Constipation is a common clinical disease, with the change of people’s lifestyle, the change of diet structure, and the acceleration of China’s population aging, the incidence gradually increased, seriously affecting people’s quality of life, some elderly patients even because of defecation difficulties induced cardiovascular and cerebrovascular diseases.
First, the diagnosis: emphasize the combination of disease identification and evidence examination and treatment of causes.
”Constipation is a common clinical disease, but very often he is a group of clinical symptoms caused by a variety of diseases, the hidden causes are often quite complex, especially for patients with relatively short duration of disease, should be carefully diagnosed and treated, not careless.” Chinese medicine has accumulated rich experience in the treatment of constipation, we should seriously learn to inherit, but this in no way means that we reject modern treatment methods, Chinese medicine is developed by our ancestors in continuous clinical practice, it is in the process of development to draw on the knowledge of astronomy, geography, philosophy and other aspects of the time for their own use, it is never a closed system, in the rapid development of modern science today, Chinese medicine should also keep pace with the times. Today, with the rapid development of modern science, Chinese medicine should also keep pace with the times. We should learn to use Chinese medicine based on the principle of “following the classics, integrating new knowledge, using the ancient for the present, and using the foreign for the Chinese”. Diagnosis of the cause of constipation should be mainly from the following aspects.
1, intestinal lesions: tumor, intestinal torsion, intestinal overlap, inflammation, ischemic enteritis; rectal and anal canal outlet obstruction, anal canal and rectal stenosis, rectal intussusception, rectal protrusion, etc.
2, extra-intestinal lesions: central neuropathy, spinal cord injury, occupying lesions in other organs of the abdominal cavity, endocrine metabolic diseases such as hypothyroidism, hypokalemia, hypercalcemia, diabetes mellitus, etc.
3, diagnostic methods: In addition to medical history, clinical symptoms and local signs, it is necessary to combine modern medical treatment methods, the intestinal tract itself should be mainly combined with gastrointestinal endoscopy, gastrointestinal imaging, fecal imaging examination and other methods to confirm the diagnosis. For extra-intestinal causes, abdominal CT or nuclear magnetic examination, related biochemical and endocrine hormone measurement can be used.
If the test results suggest that the constipation is caused by other diseases, the treatment should focus on treating the primary cause. On the basis of clear absence of other organic causes, we can use Chinese medicine, evidence-based treatment, when we should follow the treatment methods and principles of Chinese medicine, do not be disturbed by Western medical theory.
Second, the etiology and pathogenesis of the analysis of identification and typing.
Although the site of constipation in the large intestine, manifesting as the internal Qi, defecation difficulties, but it is closely related to the lungs, spleen, liver and kidneys, many patients with constipation have a history of taking laxatives, and some even long-term reliance on laxatives, these drugs contain rhubarb, senna and other bitter cold corrupting the stomach, often served for a long time will damage the spleen and stomach, the spleen in the middle jiao, the main blood, blood, fluids, can make the clear yang up, cloudy yin down, heart and lungs The lungs are in the upper jiao, for all the organs of the Huagai, the main qi of the propagation of the suction, and the large intestine, the lungs will naturally affect the function of the intestines, Tang Rongchuan in the “medical scripture essence? The official of the internal organs” said: “the large intestine is the reason for conduction, to its lung of the internal organs, lung gas down to, so can conduct.” The liver is the main drainage, the smooth flow of qi and blood depends on this, and the liver meridian circulation parts go to the front and back of the two yin, the liver meridian qi and blood flow is naturally beneficial to defecation, Tang Rongchuan in the “blood evidence theory? The internal organs pathogenesis: “The nature of wood is mainly in the drainage. Food gas into the stomach, all rely on the liver wood gas to drain the, and water and grain is transformed. If the liver’s clear Yang does not rise, it can not drain the water and grain, seepage and diarrhea in the full evidence inevitable.” The kidney lives in the lower jiao, the root of all the yin and yang, the main seal intake, the division of the two stools, kidney yang is full, the large intestine internal Qi can be drummed gasification, kidney yin enough, the intestines have fluid moistened, there is an increase in water rowing; many patients with constipation more long duration of disease, An teacher believes that the long-term disease more deficiency, long-term disease more stasis, the establishment of benefit Qi nourishing blood to remove stasis laxative method, so that the intestinal Qi and blood strip smooth and nourishing, the conduction of the function since the recovery.
Classification and typing
1. Loss of lung circulation and bowel fluid deficiency.
The symptoms include dry stools that are difficult to pass, cough, phlegm, dark tongue, thick white fur, dry and less fluid, and thin smooth or thin string pulse.
Legislation: Promote the lung and Blood, moisten the bowels and relax the stool.
Almonds 15 grams, Radix Aconiti 15 grams, Radix Platycodon grandis 12 grams, Peach kernel 15 grams, Radix Angelicae Sinensis 20 grams, Rhizoma Polygonatum 10 grams, Rhizoma Firenze 15 grams, Radix Glycyrrhiza Uralensis 15 grams, Radix Glycyrrhiza Uralensis 9 grams, Formula: The main contradiction is that the intestinal tract is deficient in fluid and dryness, and the lung loses its circulation. The lung is not clear and purified, which inevitably affects the normal operation of the blood vessels and veins, so the formula uses peach kernel to invigorate blood circulation and resolve blood stasis, angelica to nourish blood and invigorate blood, a tonic and a live is called and, and the two drugs both laxative and laxative effect, niu knee to induce the downward movement of drugs, and licorice and all drugs. In summary, the entire formula is based on the generalization of the descending, the ascending in the generalization of the descending, the nourishing of Yin and the nourishing of Blood, the nourishing in the nourishing of Blood, the activation of Blood, the opposite of each other, the combination of movement and static.
2, liver and kidney yin deficiency, fluid deficiency and intestinal dryness.
The symptoms include dry stool, weak bowel movement, red tongue with less coating and less fluid, and even visible cracks, weak pulse or thin strings.
Legislation: Nourish the liver and kidney, moisten the bowels and open the bowels.
Radix Salviae Miltiorrhiza 15g, Radix Macrocephala 15g, Radix Rehmanniae 20g, Dendrobium 12g, Fritillariae 15g, Radix Angelicae Sinensis 12g, Fructus Lycii 15g, Herba Cistanches 15g, Radix Neem 9g, Radix Astragali 40g, Rhizoma Ligustici Chuanxiong 10g, Radix Muxiang 9g, Radix Glycyrrhiza Uralensis 9g, Formula: This type of evidence is based on deficiency of liver and kidney, deficiency of yin and fluid, and deficiency of fluid and intestinal dryness, which is the standard. The formula is based on the use of sage, dendrobium, dendrobium, dendrobium, raw earthwort to nourish Yin and moisten dryness, liver and kidney to nourish blood and moisten dryness, raw astragalus, licorice to benefit Qi and strengthen the spleen, mucuna pruriens to awaken the spleen and transport the spleen.
3, liver depression, spleen deficiency, intestinal dryness and fluid deficiency.
Symptoms include constipation, stuffiness, abdominal distension, dullness, dullness and pain in the ribs, dark tongue with greasy coating and little fluid, thin or slippery pulse.
Legislation: Diversify the liver and strengthen the spleen, moisten the intestines and open the bowels.
Radix Angelicae Sinensis 20g, Radix Paeoniae Alba 20g, Radix Bupleurum Chinense 9g, Atractylodes Branched 9g, Radix Ginger 9g, Fructus Horsetail 15g, Radix Polygalae Miltiorrhizae 10g, Radix Rehmanniae 20g, Rhizoma Polygalae 10g, Radix Glycyrrhiza Uralensis 9g. The liver is a virile organ, with yin and yang. The formula uses Radix Angelicae Sinensis, Radix Paeoniae Alba and Radix Polygoni Multiflori to nourish the liver and soften the liver, and Radix Bupleurum to clear the liver and relieve depression. The raw earth, yu zhu, and fire hemp seeds produce fluid and moisten dryness, taking the meaning of increasing water flow. White peony and licorice are used together to transform yin; licorice and dry ginger are used together to nourish yang with pungency and sweetness, so that the whole formula can dredge liver and move qi without the disadvantage of just dryness and nourish yin and moisten intestines without the risk of helping dampness.
4.Qi deficiency and blood stasis, paralysis of blood vessels and veins.
Legislation: Benefit Qi and nourish Blood, eliminate stasis and promote defecation.
Symptoms include difficulty in defecation, fatigue, dark tongue with petechiae, stasis of the veins under the tongue, thin and astringent pulse.
Raw Astragalus membranaceus 30-60g Radix Paeoniae 10g Chuanxiong 12g Radix Angelicae Sinensis 10g Fritillariae 10g Peach kernel 15g Safflower 9g Dilong 9g He Shou Wu 15g Radix Rehmanniae 15g Roasted Glycyrrhiza Glabra 9g Formula: Constipation for a long time, long-standing disease into the complex, the formula reuses Astragalus membranaceus, one is to benefit the Qi and invigorate blood, secondly, Astragalus membranaceus tonifies the spleen and benefits the Qi, its nature is mainly ascending, so that the clear Yang ascends and turbid Yin descends; Peach kernel, Safflower, Radix Paeoniae Sinensis, Chuanxiong, Dilong invigorate blood and open the complex. This formula is based on the transformation of the tonic yang and five soup, with the main purpose of replenishing qi, supplemented by the elimination of blood stasis, so that the qi and blood in the intestines are smooth and nourished, and the function of conduction is restored.
Patients with long-term constipation mostly have prolonged defecation time. During defecation, the rectal mucosa is repeatedly pulled and stimulated by defecation, which separates from the rectal muscle layer and leads to rectal mucosal relaxation, which fills the rectal cavity and prevents defecation, and at the same time, patients have a sense of incomplete defecation, and only a very small amount of stool can be relieved each time they defecate, resulting in prolonged defecation time. The vicious cycle of prolonged defecation time – aggravated by rectal mucosal relaxation – aggravated by the feeling of incomplete defecation, “An’s therapy” for patients with long-term constipation, in addition to the dialectical application of traditional Chinese medicine, the use of injection of peony times in the rectal mucosa (An A In addition to the dialectical application of traditional Chinese medicine, the “An’s therapy” for long-term constipation patients, in addition to the use of national new drugs invented by Professor H, with personal invention patents), the drug can quickly promote the relaxation of the rectal mucosa atrophy shrinkage, tightening, many patients after the injection of drugs, the next day the feeling of incomplete defecation is basically disappeared, with the dialectical application of traditional Chinese medicine to achieve the effectiveness of both the symptoms and the root cause of the treatment, there will be no recurrence of constipation after stopping oral drugs.
Third, the prescription of drug characteristics shallow analysis.
1.Tonic but not stagnant, nourishing but not greasy.
For example, nourishing the liver and kidneys to moisten the bowels and open the bowels, the formula applies sweet cold nourishing yin products such as south ginseng, maitong, raw earth, dendrobium, etc., while adding angelica, chuanxiong, muxiang, pungent nourishing blood, moving qi and resolving dampness in the formula, the nature of the warm, on the side of the drugs, both conducive to the dissemination of fluids to play its moistening effect, but also to prevent nourishing yin drugs to help dampness and produce phlegm. Mr. An often said: “see Yin deficiency only know a taste of nourishing Yin, usually difficult to take effect, mainly because nourishing Yin medicine is usually nourishing, to play the role of nourishment, must be disseminated and perfumed, then in the large team of nourishing Yin medicine to add some of the moving Qi, dampness, warming Yang and other drugs of a warm nature more help to achieve a better effect of nourishing Yin. Pure nourishing yin is like ‘a pool of stagnant water’, only through the transpiration of sunlight into rain and dew, can moisten everything.”
2, yin and yang with each other, the opposite of each other.
For example, to promote the lung and blood laxative, the application of almonds and hyssop in the formula helps the lung Qi to descend and induce the downward movement of the drug, while adding Radix et Rhizoma oryzae, in the downward movement of the drug in the lifting, seemingly contradictory, but on closer consideration, Radix et Rhizoma oryzae is partial to the upper jiao, can make the clear yang rise, the heart and lungs have some nourishment, beneficial to the lungs to descend the function, and Radix et Rhizoma oryzae has the effect of resolving phlegm, helping the lungs to restore the cleanliness of the nature. In the formula, the medicinal properties of the medicine are on the side of sweet-cold and main static, supplemented by the medicinal properties of wood incense, neem, Chuanxiong and angelica, which are on the side of warm and dispersing, so that the yin and yang match each other and move in the static.