Prolapse

　　The etiology of this disease is closely related to Qi deficiency, or due to inherent weakness, deficiency of middle Qi, inability to tie the fetus, or due to excessive childbirth, injury to the fetal vessels, kidney Qi deficiency, and loss of control, leading to prolapse and inability to retract.

　　1. Delivery injury is the anatomical basis for the occurrence of uterine prolapse.

　　2. The supporting tissues of the uterus are loose and weak.

　　3. Increased intra-abdominal pressure. On the basis of the above causes, long-term chronic cough, constipation, ascites, or large pelvic and abdominal tumors can all cause it.

　　Patients with uterine prolapse often have vaginal prolapse. Or accompanied by cystocele. Rectocele. Patients with cystocele often have frequent urination. Difficulty in urination or incontinence. Rectoceles often have constipation. Difficulty in urination. The main cause is the injury to the cervix, the main cervix ligament, and the uterosacral ligament caused by delivery, and the failure of the supporting tissues to return to normal after delivery. According to a survey of 2504 patients with uterine prolapse in Jinan City, 58.21% had occurred after the first to third deliveries. In addition, most postpartum women prefer to lie on their backs, and they are prone to develop chronic urinary retention, and the uterus is prone to become posterior. The axis of the uterus is consistent with the axis of the vagina. When abdominal pressure increases, the uterus will descend along the vaginal direction, causing prolapse. Postpartum habits of squatting labor (such as washing diapers, washing vegetables, etc.) can all increase abdominal pressure, promoting uterine prolapse. Uterine prolapse in nulliparous women is due to the underdevelopment of the supporting tissues of the reproductive organs.

　　1. Symptoms

　　1. Lumbar sacral pain:Especially in the sacral region, it becomes more obvious after labor, and can be relieved after lying down and resting. In addition, patients may feel a sinking sensation in the lower abdomen, vagina, and perineum, which is also exacerbated after fatigue.

　　2. Prolapse of the vaginal mass:Patients report a spherical object prolapsing from the vagina, which is more obvious during walking and physical labor, and it retracts spontaneously after lying down and resting. In severe cases of prolapse, the object may drop outside all day and cannot be retracted spontaneously. Due to friction with clothing and walking, discomfort is felt, and ulcers, infections, increased secretion, and even bleeding may occur after prolonged friction. Over time, the local tissue thickens and keratinizes.

　　3. Urological symptoms:Most patients with uterine prolapse experience urinary incontinence and urine leakage when they laugh, cough violently, or exert themselves physically, as the abdominal pressure suddenly increases. Uterine prolapse often accompanies varying degrees of cystocele, but whether stress urinary incontinence occurs depends on whether the anatomical relationship between the bladder and the urethra changes. A few patients with uterine prolapse have difficulty urinating, leading to urinary retention, and need to push the prolapsed bladder forward with fingers to urinate. The reason is that the cystocele is severe, and the enlarged bladder is located below the urethra.

　　4. Changes in menstruation, increased leucorrhea:Due to the prolapse of pelvic organs, blood circulation is obstructed, local congestion affects normal menstruation, causing menorrhagia. In addition, due to blood circulation disorders, prolapsed organs may develop ulcers and infections, causing an increase in leucorrhea and blood-stained discharge.

　　5. Generally, it does not affect pregnancy, childbirth, and delivery, but if the prolapse of the uterus cannot be retracted, edema of the cervix may occur during labor, making cervical dilation difficult and leading to dystocia.

　　II. Signs

　　The uterus descends from the cervical position within the vagina, 2cm from the hymen, and can be as long as 4-5cm. In severe cases of uterine prolapse with cystocele, the transverse furrow of the vaginal bladder is disappeared, and the lower boundary of the bladder can be longer than the external orifice of the cervix. In severe cases of uterine prolapse, the bladder and ureter descend, forming a normal '△' area with the opening of the urethra.

　　Because the uterus often prolapses outside the vaginal opening, it is rubbed and damaged, locally red and swollen, ulcerated, with yellow pus, and copious yellow leucorrhea, or like pus with an odor. At this time, it is necessary to clear heat and dampness first, and take Longdan Xiegan Decoction with modifications. It can also be used externally to wash the affected area, and then sprinkle Houpeng powder mixed with pearl powder to clear heat, detoxify, and promote tissue regeneration. After the local symptoms improve, treatment is carried out according to the type, or surgical treatment is performed.

　　I. Prevention and care of prolapse of the uterus

　　Implement family planning, improve birth quality, and this can greatly reduce the incidence of prolapse of the uterus. Practice new methods of delivery and promptly repair lacerations of the perineum. Avoid heavy physical labor within the first three months after childbirth. Maintain smooth defecation and actively treat chronic cough.

　　II. Precautions

　　Pay attention to bed rest, and it is advisable to elevate the hip or raise the feet to the height of two bricks when sleeping.

　　Do not get out of bed too early after childbirth, especially do not participate in heavy physical labor too early, and increase nutrition for self-healing.

　　Avoid long-term standing or squatting with holding breath, which increases abdominal pressure.

　　Maintain smooth defecation and urination.

　　Treat chronic bronchitis, diarrhea, and other diseases that increase abdominal pressure in a timely manner.

　　The breastfeeding period should not exceed two years.

　　Engage in moderate physical exercise to improve physical fitness.

　　Increase the intake of foods with nourishing and kidney-tonifying effects, such as chicken, yam, mung beans, lotus seeds, euryale seeds, loach, oysters, chives, and jujube.

　　9, Abstain from sexual activity.

　　1, Gynecological examination:The cervix drops below the level of the ischial spines, or the cervix vagina is shorter than 4cm, but does not exceed the vagina, it is the first degree prolapse; the cervix and part of the uterus extrude outside the vaginal orifice, it is the second degree prolapse; the whole uterus extrudes outside the vaginal orifice, it is the third degree prolapse.

　　2, Laboratory examination:No abnormalities can be found.

1, Take 250 grams of pork large intestine, 100 grams of black sesame seeds, 9 grams of Cimicifuga. First clean the pork large intestine, wrap Cimicifuga in gauze, put it with black sesame seeds into the intestine, place it in a pot with water, stew until tender, remove Cimicifuga and add seasonings, eat the soup in two servings. Twice a week to three times a week.

2, Use 1000 grams of litchi and 1000 milliliters of yellow wine. Soak together for 7 days, drink 30 milliliters each time in the morning and evening.

3, Take 5-10 heads of turtle (water turtle) heads, clean and chop them, fry them in a pot until golden, grind into powder, take 3 grams each night before going to bed, taken with rice wine or yellow wine.

4, Use one egg and 30 grams of He Shou Wu. Boil He Shou Wu in water to get a concentrated juice, then add the egg and cook until tender, eat the egg and drink the soup, twice a day.

5, Er Ma Pork Intestine Soup: Cimicifuga 10g, Sesame Seeds 100g, pork large intestine 300g, seasonings to taste. Clean the large intestine, wrap Cimicifuga in a cloth bag, put it with sesame seeds into the large intestine, place it in a pot, add an appropriate amount of water to stew until the large intestine is tender, remove Cimicifuga, season with salt and monosodium glutamate, drink the soup and eat the intestine, once every other day, for 3 weeks. It can tonify vital energy and elevate, suitable for prolapse of the uterus caused by qi deficiency and descent.

6, Codonopsis Millet Porridge: Codonopsis 30g, Cimicifuga 10g, millet 50g. Boil the two herbs in water to get the juice, add millet to cook into a thin porridge, take twice a day on an empty stomach. It can tonify vital energy and elevate, suitable for prolapse of the uterus caused by qi deficiency and descent, exacerbated by fatigue, lower abdominal prolapse, weakness of the limbs, lack of energy and willingness to talk, pale complexion, frequent urination, abundant leukorrhea, thin and white in color, etc.

7, Bichir Astragalus Soup: Bichir 1 tail, Astragalus 20g, Ji Qiao 10g, seasonings to taste. Remove the scales and impurities from the bichir, clean it, add Astragalus and Ji Qiao to the water and boil, then cook for 30 minutes, remove the residue and take the juice, season with salt, monosodium glutamate, and cooking wine, take 200ml each time. Take twice a day. It can tonify vital energy and elevate, suitable for prolapse of the uterus caused by qi deficiency and descent.

8, Cimicifuga Ophiopogon Soup: Cimicifuga 10g, jujube 10 pieces, ophiopogon 150g. Clean the ophiopogon, cut into pieces, and cook with the herbs in a pot, add an appropriate amount of water, boil and cook until tender, drink the soup and eat the meat, once a day. It can nourish blood and vital energy, elevate yang, and is suitable for prolapse of the uterus caused by qi deficiency and descent.

9, Ba Ji Stewed Pork Intestine: Ba Ji Tian, Rou Cong Rong, Ji Qiao each 3-5g, pork large intestine 200g, seasonings to taste. Clean the pork large intestine, add the herbs and large intestine into a bowl, add an appropriate amount of water, steam until tender, and serve with a little salt and monosodium glutamate for seasoning. It can tonify the kidney and vital energy, and is suitable for kidney deficiency and incontinence, prolapse of the uterus, soreness and weakness of the waist and knees, lower abdominal prolapse, frequent urination, frequent night urination, dizziness, tinnitus, etc.

10. Astragalus and Turtle Soup: 30g of Astragalus, 15g of Zhike, 10g of Du Zhong, 1000g of turtle, and appropriate amount of seasoning. Remove the shell, intestines, and impurities of the turtle, wash and cut into pieces. Wrap all the herbs and add an appropriate amount of water to cook with the turtle until it is cooked. Remove the herb package, scallion, ginger, salt, cooking wine, monosodium glutamate, and other seasonings, and serve. Take 2 doses a day. It can nourish kidney Yin, tonify Qi and solidify the loose, suitable for prolapse of the uterus due to kidney Qi instability.

11. Jin Ying Zi Congee: 15g of Jin Ying Zi, 10 dates, 200g of rice. Remove the kernel of the dates, first decoct Jin Ying Zi to make a decoction, then add rice and dates to cook congee. Take one dose a day. It can tonify the kidney and solidify the loose, suitable for prolapse of the uterus due to kidney deficiency and instability.

12. Jin Ying Zi Paste: 150g of Jin Ying Zi, an appropriate amount of honey. Boil Jin Ying Zi to make a decoction, and then combine the two decoctions. Boil with low heat and mix with an equal amount of honey, then boil until warm and pour into bottles. Take 20-30ml twice a day, with warm water or add to congee. It can tonify the kidney and solidify the loose, suitable for prolapse of the uterus due to kidney deficiency and instability.

What foods are good for prolapse of the uterus?

1. Drink more water and eat more fruits and vegetables. Patients should increase fluid intake and eat more nuts, seeds, grains, and other beneficial foods.

2. Eat more foods with the effects of tonifying Qi and kidney, such as chicken, yam, mung beans, lotus seeds, Coix seed, eel, sea cucumber, chive, jujube, etc.

3. In daily diet, eat more blood and kidney-nourishing foods, mainly those with neutral and warm properties, such as beef, mutton, pork, etc. Various types of meat should be minced and eaten to facilitate the absorption of nutrients. Eat more vegetables with neutral and warm properties, and the ratio of meat to vegetables should be about 1:1.

What foods should be avoided for prolapse of the uterus?

1. Avoid spicy foods such as chili, Ma椒, raw scallion, raw garlic, white wine, and other刺激性 foods and beverages.

2. Avoid eating foods with hot properties, coagulating properties, and hormone components such as Longan, Red dates, E jelly, Royal jelly, etc.

3. Avoid cold and cool foods, regardless of the temperature or nature of the food.

　　1. Differentiation and treatment of prolapse of the uterus

　　1. Qi deficiency type

　　Symptoms include prolapse of the uterus or falling out of the vaginal orifice, feeling of lower abdominal坠, something falling out from the vagina, exacerbated by labor. Weak limbs, lack of Qi, lack of speech, pale complexion, frequent urination, abundant leukorrhea, thin and white in quality. Pale tongue with thin coating, weak and fine pulse.

　　Treatment method: tonify Qi and elevate

　　Medicines

　　(1) The main formula is Bu Zhong Yi Qi Decoction (from Li Dai's 'Spleen and Stomach Theory') with additional ingredients

　　Prescription: 50 grams of North Astragalus, 15 grams of Bai Zhu, 6 grams of Chen Pi, 15 grams of Cang Ma, 6 grams of Chai Hu, 30 grams of Dang Shen, 9 grams of Zhigancao, 15 grams of Danggui, 15 grams of Xu Duan, 30 grams of Jin Ying Zi (or the root of Jin Ying Zi), 15 grams of Zhike, decocted in water.

　　(2) Traditional Chinese medicine

　　Bu Zhong Yi Qi Pill, 6 grams each time, 3 times a day.

　　(3) Single and verified prescriptions

　　① Sheng Xian Decoction (Gong Qishu in Zhejiang Journal of Traditional Chinese Medicine, 1985.4)

　　Prescription: 15 grams of Bupleurum, 15 grams of Cimicifuga, 60 grams of Astragalus, 10 grams of Platycodon, 15 grams of Anemarrhena, 60 grams of Codonopsis (for the severe cases, use 15 grams of red Codonopsis, boil separately and mix in). Take two servings in the morning and evening, one dose per day.

　　② Old pumpkin calyx decoction (Lai Tiansong et al. 'Clinical Wonderful New Prescriptions')

　　Prescription: 6 pieces of old pumpkin calyx. Cut the calyx in half, decoct to get a concentrated juice and take it all at once. Once a day, 5 days as one course.

　　③ Tu Chui Formula (Lai Tiansong et al. 'Clinical Wonderful New Prescriptions')

　　Prescription: 4 grams of Cimicifuga (ground into powder), 1 egg. Make a small soybean-sized round hole on the top of the egg, put the drug powder inside, mix well; take a small piece of white paper, wet it with water and cover the egg hole tightly. Then put the egg in a steamer and steam it until cooked, peel it off and take it internally. Once a day, 10 days as one course; take a break for 2 days, and then take the second course.

　　2, Kidney deficiency type

　　Symptoms: something prolapses from the vagina. Backache, weakness of the knees, sinking sensation in the lower abdomen, frequent urination, especially at night, dizziness and tinnitus. Pale red tongue, deep and weak pulse.

　　Treatment method:补肾固脱，with adjuvant Qi tonification.

　　The main prescription is Dabuyuan Decoction (Zhu Danxi in Danxi Xinfa) with modifications

　　Prescription: 30 grams of Dangshen, 15 grams of Shanyaoju, 15 grams of Duzhong, 15 grams of Gouqizi, 20 grams of Shudihuang, 15 grams of Danggui, 9 grams of Zhigancao, 30 grams of Shanyao, 30 grams of Beihuangqi, 15 grams of Baizhu, 30 grams of Jinsuanzi. Decocted for oral administration.

　　Description: Both types mentioned above can be caused by the uterus frequently prolapsing out of the vaginal orifice, causing friction and injury, with local redness, swelling, ulceration, yellow fluid, and yellow leukorrhea in large amounts, or like pus with an unpleasant smell. At this time, it is necessary to first clear damp-heat, take Longdan Xiegan Decoction with modifications internally. It can also be used externally with this decoction, followed by sprinkling with Houfeng San and Pearl Layer Powder to clear heat and detoxify, and promote flesh regeneration. After the local symptoms improve, treatment is carried out according to the type, or surgical treatment is performed.

　　2. Other treatments for prolapse of the uterus

　　Acupuncture treatment for prolapse of the uterus

　　1, Qi deficiency:Take the Du Mai, the Foot Taiyin and Yangming meridian acupoints as the main. Use acupuncture reinforcing method and moxibustion. Acupoints: Baihui, Qihai, Weidao, Zusanli, Sanyinjiao.

　　2, Kidney deficiency:It is advisable to adjust and strengthen kidney and essence, consolidate the uterus, take the Ren Mai and the acupoints of the Foot Shaoyin kidney meridian as the main. Acupoints: Guanyuan, uterus, Zhao Hai.