Irritable Bowel |
TCM Approaches to Managing IBD
In TCM, the goal to helping IBD is to balance the immune system and harmonize the intestinal energy. Acupuncture, Qi-gong and Chinese herbs can help strengthen the immune system by balancing the flow of energy within the abdomen. Moreover, TCM can help relieve the stress that can exacerbate the flare-ups of IBD. Some IBD research done in China has found that herbs like gingko biloba, licorice, aloe vera, cinnamon and angelica appear to have anti-inflammatory and soothing effects on the intestinal walls. Furthermore, from my experience in working with IBD patients, I found that customizing Chinese herbs for patients could better help relieve spasm, ulceration, and inflammation since the symptoms of IBD vary according to the extent and duration of the disease.
If you already have IBD, be cautious of following factors that can cause flare-ups:
Infections
Medications like antibiotics
Hormonal changes
Stressful lifestyles
Smoking
I also recommend the following for IBD patients:
Eat a diet high in protein and vitamins, but low in fat and fiber
Take vitamin supplements, especially the B vitamins
Keep hydrated with warm drinks, soups, fresh vegetable and fruit juices
Eat small portions of well-cooked food throughout the day
Avoid sweets like cakes, candies and ice cream
Avoid alcohol, coffee and cold drinks.
Inflammatory Bowel Disease (IBD) is often believed to be an autoimmune disorder that causes inflammation and/or ulceration of the digestive tract. Genetics, race, diet and the immune system can all play a role in IBD, but the exact cause is still unknown.
There are two major types of IBD: Crohn’s disease and ulcerative colitis. Crohn’s disease affects deeper layers of the intestinal wall, often forming ulcers in the lowest part of the small intestine and the large intestine, while ulcerative colitis affects the inner lining of the large intestine, usually the left side of the colon and the rectum.
Crohn’s disease begins slowly with abdominal pain, loss of appetite, weight loss and anemia. Sometimes there may also be episodes of bloody diarrhea. An acute condition of the disease can cause fever and severe abdominal pain with intestinal obstruction. In comparison to Crohn’s disease, ulcerative colitis has symptoms of constipation or the urge to defecate with little stools or passage of blood or mucus in the stools. These symptoms may last a few to several months before lower abdominal pain develops with diarrhea. Like Crohn’s disease, the patient can also develop symptoms of fatigue, weight loss, loss of appetite, and fever. Long-term dependence on powerful Western drugs to treat IBD can leave the patient with debilitating side effects and surgical removal of the colon can make bowel movement even more difficult. Traditional Chinese Medicine (TCM) can offer less invasive methods to control IBD.
Etiology
Similar to Crohn's disease, ulcerative colitis may be caused by constitutional deficiencies, invasion of exterior pathogenic factors, or unbalanced diet. Constitutional deficiencies usually refer to Spleen, Stomach, and Kidney deficiencies. Invasion of exterior pathogenic factors refers to damp-heat or damp-cold. An unbalanced diet high in raw or cold injures the Spleen and the Stomach, and obstructs their functions in transforming and transporting food and nutrients.
Differential Diagnosis
Depending on the severity and characteristics, ulcerative colitis can be divided into 7 major categories: damp-heat in the Large Intestine, damp-cold affecting the Spleen, alternation of heat and cold attacks, Liver overacting on the Spleen, Qi and Blood stagnation, damp accumulation with Spleen deficiency, and Spleen and Kidney Yang deficiency.
Damp-heat in the Large Intestine is commonly caused by excessive consumption of sweet, fatty, and greasy food, and is characterized by an acute and sudden onset of intestinal symptoms. Diarrhea is usually sudden and violent with pus, mucus, and blood. There is a feeling of tenesmus, abdominal fullness and distention, abdominal cramps and pain that diminish after defecation. In addition to intestinal symptoms, the patient may also experience fever, poor appetite, dry mouth, yellow urine, yellow greasy tongue coating, and wiry, slippery, or rapid pulse.
Damp-cold affecting the Spleen is commonly caused by excessive consumption of cold or raw food, fruits, or vegetables. There is a sudden onset of diarrhea with pus, mucus, and blood. The patient also experiences abdominal fullness, distention, and mild to moderate pain that increases with exposure to cold. There is a vague feeling of heaviness in the body and extremities. The tongue coating is white and greasy, and the pulse is soft and slippery.
Alternation of heat and cold attack is a chronic condition that may be caused by many different factors, such as invasion of exterior pathogenic factors or unbalanced diet. The patient experiences constant watery or bloody diarrhea. When there is more heat than cold, bloody diarrhea predominates and the patient experiences abdominal pain, bitter taste in the mouth, dry mouth, urgency to defecate, and fever. When there is more cold than heat, watery diarrhea predominates and the patient experiences abdominal pain (increasing with exposure to cold), aversion to cold, and muscle wasting. The tongue is red with a thin yellow or white coating. The pulse is wiry and thready.
Liver overacting on the Spleen represents an excess condition in which the Wood element overacts on the earth element. The patient has obvious Liver Qi stagnation evident by emotional disturbance. This corresponds with the psychosomatic cause of ulcerative colitis suggested by Western medicine. Clinically, the patient experiences emotional disturbance such as anger, irritability, and short temper. The severity of diarrhea is directly proportional to the severity of emotional disturbance. Other gastrointestinal symptoms include diarrhea with pus, mucus, and blood, abdominal pain, fullness and distention, borborygmus, acid regurgitation, bitter taste in the mouth, and lack of appetite. The tongue is slightly red with a thin white coating, and the pulse is wiry.
Qi and Blood stagnation usually results from damp-heat injuring the Middle Jiao leading to stagnation in the Stomach and Intestines. This condition is characterized by constant pain at a fixed location. Palpation may not be possible as pain increases with touch and pressure. Other symptoms and signs of Qi and Blood stagnation include borborygmus, abdominal distention, chest fullness and distention, acid regurgitation, lack of appetite, and dark facial complexion. The tongue is purple with petechia; the pulse is wiry and knotted.
Damp accumulation with Spleen deficiency represents a chronic condition of ulcerative colitis. Spleen deficiency may be due to congenital deficiency or secondary to excess intake of raw or cold food injuring the Spleen. Damp accumulates as Spleen loses its function to transform and transport food. Clinically, the patient experiences chronic incessant diarrhea with a watery stool, sticky with pus, mucus, and blood. Other local symptoms include dull pain and distention in the abdomen. Malabsorption and malnutrition are common due to the chronic nature of Spleen deficiency. The patient usually experiences fatigue, shortness of breath, lack of appetite, and decreased sense of taste. The tongue is flabby with teeth marks and a thin white coating. The pulse is soft. Spleen and Kidney deficiencies also represent a chronic condition of ulcerative colitis perhaps due to a congenital deficiency or secondary to chronic ulcerative colitis damaging the Spleen and Kidney.
The patient has chronic incessant watery diarrhea with pus, mucus, and blood. Diarrhea may occur early in the morning and throughout the day. Diarrhea worsens with exposure to cold. Other symptoms include fatigue, lack of energy, cold body and extremities, and abdominal pain that diminishes with exposure to warmth. The tongue is pale with a thin white coating; the pulse is deep and thready.
Prevention
Both Western and Oriental medicine recognize the importance of diet and its role in the prevention and treatment of ulcerative colitis. Western medicine acknowledges that dietary intake (such as certain chemicals and drugs) may be linked to increased incidence of ulcerative colitis. Oriental medicine recognizes that dietary intake with excessive cold or raw food may injure the Spleen and the Stomach. Therefore, diet plays an important role in both prevention and effective treatment of the illness.
Patients should be encouraged to avoid foods that may trigger recurrence, such as certain chemicals and raw or cold food. Milk, cheese, and other dairy products should be avoided, especially if patients have lactose intolerance. High-roughage foods (such as raw fruits or vegetables) sometimes worsen intestinal obstruction and colic and may need to be avoided. Alcohol should be avoided. In addition to avoiding certain foods, it is equally important to ensure that patients have adequate caloric and fluid intake since malnutrition and dehydration are common problems associated with ulcerative colitis.
Oral iron supplements may be necessary for anemia due to chronic loss of blood through diarrhea; sustained-release iron products are an option. Certain over-the-counter or prescription antidiarrheal drugs may worsen the condition and create toxic megacolon. These drugs should not be taken unless supervised by a qualified health care provider.2-4
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