BOTH Crohn's disease and ulcerative colitis are commonly referred to herbal medicine, writes JACQUI HAZZARD. What causes them is unclear, although research is constantly shedding more light on each of the disease processes. A medical herbalist, working in consideration of research findings, will attempt to support the body's coping mechanisms, to relieve symptoms and to strengthen the patient's vitality.

Usually when a patient first refers to me, he or she is already on high doses of orthodox medicine such as prednisolone (steroid) or salazapyrin (anti-inflammatory). Both of these drugs do seem to temper symptoms but carry side-effects unacceptable to the patient. Over time, we are generally able to reduce the amount of orthodox medicine that needs to be taken, thereby lessening the side-effects.

It is important that patients with inflammatory bowel disease continue to be monitored by their gastro-enterologists and my work is complementary to that approach.

In ulcerative colitis and Crohn's, any attempt to improve the diet must allow for the fact that these patients often find it difficult to take high fibre foods such as beans, pulses, or raw fruit and vegetables - the very foods high in the nutrients we all need to maintain good health.

Patients are encouraged to increase gentle fibre foods such as porridge oats with oatbran sprinkled over, lightly steamed fruits and vegetables, nuts and seed spreads, fruit and vegetable juices, soups and

easily digested sources of protein such as tofu. Many naturopathic practitioners associate food sensitivities and intolerance with exacerbation of inflammatory bowel disease. Often patients are willing to try elimination diets centred around cutting out a particular food group such as dairy products, or wheat products, for a number of months to see if avoidance benefits their symptoms.

As well as recommending that patients cut out coffee, cola drinks, and alcohol; hot, spicy foods, or rich fatty foods cause problems for many people.

Because both of these conditions cause bleeding into the bowel, it is important to guard against anaemia. I often prescribe a non-constipating, easily assimilated iron supplement. Similarly, lesions on the bowel wall can affect the production of essential nutrients such as folate and B12 and therefore supplementation should be considered.

As with other inflammatory conditions affecting body tissues, UC and Crohn's seem to benefit from a good intake of essential fatty acids found in cold pressed vegetable oils. It is possible to take these as

supplements, but simply taking a teaspoon of sunflower oil a day will be beneficial.

Inflammatory bowel diseases seem sensitive to stress and this may precede a flare in the condition. Tai chi, yoga, or meditation are all enjoyable activities that can reduce stress.

When it comes to exercise, many patients note that their physical stamina is lessened, probably due to the effort the body employs in coping with a chronic illness.

Therefore any plans should not be too exertive, but enough to maintain good tone and circulation. Walking or gentle swimming come to mind. The herbalist's approach to both Crohn's and ulcerative colitis centres around attempting to stop bleeding, easing inflammation, increasing circulation to the bowel and supporting the immune function.

The patient is usually given a prescription containing concentrated extracts of several herbs individual to their presentation. Herbs such as chamomile (Chamomilla recutita), marigold (calendula officinalis), astragalus (astragalus membranous) and yarrow (achillea millefolium) are all useful for various symptom patterns.

One of the most troublesome symptoms of the disease is very frequent, loose bowel movements. I find a combination of a powdered tree bark called Slippery Elm and the powdered husk of psyllium seeds very useful if taken as a drink at night, enabling a patient to have only one to two bowel movements a day. This enhances the patient's quality of life immensely.

I receive a lot of referrals of patients with inflammatory bowel disease from Bernard King, a Glasgow-based acupuncturist. Through our experience gained in working together with patients, we both feel that herbal medicine and acupuncture form an excellent combined complementary approach to the disease process.

Herbal medicine's strengths lie in its ability to address symptoms of the disease while supporting the whole health of the patient.

Acupuncture works subtly but definitely to increase the patient's stamina and ability to withstand the burden of a chronic illness.