Case sharing: Xiao Wang is only 25 years old, when she came to the clinic, her first words were: “Doctor, can you cut my intestines?” After the conversation, we learned that although Xiao Wang is young, she has been fighting with constipation for more than 10 years, and she has taken all the medicines available in the hospital, which worked at first. “That’s why she thought of surgery as a last resort. Surgical treatment of constipation is generally very cautious in the clinic, especially colon resection, not to mention the damage and possible adverse effects of the surgery itself, in terms of results alone, post-operative may go to the other extreme, diarrhea. Since the colon is mainly used to store stool and absorb water, once removed, irreversible loose stools and frequent bowel movements can occur, seriously reducing the quality of life. The situation like Xiao Wang is now very common, in fact, it is not constipation itself how difficult to cure, but the method of the problem, the consequences of long-term indiscriminate use of drugs, eat fierce medicine is the more pass the more impassable, the more treatment is not treated. Here are a few views on the scientific use of laxatives. Laxatives to save the emergency, should be effective that laxatives according to the mechanism of action can generally be divided into six categories, namely volumetric (swelling, vegetative), irritant (contact), osmotic and lubricating laxatives and intestinal dynamics and 5-hydroxytryptamine receptor agonists. Among them, stimulant laxatives and high-dose osmotic laxatives are considered as “steep laxatives” because of their fast and strong laxative action. Stimulant laxatives include the Chinese medicines senna, rhubarb, aloe vera and the western medicines phenolphthalein (fruit-conducting tablets), bisacodyl (poo stop), sodium pyrimethamine, castor oil, etc. These medicines can stimulate the intestinal wall, increase intestinal peristalsis and promote These drugs can stimulate the intestinal wall, increase intestinal peristalsis, and promote defecation, mainly for temporary laxative, continuous use should not exceed one week. If taken for a long time, it will produce serious drug dependence, the dosage of drugs will become increasingly large, and even damage the peripheral nerves and muscle tissue of the intestinal wall, from functional lesions to the development of difficult to treat organic constipation. At the same time, rhubarb, senna, etc. contain “anthracene” compounds, which will be deposited in the intestinal mucosa over time, turning the intestinal surface black and melanosis, and this change may increase the risk of colon cancer. In addition, the intestinal ecological environment will be damaged, bifidobacteria and other beneficial bacteria balance is out of balance, the normal pH value of the intestinal cavity is changed, the intestinal secretion of a large amount of water loss, dehydration symptoms. Osmotic laxatives such as magnesium sulfate (salt laxative), mannitol, sorbitol, polyethylene glycol (Fosone) and mannitol can cause watery diarrhea when taken in large doses, and are now used clinically in the preparation of the intestine before colonoscopy. These drugs, if used in large doses and for a long time, can cause water-electrolyte disorders and alternating diarrhea and constipation. Slow laxatives are commonly used, but should not be used for a long time. Methyl cellulose, agar and pectin in volumetric laxatives, corkseed, liquid paraffin and sodium docusate in lubricating laxatives, and small doses of osmotic laxatives such as dumic, lactulose, etc. are called “slow laxatives” because of their long onset of action, slow action and low side effects, and can be used as clinical drugs. The main component of Keflex is glycerin or magnesium sulfate, which is not very irritating and effective after local application. Dumic and lactulose are not absorbed by the stomach and can reach the colon intact, and then decompose into monosaccharide and organic acid with low molecular weight. The increase of acidity is beneficial to the growth and reproduction of intestinal beneficial bacteria, thus stimulating the peristalsis of the colon, increasing the osmotic pressure and moving water into the intestinal cavity to increase the water in the stool, thus softening the stool. However, these drugs still should not be used for a long time, volumetric laxatives for a long time can reduce neurosensitivity, lubricating laxatives for a long time will affect the absorption of fat-soluble vitamins and calcium and phosphorus. Chinese preparations, should be selected with discrimination At present, there are more Chinese medicines than Western medicines in clinical laxatives, a wrong view is that Chinese medicines are safe and have fewer side effects. In fact, not, as long as the rhubarb, senna, mannite, cassia, aloe and other Chinese preparations should not be taken for a long time. Now many young women are taking “intestinal clearing” tea, weight loss tea and “detoxification” medicine, be sure to read the instructions whether the above Chinese medicine ingredients, beware of “detoxification” does not The “detoxification” can not but cause constipation. Clinically used herbal medicines such as hemp Ren Run Intestinal Pill, hemp Ren Zizhi Spleen Pill, Fangfeng Tong Sheng Pill, Niuhuang Shangqing Pill, Liu Wei Anxie Capsules, Shu Secret Capsules all contain ingredients such as rhubarb or aloe vera, although the content is not very high, you should read the instructions carefully before use to see if it is suitable according to your own constitution, and if you use it, you should also control the time, generally do not exceed three months of continuous use. Pregnant women and young and old, there are differences in medication Pregnant women should be prohibited irritating, volumetric and osmotic laxatives, you can take honey, or a short period of time to take liquid paraffin, hemp pills, acute constipation can be used open cork. Constipation in the elderly commonly used containing bifidobacterium, lactobacillus and streptococcus faecalis bifidobacterium trituberculosis, lizhu enterole, these micro-ecological agents can remove the body “garbage”, regulate the balance of intestinal flora, so that the intestinal tract function to restore normal, keep the bowel movement. According to the body and the condition of the elderly can be used internal laxative, such as hemp pill, Tongtai capsules and lactulose. However, it should be noted that lactulose is prohibited for diabetic patients. You can also use a variety of suppositories to lubricate the intestinal tract, such as Kaiser, glycerin suppositories, taining suppositories, etc. The easiest way for children with constipation is to cut soap to the size of a finger, wet it with water and insert it into the anus to stimulate defecation. Can also be used to open cork, soap and water or saline enema. Oral medicine with liquid paraffin, taken before bedtime, 0.5ml/kg/time, or mineral oil, 60-90ml/day, divided into two morning and evening, mineral oil can be used for a longer period of time, usually 3-6 months. Identify the evidence to apply treatment, cure the root and safe China’s Sui Dynasty “the source of diseases Hou theory” said: “difficult stool, by the five organs are not adjusted, yin and Yang bias deficiency, said the three jiao is not and then cold and heat and knot.” Chinese medicine categorizes constipation into four types of evidence, namely heat accumulation in the intestines and stomach, qi stagnation, qi-blood-yin deficiency and yin-cold stagnation, and takes different treatments and prescriptions according to each individual’s own characteristics. The treatment of constipation is a complex systemic project, which must start from various aspects including medicine, diet, psychology, environment, and bowel habits to achieve good results. It can be said that there is no one drug can be taken for life, must not save over-dependence on drugs, not to mention the momentary pain and love of “quick-acting” drugs. Only the scientific use of drugs, can really get rid of constipation.