Diagnosing IBD with Traditional Chinese Medicine disease patterns

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By Melissa Carr, BSc, DrTCM

While inflammatory bowel diseases (IBD), from Crohn’s disease to ulcerative colitis, are varied and complex, Traditional Chinese Medicine (TCM) describes several patterns of diagnosis that practitioners can utilize with patients.

Though some patterns are more common than others, patients may move from one pattern of diagnosis to another as their condition progresses from an acute initial flare to chronic IBD or remission. There are also several crossovers in these patterns.

Understanding these patterns can help integrative practitioners make more informed diagnoses and develop more precise treatment protocols for their IBD patients.

Damp-Heat in Large Intestines or Liver

Damp-Heat is most seen in acute onset cases with urgent diarrhea, tenesmus, burning sensation during or after bowel movements, and foul-smelling stools, sometimes with blood and mucus. Patients may also notice a feeling of heat in the body, an increase of thirst, darker yellow urine, and irritability. For those who know how to take TCM pulse and tongue readings, the pulse will feel slippery and rapid and the tongue is dark or bright red with a thick yellow coat.

This is an “excess” pattern and bitter cooling herbs help clear Heat and dry Dampness. Shao Yao Tang is a good formula to use as a modifiable base if the tenesmus, cramping, and pain are the worst symptoms, as its chief herb, bai shao yao, nourishes the Blood, soothes the Liver, and alleviates pain. Though the herb da huang has a laxative function, it helps drain Heat through the stool and it can help facilitate the bowel movements.

Bai Tou Weng Tang or Huai Hua San can be chosen if there is more blood than pus in the stool, though the latter formula has a stronger action of stopping bleeding with the herbs huai hua mi and ce bai ye.

For Liver Damp-Heat patterns, with symptoms like bitter taste in the mouth, genital itchiness or inflammation, nausea, and feeling of fullness in hypochondrium, the formula Long Dong Xie Gan Tang is a good starting point.

If there are more Dampness signs like watery stool, bloating, and foggy-headedness, the herbs yi yi ren and fu ling can be added. The “three yellow” herbs, huang bai, huang qin, and huang lian are good herbs to clear Damp-Heat. Practitioners should be forewarned that patients taking a liquid or powder form are likely to complain about the bitterness—just tell them they’ll thank you later.

Spleen Qi Deficiency and Dampness Accumulation

Spleen Qi deficiency is a common pattern of imbalance, often caused or aggravated by overthinking and worry, poor diet, and overwork or over-exercise. When severe enough, it can cause frequent diarrhea with watery stool containing undigested food. Dull abdominal pain, a poor appetite, feeling foggy-headed, exhaustion, easy bruising, prolapse, and fatigue after eating or after bowel movements are signs that the Spleen needs support. The pulse will be weak and soft, and the tongue will be pale and may be thin if weakness is the main issue or swollen if there is Dampness accumulation.

The classic formula, Shen Ling Bai Zhu San, is used to treat chronic diarrhea caused by Spleen Qi deficiency with excess Damp. In my experience, this is a great formula for those with milder forms of chronic diarrhea, but for IBD cases, modifications are needed. This might include herbs like shan zha, mai ya, and shen qu if there is undigested food in the stool or poor appetite, though the latter two herbs do contain gluten, so will need to be avoided for those who are sensitive. If there is bloating or abdominal pain, the herbs mu xiang, chen pi, and zhi ke can also be included.

Spleen and Kidney Yang Deficiency

A key symptom of diarrhea early in the morning, between 4 a.m. and 8 a.m., is called “cock crow diarrhea” and signifies Spleen and Kidney Yang deficiency. Other symptoms include aversion to cold, cold extremities, weak low back, and low libido. The pulse will be thready, weak, and slow and the tongue pale and swollen with white coating.

Si Shen Wan, Fu Zi Li Zhong Wan, and Zhen Wu Tang, will all help rebuild and warm up these systems. Moxibustion treatment, heating pads, and warming foods can be helpful too.

Qi and Blood Stagnation

For this pattern, there is stabbing pain and potentially a palpable mass. If there is blood in the stool, it is dark red, and the patient may have been told that they have strictures. The pulse will be choppy or thready and the tongue will be dark purplish or have dark purple spots.

Herbs that move the Blood include dan shen, tao ren, hong hua, and chuan xiong. To move the Qi too, choose herbs like xiang fu, mu xiang, chuan lian zi, yan hu suo, fo shou, chen pi, zhi shi, zhi ke, chen pi, and qing pi. Note that the last six herbs here are all citrus related.

Qi is needed to move Blood, so Qi deficiency may also be present. If there is not enough Blood, its deficiency can also result in stagnation. For those who have been struggling for awhile with an IBD, they may also have to be nourished. Dang gui is an important herb to both nourish the Blood and move the Blood. Use the “tail” of the herb, dang gui wei if more moving than nourishing is needed.

Case Study

When Al came in for his first TCM treatment, he had been struggling for a week with a flare of his ulcerative colitis. Though he was currently experiencing mild symptoms of two to three looser and more urgent bowel movements with cramping pain first thing in the morning, and though there was no blood or mucus, he was afraid that his flare would worsen and land him in the hospital again.

His initial flare, 10 years prior occurred when he was eating poorly, with greasy pizza being his staple food. He was also not managing his stress well, and said he felt that was a contributing factor. With 10 to 15 painful bloody mucus bowel movements daily, he was treated with aggressive medications and struggled up and down with flares for the first few years.

Recently, Al had been switched to a different biologic medication and was weaning off his prednisone prescription, so he wanted to see what TCM had to offer to help him with that transition. He also had low back pain, cold hands and feet, a bitter taste in the mouth, and a tendency to overanalyze and control.

I diagnosed Al with Spleen and Kidney Yang deficiency, with a tendency toward Liver Qi stagnation causing Heat and prescribed a modified Si Shen Wan and Jia Wei Xiao Yao San, including also zhi fu zi. I also suggested he start his day with a warm meal instead of a cold smoothie and have cooked vegetables instead of raw.

After six weeks of herbs, he was completely off his prednisone and back in remission for his ulcerative colitis, though I suggested he check in again in a month, as he may need occasional renewals and tweaks of an herbal prescription for long-term maintenance.