Dajianzhong decoction for fecal incontinence-大建中汤治疗大便失禁

Fecal incontinence often occurs after childbirth, abdominal surgery and radiotherapy. Elderly and chronic constipation are also prone to fecal incontinence due to anal sphincter injury and dysfunction. It not only causes inconvenience in life, affects the quality of life, but also causes great psychological trauma.

Dajianzhong Decoction is a classic prescription in “The Synopsis of the Golden Chamber”. It is composed of ginseng, Sichuan pepper, dried ginger, and caramel. It is a classic strong analgesic. It has anti-inflammatory, anti-tumor, and improves intestinal microcirculation. Peristalsis and intestinal anastomosis healing and regulating intestinal flora. It is suitable for cold pain and bloating of the abdominal abdomen. In modern times, it is mostly used for the protection of gastrointestinal function after abdominal surgery. The prevention and treatment of postoperative intestinal obstruction by Dajianzhong Decoction has been a research hotspot in recent years.

The “zhong” of Dajianzhong soup “build” is mainly the small intestine and large intestine. In addition, there are many applications in reflux esophagitis and chronic gastritis. As the last pass of the digestive tract, Dajianzhong Decoction also has “constructive significance” for the anus. Previous studies have found that Dajianzhong Decoction can lower the gastrointestinal sensory threshold, increase the tension of the internal and external anal sphincter, and treat chronic constipation.

A recent study found that Dajianzhong Decoction can be used to treat fecal incontinence. A single-center retrospective observational study in Japan included 157 patients with fecal incontinence. Considering patients with anal sphincter dysfunction, they took Dajianzhongtang granules (7.5 grams per day) for one month, and found that Dajianzhongtang significantly improved fecal incontinence. It significantly reduces the use of diapers and improves the fecal incontinence score; there is no significant improvement in the chronic constipation score, but it significantly reduces the dependence on other auxiliary laxative measures, and Dajianzhong soup can make the stool more shape. , Increase anal tension and defecation strength. No drug-related adverse reactions were observed.

Therefore, it can be considered that the scope of action of Dajianzhong soup covers the entire passage from the esophagus to the anus.

references:

AbeT, Kunimoto M, Hachiro Y, Ohara K, Murakami M. Clinical efficacy of Japaneseherbal medicine daikenchuto in the management of fecal incontinence: A single-center,observational study. J Anus Rectum Colon. 2019 Oct 30;3(4):160 -166. doi: 10.23922/jarc.2019-012. PMID: 31768466; PMCID: PMC6845288.

大便失禁经常发生于产后、腹部手术和放疗后,高龄和慢性便秘者也容易因肛门括约肌损伤和功能障碍发生大便失禁。不但造成生活不便,影响生活质量,对于心理的创伤也很大。

大建中汤是《金匮要略》中的经方,由人参、蜀椒、干姜、饴糖组成,是经典的强壮性镇痛剂,具有抗炎、抗肿瘤、改善肠道微循环、促进肠蠕动及肠道吻合口愈合、调节肠道菌群的作用,适用于脘腹部冷痛、腹胀的疾病,现代多用于腹部手术后胃肠功能的保护。大建中汤对于术后肠梗阻的预防和治疗是近年来的研究热点。

大建中汤“建设”的“中”,主要是小肠、大肠。此外反流性食管炎和慢性胃炎中也有诸多运用。作为消化道的最后一关,其实大建中汤对于肛门也有“建设性意义”。既往研究发现大建中汤可以降低胃肠感觉阈值,增加肛门内外括约肌的张力,治疗慢性便秘。

近日一项研究发现大建中汤可以用于治疗大便失禁。日本一项单中心回顾性观察性研究纳入了157名大便失禁,考虑肛门括约肌功能障碍患者,服用大建中汤颗粒(每日7.5克)一月,发现大建中汤显著改善了成形大便失禁和不成形大便失禁的程度,显著减少纸尿裤使用,显著改善大便失禁评分;对于慢性便秘评分无显著改善,但显著减少了对其他辅助通便措施的依赖,且大建中汤能够让大便更加成形,增加肛门张力和排便力量。未观察到药物相关不良反应。

因此可以认为,大建中汤的作用范围涵盖了从食道到肛门的整条通道。

参考文献:

AbeT, Kunimoto M, Hachiro Y, Ohara K, Murakami M. Clinical efficacy of Japaneseherbal medicine daikenchuto in the management of fecal incontinence: A single-center,observational study. J Anus Rectum Colon. 2019 Oct 30;3(4):160-166. doi: 10.23922/jarc.2019-012. PMID:31768466; PMCID: PMC6845288.

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