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Tuesday, 14 September 2010

Crohn's disease and its Chinese medicine treatment

Tiejun Tang

The first time I encountered Crohn’s disease (CD) was at beginning of 1980’s. My teacher introduced us to this disease during our university western medicine lessons. I learnt that CD is an inflammatory disease of the intestine, which can affect any part of the gastrointestinal tract causing a wide variety of symptoms including abdominal pain, diarrhoea vomiting, weight loss, and tiredness. We were told the incidence of CD is higher in western countries and much lower in Asian countries including China. The aetiology of CD is not very clear. Genetics and environmental factors, immune system disorder and bacterial infection can play a role.

The first case of CD I met at Xijing Hospital in 1985. -- a leading hospital in China. I worked as a junior resident physician in the ward of gastrointestinal disease. I acquired much clinical experience relevant to the diagnosis and treatment of CD. We gave the patients sulphasalazine (SASP) as an anti-inflammatory and the steroid prednisone or another immunosuppressive drug. Most of patients improved a lot after treatment, but all the corticosteroids caused significant side-effects following long term use. When we tried to reduce the doses or encourage the patients to stop taking them, their symptoms always got worse. We hence often gave to the patients Chinese herbal decoctions to be taken orally or as an enema which invariably improved their condition. None of the CD patients I came across in my three month’s working experience at the gastrointestinal ward had to go to have surgery.

From 1989 to 1992, I spent three years for my master degree studies at the TCM department of the First Military Medical University. My major was focused on treating gastrointestinal disease with Chinese herbs patented pills. I have read many Chinese medicine classics texts about spleen deficiency. In TCM, the spleen does not refer only to the anatomical spleen of Western Medicine it also refers to the functions of the whole digestive system. According to the theory of traditional Chinese medicine most of digestion and absorption functions are attributed to the function of spleen. Causes of spleen deficiency will manifest as poor digestion and resemble the clinical manifestation of CD. The herbs which tonify the spleen will benefit the digestive functions and relieve the symptoms of CD. I attended the endoscopy clinic to observe the pathological changes of inflammatory bowel disease (IBD). There I observed the difference in histopathological changes between CD and ulcerative colitis (UC). I have measured intestinal local immune function in spleen deficiency patients and animal models. The results of this laboratory based research I undertook showed the local immune function to be significantly reduced in patients with spleen deficiency. After treating with a patented Chinese herbal mix drug, their immune function had been greatly improved greatly [1-4]. The clinical symptoms also improved. Over 100 cases of spleen deficiency were included in these studies. Diagnoses included chronic gastritis, colonitis, UC, and CD. The name of the patented Chinese herbal mix drug is Jianpi Yikang Wan (JPEK). Jianpi means to invigorate the spleen, Yikang means to benefit health, Wan means pill. This pill has a double layer structure, the first or outer layer is absorbed in the stomach and the inner layer in the intestine. The outer layer is composed by Huangqi, Danggui, Dangshen etc which benefit effect at stomach; the inner layer is composed by Baishao, Muxiang, Yanhusuo etc which benefit the intestine. The trade name of this pill called Bupi Yichang Wan. Presently it is the first choice of Chinese herbal remedy for the treatment of IBD.

In China most of IBD is UC, only small part is CD; but in western country CD became a major disease of IBD. The clinical symptoms are very similar between UC & CD. The treatment principle is the same. The herb pills selection is the same – Bupi Yichang Wan. If herb pill is not strong enough, we can prescribe herbal decoction according to different conditions of individual case. The basic prescription is modified Sijunzi Tang and Shenling Baizhu San. If there are mucus in the stool, add Baijiangcao and Baixiapi; if there are blood in the stool, add Baiji and Diyu; if patient have watery diarrhea add Yiyiren and Cheqianzi; if vomiting, add Banxia and Zhuru; if abdominal pain, add Yanhusuo, Chuanlianzi and Baishao etc The original prescription of JPEK is not from me, it’s from my master degree tutor professor Fulin Xu. He is a specialist of gastrointestinal disease in TCM, the dean of TCM department of the First Military Medical University at that time. All my experience is from my tutors. I would like to give many thanks to my tutors, without them I am nothing. A statistics report showed CD affects about 1 in 10,000 people. There are about 60,000 people in the UK with this disease. I practice in UK for five years now. I have met many patient suffer from very bad digestion, they have chronic diarrhea, abdominal pain or distension. Some patients have a scar at their belly. They had been diagnosed as CD. Some of them already had part of intestine removed. In many cases their symptoms often recur after operation. Another report showed CD is associated with an increased risk of small bowel and colorectal carcinoma, including bowel cancer[5]. I would like to tell CD patient Chinese medicine can help you go to better prognosis and avoid unnecessary surgery.

Reference

1. Tiejun Tang. The effect of JPYK pill on T cell subpopulation and immunological function of spleen asthenia mice. Pharmacology and Clinics of Chinese Materia Medica. 1992; 8 (Sep.): 181.

2. Tiejun Tang. The effect of JPYK pill on isoenzyme of rats. Chinese Journal of Integrated Traditional and Western Medicine. 1990; 10(Sep): 96.

3. Tiejun Tang. Quantitative analysis of sIgA in the intestinal juice of spleen deficiency patients. Traditional Chinese Medicine Research. 1993; 6(1): 24.

4. Tiejun Tang. Amylase activity change in the intestinal juice of mice caused by two different animal model of spleen deficiency. Journal of Traditional Chinese Medicine and Pharmacy. 1994; (3): 40.

5. Canavan, C. et al (2006). "Meta-analysis: colorectal and small bowel cancer risk in patients with Crohn's disease". Alimentary pharmacology & therapeutics 23 (8): 1097–104.