TCM Acupuncture and Massage

Chapter 49 Digestive System Diseases (2)
3. Hepatitis A is an important intestinal infectious disease caused by hepatitis A virus (HAV), mainly caused by liver damage.Its incidence rate is high, seasonal (winter and spring), can be outbreaks, and it is easy to cause water-type and food-type epidemics.The targets are mainly children. If it is an adult, the condition is generally serious and takes a long time.It can occur all over the world, but it is more likely to occur in developing countries, and my country ranks first.

(1) Transmission route: It is mainly transmitted through water, food and daily contact.

(2) Incubation period: an average of 30 days.

(3) Clinical manifestations: acute onset, fever, general malaise, and flu-like symptoms 1 to 5 days before the onset, followed by obvious general weakness, oily feeling, nausea, and vomiting.It is often misdiagnosed as gastritis (cold plus gastritis, beware of hepatitis).Then his eyes turned yellow and his urine turned yellow like strong tea.It will not become chronic. Generally, the symptoms can disappear in about 1 month. A normal alanine aminotransferase (ALT) in the liver function test is a sign of cure.Generally, there will be no recurrence and lifelong immunity.

(4) Prevention and control: The fecal-oral transmission route should be cut off, and the susceptible population should be vaccinated to control the outbreak and epidemic and reduce the incidence rate.

4. Hepatitis B Hepatitis B is a type of hepatitis caused by hepatitis B virus (HBV) infection.

(1) Transmission route: mainly blood transmission, sexual contact transmission, and mother-to-child transmission.The chances of oral transmission and daily contact transmission are less.Air does not spread.

(2) Incubation period: 60-120 days.

(3) Important checks: two pairs and a half for hepatitis B.

①Surface antigen (HBsAg): Positive, indicating that there has been or is existing HBV infection.This alone cannot explain whether HBV is active or not, it is only an indicator of HBV infection, not the only basis for clinical diagnosis, and should be combined with other indicators.Negatives cannot be ruled out either.

②Surface antibody (HBsAb): It is a protective antibody and has the effect of neutralizing HBV. Its positivity is a sign of immunity and a symbol of hepatitis B being cured or about to be cured.

③e antigen (HBeAg): Positive, indicating that HBV still exists and replicates in the blood, and the infection is strong.If it continues to be positive, it indicates that the prognosis is poor and it is easy to become chronic.It is an important sign to judge the prognosis and the degree of infectivity.

④e antibody (HBeAb): Positive, indicating that the HBV replication is not active, the infectivity is reduced or terminated, and the disease begins to recover, which is a sign of a longer HBV infection.However, if HBV-DNA is positive, it means that there is still HBV in the blood or has mutated, which is not only infectious, but also more harmful.

⑤Core antigen (HBcAg): generally wrapped by surface antigen, it is difficult to detect, so it is called two-and-a-half.

⑥Core antibody (HBcAb): There are two types of IgG and IgM.The former is the main part and can exist for a long time. Low titer is a sign of past infection; high titer means HBV replication.The latter only exists in the acute phase and attack phase, and the positive can be used as a sign of HBV new infection or continuous replication.

Positive items 1, 3, and 5 in the two-and-a-half tests (commonly known as the big three yang) can only indicate the existence of HBV in the body, and the number is also large, but it does not mean that the inflammation and damage of the liver are serious.The damage and degree of liver depends on the test results of liver function.In general, surface antigen titers are inversely proportional to liver lesions: high titers may cause no obvious liver lesions, and low titers may cause severe damage to the liver. Generally, the titers of liver cirrhosis patients are not high.

(4) Carriers of HBV: It often occurs in cases of mother-to-child transmission, close contact with daily life, and micro-injection of blood.Generally, there are no symptoms and signs of hepatitis, and there are signs of HBV infection (1, 3, 5, one or more positive).

It is contagious and should be checked regularly.

(5) Daily life attention for hepatitis B patients: regular review, correct medication (do not use drugs indiscriminately), correct living habits (avoid eating too much meat and sugar to make you fat, leading to fatty liver and increasing the burden on the liver), quit smoking and alcohol, pay attention to rest, keep healthy Good mood (helps boost immunity).

(6) Treatment: For patients with three genitals (positive for items 1, 3, and 5), the e-antigen should turn negative, produce e-antibody, and stop HBV from replicating. Treatments such as anti-virus and liver protection can be performed to improve In the case of hepatitis, prevent liver fibrosis.Patients with small three genitals (positive for items 1, 4, and 5) may not need treatment if their liver function is normal and HBV-DNA is negative, and regular reexamination is required.

（7）疫苗：是最有效的预防措施（0，1，6方案：0月30μg，1月10μg，6月10μg），至表面抗体阳性为止。

There is no cure for hepatitis B yet, but with correct treatment and attention to daily life, the disease can be well controlled and the development of liver cirrhosis and liver cancer can be prevented.

([-]) Liver cirrhosis
Developed from liver fibrosis.Liver fibrosis is abnormal hyperplasia of connective tissue (collagen fibers, elastic fibers and matrix components, etc.) in the liver, and a large amount of fibrous tissue hyperplasia and deposition in the lobules.As it continues to develop, there may be intervals, false lobules are formed, the normal structure of the liver is destroyed, and eventually liver cirrhosis is formed.

1. Clinical manifestations Early symptoms are often not obvious.In the compensation period, symptoms such as fatigue, reluctance to eat, indigestion, nausea, vomiting, dull pain or discomfort in the left upper quadrant, and diarrhea may occur, and liver enlargement, smooth surface, medium hardness, splenomegaly, spider angioma and hepatic palm.In the decompensated stage, severe abdominal distension, low-grade fever, and ascites may appear. In severe cases, jaundice, hemorrhage, disturbance of consciousness, dark complexion, hyperpigmentation, telangiectasia and spider veins on the face, neck, and arms may appear. Feel the nodules.Among them, spider angioma, liver palm and ascites are more typical manifestations.

2. When portal hypertension is normal, 75% of the blood in the liver comes from the portal vein, which brings together blood from the gastrointestinal tract, spleen, pancreas and gallbladder.In liver cirrhosis, blood flow in the portal vein is blocked, and blood stasis in the portal system causes pressure to rise.If this happens for a long time, it can cause a series of complications, such as: congestive splenomegaly, chronic congestion of the gastrointestinal tract and peritoneum, thickened and varicose gastric fundus, esophagus, abdominal wall, and umbilical vein. B ultrasound can prompt portal vein widening, that is, portal hypertension.

3. Common complications include hepatic encephalopathy (also known as hepatic coma, which is caused by central nervous system damage caused by the decline of liver detoxification ability), upper gastrointestinal bleeding (caused by rupture of gastric fundus or esophageal varices due to portal hypertension) ), infection (tracheitis, pneumonia, intestinal infection), primary liver cancer, etc.

4. Treatment is generally symptomatic treatment, plus attention to daily life.You can eat more selenium-rich plants (mushrooms, garlic), which can prevent liver cancer.

([-]) Other liver diseases

1. Fatty liver refers to excessive accumulation of fat in liver cells.Normally, the fat in the liver only accounts for 3-5%. If it exceeds 5%, it is called fatty liver.Symptoms generally do not appear, but excessive accumulation of fat can cause metabolic disorders in liver cells, damage liver cells, and lead to abnormal liver function.A small number of patients may develop cirrhosis. 2. Hepatic cyst is a disease caused by necrosis, liquefaction and cystic degeneration of some liver cells caused by congenital or acquired obstruction.Severe symptoms generally do not appear, which is essentially different from liver cancer.

(1) Examination In addition to the aforementioned two-and-a-half examinations for hepatitis B, the following examinations can also be performed: [-]. Liver function examinations include alanine aminotransferase (ALT, also known as alanine aminotransferase, GPT), aspartate aminotransferase (AST, Also known as aspartate aminotransferase, GOT), alkaline phosphatase (ALP), γ-glutamic acid transpeptidase (γ-GT), total protein (TP, including albumin A, globulin G, A/G), total bile Bilirubin (TB, including direct bilirubin DBIL and indirect bilirubin IBIL), total cholesterol (Ch) and other items.

2. Polymerase chain reaction (PCR) gene amplification technology.

3. Alpha-fetoprotein detection (AFP) is meaningful for the diagnosis of primary liver cancer.

[-]. Point massage

([-]) Acupuncture therapy

1. Take acupuncture points
Qimen, Riyue, Zhongwan, Ganshu, Danshu, Zhigou, Neiguan, Yanglingquan, Zusanli, Sanyinjiao, Taichong, Xingjian.

2. Positioning
The gate of the chest, the nipple is straight down, the sixth intercostal space.Riyue a chest, the nipples go straight down, the seventh intercostal space.

Zhongwan one abdomen, 4 cun above the middle of the navel.

On the back of Ganshu, below the spinous process of the ninth thoracic vertebra, 1.5 cun laterally.

On the back of Danshu, under the spinous process of the tenth thoracic vertebra, 1.5 cun laterally.

Branch groove—dorsal side of forearm, 3 cun above the transverse wrist crease, between radius and ulna.

Neiguan-the palm side of the forearm, 2 cun above the transverse wrist crease, between the flexor carpi radialis tendon and the palmaris longus tendon.

On the outer side of the lower leg of Yanglingquan, in the depression anteriorly and inferiorly to the head of the fibula.In front of the calf at Zusanli, 3 cun below the nose of the calf, a transverse finger (middle finger) is opened beside the front edge of the tibia.

Sanyinjiao: On the inner side of the lower leg, 3 cun above the tip of the medial malleolus, on the posterior border of the medial side of the tibia.

On the dorsal side of Taichong’s foot, in the depression behind the space between the 1st and 2nd metatarsal bones.On the dorsal side of one foot between the rows, between the 1st and 2nd toes, at the junction of the red and white flesh behind the web edge of the toes.

([-]) Self-massage
1. Pushing the abdomen Use one palm to push down from the Tanzhong point on the chest to the Guanyuan point along the front midline, a total of 36 times.

2. Acupuncture Points are pressed on the above-mentioned points, taking the degree of soreness as the degree, and each point is 1 minute.

3. Press the back and look for tender points on both sides of the spinous processes of the 9-12 thoracic vertebrae, and press with the whole palm for 2 minutes.The strength should not be too large.

4. Rub the two ribs. Use the palms of both hands to rub from the midaxillary line on both sides to the front midline, depending on the degree of local fever.

constipation
An overview of the disease

([-]) Relevant knowledge

Constipation refers to a condition in which stool is secreted and the defecation cycle is prolonged due to abnormal conduction in the large intestine;Constipation is a common clinical symptom that can occur in various acute and chronic disease processes.

([-]) Etiology and pathogenesis

Constipation is located in the large intestine, which is caused by conduction disorders in the large intestine.According to the specific condition, it can be divided into four types: heat secret, qi secret, deficiency secret, and cold secret.details as follows:
1. Heat secret is caused by pathogenic heat injuring body fluid, dryness and heat in the intestines, or overeating spicy and dryness, accumulation of heat in the intestines, which makes the circulation abnormal and causes the disease.

2. Constipation of qi is a disorder of emotions, which leads to stagnation of liver qi and the inability of qi to flow, resulting in disease.

3. Deficiency and secrets are internal injuries caused by diet, weak temper, and qi deficiency, which leads to blood deficiency and dehydration.

4. Cold secret is the disease caused by old age and physical weakness, spleen and kidney yang deficiency, resulting in internal knot of yin and cold.

([-]) Clinical manifestations

Constipation is characterized by a decrease in the frequency of defecation; or the same frequency of defecation, but the fecal matter is dry and hard, and it is difficult to pass; or the fecal matter is not dry and hard, but there is a desire to defecate, but the discharge is weak and the defecation time is prolonged.Heat secret, qi secret, void secret, and cold secret have different manifestations.Among them, hot secret also sees ruffianity, fullness, dryness, and excess; qi secret also sees hypochondriac distension and pain; asthenia secret also sees dizziness, palpitation, spirit fatigue and timidity; cold secret also sees aversion to cold and love for warmth.

([-]) Diagnosis

1. Constipation is mainly manifested by reduced defecation frequency and prolonged defecation cycle; or hard feces, difficulty in defecation; or weak discharge, and difficulty in passing.

2. Often accompanied by abdominal distension, abdominal pain, loss of appetite, dizziness, bad breath, anal fissure, hemorrhoids, bloody defecation, sweating, shortness of breath, dizziness and palpitations and other miscellaneous diseases.

3. The onset is often related to factors such as exogenous cold and heat, diet and emotions, visceral imbalance, inactivity in sitting and lying, old age and infirmity.Slow onset, mostly manifested as a chronic disease process.

4. Colonoscopy and other related examinations are often helpful for the diagnosis of some constipation. .5. Constipation symptoms in other medical diseases should be excluded. This disease is more common in middle-aged and elderly people, and it is more common in women.

([-]) Treatment

Including the following aspects:

1. For general treatment, eat more vegetables, fruits, corn, soybeans and other foods, increase dietary fiber intake, develop the habit of regular bowel movements, and strengthen exercise.

2. Actively treat the primary disease.Such as perianal diseases.

3. Drug treatment Use various laxatives alternately, and avoid using strong laxatives.Use solvent laxatives, lubricating laxatives (such as paraffin oil), hypertonic laxatives (lactulose, sorbitol, etc.), stimulant laxatives (castor oil, anthraquinones) as appropriate.

([-]) Prevention

For habitual constipation, you should maintain a good mood, eat more fiber-rich foods, drink plenty of water, exercise regularly, and establish regular eating habits and the habit of defecating on time.

[-]. Point massage

([-]) Acupuncture therapy

1. Take acupuncture points
Tianshu, Guanyuan, Shangjuxu, Dachangshu, Zhigou, Chengshan, Zusanli, Zhongwan, Xiajuxu.

2. Positioning
Tianshu—abdomen, 2 cun lateral to the middle of the navel.

Guanyuan—lower abdomen, on the front midline, 3 cun below the middle of the navel.

Upper Juxu - 6 inches below the calf's nose, one transverse finger (middle finger) outside the anterior crest of the tibia.

Dachangyu—waist, below the spinous process of the fourth lumbar vertebra, 1.5 cun laterally.

Tributary groove—dorsal side of forearm, 3 cun above the dorsal crease of wrist, between ulna and radius.

Chengshan—in the middle of the back of the calf, where a pointed depression appears under the belly of the gastrocnemius muscle when the calf is straightened or the heel is raised.

Zusanli - 3 inches below the calf's nose, one transverse finger (middle finger) outside the anterior crest of the tibia.

Zhongwan—Abdomen, on the front midline, 4 cun above the middle of the navel.

Lower Juxu—9 cun below the calf's nose, one transverse finger (middle finger) outside the anterior crest of the tibia.

([-]) Self-massage
1. Massage the abdomen in the supine position, overlap the palms, take the Shenque acupoint (middle of the navel) as the center of the circle, and rub the abdomen in a clockwise direction on the middle and lower abdomen. It is advisable to feel heat in the abdomen for about 2 minutes.

2. Standing on the abdomen, lift the left leg so that the thigh and the upper body form a 90-degree angle, then use the hollow fist of the right hand to strike the lower abdomen, and the hollow fist of the left hand to strike the lumbosacral area for 5 minutes, then switch to the other foot.

3. Stand with vibrating abdomen, touch the toes on the ground, lift the heels, shake the whole body up and down for 5 minutes, and pay attention to the toes not leaving the ground.

4. Kneading points Use your thumb to press and knead the Bigou, Zusanli, Daheng, Tianshu and Yanglingquan on both sides for 1 minute each.

5. Rub the sacrum. Repeatedly rub the sacrum for 5 minutes.

Hemorrhoids
An overview of the disease

([-]) Relevant knowledge

1. Concept and epidemiological situation Hemorrhoids are common and frequently-occurring diseases unique to human beings.According to relevant census data, the incidence rate of anorectal diseases such as hemorrhoids is 59.1%, and hemorrhoids account for 87.25% of all anorectal diseases, and among them, internal hemorrhoids are the most common, accounting for 52.19% of all anorectal diseases.Both men and women can get the disease, the incidence rate of women is 67%, and the incidence rate of men is 53.9%. There are more hemorrhoid patients than women); it can occur at any age, and it is more common in people aged 20 to 40, and it can gradually increase with age, so there is a saying that "nine out of ten people have hemorrhoids".There are many reasons for its pathogenesis. Sedentary, standing, and fatigue make the human body stay in a fixed position for a long time, which affects blood circulation, slows blood flow in the pelvis and congests abdominal viscera, causing excessive filling, varicose, and bulging of hemorrhoidal veins. One of the important causes of hemorrhoids is the decrease in venous wall tension.If exercise is insufficient, intestinal peristalsis slows down, feces descend slowly or due to habitual constipation, thereby compressing the veins, causing local congestion and blood reflux obstruction, resulting in increased hemorrhoidal vein pressure and decreased resistance of the vein wall, which can also lead to the incidence of hemorrhoids increased.According to the analysis of clinical observation and statistical census results, there are significant differences in the prevalence rate among patients with different occupations. Clinically, the prevalence rates of office cadres, car drivers, salespersons, and teachers are significantly higher.

(End of this chapter)