Published online Sep 15, 1996. doi: 10.3748/wjg.v2.i3.141
Revised: July 29, 1996
Accepted: August 14, 1996
Published online: September 15, 1996
AIM: To study the relationship between the modern clinical and pathohistological classification and the traditional Chinese Medicine (TCM) Syndrome-typing of chronic ulcerative colitis (CUC).
METHODS: In total, 452 patients with CUC were classified according to the standards of the TCM Syndrome-typing set up by the Conference of the Combination of the Chinese-Western Medicine on Digestive Diseases in Linfen. The relevant changes between both classifications were analyzed and compared through the colonofiberscopic and pathohistological examination.
RESULTS: The type of retention of interior damp-heat is more commonly seen at the initial onset of disease (P < 0.01). No significant differences among other TCM Syndrome-typing groups in patients with persistent disease and with recurrent disease (P > 0.05) were observed. The congestion, edema, reduction of goblet cells and the infiltration of neutrophils are pathologically common to all TCM Syndrome-typing groups. Mucosal ulcers were dominant in damp-heat syndrome while crypt ulcers were dominant in spleen-stomach asthenia and spleen-kidney Yang deficiency (P < 0.01).
CONCLUSION: There appeared to be a certain relationship between the TCM syndrome-typing and pathohistological changes of the colon mucosa of CUC.
- Citation: Chen ZS, Zhou CM, Lu Y, Nie ZW, Sun QL, Wang YX, Chi Y. Study on traditional Chinese Medicine Syndrome-typing of chronic ulcerative colitis. World J Gastroenterol 1996; 2(3): 141-143
- URL: https://www.wjgnet.com/1007-9327/full/v2/i3/141.htm
- DOI: https://dx.doi.org/10.3748/wjg.v2.i3.141
In recent years, both Chinese and Western specialists have been studied the pathogenesis and treatment methods of chronic ulcerative colitis (CUC). However, the relationships between traditional Chinese Medicine (TCM) Syndrome-typing and pathohistological changes of western medicine have not yet been extensively reported. In this study of 452 patients with CUC, we analyzed this relationship and report the results.
In total, 452 patients, including 263 males and 189 females were observed in our study. The age range was from 17 years to 65 years, with an average age of 37.8 ± 9.1. The duration of illness varied between 5 months to 23 years, with an average time of 5.6 ± 4.1 years. The rectum and sigmoid were affected in 215 patients. The left half of the colon was affected in 179 patients. The right half of the colon was affected in 17 patients. The whole colon was affected in 41 patients. The number of patients with mild, moderate and severe disease was 179, 205 and 68, respectively.
All patients were diagnosed in accordance with the criteria set up in the 1987 Conference of Digestive Diseases in Hangzhou[1]. The standards of the TCM Syndrome-typing were the same as those set up in the 1992 Conference of Combination of Chinese Western Medicine on Digestive Diseases in Linfen[2].
Colonofiberscope, biopsy and the relevant pathohistological observations were carried out in all patients. Two doctors classified the TCM Syndrome-typing. The χ2 test was used to analyze the data statistically.
The relationship between the TCM Syndrome-typing and the duration of CUC is shown in Table 1. Patients who have had CUC for less than a year were more likely to have damp-heat syndrome. Patients who have had CUC for one year to ten years were more likely to have the spleen-stomach asthenia syndrome. Patients who have had CUC for more than ten years were more likely to have the spleen-kidney Yang deficiency. The other three TCM types (asthenia of Yin, asthenia of blood, liver stagnation and spleen deficiency, and stagnation of vital energy and blood stasis) had no definite relationship with the duration of the disease.
| TCM Syndrome-typing | Number | Duration (yr) | |||
| < 1 | 1-5 | 6-10 | > 10 | ||
| Spleen-stomach asthenia | 185 | 23 (12.4)1 | 81 (43.8) | 46 (24.9) | 35 (18.9) |
| Spleen-kidney Yang deficiency | 81 | 3 (3.7) | 19 (23.4) | 26 (32.1) | 33 (40.7) |
| Yin and blood asthenia | 46 | 9 (19.6) | 13 (28.3) | 14 (30.4) | 10 (21.7) |
| Liver stagnation and spleen deficiency | 55 | 15 (27.3) | 17 (30.9) | 18 (32.7) | 5 (9.1) |
| Vital energy stagnation and blood stasis | 33 | 6 (18.2) | 8 (24.2) | 10 (30.3) | 9 (27.3) |
| Damp-heat | 52 | 27 (51.9) | 18 (34.6) | 5 (9.6) | 2 (3.8) |
The relationship between the TCM Syndrome-typing and the clinical classification of CUC is shown in Table 2. The occurrence of damp-heat was more common in the initially affected patients (p < 0.01) and less common in the persistent and recurrent cases. There is no significant difference among the other TCM Syndrome-typing groups in the persistent and recurrent patients (p > 0.05).
| TCM Syndrome-typing | Number | Clinical types | |||
| Initial | Persistent | Recurrent | Onset | ||
| Spleen-stomach asthenia | 185 | 12 (6.5)1 | 59 (31.9) | 114 (61.6) | |
| Spleen-kidney Yang deficiency | 81 | 2 (2.5) | 37 (45.7) | 41 (50.6) | 1 (1.2) |
| Yin and blood asthenia | 46 | 1 (2.2) | 25 (54.3) | 20 (43.5) | |
| Liver stagnation and spleen deficiency | 55 | 8 (14.5) | 17 (30.9) | 30 (54.5) | |
| Vital energy stagnation and blood stasis | 33 | 2 (6.1) | 15 (45.5) | 16 (48.5) | |
| Damp-heat retention | 52 | 39 (75.0) | 3 (5.8) | 8 (15.4) | 2 (3.8) |
The relationship between the TCM Syndrome-typing and the changes of the colon mucosa is shown in Table 3. The congestion and edema found in all of the TCM Syndrome-typing groups had different severity levels in the different groups. Damp-heat, spleen-kidney Yang deficiency, and spleen-stomach asthenia syndrome were characterized by erosion, ulcers and bleeding. Stagnation of vital energy and blood stasis were characterized by granulation and polyp proliferation. Both Yin and blood deficiency were characterized by atrophy.
| Mucosal changes | Number | Spleen stomach deficiency (n = 185) | Spleen-kidney deficiency (n = 81) | Yin-blood deficiency (n = 46) | Liver stagnation spleen deficiency (n = 55) | Vital energy stagnation and blood stasis (n = 33) | Damp-heat ratention (n = 52) | p value |
| Mild congestion and edema | 166 | 71 (38.4)1 | 12 (14.8) | 35 (76.1) | 37 (67.3) | 9 (27.3) | 2 (3.8) | < 0.01 |
| Moderate congestion and edema | 184 | 83 (44.9) | 30 (37.0) | 11 (23.9) | 18 (32.7) | 21 (63.6) | 21 (40.4) | < 0.01 |
| Severe congestion and edema | 102 | 31 (16.7) | 39 (48.1) | 3 (9.1) | 29 (55.8) | < 0.01 | ||
| Erosion | 304 | 152 (82.2) | 75 (92.6) | 7 (15.2) | 9 (16.4) | 12 (36.4) | 49 (94.2) | < 0.01 |
| Ulcer | 383 | 163 (88.1) | 79 (97.5) | 31 (67.4) | 36 (65.5) | 23 (69.7) | 51 (98.1) | < 0.01 |
| Bleeding | 147 | 61 (33.0) | 45 (55.6) | 2 (4.3) | 3 (5.5) | 7 (21.2) | 29 (55.8) | < 0.01 |
| Granulation | 179 | 77 (41.6) | 47 (58.0) | 19 (41.3) | 5 (9.1) | 29 (87.8) | 2 (3.8) | < 0.01 |
| Atrophy | 55 | 11 (5.9) | 9 (11.1) | 27 (58.7) | 1 (1.8) | 7 (21.2) | < 0.01 | |
| Polyp proliferation | 67 | 27 (14.6) | 19 (23.5) | 1 (2.2) | 2 (3.6) | 17 (51.5) | 1 (1.9) | < 0.01 |
The relationship between the TCM Syndrome-typing and the pathohistological changes of the colon mucosa is shown in Table 4. The reduction of goblet cells and the infiltration of neutrophils are pathological features common to all groups. However, neutrophil infiltration was prevalent in damp-heat syndrome, while lymphocyte infiltration was prevalent in spleen-stomach asthenia, spleen-kidney Yang deficiency, and stagnation of liver and deficiency of spleen. Mucosal ulcers were prevalent in damp-heat, while crypt ulcers were prevalent in spleen-stomach asthenia and spleen-kidney Yang deficiency. Abnormal epithelial proliferation was prevalent both in stagnation of vital energy and blood, and in spleen-kidney Yang deficiency.
| Pathological change | Number | Spleen stomach deficiency (n = 185) | Spleen kidney Yang deficiency (n = 81) | Yin blood deficiency (n = 46) | Liver stagnation spleen deficiency (n = 55) | Vital energy stagnation, blood stasis (n = 33) | Damp-heat retention (n = 52) | p value |
| Goblet cell reduction | 444 | 182 (98.4)1 | 81 (100.0) | 44 (95.6) | 53 (96.4) | 32 (97.0) | 52 (100.0) | > 0.05 |
| Neutrophil infiltration | 421 | 171 (92.4) | 79 (97.5) | 41 (89.1) | 47 (85.5) | 31 (93.9) | 52 (100.0) | < 0.05 |
| Lymphocyte infiltration | 248 | 127 (68.6) | 52 (64.2) | 15 (32.6) | 41 (74.5) | 10 (30.0) | 3 (5.7) | < 0.01 |
| Angiitis of small vessels | 295 | 121 (65.4) | 54 (66.7) | 23 (50.0) | 36 (65.5) | 24 (72.7) | 37 (71.2) | > 0.05 |
| Crypt abscess | 395 | 161 (87.0) | 72 (88.9) | 40 (87.0) | 44 (80.0) | 29 (87.9) | 49 (94.2) | > 0.05 |
| Mucosal ulcer | 188 | 68 (38.8) | 32 (39.5) | 11 (23.9) | 13 (23.6) | 10 (30.0) | 34 (65.4) | < 0.01 |
| Crypt ulcer | 311 | 142 (76.8) | 59 (72.8) | 24 (52.2) | 28 (50.9) | 21 (63.6) | 37 (71.2) | < 0.01 |
| Abnormal epitheliosis | 63 | 27 (14.6) | 19 (23.5) | 3 (6.5) | 4 (7.3) | 9 (27.3) | 1 (1.9) | < 0.01 |
Chronic and non-specific ulcerative colitis has been under investigation for more than 100 years. The etiology and pathogenesis, according to modern medicine are associated with many factors such as the immune system, heredity, intestinal infection, mental stress, food sensitivity, and intestinal bacteriolysis. The etiology and pathogenesis, according to TCM, are associated with many factors including mental injury, disorder of diet rhythms, invasion of outside pathogenic evils, and spleen-kidney asthenia. In this series of 452 patients, 40.9% of cases were spleen-stomach asthenia, 17.9% of cases were spleen kidney Yang deficiency, 12.1% of cases were stagnation of liver and deficiency of spleen, 11.5% of cases were for damp-heat retention, 10.1% of cases were deficiency of both Yin and blood, and 7.3% of cases were stagnation of vital energy and blood. The cases involving spleen-kidney asthenia account for more than 50% and the cases involving sthenia syndromes (damp-heat and stagnation of vital energy and blood stasis) account for less than 20%. We theorized that the spleen kidney asthenia could be the prevalent syndromes in CUC, while the damp-heat is superficial. Though the lesion is located in the large intestine, the effects of the lesion could extend to the spleen, kidney and liver.
In order to investigate some objective rules of the TCM Syndrome-typing, we carried out systematic observations through clinical, pathological and laboratory examinations. After analysis of the data from 452 patients, there is a clear relationship between the TCM Syndrome-typing and the duration of CUC. The sequence of progression tended to begin with damp-heat, then to spleen asthenia, and further to kidney asthenia. This indicated that damp-heat was more common in cases with a shorter duration. The pathogenic damp may stay in the spleen as the duration of illness was prolonged. This can lead to injury of the organ and its vital energy. The disease may further progress to spleen-stomach asthenia syndrome. Moreover, the kidney could be affected by the spleen distress. Therefore, the spleen kidney Yang asthenia results.
Currently, there are no studies investigating the relationship between the TCM Syndrome-typing and the pathological change of the colon mucosa. Dai et al[3] hypothesized that the body of the tongue had significant influence on an endoscopy diagnosis. This alludes to a relationship between Chinese glossoscopy and intestinal diseases. Our study elucidated the relationship between the TCM Syndrome-typing and pathological changes of the colon mucosa, as observed by the naked eye or by micro-pathohistological examination. For example, mild congestion and edema are prevalent in cases of asthenia of both Yin and blood, and the stagnation of liver and deficiency of spleen. Moderate congestion and edema are prevalent in cases of spleen-stomach asthenia, and stagnation of vital energy and stasis of blood. Severe congestion and edema are prevalent in cases of damp-heat retention and spleen-kidney Yang deficiency.
Although cellular infiltration and ulcerative changes of the colon mucosa are features common to all of the TCM Syndrome-typings, the types of infiltrating cells and the sites of the ulcers are different. The nature of spleen-kidney Yang deficiency is opposite to that of damp-heat. The former belongs to the syndrome of Yin, deficiency and cold, while the latter belongs to the syndrome of Yang, sthenic and heat. All of the TCM Syndrome-typings have the same notable congestion, edema, and ulcers. Therefore, further studies are required to investigate the pathogenesis. Notably, we observed several differences. In the cases of spleen-kidney Yang deficiency, the mucosal edema was more apparent than congestion, there was no marked swelling around the ulcer, and a white secretion covered the surface. In the cases of damp-heat, the mucosal edema was more apparent than congestion, there was marked swelling around the ulcer, and a yellow purulent secretion covered the surface. Taken together, there are internal relationships between the TCM Syndrome-typing and pathological changes in CUC.
Our study is only a preliminary investigation of the relationships between the TCM Syndrome-typing and the pathological, pathohistological, and clinical classification of modern medicine. Further study is required for understanding the pathogenesis of CUC and establishing objective parameters of the TCM Syndrome-typing.
Original title:
S- Editor: Yang RC L- Editor: Filipodia E- Editor: Li RF
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