Sun Qing1 Xia Zhaofang Liu Jianhua 250012
From 2003 to 2006, we treated 38 cases of chronic nonspecific ulcerative colitis with rectal drip of Xianfang Lulin Drink, which is reported below. Sun Qing, Department of Surgery, Jinan Hospital of Traditional Chinese Medicine
1 Data and methods
1.1 General data: The 38 cases were all outpatients of our hospital, 26 males and 12 females; age 2o-30 years old 6 cases, 30-40 years old l8 cases, 40-50 years old 8 cases, 50-6 years old 4 cases, >60 years old 2 cases; the longest duration of the disease was 10 years and the shortest was 3 months.
1.2 Diagnosis criteria were determined with reference to the diagnostic criteria of “Diagnostic and Therapeutic Criteria of Common Diseases”.
1.3 Treatment method: Xianfang Livestrong Drink plus reduction. Drug composition: 30 g of honeysuckle, 15 g of pollen, 10 g of soapberry, 10 g of shanjia, 12 g of dahurica, 9 g of frankincense, 9 g of myrrh, 15 g of angelica, 15 g of red spoon, 12 g of zhebei, 9 g of Chenpi, 3o g of white peony, 3o g of umeboshi, 10 g of withered alum, 15 g of licorice. 400 ml of juice was decocted in water and packed in 2 bags by our automatic herbal decoction machine. Rectal drip method: medicine volume 200 ml, medicine solution temperature 38-40℃. The patient was placed in the lateral position, the operator connected the catheter with the needle removed, and the catheter was coated with appropriate amount of liquid paraffin and inserted into the anus for 10-20 cm, and the drip rate was controlled at 3o-40 drops/rain. the patient was instructed to empty the stool before treatment. The rectal drip was 200 ml each time, once in the morning and once in the evening. 10 days was considered as a course of treatment. 3 courses of treatment were followed and the efficacy was counted.
1.4 Efficacy criteria: recent cure: clinical symptoms disappeared, sigmoidoscopy or barium enema examination of intestinal mucosal lesions disappeared; improved: clinical symptoms reduced, sigmoidoscopy or barium enema mucosal lesions reduced; invalid: clinical symptoms, sigmoidoscopy or barium enema mucosal lesions no change.
1.5 Recently, 10 cases were cured, 25 cases were improved, and 3 cases were invalid.
Discussion
Ulcerative colitis, also known as chronic non-specific ulcerative colitis, is a disease with superficial, non-specific inflammatory disease of the rectum and colon, accompanied by extra-intestinal multi-organ damage, which is currently considered to be related to genetic factors, with autoimmune mechanism as the root and infection and neurological factors as causative factors, with lesions mainly in the rectum and sigmoid colon. It begins with diffuse inflammatory changes in the superficial layers of the mucosa. In the late stage, the intestinal wall becomes thicker, narrower, and the intestinal canal becomes shorter due to the proliferation of colonic tissue. (1) Clinical manifestations: Most of the disease starts slowly, the disease is more stubborn, and the symptoms often persist or have a chronic course with intermittent episodes and remission periods. Eventually, it can cause wasting, anemia, general debility and dystrophic edema. Diarrhea is the main symptom of the disease, and in severe cases, the stool can be more than 10 times a day. Stool examination often contains blood, pus and mucus. During defecation, there may be urgent and then heavy and paroxysmal abdominal pain, which may be relieved or disappear after defecation. Mental stimulation, nervousness, exertion and eating disorders are often triggers for the onset of symptoms. Some patients may have chills and fever, anorexia and nausea, abdominal pressure pain or lumps, and increased peripheral blood leukocytes. In addition to toxemia, later stage patients may also have anemia, decreased plasma protein, water and electrolyte disorders and acid-base imbalance. (2) Physical and chemical examination :Barium enema X-ray can show colonic lesions, which is important for the diagnosis and differential diagnosis of this disease. Endoscopy: fiberoptic colonoscopy has a decisive diagnostic value for ulcerative colitis. It is contraindicated in heavy patients in the acute phase to prevent perforation. Stool examination: microscopic masses of red blood cells, white blood cells and mucus. Blood count: often hypochromic, microcytic anemia. Leukocytes are elevated in the acute phase, with neutrophil elevation predominating in the classification. Blood sedimentation: mostly increased. (3) Treatment : Treatment principles: 1. symptomatic and supportive treatment; 2. anti-inflammatory treatment; 3. immunosuppressive treatment; 4. treatment of complications; 5. surgical treatment if necessary. Western medical treatment: General treatment ①The acute attack period must be appropriate lying rest. Those with excessive nervousness can take appropriate sedatives, such as Librium, Valium, etc. The diet should be soft, easily digestible and nutritious, and only give semi-liquid without residue during the acute attack. In severe cases, it is advisable to fast for the first few days and supply nutrition intravenously so that the intestine can rest. Avoid irritating foods, and avoid milk and dairy products. Antibacterial drugs are preferred to sulfonamides, which are not easily absorbed by the gastrointestinal tract. Azosulfapyridine salicylate is effective in relieving symptoms and preventing relapse and is indicated for light or heavy remission for about one year. Other sulfonamides such as sulfamethoxazole and phthalothiazole can also be used. Adrenocorticotropic hormone can inhibit inflammation and immune response and relieve toxic symptoms. The near-term efficacy is good, while the long-term efficacy is not yet certain. They are generally indicated in cases where sulfonamides are ineffective, or in acute exacerbations or fulminant cases. Prednisone, dexamethasone or prednisolone may be given orally, or hydrocortisone or succinyl hydrocortisone may be given intravenously or by enema. Other immunosuppressive drugs such as azathioprine and 6-mercaptopurine can be used, but their efficacy is not yet certain and they can be used with caution in cases where sulfonamides and adrenocorticosteroid therapy are ineffective. When combined with adrenocorticosteroids, the dose of both can often be reduced. Symptomatic treatment ① antispasmodic: Atropine, belladonna tablets, probenecid and compound benzodiazepine can be used. ②Astringent: bismuth subcarbonate and ellagitin can be used. ②Fresh blood should be transfused for severe anemia. Those who are malnourished can be transfused with plasma or human albumin. In Chinese medicine, this disease belongs to the categories of “dysentery”, “diarrhea”, “intestinal wind” and “diarrhea”. In terms of treatment, it is advocated to identify the symptoms of damp-heat in the intestines (1) The main symptoms are abdominal pain and diarrhea, pus and blood in the stool, more frequent stools, dry mouth and bitterness, or fever, red tongue, yellow and greasy coating, and slippery pulse. Treatment: Clearing the intestines and resolving dampness. Formulation: Paeonia lactiflora soup. Commonly used drugs: Huang Lian, Scutellaria, Bai Shao, Mu Xiang, Licorice. Addition and subtraction in clinical evidence: if blood in the stool, add Diyu, Xianhecao, Sophora; if heat enters the ligament and bleeding does not stop, add Buffalo’s horn slice, Red peony, Damp peel, Raw earth, Black gardenia; if dampness is heavy and the tongue is greasy, add Acorus calamus, Raw coix seeds, Fructus septicum. The main symptoms of weakness are vague abdominal pain, loose stools, loss of appetite, abdominal pain and diarrhea if slightly greasy, fatigue, light tongue, fat body, tooth marks on the side, thin white moss, and weak pulse. Treatment: Strengthening the spleen and resolving dampness. Formulation: Ginseng and Atractylodes Macrocephalae Pill. Commonly used drugs: Radix et Rhizoma Ginseng, Atractylodes Macrocephala, Poria, Rhizoma Yam, Lentil, Coix Coix Seeds, Radix et Rhizoma Sandy, Chen Pi, Licorice. Addition and subtraction of clinical evidence: if there is loss of appetite and indigestible food in the stool, add Shen Qu and Jiao Shanzha; if there is deficiency of liver and spleen, with vague pain in the abdomen and painful diarrhea, add Mu Gua to the formula for painful diarrhea (Bai Zhu, Bai Shao, Fang Feng and Chen Pi); if there is deficiency of both spleen and kidney, with thin stool, or diarrhea at dawn on the fifth night, with fear of cold, add Li Zhong Wan (Dang Shen, Gan Jiang, Bai Zhu and Gan Cao) and Si Shen Wan (Nutmeg, Wu Zhu, Wu Wei Zi and Boneset). The main symptoms of liver and kidney yin deficiency are dry stools with mucus, or pus and blood in the stool, emaciation, dry mouth, or low fever, red tongue with no moss and cracked lines, and fine pulse. Treatment: Nourishing the kidney and nourishing the liver. Formula: Liu Wei Di Huang Wan. Commonly used drugs: dried Dihuang, Cornu Cervi Pantotrichum, Yam, Poria, Dampi, Fructus Lycii, White Peony. Adding and subtracting for clinical evidence: Yin deficiency, abdominal pain or abdominal masses, add angelica, peach kernel, red peony, curcuma; Yin deficiency, blood heat, fresh blood in the stool, add Erzhi Wan (chasteberry, dry lotus grass), Phellodendron leaf, ground yu, Xianhecao; Our hospital adopts Xianfang Livestrong Drink rectal drip treatment for chronic non-specific ulcerative colitis with satisfactory results. Xianfang Livestrong Drink is from “The Good Recipe for Women”. It has the function of clearing heat and detoxification, eliminating swelling and ulceration, activating blood circulation and relieving pain, and has been used to treat red, swollen and painful surgical sores and swellings. The famous doctor’s formula said: “This is the first formula to open the hands of the ulcer door to attack the poison.” Ulcerative colitis from the local manifestations, the initial redness and swelling pain, the middle and late ulceration into pus. It belongs to the category of sores and ulcers in Chinese medicine, and is an internal carbuncle in Chinese medicine. Canker is also a congestion, qi and blood are congested by poisonous evil, congestion and become, heat and toxicity, rotting flesh into pus, pus out of poison diarrhea, the formation of chronic ulcers. This disease is caused by heat and poison, and the blood and flesh become corrupt. The Immortal Formula Living Life Drink is the first formula for ulcers in the world, and is suitable for the three stages of sores. Soapberry, Shanjia, Angelica dahurica, Dahurica dahurica, Frankincense, Myrrh, Angelica sinensis, Red spoon, Zhebei, Chen Pi, invigorate the blood. It cools the blood, opens up the qi and blood, removes decay and generates muscle, and facilitates the healing of the wound. Paeonia lactiflora and Glycyrrhiza glabra sour and sweet to relieve yin and relieve pain, and Ume plum and Ku alum to astringent and fix astringency together to treat ulcerative colitis.