Clinical experience of thousands of old Chinese medicine practitioners in treating senile constipationZhang Lihong1 Sun Songge2 Qiu Xinping3 Ma Wanqian41 Department of Spleen and Stomach Diseases, Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital 2Education Department, Shunyi Hospital, Beijing Traditional Chinese Medicine Hospital 3 Beijing Traditional Chinese Medicine Hospital Shunyi Hospital Research Office 4 Beijing Traditional Chinese Medicine Hospital Shunyi Hospital Famous and Old Chinese Medicine Studio
Abstract:Ma Wanqian, Chief Physician, Department of Beijing No. 1 Four batches of old Chinese medicine experts inherit the academic experience of the work instructor, and the famous old Chinese medicine doctor of Shunyi Hospital of Beijing Chinese Medicine Hospital. In the 10 years of clinical diagnosis, Ma Lao has a unique opinion on the treatment of senile constipation. He believes that Qi and Yin deficiency is the main pathogenesis of senile constipation. Removing blood stasis, clearing bowels, etc. Clinically, the addition and subtraction based on the self-made recipe for nourishing qi, nourishing yin and moistening the intestines are often used to achieve good results. In addition to drug treatment, Ma Lao attaches great importance to the important role of physical factors in the pathogenesis of constipation. In clinical syndromes, dietary structure adjustment and emotional adjustment are often carried out according to the patient’s different constitution to assist drug treatment, which is as effective as a drum. This article systematically summarizes the clinical experience of Ma Lao in the treatment of senile constipation, for the sake of fellow practitioners.
Keywords:< span>senile constipation; nourishing qi and nourishing yin; self-made formula for nourishing qi, nourishing yin and moistening intestines; physical factors; clinical experience;
Category code:R256.35;R249Document identification code:< span>J
DOI:10.16343/j.cnki.issn.2095- 512x.2021.01.011
The symptom of constipation was first seen in the “Huangdi Neijing”, which was called “unfavorable afterward” and “difficulty in defecation”. “, “Secret knot”, “The Origin and Syndrome of All Diseases” pointed out that the cause of constipation is related to the deficiency of yin and yang of the five internal organs and the excess of cold and heat. “Prescriptions for Emergencies” call it “secrecy”, “stool obstruction”, as well as “wind-dryness, vacuity, qi, and intestinal knots” [1]. The term “constipation” we use today first appeared in “The Rhinoceros Candle of Miscellaneous Diseases”.
Constipation can exist either as a disease on its own or as a symptom, including bowel Tumors, intestinal obstruction, constipation-type irritable bowel syndrome, functional constipation and other diseases. The short-term efficacy of western medicine treatment is certain, but the long-term treatment will cause the disease to recur. Traditional medicine should be used reasonably and prudently in the clinical treatment of TCM for the elderly who repeatedly fail to heal. Intestinal Qi machine [2].
Chief Physician Ma Wanqian is the instructor of the fourth batch of old Chinese medicine experts in Beijing to inherit the academic experience. He is a famous old Chinese medicine doctor in Shunyi Hospital of Beijing Traditional Chinese Medicine Hospital. The author is fortunate to study with Chief Physician Ma Wanqian and know that Chief Physician Ma Wanqian has unique experience in the diagnosis and treatment of senile constipation.
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The main causes of constipation include improper diet, emotional disorders, sedentary and inactivity, overwork, old age and physical weakness, post-illness and postpartum, Drugs, etc. [3], the disease is located in the large intestine, and is related to the dysfunction of the lung, spleen (stomach), liver, kidney and other organs.
The change of modern diet structure and the decrease of physical activity, people have not developed good defecation habits, and defecation difficulty has become a problem over time. One of the problems that plagues people is that it affects the digestive function and causes other disorders of the spleen and stomach. Chief Physician Ma Wanqian believes that the main etiology and pathogenesis of constipation is intestinal failure, abnormal conduction, resulting in intractable dry feces and obstruction of viscera. Qi-yin deficiency is the main pathogenesis of senile constipation, mixed with liver stagnation and spleen deficiency, damp-heat blood stasis, etc. The treatment should be in harmony with the liver, spleen, lung and kidney, nourishing yin and moistening the intestines, nourishing qi and nourishing blood, and dispersing lung qi and ventilating qi.
1.1 Qi-yin deficiency is the main pathogenesis of senile constipation< span>
Constipation is a common and frequently-occurring disease in the elderly. higher than the prevalence of constipation in young adults. Thousands of old Chinese medicine practitioners believe that the elderly have a constitution of deficiency of both qi and yin, and are prone to constipation. In the old people, the spleen is deficient, the qi is stagnant in the intestines, and the dross in the intestines is stagnant.The feces are knotted inside, and because blood is the mother of qi, the deficiency of body fluid and blood leads to the deficiency of both qi and blood. If the intestinal dregs cannot go down, the turbid and evil qi will be absorbed by the intestinal tract, and the internal evil will be chaotic, resulting in repeated and aggravated symptoms [4].
Therefore, Chief Physician Ma Wanqian believes that deficiency of both qi and yin is the main pathogenesis of senile constipation. The treatment is based on the harmony of spleen and kidney, nourishing yin and moistening the intestines, nourishing qi and nourishing blood. For senile constipation, it is not advisable to use high-grade products to clear the bowels. It should focus on nourishing yin and moistening the intestines, not blindly attacking them. On the contrary, the qi, blood and body fluids will be more deficient, and the bowel and viscera transport and transformation will be abnormal.
1.2 Simultaneous treatment of liver and spleen, dispersing lung qi and ventilating qi
Modern people suffer from impatience and stagnation in the liver. Fatigue, lack of mediation, affecting intestinal peristalsis and inability of qi transformation, so often manifested as irritability, boredom, etc. The treatment not only strengthens the spleen and regulates qi, but also relieves the qi of the liver and gallbladder. Clear.
Chief Physician Ma Wanqian often found that the cough symptoms of elderly patients with lung disease were not relieved during consultation, and he continued to use it. A lot of antibiotics, a lot of antibiotics cold and cold hurt the spleen and stomach, and some patients are accompanied by more serious symptoms of constipation, but many young doctors ignore the problem of constipation. The amount of activity is reduced, and more critically ill patients have obvious abdominal distension and persistent constipation after being treated with a ventilator. The qi mechanism of the lungs is regulated, the intestines are nourished, and the intestinal conduction is normal. If the conduction and descending of the large intestine is normal, and the qi mechanism is smooth, the lung qi will not be blocked and stagnant. On the contrary, the lung qi will be reversed. “Treatise on Febrile Diseases and Miscellaneous Diseases” discusses the treatment of the lung and intestine from the clinical manifestations. Among them, the Yangming disease is full of heat, and because of dry urine, the stomach is full, unable to lie down, and even gasping for breath, etc. For lung syndrome, use salty, bitter, cold and cool recipes, such as Chengqi, to make the qi of the viscera clear, the heat in the lungs to self-discharge, and the wheezing and fullness can be eliminated [5]. Chief Physician Ma Wanqian believes that in the treatment, attention should be paid to clearing the internal organs, not just treating lung diseases. In the use of traditional Chinese medicines for dispersing the lungs and resolving phlegm, it is necessary to add the products of clearing the internal organs and moistening the intestines, so as to clear the lungs and qi to reduce the Jiao Yangming, and the lower Jiao Yangming and the descending Jiao Yangming. Lung Qi.
1.3 Damp heat and blood stasis can be combined
Overeating, food accumulation in the stomach and intestines, metaplasia of damp-heat; spleen and stomach involvement, gastrointestinal qi obstruction, food cannot be transported and transformed normally, This leads to constipation
Senile constipation is a chronic disease with more deficiency and more blood stasis, and there will be blood stasis in the development of the disease, so Can be added with the product of promoting blood circulation and removing blood stasis. If the patient has symptoms such as abdominal pain, abdominal distension, weight loss, etc., they should be alert to the accumulation of symptoms, but also need to keep in mind that the disease will stop soon, and often take care of the qi of the spleen and stomach and the yin and blood of body fluid
2 Discuss the addition and subtraction, the main is to nourish qi and nourish yin
< p>Thousands of old Chinese medicine practitioners believe that the treatment of constipation should focus on soothing the liver and spleen, nourishing qi and nourishing yin, moistening the intestines and dredging the bowels. With clearing heat, promoting blood circulation and removing blood stasis, and unblocking the internal organs, the formula is based on the formula of nourishing qi, nourishing yin and moistening the intestines. Powder 10g, Scrophularia 10g, Rehmannia glutinosa 10g, Hemp seed 10g, Fried bitter almond 10g, Yu Liren 10g, Cistanche cistanche 10g.
Astragalus in the recipe has the functions of invigorating qi and raising yang, strengthening the appearance and benefiting health; Atractylodes has the effects of invigorating the spleen and replenishing qi, drying dampness and diverting water; Scrophulariflora can nourish yin and reduce fire, detoxify and clear heat; Ophiopogon japonicus can clear the yin of lung and stomach, moisten dryness and produce body fluid, clear heart and remove irritability, nourish yin and moisten intestines; medicine. Scrophularia Radix, Ophiopogon japonicus, and raw land are used together, and they are used for diarrhea and tonic, as a plan to increase water and boat. It is just the so-called use of tonic body as a laxative. “>[8]. Rhubarb has the effect of clearing the stomach and stomach, and walking without guarding; Glauber’s salt has the effect of purging heat and laxative, moisturizing dryness and firmness, and purging the stomach and stomach. The dosage of traditional Chinese medicine can be adjusted flexibly according to the length of the medical history and personal constitution. For example, those with partial heat, rhubarb and Glauber’s salt should be reused; those with partial yin deficiency should be reused with Scrophularia, Ophiopogon japonicus, and Shengdi. Bitter almonds can relieve cough and relieve asthma, moisten the intestines and laxatives; hemp seed and Yu Liren can moisten dryness and smooth intestines; Cistanche buckwheat tonifies kidney yang, nourishes essence and blood, moistens dryness and smoothes intestines; Magnolia officinalis removes fullness, dampness and phlegm; Stir-fried Citrus aurantium breaks qi and eliminates accumulation, resolves phlegm and eliminates suffocation.
Modern pharmacological studies have confirmed that traditional Chinese medicine has the effect of relieving constipation, such as rhubarb containing anthraquinone derivatives, mirabilite containing sulfuric acid Sodium
Many famous Chinese medicine experts have unique views on the treatment of senile constipation, such as Professor Cao Jixun
In summary, the self-made Yiqi Yangyin Runchang formula can improve the symptoms of senile constipation patients. , the effect of promoting intestinal peristalsis. Chief Physician Ma Wanqian believes that the clinical diagnosis should not be restricted to one side, and the four diagnoses are combined according to the patient’s symptoms, and the medication can be added or subtracted. If you have abdominal distension and poor appetite, you should add products that transport the spleen, regulate qi and eliminate food, such as Erchen Tang, Muxiang, Cyperus officinalis, Jiao Sanxian, Ji Nei Jin, etc., to quickly restore the function of spleen and stomach transport and transformation; also dry mouth and thirst and other body fluids For those who are insufficient, add products that nourish yin and increase liquid, such as Dendrobium, Polygonatum, etc.; also have symptoms such as poor sleep, five upset and heat, and add products that clear away heat, eliminate vexation and soothe the nerves, such as Suanzaoren Decoction, etc.; also have irritability and short temper Other symptoms, such as Bupleurum, rose flower, green calyx plum, etc., should be added to soothe the liver and qi; for those with bitter and bad breath, yellow and greasy tongue coating, should be added to clear the liver and gallbladder damp-heat products, such as Longdan Xiegan Decoction.
3 Always take care of the spleen and stomach, and adjust the diet according to the constitution
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Chief Physician Ma Wanqian believes that drug treatment is important, psychological counseling is essential, and usual dietary care is particularly important. First of all, in terms of treatment, he is the first to solve the problem of constipation, and often inquires about the patient’s medical history, eating habits, and living habits in detail.
Secondly, Chief Physician Ma Wanqian often encourages patients with words: although the disease is a chronic disease, it needs to be Confidence and mentality are good, and constipation can be prevented through some life coup, such as developing bowel habits: regular bowel movements, drinking more water, massage the abdomen before going to bed, and promote intestinal peristalsis. It is recommended that the elderly do more levator ani exercises.
Finally, Chief Physician Ma Wanqian believes that physical factors play an important role in the pathogenesis of constipation. Different constitutions suggest different diets. As early as the “Huangdi Neijing”, the characteristics of human physique were described, and there were records of targeted treatment and health preservation. Chief Physician Ma Wanqian has formulated the therapeutic formula of nourishing qi and moistening the intestines, the therapeutic formula of warming yang and moistening the intestines, the therapeutic formula of regulating qi and resolving stagnation, and the therapeutic formula of nourishing yin and moistening the intestines for constipation patients with qi deficiency, yang deficiency, qi stagnation, yin deficiency and damp-heat constitution. Clearing away heat and dampness and laxative diet.
4 Examples of Medical Cases4.1 Medical Cases 1 strong>
Xie Moumou, male, 80 years old. The patient first visited the Shunyi Hospital of Beijing Traditional Chinese Medicine Hospital on January 25 due to “poor defecation accompanied by dry stools for more than 20 days”. 20 days ago, the patient had no obvious incentives for defecation, weak defecation, dry stool, hard ball-like stool, about 4 to 5 days, dry mouth, obvious at night, occasional cough, epigastric fullness, belching, satiety Poor, poor sleep, urination. Physical examination: Abdominal soft, no tenderness and rebound tenderness. Red tongue, yellow and white fur, slightly thick, weak pulse.
Chief Physician Ma Wanqian inspected the patient and considered the diagnosis of TCM according to the patient’s symptoms and signs, tongue and pulse: constipation, Qi and Yin deficiency syndrome. The method of nourishing qi, nourishing yin, and moistening the bowels is used to supplement and subtract the formula of nourishing qi, nourishing yin and moistening the intestines. The prescriptions are as follows: Astragalus 15g, Atractylodes Rhizoma 30g, Rhubarb 6g, Ginger Magnolia 10g, Bran Fried Citrus aurantium 10g, Xuanming Powder 10g , Scrophularia 10g, Rehmannia glutinosa 10g, Hemp seed 10g, Fried bitter almond 10g, Yu Liren 10g, 7 doses, herbal preparations decoct in water, 1 dose a day, morning and evening.
The patient had a second visit on February 1, and complained that the defecation was smoother than before, and the defecation was performed every 2 to 3 days. In the form of a hard ball, the stomach bloating and belching are relieved than before, and it is acceptable. This time, the patient’s defecation was significantly relieved, but he still had stomach bloating, belching, and anorexia. Chief Physician Ma Wanqian considered that the spleen and stomach were weak, the stomach was out of harmony, and the qi was blocked. On the basis of the original prescription, the spleen and qi were strengthened. Product: 15g of dried tangerine peel, 10g of Muxiang, 10g of Chine Neijin, 7 doses, decocted in water for herbal preparations, 1 dose a day, taken in the morning and evening. On February 8, the patient had three visits, and complained that the defecation was smooth. One to two days, the stool was formed and soft, and the stomach bloating, belching, and anorexia were significantly improved. Chief Physician Ma Wanqian suggested that the patient take nourishing Yin Runchang Oral Liquid to continue the consolidation treatment, and suggested that he take the nourishing Yin Runchang diet.
The patient is elderly, and in addition to dry stools, he also has symptoms such as cough and stomach fullness. Tongue and pulse, so the chief physician Ma Wanqian believes that the liver and spleen should be treated together, and the lungs and qi should be dispelled and the qi of the fu-organs should be diffused, so bitter almonds are used. At the second consultation, the patient still had symptoms of stomach distention and lowering of the stomach, so some spleen-invigorating and qi-regulating products were used to restore the gastrointestinal qi.
4.2 Medical Case 2
Wang Moumou, female, more than 69 years old, suffered from dry stool in November. The first visit to Shunyi Hospital of Beijing Traditional Chinese Medicine Hospital on the 8th. The patient had no obvious incentive for defecation and dry stool a year ago. Dreamy, night sweats, irritability, short temper, easy to urinate. Physical examination: abdomen is soft, no tenderness and rebound tenderness. Red tongue, thin yellow coating, thin pulse.
Chief Physician Ma Wanqian inspected the patient and considered the diagnosis of TCM according to the patient’s symptoms and signs, tongue and pulse: constipation, qi and yin deficiency with heat syndrome. Treatment is to replenish qi and nourish yin and increase fluid The method of moistening the intestines and laxatives, adding and subtracting the formula of nourishing qi, nourishing yin and moistening the intestines, the prescription is as follows: Astragalus 10g, Atractylodes 30g, Rhubarb 6g, Ginger Magnolia 15g, Cistanche 10g, Fried Bitter Almond 10g, Fried Raisin Seed 10g, Xuanming Powder 10g , Scrophularia 10g, Rehmannia glutinosa 10g, Hemp Seed 10g, Yu Liren 10g, Rose 10g, Bupleurum (North) 10g, 7 doses, herbal preparations, decocted in water, 1 dose per day, taken in the morning and evening.< /p>
The patient had a second visit on November 15th, and complained that the defecation was smoother than before, but the stool was still dry, and the patient was thirsty for 2 to 3 days. Improvement, poor sleep, and more dreams. This time, the patient’s defecation was significantly relieved, but he still had poor sleep and irritability. Chief Physician Ma Wanqian combined Suanzaoren Decoction on the basis of the original prescription, adding 10g of Suanzaoren, 6g of licorice, and Mother 6g, Poria 10g, Chuanxiong 10g, 7 doses, herbal preparations, decocted in water, 1 dose per day, taken in the morning and evening. Suanzaoren Decoction has the effects of nourishing blood and calming the nerves, clearing away heat and eliminating vexation, and mainly treats liver blood deficiency and internal disturbance of deficiency heat. On November 22, the patient had three consultations, and complained that the defecation was smooth, and the sleep condition was relieved for 1 to 2 days, and the effect was not improved. On November 29, the patient had four consultations. Consolidation treatment with Ziyin Runchang Oral Liquid and Jiuwei Zhenxin Granules was continued.
The patient was diagnosed with constipation for the first time. The main complaint is to solve the main symptoms of the patient first, but the patient has poor sleep for a long time, so on the basis of the main prescription, Suanzaoren Decoction is added to nourish the heart and calm the nerves to help sleep. In the later stage, it is recommended that the patient continue to use Chinese patent medicine to soothe the nerves in the consolidation treatment.
5 Summary
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Constipation often affects people’s life and diet, and it is also one of the psychosomatic diseases. Patients who seek medical treatment have varying degrees of anxiety, so long-term stability and consolidation of curative effects are essential of. Chief Physician Ma Wanqian has unique insights into the diagnosis and treatment process of constipation. (1) Qi-yin deficiency is the main pathogenesis of senile constipation, mixed with liver stagnation and spleen deficiency, damp-heat blood stasis, etc. In treatment, the liver, spleen, lung and kidney should be in harmony, nourishing the yin and moistening the intestines, nourishing the qi and nourishing the blood, and dispersing the lung qi and dredging the internal organs. gas. It is also necessary to remember that during the diagnosis and treatment, it is necessary to always care for the qi, blood and body fluids. Do not use cold and cool products to waste the qi of the spleen and stomach and damage the body fluids. The clinical symptoms cannot be singled out. It is necessary to look at the overall situation and to regulate the qi mechanism of the whole body as the foundation. ; Medication should not be too aggressive, and the medication should be adjusted in time according to the outcome of the disease; (2) Senile constipation is easy to be repeated and difficult to heal, and in addition to drug treatment, psychosomatic and dietary care are equally important; (3) Chief Physician Ma Wanqian has treated himself for many years The concept of physique influencing disease development and outcome summarized from experience is brought to the treatment of senile constipation, and different diets are recommended according to different physiques.
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