Mixed hemorrhoids is the name of the disease in Chinese medicine. The main manifestation of hemorrhoid disease is the formation of a mass of varicose veins above and below the dentate line in the same direction of the anus, with no clear demarcation between the inside and outside. The clinical manifestation is blood in the stool and swelling in the anus, which may be accompanied by anal swelling, foreign body sensation or pain, and local discharge or itching. It has the same name as Western medicine. The prognosis of this disease is generally good if treated early. However, in some patients, the disease is accompanied by complications such as anemia during the course of the disease.
The main manifestation of hemorrhoid disease is the formation of a mass of varicose veins in the same direction of the anus, above and below the dentate line, with no clear demarcation between the inside and outside. The clinical manifestations are blood in the stool and swelling in the anus, which may be accompanied by anal swelling, foreign body sensation or pain, and local discharge or itching.
Relationship with Western medical names
According to the clinical manifestations of this disease, it is basically the same as Western medicine mixed hemorrhoids.
Etiology
Mostly due to untreated stage II and III internal hemorrhoids, repeatedly prolapsing, and then due to pregnancy and childbirth, weight-bearing and long-distance travel, resulting in the transverse release of tendons and veins and stagnation of qi and blood, leading to the occurrence of this disease.
Pathogenesis
Most of the internal organs are weak, the vein wall is weak, and because of prolonged sitting, weight-bearing, or long-term constipation, or diarrhea and dysentery for a long time, or the toilet squatting for a long time, or poor diet, over-eating spicy, fatty and sweet crystals, resulting in the dysfunction of the internal organs, wind, dryness, dampness and heat, stagnation of qi and blood does not work, blocking the pranic door, knotted but not dispersed, the tendons and veins are transversely disintegrated face hemorrhoids. Or because of the deficiency of qi and blood, the intake is weak, qi deficiency down trapped, then hemorrhoids nucleus prolapse.
Diagnostic points
Diagnostic basis
1.Blood in the stool and swelling in the anus, there may be anal swelling, foreign body sensation or pain.
2.It may be accompanied by local discharge or itching.
3. Swelling in the anal canal in the same direction above and below the dentate line (under the dentate line may be superfluous skin, or varicose veins).
Differentiation of disease evidence
1.Mixed hemorrhoids and rectal cancer
Rectal cancer often leads to bleeding in the stool, or blood in the stool, mostly dark red blood or skeletal fluid-purulent stool, often accompanied by an increase in the number of ambassadors, later may appear due to the difficulty of defecation or even obstruction, the stool characteristics also change. Rectal finger examination and endoscopy can find uneven, hard masses in the intestinal cavity, and there can be ulcers on the surface, which bleed easily when touched. Biopsy for pathological examination can clarify the diagnosis.
2.Mixed hemorrhoids and anal fissures
Anal fissure often leads to anal bleeding during stool, mainly blood on the surface of stool or on stool paper, with bright red color, pain in the anus during defecation, and after the stool, contraction of the anal sphincter can lead to long lasting anal pain, the pain level even exceeds the anal pain during defecation, and some last for several hours or even all day. Most of the anal canal skin fissures can be seen in the front and back of the anal canal during anal examination, with pressure pain, and a more tense anal canal during finger examination.
3.Mixed hemorrhoids with enlarged anal papillae and rectal polyps
The anal papillae and rectal polyps often come out of the anus when they are enlarged, and the anal papillae indicate that they are covered with skin, are hard, have gray surface, have carbuncles, and do not bleed easily. And rectal polyps indicate covered with mucous membrane, often with a tip, dark red, easy to bleed.
4.Mixed hemorrhoids and rectal prolapse
Mild prolapse of the rectum taught bile, its pals have ring-shaped levirate, color talk red and flaccid. Full prolapse some can be up to 10cm long, smooth surface, swollen and congested mucosa, easy to bleed after friction.
Related tests
The diagnosis of this disease can also be based on.
1.Anal visual examination: use both hands to gently hold the anus open to both sides, except for stage I internal hemorrhoids, most of the other three stages of internal hemorrhoids can be seen under anal visual examination. For patients with prolapse it is best to observe immediately after squatting and defecating, so that the true situation of the size, number and location of hemorrhoids can be clearly seen, especially for the diagnosis of circumferential hemorrhoids is more meaningful.
2.Endoscopic examination. Observe the rectal mucosa for congestion, edema, ulcers, and masses, and then observe the upper dentate line for hemorrhoids after excluding other rectal disorders. If there are hemorrhoids, the internal hemorrhoids will be seen to protrude into the anoscope as dark red nodules. The number, size and location of the hemorrhoids should be noted at this point.
Dialectical treatment
Key points of dialectical evidence
This disease should be identified from the internal organs, deficiency and reality. Blood in the stool, dripping or spraying, bright red blood, or blood in the stool, bright red, large amount, hemorrhoid nucleus prolapsed and embedded, swelling and pain, or erosion and necrosis; dry mouth, not wanting to drink, bitter mouth, should be considered as wind injury intestinal complex or damp-heat injection, the dialectical evidence is based on the actual evidence; anal swelling, hemorrhoid nucleus prolapsed, need to use the hand to hold back, blood in the stool, bright red or light red, the duration of the disease; the face is less florid, fatigue, loose bowel movements, should be considered as Spleen deficiency and qi trapping, the evidence is based on spleen deficiency.
Treatment principles
This disease is mainly based on the principle of surgery. In case of damp-heat infusion, treatment should be given to clear heat and dampness to stop bleeding; in case of spleen deficiency and Qi trapping, treatment should be given to strengthen spleen and benefit Qi; in case of wind injury to intestinal ligaments, treatment should be given to clear heat and cool blood to dispel wind.
Classification of evidence and treatment
1.Wind injury to intestinal ligaments
Evidence: Blood in the stool, dripping or ejected, bright red blood; or with dry mouth, constipation; red tongue, yellow coating, pulse count.
Treatment: Clearing heat and cooling the blood to dispel wind.
Representative formula: Cool the Blood with addition and subtraction.
Commonly used formula: Gardenia jasminoides, Scutellaria baicalensis, Baimao, Zhi Mu, Radix Platycodon grandiflorus, Glycyrrhiza glabra, Phellodendron spp.
2.Damp-heat infusion evidence
Main symptoms: bright-colored blood in the stool, large amount, prolapsed and embedded hemorrhoids, swelling and pain, or erosion and necrosis; dry mouth without desire to drink, bitter mouth, yellow urine; yellow and greasy moss, pulse Pan count.
Treatment: Clearing heat and relieving dampness to stop bleeding.
Representative formula: pain relief like Shen Tang plus reduction.
Commonly used formula: Gentiana macrophylla, Peach kernel, Soapberry, Atractylodes macrocephala, Bupleurum, Phellodendron, Radix Angelicae Sinensis, Radix Zeligae, Betel nut, Rhubarb.
3.Spleen deficiency and Qi trapping evidence
The main evidence: anal swelling, hemorrhoid nucleus prolapse, need to use the hand to return, blood in the stool, bright red or light red, the duration of the disease for a long time; the face is less florid, fatigue, less fat, loose stool; light tongue, white coating, weak pulse.
Treatment: Strengthening the spleen and benefiting Qi.
Representative formula: tonifying Zhong Yi Qi Tang plus reduction.
Commonly used herbs: Astragalus, roasted licorice, ginseng, angelica, orange peel, asclepias, bupleurum, atractylodes.
Other Treatments
For more serious mixed hemorrhoids, external hemorrhoid stripping and internal hemorrhoid ligation are feasible.
(1) Indications: more severe mixed hemorrhoids.
(2) Operation method: Take a truncated or lateral position, routinely disinfect the anus, local infiltration anesthesia, fully expose the hemorrhoid nucleus, make a “V” or shuttle-shaped incision in the external hemorrhoid, cut the skin and peel the venous plexus to slightly below the tooth line, then use a curved hemostatic forceps to clamp the base of the internal hemorrhoid, then ligate or ligate through the 10 or 7 gauge silk wire. The internal hemorrhoid is then cut out and the external part of the hemorrhoid is removed. Treat the other hemorrhoids in the same way.
Prognosis for regression
If the disease is diagnosed early, the positive energy is strong, and the condition is mild, early treatment is generally good prognosis. If the patient is sicker and has weaker positive energy, some patients may develop complications such as anemia during the course of the disease.
Prevention and care
1, keep the stool smooth, regular bowel movements, do not squat for a long time when bowel movements.
2, timely treatment of acute and chronic inflammatory diseases of the intestinal tract.
3, keep the anal part clean, adhere to the post-poo with cold water bath.
4, eat less spicy stimulating crystals, eat more vegetables and fruits.