cold – American Institute of Acupuncture

Ulcerative Colitis

acuherb — Wed, 22 Aug 2012 18:56:11 +0000

By Dr. Kenneth Wang

Ulcerative colitis (UC) is a chronic medical condition characterized by inflammation of the inner lining of the colon and rectum.

The inflammation usually begins in the rectum and lower intestine and spreads upward to the entire large intestine, which causes ulceration of the surface of the colon, and results in pus, mucus, and bleeding. The disease commonly starts gradually, with non-bloody diarrhea progressing to bloody diarrhea with symptoms slowly worsening over the course of a few weeks. In about 20 percent of patients, the initial attack of ulcerative colitis is associated with bloody diarrhea and other severe symptoms, with inflammation extending into the colon.

Ulcerative colitis commonly follows a chronic intermittent course, with long periods of remission interspersed with acute attacks lasting weeks to months.

Sections of Large Intestine

Ulcerative colitis (Colitis ulcerosa, UC) is a form of inflammatory bowel disease (IBD) that causes inflammation and ulcers in the lining of the large intestine. 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”.

In China, TCM treatment in the diagnosis of ulcerative colitis was first reported in 1958; however, similar clinical experiences can be tracked to a very early period. In theÂ Han dynasty, the symptoms were recorded in a TCM classic,Â Jinkui Yaolue (Synopsis of the Golden Chamber), which proposed to treat ulcerative colitis byÂ therapeuticÂ approachesÂ like detoxifying, cleansing, warming, astringing and consolidating. The author also formulatedÂ Pulsatilla Root Decoction (bai tou weng tong)Â andÂ Peach Blossom Decoction (tao hua tang)Â specifically for the condition. This established an important foundation for exploring the mechanism of the disease and developing relevant treatment methods. Modern TCM after many years of clinical studies concluded that herbal administrations along with herbal enemas are a better way to control symptoms and can maintain a longer remission from the disease.

Pulsatilla root

In respect to herbal usage, traditional prescriptions usually contain ingredients that fortify theÂ spleen, replenishÂ qi, clearÂ heatÂ and expelÂ dampness. However, specialists have found that mere application of herbs to activate circulation and remove stasis can also achieve similar results.

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

Â Causes

Ulcerative colitis primarily affects young adults, but it can occur at any age from five to eighty years and women tend to be more commonly affected than men. It is a worldwide disorder with high-incidence areas that include United Kingdom, the United States, northern Europe and Australia. Low-incidence areas include Asia, Japan, and South America.

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 otherÂ antigens.

InfectionÂ : Although use of antibiotics has been shown to improve treatment of active ulcerative colitis, no specific bacteria or virus have been isolated despite many attempts; therefore ulcerative colitis is unlikely to be due to a simple infection. Organisms such asÂ shigellaÂ and pathogenicÂ E. ColiÂ have been investigated as possible infectious agents but they have not been associated with the etiology of the disease.

Food AllergyÂ : The majority of patients with ulcerative colitis are found to be sensitive to milk and this led to claims that food allerg ies , particularly to milk, were the cause of the disease. Although some studies suggest that about twenty percent of patients with ulcerative colitis can benefit from a milk-free diet, there is very little scientific evidence to prove dietary allergy as the etiology of ulcerative colitis.

Environmental FactorsÂ : Other environmental factors proposed as contributing factors in the etiology of ulcerative colitis are oral contraceptives and smoking. The use of birth control pills was found to be more common in women with ulcerative colitis compared to women without the disease. Many studies have shown that ulcerative colitis is more common in nonsmokers than in smokers. The risk of developing ulcerative colitis is shown to be highest for previously heavy smokers, especially within the first two years of cessation. Smoking has shown to alter the function of the cells in the inner lining of the colon but the exact mechanism of the protective effect of smoking is unknown.

GeneticsÂ : There is some evidence that support the theory that ulcerative colitis may be due to genetic factors. The relatives of patients with ulcerative colitis are more likely to have the same disease compared to the general population and approximately ten to twenty percent of patients affected also have at least one other family member with the same disease. Numerous genes with a possible association with ulcerative colitis have been identified. Possible mechanisms proposed for genetic factors contributing to the cause of ulcerative colitis include metabolic defects and connective tissue disorders.

Autoimmune DiseaseÂ : The current leading theory suggests that ulcerative colitis is an autoimmune disease, where the body’s own immune system triggers an inflammatory response against an antigen in the intestinal wall. In this theory, the patient’s immune system mounts an immune response against an antigen, either food particles or microbial organisms which the immune cells recognize as foreign objects, and this immune response triggers inflammatory effects. However, because of similarities between proteins on the cells of the inner lining of the colon and the antigens (dietary or microbial), the patient’s own immune system is activated against the cells on the surface of the colon. Once the immune cells are activated, inflammatory mediators are released which not only cause tissue damage but also amplify the immune response and promote further inflammation in the inner lining of the colon.

Ulcerative colitis is a systemic disease that affects many parts of the body, although patients mainly manifest with intestinal symptoms. In TCM understanding, the problem is closely associated withÂ organÂ dysfunction, in particular theÂ spleen, that cause a failure to self regulate the intestinal environment. TCM specialists generally agree that constitutional weakness, invasion ofÂ exogenous pathogens, anÂ unbalanced dietÂ andÂ emotional factorsÂ all contribute to the development of the problem. The pathogenesis is described below:

Damp-heat in the large intestineÂ
In TCM theory, theÂ large intestineÂ is a hollow organ belonging to the digestive system; it receives the “impure” parts of digested food from the small intestine and continues to absorb water from these materials. At the end of the process,Â stoolsÂ are formed and excreted through the anus. Digestive problems, whether resulting from either external or internal origin, tend to retainÂ dampnessÂ in the intestines, and will further transform intoÂ damp-heatÂ Â in the long run. When the damp-heat pathogens disturb the transmission process in the large intestine, diarrhea will occur; and if the intestinal membrane is irritated, the passing stools will have pus and blood.

Liver overacting spleenÂ
In TCM, theÂ liverÂ promotes flowing and spreading movements, which is embodied in three functional aspects: regulating qi, regulating emotions and enhancing the digestive processes. Long-term emotional stimulation cause a state called “liver stagnation”, not only making the blood and qi flows sluggish, but also interfering with the digestive functions in the spleen andÂ stomach. This facilitates damp-heat to accumulate in the large intestine.

Spleen and kidney deficienciesÂ
The spleen rules transformation and transportation, which means it is the primary organ in regulating digestion. On the other hand, theÂ kidneys‘ warming and propelling activities enable the spleen to work properly. Deficiencies in these two organs lead to a chronic state, which causes intestinal problems such as persistent or intermittent diarrhea to occur.

Blood stasis and qi congestionÂ
Long duration of diarrhea leads to a depletion ofÂ bloodÂ andÂ qi, which causeÂ pathological wastesÂ to form inside the intestines. They can in turn act directly or indirectly on the organs, and give rise to more complex conditions.

SymptomsÂ

Major symptoms of ulcerative colitis are diarrhea, rectal bleeding, the passage of mucus, and abdominal pain. The onset of symptoms is usually slow and insidious and often symptoms have been present for weeks or even months before patients seek medical help. Patients often experience frequent bowel movements of small volume and fecal incontinence. Other symptoms include fever, pain and weight loss.

In general, the severity of symptoms correlates with the severity of the disease. More generalized symptoms such as fever, fatigue, and weight loss are more common if inflammation is extended to all or most of the colon. If the disease is confined to the rectum, the only symptoms may be persistent desire to empty the bowel or spasm of the rectum with or without bloody diarrhea. Some patients, especially elderly patients or those with inflammation confined to the rectum, may complain of constipation and hard stools.

Classification of disease severityÂ
Severity of disease is categorized as mild, moderate, or severe according to clinical symptoms.

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

Moderate:Â 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:Â 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.

Other organ systems affected by ulcerative colitisÂ

Skin:Â most rashes are related to drug therapy, which can cause an allergic skin reaction or photosensitivity reaction to sulfasalazine and 5-aminosalicylic acid (5-ASA). A condition calledpyoderam gangrenosum, an inflammatory bacterial dermatitis with pus and ulceration, is a rare skin condition that occurs in patients with ulcerative colitis and it occurs principally on the trunk or the limbs.

Mouth:Â oral ulcers occur in about ten percent of patient s with active ulcerative colitis.

Eyes:Â inflammation of the eyes occurs in approximately five to eight percent of patients with active ulcerative colitis. Corticosteroid eye drops are useful for controlling symptoms of inflammation.

Joints:Â in approximately ten to fifteen percent of patient s with an acute attack of ulcerative colitis, larger joints (knees, hips, ankles, wrists, and elbow) become hot and swollen. This condition resolves as the disease goes into remission.

Liver disease:Â in severe attacks of ulcerative colitis, minor elevations in liver enzymes are common and the level returns to normal once remission is achieved. However, in about three percent of patients with ulcerative colitis, a major liver complication can occur in which chronic inflammation of the bile duct can lead to progressive liver disease. The cause of this liver disease is unknown and there is currently no satisfactory treatment for this condition.

TCM identifies ulcerative colitis according to the severity and symptoms exhibited in each individual; these are then allotted into differentÂ disharmony patternsÂ or syndromes. Basically, physicians pay special attention toÂ bowel habitsÂ such as frequency, quantity, nature, form, color and smell of the stools, as well as the presence of accompanying physical sensations.

Damp-heat in theÂ large intestine
There is usually acute onset of this type. The diarrhea is violent and foul smelling and with a large amount of pus or blood. There is a burning feeling in the anus, abdominal pain and cramps, a rumbling noise and distention that diminishes after defecation. Other accompanying signs are fever or alternating chills and fever, poor appetite, dry mouth, and scanty yellow urine.

Damp-cold in theÂ spleen
Diarrhea with excessive mucus or watery thin stools,Â tenesmus, abdominal cramps and rumbling noise are also experienced. There are accompanying signs like a bland taste in mouth, stomach stuffiness, no appetite, headache, generalized heaviness, and clear urine.

Qi and Blood stagnationÂ
Diarrhea with alternative solid or loose stools, sticky with mucus or darkish bloody contents; straining to pass a small amount of stools may occur each time; there are also constant stabbing pains at a fixed location that can be aggravated by pressure. Other accompanying signs may be abdominal masses, distention, chest fullness, poor appetite and a darkish facial complexion.

LiverÂ stagnation and spleen weaknessÂ
Symptoms are always triggered by emotional stimulation. Usually, diarrhea immediately comes after abdominal cramps; there are loose stools full of mucus with some pus or blood. There are also tenesmus, chest oppression, sighing, irritability, poor appetite and frequent passage of gas. Some individuals may present with alternating diarrhea and constipation.

Spleen qi deficiencyÂ
Individuals develop alternating diarrhea and loose bowels, and undigested foods may present in the stools. The loose bowels and frequency are worsened by poor lifestyle habits or consumption of greasy foods. The abdominal cramps are dull in nature and can be relieved by palpation. Other accompanying signs are lack of appetite, gastric fullness after meals, fatigue, sallow complexion, frequent passage of gas, irregular menstruation or even rectal prolapse.

Spleen andÂ kidneyÂ deficienciesÂ
Individuals develop a chronic persistent diarrhea that usually contains undigested foods. Diarrhea typically occurs early in the morning after an episode of colic around the navel, and then throughout the day. Other symptoms include fatigue, cold body and extremities, soreness in the lumbar and knees, abdominal dull pain that diminishes with exposure to warmth, profuse clear urine or frequent urination at night.

It should be noted that during the course of ulcerative colitis, the above syndrome patterns may appear alone or in complex form. An experienced physician can accurately identify the pattern.

Diagnosis

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.

Stool SamplesÂ
Stool samples from patients with ulcerative colitis contain pus cells, red blood cells, and commonly eosinophils (a type of white blood cells). Since inflammation of the colon due to infections can also produce symptoms similar to those of ulcerative colitis, stool samples are examined to exclude parasitic, amoebic or bacterial infection.

SigmoidoscopyÂ
Sigmoidoscopy allows the physician to find typical features of ulcerative colitis in the colon, such as swelling, small bleeding points, and ulceration of the inner lining of the colon. For patients with longstanding disease, pseudo polyps may also be seen. Colonoscopy is sometimes necessary for determining the extent of the disease, especially in severe attacks.

Sigmoidoscopy

BiopsyÂ
Because the findings from sigmoidoscopy can also be found in other medical conditions such as infectious inflammation of the colon, biopsies of the tissue in the colon are necessary to confirm diagnosis of ulcerative colitis. Patients with Crohn’s disease can also have a medical history and symptoms similar to those of ulcerative colitis and several biopsies via colonoscopy may be needed to confirm a diagnosis of ulcerative colitis.

Differential DiagnosisÂ
Patients with Crohn’s disease, which usually also involves the small intestines, often present with symptoms similar to ulcerative colitis. Endoscopy and x-ray s of the small intestine are sometimes necessary to correctly diagnose ulcerative colitis. Other differences between ulcerative colitis and Crohn’s disease are found in laboratory values and biopsy specimens.

In TCM understanding, ulcerative colitis is mainly due to internal weakness of theÂ spleenÂ andÂ stomachÂ that result in transmission disorders of theÂ large intestine. Triggering factors likeÂ exogenous pathogens, an improper diet andÂ emotional stimulationÂ further disturb the internal disharmony and make the symptoms worse.

DuringÂ diagnosis, TCM physicians rely onÂ special skillsÂ to gather health information from patients so that appropriateÂ therapeutic strategiesÂ can be undertaken.

Damp-heat in the large intestineÂ
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 isÂ rollingÂ andÂ rapid.

A red tongue covered by yellow greasy fur.

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

Qi and Blood stagnationÂ
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 weaknessÂ
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 isÂ taut.

Spleen qi deficiencyÂ
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 andÂ thready.

Spleen and kidney deficienciesÂ
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 isÂ deepÂ 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 .

Treatment

The goals of treatment of ulcerative colitis are to induce and maintain remission of symptoms and inflammation of the inner lining of colon. Treatment options are determined according to the extent of the inflammation and the severity of the disease.

5-Aminosalicylic Acid (5-ASA)Â
The majority of patients with ulcerative colitis have mild or moderate disease with inflammation involving areas close the rectum. In these patients, rectally administered preparation of 5-aminosalicylic acid (5-ASA) is the best treatment option. Rectal preparation of 5-ASA is available as an enema, foam, gel, or suppository, which are equally effective. For patients who prefer oral therapy, sulfasalazine and 5-ASA derivatives (mesalamine, olsalazine, and balsalazide) are also effective in the treatment of mild to moderate ulcerative colitis, although rectal preparations have higher remission and improvement rates.

Sulfasalazine is less effective than corticosteroids for active disease and its major role in the management of ulcerative colitis is to maintain remission once the active inflammation has resolved. However, side effects from sulfasalazine such as headache, nausea, and vomiting can be severe. Rash and infertility in males are also commonly reported with sulfasalazine therapy.

Mesalamine, olsalazine, and balsalazide have been developed to minimize adverse effects seen with sulfasalazine therapy. These new 5-ASA derivatives are shown to be as effective as sulfasalazine in both treating active ulcerative colitis and maintaining remission with fewer side effects.

CorticosteroidsÂ
For patients whose symptoms are inadequately controlled with 5-ASA, corticosteroids are used in active disease.

Hydrocortisone is available as an enema, suppository, or foam for rectal administration. For patients with severe ulcerative colitis, oral corticosteroid is used. Prednisone and cortisone are commonly used oral corticosteroids for severe ulcerative colitis but prolonged use can cause many long-term side effects, including osteoporosis and cataract. For patients with severe disease requiring hospitalization, intravenous corticosteroid is also available.

Although corticosteroids deliver fast and reliable remissions of the active ulcerative colitis, these drugs do not change the underlying disease course and they were shown to be ineffective in maintaining long-term remission with continued use. Therefore, corticosteroids should be used to treat active disease and should be used to maintain remission of the disease.

Immunosuppressive AgentsÂ
Immunosuppressive agents are often used to allow reduction or elimination of corticosteroids and also to maintain corticosteroid-induced remissions of the disease. The immunosuppressive agents used in ulcerative colitis include azathioprine (AZA), 6-mercaptopurine, and cyclosporine.

Azathioprine and 6-mercaptopurine are most widely used immunosuppressive agents used in ulcerative colitis. These drugs are especially useful in patients who are having repeated relapses from their disease once corticosteroids have been discontinued. It may take up to 6 months for these drugs to achieve a therapeutic effect. Both azathioprine and 6-mercaptopurine are associated with minimal side effects which include nausea, fever, and diarrhea. Pancreatitis and liver dysfunction can also occur and rare occurrence of bone marrow suppression with these drug warrant regular monitoring of blood counts.

Cyclosporine is used for patients hospitalized with severe ulcerative colitis who do not respond to high doses of intravenous corticosteroid s . Although oral formulation of the drug is available, only intravenous administration of cyclosporine has been shown to provide favorable effects in severe ulcerative colitis. It has much faster onset of therapeutic efficacy compared to azathioprine and 6-mercaptopurine, but is not found to be as effective in maintaining remission. Unlike azathioprine and 6-mercaptopurine, cyclosporine is not associated with bone marrow suppression but can cause kidney toxicity.

SurgeryÂ
In patient with ulcerative colitis, surgery is performed to remove the colon in the following situations:

	Severe attacks not responding to medical treatment
	Perforation or dilatation of the colon during a severe attack
	Cancer due to ulcerative colitis

TCM believes that the major pathologies of ulcerative colitis includeÂ spleenÂ andÂ stomachÂ dysfunctions, intestinal turbid accumulations, andÂ bloodÂ andÂ qiÂ disturbances . Therefore, TCM treatment strategies are to restoreÂ organÂ functioning, eliminate turbid accumulations and harmonize the flows of qi and blood.

In clinical applications, if individuals have obvious pus, mucus or bloody loose bowels, physicians will focus on clearingÂ pathogensÂ likeÂ damp-heatÂ or damp-cold, so as to improve the bowel environment. Afterwards,Â tonifying methodsÂ are employed to overcome the internal weakness and promote a longer remission period.

Prescriptions according toÂ syndrome differentiation

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

In the prescription, the peony root and angelica root enrich the blood; the betel nut, costus root and rhubarb promote qi flow, the thread rhizome and skullcap root clear damp-heat and detoxify. The whole combination resolves the pathogenic accumulation in the large intestine, enabling the bowel to resume its normal transmission process.

In the prescription, the atractylodes rhizome and root enhanceÂ fluid metabolismÂ in the spleen; the magnolia bark and tangerine peel regulate qi flow to dispel damp-cold; the poria, water-plantain root andÂ chu-linginduce urination; cassia bark and ginger promote warmth to expel coldness. The whole combination enables the intestinal functions to perform normally by enhancing spleen functioning and dispelling damp-coldÂ pathogens.Damp-cold in the spleenÂ
Therapeutic aim: warming and dissolving dampness, harmonizing blood and qi
Sample prescription: ModifiedÂ Weiling Decoction (Wei Ling Tang)

Qi and Blood stagnationÂ
Therapeutic aim: regulating blood and qi flows to arrest diarrhea and pain.Â
Sample prescriptionÂ : ModifiedÂ Decoction for Removing Blood Stasis in the Lower Abdomen (Shao Fu Zhu Yu Tang)

In the prescription, the cattail pollen, angelica, lovage and squirrel feces nourish blood and promote tissue regeneration; the corydalis rhizome, peony root and myrrh promote blood and qi flows to arrest pain; the fennel, ginger and cassia bark warm theÂ meridianÂ to dispel blood stasis. The whole combination improves the circulation in the large intestine so as to arrest diarrhea and pain.

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

In the prescription, the atractylodes root invigorates the spleen; the peony root works on the liver; the tangerine peel regulates qi flow and expels dampness; the ledebouriella root assists the above herbs to work properly. The whole combination invigorates the spleen and expels dampness to arrest diarrhea, soothes the liver and regulates qi to arrest pain.

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

In the prescription, the ginseng, atractylodes root and poria are the main ingredients to replenish qi and invigorate the spleen; the hyacinth bean, coix seed, lotus seed and yam enhance the water metabolism of the spleen which helps to drain dampness and arrest diarrhea; the amomum fruit promotes the digestive process; the balloonflower regulate the water passages and the liquorice acts as a buffer.

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

In the prescription, the poppy capsule is used in high dosage to consolidate the intestine and arrest diarrhea; cassia bark warms theÂ kidneyÂ and spleen; both herbs are the main ingredients. The nutmeg and myrobalan fruit provide warming to arrest diarrhea; the ginseng and atractylodes root replenish qi; the angelica and peony root replenish blood; the costus root and liquorice root act as buffer.

Herbal enemas

An enema is the procedure of introducing liquids into the rectum and colon via the anus. Herbal enemas help improve problems affecting the lining of the bowel such as abrasions, edema, ulcers and bleeding, therefore effectively relieving the intestinal symptoms.

Herbal enemas for ulcerative colitis must be carried out in medical or hospital environments. Before the procedure is undertaken, the lower bowel must be cleaned properly; drip a warm herbal preparation slowly into the colon; let the liquid be retained for at least 4 hours so as to obtain the full herbal effects. Do once a day for ten days, and then rest for 4 days before repeating the treatment. Patients usually feel an improvement after 3 courses. Selection of herbs is based on individual cases, below are some suggested ingredients:

Clearing damp-heat accumulation

bai tou weng	Chinese pulsatilla root	Radix Pulsatillae
ye ju hua	wild chrysanthemum	Flos Chrysanthemi Indici
pu gong ying	dandelion	Herba Taraxaci
huang lian	golden thread rhizome	Rhizoma Coptidis
bai jiang cao	patrinia	Herbal Patriniae

Removing blood and qi stagnation

dan pi	peony tree root bark	Crotex Moutan Radicis
huang qin	baical skullcap rootÂ	Radix Scutellariae
huai hua	pagoda tree flower	Flos Sophorae
san chi	notoginseng	Radix Notoginseng
da huang	Chinese rhubarb	Radix et Rhizoma Rhei

Soothing liver and invigorating spleen

bai ji	common bletilla tuber	Rhizoma Bletillae
chai hu	bupleurum root	Radix Bupleuri
bai shao	white peony root	Radix Paeoniae Alba
yu jin	turmeric root tuber	Radix Curcumae
wu yao	lindera root	Radix Linderae

Tonifying spleen and stomach

huang qi	astragalus	Radix Astragali
dang shen	pilose asiabell root	Radix Codonopsis Pilosulae
bai shu	largehead atractylodes root	Rhizoma Atractylodis Macrocephalae
chen pi	dried tangerine peel	Pericarpium Citri Reticulatae
dang gui	angelica root	Radix Angelicae Sinensis

Pilose asiabell root

Acupoint therapies

Stimulation ofÂ acupointsÂ not only enhances the immune modulation effect, but also mobilizes 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),Â tian-shu, guan-yuanÂ &Â qi-hai;Â
Assist points:Â da-chang-shu, zhang-qiang, pi-shu, wei-shu, zu-san-liÂ &Â san-yin-jiao.

When applying, first punch the four-point needle in 0.3-0.5 cm deep and rotate for about 30 seconds, stimulate the four locations in a clockwise sequence, noÂ needle retention; then select one more major point and 2-3 assist points for stimulation, retain the needles on the locations for 15-20 minutes, moxa cones can be attached for heating during this time. Do this once daily or every two days, ten times is one course.

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

Each time, select 1-2 major points and heat for 30-40 minutes; while select 2-3 assist points and heat for 15-20 minutes. Do this once daily or every two days, 15-20 times is one course.

Six Evils

acuherb — Mon, 02 Jul 2012 19:22:11 +0000

By Dr. Wang

The Six Evils or Six Pernicious Influences

The evils are external in origin, but can penetrate deeply into the body.

The Six Evils are:

Wind

Cold

Damp

Heat

Summer Heat

Dryness

Wind

(Associated with Liver, Wood, Spring, Yang evil)

Wind is involved with movement and activity, and brings other evil Qi in with it. It is the most important evil as it is the cause of the “100 diseases”.

Disperses Qi upward and outward

Yang energy wants to rise and expand

Illnesses manifest in upper and outer parts of the body in early stage: head, sense organs and skin

Rashes Common: itchy, come and go quickly, spread quickly

Sweating common: causes opening of pores (Qi and fluids lost)

Rapid onset and rapid changes

Acute illnesses with rapid progression such as fever, infectious diseases

Creates abnormal or sudden movement

spasms, convulsions, twitches

Creates abnormal positions

Stroke

Stiff neck with flu

Most common in spring

Wind Syndromes – External Wind

1.) Wind-Cold

chills more than fever
aversion to cold
occipital headache
stiff neck
sneezing
mucous will be clear and copious
runny nose
body aches that move around
tongue: slightly pale, thin white coat

Excess Type External Wind

Little or no sweating

pulse: floating, slow, tight

Wei Qi is strong so pores are held closed

warm relieve surface treatment is used to sweat

out evil and excess Wind and Cold

Ma Huang Tang

Xu Type External Wind

Sweating

Pulse: floating, slow, Xu

Wei Qi is weak. There is sweating but it does not release the Exterior

Harmonize Ying and Wei Qi. Ying nourishes Wei to gently strengthen it, without tonifying Evil Qi

Gui Zhi Tang

2.) Wind-Heat

fever more than chills
sore throat
cough with thick, yellow mucous
thirst for cold drinks
frontal headache; can be stronger, pounding (Yang Ming)
redness or inflammation of eyes
sinusitis
earache
red face
Pulse: Floating, rapid
Tongue: slightly red in early stage, yellow coat, thorns on lung area

3.) Wind-Damp

sensitivity to wind
fever and chills with fever more pronounced in the afternoon
strong body aches
body and head feel heavy
copious phlegm – runny nose, congestion, stuffiness, sinusitis
sinus headache
foggy headed, difficult thinking
Pulse: slippery
Tongue: swollen, likely to be a thick coat, could be greasy

4.) Wind-Damp Bi Pain

Arthritis, nerve pain, and numbness that is worse with cold and damp
weather
Pulse: slippery
Tongue: swollen, thick coat
Treat by opening channels and mildly relieving surface

5.) Wind-Water

disruption of Jin-Ye
anything with sudden Edema
acute onset
frequently occurs in the face
Treat by relieving surface, eliminating water
causes include allergic reaction, rash, acute nephritis
Pulse: slippery
Tongue: swollen, greasy coat

6) Wind-Rash

acute onset
moves around to different parts of body
will appear and disappear
Pulse: floating, rapid
Tongue: red with yellow coat

Wind Syndromes – Internal WindÂ

Associated with the Liver, and causes diseases of shaking and abnormal body positions.
It is usually chronic, where external wind is usually acute.
It combines easily with phlegm, as in Deviation (Wind blows it out of position and the phlegm makes it stick in an abnormal position).

Symptoms of Internal Wind

spasms and abnormal muscle contractions

convulsions

Parkinson’s

post-stroke sequelae

seizures(epilepsy)

shaking from anger

migraine (Wind blowing in head)

Pulse: wiry usually rapid

Tongue: shaking or deviated

Causes of Liver Wind

Excess fire affecting the Liver

Fire creates Wind

enters the Blood level

high fever (diseases such as meningitis)

poisons, toxins, radiation, drugs, alcohol

constitutional Liver Fire

Pulse: rapid, wiry, excess

Tongue: red, yellow coat; shaking or stiff

Liver Yin Xu, Yang KanÂ – Long-standing Yin deficiency with Heat

long term use of drugs, alcohol

chronic Yin Xu fevers

Pulse: Wiry, rapid, thin

Tongue: red, no coat, shaking

Liver Blood Deficiency

1) Blood Xu makes Heat
2) Blood not nourishing the “General”

Numbness of limbs common

Pulse: thready or hollow

Tongue: pale with white or yellow coat

Liver wind mixing with Phlegm

Wind blows it into an abnormal position and phlegm makes it stick. It affects Liver (Wind) and Heart (Phlegm misting). There is rigidity especially of limbs, neck, tongue, and stiffness in tongue (May affect the Speech)

Neurological conditions

brain disorders

Alzheimer’s, senility

Stroke

brain tumors

Fire and Phlegm occurring together

more sweating than with internal wind alone

rapidly changing emotions

commonly occurs with long term alcohol and drug use

red face

Pulse: Rapid, slippery, full

Tongue: red, particularly at tip, may be skewed to one side

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Cold

(Associated with Kidney, Winter, Water element, Yin evil)

Damages the Yang
Impairs ability to maintain body temp
Weakens and slows life activities
Feeling of cold
Symptoms better with warmth
causes Qi and Blood to contract and congeal which creates stagnation, pain, stiffness
Easily effects the low back and knees, joints
Easily effects the Stomach, Intestines, Liver
Thin, watery, pale, cold discharges urine, stools, blood etc.

Syndromes of Cold

Wind Cold

chills more than fever
aversion to cold
occipital headache
stiff neck
clear copious phlegm
runny nose
sneezing
mild body aches
Excess type
- little or no sweating
- Pulse: Floating, slow, tight
- Tongue: slightly pale, thin white coat
Deficiency type
- sweating
- Pulse: Floating, slow, Xu
- Tongue: slightly pale, thin white coat

Cold attacking the Spleen and Stomach

Looks like spleen Qi Xu but the cause is external (Examples are living by the ocean or eating cold foods). Phlegm and Dampness can also collect and cause dizziness.

diarrhea

loose stools

watery stools

bloating

poor digestion

nausea

vomiting

stomach or abdominal pain that is worse with cold

loss of appetite

fatigue

Pulse: slow

Tongue: pale

Cold evil damaging both spleen and Kidney Yang

Can be acute, as in hypothermia, or chronic, as in a cold climate damaging spleen and kidneys.

Symptoms as in previous syndrome with:

watery stools
undigested food in stools
bird stools
aversion to cold
feeling of cold in entire body
profuse urination or edema
strong fatigue
pale face
possibly green or purple lips
Purple or black under eyes if the Kidney Yang is damaged
Pulse: slow, weak
Tongue: pale, white coat, tooth marks

Cold contracting the Qi and Blood

Cold slows circulation, contracts, congeals, stagnates

Liver Qi Stagnation

abdominal bloating

depression, irritability

Pulse: wiry

Tongue: light purple

Blood stagnation

pain that is sharp, stabbing, needle-like, constant

purple lips, complexion etc.

Pulse: choppy

Tongue: deep purple, possibly purple spots

Wind cold damp Bi pain

arthritis (more commonly Osteoarthritis) with cold, stiff, contracted joints

sensitivity to cold is strongest symptom

can be nerve or muscle involvement

symptoms better with warm weather, heat therapy, saunas

Cold contracting the liver meridian

pain on inside of legs, genital area along liver meridian

severe menstrual pain

endometriosis

hernia

muscular problems i.e. groin pull

testicular problems

sperm production

may be infertility

will exhibit signs of liver blood stagnation

Pulse: choppy

Tongue: pale and purple

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Damp

(Associated with spleen, late summer, Earth element, Yin evil)

Dampness is heavy, tenacious, difficult to treat, and lasts a long time. It tends to move downwards in the body.

Sticky, greasy, oily, dirty, bad smell

“looks like water or mud, “looks and smells dirty

greasy hair and face

greasy skin: acne, pus, oozing wound

mucous or discharge anywhere in body

bad body odor, bad breath, smelly perspiration

bad smelling diarrhea with mucous (if mixed with heat, there can be cloudy urine)

thick or bad smelling vaginal discharge as in STD

copious nasal discharge

edema or swelling

arthritis with swollen joints

fluid coming out of anywhere

candida, fungus, yeast

Damages the Yang of body

worse in cold, damp weather

Spleen works to transform Damp; Kidney supports Spleen

Creates stagnation

Stagnate fluids will also stagnate Qi and Blood

Syndromes of damp

Wind-Damp
Acute condition, but has the slowest onset of all winds. It is affected by damp and cold weather. Symptoms can reflect a respiratory infection with copious phlegm or a gastrointestinal flu.

strong generalized body aches

heavy feeling in head and body

foggy headed, unclear thinking, band headache

copious phlegm, can be runny or thick

sneezing

afternoon fever

nausea, vomiting

diarrhea, possibly with mucous

Pulse: slippery, slowing down pulse

Tongue: swollen with thick, greasy coat

Wind-Damp Bi pain

swelling of joints

edema

Pulse: slippery

Tongue: swollen with thick, greasy coat

Damp poison in skin

discharge: pus, carbuncles, boils, acne, oozing

infection after wound

warts, fungus, yeast

Damp heat

Infection or inflammation that can affect many places, such as the Liver, Gallbladder, Urinary Bladder, Intestines, Sinuses, etc.

“itis” Diseases

Bronchitis

Hepatitis

Vaginitis

Prostatitis

Colitis

Pulse: slippery, rapid (which quality is greater?)

Tongue: red, thick yellow coat, swollen (how thick, how swollen, how red?)

Internal dampness arising in the body

Dampness arising from Spleen Xu: Dampness is the main factor, the Xu is secondary. It often compromises immunity due to congestion of lymphatic system, autoimmune conditions in particular. If severe, it becomes Phlegm. A long term chronic situation is often due to damp, cold, raw foods.

Symptoms may be associated with a wide variety of diseases: Chronic Fatigue, Fibromyalgia, Candida, Lymphoma, Etc.

bloating

nausea

vomiting

diarrhea

heaviness of head and body

dizziness

low appetite

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Heat

(Associated with the Heart, summertime, Fire element, Yang Evil)

Damages Yin

dries fluids, easily leads to Yin Xu

Heat rises

diseases most common on face, eyes, and nose

Causes redness

the more red, the more heat

Easily produces wind

when heat affects the Liver

Speeds things up

agitation, restlessness

can be bleeding: Blood moves so fast it leaves the vessels

Easily affects the skin

red, itchy, painful rashes

Syndromes of Heat

Wind-Heat

fever more than chills

sore throat

frontal headache (yang Ming channels)

big thirst

sinus infection

red eyes, conjunctivitis

cough with yellow, green or brown phlegm

Tongue: red and raised dots in lung area (thorns)

Pulse: rapid, floating

Damp Heat

Upper Jiao – Affects face and chest

Middle Jiao – Affects Spleen and Liver

Lower Jiao – Intestines, bladder, genitals, etc.

Excess Fire

Strong heat that reaches deep in to organs. It can have an external or internal origin.

Symptoms

big thirst

redness

restlessness

symptoms are loud and forceful (cough, diarrhea etc.)

Syndromes

Lung fire

can be loud, forceful cough with blood (fire has burnt off protection of mucous membranes so capillaries have burst)

mucous is yellow, green , brown

red, painful rash

Stomach fire

burning ulcer, heartburn)

Stomach channel problems: toothache (infection), frontal headache strong pain or burning on channel

Heart fire

strong anxiety

restlessness

insomnia

mania

Liver fire

anger

shingles in costal region

burning pain in genital area as from STD’s

Large Intestine fire

dysentery

toothache (channel pain) -> Kidney fire

long term alcohol or drug abuse

bone infection

meningitis (affects Marrow)

Deficient Fire

Yin Xu, Yang Kan, Heat is deep in the body: Ying level. Pattern of mixed Xu and excess. Treatment must include quelling fire as well as nourishing yin

smoldering heat especially at night

low grade rashes

severe restlessness

slight bleeding

Tongue: scarlet

Pulse: thready, rapid

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Summer Heat

(Associated with the Heart, Fire Element, Summer, Yang Evil)

Syndromes of Summer Heat

Summer heat

high fever

restlessness

thirst with strong desire to drink

can go up and affect the head

dizziness

blurred vision

headache

constipation

scant yellow urine

coma

Yin collapse

profuse sweating

Tongue: dry, red

Pulse: surging (flooding – strong, big waves)

Summer Heat combined with Dampness

A person with a Damp constitution experiencing Summer Heat, or a person who eats Damp foods in summer (ice cream, cold soda).

Dampness turns into phlegm because of heat

nausea

vomiting

loose stools or diarrhea

poor appetite and fatigue

phlegm can rise to head

dizziness

heavy head

foggy thinking

suffocating feeling in chest

tightness in chest

sweating, but not as much as Summer Heat without Dampness

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Dryness

(Associated with the Lung, Autumn, Metal Element, Yang evil)

Exterior in origin (not yin Xu, not internal)

Easily damages body fluids

Dry skin

Dry hair

Dry eyes

Dry lips

Dry throat or low grade sore throat

Dry stools

Scant urine

Thirst

Easily damages lungs

Could be from dry climate or smoking

Dry cough and dry phlegm (thick, sticky, hard to expel)

Syndromes of Dryness

Warm Dryness

Symptoms

Fever

Headache

Thirst

Dry Mouth

Dry Nasal Passages

Dry cough with Dry Phlegm

Tongue: red with thin or no coat

Pulse: rapid

Treatment

acute: treat as wind-heat

chronic: tonify yin

Cool drynessÂ (Example: Dried out from air conditioning)

Symptoms

Dry phlegm (thick, doesn’t move)

Sensitive to cold

Chills

Mild fever

Headache

Dry cough

Dry mouth

Dry nasal passages with stuffiness

Tongue: thin, white

Pulse: tight, slow

Treatment

Acute: Treat as wind-cold