I. Diagnosis
(A) Disease diagnosis
1. Diagnostic criteria for TCM: refer to the Chinese medicine industry standard of the People’s Republic of China “Diagnostic and efficacy criteria for TCM diseases” (ZY/T001, 7-94).
(1) Main symptoms: Pain is obvious during defecation and may increase after defecation, often with constipation and a small amount of blood in the stool. Prevalent in the front and back of the anus. Liu Bing, Department of Anorectology, Luohe City Hospital of Traditional Chinese Medicine
(2) Main signs.
Superficial longitudinal fissures of the anal canal skin, with neat wound edges, fresh base, red color, obvious tenderness, and elasticity of the wound surface. Mostly seen in early anal fissures: history of recurrent attacks. The trabecular margin is irregular, thickened, poorly elastic, with a purplish red ulcer base or purulent discharge, hypertrophy of the anal papilla at the upper end adjacent to the anal sinus, sentinel hemorrhoids at the lower end of the trabecular margin, or subcutaneous fistula formation. Mostly seen in old stage anal fissure.
2. Western medical diagnostic criteria: refer to the seventh edition of Surgery (Wu Zaid et al., eds., People’s Health Publishing House, 2008).
The diagnosis of anal fissure should have the main symptoms such as pain in the anal area, blood in the stool or with constipation. The pain of anal fissure is typical periodic pain, pain during defecation, which can be relieved after several minutes after defecation, and then the pain occurs again up to several hours later; blood in the stool is dripping blood or blood stained by hand paper, fresh blood, and small amount. The diagnosis can be made by examination of the anus with signs such as anal canal skin fissures, hypertrophic papillae and sentinel hemorrhoids.
(II) Staging of the disease
1.Acute stage: short duration of the disease, fresh fissure innovation, red color, shallow bottom, neat and elastic edge, and severe pain.
2.Chronic stage: long duration, recurrent attacks, deep fissure bottom, untidy edge, or purulent discharge, hypertrophy of anal papilla at the upper end adjacent to the anal sinus, sentinel hemorrhoids at the lower end of the trauma edge, or formation of subcutaneous fistula, thickening and hardening of the pectineal membrane at the bottom of the fissure, forming a pectineal belt.
(C) Diagnosis of symptoms
1, blood-heated intestinal dryness: stool two or three days a line, dry and hard, dripping blood or hand paper stained with blood, anal pain, abdominal distension, yellow urine. The fissure is red in color. The tongue is red, the coating is yellow and dry, and the pulse is stringy.
2. Yin deficiency and fluid deficiency: dry stool for several days and one line, painful dripping blood in stool, dry mouth and throat, irritable heat in the five hearts. The fissure is deep red. Red tongue, little or no moss, fine pulse.
3.Qi stagnation and blood stasis: stabbing pain in the anus, especially after defecation. The anus is tight and the fissure is purple and dark. The tongue is purple and dark, and the pulse is stringent or astringent.
Treatment options
(A) Anal fissure excision and internal sphincter release
1.Indications: chronic anal fissure
2.Operation method.
The patient is placed in a lithotomy position, and after sacral anesthesia or local anesthesia, a shuttle-shaped incision is made at 5 or 7 o’clock about 1.5 cm from the posterior anal margin, the index finger is inserted into the anus and touches the intersphincteric sulcus, the curved forceps are used to enter the incision, and the subcutaneous part of the anal canal is entered along the subcutaneous part of the intersphincteric sulcus, and under the guidance of the index finger, part of the internal sphincter is cut off, the anal canal is relaxed by finger diagnosis, and the obvious fissure can be found above the intersphincteric sulcus; The fissure was partially excised to expose the fresh wound; pressure dressing was applied. After surgery.
3.Postoperative treatment.
(1) postoperative fumigation sitz bath twice a day, or after each bowel movement to fumigate sitz bath.
(2) Change the wound surface l or 2 times a day.
(3) According to the condition and clinical reality, the comprehensive anal and intestinal treatment instrument, ultrasonic atomization fumigation instrument, fumigation bed (sitting), intelligent perianal fumigation instrument, etc. can be used.
(2) Select oral Chinese medicine tonics and proprietary Chinese medicines according to the disease
1.Chinese herbal soup
(1) Blood-heat and intestinal dryness
Treatment: Clearing heat and fire, increasing fluid and relaxing the bowels.
Recommended formula: Scutellaria baicalensis, Radix et Rhizoma cypress, Radix et Rhizoma gypsum, Radix et Rhizoma yuanhu, Radix et Rhizoma elm, Radix et Rhizoma acaciae, Panax notoginseng powder, Radix et Rhizoma rhubarb (later).
(2) Yin deficiency and fluid deficiency
Treatment: Cool the Blood, nourish the Blood, increase fluid and relax the bowels.
Recommended prescription: Zhi Mu, Huang Bai, Xuan Shen, Sheng Di, Mai Dong, Bai Shao, Angelica Sinensis, Agaricus blazei (closed), Tao Ren, Hong Hua, Shu Di, Chuan Xiong, Yuan Hu.
(3) Qi stagnation and blood stasis
Treatment: Promote the flow of Qi and Blood, moisten the bowels and open the bowels.
Recommended remedies: Angelica sinensis, Hammer Piece, Hou Pu, Semen cassiae, Peach kernel, Safflower, Ma Ren, Gua Pou Ren, Yu Li Ren, Chen Pi, Yuan Hu.
2.Chinese patent medicine
(1) Suppositories for anal: You can use Ma Yinglong musk hemorrhoid suppositories, Puji hemorrhoid suppositories, Anal Tai suppositories, etc.
(2) Chinese herbal ointment for external use: Anal Tai ointment, Longzhu ointment, Ma Yinglong musk hemorrhoid ointment, etc.
(3) Chinese medicine fumigation
Fumigation with Jin Xuan lotion can be used.
(iv) Acupuncture therapy
According to the condition needs to choose acupuncture to treat postoperative complications
1.pain: acupuncture points of Changqiang, Chengshan, Feosanli and Huanjiao.
2, urinary retention: acupuncture Guanyuan, Zhongji, Qihai, Sanyinjiao, Waterway, Yanglingquan through Yinlingquan.
3, fecal impaction: acupuncture of branch gou, foot sanli, qihai, hegu, and quchi.
(E) Basic treatment
Treatment of infection, fever, pain, constipation and other comorbidities.
(VI) Nursing care: identification of symptoms.
1. Postoperative care
Instruct patients to take herbal fumigation, sitz bath, application of medicine to the affected area and physiotherapy after stool to promote wound healing.
2.Dietary care
(1) Blood-heat intestinal dryness with more vegetables and fruits
(2) Yin deficiency and fluid deficiency should be eaten to nourish Yin and increase fluid
(3) For Qi stagnation and blood stasis, give products to regulate Qi and activate blood circulation.
Evaluation of therapeutic effect
(I) Evaluation criteria
Refer to the Guidelines for Clinical Research on New Chinese Medicines promulgated by the Ministry of Health of China in 2004.
Cured: symptoms disappear and signs disappear.
Significantly effective: symptoms improve significantly, and the score is reduced by ≥2/3 compared with that before treatment.
Effective: symptoms improved, and the score decreased by ≥1/3 compared with that before treatment.
Ineffective: no improvement of symptoms and less than 1/3 reduction of points compared with that before treatment.
(II) Evaluation method
Symptom evaluation index: refer to the Guidelines for Clinical Research on New Chinese Medicines issued by the Ministry of Health of China in 2004.
Blood in stool
Grade 0: normal 0 points
Grade l: Mild 2 points with blood
Grade 2: Moderate 4 points dripping blood
Grade 3: Severe 6 points ejection of blood
Pain
Grade 0: normal 0 points
Grade 1: mild 2 points mild pain, tolerable
Grade 2: moderate 4 points obvious pain, relieved by medication
Grade 3: severe 6 points severe pain, unbearable
Dry or constipated stool
Grade 0: no 0 points
Grade 1: with 1 point
② Symptom evaluation index: refer to the “Guidelines for Clinical Research on New Chinese Medicines” issued by the Ministry of Health of China in 2004
Red tongue with yellow coating
Grade 0: no
Level 1: Yes
Pulse count or slippery count
Grade 0: no
Grade l: Yes