Diagnosis】 1. The following conditions must be met to diagnose functional constipation. (1) Must include 2 or more of the following ① at least 25% of bowel movements are strained; ② at least 25% of bowel movements are dry ball or hard stools; ③ at least 25% of bowel movements have a sense of incompleteness; ④ at least 25% of bowel movements have a sense of anorectal obstruction/blockage; ⑤ at least 25% of bowel movements require manual assistance (e.g., finger-assisted defecation, pelvic floor support); ⑥ less than 3 bowel movements per week. (2) Scanty stools rarely occur when laxatives are not used. (3) Does not meet the diagnostic criteria for irritable bowel syndrome. (4) Symptoms have been present for at least 6 months prior to diagnosis, and the last 3 months meet the above diagnostic criteria. 2, functional constipation typing and severity judgment (1) typing according to the characteristics of the intestinal dynamics and anorectal function changes that cause constipation, functional constipation is divided into three types: slow transmission constipation (STC), outlet obstruction constipation (OOC) and mixed constipation (MIX), The clinical manifestations of OOC patients are straining to defecate, requiring manipulation to help defecate, and a sense of incomplete defecation. The Rome III standard classifies OOC as a functional anorectal disorder, called functional defecation disorder. The diagnosis of functional defecation disorder must meet the diagnostic criteria of functional constipation, and there must be objective evidence of uncoordinated contraction of the pelvic floor muscles during defecation, insufficient relaxation of the anal sphincter, or insufficient propulsion during defecation. (2) Severity is judged according to the severity of constipation and related symptoms and their impact on life, which are classified into 3 degrees: mild, moderate and severe. Mild means that the symptoms are mild and do not affect life, and can be treated by overall adjustment or short time medication; severe means that the symptoms are heavy and persistent, seriously affecting work and life, requiring medication and cannot be stopped or medication is ineffective; moderate is between mild and severe. Treatment】 1. The purpose of treatment measures is to relieve symptoms and restore normal bowel dynamics and defecation physiological functions. Therefore, the general principle is individualized comprehensive treatment, mental-psychological status, recommending reasonable dietary structure and establishing correct defecation habits; etiological treatment for those with clear etiology; those who need long-term application of laxative maintenance treatment should avoid laxative abuse; surgical procedures should strictly grasp the indications and make objective prediction of surgical efficacy. (1) General treatment: Help patients fully understand the factors that cause constipation and relieve their psychological burden of excessive tension about defecation. It is recommended to increase water intake and physical activity, and to instruct patients to develop good defecation habits, such as regular toileting and defecation, and some doctors recommend adopting a “squatting position” and using a footstool to elevate the feet during defecation. (2) Dietary fiber and dietary fiber preparations constipated people need more fiber to maintain the volume of stool and intestinal transport function. Increasing dietary fiber increases the water content of stool, promotes the proliferation of beneficial bacteria in the intestine, increases the volume of stool, accelerates intestinal transmission, and increases the number of bowel movements. If necessary, dietary fiber preparations can be supplemented by dietary fiber preparations, including wheat bran, methyl cellulose, etc. It should be noted that high doses of dietary fiber preparations can cause abdominal distention and are contraindicated in cases of suspected intestinal obstruction. Compliance with fiber supplementation is generally poor, as many patients complain of increased gas, abdominal distention, bloating, and loss of taste when starting fiber therapy. Oxytocin increases gas production in the colon and slows gas transport in the intestine, causing gas-related symptoms. Allergic reactions caused by Oxytetracycline, including allergies and asthma, are rarely reported. (3) Laxatives The selection of laxatives should take into account efficacy, safety, drug dependence, and price to efficacy ratio. Avoid long-term use of irritating laxatives. For fecal impaction, use clean enema or liquid paraffin and other rectal administration to soften the feces. For constipation combined with hemorrhoids, compounded keratolide preparations are available. (1) Volumetric light laxatives (bulking agents) play a laxative role by increasing the water content and solids in the stool, such as Oxytetracycline. 2) Osmotic laxatives include non-absorbed sugars, salt laxatives, and polyethylene glycol. Non-absorbed sugars can increase the volume of feces in the intestinal lumen and stimulate intestinal peristalsis, which can be used for the treatment of mild and moderate constipation (such as lactulose). Salt preparations (such as magnesium sulfate) are incompletely absorbed in the intestine, allowing water to seep into the intestinal lumen. It should be noted that excessive application can cause electrolyte disorders, and should be used with caution in the elderly and those with reduced renal function. Polyethylene glycol L1 is not absorbed and metabolized by the intestine after taking, can effectively treat constipation, and its low sodium content, does not cause the absorption or loss of intestinal net ions, less adverse reactions. (3) Stimulant laxatives include phenolphthalein (banned by FDA), anthraquinones, castor oil, etc., which can stimulate intestinal peristalsis, increase intestinal motility and reduce absorption. Such laxatives are prone to drug dependence, electrolyte disorders and other adverse reactions, and long-term application can cause colon melanosis and increase the risk of colorectal cancer. (4) Prokinetic agents act on intestinal nerve endings, releasing motor neurotransmitters, antagonizing inhibitory neurotransmitters or acting directly on smooth muscle to increase intestinal motility, thus having a better effect on STC. However, certain drugs that act on 5-hydroxytryptamine (5-HT) receptors have the potential to increase the risk of cardiovascular disease. (5) Chinese herbal medicine Chinese herbal medicines (including proprietary Chinese medicine preparations and tonics) can effectively relieve the symptoms of chronic constipation, but the assessment of the efficacy of chronic constipation needs to be supported by more evidence-based medical studies. (1) Identification and treatment of actual heat in the intestines: clearing heat and moistening the intestines. Main formula: Ma Zi Ren Wan (Treatise on Typhoid). Drugs: fire hemp seed, peony, almond, rhubarb, thick park, hedgehog. Treatment for intestinal Qi stagnation: Shun Qi and guide stagnation. Main formula: Liu Mo Tang (“The Standard Rules for the Treatment of Disease”). Effects: Shen Xiang, Mu Xiang, Wu Yao, Citrus aurantium, Betel nut, Da Huang. Treatment: Benefiting Qi and moistening the bowels. Main formula: Huang Qi Tang (Jin Kui Yi) with added flavor. Effects: Roasted astragalus, hemp seeds, Chen Pi, white honey, hedgehog, raw atractylodes, lycopodium. Treatment for deficiency of spleen and kidney yang: warming and moistening the bowels. Main formula: Ji Chuan Decoction (Jing Yue Quan Shu). Effects: Radix Angelicae Sinensis, Radix Achyranthes Bidentatae, Rhizoma Cistanches, Radix Zeleniae, Radix Achyranthes Bidentatae, Citrus Aurantium. Treatment for deficiency of fluid and blood: nourishing Yin and nourishing blood, moistening dryness and relaxing stool. Main recipe: Luningwan (Shen’s Zun Sheng Shu). Effects: Radix Angelicae Sinensis, Radix Rehmanniae Sinensis, Fructus Hemp Seed, Peach kernel, Citrus aurantium shell, Cistanches. For those who have constipation and dry stools like goat droppings, add Sophora japonica and Diyu; for those who have constipation and dry stools like goat droppings, add Cyperus rotundus (pounded), fire flax seed and Juniperus rotundus; for those who have cough and asthma and constipation, add Su Zi, Juniperus rotundus and almonds; for those who are depressed and reticent, add Chai Hu, Bai Shao and Hedychium; for those who have red tongue with yellow coating and fire from qi depression, add Gardenia jasminoides and Gentiana; for those who are weak and sweaty, add Radix et Rhizoma ginseng and Radix et Rhizoma oryzaeum; for those who have Qi deficiency and prolapse, add Sheng Ma, Chai Hu, Radix et Rhizoma oryzaeum and Ginseng, For those with white face and dizziness, add Radix et Rhizoma Ginseng, Radix Polygoni Multiflori, Fructus Lycii; for those with heat in the heart of the hands and feet and hot flashes in the afternoon; add Radix et Rhizoma Ginseng, Radix et Rhizoma Hu; for those with weakness in the waist and knees, add Radix et Rhizoma Huangjing, Radix et Rhizoma Black Sesame, Radix et Rhizoma Mulberry. (2) Chinese patent medicine treatment Ma Ren Run Yin Wan 1~2 pills each time, twice a day, for the evidence of actual heat in the intestines; Huang Lian Shang Qing Wan: water pills or water honey pills 3~6g each time, large honey pills 1~2 pills each time, twice a day. It is suitable for the evidence of evil fire and solid heat in the intestine. Hovenia Conduit Pill: 6-9g per time, 2 times daily, for dampness, food stagnation and intestinal Qi stagnation; Mu Xiang Penang Pill: 3-6g per time, 2-3 times daily, for intestinal Qi stagnation; Si Mo Tang: 20ml per time, 3 times daily. Indicated for those with intestinal Qi stagnation evidence. Constipation Tong: 20ml each time, 2 times daily; Cistanche Laxative Oral Liquid: 10-20ml each time, 1 time daily. For evidence of spleen and kidney yang deficiency. Qi Rong Run Intestine Oral Liquid: 20ml each time, 3 times daily, for evidence of deficiency of lung and spleen qi. Wu Ren Run Intestine Pill: 1 pill each time, 2 times a day, for evidence of deficiency of fluid and blood. (3) Other therapies Acupuncture therapy Body acupuncture therapy: mostly use points such as large intestine Yu, Tianshu and Zhigou, with laxative method for real constipation; and tonic method for deficiency constipation. Intestinal real heat can be added to acupuncture Hegu, Quchi; intestinal Qi stagnation can be added to acupuncture Zhongyu, Xingma; Spleen Qi weakness can be added to acupuncture Spleen Yu, Stomach Yu; Spleen and Kidney Yang deficiency can be moxibustion Shen Que, Qihai. Ear acupuncture therapy: commonly used in the stomach, large intestine, small intestine, rectum, sympathetic, subcortical, Sanjiao and other points, 3 or 4 points at a time, medium stimulation, once a day, alternating between the two ears, 10 times a day, 3min each time. Commonly used drugs for enema therapy: senna leaf 30g decocted in water into 150-200ml, or rhubarb 10g with boiling water 150-200ml, soak for 10min, add Xuanming powder is stirred until completely dissolved, the residue is removed, and the temperature of the solution is controlled at 40°C. Enema is administered. The patient is placed in the left lateral position, the buttocks are exposed, the anal tube is inserted 10-15cm and then the solution is injected slowly, kept for 20min and then the stool is expelled, if not effective, the enema is repeated at intervals of 3-4h. It is suitable for patients with abdominal pain, bloating and other constipation emergencies, with hard stool embedded in the intestine, and does not continue for several days. Compressing therapy point compress is to grind the drug, use certain solvents to make a paste or paste, or decoct the drug to take the juice to concentrate, add excipients, make a paste, compress fixed in selected points or umbilicus, through the skin absorption, action on the intestinal tract, so as to achieve the purpose of laxative. For solid evidence, rhubarb powder, Gansui powder and mangosteen are mostly used; for deficient-cold evidence, epimedium, clove, pepper and aconite are mostly used. (6) Biofeedback therapy involves inserting and inflating an airbag into the rectum under simulated defecation and then attempting to expel it, while observing the pressure and electromyographic activity of the internal and external anal sphincter, so that patients can understand which indicators are abnormal, and then observe the changes of the above indicators through training such as increasing abdominal pressure, forceful defecation, coordinating the movement of the internal and external anal sphincter, and continuously adjusting and training to learn to consciously control the obstruction of contraction, the paradoxical contraction of the anus or inappropriate relaxation of the anus, so as to achieve the purpose of adjusting the organism and preventing diseases. It is suitable for constipation of the outlet obstruction type. (7) Surgery is still a minority of patients with chronic constipation who really need surgical treatment. When the patient’s symptoms seriously affect work and life, and after a period of strict non-surgical treatment is not effective, surgery can be considered. It is important to master the indications for surgery. Preoperative air-barium contrast angiography, colonic transmission test, fecography, anorectal pressure measurement, balloon forcing out test, and special tests such as pelvic floor electromyography or pelvic multiplex angiography should be performed if necessary. If the special examination clearly shows the pathological anatomy and functional abnormalities, the indications for surgery should be carefully grasped and the procedure should be selected in a targeted manner. When multiple lesions are present at the same time, surgery should address the primary lesion causing constipation, while trying to address secondary or sequential lesions. Surgical treatment has a certain recurrence rate. Necessary medication should be given after surgery. After a period of standardized non-surgical treatment with poor efficacy, surgical treatment may be considered after a special examination showing significant abnormalities. It is important to pay attention to the measures of non-surgical treatment to consolidate the therapeutic effect after surgical operation. It is worth noting that some patients whose constipation symptoms are not completely relieved after surgical treatment or who experience recurrence may first be treated with non-surgical treatment and, if necessary, the corresponding tests. If necessary, the appropriate treatment method will be chosen again.