Fourty-six cases of US were out-patients and in-patients who were diagnosed a ccording to the diagnostic criteria established by National Academic Conference on Digestive System Diseases held in Taiyuan, 1993[3], and were randomly divided into two groups: moxibustion with herbal medicine underneath (designated below as moxibustion) group and the SASP group. Differentiation of symptoms and signs by TCM was classified according to the criteria described in “Internal Medicine” edited by Shanghai College of TCM. The moxibustion group was made up of 30 cases, including 16 males and 14 females, mean age of 38.75 years (25-63). The course of illness ranged from 5 mo to 18 years. The control group comprised 16 cases, including 9 males and 7 females with a mean age of 37 years (27-69), the course of illness ranged from 4 mo to 17 years.

Method in the moxibustion group Selection of acupoints: The main acupoints of the two groups: Zhongwan (RN 12), Qihai (RN 6) and Zusanli (ST 36 Bilateral); Dachangshu (BL 25 bilateral), Tianshu (ST 25, bilateral), and Shangjuxu (ST 37, bilateral) were used alternately. Auxiliary acupoints was added to different clinical types: Pishu (BL 20) for deficiency of Spleen and Stomach; Shuifen (RN 9) for accumulation of damp-heat Ganshu and Pishu for stagnancy of Liver-qi and deficiency of Spleen; Guanyuan (RN 4) for deficiency of both Spleen-yang and the Kidney-yang, Zhongzhu (KI 15) for constipation and Yinbai (SP 1) for pus and bloody stool. Preparation of medicinal pads for moxibustion: Radix Aconiti Praeparata, Cortex Cinnamomi, Radix Salviae Miltiorrhizae, Flos Carthami, Radix Aucklaudiae, Rhizoma Coptidis, etc. were respectively ground into fine powder and stored for use. Rhizoma Coptidis, Radix Salviae Mitiorrhizae and Flos Carthami were used as main ingredients for the type of accumulation of damp-heat, supplemented with an appropriate amount of Radix Aucklandiae; Radix Aconiti Pracparata was used as the main ingredient for other types of the syndrome, supplemented with a suitable amount of Cortex Cinnamomi, Flos Carthami, Radix Salviae Miltiorrhizae and Radix Acucklandiae. Each medicinal pad contained herbal powder 2.5 g which was mixed up with rice wine 3 g to make paste. The paste was then made into pads of 2.3 cm in diameter and 0.5 cm in thickness.

Method of moxibustion Mugwort floss was made into moxacones, each being 2.1 cm in base diameter, 2 cm in height, and about 2 g in weight, which were then placed on the medicinal pads and ignited. For deficiency of spleen and stomach, 3 moxacones were used for each acupoint; for the type of accumulation of damp-heat, 2 cones were used for Dachangshu (BL 25), Tianshu (ST 25), Zhongwan (CV 12), Qihai (CV 6) and 4-7 cones for Zusanli (ST 36) and Shangjuxu (ST 37) until a strong warm sensation was felt by the patient; for stagnancy of liver-qi and deficiency of spleen, 3 cones were needed; for deficiency of both spleen-yang and kidney-yang, 3 cones were needed for the main acupoints and 4-7 cones for the auxiliary acupoints; for constipation, 2 cones were used on Zhongzhu (KI 3) and one cone was used on Tianshu (ST 25); and for serious pus and bloody stool, 4-7 moxacones were needed on Yinbai (SP 1). The treatment was given once daily, 12 treatments constituting a therapeutic course with an interval of 3 d between each two courses. After 5 courses of treatment the results were analyzed.

Method in the control group Patients were given Salicylazos ulfapyridine 1 g each time, 4 times a day at the beginning, and 0.5 g each time, 4 times daily in the convalescent period. After 3 mo of treatment the results were analyzed.

Clinically cured: clinical symptoms and signs disappeared, and colomoscopy showed disappearance of ulceration of colonic mucosa without recurrence after follow-up for 6 mo. Improved: symptoms and signs ameliorated significantly, colonoscopy indicated amelioration of mucosal pathological changes. Ineffective: Clinical symptoms, signs and colonoscopy showed no sig nificant difference before and after treatment.

Pathological observation of colonic mucosa All specimens were taken from the most masked region or the edge of mucosal ulceration during colonoscopy. Three specimens were obtained in each patient, fixed with formalin, embedded in paraffin and sectioned, followed by H.E staining and pathologic observation.

AB-HID and AB-PAS methods were used for the staining.

Seventeen patients were clinically cured, 12 were improved and one was ineffective, which made up 56.66%, 40.00%, and 3.33% respectively in the moxibustion group. In the control group, 5 patients were clinically cured, 7 improved and 4 ineffective, which accounted for 31.25%, 43.75%, 25.00% respectively. The cure rate in the moxibustion group was superior to that in the control group (P < 0.01).

Thirteen patients with active UC were taken as the subjects for histopathologic analysis in this study.

Pathological changes before treatment The mucosa showed non-specific inflammation. The lamina propria showed hyperemia and edema with a great number of plasma cells, lymphocytes, mononuclear cells, neutrophils and eosinophils infiltration. The goblet cells in the body of the gland reduced in various extent, even disappeared, and replaced by columnar cells (Figure 1, Figure 2, Figure 3). Vacuoles, could be seen in the distal region of the nucleus (Figure 2). No mucin was present in the vacuoles. The lumen of gland became dilated, irregular or branched in some lesions, some regions were neplaced by immature glandulas body of smaller volume. The neutrophilic infiltration was present in the inter-epithelial cells in majority of sections. Most of sections showed crypt abscesses (Figure 3), abscesses near crypts and ulceration of the mucosa. The amount of mucin in the body of the gland of the colonic mucosa in all patients decreased or decreased remarkably. As to the change of the mucin characteristic, most of the acid mucins in the body of gland disappeared (Figure 4). Most of AB-PAS staining was negative, mucin sulfate in the body of gland disappeared (Figure 5). HID-AB staining became hypochromatic. As the mucin in the body of gland decreased, the amount of neutral mucin increased relatively (Figure 6).

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Figure 1 The colonic mucosa shows hyperemia, edema and inflammatory cell infiltration. The goblet cells in the body of gland decrease remarkably, which are composed of columnar cells.

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Figure 2 The lesion is the same as above. The arrowhead shows an infranuclear vacuole.

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Figure 3 The lesion is the same as above. The arrowhead shows a crypt abscess. H.E. × 100

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Figure 4 The majority of acid mucin in the body of gland disappear. AB-PAS staining × 100

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Figure 5 The majority of mucin sulfate in the body of gland disappears. HID-AB staining × 100

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Figure 6 The mucin in the body of gland decre ases. The amount of neutral mucin relatively increases (arrowhead). AB-PAS staining × 100

Changes after moxibustion treatment The mucosal inflammatory lesions in the majority of sections from the 13 patients with active UC abated remarkably. No hyperemia and edema were seen. Inflammatory cell infiltration decreased. In the majority of sections, neutrophil infiltration disappeared. Crypt abscesses, abscesses near crypts and ulceration of the mucosa were not seen. The reduction of the goblet cells in the body of gland was not obvious (Figure 7). The amount of mucin in the body of gland was almost normal. AB-PAS staining showed no obvious reduction in acid mucin (Figure 8). HID-AB staining showed no reduction in mucin sulfate (Figure 9).

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Figure 7 The colonic mucosa shows mild hyperemia, with less mucosal inflammatory cell infiltration. The goblet cells in the body of gland show no reduction. H.E. × 100

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Figure 8 The reduction of acid mucin is not obvious. AB-PAS staining × 100

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Figure 9 No reduction of mucin sulfate occurs. HID-AB staining × 100

The occurrence and severity of the main pathologic lesions before and after treatment (Table 1, Table 2).