1. The concept of constipation: Foreign scholars Drossman and others believe that constipation can be regarded as constipation if the time of defecation is more than 25% of normal or/and 2 times a week or less. But in fact, due to differences in diet, lifestyle, bowel habits and food composition, the time between bowel movements is very different. Although it takes a long time to defecate,
1. The concept of constipation:
Foreign scholars Drossman and others believe that constipation can be regarded as constipation if the time of defecation is more than 25% of normal or/and 2 times a week or less. But in fact, due to differences in diet, lifestyle, bowel habits and food composition, the time between bowel movements is very different. Although the defecation time is long, as long as the bowel movement is smooth and there is no discomfort, constipation cannot be considered. Therefore, it is generally believed that constipation refers to those who have uncomfortable constipation, prolonged defecation time, or difficulty in defecation despite the intention of defecation, or feeling of incompleteness or discomfort after defecation, or accompanied by full abdominal distension or other discomfort. If you have the above symptoms, even if you have one or more bowel movements a day, it should be considered constipation.
2. The harm of constipation:
Long-term constipation, because the harmful substances produced in the body cannot be discharged in time, and the blood is collected, causing anorexia, nausea, belching, bitter mouth, bad breath, upset and irritability, sore mouth and tongue, swollen gums, red eyes, swelling and pain, mouth and nose A series of poisoning symptoms such as bleeding, acne and dizziness, fatigue or apathy, depression, and strange personality. Some even cause anemia, malnutrition, fecal stone disease, fecal incarceration, anal fissure, hemorrhoids, colorectal ulcers, induce rectal cancer, and can also cause asthma, emphysema, pulmonary heart disease, high blood pressure, coronary heart disease, gastrointestinal disease Aged or chronic diseases such as illnesses are exacerbated, and even sudden death from defecation. Constipation causes the retention and absorption of toxins in the intestinal tract, and can also induce premature aging or premature aging.
3. Classification of constipation:
(1): Outlet obstructive constipation
1. Organic outlet obstructive constipation
2. Functional outlet obstructive constipation
1): Rectal protrusion
2): Puborectal myopathy
3): Internal rectal prolapse/intussusception
4): Perineal descent syndrome
(Two): colonic constipation
1. Organic colonic constipation
2. Functional colonic constipation
1): Colon lengthy syndrome
2): Colon paralysis (chronic colonic transit syndrome)
(1) Decreased neurological activity
(2) Thinning of intestinal muscles
(3) Mixed constipation:
Four, the performance of constipation:
(1) Outlet obstructive constipation
(2) Colonic constipation
(3) Mixed constipation
5. Diagnosis of constipation:
(1) Detailed medical history
(2) Defecation imaging
(3) Colon transport test
(4) Barium enema
(6) Rectal pressure measurement
6. Treatment of constipation:
(1) Conservative treatment
1. Increase exercise
2. Drinking water
1) Western medicine:
(1) Dilatant laxatives, whose main function is to increase intestinal contents to promote bowel movements. Commonly used are Metamucil, agar, Isogel, and methylcellulose.
(2) Stimulant laxatives, commonly used such as phenolphthalein, anthraquinone drugs such as rhubarb, senna standard preparation Senokot and Cascara. These drugs are absorbed in the small intestine, decomposed in the body into the active substance emodin, and discharged into the colon, which stimulates the intestinal muscular plexus to cause bowel movement. After oral administration, castor oil is hydrolyzed into ricinoleic acid and glycerol by pancreatic lipase. The former has a stimulating effect on the small intestinal mucosa, causing intestinal reflex peristalsis to increase.
(3) Salt laxatives, such as magnesium sulfate, sodium sulfate, etc., are not absorbed in the intestines and will work for three hours.
(4) Stool softeners, such as Di-octyl sodium sulphasuccinate (DSS) is a surfactant that softens the feces, reduces the surface tension of the feces, and allows water to penetrate into the feces. Lactulose is a synthetic disaccharide that is fermented in the colon to produce soft stools. The side effect is gas production and abdominal distension, which is often related to dosage. Polyoxyethylene propylene and Poloxalkal can be used alone or in combination with stimulant laxatives.
Glycerin suppositories and Beog-ex are commonly used in rectal colon medicines. The latter produces CO2 gas in the rectum, causing the intestinal cavity to swell and cause defecation.
But whether lubricating laxatives such as liquid paraffin, olive oil, glycerin, or irritating laxatives such as phenolphthalein, rhubarb, or swelling laxatives such as agar, methylcellulose, etc., all have side effects that interfere with normal intestinal activity and absorption Long-term use can reduce the responsiveness of nerve sensor cells in the intestinal wall. Even if there is a sufficient amount of stool in the intestine, normal peristalsis and defecation reflex will not occur, so that it is difficult to defecate without taking laxatives or enema, making it addictive and forming laxative-dependent Intractable constipation. Long-term use of diacetin can cause liver dysfunction; long-term use of liquid paraffin can hinder the absorption of fat-soluble vitamins A, D and K, calcium and phosphorus, and may cause lipoid pneumonia; the stimulating effect of laxatives It can also reflexively cause congestion of the pelvic organs, causing women to have menorrhagia and abortion in pregnant women.
Traditional Chinese medicine believes that regular use of bitter cold laxatives such as rhubarb, fanxie leaves, morning glory seeds, maren nine, bezoar detox tablets, and Shangqing nine will damage the air and body fluid, and the more diarrhea, the more secret.
2) Traditional Chinese Medicine: Syndrome Differentiation and Treatment
Constipation is generally divided into two types of deficiency and excess. Regulating Qi and moisturizing the intestines are always the treatment methods.
1. Empirical constipation: more common in new diseases or temporary intestinal dysfunction. Most of the patients are physically strong and the course of the disease is short. Proper dialectics often heals by rubbing hands. However, the diarrhea is bitter and cold, which can easily hurt the stomach.
① The same disease on the outside and inside: gastrointestinal fever and both symptoms. The main symptoms are constipation, irritability and thirst, red face and lip scorching, irritated heat in the chest and diaphragm, and slightly aversion to cold in the body. The tongue is red, the coating is yellow or white, and the pulse is floating. Prescription Lianggesan addition and subtraction: raw rhubarb 6g, Glauber's salt 12g, gardenia 12g, scutellaria 12g, Yinqiao 15g, mint 10g, bamboo leaf 10g, licorice 3g.
② Internal knot of dryness and heat: The main symptom is dry stool, short red urine, abdominal distension, dry mouth and bad breath, and body heat and irritability. Red tongue, yellow dry fur, slippery and firm pulse. Cure to clear heat and moisturize the intestines. Add and subtract with Maziren Pills: Maziren 18g, raw rhubarb 6g, white peony 12g, magnolia officinalis 12g, apricot red 12g, and Citrus aurantium 12g. For those suffering from body damage, add Scrophulariaceae and Habitat to nourish yin and nourish body fluid; if the liver fire is too strong and the eyes are red and easy to onion, add gentian grass or other clothes pills (aloe, vera) to relieve the liver and relax the bowel movement.
③Yangmingfu organs: incapable of constipation, or pure water is stinky, full of abdominal distension and pain, body heat does not go away. The tongue is red, the fur is yellow and dry, and the pulse is dense. Cure to attack the vent pad. Use Tiaowei Chengqi Decoction: 12g raw rhubarb, 15g Glauber's salt, 6g licorice. Ruoyangmingfu organs, attacking bosses, hot flashes and whisperers can use Xiaochengqi Decoction, 12g of raw rhubarb, 12g of Citrus aurantium, and 6g of Magnolia officinalis to relieve the heat. If the tongue is more dry and hot, if you are faint and delirium, you can use Dachengqi Decoction, 12g of raw rhubarb, 15g of magnolia, 15g of citrus fruit, and 12g of Glauber's salt. For those with Yangming Fu organs, severe body injury, dry mouth and cleft lip, and dry tongue coating, use Tiaowei Chengqi Decoction with Scrophulariae 15g, Shengdi 15g, and Ophiopogon 15g to relieve heat and promote body fluid. Two servings of Qi and Jin, with dry mouth and throat, fatigue, fatigue, yellow or scorched black, and weak pulse, use Zengye Chengqi Decoction to add flavor: raw rhubarb 6g, Glauber's salt 10g, licorice 6g, Scrophulariaceae 15g, Shengdi, Ophiopogon japonicus, Each 15g of sea cucumber, 10g of ginseng, (or 30g of Codonopsis) is used to relieve the viscera and promote fluids. If the yangming fu organs are solid, accompanied by yellow, red and astringent urine, and body heat and polydipsia, you can use Tiaowei Chengqi Decoction with 15g of Habitat, 10g of red peony root, 6g of Coptis chinensis, and 10g of Fructus chinensis.
④coldness internal knot: stool obstruction, abdominal pain or pain under the thigh, or accompanied by aversion to cold, cold limbs, and fever. The tongue coating is white or sticky, and the pulse is tight. The treatment is to warm yang to lax, dispel cold and relieve pain, and use warm spleen decoction: 12g of attached tablets, 10g of raw rhubarb, magnolia, dried ginger, cassia twig 10g, asarum 3g, licorice 5g. The weak can add Codonopsis and Angelica to nourish the blood. The secret of the internal knot of coldness is to observe the tongue and veins carefully. Although fever is seen, it is caused by the internal knot of coldness, stagnation of yang, and imbalance between camp and health. If you see constipation and abdominal pain, you will often fall into the cold, not only will the more secretion become more secretive, but the syndrome may become rushed, so the clinical syndrome has to be checked carefully.
⑤ Failure of Qi stagnation: symptoms of constipation, lack of desire, belching and eating less, full chest and abdomen, and even abdominal pain and bowel. Thin moss, stringy pulse. This is often caused by emotional injury and relapses or worsens due to mood swings. The treatment is to induce stagnation of qi and relax bowel movement, and use Liumo Decoction to add and subtract: raw rhubarb 6g, Citrus aurantium 10, betel nut 10, black medicine 10, agarwood 6, Guangxiang 12g. For those with a bitter mouth and dry throat and a few pulse strings, gentian, scutellaria, paeonol, etc. can be added to clear away heat and relieve fire.
⑥Damp-heat complication: Symptoms: obstructed stool, hard abdomen, or loose stool but hard to get out, or pain in the anus, dizziness, red tongue, yellow greasy coating, pulse number. The treatment is to clear heat and promote dampness, guide turbidity and stagnation, use Xuanqing Daozhuo Decoction to add and subtract: Polyporus umbellatus, Yunling 12g, 30g silkworm excrement, 15g acacia, 20g cold water stone, and 10g each of Citrus aurantium and apricot. This symptom is more common in people who are addicted to strong tea and who have been drinking liquor. In functional outlet obstructive constipation, most patients with puborectalis muscle spasm or pelvic floor muscle spasm syndrome belong to this syndrome. 30g of Radix Paeoniae Alba, 15g of Licorice, Yuanhu, and Taohong can be added to relieve spasm, relieve pain and promote blood circulation.
⑦Gastrointestinal stagnation: symptoms can be seen with constipation, abdominal distension and fullness. Use Zhi Hu Daozhi Decoction to add and subtract: raw rhubarb, coptis, and Atractylodes macrocephala each 10g, citrus aurantium, Yunling, scutellaria, each 12g, Alisma 6g, haw song each 15g.
⑧ Blood stasis internal knot: Symptoms of constipation, abdominal pain and refusal to press. Dark purple tongue or petechiae, strong or astringent pulse. To cure the bowel movement, use Xuefu Zhuyu Decoction: Angelica, Red Peony, Chuanxiong, Chuanxiong, 12g each, Pink 15g, Bupleurum, Citrus aurantium, Yuanhu, Rhubarb, Glauber's salt each 10g, Guizhi 3g, If the stasis heat internally, the night heat and early cool, or irritable, such as mania, faint and delirium, it is advisable to use Taohe Chengqi Decoction: peach red, raw rhubarb 12g, mirabilite 10g, cassia twig, licorice each 6g to break blood Blood stasis, wash away heat evil. This is more common in those who suffer from trauma or typhoid fever and suffer from heat transfer.
2. Deficiency constipation: It is more common in patients with chronic illness or habitual constipation, most of them are old and weak, and the course of the disease is longer. Therefore, the treatment only needs to slow the recovery of the function, and it is not necessary to make up for the problem.
①Yin deficiency and less blood: constipation, hard work, weak lips, sore waist and knees, dizziness, restless heart palpitations, pale tongue, thin pulse. The treatment is to nourish yin and nourish blood, moisten the intestines and lax, use Wuren pill to add and subtract: Baiziren, pine nut, Yuliren, Lycium barbarum each 12g, Shengdi, raw Shouwu each 15g, Cistanche 10g, hemp seed 20g, tangerine peel 10g , Licorice 5g. The prescription is mild in nature and can be used as a long honey pill. If the qi is weak, add 20g of Astragalus and 10g of Platycodon.
②Yin deficiency and fire: constipation, dizziness, tinnitus, five upset fever, or hot flashes and night sweats. Red tongue with little coating, fine pulse. The treatment is to nourish yin and reduce fire, increase water and move boats, and use Zengye Decoction and Baihe Dihuang Decoction to add flavor: 30g of raw land, 12g of lily, 12g of Ophiopogon japonicus, 15g of Scrophulariaceae, 10g of white peony root, and 5g of licorice. If the stool is dry and hard, add 3g of rhubarb and 10g of Glauber's salt.
③ Deficiency of qi and unlucky: The main reason is that the bowel movement is not smooth, and the stool is not necessarily dry. Stool is solved for several days or counted for a day, or stool is not easy to pass, or the time of defecation is prolonged, or there is a feeling of incomplete defecation after defecation, or the anus is swollen all day long, or despite the intention to defecate, the toilet is weak and sweating Short breath. His complexion was pale, tired and timid. Pale tongue, thin and weak pulse. This is more common in the elderly, frail, prolific and chronically ill. Functional outlet obstructive constipation such as rectal protrusion, rectal mucosal prolapse, and perineal descent syndrome are mostly of this type. The treatment is to invigorate the spleen and invigorate the qi, moisturize the intestines and relax the bowels. Use Buzhong Yiqi Decoction to add or subtract: Astragalus 30-60g, Codonopsis 30g, Angelica 15-30g, Gastrodia, Bupleurum, Platycodon, Citrus aurantium, Atractylodes atractylodes each 10g, Cistanche 20g , Shenqu 18g, licorice 6g, hemp seed 20g. For those with kidney-yang deficiency, cold limbs in shape, and more pain in the waist and knees, add 15g of attached tablets, 12g of dried ginger, and 3g of asarum to warm the spleen and kidney.
④ Deficiency of Qi and dampness: poor bowel movements, swelling of the anus, chlorosis, fatigue, faintness, anorexia. The fur is white and greasy and the pulse is fine. Treat the spleen and reduce dampness and relax the stool, use Shenlingbaizhu powder to add flavor: soaking, astragalus, silkworm excrement, cistanche each 20g, atractylodes, yunling, lentil citrus husk, array peel, almond 12g each, columbine 15g, sand 10g each of kernel and platycodon, 30g rice bran.
⑤ Deficiency of Qi and Yin: Constipation, difficulty in passing out, or incomplete defecation. Physical fatigue, laziness, thirsty, sweating or spontaneous sweating, dry mouth and tongue. Red tongue, less coating, fine pulse. The treatment is to replenish qi and nourish yin, moisturize the bowel, and use Sijunzi Decoction and Zengye Decoction to add and subtract: Codonopsis pilosula, Shouwu, hemp seed, 20g each, Atractylodes, 12g, Radix Scrophulariaceae each 15g, Scrophulariaceae 15g, Licorice 5g. If the secret knot is severe, add yellow and thenardite.
⑥ Condensation of moisture: Constipation, palpitations and chest tightness, dizziness, shortness of breath, or see edema, thirsty and not drinking too much or vomiting when water enters, short and astringent urine, complexion, dark complexion, slippery tongue, sinking pulse. The treatment is to warm the yang and transform the qi, diure and relax the bowel movement, and use Wuling San to add 12g each of Poria, Polyporus, and Atractylodes, 15g of Alisma, 10g of Guizhi, and 20g of Cistanche. This syndrome is rare, mostly due to the deficiency of spleen and kidney yang and the lack of steaming, so that moisture condenses, body fluid is not distributed, and the large intestine is not moisturized. Professor Liu Duzhou believes that the water disease of this syndrome seems dry, and it is all caused by the non-distribution of body fluid. If you mistakenly treat dryness and throw in a product that nourishes, greasy and femininity, it will help the yin to reduce the yang, make the moisture uncontrollable, often have abdominal distension, swelling of the limbs, eating and drinking, and death due to panting, so don't be careful!
⑦Yin and cold stagnation: stools are difficult to resolve, clear and long urination, cold limbs, or bloating or pain in the abdomen, which reduces the temperature and pain. The tongue is pale, the pulse is slow and weak. The treatment is to warm Yang to lax, and use Jichuan decoction to add and subtract: Cistanche and Angelica 20g each, Gastrodia and Citrus aurantium each 5g, Cynomorium 12g, Hemp 15g. Add 30g of attached tablets and 15g of dried ginger for severely yang deficiency; add Codonopsis 30g and astragalus 20g for obvious qi deficiency; add Radix Scutellariae 10g for deficiency of fire; add Rehmannia glutinosa, Lycium barbarum, and Eucommia 15g each; Decoction: 6g of raw rhubarb, 12g of ginseng, dried ginger, attached tablets, 3g of licorice.
In addition, adding 30~60g of rice bran to the above certificates is more effective. Cover with rice bran and Xinganping, start with Yangming Sutra of Hands and Feet. It is rich in oil, oryzanol and a variety of glycerides, free fatty acids, vitamins B and E, etc., and has anti-tumor effects, "can eliminate the accumulation in the stomach." The author has realized that it has the functions of opening the spleen and stomach, eliminating food and promoting stagnation, clearing the turbid and decayed gas in the stomach and intestines, and moistening the intestines and laxatives.
(2) Single proven prescription treatment
There are many single proven prescriptions for treating constipation in the folk, among which the effective ones are:
1. Take 2~5g of raw rhubarb or 5~10g of senna leaf in boiled water to treat constipation.
2. Decoction of 15g betel nut, 9g magnolia leaf and 9g tangerine leaf each, mainly treats qi stagnation and constipation.
3. Appropriate amount of sesame oil or beehive can be taken orally to cure the secret of deficiency of Yin and blood.
4. Decoction of 30g of Astragalus and Hemp seed and 15g of Suzi to treat the secret of Qi deficiency.
5. Tremella decocted with 30g water daily and appropriate amount of sugar, or decocted with 30g raw shouwu; or decocted with 20g of angelica and cistanche in water instead of tea. Can cure habitual constipation.
(3) Surgical treatment
1. Protrusion of the rectum
1) Transvaginal repair
A: Purse-string repair
B: overlap repair
2) Transrectal repair
A: overlap repair
C: PPH incision
2. Removal of the rectum/inner sleeve
1) PPH incision
2) Suture fixation
4) PPH incision + suture fixation
5) Mucosal incision
3. Puborectal muscle sign
1) Transanal amputation
2) Transcaudal sacral resection
3) Transcaudal partial resection
4) Transcaudal sacral cut and reverse embedding
4. Colonic redundancy:
Partial colon excision and anastomosis
5. Colon paralysis (slow colonic transit)
1) Total colon resection, back-straight anastomosis
2) Partial colectomy
3) Subtotal colonectomy
4) Selective colectomy and anastomosis