I. Treatment principles
It needs to be formulated according to the differences of grading, staging and segmentation. In the active phase, the main goal is to control inflammation and relieve symptoms, and in the remission phase, the remission should be maintained and relapse should be prevented; segmental treatment refers to the determination of the extent of the lesion to choose different methods of drug delivery. The main treatment is systemic. The clinical treatment method includes the combination of etiology and symptomatic treatment, overall treatment and local treatment of the intestine, western medicine treatment and Chinese medicine treatment.
Key points of combined Chinese and Western medicine treatment
1, mild-moderate patients can be treated with Chinese medicine or Chinese medicine prescriptions, or oral salazosulfapyridine or 5-aminosalicylic acid preparations, if not effective, the combination of Chinese and Western drugs, the distal colitis can be combined with rectal local drug delivery treatment. If the above treatment is not effective, prednisone can be used for oral treatment.
2, refractory ulcerative colitis (hormone dependence or hormone resistance) is appropriate to early use of Chinese and Western medicine combined with a comprehensive medical treatment program, if necessary, the choice of purine drugs, methotrexate and other immunosuppressive drugs, or choose to infliximide intravenous infusion.
3, severe ulcerative colitis is recommended to use a combination of Chinese and Western medicine treatment, the patient to oral prednisone, aminosalicylates or local treatment is ineffective, or the emergence of high fever, pulse count and other symptoms of systemic toxicity, glucocorticoids should be used intravenous infusion
If it is not effective, cyclosporine or infliximide intravenous drip treatment should be considered, and if necessary, surgical treatment should be transferred.
4.Maintenance treatment: When the acute attack is controlled, it is appropriate to use Chinese medicine for maintenance treatment, also with small doses of amino salicylic acid preparations.
Western medicine treatment
1.The treatment of the active period
Mild UC treatment: SASP can be used, 0.75 ~ 1g / time, 3-4 times / d, oral (should be supplemented with folic acid); or an equivalent dose of 5-ASA preparation. If the lesion is distributed in the distal colon, SASP or 5-ASA suppository 0.5-1g/d, 2 times/d may be used as appropriate; 5-ASA enema 1-2g or hydrocortisone sodium succinate enema 100-200 mg, reserved enema, 1 time/night. If necessary, use budesonide 2 mg, reserved enema, 1 time/night.
Treatment of moderate UC: the above-mentioned doses of salicylic acid preparations available for treatment, the response is not good, the appropriate increase or change to oral glucocorticoids, commonly used prednisone (prednisone) 30 ~ 40 mg / d, divided into oral.
Treatment of severe UC: severe ulcerative colitis generally has a wide range of lesions and rapid changes in the development of the disease, should be dealt with in a timely manner after making the diagnosis, the dose of medication should be adequate, the treatment is as follows.
If the patient has not used oral glucocorticoids, oral prednisolone 40-60mg / d, observe 7-10d, or direct intravenous administration. In established users, hydrocortisone 300mg/d or methylprednisolone 48mg/d should be administered intravenously.
Parenteral application of broad-spectrum antibiotics to control secondary intestinal infections, such as nitroimidazole and quinolone preparations, ampicillin or cephalosporin antibiotics, etc.
Patients should be put on bed rest, appropriate fluid infusion and electrolyte supplementation to prevent salt balance disturbance.
Blood transfusion should be considered for large amount of blood in stool, following and persistent bleeding.
Malnutrition, elemental diet is available for the more severe cases, and parenteral nutrition should be given for severe cases.
If intravenous glucocorticosteroids are ineffective after 7-10 d, cyclosporine can be considered for 2-4 mg?kg-1?d-1 intravenous drip for 7-10 d. Because of the immunosuppressive effect of drugs, nephrotoxicity and other adverse effects, blood concentration should be strictly monitored. Therefore, from the comprehensive consideration of hospital monitoring conditions, it is advocated to be used in a few medical centers
2.Treatment of remission period
After remission of symptoms, maintenance therapy with SASP or 5-ASA drugs should be continued for at least 1 year or for a long period of time; the maintenance dose of SASP is usually 2-3g/d orally, and an equivalent dose of 5-ASA drugs may be used. Glucocorticoids should not be used for maintenance therapy. 6-Thiopurine or azathioprine are used for those who cannot be maintained on these drugs or are dependent on glucocorticoids.
3.Surgical treatment
Absolute indications: haemorrhage, perforation, clear or high suspicion of cancer, and histological examination of severe heterogeneous hyperplasia.
Relative indications: severe UC with toxic megacolon and ineffective intravenous medication; persistent symptoms, decreased physical fitness, resistance to or dependence on glucocorticoids, and ineffective replacement therapy; UC combined with gangrenous sepsis, hemolytic anemia and other extraintestinal complications.
4.Monitoring of cancer
For more than 8 to 10 years of extensive colitis, total colitis and disease duration, more than 30 to 40 years of left hemichalasis, rectosigmoiditis patients, UC combined with primary sclerosing cholangitis, surveillance colonoscopy should be performed, at least once every 2 years, and multi-site biopsy. The histological examination found to have heterogeneous hyperplasia, more should be closely followed up, such as severe heterogeneous hyperplasia, once confirmed that the surgical treatment.
IV. Chinese medicine treatment
Identification and treatment
Damp-heat evidence in large intestine
Treatment: Clearing heat and drying dampness, regulating Qi and promoting blood circulation.
Formula: Paeonia lactiflora soup (Paeonia lactiflora, Scutellaria baicalensis, Huanglian, Rhubarb, Betel nut, Angelica sinensis, Mu Xiang, Cinnamon, Licorice) plus or minus.
Add and subtract: for more pus and blood in the stool, add Baitou Wang, Zi Zhu and Di Yu to cool the blood and stop dysentery; for more white jelly and mucus in the stool, add Cang Zhu and Coix Seed to strengthen the spleen and dry dampness; for more abdominal pain, add Yan Hu Suo, Wu Yao and Hovenia to regulate Qi and relieve pain; for more heat, add Ge Gen, Jin Yin Hua and
For severe fever, add Radix et Rhizoma Glycyrrhiza Glabra, Radix et Rhizoma Polygonatum, Radix et Rhizoma forsythiae.
Traditional Chinese medicine: Xianglian pill, 3-6g/time, 2-3/time; Xianglian anti-diarrheal tablet, 4 tablets/time, 3 times/day.
Weak Spleen Qi
Treatment: Strengthening the spleen and benefiting Qi, resolving dampness and stopping diarrhea.
Formula: Ginseng, Poria, Atractylodes Macrocephala, Radix Platycodon, Rhizoma Polygonati, Rhizoma Polygonati, Rhizoma Polygonati, Rhizoma Polygonati, Rhizoma Polygonati, Radix et Rhizoma Glycyrrhiza) plus or minus.
Add and subtract: if there is pus and blood in the stool, add sorrel, Huang Lian, and Guang Mu Xiang; if there is indigestible food in the stool, add Shen Qu and Citrus aurantium to eliminate food and lead to stagnation; if there is abdominal pain and fear of cold and prefer warmth, add
If the abdominal pain is cold and prefers warmth, add Radix et Rhizoma Pseudoginseng to warm the spleen and kidneys; if the diarrhea is prolonged, add Astragalus, Shengma and Chaihu to raise the Yang and lift the spleen.
Traditional Chinese medicine: ①Tonic Spleen and Intestine Pill, 6g/time, 3 times/day; ②Senghuang Baijiao Granules, 3-6g/time, 3/day.
Spleen and kidney Yang deficiency
Treatment: Warming Yang and dispelling cold, strengthening the spleen and tonifying the kidney.
Formula: Radix et Rhizoma Polygoni (Radix et Rhizoma Ginseng, Radix Ginger, Atractylodes Macrocephala, Radix Glycyrrhiza Uralensis) plus or minus.
Addition and subtraction: for obvious Yang deficiency, add bone marrow and nutmeg to warm the spleen and kidney; for abdominal pain, add peony to relieve urgency.
If the abdominal pain is severe, add white peony to ease the pain; if the abdomen is full, add wu yao, cumin and heliotrope to regulate qi and remove fullness; if the stool is slippery and incontinent, add red stone resin and horseradish to astringently stop diarrhea.
Traditional Chinese medicine: ①Six Shen Wan, 9g/time, 2 times/day; ②Gu Ben Yi intestinal tablets, 8 tablets/time, 3 times/day.
Liver depression and spleen deficiency
Treatment: Diversify the liver and Qi, tonify the spleen and strengthen the circulation.
Remedy: Add and subtract from the essential formula for painful diarrhea (Chen Pi, Atractylodes Macrocephala, Paeonia lactiflora, Fengshui).
Addition and subtraction: for irregular bowel movement and frequent vexation, add Citrus aurantium and Betel nut to regulate Qi and guide stagnation; vague abdominal pain. Loose stools. For those who are tired and weak, add Radix Codonopsis, Poria, fried lentils to strengthen the spleen and resolve dampness; for those who have chest distension and pain, add Green Peel and Radix Aromaticus to regulate the liver and Qi; for those who have yellowish white mucus, add Huang Lian and Mu Xiang to clear the intestines and dry dampness.
Chinese patent medicine: solid intestine stop diarrhea pill (colon pill), 4-5g/time, 3 times/day.
Cold-Heat Mixed Evidence
Treatment: Warming Yang and strengthening the spleen, clearing heat and drying dampness.
Remedy: Wu Mei Wan (Wu Mei Pulp, Huang Lian, Huang Bai, Ginseng, Radix Angelicae Sinensis, Radix Aconiti, Gui Zhi, Chuan Pepper, Dry Ginger, Hsiang Xin) plus or minus.
Add and subtract: if the stool is accompanied by pus and blood, remove Chuan Pepper and Hosanna, add Qin Pi and Sheng Di Yu; if the abdominal pain is severe, add Xu Changqing and Yuan Hu.
Chinese patent medicine: Wu Mei Wan, 2 pills/time, 2-3 times/day.
Incendiary evidence of heat toxicity
Treatment: Clearing heat and detoxification, cooling the blood to stop dysentery.
Remedy: Bai Tou Weng Tang (Bai Tou Weng, Huang Lian, Huang Bai, Qin Pi) plus or minus.
Addition and subtraction: for those with fresh blood in the stool and red descending tongue, add Comfrey, Shengdiyu, Shengdi; for those with high fever, add water hyacinth powder, gardenia, jinyinhua; for those with cold sweating limbs and thin pulse, intravenous injection of ginseng and sorbit or raw pulse injection.
Chinese medicine enema treatment
Tin-like san 1.5g plus 100 ml of physiological saline, retain enema, times/day.
Kang Fu Xin Liquid 50ml plus 50ml physiological saline, reserved enema, 1 time/day (this product can also be taken orally, 10ml/time, 3 times/day).
Colonin enema, take 5g of ointment, dissolve in 50-80ml of warm water, keep enema, 1 time/day.
Chinese medicine compound enema, can be used to astringent sores and muscle (ice chips, pedialyte, pearl powder, etc.), blood circulation and blood stasis (Panax ginseng powder, raw cattail, etc.), clear heat and detoxify and dry dampness (Qing Dai, bitter ginseng, Phellodendron, etc.) type of drugs.
Suppository treatment
For ulcerative proctitis, or rectal or sigmoid colitis, with lesions in the lower part of the body, pus and blood in the stool, and obvious urgency, anal suppositories can be given. The choice of drugs is similar to enemas, clearing heat and detoxifying Chinese medicines such as wild chrysanthemum suppositories, usage: 1 capsule, nano-anal, 1 to 2 times / day.
Acupuncture treatment
Acupuncture treatment: main points Hegu, Tianshu and Shangjiu. For damp-heat, add Quchi and Neiting; for cold-damp, add Zhonggui and Qihai; for spleen-heat deficiency, add Spleen Yu, Stomach Yu and Guan Yuan; for spleen-kidney-yang deficiency, add Spleen Yu and Kidney Yu; for yin deficiency, add Zhaohai and Taixi; for blood stasis, add Blood Sea and Diaphragm Yu. For deficiency, use tonic method; for actual evidence, use diarrhea method; for cold, add moxibustion.
Moxibustion treatment: take acupuncture points Zhonggui, Tianshu, Guan Yuan, Spleen Yu, Stomach Yu and Large Intestine Yu. For obvious cold deficiency, add Shen Que. Moxibustion with moxa stick or moxa column, 30min. 1 to 2 times a day, alternating abdominal acupoints with back acupoints.