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Ulcerative Colitis : Diagnosis
   
Western Medicine Chinese Medicine

The diagnosis of ulcerative colitis is made from the patient's medical history, a stool examination, sigmoidoscopy findings, and biopsy of specimens from the rectum or colon.

Stool Samples
Stool samples from patients with ulcerative colitis contain pus cells, red blood cells, and commonly eosinophils (a type of white blood cells). Since inflammation of the colon due to infections can also produce symptoms similar to those of ulcerative colitis, stool samples are examined to exclude parasitic, amoebic or bacterial infection.

Sigmoidoscopy
Sigmoidoscopy allows the physician to find typical features of ulcerative colitis in the colon, such as swelling, small bleeding points, and ulceration of the inner lining of the colon. For patients with longstanding disease, pseudo polyps may also be seen. Colonoscopy is sometimes necessary for determining the extent of the disease, especially in severe attacks.


Sigmoidoscopy

Biopsy
Because the findings from sigmoidoscopy can also be found in other medical conditions such as infectious inflammation of the colon, biopsies of the tissue in the colon are necessary to confirm diagnosis of ulcerative colitis. Patients with Crohn's disease can also have a medical history and symptoms similar to those of ulcerative colitis and several biopsies via colonoscopy may be needed to confirm a diagnosis of ulcerative colitis.

Differential Diagnosis
Patients with Crohn's disease, which usually also involves the small intestines, often present with symptoms similar to ulcerative colitis. Endoscopy and x-ray s of the small intestine are sometimes necessary to correctly diagnose ulcerative colitis. Other differences between ulcerative colitis and Crohn's disease are found in laboratory values and biopsy specimens.

In TCM understanding, ulcerative colitis is mainly due to internal weakness of the spleen and stomach that result in transmission disorders of the large intestine. Triggering factors like exogenous pathogens, an improper diet and emotional stimulation further disturb the internal disharmony and make the symptoms worse.

During diagnosis, TCM physicians rely on special skills to gather health information from patients so that appropriate therapeutic strategies can be undertaken.

Damp-heat in the large intestine
TCM diagnostic criteria for this type of ulcerative colitis include diarrhea with pus and blood, a burning feeling in the anus, abdominal cramps, fever and scanty yellow urine. On examination, the tongue is red and covered by yellow greasy coating; the pulse is rolling and rapid.

A red tongue covered by yellow greasy fur.

Damp-cold in the spleen
Diagnostic criteria for this type are diarrhea with mucus or watery stools, tenesmus, abdominal cramps, stomach stuffiness, generalized heaviness and clear urine. On examination, the tongue is pale and covered by white greasy coating; the pulse is hesitant and slow.

Qi and Blood stagnation
Diagnostic criteria for this type of ulcerative colitis include diarrhea with mucus or darkish blood, straining for defecation, fixed stabbing pain, distention, belching and a darkish complexion. On examination, the tongue is purple with bleeding spots; the pulse is taut and hesitant.

Liver stagnation and spleen weakness
Diagnostic criteria for this type of ulcerative colitis includes diarrhea triggered by emotional stimulation; attacks usually come after abdominal cramps, chest oppression, belching and frequent passage of gas. On examination, the tongue fur is thin, white and greasy; the pulse is taut.

Spleen qi deficiency
Diagnostic criteria for this type of ulcerative colitis includes loose bowels made worse by poor lifestyle habits or consumption of greasy foods, undigested foods in the stools, lack of appetite, distention, fatigue and sallow complexion. On examination, the tongue is pale and covered by white fur; the pulse is weak and thready.

Spleen and kidney deficiencies
Diagnostic criteria for this pattern are early morning diarrhea that comes after an episode of colic, undigested food in the stools, cold body and extremities, soreness in the lumbar region and knees, and frequent urination at night. On examination, the tongue is pale; the pulse is deep and thready.

According to TCM experience, damp-heat in the large intestine, qi and blood stagnation, spleen qi deficiency are the most common types of syndrome patterns; while spleen and kidney deficiencies are usually seen in the late stage of ulcerative colitis .