Yin-jie

　　Yin-jie is caused by Qi deficiency and Yang deficiency leading to the lack of power in the movement of the large intestine; or Yin deficiency and blood deficiency causing the intestines to lose their nourishment; or Yin cold prevailing inside, coagulating the intestines, failing to convey, thus causing constipation.

　　Modern medicine believes that this disease is equivalent to habitual constipation in Western medicine. The causes of constipation include intestinal lesions and systemic diseases, and some patients' constipation is idiopathic constipation. Intestinal lesions include inflammatory bowel disease, tumor, hernia, rectal prolapse, etc. Systemic diseases include diabetes, uremia, cerebrovascular accidents, Parkinson's disease, etc. Regular use of certain drugs is easy to cause constipation, such as opiate analgesics, anticholinergic drugs, antidepressants, calcium channel blockers, diuretics, etc. In addition, the reduction of physical activity in the elderly and the lack of dietary fiber in the diet are also factors that promote constipation.

　　Normal defecation includes two processes: the feeling of defecation and the defecation action. After eating, through the gastrocolic reflex, colonic motility is enhanced, and feces are pushed towards the distal colon. When the rectum is filled, the internal anal sphincter relaxes, while the external anal sphincter contracts, increasing the intrarectal pressure. When the pressure stimulation exceeds the threshold, it triggers the feeling of defecation. This impulse of defecation sensation is transmitted along the pelvic nerve and hypogastric nerve to the defecation center in the lumbar sacral spinal cord, and then上行 to the thalamus and reaches the cerebral cortex. If the environment allows, the puborectalis muscle and the internal and external anal sphincters are all relaxed, the levator ani muscles on both sides contract, the abdominal muscles and diaphragm also coordinate contraction, and the abdominal pressure increases, promoting the excretion of feces.

　　The occurrence of constipation is due to abnormality in the nervous system or pathological changes in the intestinal smooth muscle. Elderly colonic movement is slow, the sensitivity and responsiveness of the receptors around the anus are reduced, cerebral vascular sclerosis is prone to produce cerebral cortex inhibition, gastrocolic reflex is weakened, and other factors such as drugs, etc., so constipation is prone to occur.

　　Patients with anal fissure often have symptoms such as pale complexion, lack of energy, dizziness and palpitations, pale lips, pale tongue, thin white coating, deep and fine pulse. Excessive forceful defecation can trigger syncope during defecation, and even myocardial infarction and cerebral infarction may occur on the basis of atherosclerosis. Constipation can cause or worsen hemorrhoids and other perianal diseases. After fecal impaction, intestinal obstruction, fecal ulceration, urinary retention, and fecal incontinence may occur. There are also reports of spontaneous perforation of the colon and sigmoid colon volvulus.

　　The clinical manifestations of anal fissure are that patients are often weak in physique, have not defecated for many days, although they have the urge to defecate, it is difficult to expel, there is generally no feeling of distension in the abdomen, the limbs are not warm, the urine is clear, the tongue is pale, the coating is thin and white, and the pulse is deep and slow. This condition is similar to habitual constipation in Western medicine, often manifested as a lack of defecation urge, few defecation times, difficult defecation, strenuous defecation, defecation not smooth, and a sense of incomplete defecation. At the same time, it is accompanied by abdominal pain or discomfort, and some patients also have insomnia, irritability, frequent dreams, depression, anxiety, and other mental and psychological disorders.

　　Deficient Qi constipation, damp constipation, and other conditions are classified as anal fissure. Patients with anal fissure have Yin cold fixed in the colon and stomach, blood and Qi congestion leading to constipation. The external symptoms include no thirst or appetite, cold limbs, cool body, hard and closed stools, deep and slow pulse. It is advisable to use the Four Herbs Combined with Aconite Decoction. If there is no defecation for a long time and the pulse is weak and涩, it indicates cold and deficiency constipation, which is anal fissure. Modern medicine believes that this condition is equivalent to habitual constipation in Western medicine. It is necessary to avoid eating too little or too refined food, lack of residue, and reduce the stimulation of colonic movement. The滥用 of laxatives can weaken the sensitivity of the intestines, form dependence on certain laxatives, and cause constipation. Develop good defecation habits, defecate at a fixed time every day, form a conditioned reflex, and establish a good defecation routine. Do not ignore the urge to defecate and defecate in time. Make the environment and posture for defecation as convenient as possible to avoid suppressing the urge to defecate and destroying defecation habits.

　　The main clinical examination methods for anal fissure include fecal examination, rectal examination, and gastrointestinal X-ray examination, as follows:

　　1. Fecal examination

　　Observe the shape, size, firmness, and presence of pus, blood, and mucus in the feces. During rectal constipation, due to the relaxation of the rectal smooth muscle, the excreted feces often present in a blocky form; while in spastic colonic constipation, the feces present in a sheep feces-like form. Routine fecal examination and occult blood test are part of the routine examination.

　　2. Rectal examination

　　It is helpful to detect rectal cancer, hemorrhoids, anal fissure, inflammation, stricture, hard fecal mass obstruction, external pressure, anal sphincter spasm or relaxation, and other conditions. When there is constipation in the rectum, a large amount of dry fecal mass can be found inside the rectum.

　　3. Gastrointestinal X-ray Examination

　　Barium meal examination of the gastrointestinal tract is of reference value for understanding the function of gastrointestinal motility. Normally, barium can reach the splenic area of the colon within 12-18 hours, and should be completely excreted from the colon within 24-72 hours. There may be delayed emptying during constipation. Barium enema, especially the colon hypotonic double-contrast examination adopted in recent years, may be helpful in finding the cause of constipation.

　　4. Special Examination

　　Swallowing a certain amount of X-ray opaque tube fragments as markers, taking abdominal films at regular intervals, can understand the speed and distribution of the markers in the gastrointestinal tract. If it is rectal constipation, the markers can be seen to run quickly in the colon and finally accumulate in the rectum; if it is colonic constipation, the markers are distributed between the jejunum and rectum.

　　Patients with constipation should eat high-calorie, nutritious, easily digestible liquid or semi-liquid foods, and avoid spicy and刺激性, sour and rich in caffeine foods. Pay attention to develop a regular defecation habit, drink warm water in the morning, and add honey to moisten the intestines if appropriate.

　　Modern medicine believes that constipation is equivalent to habitual constipation in Western medicine. Constipation patients need to adopt comprehensive treatment according to the severity of constipation, etiology, and type, including general lifestyle treatment, medication, biofeedback training, and surgical treatment to restore normal defecation physiology. Pay attention to lifestyle treatment, strengthen patient education, adopt a reasonable diet, such as increasing dietary fiber content, increasing water intake to stimulate the colon, and develop good defecation habits, such as defecating in the morning, defecating in time when having a bowel movement, avoiding forceful defecation, and at the same time, increase activity. Pay attention to clearing excessive feces in the distal rectum during treatment; actively adjust the mindset, which is extremely important for obtaining effective treatment.

　　If the feces are hard and stuck near the anal orifice of the rectum, or if the patient is elderly and weak with poor defecation power or lacks it, colonic hydrotherapy or clean enema can be used. For patients with constipation due to colonic transit dysfunction and severe conditions, surgical treatment can be considered, but the long-term effects of surgery are still controversial, and the selection of cases must be cautious. Among the vast number of constipation diseases, those that truly require surgical treatment are still a very small number.