《金匮要略》通便法探析

通便法即指运用通大便的方法使燥屎、瘀血、宿食、痰饮及虫积等有形之邪从大便而出的一种方法。本文结合《金匮要略》原文对仲景对该法的运用加以探讨。     

A Case of a Patient with a Rectal Ulcer Who Had an Unusual Defecation Habit

Abstract: This case report describes a patient with a rectal ulcer who had an unusual defecation habit. Complete healing was recognized colonoscopically after the patient was instructed to break this habit. A polyp of the ascending colon was detected by a barium enema in a 37-year-old man complaining of anal bleeding. He was admitted to our division to undergo a polypectomy. At the time of the polypectomy, a round ulcer, measuring 1 cm in diameter, was detected on the right wall of the rectum 3 cm from the anal verge. A diagnosis of mucosal prolapse syndrome of the rectum could not be made because the patient did not exhibit the characteristic habit of excessive “straining” mentioned by patients with this syndrome, and no characteristic finding of fibromuscular obliteration was found on histological examination of biopsied specimens taken endoscopically from the lesion. Repeated history taking, however, revealed that the patient had the unusual habit of inserting his finger into his rectum after defecation. He broke this habit following instruction to do so. As a result, on colonoscopic examination 15 month later, the ulcer was found to have become a scar:     

无毒棉籽液抗腹泻作用研究

通过对正常小鼠、生大黄致泻小鼠及脾虚小鼠的作用研究表明，无毒棉籽液有较好的抑制排便频度、治疗腹泻的作用．无毒棉籽液６ｇ／ｋｇ可极其显著地抑制正常小鼠的排便频度，无毒棉籽液６ｇ／ｋｇ和３ｇ／ｋｇ可极其显著地抑制生大黄致泻小鼠及脾虚小鼠的排便频度．６ｇ／ｋｇ无毒棉籽液且可极其显著地抑制正常小鼠及脾虚小鼠的小肠推进运动．     

Behavior in chimeric mice combining differently behaving strains

A/J and C57BL/6J mice behave differently in tests for alcohol preference, open-field activity, defecation in the open field, cricket attacking, and rope climbing. Chimeric mice, i.e., mice containing both A/J cells and C57BL/6J cells, were constructed and tested for these behaviors. Patterns of behavior among A/JC57BL/6J chimeras are such as to suggest that none of these behavior differences is controlled by a single cell or clone and that the same cell population that gives rise to the strain difference in alcohol preference also gives rise to the differences in open-field activity and defecation, while separate cell populations control cricket killing and rope climbing.This research was supported by Research Grants AA 00388 and HD 03015 to M. N. N. and MH 18996 to K. B. Computing assistance was obtained from the Health Sciences Computing Facility, UCLA, supported by NIH Special Research Resources Grant RR-3.     

通便玉蓉丸对便秘小鼠胃排空和小肠推进的影响

目的探讨通便玉蓉丸对便秘小鼠排便功能的影响,以阐明其治疗便秘的机理。方法将60只清洁级ICR小鼠随机分为空白组、模型组、麻仁润肠丸组、通便玉蓉丸大、中、小剂量组。经过造模、治疗,检测胃排空率和小肠碳末推进率。结果通便玉蓉丸促进胃排空作用明显,碳末推进百分率高,碳末移动距离延长,与模型组比较,有显著差异(P<0.05)。结论通便玉蓉丸通过提高胃排空率和小肠碳末推进率,能够增加排便治疗便秘。     

Consumption of Dietary Fiber with Different Physicochemical Properties during Late Pregnancy Alters the Gut Microbiota and Relieves Constipation in Sow Model

Constipation is a common problem in sows and women during late pregnancy. Dietary fiber has potential in the regulation of intestinal microbiota, thereby promoting intestinal motility and reducing constipation. However, the effects of fibers with different physicochemical properties on intestinal microbe and constipation during late pregnancy have not been fully explored. In this study, a total of 80 sows were randomly allocated to control and one of three dietary fiber treatments from day 85 of gestation to delivery: LIG (lignocellulose), PRS (resistant starch), and KON (konjaku flour). Results showed that the defecation frequency and fecal consistency scores were highest in PRS. PRS and KON significantly increased the level of gut motility regulatory factors, 5-hydroxytryptamine (5-HT), motilin (MTL), and acetylcholinesterase (AChE) in serum. Moreover, PRS and KON promoted the IL-10 level and reduced the TNF-α level in serum. Furthermore, maternal PRS and KON supplementation significantly reduced the number of stillborn piglets. Microbial sequencing analysis showed that PRS and KON increased short-chain fatty acids (SCFAs)-producing genera Bacteroides and Parabacteroides and decreased the abundance of endotoxin-producing bacteria Desulfovibrio and Oscillibacter in feces. Moreover, the relative abundance of Turicibacter and the fecal butyrate concentration in PRS were the highest. Correlation analysis further revealed that the defecation frequency and serum 5-HT were positively correlated with Turicibacter and butyrate. In conclusion, PRS is the best fiber source for promoting gut motility, which was associated with increased levels of 5-HT under specific bacteria Turicibacter and butyrate stimulation, thereby relieving constipation. Our findings provide a reference for dietary fiber selection to improve intestinal motility in late pregnant mothers.     

生物反馈治疗不同亚型功能性排便障碍的临床疗效及影响因素分析

目的 分析生物反馈治疗不同亚型功能性排便障碍的临床疗效及其影响因素。方法 选取2019年1月至2021年6月在温州市中心医院就诊的功能性排便障碍患者98例,将其分为不协调性排便组（66例）和排便推进力不足组（32例）。两组患者均进行生物反馈治疗,比较两组患者的临床疗效,并分析疗效的影响因素。结果 两组患者的治疗总有效率比较差异无统计学意义（χ2=0.170,P=0.683）。治疗结束时、治疗结束后1个月,两组患者的便秘症状积分、便秘生存质量量表评分均显著低于本组治疗前,肠道满意度评分均显著高于本组治疗前（P<0.05）,但两组间上述指标比较差异均无统计学意义（P>0.05）。治疗结束时,排便推进力不足组患者的直肠排便压显著高于治疗前（P<0.05）,两组患者的肛管残余压均显著低于本组治疗前（P<0.05）。治疗结束时,排便推进力不足组患者的直肠排便压显著低于不协调性排便组,肛管残余压显著高于不协调性排便组（P<0.05）。多因素二元Logistic回归分析结果显示,受教育年限、肠道满意度评分均是生物反馈治疗功能性排便障碍疗效的独立保护因素,而直肠初始便意感阈值是独立危险因素（P<0.05）。结论 生物反馈治疗不同亚型功能性排便障碍均有效,其疗效与患者的受教育年限、肠道满意度及直肠敏感性等因素相关。     

腹部热敷配合按摩促进早产儿胎粪排出的效果观察

目的探讨腹部热敷配合按摩对促进新生儿胎粪排出的效果。方法以80例早产儿为研究对象,随机分成对照组和实验组,每组40例,对照组给予新生儿常规护理,实验组在常规护理基础上实施腹部热敷配合按摩。观察并记录两组新生儿首次胎粪排出的时间、首次排出胎粪的重量及出生24 h内胎粪排出次数。结果实验组患儿首次排便时间明显早于对照组(p<0.05),首次排出胎粪的量多于对照组(p<0.05),出生24 h内胎粪排出的次数多于对照组(p<0.01)。结论对早产儿早期进行腹部热敷配合按摩能促进早产儿胎粪排泄及胃肠道功能的成熟,防止胎粪排泄延迟发生相关的并发症。