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Chinese Medicine Assistant Physician Examination Center: Constipation
Chinese Medicine Assistant Physician Examination Center: Constipation

Constipation is a common and complicated symptom in clinic, not a disease, which mainly refers to the reduction of defecation times, decreased stool volume, dry stool and laborious defecation. Be sure to combine the characteristics of feces, my usual defecation habits, and whether it is difficult to defecate to judge whether there is constipation. If it is more than 6 months, it is chronic constipation.

Constipation refers to constipation, the patient's feces are dry and hard, and it is difficult to defecate, which often lasts for several days, even without laxatives, suppositories or enemas.

The cause of disease

Constipation can be divided into two categories: organic and functional.

organic

(1) Intestinal stricture or obstruction caused by tumor, inflammation or other reasons.

(2) Rectal prolapse, hemorrhoids, proctoptosis, puborectal muscle hypertrophy, pubic separation, pelvic floor diseases, etc.

(3) Endocrine or metabolic diseases, such as diabetes, hypothyroidism and parathyroid diseases.

(4) Systemic diseases such as scleroderma and lupus erythematosus.

(5) Nervous system diseases, central brain diseases, apoplexy, multiple sclerosis, spinal cord injury and peripheral neuropathy.

(6) Intestinal smooth muscle or neurogenic lesions.

(7) Colon neuromuscular diseases, pseudointestinal obstruction, Hirschsprung's disease, megarectum, etc.

(8) Neuropsychological disorder.

(9) Drug factors: iron, class X drugs, antidepressants, anti-Parkinson drugs, calcium channel antagonists, diuretics and antihistamines.

2. Function

The etiology of functional constipation is unclear, and its occurrence is related to many factors, including:

(1) Decreased food intake or lack of cellulose or water in food reduced the stimulation to colon movement.

(2) Normal defecation habits are disturbed by intense work, too fast pace of life, changes in the nature and time of work, and mental factors.

(3) Colonic dyskinesia, which is common in irritable bowel syndrome, is caused by spasm of colon and sigmoid colon. In addition to constipation, abdominal pain or bloating also occurs, and some patients may show constipation and diarrhea alternately.

(4) The tension of abdominal muscles and pelvic floor muscles is insufficient, the driving force of defecation is insufficient, and fecal excretion is difficult.

(5) Abuse of laxatives leads to drug dependence and constipation.

(6) The elderly are weak, have too little activity, have difficulty defecating due to intestinal spasm, or have a long colon.

classify

Constipation is mainly divided into two types according to the pathogenesis: slow transmission type and outlet obstruction type.

(1) Slow transit constipation is caused by the weakening of intestinal contraction, which slows down the movement of feces from cecum to rectum, or the uncoordinated movement of left colon. It is most common in young women and occurs around puberty. It shows that the frequency of defecation is reduced (the frequency of defecation per week is less than 1 time), the frequency of defecation is less, the feces are hard and it is difficult to defecate. There is no stool or hard stool during anorectal digital examination, but the external anal sphincter has normal anal contraction and forced defecation function; The total gastrointestinal or colonic transit time is prolonged; Lack of evidence of outlet obstruction, such as balloon exhaust test and normal anorectal manometry. Increasing dietary fiber intake and osmotic laxatives are ineffective. Diabetes, scleroderma complicated with constipation and constipation caused by drugs are mostly slow transmission type.

(2) Outlet obstructive constipation is due to the disharmony of abdominal, anorectal and pelvic floor muscles, which leads to the obstruction of fecal discharge. It is especially common in elderly patients, and many patients are ineffective in routine medical treatment. The outlet obstruction type can have the following manifestations: strenuous defecation, endless feeling or falling feeling, less defecation, defecation or insufficient defecation; There is a large amount of muddy feces in the rectum during anorectal examination, and the external anal sphincter may contract violently when defecating forcibly; The total gastrointestinal or colon transit time is normal, and most markers can remain in the rectum; Anorectal manometry showed that the external sphincter of anus contracted sharply or the sensory threshold of rectal wall was abnormal during forced defecation. Many patients with outlet obstructive constipation also have slow transit constipation.

Distinguish the symptoms of a disease

The main symptoms are constipation and difficulty in defecation.

Dry stool, abdominal distension and abdominal pain, body heat, dry mouth, bad breath, liking cold drinks, red tongue, yellow or dry fur and slippery pulse are the symptoms of heat evil (heat secret); If you want to worry, frequent belching, abdominal distension and pain, loss of appetite, fullness in the chest and hypochondrium, thin and greasy tongue coating and thin pulse are symptoms of qi stagnation (secret qi); Although there is a feeling of defecation, those who are tired when going to the toilet, sweating and shortness of breath when earning, fatigue after defecation, pale face, mental fatigue and timidity, pale tongue, thin fur and weak pulse are qi deficiency (virtual secret); Constipation, provided by doctors, students and stations, is characterized by blood deficiency (deficiency and secret), dull complexion, dizziness and palpitation, pale lips and tongue, and thready pulse; Difficulty in defecation, difficulty in excretion, cold pain in abdomen, pale complexion, tepid limbs, aversion to cold and preference for warmth, long and clear urine, pale tongue with white fur and delayed pulse are symptoms of yang deficiency and yin cold (cold secret).

treat cordially

Treat and regulate the stomach and relieve constipation. Mainly points of Foot Yangming and Hand Shaoyang.

The main scenic spot Shutian Zhigou Waterway returns to Hong Long.

For those who match the hot secrets of acupoints, add Hegu and Neiting; Those who are secretive, plus Tai Chong and Zhong Wan; For patients with qi deficiency, spleen Shu and Qi Hai should be added; For those with blood deficiency, add Zusanli and Sanyinjiao; For those with yang deficiency, Shenque and Guanyuan are added.

Key points of filiform needle operation. Operate acupoint matching according to the method of tonifying deficiency and purging excess; Shenque and Guanyuan used moxibustion.

The prescription "Yi Tian Shu" provides points for the large intestine to dredge the qi of the large intestine, and the conduction function of the large intestine returns to normal due to the gas pain in the intestine. Direct purchase Xuantong Sanjiao Miracle

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