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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