Ancestral medicine’s understanding of the large intestine and anus
The anatomy of the large intestine and anus was recorded in detail by ancient Chinese medical practitioners more than two thousand years ago. As early as in the Shang and Zhou periods, that is, the human body has done field anatomy. Such as the “Ling Shu – Jing Shui” day: “If the eight feet of the man, the skin and flesh in this. Outside can measure the cut and get, its death can be dissected and seen, its organs of the hard and brittle, the size of the bowels, the amount of grain, the length of the veins, the blood of the clear and turbid, the amount of gas, the twelve meridians of more blood and less gas, with less blood and more gas; with all the blood and gas, with all the less blood and gas, all have the number of people”. Thus, it is clear that a lot of information on the structure of the human body had been accumulated at that time. Li Jingxiang, Department of Anorectal Medicine, Dongzhimen Hospital, Beijing University of Traditional Chinese Medicine
The “Ling Shu – Intestines and Stomach” cloud: “The Yellow Emperor asked in Bo Gao day: I would like to know the six internal organs to transmit grain, the size of the intestines and stomach, the length, the amount of grain received how? The day: please tell all, the valley from the in and out, shallow and deep, near and far, the length of the degree; lips to teeth length of nine minutes, mouth wide two and a half inches, …… pharynx door weight ten taels, wide one and a half inches, to the stomach length of one foot six inches. …’Stomach relieve flexion, stretching, two feet six inches long, one foot five inches large, diameter of five inches, large capacity of three buckets of five liters. … small intestine after the left ring attached to the ridge, back around the iterative accumulation of its injection in the ileum, attached to the umbilicus, the upper back to transport the ring of sixteen curves, large two and a half inches, diameter of eight points less than half, three feet two feet long”. “ileum when the umbilicus left ring, back to the week leaf accumulation and down, back to the transport ring anti-sixteen curves, large four inches, diameter of an inch and a half of the less, length of two zhang a foot. … ‘wide intestine Fu ridge to receive the ileum, the left ring leaf ridge, up and down to open, large eight inches, diameter two inches of the greater half, two feet eight inches long. Intestines and stomach by the people to the out, six feet long concave inch and a quarter, back to the ring reverse, thirty-two curves also.”
Zhao Sijian testimony, the pharynx to the stomach (now the esophagus) is one foot six inches long, the small intestine (now the duodenum and jejunum) is three feet three feet long, the ileum (now the ileum and the large part of the colon) is two feet one foot long. The wide intestine (today’s sigmoid colon, rectum and anus) is two feet eight inches long. Small intestine, ileum, wide intestine total length of five feet six feet eight inches.
Zhao’s view. The length of the gastrointestinal tract contained in the “Ling Shu” was recorded during the Yin and Shang dynasties 3,000 years ago, and was used in the preparation of the “Nei Jing” for later generations, thus showing that our anatomy has a long history. The study of the anatomy of the large intestine and anus is only briefly described as follows.
The Book of Difficulties. Forty-two difficulties”: “ileum four inches, diameter of one and a half inches, two feet long, a bucket of grain, water seven and a half liters. The wide intestine is eight inches large, two and a half inches in diameter, two feet eight inches long, receiving grain nine liters and three eighths of one. …’Large intestine weighs two pounds and twelve taels, two feet long, four inches wide, diameter of one inch, when Qi (umbilicus) iterative accumulation of sixteen curves, holding a bucket of grain, seven and a half liters of water. … ‘anus weighs twelve taels, large eight inches, diameter two inches and a half, two feet eight inches long, receiving grain nine liters of three eighths of one. … large intestine and small intestine for the appendix. The lower extremely pranic door.”
Ming Li Ting “Introduction to Medicine”: “large intestine is also known as ileum, two feet long and four inches, by the water and grain a bucket of seven and a half liters. Pahmen on the appendix should be two feet eight inches long and eight inches large, by the valley of nine liters of three eighths (pahmen the lungs hide pahmen also, also known as wide intestine, said broad in the large and small intestine also, and the day of the anus, said its place like the shape of the cylinder also).” The weight of the anus, only twelve, the weight of the intestines, plus two pounds, total access to the lungs, and the heart, kidney and bladder connected to the diaphragm (the anus is also under the large intestine intercepted, total and lung for the table, the large and small intestine system from the diaphragm under the spine and brawn connected to the heart, kidney and bladder, the phase system lipid membrane tendons scattered including. However, each part of the texture Luo Luo large and small intestine and bladder, the fine vein is the way of gas, blood and fluid flow.) This is the large and small intestine blood supply, blood vessels from the mesentery, including scattered, and there are small branches to the intestinal tube, nutrients through this transport large and small intestine.
The East medical treasure} (1611): “large intestine image, large intestine a ileum also known as wide intestine (there is a mistake), two zhang a foot (a for two feet), back to the stacked accumulation of sixteen curves, Shenggu two buckets (should be a bucket), water seven and a half liters (difficult to Jing). Intestines and stomach from the people to the out of the length of six feet four inches and four minutes, back to the bend ring reverse thirty-two curves also, where the intestines and stomach together by the water and grain eight buckets of seven liters and six eighths of one (difficult Jing).”
Ming Li Zhongzhi “medical must read” (1637): “the large intestine to transmit the official, change out of it. Ileum when the umbilicus right back to sixteen curves, four inches large, diameter of one inch inch of less than half, two feet long, receiving a bucket of water seven liters of grain. Wide intestine Fu ridge to receive ileum, is out of the road of dregs, large eight inches, diameter of two inches of half, two feet eight inches long, by the valley nine liters of three eighths of one. Is more gas more blood, difficult by day, large intestine two pounds twelve two. Ileum, to its back stack also, wide intestine that is ileum of the larger, rectum and wide intestine of the end also, under even the anus, is the valley after the yin, a pranic door, total are large intestine also.”
Hemorrhoids, is one of the most common diseases in anorectal surgery. The first thing to remember from the Song Dynasty is that arsenic was melted into yellow wax and used in the hemorrhoid fistula, which is about 900 years earlier than the foreign injection therapy for internal hemorrhoids (Morgan, 1889). …with a small rope and cut with a knife”, which is also the earliest recorded human account of hemorrhoid ligation therapy. Chinese herbal medicine has long been used internally and externally as the main non-surgical treatment. The use of Chinese medicine in the treatment of hemorrhoids emphasizes evidence-based treatment. For the pathogenesis of hemorrhoids, most of them belong to dampness, heat, wind and dryness, and fire evil injures the veins and moves the blood, resulting in stagnation of qi and blood, which results in hemorrhoids, the specific treatment rules are applied such as dipping fire and cooling blood, dispelling wind and dampness, relieving depression and tonifying deficiency. The Chinese medicine commonly used includes the Chinese medicine Huaijiao pill, Diyu Dilian pill for internal use, Xiong Bing hemorrhoid capsule, hemorrhoid external sitting liquid fumigation for external use, which has the effect of laxative cooling the blood to stop bleeding, reduce swelling and pain. In the treatment of internal hemorrhoids, the traditional Chinese medicine withered hemorrhoid therapy has developed in succession, with good efficacy and little pain. The indications have been expanded. The main applied medicine for withered hemorrhoids are sclerotherapy (eliminating hemorrhoid spirit, etc.), and also the use of necrotizing agent (new No. 6 liquid, etc.) injection. Chinese ligation therapy draws on modern medical-surgical techniques, using a combination of open and sutured wounds, flap transfer and advancement, and intraoperative attention to preserving the skin bridge, which differs from both the open wound represented by Milligan Morgan and the closed wound method represented by Park. Even the use of withered hemorrhoid injection therapy is combined with the surgery, thus achieving good results.
Perianal abscess, an acute infectious disease of the soft tissues surrounding the anal canal and rectum. “If the Ying Qi is not obeyed and reverses with the meatus, it gives rise to hernia and swelling.” In the treatment, we pay attention to discriminative treatment, combining pus and skin color, the form and nature of the mass, discriminative application of Chinese medicine to eliminate and tonic method, once pus is formed, early incision and drainage, combined with the correct application of antibiotics to avoid the development of local disease and systemic serious infection and other complications. For abscesses below the anal raphe, the traditional staged surgery is basically avoided in the treatment, and one incision is made for cure. In terms of new technology application, for deep abscesses such as pelvic-rectal gap, with intracavitary ultrasound and MRI, early and accurate localization can be concluded, avoiding the blindness of surgery, shortening the time of treatment and reducing the occurrence of complications.
Anal fistula, Xu Chunfu “ancient and modern medical unification of the whole book” on the hanging line therapy of anal fistula made a pithy discussion: “…… medicine line under the day, the intestinal muscle with the long, the remote place both fill, water flow by line, not penetrate the sore, goose tube since eliminated.” This is about 500 years earlier than the foreign 1873 Vienna hanging thread therapy. The development of thread hanging therapy in China has basically solved the problem of incontinence in the treatment of high anal fistula, and has had a profound impact abroad. In particular, high complex anal fistula has long been a difficult disease in anorectal surgery. Nowadays, we can control postoperative defecation and prevent infection by using the integrated methods of Chinese medicine, such as hanging thread, open placement, repairing the internal opening, flap grafting, and changing open drainage to closed drainage (drip drainage method) after fistula removal, and with the support of surgical nutrition and antibiotics. At the same time, the use of anorectal pressure measurement equipment, attention to the functional protection of the anal sphincter before and after surgery, China in the treatment of anal fistula preservation of the sphincter to maintain normal bowel control function. We have made great progress in the treatment of anal fistula with preserved sphincter to maintain normal bowel control function.
The anal fissure is characterized by a rupture around the anus and a rupture in the folds. It is also dry with fire. In Chinese medicine, the pathogenesis of anal fissures is usually caused by dry fire, damp heat in the anus or blood-heat and intestinal dryness. Western medicine believes that it is related to infection. At present, non-surgical treatment with Chinese medicine, topical drugs, local closure or injection are the main treatments. For severe chronic anal fissures, especially those with submerged sinus tracts and enlarged anal papillae, surgical treatment can be used. It includes severance of the internal sphincter (posterior median and lateral) and excision of the anal fissure, as well as a better understanding of the pathological changes of anal fissure, such as spasm of the sphincter and relative narrowing of the anal canal due to chronic inflammation of the anal canal.
The epidemiological data shows that the incidence of colorectal cancer is on the rise, with an incidence rate of 5.5-6.8/lO million, ranking third in cancer death rate in Zhejiang, and second in cancer death rate in the U.S. At present, the level of early diagnosis has improved, and from the initial emphasis on surgical thoroughness to comprehensive treatment (surgery, radiotherapy, chemotherapy, Chinese medicine treatment, biological therapy, etc.), and pay attention to the patient’s The quality of life of the patient. With the improvement of modern medical technology and instruments, the proportion of anus-preserving surgery has increased significantly. The Dixon procedure, which preserves the complete anal levator muscle, the internal and external anal sphincter and its innervated nerves, as well as part of the lower rectum and the complete anal canal, provides good defecation and bowel control after surgery. Transabdominal rectal cancer resection through the anus with transanal pouch anastomosis is now more popular because it can improve the rate of rectal preservation in the lower and middle rectum. After the 1980s, transanalendoscopicmicrosurgery (TEM) was introduced, which can be extended to upper rectal cancer and sigmoid colon cancer (localized submucosal lesions). In addition, total resection of rectal mesentery is important to reduce recurrence. The use of Chinese medicine in postoperative colorectal cancer, which can reduce the adverse effects of radiotherapy, has been further confirmed. Recently, it has been elucidated from the level of gene transcription in China: experiments have confirmed that raw Astragalus, raw Dihuang, raw Atractylodes and raw Coix seeds mainly have the effect of regulating the content of p-endorphin in peripheral blood, realizing the effect of elevating the number of white blood cells and platelets in peripheral blood and enhancing the immune function of the body.
Rectal prolapse, Ming “medical prescription examination” cloud: “cover diarrhea for a long time will hurt the gas, under more than the death of Yang, is a loss of gas and blood are carried out, so that the wide intestine deficiency off.” Complete external prolapse, the prevalence has significantly decreased. According to incomplete statistics. Rectal prolapse is 4 to 5 times the incidence of external prolapse. Treatment methods include internal treatment, external treatment, acupuncture, injection, surgery and other methods. The combination of diagnosis and disease identification, and the “double-layer injection therapy” of Chinese medicine can avoid open surgery for some patients. For severe rectal prolapse, surgical treatment is required. Reconstruction of the pelvic floor, removal of long intestinal segments, raising the level of peritoneal reflexion, etc.
Chinese medicine has strong advantages in the treatment of inflammatory diseases of the colon, and the current classification is generally: damp-heat, blood stagnation, spleen and stomach weakness, spleen and kidney deficiency, liver depression and spleen deficiency, etc. The treatment principles include strengthening the spleen and benefiting the qi, activating blood stasis, clearing heat, detoxifying and drying dampness, astringent intestines to stop diarrhea, and dispelling rot and creating muscle. The treatment pathways include: internal administration, enema method, internal administration and enema method, combination of disease identification and evidence identification, combination of local and overall, to achieve better curative effect. For patients with severe, explosive type of emergency and various types of ulcerative colitis requiring supportive therapy, the combination of Chinese and Western medicine can bring into play their respective strengths, such as the combined use of salbutamol, corticosteroids, to achieve better results.