Home Forums Diplomate Discussion Ulcerative Colitis Flare Case

  • This topic has 7 replies, 1 voice, and was last updated 4 years ago by Sita.
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    • #7127
      Sita
      Participant

      Would greatly appreciate some guidance! CC: ulcerative colitis flare in a 32-yr-old F. She was diagnosed with UC 3 years ago. In February she had a flare-up with very frequent, urgent and painful BMs consisting of mucus and blood. Started 1 month of steroids in March and had immediate relief. She simultaneously stopped oral contraceptives and hasn’t had a period since February. UC sx returned 3 weeks after completing steroids, which was when she came in. When I first met her a month ago, her pulse showed what I read as a shaoyang flare. I put her on XCHT -RS/DZ + EJ + BS18. Both mucus and blood greatly reduced, and she stopped having blood-only BMs, but frequency of BMs remained the same. Nausea & post-nasal drip improved; sleep & anxiety slightly improved; and she had less nightsweats. However, she’s having more abdominal cramping, especially at night and in the morning. Then, two weeks ago I switched her to THT + YYFZBJC. Pulse: L1 deep slippery, Dong 1/2, L2 deep thin wiry slippery, L3 deep rapid wiry; R1 deep rapid, R2 upper level slippery thin, R3 deep rapid tight. I’ll be seeing her on Friday, but when we checked in, she doesn’t seem to be doing as well as I’d like to see her be. She’s having a mix of diarrhea and loosely formed stool now, still 5-6x/day and 2-3x/night. There’s still a small amount of blood, but almost no mucus. Abdominal cramping is more frequent and more severe. Sometimes it resolves with BM and sometimes not. Cramping is waking her up at night. Abdomen feels distended and hard, and she’s having more night-sweats. On the bright side, she’s having some pink vaginal discharge, so we think she might be getting her period back.

    • #7635
      Christoph Ludwig Beer
      Guest

      Hi Sita. Is there any depth difference for those pulses on the left, or are they just all deep on the same level?

    • #7636
      Clint Cain
      Participant

      Does she have any urinary symptoms — difficulty or blood? Are her pulses faint or expiring? Is she thirsty?

    • #7638
      Sita
      Participant

      Christoph: the L cun is higher than the guan and chi, as of 1 week ago. Clint no urinary sx. I don’t think any of her pulses were faint or expiring, but I’m not 100% sure. No thirst complaints. What are you both thinking?

    • #7637
      Clint Cain
      Participant

      Those deep thin slippery rapid pulses with tight R3, along with pus and blood in the stool, no menstrual flow, severe abdominal pain, and distended and hard abdomen make me think of treating the blood layer. BTWJGCEJT could be part of what you need if her pulses are expiring and she is thirsty; DHMDPT is a possibility if her urine is regular, she feels hot, etc. Also, I’d consider GZFLW with that deep tight R3, abdominal pain, etc.

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