Integrated Traditional Chinese and Western Medicine Treatment of Ulcerative Colitis
Ulcerative colitis is a chronic inflammatory disease of the rectum and colon of unknown cause, often recurring. I once encountered a 23-year-old male patient who began experiencing mild abdominal pain and diarrhea (1–2 times daily) around the time he was finishing his studies in the Netherlands at age 19. His condition gradually worsened, and six months later, he had 7–8 episodes of bloody diarrhea daily, accompanied by nausea and poor appetite. Local Dutch hospitals diagnosed him with ulcerative colitis and recommended surgery. At that time, a doctor from our hospital who was studying in the Netherlands helped transfer him back to China and admitted him to our department of gastroenterology. He was extremely weak, pale, with a fever of 39°C, and had large ulcers throughout his mouth, making drinking water painful. Physical examination revealed tenderness throughout the abdomen and severe edema in the lower limbs. Colonoscopy showed numerous ulcers and inflammatory polyps of varying sizes throughout the colon. After appropriate supportive therapy, correct use of adrenal corticosteroids, plus traditional Chinese medicines such as Xilile Powder, Shengji Powder, and Kangfu Xin Liquid, his condition improved, and he was discharged cured after three months.
This disease typically progresses slowly, though some cases present acutely. Clinical manifestations depend on disease duration, extent of lesions, stage of illness, and presence of complications. Mainly manifesting in two aspects:
First, gastrointestinal system:
1. Diarrhea, stool appears as mushy with mucus and pus-blood, or as bloody stools.
2. Abdominal pain, mild to moderate cramping, accompanied by left lower abdominal or generalized distension.
3. Loss of appetite, nausea, vomiting, etc.
4. Mild cases may have tenderness in the left lower abdomen; severe cases may have generalized abdominal tenderness.
Second, systemic manifestations:
Low-grade or moderate fever during acute or flare-up phases. Severe cases may present high fever, weight loss, anemia, fluid and electrolyte imbalance, hypoproteinemia, and malnutrition. Diagnosis requires comprehensive analysis of repeated stool examinations for pathogens, colonoscopy, and X-ray imaging. The exact cause remains unclear, possibly involving immune factors, genetics, food allergies, infection, and nervous-psychological influences, making treatment very difficult and lacking specific methods. In internal medicine, we adopt an integrated approach:
1. Enhance nutrition; if necessary, administer albumin, various amino acids, and intravenous hyperalimentation.
2. Symptomatic treatment focuses on anti-diarrheal therapy, using agents like diphenoxylate or loperamide, but avoid addiction.
3. Anti-inflammatory: If there is concurrent systemic or local bacterial infection, antibiotics should be selected. For colonic inflammatory lesions, 5-aminosalicylic acid, sulfasalazine, and Eddisa are primarily used.
4. Chinese medicine options include Guchang Kang, Xianglian Tablets, Baijie Tablets, Ge Gen Qin Lian Tablets, etc. Guben Yichang Tablets have better effect in consolidating and stopping diarrhea.
5. Probiotics: Long-term antibiotic use often leads to reduction of beneficial bacteria; consider using products like Peifeikang, Jianshuangqi, and Lizhudele.
6. Complications: Correct anemia, hypoproteinemia, toxic megacolon, or perforation. The former two can be managed conservatively, while the latter two require surgical intervention.
When internal medicine fails and complications such as intestinal stricture, multiple inflammatory polyps causing obstruction, abscesses, fistulas, or malignant transformation into colon cancer occur, surgical resection is indicated. Mild cases have good prognosis; chronic, recurrent cases have poor prognosis; fulminant cases require surgery.