incidence of inflammatory bowel disease is co-factored with exogenous substances, the genes and the immune response. Psychological factors play an important role in the deterioration of the disease. And some believe that ulcerative colitis is an autoimmune disease.
Ulcerative colitis is a disease limited in the colonic mucosa and submucosa. There are distinct differences in the inflammatory changes of the intestinal wall between UC and Crohn’s disease, which involves all layers of the intestinal wall in the granulomatous inflammatory process. Patients with UC have congested oedematous colonic mucosa, where can form many different sized, easy bleeding ulcers. In severe cases, there can be no normal mucosa in large segment of the colon. But the pathological changes seen in ulcerative colitis is non-specific, as they can also be seen in bacterial dysentery, amoebic dysentery and gonococcal colitis.
Both ulcerative colitis and Crohn’s disease are inflammatory bowel disease (IBD), they share the same symptoms of recurrent intestinal ulcers, frequent diarrhoea, bloody mucus and abdominal pain. The initial manifestation of ulcerative colitis can have many forms. Bloody diarrhoea is the most common symptoms in early stage. The main symptoms include diarrhoea, abdominal pain, stool with pus/mucus, and tenesmus (urgent and incomplete). Other symptoms may include fever, fatigue, nausea, vomiting, sweating, joint pain, weight loss and anaemia.
- Massive blood in the stool: Blood in the stool is one of the major clinical manifestations of this disease, and it is an indicator of the severity. But sometimes it is hard to measure in quantity. Massive blood in the stool mentioned here refers to a large amount of intestinal bleeding in a short time, accompanied by fast pulse rate, blood pressure drop and decreased hemoglobin, which requires blood transfusion.
- Intestinal stenosis: It mostly occurs in those cases with a wide range of pathological changes and long course of more than 5-25 years. it often occurred in the left part of the colon, sigmoid colon or rectum. The reason can be mucosal thickening of the muscle, or false polyp group that blocked intestine. It is generally clinically asymptomatic, but severe cases can cause some intestinal obstruction.
- Intestinal perforation: It is more a complication of toxic intestinal dilatation but can occur in severe cases of UC. Corticosteroid use is considered to be a risk factor for intestinal perforation.
- Toxic intestinal dilatation: This is a serious complication of UC in patients with UC in the entire colon, the mortality rate can be as high as 44%. Clinical manifestations include high degree of bowel expansion accompanied by poisoning symptoms, marked abdominal bloatingc, the most obvious part of the expansion is in the transverse colon, on medical examination abdominal tenderness or rebound tenderness, bowel sounds significantly diminished or disappeared.
- Fistula: Adhesions with each other between intestines or intestine and other hollow organs (such as the bladder, vagina, etc). External fistula formation between intestine and skin, although less often, but occasionally occurs.
- Anal and perianal diseases such as anal fissure, rectal abscess, anal fistula, hemorrhoids prolapse.
- Polyps: The incidence of 10% to 80%, often referred to as pseudo polyps. Polyps often occur in the rectum, but some suggested that most in the descending colon and sigmoid, reducing upward, which can disappear with the cure of inflammation, destruction with ulceration, long stay can lead to cancer.
- Colon Cancer: It has been recognized that ulcerative colitis complicated by colorectal cancer compared with the same age and sex group was significantly higher than that in the general population. It is generally believed that tendency to cancer relates to duration of disease, for duration of 15-20 years onwards, the risk of cancer increases by about 1% per year. Those with UC for more than 10 years should pay attention to the possibility of cancer.
- Other complications: such as non-specific arthritis, erythema nodosum, pyoderma gangrenosum, iritis, iridocyclitis, keratitis, stomatitis and mumps, fatty liver, inflammation of small bile duct, etc.
Western Medicine Treatment
Western medicine treatment of UC is mainly categorised to surgical and non-surgical therapy. For UC with cancerous tendency, UC complicated by toxic megacolon, fulminant UC, UC that difficult to control with conservative treatment, UC with many complications, and intractable UC, timely surgery should be considered. Non-surgical treatments include oral, intravenous and retention enema. Drugs used include anti-infectives, corticosteroids, immunosuppressive agents, and antidiarrheal medicine. However, immunosuppressive and immunomodulatory agents have certain side effects, and some can cause nausea, vomiting, headache, rash, sexual function damage, neutropenia, anemia and liver function damage. Long-term use of glucocorticoids, also prone to side effects.
Understanding Ulcerative Colitis in Chinese Medicine
UC in Chinese medicine literature are categorised into “Xie Xie泄泻”(diarrhea), “Chang Pi肠癖”, “Chang Feng Xia Xue肠风下血”(intestinal wind of bloody stool), “Jiu Li久痢”, “Xiu Xi Li休息痢” and other areas. Disease location is the large intestine, staged in the Blood; internal organs involved in are spleen, kidney, lung, and liver. Its onset usually caused by spleen has impaired transform and transport function, leading to endogenous dampness, and the stagnated dampness turned into damp-heat; or external pathogenic factors invasion damage the spleen/stomach, leading to damp-heat; or emotional disturbance damages the liver and spleen, causing disharmony between liver and spleen, leading to Qi stagnation & blood stasis. All of these can lead to heat accumulation in colon, Qi & blood stagnation, obstruction can cause pus formation, manifesting as abdominal pain, diarrhoea, stool with mucus/pus/blood and other symptoms. As the disease progresses its course, the spleen and kidney are damaged, causing spleen Qi collapse, kidney yang deficiency, anti-pathogenic Qi weakness, eventually yin and yang damaged. Its pathogenesis has characteristics of mixed deficiency and excess, cold and heat. Deficiency refers to yin and yang, Qi and blood, liver and kidney yin deficiency, spleen and kidney yang deficiency, lung and spleen Qi deficiency. Excess refers to damp-heat, heat toxicity, liver qi stagnation, blood stasis. Excess dominates at acute stage and deficiency dominates at remission stage, but damp-heat and blood stasis exist throughout the course.
According to the “Jing Yue Quan Shu – Xie Xie 景岳全书·泄泻”, “the root cause of diarrhoea, is all because of the spleen & stomach”. The beginning of the disease usually caused by intrinsic damp-heat toxin in large intestine, and delayed healing leads to spleen and stomach damage, or further damaging the liver and kidney. Chinese medicine doctors may have different view on aetiology of the disease, but it can be summed up with spleen/stomach weakness, Qi and blood stagnation. Therefore, most of the treatments in Chinese medicine are mainly focused on tonifying Spleen Qi and moving the blood to remove stagnation.
Acupuncture Treatment of Ulcerative Colitis
After examined 11 papers of randomized controlled trials (RCT) of acupuncture treatment for UC in 10 years during 1997-2007, researchers in their systems analysis concluded that the therapeutic effect of acupuncture and moxibustion on ulcerative colitis is superior to that of western medicine with safety and less adverse reactions.
Another study found that acupuncture has therapeutic effect targeting the pathogenesis of UC that currently widely believed, and the effect is quick and long-lasting. With the holistic concept of Chinese medicine acupuncture treats gastrointestinal disease by regulating the immune, endocrine and other systems. Therefore, acupuncture for the treatment of ulcerative colitis is an effective, quick option with broad prospects.
Chinese Herbal Medicine Treatment of Ulcerative Colitis
Depending on the understanding of the pathogenesis of UC, the pattern identification varies. Generally speaking, Chinese herbal medicine treatment for UC is based on modification of ancient renowned formulas. For instance, damp-heat in the large intestine is treated with modified Bai Tou Weng Tang白头翁汤 or Shao Yao Tang芍药汤; spleen and stomach deficiency treated with modified Shen Ling Bai Zhu San参苓白术散; spleen and kidney yang deficiency treated with Si Shen Wan四神丸 or Li Zhong Tang理中汤 modification; liver Qi stagnation overacting spleen deficiency treated with Tong Xie Yao Fang痛泻要方 modification.
In recent years, researchers have performed RCT with 90 chronic ulcerative colitis patients that were randomly divided into two groups: 40 patients in the control group using Western medicine (WM) antibiotics, hormones and immunosuppressive therapy; 50 patients in CM group treated with Chinese medicine treatment methods like decoction, enema, points sticking, CM suppository and acupuncture. Compared two groups after treatment, the total effective rate (TER) of CM group was 94.0%, significantly higher than 67.5% of WM group. Thus, the CM treatment of ulcerative colitis has good clinical efficacy.
The researchers also found that herbs can improve the immune function in patients with UC, enhance cell immunity and restore the increased IgA/IgM to normal. By comparing the infiltration of intestinal eosinophils and degranulation of mast cells of UC patients before and after treatment, it was confirmed that Chinese herbal medicine can significantly reduce infiltration of eosinophils, reduce the degranulation of mast cells, and suppress allergy. For example, the researchers used electron spin resonance (ESR) revealed that Chinese herb Qing Dai青黛 possesses strong hydroxyl radical scavenging activity and it has significant clinical and endoscopic efficacy in patients who failed to respond to conventional medications.
The latest animal studies also found that traditional Chinese medicine formulas for the treatment of gastrointestinal disorders, Huang Qin Tang黄芩汤 and Ban Xia Xie Xin Tang半夏泻心汤 have anti-inflammatory, antioxidant effects.
Prevention of Ulcerative Colitis and Dietary Consideration
Prevention of Ulcerative Colitis
- Blueberries can help prevent ulcerative colitis. Blueberries are of high nutritional value and health maintenance effects, and rich in anti-cancer antioxidants and vitamins. The study has confirmed that taking blueberry together with yogurt can effectively prevent ulcerative colitis.
- Patients should do some exercises, such as tai chi, to strengthen the waist and kidney, and enhance their resistance to pathogenic factors.
- To maintain intestinal flora balance. Once the normal flora in the gut is out of balance, it is prone to diarrhea and other symptoms. Human intestine is the host to abundant microbial, and they are in equilibrium under normal circumstances, when the pH change in the gut of patients, it is easy to cause intestinal flora imbalance, the original balance is broken, which will damage the intestinal mucosa, then induce ulcerative colitis.
- To have enough protein and vitamins supply. In the daily diet there should include a number of high-quality protein and easily digestible food, such as fish, eggs, soy, and vitamin-rich vegetables and other fresh leaves.
- UC patients should keep taking Chinese medicine for 2 to 3 years after they have been treated to show normal under colonoscopy. Before stopping herbal medicine, they should have another checkup with colonoscopy. At the same time they need to pay attention to diet and regulate their emotions.
Four Don’ts in Diet for Ulcerative Colitis
- Less crude fiber foods: Avoid the crude fiber foods and rough processed foods. Because a large number of crude fiber foods can irritate the gut, and affect the absorption of nutrients, to patients that already malnourished it will worsen the condition. Therefore, they should limit intake of dietary fiber, such as leeks, celery, sweet potatoes, carrots, coarse grains, and dried beans. At the active stage of the disease it is advised not to eat raw vegetables and fruits. They can be made into purée and juice before intake. Do not use a large piece of meat for cooking, but rather use minced meat, diced meat, pork, minced meat and steamed custard, boiled eggs and other forms.
- Be cautious with seafood: In terms of Chinese medicine seafood are considered as the “stimulating foods”. Unlike the protein in food we often eat, seafood contains some heterologous proteins can lead to allergies, or worsen the inflammation, so ulcerative colitis patients must be cautious to eat seafood. Also it is not recommended to drink milk or dairy products at the active stage of the disease. In the course of diet therapy, patients and their families should pay attention to: what foods are good for the patient, what foods cause patient discomfort after eating or have an allergic reaction. Learn from the experiences, and continue to explore suitable diet.
- Avoid spicy food: spicy food would cause adverse gastrointestinal stimulus, therefore, they should be contraindicated in patients with ulcerative colitis, including pepper, wasabi, wine and other spicy foods. Garlic, ginger and onions should be minimised too. Do not eat cold or hot food. Especially in the summer to avoid eating cold food or drinks out of the fridge.
- Avoid greasy food: Patients with ulcerative colitis often have diarrhoea accompanied by fat malabsorption, in severe cases accompanied by steatorrhea. Therefore, it is necessary to limit the amount of dietary fat, less oil should be used in cooking. For steatorrhea cases, mid-chain fatty oils can be used, such as coconut oil. When having diarrhoea patients should not eat oily food and deep-fried food, and minimal oil should be used in cooking dishes, try to use cooking methods like steam, boil, braise, fry, stew, water slide and other methods.
In short, patients with ulcerative colitis should choose soft, light, low residue, easily digestible, nutritious, calorie enough food; Eat small meals; In the acute phase of the outbreak of the severe cases, patients should take the first few days of fasting with intravenous nutrition therapy, let the intestines rest, and after symptoms improved a gradual transition to liquid, semi-liquid diet with less or no residue.
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Melbourne acupuncturist & Chinese herbalist Dr. Rayman Wu is a fully qualified acupuncturist and Chinese herbal medicine practitioner. He has special interest and substantial experience in treating chronic conditions including ulcerative colitis, dementia and Alzheimer disease, depression, anxiety, hypertension and diabetes.
Call 03 8839 0748 or make online appointment to see how Chinese medicine can help.