May 1, 2017

Crohn’s Disease

What is Crohn’s Disease? Crohn’s disease is a chronic gastrointestinal inflammatory disease that may affect any part of the gastrointestinal tract, but is most common in the ileum and colon. It has no known cause, although immunological factors, infectious agents (bacteria, viruses, fungi), and dietary factors (chemicals and drugs) have been suggested as possible risk factors.

What are the symptoms?

  • Chronic diarrhea
  • Abdominal pain
  • Fever
  • No appetite
  • Weight loss
  • Ulcerations of the mouth
  • Right lower quadrant mass or fullness in abdomen that mimics appendicitis
  • Pus, mucus, and blood may be present in the stool if the rectum is involved
  • In severe cases, abdominal fistulas and abscesses may develop causing fever, painful abdominal masses, generalized malnutrition & muscle wasting.

Complications of Crohn’s Disease In addition to the gastrointestinal symptoms, Crohn’s disease is often associated with other complications involving the eyes, mouth, skin, and joints. Some examples include: episcleritis, aphthous stomatitis, arthritis of the larger joints, & ankylosing spondylitis.

Treatment Since there is no known cause for Crohn’s disease, there is no therapy specific to its treatment. Drugs simply treat the symptoms but do not treat the underlying cause. What this means to Crohn’s patients, is taking a drug, which, unfortunately, frequently comes with side effects. Some types of drugs given to Crohn’s patients include:

  • Antidiarrheal drugs – diphenoxylate (lomotil), loperamide (Imodium), and other drugs containing codeine or opium. Common side effects of these include dizziness, drowsiness, and sedation. The drugs containing codeine or opium may also cause addiction with long-term use. The antidiarrheal drugs have to be given with caution because they may cause toxic megacolon (dilation of the colon), which is an emergency condition.
  • Antibiotics – The most common antibiotic given is metronidazole (flagyl) with side effects being metallic taste, dyspepsia, & paresthesias.
  • Salicylate drugs – These drugs suppress low-grade inflammation but are not used much due to their frequent side effects including no appetite, dyspepsia, nausea and vomiting.
  • Corticosteroids – These drugs have good anti-inflammatory effects but long-term use has numerous side effects including osteoporosis, glucose intolerance, cataracts, fluid retention, addiction, and muscle wasting.
  • Immunosuppressive drugs: common side effects include fever and joint pain, pancreatitis, hepatitis, and leukopenia.
  • Surgery – may become necessary if Crohn’s disease is complicated with frequent intestinal obstruction or abscesses and fistulas. Unfortunately, Crohn’s is known to recur after surgery so other treatments should be tried first.

Chinese Medicine perspective of Crohn’s Disease According to TCM, Crohn’s disease may be caused by constitutional deficiencies, invasion of exterior pathogenic factors, and/or an unbalanced diet. TCM uses Chinese herbal formulas, acupuncture, and dietary recommendations in order to treat the root cause of the illness (not just simply symptom relief). In my clinical experience, using a combination of all three modalities is the most effective way of treating Crohn’s disease.

TCM classifies Crohn’s disease into one of four categories:

Invasion of Damp-Heat in the large intestine – acute and sudden onset of gastrointestinal symptoms. Some symptoms include diarrhea, mucus and blood in the stool, foul-smelling stools, yellow urine, abdominal fullness & pain, defecation with urgency, tenesmus, a burning sensation of the anus after passing stool, irritability, thirst, and preference to drinking cold water.

Spleen Deficiency – may be due to constitutional deficiency or overeating cold and raw food. Patients with Crohn’s disease usually have spleen deficiency characterized by a compromised ability of the spleen to transform and transport food. Symptoms include frequent and severe diarrhea, watery stool with undigested food, dull abdominal pain, poor appetite, poor digestion, gastric discomfort after food intake, pale facial complexion, fatigue and lethargy due to chronic malabsorption and malnutrition.

Spleen and Kidney Deficiency – may be due to constitutional deficiencies or secondary to the chronic nature of the illness. Symptoms include early morning diarrhea around 5:00 am, abdominal pain increases with cold but decreases with defecation, intolerance to cold, and cold hands & feet.

Qi (energy) and Blood Stagnation – resembles an acute phase of Crohn’s disease with severe abdominal pain and fullness with a palpable mass in the right lower abdomen (mimics appendicitis). Other symptoms include diarrhea, lack of appetite, muscle wasting and lethargy.

Research There is little doubt that acupuncture is an excellent therapy for people suffering from Crohn’s disease. In 1979 the World Health organization listed 40 major diseases that could find relief by acupuncture treatment: diseases of the intestinal tract were included in that list. This is not surprising since acupuncture works through the nervous system and energy channels in the body. It has also been shown to boost the immune system, calm the nervous system, and cause the brain to release endorphins and encephalins (natural pain killers). It has also been established that all psycho-physiological health problems (of which Crohn’s disease is included) are particularly suitable for acupuncture treatment.

A study published in Digestion 2004;69(3):131-9. Epub 2004 Apr 26 by Joos et al entitled “Acupuncture and moxibustion in the treatment of active Crohn’s disease: a randomized controlled study” concluded that apart from a marked placebo effect, traditional acupuncture offers an additional therapeutic benefit in patients with mild to moderately active Crohn’s disease.

Dietary Recommendations Diet plays a very important role in prevention and effective treatment of Crohn’s disease. Dietary intake of excessive cold or raw food may injure the spleen and stomach. Patients are also advised to avoid certain food triggers, such as certain chemicals, milk & other dairy products (especially in patients with lactose intolerance). High roughage like raw fruits and vegetables sometimes worsen the intestinal obstruction and colic and should be avoided. In addition to eating the wrong food, it is important to have adequate fluid and calorie intake, as malnutrition and dehydration are common problems associated with Crohn’s disease.

Limitations of TCM There are cases where just acupuncture and Chinese herbal medicine is not appropriate. If the patient has such complications as toxic colitis or toxic megacolon, immediate hospitalization is required. In addition, serious complications such as massive hemorrhaging, free perforation, or fulminating toxic colitis require immediate surgical intervention.

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