Analysis of Professor An Ayue's Experience in Treating Constipation
Feng Dayong Wang Chunhui Bai Zhiyong An Ayue
Constipation is a common clinical disease. With changes in people’s lifestyles, changes in dietary structure, and the acceleration of population aging, the incidence is gradually increasing, which seriously affects people’s quality of life. Some elderly patients even cause heart and brain problems due to defecation difficulties. Vascular disease. The author's tutor, Professor An Ayue, learns from the past, integrates new knowledge, and has accumulated rich experience in the diagnosis and treatment of constipation, and the clinical effect is remarkable.
1 Diagnosis: Emphasizing the combination of disease differentiation and syndrome differentiation. The teacher of Zhi'an often said: "Constipation is a common clinical disease, but in many cases it is a group of clinical symptoms caused by multiple diseases. The underlying causes are often the same. It is complicated, especially for patients with a relatively short course of disease. Careful diagnosis and treatment should not be taken carelessly.” Traditional Chinese medicine has accumulated rich experience in the treatment of constipation. We should study and inherit carefully, but this does not mean that we reject modern diagnosis and treatment methods. , Chinese medicine was developed by our ancestors in continuous clinical practice. In the process of development, it continuously absorbed the knowledge of astronomy, geography, philosophy and other aspects for its own use. It was never a closed system, and it developed rapidly in modern science. Today, Chinese medicine should also keep pace with the times. We should learn to apply Chinese medicine based on the principle of "following classics, integrating new knowledge, serving the past for the present, and serving the Chinese as foreigners". Diagnosis of the cause of constipation should mainly start from the following aspects: ①Intestinal disease: tumor, volvulus, intussusception, inflammation, ischemic enteritis; rectal anorectal outlet obstruction, anorectal stenosis, intussusception, anterior rectum Convex and so on. ②Extra-intestinal diseases: central neuropathy, spinal cord injury, space-occupying lesions of other abdominal organs, endocrine and metabolic diseases such as hypothyroidism, hypokalemia, hypercalcemia, diabetes, etc. ③Diagnostic method: In addition to medical history, clinical symptoms and local signs, it is necessary to combine modern medical diagnosis and treatment methods. Intestinal diseases should be diagnosed with digestive endoscopy, gastrointestinal angiography, defecography and other methods. For extraintestinal reasons, abdominal CT or NMR can be used, and related biochemical and endocrine hormones can be measured. If the test results suggest that constipation is caused by other diseases, the treatment should focus on the primary disease. On the basis of clarifying that there are no other organic causes, Chinese medicine can be used to treat according to symptoms and signs, follow the diagnosis and treatment methods and principles of Chinese medicine, and do not interfere with Western medicine theories.
2 Analysis of etiology and pathogenesis
"Jisheng Prescription · Secret Conclusion Treatment": "Large intestine, the conduction official, changes out of Yan. The five internal organs are smooth, yin and yang are two qi, no partiality, then semen circulates, the intestines and stomach are nourished, and the transmission is like a meridian. The three energizers are astringent, and they cannot be transported. It is caused by the stomach and intestines, and it becomes the problem of the five secrets." It is not difficult to see that smooth stool mainly depends on the following aspects: First, the coordination of the five internal organs and the balance of Yin and Yang ; Secondly, the body fluid is generated and transported normally; thirdly, the three-burner gas machine is smooth. Teacher An believes that although the site of constipation is in the large intestine, it is manifested as obstruction of the internal organs and difficulty in defecation, but it is closely related to the lungs, spleen, liver, and kidneys. Many patients with constipation have a history of taking laxatives, and some even have a long-term history. Depend on laxatives, these drugs mostly contain rhubarb, senna leaves and other bitter cold products that can damage the spleen and stomach, and the spleen will be at the center of the focus. It will lead to anger and blood, and promote body fluid, which can make the clear Yang rise, and the turbid yin will drop. , The heart and lungs are nourished, the liver and kidneys are hidden, and the organs are ventilated; the lungs are the upper focal point, which is the canopy of the viscera. Tang Rongchuan said in the "Essence of Medical Classics·Officials of the Viscera": "The reason why the large intestine conducts is that it is the organ of the lungs, and the lung qi is released, so it can be transmitted." The liver governs the flow of qi and blood. Relying on this, and the two yin before and after the passage of the liver meridian, the smooth flow of qi and blood in the liver meridian is naturally beneficial to defecation. Tang Rongchuan said in "Blood Syndrome · Zang-Fu Pathogenesis Theory": "The nature of wood is mainly for venting. The stomach depends on the Qi of the liver wood to relieve the qi, while the water is transformed. If the liver does not clear the yang, the water cannot be relieved, and the evidence of fullness in the exudation and diarrhea is inevitable. Fundamentally, the main function is to seal and absorb the ingestion, and the two stools. When the kidney yang is filled, the qi of the large intestine can be agitated and qi. The kidney yin and feet are moisturized by the body fluid, which means to increase water and move the boat. Many patients with constipation have a long course of disease. , Teacher An believes that chronic illnesses are often deficient, chronic illnesses are often stasis, and the method of replenishing qi, nourishing blood and removing blood stasis is established, so that the intestinal qi and blood can be smooth and nourished.
Syndrome differentiation: ① Loss of lung loss and lowering of blood, large intestine fluid deficiency. Symptoms: Difficulty with dry stools, coughing, excessive phlegm, dark tongue, white and thick dry fur, less fluid, and slippery or thin pulse. Method: Promoting lung and blood, moistening bowel, 15 g almonds, 15 g achyranthes, 12 g platycodons, 15 g peach kernels, 20 g angelica sinensis, 10 g polygonatum, 15 g hemp seed, 15 g raw rehmannia, licorice 9 g.Recipe: The main contradiction of this type of syndrome is the intestinal fluid deficiency and the loss of lung loss. The prescription uses almonds and Platycodon grandiflorum to promote lung qi, and use Polygonatum, hemp seed, and Sheng Dihuang to increase fluid to promote fluid and moisten the intestines. Dao, because the lungs move towards the hundred pulses to help the heart and blood flow, and the lungs are purged, which will inevitably affect the normal operation of the blood and cause the disorder of the veins. The prescription uses peach kernels to promote blood circulation, and angelica nourishes blood and promotes blood. In addition, the two drugs have the effect of moisturizing the intestines and laxative. Achyranthes bidentata is used to introduce the drugs downward, and licorice is used to reconcile the drugs. Looking at the whole prescription, the main purpose is to relieve descent, to promote descent during descent, to nourish yin and nourish blood, to nourish blood, to promote blood circulation, the opposite is mutually reinforcing, combining movement and static. ② Deficiency of liver and kidney yin, dryness of body fluid and intestines. Symptoms include dry stool, weak defecation, red tongue with little moss, less fluid, even cracks, weak pulse or thin strings. Method: Nourish the liver and kidney, moisten the intestines and laxatives, 15 g of Adenophora glabra, 15 g of Ophiopogon japonicus, 20 g of Radix Rehmanniae, 12 g of Dendrobium, 15 g of hemp seed, 12 g of Chinese angelica, 15 g of wolfberry, 15 g of Cistanche deserticola 15 g, Sichuan Neem Seed 9 g, Astragalus 40 g, Chuanxiong 10g, Woody 9 g, Licorice 9 g. Recipe: This type of syndrome is based on insufficient yin fluid due to deficiency of liver and kidney, deficiency of the intestines and dryness of the intestines and qi. The prescription uses Adenophora, Ophiopogon, Dendrobium, Rehmannia glutinosa to nourish yin and moisturize dryness, wolfberry, angelica, Cistanche nourishes the liver and kidneys, nourishes blood and moisturizes dryness, astragalus, licorice nourishes qi and invigorates the spleen, wood fragrance wakes up the spleen and nourishes the spleen. Ligusticum chuanxiong soothes the liver and relieves depression, Chinese angelica and Chinese wolfberry nourish the liver, and Chuanxiong and Ligusticum chuanxiong can help the liver. ③ Liver depression, spleen deficiency, intestine dryness and body fluid deficiency. Symptoms include constipation, nausea, abdominal distension, appetite, flank pain, dark tongue, greasy tongue coating, less fluid, thin or slippery pulse. Method: Soothing the liver and invigorating the spleen, moistening the intestines and laxative, 20 g of Chinese angelica, 20 g of red peony, 20 g of white peony, 9 g of Bupleurum, 9 g of bran-fried Atractylodes, 9 g of dried ginger, 15 g of hemp seed, 10 of fleece-flower root g, 20 g of Rehmannia glutinosa, 10 g of Polygonatum odoratum, 9g of roasted licorice. Recipe: This type of syndrome is mainly liver-qi stagnation, liver-stagnation and spleen deficiency. The liver is the viscera, the body is yin and yang. The prescription is made of angelica, white peony root, shouwu to nourish the liver and soften the liver, chaihu soothes the liver and relieves depression; atractylodes, licorice, dried ginger, nourishes the qi and invigorates the spleen, warms the middle yang and makes clear When the yang rises, the turbidity falls, and the Mizutani micro is distributed. Rehmannia glutinosa, Polygonatum odoratum and hemp seed produce body fluid and moisturize dryness, which means increasing water and sailing. In the prescription, white peony and licorice are used together, sour and sweet to transform yin; licorice and dried ginger are used together to nourish yang, soothing the liver and promoting qi without the disadvantages of rigidity, and nourishing yin and moisturizing the intestine without the risk of dampness. ④ Deficiency of Qi, blood stasis and arthralgia obstruction. Symptoms: Difficulty defecation, fatigue and fatigue, dark tongue with ecchymosis, blood stasis under the tongue, astringent and weak pulse. Method: Nourishing qi and nourishing blood, removing blood stasis and laxative, raw astragalus 30 ～ 60 g, red peony 10 g, chuanxiong 12 g, angelica 10 g, hemp seed 10 g, peach kernel 15 g, safflower 9 g, earthworm 9 g, 15g of Polygonum multiflorum, 15g of Rehmannia glutinosa, 9g of licorice. Recipe: The course of constipation is long and the disease enters the collaterals for a long time. Astragalus is used in the prescription. One is to replenish qi and activate blood. Secondly, astragalus replenishes the spleen and qi. Its sexuality mainly rises, so that Qingyang rises and turbidity falls; peach kernel, safflower, red Peony root, Chuanxiong, Dilong activating blood and dredging collaterals, Polygonum multiflorum, Radix Rehmanniae, Hemp seed nourish liver and kidney, moisten the intestines and laxative, Radix Rehmanniae, Radix Paeoniae Rubra has a colder nature, can also produce astragalus, Chuanxiong and other pungent and dry properties, this prescription It is made from Buyang Huanwu Decoction, mainly to invigorate qi, supplemented by dissipating blood stasis, so that the qi and blood flow, the intestinal qi and blood are smooth and nourished, and the power of conduction is restored.
3 Analysis of the characteristics of prescription drugs
① Tonic but not stagnant, nourishing but not greasy. For example, to nourish the liver and kidneys and moisten the intestines, the prescriptions use Radix Adenophora, Ophiopogon, Rehmannia glutinosa, Dendrobium and other sweet and cold nourishing yin products, and add angelica, Chuanxiong, Muxiangxin to nourish blood, activate blood, and promote qi. Drugs that are moist, warm in nature, and prefer to Xing San, not only help Xuan San body fluid to exert its moisturizing effect, but also prevent Yin medicine, dampness and phlegm. Teacher An often said: "When you see yin deficiency, you only know how to nourish yin, and it is usually difficult to take effect. This is mainly because yin nourishing drugs are usually nourishing and nourishing. To nourish, you must get a Xuan scattered compress. At this time in the brigade Adding some medicines that promote qi, reduce dampness, warming yang and other medicinal properties to the medicine is more helpful to achieve better yin nourishing effect. Simply nourishing yin is like'a pool of stagnant water', which can only be moisturized by the transpiration of sunlight into rain and dew Everything."②Yin and Yang match, but opposite. For example, the method of Xuanfei and blood moisturizing the intestines, the use of almonds, achyranthes, etc. in the prescription helps to suppress the lung qi and induce the medicine to descend. At the same time, the addition of Platycodon grandiflorum can promote the promotion in the Tongjiang, which seems contradictory, but If you think carefully, Platycodon grandiflorum has a strong medicinal effect, which can promote clearing yang, nourish the heart and lungs, and help the lungs to subdue. Moreover, Platycodon grandiflorum has the effect of resolving phlegm and helps the lungs to restore their cleanness. Another example is the method of nourishing the liver and kidney and moisturizing the intestines. The prescriptions of Adenophora adenophora, Ophiopogon japonicus, Rehmannia glutinosa, Dendrobium and other medicinal properties tend to be cold and calm, and supplemented with Muxiang, Melia Chinensis, Chuanxiong, Angelica and other medicinal properties. The medicine that is warm and deviates from Xing San, matches yin and yang, and blends movement in calmness. ③The medicine is simple and powerful, with ranks in primary and secondary. Teacher An’s prescriptions are mostly controlled at around 10 medicines. The medicines for the main contradictions of the disease are relatively large, such as the method of replenishing qi, nourishing blood and removing blood stasis and laxative, the dosage of astragalus is 40 g or more, while other blood-activating medicines are controlled at 10 Around g, this can not only invigorate qi, promote blood and remove blood stasis, but also prevent blood stasis products from hurting blood and qi.
4 Typical cases
Chen, a 73-year-old female, went to the clinic in June 2011. The patient has difficulty defecation for more than 6 years, once every 4 to 5 days, usually takes more than 15 minutes to defecate, and has a feeling of incomplete defecation. He has taken Paiduyangyan Capsules and Maren Pills , Changrun tea, Guoguo tablets and other drugs slowly failed. Colonoscopy: It indicated mild melanosis of the intestinal mucosa, and there was no abnormality. Intra-anal digital examination: The rectal mucosa has obvious finger-wrapping sensation. The rectal mucosa can be seen lax under the proctoscope and the front side is obvious. The patient is thin, with slightly dry stools, fatigue and fatigue, especially after defecation, poor sleep, dark tongue, thin fur, and weak pulse. Mr. An believes that the patient has a long course of illness and has taken a variety of laxative drugs. The detoxification and beauty capsules and Maren pills contain rhubarb, and the intestinal moisturizing tea contains senna, which are all irritating laxatives. The drug properties are more bitter and cold. After taking it, it is decomposed into soluble sodium salt in the intestinal tract, which stimulates the intestinal nerve plexus and accelerates intestinal peristalsis. In addition, it can inhibit the absorption of intestinal and intestinal water and produce volumetric diarrhea. Generally speaking, it is also a stimulating laxative. At the same time, local examination of the anorectum: It suggests that the rectal mucosa is lax and there are outlet obstruction factors. Therefore, patient treatment should not only pay attention to overall adjustment, but also solve the problem of rectal mucosal relaxation. The patient has a long course of disease, chronic illness and kidney, and the disease enters the collaterals for a long time, combined with its symptoms, tongue and pulse conditions, the syndrome is differentiated by liver and kidney yin deficiency, qi deficiency and blood stasis; Methods: Nourish liver and kidney, nourish qi and activate blood. Prescription: Scrophulariaceae 15 g, Rehmannia glutinosa 20 g, Cistanche 15 g, Ophiopogon 12 g, Polygonatum 15 g, Cypress kernel 15 g, Angelica tail 15 g, Peach kernel 10 g, Astragalus 30 g, Chinese wolfberry 15 g, Citrus aurantium 10 g, 7 doses of water decocted. The problem of rectal mucosal relaxation should be subrectally injected with Shaobei injection. Shaobei injection has obvious astringent and stasis-removing effects, which can promote the retraction of loose rectal mucosa and solve the problem of outlet obstruction. Second visit: After local injection of oral drugs with Shaobei injection, the patient's defecation time was shortened to about 5 minutes, and the patient had two bowel movements within 7 days. The feeling of incomplete defecation basically disappeared, the stool was slightly dry, the tongue was dark and the tongue was less fluid, and the patient was tired. Get better. The original prescription added 20 g of hemp seed, the patient’s tongue is darker, and each dose is added with 3 g of powdered gunpowder. Zhang Xichun said: “Pangolins are angry and scavenge, and their scavenge is in every way, so it can be declared Clear the viscera, implement the meridians, and reach the official orifices. Any disease caused by blood coagulation can be cured." I returned to the clinic a week later, and I had stool once every 1 to 2 days, and the feeling of incomplete defecation disappeared. The patient was instructed to take 7 doses and then change to water pills for 3 weeks for consolidation.