TCVM Approach to TCVM Approach to Inflammatory Bowel Inflammatory Bowel

DiseaseDisease

IBDIBD

• Group of GI disorders with Group of GI disorders with inflammatory infiltrates in the lamina inflammatory infiltrates in the lamina propria of SI & LIpropria of SI & LI

• Damage from tissue cytokinesDamage from tissue cytokines

• Caused byCaused by• Genetic factorsGenetic factors• EnvironmentEnvironment

Feline IBD touch prepFeline IBD touch prep

IBDIBD

• Ulcerative colitisUlcerative colitis

• Crohn’s disease (regional enteritis)Crohn’s disease (regional enteritis)

• Systemic disease (arthritis, uveitis, Systemic disease (arthritis, uveitis, liver disease, etc.)liver disease, etc.)

Crohn’s disease vs Ulcerative Crohn’s disease vs Ulcerative colitiscolitis

IBD- -SignsIBD- -Signs• Dogs:Dogs:• Chronic vomiting, diarrhea, weight lossChronic vomiting, diarrhea, weight loss

• CatsCats• Vomiting followed by diarrheaVomiting followed by diarrhea

• Other signsOther signs• Flatulence, gas, altered appetite, Flatulence, gas, altered appetite,

abdominal pain & mucois stoolsabdominal pain & mucois stools• Dry hair coatDry hair coat• Thickened loops of bowel on palpationThickened loops of bowel on palpation

IBD- -CausesIBD- -Causes

• InfectiousInfectious• (Damp-Heat)(Damp-Heat)

• DietaryDietary• (Stomach Heat/Stagnation)(Stomach Heat/Stagnation)

• GeneticGenetic• (Kidney Jing)(Kidney Jing)

Diagnosis usually by biopsyDiagnosis usually by biopsy

IBD- -TreatmentIBD- -Treatment

• Anti-infectivesAnti-infectives• Sulfasalazine (Azulfidine)Sulfasalazine (Azulfidine)

• DietaryDietary• Diet eliminationDiet elimination• Vitamin support (all but high vitamin C)Vitamin support (all but high vitamin C)• Western herbalsWestern herbals

• Bromelain/curcuminBromelain/curcumin• GingerGinger• Cat’s ClawCat’s Claw

• ImmunosuppressiveImmunosuppressive

Mechanism of Action of Azulfadine

• Antibacterial activityAntibacterial activity

• Local and systemic immunity-lymphs, IgGLocal and systemic immunity-lymphs, IgG

• Arachidonic acid metabolism-PG, Thr, Arachidonic acid metabolism-PG, Thr, leukotrienesleukotrienes

• Free radical scavengers (5-ASA)Free radical scavengers (5-ASA)

• Inhibit PAF, histamine release (mast cells)Inhibit PAF, histamine release (mast cells)

TCM Pathology of IBDTCM Pathology of IBD

• ExcessExcess• Heat Toxin/Damp HeatHeat Toxin/Damp Heat• Qi/Blood StagnationQi/Blood Stagnation

• DeficiencyDeficiency• SP Qi DeficiencySP Qi Deficiency

• ParvovirusParvovirus

Heat Toxin/Damp HeatHeat Toxin/Damp Heat• SignsSigns• Bloody/watery diarrhea (mucoid) with foul smellBloody/watery diarrhea (mucoid) with foul smell• AcuteAcute• Heat signs (nose/ears)Heat signs (nose/ears)• VomitingVomiting• ThristyThristy

• TongueTongue• Deep red Deep red yellow coating yellow coating

• PulsePulse• Superficial/Deep and fastSuperficial/Deep and fast

Qi-Blood StagnationQi-Blood Stagnation• SignsSigns• Chronic diarrhea with stink smellChronic diarrhea with stink smell• Abdominal painAbdominal pain• VomitingVomiting• Loss of appetiteLoss of appetite

• TongueTongue• Purple or redPurple or red

• PulsePulse• WiryWiry

Spleen Qi DeficiencySpleen Qi Deficiency• SignsSigns• Chronic diarrhea with undigested materialChronic diarrhea with undigested material• AnorexiaAnorexia• Loss of body weight (muscle mass)Loss of body weight (muscle mass)• Exercise intoleranceExercise intolerance

• TongueTongue• PalePale

• PulsePulse• Deep & weakDeep & weak

ParvovirusParvovirus• SignsSigns• Bloody diarrhea with mucous and/or foul odorBloody diarrhea with mucous and/or foul odor• AnorexiaAnorexia• VomitingVomiting

• TongueTongue• Red & dryRed & dry

• PulsePulse• Fast (superficial or deep)Fast (superficial or deep)

TCM Treatment of IBDTCM Treatment of IBD

• Heat Toxin/Damp HeatHeat Toxin/Damp Heat• Great Saussurea CoptisGreat Saussurea Coptis

• Qi/Blood StagnationQi/Blood Stagnation• Xiang Lian SanXiang Lian San

• SP Qi DeficiencySP Qi Deficiency• Shen Ling Bai ZhuShen Ling Bai Zhu

• ParvovirusParvovirus• Red Back DoorRed Back Door

Great Saussurea CoptisGreat Saussurea Coptis

Saussurea Saussurea Mu Xiang Mu Xiang Move Qi & relieve painMove Qi & relieve pain

Coptis Coptis Huang Lian Huang Lian Clear Damp-Heat in the intestinesClear Damp-Heat in the intestines

Evodia Evodia Wu Zhu Yu Wu Zhu Yu Warm the middle Jiao & stop vomitingWarm the middle Jiao & stop vomiting