Vaginal blowing

　　The main pathological condition of this disease is the descending of stomach Qi, not following the usual path, forcing the Qi to block in front, and the reasons are:

　　1, Dryness of the intestines and stomach, deficiency of Yin fluid in the Yangming, dryness of the intestines and stomach, poor passage of Qi in the bowels, and the descending of stomach Qi caused by it.

　　2, Deficiency of middle Qi, weakness of the spleen and stomach, deficiency of middle Qi, lack of power in operation, and derangement of Qi in the bowels.

　　3, Stagnation of liver Qi, internal injury of the seven emotions, liver Qi stagnation, horizontally attacking the stomach, and grain Qi not following the usual path.

　　4, Stagnation of fluid in the middle Jiao, with accumulated phlegm and fluid, residing in the middle Jiao, interfering with turbid pathogens, and the descending of grain Qi caused by it.

　　Fatigue, shortness of breath, pallid and lackluster complexion, constipation, thirst, and restlessness and heat, with fullness and distension in the epigastrium and abdomen. Fullness and distension in the epigastrium and abdomen is a common symptom of the digestive system, which can be a subjective feeling of abdominal distension in part or the entire abdomen; it can also be an objective finding, where abdominal distension is observed due to reasons such as gastrointestinal bloating, ascites caused by various reasons, abdominal tumors, and so on. Normally, there may be a small amount of gas in the gastrointestinal tract, about 150 milliliters (ml) or so. When too much air is swallowed into the stomach or due to poor digestion and absorption, excessive gas production in the gastrointestinal tract occurs, and the gas in the intestines cannot be expelled from the anus, leading to abdominal distension. Constipation is a complex clinical symptom commonly seen, but not a disease itself, mainly referring to the reduction in defecation frequency, decrease in fecal volume, dry and hard stools, and difficult defecation. When two or more of the above symptoms are present simultaneously, symptomatic constipation can be diagnosed. It is usually characterized by a decrease in defecation frequency, generally defecating every 2 to 3 days or even longer (or weekly

　　Constipation will worsen the symptoms of 'yinsou'. Constipation will increase the patient's abdominal pressure, and the abdomen is like a inflated balloon pressing on the vagina. If there is a small amount of gas in the patient's vagina, it will be squeezed out and produce a noticeable sound.

　　In addition, after infection with anaerobic bacteria, trichomonas, or certain gas-producing bacilli in the vagina, 'yinsou' may also occur. In this case, the air discharged from the vagina is usually weak, and more importantly, there is an increase in leukorrhea, vulvar itching, or vaginal discomfort. This is because the microorganisms that infect the vagina produce gas during reproduction and exist in the vagina. When the position changes or abdominal pressure is increased, these gases are discharged from the vagina. Doctors remind that when this situation occurs, it is necessary to go to the gynecology department of the hospital in a timely manner and receive treatment under the guidance of a doctor.

　　From the perspective of traditional Chinese medicine, 'yinsou' is a manifestation of spleen deficiency. Women with postpartum imbalance often have spleen deficiency, although the injury is not severe, the muscle recovery is slow. In such cases, when the vagina forms a negative pressure (such as lying on the back, inhaling), air enters the deepest part of the vagina. When getting up or increasing abdominal pressure, air is expelled from the vagina and there is often a sound. At this time, you can take a decoction for strengthening the middle and benefiting the qi, composed of radix codonopsis pilosulae, radix astragali, and radix angelicae sinensis. In addition, some women's 'yinsou' is caused by liver qi stagnation, and traditional Chinese medicine can be taken under the guidance of a doctor.

　　In traditional Chinese medicine, patients with 'yinsou' due to vaginal inflammation are considered to have 'lower焦damp-heat'. They often have symptoms such as bitter taste in the mouth, dry mouth, thick and yellow tongue coating, red tongue, and sore waist. These symptoms can be treated with traditional Chinese medicine under the guidance of a doctor.

　　As described in 'Chen Suanan's Supplement to Gynecology': "The disease of pregnancy 'yinsou' has a rumbling sound in the uterus, like a belch. Or there may be red and white vaginal discharge, or there may be a turbid, smelly fluid discharged from the vulva first, followed by a sound. This is due to blood deficiency in the two meridians of the Spleen and Kidney. "As discussed in 'Miscellaneous Diseases and Their Wonders': "The disease of 'jiaoxiang' is characterized by stool discharged from the anterior vulva and urine discharged from the posterior orifice. ... If stool is discharged from the anterior vulva, it indicates that the intestines and bladder have been ruptured. If the bladder is not ruptured, then stool will not enter through the orifice. To be sure, the intestines must be perforated and the bladder must be ruptured before urine can be displaced and discharged. It is also necessary that the damaged part of the intestines and bladder should be adherent, so that the entrance and exit are not smooth. If they are not adherent, then even if the intestines are perforated, stool will only flow outside the original intestinal serous layer. Even if the bladder is damaged, and the orifices do not connect, stool cannot be discharged from the anterior vulva. "These descriptions are very similar to modern medicine's rectovaginal fistula or concurrent vesicovaginal fistula.

　　One, symptoms:If a woman's vagina emits a sound when exhaling, it is called 'yinsou'.

　　Two, rectovaginal fistula examination:This disease should be distinguished from rectovaginal fistula. Rectovaginal fistula examination should be performed.

　　Three, the examinations needed for rectovaginal fistula

　　1. Vaginal examination:Sometimes, the fistula orifice can be felt on the posterior vaginal wall. The position of the fistula should be explored by inserting a probe into the fistula or observed under rectoscopy. Fistulography may be performed if necessary to determine the position of the fistula.

　　2. Probe examination:Insert the uterine sound through the vaginal fistula orifice, and when the other finger is inserted into the anus, the tip of the finger can touch the tip of the probe.

　　3. Vaginal speculum examination:Large fistulae can be seen under the exposure of the vaginal speculum, and small fistulae or a small bright red granulation tissue can be seen.

　　4. Barium enema:When there is a rectovaginal fistula, barium can be seen to flow into the fistula, which is also an examination that needs to be done for rectovaginal fistula.

　　5. Methylene blue injection test:Place gauze in the vagina, inject 10ml of methylene blue into the rectum, and remove the gauze after a few minutes to observe whether it turns blue to determine whether there is a vaginal fistula.

　　1. Pay attention to adequate rest, do not overwork, and master the combination of activity and rest. Good rest is conducive to the recovery of fatigue; exercise can enhance physical strength and enhance the ability to resist diseases. The combination of both can better recover.

　　2. Maintaining a good attitude is very important. Keep the mood pleasant, have an optimistic and open spirit. Do not be afraid, only in this way can one mobilize the subjectivity of the individual and improve the body's immune function.

　　3. Appropriate nutrition supply is very important. Under the current living conditions, it is not advisable to emphasize high sugar, high protein, high vitamin, and low-fat diet too much. However, the nutrition should be balanced, with a mix of meat and vegetables, and eat more vegetables, fruits, meats, dairy products, etc. The intake amount should be determined according to the person's weight, and smoking and drinking are strictly prohibited.

　　First, Western medicine treatment

　　1. Conservative treatment

　　(1) Treatment of early rectovaginal fistula.

　　① Empty the bowels, take a sitz bath, and clean the perineum.

　　② Disinfect the perineum, perianal area, rectum, anal canal, and vagina with 1‰ New Jie'erming.

　　③ Trim the fresh wound, excise the excess tissue, and ensure unobstructed drainage to facilitate the healing of the wound.

　　④ Apply 0.1% Levofloxacin sand to both sides of the vaginal and rectal fistula tracts.

　　⑤ Change the dressing once in the morning and evening, and add an additional change after sitting in the bath if there is a bowel movement.

　　⑥ Pay attention to local cleanliness and hygiene to prevent infection.

　　⑦ Abstain from sexual activity during treatment.

　　⑧ Antibacterial treatment can be selected: 2 tablets of berberine, three times a day, or 2 capsules of oral norfloxacin, three times a day, or give intravenous 5% glucose and sodium chloride injection 500ml, add 160,000 units of gentamicin, or add 6g of ampicillin injection. It can also be adopted by intramuscular injection of gentamicin 80,000 units, twice a day.

　　⑨ After the secretion of the wound decreases, stop using 0.1% Levofloxacin gauze for dressing changes, and instead use Vaseline gauze to promote the growth of granulation tissue.

　　(2) Treatment of chronic rectovaginal fistula. In addition to the difference in debridement methods, the rest can be carried out according to the previous method.

　　(3) Debridement method: Use a special挫型探针to abrade the granulation tissue of the old fistula tract wall, expose the fresh wound surface, and facilitate healing. The making of the挫形探针: Select a silver probe with a diameter of 1.5mm, straighten it, and place it on a flat plate covered with thick cloth. Use a razor blade to make slits on the silver probe at an angle, disinfect and reserve it.

　　2. Surgical Treatment:Before surgery, it is advisable to actively control vulvar and vaginal inflammation; for those with multiple and hard scars around the fistula, adrenocorticosteroids, trypsin, hyaluronidase, and other agents can be used to soften the scars; intestinal preparation should be done before surgery, and the operation should be performed 3-5 days after the menstrual period. After surgery, a diet of semi-liquid food without residue can be given, but there is no need to use medication to control defecation. If defecation has not occurred after 4-5 days postoperatively, a mild laxative can be taken to soften the stool for easy excretion. After surgery, local hygiene should be maintained to prevent infection.

　　II. Traditional Chinese Medicine

　　1. Type-specific Treatment

　　(1) Treatment for Dry Intestines: Nourish dryness and promote defecation.

　　Prescription: Modified Mahuang pills with additions.

　　10 grams of Sesamum indicum, 10 grams of Semen Cassiae, 10 grams of Codonopsis pilosula, 10 grams of Rhizoma Rhei, 10 grams of Rehmannia glutinosa, 10 grams of Ophiopogon japonicus, 10 grams of Radix Rehmanniae, 10 grams of Radix Scutellariae.

　　(2) Treatment for Deficiency of Middle Qi: Tonify the middle qi and promote defecation.

　　Prescription: Modified Bu Zhong Yi Qi Decoction.

　　10 grams of Codonopsis pilosula, 10 grams of Astragalus membranaceus, 10 grams of Cimicifuga foetida, 3 grams of Bupleurum chinense, 10 grams of Angelica sinensis, 10 grams of Radix Paeoniae alba, 10 grams of Stroma rubiginosum, 10 grams of Poria cocos, 3 grams of Cinnamomum cassia.

　　(3) Treatment for Liver Qi Stagnation: Soothe the liver, regulate qi, and promote defecation.

　　Prescription: Modified Chai Hu Shu Gan Decoction.

　　10 grams of Bupleurum chinense, 10 grams of Semen Cassiae, 12 grams of Radix Paeoniae Lactiflorae, 6 grams of Glycyrrhiza uralensis, 9 grams of Rhizoma Cyperi, 6 grams of Ligusticum chuanxiong, 10 grams of Sargassum, 12 grams of Persica.

　　Modification: Liver depression transforming into fire, add 12 grams of Lu Tai or Long Tao Wan.

　　(4) Treatment for Stagnation in the Middle Jiao: Resolving phlegm and dampness, and harmonizing the spleen and stomach.

　　Prescription: Modified Ju Ban Gui Lin Zhi Gu Liao Decoction.

　　6 grams of orange peel, 10 grams of Pinellia ternata, 6 grams of Cinnamomum cassia, 10 grams of Poria cocos, 10 grams of Fructus aurantii, 15 grams of Trichosanthes kirilowii, 3 slices of ginger, 6 grams of prepared Liquorice root, 10 grams of Curcuma aromatica.

　　2. Prepared Medicines

　　(1) Bu Zhong Yi Qi pills twice a day, 4.5 grams each time, swallow them.

　　Used for yin shi with insufficient middle qi.

　　(2) Xiaoyao pills twice a day, 4.5 grams each time, swallow them. Used for liver depression.

　　(3) Take Mahuang pills twice a day, 5 grams each time, swallow them. Used for dry intestines and constipation.

　　3. Simple Prescriptions

　　(1) 5 grams of raw rhubarb, soaked in water and taken orally.

　　(2) 9 grams of Cnidium Monnieri, 6 grams of Phellodendron amurense, 3 grams of Evodia rutaecarpa, wrapped in cloth, soaked in water, and bathed in the water.

　　4. Other Therapies

　　Needle the Yingxiang acupoint for 20 minutes. Or press the Yingxiang acupoint with both hands.