1 Western medical aetiology and pathology

In Crohn’s disease, autoimmune cells attack the gastrointestinal system. The initial trigger may be the immune system trying to suppress a viral or bacterial infection. However, based on a person’s genetic predisposition, the disordered immunity attacks the end of the small intestine that joins to the large intestine instead. It causes swelling of the deeper layers of the lining of the intestine, but the condition may affect any area of the digestive tract and cause bowel tissue injury. As a result of the immune attack, the intestinal wall becomes thick and deep ulcers may form.

So far, no one knows whether the abnormally functioning immune system in people with Crohn’s disease is a cause or a result. Crohn’s disease may result from several factors:

• Genes the patient has inherited

• The immune system itself

• The environment.

Antigens normally exist in the environment. They may stimulate the body’s defences to produce an inflammatory response that continues without control, either directly by causing the inflammation or indirectly by causing a reaction to which the body responds with inflammation.

Crohn’s disease also can affect other parts of the body, causing different complications. These complications include various forms of arthritis, renal or biliary calculi, skin problems, inflammation of the eyes or mouth, or other diseases of the liver and biliary system.

2 Diagnosis by Western medicine

1. Upper gastrointestinal series

2. Colonoscopy or sigmoidoscopy

3. Biopsy of the ileum

4. Blood labs: there may be anaemia and/or a high white blood cell count

5. Stool sample: there may be red blood cells in the stool.

Crohn’s disease and ulcerative colitis are similar – so similar that they are often mistaken for one another. Both are autoimmune inflammatory bowel diseases that inflame the lining of the digestive tract, and both can cause severe bouts of watery or bloody diarrhoea and abdominal pain. Crohn’s disease can occur anywhere in the digestive tract, often spreading deep into the layers of affected tissues. Ulcerative colitis, on the other hand, usually affects only the innermost lining of the large intestine and rectum. Symptoms of Crohn’s disease are persistent diarrhoea, which may be bloody in 75–85% of patients, abdominal pain and general fatigue. Symptoms of ulcerative colitis are bloody diarrhoea, pain, urgent bowel movements, joint pains and skin lesions. In both diseases there is a risk of significant weight loss and malnutrition.

3 Chinese medicine aetiology and pathology

Crohn’s disease is not mentioned directly in Chinese medicine, but according to the pathology and symptoms described by Western medicine, it can be characterized as Fu Tong , abdominal pain, Bian Xue , haemafaecia, and Xie Xie , diarrhoea.

When a patient has a Yin-deficient constitution, if Cold-Dampness, Damp-Heat, and/or Heat-Toxin invade the body, vital Qi cannot resist the invaders. These exogenous factors can stagnate in the Small Intestine, causing Blood stasis, and destroy blood vessels, thereby causing Crohn’s disease.

According to Chinese medicine theory, haemafaecia, abdominal pain, diarrhoea and similar symptoms are due to a disorder of the Small or Large Intestine. Related organs are the Spleen, Liver, and Lung. The Small and Large Intestine have different functions. The function of the Small Intestine is to transform and absorb food content and Essence. It separates the Essence from the turbidity, or the pure from the impure, to support and nourish the body. It transforms the turbidity and sends it down to the Large Intestine. The Large Intestine receives the turbidity, continues to absorb the remaining water and sends it to the Urinary Bladder, which further separates the pure from the impure, steaming the pure and sending it upward and excreting the impure by urination. The remaining turbidity is excreted from the body via the anus.

While the Small Intestine is digesting, the Spleen absorbs the pure Essence and then distributes it to the Lung and the entire body. Liver Qi assists the general Qi activities of ascending, descending, exiting and entering in the whole body including the Small Intestine. The Lung has an internal channel that connects to the Large Intestine. Qi moving downward from the Lung assists the Large Intestine in descending smoothly and transporting normally. Therefore, any factor such as external or internal pathogens, emotional disorder, poor diet and/or congenital variables may negatively affect the intestinal function of transportation, leading to Qi stagnation, Damp-Heat stasis and/or Blood stasis causing the illness. Qi stagnation, Blood stasis and Heat are the most critical pathogens in the process of the illness.

There are two different symptoms called Jin Xue and Yuan Xue in the process of the illness. Jin Xue refers to nearby bleeding where blood is bright red and fresh, indicating the pathological location of the problem is near the rectum and anus. Yuan Xue refers to distant bleeding where the blood is dark, indicating the pathological location is far away from the anus, generally suggesting that bleeding is occurring higher up in the digestive tract.

4 General treatment principle

Eliminate pathogenic Heat, transform Dampness, stop bleeding, remove Blood stasis and nourish Yin.

Differentiation and treatment

The most common symptoms of Crohn’s disease are abdominal pain, often in the lower right quadrant, and diarrhoea. Rectal bleeding, weight loss and fever may also occur. Bleeding may be serious and persistent, leading to anaemia. Children with Crohn’s disease may suffer delayed development and stunted growth.

To provide correct treatment of Crohn’s disease, one must first understand the pathogenic factors: are they deficient or excess? One must distinguish between excess or deficient Heat and deficiency of Yin or Qi (this latter deficiency is rare). One must realize that first one treats Blood; secondly one treats Fire; thirdly one treats Qi.

1. Treating Blood: primarily one must stop bleeding by astringing, cooling Blood and removing Blood stasis to arrest bleeding.

2. Treating Fire: the treatment includes eliminating excess Fire, clearing deficient Fire and nourishing Yin.

3. Treating Qi: if there are excess symptoms, one should clear Heat in the Qifen and descend the rebelliously ascending Qi; if there is deficient Qi, one should nourish Qi and replenish Spleen Qi.

1 Downward flow of damp-heat

2 Hyperactive liver fire with Qi stagnation

Clinical manifestations

Chronic diarrhoea with light, intermittent bleeding usually occurring after emotional stress, abdominal distension and pain, especially before diarrhoea with the pain being reduced after diarrhoea, and thirst with no desire to drink. The tongue is red with a thin and whitish coating. The pulse is taut.

Treatment principle

Clear Liver Fire, remove stagnant Qi and arrest bleeding.

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Musculoskeletal Key

Fastest Musculoskeletal Insight Engine

Crohn’s disease

1 Western medical aetiology and pathology

2 Diagnosis by Western medicine

3 Chinese medicine aetiology and pathology

4 General treatment principle

Differentiation and treatment

1 Downward flow of damp-heat

Clinical manifestations

Treatment principle

Herbal treatment

Acupuncture

Supplementary treatment

2 Hyperactive liver fire with Qi stagnation

Clinical manifestations

Treatment principle

Herbal treatment

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