Traditional Chinese Medicine Treatment of Constipation
Constipation is a common clinical complex symptom, not a disease. It mainly refers to the decrease in the number of bowel movements, the decrease in stool volume, dry stool, and laborious defecation. It is necessary to judge whether there is constipation based on the characteristics of the stool, my usual bowel habits and whether it is difficult to defecate. If more than 6 months is chronic constipation.
Constipation can be divided into two categories, organic and functional.
(1) Intestinal stenosis or obstruction caused by intestinal organic disease, tumor, inflammation or other reasons.
(2) Rectal and anal diseases, internal rectal prolapse, hemorrhoids, anterior bulge, puborectalis hypertrophy, puborectalis separation, pelvic floor disease, etc.
(3) Endocrine or metabolic diseases, diabetes, hypothyroidism, parathyroid diseases, etc.
(4) Systemic diseases, scleroderma, lupus erythematosus, etc.
(5) Nervous system diseases: Central brain diseases, stroke, multiple sclerosis, spinal cord injury and peripheral neuropathy, etc.
(6) Intestinal smooth muscle or neurogenic disease.
(7) Colonic neuromuscular disease, pseudo intestinal obstruction, Hirschsprung's disease, giant rectum, etc.
(8) Neuropsychological disorders.
(9) Drug factors: iron, opioids, antidepressants, anti-Parkinson's disease drugs, calcium channel antagonists, diuretics, and antihistamines.
The etiology of functional constipation is not clear. Its occurrence is related to many factors, including:
(1) Insufficient food intake or lack of fiber or lack of water will reduce the stimulation of colon movement.
(2) Normal defecation habits are interfered with due to stressful work, fast pace of life, changes in the nature and time of work, and mental factors.
(3) It is caused by colonic motility disorder, which is common in irritable bowel syndrome. It is caused by colon and sigmoid colon spasm. In addition to constipation, it also has abdominal pain or bloating. Some patients may have alternating constipation and diarrhea.
(4) Insufficient tension of abdominal muscles and pelvic muscles, and insufficient defecation driving force, making it difficult to excrete feces from the body.
(5) The abuse of laxatives leads to drug dependence and constipation.
(6) Old age is weak, too little activity, bowel cramps cause difficulty in defecation, or due to lengthy colon.
Constipation is mainly divided into two categories according to the pathogenesis: slow transit type and outlet obstruction type.
(1) Slow transit constipation is caused by weakening of the intestinal contraction movement, which slows down the movement of stool from the cecum to the rectum, or due to the uncoordinated movement of the left colon. It is most common in young women and occurs around puberty. It is characterized by decreased bowel frequency (less than 1 bowel movement per week), low bowel movements, hard stools, and difficulty in defecation; no stool or touching hard stools during digital rectal examination. The external anal sphincter has normal anus retraction and forced defecation functions; the total gastrointestinal or colon transit time is prolonged; there is no evidence of outlet obstruction, such as air sac discharge test and anorectal pressure measurement. Increasing dietary fiber intake and osmotic laxatives are ineffective. Diabetes, scleroderma combined with constipation and drug-induced constipation are mostly slow transmission type.
(2) Outlet obstructive constipation is due to the incoordination of the muscles of the abdomen, anorectum and pelvic floor, which leads to obstruction of stool discharge. It is especially common in elderly patients, many of whom have failed conventional medical treatment. Outlet obstruction type may have the following manifestations: laborious defecation, feeling of incompleteness or falling, low defecation volume, intentional or lack of defecation; there is a lot of mud-like stool in the rectum during digital anorectal examination, and the external anal sphincter may appear when defecation is forced. Paradoxical contraction; total gastrointestinal or colonic transit time is normal, and most markers can be retained in the rectum; anorectal manometry shows that the external anal sphincter is contradictory contraction or the sensory threshold of the rectal wall is abnormal when defecation is forced. Many patients with outlet obstructive constipation also have slow transit constipation.
The prevalence of constipation in the population is as high as 27%, but only a small percentage of constipation patients will see a doctor. Constipation can affect people of all ages. There are more women than men, and more old people than young and middle-aged people. Due to the high incidence of constipation and the complicated etiology, patients often have a lot of distress, and severe constipation can affect the quality of life.
Constipation is often manifested as: less urge to defecate, less frequent defecation; difficult and laborious defecation; poor defecation; dry stool, hard stool, unclean sensation; constipation accompanied by abdominal pain or abdominal discomfort. Some patients also have mental and psychological disorders such as insomnia, irritability, dreaminess, depression, and anxiety.
Because constipation is a relatively common symptom with varying degrees of severity, most people often ignore it and think that constipation is not a disease and do not need treatment, but in fact, constipation is very harmful. The "alarm" signs of constipation include hematochezia, anemia, weight loss, fever, melena, abdominal pain, etc. and family history of tumors. If there are alarm signs, you should go to the hospital immediately for further examination.
In the diagnosis and differential diagnosis of constipation, necessary inspections should be done according to clinical needs. First of all, pay attention to whether there is evidence of alarm symptoms and other organic diseases of the whole body; for patients over 50 years of age, with a history of long-term constipation, and short-term symptoms, colonoscopy should be performed to eliminate the possibility of colorectal tumors; for long-term abuse of diarrhea Colonoscopy can determine whether there is laxative colon or (and) melanosis of the colon; barium enema is helpful in the diagnosis of Hirschsprung's disease.
Special examination methods for refractory constipation include: gastrointestinal passing test (GITT), rectal and anal manometry (RM), rectal-anal reflex test, tolerance sensitivity test, balloon expulsion test (BET), Pelvic floor electromyography, pudendal nerve latency measurement test, and anal canal ultrasound; colonoscopy or barium enema can help determine whether there is organic disease.
Inquire in detail about the patient’s diet, living habits and work conditions, past medical history, surgical history, especially whether hemorrhoids, anal fistulas and anal fissures, recent history of medication, especially long-term history of laxatives, pass The corresponding examination is as clear as possible the cause of constipation. For middle-aged and older patients, there is a change in bowel habits, and the stool changes gradually from once a day or once every 2 days to once every 3 days or several days. You should be alert for the possibility of left colon cancer.
1. General treatment
Patients with constipation need to adopt comprehensive treatments according to the severity, cause and type of constipation, including general life treatment, medication, biofeedback training, and surgical treatment to restore normal bowel physiology. Pay attention to life treatment, strengthen the education of patients, adopt reasonable eating habits, such as increasing dietary fiber content, increasing drinking water to strengthen the stimulation of the colon, and developing good defecation habits, such as waking up in the morning and defecation in time. Avoid forceful bowel movements and increase activity. During treatment, attention should be paid to removing excessive fecal accumulation in the distal rectum; positive adjustment of mentality is required, which are extremely important to obtain effective treatment.
(1) Volumetric laxatives mainly include soluble cellulose (pectin, plantain, oat bran, etc.) and insoluble fiber (plant fiber, lignin, etc.). Volumetric laxatives have a slow onset of action with small side effects and are safe. Therefore, they have a good effect on pregnancy constipation or mild constipation, but they are not suitable for rapid laxative treatment of temporary constipation.
(2) Lubricating laxatives can lubricate the intestinal wall, soften the stool, make the stool easy to pass, and convenient to use, such as corkscrew, mineral oil or liquid paraffin.
(3) Salt laxatives, such as magnesium sulfate and magnesia milk, can cause serious adverse reactions and should be used with caution in clinical practice.
(4) Commonly used drugs for osmotic laxatives include lactulose, sorbitol, polyethylene glycol 4000 and so on. It is suitable for fecal impaction or as a temporary treatment for chronic constipation. It is a better choice for constipation patients with poor curative effect of volumetric laxatives.
(5) Stimulant laxatives include anthraquinone-containing botanical laxatives (rhubarb, cascara frangipani, senna, aloe), phenolphthalein, castor oil, diester phentine, etc. Stimulant laxatives should be used only when volume laxatives and salt laxatives are ineffective. Some are more intense and not suitable for long-term use. Long-term application of anthraquinone laxatives can cause melena or laxative colon, cause atrophy of smooth muscle and damage the intestinal myenteric plexus, but aggravate constipation, which can be reversed after stopping the drug.
(6) Mosapride and itopride can promote gastrointestinal motility, and procapride can selectively act on the colon and can be selected according to the situation.
3. Equipment assistance
If the stool is hardened, stagnated in the rectum near the anal orifice, or the patient is old and weak, poor or lacking in bowel movement, colon hydrotherapy or cleaning enema can be used.
4. Biofeedback therapy
It can be used for constipation patients with dysfunction of the rectum, anus and pelvic floor, and its long-term effect is good. Biofeedback therapy can train patients to relax the pelvic floor muscles during defecation, and coordinate the activities of the abdominal muscles and pelvic floor muscles during defecation. For patients with abnormal stool intention threshold, attention should be paid to the reconstruction of defecation reflex and the training of adjusting the perception of stool intention. There is no specific standard for the training plan, and the training intensity is high, but it is safe and effective. For patients with pelvic floor dysfunction, biofeedback therapy should be preferred over surgery.
5. Cognitive therapy
Patients with severe constipation often have symptoms of anxiety or depression and other psychological factors or disorders. Cognitive therapy should be given to relieve the tension. Anti-depressant and anti-anxiety treatments should be given when necessary, and psychologists should assist in diagnosis and treatment.
6. Surgical treatment
All the above treatments are ineffective for severe and refractory constipation. If it is colonic transit dysfunction constipation and the condition is serious, surgery can be considered. However, the long-term effect of surgery is still controversial, and case selection must be cautious. In the huge group of constipation, those who really need surgery are still very few.
Traditional medicine believes that constipation is mostly caused by heat accumulation in the large intestine, stagnation of qi, cold coagulation or deficiency of yin and yang qi and blood, which makes the conduction function of the large intestine imbalance. Clinically, the symptoms of constipation will be improved in general patients after life conditioning and drug treatment. Due to long-term constipation, the body's turbid qi does not decrease and the clearing of the yang does not rise, resulting in abdominal distension, dizziness, bloating, nausea, belching, loss of appetite, restless sleep, upset and irritability. In severe cases, it can cause hemorrhoids, anal fissures and even blood in the stool. In addition, patients with constipation can induce hernia, high blood pressure, heart disease and other diseases if they use excessive force during defecation. Due to different causes of constipation, the accompanying symptoms of constipation are also different.
Heat constipation patients with this type of constipation often have symptoms such as short red urine, flushed face, upset, dry mouth, bad breath, and abdominal pain. The treatment should be based on clearing heat and moisturizing the intestines, and Maziren pills can be used for treatment. The commonly used prescriptions are Qingrun Decoction: 12 grams of Ma Ziren, 12 grams of Yu Liren, 20 grams of Cassia, 20 grams of Gypsum, 20 grams of Talc, 12 grams of Cork, 12 grams of Scutellaria, 12 grams of Sophora flavescens, 15 grams of Polygonum cuspidatum, 20 grams of Peony. 12 grams of Citrus aurantium, 10 grams of rhubarb, 12 grams of magnolia, 12 grams of almonds, 6 grams of licorice, decocted in water. Huadu pills and rhubarb pills are taken orally.
Air constipation Patients with this type of constipation are often accompanied by frequent belching, abdominal distension and abdominal pain. The treatment should be based on leading to stagnation of Qi. Shunqi decoction can be used for treatment: 12 grams of Wuyao, 12 grams of Cyperus rotundus, 12 grams of bergamot, 10 grams of Dalbergia odorifera, 20 grams of raspberry seeds, 12 grams of Chinese neem seeds, 12 grams of Chuanxiong, 12 grams of peach kernels, 12 grams of woody incense, 6 grams of agarwood, 15 grams of Citrus aurantium, 12 grams of betel nut, 10 grams of rhubarb, 6 grams of licorice, decocted in water.
Qi deficiency constipation Patients with this type of constipation are mostly accompanied by symptoms such as shortness of breath, fatigue, and hyperhidrosis. The treatment should be based on invigorating the qi and invigorating the spleen. You can choose to use Qi-buying decoction: 30 grams of Astragalus, 20 grams of Codonopsis, 12 grams of Atractylodes, 15 grams of Poria, 12 grams of lentils, 12 grams of Ganoderma lucidum, 12 grams of lotus seeds, 12 grams of Polygonatum. Gynostemma pentaphyllum 12g, vine pear root 20g, Chuanxiong 12g, yam 20g, peony 12g, hemp seed 12g, white honey 20g, tangerine peel 12g, licorice 6g, decocted in water. Shenfu pills and Lingzhi pills are taken orally.
Blood deficiency constipation Patients with this type of constipation are mostly accompanied by symptoms such as palpitations, forgetfulness, dizziness, and pale complexion. The treatment should be based on nourishing blood and moistening dryness, and nourishing blood and nourishing intestine soup: 20 grams of rehmannia, 15 grams of longan meat, 20 grams of cornus, 20 grams of wolfberry, 20 grams of yam, 15 grams of peony, and 12 grams of rhizome , Polygonatum 12 grams, Shouwu 12 grams, Ligustrum lucidum 12 grams, Eupatorium 12 grams, Rhubarb 6 grams, Angelica 15 grams, Peach kernel 15 grams, Maren 15 grams, Roasted licorice 10 grams, decoction. Huanshao pills and Huoxue pills are taken orally.
Yin deficiency constipation Patients with this type of constipation are mostly accompanied by physical weight loss, dizziness, tinnitus, waist and knee weakness, and heart palpitations. The treatment should focus on nourishing yin and invigorating the kidney. You can choose nourishing yin decoction: 12 grams of Adenophora, 12 grams of Ophiopogon japonicus, 12 grams of lentils, 20 grams of peony, 12 grams of mulberry leaves, 12 grams of Yuanshen, 15 grams of Anemarrhena. 15 grams of mulberry, 15 grams of longan meat, 15 grams of cornus, 12 grams of Yu Liren, 12 grams of hemp seeds, 12 grams of Cassia, 12 grams of Astragalus sinensis, 12 grams of Weizi, 10 grams of licorice . Zhibai pills and pearl pills are taken orally.
Cold constipation Patients with this type of constipation are mostly accompanied by symptoms such as pale complexion, cold hands and feet, hot and cold, and cold and pain in the abdomen. The treatment should be based on warming and laxative. You can choose warming soup: 15 grams of Cistanche, 12 grams of Cunyun, 6 grams of Cinnamon, 10 grams of Evodia, 10 grams of Cumin, 30 grams of Codonopsis, 30 grams of Astragalus, 10 grams of turtle shell 15 grams of Gynostemma pentaphyllum, 20 grams of vine pear root, 15 grams of angelica, 12 grams of hyssop, 12 grams of Alisma, 12 grams of Citrus aurantium, 12 grams of cohosh, 10 grams of roasted licorice, decoction. Lizhong pills and Jianzhong pills are taken orally.