Experience And Clinical Observation On The Treatment Of Bowel Dysfunction After Surgery For Colorectal Cancer With The Method Of Benefiting Qi And Unclogging Fu

Objective: To analyze the articles of traditional Chinese medicine for the treatment of postoperative defecation disorders in colorectal cancer in the past 20 years,to understand the research overview,summarize the treatment rules,and provide a basis for the research and clinical study of postoperative defecation disorders in colorectal cancer.We used the TCM Heritage Assist Platform V2.5 to analyze the prescription of Chinese medicine by Director Fang Wenyan for the treatment of postoperative defecation disorder of colorectal cancer,to summarize the rules of his medication,to summarize his academic ideas,and to provide some reference for the treatment of postoperative defecation disorder of colorectal cancer by Chinese medicine.The clinical efficacy of Director Fang Wenyan’s treatment of this disease using the method of benefiting qi and unclogging fu was observed through his own before-and-after control.Methods:(1)China Knowledge Resources Database(CNKI),WANFANG DATA Database,Wipu Chinese Science and Technology Journal Database,and Pub Med Database were selected as data sources,and the published literature on Chinese medicine for postoperative defecation disorders in colorectal cancer in the four major databases was retrieved,inclusion and exclusion criteria were formulated,the initially obtained literature was screened,and the collected literature was downloaded and read in full for collation and analysis.(2)To collect prescriptions of patients with postoperative defecation disorders after colorectal cancer who attended the clinic of Director Fang Wenyan at the First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine from January 2019 to October 2020,to establish a database,to perform data mining on 134 data using the TCM heritage assistance platform(V2.5),and to combine the guidance of Master Fang as well as my own experience to the results The results were discussed.(3)The clinical efficacy of benefiting qi and unclogging fu method in the treatment of postoperative bowel obstruction after colorectal cancer was observed by using the symptom grading and quantification scale and the EORTC quality of life measurement scale QLQ-C30(V3.0)with a before-and-after control method.Results:(1)A total of 111 papers were obtained after screening the initially obtained literature,and the annual publication volume of papers about abnormal defecation function after surgery for colorectal cancer from 1999 to 2021 showed an overall increasing trend;the types of literature papers were mainly clinical research papers(64%)and clinical experience papers(18%),and the language was mainly Chinese;the first high-frequency keyword was tonic Chinese Among the 73 clinical research papers,14 papers were before-and-after controlled studies and 59 papers were grouped controlled studies,of which 51 papers(70%)were on diarrhea;the top three commonly used prescriptions in Chinese medicine for the treatment of postoperative diarrhea in colorectal cancer were Tonic Zhong Yi Qi Tang,Essentials of Painful Diarrhea,Zhen Zhen Yang Dou Tang,Ginseng Ling Bai Zhu San,and Ge Gen Scutellaria Tang;the top three common types of evidence were Spleen Deficiency and Qi Trapping,Spleen and Kidney Yang Deficiency,and Spleen and Kidney Yang Deficiency.The top three common types of symptoms were spleen deficiency and qi trapping,spleen and kidney yang deficiency,and spleen deficiency and dampness.(2)A total of 134 items of data were included,and the analysis of the four tastes of drugs: cold drugs appeared 852 times(39%),warm drugs appeared 704times(32%),flat drugs appeared 539 times(25%),hot drugs appeared 54 times(2%),and cool drugs appeared 43 times(2%);the analysis of the five tastes of drugs: bitter drugs appeared1250 times(37%),sweet drugs appeared 998 times(30%),833 times(25%)for pungent drugs,123 times(4%)for sour drugs,83 times(2%)for astringent drugs,and 55 times(2%)for salty drugs;analysis of drug meridians: 1254 times for drugs to the spleen meridian,1054 times for drugs to the liver meridian,956 times for drugs to the stomach meridian,763 times for drugs to the lung meridian,668 times for drugs to the large intestine meridian,and 668 times for drugs to the heart meridian.668 times,heart meridian 613 times,kidney meridian 427 times,gall bladder meridian 204 times,pericardium meridian 171 times,small intestine meridian 110 times,bladder meridian 86 times,and triple jiao meridian 30 times;according to the association pattern,the core drug composition was determined as follows: Radix Codonopsis,Atractylodes,Poria,Glycyrrhiza,Radix Bupleurum,Rhubarb,Citrus aurantium,Hodgsonii,Astragalus,Mudanjiang,and Phyllanthus.Based on the "entropy clustering" and "improved mutual information method",the candidate new prescriptions were:(1)fried malt,grain bud,bitter ginseng,white flowered snake’s tongue herb,(2)fried malt,grain bud,peach kernel,white flowered snake’s tongue herb,red flower,and(3)fried malt,bitter ginseng.(iii)fried malt,bitter ginseng,Liu Shen Qu,peach kernel,(iv)Shu Di Huang,Cornu Cervi Pantotrichum,Tu Fu Zi,Lady’s Mantle,Xiang Xiang Shen,(v)Citrus astragali,Astragali,Dandelion,Huang Lian,(vi)Rhodiola rosea,Glycyrrhiza glabra,Hemerocallis,Chicken Blood Vine,Gynostemma,(vii)Dan Shen,Di Yu,Xia Gu Cao Cao,Fishy Herb,(viii)Bai Shao,Scutellaria,Radix Panax,Ginger,Chai Hu,Dandelion,(ix)Dang Shen,Roasted Licorice,Prince’s Ginseng,Peony Skin,Poria,(x)Sheng Ma,Cornu Cervi Pantotrichum,Lady’s Mantle,Peach Flower The top ten most frequently used herbs were rhubarb,Citrus aurantium,Huperzine,Astragalus,Poria,Shen Qu,Atractylodes,Mudanpi,and Radix Codonopsis in order;(3)Clinical efficacy observation:after 40 patients took Chinese herbal medicine for 2 weeks,there were statistical differences(P< 0.05)in stool properties,frequency of defecation,number of complete spontaneous defecation per week,number of stools,bloating,abdominal pain,incontinence of stools,incontinence of stools and anal swelling compared with those before treatment;among them,4 patients with 18 LARS changed from severe LARS to no LARS,4 patients changed from mild LARS to no LARS;after 40 patients took traditional Chinese medicine for 2 months,there were statistical differences(P < 0.05)in the symptom scores of stool properties,frequency of bowel movements,number of complete spontaneous bowel movements per week,number of bowel movements,abdominal pain,abdominal distension,fecal incontinence,dyspareunia,incomplete bowel movements,and anal swelling compared with those before treatment,among which in 18 patients with LARS,10 patients were converted from severe LARS after 2 months of treatment Among the 18 patients with LARS,10 patients changed from severe LARS to no LARS and 4patients changed from mild LARS to no LARS after 2 months of treatment,indicating that the Yi Qi Tong Qi method has certain efficacy on abnormal bowel function after colorectal cancer surgery;there were statistical differences in somatic function,role function,emotional function,social function,fatigue,loss of appetite,nausea and vomiting,constipation,diarrhea,and total health degree after 2 months of taking Chinese medicine compared with those before treatment(P < 0.05),indicating that The additive and subtractive formula formulated with the method of benefiting the qi and internal organs had a certain improvement on the quality of life of the patients.Conclusions:(1)In the past 20 years,the study of abnormal bowel function in the treatment of postoperative colorectal cancer has shown a growing trend,and the current literature mainly focuses on clinical research and clinical experience;most physicians agree that spleen deficiency is one of the pathogenic mechanisms of postoperative diarrhea in colorectal cancer,and it is often combined with other pathogenic mechanisms;most physicians promote the formula of tonifying Zhong Yi Qi Tang,Painful Diarrhea Essentials,Real People Nourishing Dirty Tang,Ginseng and Bai Zhu San,and Ge Gen and Scutellaria Tang are also commonly used.Most physicians promote acupuncture to treat anterior resection syndrome.(2)Director Fang Wenyan’s treatment of abnormal bowel function after surgery for colorectal cancer is characterized by a combination of cold and warmth,with bitter,sweet and pungent flavors,and the basic combinations of drugs used are: Dang Shen,Bai Zhu,Fu Ling,Gan Cao,Chai Hu,Da Huang,Hovenia,Hou Pu,Huang Qi,Mudan Pi,Liu Shen Qu,Prince Ginseng,and Bitter Ginseng.The candidate new formula of Bai Shao,Baicalin,Radix Scutellariae,Radix Panax,Radix Bupleurum,Dandelion and Ginger charcoal,Goldenseal,Stachysandrae,Salviae Miltiorrhiza,Di Yu and Sophora can be used as the base formula for both Qi irregularities and postoperative heat and toxin congestion in the large intestine,respectively.(3)The method of benefiting qi and unclogging fu can effectively improve the abnormal bowel function and improve the quality of life of postoperative patients with colorectal cancer.