Constipation is a symptom of a variety of common clinical diseases. It refers to a decrease in the frequency of bowel movements, a bowel movement every 3 to 4 days or longer without the use of laxatives, or a small and dry hard stool, some like sheep feces, and often a feeling of difficulty in defecation, or a combination of long bowel movement time, rectal distension, or a feeling of incomplete defecation. Beijing, Tianjin, Guangzhou, Hangzhou population survey data show that the prevalence of constipation is 3% to 17% of the population, more women than men, more elderly than young adults. With the development of the aging of the population, the change of people’s diet structure and the influence of psychological and social factors, constipation has become an important disease affecting people’s quality of life. According to Chinese medicine, constipation is a condition of constipation, prolonged defecation time or the desire to defecate but not smooth. Due to individual differences, each person’s situation is different, so we cannot take one bowel movement per day as the standard for bowel movement.
I. Pathogenesis of constipation
Regarding the pathogenesis of this disease, Western medicine and Chinese medicine have their own interpretation, Western medicine mainly from the nerve, muscle, primary disease and other aspects to understand, while Chinese medicine believes that the cause of the disease is mainly blamed on the large intestine conduction malfunction, but also with the lung, spleen and kidney is very close relationship. The understanding of these two is described as follows.
1.Western medicine’s understanding
Regarding the mechanism of defecation, Western medicine believes that the food absorbed by the digestive tract is transformed into fecal mass, which forms a sufficient volume of feces in the rectum to reach the rectum at a normal speed through the gastrointestinal tract in time to produce bowel movement and cause the defecation reflex. During defecation, the pelvic floor muscle groups coordinate their activities to complete defecation. This includes the involvement of the nervous system and muscle activity (smooth muscle) with three lesions.
(1) neurological lesions: mainly damage to the sacral nerve, lumbosacral spinal cord, and higher spinal cord causes decreased tone of the colon and rectum, resulting in the absence of bowel movements; intestinal neuropathy, such as congenital megacolon; or central diseases, such as various cerebral infarcts and cerebral hemorrhage.
(2) Intestinal smooth muscle lesions: such as connective tissue disease, endocrine, metabolic diseases and other systemic diseases causing intestinal smooth muscle lesions.
(3) Intracavernous lesions of the gastrointestinal tract: most of the intestinal lesions lead to intestinal obstruction, obstructed passage and no bowel movement, such as intestinal tumors, chronic intestinal stasis, rectal prolapse, etc. There are also constipation caused by drugs or psychosomatic disorders, such as the use of morphine preparations, or suffering from depression, anorexia nervosa, etc.
At present, some special tests are taken clinically, such as gastrointestinal passage test, or colonic transmission test, fecal imaging, and anorectal manometry, and constipation is divided into three types.
① slow transmission type constipation.
② outlet obstruction type constipation.
③ mixed constipation.
2, the understanding of Chinese medicine
In Chinese medicine, the disease is called constipation, which has the following different names according to different causes and symptoms, i.e. “difficult to pass stool”, “unfavorable after”, “spleen about”, “closed”, “constipation”. “closed”, “yin knot”, “constipation”, etc., “Ji Sheng Fang”, “the regimen is not correct, the three jiao qi is astringent, the transportation is not possible, so the congestion in the intestines and stomach Between, so into five secret of the problem. …… five secret, wind secret, gas secret, wet secret, cold secret, hot secret is also.” Now it is believed that constipation is mostly caused by heat accumulation in the large intestine, or gas stagnation, or cold condensation, or deficiency of yin and yang qi and blood, so it is mostly divided into four cases of heat constipation, gas constipation, cold constipation, false constipation. Jing Yue Quan Shu” clearly pointed out that constipation is the large intestine conduction malfunction, including the modern medicine of habitual constipation, investigate its mechanism, “the source of the diseases of the theory of” cloud: “difficult to stool, by the five Tibet is not regulated, yin and Yang bias deficiency, said the three jiao is not and then hot and cold knot. The stomach is the sea of water and grain, the essence of water and grain for the Rongwei, its dregs travel in the large intestine to get out also.” The whole process takes 24 to 48 hours, as in the Confucianism: “The stomach is the sea of water and grain, and it receives its new in order to change its old, one stool a day, which is also the normal degree.” There are four main pathological mechanisms as follows.
(1) heat accumulation in the gastrointestinal tract: the accumulation of heat in the gastrointestinal tract caused by alcohol, spices, or after typhoid fever, residual heat stays, fluid depletion, resulting in the loss of intestinal moistening and the onset of disease, such as “Suwen – Linglan Secret Discourse” cloud: “the large intestine, the official of conduction, change out of the”, is the cause of the disease, lies in the large intestine conduction disorder.
(2) qi stagnation: thinking about the mood is not comfortable, sitting for a long time and less movement, resulting in qi stagnation, the loss of publicity and the abnormal conduction, conduction failure, dregs within the stop, can not go down, and constipation. For example, the conclusion of the “symptoms of the pulse – constipation” cloud, “anger is qi up, thinking is qi knot, worrying and thinking, all qi fries and depressed, then qi congestion large intestine, and the stool is knotted.”
(3) deficiency of qi, blood, yin and fluid: fatigue and internal injury, postpartum and old age deficiency, and into the fluid deficiency, qi deficiency, blood deficiency or deficiency of both qi and blood. Qi deficiency results in weakness of large intestine conduction. The conclusion of constipation of the bowels, “If there is a deficiency of vital energy, the lung gas can not reach down, the large intestine can not transmit the order, and the bowels also knot.” Blood deficiency can not nourish the large intestine, such as the diagnosis of the remaining set – not eat inconvenience cloud: “people’s stool does not work, such as the river boat does not work …… river water dries up, the boat can not travel. When into the blood to nourish and moisten the intestines medicine.” Another example is the “miscellaneous disease source rhinoceros candle – constipation source” cloud: “by the blood after the disease is not restored, by the postpartum to go too much blood and constipation”, and the “symptoms of pulse treatment – constipation conclusion” cloud: “high yin depletion, blood dry and exhausted, then the stool is dry and constipated.
(4) Yin cold stagnation: Yang deficiency or senior body weakness is cold stagnation intestine, cold condensation block Yang, fluid can not, intestinal lame, loss of transmission and constipation. Such as “diagnosis Yu set – not food inconvenience” cloud: “the river freeze does not untie, can not travel, ……, yin stagnation of the disease, non-warm medicine an can work.”
Second, the combination of Chinese and Western medicine to explore the pathogenesis of constipation
As mentioned above, both Chinese and Western medicine from the etiology to the onset of the disease to give a systematic understanding of the disease, and there are dark and. We believe that only by integrating the theories elaborated by Chinese and Western medicine can we help to better understand the nature of the disease, and ultimately eliminate the disease and solve the problem. In view of this, we have analyzed and organized the relevant theories of Chinese and Western medicine, the key to the treatment of this disease is to clarify the causes of constipation, the specific location of the disease, the treatment of the cause, the treatment of the disease to seek the root, can be described from the following three aspects.
1, fecal formation: Western medicine, the formation of feces, is the food in the digestive tract after digestion and absorption, the remaining residues of chyme transported to the colon, most of the water and electrolytes in the colon and then absorbed, and finally formed a fecal mass, transported to the sigmoid colon and rectum and excreted. Here, the same understanding in Chinese medicine is that after the food enters the stomach, is putrefied by the stomach and transported by the spleen, and its essence is absorbed, the remaining dregs become stool, which is mainly attributed to the putrefaction and transport function of the stomach and spleen. constipation. Zhang Zhongjing, because of the inability of the stomach qi to move down, listed Cheng Qi Tang as a way to pass the stool, and “the spleen cannot move its fluids for the stomach” and listed the evidence of “spleen contract”, believing that the disease is related to cold, heat and qi stagnation.
2, fecal discharge: modern medicine will defecation process is very clear, specifically, the accumulation of fecal mass in the rectum swelling mechanical stimulation, when it exceeds a certain threshold causes the urge to stool impulse, impulse through the pelvic nerve, lumbosacral spinal defecation center, and then transmitted to the cerebral cortex. When the brain responds to this impulse, it produces a series of defecation agitation, including the pushing contraction of rectal smooth muscle, the relaxation of internal and external anal sphincter, and the contraction of pelvic floor muscle to raise the abdominal muscle and diaphragm, which increases the abdominal pressure, etc. Finally, the feces is expelled from the body. The action potential activity of the colon is enhanced after sleep and meal, the peristalsis of the colon increases, and the stool is pushed forward, often causing the urge to defecate, and the urge to defecate of the participant is caused by the gastrocolic reflex. The so-called “change” means that the water and grain essence is decomposed by the stomach and transported by the spleen, and finally passed into the large intestine to become feces and excreted, so the large intestine conduction failure can cause constipation. Because the lung and the large intestine are on top of each other, so the lung is not purified, the large intestine is out of balance, affecting the large intestine conduction function can also cause constipation. Tang Zonghai in the “medical scripture essence – the official of the internal organs”: “the large intestine can conduction, because it is the lung of the internal organs. Lung gas down to be able to conduct.” The secret record of the stone room – stool dry knot ” said:” constipation, people think that the large intestine is dry, who knows is the lung gas dry, lung dry, then clean and purified gas can not go down in the large intestine.” Treatment can help the large intestine conduction by decluttering the lung qi.
3, fecal control: this phase includes a complex process involving the pelvic nerve, lumbosacral spinal defecation center, cerebral cortex, rectal smooth muscle, anal sphincter, as well as the pelvic floor muscles, abdominal muscles, colon peristalsis and so on. Ancestral medicine also attributed this part to the conduction function of the large intestine, which also includes the lung, as mentioned earlier, and some of the kidney function in it. If the kidney is the organ of water and fire, the division of yin and yang, such as kidney essence loss of solidity, can be caused by less fluid and intestinal dryness and eventually become kidney deficiency constipation, mostly treated with a formula such as Jichuan decoction, the kidney in the orifice for the two yin, the latter is the anus. The excretion of feces is the function of the large intestine to transfer the dregs, but it is also related to the qi of the kidney. If the kidney is deficient in yin, it can lead to constipation due to the drying up of intestinal fluids, and if the kidney is deficient in yang, it can lead to constipation or diarrhea due to yang deficiency. Treatment can be to nourish kidney qi, nourish kidney yin and strengthen kidney yang.
Therefore, the identification and treatment of Chinese medicine is particularly important, only to identify the nature of the disease, especially the location of the disease, in order to make the appropriate time, or tonic, or diarrhea, or descending, or blood to achieve the success of the medicine to the work. The importance of diet and life conditioning is very much emphasized in the theory of Chinese medicine, such as the “Thousand Gold Formula – food treatment formula” cloud: “the human body is peaceful, but must be well nourished, do not take drugs. …… doctor, we should first understand the source of the disease, know the offense, and treat it with food. If the food treatment does not heal, then order the medicine.” The first thing you need to do is to take medicine and always maintain a healthy and reasonable lifestyle, such as changing the habit of reading books and newspapers during bowel movements. It is not necessary to pursue regular bowel movements too much, so as not to increase the psychological burden and make the intestinal peristalsis unduly disturbed.