Inflammatory bowel disease (IBD) occurs when the immune system responds to the intestinal flora (bacteria, microbiome) in an exaggerated or disordered way.^[8] IBD includes Chron(‘s) disease (CD) and ulcerative colitis (UC). Chron(‘s) affects the both the small and large intestines (“skip lesions”), whereas UC and affects only the large intestine. As with most inflammatory disorders, there is a genetic tendency for developing IBD. The presence of IBD does confer an increased for certain intestinal cancers, and surveillance with regular colonoscopy is necessary, even when the symptoms are well controlled.

Classical intestinal IBD symptoms include cramping, irregular bowel habits, possible bowel incontinence, severe urgency, occasionally severe constipation, blood and/or mucus in the stool, or grossly bloody stool. Perianal fistulae/fissures commonly form. Additionally, especially with Crohn’s disease, “extra-intestinal” (outside the intestine) associated symptoms/conditions occur: weight loss, fever, sweats, mouth ulcers, growth retardation (in children), and the classic “skin/eye/joint” problems: uveitis (inflammation of the eye’s iris), joint pain/spinal inflammation (ankylosing spondylitis) possibly liver/gall bladder duct inflammation/scarring/gall stones, and osteoporosis. The skin condition pyoderma gangrenosum can lead to dramatic skin ulcerations. Failure to absorb food often leads to dehydration and/or anemia.

While blood work and imaging studies are important to evaluate the complications of IBD, it is usually diagnosed by endoscopy (camera study) of the intestine with biopsy.

Treating acute flare-ups requires bowel rest (nothing by mouth) and medications including steroids, antidiarrheal and anticholinergic medications, and occasionally antibiotics. Prevention may require very strong medications including steroids, aminosalicylates (sulfasalazine, mesalamine), immunosuppressants (azathioprine, methotrexate, cyclosporine), and/or medications that “soak up” inflammatory chemicals (tumor necrosis factor inhibitors) that are also used to treat autoimmune disease. For those failing medication, surgery (removal of a portion of the bowel) may be required.^[1]

In Traditional Chinese Medicine (TCM), all forms of IBD have complex, but common, etiologies. The presenting (“branch”) symptoms of bloody diarrhea with mucus reflect “Damp Heat” in the intestines. As a chronic condition, the “root” of this is “False Heat” pattern lays in significant “Spleen, Defensive, and Kidney Qi deficiencies”. Acupuncture and especially Chinese herbs can be effective adjuncts in IBD treatment; they remove “Heat” and improve “deficient Spleen and Kidney Qi”. Dietary modification is imperative: gluten avoidance and strict adherence to easily digested foods are cornerstones of adjunctive therapy. Dietary modifications as recommended in Ayurveda are valuable in varying the gut microbiome. Ayurveda teaches that eating tasty, easily digested food avoids overtaxing the digestive mechanism so that that “Spleen Qi” remains strong, thus preventing bowel abnormalities.^{[2, 3]}

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