A Study On The Theory And Clinical Study Of The Combination Of Acupuncture And Medicine In The Treatment Of Slow Transport Type Constipation

Research background:The symptom of constipation has been known by the majority of patients, but only a small part of it are willing to come to the hospital looking for medical treatment, which is not only because the understanding of the disease and shallow awareness of high-risk cardiovascular disease induced by it, but also lack of public education about the disease by our country. It deserves our more attention.Only in terms of academia of Traditional Chinese Medicine(TCM), it is a majority part of experts who are focused on Chinese medicine or acupuncture. More and more attention are drawn on the functional constipation disease by the experts, who are engaged in the spleen and stomach disease of TCM.The research of pathogenesis of slow transit constipation is mainly concentrated in the message delivery of intestinal smooth muscle regulation, the change of titanium hormone in gastrointestinal, the obstacle in gastrointestinal motility, and the abnormalities in Cajal interstitial cells in modern medicine. In recent years, the impact of psychological factors for constipation has also been a high degree of concern, however, the cognition of any kind or even several causes of hybridity on the pathogenesis about slow transit constipation in modern medicine, can not explain the disease underlying pathogenesis, which makes drug development difficult. It is due to a single target for its treatment, so a wide range of drug treatment of constipation is used. In the clinical application of western medicine, most patients had better effect in early treatment, but with the extension of treatment time, the clinical results were more and more unsatisfied, the occurrence probability of drug side effects will also be greatly increased. This not only reduced the patience and confidence of patients’ in the treatment, but also made the patients more painful because of the side effects.What’s more, discontinuation dependence of long-term application is another problem.With thousands of years’ heritage and innovation, a wealth of experience of the understanding and treatment for constipation was accumulated. It showed a significant advantage of TCM, including acupuncture, in terms of the prevention and treatment ofconstipation.According to the basic theory of TCM, " Sweat Pore " theory was highly valued by my tutor Professor Suning Chen. Professor Suning Chen is proficient in both Chinese and Western medicine, she expands " Sweat Pore " theory, that "all the internal organs have sweat pore ", which innovatively apply " Sweat Pore " theory in digestive disease combined with her decades of clinical practice experience. Especially in the application of Chinese medicine treatment in functional gastrointestinal disorders, it is the first time who put forward the argument of " soothing the liver, tonifying the spleen, opening the striae ", which is three methods of treatment for chronic constipation. With a large number of clinically proven,Professor Chen thinks that the sick position of the slow transit constipation is in the large intestine, but they are closely related to the liver and spleen. The long duration of the course involving the lung and kidney is the foundation lead to chronic constipation. Thus, Professor Chen proposed the treatment of using acupuncture combined with traditional Chinese medicine to soothe the liver, supply the internal organs and open sweat pore to fight against the deficiency of their internal organs. It had little clinical side effects, but a genuine effect to treat the chronic constipation by applying the combination of acupuncture and the Chinese prescription of relieving distension to eliminate abdominal mass.This topic is under the guidance of “Sweat Pore” theory, to evaluate the clinical efficacy of the treatment on slow transit constipation, in-depth discussion of the theory based on treatment of constipation would be studied. The paper is mainly divided into theoretical research and clinical observation two parts:Theoretical Study:1. The foundation explore of spleen and stomach Sweat Pore theory: TCM had more profound understanding of sweat pore from "Inner Canon of Huangdi" to the sweat pore theory of Wansu Liu, which is distributed throughout the body and also is the most micro structure. It is the blood and body fluids, internal organs’ air and the access channel of vital activity. Internal organs such as spleen and stomach also have sweat pore, and the air of internal organs can pass through them.2. The experience summary of the treatment on slow transit constipation by Professor SuningChen applying the extension of " Sweat Pore " theory.It is believed by Professor Chen that “all the internal organs have sweat pore”, and the method to open it derived therefrom is a treatment to keep the Qi movements orderly. Because it can promote an unimpeded flow both inside and outside, it makes more sense compared with Sweat method. Moreover, it can also be applied on the skin, striae, internal organs and the treatment on the diseases of the digestive system. And the experience of the treatment with the combination of acupuncture and medicine would be introduced.Clinical Study:Purpose: The evaluation of clinical efficacy on slow transit constipation of the treatment with the combination of acupuncture and medicine was studied. It is with the guidance of the expanding spleen and stomach Sweat Pore theory, and based on the clinical experience. By observing the key indicators such as anorectal pressure and colonic slow transit test in patients with slow transit constipation, applying the assessment tools including the Patient Assessment of Constipation Quality of Life(PAC-QOL), Self-Rating Anxiety Scale(SAS) and Self-rating Depression Scale(SDS)to evaluate the clinical efficacy of “open sweat pore”method of slow transit constipation, and also provide the clinical data, objective factual basis and a new train of thought for it. It is of great significance to expand the innovation of Chinese medicine theory and to benefit the patients by backtracking the theoretical basis of“open sweat pore”.Material and Method:According to a randomized, controlled research design principles, depending on the disease diagnostic criteria and test the inclusion criteria, in the Third Affiliated Hospital of Liaoning University of Traditional Chinese Medicine(Anorectal Hospital of Liaoning Province). The patients who meet the inclusion criteria and exclusion criteria 90 patients(42 males, 48 females) were randomly assigned into three groups, 30 in each group. Treatment group of acupuncture combined with medicine(group A); control group of acupuncture combined with medicine(group B); group of just western medicine(group C). Group A used traditional Chinese prescription of relieving distension to eliminate abdominal mass combined with corresponding acupuncture treatment. Group B adopted the treatment of generally acupuncture combined with Maren soft capsule. Group C usedMosapride Citrate Capsule. The treatment sustained for 28 days. Assessment tools were used in slow transit constipation patients before and after therapy to evaluate the therapy efficacy.Results:1. Comparison of baseline information: Ninety research subjects were divided to group A,group B and group C, 30 cases each. There was no significant difference among all three groups in sex ratio, age, course of the disease, test results of colon transmission and rating score.(P<0.05=2. There were significant differences among three groups in overall effect according to statistical analysis(P<0.05=. The total effective rate of group A(Combined acupuncture and medicine treatment group) is 96.66%. The total effective rate of group B(Combined acupuncture and medicine control group) is 90%. The total effective rate of group C(Western medicine group) is 77%. Group A was superior to both control groups.3. The main symptoms points of the three groups were compared after the treatment, showing that there was no significant difference between group A and group B(P>0.05), but there was a significant difference between group A and group C(P<0.01=. Experiment shows that group A(Combined acupuncture and medicine treatment group) is highly advanced in improving constipation symptoms points compared to group C.(Western medicine group).4. The main symptoms points of the three groups were compared before and after the treatment, showing that group A(Combined acupuncture and medicine treatment group) is statistically different from group B(Combined acupuncture and medicine control group)and group C.(Western medicine group)(P<0.05)5. Slow colonic transits of three groups were compared before and after the treatment according to statistical analysis. There were significant differences between before and after treatment in all three groups(P<0.05). The difference of group A is more apparent than group B and group C(P<0.01). Group A has advantage on indicators.6. Patients` anxiety and depression of three groups were statistic analyzed. There were statistical significance between before and after the treatment in group A and group B(P<0.05).But there was no statistical difference before and after treatment in group C(P>0.05).The score of SAS and SDS after treatment in group A reduced more remarkable than group B, showing that the curative effect of group A is better than group B.7. Life quality of three groups was intra-group compared before and after the treatment. There were significant differences between before and after treatment in all three groups according to statistical analysis(P<0.05). Decreased integrals of group A> Decreased integrals of group B>Decreased integrals of group C. Constipation patients` life quality can be improved by treatment group, which shows remarkable advantages over TCM control group and western medicine group.8.Anorectal manometry of three groups were compared before and after the treatment accordi ng to statistical analysis. There was not significant difference among before and after treatmen t in all three groups(P>0.05).Conclusion:Prosser Suning Chen applied “ Sweat Pore ” theory to TCM therapy on slow-transit constipation according to the development of TCM. This would be significant in inheriting the TCM and practicing innovation of the basic theory of TCM. At the same time, the efficacy of the combination of acupuncture and the Chinese prescription of relieving distension to eliminate abdominal mass is a satisfactory according to the theory of “Sweat Pore”. It can significantly improve stool property, promote defecation, promote bowel movements,improve patient`s quality of life and their anxiety and depression. This method is beneficial for clinical application in the future with stable curative effect and satisfactory result. It is also in favor of the standardization applications of TCM syndrome differentiation and clinical promotion.