CLINICAL APPLICATIONS

* Ulcerative colitis

* Crohn’s disease

* Other inflammatory bowel disease, such as diverticulitis, fistula, colitis

* Chronic diarrhea with mucus, pus and blood, feeling of incomplete evacuation and abdominal cramps

 

WESTERN THERAPEUTIC ACTIONS

* Anti-inflammatory effect to reduce swelling and inflammation

* Antispasmodic action to alleviate abdominal spasms and cramps

* Antibiotic effect to treat infection

* Gastroprotective benefit to promote normal digestion and absorption of nutrients

* Antidiarrheal function to relieve diarrhea

* Antidotal function to eliminate toxins

 

CHINESE THERAPEUTIC ACTIONS

* Dispels damp-heat in the Intestines

* Relieves diarrhea

* Disperses stagnation and detoxifies

* Tonifies yin

 

DOSAGE

Take 3 to 4 capsules three times daily on an empty stomach with warm water. Dosage may be increased up to 8 to 10 capsules three times daily in acute conditions for no more than four days or until symptoms subside. After relief of symptoms the dosage then can be reduced to 3 to 4 capsules daily. For prevention or maintenance, take 2 capsules daily.

 

INGREDIENTS

Bai Shao (Radix Paeoniae Alba)

Chun Pi (Cortex Ailanthi)

Di Yu Tan (Radix Sanguisorbae Carbonisatum)

Dong Gua Zi (Semen Benincasae)

Fang Feng (Radix Saposhnikoviae)

Hou Po (Cortex Magnoliae Officinalis)

Huang Lian (Rhizoma Coptidis)

Ma Chi Xian (Herba Portulacae)

Mai Ya (Fructus Hordei Germinatus)

Nan Sha Shen (Radix Adenophorae)

Shan Yao (Rhizoma Dioscoreae)

Shan Zha Tan (Fructus Crataegi Carbonisatum)

Shi Liu Pi (Pericarpium Granati)

Wu Bei Zi (Galla Chinensis)

Yi Yi Ren (Semen Coicis)

 

BACKGROUND

Inflammatory bowel disease, which includes ulcerative colitis and Crohn’s disease, is a condition characterized by chronic inflammation affecting various parts of the gastrointestinal tract. Ulcerative colitis and Crohn’s disease are chronic, non-specific, inflammatory, ulcerative diseases that have no known etiology. Possible risk factors include immunological factors, infectious agents (such as bacteria, virus or amoeba), dietary factors (including chemicals and drugs), and psychosomatic factors. Ulcerative colitis and Crohn’s disease usually occur between ages 14 to 24, or between 50 to 70. Clinical presentations of ulcerative colitis and Crohn’s disease vary greatly depending on the extent and severity of the illness. The initial presentation begins with gradual onset of diarrhea with mucus and blood. There are symptomatic and asymptomatic intervals of diarrhea. Patients may also experience tenesmus and left lower quadrant pain and cramps.[1] Optimal treatment requires use of herbs to address the cause, the symptoms, and the complications.

 

FORMULA EXPLANATION

According to traditional Chinese medicine, ulcerative colitis and Crohn’s disease are diagnosed as disorders characterized by the disharmony between the Spleen/Stomach and the Liver. Liver qi stagnation overacts on the Spleen and Stomach to impair the normal transformation and transportation of food. Over a long period of time, this dampness combines with heat to lodge in the Large Intestine to cause diarrhea with inflammation. Because of prolonged diarrhea and loss of fluids, yin also becomes deficient.

        Nan Sha Shen (Radix Adenophorae) nourishes yin and dries up dampness. Shan Yao (Rhizoma Dioscoreae) nourishes the Spleen yin and relieves diarrhea. Mai Ya (Fructus Hordei Germinatus) and Shan Zha Tan (Fructus Crataegi Carbonisatum) promote digestion and stop bleeding. Ma Chi Xian (Herba Portulacae) and Huang Lian (Rhizoma Coptidis) dispel damp-heat in the Intestines to relieve intestinal irritations. Di Yu Tan (Radix Sanguisorbae Carbonisatum), Chun Pi (Cortex Ailanthi), Shi Liu Pi (Pericarpium Granati) and Wu Bei Zi (Galla Chinensis) are used to bind the Intestines to stop diarrhea, dispel pus, stop bleeding and generate new tissue. Yi Yi Ren (Semen Coicis) and Dong Gua Zi (Semen Benincasae) are traditionally used to treat intestinal abscess and are used here to dispel pus and mucus present in the stool. They both enter the Lung, which is connected to the Large Intestine via the zang fu relationship. These two herbs help to dry up dampness and enhance the ability of the Lung to metabolize water and prevent further accumulation of dampness, especially in the Large Intestine. Fang Feng (Radix Saposhnikoviae) is used to stop diarrhea and relieve pain. Together with Bai Shao (Radix Paeoniae Alba), these two herbs relieve abdominal and intestinal spasms, cramps, and pain. Hou Po (Cortex Magnoliae Officinalis) regulates qi in the abdomen to relieve bloating, distension, and pain.

        GI Care (UC) effectively treats ulcerative colitis and Crohn’s disease by targeting both the cause and the symptoms. Herbs are used to treat the underlying cause of disharmony between the Spleen/Stomach and the Liver, and accumulation of damp-heat in the Intestines. In addition, herbs are used to symptomatically relieve diarrhea, treat intestinal abscess, dispel pus, and alleviate pain and distension.

 

CAUTIONS & CONTRAINDICATIONS

* This formula is contraindicated during pregnancy and nursing.

* This formula is contraindicated in cases of diarrhea due to Spleen qi deficiency or Kidney yang deficiency.

* While the use of herbs is effective in treating mild to moderate ulcerative colitis and Crohn’s disease, it may not be appropriate for treating certain complications, such as toxic colitis, toxic megacolon, massive hemorrhage, free perforation, or fulminating toxic colitis. Surgical intervention may be necessary for such complications, but will require permanent ileostomy in addition to physical and emotional burden.

 

CLINICAL NOTES

* There are two formulas that can be used to treat inflammation of the bowel.

§ GI Care (UC) is designed more for patients suffering from chronic ulcerative colitis and Crohn’s disease without the active infection. Therefore, it contains many herbs that would generate new tissue and repair the normal flora of the intestines.

§ GI Care II is designed more for an active infection and inflammation of the intestines due to improper food intake. Because bacteria lodged in the intestines need to be purged out, purgative herbs such as Da Huang (Radix et Rhizoma Rhei) are used.

 

Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:

* Rainbow pulse, a convex-shaped pulse that is thick, forceful, and expanding on and extends distally to the left cun.

* Floating and forceful pulse on the right cun and guan.

 

SUPPLEMENTARY FORMULAS

* With bleeding, add Notoginseng 9.

* For diverticulitis and fistula, add Resolve (AI) and Astringent Complex.

* For burning diarrhea with tenesmus, add GI Care II.

* For hemorrhoids, add GI Care (HMR).

* For stress related ulcerative colitis and Crohn’s disease, add Calm or Calm (ES).

* For bloating, add GI Harmony.

* For constipation, add Gentle Lax (Deficient).

* For low-grade fever or night fever, add Balance (Heat).

* For excess heat or fever, add Gardenia Complex.

* For perirectal abscesses, fever, add Resolve (AI) and Herbal ABX.

* For intestinal spasms or abdominal cramping, add Flex (SC).

* With anemia, add Schisandra ZZZ.

* With excessive damp/phlegm, add Pinellia Complex.

* With severe inflammation, combine with Astringent Complex.

* For chronic diarrhea with overall weakness and deficiency, add Imperial Tonic.

* For chronic diarrhea with qi deficiency manifesting in weight loss, malaise, fatigue and poor appetite, add GI Tonic. This formula should be taken to tonify the Spleen qi when the symptoms are in remission or under control.

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Zusanli (ST 36), Dadun (LR 1), Daimai (GB 26), Weizhong (BL 40), Huangshu (KI 16), Guilai (ST 29), Fushe (SP 13), Tianshu (ST 25), Sanyinjiao (SP 6), Yinlingquan (SP 9)

* Tianshu (ST 25), Zusanli (ST 36), Yinlingquan (SP 9), Zhongwan (CV 12), Neiguan (PC 6), Hegu (LI 4)

 

Classic Master Tung's Points:

* Ulcerative colitis: Qimen (T 33.01), Qijiao (T 33.02), Qizheng (T 33.03), Sihuashang (T 77.08), Sihuazhong (T 77.09), Sihuaxia (T 77.11), Menjin (T 66.05), Changmen (T 33.10)  

* Gastroenteritis (acute): Huozhi (T 88.15), Qihuang (T 88.14), Zusanli (ST 36), Ganmen (T 33.11), Changmen (T 33.10), Fuchang (T 77.12), Zhiwujin (T 11.08), Zuqianjin (T 77.24), Zuwujin (T 77.25)

* Gastroenteritis (chronic): Piyi (T 88.35)*, Pier (T 88.36)*, Pisan (T 88.37)*, Cesanli (T 77.22), Menjin (T 66.05), Linggu (T 22.05), Changmen (T 33.10), Zhiwujin (T 11.08). Bleed the dark veins nearby the ST channel on the lower limb.

* Bloating: Pizhong (T 11.18), Sihuashang (T 77.08), Sihuazhong (T 77.09), Sihuaxia (T 77.11), Fuchang (T 77.12), Menjin (T 66.05), Huoju (T 66.11), Changmen (T 33.10), Minghuang (T 88.12), Tianhuang (T 88.13), Qihuang (T 88.14), Beimian (T 44.07), Fukuai (T 1010.15), Shangjiuli (T 88.26), Zhongjiuli (T 88.25), Xiajiuli (T 88.27), Sifuyi (T 1010.11), Sifuer (T 1010.10)

* Enteritis (acute): Changmen (T 33.10), Sihuashang (T 77.08), Sihuazhong (T 77.09), Zusanli (ST 36), Ganmen (T 33.11), Fuchang (T 77.12), Jinyingshang (T 88.33)* and Jinyingxia (T 88.34)*. Bleed the LU area on the lower limb.

 

Master Tung’s Points by Dr. Chuan-Min Wang:

* Crohn’s disease, ulcerative colitis: Menjin (T 66.05), Zuqianjin (T 77.24)

 

Balance Method by Dr. Richard Tan:

* Left side: Zhongfeng (LR 4), Gongsun (SP 4), Yinlingquan (SP 9), Hegu (LI 4), Linggu (T 22.05)

* Right side: Lieque (LU 7), Kongzui (LU 6), Neiguan (PC 6), Zusanli (ST 36), Tiaokou (ST 38) or ah shi points nearby.

* Left and right sides can be alternated from treatment to treatment.

* Ear points: Shenmen, Intestine

 

Ear Acupuncture:

* Main points: Large Intestine, Small Intestine, Sympathetic

* Adjunct points: Spleen, Rectum, San Jiao, Endocrine

 

Auricular Medicine by Dr. Li-Chun Huang:

* Ulcerative colitis: Large Intestine, Sigmoid, Lower Jiao, Sympathetic, Spleen, Rectum, Endocrine, Digestive Subcortex. Bleed Ear Apex.

* Crohn’s disease: Large Intestine, Lower Jiao, Small Intestine, Spleen, Sympathetic, Endocrine, Ileum, Digestive Subcortex. Bleed Ear Apex.

* Relieving diarrhea: Spleen, Occiput, Large Intestine, Sympathetic, Rectum, Shenmen, Digestive Subcortex. Bleed Ear Apex.

* Invigorating the Spleen and promoting the digestion: Spleen, Stomach, Mouth, Pancreas, Endocrine, Digestive Subcortex, Small Intestine

* Stop bleeding: Pituitary, Diaphragm, Adrenal Gland, Spleen, Large Intestine, Rectum

 

NUTRITION

* Encourage the consumption of fruits and vegetables such as apricots, winter melon, asparagus, avocados, bananas and broccoli in addition to brown rice, dried fruit, figs, salmon, garlic, green leafy vegetables, soy products, and yogurt.

* Avoid any and all foods that contain sugar, such as cake, dessert, candy, chocolate, canned juice, soft drinks, caffeinated drinks, stevia, sugar substitutes, agave, xylitol, and corn syrup.

* Avoid fermented foods like cheese or fermented tofu.

* Do not eat dairy products, such as milk, cream, yogurt, cheese, and ice cream.

* Warm and hot natured foods that damage qi and yin should be avoided, such as:

§ certain fruits like mango and durian that produce heat.

§ stimulants like coffee, alcohol, and energy drinks.

§ spicy/pungent/aromatic vegetables such as pepper, garlic, onions, basil, rosemary, cumin, funnel, anise, leeks, chives, scallions, thyme, saffron, wormwood, mustard, chili pepper, and wasabi.

* Avoid food and drinks with artificial coloring.

* Consume as few meat products as possible. Do not eat processed meats, such as lunch meats, hot dogs and sausages, ast hey contain nitrites that are associated with inflammation and chronic disease.

 

The Tao of Nutrition by Dr. Maoshing Ni and Cathy McNease:

* Diarrhea

§ Recommendations: garlic, black pepper, blueberries, cinnamon, raspberry leaves, lotus seeds, burned rice, yams, sweet potatoes, fresh fig leaves, peas, buckwheat, litchi, guava peel, apple, charcoaled bread, ginger, pearl barley, basil, and unripe prunes.

§ Cook rice porridge with lotus seed and yam or with barley.

§ Cook rice porridge with ginger and black pepper.

§ Eat sweet rice porridge.

§ Eat burnt rice or bread.

§ Take two tablespoons of dried apples, three times daily on an empty stomach with warm water.

§ Drink black tea.

§ Take two bulbs of garlic, bake until black. Then boil in water and drink the tea.

§ Make tea from guava peel.

§ Make tea from ginger, fennel, basil, and Chinese black dates.

§ Make tea from unripe prunes.

§ Make tea from dried litchi and Chinese black dates.

§ Avoid cold, raw foods, most fruits, juices, and overeating.

* Gastritis and colitis: drink diluted lotus root juice.

 

LIFESTYLE INSTRUCTIONS

* Avoid the use of certain drugs and chemicals that cause and/or aggravate ulcerative colitis and Crohn’s disease. The list of offending drugs and/or chemicals may be different for every patient.

* Certain over-the-counter or prescription antidiarrheal drugs may worsen the condition and create a toxic megacolon. These drugs should not be taken unless supervised by a qualified health care provider.

* Bed rest and relaxation are helpful for short- and long-term recovery.

 

CASE STUDIES

* S.C., a 62-year-old female, presented with chronic intestinal pain, including blood in the stool and rectal bleeding. The patient had been hospitalized back in March due to a blood clot in her leg. Additional notations while at the hospital include decrease of hemoglobin, infusion of two pints of blood, and weight decrease from 90 to 79 pounds. The doctors had noted she was at increased risk for stroke. Peripheral neuropathy, edema on the dorsal foot, hair loss, and insomnia symptoms were also present. The practitioner diagnosed this condition as damp-heat in the Intestines, Kidney deficiency, and blood stasis in the lower jiao; her Western diagnosis was ulcerative colitis. For treatment, GI Care (UC) was prescribed at 4 capsules three times a day. Patient continued to take Remicade (infliximab) 10-15 mg, iron, and Pepcid (famotidine). After taking the herbs for one month the patient’s colon was saved and no longer needed a colostomy. The frequency of her bowel movement decreased from twelve to two per day. Bleeding had stopped within two weeks of taking the herbs and the stools went from being very watery to full formed and soft. The patient was very pleased with the outcome. Submitted by D.K., Lincroft, New Jersey.

* A 49-year-old female has chronic ulcerative colitis as well as epigastric and abdominal pain and bloody stool. In the past 12 months, the patient has been treated with various herbs and drugs. The patient stated that while the treatments were effective, bloody stools returned as soon as the treatment was discontinued. The patient had two to three bowel movements per day and was constantly tired. The tongue was dark purple with thick greasy yellow coat. The pulse was deep and slippery. The diagnosis was accumulation of damp-heat and toxins in the Large Intestine. After taking GI Care (UC) for 30 days, the patient reported significant improvement of all symptoms. Furthermore, her bowel movement returned to normal without blood. In the follow-up session one year later, the patient noted that she has remained healthy and without a relapse of her original chief complaint. Submitted by Y.L., Hebei, China.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

GI Care (UC) is designed to treat inflammatory bowel disease (including ulcerative colitis and Crohn’s disease), a condition characterized by chronic, non-specific, and idiopathic inflammation affecting the gastrointestinal tract. Because there are no known causes in Western medicine, drugs are used mainly to treat only the symptoms and complications.

      In treating ulcerative colitis and Crohn’s disease, GI Care (UC) incorporates many herbs with marked effect to treat inflammation of the gastrointestinal tract. Huang Lian (Rhizoma Coptidis) and Huang Bo (Cortex Phellodendri Chinensis) both have marked anti-inflammatory effects,[2] with potency comparable to dexamethasone for treatment of both acute and chronic inflammation-related diseases.[3] According to one clinical study, 100 patients with inflammation of the gastrointestinal tract were treated with Huang Lian (Rhizoma Coptidis) and Dou Kou (Fructus Amomi Rotundus), 2 to 3 grams per dose for four to six doses per day, with all patients reporting improvement.[4] According to another study, 276 patients with chronic colitis were treated with 90% rate of effectiveness using an herbal formula with Huang Bo (Cortex Phellodendri Chinensis), Di Yu (Radix Sanguisorbae) and others.[5] Bai Shao (Radix Paeoniae Alba) and Hou Po (Cortex Magnoliae Officinalis) are two other herbs that are very helpful for treatment of inflammatory bowel disease. Both herbs have anti-inflammatory effects to suppress inflammation,[6]^,[7] and antispasmodic effect to relieve spasms and cramps of the intestines.[8]^,[9]

        Since infection is one of the common causes of ulcerative colitis and Crohn’s disease, GI Care (UC) uses many herbs with marked antibiotic effects. Herbs in this formula have shown marked antibacterial, antiviral, and antifungal effects. Examples of such herbs include Bai Shao (Radix Paeoniae Alba),[10] Hou Po (Cortex Magnoliae Officinalis),[11] Ma Chi Xian (Herba Portulacae),[12] Huang Lian (Rhizoma Coptidis),[13]^,[14] and Shi Liu Pi (Pericarpium Granati).[15] In fact, many herbs have been used successfully for treatment of infection and inflammation of the gastrointestinal tract. In one study, Shan Zha (Fructus Crataegi) was used to treat 100 patients with acute bacterial enteritis with satisfactory results. [16] In another study, use of Ma Chi Xian (Herba Portulacae) was 83.62% effective in treating 403 patients with chronic bacterial dysentery, and 89.12% effective in treating 331 patients with acute bacterial dysentery. [17] Lastly, use of Huang Lian (Rhizoma Coptidis), individually or in an herbal formula, is associated with excellent clinical results in treating over 1,000 patients with bacterial dysentery. The treatments are characterized by marked effectiveness, short duration of treatment, and low incidence of side effects. [18]

        GI Care (UC) also employs herbs to promote normal digestion and absorption, and reduce the stress of the intestines. Shan Yao (Rhizoma Dioscoreae) is used to treat indigestion and reduce the stress of the intestines. In one study, it has been found that use of Shan Yao (Rhizoma Dioscoreae) and other herbs were effective in treating 101 infants with indigestion and related complications.[19] Mai Ya (Fructus Hordei Germinatus) improves digestion by increasing gastric emptying time and intestinal peristalsis. Shan Zha (Fructus Crataegi) facilitates digestion and absorption by inducing the production of gastric acid.[20] Lastly, Shi Liu Pi (Pericarpium Granati) has a gastroprotective effect, and use of this herb protects the stomach from alcohol-, indomethacin-, and aspirin-induced ulcers by increasing the pH and mucus secretion.[21]

        In addition to treating the cause, GI Care (UC) incorporates herbs that address the symptoms of ulcerative colitis and Crohn’s disease. Shan Yao (Rhizoma Dioscoreae) and Shan Zha (Fructus Crataegi) consolidate the stool and treat diarrhea.[22]^,[23] Wu Bei Zi (Galla Chinensis) has a marked effect to suppress diarrhea due to enterotoxigenic Escherichia coli, the most frequently isolated enteropathogen that accounts for approximately 210 million diarrhea episodes annually.[24] Lastly, Fang Feng (Radix Saposhnikoviae) is added to facilitate the elimination of heavy metals,[25] which may irritate the bowel and cause inflammation of the intestines.

        In summary, GI Care (UC) is a carefully crafted formula with many herbs that treat the cause and the symptoms of ulcerative colitis and Crohn’s disease. GI Care (UC) contains herbs that reduce the inflammation of the gastrointestinal tract, treat the infection, promote normal digestion and absorption, relieve diarrhea, alleviate abdominal spasms and cramps, and eliminate irritating toxins.

 

COMPARATIVE ANALYSIS

Ulcerative colitis and Crohn’s disease are chronic, non-specific, idiopathic, inflammatory and ulcerative diseases of the gastrointestinal tract.[26] Because Western medicine recognizes no known etiology, drug treatments are focused primarily to treat symptoms. Three classes of drugs used to treat ulcerative colitis and Crohn’s disease include antidiarrheals, 5-Aminosalicylates, and corticosteroids. Antidiarrheal agents [such as Lomotil (diphenoxylate) and Imodium (loperamide)] stop diarrhea, but may cause dizziness, drowsiness, sedation, and in some cases, dependence with long-term use. 5-Aminosalicylates [such as Azulfidine (sulfasalazine), Dipentum (olsalazine) and Pentasa (mesalamine)] suppress low-grade inflammation, but are not used often because of side effects such as anorexia, dyspepsia, nausea and vomiting. Lastly, oral or intravenous corticosteroids are used to suppress moderate to severe cases of ulcerative colitis and Crohn’s disease. However, long-term use of corticosteroids has numerous side effects, including but not limited to osteoporosis, glucose intolerance, cataract formation, fluid retention, dependence and muscle wasting. Finally, surgical colectomy is performed in severe and emergency cases of massive hemorrhage, free perforation, or fulminating toxic colitis. The disadvantages of surgery include permanent ileostomy, possible sexual dysfunction in males, and physical and emotional burden.

        Use of acupuncture and herbs is effective to treat inflammatory conditions of the gastrointestinal tract, including ulcerative colitis, Crohn’s disease, and other inflammatory bowel diseases. While acupuncture and herbal treatments are effective for both prevention and treatment, they do have limitations. Certain complications of ulcerative colitis and Crohn’s disease are considered medical emergencies, and should not be treated with acupuncture and herbs. Complications such as toxic colitis or toxic megacolon require immediate hospitalization. Furthermore, serious complications such as massive hemorrhage, free perforation, or fulminating toxic colitis require immediate surgical intervention.