Advantages and disadvantages of rectal administration

Application of rectal administration in urinary system and andrology diseases

Rectal administration means that drugs enter the intestine through the anus, are quickly absorbed by the rectal mucosa and enter the large circulation.

Give full play to its efficacy to treat systemic or local diseases. There are three main methods: ① retention enema,

② rectal instillation, ③ suppository insertion. In recent years, many scholars have used rectal administration to treat a variety of acute and chronic diseases.

Both sexual diseases and difficult diseases have achieved good results. In this paper, the recent domestic reports on rectal administration in the treatment of urinary system diseases are reviewed.

The systematic overview of andrology diseases and the absorption mechanism of rectal administration were comprehensively analyzed.

1 progress of rectal administration in the treatment of urinary system and andrology diseases

Acute renal failure (ARF)

Acute renal failure is a syndrome. Clinical experience shows that the application of traditional Chinese medicine decoction with raw rhubarb as the main component is retention washing.

Intestine has obvious therapeutic effect on renal failure. Yanshi [1] traditional Chinese medicine enema (rhubarb, mirabilite, cassia twig, Dan)

According to syndrome types, 26 cases of acute renal failure were treated, while the control group had 65438 06 cases.

Using western medicine, 9 cases were cured/kloc-0 in the treatment group, 5 cases were improved and 2 cases died. The control group was cured and improved 10 cases.

Three people each died. Liu et al [2] used rhubarb mixture (rhubarb, Sophora japonica, oyster, phellodendron amurense and asarum) for retention enema 3.

48 cases of acute renal failure in children were treated twice a day for 0 ~ 60 min, and the essential amino acids of western medicine and dessemide were used at the same time.

Loose, furosemide, etc. The control group was only treated with western medicine. Results The effective rate was 85.4% in the treatment group and 73.5% in the control group.

%, the curative effect is better than that of the control group (P < 0.0 1). Yang et al [3] divided 45 children with acute renal failure into two groups.

25 cases in the treatment group were treated with enema with western medicine combined with rhubarb mixture and captopril orally, while 20 cases in the control group were treated with only 2.

After 7 days of comprehensive treatment with western medicine, the changes of blood urea nitrogen, blood creatinine, blood pressure and urine volume in the treatment group were as follows

Obviously superior to the control group. It shows that rhubarb mixture enema plus captopril can improve renal function in children with acute renal failure.

Clinical symptoms.

1.2 Chronic renal failure

Chronic renal failure (CRF) belongs to the category of "Guan Ge", "Obstruction" and "Poisoning" in TCM. Mars [4] etc.

Urine-regulating enema (composed of rhubarb, cassia twig, cogongrass rhizome, oyster, raw Sophora japonica, etc.). ) use, make an appointment to wash every night.

Intestine 1 time, each time 150mL, combined with oral Chinese medicine and a small amount of western medicine to treat 309 cases of chronic renal insufficiency, all failed.

Adrenal corticosteroids and immunosuppressants were used instead of hemodialysis and peritoneal dialysis. Results 62 cases were cured clinically.

233 cases were improved, and 4 cases were ineffective/kloc-0. The total effective rate is 95.5%. 93 cases in the control group were treated with traditional Chinese medicine and a small amount of western medicine.

The total effective rate of drug treatment was 84.9%, and the difference between them was significant (P < 0.0 1). Qiu et al. [5] used Jiushen Decoction (Shengda)

Yellow 10g, dandelion 30g, aconite 10g, angelica 5g) are decocted in 200mL, and enema is performed every night 1 time. The symptoms are obvious

Patients with significantly increased urea nitrogen and serum creatinine were treated twice a day for 3 weeks, 1 course, and Shen Zhu decoction was taken orally at the same time.

In 56 cases of chronic renal insufficiency, 22 cases were markedly effective and 28 cases were effective. Kang et al. [6] increased yellow 10~20g ~ 20g and calcined it.

30 grams of oyster and 20 grams of dandelion are soaked in 600 ~ 800 ml of boiling water for 30 minutes, stirred evenly, and cooled to about 38℃.

150 ~ 200 ml low enema for 20 minutes,/kloc-0 times a day, 50 cases of chronic renal failure were treated, 37 cases were relieved and hematuria occurred.

The average values of elemental nitrogen and serum creatinine decreased significantly. Kong et al. [7] treated 35 cases of chronic diseases by enema with combination of traditional Chinese and western medicine.

To observe the clinical efficacy of patients with renal failure, and 20 patients were treated with enema of traditional Chinese medicine combined with oral or intravenous alkali supplementation and calcium supplementation.

The control group was compared and analyzed. Results The total effective rate was 80% in the treatment group and 50% in the control group. Liao Shi [

[8] et al. have also studied the mechanism of enema with traditional Chinese medicine in treating chronic renal failure, and think that its therapeutic mechanism may be related to

Reducing MMS in blood is related to increasing SOD. A lot of data and clinical practice have proved that rectal administration of traditional Chinese medicine is effective for chronic diseases.

Treatment of renal failure can achieve the effect of relieving illness, improving clinical symptoms and prolonging life.

1.3 uremia

Nie [9] mainly treated 7 cases of uremia/kloc-0 with aconite, rhubarb, calcined oyster, decoction 100mL and retention enema.

The total effective rate was 76.5%. Liu [10] took 20 grams of raw rhubarb, 30 grams of black beans, 30 grams of potherb mustard and 30 grams of oysters.

Two cases of chronic nephritis uremia/kloc-0 were treated by retention enema, intravenous infusion of ligustrazine and oral Yiqi Huoxue Paidu decoction.

Results 3 cases were markedly effective, 7 cases were effective and 2 cases were ineffective. Jushi et al. [1 1] reported increasing peritoneal dialysate with traditional Chinese medicine.

(4.25%B5 185) 6 1 case of uremic chronic renal failure. Blood urea nitrogen, creatinine and serum creatinine were detected after treatment.

Its settlement rate is obviously improved. This method can obviously improve the quality of life of patients and prolong the survival time.

This method is worth studying and popularizing.

1.4 Acute nephritis in children

Liu [12] used rhubarb enema to treat acute nephritis in children, and the results proved that rhubarb enema was effective.

It has obvious curative effect on detumescence, diuresis, blood pressure reduction and improvement of renal function. Plum [13] also confirmed rhubarb.

It has the functions of purging excess, purging heat, removing blood stasis, expelling toxin and "colon dialysis". Yue [14] was treated by enema with traditional Chinese medicine.

68 cases of acute nephritis in children were treated with rhubarb 15g, phellodendron amurense 15g and mirabilite 15g.

0 restraint into decoction retention enema. This method is safe and effective, easy to be accepted by children and worth popularizing.

1.5 renal colic

Xu [15] et al. made diclofenac mucilage with indomethacin suppository as control by randomized controlled single blind method.

Treatment of renal colic 152 cases by rectal administration. There was no significant difference in the total effective rate of analgesia between the two groups, but there was no significant difference in the onset time of analgesia.

Compared with the control group, the difference is significant, and diclofenac is considered to be an ideal drug for the treatment of renal colic at present.

Rectal administration is quick and effective in relieving pain, which is worthy of clinical application.

1.6 BPH (BPH for short)

Rectal administration of traditional Chinese medicine is an important means to treat BPH at present. Yu [16] According to syndrome differentiation, blood

Guizhi Fuling Pill is used for treating blood stasis, and Zishen Tongguan Pill is used for treating kidney deficiency. It is decocted twice a day, 300 ml each time, and taken directly.

20 cases of benign prostatic hyperplasia were treated with 150mL enteral drip, 3 cases were cured and 7 cases were markedly effective. Li [17], etc.

Qi Yi Tang (Radix et Rhizoma Rhei, Herba Leonuri, Semen Vaccariae, Radix Cyathulae, Herba Asari) was prepared by activating blood circulation, removing blood stasis and dredging collaterals.

35 cases of prostatic hypertrophy and urinary retention were treated by retention enema, and the total effective rate was 68.6%. I think this prescription has changed.

Local inflammation, eliminating urinary retention and achieving diuretic effect. In recent years, Chinese medicine has been used to treat prostatic hyperplasia.

Satisfactory results have been achieved. The effective components extracted from traditional Chinese medicine are directly administered locally, with little pain and few side effects.

Rectal administration will be an important way to treat BPH in the future.

1.7 chronic prostatitis (CP)

Chronic prostatitis is a common and frequently-occurring disease among young and middle-aged men, accounting for about 10% of urology outpatient service.

About 1/3, this disease belongs to the category of "white turbidity", "fatigue stranguria" and "lumbago due to kidney deficiency" in traditional Chinese medicine. Because of the prostate

Because of the barrier effect of epithelium, it is difficult for drugs to enter the prostate capsule to play an effective therapeutic role, so the therapeutic effect is not enough.

Ideal. In recent years, the treatment of CP by rectal administration has achieved good clinical results. Tian [18] and other adoption places.

Tiger soup (Kochia scoparia, Plantago asiatica, Polygonum cuspidatum, Akebia Akebia, Linderae, Salvia miltiorrhiza, etc.). 40 cases of chronic pancreatitis were treated by retention enema, and the control group

40 cases in group A were decocted with this recipe for 65,438 0 days. The results showed that 28 cases were cured, 20 cases were markedly effective and 9 cases were effective.

10 cases, 3 cases ineffective, 10 cases. Zhang [19] and others enlarged yellow 10g, mirabilite 12g, peony bark, peach kernel and wax gourd kernel respectively.

9g, decocted into 100 ~ 150ml, and treated with retention enema, 60 cases were cured, 47 cases were improved, and 3 cases were improved/kloc-0. Gu [2]

0] Suppositories (including Herba Hedyotidis Diffusae, Semen Vaccariae, Verbena, Notoginseng Radix, Squama Manis, etc. Insects, etc. ), each

35 cases of CP were treated with 1 ~ 2 suppositories per day and pushed into rectum for 8 ~ 12 cm before going to bed or after defecation. Every 10 day is 1 course of treatment. knot

Results 2 cases were cured, 2 cases were improved, and 2 cases were ineffective. Yuan [2 1] et al. used traditional Chinese medicine (Coptidis Rhizoma, Cortex Phellodendri, Scutellariae Radix, Radix et Rhizoma Rhei

46 cases of infantile cerebral palsy were treated by retention enema, 24 cases were cured, and the effective rate was 82.6%.

It has the effects of softening and resolving hard mass, dredging orifices and treating stranguria. Gui et al. [22] treated with compound Ilex pubescens liquid (a traditional Chinese medicine decoction) by anal perfusion.

The results showed that 32 cases were cured, 30 cases were markedly effective and 27 cases were improved, and the total effective rate was 83. 17%. Gao [23]

28 cases of chronic pancreatitis were treated by enema with Wu Mei decoction and Jinhuangsan. Results Seven cases were clinically cured, with remarkable effect 12 cases and improvement in 5 cases. pass by

For chronic prostatitis, the condition is stubborn, lingering and difficult to heal, and it is easy to relapse. At present, rectal administration is used to treat this disease.

The cure rate of this disease is not high in clinical treatment, and how to improve its curative effect needs further study and discussion.

2 absorption mechanism of rectal administration

Modern medicine has confirmed that there are abundant arteries, veins and lymphatic plexus around the rectum, and the rectal mucosa has strong

The absorption function of. For rectal administration, drugs are mixed in rectal secretions and absorbed through intestinal mucosa, and their transmission routes

There are roughly three diameters: first, it is directly absorbed by the middle rectal vein, inferior vein and anal vein into the great circulation, because it is not

After passing through the liver, the first-pass detoxification of the liver is avoided, and the blood drug concentration is increased; Secondly, it passes through the superior rectal vein.

Portal vein enters the liver and participates in the great circulation after metabolism; Third, the rectal lymphatic system will also absorb some drugs. three

Each route does not pass through the stomach and small intestine, which avoids the influence and destruction of acid-base digestive enzymes on drugs, and also reduces

Drugs stimulate the gastrointestinal tract, so rectal administration greatly improves the bioavailability of drugs. Chinese medicine believes that,

The large intestine includes the colon and rectum, which connect the veins of the lungs, showing the exterior and interior of the lungs, and "the lungs face the pulse", so it is straight in medicine.

After intestinal absorption, it can be transported to the lungs through meridians, and then the drugs can be transported to the five internal organs and limbs by the lungs, which is also big.

Intestine, small intestine and bladder live together to reduce coke, kidney controls water and fluid, and acute and chronic renal function is treated by rectal administration.

Failure provides a theoretical basis, similar to "dialysis". And the prostate is adjacent to the rectum, so rectal administration can

Drugs can directly reach the lesion site and have local hyperthermia effect, which is an effective method to treat prostate diseases.

3 Prospects and prospects

According to clinical reports, rectal administration has a good effect on the treatment of urinary system and andrology diseases.

Good development prospects. This is because: ① the operation is simple and non-invasive, and patients are willing to accept it; ② For those who can't swallow.

Patients are more suitable for this mode of administration; ③ The absorption of drugs in rectum is faster than oral administration, especially for prostate and pelvic diseases.

Treatment; ④ The traditional Chinese medicine enema method is simple, the medicine source is easily available and the price is low, which is especially suitable for dialysis.

Rescue patients with renal failure. In a word, rectal administration has a wide application range, quick effect and reliable curative effect.

There are no obvious adverse reactions and side effects, and it is worth popularizing. But so far, rectal administration is mostly limited to traditional Chinese medicine decoction.

Or a Chinese patent medicine diluent used together with the preparation. Except for some suppositories, there is still a lack of standardized Chinese patent medicine preparations and anal injection.

Special instruments have affected the popularization and popularization of rectal medication.