浅析老年危重患者“热结旁流”证的辨证及治疗

Analysis on syndrome differentiation and treatment of ＂heat fecaloma with watery discharge＂ in critically ill elderly patients

老年危重患者“热结旁流”证虚者居其八九，“热结”者不过十中一二耳，实为“屎结旁流”。气虚、血虚、阴虚、阳虚等诸多因素是导致燥屎内结、粪水旁流的主要病因，其治疗方法则是在急下结滞的同时，或益气润肠、或养血润燥、或养阴增液、或温阳通便，以图根本。且老年危重患者“热结旁流”证与普通人不同，临证时更需详细询问病史，四诊合参，明辨标本虚实、轻重缓急，不可肆意攻伐，当治病求本。

Objective In critically ill elderly patients with ＂heat fecaloma with watery discharge＂, deficiency syndrome occupies its eighty to ninety percent, while ＂heat accumulation＂ occupies its ten to twenty percent; in fact, it is ＂dry feces accumulation stagnation and manure water side stream＂. Factors of Qi deficiency, blood deficiency, Yin deficiency, Yang deficiency, etc. are the main causes of dry stool accumulating in the intestine and manure water flows to side stream. The therapeutic principles of this disease should be removing stasis by purgation, in the mean time supplementing Qi and moistening intestine, or moisturizing dryness by nourishing blood, or supplementing Yin and increasing fluids, or warming yang for relaxing bowels in order to solve the root causes of the disease. The mechanism of heat fecaloma with watery discharge in critically ill elderly patients is different from that of general patients; clinically it is necessary to interrogate the disease history in detail, synthesize the four diagnostic methods, and differentiate manifestations from root cause, deficiency from sthenia, mildness from severity and amelioration from urgency. Casually using attack should he avoided, and aiming to treat its root cause is the proper therapeutic method.