Granulomatous colitis, also known as Crohn’s disease of the large intestine and limited colitis. It develops in the colon, rectum and anus and is an inflammatory disease of the large intestine of unknown origin. Cancer is less common. In the small intestine and colon, the disease is more common in young adults; in the sigmoid colon and rectum, it is more common in middle-aged adults over 45 years of age. There is no significant difference between males and females. I. Etiology The pathogenesis of granulomatous colitis has more theories, including bacterial, viral, mycobacterial, protozoal infections or allergies, but no pathogens have been found, and it has not been possible to prove that the above factors are significantly related to the onset of the disease. Some believe that abdominal trauma, which can involve lymphatic tissue, and neuropsychiatric factors are also related. Others believe that lymphedema or lymphatic vessel obstruction and abnormal fat metabolism are also related to the onset of the disease. There is still no conclusive answer to all these arguments. Therefore, the disease is still an inflammatory disease of the intestine of unknown origin. The lesions are segmental, commonly granulomatous, ulcerative, necrotic, and scarring, all of which can cause intestinal luminal narrowing and obstruction. Intestinal infection, which can form an anal fistula. Second, the symptoms Early in the disease, there can be a low fever, often no cause can be found, and there are no other specific symptoms. As the disease progresses, patients may experience weight loss, fatigue, diarrhea, abdominal pain (mostly in the lower left abdomen), and mild colic before stool, which may be relieved after stool. Diarrhea is not as severe as ulcerative colitis, 3 to 5 times a day, mostly thin stools, without pus and blood. Sometimes the bowel movements are normal or there is constipation, and also sometimes steatorrhea occurs. Perianal infections are more common than ulcerative colitis and can occur as ulcers, anal fissures, abscesses, fistulas, rectovaginal fistulas, anal sphincter malfunction, etc. Late malnutrition can lead to anemia, and intestinal obstruction due to colonic stricture and chronic intestinal perforation can lead to limited infection and formation of abscesses or intestinal fistulas. This kind of intestinal fistula is mostly between the intestinal tubes, or connected with the bladder or vagina. III. Diagnosis Any patient with prolonged low fever, abdominal pain, mild diarrhea, chronic intestinal obstruction, and poor general health should be considered to have the possibility of granulomatous colitis. (i) Sigmoidoscopy: Most patients have rectal lesions with plaques and red congested areas of rectal and sigmoid mucosa with irregular nodular protrusions in the shape of cobblestones and normal mucosal surfaces in the middle of the nodules. (b) X-ray agent enema examination: thickening and hardening of the intestinal wall, narrowing of the intestinal lumen, irregular edges, and sometimes fistulas are seen. The intestinal luminal stenosis is multiple and the sites are mostly at the rectum, transverse colon and right hemicolectum. The lesions are not continuous, but segmented with normal intestinal canal in between. The ulcers vary in depth and size, and the mucosa is cobblestone-like. (C) Histological examination: biopsy of the lesion area in the protruding nodes or anus is taken. Initially, the mucosa is normal, but may invade the entire intestinal wall. Granuloma or sarcomatous changes are common, and multinucleated Langham’s foreign body giant cells and epithelioid cells are seen within the granuloma. Treatment Where the symptoms are mild and there is no obvious intestinal obstruction, if the diagnosis is clear, pharmacological treatment can generally be used. (A) Internal treatment: Chinese herbal medicine treatment, refer to the prescription of evidence-based treatment in one section. In the acute stage, in order to control the secondary infection, phthalidothiazole, aunitothiazole, salicylic acid azo-sulfamethoxazole, kanamycin, ampicillin, etc. are often used simultaneously with good effect. Corticosteroids, cortisone or hydrocortisone, are also commonly used in the acute phase of treatment, but should be used with caution, as overdosing can cause complications such as bleeding and perforation. (B) External treatment method: use Huanglian mold liquid plus Qing Dai and Banlangen, the decoction of a total of 50-100 ml, retain the enema, 2 times a day, 15 days as a course of treatment. Surgical therapy is only applicable to patients with intestinal obstruction, intestinal perforation, abdominal infection, intestinal fistula and serious infection around the rectum. In addition, patients with long-term drug treatment that is ineffective or stable lesions that are limited should also consider surgical treatment. (C) systemic therapy: diet should be both nutritious and easy to digest food, avoid eating cold, sticky and irritating food, and in the acute stage, supportive therapy can be used.