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Kui Jie Qing in the Treatment of IBS and Chronic Non-Specific Ulcerative Colitis
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Appearing originally in The Journal of Traditional Chinese Medicine
by
Wang Bihui
Sino-Japanese Friendship Hospital, Beijing 100029
Ren Shunping
Affiliated Hospital, Shanxi College of Traditional Chinese
Medicine
Feng Wujin, Zhao Zhizhong
Shanxi Provincial Institute of Chinese Medicine
Qin Changlin
Affiliated Hospital of the Handan Steel General Factory,
Hebei Province
Chronic non-specific ulcerative colitis (CNUC) is an idiopathic
inflammatory disease of the intestine. Rather satisfactory
results have been achieved in recent years in treating CNUC with
a Chinese medicine known as KUI JIE QING (KJQ). The results are
thus reported as follows.
Clinical Data
95 cases were treated with the Chinese medicine KJQ (called
the therapeutic group), having been accurately diagnosed
according to Clinical Diagnostic Criteria Regarding Ulcerative
Colitis formulated at an academic meeting on diseases of the
digestive system held in 1978. Of these, Sixty-five of the
patients were male and 30 female. The oldest was 70 years of age
and the youngest 18, with an average of 34 years. The longest
course of disease was 39 years, the shortest one month, for an
average of 5.6 years. Another 11 patients selected according to
the diagnostic criteria mentioned above received Western medicine
and were under controlled observation (called the control group).
Eight of these patients were male and 3 female. Age range was
from 20 to 60 years, for an average of 35.5 years. The longest
course of disease was 15 years and the shortest 8 months, for an
average of 5.8 years.
Therapeutic Methods
The patients in the therapeutic group received KJQ enema for
therapy. KJQ had been prepared into a powder by mixing alum,
Halloysite, Calmine, Indigo Naturalis and plum-blossom tongue-
pointing pills. The dosage of KJQ powder was 8
grams, into which
60 to 80 ml of warm boiled water was added to make a smooth
paste, the temperature of which was maintained at 36 to 40¡C.
KJQ was used as a routine enema q.d. The patient having had the
enema maintained a knee-chest position for half an hour. The use
of other drugs was stopped during the treatment.
Each patient in the control group received 1.5 g of
Salicylazosulfapyridine and 10
mg of hydroprednisone orally t.i.d. To this was added q.d. a
retention enema containing 100 mg of succinic acid hydrocortisone
with water added to 60-100 ml.
The course of therapy for both groups was 20 days. In severe
cases 2 to 3 courses were administered with an interval of 5 to 7
days between courses. The last therapy was followed by a
colonoscopy.
Therapeutic Results
- The criteria for curative effect fall into three
categories; i.e., basically cured, improved, and failed.
"Basically cured" means the disappearance of clinical symptoms with
normal findings in colonoscopy and fecal routine exam. "Improved"
means a relief from clinical symptoms, improvement in fecal
routine exam, and less pathological changes in intestinal mucosa.
"Failure" means no definite improvement in clinical symptoms, fecal
exam or colonoscopy.
- Cure rate: There were 68
basically cured cases in the therapeutic group, 22 cases
improved, and five failures. The Short-term basically cured rate
was 71.6%, and total effective rate 94.7%. The average therapeutic
course lasted 36 days. There was only one basically cured
case in the control group, 6 cases improved and 4 failures.
The Short-term basically cured rate was only 9.1%, and the total
effective rate was 63.6%. The average therapeutic course lasted 68
days. The short-term basically cured rate for the therapeutic group
appears very optimistic, being higher than in the controls
(P<0.001). As analysed by the relationship between the types of
pathological differentiation and the curative
effect in the therapeutic group, most of the cases in the
therapeutic group with best curative effect fall into the type of
deficiency of vital energy in spleen with damp-heat. Other types
with good curative effect have been observed as well.
59 of the short-term recent basically cured cases in the
therapeutic group have been followed up. Of
these, 18 cases were given a period of follow-up within one
year, 30 cases a period between one and 3 years, and another 11
cases between 3 and 5 years. Results showed relapses in 4 cases,
making a relapse rate of 6.8%
.
During the first KJQ enema dull pain of transient duration was
felt in the abdomen in some cases. It was not usually necessary
to halt the treatment in these cases, while an enema temperature
not lower than 36¡C (approximately body temperature) was better
tolerated.
Discussion
Ulcerative colitis belongs to the scope of Diarrhea and
Dysentery as viewed in traditional Chinese medicine, the site of
disease being the spleen, stomach and large intestine. The
disease is mainly characterized by moisture (or "dampness," as it is sometimes called). It
usually results either from weakness of stomach and spleen, or
from dietary indiscretion, at times from melancholy and anger.
These lead to injury to the stomach and spleen, causing the liver
wood to overcome its earth, and the moisture and heat thus
gradually generated to dwell within the gut. There the
circulation stagnates, bringing about necrosis of muscle and
resulting in bleeding and pus formation. Since the course of
disease is generally long, such pathological conditions as inner
deficiency with outer solidity and alternation of cold and fever
occur frequently.
KJQ is composed of various Chinese herbs for topical use. Of
these, alum (Ming Fan), being acid and astringent, is cold in nature and
puckers the intestinal mucosa, thus stopping bleeding and
diarrhea. Halloysite (Chi Shi Zhi) also brings about hemostasis and checks
diarrhea. It is effective in promoting muscle regeneration, and
made into powder and applied topically, may heal old ulceration.
Calamine, (Lu Gan Shi) being astringent, is effective in dispersing toxins
and puckering ulceration to enhance absorption of ulcerative
secretions and thus promote healing of the ulcer. Plum-blossom
tongue-pointing pills dissipate heat and disperse toxins as well
as reducing swelling and pain. Experiments have shown that the
pills can strengthen immunological function of the body. Topical
application of Indigo Naturelis dissipates heat and disperses
toxins aside from absorbing moisture, puckering ulcer and
effecting hemostasis. The ingredients of KJQ supplement each
other in dissipating heat and dispersing toxins, collecting
moisture to stop diarrhea, invigorating blood circulation and
removing necrotic tissue to promote the growth of new. The final
goal is clearing moisture and heat from the colon so that
hemostasis may be effected with healing of ulcerations. The exact
mechanism of this process, however, awaits further investigation.
In recent years, investigation of the route of drug
administration for the treatment of ulcerative colitis has shown
retention enema to be clinically a routine means. This method was
used in the present experiment. Local application of KJQ brings
it in direct contact with the lesion, thus avoiding action by the
digestive juices and enzymes on KJQ and prolonging the duration
of drug action. Clinical treatment indicates that KJQ has a high
total rate of effectiveness, good remote curative effect, low
relapse rate, simple application, and little side effect.
In those pathological models of ulcerative colitis reproduced in
rats by auto-immunological means, observation on the therapeutic
group using KJQ indicated obvious shrinkage in the area of
infiltration by ulcerative lesion and thickening of peripheral
granulomatous tissue. These changes show definite difference from
those of the control group with physiological saline (P<0.01).
KJQ is thus thought to promote ulcer healing and relieve chronic
inflammation of intestinal mucosa. The underlying mechanism may
be related to the modulation and strengthening of the
immunological function of the body.