Constipation is a condition in which feces are retained in the intestine for too long, with prolonged bowel cycles; or cycles are not long, but the feces are dry and difficult to pass; or the feces are not hard, and although there is an intention to pass stool, but the stool is not smooth. It is equivalent to functional constipation in Western medicine. The evidence of constipation is not hard, although there is the intention of stool, but the stool is not smooth, and is divided into two cases: the fecal matter is sticky and difficult to solve and the fecal matter is not sticky. There is not enough knowledge and discussion in the literature about the disease of sticky stool, but many articles have mentioned that some diseases have the symptom of sticky stool that is difficult to be relieved, such as in chronic hepatitis, ulcerative colitis, recurrent mouth sores, wet temperature disease, diabetes mellitus, etc. can be seen in the case of sticky stool that is difficult to be relieved. The author will not dry and hard feces, but the stool stagnant difficult to solve the constipation disease called “sticky constipation”, now on its pathogenesis and its treatment to elaborate.
I. Clinical characteristics
The clinical characteristics of sticky constipation are, the fecal quality is not dry, but the fecal quality is very sticky, the stool is more soft and loose or in the form of thin strips. Because of the sticky feces is difficult to discharge, the patient is extremely difficult to defecate, defecation volume is small, slow and not smooth, there is a sense of residual stool after the stool, resulting in multiple bowel movements per day. It is not easy to wipe the anus clean after the stool stains the paper, or it is difficult to flush the stool pool. Doctors for rectal palpation, the finger in the intestinal cavity feel the intestinal wall sticky and difficult to turn, and when the finger is withdrawn, it can be seen on the finger sleeve stain sticky and difficult to wipe clean.
Mucous constipation is most often seen in elderly, frail, after a serious illness, or in patients with a high level of dampness and heat or phlegm and dampness. Patients may have fatigue, shortness of breath, abdominal distention and fullness, dullness and less food, chest tightness and vomiting, sores on the mouth and tongue, obscene breath, etc.
Disease Mechanism
1.Spleen deficiency and loss of transportation
This disease is mostly seen in patients with spleen weakness, old age, and chronic illness. Because the spleen is the master of transportation and transformation, spleen deficiency and weakness of the spleen’s transportation and transformation will lead to the involvement of both transportation and conduction of water and grain, resulting in sticky and constipated stools. Ling Shu? Insufficient middle qi makes the urine and stool change. In the book “Taiping Shenghui Fang? Volume 29? The formula for the treatment of deficiency labor and difficult stools says: “People with deficiency labor, the spleen and lungs are weakened, the grain and food are reduced, the qi and blood are blocked, the yin and yang are not harmonized, the stomach is congested, the upper jiao is deficient in heat, and the large intestine is injected, thus making it secret and astringent.” . Older people, after a serious illness and the development of sticky stools, are due to the weakness of the vital energy, spleen qi deficiency, the inability to transport and transform, water and grain essence can not be transferred, dampness and turbidity, intestinal bowel transmission and transformation of the cause. Therefore, spleen deficiency and loss of transportation is the root cause of this disease.
2, dampness or phlegm dampness blocking the qi mechanism
Dampness obstructs the qi stagnation is an important pathogenesis of this disease. Su Wen? To the true to the great theory of cloud: “Taiyin Division of the sky, dampness, ……, difficult to stool.” The said that refers to the damp evil sticky, damp evil trapped spleen, qi stagnation, the internal Qi is not pass, the stomach gas does not descend, the large intestine is not conducive to conduction and lead to unfavorable or difficult stool, loose stools and unpleasant disease. Jing Yue Quan Shu? Miscellaneous evidence of mu” cloud: “wet secret, ……, wet can not be secret? But the wet does not turn, by the gas does not work ear.”
The “clinical guide to medical cases” says: “Loose discharge of intestinal dirt and dirt accumulation, dampness and heat also. This disease is also seen in patients with phlegm and dampness, “Zhang’s Medical General? Volume 7” cloud: “fat people have a lot of phlegm and dampness and heat agglomeration, due to the disease every cause of urinary and fecal inaccessibility, abdominal fullness without food, gas reversal and panting, the potential Sheng had to down, there are repeatedly down not pass the benefit, there are again and again under the beginning of the pass, there are under the then more than the benefit. The person who has a high level of dampness and heat, the stool does not work, although the number of days, very little feces, the next but loose feces and greasy, and even suddenly under the unstoppable. ……, this is originally damp heat”. The spleen is deficient in dampness and turbidity, dampness and turbidity are stagnant and heat, or dampness and heat are knotted in the intestines, leading to stagnation of Qi in the intestines and bowels, then the stool is sticky, wanting to stool can not stool.
Mucous constipation with sticky stools difficult to solve, in line with the characteristics of dampness heavy stagnation, filth; at the same time, the stool is sticky and difficult to get down, and in line with the characteristics of phlegm and dampness. Therefore, “dampness” or “phlegm-dampness” is an important pathological factor of this disease. Dampness stagnates or phlegm-dampness gumming up, blocking qi, resulting in poor qi flow in the intestinal organs, abnormal conduction, and constipation of stool. Therefore, “qi stagnation” is also an important pathological factor of this disease. Sui? Chao Yuanfang’s “Treatise on the origin of various diseases? The “stool does not pass Hou” said: “stool does not pass, from the three jiao five organs and not harmonious, hot and cold gas is not regulated, ……, congestion does not pass.” The “Jin Kui Wing? The “Closed unified theory” also cloud “gas stagnation, and things do not work.”
3, and also the trapped qi and blood yin and yang deficiency
Because of the weakness of the spleen and Qi, the biochemical deficiency of Qi and Blood, some patients with stagnant stool can also see the manifestation of deficiency of Yin and Blood, dry skin, hair loss, low menstrual flow, dry eyes, etc., which makes the clinical manifestation of this disease more complex and increases the difficulty of identification, which needs to be noted in the clinical evidence.
To sum up, this disease is based on spleen deficiency and weakness of qi to transport and transform, and dampness or damp-heat blocking qi, resulting in the smooth flow of qi from the intestinal organs and unfavorable conduction and development. Spleen deficiency is the basis, dampness obstructs the qi or damp-heat obstruction is the standard.
Third, identification and treatment
1.Spleen deficiency and loss of transportation.
Symptoms: loose and sticky stools, difficult to discharge even after struggling, sweating and shortness of breath after struggling, heavy residual feeling after the stool. The face is less florid, fatigue, weak limbs, less breath and lazy speech, sweating when moving. Pale tongue with white coating and weak pulse. Treatment: Strengthening the spleen, benefiting Qi and helping transportation. Representative formula: Huangqi Ginseng Tang (Spleen and Stomach Theory, Volume 1). Commonly used medicines: Huang Qi 20g, Sheng Ma 8g, Dang Ginseng 12g, Chen Pi 6g, Mai Dong 8g, Cang Zhu and Bai Zhu 10g each, Huang Bai 6g, Shen Qu 8g, Angelica Sinensis 6g, Roasted Licorice 3g, Wu Wei Zi 8g, Bai Zhi 9g, etc.
2.Spleen deficiency and dampness stagnation evidence.
Symptoms: loose stools, astringent stagnation difficult to descend, posterior anal weight embarrassment, or even abdominal fullness or distension, belching and less food, normal or reduced food intake, or anal dampness and uncleanliness. The tongue coating is white and greasy, and the pulse is thin or thin and astringent. Treatment: Strengthening the spleen, drying dampness and removing stagnation. Representative formula: Shengyang De-Dampness Soup (Spleen and Stomach Treatise, Volume 2). Commonly used herbs: 12g of Atractylodes macrocephala, 6g each of Cang Hu, Qiang Wu, Fang Feng, Sheng Ma, Shen Qu, Ze Di, Pig Ling, 4g of roasted licorice, Chen Pi and Shen Qu, 8g of Radix Platycodon, etc.
3.Spleen deficiency and damp-heat evidence.
Symptoms: Soft, loose and sticky stools, difficult to go down. Or have anal burning or swelling discomfort, bitter mouth, dry mouth does not want to drink, mouth and tongue sores, stuffy stomach and less, fatigue. The face is scaly, the palms sweat a lot, and the breath is foul and heavy. Light tongue and fat body, white or light yellowish greasy tongue coating, thin or fine smooth pulse. Treatment: Strengthening the spleen, clearing heat and drying dampness. Representative formula: Han Xia Di Xuan Xin Tang (Treatise on Typhoid). Commonly used herbs: Fa Xian Xia 12g, Baicalin 9g, Radix Codonopsis 12g, Gan Jiang 9g, Huang Lian 6g, Mu Xiang 6g, Sheng Coix Seed 10g, Shen Qu 8g, Citrus aurantium (fried) 9g, Gua Gua Ren 6g, Han Xia (made) 9g, Chen Pi 6g, Bai Fu Ling 6g, Radix Platycodon 6g, Scutellaria Baicalensis (fried) 6g, Atractylodes Macrocephalae (fried) 6g, etc.
IV. Conclusion
In conclusion, mucous constipation as a special type of constipation As mentioned above, mucous constipation as a special type of constipation is not uncommon in clinical practice. This disease belongs to the deficiency of the spleen and the actual evidence, based on spleen deficiency, dampness and turbidity do not transform, dampness blocking qi stagnation, or dampness and heat intertwined, intestinal conduction of the bowel failure, qi is not conducive to the development of this disease. For the treatment of this disease, both the symptoms and the root cause should be taken into account, and while strengthening the spleen, dampness, dampness and stagnation should be transformed, and dampness and stagnation should be facilitated and cleared. Due to the relatively slow recovery of spleen deficiency and the drying out (clearing) of dampness (damp-heat), the treatment process of this disease is slow, and both doctors and patients must be aware of this. Do not be in a hurry, because of the slow onset of action, and increase the yellow, senna leaf, aloe vera and other dire down the drug to fast, the results increase the difficulty of treatment.