Faced with the "gift" of evolution, human beings have come up with these "tricks".
Written by | Ye Yichu
The heat is steaming, and the college entrance examination has just ended. If you want to count the scholars in the examination room in the history of the mainland, Zhang Juzheng, the first assistant of the Ming Dynasty, undoubtedly has a place. He was admitted to Xiucai at the age of twelve, was promoted at the age of sixteen, and became a jinshi at the age of twenty-three. This is because the examiner wants to give him frustration education, otherwise he would have been lifted in the first township examination at the age of thirteen. It is precisely because of this that Yan Shifan will call him "Zhang Prodigy" ridiculously. Zhang Juzheng entered the cabinet at the age of 42, becoming the youngest first assistant, and after taking power, he implemented reforms and single-handedly continued the life of the Ming Dynasty for decades. It's a pity that just when Daming was about to realize Zhongxing, Zhang Juzheng died suddenly.
So, what was the reason for the death of Zhang Juzheng, who was unparalleled in his fifties? There are different opinions about the cause of death, one of which is rumored to be related to hemorrhoid treatment. According to the record of "The First Auxiliary Biography since Jiajing": "If you get too much and don't give it, you will bait Chinese medicine in the day, and if you have strong yang and dryness, you will drink cold agents to vent it, and it will become hemorrhoids." And the spleen and stomach cannot eat. [1] Translated, it means that Zhang Juzheng was unable to eat because he had hemorrhoids. Zhang Juzheng himself wrote in "Answering the Thirty-fourth Question of the Guru Xu Cunzhai": "The cheap and real hemorrhoids have never been treated with hemorrhoids, and they have been ruined to this day. It was close to Zhao Yu, the medical officer of your house, and pulled out its roots. However, in aging people, although the hemorrhoids are gone, the vitality is greatly damaged, the spleen and stomach are weak, and they cannot eat and drink. "It is mentioned here that he himself became extremely debilitated because of the curative treatment for hemorrhoids. At that time, the "cure" treatment for hemorrhoids was to apply dry hemorrhoids to let the hemorrhoids fall off on their own.
According to the Ming Dynasty's "Surgical Zhengzong", the ingredients of withered hemorrhoids include alum, toad crisp, light powder, arsenic, and Tongzi's Tianling Gai [2]. Among them, except for the boy's Tianling Gai, they are all well-known poisons. Among them, alum contains aluminum ions, which may cause osteoporosis, anemia and dementia; Toad crisp may contain toad toxin, which acts similarly to digitalis, which can excite the vagus nerve and cause arrhythmia, shortness of breath, muscle spasm and paralysis; Light powder is a mercurous chloride crystal, which combines with cells after entering the human body and may cause mercury poisoning; Not to mention arsenic, which has been regarded as a representative of poison since ancient times. At that time, the treatment for hemorrhoids was to apply the dried hemorrhoids to the affected area repeatedly. Because the rectal mucosa has a strong absorption capacity, the various components of the hemorrhoids will be continuously absorbed. From this point of view, Zhang Juzheng's self-report that "the spleen and stomach are weak and cannot eat and drink, and it is almost impossible to afford it" is very consistent with the situation of arsenic and other toxic substance poisoning. Zhang Juzheng, who is unparalleled in the country, suffers from hemorrhoids, and may even die because of this, which is really embarrassing.
History of strange treatment of hemorrhoids
Throughout history, it seems that hemorrhoids have been accompanied by human beings since the beginning of their lives. Hemorrhoids are one of the earliest recorded diseases in ancient times on the mainland, and they have been recorded in the ancient Jiawen language. By the Spring and Autumn Period and the Warring States Period, there were already different classifications of hemorrhoids. Hemorrhoids are also specifically recorded in the "Fifty-two Prescriptions" found in the Mawangdui Han Tomb [3]. Coincidentally, records of hemorrhoids were also found in ancient Egyptian papyrus. The English hemorrhoid for hemorrhoids comes from the Greek language, which proves the long history of hemorrhoids. Despite being a disease, hemorrhoids have long been considered a "cause of longevity" in the West, and hemorrhoids bleeding are considered a good sign [4]. But after all, the pain of hemorrhoids is unbearable, so both Chinese and foreign doctors are constantly exploring treatments.
Fig.1 Illustration of hemorrhoids removed by European doctors circa 1175-1200丨Image source: References[5]
Existing records indicate that Hippocrates was the first to start the treatment of hemorrhoids in the 4th century BC. His method sounded horrible, and it was to cauterize the hemorrhoids with a hot soldering iron. In the book, Hippocrates also shared his experience in immobilizing the patient, who is more likely to protrude more outwards when he screams in fright, and the cautery is better. Just looking at the words, the treatment is even worse than torture, which is really distorted.
After Hippocrates, European doctors invented bloodletting therapy for hemorrhoids, which involves placing leeches near the patient's anus to suck blood. There are also doctors who make a cut in a vein near the patient's ankle in the hope of bleeding there to treat hemorrhoids.
The effectiveness of these methods is difficult to assess. When Napoleon was fighting in Europe, he had been using leeches to treat hemorrhoids, and by the time of the Battle of Waterloo, Napoleon, who was suffering from hemorrhoids, could only take a large amount of opium tincture to relieve the pain. It has been theorized that Napoleon's defeat at Waterloo was probably related to this[6].
Figure 2 A variety of treatments for hemorrhoids by ancient doctors in mainland China丨Image source: Internet
Speaking of the mainland, the treatment of hemorrhoids is also unique. The idiom "sucking hemorrhoids and licking hemorrhoids (there is a writing sucking hemorrhoids)", it is said that King Qin Hui gave five chariots of rewards to those who licked hemorrhoids with his tongue. During the reign of Emperor Wen of the Han Dynasty, his male pet Deng Tong was also rewarded by helping him lick and suck hemorrhoids to relieve pain [7].
At that time, there was also a therapy, which was to make the patient strip naked and do a handstand, and then the doctor suddenly splashed the patient with cold water when the patient was not looking, so that the patient was frightened and inhaled the hemorrhoids into the body. There are also doctors who boil white arsenic, alum, cinnabar, realgar, etc. into match-sized nails, insert hemorrhoids, and let the hemorrhoids die on their own [8].
In continental antiquity, surgical treatment of hemorrhoids also appeared. One is the ligation method, in which the hemorrhoids are tightly tied at the root of the hemorrhoids with a thread soaked in the drug, and the hemorrhoids shrink and fall off by blocking the blood supply. Another surgical method involves sacrificing a dog. During the treatment, it is necessary to kill the dog first, take out the dog's bladder, put it outside the hollow bamboo tube, and insert it into the patient's anus together. The doctor then blows on the bamboo tube, and the dog's bladder expands in the patient's body, and when it reaches a certain point, the doctor pulls out, pulls out the rectum, and then uses a knife to cut off the hemorrhoids on it, and then has the patient stand upside down to retract the pulled rectum back into the body [8].
However, not all hemorrhoid treatments are so terrifying, Su Dongpo University, who was suffering from hemorrhoids, invented sesame poria noodles. He wrote in "The Book with Cheng Zhengfu": "Peel the black sesame seeds, nine steaming and drying, peel the poria cocos, and add less white honey for the noodles." The food is very beautiful, and if you take it like this for many days, your strength will not fail, and your hemorrhoids will subside. "The role of sesame and poria noodles is no longer verifiable, but nearly a thousand years have passed on, and it has been passed down as a delicacy [9].
Traceable to hemorrhoids
After talking so much about the "battle of wits and courage" with hemorrhoids in medical history, it is inevitable that a question will arise, what exactly are hemorrhoids?
Hemorrhoids are essentially swollen veins in the anus and lower rectum [10]. Hemorrhoids that grow inside the rectum are internal hemorrhoids, and external hemorrhoids that grow under the skin of the anus. Internal hemorrhoids rarely cause discomfort, but they may bleed when straining to have a bowel movement, or when hemorrhoids protrude from the anus during a bowel movement, causing pain. External hemorrhoids are much more uncomfortable than internal hemorrhoids, often accompanied by itching, pain in the anal area, swelling around the anus, and some patients may also have a hard, discolored lump near the anus. External hemorrhoids also bleed during bowel movements, and the pain is usually worse than internal hemorrhoids. If both internal and external hemorrhoids are present, they are called mixed hemorrhoids. Different types of hemorrhoids can be simply summarized as internal hemorrhoids with blood in the stool without pain, external hemorrhoids with inconvenient blood and pain, and mixed hemorrhoids with blood in the stool.
Fig.3 Illustration of hemorrhoids丨Image source: References[13]
So, how exactly do hemorrhoids occur?
There are many theories that it is because humans walk upright that hemorrhoids occur. When crawling, the blood flows parallel to the whole body, and after walking upright, the anus becomes the bottom of the torso, and the blood circulation here is easily blocked, and hemorrhoids may form after a long time. For this reason, hemorrhoids are also called the "price of evolution" for human beings.
However, how hemorrhoids occur has not yet been studied. At present, there are several different theories about the occurrence of hemorrhoids in the academic community [11]:
• Varicose veins theory: anal veins and rectal veins do not have venous valves, and when constipation, pregnancy, prostate hypertrophy and other conditions occur, it may cause venous return to be blocked, and blood stasis leads to the formation of hemorrhoids.
• Anal pad downward transfer theory: The anal pad is an anal vascular pad composed of veins, smooth muscles, elastic tissues and connective tissues under the mucosa of the anal canal. Under normal circumstances, the anal pad retracts into the anal canal after a bowel movement. However, when the ability to retract is weakened, the anal pad may become congested and move down to form hemorrhoids.
• Genetics: More than 100 individual hemorrhoidal risk gene loci have been identified, and the expression of these genes, in vascular and gastrointestinal tissues, is involved in controlling smooth muscle function and the development and integrity of intestinal epithelial and endothelial structures. Therefore, hemorrhoids are caused by dysfunction of smooth muscle, epithelium, and connective tissue.
Although the cause is not yet fully understood, it is known that some behaviors and habits in life can induce hemorrhoids. These behaviors include poor bowel habits, such as straining too hard during bowel movements, taking too long to defecate (using mobile phones in the toilet), chronic constipation or diarrhea, unhealthy diet, obesity, pregnancy, etc.
Modern treatment of hemorrhoids
Thanks to modern medicine, there are now many reliable treatments. In fact, clinically, most hemorrhoids with no obvious symptoms do not require treatment [12].
For hemorrhoids with bleeding and pain, the main focus is to relieve the symptoms. The most important way to do this is to make lifestyle changes that reduce or eliminate the factors that can trigger hemorrhoidal flare-ups, including:
• Practice healthy bowel habits: Avoid straining or taking too long to have a bowel movement. Hemorrhoids are actually similar to a small balloon in the anus, and when you try too hard to defecate, the hemorrhoids will be blown up like a balloon and burst and bleed. Prolonged bowel movements (more than 5 minutes) can lead to anal congestion and distention, and infections are also susceptible, so it is important to be careful.
• Keep your anus clean, but take care to avoid overdoing it: Cleaning your anus reduces the risk of infection and relieves itching and discomfort around the anus. However, if you use a smart toilet to flush, the water flow is too large or the temperature is too high, which may cause sensitivity and chapped skin around the anus, and may also cause perianal eczema.
• Healthy diet: Drink plenty of water and eat more fiber-rich foods (all kinds of vegetables and fruits, such as spinach, celery, callus, etc.) can effectively increase the water in the stool and keep the stool smooth.
• Intensify exercise: Physical activity will speed up intestinal peristalsis, which is conducive to keeping stools smooth. In addition, levator ani training can also help control hemorrhoidal symptoms.
Fig.4 How to avoid hemorrhoids in daily life丨Image source: References[14]
If there is no improvement despite lifestyle adjustments, you should seek medical attention promptly and use medication as prescribed. Medications for hemorrhoids can be divided into topical medications, sitz bath medications, oral medications, and some dietary supplements that are beneficial in controlling hemorrhoidal symptoms. Among them, topical drugs include ointments containing hydrocortisone (hormones), local anesthetics (with "caine" in the name or composition), various hemorrhoidal suppositories, and hemorrhoid creams. It should be noted that topical drugs should not be used for a long time, otherwise they will cause damage to the anal tissues. Potassium permanganate (also known as PP powder) is commonly used in sitz baths, which are diluted at 1/1000 [12]. Oral medications include antipyretics and anti-inflammatory drugs and some proprietary Chinese medicines, as well as dietary supplements such as B vitamins, vitamin A, and vitamin C.
However, for hemorrhoids that have an acute attack and have incarcerated hemorrhoids, because of the severe pain that may occur, the doctor will promptly reset the prolapsed hemorrhoids, and if there is incarceration necrosis, emergency surgery will be performed to remove the necrotic tissue.
In addition, for more severe hemorrhoids, surgery is currently used. Surgical methods include simple hemorrhoidectomy, stapler hemorrhoidopexy, and thrombotic external hemorrhoidectomy [12]. In addition, physiotherapy has also become an option for the treatment of hemorrhoids, such as liquid nitrogen freezing, laser, microwave, infrared coagulation, electrons (low frequency, high frequency, radio frequency, capacitive field, ion permeabilization, electrodynamic oscillation), etc. Its principle is to use physical effects such as sound, light, electricity, heat, and magnetism to make local tissue protein coagulation, electrocoagulation hemostasis, electrocautery cutting, tissue degeneration, necrosis, exfoliation and atrophy to achieve the purpose of treating hemorrhoids.
With the advancement of medical technology, the misunderstanding of hemorrhoids has been constantly clarified, and the treatment methods have become more and more abundant, and the results have become better and better. It is foreseeable that there will be more and better treatments in the future to bring benefits to hemorrhoid patients.
Note: The above treatment is only popular science, and the specific treatment should be prescribed by the doctor.
bibliography
[1] https://yd.qq.com/web/bookDetail/7e0320d0811e74a9dg018835
[2] https://weread.qq.com/web/reader/f0e32910813ab6bb6g010418
[3] https://jicheng.tw/tcm/book/%E4%BA%94%E5%8D%81%E4%BA%8C%E7%97%85%E6%96%B9/index.html
[4] https://www.sciencenordic.com/denmark-forskerzonen-mens-health/everything-you-ever-wanted-to-know-about-the-history-of-haemorrhoids/1461058
[5] Sloane MS 1975, f. 91v
[6] https://pubmed.ncbi.nlm.nih.gov/3282839/
[7] https://www.zdic.net/hans/吮疽舐痔
[8] Zhan Xiaonong, Yu Chengdong, Liu Lian. On the understanding of hemorrhoids treatment method by ancient doctors[J].International Medicine and Health Guidance News,2007(13):122-125.)
[9] https://www.jksb.com.cn/newspaper/Html/2016-01-25/37677.html
[10] https://www.health.harvard.edu/diseases-and-conditions/hemorrhoids_and_what_to_do_about_them
[11] https://pubmed.ncbi.nlm.nih.gov/33888516/
[12] Colorectal and Anal Disease Professional Committee of Chinese Association of Integrative Medicine. Guidelines for the diagnosis and treatment of hemorrhoids in China (2020 edition)[J]. Colorectal and Anal Surgery.2020.26(5):519-533.
[13] https://www.medicalnewstoday.com/articles/73938
[14] https://www.cdi.org.in/best-way-to-treat-haemorrhoids/
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