Anal eczema; surgical treatment; herbal fumigation; Anal eczema is a metaplastic disease of the anus caused by a variety of internal and external factors, the main lesions are in the superficial dermis and epidermis of the anal skin, the local skin itching is intense, the lesions show a limited infiltrative hypertrophy of the skin at the anal margin, the surface is rough, there may be chaps and mossy changes. Although there is a certain effect of medication, some patients do not show the effect of medication due to recurrent attacks. In recent years, the author used surgical therapy to treat patients with intractable anal eczema and achieved satisfactory results, which are reported as follows: I. Clinical data 1. General data The selected cases were all from patients who came to the Department of Anal Surgery of Xuzhou Hospital of Traditional Chinese Medicine from July 2008 to July 2011 [CU1], and 60 cases meeting the diagnostic criteria of anal eczema were randomly divided into 2 groups. In the treatment group, there were 30 cases, 18 males and 12 females; ages ranged from 25 to 63 years; disease duration ranged from 4 months to 5 years. In the control group, there were 30 cases, 16 males and 14 females; ages ranged from 23 to 66 years; disease duration ranged from 6 months to 4 years. there was no statistically significant comparison between the 2 groups in terms of gender, age and disease duration (P>0.05). 2. Diagnostic criteria All conformed to the diagnosis of anal eczema in the Diagnostic Efficacy Criteria for Chinese Medical Evidence promulgated by the State Administration of Traditional Chinese Medicine. Symptoms: Patients felt itchy and uncomfortable around the anus, especially at night. Specialized examination: the skin of the anal verge is limitedly infiltrated and thickened, brownish red or grayish white, with a rough surface, covered with a little bran-like scales, which can be radially chapped or crusted due to scratching, with a few moss-like changes. Exclusion criteria: combined with perianal disorders such as hemorrhoids, anal fistula, anal fissure; patients with endocrine system diseases such as diabetes mellitus and tumors. 3. Statistical methods The statistical software SPSS10.0 was used for processing. Treatment methods 1. Treatment group Patients were placed in a lithotomy position, routinely disinfected, and anesthetized with anal infiltration or small-dose saddle anesthesia. After completion of anesthesia, the anal canal and the lower rectal mucosa were disinfected with iodophor cotton balls, and no abnormal swelling was detected by finger diagnosis. The incision was made with medium curved forceps or curved scissors along 1-11, 11-7, 5-7, and 1-5 points in several directions to make blunt separation of the skin and subcutaneous tissue free and to stop bleeding sufficiently. The wound is dressed with triple butter gauze and fixed with sterile gauze with pressure bandage. Intraoperative attention: 1) when separating subcutaneous tissue with vascular forceps or curved scissors, do not use violence to break the skin of the anal canal; 2) try to use blunt separation to prevent damage to blood vessels and formation of subcutaneous thrombosis. Postoperatively, defecation can be controlled for 2-3 days, with a semi-liquid diet and routine anti-infection treatment. Keep the anal area clean, and use Chinese medicine fumigation formula to take a sitz bath for 15-20 min each time after the bowel movement, 2 times/day, and regular drug change treatment. 2. Control group: Apply compound trimethoprim econazole cream (Pirexon, produced by Xi’an Janssen Pharmaceutical Co., Ltd.) on the perianal lesions after the daily sitz bath with Chinese herbal fumigation formula, and rub gently to make the drug absorbed, 2 times/day. 3. Efficacy standards and results Efficacy standards were formulated with reference to the Diagnostic Efficacy Standards for Chinese Medicine Evidence promulgated by the State Administration of Traditional Chinese Medicine. Cured: normalized skin lesions, no itchy exudation; improved: basic recovery of skin lesions, no exudation, still itchy; not cured: skin lesions not fully recovered, still itchy and exudation from time to time. Anal eczema is a common non-infectious skin disease, with lesions mostly limited to the skin around the anus, but also spreading to other parts. Its pathogenesis is complex, and it can develop at any age. In recent years, many foreign dermatologists believe that the disease is a delayed metamorphosis caused by complex internal and external excitatory factors. Patients with chronic anal eczema discussed in this article have a long duration of the disease, which is prolonged and recurrent, resulting in thickening of the skin around the anus, grayish or dark red, rough and even cracked, oozing and itchy, making treatment difficult. In Chinese medicine, eczema is also called “dip sores” and “perianal wind”, and its internal causes are mainly due to deficiency of the body, lack of endowment, internal injury to the emotions, dysfunction of the liver and spleen due to poor diet, dampness and heat, and internal wind due to depletion of yin and blood from prolonged illness; external causes are mainly external sensations Damp-heat evil. Damp-heat injection, blood deficiency and wind dryness are the basic pathogenesis of this disease. In Chinese medicine, it has been said that “prolonged illness will lead to siltation” and “prolonged illness will lead to deficiency”. When the evil of wind, dryness, dampness and heat accumulates in the anus for a long time, the flow of qi and blood is not smooth, the meridians are blocked and blood stasis develops. In the course of general treatment, chronic anal eczema patients suffer from thickening and thickening of the affected skin, which affects the absorption of drugs and the effect of treatment, and scratching causes aggravation of lesions and mossy lesions, which further prevents the absorption of drugs, leading to a vicious circle and delayed healing. The author used surgical treatment combined with Chinese medicine fumigation to treat this disease. Through surgical treatment, the subcutaneous nerves were severed to block the conduction of perineural nerve endings receptors, and with the Chinese medicine fumigation formula, the anti-inflammatory and anti-itching treatment was achieved. The formula is composed of Chinese herbs such as Serpentine, Phellodendron, Cicada, Radix Angelicae Sinensis, Bitter Ginseng, Rhizoma Alba, and Tiger Balm. The operation is simple, with little tissue damage, quick elimination of symptoms, no postoperative complications, no distant anal deformation, stenosis, numbness and other anal function abnormalities, and care should be taken not to damage the skin blood supply during the operation. After 30 cases of clinical observation, the cure rate reached 90%, and the patients’ local pruritus and a variety of metaplastic rashes in the process of skin nerve recovery were gradually reduced or even disappeared, and the skin returned to normal. In addition, it is also necessary to do a good job of hygiene education, educate patients to avoid scratching, avoid washing with high temperature water and alkaline soap, avoid eating seafood and spicy stimulating food, and prohibit the use of irritating topical drugs to reduce the recurrence rate after treatment.