The acute phase of perianal septic infection is called anal abscess and the chronic phase is called anal fistula. They are actually two stages of one disease. Chinese medicine considers it as carbuncle and leakage, which is the same meaning as Western medicine. The principle of treatment is to drain and expel pus, and TCM belongs to TO, which is consistent with both. But why does TCM need to hang wires? This is because in ancient times there was no anesthesia, and forcing an incision could not be done, nor could it be sutured, so the ancestors exercised their ingenuity and used the hanging thread method, which could achieve the four major effects of incision, drainage, suturing, and pain relief. Can a simple thread be used to treat anal fistulas and anal abscesses? Obviously not. After the introduction of anesthesia, the anatomy of the anus has been gradually clarified, and the means of TCM treatment has progressed. With the efforts of the older generation of TCM anorectal predecessors, such as Ding Zemin and Shi Zhaoqi, the level of treatment of TCM anorectal diseases has continued to improve with an open mind and an enterprising spirit, which is one of the few disciplines where TCM has an advantage over Western medicine. There is also a lot of common language and topics in domestic and international exchanges. The previous statement on the principle of treatment is not fully expressed, and should be a cure by complete surgical removal of the lesion with maximum protection of normal tissues and functions. In fact, all medical principles are the same. Not only anal diseases. Then why must the internal opening be treated? It is to remove the lesion completely and not to recur. Do I have to treat the internal opening for an abscess? Of course. What if I can’t find it? Take your time to find it. If you can’t find it, ask someone else to find it. If you can’t find it, cut and drain it first, as close to the internal opening as possible. The external side of the abscess cavity should be incised, drainage should be thorough, all abscess cavities should be opened, sometimes to drain the mouth, drainage should be thorough, and try not to leave abscess cavity. If the patient has hypothermia that does not go away after surgery, there is definitely a residual pus cavity, and a second surgery is usually required. How to find the internal opening? This is technical work, scrape with a spatula, scrape off any decaying tissue you find, and probe with a probe if there is suspicious. It is best to have a superior physician to open a few, and experience each case yourself. Open more and you will. It doesn’t matter if you don’t find an internal opening, by opening the abscess in this way, the anal fistula formed is very small. It is often a low level simple anal fistula, and the incision will be done after three months. Do I have to hang a wire for an anal abscess? In principle, it is not possible to hang a wire. Because the pus cavity will shrink rapidly after draining and the surrounding tissues are soft, hanging a wire will cause more damage and cause a certain defect in the anal canal, resulting in postoperative anal leakage or inadequate anal sphincter function in old age. Is it absolutely impossible to hang a wire? No, if we explore the internal opening, but there are more normal tissues between the incision and the internal opening, sometimes there are more sphincters, then the forced incision may cause damage to the anal function, we can hang a thread, this thread is not tight, it is rubber band or silk thread can be, mainly play the role of marking and stimulation, to be most of the wound healing around the tissue scar formation, here is a simple low The fistula, the internal opening is also clear, the surgery is extremely easy and the damage is small. There is also a pus cavity that has collapsed into the rectum, and this kind of internal opening is higher, so you can hang the thread after cutting the real internal opening, but do not tighten the thread, and wait until the wound is almost healed. The surgery of anal fistula is more complicated because no patient’s fistula is the same. Just cut the low anal fistula, no matter how many external openings, cut them all, and close them if they can be sutured, or open them for second-stage healing if they cannot. It can also be drained to the mouth. The internal port must be incised. In the case of high complexity fistulas, iodine oil imaging should be done before surgery, repeated probing and palpation, MR if necessary, and pre-planning before surgery. The internal opening is found and the high part is left open to completely remove the dead cavity. A skin flap can be done at the same time, and a muscle flap filled. It can also be sutured or partially sutured. Try not to hang threads, and curved and deep fistulas that are incised should be flushed with medication and drained with oiled gauze every day after the change, which usually heals. Some anal fistulas require multiple surgeries to completely heal, and the key is that each opening is in the plan to solve the problem. Why do you need to open it so many times? It is to protect the function of the anus to the greatest extent possible. The principle of hanging wire therapy: cutting effect, drainage effect, stimulation effect, marking effect. Advances in the treatment of anal fistula and other therapies: sealing therapy.