▲ Li Tonggui is a master of traditional Chinese medicine
Li Tonggui, a master of traditional Chinese medicine, believes that constipation belongs to a functional bowel disease, which is mainly manifested in the clinical manifestations of dry stool, difficulty in defecation, decreased frequency of defecation or incomplete defecation. Mostly due to poor diet, poor emotions, weak body, etc., liver and spleen disorders, poor gas machine, affecting the operation of water, qi, blood, water stop gathering for a long time and turned turbid into poison, turbidity is blocked in the intestines, dross can not be down, then it is constipated evidence, turbidity contains long-term injury and yin fluid qi and blood, yin injury and yang, constipation false evidence.
In the treatment of functional constipation, Li Tonggui pays attention to the combination of medicinal taste and efficacy, and at the same time, he uses the drug well and achieves good results.
Thermal constipation
External sense of evil qi is depressed and turns into heat, emotional disorder turns into fire, or like spicy, alcohol and food lead to gastrointestinal heat, hot turbidity and evil obstruction in the intestines, consuming yin fluid, dross is difficult to get down. Choose bitter cold, sweet cold, salty cold heat medicine, such as rhubarb, plaster, seaweed and other medicines. Bitterness can drain heat, can be dry and wet; sweet can be slow, can nourish liquid; salty can be soft and firm, can be discharged. Rhubarb 3g is often used for clinical evidence to play the effect of strengthening the spleen to help digestion and slow down diarrhea. Gypsum has the effect of clearing heat and diarrhea, eliminating annoyance and quenching thirst, using gypsum of sweet and cold, one to clear the heat of the gastrointestinal tract, and then to avoid bitter cold and clear heat to chemical dryness and yin, aggravating the degree of constipation. Seaweed has the effect of dissipating heat and softness.
Stagnation and constipation
When treating constipation caused by poor qi machine, it is good to adjust the qi machine from the level of drug lifting and descending. Choose wood incense, citrus fruit, almond and other medicines. Wood fragrance, with the effect of relieving pain and strengthening the spleen and eliminating food. "Compendium of Materia Medica" Yanmu Xiang can perform three jiao, five visceral qi. Citrus aurantium, bitter taste, bitter, slightly cold, returned to the spleen, stomach, large intestine meridian, has the effect of breaking the gas to eliminate accumulation, phlegm and remove the diarrhea, for the treatment of spleen and stomach, large intestine qi stagnation empirical medicine. Almonds, warm in nature, bitter in taste, return to the lungs, large intestine meridians, with the effect of moisturizing the intestines and laxative.
Stagnant constipation
In the "Su Qing Zhi Zhi Zhi Da" it is said that "too yin si tian, wet fornication wins... Difficulty defecating". Spleen loss of good luck, water and fluid operation disorders, wet evil stop gathering, block the gas machine, or internal depression fire, or turbidity into poison, internal difficulty in the intestines, constipation. Li Youguishan used the two medicines of Bai Shu and Cang Shu together. Baishu tonifies dryness and wetness, quenches thirst and vitality, is the most beneficial to the spleen, nourishes the stomach qi; Cangshu is spicy and warm, healthy and wet, and dispels turbidity and pleasant spleen. The two drugs are used together, there are supplements and leaks, weighing the middle focus, then the dry and wet spleen is more effective.
False evidence of constipation
When yin deficiency and constipation, it is commonly used to increase water and boats, such as Xuan Ginseng and Sand Ginseng, which nourishes the yin and does not hurt the yang, and at the same time cooperates with hemp seed, Yu Li Ren and other kernel Chinese medicines to moisten the intestines and laxative. When yang deficiency is constipated, make good use of cistanche. Cistanche has the effect of tonifying kidney yang and moisturizing intestines, and its yang is not harmful to yin. When clinically treating the elderly yang deficiency and constipation, cistanche is often used 20g, and the effect is better.
Case inspection examples
Zhang Mou, male, 69 years old. Initial consultation on June 23, 2018. Sued the stool dry for more than 4 years. Now the stool is dry and knotted like a ball, 2 to 3 days 1 line, normal urination, accompanied by abdominal distension, poor, red tongue moss thin yellow grease, smooth veins.
Diagnosis: depressed gas machine, damp heat turbidity type constipation (called habitual constipation in Western medicine).
Treatment: Shunqi conduction stagnation, clear heat and turbidity.
Prescription: Magnolia 15g, Citrus aurantium 15g, Chai Hu 15g, Xiangfu 12g, Wood Fragrance 9g, Raw White Technique 12g, Turmeric 9g, Banxia 12g, Angelica 30g, Raw Hawthorn 30g, Knotweed 20g, Hemp Seed 30g, Cistanche 20g, Aloe Vera 1g. 7 doses, 1 dose per day, divided into 2 divided doses.
Second diagnosis on July 1, 2018: The patient's symptoms were significantly alleviated after taking the drug, the stool was dry, once a day, the urine was yellowish, the abdominal distension was reduced, the appetite improved slightly, the sleep was ok, the tongue was red, and the root of the moss was thin and yellow. On top add 20g of plum kernels, 20g of seaweed, 20g of konbu. 7 doses, decoction method as before.
Three consultations on July 10, 2018: the patient had normal stools, smooth bowel movements, 1 time a day, urine adjustment, abdominal discomfort is still slightly full, appetite is significantly improved, tongue is red, and the root of the tongue is thin and yellow. Go to the top half summer, add 10g each of coke malt and scorched divine comedy. 14 doses, decoction method as before.
Fourth consultation on July 27, 2018: The patient has no obvious discomfort, considering the long course of his illness, fearing his recurrence, so he is treated.
Press: Patients due to diet, poor mood and other factors caused by liver and stomach disharmony, long-term turbidity and endogenous, internal qi is not clear, and the dross is stopped internally. Fangzhong citrus fruit, magnolia, turmeric turbidity and stomach, qi to remove bloating; chai hu, incense attached to the liver to relieve the qi; half summer, white art dry and moist turbidity; raw hawthorn softening the intestine dry stool; hemp seed laxative; considering that the patient is old, need to take into account the bias of his yin and yang and the lack of qi and blood, so add angelica to nourish the blood to moisten the intestine laxative, cistanche nourish the sperm blood to moisten the intestine laxative, knotweed Qing day long accumulation of wet and hot turbidity. In the second diagnosis, the patient's symptoms have improved significantly, and the stool is still dry, so seaweed and kelp are added to loosen the knot with soft firmness to soften the stool accumulated in the intestine. During the third diagnosis, the patient's appetite was still poor, so he added coke malt and scorched divine comedy to help digestion.
【Content compiled from: China Traditional Chinese Medicine News, July 31, 2020, fifth edition, author: Jia Sujie, Hebei College of Traditional Chinese Medicine, Guo Lifang, Hebei Provincial Hospital of Traditional Chinese Medicine】