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).
Local symptoms: rapid onset, perianal swelling and pain, severe pain during defecation, followed by rupture and pus flow for a long time.
Systemic symptoms: head and body pain, weakness, constipation, yellow and red urine.
2. Western medical diagnosis criteria: refer to the 7th edition of Surgery (Wu Zaid, et al., eds., People’s Health Publishing House, 2008).
(1) Burning or throbbing pain in the anus, aggravated by defecation or walking, with difficulty in urination in a few patients.
(2) It may be accompanied by chills, fever and general malaise.
(3) Pus cavity can be detected by perianal ultrasonography.
(4) Blood leukocyte and neutrophil counts may be increased in varying degrees.
(5) There are hard nodes or lumps around the anus, with increased local temperature, pressure pain or fluctuating sensation.
For abscesses located below the anal raphe, the local symptoms of redness, swelling, heat and pain are more severe while the systemic symptoms are less severe; for abscesses located above the anal raphe, the local symptoms are less severe while the systemic symptoms are more severe, and a painful mass can be palpated on rectal finger examination, and pus can be extracted by perianal puncture.
If necessary, the diagnosis can be confirmed with the aid of intra-rectal ultrasound examination, CT or MRI examination to find the lesion.
(B) Disease stage
1.Acute stage: hard nodes or masses around the anal canal and rectum, pain, swelling, and persistent aggravation.
2.Pus-forming stage: severe pain, enlarged mass, redness, swelling and heat, central fluctuation, swelling and discomfort, accompanied by systemic symptoms, such as chills and fever, tiredness and fatigue, loss of appetite, constipation, yellow urine, etc;
3.The ulcerated stage: the mass shrinks, forms hard nodes and gradually softens or the abscess breaks down and forms a fistula, which does not heal over time.
(C) Disease classification
1.Low abscess (abscess below the anal raphe): including perianal subcutaneous abscess, sciatic rectal fossa abscess, and post-anal canal abscess.
2.High abscess (abscess above the anal raphe): posterior rectal space abscess, pelvic rectal space abscess, and submucosal abscess.
(IV) Diagnosis of symptoms
1. Fire and poisonous accumulation syndrome: sudden swelling and pain around the anus, continuously increasing, accompanied by vicious cold, fever, constipation and red urine. Redness and swelling around the anus, with obvious pain to touch, hard texture and burning surface. The tongue is red, with thin yellow coating, and the pulse is counted.
2.Heat toxin incandescence syndrome: severe anal swelling and pain, which can last for several days, pain like chicken pecking, restless sleep at night, accompanied by vicious chills and fever, dry mouth and constipation, and difficulty in urination. The perianal area is red and swollen, with a fluctuating sensation or pus on compression. Red tongue, yellow coating and slippery pulse.
3. Yin deficiency and toxin-loving syndrome: anal swelling and pain, burning, red epidermis, difficult to converge after ulceration, accompanied by afternoon hot flashes, irritable heart and dry mouth, night sweating. The tongue is red, with little coating and a fine pulse.
II. Treatment options
(I) Surgical treatment
Perianal rectal abscess incision and hanging surgery
1.Indications: Applicable to high level abscess.
2. Operation method: After satisfactory conventional anesthesia, make a radial incision or curved incision in the center of the abscess, bluntly separate the tissue interval with hemostatic forceps, fully drain the pus, then separate the pus interval with the index finger, flush the pus cavity, insert the ball probe from the incision, gently and carefully probe into the anus along the bottom of the pus cavity, and at the same time use the other index finger as a guide in the anus to find the inner mouth. If the abscess is not explored through, the highest point of the abscess cavity and the thinnest mucous membrane are pierced and hung with a rubber band, one end of which is pierced through the abscess cavity and the other end is pierced through the anus, and then the two ends of the rubber band are brought together to make them loose and tight, and then ligated and fixed. If the abscess is large in scope, it is feasible to make more than two incisions and place rubber sheets for drainage respectively. The trauma edge is trimmed, checked for any active bleeding points, Vaseline gauze is embedded in the trauma, gauze is compressed, and the tine band is fixed, and the operation is final.
Optional.
Perirectal abscess incision and drainage of the anal canal
1, Indications: Applicable to high-grade abscesses.
2, operation method: after satisfactory conventional anesthesia, radial incision or curved incision is made in the center of abscess, tissue interval is separated bluntly with hemostatic forceps, pus is fully drained, then pus interval is separated with index finger, pus cavity is flushed, and gauze is placed for drainage. Trim the trauma edge, check whether there are active bleeding points, embed Vaseline gauze into the trauma, and wrap the end of the operation.
3.Postoperative treatment.
(1) Postoperative fumigation sitz bath twice a day, or after each bowel movement to fumigate sitz bath.
(2) The traumatic surface should be changed 1 to 2 times daily.
(3) According to the condition and clinical reality, the comprehensive anal and intestinal treatment instrument, ultrasonic nebulizing 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) Fire and poisonous nodules
Treatment: Clearing heat, diarrhea and detoxification
Recommended formula: Xianfang Livestrong Drink plus or minus, dahurica dahurica, mother-of-pearl, antiphlogistic, red peony, angelica tail, licorice knot, soapberry (fried), panax ginseng (sizzling), smallpox powder, frankincense, myrrh, honeysuckle, Chen Pi.
(2) Heat toxin incandescence
Treatment: Clearing heat and defeating toxins to penetrate pus
Recommended remedy: Pus-permeable powder with addition, Astragalus, Shanjia (fried), Chuanxiong, Angelica, Saponaria.
(3) Yin deficiency and toxin love syndrome
Treatment: Nourishing Yin, clearing heat and detoxifying toxins
Recommended formula: Artemisia annua and turtle shell soup with addition and subtraction: Artemisia annua, turtle shell, raw earth, Zhi Mu, Dan Pi.
2.Chinese patent medicine
(1) suppositories nano-anal: can be used Ma Yinglong musk hemorrhoid suppositories, anal tai suppositories, hemorrhoid Ning suppositories Puji hemorrhoid suppositories, etc.
(2) Chinese herbal ointment for external use: you can choose Ma Yinglong musk hemorrhoid ointment, Longzhu ointment, Anal Tai ointment, etc.
(C) Acupuncture therapy, physical therapy
(1)Pain
Acupuncture Changqiang, Chengshan, Feet Sanli, Huanjiao points, or procaine for long-lasting pain relief, and closure of Changqiang points.
(2) Urinary retention
Acupuncture Guan Yuan, Shi Ji, Qi Hai, San Yin Jiao, Water Channel, Yang Ling Quan through Yin Ling Quan.
(3) Fecal impaction
Acupuncture of the branch gou, foot three li, qihai, hegu and quchi.
(4) Ten-drug fumigation therapy: use ten-drug fumigation according to the diagnosis of the disease.
(E) Basic treatment: treatment of infection, fever, pain and other comorbidities, antibiotics can be used.
(6) Nursing care: symptomatic care, emotional care, and dietary care.
l. Symptom identification care: Patients with anal canker sores mostly have Yin deficiency and heat, and this factor should be considered first in the overall care. When arranging the beds, attention should be paid to the orientation of the ward and the appropriate reduction of clothing and blankets. We should pay attention to the combination of Chinese and Western medicine as the main nursing measures, and we should consider the impact of the patient’s disease itself changes, emotional disorders, poor diet and improper adjustment and expansion on health.
2.Emotional care: Since most patients with anal canker sores are admitted with local pain as the main symptom and fever, they are prone to irritability, anxiety and other tensions. Therefore, nursing staff is required to do a good job of nursing both physically and mentally to alleviate patients’ unfamiliarity with the hospital and enhance their confidence in overcoming the disease. They should also understand the patient’s social background, cultural level, organizational structure, internal family situation and the patient’s own personality to carry out comprehensive care.
3.Dietary care: Diet plays an extremely important role in the treatment and recovery of anal canker. Ask the patient to avoid smoking and alcohol, and not to eat spicy and stimulating food. It is advisable to have a nutritious, light, less slaggy and easily digestible diet. Eat more vegetables and fruits to prevent constipation. Do not overexert yourself and take laxative drugs to recover as soon as possible.
III. Evaluation of therapeutic effect
(A) Evaluation criteria.
Refer to the “Diagnostic Efficacy Criteria for Ten Medical Diseases” promulgated by the State Administration of Ten Medicine in 1994
Cured: symptoms and signs disappeared, wound U healing, points lower than before treatment ≥ 2/3
Improved: symptoms improve, lesions or wounds shrink, points reduced by ≥1/3 compared with before treatment
Not healed: no change in symptoms and signs, less than 1/3 reduction in points compared with before treatment
(B) Evaluation method
1.Symptom evaluation index: refer to the guideline of clinical research of ten new drugs issued by the Ministry of Health of China in 2004.
Bleeding
Grade 0: normal 0 points
Grade 1: 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
Secretion
Grade 0: no 0 points
Grade 1: 1 point
2. Symptom evaluation index: refer to the “Guidelines for Clinical Research on New Chinese Medicines” promulgated by the Ministry of Health of China in 2004.
Red tongue with yellow coating
Grade 0: no
Grade 1: Yes
Pulse count or slippery count
Grade 0: no
Grade 1: Yes