Intestinal flora imbalance

　　1 Dietary factorsDietary fiber can maintain the normal ecological balance of intestinal flora, and the final products of bacterial metabolism of fiber have a nutritional effect on the intestinal epithelium. Fiber can maintain the normal metabolism and cell kinetics of intestinal mucosal cells.

　　2 Factors of flora change: The composition of the flora can vary from person to person, but for the same person, the composition of the flora is very stable for a relatively long period of time. The ecological position of each strain is determined by the host's physiological state, the interaction between bacteria, and the influence of the environment.

　　3 Factors of drug metabolism: The intestinal flora plays an important role in the metabolism of many drugs, including lactulose, salicylate azosulfapyridine, levodopa, and others. Any antibiotic can cause changes in the colon flora, which depends on the antibacterial spectrum of the drug and its concentration in the intestinal lumen.

　　4 Age factors: With the increase of age, the balance of intestinal flora can change, the number of Bifidobacteria decreases, and the number of Clostridium perfringens increases. The former may weaken the stimulation to the immune function, and the latter may lead to increased toxins, inhibiting the immune function. If the elderly can maintain the balance of intestinal flora in their youth, it may be able to improve the immune function.

　　5 Factors of gastrointestinal immune dysfunction: The normal gastrointestinal immune function comes from the plasma cells of the mucosal stroma, which can produce a large amount of immunoglobulin, namely secretory IgA, which is the main substance for preventing bacteria from entering the gastrointestinal tract. Once the synthesis of monomer, dimer IgA, or secretion film function of the gastrointestinal mucosa is impaired, it will cause the overgrowth of aerobic and anaerobic bacteria in the small intestine, thus causing flora imbalance and causing chronic diarrhea. Even in asymptomatic IgA deficiency, the intestinal flora in the small intestine can also over-grow. The incidence of flora imbalance in the neonatal period is high, which may also be related to the underdeveloped or imperfect immune system.

　　Intestinal flora imbalance can cause the following diseases:

　　1. Acute and chronic diarrhea: Typical dysbacteriosis diarrhea cases mostly occur after the use of antibiotics, at this time, most of the normal flora's physiological obligate anaerobic bacteria decrease or disappear, and the "passage bacteria" with drug resistance, such as Pseudomonas, Klebsiella, Staphylococcus, Candida albicans, Proteus, and others over-reproduce. In addition, normal intestinal flora can also cause diarrhea due to structural changes under the influence of antibiotics. The detection results of these cases show that aerobic or anaerobic bacteria, such as Enterobacter, Enterococcus, and others, are significantly reduced or disappeared, and anaerobic bifidobacteria and lactobacilli are also significantly reduced. After the diarrhea stops, the intestinal flora also returns to normal. Clinical and animal experiments have proven that intestinal flora imbalance can cause acute diarrhea. One of the reasons for traveler's diarrhea may be intestinal flora imbalance caused by changes in climate and environment. Foreign research has shown that some non-specific pathogens of acute diarrhea, such as Pseudomonas, Klebsiella, Proteus, and others, can also cause chronic diarrhea. However, in fact, the pathogenic bacteria causing chronic diarrhea are the imbalance of resident flora. Only a few "passage bacteria" are the causes of chronic diarrhea. The research of Kang Bai and others also proves this point.

　　2 Tropical steatorrheaAlthough the etiology of this disease is not yet clear, there is sufficient evidence to show that chronic diarrhea, weight loss, and malabsorption of carbohydrates, fats, folic acid, and vitamin B12 in tropical steatorrhea are due to intestinal flora imbalance in the small intestine. The analysis of the feces of patients with tropical steatorrhea shows that there are significantly more aerobic bacteria and facultative anaerobic bacteria than anaerobic bacteria, while in healthy people, the former is 1% of the latter. Further research has shown that Escherichia coli, Enterobacter cloacae, and Pseudomonas aeruginosa capable of producing enterotoxins have been isolated from the ileum of patients with tropical steatorrhea. This indicates that the clinical manifestations of this disease are caused by the colonization of the above bacteria in the proximal small intestine, while under normal circumstances, these bacteria mainly colonize the large intestine.

　　3 Bacterial overgrowth syndromeThe syndrome of bacterial overgrowth is characterized by gastrointestinal anatomical abnormalities and physiological dysfunction. Such changes promote the colonization of colonic flora in the upper small intestine, leading to symptoms such as steatorrhea, vitamin deficiency, and malabsorption of carbohydrates. The analysis of small intestinal bacteria in patients with the syndrome of bacterial overgrowth proves that both aerobic bacteria and anaerobic bacteria exist. This leads to malabsorption and increased free bile acids, causing diarrhea and malnutrition, anemia, and vitamin deficiency.

　　4 EndotoxemiaThe proportion of Gram-negative bacilli in the intestinal flora increases, leading to further increased endotoxin levels. Generally, endotoxins in the colon can be inactivated by bacteria or partially enter the liver through the portal vein and be detoxified by Kupffer cells. If the level of endotoxins is abnormally increased, the detoxification function of the liver is reduced, and systemic endotoxemia may occur.

　　What symptoms are accompanied by intestinal flora imbalance? First of all, it is mainly manifested by severe diarrhea or chronic diarrhea. During the process of applying antibiotics for treatment, if diarrhea occurs suddenly, or the original diarrhea worsens, it is possible to have this disease. Diarrhea is usually pale yellow-green watery stool, sometimes like egg yolk. The clinical common symptom types: symptoms of intestinal flora imbalance

　　1 Candida albicans enteritisIt is the most common type of intestinal flora imbalance. Commonly seen in thin infants, poor digestion, malnutrition, diabetes, malignant tumors, patients with long-term use of antibiotics or hormones. Candida albicans infection usually starts from the upper gastrointestinal tract, spreading to the small intestine and even the perianal area. Thrush is often the earliest sign of Candida albicans enteritis. If the mucosa of the small intestine is eroded or ulcerated, it can cause multiple odorless mucopurulent stools, sometimes watery diarrhea, accompanied by poor digestion. If not treated in time, it may spread to the respiratory tract, urinary tract, and even brain tissue.

　　2 Staphylococcal enteritisCommonly seen in elderly patients or chronic disease patients with long-term use of antibiotics (tetracyclines, ampicillin, etc.), adrenal cortex hormones, and those who have undergone intestinal surgery. Staphylococcal infection can cause yellow-green loose stools, 3 to over 20 times a day, accompanied by abdominal distension, general mild abdominal pain, and severe vomiting and diarrhea may be accompanied by dehydration, electrolyte imbalance, elevated blood urea nitrogen, and decreased blood pressure.

　　3 Clostridium perfringens acute necrotizing enteritis: The β-toxin produced by Clostridium perfringens can cause acute necrotizing enteritis, consumptive diseases, and infections in situations where antibiotics, corticosteroids, and other drugs are used.

　　4 Pseudomonas aeruginosa intestinal infection: Pseudomonas aeruginosa is a pathogenic bacterium that often causes secondary infection, and it is most susceptible to infection in infants, the elderly, certain malignant tumors, consumptive diseases, and in situations where antibiotics, corticosteroids, and other drugs are used. Pseudomonas aeruginosa infection can produce blue-green fluorescent substances that make the stool green, but it does not always cause diarrhea. In some cases, the stool may contain powder, and the abdominal pain is usually mild, with a few cases accompanied by nausea and vomiting. There is often a disturbance of water and electrolytes, and in severe cases, shock may occur. Some travelers may experience intestinal flora imbalance, commonly known as 'not adapting to the local climate', due to changes in climate and environment.

　　5 Proteus intestinal infection: Under certain conditions, Proteus mirabilis can be a pathogenic bacterium, such as ordinary Proteus,奇异 Proteus, Morgan's Proteus, which can cause food poisoning, and Proteus variabilis can cause summer diarrhea in infants and young children.

　　6 Escherichia coli intestinal infection: When the body's resistance decreases or for other reasons, the normal parasitic Escherichia coli in the intestines can cause infection, especially severe diarrhea in children.

　　Preventing intestinal flora imbalance requires reasonable use of antibiotics. For the elderly, the weak, and those with chronic consumptive diseases, antibiotics or hormones should be used strictly based on indications, and it is best to conduct drug sensitivity tests to select the most sensitive antibiotic. For the elderly, the weak, and those who are weak after illness, while using antibiotics, it is recommended to use lactic acid bacteria or bifidobacteria live bacteria preparations and vitamin B complex or vitamin C, etc., to prevent intestinal flora imbalance. Before major surgery, attention should be paid to comprehensive support therapy, such as improving nutrition, blood transfusion, intramuscular injection of gamma globulin, and taking vitamins, etc. Pay attention to food procurement. Fresh food should be selected, and病死 animals, unrefreshed aquatic products should not be purchased. Even for salted food, one should not be careless; when cooking, cooking utensils should be disinfected, and utensils for raw and cooked food should be separated. The cook should also pay attention to personal hygiene, such as frequently trimming nails and changing clothes.

　　At the same time, tableware should be strictly disinfected; cold dishes should be eaten sparingly, and they should be washed and rinsed with cold water before eating. Melons and fruits should be washed and peeled before eating; it is not advisable to hold family banquets in summer, and food should be cooked and eaten immediately. If there is any leftover, it should be boiled thoroughly the next day before eating. However, even after boiling, some bacterial toxins cannot be destroyed, such as Staphylococcus aureus enterotoxin, which retains its pathogenicity for 30 minutes after boiling; keep the indoor environment clean. Flies, cockroaches, and other insects can transmit intestinal infectious diseases. Therefore, eliminating flies and cockroaches is also one of the important measures for preventing intestinal infectious diseases in summer; adequate sleep and a rich diet help to enhance physical strength and also help prevent intestinal infectious diseases in summer. In addition, it is also important to exercise actively and drink plenty of water in summer, as a good physical condition can enhance the body's immunity.

　　The laboratory examination of intestinal flora imbalance is as follows

　　1. Medical technology examination Flora analysis: It is the main examination method, with qualitative analysis and quantitative analysis. Qualitative analysis: It is the same as general microbiological examination, such as the Gram staining of Staphylococcus aureus in the fecal smear can find clusters of positive Staphylococcus and neutrophils. Fecal culture can show a large amount of Staphylococcus aureus growth. Candida albicans enteritis can take its pathological material for direct smear, treated with potassium hydroxide solution and Gram stained, and the microscope can see clusters of oval white Candida albicans. Gram-positive, unevenly stained in the cell, and bacterial culture can form creamy smooth bacterial-like colonies with a yeast smell. However, except for the three-degree imbalance (i.e., flora alternation), it is difficult to analyze other proportions. Therefore, in addition to qualitative examination, further quantitative examination is needed to judge whether the values are normal. Quantitative examination of intestinal flora imbalance: First, the feces need to be homogenized, and then diluted in a certain proportion. After culture, the colony count of various cell bacteria needs to be calculated to obtain the total bacterial value, which is麻烦, and is rarely used in general laboratories. The culture medium used for normal flora analysis requires high selectivity, such as S medium for intestinal pathogenic bacteria, Eosin Methylene Blue medium for aerobic Gram-negative bacilli in the intestines, 7.5% sodium chloride agar for Staphylococcus, and few Bacto agar for fungi, etc. The culture method includes aerobic culture, and it is necessary to perform anaerobic culture when necessary. Aerobic culture is the same as general bacterial culture, while anaerobic culture uses biological anaerobic method or anaerobic jar method.

　　2. Colonoscopy: The intestinal mucosa shows diffuse congestion, edema, and blurred or disappeared vascular branches. There are scattered erosions, ulcers, and bleeding, and sometimes yellow pseudomembranes can be seen.

　　Dysbiosis of intestinal flora is a chronic disease, not formed in a day, nor can it be cured in a day. In addition to配合treatment, attention should also be paid to daily health care: balanced diet; supplementation of prebiotics; persistent physical exercise; maintaining a good mood. For patients with chronic consumptive diseases, when using antibiotics or hormones, strict control of indications is required, and it is best to conduct a drug sensitivity test to select the most sensitive antibiotic. For the elderly, the weak and the weak after illness, while using antibiotics, it is recommended to use Lijian and vitamin B group or vitamin C, etc. The diet should be light; appropriate to increase lean meat, fish, eggs, mushrooms, etc. in the diet, as long as it is not too much and not too greasy, increase the meat gradually, and there is no need to worry about indigestion and other problems; food should be easy to digest, soft, less residue, and non-irritating. It should be noted that vegetables with high fiber content such as chive, celery, bamboo shoots, etc. should be eaten less, and leafy vegetables should also be controlled appropriately. If necessary, the method of chewing and drinking the juice while spitting out the residue can be adopted. It is forbidden to eat gas-producing foods such as soybeans, soy products, fried broad beans, sweet potatoes, etc.; it is forbidden to eat cold fruits and vegetables. It is forbidden to eat milk and seafood. After consuming milk, condensed milk, shrimp, sea fish, etc., diarrhea patients are prone to colonic allergy, leading to worsened diarrhea. In addition, honey and its products have the effect of moistening intestines and defecation, so they cannot be eaten either.

Traditional Chinese medicine treatment: According to traditional Chinese medicine, 'The root of diarrhea is always related to the spleen and stomach'. Acute diarrhea disease is often of excess nature, responsible for the spleen and stomach; chronic diarrhea disease is often of deficiency, often involving the spleen and kidney. The former should clear heat and transform dampness, while the latter should tonify the spleen and kidney. Herbal清热解毒 drugs have an impact on humoral immunity, such as蒲公英, Baihua Shejiecao, which can promote antibody production, Yuxingcao can increase the concentration of bivalency, and the bivalency, C3, Mg++ composed of the bivalency system has a certain killing effect on Gram-negative bacilli such as Shigella, Salmonella, Pseudomonas aeruginosa, etc., which is an important non-specific immune defense function before the body produces antibodies. When applying traditional Chinese medicine differential diagnosis and treatment to treat intestinal flora disorders, the above drug effects should be considered, and proper compatibility should be used in the methods of clearing heat and dampness, tonifying qi and strengthening the spleen, harmonizing the stomach and permeating dampness, warming the kidney and strengthening the spleen, etc., then the effect is relatively ideal.

(1) Differential diagnosis and treatment:

1. Suffering from cold and dampness

Symptoms: Onset is acute, abdominal pain, intestinal rumbling, loose stools even like water, no thirst, or accompanied by aversion to cold, fever, headache, nasal congestion, achiness in the limbs, white fur, soft and slow pulse.

Treatment method: Resolve the exterior and disperse cold, aromaticize turbidity.

Herbal medicine: Modified Huoxiang Zhengqi Powder from 'Heji Jufang'. Huoxiang 10g, ZisSu 10g, Baizhi 10g, Chuanpu 6g, Dafupi 10g, Banxia 6g, Chenpi 10g, Fuling 10g, Baizhu 10g, Gancao 6g. For those with severe exterior syndrome, Jingjie and Fangfeng can be added; for those with chest oppression, poor appetite, white greasy fur, it is advisable to add Cangzhu and Zexie.

2. Downward pressure of damp-heat

Symptoms: Abdominal pain followed by diarrhea, urgent defecation, yellowish and smelly feces, burning sensation in the anal region, restlessness, dry mouth, short and red urine, or accompanied by fever, aversion to cold, headache, nasal congestion, achiness in the limbs, white fur, slippery and rapid pulse.

Treatment method: Clear heat and promote diuresis.

Herbal medicine: Modified Ge Gen Qin Lian Decoction from 'Shang Han Lun'. Ge Gen 15g, Huanglian 9g, Huangqin 9g, Gancao 6g. Silver flower, Mutong, and Cheqianzi can be added to assist in clearing heat and dampness, making the body and exterior be resolved, dampness and heat separated, and diarrhea stopped. For those with severe dampness, Huoxiang, Peilan, and Houpu can be added; for those with excessive heat, you can add Lianqiao, Zhizi, and Masidai.

3. Spleen and stomach weakness

Symptoms: Loose stools, recurrent episodes, varying in severity, epigastric oppression, poor appetite, desire to defecate after eating, sallow complexion, fatigue, pale tongue, thin white fur, slow and weak pulse.

Treatment principle: Tonify qi and strengthen the spleen.

Herbal medicine: Modified Shenling Baizhu Powder from 'Heji Jufang'. Dangshen 12g, Baizhu 12g, Fuling 12g, Shanyao 12g, Biandou 15g, Lianren 10g, Chenpi 10g, Shaoren 6g, Yiren 10g, Jiegeng 6g, Gancao 6g. For those with spleen deficiency and poor digestion, stagnation of food and qi, Xiangsha Liujun Decoction can be added with Shengqu, Shanzha, and Houpu; for those with chronic diarrhea, qi deficiency, and downward prolapse, Bu Zhong Yi Qi Decoction can be used to tonify qi, lift, and stop diarrhea.

4. Spleen and stomach deficiency-cold

Symptoms: Slight abdominal pain, preference for warmth and pressure, loose stools, or even undigested grains, cold hands and feet, dry mouth without thirst, thin tongue, white tongue coating, thin and slow pulse.

Treatment principle: Warming the middle energizer and invigorating the spleen.

Herbal medicine: Li Zhong Tang from Shang Han Lun with modifications. 12 grams of Dang Shen, 12 grams of Bai Zhu, 10 grams of Gan Jiang, 6 grams of Gan Cao. Adding Mu Xiang, Sha Ren, and Bai Dou Kou can warm the middle energizer and invigorate the spleen, regulate the qi and harmonize the stomach. If the middle energizer is severely deficient, leading to diarrhea that cannot be self-contained, treatment should be to warm the yang and astringe, using Li Zhong Tang with added Fu Zi, and selecting Tian He Zi, Ying Su Ke, Chi Shi Shi; if there is a mixed syndrome of cold and heat due to chronic diarrhea with intermingled heat pathogen, or due to dampness and food stagnation transforming into heat, then use Lian Li Tang with modifications.

5. Spleen and kidney yang deficiency

Symptoms: Before dawn, there is hidden pain in the umbilical area, diarrhea occurs after intestinal sounds, slightly relieved after defecation, abdominal aversion to cold, feeling of coldness in the limbs, soreness in the waist and knees, white tongue coating, deep and thin pulse.

Treatment method: Warming and tonifying the spleen and kidney.

Herbal medicine: Four Shen Wan from Zheng Zhi Zhun Ren combined with Fu Zi Li Zhong Wan from Yan Shi Xiao Er Fang Yao, with modifications. 10 grams of Fu Zi, 12 grams of Bu Gu Zhi, 12 grams of Wu Ying, 12 grams of Rou Kou, 15 grams of Wu Wei Zi, 10 grams of Dang Shen, 12 grams of Bai Zhu, 10 grams of Gan Jiang, 6 grams of Gan Cao. Add Guang Mu Xiang for abdominal distension; for the elderly with prolonged diarrhea due to physical decline, Four Shen Wan and Yang Zang Tang can be used with modifications.

(Two) Other therapies

1. Single prescription: 100 grams of garlic, pounded and added with 100 milliliters of physiological saline, retained enema, 3-4 times a day. 10 grams of Er Hua, 10 grams of Zhizi, 15 grams of Di Yu, 10 grams of Bing Tong, 10 grams of Fang Feng, 10 grams of Huang Lian, 10 grams of Bai Shao, 10 grams of Gan Cao, decocted in appropriate amount, 80-100 milliliters after warming, retained enema, 2-3 times a day.

2. Acupuncture: Acupuncture therapy for diarrhea requires rigorous attention to acupoint selection, needle manipulation techniques, and needle retention time. For people with spleen and stomach deficiency-cold: take Tian Chi, Da Chang Shu, Zhong Wan, Qi Hai (all using moxibustion). For those with damp-heat downward pressing: take Xia Wan, He Gu, Nei Ting (all using purgation method). For those with spleen deficiency and dampness excess: take Pi Shu, Shui Fen (all using moxibustion), Yin Ling Quan, Gong Sun (all using purgation). For those with spleen and kidney yang deficiency: take Ming Men, Guan Yuan, Bai Hui (all using moxibustion), Shen Shu, Pi Qian (all using tonification method). Western medical treatment for intestinal flora imbalance

Medication therapy:

1. Diet adjustment: For fermentative diarrhea, carbohydrates should be restricted; for putrefactive diarrhea, protein intake should be restricted. To enhance the local defense barrier function of the intestinal mucosa and prevent bacterial translocation, fiber-rich foods should be increased.

2. Antibacterial drugs: Immediately stop the original antibiotic and select appropriate antibiotics and bacteria that inhibit excessive proliferation based on flora analysis and sensitivity testing of antibacterial drugs, thereby indirectly supporting the proliferation of bacteria that are insufficient in the intestines. In addition, broad-spectrum antibacterial drugs can be used to destroy most of the intestinal bacteria, and then normal intestinal flora bacteria solution can be infused to restore it.

3. Live bacterial preparations: Currently commonly used live bacterial preparations include Lactobacillus acidophilus, Lactobacillus bulgaricus, Lactobacillus lactis, Bacillus cereus, Bifidobacterium bifidum, Streptococcus faecalis, Escherichia coli, Enterococcus faecium, and Bacillus subtilis, among which the bifidobacteria preparation has the best curative effect. The preparation of Bacillus subtilis also has a good curative effect, and its mechanism of action may be due to the fact that the bacterium is aerobic, can absorb oxygen, reduce the oxidation-reduction potential of the intestinal lumen, support the growth of anaerobic bacteria (bacteroides, lactobacilli), and thus indirectly support the normal flora. It can also be used to make a compound live bacterial preparation from the fecal suspension of normal people to treat pseudomembranous enteritis caused by Staphylococcus, and achieve good results. The clinical application of Lactobacillus casei made from lactic acid streptococcus is also good. Preparing preparations from the resistant strains with insufficient reproduction in the normal intestinal flora is also an effective method for adjusting intestinal flora imbalance. The latest biologic preparation Lizhu Intestine Happiness (Hui Chun Sheng Capsule) is a bifidobacteria live bacterial preparation (bifidobiogne), according to the research of medicine one, the preparation has barrier action, control of endotoxemia, nutritional action, anti-tumor action, immune enhancement action, anti-aging action, etc.

4. Bacterial flora enhancers: Oral bacterial flora enhancers can also achieve the purpose of supporting normal flora. For example, use lactulose to support Enterobacter, use folic acid to support enterococcus, and use bifidobacteria factors commonly used in children to promote the growth of Bifidobacterium bifidum. The application of galactoside-fructose acid, after decomposition by bacteria, forms lactic acid or acetic acid, reduces the pH value, inhibits other bacteria, and supports the growth of lactobacilli.

5. Resistant enterococcus preparation: Professor Murohashi of Japan and others obtained a strain of enterococcus, BIO-4R, resistant to streptomycin, erythromycin, tetracycline, and ampicillin, by thickening the passage culture method. Animal and human trials have shown that this bacterium has resistance to a variety of antibiotics, so it can prevent the abnormal proliferation of other bacterial populations, overcome dysbacteriosis, improve fecal abnormalities, and has a quicker curative effect than the previous single use of antibiotics, and can prevent the transfer of the resistant factor of Streptococcus faecalis BIO-4R strain to Escherichia coli K-12 strain.