Before reading this article, we sincerely invite you to click "Follow", which is not only convenient for you to discuss and share, but also brings you a different sense of participation, and it is more convenient to come back at any time to read more wonderful content, thank you for your support.
Diabetes mellitus (DM) is a chronic, non-infectious, multi-system, metabolic disease characterized by elevated blood sugar, and the pathogenesis type is type 2 diabetes mellitus (T2DM).
Long-term exposure to hyperglycemia can lead to autonomic neuropathy of the digestive system, causing gastrointestinal symptoms including gastroparesis, constipation, diarrhea and so on.
Among them, constipation is the most common, with an incidence of up to 60%. Patients with mild constipation may have abdominal pain and bloating; Recurrent authors can induce fissures, hemorrhoids, etc.; Severe constipation can induce or aggravate cardiovascular and cerebrovascular diseases.
In addition, patients with long-term constipation often have anxiety, irritability and other bad emotions, resulting in increased levels of hormones such as glucagon and epinephrine, causing blood sugar fluctuations.
Western medicine usually adopts laxatives, gastrointestinal prokinetic drugs, vitamins, microecological systems, etc., with general clinical efficacy, and the condition is prone to repeated attacks, with certain limitations.
Although there is no name for diabetes combined with constipation in traditional Chinese medicine, it can be classified as "thirst quenching disease" and "constipation" according to clinical symptoms, and the pathological factors of thirst quenching disease are based on yin deficiency, dry heat as the target, and the evil of dry heat is sparkling liquid, causing irritable bowel and constipation;
Or dry evil days and long wounds and consumption of qi, qi deficiency and inability to push, jin injury can not moisturize the intestines, resulting in constipation of qi and yin deficiency, and in the process of sputum dampness, blood stasis, Qi stagnation and other evil diseases.
Therefore, constipation is closely related to thirst reduction, often manifested as a mixture of virtual and solid, treatment or acute lower Yin, or deficiency and laxative, or clear up and moisturize.
TCM treatment focuses on a holistic view, examines the causes, varies from person to person, and treats the symptoms and the root causes. Traditional Chinese medicine characteristic treatments include Chinese medicine decoction, Chinese proprietary medicine, acupuncture, tuina, etc., all of which have good clinical efficacy, and have few side effects and low dependence.
Overview of medical research in the motherland
Awareness of etiology and pathogenesis
Diabetes combined with constipation has no direct corresponding disease name, and it is classified as "thirst disease" and "constipation" in the medicine of the motherland. "Treatise on the Origin of Diseases" cloud: "In the house of thirst, it is difficult to stool", which shows that the two are very closely linked.
The disease is mainly in the large intestine, involving the lungs, spleen and stomach, kidneys and other organs. Insufficient lung qi and lack of fluid; Spleen deficiency and lack of qi, weak movement, loss of lifting, inability to metaplasia and cloth, dry intestines, dry feces;
The large intestine is the main jin, and if there is no water, the boat stops; Kidney qi deficiency, push weakness, or kidney yin deficiency, deficiency fire endogenous, consumption of fluid, or kidney yang deficiency, warm weakness, all of which can cause abnormal conduction function of the large intestine and constipation.
Its pathogenic factors are mostly external sensibility, insufficient endowment, emotional disorders, uncontrolled diet, and overwork. At present, most of the people believe that the main cause of the disease is based on the deficiency of qi and yin, and the heat is hot, stagnation of qi and blood stasis.
Due to the intricacies of diabetes combined with constipation, doctors have different understandings and understandings of the pathogenesis.
Zhang Xichun's "Medical Heart Zhong Shen Xilu" has a cloud: "A certificate of thirst quenching all originates in Zhongjiao", pointing out that thirst-quenching disease occurs in Zhongjiao, spleen and stomach, and then spreads to various organs.
"Three Causes and One Disease Evidence" said: "People may be injured by wind, cold, heat and humidity, heat, sweating and urinating, walking dry liquid, causing gastrointestinal dryness, and secrets", quenching thirst for a long time, already yin and yin deficiency, righteous qi is greatly injured, if it coincides with external evil qi, the right is not victorious, enter the heat inside, consume the fluid, the stomach is dry and dry, and the constipation is constipated.
In the "Medical Law", Yu Jiayan once stated: "Fat and expensive... Brewing internal heat... The liquid dried up... And the middle of the elimination of it", overeating fat and thick taste, spleen and stomach are affected, weak transportation, so that the food is stagnation and scorching, and over time it becomes wet and turbid, contains evil heat, burns the yin fluid, and finally the pathological state of yin deficiency and heat.
"The Secret of the Orchid Chamber" cloud: "If hunger and fullness are lost... Eat spicy and hot things with thick taste, and help fire evil... Jin liquid deficit, so the stool is dry", qijin has been consumed, followed by the spicy taste of heat, fiery and hot, refining liquid wounds, dry and burning intestines, dry stool in the colon.
If the mood is not comfortable, the qi machine is sluggish, and the qi machine is out of balance, resulting in the imbalance of lung qi and the inability to release the qi of the large intestine; Transverse spleen, spleen suppression, temper loss, large intestine weakness downward conduction to discharge waste, so that stool remains in the intestine.
"Outer Taiwan Secrets, Quenching Thirst" Yun: "Excessive atrium... The lower scorching heat, heat is kidney dryness, kidney dryness is thirst", unruly intercourse, consuming kidney yin, yin deficiency and heat, and even constipation.
The pathogenesis of thirst quenching disease is yin deficiency and heat, yin deficiency and internal heat, gas consumption and yin, intestinal fluid deficiency, and constipation; For a long time, the qi machine is not smooth, and there is blood stasis, so the common clinical diabetes combined with constipation is mainly manifested as the symptoms of virtual and real inclusion.
Based on the principle of "state target differentiation", diabetes is divided into four "states": depression, heat, deficiency and loss, and constipation can occur in every state of thirst-quenching disease.
Advances in TCM treatment
Internal governance
Treat the internal organs
"Theory of the Origin of Diseases, Difficult to Wait for Bowel Movement": "Those who have difficulty in stool, due to the five internal organs are not adjusted, the yin and yang are partial to reality, and the three focal points are not harmonious, then cold and hot are also knotted", indicating that the occurrence of constipation is closely related to the disharmony of the five organs.
Spleen deficiency is the main pathogenesis of diabetic constipation, self-like strengthening the spleen, regulating bowel drinking, replenishing qi and strengthening the spleen, supplementing heat and promoting qi and blood and other drugs, so that the spleen and luck, the subtlety of the water valley can be infused to the heart and lungs, and the liver and kidneys can be returned. In this way, the jin fluid is restored, the qi and blood are filled, the qi machine is reached, and the conduction function of the large intestine returns to normal.
Deficiency of temper, dereliction of duty is the pathological basis of the disease, self-prepared conditioning soup to treat diabetic constipation, to strengthen the spleen and invigorate qi, to remove qi, and emphasize that in the process of differential treatment of elderly patients with diabetic constipation, we should pay attention to the treatment from the void and take care of the physiological function of the spleen.
Spleen deficiency is an important factor in the occurrence and development of diabetic constipation, which can not only stabilize blood sugar, but also restore intestinal dysbacteria, increase the number of flora, increase gastrointestinal peristalsis, and improve constipation symptoms.
Spleen loss of healthy luck is the key to the pathogenesis of diabetic constipation, the treatment is based on the "Suwen" "some seek, those who do not seek, the prosperous are responsible, the weak are responsible, must first five victories" as the guiding ideology, and it is recommended that patients should move more and relax less to enhance the transport of the spleen and promote stool excretion.
In accordance with the principle of "preserving stomach qi and storing jin liquid", in clinical diagnosis and treatment, Bazhen Tong plus minus was used to treat patients with diabetes complicated with constipation, and the clinical effect was considerable, compared with the Western medicine control group, the defecation time, interval time, stool quality, etc. were significantly improved.
Dirst quenching constipation, mainly in the lungs and large intestine. The clinical combination of tonic and moisturizing method was used to treat diabetic constipation and achieved good results.
The group reuses astragalus to replenish lungs and invigorate qi, and almonds have the meaning of lifting the lid of the pot, so that the lungs are filled, the jin fluid is full, the intestines are moist, and the stool is smooth. The use of the lid lifting method to treat patients with diabetes and constipation has improved the time, frequency and characteristics of bowel movements, which can better accelerate intestinal peristalsis.
If the liver qi is not loose and the qi is not smooth, it will lead to constipation. The occurrence and development of diabetic gastrointestinal disease is related to the imbalance of qi machine lifting, through the theoretical method of heart and kidney drainage.
Patients with diabetes and constipation are treated with diabetic patients with difficulty in defecation with Coptis warm gallbladder decoction to achieve the effect of draining liver qi, ventilating the air, clearing stomach heat, and clearing stool.
Follow the six intestines to use the general use, use the four reverse dispersion of liver and qi, achieve the effect of loosening the liver and spleen, practicing qi and activating blood, dialectical treatment or both promoting lung qi, or replenishing qi and strengthening the spleen, or nourishing yin and vitality, and emphasizing that for such patients, daily care should be done to maintain emotional comfort.
Constipation is closely related to kidneys, in the clinical observation of the use of Qibang laxative decoction for diabetic constipation, the control group used mosapride dispersible tablets, the results showed that compared with conventional treatment, the efficacy of Qibin laxative decoction was significantly increased, which not only improved the intestinal environment of patients with constipation, promoted intestinal peristalsis function, but also had a good effect on reducing the recurrence rate of constipation.
Syndrome differentiation
Zhang Zhongjing mentioned in "Suwen Yin and Yang Betwen": "Two Yang knots are called elimination", dividing the pathogenesis of diabetes into two parts: yang knots and yin knots. Yang knots are mostly heat accumulation and injury Yin, and the treatment is Xinjia Huanglong Tong plus heat relief to reduce heat release;
The yin knot is mostly yang deficiency and stagnation, and the treatment is to warm the spleen soup plus reduce temperature to replenish the spleen and yang. Constipation can occur in every state of diabetes progression, depending on the course of diabetes, heat, weakness, and loss.
In summary, in the dialectical treatment of diabetic constipation, Academician Tong Xiaolin divided the depression into liver depression and gastrointestinal gas stagnation, and selected four reverse dispersal liver qi and magnolia three-object soup for qi conduction;
The hot state is divided into lung and stomach heat, liver and stomach fever, intestinal humid heat, phlegm heat stagnation, blood heat type, choose white tiger soup clear heat and clear qi to distinguish evil heat, Da Chai Hu soup internal diarrhea hot knot, Lian Pu drink clear li humid heat, small trap chest soup polyester phlegm release heat, Qingying soup clear heat and cool blood;
The virtual state is divided into qi deficiency, yang deficiency and yin deficiency type, the use of Fengshu soup to strengthen the spleen and improve qi, Jichuan frying temperature to replenish yang qi, liquid soup or liquid to bear gas soup to nourish yin and increase liquid, the damaged state is mainly blood stasis constipation, and the use of Wang Blood Fu Zhu Wei soup to activate blood stasis.
It is concluded that the treatment of diabetic constipation should first distinguish between the false and the real, the empirical evidence includes lung and stomach fever, liver and stomach qi stagnation, deficiency includes lung and kidney yin deficiency, lung and spleen deficiency, qi yin deficiency, respectively, to clear diarrhea internal heat, moisturize the intestines and laxation, loosen the liver and regulate qi, clear the intestines and eliminate ruffles, nourish the lungs and kidneys, nourish the yin and vitality, replenish the spleen and lungs, eliminate qi, replenish the spleen and qi, nourish the blood and rejuvenate the rule of law.
Gastrointestinal heat, intestinal dryness and deficiency are the root of the onset of diabetic constipation, and the clinical use of hemp seed pills plus and minus treatment is used to moisturize the intestines and relieve fever and relieve gas.
Diabetes combined with constipation is divided into large intestine heat and dryness and large intestine cold, and the self-formulated "Wuren Soup" that nourishes yin and dryness, strengthens the spleen and invigorates blood is added and subtracted, and clear heat or warm and yang laxative products are added according to the cold and heat differentiation, so that the jin liquid can be filled and the stool will fall in time.
Other theoretical treatments
Based on the theory of Changsang Junmai method, patients with diabetes complicated with constipation and dry pulse are treated with Da Chai Hu Tang plus minus, and the treatment is rational qi and clears the body, clears heat and vents turbidity, so that the qi machine is adjusted smoothly and the stool can be obtained.
Based on the theoretical guidance of three yin and three yang, it is believed that the basic pathogenesis of diabetic constipation is heat injury qi yin, and it is concluded that diabetes combined with constipation disease often occurs in people with Yangming stomach heat, gastric heat and yin deficiency, less yang qi depression, less yang depression, taiyin and spleen deficiency, and less yin kidney deficiency.
Externality
According to the results of TCM treatment of diabetic constipation, TCM dialectical treatment is more effective than Western medicine, and in the treatment, TCM external treatment reflects the normative and scientific nature. These include acupuncture, tuina, acupressure and dressing, ear point pressure and other methods.
acupuncture
For the clinical treatment of diabetes complicated with constipation, acupuncture treatment has a definite effect, a variety of therapies, and flexible point selection, which can avoid the side effects caused by long-term application of Western drugs and improve blood sugar.
Through the clinical observation of acupuncture of Baji Point and Colonyu Point, it was found that the symptoms of long defecation interval, difficulty in defecation, and rectal obstruction were significantly improved, and it had a good effect on promoting intestinal peristalsis and reducing basin muscle tone.
Statistics have been found in the study of acupuncture in the treatment of diabetes complicated with constipation that acupuncture points with high efficacy are mainly distributed in Ren Pulse, Gastric Meridian and Sanjiao Meridian, which have the effect of regulating the spleen and stomach and moisturizing the intestines and laxation. Among them, the acupuncture points that are used more are Tianshu, Zusanli, Shenque, Zhongxuan, etc., accounting for 50% of the total frequency.
massage
Tuina treatment is guided by the basic theory of traditional Chinese medicine, selects the corresponding meridians and acupuncture points according to dialectical treatment, unblocks meridian qi and blood, and restores the function of internal organs.
A total of 150 elderly patients with chronic constipation were randomly divided into treatment group and control group, with routine intervention in the control group and intervention in the treatment group.
After 3 weeks, the results showed that the scores of stool frequency and difficulty in defecation were significantly better than those of the control group after Tuina treatment, which proved that the use of meridian acupoint Tuina treatment was conducive to the flow of qi and blood, supporting healthy qi, and increasing intestinal peristalsis to relieve constipation symptoms.
Through the clinical observation of acupressure massage, the treatment group used acupressure point massage, selected Tianshu, Shenmen and Guan Yuan and other acupoints, and the control group orally took hemp seed soft capsules, after 4 weeks of treatment, the clinical effect of the treatment group was remarkable, avoiding the stimulation of the gastrointestinal tract by oral drugs, and the side effects were small, promoting local blood circulation, and providing new ideas for the clinical treatment of diabetes complicated with constipation.
Auriculopathic compression
"Lingshu Oral Question": "Those who ear are also the ones who gather in the lineage". There is a close connection between the ear points and the human organs and meridians, and in the ear points, you can select the corresponding small intestine meridian and Sanjiao meridian acupuncture points, and use the way of ear point bean pressing to stimulate the acupuncture point to guide the qi and promote the peristalsis of the intestine to promote bowel movements.
Through the clinical observation of 147 patients with diabetes mellitus and constipation, it was found that ear acupoint pressure can improve intestinal disorders and hormonal imbalances by stimulating the cerebral cortex and intestinal nerves, and the clinical effect is significant, while reducing the incidence of constipation.
Eighty diabetic patients were randomly divided into treatment group and 40 cases in control group, among which the treatment group was given ear point compression and the control group was given conventional treatment, and the results showed that the effect of ear point pressure group in improving constipation was more obvious, and the effective rate reached 95.24%.
Acupressure point application
Based on the meridians of traditional Chinese medicine, Chinese medicine acupoint application is ground into cake and applied to acupuncture points to achieve non-invasive treatment of diseases.
Through the clinical observation of acupoint application in the treatment of diabetes mellitus and constipation, it is concluded that the use of acupoint application can effectively improve the clinical efficacy, better volatilize through pores, communicate with the surface, regulate the internal organs, differentiate treatment, have few side effects, and directly improve the symptoms of constipation.
Through the meta-analysis of acupoint application for the treatment of diabetes mellitus and constipation, the umbilical Shenque points were selected, the skin was thin, the subumbilical blood vessels were rich, the drug was easily absorbed, and the effect on improving constipation symptoms was high, with high safety, few side effects, and higher psychological acceptance of patients.
Comprehensive treatment
Patients with diabetic constipation were randomly divided into treatment group of 45 cases and control group of 40 cases, the control group was given oral sulfonylureas and biguanides, and the treatment group was treated with Primos combined with flavored intestinal pills with an effective rate of 95.6% in the treatment of diabetic constipation.
The control group had an effective rate of 62.5%, and the clinical effect was significant. By observing the clinical efficacy of needle combined with hemp seed pills in the treatment of diabetes complicated with constipation, 64 patients with diabetes complicated with constipation were randomly divided into control group and observation group with 32 cases.
The control group was treated with Ma Ziren Pill, and the treatment group was treated with acupuncture on the basis of the control group, and the treatment group had better efficacy in defecation frequency and defecation time, and selected acupuncture points such as Zusanli and Sanyin intercourse to not only protect the spleen and stomach, but also unblock the intestines.