The typical clinical manifestations of patients with anal fissures are pain, constipation and blood in the stool. So how to treat anal fissure? 1.TCM diagnosis and treatment: Anal fissure is divided into three types: blood-heat and intestinal dryness type: the symptoms include two or three days of one line of stool, dry and hard, pain in the anus during the stool, blood dripping from the stool or blood staining the hand paper, red color of the fissure, abdominal distension, yellow urine, red tongue and string pulse; Yin and blood deficiency type: dry stool, one line for several days, painful blood dripping from the stool, deep red fissure, dry mouth and throat, irritable heat in the heart, red tongue, little or no moss, and fine pulse; Qi stagnation and blood stasis type: stabbing pain in the anus is obvious, especially after the stool, the anus is tight, the fissure is purple and dark, the tongue is purple and dull, and the pulse is stringent or astringent. For the type of blood-heat and intestinal dryness, the main purpose is to moisten the bowels and open the stool, and the hospital’s homemade oral medicine is Ma Ren Wan; for the type of Yin and Blood deficiency, the main purpose is to nourish Yin and Blood and open the stool, and the hospital’s homemade oral medicine is Sheng Xu Tong Po granules; for the type of damp-heat injection and Qi stagnation and Blood stasis, the hospital’s homemade Scutellaria Baicalensis granules can be taken orally with good effect. 2. External treatment of Chinese medicine 2.1 Drug fumigation treatment Decoct the drug into water, or directly flush with boiling water, fumigate first and then wash while hot, then sit in a bath for about 15 minutes after each bowel movement, once a day. It can be used for conservative treatment of anal fissure and postoperative medicine. It has the effect of reducing swelling and relieving pain. Commonly used drugs include Scutellaria granules, fumigation enema solution, fumigation combination, etc., all of which are self-prepared by the hospital. 2.2 External drug treatment Apply the drug directly on the affected area or apply the drug evenly on the small gauze and cover the small gauze on the wound surface. It has the function of stopping pain and hemorrhage, creating muscle and closing the mouth, reducing swelling and promoting wound healing. Commonly used drugs include silver ash cream (powder), Jiuhua cream (powder), crispy bile hemorrhoid cream, etc. 3.Surgical treatment 3.1 Finger method anal dilatation is suitable for stage I-II uncomplicated anal fissure. Local anesthesia, left side lying position. Procedure: Apply petroleum jelly or paraffin oil to the index and middle fingers of both hands, lubricate the anus deeply with the right index finger first, then extend the left index finger dorsally to gently open the anal canal on both sides and maintain for 3-5 minutes, then extend the middle fingers of both hands, if the anal fissure is in the posterior median position, press the two fingers near the lesion downward and outward, if the anal fissure is in the anterior median position, press upward and outward, and maintain the anal dilation for 5 minutes. During the operation, note that anesthesia must be adequate and violence should not be used. Gradual force should be used to avoid tearing of the mucosa or skin. 3.2 Hanging wire surgery Applicable to anal fissure with submerged fistula. Procedure: After satisfactory anesthesia, routine disinfection, make a small radial incision of about 37.5 px in the skin of the external anal margin of the fissure, remove the sentinel hemorrhoid and the hypertrophic anal papilla at the same time, insert a ball probe through the lower part of the external sphincter skin and the internal sphincter with the small incision, under the guidance of the index finger of the left hand in the anus, search for the posterior anal sinus, insert the probe through the sinus at the upper end of the fissure, hang the rubber band, retreat the needle and lead to the external anal area. The two ends of the rubber band are clamped together and clamped, and the silk is ligated under the clamp. 3.3 Internal sphincter dissection 3.3.1 Excision and in situ sphincter dissection Because the sphincter under the fissure has been stimulated for a long time and has become fibrotic, bleeding and pain are less than those of the unfibrotic sphincter after dissection, so the sphincter is dissected in situ. Xiong Zhiyan et al. used anal fissure incision and in situ sphincterotomy (the perianal skin is incised in the center of the fissure with the tip not exceeding the tooth line. The skin of the underlying incision was lifted with tissue forceps, the subcutaneous tissue was sharply separated upward, and the fissure, connective tissue external hemorrhoid and hypertrophic anal papilla were excised together, and the exposed lower part of the external sphincter and the lower edge of the internal sphincter were picked up and cut off about 25 px. It was found that the postoperative pain in the two groups was mainly grade I in patients who underwent incision and in situ sphincterotomy from day 1 to 3, and the pain was significantly less than that in the control group. 3.3.2 Lateral internal sphincterotomy is suitable for simple anal fissure with anal sphincter spasm and anal stenosis. The intersphincteric groove is felt, and a curved incision of about 50 px is made on either side of the anal margin at a distance of 1 to 37.5 px from the anal canal. A hemostatic forceps is extended from the incision to the intersphincteric groove, and the internal and external sphincters are separated upward, the lower edge of the internal sphincter is clamped, and the internal sphincter is separated upward to the dentate line, and then the internal sphincter is picked out from the incision and cut under direct vision. The lateral incision is closed with a mattress suture, and the stitches are removed in 3-7 days, and the suture is not allowed to sit in the bath before removal. 3.3.3 Posterior median internal sphincterotomy For posterior median stage III anal fissure. A longitudinal incision of about 37.5 px is made from the dentate line to the anal verge to separate the tissues between the internal and external sphincters, and the lower edge of the internal sphincter is cut directly through the fissure in the posterior median line if it is complicated by sentinel hemorrhoids and anal papillomegaly. 3.4 Anal fissure excision and dilatation A shuttle incision is made from the dentate line downward along both sides of the fissure, down to about 25px outside the fissured hemorrhoid and deep to the base of the ulcer, and the scar tissue at the edge of the fissure is excised along with the sentinel hemorrhoid, subcutaneous fistula, hypertrophied anal papilla and infected anal sinus. For the surgical treatment of old anal fissures, our conventional treatment plan is: fissure dilation with internal sphincter lateralization and 10 minutes of anal dilation after surgery.