Lower Gastrointestinal Bleeding

Lower gastrointestinal bleeding (LGIB) is defined as bleeding originating distal to the ligament of Treitz. Acute LGIB refers to bleeding occurring within the past 3 days and may be accompanied by hemodynamic instability, anemia, and/or a need for transfusion. Chronic LGIB refers to bleeding that takes several days or longer to pass from the lesion to the rectum (i.e., intermittent or slow bleeding). Patients commonly have a positive fecal occult blood test, intermittent melena, dark brown stools, or small amounts of bright red blood per rectum. In traditional Chinese medicine (TCM), this condition falls within the categories of “blood disorders” and “bloody stools.”

TCM Pattern Differentiation and Medication Reference

|Common Symptoms

Clinical description:

Bright red blood in the stool; difficult or loose stools; possible abdominal pain and bitter taste in the mouth; a red tongue with a yellow, greasy coating; and a soggy, rapid pulse.

In plain language:

  • Bright red blood may be visible in the stool during a bowel movement.
  • Bowel movements may be difficult, or the stool may be soft and loose.
  • Abdominal pain may occur, either as a dull ache or in intermittent cramps.
  • A bitter taste in the mouth may cause discomfort.
  • The tongue may appear red overall.
  • The tongue coating may be yellow and greasy, appearing thick and sticky.
  • The pulse may feel soft and faster than usual.

|Treatment Approach

Clinical description:

Clear heat and resolve dampness; cool the blood and stop bleeding.

In plain language:

  • TCM approaches that clear heat and dispel dampness are used to address sensations of heat and heaviness, a bitter or sticky taste in the mouth, fatigue, a thick or greasy tongue coating, and scanty, dark urine.
  • Approaches that cool and nourish the blood and help stop bleeding are used to address nosebleeds, gum bleeding, blood in the stool or urine, or small spots of bleeding under the skin.

|Related Products

The products below are provided for informational reference only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

|Common Symptoms

Clinical description:

Bright red or dark purplish blood in the stool; poor appetite, fatigue, a sallow complexion, palpitations, poor sleep, a pale tongue, and a thin pulse.

In plain language:

  • Blood may be visible in the stool, appearing bright red or dark purplish.
  • Appetite may be reduced, with less interest in eating.
  • The person may tire easily and feel low in energy.
  • The complexion may appear yellowish and dull, with little color.
  • Palpitations or a feeling that the heartbeat is unsettled may occur.
  • Sleep may be short or restless.
  • The tongue may appear pale.
  • The pulse may feel thin beneath the fingers.

|Treatment Approach

Clinical description:

Tonify qi and contain blood.

In plain language:

  • TCM approaches that replenish qi and support the spleen are used to strengthen the traditional function of qi in containing blood, and to address bleeding such as nosebleeds, gum bleeding, heavy menstrual bleeding, spots of bleeding under the skin, or blood in the stool or urine.
  • They are also intended to support energy and stabilize qi, addressing fatigue, shortness of breath, weakness, a pale complexion, dizziness, and palpitations. The traditional aim is to help prevent recurrent bleeding and support a steadier recovery.

|Related Products

The products below are provided for informational reference only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

Guipi Decoction

|Common Symptoms

Clinical description:

Dark purplish blood in the stool, sometimes black; dull abdominal pain; preference for warm drinks; a dull complexion; fatigue and reluctance to speak; loose stools; a pale tongue; and a thin pulse.

In plain language:

  • Blood in the stool may look dark purple or black in more severe cases.
  • There may be a dull abdominal ache.
  • The person may prefer warm drinks.
  • The complexion may look dull and lack luster.
  • The person may feel fatigued and weak and may not feel like talking.
  • Stools may be soft and loose.
  • The tongue may appear pale.
  • The pulse may feel thin beneath the fingers.

|Treatment Approach

Clinical description:

Strengthen the spleen and warm the middle; nourish the blood and stop bleeding.

In plain language:

  • TCM approaches that warm the middle and support the spleen are used to support digestion and transformation, and to address sensitivity to cold, a cold abdomen, poor appetite, bloating after meals, fatigue, and loose or watery stools.
  • Approaches that nourish the blood and help stabilize its movement are used to help stop bleeding and address a pale complexion, dizziness, and palpitations, as well as bleeding such as nosebleeds, gum bleeding, or heavy menstrual bleeding.

|Related Products

The products below are provided for informational reference only and do not constitute medical advice or a prescription. Refer to the product packaging and instructions, and use under the guidance of a doctor or pharmacist.

Aconite and Ginseng Lizhong Decoction

References

  1. Raju GS, Gerson L, Das A, et al. American Gastroenterological Association (AGA) Institute technical review on obscure gastrointestinal bleeding[J]. Gastroenterology, 2007(133): 1697-1717.
  2. ASGE Standards of Practice Committee, Pasha SF, Shergill A, et al. The role of endoscopy in the patient with lower GI bleeding[J]. Gastrointest Endosc, 2014, 79(6): 875-885.
  3. Chen Jie, Yu Xiaofeng, Xiang Ping, et al. Analysis of the causes of lower gastrointestinal bleeding in 1,431 cases[J]. Shanghai Medical Journal, 2005, 28(7): 589-590.
  4. Bai Y, Peng J, Gao J, et al. Epidemiology of lower gastrointestinal bleeding in China; single-center series and systematic analysis of Chinese literature with 53951 patients[J]. Gastroenterol Hepatol, 2011, 26(4): 678-682.
  5. Ge Junbo, Xu Yongjian. Internal Medicine (8th edition)[M]. Beijing: People’s Medical Publishing House, 2013: 452-457.
  6. Scottish Intercollegiate Guidelines Network (SIGN). Management of acute upper and lower gastrointestinal bleeding. A national clinical guideline[M]. Edinburgh (Scotland): Scottish Intercollegiate Guidelines Network (SIGN), 2008.
  7. Zuccaro G Jr. Management of the adult patient with acute lower gastrointestinal bleeding[J]. Am J Gastroenterol, 1998, 93(8): 1202-1208.
  8. Chinese Pharmacopoeia Commission. Pharmacopoeia of the People’s Republic of China (2015 edition)[M]. Beijing: China Medical Science Press, 2015.
  9. Song Minxian, Yang Ming. New Compendium of National Chinese Patent Medicines (2nd edition)[M]. Beijing: People’s Medical Publishing House, 2011.