A case study by Jonny Woodall
Introduction
Ulcerative Colitis (UC) is an autoimmune disease that is prevalent in around 1 of 420 people living in the UK. Both men and women are equally affected by UC.
The patient contacted me during a severe flareup. A flareup that was no longer responding to any pharmaceutical steroids. The patient told me that the NHS informed him the only option remaining was the surgical removal of parts of his colon and the fitting of a colostomy bag via a stoma. The patient said to me “I will kill myself before having that fitted, so if you have something different to offer then I’m interested”.
This case study is important to me to share for a number of reasons:
- This was one of the first patient’s I ever took on outside of university after graduating.
- The severity of the situation was intense and I remember feeling quite nervous about offering to help this patient.
- I learned a lot from the time I spent with this patient.
- It is a profound success story that has inspired how I formulated many a treatment plans after this patient.
Presentation & Case history
Male, 30. Seeking help for UC. Currently in a flareup. Visiting the toilet 20-30 times a day. Severe blood loss during bowel movements.
The patient had to interrupt our consultation numerous times to visit the bathroom.
UC started 3-4 years ago.
The patient has a constant feeling of dread. He has a history of horrific violent dreams that often include murder and pain. His most recent dreams involve seeing himself as a child screaming in a cauldron of hot fire and volcanic lava. Insomnia is a constant problem, including struggling to get to sleep and staying asleep.
He has a history of poor respiratory health. Claiming he had constant colds and chest infections as a child. He currently goes through repeated rounds of respiratory infections that leave him weak and needing to cough up phlegm. The phlegm is of a yellow/green colour. He uses an inhaler when needed to help with the ongoing effects of asthma.
He suffers with headaches when his UC is severe.
Hands and feet are described as always very hot.
The patient had an extremely dysfunctional childhood. Mother left father when patient was 1 and the patient didn’t see father again until he was in his twenties. Mother married a schizophrenic man and they both fell into patterns of severe mental illness, violence, drug and alcohol abuse, self harm and neglect of patient. Mother died of drug abuse when patient was a teenager which left him homeless until a family member saved him.
The patient has a long history of alcohol, cannabis and cocaine use. Describing himself as a “work hard, play hard” type of guy. He has to smoke cannabis every night before bed so he can fall asleep and switch off.
He can sometimes work (when not in a flareup) over 60 hours a week. Spending time off by visiting bars, house parties and lavish weekend breaks where he excessively consumes alcohol, cocaine, cannabis and tobacco.
Investigations
Pulse: 64
BP: 128/60
Tongue: Very red tip, dark red/purple sides and a thick covering all over the tongue. Yellow at the back and more white towards the front.
Hands: Patient’s hands were hot and sweaty.
Appearance: Patient looked pale, exhausted and unwell.
Diagnosis
Constitution: Hot / Excessive damp-heat
The patient is in a pattern of sympathetic excess with underlying depletion. Meaning he is stuck in a perpetuating stress response and losing resources (vitality). His flareups seem to coincide with excessive states of work and recreational substance consumption.
His systolic BP was probably a lot higher during states of activity or work. I suspect his diastolic score is currently a lot lower than it should be due to his exhausting flareup.
Approach to treatment
The roots of his illness stem from a traumatic and dysfunctional childhood. If the patient was to fill in the adverse childhood experiences (ACE) survey then his score will most likely be high. High ACE scores correlate with self-destructive behaviours and chronic health problems.
The patient needs help to unravel the experiences of his childhood and how his pattern of overworking and substance abuse are connected to his present-day inflammatory condition.
My suspicion was that the patient’s childhood was a prolonged chronic state of stress with very little intimacy, relaxation and joy. This pattern is now ingrained in his psyche as the norm where even as an adult with freewill he struggles to break the pattern of constant stress that he seems to induce with his choices.
The patient needs a treatment program that will help facilitate his nervous system to find balance whilst integrating childhood experiences. It is hoped his substance use will decrease as he feels confident to access a more innate vulnerability with his feelings.
The prescription needs to contribute to the movement of “fire” or inflammation. Simply providing an overall cooling prescription will not move the heat out of this patient with the resulting psyco-spiritual breakthroughs needed for integration. This is performed with dispersive herbs that help stimulate the blood from the core to the periphery.
Treatment Dynamics:
- Astringent herbs will help with congestion, phlegm, excess mucus and the current UC flareup.
- Tonics will restore vitality and provide the patient resources with which to approach life changes.
- Dispersive circulatory stimulants will help move the blood, providing a change to inflammation dynamics.
- Anxiolytics, nervines and hypotensives will bring in a much needed sense of calm so the patient can discover how to operate without the need to be stuck in a perpetual stress response.
- Nootropic herbs help the limbic system process past memories.
First prescription
| Tincture | ml | Energetics |
|---|---|---|
| Centella asiatica | 25 | Warming, anxiolytic, ANS balancing, nootropic |
| Schisandra chinensis | 15 | Warming, Moves the “fire”, healing tonic |
| Achillea millefolium | 10 | Neutral, circulatory stimulant, astringent |
| Rosmarinus officinalis | 5 | Warming, aromatic, integration, nootropic |
| Borago officinalis | 15 | Cooling, tonic, flexibility in movement |
| Tilia x europaea | 25 | Cooling, nervine, helpful for childhood trauma |
| Lavandula angustifolia | 10 | Cooling, hypotensive, resolves damp |
| Total (per month) Total (per week) Total (per day) | 420 105 7.5 x 2 |
| Powder | g |
|---|---|
| Matricaria recutita | 20 |
| Ulmus fulva | 40 |
| Melissa officinalis | 10 |
| Filipendula ulmaria | 20 |
| Curcuma longa radix | 10 |
| Total | 100 |
| Dosage | 1 teaspoon 2-3x per day as tolerated |
Treatment plan
The patient was prescribed a tincture to take morning and evening as well as a powder formulated for gastrointestinal inflammation.
Advised to stop all coffee, decaf, caffeinated tea, tobacco and alcohol. Agreed with the patient that staying on cannabis to help with sleep was probably needed until the patient felt better.
I pointed out to the patient that working more than 40 hours a week for most people without a debilitating condition will lead to illness and exhaustion. The patient seemed dismissive to this, whilst also acknowledging that he has lots of ideas about doing fun things with his spare time yet struggles to act on them.
He agreed to reflect on working less, partying less and trying to give himself permission to do things on his own that don’t involve substances.
Other medication and treatments
- Patient consumes 4-5 tablespoons of coconut oil per day.
- 1 tablespoon of L-Glutamine powder
- 1 teaspoon of Vitamin C
- A multivitamin daily
- No pharmaceutical medication
Follow-up appointments
The patient called me 2 days into the treatment to tell me that he is constipated and hasn’t gone to the toilet since the day before. He is complaining of spasms in his gut that feel different to the standard UC flareup pains he is used to. In my opinion this rapid alteration in symptoms was reflective of the medicine working. Sometimes patients can experience a sudden drastic spasm in smooth muscle early into treatment which I suspect is an internal protective mechanism at play. It usually resolves within 3-7 days once the patient trusts the process unfolding. Advised to drink Matricaria recutita (Chamomile) tea until constipation resolves.
1st Follow up (1 month): Patient says he is “feeling great”. Currently visiting the toilet approximately 10 times per day with a significant reduction in blood loss. Feels like he has improved a lot since the first consultation.
Still producing lots of phlegm and chest is feeling tight.
Cocaine and alcohol consumption is much lower. Still using cannabis at night to get to sleep.
BP: 120/80 (Was 128/60)
Pulse: 60 (Was 64)
Hands and feet: Still hot
The patient states that his nightmares and dreams have changed. Still very intense but now involve more friends and family in other situations that don’t involve murder, violence and aggression. It is interesting to note a recent dream in which he met with his dead mother and asked her to stop following him around everywhere he goes.
We spoke further about his substance abuse to which he replied that he can’t imagine life is very exciting without them. Acknowledges that this belief is problematic.
2nd Follow up (2 months): The patient had just returned from a working trip abroad. Stated that he felt good whilst abroad and was surprised at how well he handled the experience.
Patient visiting toilet 5-10 a day. With further reduction in blood loss during bowel movements. Energy levels good.
He acknowledges how damaging his alcohol and drug habits have been and makes a decision to stop using all drugs, alcohol, tobacco and even cannabis before bed.
The patient spent time discussing how addictive he can be with work, parties, relationships and substances. Many romantic connections end up becoming abusive. Patient making connections with childhood experiences.
3rd Follow up (3 months): Patient is exhausted. He has spent the past month free of all substances and is struggling to sleep. We spent most of the consultation discussing his feelings around having no purpose in life.
Still visiting toilet 5-10 times a day but with minimal blood loss and very little mucus.
Prescribed a sleep mix alongside treatment protocol.
4th Follow up (4 months): The patient found the sleep mix very helpful.
Now experiencing days with healthy, normal bowel movements. Noticing that he needs to start bringing in more free time and fun. Decides to start climbing as a recreational sport.
Believes that only 40% of stools now have a small amount of blood in them.
His respiratory health has greatly improved with significantly less phlegm, coughing or infections now bothering him.
Follow-up prescriptions – with rationale for changes
1st Follow up (1 month):
| Tincture | ml | Energetics |
|---|---|---|
| Centella asiatica | 25 | Warming, anxiolytic, ANS balancing, nootropic |
| Schisandra chinensis | 20 | Warming, Moves the “fire”, healing tonic |
| Achillea millefolium | 15 | Neutral, circulatory stimulant, astringent |
| Rosmarinus officinalis | 10 | Warming, aromatic, integration, nootropic |
| Borago officinalis | 15 | Cooling, tonic, flexibility in movement |
| Tilia x europaea | 20 | Cooling, nervine, helpful for childhood trauma |
| Lavandula angustifolia | 10 | Cooling, hypotensive, resolves damp |
| Salvia triloba | 20 | Nootropic, helpful for addictions |
| Arctium lappa radix | 15 | Cooling, depurative, liver heat |
| Total (per month) Total (per week) Total (per day) | 450 150 7.5 x 2 |
I use Salvia triloba specifically for addictions.
Arctium lappa radix is specific for liver heat and reducing inflammation.
2nd Follow up (2 months):
| Tincture | ml | Energetics |
|---|---|---|
| Centella asiatica | 20 | Warming, anxiolytic, ANS balancing, nootropic |
| Schisandra chinensis | 15 | Warming, Moves the “fire”, healing tonic |
| Achillea millefolium | 15 | Neutral, circulatory stimulant, astringent |
| Verbena officinalis | 15 | Cooling, astringent, diffusive |
| Borago officinalis | 10 | Cooling, tonic, flexibility in movement |
| Tilia x europaea | 20 | Cooling, nervine, helpful for childhood trauma |
| Lavandula angustifolia | 10 | Cooling, hypotensive, resolves damp |
| Salvia triloba | 20 | Nootropic, helpful for addictions |
| Arctium lappa radix | 15 | Cooling, depurative, liver heat |
| Total (per month) Total (per week) Total (per day) | 450 150 7.5 x 2 |
Swapped Rosmarinus for Verbena. Verbena is a liver remedy and nervine.
3rd Follow up (3 months):
| Tincture | ml | Energetics |
|---|---|---|
| Centella asiatica | 20 | Warming, anxiolytic, ANS balancing, nootropic |
| Ocimum sanctum | 20 | Warming, aromatic, mood enhancer, nootropic |
| Achillea millefolium | 15 | Neutral, circulatory stimulant, astringent |
| Verbena officinalis | 10 | Cooling, astringent, diffusive |
| Agrimonia eupatoria | 15 | Cooling, astringent |
| Tilia x europaea | 20 | Cooling, nervine, helpful for childhood trauma |
| Plantago lanceolata | 20 | Cooling, astringent, anti-inflammatory |
| Salvia triloba | 15 | Nootropic, helpful for addictions |
| Arctium lappa radix | 15 | Cooling, depurative, liver heat |
| Total (per month) Total (per week) Total (per day) | 450 150 7.5 x 2 |
Sleep mix:
| Tincture | ml |
|---|---|
| Scutellaria lateriflora | 20 |
| Melissa officinalis | 30 |
| Avena sativa seed | 30 |
| Piscidia erythrina | 20 |
| Total Dosage (before bed) | 100 7.5 |
4th Follow up (4th month):
| Tincture | ml | Energetics |
|---|---|---|
| Centella asiatica | 20 | Warming, anxiolytic, ANS balancing, nootropic |
| Rosa damascena | 20 | Cooling, resolution of emotional turmoil |
| Achillea millefolium F.E. | 10 | Neutral, circulatory stimulant, astringent |
| Filipendula ulmaria | 15 | Cooling, astringent, GIT anti-inflammatory |
| Agrimonia eupatoria | 15 | Cooling, astringent |
| Tilia x europaea | 20 | Cooling, nervine, helpful for childhood trauma |
| Plantago lanceolata | 20 | Cooling, astringent, anti-inflammatory |
| Hypericum perforatum | 15 | Nootropic, helpful for addictions |
| Arctium lappa radix | 15 | Cooling, nervine, moodlifter, transformation |
| Total (per month) Total (per week) Total (per day) | 450 150 7.5 x 2 |
Final outcome
The patient stopped treatment after 12 months. Moving to a different country to take on a new job in an industry he had longed to explore since he was a child. He recognised the importance of following his childhood dreams as a means to bring further balance, purpose and meaning to his life.
He still remains to this day relatively healthy, considering he still enjoys pushing himself with his work. The big difference is that he now enjoys time off, taking holidays to explore the country he has moved to and engaging in further self-development and healing programs. He is mostly now in complete remission although he can still rarely have small flareups, but he states they are minor, short-lived and easily solved by listening to his body. Preferring to book an acupuncture session, spa day or relaxing weekend to help calm him down.
During our final consultation we deeply explored the patient’s connection with his mother, the feelings of intense anger he now acknowledges he had towards her and how they fuelled his condition. The patient could truly acknowledge, feel, understand, reflect and contemplate his childhood experiences with a level of mature integration that reflected the healing process. One of the final sentences he shared was how he recognised that he had come to terms with an inner hatred of women that he knew was part of his need to choose self-destructive relationships with people, particularly with women. This was a very poignant discussion that gave me lots to reflect on with how traumatic childhoods can fuel social and romantic connections as adults.
One year after I last consulted with the patient he contacted me to say he had taken part in a weekend retreat involving psychoactive plant medicine. During the medicine experience the patient was taken back into his mother’s womb as a growing baby, where he re-lived traumatic events that his mother was going through whilst pregnant. He stated that he felt like the medicine managed to take him to another level of integration with his past and a forgiveness was finally coming through. His social connections with women have since dramatically improved with healthier boundaries, compassion, trust and a reduction in destructive behaviours. He feels liberated from his original condition and is in his own words, “unrecognisable” from the man who originally contacted me.