Rectal prolapse is a disease in which the anal canal, rectal mucosa, the whole rectum and part of the sigmoid colon are displaced downward and prolapse out of the anus. From July 2000 to July 2004, we treated 96 cases of rectal prolapse in pediatric patients with the oral application of Prolapse Ning Oral Liquid, and made control observations with 4l cases treated with the oral application of Tonic Zhong Yi Qi Tang.
1.Data and methods
1.1 General data: All 137 cases were inpatients of the Department of Proctology of our hospital and were randomly divided into 2 groups. In the treatment group, there were 96 cases, 65 males and 31 females; age ranged from 18 months to 13 years, with an average of 5.3 years; disease duration ranged from 6 months to 10 years, with an average of 3.4 years; 35 cases had I degree prolapse, 46 cases had II degree prolapse, and 15 cases had III degree prolapse. In the control group, there were 41 cases, 28 males and 13 females; age 1-13 years, average 4.7 years; duration of disease 1-11 years, average 3.6 years; 15 cases of I degree prolapse, 20 cases of II degree prolapse, 6 cases of III degree prolapse. there was no significant difference between the general data of the two groups (P>0.05), and they were comparable.
1.2 Diagnostic criteria: The diagnosis was determined with reference to the Diagnostic Efficacy Criteria of Chinese Medicine issued by the State Administration of Traditional Chinese Medicine. degree I prolapse: prolapse of the rectal mucosa, light red in color, <4 cm in length, soft, no bleeding, can be returned by itself after defecation, good anal function, incomplete prolapse. degree II prolapse: prolapse of the whole rectum, red in color, 4-8 cm in length, conical in shape, soft, good anal function, when defecation or abdominal pressure increases. The length of the prolapse is 4-8 cm, conical, soft, and the surface is circular with layered mucosal folds.
After defecation, the anal sphincter function can be decreased, which is a complete prolapse. III degree prolapse: when defecating or increasing abdominal pressure, the whole rectum or part of the sigmoid colon prolapses, length >8 cm, cylindrical, with shallow annular folds on the surface, which is very thick when touched, requiring manual reset, anal relaxation, sphincter function obviously decreased, which is a severe prolapse.
1.3 Treatment methods
1.3.1 Treatment group
1.3.1.1 Give prolapse Ning Oral Liquid. Drug composition: Pueraria lobata 20 g, Radix Astragali 30 g, Ephedra 8 g, Radix Platycodon 10 g, Radix Paeoniae 15 g, Radix Codonopsis pilosulae 20 g, Rhizoma Atractylodes Macrocephalae 15 g, Radix Asclepias 10 g, Radix Bupleurum 15 g, Radix Ginger 6 g, Fructus Jujubae 5, Rhizoma Huanglian 10 g, Radix Cinnamomi 10 g, Radix Glycyrrhizae 10 g.
1.3.1.2 Drug preparation Take the above concocted herbs, put them in a stainless steel container, add water to submerge the surface of the herbs for 5 cm, soak for 50 minutes, then heat and steam decoction, high heat to boiling, low heat to slightly boiling, first decoction for 1 hour, filter out the liquid, then add water to re-decoct the dregs for 1 hour, filter out the liquid, press the dregs to extract the liquid, mix the decoction and the pressed liquid, rest and precipitate, filter through, heat and concentrate the filtrate to The filtrate is heated and concentrated to 500 ml, divided into sterilized 500 ml bottles, sealed with caps and steam sterilized.
1.3.1.3 Dosage and Administration 50 ml each time for <5 years old, twice a day; 100 ml each time for 5-10 years old, twice a day; 150 rnl each time for 10-13 years old, twice a day. 10 days is a course of treatment.
1.3.2 The control group was given Tonic Zhong Yi Qi Tang. Drug composition: Astragalus membranaceus 30 g, Glycyrrhiza glabra 10 g, Radix Codonopsis pilosulae 20 g, Radix Angelicae Sinensis 20 g, Pericarpium Citri Reticulatae 12 g, Radix et Rhizoma lactis 6 g, Radix et Rhizoma Atractylodes Macrocephalae 6 g, Atractylodes Macrocephalae 20 g. Decoct 500 ml of juice, 1 dose daily. The dosage and duration of treatment were the same as those of the treatment group.
1.4 Efficacy criteria were determined according to the Diagnostic Efficacy Criteria for Chinese Medicine Evidence issued by the State Administration of Traditional Chinese Medicine. Cured: symptoms and signs disappeared; effective: symptoms and signs improved; ineffective: no change in symptoms and signs.
2. Results
The comparison of the efficacy of the two groups is shown in Table 1.
Table 1 Comparison of efficacy between the 2 groups Example
Group
Treatment group (n=96)
Control group(n=41)
n
Cured Improved Not cured Total effective rate %
n
Cured Improved Not cured Total effective rate %
Degree I
35
33
2
0
100
15
7
6
2
86.67
II degree
46
42
4
0
100
20
8
7
4
80.00
III degree
15
11
3
1
93.33
6
1
25
3
50.00
Total
96
86
9
1
98.96
41
16
38
9
78.05
Compared with the control group, p<0.05.
As seen in Table 1, there were 96 cases in the treatment group, and 86 cases were cured, with a cure rate of 89.58%, including 8l cases of I- and II-degree rectal prolapse, and 75 cases were cured, with a cure rate of 92.59%, suggesting that the drug is more effective for those with mild disease. Among the 86 patients cured, 34 cases had a disease duration <1 year, 2l cases had a disease duration of 1-3 years, 18 cases had a disease duration of 3-5 years, and 13 cases had a disease duration of ≥5 years, suggesting that the drug is more effective for those with a short disease duration.
3.Experience
Modern medicine believes that pediatric rectal prolapse is mainly due to incomplete development of the pelvic support tissues in children, which cannot assume a supportive role for the rectum, or imperfect development of the sacral bend, the rectum is vertical and the lumbosacral nerve is congenitally underdeveloped, plus long-term constipation, diarrhea, chronic cough, etc., so that the abdominal pressure continues to rise, resulting in rectal prolapse. The source of diseases: “prolapse, large intestine deficiency and injury to the son of cold dysentery, and for the gas weir, the gas down, the anus prolapse, so called prolapse also.”
The Zhang’s medical general・Prolapse of the anus says: “Lung …… out of the person for the deficiency. The anal prolapse, not deficiency and what? In addition, the large intestine and lung for the surface, the lung Tibetan heat is closed. The deficiency is off, must be lifted and replenished, careful not to use the drop gas medicine.” Difficult Jing: “The deficiency of the disease, into the real, out of the deficiency. The lung deficiency is intestinal,” the lung and prolapse of the closest relationship, spleen Yang deficiency in the Qi can not be collected and fixed off can also make the rectum prolapse and lung, spleen deficiency of the two organs related to the clear Yang does not rise, the lung Qi loss of propagation, so the treatment to ascend Yang fixed off, open propagation of lung Qi as the method.
The formula uses less cinnamon branch to promote yang qi to benefit spleen yang; because the herbs are warming and tonic, it is easy to help fire, so add bitter cold Huang Lian to remove heat from the intestines.
The whole formula ascends Yang to consolidate deficiency, opens and promotes lung qi, both tonifies and collects, taking into account both the symptoms and the root cause, and the effect is rapid.