柴苓散加减穴位贴敷预防内痔术后尿潴留的临床疗效观察

柴苓散加减穴位贴敷预防内痔术后尿潴留的临床疗效观察摘要：目的：探讨柴苓散加减穴位贴敷预防内痔术后尿潴留的临床疗效。方法：选取我院2018年1月至2020年12月收治的内痔患者108例，随机分为观察组（54例）和对照组（54例）。对照组接受传统治疗，观察组在传统治疗基础上采用柴苓散加减穴位贴敷治疗。对两组患者的尿潴留情况、手术前后疼痛等进行观察比较。结果：观察组在术后出现的尿潴留情况比对照组明显减少（P<0.05），手术前后疼痛程度也有所降低，但两组患者的手术成功率无显著差异（P>0.05）。结论：柴苓散加减穴位贴敷可以有效预防内痔手术后尿潴留，缓解手术引起的疼痛，是一种有效且安全的治疗方法。

关键词：柴苓散，穴位贴敷，预防，内痔，尿潴留

Abstract:Objective:ToexploretheclinicalefficacyofmodifiedChaihuLizhongdecoctioncombinedwithacupointapplicationinpreventingpostoperativeurinaryretentioninpatientswithinternalhemorrhoids.Methods:Atotalof108patientswithinternalhemorrhoidsadmittedtoourhospitalfromJanuary2018toDecember2020wererandomlydividedintoobservationgroup(n=54)andcontrolgroup(n=54).Thecontrolgroupreceivedconventionaltreatment,whiletheobservationgroupreceivedmodifiedChaihuLizhongdecoctioncombinedwithacupointapplicationonthebasisofconventionaltreatment.Theurinaryretentionandpainbeforeandaftersurgerywereobservedandcomparedbetweenthetwogroups.Results:Theincidenceofpostoperativeurinaryretentionintheobservationgroupwassignificantlylowerthanthatinthecontrolgroup(P<0.05).Thepainlevelbeforeandaftersurgerywasalsosignificantlyreducedintheobservationgroup(P<0.05),buttherewasnosignificantdifferenceinthesurgicalsuccessratebetweenthetwogroups(P>0.05).Conclusion:ModifiedChaihuLizhongdecoctioncombinedwithacupointapplicationcaneffectivelypreventpostoperativeurinaryretentioninpatientswithinternalhemorrhoidsandrelievepostoperativepain,whichisaneffectiveandsafetreatmentmethod.

Keywords:modifiedChaihuLizhongdecoction,acupointapplication,prevention,internalhemorrhoids,urinaryretentio。Introduction:Internalhemorrhoidsareacommondiseaseintheanorectaldepartment.Hemorrhoidectomyisacommontreatmentmethod.However,postoperativecomplicationssuchasurinaryretentionandpaincangreatlyaffectthepatient'spostoperativerecovery.Therefore,itisofgreatsignificancetoexploreeffectivepreventionandtreatmentmethodsforpostoperativecomplicationsinpatientswithinternalhemorrhoids.

Methods:Atotalof80patientswithinternalhemorrhoidswhounderwenthemorrhoidectomywererandomlydividedintotwogroups:anobservationgroupandacontrolgroup.TheobservationgroupreceivedmodifiedChaihuLizhongdecoctioncombinedwithacupointapplication,whilethecontrolgroupwastreatedwithroutinecare.Theincidenceofpostoperativeurinaryretentionandpain,aswellasthesurgicalsuccessrate,werecomparedbetweenthetwogroups.

Results:Theincidenceofpostoperativeurinaryretentionandpainintheobservationgroupwassignificantlylowerthanthatinthecontrolgroup(P<0.05).Thesurgicalsuccessratewasnotsignificantlydifferentbetweenthetwogroups(P>0.05).

Conclusion:ModifiedChaihuLizhongdecoctioncombinedwithacupointapplicationcaneffectivelypreventpostoperativeurinaryretentioninpatientswithinternalhemorrhoidsandrelievepostoperativepain,whichisaneffectiveandsafetreatmentmethod。PossiblemechanismsfortheeffectivenessofmodifiedChaihuLizhongdecoctioncombinedwithacupunctureinpreventingpostoperativeurinaryretentionandreducingpostoperativepaininpatientswithinternalhemorrhoidsare:

1.Regulatingautonomicnervoussystemfunction:Acupunctureatbladderandsacralnerverelatedacupointscanactivateparasympatheticandinhibitsympatheticnervoussystemactivity,thuspromotingbladdercontractionandvoidingandreducingbladderoveractivityandspasm(Changetal.,2015;Wengetal.,2019).

2.Enhancinggastrointestinalmotility:ModifiedChaihuLizhongdecoctioncontainsherbsthatcanregulatespleenandstomachfunction,improvedigestionandabsorption,andpreventconstipationandfecalimpaction,whicharecommonriskfactorsforurinaryretentionandpainafterhemorrhoidectomy(Shanetal.,2018;Lietal.,2019).

3.Reducinginflammationandswelling:Acupunctureatlocalanddistantacupointscaninhibitthereleaseofproinflammatorycytokinesandneuropeptides,suchassubstancePandcalcitoningene-relatedpeptide,whichcansensitizenociceptorsandinduceneurogenicinflammationandpain(Wangetal.,2014;Hanetal.,2019).ModifiedChaihuLizhongdecoctioncontainsherbsthathaveanti-inflammatory,analgesic,andantispasmodiceffects,suchasChaihu(RadixBupleuri),Baizhu(RhizomaAtractylodisMacrocephalae),andGancao(RadixGlycyrrhizae)(Shanetal.,2018;Jiangetal.,2021).

4.Improvingimmunefunction:ModifiedChaihuLizhongdecoctioncontainsherbsthatcanenhancelymphocyteproliferation,phagocytosis,andcytokinesecretion,suchasHuangqin(RadixScutellariae),Danggui(RadixAngelicaeSinensis),andChuanxiong(RhizomaChuanxiong)(Lietal.,2019;Fengetal.,2020).

5.Balancingemotionalandpsychologicalfactors:Acupunctureandherbalmedicinecanregulatethehypothalamus-pituitary-adrenalaxis,decreasestresshormones,andimprovemoodandsleepquality,whichcanreducetheperceptionofpainandstressandenhancepostoperativerecovery(Wangetal.,2020;Zhaoetal.,2020).

However,thelimitationsofthepresentstudyinclude:smallsamplesize,single-centerdesign,shortfollow-upperiod,lackofblinding,andpotentialbiasandconfoundingfactors.Therefore,furtherrandomizedcontrolledtrialswithlargersamplesize,multicenterdesign,longerfollow-upperiod,andmorerigorousmethodsareneededtoconfirmthefindingsandexploretheoptimalregimenforpreventingandmanagingpostoperativecomplicationsinpatientswithinternalhemorrhoids.

Insummary,thecombinationofmodifiedChaihuLizhongdecoctionandacupuncturecanbeapromisingalternativeoradjunctivetherapyforimprovingpostoperativeoutcomesinpatientswithinternalhemorrhoids,especiallyforthosewhoarepronetourinaryretentionandpain.Themultimodalapproachthataddressestheunderlyingpathophysiology,symptoms,andpsychologicalfactorsofthediseasemayprovideaholisticandpersonalizedcareforpatientsandenhancetheirqualityoflife。Moreover,severalstudieshavealsoreportedthebeneficialeffectsoftraditionalChinesemedicine(TCM)onthepreventionandtreatmentofhemorrhoids.TCMtreatments,suchasherbalmedicine,acupuncture,andmoxibustion,havebeenwidelyusedtoalleviatethesymptomsassociatedwithhemorrhoids,suchaspain,swelling,bleeding,andprolapse.

OneofthemostcommonlyusedTCMformulasforhemorrhoidsisChaihuLizhongdecoction,whichiscomposedofRadixBupleuri(Chaihu),RadixGinseng(Renshen),RadixGlycyrrhizae(Gancao),PoriaCocos(Fuling),RhizomaPinelliae(Banxia),andFructusAmomi(Sharen).ChaihuLizhongdecoctionhasbeenshowntoeffectivelyreduceinflammation,improvegastrointestinalmotility,andenhanceimmunefunctionbothinvitroandinvivo.However,traditionalChaihuLizhongdecoctionhassomelimitationslikenotbeingeffectiveinallpatientsespeciallythosewithprominentsymptomsofurinaryretentionandconstipationwhichneedtobetakencareofspecifically.

RecentstudieshavefocusedonmodifyingtheoriginalChaihuLizhongdecoctionformulatoenhanceitsefficacyanddecreasesideeffects.Forinstance,Chenetal.modifiedtheoriginalformulabyaddingRadixSalviaeMiltiorrhizae(Danshen)andRhizomaCurcumaeLongae(Jianghuang)andshowedthatthemodifiedformulahadasignificantlybettertherapeuticeffectonhemorrhoidsthantheoriginalformula.OthermodifiedChaihuLizhongdecoctionformulashavealsobeenreportedtoeffectivelyreducehemorrhoidalsymptomsandimprovequalityoflifeinpatientswithhemorrhoids.

InadditiontomodifiedChaihuLizhongdecoction,acupuncturehasalsobeenshowntobeeffectiveinthetreatmentofhemorrhoids.AcupunctureisatraditionalChinesemedicinetreatmentthatinvolvesinsertingfineneedlesintospecificpointsonthebodytoalleviatepainandimproveoverallhealth.Severalstudieshavereportedthatacupuncturecaneffectivelyrelievethesymptomsassociatedwithhemorrhoids,suchaspain,bleeding,itching,andprolapse.Acupuncturehasalsobeenreportedtoenhanceimmunefunction,reduceinflammation,andimprovegastrointestinalmotility,whichmaycontributetoitstherapeuticeffectsonhemorrhoids.

ArecentrandomizedcontrolledtrialhasinvestigatedthecombinedeffectsofmodifiedChaihuLizhongdecoctionandacupunctureonthetreatmentofinternalhemorrhoids.Thestudyincluded60patientswithinternalhemorrhoids,whowererandomlyassignedtoeitherthetreatmentgrouporthecontrolgroup.ThetreatmentgroupreceivedmodifiedChaihuLizhongdecoctionandacupuncture,whilethecontrolgroupreceivedmodifiedChaihuLizhongdecoctionalone.Aftertreatment,thetreatmentgroupshowedsignificantimprovementsinhemorrhoidalsymptoms,includingbleeding,swelling,pain,andprolapse,aswellassignificantimprovementsinpsychologicalparameters,suchasanxietyanddepression.Incontrast,thecontrolgroupshowednosignificantimprovementsintheseparameters.

Overall,thecombinationofmodifiedChaihuLizhongdecoctionandacupuncturecanbeapromisingalternativeoradjunctivetherapyforimprovingpostoperativeoutcomesinpatientswithinternalhemorrhoids.Thismultimodalapproachthataddressestheunderlyingpathophysiology,symptoms,andpsychologicalfactorsofthediseasemayprovideaholisticandpersonalizedcareforpatientsandenhancetheirqualityoflife.However,furtherstudiesarerequiredtoconfirmthesefindingsandelucidatetheunderlyingmechanismsoftheseinterventions。Furthermore,itisimportanttonotethateveryindividualisdifferentandtheirresponsetotreatmentmayvary.Therefore,thetreatmentplanshouldbecustomizedtoeachpatient'sspecificneedsandpreferences.Itisalsoimportanttoconsultwithaqualifiedhealthcareprofessionalbeforestartinganynewtreatment.

Inadditiontoacupunctureandherbalmedicine,lifestylemodificationssuchasdietarychanges,regularexercise,andstressreductiontechniquesmayalsobebeneficialforpatientswithinternalhemorrhoids.Theseinterventionscanhelppromoteoverallhealthandwell-being,andmayalsopreventthedevelopmentorrecurrenceofhemorrhoids.

Inconclusion,theuseoftraditionalChinesemedicine,includingacupunctureandherbalmedicine,mayoffersignificantbenefitsforpatientswithinternalhemorrhoids.Byaddressingboththephysicalandpsychologicalaspectsofthedisease,thisholisticapproachcanimprovesymptoms,reduceinflammation,andpromotehealing.However,morestudiesareneededtofullyunderstandthemechanismsbehindthesetherapiesandtheirlong-termefficacy.Therefore,patientsshouldworkcloselywiththeirhealthcareproviderstodevelopapersonalizedtreatmentplanthatincorporatestraditionalandconventionaltherapiestooptimizeoutcomesandenhancequalityoflife。Moreover,itisimportantforpatientswithautoimmunediseasestomakelifestylechangesthatsupporttheiroverallhealthandwell-being.Thisincludesmaintainingahealthydiet,stayingphysicallyactive,gettingenoughsleep,reducingstress,andavoidingexposuretoenvironmentaltoxins.Theselifestylechangescanhelpboosttheimmunesystem,reduceinflammation,andpromotehealing.

Inaddition,patientswithautoimmunediseasesmaybenefitfromjoiningsupportgroupsorseekingcounselingtohelpmanagetheemotionalandpsychologicalimpactoftheirdisease.Theseresourcescanprovideasenseofcommunityandunderstanding,aswellasstrategiesforcopingwiththechallengingaspectsoflivingwithachronicillness.

Overall,thetreatmentofautoimmunediseasesrequiresacomprehensiveapproachthataddressesboththephysicalandpsychologicalaspectsofthedisease.Bycombiningtraditionalandconventionaltherapies,makinglifestylechanges,andaccessingemotionalsupport,patientscanimprovetheirsymptoms,reduceinflammation,andenhancetheiroverallqualityoflife.Itisimportantforpatientstoworkcloselywiththeirhealthcareproviderstodevelopapersonalizedtreatmentplanthatmeetstheirindividualneedsandgoals。Inadditiontotraditionalmedicaltreatmentssuchasmedicationsandsurgeries,thereareavarietyofalternativetherapiesthatcanhelpmanagesymptomsofautoimmunediseases.Theseincludeacupuncture,massagetherapy,herbalsupplements,andmeditation.Whilethereislimitedscientificevidencetosupporttheeffectivenessofthesetherapies,manypatientsreportimprovementsintheirsymptomsandqualityoflife.

Lifestylechangescanalsoplayasignificantroleinmanagingautoimmunediseases.Eatingahealthyandbalanceddiet,includinganti-inflammatoryfoodssuchasomega-3fattyacids,fruits,andvegetables,canhelpreduceinflammationinthebody.Regularexercisecanalsohelpimprovephysicalfunctionandreducesymptomssucha