Clinical Research On Herb Enema Prescription For Intestinal Dampness-heat Radiation Proctitis

Objective:To explore the roles of herb enema prescription in treating hematochezia,diarrhea,abdominal pain,tenesmus and other symptoms,its effects on inflammatory indexes and evaluate its safety by observing the short-term clinical efficacy of herb enema prescription for radiation proctitis.Methods:40 cases with radiation proctitis in inpatient and outpatient settings of the colorectal surgery center and oncology department of the Affiliated Nanjing Hospital of Nanjing University of Chinese Medicine from September 2016 to February 2019 were collected.All the patients met the diagnostic criteria for radiation proctitis and were randomly divided into two groups:treatment group(N=20);control group(N=20).For the treatment group,100ml of herb enema prescription in liquid form was heated to 38??40? for retention enema once per night and retained for at least 1 hour.For the control group,100ml of 0.9%NaCl injection,5mg of dexamethasone and 2 bags of montmorillonite powder were mixed for retention enema once per night after the liquid medicine was heated to 38??40?,and the medicine was maintained for at least 1 hour.Both groups received two cycles of treatment,7 days for a cycle.The patients in the two groups rested in bed and were given intensive nourishment and high protein diet rich in vitamins(vitamin C,E,A and B)and trace elements.Water,electrolyte and acid-base equilibrium was maintained to correct anemia.The changes in symptoms and levels of inflammatory factors and adverse reactions of the two groups were observed.Results:(1)Overall response rate(ORR):The ORR of the treatment group was 95%,while that of the control group was 65%,showing a statistically significant difference(P<0.05).The curative efficacy of the treatment group was better than that of the control group.(2)TCM symptom score:The score of each TCM symptom of the treatment group after treatment was decreased than that before treatment,showing a statistically significant difference(P<0.05).The scores of abdominal pain,mucobloody stool,tenesmus,defection frequency and stool property of the control group after treatment were decreased than those before treatment,showing statistically significant differences(P<0.05),but showing no statistically significant differences in the scores of bitter taste or sticky mouth,ozostomia and thirst without the desire to drink water(P>0.05).The two groups showed no statistically significant differences in the score of each symptom(P>0.05)before treatment.Abdominal pain,mucobloody stool,tenesmus,bitter taste or sticky mouth,ozostomia and thirst without the desire to drink water of the treatment group after treatment were improved than the control group.(3)The Karnofsky performance status(KPS)scores of the two groups after treatment were elevated,showing no statistically significant difference(P>0.05).(4)Inflammatory factors:The levels of serum IL-1,IL-6 and CRP of the two groups after treatment were decreased compared with those before treatment,showing statistically significant differences(P<0.05);the levels of serum IL-1,IL-6 and CRP of the treatment group after treatment were lower than those of the control group;the two groups had no statistically significant differences in the levels of serum IL-1,IL-6 and CRP before treatment(P>0.05).(5)No obvious adverse reactions were observed in the both group during treatment.Conclusion:Herb enema prescription is effective in treating intestinal dampness-heat radiation proctitis.It can significantly relieve tenesmus,mucobloody stool and other symptoms in a safe way.This prescription can lower the levels of IL-1,IL-6 and CRP,which might be one of the inflammatory mechanisms of radiation proctitis.