A 72-year-old woman with a two-year history of ulcerative colitis and chronic diarrhea was managed using a modified Fuzi Lizhong Tang to warm the middle and strengthen the Spleen.

Case ID: CHC-0008

Case Summary

This case describes a 72-year-old woman presenting with a two-year history of chronic diarrhea, mucus, and occasional bloody stools, previously diagnosed by colonoscopy as ulcerative colitis. The original report documented a TCM assessment of Spleen and Stomach deficient cold. The patient was managed with a classical warming herbal formula designed to dispel internal cold and restore digestive function.

Patient Presentation

• Patient: 72-year-old female.
• Main Complaint: Chronic loose stools with mucus and occasional fresh blood for two years.
• History: The patient experienced loose, unformed stools 5 to 6 times a day over the past two years, accompanied by mucus and occasional bleeding, but without abdominal pain, bloating, or tenesmus. A prior colonoscopy at another hospital confirmed a diagnosis of ulcerative colitis. After conventional Western pharmacological treatments failed to provide significant symptomatic improvement, she sought a TCM consultation on October 1, 2020. At the time of her first visit, her bowel movements occurred 3 to 4 times a day.

Examination and Diagnosis

• Conventional Diagnosis: Ulcerative Colitis.
• TCM Tongue and Pulse: The tongue was pale and dark with a white, greasy coating. The pulse was stringy and fine (弦细).
• Physical Examination: General vitals were stable. Auscultation revealed a systolic murmur in the mitral, tricuspid, and aortic valve areas. Symmetrical, pitting edema was observed in both lower extremities.

TCM Assessment

The original practitioner interpreted the presentation as Chang Pi (Intestinal Dysentery/Diarrhea) driven by Spleen and Stomach Deficient Cold (脾胃虚寒).

According to the principles of Yin and Yang Chinese Medicine, a healthy digestive system relies on the robust warmth of Yang energy to properly “cook” and transform food and fluids. In this patient, the Yang energy of the Spleen and Stomach was deeply depleted, allowing internal cold and dampness (Yin pathogens) to accumulate in the intestines. This severe lack of warming and holding power caused the chronic, unformed diarrhea and permitted the leakage of mucus and blood.

Treatment Approach

The primary treatment principle was to warm the middle, disperse cold, strengthen the Spleen, and stop diarrhea (温中散寒，健脾止泻). The strategy utilized potent warming herbs to rebuild the patient’s internal Yang and drive out the lingering cold-dampness that had settled in her gastrointestinal tract.

Herbal Formulas and Modifications

• Formula Prescribed: A modified version of Fuzi Lizhong Tang (Aconite Decoction to Regulate the Middle).
• Action and Composition:
  • Warming the Middle and Kidneys: Hei Shun Pian (Processed Aconite root), which is highly pungent and hot, was used as the chief herb to forcefully warm the middle and the Kidneys, driving out the deep-seated cold.
  • Strengthening the Spleen and Yang: Gan Jiang (Dried Ginger), Shu Dang Shen (Prepared Codonopsis), Bai Zhu (Atractylodes), and Gan Cao (Licorice) form the core of the traditional Li Zhong Tang to tonify Spleen Qi, restore the digestive fire, and aid the transformation of fluids.
  • Resolving Dampness and Regulating Qi: Fu Ling (Poria), Chen Pi (Tangerine Peel), and Mu Xiang (Aucklandia) were included to dry the greasy dampness and regulate intestinal movement.
  • Additional Support: Wu Zhi Mao Tao was added to further boost Spleen Qi, while Huang Lian (Coptis) and Bai Shao (White Peony) provided a balancing effect, clearing localized inflammation and soothing intestinal spasms without compromising the overall warming nature of the formula.

Follow-Up

• October 8, 2020 (Second Visit): After completing the initial 7-day course of the decoction, the source reported a significant reduction in her symptoms. Her appetite, sleep, and urination remained stable. Given the positive clinical response, the practitioner prescribed a continuation of the same formula to consolidate the treatment.

Why This Case Is Interesting (Clinical Reasoning)

The notable feature of this case is the bold use of Fuzi (Prepared Aconite) in treating ulcerative colitis. Conventional treatments often approach ulcerative colitis with anti-inflammatory or immunosuppressive strategies, and even many modern TCM approaches default to clearing “Damp-Heat” when blood and mucus are present in the stool.

However, the original practitioner strictly adhered to the patient’s objective signs—a pale, dark tongue with a white, greasy coating and a fine pulse—identifying the root cause as Deficient Cold rather than Heat. By prioritizing the restoration of digestive Yang over simply stopping the bleeding with astringent herbs, the treatment addressed the underlying metabolic weakness that was maintaining the chronic intestinal dysfunction.

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What This Case Can — and Cannot — Tell Us

This is an individual case report, not a controlled clinical trial. It documents the reasoning, treatment, and outcome reported for one patient and should not be interpreted as evidence that the same approach will produce the same result in another person.

Source

• Original source: Dongguan Hospital of Traditional Chinese Medicine (东莞市中医院) / Guangdong Provincial Administration of Traditional Chinese Medicine
• Original title: 【以案说医】董明国：温中散寒，健脾止泻法治疗肠辟案
• Practitioner: Professor Dong Mingguo (董明国)
• Publication date: November 4, 2024
• Original language: Chinese
• Source link: View original page
• ChineseHerb.org version: English translation and editorial adaptation