Functional constipation is a more common clinical gastrointestinal disorder. The incidence of functional constipation in China is about 10% to 25%, and the incidence of constipation is increasing with age, some data reported that the incidence of constipation in young people is 3%, middle-aged people is 8%, the elderly is 20%, and a considerable part of the elderly constipation for gas deficiency type constipation, the diagnostic criteria are as follows.
1, Western medicine diagnostic criteria, according to the Rome III functional constipation criteria for diagnosis
(1) 2 or more of the following must be met.
(1) At least 25% of the bowel movements are labored;
(2) At least 25% of the bowel movements are dry bulbous stools or hard stools;
(3) At least 25% of the bowel movements are incomplete;
④At least 25% of the bowel movements had a feeling of anorectal obstruction/obstruction;
⑤ At least 25% of the bowel movements required manual assistance (e.g., finger assist, pelvic floor support);
(6) Frequency of bowel movement <3 times/week.
(2) Rarely have loose stools without the use of laxatives;
(3) There is insufficient evidence to diagnose irritable bowel syndrome.
Symptoms have been present for at least 6 months prior to diagnosis, and the above criteria have been met in the last 3 months.
2. Diagnostic criteria of Chinese medicine
According to the diagnosis of qi deficiency constipation in the Internal Medicine of Chinese Medicine, edited by Zhou Zhongying, the diagnosis is formulated as follows.
In the symptoms can be seen that the stool is not dry and hard, although there is the intention to defecate, but defecation is difficult, sweating and short breath when struggling with force, weakness after defecation, fatigue, tired limbs and lazy speech, light tongue with white coating, weak pulse.
3, qi deficiency constipation of Chinese medicine syndrome recognition
Ancestral medicine believes that constipation is a disease caused by imbalance of yin and yang, disharmony of internal organs, abnormal transportation and transformation, disorder of emotion and will, poor diet and deficiency of middle energy, which leads to poor intestinal qi, resulting in difficulty in stool discharge. Su Wen? Linglan Secret Discourse” said “the spleen and stomach, the official of the granary, the five tastes out of it. The large intestine is the official of conduction, the change comes out. The small intestine is the official of the receiving power, and the chemical substances come out.” Su Wen? The five viscera are said to be “the prana also for the five organs to make, water and grain can not be long hidden.”
It can be seen that after food is digested by the spleen and stomach and nutrients are absorbed, it is finally discharged in the form of feces through the large intestine by conduction. Therefore, the spleen, stomach, large intestine and prana are important organs of defecation. The prana gate is the end of the large intestine, and the “Treatise on the Origin of Diseases? The “Treatise on the Origin of Diseases?”: “The anus is the end of the large intestine.” Therefore, the prana gate is more influenced by the large intestine. Once the large intestine conduction failure, the prana door opening and closing abnormal, then can be constipation.
Qi deficiency constipation pathogenesis is a disease of Qi deficiency without the ability to push the dregs to stop inside. The conduction of the intestinal tract and the opening and closing of the prana gate are closely related to the Qi lifting function of the spleen and stomach, and the lung Qi propagation and descent. The main manifestation of qi deficiency can be spleen qi deficiency.
The spleen is the source of the posterior, the source of Qi and blood biochemical, the spleen in the middle jiao and the division of transport and transformation, the normal transmission of fluids, gasification is sufficient, the intestinal tract smooth conduction is strong, the stool is smooth. If the spleen is weak, the large intestine is unable to push, resulting in internal stagnation of dregs. As the Ling Shu? The mouth question says: “Insufficient middle qi, urine and stool for the change. The spleen is the main ascending, the stomach is the main descending, if the spleen is deficient, then the qi is unfavorable to lift, the medical door stick drink “has the cloud:” the lift of the machine, in the spleen and earth of the healthy movement.
If the Qi is disordered, the upper and lower gates will not open and close properly, and the prana gate will be slow to open and close, and the opening and closing of the gates will be out of order, making it difficult to defecate. Deficiency of the spleen leads to dysfunction of transportation and transformation, and fluid is not distributed, so the intestines are not moistened and the conduction is not normal, resulting in constipation. Deficiency of the spleen may be accompanied by deficiency of blood and fluid to moisten the stool, making it difficult for the intestines to transmit.
The lung is the master of the qi of the body and the main ruler of the joints. Insufficient spleen and earth deficiency, the mother’s disease and the child will be easily transmitted to the lung gold, resulting in lung weakness, “Spleen and stomach” in the cloud: “Spleen and stomach deficiency, the lung is the most affected”, and then the lung is not suction, lung and large intestine, lung deficiency is unable to promote the large intestine, causing the large intestine conduction failure, as Tang Zonghai in the “Medical Jing Jing Jing Jing Yi? The official of the internal organs said: “the large intestine can conduct because it is the internal organs of the lung, the lung gas down to so can conduct.” Lung deficiency, pushing weak, large intestine conduction malfunction, prana door open weak, struggling to defecate and difficult to eliminate.
Zhou Shenzhai believes that the manifestation of qi deficiency constipation is: “the stool wants to go but not, or with but not,” the symptoms are seen in the stool is not dry and hard, although there is the intention to defecate, but defecation is difficult, forceful struggle is sweating short breath, weakness after the stool, fatigue, limbs lazy speech, light tongue with white fur, weak pulse.
4, modern medical understanding of the pathological mechanism of qi deficiency constipation
The essence of qi deficiency constipation should be qi deficiency of the large intestine is unable to push, so it is consistent with the defecation propulsion power deficiency in functional defecation disorder. In patients with this disease, deficiency of spleen qi is associated with pelvic floor descent and pelvic floor organ bulging, which aggravates pelvic floor neuromuscular injury and pelvic floor structural changes.
According to the Rome III diagnostic criteria, functional defecation disorders are divided into 2 subtypes: uncoordinated defecation and inadequate defecation propulsion, the latter being functional constipation with inadequate rectal propulsion during repeated defecation attempts with or without uncoordinated pelvic floor muscle contractions. The pathological mechanism may be related to the following factors.
(1) injury to the pelvic floor neuromuscles and structural changes in the pelvic floor
A large number of patients with constipation due to long-term defecation difficulties, excessive straining and chronic increase in abdominal pressure, which exceeds the physiological limit of anal raphe load, can lead to a decrease in the tone of the anal raphe, atrophy and sagging, and the pelvic floor dropping below the normal range during defecation. The nerve that governs the pelvic floor muscle is short, small and fixed, so when the pelvic floor falls, the nerve is bound to be stretched.
If the nerve is still stretched for 20-30 minutes after losing its conductivity, the excitability and conductivity of the nerve will not be restored, and the transverse pelvic floor muscle innervated by it will be gradually weakened and the contraction force will be reduced, which will be manifested as a decrease in the systolic pressure of the anal canal. The relaxed pelvic floor muscles are prone to pelvic floor organ bulge aggravating the strain injury of pelvic floor nerves.
(2) Damage to the intestinal nerve degeneration
Research data show that the colorectal wall of patients with constipation has muscle fiber degeneration, muscle atrophy, degeneration, deformation and reduction in the number of intermuscular plexus of the intestinal wall, and pelvic parasympathetic nerves can undergo pathological changes such as vacuolar degeneration of nerve axons, loss of myenteric neurons and degeneration of non-specific plexus. This is associated with patients producing abnormal rectal sensory thresholds and even insufficient rectal propulsion.
(3) Estrogen deficiency
This disease is most often seen in older women, some of which can be traced to birth injuries during the reproductive years. With increasing age, the estrogen level in the body decreases significantly, which can be manifested in the skin as a decrease in elasticity and in the abdominal wall as a thinning and decrease in tension of the transverse muscle fibers. By
(4) abdominal muscle diaphragm muscle strength deficiency
The contraction of abdominal muscles and diaphragm can increase the abdominal pressure to promote the excretion of feces, and the decrease of their muscle strength can reduce the defecation thrust.
Inadequate defecation power should be related to long-term defecation difficulties and pelvic floor decline on the pelvic floor neuromuscular strain injury, coupled with estrogen decline caused by the pelvic floor muscle degeneration atrophy. The mechanism should be pelvic floor descent, perineal support structure relaxation, motor and sensory nerve dysfunction innervating the pelvic floor, and decreased tension level of muscle fiber ligaments in the pelvic cavity.
5.Treatment of this disease by Chinese medicine
Chinese medicine treatment
Chinese medicine treatment is mainly to pass the lower part of the body, but emphasis is placed on diagnosis and treatment, replenishing qi to make the large intestine conductive and powerful, nourishing yin and moistening dryness to make the dregs discharged smoothly, as Zhu Danxi said, “replenish qi to move the boat powerfully, replenish yin to increase water to move the boat”. 94.3%. Sun Guangquan and Xu Hong used the method of tonifying the spleen, benefiting qi and nourishing the kidney to treat 86 cases of senile constipation. The total effective rate was 100%.
Fan Dongmei, Ou Zhihui et al [28] used the method of regulating the intestines and strengthening the spleen to promote the flow of qi and lowering the spleen, and also to strengthen the spleen to help the qi-chemical function of the intestines and stomach. The results showed that 6 cases (17. 1%) were clinically cured, 17 cases (48. 6%) were apparently effective, 9 cases (25. 7%) were effective, and 3 cases (8. 6%) were ineffective.
The treatment of constipation in the elderly is based on the theory of deficiency, using the method of benefitting Qi and nourishing Blood, moistening the bowels and opening the bowels, and self-formulated Ginseng and Gui Run Tong Tang orally (15g each of Radix et Rhizoma Ginseng, Atractylodes Macrocephala, Citrus Aurantium, Radix Angelicae Sinensis, Radix He Shou Wu, Herba Cistanches, Radix et Rhizoma Ginseng, l0g each of Peach kernel, Ma Ren and Almond, 5g of Licorice) with the addition and subtraction of evidence, treating 60 cases of functional constipation in the elderly. The results showed that 16 cases were cured, 29 cases were effective, 10 cases were effective, and 5 cases were ineffective, with an overall effective rate of 91.7% Qiu Xinping;
Liu Yuancheng treated slow-transmission constipation with the method of Yi Qi and intestines combined with the addition and subtraction of Chinese medicine, using raw Astragalus, Atractylodes, Radix Codonopsis, almonds, peach kernel, melaleuca, and powdered licorice, while the control group was treated with polyethylene glycol 4000. The near- and long-term efficacy of the treatment was observed. The results showed that the near-term efficacy of the treatment group for constipation was better than that of the control group (P< 0. 05), and the long-term recurrence rate was lower, which was more significantly different from that of the control group (P<0. 05).
Liu Mingyue used the method of tonifying qi and promoting lung to advocate functional constipation by tonifying qi and promoting blood, promoting lung and laxity, and formulated her own formula of Huangqi Tang (Astragalus membranaceus, Fritillariae, Chen Pi, White Honey) with the addition of Radix et Rhizoma Ginseng, Rhizoma Atractylodes Macrocephalae, Rhizoma Gastrodiae, Almond, Radix et Rhizomae, Radix Angelicae Sinensis, Peach kernel, Medlar, Licorice, treating 98 cases, curing 67 cases, showing efficacy in 28 cases, effective in 3 cases, and ineffective in 0 cases.