1. General information All 106 cases were inpatients of the Department of Oncology, Dongfang Hospital, Beijing University of Chinese Medicine, who could not perform surgical treatment for various reasons. Age 30-88 years old; 47 male and 59 female; duration of disease 3-60 days; 55 cases of primary malignant tumor (46 cases of colon and rectal cancer, 9 cases of pancreatic cancer); 51 cases of metastatic cancer (17 cases of gastric cancer, 14 cases of ovarian cancer, 7 cases of liver cancer, 6 cases of endometrial cancer, 7 cases of others); 54 cases of complete intestinal obstruction, 52 cases of incomplete intestinal obstruction; pathogenic tumor foci visible by CT or ultrasound, 61 cases of thickened and occupied colon and rectal walls. All 106 patients received conservative treatment such as gastrointestinal decompression and soap and water enema for 3 days before the Chinese medicine enema was ineffective.
2. Diagnostic criteria The diagnostic criteria for intestinal obstruction were formulated with reference to the Guidelines for Clinical Research on New Chinese Medicines issued by the Ministry of Health of the People’s Republic of China [2].
Methods and efficacy 1. Treatment 1.1 Conventional treatment Fasting, gastrointestinal decompression, active intravenous nutritional support, control of intestinal infection with antibiotics as appropriate, rehydration to correct water and electrolyte disorders, etc. were given.
1.2 Chinese medicine enema 1.2.1 The main formula is Da Cheng Qi Tang with the addition and subtraction of 10g of raw rhubarb (later), 9g of mangosteen (divided and flushed), 12g of hedgehog, 15g of Hou Pu.
1.2.2 Enema method The mixture of the first and second decoction is decocted into 200-300ml of medicinal solution for enema. -The temperature of the medicinal solution is 39℃～41℃; insert the anal canal to a depth of 15-30cm, insert the medicinal solution into the canal quickly, after the enema, ask the patient to lie on the left side first, then on the right side, and finally lie down for more than 30min, so that the medicinal solution is evenly distributed in the intestinal cavity and kept for more than 1h to facilitate the full absorption of the medicinal solution and better performance. fully absorbed and better function.
1.3 Observation time Observe for 7 days to determine the efficacy.
1.4 Combined use of Chinese medicine According to the identification of Chinese medicine, enema was given with 50~l00ml of raw pulse injection, 1~2 times a day, intravenous drip.
2.Efficacy observation 2.1 Efficacy criteria[3] were formulated with reference to the Practical Diagnosis and Treatment of Traditional Chinese and Western Medicine. Complete remission: abdominal pain and bloating disappeared, appetite and defecation were normal, no pressure pain and rebound pain in the abdomen, normal intestinal whine, abdominal X-ray showed no abnormality; Improvement: abdominal pain disappeared, mild abdominal bloating, abdominal bloating could be aggravated after eating semi-liquid diet, but relieved after rest, anal exhaustion and defecation, no or light pressure pain in the abdomen, but no rebound pain and muscle tension, abdominal X-ray showed normal or mild intestinal distension; Invalid. Abdominal pain and bloating did not reduce or worsen, still vomiting, unable to eat, no anal venting and defecation, abdominal pressure carbuncle was obvious, there could be rebound pain and muscle tension, abdominal X-ray still had obvious fluid plane and intestinal tube distension.
2.2 Treatment results Among 106 patients, 40 cases (37.7%) were completely relieved and 43 cases (40.6%) were improved, with a total effective rate of 78.3%. The shortest duration of anal evacuation and defecation after medication was 3h and the longest duration was 70h; 23 cases (21.7%) were ineffective, all of them were high level complete obstruction. 23 ineffective patients did not show significant deterioration during the observation period.
Discussion Intestinal obstruction is very common in oncology department, and it is more likely to occur in elderly patients [4], and it is difficult to implement surgical treatment and radiotherapy and chemotherapy treatment due to age, physical condition and late stage of tumor. This can seriously affect the quality of life of patients and even endanger their lives. In contrast, Chinese medicine enema is easy to operate, well tolerated by patients, inexpensive, and has positive clinical efficacy, so it is worthy of clinical promotion and application.
Chinese medicine believes that intestinal obstruction belongs to the category of “abdominal pain” and “intestinal knot” of the six internal organs diseases. The physiological characteristics of the six internal organs are to transmit and transform water and grain, to drain but not to hide, to be real but not satisfied, to descend but not to ascend, and to be used to pass. Tumor patients with cancer toxicity, which affects the intestinal tract, make the intestinal tract blocked and obstructed, the Qi and blood is not smooth, and the circulation and descent are not regulated. Therefore, the clinical manifestations are pain, vomiting, distension, closedness, heat and other symptoms of inaccessibility of the internal organs, and the tongue is greasy or yellowish. In clinical treatment, according to the theory of “the six internal organs are used to pass through”, the principle of identifying and treating the internal organs, promoting the flow of Qi and blood, resolving phlegm and detoxifying the toxins is adopted, so that the Qi of the six internal organs can be regulated and balanced, and the physiological function of leaking without hiding can be restored.
Da Cheng Qi Tang originated from Zhang Zhong Jing’s Treatise on Typhoid Miscellaneous Diseases, and is the main formula for the treatment of Yang Ming internal organs. The formula includes raw rhubarb, which is used to pass through the lining and attack the lower part of the body, pushing out the old, removing blood stasis and eliminating tumors. It is also used in combination with raw rhubarb to remove heat and stagnation. Modern pharmacological studies have shown that Da Cheng Qi Tang has the ability to promote peristalsis of smooth muscles of the gastrointestinal tract, improve blood flow in the abdominal cavity and blood circulation in the intestinal wall, reduce tissue edema, promote the absorption of necrotic tissue and antibacterial and anti-inflammatory effects [5]. Rhubarb contains rhubarb acid and rhubarbin, which can inhibit the oxidation and dehydrogenation of cancer cells, and has anti-cancer effects; white flowered snake’s tongue herb, half-branch lotus, raw semen, toad bark, and tu Fu Ling have anti-cancer effects in vitro and in vivo, and can significantly enhance the body’s specific immunity and resist cancer cells. The combination of these drugs has the effects of promoting the discharge of toxins in the intestine, antibacterial and anti-inflammatory, and inhibiting the growth of tumor cells.
Due to long-term consumption, inability to eat, progressive malnutrition and physical weakness of tumor patients, the patients are thin and weak, with dry teeth and little fluid, which manifests the mixed symptoms of local heat and toxicity and systemic deficiency of qi and yin. In the treatment, the principle of treating the symptoms with urgency was adopted, and the Chinese herbal enema was used to remove heat from the internal organs, resolve blood stasis and detoxify the toxin. Chinese medicine enema at the same time, pay attention to strengthen intravenous nutritional support to actively adjust the body, to create conditions for active treatment of the original disease, and strictly observe the changes in the condition, and adjust the treatment plan at any time.