1. Knee-chest position: The patient kneels on the examination table, with his chest close to the bed surface and his hips raised. It is suitable for patients with lower rectum, anterior rectal wall or obesity. Squat position: the patient squats hard to increase abdominal pressure. In order to check the common postures of prolapsed diseases, internal hemorrhoids, rectocele and polypoid hemorrhoids. It can be found in phase II and III.
2. Location of internal hemorrhoid: 3,7, 1 1 point on the dentate line. The position of external hemorrhoids: below the dentate line (thrombotic external hemorrhoids: 3 o'clock, 9 o'clock; Sesame cake hemorrhoids: 6, 12 points). Location of mixed hemorrhoids: above and below the dentate line.
3. In the main clinical manifestations, internal hemorrhoids are hematochezia, swelling and mass prolapse; External hemorrhoids are swelling, pain and foreign body sensation; Mixed hemorrhoids are internal hemorrhoids+external hemorrhoids.
4. Pathogenesis of internal hemorrhoids: heat and blood are related, qi and blood crisscross, tendons and veins crisscross, and blood stasis does not disperse.
5. Internal hemorrhoid staging? Stage I internal hemorrhoids: hemorrhoid nucleus is small, not prolapsed, and blood is the main factor. Stage II internal hemorrhoid: The hemorrhoid nucleus is large, which can be pulled out from the anus, and it will recover automatically after defecation, and the stool is more or less bloody. Stage III internal hemorrhoids: The hemorrhoid nucleus is large, which will come out during defecation and cannot recover by itself. It must be pushed back by hand, and there is little or no blood in the stool. Stage Ⅳ Internal hemorrhoids: Hemorrhoid nucleus prolapse, unable to recover in time, incarcerated outside, resulting in incarcerated internal hemorrhoids.
6. Classification of external hemorrhoids? Connective external hemorrhoid: There is no varicose vein in hemorrhoid, and the main symptom is anal foreign body sensation. Varicose external hemorrhoids: the external venous plexus of hemorrhoids is enlarged and varicose. The main manifestations are the discomfort of falling and swelling. Thrombotic external hemorrhoid: external hemorrhoid vein rupture bleeding. It is characterized by sudden and severe pain in anus and dark purple lump; It usually occurs at 3 or 9 o'clock in the lithotomy position of the bladder.
7. The treatment of internal hemorrhoid wind hurting intestinal collateral syndrome is mainly to clear heat, cool blood and dispel wind, and the representative prescription is Liangxuehuangtang/Huaihua Powder. The treatment of damp-heat downward flow syndrome is mainly to clear heat, ooze dampness and stop bleeding, and the representative prescription is Zanglian Pill. The treatment of qi stagnation and blood stasis syndrome is mainly to clear heat and promote diuresis, dispel wind and promote blood circulation, and the representative prescription is Zhitong Rushen Decoction. The treatment of spleen deficiency and qi stagnation syndrome is mainly to replenish qi and promote qi, and the representative prescription is Buzhong Yiqi Decoction.
8. Ligation: Simple ligation is suitable for internal hemorrhoids I and II; Penetrating ligation is suitable for stage ⅱ and ⅲ internal hemorrhoids, especially fibrous internal hemorrhoids. The apron ligation method is suitable for stage ⅱ and ⅲ internal hemorrhoids and mixed hemorrhoids.
Example Which of the following is the representative of wind-induced intestinal collateral injury syndrome in internal hemorrhoids:
A. Huai Hua San Cang Lian Wan
C. Zhitong Rushen Decoction D. Buzhong Yiqi Decoction
Answer A. Analysis: The treatment of internal hemorrhoid wind hurting intestinal collaterals is mainly to clear heat, cool blood and dispel wind, and the representative prescription is Liangxuehuangtang/Huaihua Powder. The treatment of damp-heat downward flow syndrome is mainly to clear heat, ooze dampness and stop bleeding, and the representative prescription is Zanglian Pill. The treatment of qi stagnation and blood stasis syndrome is mainly to clear heat and promote diuresis, dispel wind and promote blood circulation, and the representative prescription is Zhitong Rushen Decoction. The treatment of spleen deficiency and qi stagnation syndrome is mainly to replenish qi and promote qi, and the representative prescription is Buzhong Yiqi Decoction.