Doctor says I have internal hemorrhoids, what should I do?

Open Category: Medical, Science, Disease, Medicine, Hemorrhoids

Clinical manifestations of internal hemorrhoids

1. Preferably above the anal dentate line, the truncus is located at 3, 7, 11 points.

2. The main symptom is bleeding during stool, or with hemorrhoidal prolapse.

3. The initial stage (work stage) hemorrhoid nucleus is small, soft, hemorrhoidal surface bright red or greenish purple, defecation hemorrhoid nucleus does not prolapse out of the anus. Bleeding during defecation or bleeding after defecation, in the form of drips or jets, bright red blood, not mixed with feces, intermittent episodes.

In the middle stage (stage II), hemorrhoids are large and bulging, and the hemorrhoids prolapse out of the anus during defecation, and then retract on their own after defecation. Bleeding after defecation is less than in the early stage.

Post-phase (Ⅲ) hemorrhoid nucleus is bigger, harder, the surface is slightly grayish-white, the hemorrhoid nucleus is out of the anus, even when walking, coughing, sneezing, or standing, can not be self-recovery, have to be pushed back, or lying down, hot compresses can be reincorporated, the blood is not much or no longer bleed.

4. Generally no pain feeling, in the middle and late may have anal swelling, itching. If the hemorrhoidal nucleus prolapse embedded, can cause swelling and pain, erosion, necrosis, or even pus, secondary anal fistula and other evidence.

5. generally no systemic symptoms. In the later stage, some may be secondary to anemia, fecal difficulties, urine is not easy to empty and other symptoms.

6. This disease needs to be differentiated from the following anal diseases.

Polyp hemorrhoids: for the lower end of the rectum produced polyps, thin, tender, root thin, bright red color. Generally single, occasionally a series of two, thirty as many, like grapes. They may prolapse out of the anus during defecation and are most common in children.

Locked hemorrhoids: the swelling can not come out of the anus, palpation of its hard and uneven. The anus is narrowed, the stool becomes thin, or stool as dysentery, the frequency increases, the urgency and heaviness, when the flow of foul-smelling pulp sewage. Mostly seen in middle-aged and elderly people over 40 years old.

Anal fissure: It occurs at 6 or 12 o'clock in the truncus position, with a fissure in the anus, a small amount of blood, pain during bowel movement, and sometimes the pain lasts for several hours after bowel movement.

Proctosis: ① rectal prolapse prolapse: prolapse color light red, shaped like a spiral and hierarchical, its quality is hard. Mostly seen in frail children and the elderly. ② rectal mucosal prolapse prolapse: there is a ring or part of the mucosa prolapse, its color is bright red, soft, no hemorrhoids high protrusion, slightly oozing blood. Mostly seen in the elderly, occasionally seen in patients after internal hemorrhoid surgery.

--------------------------------------------------------------------------------

Symptoms of internal hemorrhoids

This disease is mainly due to dietary irregularities, over-eating alcohol and wine, spicy and cold stimulation, or hunger and satiety. It is characterized by painless blood in the stool, and in the late stage there may be hemorrhoidal nucleus prolapse.

This disease is characterized by blood, swelling and itching, prolapse and constipation as the four main symptoms. The blood in the stool is due to the blood injury, but due to the different physique, the difference in the sense of evil, and there is a distinction between the real and the imaginary. The real blood is bright red, or red and dirty, such as drops such as shot, constipation, abdominal pain and refusal to press; the false blood is light red and thin, or obscure and not fresh, accompanied by fatigue. Swelling and itching pain is due to the lower jiao damp heat, agglomeration of anus, qi and blood rebellion, tendons and veins horizontal dissolution, blood stasis, hair for hemorrhoids swelling and itching pain. If the qi and blood deficiency, qi deficiency ascension powerlessness, the hemorrhoidal nucleus prolapse, not easy to return to the main; qi deficiency does not regulate, blood does not astringent gas, stool blood color pale and more.

Patients with internal hemorrhoids, can be due to anal swelling and frequent stool, or fear of bleeding and dare not defecate, resulting in the internal organs of the gas is not smooth and constipation occurs. Constipation is also divided into real and real, real constipation for real heat knot, burning fluid, gastrointestinal dry knot, dry and difficult to dissolve, abdominal pain; false secret of the gas deficiency lung loss of purgation, the large intestine conduction powerlessness, or blood deficiency Jin wither, gastrointestinal dry knot, abdominal distension, constipation, palpitations and sweating. Treatment is based on clearing heat and moistening dryness, cooling the blood and stopping bleeding, and benefiting the qi and astringency.

--------------------------------------------------------------------------------

Treatment of internal hemorrhoids

Blood injury type

Demonstration The actual person's stool blood is bright red in color, or red and dirty. The actual person's blood is bright red, or red and dirty, before and after the bowel movement is uncertain, the amount of more or less varies, such as drops such as the shot varies. The hemorrhoidal nucleus is bright red, dry and secretive, abdominal pain and refusal to press, dry mouth and tongue, yellow dry moss, pulse is strong.

The false evidence of the blood color light red thin, or obscure and not fresh, the anus sheer pain, fatigue, tongue pale, weak pulse.

The treatment: For the positive cases, clearing away heat and cooling the blood is recommended, while for the deficiency cases, strengthening the spleen and taking in the blood is recommended.

Prescription

1. The main prescription

(1) clearing heat and cooling the blood, choose cool blood, dihuang tang (Qi Kun, "Surgery Dacheng") plus subtraction

Prescription: 15 grams of raw dihuang, 9 grams of red peony, 9 grams of Hovenia, 9 grams of Scutellaria, 12 grams of acacia, 12 grams of elm, 9 grams of Huanglian, 9 grams of jingdao, 6 grams of licorice, 6 grams of windbreaks, 9 grams of mudanpi. Water decoction, 1 dose daily.

For constipation, add 12 grams of Psidium guajava kernel (beaten), 12 grams of flaxseed (beaten).

(2) Strengthening the spleen and blood regeneration formula selects Gui Spleen Tang (Yan Yonghe "Jisheng Fang") plus or minus

Prescription: 30 grams of Codonopsis pilosulae, Poria cocos 12 grams, 9 grams of Atractylodes macrocephala, Astragali 15 grams, 9 grams of Angelica sinensis, 9 grams of Atractylodes macrocephala, Scutellaria baicalensis charcoal 6 grams, Panax quinquefolii charcoal 9 grams, Agaricus indica charcoal 9 grams, Agaricus indica 6 grams (melting to be taken). Water decoction, daily l dose.

2. Proprietary Chinese medicines

(1) Dirty Lian Pill, 9 grams each time, twice a day, warm water. Suitable for solid evidence.

(2) Bile Bean Pill, 3 pills each time, twice a day, with warm water. It is suitable for solid symptoms.

(3) Gui Spleen Pills, 9 grams each time for honey pills, 6 grams each time for water honey pills, 3 times a day, with warm boiled water. It is suitable for the deficiency syndrome.

(4) Shiquan Dachan Pill, honey pill 9 grams each time, water honey pill each time 6 grams, 3 times a day, warm boiled water. It is suitable for the deficiency syndrome.

3. Single formula prescription

(1)Compound Dirty Lian Pill (Chen Songshan prescription)

Prescription: 156 grams of charcoal of the ground elm, 150 grams of Huang Huang, 150 grams of Scutellaria baicalensis, 150 grams of windbreaks, 150 grams of raw rhubarb, 150 grams of charcoal of Thornybush, 250 grams of raw acacia, 250 grams of flaxseed, 250 grams of raw dizhen, pig intestines, 5 vice. The above medicines *** research fine powder, made of honey pills, such as sycamore seeds, divided into 20 grams per bag. Each time to take 5 grams, 2 times a day, 10 days for a course of treatment. Applicable to internal hemorrhoid bleeding, prolapse and embolism, internal and external hemorrhoids.

(2) elimination of hemorrhoid soup (Ling Chaoguang prescription)

Prescription: 10 grams of umeboshi, 10 grams of WuBeiZi, 15 grams of bitter ginseng, 10 grams of shotgun, 10 grams of shelled andrographis paniculata, calcined zaoyao 30 grams, 10 grams of flaxseed. Water decoction, 1 dose per day.

If the blood in stool is very serious, add the charcoal of ground elm and the leaves of cypress. Inflammation, add cypress, Huang Huanglian. For constipation, add senna. If the pain is severe, add frankincense, Yanhuosuo. For anal distension, add Mucuna pruriens and Citrus aurantium. For spleen deficiency, add Astragalus, Pueraria Mirifica, Shengma. Suitable for hemorrhoid bleeding, swelling and pain, prolapse.

Lower Jiao damp-heat type

Demonstration Hemorrhoids prolapsed outside the anus, color purple red moist, conscious of anal distension and pain, seems to have a sense of urgency and heaviness. Fecal discomfort, accompanied by bleeding, urine yellow and red. The tongue is red, the moss is yellow and greasy, and the pulse is slippery or stringy.

Treatment Clearing heat and removing toxins, dispelling wind and removing dampness.

Prescription

1. Main prescription

(1) Fangfeng Qin Macrophyllae Soup (Chen Shikong "Surgery Zhengzong") plus and minus

Prescription: 9 grams of Fangfeng, 15 grams of Gentiana Macrophyllae, 9 grams of Angelica sinensis, 15 grams of Dibasic radix et rhizoma, 9 grams of Paeonia lactiflora, Poria 12 grams, Forsythia 9 grams, betel nut 9 grams, 12 grams of Dijie, 12 grams of acacia, Hovenia citriodora 9 grams, dahuric dahurian dahurian, Cangzhu 9 grams, Gan cao 6 grams, gardenia jasmine. Licorice 6 grams, gardenia 9 grams, zedoary 9 grams. Water decoction, 1 dose daily.

(2) if the damp-heat and stasis, swelling and pain for itching, can be used to relieve pain, such as God Soup (Wu Qian et al. "Medical Zong Jinjian")

Prescription: Gentiana Macrophyllae 15 grams, Cangjiazui 9 grams, 12 grams of peach kernel, Saponaria pinnatifida 9 grams, 9 grams of fengfeng, Phellodendron Bark 9 grams, Angelica sinensis tail 9 grams, Zedoarya 12 grams, betel nut 9 grams, 9 grams of rhubarb. Water decoction, daily l dose.

2. Proprietary Chinese medicines

(1) Diyu Saijiao Pill, 9 grams each time, twice a day, warm water.

(2) hemorrhoids speed Ning, each 9 grams, twice a day, warm water.

3. Single formula prescription refer to the blood injury evidence single formula prescription.

Qi and blood deficiency type

Evidence Hemorrhoids prolapse, not easy to return. In case of Qi deficiency, there is a feeling of falling in the anus, shortness of breath and laziness, lack of food and fatigue, blood in stool; in case of Blood deficiency, the blood in stool is pale in color and large in quantity, dizziness and dizziness, whiteness of the face, fatigue and palpitation. The tongue is pale and the pulse is weak and feeble.

Treatment: Tonify Qi and elevate, nourish Blood and soften the Liver.

Prescription

1. Main prescription

(1) tonifying the middle and benefiting the qi (Li Gao "Dongguan Ten Books") combined with the prolongation and reduction (Chen Shiwen et al. "Taiping Huimin Hejian Burei Fang")

Prescription: 30 grams of Astragalus, 30 grams of Radix et Rhizoma Ginseng, 9 grams of Sheng Ma, 6 grams of Radix Bupleurum Chinense, 9 grams of Atractylodes Macrocephalae, 9 grams of Radix Angelicae Sinensis, 9 grams of Paeoniae Lactiflorae, 9 grams of Poria, 6 grams of Radix glycyrrhizae, 9 grams of Sophora japonica, 12 grams of Radix Dioscorea Sagittata, 12 grams of Rhizoma Glycii. Sheng Di Huang 12 grams. Water decoction, daily l dose.

(2) If the deficiency of qi and blood is more serious, use Ten Complete Great Replenishment Soup (Chen Shiwen et al. "Hejiaobu Fang") with additional subtraction

Prescription: Astragalus 30 grams, Radix et Rhizoma Ginseng 30 grams, Atractylodes Macrocephala 12 grams, Poria 12 grams, Ligusticum Chuanxiong 6 grams, Radix Angelicae Sinensis 9 grams, Radix Rehmanniae Praeparatae 18 grams, Paeoniae Lactiflora 9 grams, Radix et Rhizoma Glycyrrhizae Praeparatae 6 grams, Jujubes 9 grams, Agaricus Bidentatae 9 grams (melted), Radix et Rhizoma Glycyrrhizae 9 grams (after the next dose). Water decoction, 1 dose daily.

2. Proprietary Chinese medicines

(1) tonifying the middle and benefiting the qi pill, honey pill each time 9 grams, water honey pill each time 6 grams, 3 times a day, warm boiled water to take.

(2) Shiquan Dazhong Pills, honey pills 9 grams each time, water honey pills 6 grams each time, 3 times a day, warm boiled water.

3. Single formula prescription refer to the single formula prescription of the blood injury certificate.

Constipation type

Signs Solid constipation, abdominal distension and pain, stool refuses to be pressed, dry mouth and belching, heartburn. The moss is yellow and dry, and the pulse is strong. In the case of deficiency constipation, abdominal pain, distension and fullness, dizziness, palpitations and spontaneous sweating. The lips and tongue are pale and the pulse is weak.

Treatment For solid secretion, it is better to pass the internal organs and remove heat; for deficiency secretion, it is better to moisten the intestines and pass the bowels.

Prescription

1. The main prescription

(1) through the bowels of the diarrhea and heat prescription selection of Da Cheng Qi Tang (Zhang Zhongjing "Treatise on Typhoid Fever") flavored

Prescription: 9 grams of rhubarb (after the next), Mann Nitro 9 grams (punch), Citrus aurantium 9 grams, thick Park 9 grams, acacia 9 grams, Laptopus 15 grams, 9 grams of honeysuckle, 6 grams of licorice. Water decoction, 1 dose per day, in order to pass the distension reduced to the degree.

(2) Run soup laxative formula selected to increase the liquid Cheng Qi Tang (Wu Jutong, "WENDING DISCUSSION") and the five kernel pill (Gui Yilin, "World Medicine") plus and minus

Prescription: XuanShen 9 grams of raw rhubarb 12 grams of maitake 9 grams of rhubarb 9 grams of licorice 6 grams of apricot kernels 9 grams of YuLiRen 12 grams of flaxseed 12 grams (broken), ChenPi 9 grams of acacia horn 9 grams of citrus aurantium 9 grams. Water decoction, daily l dose.

2. Proprietary Chinese medicines

(1) oxalic acid detoxification tablets, 3 tablets each time, 3 times a day, warm water. Suitable for solid constipation.

(2) Liang Diaphragm San, 9-15 grams per day, plus bamboo leaves l, a little honey, decocted in water and taken in 2 times. It is suitable for solid constipation.

(3) Run intestines pill, each time 9 grams, 2 times a day, warm water, applicable to false constipation.

(4) Ma Ren Zi Spleen Pill, 10 grams each time, twice a day, with warm water. It is suitable for deficiency constipation.

3. Single formula prescription refers to the single formula prescription for the blood and blood network injury certificate.

--------------------------------------------------------------------------------

External treatment of internal hemorrhoids

1. Fumigation All stages of internal hemorrhoids can be medicines and water boiling, first smoked and then washed. Commonly used for five times the soup or bitter ginseng soup, or choose to use mangosteen, honeysuckle, forsythia, bitter ginseng, ground elm, amaranth, Sichuan pepper and other 1 to 2 flavors of decoction water fumigation. Fumigation can play the role of activating blood swelling, clearing heat and pain, astringency and itching.

2. external compress internal hemorrhoids late, hemorrhoidal surface erosion oozing, temporarily inoperable, can first use the above method of fumigation of the affected area, and then use the five times the seeds scattered, eliminating hemorrhoids scattered with withered alum powder external compress. The external application has the effect of clearing away heat and swelling, stopping pain and convergence and stopping bleeding, which can make the hemorrhoid nucleus shrink, and the ulcerated surface healing.

3. Plug medicine I, II, III stage of internal hemorrhoids and internal hemorrhoids after surgery is inconvenient to the dressing, the drug can be made into a paste or embolus, Cypriot anus, to achieve the purpose of heat dissipation of swelling, analgesia and stop bleeding. Plugging medicine can be used to choose nine Hua cream, comfrey cream, etc..

4. withered hemorrhoids method

To medicine or medicine nail inserted into the hemorrhoidal nucleus, so that hemorrhoids dry necrosis, shedding and healing. Now the general use of arsenic-free medicine nail such as seven immortal strip, two yellow withered hemorrhoids nail, etc..

Indications: Ⅱ, Ⅲ stage of internal hemorrhoids, internal and external hemorrhoids of the internal hemorrhoid part.

Contraindications: concurrent with various acute diseases, severe chronic diseases, acute inflammation of the anorectum, diarrhea, malignant tumors, bleeding patients, as well as allergic to arsenic.

Operating method: preoperative clean enema, take the lateral position or truncated position, fully expose the anus. After washing with saline. Turn out the hemorrhoidal nucleus outside the anus, fix the hemorrhoidal nucleus with the left index finger and middle finger, and make surface disinfection. With the right thumb, forefinger holding the tail section of the nail, at 0.3-0.5 cm from the dentate line, and the longitudinal axis of the intestinal wall into the direction of 250.350 rotary insertion of submucosal hemorrhoidal nuclei in the center, the depth of about l cm. Generally, each nucleus is inserted into 4 to 6, or depending on the size of the hemorrhoidal nucleus. Spacing is 0.3 ~ 0.5 cm. Then cut off the excess nail exposed in the hemorrhoidal nucleus, nail root exposed about 1 mm. Too short easy to cause socket bleeding, and not easy to fix; too long is easy to damage the opposite side of the intestinal wall. And then push the hemorrhoid nucleus back into the anus. The same method to deal with other hemorrhoids, a maximum of three at a time. Each insertion of the nail is completed, at the same time, Cypriot Yellow Cream or comfrey ointment. Generally about 7 days hemorrhoids shrink and fall off.

Precautions: the insertion of nails can not overlap, the depth is appropriate, too deep can make the sphincter muscle damage necrosis, infection and pain; too shallow nails are easy to fall off, resulting in the socket bleeding, can not achieve the therapeutic purpose. First insert the small hemorrhoid nucleus, after inserting the large hemorrhoid nucleus, or first insert the hemorrhoid nucleus with bleeding point, in the bleeding point insert nail 1 can stop bleeding. The distance between the nail and the tooth line should be correctly grasped when inserting the nail, too close can cause pain. The total number of nails inserted at one time is not more than 20.

Postoperative treatment: 24 hours after the operation, do not defecate, in order to prevent the nail slippage caused by bleeding. If the hemorrhoidal nucleus comes out after defecation, it should be pushed back immediately to avoid edema embedded causing severe pain, and supplemented with hemostatic swelling laxative drug treatment. If the use of arsenic-containing mercury nails, the patient should be asked to drink more boiled water, or silver flowers, mung beans decoction of internal consumption, in order to facilitate the excretion of arsenic. At the same time, pay attention to observe whether the patient has high fever, abdominal pain, vomiting, oral ulceration and other toxic conditions, in order to timely treatment.

5. Ligation method

To medicine line or thick silk thread, or adhesive ring ligation hemorrhoid root, blocking hemorrhoid blood supply, so that the ischemia of hemorrhoids dry, necrosis and fall off, so as to achieve the purpose of healing. Generally more commonly used methods are through the ligation method, rubber ring ligation method.

(1) Through the ligation method: with a silk thread through the ligation in the hemorrhoidal root, in order to block the flow of blood and gas in the diseased area, so that the hemorrhoidal nucleus necrosis off the purpose.

Indications: Ⅱ, Ⅲ stage of internal hemorrhoids, especially fibrous internal hemorrhoids is more suitable.

Contraindications: acute and chronic perianal inflammation, acute and chronic dysentery, diarrhea, infiltrative tuberculosis, severe hepatic and renal disorders, hypertension, patients with various blood disorders, and pregnant women in labor.

Operating method: routine skin preparation, clean enema, using lumbar anesthesia or local anesthesia. Take the side lying position or truncal position, fully expose the anal area, routine disinfection and laying of towels. The forefinger of the operator's two hands is crossed, slowly expanding the anus, so that the sphincter muscle relaxes and the hemorrhoid core is fully exposed. To curved vascular clamp clamped hemorrhoidal nucleus base, with the left hand to the outside of the anus gently traction, the right hand holding a curved round needle through the No. 10 thick silk thread from the hemorrhoidal nucleus base center slightly above the cross, and then use scissors along the tooth line to cut a superficial incision, suture around the hemorrhoidal nucleus base of the "8" word ligation. After the ligation of the hemorrhoidal nucleus and then injected into the 15% alum liquid or anti-hemorrhoidal injection, or rolling hemorrhoidal nucleus, in order to accelerate the necrosis of hemorrhoidal nucleus to fall off. Finally, cut the ligature short, leaving about 3. 5 centimeters, and then push the hemorrhoidal nucleus back into the anus. After the operation, injected with comfrey cream, fixed with gauze external cover. Generally 3 hemorrhoids are treated at one time. If the ring-shaped internal hemorrhoids, hemorrhoids can be divided into several hemorrhoidal blocks, in the hemorrhoidal block on the side of the two hemostatic forceps clamp up the mucosa. Cut from the middle, the same way to deal with the opposite side of the hemorrhoids, and then the hemorrhoids for the "8" through the ligation, the same way to deal with other hemorrhoids one by one.

Note: Ligation should be small before large. When the needle passes through the base of the hemorrhoidal nucleus, it should not penetrate into the muscle layer, so as not to cause necrosis of the muscle layer or complication of perianal abscess. Prohibit defecation on the day after surgery. If the hemorrhoidal core prolapses after defecation, it should be pushed back into the anus immediately, so as not to aggravate the pain by edema. Postoperative 7 ~ 14 days for the hemorrhoidal shedding period, the patient is asked to minimize the activities, stool should not be forceful nudging, in order to prevent hemorrhage.

(2) rubber ring ligation method: with the help of the instrument will be small latex rubber ring set into the hemorrhoid root, the use of rubber ring after the expansion of the tightening force, blocking the hemorrhoid blood supply, so that the ischemia and necrosis of the hemorrhoids fall off.

Indications: Ⅱ, Ⅲ stage of internal hemorrhoids and internal and external hemorrhoids of internal hemorrhoids part.

Contraindications: same as penetrating ligation method.

Operating method: before the operation, the patient is instructed to empty the bowels or clean the irrigation soup, and take the side lying position or knee-chest position. First inserted into the oblique anoscope, to determine the location and number of hemorrhoids, selected ligation site; fully exposed hemorrhoidal nuclear area. The hemorrhoidal area was fully exposed and sterilized with 0.1% Neosporin cotton balls. And then by the assistant fixed anoscope, the operator's left hand holding ligature sleeve hemorrhoids, right hand holding wheat grain pliers, through the ligature ring pincer hemorrhoidal nucleus root, hemorrhoids will be pulled into the ligature. Press the ligature handle, so that the ligature jacket to the hemorrhoid root; followed by the ligature will be pushed out, tied to the root of the hemorrhoids. Then release the wheaten pliers to withdraw with the lancing device, and then slowly withdraw the anoscope.

Note: Same as penetrating ligation method.

6. injection therapy

(1) sclerosis and atrophy injection method: the sclerosis and atrophy injection into the hemorrhoidal nucleus of the submucosal venous plexus in the interstitial space, causing chemical inflammatory reaction, varicose hemorrhoidal venous plexus is also due to the veins, perivenous inflammation and progressive fibrous tissue hyperplasia and gradual occlusion, so as to achieve the hemorrhoid nucleus of the sclerosis and atrophy of the purpose.

Indications: I, Ⅱ, Ⅲ stage internal hemorrhoids, internal hemorrhoids and anemia is not suitable for other therapies, internal and external hemorrhoids of the internal hemorrhoid part.

Contraindications: embedded internal hemorrhoids; internal hemorrhoids with acute and chronic inflammation and diarrhea; severe tuberculosis, hypertension, liver and kidney disorders and blood disorders; abdominal tumors caused by the internal hemorrhoids, external hemorrhoids and pregnant women on the verge of delivery, prostate hyperplasia heavier.

Commonly used drugs: anti-hemorrhoidal spirit, 6% to 10% alum liquid, 5% sodium cod liver oil, 5% to 10% glycerol carbolic acid.

Operating method: take the lateral position or lithotomy position, routine field disinfection, local anesthesia, with 0.1% of the new cleaner disinfection of the anal canal and intestinal cavity. After dilating the anus, the liquid was extracted with a skin-test needle and injected under the Loudspeaker anoscope. The liquid should be injected into the submucosal layer of hemorrhoidal nucleus at 0.5 cm from the dentate line, and the needle should be injected at an oblique angle of 150. Each nucleus injected into the liquid 0.5 ~ 1 ml, in order to hemorrhoid nucleus swelling surface color unchanged to the degree. Each injection of no more than 3 hemorrhoidal nuclei, the total amount of medicine does not exceed 3 ~ 4 ml. If an injection is not cured, 7 days apart can be injected again, usually 3-4 times can be cured.

(2) eliminate hemorrhoid spirit four-step injection method: is also a sclerosis atrophy injection method, the principle and sclerosis atrophy injection method with. ① Indications: all stages of internal hemorrhoids, bleeding, Ⅲ internal hemorrhoids further development and the formation of varicose internal and external hemorrhoids. ② contraindications: internal hemorrhoids embedded inflammation; accompanied by acute enteritis, dysentery; dermatological external hemorrhoids. ③ operation method: take the lateral position or truncated position, with 0.5% e chlorhexidine cotton ball local disinfection, fully exposed lesions, with l% procaine 10-15 ml for anal local anesthesia, and then 0.5% o chlorhexidine cotton ball disinfection of internal anal hemorrhoid area. Expand the anus with the hand, in the Loudspeaker-shaped anoscope to carefully check the site of internal hemorrhoids, the number and size of hemorrhoids, and then touch the hemorrhoidal area with the index finger with or without arterial pulsation, to determine the injection site. Then use a No. 5 needle, 5 ml syringe, suction cancel hemorrhoidal liquid, under the anoscope in four steps, low concentration, high dose injection. Each specific operation is described below.

Superior rectal artery area injection: in order to avoid the concentration of liquid caused by tissue necrosis and bleeding, with l% procaine will eliminate hemorrhoidal spirit liquid diluted in the ratio of l:1 for injection, each point of the injection of 2 to 3 ml.

Hemorrhoids submucosal layer injection: to prevent tissue necrosis, with 1% procaine will eliminate hemorrhoidal spirit diluted liquid according to 2:1 from the hemorrhoidal core of the central needle to the muscle layer. When there is a sense of muscular resistance while backing out of the needle while injecting, and then fan-shaped injection, so that the liquid uniformly filled to the submucosal tissues. The amount of drug injected can be depending on the hemorrhoidal nucleus is diffusely swollen as appropriate, the amount of drug injected into each nucleus for 4-6 ml.

Hemorrhoidal mucosal lamina injection: when the second step of the injection is completed, and then slowly back out of the needle, there is a sense of emptiness, that is, into the hemorrhoidal mucosal lamina, slowly injected, each nucleus injected 2-3 ml of medicine. After injection, the mucous membrane of hemorrhoidal nucleus can be seen as a blister, and the microvascularization of the mucous membrane can be seen.

The cavernous vein area injection: the last in the tooth line slightly above the lowest part of the internal hemorrhoids, that is, the cavernous vein initiation for injection. To avoid pain caused by the spread of the drug below the tooth line, the drug is diluted to a l:l concentration. Under the anoscope or with a finger to expose the lower part of the internal hemorrhoids, in the tooth line O.1 cm into the needle, the tip of the needle into the internal hemorrhoids of the oblique for fan-shaped injection, each nucleus injection drug 1-3 ml. Stage III internal hemorrhoids once the injection volume is 20-45 ml (diluted dose). Finally, a 3-cm-long, 1-cm-wide petroleum jelly gauze, mostly placed into the anus, is used to fix the internal hemorrhoid and prevent incarceration. External gauze fixation. In principle, all internal hemorrhoids are injected at one time, and after injection, the internal hemorrhoids become foreign bodies due to tissue atrophy and drying up. This method generally has no adverse reactions, if there is a slight pain after injection, no treatment; there may be low fever, a very few cases of high temperature, can be symptomatic treatment, 3-5 days can return to normal. Precautions: the injection should be strictly sterilized, each injection into the needle must be disinfected to prevent infection. A fine needle must be used to avoid bleeding caused by too large a hole. After the injection should do blood test, no blood can slowly push the medicine. Needle not to the hemorrhoidal nucleus in all directions, so as not to damage the hemorrhoidal blood vessels caused by bleeding, resulting in hemorrhoidal hematoma, local exudate increased, prolonged hemorrhoidal atrophy time. The depth of the injection should be moderate, too shallow easy to cause mucosal ulceration, too deep can make the muscle layer tissue hardening. Do not make the liquid injected into the external hemorrhoidal area, or the injection position is too low, so as not to spread the liquid to the anal canal, resulting in perianal edema pain. Do not defecate for 24 hours after injection, and reduce activities.

(3) necrosis withered off injection method: is the corrosive liquid injected into the hemorrhoidal nucleus, so that the hemorrhoidal nucleus tissue necrosis and shedding, after wound repair and healing.

Indications: Ⅱ, Ⅲ stage internal hemorrhoids.

Contraindications: same as sclerosis and atrophy injection method.

Commonly used drugs: withered hemorrhoid oil, new No. 6 injection.

Operating method: lumbar anesthesia or local anesthesia, take the truncated position, fully expose the anus, disinfected with 0.1% Xinjiermei cotton balls. The internal hemorrhoids turned out of the anus, the left hand holding mosquito hemostatic forceps in the dental line hemorrhoids clamped part of the fixed, the right hand holding the prepared liquid syringe, in the dental line 0.3 ~ 0.5 cm, stabbed hemorrhoids mucous membrane layer, from low to high in the shape of a column will be slowly injected into the hemorrhoids hemorrhoid nucleus to the extent that the hemorrhoids nucleus slightly inflated and discoloration. After injection, the hemorrhoids will be pushed back into the anus. Hemorrhoids about 7 ~ 14 days of necrosis, dry off. An injection of no more than 3 hemorrhoids; if the hemorrhoids are larger or more, the injection can be staged, with an interval of 2 weeks injection. If you use withered hemorrhoid oil injection, each nucleus injected 0.5 ~ 1 ml, the total amount does not exceed 4 ml.

Precautions: the same sclerotic atrophy injection. Reduce activities 7-14 days after injection to prevent hemorrhage when the hemorrhoidal nucleus is dislodged.

7. Postoperative complications of internal hemorrhoids and their management.

Pain: oral painkillers, or 1 percent procaine 10 ml in the middle or lower sacs closed, 5 ml on each side. It can also be used as Shaobu Yuyu Tang (Wang Qingren's "Medical Forest Correction") with 15 g of honeysuckle, 10 g of forsythia, and 20 g of dandelion to activate blood circulation, relieve pain, and clear heat and toxins.

Bleeding: if the internal hemorrhoid ligation is not secure, or hemorrhoids withered off, there is a traumatic blood seepage, can be filled with petroleum jelly gauze, pressure to stop bleeding, but also can be applied externally to stop bleeding scattered. If the small arteries bleeding, should be able to fully expose the bleeding point under the conditions of suture hemostasis; postoperative oral Yunnan Baiyao, etc., to prevent bleeding.

Fever: Fever caused by tissue necrosis is absorbed, the body temperature is usually not high (below 38 ℃), generally do not need to deal with, pay attention to observation. If the fever is caused by localized infection, it should be taken to remove heat and toxins, and the formula is Huanglian Xieyue Tang (Wang To's "Secret Essentials of Wai Tai") plus honeysuckle, forsythia, septicaemia.

Oedema: 30 grams of Park Nitrogen, 30 grams of cypress, 15 grams of honeysuckle, 15 grams of safflower, 20 grams of dandelion, 3 grams of alum decoction and fumigation, 1-2 times a day. Or use 1:5000 potassium permanganate hot water sitz bath, after the bath external hemorrhoid cream. In mild cases, a hot water bag can be used to apply hot compresses.

Small urine: ask the patient to drink more water, or with 30 grams of psyllium, 30 grams of winter melon skin decoction water to drink tea; can also be acupuncture three yinjiao, water, Guanyuan, Zhongji and other acupuncture points, or l% procaine 10 ml Changqiang point closed, or hot water bag hot compresses.

--------------------------------------------------------------------------------

How to treat internal hemorrhoids

1. Acupuncture therapy

Acupuncture: mainly applicable to the work stage Internal hemorrhoids, or Ⅱ, Ⅲ stage internal hemorrhoids temporarily inoperable. The main points: Changqiang, Chengshan, Bashi. Supporting points: Huiyin, foot Sanli, Sanyinjiao, large intestine Yu. Dampness and heat use the diarrhea method, and spleen deficiency uses the tonic method.

Pick hemorrhoid therapy: for stage II and III internal hemorrhoids. You can take the large intestine Yu, second and third points, or in the patient's back on both sides of the spine on the side of the lumbosacral region to look for hemorrhoidal points, that is, protruding epidermis, pressure does not fade of red or grayish-white pimples, routine disinfection, the hemorrhoidal points of the epidermis with a thick needle, and then pick the skin of the white subcutaneous fibers several strips. Postoperatively covered with sterilized gauze.

2. Dietary therapy

Banana water spinach porridge: 100 grams of banana peeled for the mud, water spinach (water spinach) 100 grams to take the tip of the round-grained rice 50 grams. Japonica rice boiled in water until it will be cooked, into the water spinach tip, banana mud, add an appropriate amount of salt or sugar, cooked with porridge, for breakfast staple. Suitable for hemorrhoids, fistula real heat evidence.

Pig intestine soup: fresh dandelion 50 grams (25 grams of dried products), 25 grams of seaweed, wrapped in a cloth, and 250 grams of pig intestines stewed in a casserole until well cooked, remove the bag, add salt to taste, eat the pig intestines and drink the soup in 2 times. Applicable to hemorrhoids, fistula real heat evidence.

Party ginseng fig stewed pork: 50 grams of ginseng, fig 250 grams of pork 500 grams of pork, with stewed until the meat is cooked through, add salt to taste, eat meat and drink soup. Applicable to hemorrhoidal fistula day long qi and blood weakness certificate.

Jujube fish soup: 50 grams of jujube (core), 500 grams of fish, stewed in a casserole until cooked, add salt, ginger a little, eat meals. Applicable to hemorrhoidal fistula deficiency.

3. preventive care

Cultivate good eating habits, regular meals, avoid eating spicy, alcohol and wine taste.

Rise and shine, work and rest. The first thing you need to do is to change the position of your body when you are engaged in a long standing job.

Pay attention to anal hygiene, develop good defecation habits, and often keep the bowels open.

The timely treatment of diarrhea, constipation, dysentery and other diseases.

After internal hemorrhoid surgery, the diet should be light, and if necessary, give half-flow or full-flow diet.

Post-operative hemorrhoid shedding period, minimize activities, more bed rest.

After each postoperative bowel movement, sitz bath with light saline or 1:5000 potassium permanganate solution, and then change the medicine.

Attention to observe the patient's postoperative reaction, if there is fever, pain, difficulty in urination and bleeding after defecation, the cause should be identified in time and properly treated.

If the hemorrhoidal nucleus is prolapsed after the operation, it should be put back into the anus in time to prevent the edema from becoming embedded.