Inflammatory Bowel Disease
IBD, Ulcerative Colitis, Crohn’s DiseaseInflammatory Bowel Disease is a general term for chronic inflammation of the Bowels. There are 2 main types:
- Ulcerative Colitis: inflammation of the Bowel with sores and ulcers.
- Crohn’s Disease: is marked with a chronic inflammation in the digestive tract, usually involving deeper layers of the mucosa. It typically affects the small intestine but can involve the large intestine or upper gastrointestinal tract.
The primary symptoms include abdominal disocomfort or pain, diarrhea with or without blood or mucus, weight loss, indigestion, loss of appetite and fatigue. It can range from mild, almost asymptomatic to a severe and even life-threateneing disease.
Causes according to modern mediicne are uncertain. However, it is probably an autoimmune disease in most cases and there is also gene mutations associated with IBD meaning that it is more common in people with a family history of the disease.
Traditional Medicine
In Traditional medicine it is generally classed as a type of Diarrhea, and remediies used for Diarrhea and Dysentery in the past are generally those most useful for IBD.
In most chronic cases there is a clear aspect of Spleen (Digestive) deficiency and/or Qi deficiency. This is manifested by the fatigue, poor appetite and digestion, the digestive sensitivity seen in most cases, and the general weakness and loss of weight. Pulse and tongue will also generally indicate deficiency.
Differential diagnosis according to Traditional Medicine:
- Heat/Bile: burning stool and rectum, diarrhea with foul-smelling stool, red face and face, irritable, red tongue with yellow coat, big pulse
- Phlegm/Damp: diarrhea with is watery, no burning, generally not as foul smelling, feels cold, pale face, weak and slow pulse
- Wind/Qi stagnation: rumbling and bloating in the abdomen, explosive diarrhea, nervous disposition, worse with stress, cramping abdominal pain, tight pulse
- Spleen deficiency: fatigue, weakness, pale face, poor appetite, indigestion, loose bowels, pale face, low and weak pulse
Other pathologies that can also be related are Kidney weakness, Yang deficiency, Dishharmony between the Liver and Spleen, Damp-Heat etc.
Treatment:
Choice of formula will be related to differential diagnosis. However, astringent medicines will play an important role as long as they are combined with appropriate other medicines, according to the individual; for example, medicines to clear Heat, or medicines to clear Phlegm and Damp, for example.
In general, the majority of cases require Spleen/Digestive tonics. In an acute flare-up or period of aggravation of symptoms, medicines are used to directly treat the acute condition. But in the majority of cases, a long continuation of symptoms would require use of strengthening medicines along with astringents and other necessary medicines according to the individual. After symptoms have been controlled, an extended course of Spleen/Digestion and Qi strengthening medicines should be used to prevent relapse. Xiang Sha Liu Jun Zi Tang and Bu Zhong Yi Qi Tang are 2 very useful formulas from TCM for this purpose.
It is worth mentioning that Triphala-based medicines can be very good in such chronic digestive diseases. This is because Triphala is primarily used as a digestive regulator; it harmonises the 3 main energies of digestion in the Ayurvedic system. It is both mildly astringent, but also cleansing, and so is viewed as separating the good from the bad. It has also demonstrated anti-inflammatory effects as well as being viewed as a health tonic, able to restore strength and vitality. It is also very safe and well-tolerated. Triphera Minor (Triphera Phoenonis, Triphera Minus) of Mesue is one such formula, used for chronic Leakage including Diarrhea. It is based on Triphala and also contains Frankincense and Cyperus rotundus, another important anti-inflammatory medicine. Electuary of Micleta (Nicholas)
is likewise a useful Myrobalan-based formula.
One last important point is the involvement of Blood stasis in most chronic inflammatory processes. The end result of chronic inflammation may involve excess cellular debris in the area starving local tissues of good blood supply. In addition, the chronic inflammatory process itself leads to fibrosis which is also associated with Blood Stasis, from a traditional point of view. So many cases will benefit from the addition of Blood-moving medicines, with 2 of the most important, well researched Blood-moving anti-inflammatory medicines being Frankincense (Olibanum) and Turmeric.
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Western Tradition Simples
Formulas General Emperors Powder Powder to Warm the Belly (Rondeletius) Lesser Cumin Composition Diospoliticum Galen Electuary for Gastric Pain Electuary of Bayberries (Electuarium de Baccis Lauri) Electuary of Micleta (Nicholas) Triphera Minor (Triphera Phoenonis) (Mesue) Powder of Clove (Ayurveda) Bilwadi Churna (Ayurveda) Amomum 4 (Ko la 4) (Tibetan Medicine) Great Decoction 25 (Thang chen nyer lnga) (Tibetan) Rolled Turquoise 13 (Gyu dril 13) (Tibetan) Cold Powder to Warm the Belly (Rondeletius) Wind Lesser Cumin Composition Diospoliticum Galen Powder of Cumin Greater (Nicholas) Electuary of Cumin (Diacyminum) Mesue To strengthen after Treatment: Aromaticum Rosatum |
Chinese Classification Simples
Formulas Spleen Deficiency Fatigue, loose stool, pale face, weak pulse Liu Jun Zi Tang Xiang Sha Liu Jun Zi Tang Bu Zhong Yi Qi Tang Bai Zhu Shao Yao San Shen Ling Bai Zhu San (better for excess Damp) Spleen Deficiency with Cold Abdominal and epigastric pain and cramping, improves with warmth but aggravated by cold, indigestion, poor appetite, pale tongue with white coat, deep, weak and slow pulse Li Zhong Wan Fu Zi Li Zhong Wan Da Huang Fu Zi Tang Tao Hua Tang Zhen Ren Yang Zang Tang Spleen Deficiency with Qi Stagnation Abdominal pain and cramping, bloating, gurgling, fatigue, poor appetite, pale tongue with white coat, weak and tight pulse. Tong Xie Yao Fang Damp-Heat Abdominal pain, distention, cramping, burning anus when defecating, blood in the stool with a Fast pulse and Red tongue with yellow coat. Bai Tou Weng Tang Heat and Damp with Clumping Qi Ban Xia Xie Xin Tang Spleen Deficiency with Food Stagnation Poor appetite, indigestion, abdominal fullness, belching and passing foul-smelling gas, fatigue, constipation or loose stool. Aggravated by diet or after eating. Greasy white or yellowish tongue coat, weak pulse Jian Pi Wan Spleen and Kidney Yang Deficiency Poor appetite, Diarrhea early in the morning or chronic Diarrhea, undigested food in the Stool, abdominal and lower back cold pain, fatigue, feels the cold, pale tongue with a white coat, and a weak, slow pulse. Si Shen Wan Wen Pi Tang (with Cold accumulation) Heat-type Alternating constipation and diarrhea, fullness and pain in the epigastrium and lower abdomen, nausea, bitter taste, thick yellow tongue coat, Wiry and forceful pulse Bai Tou Weng Tang Da Chai Hu tang |
Special Formula
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JIAN PI LING Astragalus Huang Qi Codonopsis Dang Shen Atractylodes Bai Zhu Dang Gui Roasted Ginger Pao Jiang Licorice (Gan Cao) Peaonia Bai Shao Costus (Mu Xiang) Mume Wu Mei Catechu (E Cha) Corydalis Yan Hu Suo This is prepared into pills from extract. Trials showed over 60% were cured (judged by gastroscope and six-month follow-up) after 40–60 days treatment. XILEI SAN Indigo (Qing Dai) Bezoar (Niu Huang) Pearl powder (Zhen Zhu) Mirabilitum (Mang Xiao) Calcite (Han Shui Shi) Borax (Peng Sha) Sal ammoniac Borneol (Bing Pian) This is traditionally used for ulcer and erosion of the skin or mucous membrane. It has been used in enemas and suppositories for Ulcerative Colitis in modern TCM with good effects. Xian He Cao Chang Yan Agrimonia Xian He Cao, 5 parts Coptiis Huang Lian, Costus (Mu Xiang), Cicada Slough (Chan Tui), Acorus Shi Chang Pu 1.5 parts each. Platycodon Jie Geng 1 part This has been used for Ulcerative Colitis with success. (See here) |
FU FANG KU SHEN CAPSULE Sophora Ku Shen Burnet (Di Yu) Indigo (Qing Dai) Bletilla (Bai Ji) Licorice (Gan Cao) This is made up into capsules. FORMULA FOR CHRONIC COLITIS Astragalus Huang Qi Codonopsis Dang Shen Atractylodes Bai Zhu Licorice (Gan Cao) Paeonia Bai Shao Costus (Mu Xiang) Citrus Zhi Shi Bupleurum Chai Hu Cimicifuga Sheng Ma Lotus seed Lian Zi Hedyotis Bai Hua She She Cao Pulsatilla Bai Tou Weng This is used for Spleen and Stomach Deficiency. It is modified for other diagnoses. Modifications: i. For Deficiency with Cold, add Ginger, Aconitum Fu Zi and remove Bulpleurm Chai Hu ii. Deficiency with Damp-Heat, add Coptis Huang Lian, Artemisia Yin Chen Hao, Sanguisorba Di Yu and remove Cimicifuga Sheng Ma, Oldenlandia Bai Hua She She Cao, Pulsatilla Bai Tou Weng iii. Qi and Yin deficiency, add Ophiopogon Mai Men Dong, Rehmannia Shu Di Huang |
Research
1. A review of the efficacy of traditional Iranian medicine for inflammatory bowel disease
2. Herbal and plant therapy in patients with inflammatory bowel disease
3. Efficacy of Rose Oil Soft Capsules on Clinical Outcomes in Ulcerative Colitis: A Pilot Randomized, Double-Blinded, Placebo-Controlled Clinical Trial