Un hemoroid este un corp moale format prin dilatarea a unei parti a plexului venos al rectului. Functie de localizarea lor relativa fata de piele sau fata de membrana intestinala, hemoroizii sunt clasificati ca interni, externi sau combinati. Un hemoroid intern este o vena sub o membrana mucoasa; un hemoroid extern este o vena sub piele; iar un hemoroid combinat presupune vene sub ambele.
I Etiologie, Patologie şi manifestare clinică
Hemoroizii se pot forma din diferite cauze. Dieta necorespunzatoare poate afecta splina, iar insuficienta splinei la randul ei poate genera cresterea endogena a Uscaciunii si Caldurii. Uscaciunea si Caldura Endogena then press downward against the large intestine and may lead to the formation of hemorrhoids. Excessively prolonged sitting or bearing of heavy loads may cause impedance to blood circulation, which in turn may lead to blood stasis in the rectal veins. Cand Caldura ataca sangele, lupta dintre sange si Qi-ul cel rau poate produce miscari dezordonate ale Qi-ului si sangelui. Uneori, aceasta poate duce la stagnarea Qi-ului si a sangelui si sa duca la formarea de hemoroizi.
Adesea constipaţia obisnuita duce la dezvoltarea hemoroizilor. Uneori, si diareea poate duce, de asemenea, la aparitia de hemoroizi.
Hemoroizii externi se formeaza sub the junction between the mucous membrane and skin. They are usually visible on inspection, and on palpation they feel like soft masses. They are most obvious immediately following defecation or squatting. Associated symptoms depend upon whether there is thrombosis (clot) in the dilated vein and whether there is inflammation. In the absence of thrombosis or inflammation, there may be no symptoms, a sensation of having an object in the anus, or mild itch. Daca exista o tromboza, there may be abrupt pain that is sometimes intense. Umflatura are aspectul of a dark purple mass. An inflamed external hemorrhoid may be quite painful and tender.
Hemoroizii interni se formeaza above the junction of the mucous membrane and skin. A small internal hemorrhoid may be asymptomatic or manifest only hematochezia (bloody feces). Upon inspection with an anoscope it may appear as a crimson red flat mass. A large internal hemorrhoid may prolapse, especially with defecation, and bleed. The prolapsed hemorrhoid may retract spontaneously, with bed rest if necessary, or may require manual manipulation to re-position. If the prolapsed internal hemorrhoid does not retract or is not manually re-positioned reasonably promptly, it may swell further from edema or inflow of blood. The blood may clot, or the hemorrhoid may necrose; in either case, prompt surgery may become necessary.
Combined hemorrhoids may manifest symptoms of both external and internal hemorrhoids.
II Tratament cu plante
1 Tratament intern
Internal treatment with herbal medicine is mostly suitable for hemorrhoids that have not prolapsed or though prolapsed can be re-positioned. Hemorrhoids with thrombosis or at risk of necrosis should be treated by other methods.
i Downward Flow of Dampness and Heat
This causes mostly external hemorrhoids.
Simptome principale. In some, the hemorrhoid is swollen, hanging and fresh red in color. There is some bleeding and hematochezia. In others, there is local moistness and itch. The tongue is red, with yellow greasy coating. The pulse is slippery and rapid.
Therapeutic Principle. Regulate blood, moisten Dryness, dispel Wind and stop pain.
Treatment. Qinjiao Cangzhu Tang (Gentiana-Atractylodes Decoction). It has the following composition: qinjiao (Gentiana) 12 g, taoren (Prunus persica) 6 g, zaojiao seed (Gleditsia sinensis) 3 g, cangzhu (Atractylodes) 9 g, fangfeng (Saposhnikovia) 9 g, danggui (Angelica) 9 g, zexie (Alisma) 9 g, huangbai (Phellodendron) 1.5g, binglang (Areca) 0.5 g, and dahuang (Rheum palmatum) 1 g.
Note: zaojiao seed is burned, ground into powder and the powder added to the decoction.
ii Yin Deficiency with Blood-Heat
This causes mostly internal hemorrhoids or external hemorrhoids with thrombosis.
Simptome principale. There is much bleeding from the hemorrhoid. In addition, there are such symptoms as thirst with desire to drink, constipation, and decreased and dark urine. The tongue is red, with thin coating. The pulse is rapid.
Principiu terapeutic. Nourish Yin, cool blood and eliminate Dampness.
Tratament. Liang Xue Dihuang Tang (Blood-Cooling Rehmannia Decoction). It has the following composition: huangbai (Phellodendron) 6 g, zhimu (Anemarrhena) 6 g, qingpi (Citrus tangerina) 3 g, huaizi (Sophora japonica) 3 g, shudihuang (Rehmannia) 16 g, and danggui (Angelica) 16g.
iii Spleen Insufficiency with Prolapse
This causes mostly internal hemorrhoids. Prolapse refers to prolapse of the hemorrhoid.
Simptome principale. The prolapsed hemorrhoid requires manual re-positioning. The complexion is sallow. There are palpitations of the heart, shortness of breath, fatigue and weakness. The tongue is pale, with thin white coating. The pulse is threadlike and feeble.
Principiu terapeutic. Augment and raise Qi; or, nourish both Qi and blood; or, augment Qi and nourish blood.
Tratament. Modified Bu Zhong Yi Qi Tang (Middle-Restoring and Qi-Augmenting Decoction). The modified composition is as follows: huangqi (Astragalus) 20g, baizhu (Atractylodes) 10 g, danggui (Angelica) 10 g, chenpi (Citrus tangerina) 6 g, shengma (Cimicifuga) 6 g, chaihu (Bupleurum) 6 g, gancao (Glycyrrhiza) 6g, dangshen (Codonopsis) 15 g, and baishaoyao (Paeonia) 10g.
2 Tratament local
Two herbal formulas are commonly used, Fufang Jingjie Xiyao (Augmented Schizonepeta Wash) and Que Du Tang (Poison-Eliminating Decoction). As soon as the decoction is done use it to steam the hemorrhoid. When it is sufficiently cool, use it to wash or apply it as a wet compress. Apply – two to three times a day for half an hour each time.
The composition of Fufang Jingjie Xiyao is as follows: jingjie (Schizonepeta) 10–15 g, fangfeng (Saposhnikovia) 10–15 g, tougucao (Speranskia tuberculata) 15 g, sumu (Caesalpinia sappan) 15–30 g, cheqiancao (Plantago asiatica) 15–30 g, raw chuanwu (Aconitum carmichaeli) 9 g, jinyinhua (Lonicera) 12 g, and kushen (Sophora) 12 g. For severe cases, add huajiao (Zanthoxylum bungeanum) 9g.
The composition of Que Du Tang is as follows: xiaoshi (niter) 30 g, wasong (Orostachys fimbriatus) 15 g, machixian (Portulaca oleracea) 15 g, fried gancao (Glycyrrhiza) 15 g, wubeizi (Melaphis chinensis) 9 g, huajiao (Zanthoxylum bungeanum) 9 g, cebaiye (Biota orientalis) 9 g, zhiqiao (Poncirus trifoliata) 9g, congbai (Allium fistolosum) 9 g, and cangzhu (Atractylodes) 9g.
Use Jiu Hua Gao (Nine-Magnificent Ointment). Apply it directly to the hemorrhoid, both external and internal, or apply it on gauze or cotton ball as packing. The composition is as follows: huashi powder (talcum) 600 g, longgu (fossil bones) 120 g, pengsha (borax) 90 g, beimu (Fritillaria) 18 g, zhusha (cinnabar) 18 g, and bingpian (Dryobalanops) 18 g. Prepare Jiu Hua Gao by grinding the ingredients together into fine powder and mixing it evenly in vaseline to form a 30% ointment.
3 Other Treatment
i Sclerosis-Induction Therapy
In this approach special solutions are injected into the internal hemorrhoid to induce sclerosis and withering. This is a very specialized technique and should be performed only by experienced physicians.
ii Ligation Therapy
In this approach the blood supply to the internal hemorrhoid is ligated at the base, so that the hemorrhoid would atrophy, become necrotic and slough without risk of causing bleeding. Again, only experienced physicians should perform this technique.
iii Taierea chirurgicala a hemoroizilor
Surgical excision of hemorrhoids should be performed only by experienced surgeons.
III Acupuncture Treatment
Acupuncture treatment is suitable for treating acute hemorrhoids with pain and swelling.
For downward flow of Dampness and Heat, select the acupoints Huiyang (BL-35), Chengshan (BL-57), Changqiang (DU-1), Yinlingquan (SP-9) and Sanyinjiao (SP-6).
For Yin deficiency with blood-Heat, select the acupoints Huiyang (BL-35), Chengshan (BL-57), Erbai (EX-UE-29), Quchi (LI-11), Xuehai (SP-10), Geshu (BL-17) and Sanyinjiao (SP-6).
For spleen insufficiency with prolapse, select the acupoints Baihui (DU-20), Shenque (RN-8), Pishu (BL-20), Sanyinjiao (SP-6), Zusanli (ST-36) and Huiyang (BL-35).
Moxibustie. This is applied mostly for hematochezia. Select the acupoints Zusanli (ST-36), Zhongwan (RN-12), Qihai (RN-6) and Changqiang (DU-1).
Auriculopunctura. Se aleg punctele de auriculoterapie: Intestinul Gros, Subcortex, Shenmen si Splina.
IV Studiu de caz
The patient was a 54-year old woman who presented with intermittent painless hematochezia for 2 years, worse during the two most recent months. Sometimes the bleeding was in the form of dribbling and sometimes in spurts, and the amount varied. Two months prior to consultation, she developed dry constipation, so that when she defecated she had prolapse of a soft mass and worsened hematochezia.
The mass retracted spontaneously. The increased hematochezia prompted the consultation.
Temperatura ei era de 36,7°C. Pulsul ei era 70/min iar tensiunea era de 128/90 mmHg. She had a pale complexion. Her tongue was pale red, with thin white coating. Her pulse was taut and threadlike. Her anus was normal in appearance.
Digital examination of the rectum was normal. Examination with an anoscope showed a hemispherical swelling of the mucous membrane above the juncture between mucous membrane and skin. The soft mass was dark red in color and had three spots of recent bleeding.
Diagnostic. Internal hemorrhoid due to spleen insufficiency, with prolapse.
Principiu terapeutic. Strengthen the spleen, mobilize Qi, astringe blood and stop bleeding.
Treatment si Evolutie. Pacientul a fost tratat cu o formula pe baza de plante si cu injectie. Formula era o formula Gui Pi Tang modificata (Decoct de Refacere a Splinei), cu urmatoarea alcatuire: dangshen (Codonopsis) 12 g, huangqi (Astragalus) 15 g, baizhu (Atractylodes) 9 g, gancao (Glycyrrhiza) 6 g, shengjiang (Zingiber) three slices, danggui (Angelica) 9 g, fuling (Poria) 10 g, suanzaoren (Ziziphus) 10g, yuanzhi (Polygala) 9 g, si muxiang (Aucklandia) 9 g. A trebuit sa ia o doza zilnic.
In plus, a fost tratata folosind o injectie se provoca sclerozarea hemoroizilor numita Xiao Zhi Ling (Solutie de Disipare a Hemoroizilor).
A revenit pentru control dupa 2 saptamani. Era complet vindecata.
sursa: Essentials of Chinese Medicine, vol. 3, Springer-Verlag, pp. 421-424
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