"External main and internal auxiliary" treatment on refractory radiation proctitis

He Ju,Yuan-Hong Zhao,2＊,Qian-Qian Niu,Li-Na Yan,Zheng Li

1National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion/The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300381,China; 2Department of Oncology,The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300381,China; 3Department of Preparation,The First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300381,China.

Abstract Radiotherapy is an essential method in the comprehensive treatment of malignant tumors.However,radiation proctitis (RP) is a common complication of pelvic tumors after radiotherapy.Due to RP's various etiology and complex pathogenesis, it is currently no standard for traditional Chinese medicine (TCM) treatment.Professor Yuan-hong Zhao believes that refractory RP, which is named chronic hemorrhagic radiation proctitis (CHRP), should be classified as "Intestinal Wind Bleeding"(Bleeding like a note before defecation, bright red blood, no swelling and pain in the anus) and"Intestinal Afflux" (Refers to the symptoms of pus and blood in the lower mucus, similar to ulcerative colitis, peptic ulcer and other diseases in modern medicine.) in TCM.The critical pathogenesis of CHRP lies in local stasis and collaterals injury of intestinal collaterals.In general, it is a syndrome of excess and scarcity.External treatment with TCM is the preferred treatment strategy for CHRP, and the primary way is to disperse blood stasis and detoxify and nourish the intestinal collaterals.

Keywords: chronic hemorrhagic radiation proctitis; radiation proctitis; intestinal wind bleeding;internal and external treatment; dispersing blood stasis and detoxifying and nourishing the intestinal collaterals method

Background

Chronic radiation proctitis (CRP)is a common long-term complication after pelvic radiotherapy, with an incidence of up to 20%, and it is more likely to occur after radiotherapy for cervical cancer [1].Chronic hemorrhagic radiation proctitis (CHRP) is a refractory CRP mainly manifested by repeated rectal bleeding, varus, anal pain, mucus stools or associated diarrhea.It is caused by endarteritis obliterans, submucosal fibrosis, local tissue angiogenesis and vasodilation bleeding, etc [1].The disease persists and is challenging to cure, leading to iron deficiency anemia, fatigue,anxiety, depression and other psychological disorders, which seriously reduce the subsequent quality of life of patients.For CHRP, modern medicine uses endoscopic argon-ion coagulation, formalin treatment,sucralfate enema, hyperbaric oxygen therapy, and anti-inflammatory drugs.But they have disadvantages such as slow onset, serious side effects,uncertain long-term curative effects, expensive and complicated operations,etc [2–4].Colonic shunting and other surgical treatments are often used for patients with intractable symptoms [5].Iron deficiency anemia caused by long-term hematochezia is mainly treated with iron supplements, blood transfusion, and other symptomatic treatments.But blood transfusion will reverse the vasoconstriction caused by low blood volume, increase visceral blood flow and damage the formation of the blood clot, which may further aggravate local bleeding and form a vicious circle, finally affecting the overall effect of clinical treatment.In recent years, the application of traditional Chinese medicine(TCM) has shown significant advantages in the treatment of radiation proctitis (RP).It has been reported that oral administration of Qingdai combined with routine treatment of hemorrhagic CRP was effective in small samples [6].Lian Yajun et al.conducted a meta-analysis on 50 articles recording TCM enema-related clinical studies and found that TCM enema was significantly better than the control group in terms of treatment efficiency and Karnofsky score [7].There are relatively few clinical reports and literature about CRP with refractory hematochezia as the main symptom.

Professor Zhao has been engaged in clinical, scientific research and teaching for 35 years with profound thinking and a modest attitude.She has rich clinical practice experience in the disease differentiation and treatment of digestive system tumors.In the treatment of CRP, she traces the etiology by syndrome differentiation and advocates using internal and external therapy at the same time, then satisfactory results have been obtained.The clinical diagnosis and treatments with CHRP of experience of our teacher are summarized as follows.

Recognize local lesions of blood stasis blocks and collaterals injury, and focus on differentiation of disease and external treatment.

CHRP is mainly characterized by intractable hematochezia and anemia.In TCM, it is categorized into "hematochezia", "Blood Under Intestinal Wind"(TCM disease name Intestinal wind.) and "intestinal bleeding".Our teacher believes that the description of "gurgling and sound" of"intestinal bleeding"is more consistent with it.Located in the intestinal collaterals, the disease’s root cause is collaterals injury and blood stasis.Hematochezia is the main symptom of intestinal afflux and the most urgent and dangerous syndrome.Tang Rongchuan (1847–1897)proposed that "intestinal wind bleeding" was"Gan Feng Xia Xue".As the ancient book of Chinese medicine"Xuezhenglun"(a treatise on blood troubles; 1884C.E.) said: "the intestines are in the lower part, where does the wind attack? If there is "wind"(Etiological terms.It is one of the six etiological factors.Also known as climate.It belongs to Yang evil and is the leader of exogenous diseases.),wind evil of"Taiyang"(One of the names of meridians.It has the meaning of vigorous Yang Qi.) meridian outside is introduced into "Yangming" (one of the names of meridians.It is the last stage of the development of Yang Qi,and it is also the continuation of Yang Qi based on the two meridians of sun and Shaoyang.)to help heat to cause bleeding.And"Jueyin"(meridian name.It means that Yin Qi develops to the final stage and begins to transform into Yang.) liver wood inside, virtual heat generates wind to incite blood".Modern medicine also reveals that ionizing radiation can cause water in intestinal cells to generate oxygen free radicals.Oxygen-free radicals destroy DNA spiral structure and block transcription and replication to cause cell death, resulting in the destruction of the intestinal barrier and radiation enteritis [8].The toxic and side effects caused by radiation are in line with the characteristics of "fire heat" and "toxin" in TCM.An external evil enters the interior to combine internal evil, leading to the generation of fire evil.The evil of fire heat burns the intestinal collaterals, hinders the intestinal collaterals, impedes "Qi" (Qi is considered to be the force that informs and animates all things in Daoism, which is believed to flow through the body along routes known as meridians; illness is attributed to changes in the flow of Qi according to the construct of Chinese medicine.) and blood.Heat poison stays in the blood for a long time combining with liver weathering fire, and jointly injuring "Yin" (Yin and Yang are a pair of categories in ancient Chinese philosophy.The original meaning refers to the back of the sun,the sun is Yang,the back of the sun is Yin.From this extension,it is the cold and warm climate, the up and down, around, inside and outside of the azimuth,and the restlessness and tranquility of the movement state.It is used to represent the positive and negative aspects of opposites and mutual fluctuations of things, and then expounds the rules of occurrence,development and change of things.)and blood bringing about the damage of intestinal collaterals.Because of deficiency of "Qi" unable to stir up and deficiencies of "Yin" and fluid, blood viscosity is difficult to move and gradually becomes blood stasis syndrome, perhaps blood overflows and forms congestion outside the vein.The blood stasis and toxin are combined with each other, resulting in damage to the collaterals and blood overflow outside.Therefore, hematochezia is profuse and vermeil.The repeated bloody stool lasts for a long time.At any time, there will be crises such as"Qi" falling off with the blood and blood sinking with Qi.In case of emergency, the symptoms should be treated urgently, so external treatment and local disease differentiation are in the first place.

Grasp the levels of cold and heat,apply the method of Wei treatment to give an enema that we use dispersing blood stasis and detoxifying and nourishing the intestinal collaterals method.

"Methods of Wei treatment" is a therapy that adopts the method of encirclement to surround the diseases with complex pathogenesis.According to the main disease location and pathogenesis, the overall situation and key breakthroughs should be taken into account.Using this method, we select multiple treatment methods, prescriptions and drugs, simultaneously pay attention to the patient's own characteristics.Think over the exterior and interior, "Yin" and Yang, deficiency and excess, cold and heat.It not only aims at the symptoms of the disease, but also adjusts the underlying pathogenesis, so as to achieve the effect of "treating the symptoms and eliminating the root causes" [9].This method has received excellent results in clinical acute and severe problems[10].In the consensus of TCM experts,it was pointed out that "TCM retention enema" was the best scheme for the treatment of RP[11].There are abundant arteriovenous and lymphatic plexus around the colorectal, which have a strong absorption function.Local retention enema can avoid the first-pass effect of gastric acid,digestive juice and liver to make the effective components of TCM directly to the disease site.Herbal enema enters the blood through the intestinal wall mucosa and acts on the pelvic cavity through nearby lymphatic vessels and capillaries to improve the drug concentration and bioavailability of the pelvic cavity.And it can promote local blood and lymph circulation.TCM retention enema with high peak concentration and short peak time is faster in absorption and onset than pills, tablets, suppositories and decoction.Prolong the retention time of liquid medicine as far as possible and make it fully contact with the intestinal wall to maximize the efficacy.

The dispersing blood stasis and detoxifying and nourishing the intestinal collaterals enema formula for the local intestinal afflux is an empirical prescription with many years of clinical experience from our teacher.The eight medicines are composed in proportion (Baizhi (Angelicae Dahuricae Radix), Shiliupi (Granati Pericarpium), Huanglian (Coptidis Rhizoma),Huangbo (Phellodendri Chinensis Cortex) ,Cebaitan (Platycladus orientalis charcoal), Dahuangtan (Rhubarb charcoal), Danggui (Angelicae Sinensis Radix), Chuanxiong (Chuanxiong Rhizoma) and Baiji (BletillaeRhizoma)).Angelicae Dahuricae Radixwith pungent and aromatic tastes can scatter and penetrate.It enters into the channel of the lung, the stomach, and the large intestine."...the main medicine of"Yangming",so it can treat blood diseases and fetal diseases, expel pus, regenerate muscle and relieve pain", eliminate blood stasis, dispel wind.Granati Pericarpiumtastes sour and astringent, as the ancient book of Chinese medicine"Diannan Bencao"(Materia Medica Of Southern Yunnan; 1436C.E.) said: "treat the blood under the large intestine",it can astringe intestines,stop diarrhea,astringe and stop bleeding.The above two drugs are monarch drug drugs.Pharmacological studies showed thatGranati Pericarpiumhas effective components of anti-tumor and anti-oxidation,and can also improve human immunity,such as contains polyphenols, etc [12].Coptidis RhizomaandPhellodendri Chinensis Cortexhave the characteristics of cold and bitter.They can clear heat and detoxification, and harden "Yin" and thick intestines.Platycladus orientalis charcoalandRhubarb Charcoalcool the blood and stop bleeding, the latter also can reduce heat and expel blood stasis.The four drugs detoxify and disperse the knot together as minister medicine.Chuanxiong Rhizomacan harmonize blood and enrich collaterals, and play hemostasis without blood stasis, as an adjuvant in this prescription.BletillaeRhizoma, sour and astringent in nature and taste, can produce muscle, astringe and protect the skin, as a conductant drug in the prescription."Bencao Qiuzhen" (Seeking Truth From Materia Medica; 1769C.E.) metioned: "BletillaeRhizomais astringent taste ...remove rot, expel blood stasis and regenerate new".The stages and pathogenesis of radiation enteritis are complicated.This prescription can clear heat, detoxify, nourish the intestinal collaterals,hemostasis,reduce swelling and generate muscle,grasping the core elements of the pathogenesis—"heat toxin", "blood stasis", "intestinal wind" and"loss of glory".It can not only treat the emergency of"collateral injury" and bloody stool, but also adjust the pathogenesis behind it by means of drugs and multiple points.Besides repairing local intestinal wall injury, the drugs in the formula also have multiple effects such as anti-cancer,anti-oxidation,antibacterial and anti-inflammatory, analgesia and spasmolysis, etc.In clinical practice, the proportion of medication can also be flexibly adjusted on the basis of the specific symptoms of patients.For example, if the anal pain is serious, the dosage ofAngelicae Dahuricae Radixcan be increased.This prescription is repeatedly used and effective, taking effect quickly within seven days and maintaining efficacy.There is little recurrence in clinical practice.So far,no adverse reactions have been found.

Combine with the overall syndrome differentiation, flexibly use the Qingxin Fupi Jieyu formula

The nature of the disease is deficiency-excess mixing.Local intestinal wind blood caused by "blood stasis and collateral injury" is the core key to be solved urgently.Deficiency syndrome refers to disharmony of viscera and"Qi", and involves liver prosperity and spleen deficiency with depression(heat).The overall syndrome differentiation can not be ignored.The disease is mainly located in the large intestine, originally in the spleen and stomach,and is also closely related to the liver and heart."The liver is the viscera where blood is stored", liver controlling dispersion.If the emotion is not smooth, the spleen restricted by "Qi" stagnation of the liver will lead to abdominal pain."Qi" Depression turns into heat over time, together with radiation heat toxicity, consuming the true "Yin" of liver and kidney, finally resulting in vacuity wind stirring internally.As booka treatise on blood troublesmentioned: "Liver is the viscera of wind wood, which mainly stores blood,and the blood disturbed by wind cannot be stored,there is a disease of intestinal wind bleeding"."The spleen governs the blood", it is the foundation of the day after tomorrow.Chemotherapy and radiotherapy injury the spleen unable to operate normally, causing a lack of source of "Qi" and blood.The above coupled with bloody stool causes a significant deficiency of "Qi" and blood, unable to nourish the whole body.The following symptoms occur: visible fatigue, shortness of breath, unsightly complexion,etc.If "Qi" of the spleen does not control the blood with the stagnation of"Liver Qi" (name of disease syndrome.Diseases and syndromes caused by abnormal release of Liver Qi), it is easy to induce and aggravate hematochezia.Spleen-stomach disharmony and imbalance of liver and spleen lead to growth in dampness and turbidity.Long accumulation of dampness producing heat pour the intestine,together with local fire heat and toxin, steaming and rotting fat collaterals, the following symptoms occur:various mucus stool, pus and blood stool, and even intestinal fistula."Thinking leads to "Qi" stagnation" means that thinking is easy to lead to sluggish"Qi"of the spleen,and there will be indigestion and loss of appetite,ruffian fullness abdominal distension, diarrhea, abdominal pain and other symptoms."Heart controlling blood circulation", controls mental activities and is the great lord of the five Zang organs."Blood is the material basis of God", blood deficiency cannot nourish spirit, together with liver fire disturbing the heart, appearing fullness of thoracic flank, dreaminess and sleeplessness, etc.Blood deficiency can not nourish the heart, and heart regulating blood circulation is also abnormal.There will be manifested as palpitation, chest tightness, pulse deficiency and weakness, etc."All kinds Diseases with Pain, Itching and Sore are Exclusively Related to the Heart".Although the disease occurs in the intestinal mucosa, the long-term stagnation of the sickness is also related to the stagnant heat of the heart’s Yinfen.It can be seen that the pathological changes of intestinal collaterals in varying degrees will not only lead to the loss of local "Qi" and blood, but also bring to the imbalance of function of"Zang and Fu"(Zang Fu organs are the internal organs of the human body in Traditional Chinese medicine.The heart, liver, spleen, lung and kidney are the five organs, while the stomach,gallbladder, trijiao, bladder, large intestine and small intestine are the six organs.), "Yin and Yang" (Yin and Yang can represent opposite things or phenomena as well as two opposite aspects of the same thing or phenomenon.Generally speaking, everything moving, outward, ascending,diffuse, warm, bright, excited belongs to Yang; Relative static, internal,falling, condensed, cold, dull, suppressed are Yin.), "Qi" and blood.The liver,spleen and heart are involved, affecting each other,further aggravating the intestinal bleeding symptoms of refractory radiation enteritis.

In different stages of clinical CHRP disease, patients are often accompanied by emotional anxiety.It is inseparable from syndrome differentiation and treatment of the liver, spleen and heart.Aiming at the emotional disorders related to cancer patients, our teacher puts forward that the core of the pathogenesis lies in the imbalance of"Yin and Yang"and"Qi"and blood in the Zang-Fu organs, which mainly refers to liver prosperity,spleen deficiency and stagnant heat disturbing the heart.The teacher treated cancer-related depression, sleep disorders, cognitive dysfunction and adverse reactions related to tumor treatment by Qingxin Fupi Jieyu method,and achieved remarkable results [13–19].The etiology and pathogenesis of CHRP are diverse and complex.The core pathogenesis of emotional disorders and internal and external comorbidities overlap each other.Clinically, we should examine the evidence and seek the cause to achieve"homotherapy for heteropathy".Based on Zang-Fu organs, Professor Zhao skillfully uses the Qingxin Fupi Jieyu method to treat CHRP.This way can not only smooth emotions but also regulate and replenish "Qi" and blood so that the liver can store blood,the spleen can regulate blood,and the heart can play a major role.Oral Decoction of TCM is able to be an auxiliary for external enema treatment,which has achieved good results.

Typical case

On March 3, 2020, a 61-year-old female chief complained of chronic bloody stools and fatigue and consulted Professor Zhao.The patient was diagnosed as cervical squamous cell with carcinoma stage ⅢB, in April 2018.From May 29, 2018 to July 19, 2018, the patient received cavity plus afterloading radiotherapy and 6 cycles of chemotherapy at the same time.In September 2018, colposcopy re-examination displayed: no squamous epithelium was found.Meanwhile, MRI reported: 1.the performance of cervical cancer after radiotherapy and chemotherapy 2.Splenomegaly 3.Decreased liver signal.During the 14th round of radiotherapy, the patient suddenly developed progressively worse abdominal pain, diarrhea, and frequent defecation.In order to ensure the long-term effect, the patient insisted on completing 27 times of radiotherapy.At the end of June 2019,the patient began to have frequent massive hematochezia with multiple blood clots and abdominal pain.Mesalazine suppository and Mesalazine tablets were once used, but blood in stool was persistent.On December 20, 2019,the patient's colonoscopy showed: at 15 cm away from the anus, and there was mucosal telangiectasia with congestion and erosion; the intestinal wall was fragile and easily shed blood after slight touch, suggesting hemorrhagic RP.At the first visit, she suffered from pure fresh bloody stool 3–4 times every two days accompanied by abdominal pain, the amount of blood in the stool was large with blood clots, and there was a sense of urgency in her anus.She had a pale complexion with palpitation and chest tightness,easy to gasp after activity.And her sleep quality was poor.Tongue image:light and dark tongue, thin and white fur.Main feature of Pulse-feeling: heavy and thin pulse.(See Table 1 for blood routine).She had a history of HBV infection.The diagnosis of western medicine was CRP Level 2(according to the response score standard after radiotherapy (RTOG/EORTC)) [20],moderate and severe anemia, cervical cancer after radiotherapy and chemotherapy, compensatory liver cirrhosis.The diagnosis of TCM was“intestinal afflux”,the local syndrome differentiation was heat toxin injuring collaterals and blood stasis syndrome, and the overall syndrome differentiation was strong liver and weak spleen with depression syndrome.The patient was suggested to be treated with TCM decoction combined with local retention enema,but she was unwilling to accept external treatment due to inconvenient operation.Professor Zhao gave her a prescription that included modified Xiaoyao Powder combined with Danggui Buxue decoction, the specific composition was as follows: Raw Puhuang (Typhae Pollen)15g, stir-friedTyphae Pollen15g, Cebaiye (Platycladi Cacumen)15g,Huangqin (Scutellariae Radix)12g,Huangqi (Astragali Radix)30 g,Wuweizi(Schisandrae Chinensis Fructus)6g, Taizishen (Pseudostellariae Radix)30g,Angelicae Sinensis Radix6 g, Yimucao (Leonur Iherba)30g, Mujinhua(Hibiscus Syriacus Linn.)15g, Chaihu (Bupleuri Radix)6g, Baishao(Paeoniae Radix alba)6 g, Fuling(Poria)15g, stir-fried Baizhu(Atractylodis macrocephalae Rhizoma)15g, Bohenao (Menthol)6g, Muli(Ostreae Concha)30g (it needs to be boiled first), and Jixueteng (Spatholobi Caulis)15g.Prescribe a total of 14 doses and instructe her to add Shengjjiang(Zingiberis Rhizoma Recens) and Dazao (Jujubae Fructus) when decocting medicine,1 dose per day.After that,she continued to use it for two weeks.

Table 1 Changes of related indexes before and after treatment

At the second visit on April 2, 2020, the patient's character and frequency of stool tended to be normal,bloody stool reduced to 3–4 times a week, and her fatigue was significantly relieved.However,she was admitted to the hospital with anemia due to the recheck of hemoglobin 68g/L.After infusion of component blood, she had blood splashing in his stool and also became more restless.Tongue image: light tongue and red tip of tongue,thin white fur.Main feature of Pulse-feeling: thin pulse.Therefore, Professor Zhao adjusted the medication to increase the amount ofSchisandrae Chinensis Fructus,Pseudostellariae Radix,Paeoniae Radix albaandOstreae Concha, add extensive Sangye (Mori Folium)mulberry leaves, Jili(Tribuli Fructus)Tribulus Terrestris and Fangfeng (Saposhnikoviae Radix).It was important that Professor Zhao required the patient to accept the enema scheme and gave the retention enema with the formula of dispersing blood stasis and detoxifying and nourishing the intestinal collaterals.The usage was as follows:1.the drugs are decocted in proportion,taking 100ml from it 2.the optimum temperature of liquid medicine is 38–40℃3.the patient need to empty their intestines before enema, keep lateral position and raise the hips 4.the thin and soft catheter is gently inserted into the anus 15–20cm after lubrication 5.enema liquid is slowly and uniformly dripped and kept for as long as possible 6.once a day.The stool frequency and blood volume on that day were significantly reduced, and the effect was immediate.The patient voluntarily asked for both internal and external treatment for one month.

At the third visit on May 4,2020,she was in good spirits and had a rosy complexion.She defecated twice a day, occasionally saw a little blood on toilet paper every week.Due to fear of secondary damage to the intestinal wall,she did not undergo enteroscopy reexamination.Pelvic CT showed that the cervix was in line with the changes after radiotherapy and chemotherapy,and there was no abnormality in the intestinal wall, especially no recurrence or metastasis of cancer was found in the pelvic cavity.The following table combs the patient's reexamination results and physical fitness evaluation.After the first visit,the reduction of white blood cell and platelet and fatigue degree was significantly alleviated, and the anemia state returned to the normal level after the second visit combined with TCM enema.CRP level had been reduced to 0–1, and the quality of her life had been significantly improved.She has been followed up for one and a half years, and the bleeding of the stool has been rare.At present, the combined medication is used three times a week,and her life is pleasant and contented.

Note:

This patient has a history of cervical malignancy, who used high-dose radiotherapy combined with chemotherapy, bringing about acute radiation proctitis (ARP).And she was complicated with previous history of liver cirrhosis, splenomegaly and thrombocytopenia.Her endoscopic presentation showed varicose changes in perianal veins.She suffered from symptoms of frequent and long-term non-healing bloody stool along with moderate and severe anemia.The above information combined with endoscopic findings was consistent with the diagnosis of CHRP.In this case,our teacher analyzes primary and secondary relations, paying attention to the physiological characteristics of menopausal women and the emotional disorders such as anxiety and tension caused by tumor radiotherapy and chemotherapy.The first visit was to take oral Chinese medicine to adjust steady-state with inhibiting liver, relieving depression and strengthening spleen.Professor Zhao used Xiaoyao powder to relieve liver depression and strengthen spleen weakness.As the old saying goes: "tangible blood cannot grow quickly, and intangible "Qi" should be urgent and solid", Danggui Buxue decoction was used to replenish "Qi" and generate blood.Spatholobi Caulis, which tastes pungent and is warm can dredge collaterals, nourish blood and strengthen tendons.Xianhecao (Agrimoniae herba) can stop the bleeding and tonify deficiency.Mohanlian (Ecliptae Herba) and various coals play the function of tonifying liver and kidney,cooling blood and hemostasis.Pseudostellariae RadixandSchisandrae Chinensis Fructusare able to replenish "Qi", "Yin"and calm mind.Baihua Sheshecao (Hedyotis diffusa willd) andAgrimoniae herbacan clear the heat toxin in the intestine.Ostreae Conchanourish "Yin and Yang", making patient calm down.During the second visit, local hematochezia after blood transfusion was aggravated, and the disease was urgent."Only hemostasis was the first method".External medication retention enema was immediately used to alleviate the symptoms of an illness.Combined with tongue image and medical history, our teacher considered that the patient's virus lived in the Yinfen and the blood was hot and transpiration.It was recommended to add drugs for dispelling wind,cooling liver and clearing heat.And drugs for increasing"Qi"and nourishing"Yin" was added quantity to consolidate "Qi" and blood and moisten the whole body.After using an enema, the patient's stool blood stopped immediately, and it worked very quickly.In this case, the overall condition can be improved when taking TCM only orally, but the local condition was not solved, the blood in the stool continued repeatedly.The local enema can directly act on the focus and took effect quickly combined with oral administration of TCM,it won greatly.Now the patient insists on medication to consolidate the curative effect.

Conclusion

With the popularization and application of radiotherapy,the incidence rate of radiation enteritis is increasing year by year.Professor Yuan-hong Zhao emphasizes that in the treatment of this disease,external treatment is the key in the treatment of this disease and the root cause and symptoms should be given reasonable consideration, which is of great significance to the prognosis and quality of life of CHRP patients.In view of the core pathogenesis, local disease differentiation should be treated by enema.In case of this emergency,the intestinal wind bleeding should be saved,and the mucosal damage should be repaired quickly,aiming to take effect safely.The empirical formula—dispersing blood stasis and detoxifying and nourishing the intestinal collaterals TCM enema should be used to act on local lesions directly.According to the evolution characteristics of pathogenesis, the main method is to Qingxin Fupi Jieyu in the overall syndrome differentiation.This way can clear the heart and detoxify, cool the liver, protect the spleen,regulate and supplement"Qi"and blood,and improve systemic symptoms.In order to maximize the therapeutic effect and benefit of drugs, TCM internal administration and TCM enema should be used at the same time, so as to achieve comprehensive coordination between internal and external, root cause and symptom, local and whole, virtual and reality.The TCM enema formula for dispersing blood stasis and detoxifying and nourishing the intestinal collaterals used in this paper has applied for a patent.