1. Be a good example of others and be tireless in teaching others
From October 1985 to October 1986, the first one-year national anorectal specialist improvement class was held in Xi'an by the Chinese Society of Traditional Chinese Medicine. The class was held under the premise that China's anorectal professionals were lacking in talents, and the purpose of running the class remembered that it was clearly stated in the admissions chapter of the "Chinese Medicine Daily" that it was intended to cultivate the young and middle-aged anorectal talents that China urgently needs. To this end, the society gathered a group of the most famous Chinese and Western medicine anorectal veterans such as Ding Zemin, Zhang Qingrong, Yu Dehong, Shi Zhaoqi, Zhang Dongming, Yin Boyue, Li Yunong, Lu Qi, Cao Jixun, Wang Chengye, Wang Yucheng, Wu Fei, Zhang Yousheng. , Li Runting, Wang Fanglin, Huang Naijian, Huang Chunlin, Peng Xianguang and nearly 20 domestic most famous anorectal experts and professors as teachers. I have the honor to participate in this once-in-a-lifetime, the highest level of anorectal teaching class since liberation. During the one-year study period, the learning content mainly includes the ancient Chinese medicine, the anorectal theory of Chinese and Western medicine, and the introduction of the clinical experience of the above anorectal experts. Among the many teachers, the deepest impression left by Professor Shi Zhaoqi is that he has a strong compassion and sense of responsibility for patients, and he is tireless in teaching others and being a teacher. In the study class, he repeatedly warned us that "anal function is very important. When performing an operation, we should take care of the patient's anal skin tissue as much as our own eyes." Professor Shi’s teachings have been deeply recorded in my mind and become my motto for anorectal patients in the future. Professor Shi also told us that when an anorectal doctor draws "three" diagrams, namely anal plan view, anal sagittal view, and coronal map, he can treat anorectal diseases (mainly hemorrhoids, anal Peripheral abscess, anal fistula, anal fissure, etc.) the location, number, size, shape, path of the lesion (fistula), and passing position (relationship between anal fistula and sphincter) are drawn very clearly. For more than 20 years, I have adhered to the three schematic diagrams of the anorectum emphasized by Professor Shi and benefited a lot.
2. Intensive research on traditional Chinese medicine "non-invasive, minimal pain, and high-efficiency "Xiaozhiling and four-step injection operation method" brings good news to the majority of hemorrhoid patients.
Professor Shi believes that "hemorrhoids is a common disease with a high incidence, and it is necessary to find a method of "simplicity, ease, defecation and effect" in the treatment, and put forward that "an ideal treatment method must pay attention to the following : (1) The short-term and long-term effects are satisfactory; (2) The treatment method is simple, the treatment course is short, and it is easy to promote; (3) The treatment is painless or almost painless; (4) No difficulty in urination and defecation; (6) No bleeding and Secondary hemorrhage, (6) no infection; (7) no sequelae such as anal stenosis and loose anus. It also emphasizes that: only by considering the above requirements, can a correct evaluation of a treatment method be made.
The new treatment of Xiaozhiling "Xiaozhiling for three-stage hemorrhoids" invented by Professor Shi is non-invasive, mildly painful, highly effective, satisfactory long-term and short-term effects, no obvious sequelae, economical and cheap, and it can be said to perfectly meet the above treatment requirements. . Professor Shi's profound understanding of the treatment of anorectal diseases and his scientific, rigorous and innovative attitude in evaluating a new treatment method for anorectal diseases still have great guiding and practical significance for our current clinical and scientific research work.
The four-step method of Xiaozhiling to inject hemorrhoids generally requires a larger dose (about 50-100ml each time). Due to the large number of puncture points, the needle used is thicker (No. 5), and the liquid is easy to overflow from the needle hole after injection. The effective dose that can be retained in the hemorrhoids has been greatly discounted. In the past 20 years, the author has repeatedly observed the principle of the four-step operation of Xiaozhiling, and tried the two-step method of small dose (about 20cm in total) and small needle (using skin test needle) (inject 1 in the suprahemorrhoidal artery area). First, balance the needle at the lowest part of the internal hemorrhoids in the dental line to the highest part of the internal hemorrhoids once) Simplify the Xiaozhiling injection method for internal hemorrhoids and Xiaozhiling injection. Due to the small (small) injection points and injection holes, the liquid medicine is not easy to overflow and overflow. Hemorrhoids can retain more liquid medicine to the utmost extent, resulting in the same therapeutic effect as the Xiaozhiling four-step method, but the dose of Xiaozhiling injection is reduced by more than one and a half compared with the conventional Xiaozhiling four-step method, and after injection The discomfort of anal drop was significantly reduced.
3. Treat complete rectal mucosal prolapse with double injection of Xiaozhiling.
The Xiaozhiling invented by Professor Shi has obvious astringent and solidifying effect, not only for internal hemorrhoids and mixed hemorrhoids mainly internal hemorrhoids, but also for mild and moderate rectal prolapse. In September 1986, during the internship at Guang'anmen Hospital when I participated in the first training course for anorectal physicians in China, I had the honor to follow Professor Shi to a hospital in Beijing to treat a female patient with severe rectal prolapse. The patient was about 60 years old.He has been suffering from rectal prolapse for more than 2 years. The examination revealed that the patient's rectum prolapsed from the anus about 8cm, the surface was dark red, and the blood was dripping. The diagnosis was full-thickness rectal prolapse. Professor Shi believes that full-thickness rectal prolapse occurs at the attachment point of the sigmoid colon and rectum (fixed point), and the focus of treatment is to fix the attachment point of the sectorectum. After successful sacral anaesthesia, the patient undergoes strict perianal and intra-anal disinfection. He first injects Xiaozhiling with a concentration of Xiaozhiling 1:1 (1 part of Xiaozhiling stock solution and 1 part of 1% procaine) in the rectal submucosa. Ling, then insert a needle into the mucosa of the rectum 8-10cm, in a multi-point or columnar injection, focusing on the submucosal injection at the junction of the rectum and the sigmoid colon, each injection is about 3cm, the total amount is about 30-40cm. (2) High injection method around the rectum: After the rectal mucosa is injected with Xiaozhiling, the needles are inserted outside the rectum at 3, 6, and 9 o'clock outside the anus at 3, 6, and 9 o'clock from the anal edge, and then the needles arrive at both sides in turn. After the pelvic rectal space and the posterior rectal space, first suck back the blood without returning blood, and then withdraw the needle while injecting Xiaozhiling into the above space. Xiaozhiling 1:1 solution is about 10cm on each side. Make the high position of the rectum and the surrounding tissues produce aseptic adhesion and fixation. Just like using sutures as a fixed suture, the rectum is restored to its original position and fixed with the surrounding tissues, so that it will no longer protrude outside the anus. In order to improve the therapeutic effect and prevent postoperative infections, Professor Shi repeatedly emphasized when demonstrating injections that whether it is for hemorrhoids or rectal prolapse injections, the following issues should be paid attention to: (1) Pay attention to strict aseptic operation. Sterilize the injection site and change the injection needle. (2) When performing rectal prolapse injection, inject Xiaozhiling into the left and right and posterior spaces of the rectum accurately under the guidance of the index finger. (3) After injection, it is necessary to fully press the injection site to make the liquid medicine evenly distributed to prevent induration and necrosis caused by excessive concentration of the liquid medicine. For more than 20 years, the author keeps in mind the teacher’s teachings, strictly implements aseptic operation and related operating procedures, and has injected Xiaozhiling into nearly 100 patients with mild to moderate rectal prolapse, and all have achieved satisfactory treatment results without any complications. Symptoms and sequelae occur.
Typical case: Tan, female, 79 years old. First visit on August 20, 2001. Complaints of prolapsed anal and vaginal masses, pain, and blood dripping for 1 year and 8 months after defecation or walking, squatting. The check was thin, pale, with pale red tongue and no moss. The pulse string is thin and weak. The total protein was 56.67g/l in the biochemical examination. There was a ring-shaped mass prolapsed from the anus in the specialist examination, which was about 8cm long in a spiral column shape and dark red in color. Surface hyperemia, edema, erosion, bloody secretions, wet clothes and pants. Finger examination anus is loose and can enter the three transverse fingers. The rectum recedes into the anus and then comes out of the anus. There is an oval-shaped mass protruding outside the vagina, gray and dark. Diagnosis 1 complete rectal prolapse (Chinese medicine deficiency of both qi and blood, depression of the middle qi type) 2. Uterine prolapse is 2 degrees.
Treatment: After admission, double-layer injection of Xiaozhiling rectal prolapse + multi-point ligation + anal fixation was performed. Routinely disinfect and spread towels after successful saddle anesthesia.
1. In order to ensure the therapeutic effect of rectal prolapse, the uterus is reset and returned to the vagina before injection, and then the vagina is closed temporarily, only the urethral opening is exposed and the urinary catheter is catheterized, and the suture is removed one week later.
2. During the operation, the prolapsed rectum was first sent back into the anus, and the middle and upper rectal mucosa were injected into the middle and upper rectal mucosa with a 1:1 solution of Xiaozhiling and normal saline in a columnar shape, a total of 40ml for each point of 2-3ml. After mucosal injection, fully press the soft surface mucosa to distribute the liquid evenly.
3. Perianal multi-point cross reticulation injection. Re-sterilize the perianal area. Use the dental injection needle to reach the presacral space from a distance of 1.5 cm away from the anal edge at 6 o'clock under the guidance of the left index finger. After the blood is returned, the needle is withdrawn and the medicine is injected for a total of 5 cm. Then withdraw the needle to 6 subcutaneously and then perform cross-net injections at 5 and 7 o'clock respectively, according to the law from 9 o'clock as the center and to 8, 10 and 3 o'clock as the center and inject both sides to 2 and 4 o'clock Space around the rectum. In order to strengthen the treatment effect, at 12 o'clock, the mucosa was injected with 5ml of Xiaozhiling 1:1 solution according to the above method.
4. Lower rectal mucosal ligation and fixation: Lift the loose rectal mucosa near the anus at 12 o'clock, clamp the base with hemostatic forceps, and ligate with 10 gauge silk thread. Treat loose rectal mucosa at 3, 6, and 9 points in accordance with the law.
5. External sphincter folding and anal fixation make a 3cm incision from the anal margin at 6 o’clock, remove part of the skin and part of the subcutaneous tissue, insert a hemostatic forceps, separate the superficial external sphincter, and fold it and suture it with No. 000 absorption thread 2 Needle, and then stitch the outer incision with 3 stitches until the anus can accommodate a finger width.
The wound was routinely disinfected and dressing changed, and stitches were removed within 7 days. Plus take Chinese medicine for replenishing yin, nourishing yin, nourishing the middle and solidifying the body: 30g each of Taizishen, Astragalus, Jinyingzi, Shanyu meat, Cohosh, Rehmanniae 15, 15g of donkey-hide gelatin (Huahua), 10g each of Cohosh and Phellodendron amurense. Take 1 oral daily. Result: He recovered and was discharged after 15 days of hospitalization. No complications and sequelae such as anal incontinence, infection and difficulty in defecation occurred, and no recurrence occurred after 7 years of follow-up
What was particularly unforgettable was that on the evening of December 18, Professor Shi was considering returning to Beijing. Despite the exhaustion of more than 10 days, he personally came to my residence, had a long conversation with me, and unreservedly taught him his knowledge. The precious diagnosis and treatment technology and experience of hemorrhoids, anal fistulas, anal fissures, ulcerative colitis, allergic enteritis (irritable bowel syndrome), colorectal polyps, etc. accumulated over the past ten years. While talking, Professor Shi wrote down the main points of diagnosis and treatment of the above-mentioned diseases in my notebook. When talking about ulcerative colitis, Professor Shi said, "Colonoscopy is very important for inflammatory bowel disease. When performing colonoscopy (in the order of notes at the time), you should pay attention to the following issues:
(1) Observation content: 1. (colon) mucosal morphology: normal pink with clear blood vessels 2. (Observation) Secretion: No obvious secretion under normal conditions.
(2) Pathology (during microscopic examination, the pathological tissue will be taken and sent for pathological examination at the same time)
1. Mucosal hyperemia, edema, vascular appearance, and mesh- (reminder) acute inflammation.
2. The mucosa is locally pale, thickened, and has (rough) rough blood vessels—indicating long-term chronic inflammation or inflammation recovery.
3. Ulcers (multiple, sporadic, punctate, or isolated ulcers)
4. Pseudo polyps (single, multiple, ulcer bleeding between polyps).
5. Polyps, cancers. Polyps without pedicles may become cancerous. Polyps with pedicles are mostly benign and flattened. Most flat ulcers become cancerous.
6. Abnormal discharge (increased, mucus, serous)
7. Vascular morphology and disease stage
8. Secretions any abnormal secretions must be taken out for smear examination and sent for culture (understand whether there are paracolitic bacteria, tuberculosis, cocci, mold, trichomoniasis, amoeba, dysentery, etc.)
9. Stool: for pathogen culture, occult blood test
Patients with colitis are prone to repeat the procedure, and each case requires multiple pre-fecal examinations.
(3) The most talked about is the diagnosis of colitis and the treatment of Chinese medicine.
1. Colitis classification
(1). Specific ulcerative colitis (caused by bacteria, molds, amoeba, etc.)
(2). Non-specific ulcerative colitis (with unknown cause) is divided into three types: mild, moderate and severe) Take the number of diarrhea as an example:
Mild-symptomatic diarrhea 3 times/day↓
Medium-symptomatic diarrhea 3～5 times/day
Severe—symptomatic diarrhea 5 times/day↑
(3). Hypersensitivity (irritable bowel syndrome)-colonoscopy without organic disease.
(4) Treatment of colitis with Chinese medicine
Classification and treatment:
The treatment of damp-heat type is suitable for clearing heat and removing dampness, promoting blood circulation and removing blood stasis, using Baitouweng decoction.
(1) The type of spleen deficiency and dampness is suitable for strengthening the spleen and dispelling dampness. Add and subtract Shenlingbaizhusan.
(2) The spleen and kidney deficiency type is suitable for the treatment of spleen and kidney supplementation, strengthening the body and strengthening the foundation. Use ten tonic decoctions combined with Angelica Sini Decoction.
He emphatically pointed out: If you have long-term lower abdomen pain, you should pay attention to blood stasis and qi depression, and you can add anti-depression and blood-activating medicine on the basis of TCM syndrome differentiation.
Allergic colitis (irritable bowel syndrome)
It is more common in women and often has a history of mental stimulation. The treatment mainly implies therapy (Note: psychotherapy)
Chinese medicine: ebony pill or ebony decoction
Constipation or dry feces (a lump of sheep dung) plus Sini Powder are treated with Citrus aurantium, Radix Paeoniae Rubra, Radix Glycyrrhizae, Rhubarb, etc.
Western medicine: compound salicylic acid and sulfasalazine, long-term use (six months to 2 years).
Colitis enema prescription:
Gardenia, Patriniacea, Sanhuang (Coptis, Phellodendron, Huang Cen), Galla Chinensis, Baiji, Puffball, etc. Choose 3 to 5 Chinese herbal medicines for each dose and use 100-200ml retention enema to remove the residue after decoction.
Severe diarrhea: pay attention to supplementing protein, amino acids, vitamins, etc.
The above precious record has been cherished in my study room.
5. Love the anorectal business in Guangdong and Zhongshan
Professor Shi Zhaoqi's great contribution to the cause of the anorectal in China will forever shine in the history of the anorectal in China. Professor Shi Zhaoqi, a generation of anorectal Chinese medicine master, will always live in our hearts.
1. Du Yong "Biography of Chinese Science and Technology Experts. Biography of Shi Zhaoqi
2. Shi Zhaoqi et al. Questions and answers on colorectal diseases. Beijing: Science and Technology Literature Press, 1982
3. Shi Zhaoqi et al. Chinese Colorectal Diseases. Zhengzhou: Henan Science and Technology Press, 1985
4. Shi Zhaoqi. The standard of Xiaozhiling and its treatment. Chinese Anorectal Journal, 1987, (2).