中医药治疗便秘的经验与体会（附135例分析）

Experience of Treating Constipation with Traditional Chinese Medicine：Clinical Analysis of 135 Cases

通过分析便秘的疗效及便秘的复诊率、证型、治疗起效时间等，总结运用中医药治疗便秘的经验与体会。近1年内诊治便秘患者135例，初诊53例（39．3％），患者接受过肠镜、胃镜、排粪造影、气钡灌肠等检查；服用过或正在服用泻药者31例，占23．0％；服用泻药时间1～22年，主要为间断或持续服用，以刺激性泻药为多。便秘患者中以肾阳虚型为多，占84．4％，采用济川煎加减治疗者108例（80．0％）。早期配合运用西药治疗者57例，占42．2％。可以判断疗效的48例中，临床治愈42例，有效4例，无效2例，临床治愈率为87．8％，总有效率为95．8％。其中服药7剂起效者34例（70．8％），10剂起效者1例（2．1％），14剂起效者5例（10．4％），21剂起效者3例（6．3％），28剂起效者1例（2．1％）。结果表明，慢性便秘多为虚证或虚实夹杂证；必须以辨证治疗为主方能获得较好的远期疗效，早期配合对症治疗很有必要；舌质、脉象对于辨证、用药乃至预后的判断很重要；直肠指诊对于便秘的辨证有重要的参考意义；不可根据有关辅助检查结果指导辨证用药；起效后坚持治疗，巩固治疗很重要；便秘的预后主要与证型有关，虚证与虚实夹杂型便秘起效较慢，疗效相对较差；给予患者饮食、生活等方面的指导很有必要。

The author summarized the experience of treating constipation with traditional Chinese medicine by observing the clinical efficacy,return visit rate, syndrome patterns and the time to onset of action. The 135 cases treated for constipation in recent one year were selected,among which 53 cases were on their ini- tial treatment（39.3%）and underwent gastroscope, enteroscope, defecography and air contrast barium ene- ma; there were 31 cases who had taken or were taking laxatives （23.0%）, mainly irritant laxatives,inter- mittently or continueously for a period ranging from 1 to 22 years. In patients with constipation,kidney yang deficiency was most commonly seen,accounting for 84.4% ,108 cases had been treated with modified Jichuan decoction, accounting for 80. 0%. There were 57 cases treated with western medicine in initial stage, accounting for 42.2 %. Among 48 cases with determined efficacy, 42 got cured clinically, 4 effective, 2 no response,the curative rate was 87.8%,the total effective rate was 95. 8%. Thirty-four cases got im- proved after taking 7 doses（70.8%） ,one case after 10 doses （2.1%）,5 cases after 14 doses （10.4%） ,3 ca- ses after 21 doses （6.3%）,1 case after 28 doses（2.1M）. It is concluded that chronic constipation is usually of deficiency syndrome or syndrome of deficiency complicated by exces symptoms and should be treated based on syndrome differentiation just to achieve long-term efficacy, and it is necessary to have symptomat- ic treatment at the early stage;the tongue nature and pulse condition are vita! to syrldrome differentiation, medication and even prognosis. Digital rectal exam{nati6n is of importance to syndrome differentiation of conStipation;relevant auxiliary examination results should not be used to guide clinical treatment; when treatment acts, it should be strengthened. The prognosis of constipation is mainly associated with syndrome patterns. For deficiency syndrome or syndrome of deficiency complicated by exces symptoms, treatment acts slowly and has poor efficacy. It is necessary to given patients guidance on diet and lifestyle.