ULCERATIVE COLITIS

Copyright Giovanni Maciocia

Ulcerative colitis is a type of inflammatory bowel disease (IBD) that affects the lining
of the large intestine (colon) and rectum. Crohn's disease is a related condition.

The cause of ulcerative colitis is unknown. People with this condition have an
autoimmune disease, but it is not clear whether immune problems cause this illness.

Ulcerative colitis may affect any age group, although there are peaks at ages 15 - 30
and then again at ages 50 - 70.

The disease can begin the rectal area, and may involve the entire large intestine over
time. It may also start in the rectum and other parts of the large intestine at the same
time.

Risk factors include a family history of ulcerative colitis, or Jewish ancestry.

Symptoms
The symptoms vary in severity and may start slowly or suddenly. About half the patients only
have mild symptoms. Others have more severe attacks that occur more often. Many factors
can lead to attacks, including respiratory infections or physical stress.

Symptoms include:

Abdominal pain and cramping

Abdominal sounds (gurgling or splashing)

Blood and mucus in the stools

Diarrhea, from only a few episodes to very often

Fever

Tenesmus (rectal pain)

Weight loss

Children's growth may slow.

Other symptoms that may occur with ulcerative colitis include the following:

Gastrointestinal bleeding

Joint pain and swelling

Mouth ulcers

Nausea and vomiting

Skin lumps or ulcers

Signs and tests

Colonoscopy with biopsy is generally used to diagnose ulcerative colitis.

Colonoscopy is also used to screen people with ulcerative colitis for colon cancer. Ulcerative
colitis increases the risk of colon cancer. Anyone with this condition, should be screened with
colonoscopy about 8 - 12 years after being diagnosed and then have follow-up colonoscopies
every 1 - 2 years.
Other tests that may be done to help diagnose this condition include:

Barium enema

Complete blood count (CBC)

C-reactive protein (CRP)

Sedimentation rate (ESR)

Colonoscopy

Treatment

The goals of treatment are to:

Control the acute attacks

Prevent repeated attacks

Help the colon heal

MEDICATIONS

Medicines that may be used to decrease the number of attacks include:

• 5-aminosalicylates such as mesalamine or sulfazine (Azulfidine), which can help control

moderate symptoms

• Immunomodulators such as azathioprine (Imuran ) and 6-mercaptopurine

• Corticosteroids (prednisone and methylprednisolone) taken by mouth during a flare-up or as

a rectal suppository, foam, or enema

• Adalimubab (Humira ) (anti TNF medication), Infliximab (Remicade ).

SURGERY

Surgery to remove the colon will cure ulcerative colitis (!!) and removes the threat of
colon cancer. Surgery is usually recommended in:

Colitis that does not respond to complete medical therapy

Changes in the lining of the colon that are thought to be precancerous

Serious complications such as rupture perforation of the colon, severe bleeding, or

toxic megacolon

Most of the time, the entire colon, including the rectum, is removed (total
proctocolectomy with ileostomy). Afterwards, one needs an ileostomy.
 ULCERATIVE COLITIS IN CHINESE MEDICINE

Obviously, there is no category of “ulcerative colitis” in the original texts. In

Chinese medicine, ulcerative colitis might correspond to various categories of
disease:

Dysentery 痢 疾
Diarrhoea 泄 泻
Blood in the stools 便 血
Intestinal Wind 肠 风
Intestinal Pi masses 肠 癖

AETIOLOGY
External pathogenic factors
Cold easily invades the intestines but the two most likely external pathogenic
factors are Heat and Dampness.

Irregular diet
Excessive consumption of greasy foods, sugars and dairy foods. Also excessive
consumption of spicy foods and alcohol.
Emotional stress
Emotions that lead to Qi stagnation may affect the Intestines. It is not only Liver-Qi
stagnation that affects the Intestines but also Spleen-Qi stagnation and Stomach-Qi
stagnation.
Qi stagnation may lead to Blood stasis which often plays a role in ulcerative
colitis. Also, Qi stagnation contributes to the formation of Phlegm which may also
play a role in UC.

Stomach and Spleen deficiency

A deficiency of Stomach and Spleen deriving from a chronic illness or overwork is
very often at the root of the development of UC.

Latent Damp-Heat
Latent Damp-Heat forms after an invasion of external pathogenic factors that does
not cause immediate symptoms. The formation of Latent Damp-Heat is more
common at the end of summer. This is often the Chinese correspondent to the
autoimmune aspect of UC.
PATHOLOGY
Deficiency of Stomach and Spleen
A deficiency of Stomach and Spleen is practically always a factor in the development of
UC. Spleen deficiency itself may be a cause of the diarrhoea. Spleen deficiency may
also cause bleeding.

Dampness (Damp-Heat)
In my experience, in UC there is always Dampness and especially Damp-Heat.
Dampness obstructs the Intestines and may also cause diarrhoea by itself.

Qi stagnation
Qi stagnation is also nearly always present in UC. It causes borborygmi and distension.

Blood stasis
Blood stasis may develop from Qi stagnation and it causes intense pain.

Toxic Heat
Toxic Heat may develop from Damp-Heat and it is present in acute cases or in flare-ups
of chronic cases.

Blood Heat
Blood Heat may also develop from Damp-Heat and it causes bleeding.
PATHOLOGY OF “INTESTINES”
Three things to clarify. Firstly, Qi stagnation can affect almost any organ, not just
the Liver. For example, it affects Lungs, Heart, Stomach, Spleen, Gall-Bladder and
the “Intestines”.
Secondly, in many pathological conditions of the digestive system, in my
experience, one cannot really differentiate the Small from the Large Intestine: this is
due to the close anatomical connection between ileum and colon. Please note that I
am referring to digestive-system conditions as the Small Intestine may be involved in
other symptoms such as urinary conditions.
Thus, when a digestive-system pathology is in in the Intestines, the patterns
involved (Qi stagnation, Blood stasis, Damp-Heat, Toxic Heat) usually affect both
Small and Large Intestine.

Ileum
Thirdly, a pathology of the Stomach is very often associated with the same pathology
in the Large Intestine. This happens especially with Yin Xu and Dampness. This is
because the Stomach and Large Intestine are connected through the Yang Ming

STOMACH
YANG
MING
LARGE
INTESTINE

This is reflected also on the pulse if you put the Large Intestine on the right Chi
position (as I do).

Damp-Heat in ST and LI Yin Xu of ST and LI

 DEFICIENCY OF YIN OF STOMACH AND INTESTINES

Yang Ming = Stomach and Large Intestine.

A Yin deficiency of the Stomach often affects the Large Intestine too, although
we do not have a syndrome called “Yin deficiency of Stomach and Large
Intestine”.
The association between a pathology of the Small Intestine with that of the Large
Intestine is reflected in pulse diagnosis with a pulse that is abnormal in both Chi
positions.

Wiry on both Chi positions = Qi stagnation (or Blood stasis) in Intestines

Slippery on both Chi positions = Dampness in Intestines

It follows that the treatment outlined for ulcerative colitis may apply also to
Crohn’s disease, even though this is different from the biomedical point of view
(Crohn’s disease may affect the whole digestive system from mouth to anus).

NOTE: if both Chi are weak and deep, it is a KI deficiency

Yao Cheng Wen, A Vernacular Explanation of the Discussion on Stomach and
Spleen Pi Wei Lun Bai Hua Jie, Three Qin Publishing House, Xian, 2002, p. 206.
Citing Acupuncture Channels of the Yellow Emperor Huang Di Zhen Jing 黄 帝
针 经.

“The Large Intestine and the Small Intestine pertain to the Stomach Yang Ming.
The point of the Small Intestine is ST-39 Xiajuxu and that of the Large Intestine is
ST-37 Shangjuxu, both below ST-36 of the Stomach Yang Ming. The Large
Intestine controls the Jin fluids and the Small Intestine the Ye fluids. The Small and
Large Intestine receive Ying Qi from the Stomach and send the Jin-Ye fluids to the
Upper Burner where they irrigate the skin and hair and fill the Cou Li space.”

Practically the same quote is in chapter 2 of the Ling Shu.

What this quote is saying is that the Small and Large Intestine, in the field of
digestive disease, come under the sphere of influence of the Stomach. It also
confirms the importance of ST-39 and ST-37 for intestinal diseases. Note the
location of ST-37 and ST-39 in relation to ST-40: the former is above it and the
latter below. ST-40 is the Luo point and the Great Luo of the Stomach is called Xu
Li 虚 里. The names of ST-37 and ST-39 could be related to this: “above the
great emptiness” and “below the great emptiness” (or “void”).
 XU LI

...
ST-37 Shangjuxu- Upper Great Void
ST-40
ST-39 Xiajuxu- Lower Great Void

The Small and Large Intestine are different than other organs in so far as the their
channels have a physiology and pathology that is quite distinct from that of their
organs (the Triple Burner is also like this).
Essential points for ulcerative colitis ACUPUNCTURE
ST-25 Tianshu
BL-25 Dachangshu
ST-37 Shangjuxu
..
ST-39 Xiajuxu

Points for Damp-Heat

Upper Burner: LI-6 Pianli
.. ..
Middle Burner: Ren-9 Shuifen, Ren-12 Zhongwan
Lower Burner: ST-28 Shuidao, Ren-5 Shimen, BL-22 Sanjiaoshu, SP-9
Yinlingquan, SP-6 Sanyinjiao.

Points for Blood stasis

SP-4 Gongsun and P-6 Neiguan (Chong Mai), KI-14 Siman, ST-29 Guilai, ST-30
Qichong, SP-10 Xuehai, BL-17 Geshu, LIV-3 Taichong.

Points to tonify Stomach and Spleen

Ren-12 Zhongwan, BL-20 Pishu, BL-21 Weishu, ST-36 Zusanli.

Points for Toxic Heat (in addition to Damp-Heat points)

LI-11 Quchi, P-3 Quze, P-8 Laogong, LIV-2 Xingjian.
 IDENTIFICATION OF PATTERNS AND TREATMENT
1) TOXIC HEAT
Acute episode or re-activation of chronic disease, severe abdominal pain, diarrhoea
with mucus and blood, pain alleviated by defecation, tenesmus, possibly fever,
thirst, irritability.
Tongue: red with thick-yellow coating, red points.
Pulse: Rapid-Wiry-Overflowing.

Treatment principle
Clear Heat, resolve Toxin, cool Blood, stop diarrhoea.

Prescription
Bai Tou Weng Tang Pulsatilla Decoction

Bai Tou Weng Radix Pulsatillae

Huang Lian Radix Coptis
Huang Bo Cortex Phellodendri
Qin Pi Cortex Fraxini
2) DAMP HEAT
Chronic condition, abdominal pain, foul-smelling diarrhoea with mucus and blood,
pain alleviated by defecation, tenesmus, borborygmi, rectal pain and burning in
anus, possibly fever, thirst, irritability, scanty-dark urine.
Tongue: red with thick-sticky-yellow coating.
Pulse: Rapid-Slippery.

Treatment principle
Clear Heat, resolve Dampness, cool Blood, stop diarrhoea.

Prescription
Ge Gen Qin Lian Tang Pueraria-Scutellaria-Coptis Decoction

Ge Gen Radix Puerariae

Huang Lian Radix Coptis
Huang Qin Radix Scutellariae
Gan Cao Radix Glycyrrhizae
3) STOMACH AND SPLEEN DEFICIENCY
Chronic condition, chronic diarrhoea with mucus that may be mixed with blood, dull
abdominal pain that is aggravated by diarrhoea, tiredness, poor appetite, abdominal
distension, desire to lie down.
Tongue: Pale.
Pulse: Weak.

Treatment principle
Tonify Stomach and Spleen, resolve Dampness, stop diarrhoea.

Prescription
Xiang Sha Liu Jun Zi Tang Aucklandia-Amomum Six Gentlemen Decoction

Mu Xiang Radix Aucklandiae

Sha Ren Fructus Amomi
Dang Shen Radix Codonopsis
Bai Zhu Radix Atractylodis
Fu Ling Poria
Chen Pi Pericarpium Citri reticulatae
Ban Xia Rhizoma Pinelliae preparatum
Zhi Gan Cao Radix Glycyrrhizae preparatum
 4) BLOOD STASIS
Chronic condition, chronic diarrhoea, small amount of mucus in stools, dark stools,
stabbing abdominal pain, dark complexion, dark rings under eyes.
Tongue: Purple.
Pulse: Wiry both Chi, Firm in general or Choppy in general.

Treatment principle
Move Qi, invigorate Blood, resolve Dampness.

Prescription
Shao Fu Zhu Yu Tang Dispelling Stasis in the Lower Abdomen Decoction

Dang Gui Radix Angelicae

Pu Huang Pollen Typhae
Chi Shao Radix Paeoniae rubra
Wu Ling Zhi Excrementuym Trogopterii
Mo Yao Resina Commiphorae Myrrhae
Rou Gui Cortex Cinnamomi cassiae
Chuan Xiong Radix Chuanxiong
Yan Hu Suo Rhizoma Corydalis
Xiao Hui Xiang Fructus Foeniculi
Gan Jiang Rhizoma Zingiberis
Prescription
Ge Xia Zhu Yu Tang Dispelling Stasis below the Diaphragm Decoction

Dang Gui Radix Angelicae

Chi Shao Radix Paeoniae rubra
Wu Ling Zhi Excrementuym Trogopterii
Chuan Xiong Radix Chuanxiong
Yan Hu Suo Rhizoma Corydalis
Tao Ren Semen Persicae
Hong Hua Flos Carthami
Wu Yao Radix Linderae
Mu Dan Pi Cortex Moutan
Zhi Ke Fructus Aurantii
Xiang Fu Rhizoma Cyperi
Gan Cao Radix Glycyrrhizae
HERBS FOR MODIFICATIONS

Astringent, stop diarrhoea

Qian Shi Semen Euryales ferocis

Pao Jiang Rhizoma Zingiberis officinalis preparatum
He Zi Fructus Terminaliae chelubae

NOTE: using astringent herbs to stop diarrhoea is not advisable in acute

inflammation with diarrhoea, mucus and blood: this is treated by clearing Heat and
resolving Dampness. Astringing can be used when we are treating the Root, i.e.
tonifying the Spleen.

Treating diarrhoea by purgation

Da Huang Radix et Rhizoma Rhei

Ma Chi Xian Herba Portulacae oleraceae
Hu Zhang Radix et Rhizoma Polygoni cuspidati

NOTE: this method is used for acute inflammation with mucus and blood and with
tenesmus.
Stopping bleeding

Xian He Cao Herba Agrimoniae

San Qi Radix Notoginseng (also stop bleeding)
Qian Cao Gen Radix Rubiae cordifoliae (also stop bleeding)
Di Yu Radix Sanguisorbae (also stop bleeding)

NOTE: the method of stopping bleeding is particularly applied when there is more
blood than mucus. In order to stop bleeding must always treat the Root, i.e.
clearing Heat, cooling Blood, draining Dampness and stopping bleeding or
tonifying Qi. Which means that there must be also herbs that clear Heat such
Huang Qin or Huang Lian.
 TREATMENT OF BLEEDING

1. HARMONIZE BLOOD

a) Stop bleeding

Xian He Cao, Qian Cao Gen, San Qi

a) Calm Blood
Bai Shao, Sheng Di Huang, Han Lian Cao, Mu Dan Pi
c) Invigorate Blood
Chuan Xiong, Yan Hu Suo, etc.
d) Nourish Blood
Dang Gui, Shu Di Huang, Bai Shao
 2. TREAT THE ROOT CAUSE
a) Clear Heat and drain Fire
Shan Zhi Zi Fructus Gardeniae jasminoidis, Shi Gao Gypsum,
Huang Qin Radix Scutellariae, Huang Lian Radix Coptidis
b) Clear Heat and cool Blood
Sheng Di Huang Radix Rehmanniae, Chi Shao Radix Paeoniae
rubra, Mu Dan Pi Cortex Moutan
c) Cool Blood, Clear Empty Heat (Blood Empty Heat)
Qing Hao Herba Artemisiae apiaceae, Han Lian Cao
Herba Ecliptae
d) Cool Blood, clear Heat, resolve Dampness (Damp-Heat)
Huang Bo Cortex Phellodendri
e) Tonify Qi (Qi deficiency)
Huang Qi Radix Astragali membranacei

f) Tonify Qi and nourish Yin (Qi and Yin deficiency)

3. ASTRINGE
Shan Zhu Yu Fructus Corni officinalis, Bai Shao Radix Paeoniae alba, Di
Yu Radix Sanguisorbae

4. TREAT QI
a) Tonify and Firm Qi (Huang Qi Radix Astragali, Ren Shen
Radix Ginseng, Mu Li Concha Ostrae)
b) Raise Qi (Sheng Ma Radix Cimicifugae, Huang Qi Radix
Astragali, Chai Hu Radix Bupleuri)
c) Make Qi descend (Niu Xi Radix Achyranthis)
 1) Treat Root
QING RE ZHI BENG TANG Clear Heat, Cool Blood
Clearing Heat and Arresting Flooding Decoction
Shan Zhi Zi Fructus Gardeniae
2) Harmonize Blood
Huang Qin Radix Scutellariae a) Stop bleeding
Huang Bo Cortex Phellodendri b) Nourish Blood
Sheng Di Huang Radix Rehmanniae c) Calm Blood
Mu Dan Pi Cortex Moutan radicis d) Invigorate Blood
Di Yu Radix Sanguisorbae
Ce Bai Ye Cacumen Biotae
Chun Gen Bai Pi Cortex 3) Astringe
Gui Ban Plastrum Testudinis
Bai Shao Radix Paeoniae alba
4) Treat Qi
 FORMULAE
Bai Tou Weng Tang Pulsatilla Decoction (Damp-Heat)

Bai Tou Weng Radix Pulsatillae

Huang Lian Radix Coptis
Huang Bo Cortex Phellodendri
Qin Pi Cortex Fraxini

Tong Xie Yao Fang Important Formula for Painful Diarrhoea (Liver-Qi invading
the Spleen, Dampness)
Bai Zhu Radix Atractylodis
Bai Shao Radix paeoniae alba
Chen Pi Pericarpium Citri reticulatae
Fang Feng Radix Saposhnikoviae
Shen Ling Bai Zhu San Ginseng-Poria-Atractylodes Powder (Qi and Yin Xu of
Stomach and Spleen)
Ren Shen Radix Ginseng
Bai Zhu Radix Atractylodis
Fu Ling Poria
Shan Yao Rhizoma Dioscoreae
Lian Zi Semen Nelumbinis
Bai Bian Dou Semen Lablab album
Yi Yi Ren Semen Coicis
Sha Ren Fructus Amomi
Jie Geng Radix Platycodonis
Gan Cao Radix Glycyrrhizae

Ge Xia Zhu Yu Tang Dispelling Stasis below the Diaphragm Decoction (Blood
stasis)
Dang Gui Radix Angelicae Hong Hua Flos Carthami
Chi Shao Radix Paeoniae rubra Tao Ren Semen Persicae
Wu Ling Zhi Excrementuym Trogopterii Mu Dan Pi Cortex Moutan
Chuan Xiong Radix Chuanxiong Zhi Ke Fructus Aurantii
Yan Hu Suo Rhizoma Corydalis Xiang Fu Rhizoma Cyperi
Gan Cao Radix Glycyrrhizae Wu Yao Radix Linderae
Gen Gen Huang Qin Huang Lian Tang Pueraria-Scutellaria-Coptis Decoction
(Damp-Heat)

Ge Gen Radix Puerariae

Huang Qin Radix Scutellariae
Huang Lian Radix Coptis
Zhi Gan Cao Radix Glycyrrhizae

Shao Yao Tang Paeonia Decoction (Damp-Heat)

Huang Lian Radix Coptis

Huang Qin Radix Scutellariae
Da Huang Radix et Rhizoma Rhei
Dang Gui Radix Angelicae sinensis
Bai Shao Radix Paeoniae alba
Gan Cao Radix Glycyrrhizae
Mu Xiang Radix Aucklandiae
Bing Lang Semen Arecae
Rou Gui Cortex Cinnamomi
 EXAMPLE OF FORMULA FOR UC FROM DAMP-HEAT WITH BLEEDING

1) Treat Root
Bai Tou Weng Tang Pulsatilla Decoction Clear Heat, drain
Dampness. cool Blood
Bai Tou Weng Radix Pulsatillae
Huang Lian Radix Coptis
Huang Bo Cortex Phellodendri 2) Harmonize Blood
Qin Pi Cortex Fraxini a) Stop bleeding
Dang Gui Radix Angelicae sinensis b) Nourish Blood
Bai Shao Radix Paeoniae alba c) Calm Blood
Di Yu Radix Sanguisorbae d) Invigorate Blood
Mu Dan Pi Cortex Moutan
Huang Qi Radix Astragali
3) Astringe

4) Treat Qi
EXAMPLE OF FORMULA FOR UC FROM DAMP-HEAT WITH BLEEDING
Li Zheng Quan, Practical Study of Stomach and Spleen in Chinese Medicine Shi Yong Zhong Yi Pi Wei
Xue, Chongqing Publishing House, Chongqing, 1992, p. 582.

1) Treat Root
Huang Bo Cortex Phellodendri Clear Heat, drain
Huang Lian Radix Coptis Dampness. cool Blood
Di Yu Radix Sanguisorbae
Huai Hua Flos Sophorae
Bai Tou Weng Radix Pulsatillae 2) Harmonize Blood
Bai Shao Radix Paeoniae alba a) Stop bleeding
Mu Dan Pi Cortex Moutan b) Nourish Blood
Mu Xiang Radix Aucklandiae c) Calm Blood
Xian He Cao Herba Agrimoniae d) Invigorate Blood
Gan Cao Radix Glyryrrhizae

3) Astringe

4) Treat Qi
 PATIENTS

Western disease Chinese disease Patterns Pulse Tongue Formula

Damp-Heat Intestines, Bai Tou Weng

Ulcerative colitis Diarrhoea SP-Qi Xu Weak Red tip, sticky-yellow coating Tang ah
Bai Tou Weng
Ulcerative colitis Diarrhoea Damp-Heat Intestines Slippery Red Tang ah

Diarrhoea, Damp-Heat Intestines, Right Weak, left Red, Swollen, sticky-yellow Bai Tou Weng
Ulcerative colitis Abdominal Pain SP-Qi Xu Slippery coating Tang h

Damp-Heat, stasis of Slippery, Firm, left Purple, rootless-yellow Bai Tou Weng
Ulcerative colitis Diarrhoea Blood Guan and Chi Weak coating Tang ah

Ulcerative colitis Diarrhoea Damp-Heat, Ki Xu Deep, Weak Pale, Swollen, teethmarks a

Wiry both Chi, Weak Bai Tou Weng
Ulcerative colitis Diarrhoea Damp-Heat L.I., SP-Qi Xu on right Pale, sticky coating Tang ah

Rapid, Wiry, Slippery, Red, slightly Purple, sticky Bai Tou Weng
Ulcerative colitis Diarrhoea Damp-Heat both Chi Wiry coating, swollen sides Tang h

Red sides, yellow-sticky

Ulcerative colitis Diarrhoea Damp-Heat, Blood Heat Slippery, Weak coating Si Miao San h
Damp-Heat L.I., LIV-Blood Bai Tou Weng
Ulcerative colitis Diarrhoea Xu, SP-Qi Xu Wiry, left Wiry-Empty Red, sticky coating Tang h

Ulcerative colitis, Diarrhoea, Bai Tou Weng

psoriasis, arthritis psoriasis Damp-Heat L.I., LU-Yin Xu Rapid, Floating-Empty Red, Peeled, cracks Tang ah

Damp-Heat Large Bai Tou Weng

Ulcerative colitis Diarrhoea Intestine Wiry-Slippery Red, red sides, Swollen Tang h
 400
350
300
Denmark
250
US-Hungary-NZ
200
Lebanon
150 Puerto Rico
100
50
0
Ulcerative colitis

Journal of Autoimmunity 33 (2009) 197–207

 250
Denmark
200
Bosnia-Herzegovina,
Hungary
150
US, Spain, Denmark,
New Zealand
100 Puerto Rico,
Malaysia, Lebanon
50 Israel

0
Crohn's disease

Journal of Autoimmunity 33 (2009) 197–207

 Denmark
600

500
France, Hungary,
400 Spain, Turkey,
Greece, UK
300
Thailand,
200 Phillipines,
Vietnam, China
100 India, Pakistan
0
Rheumatoid arthritis

Journal of Autoimmunity 33 (2009) 197–207

 300 Denmark

US, Canada
250
Italy, Greece, France,
Ireland
200 Norway

Portugal, NZ
150

Colombia, Brazil, Argentina

100
Japan

50 Israel, Kuwait, Jordan, Iran

Turkey
0
Multiple sclerosis

Journal of Autoimmunity 33 (2009) 197–207

 700
600
500 USA
400 UK
300 Iran
200
100
0
Graves' Disease

Journal of Autoimmunity 33 (2009) 197–207