First, the overview of anal fissure Anal fissure is a laceration in the anal area, a chronic disease in which the entire skin of the anal canal is split longitudinally and an infected ulcer is formed. In the anal part of the disease, its incidence rate is second only to hemorrhoids. Both men and women can be ill, generally occurring in the anus before and after the midline, rare on both sides, to the anus after the lateral position of the predominant. The majority of young female patients aged 20 to 40 years old, due to anatomical factors, female patients are located in the anterior midline more common. It is characterized by periodic anal pain, bleeding and constipation. Second, the etiology of anal fissure Chinese medicine believes that this disease is mostly related to dampness, heat, blood stasis, the disease is easy to cause blood deficiency and fluid loss, the intestinal tract is not moistened, and constipation is caused by constipation. Western medicine believes that the occurrence of this disease and the anus before and after the anatomical organization is weak, the lack of necessary protection; local tissue blood supply is poor, wound healing ability is insufficient and other anatomical factors. In addition, it is also related to mechanical injury, inflammatory factors, sphincter spasm, congenital anal stenosis and other factors. Third, the diagnosis of anal fissure (a) clinical manifestations 1. Symptoms Anal fissure occurs in the bladder truncation position at 6:00 and 12:00; the symptoms are pain, bleeding, constipation, and mutual causation. (1) Pain: it is cyclic, the pain is aggravated during defecation, and it is paroxysmal cutting pain or burning pain, and the pain is reduced or disappears in several minutes to more than ten minutes after defecation, which is called the pain interval. Subsequently, the pain is severe due to persistent spasm of the sphincter muscle, which often lasts for several hours before it can be gradually relieved. In severe cases, coughing and sneezing can cause pain that radiates to the pelvis and lower extremities. The degree and length of pain varies greatly from person to person. Pain is also the main reason for most patients to visit the clinic. (2) Bleeding: Bleeding can be seen during bowel movement, usually blood stained on the handkerchief or dripping blood, which is bright red in color but small in amount or only attached to the surface of feces. (3) Constipation: patients often have habitual constipation, and dry feces often cause anal fissure by tearing the skin of the anal canal, and they are reluctant to defecate regularly because of fear of pain in the anus during defecation, which leads to prolonged retention time of feces in the rectum, excessive absorption of water, aggravating constipation, and the formation of a vicious circle. 2. Physical signs (1) fissure: early patients with fresh trauma, superficial, red, soft, no fibrous tissue proliferation. Long time trauma color gray, or gray, hard, can be touched stripes of hard knots (2) pathological changes in the anal canal: no pathological changes in the early stage of the disease long in the trauma around the anus and the anal canal and the dentate line to form a “cylinder mouth” thickening, pectus band thickening, connective tissue external hemorrhoids enlargement, anus hypertrophic papilla, subcutaneous fistulas and anal sinusitis and other six kinds of pathologic changes. . (B) other auxiliary examination 1. local diagnostic examination of anal fissure to local diagnostic examination, the patient generally take the lateral position, riding position or knee-chest position, pay attention to warmth and light, ask the patient to cooperate and relax the anus, the examiner with both hands thumb, forefinger will be gently separated from both sides of the anus, from the outside to the inside, one by one to see, can not be omitted. 2.Other: Rectal diagnosis, anoscopy and anal speculum examination will often cause severe pain and aggravate the pain of the patients, and are generally not used as routine examination items. In conclusion, the diagnostic points of anal fissure are as follows: (1) Medical history: there is a history of constipation. (2) Clinical symptoms: periodic pain in the anus, blood in the stool, constipation and so on. (3) Signs of anal canal: longitudinal fissure wound in the skin of anal canal. (4) Diagnostic or anoscopic examination: Note that this type of examination is best performed under anesthesia. Common complications of anal fissure can be detected, such as sinus tract or fistula, sentinel hemorrhoids, and anal papillary hypertrophy. (5) Clinical need to differentiate from anal fissure, skin abrasions of the anal canal, tuberculous ulcers of the anal canal, anal canal ulcers of Crohn’s disease, anal noma ulcers, early anal canal cancer, and epithelial defects of the anal canal. (c) Disease staging is generally divided into two phases, namely: 1. Early anal fissure There is a small pike-shaped ulcer on the skin of the anal canal, the wound is shallow, bright red in color, with neat and elastic edges, no scar, hard knot formation, the course of the disease is shorter, and it is easy to be cured. 2. Stale anal fissure, with a history of repeated attacks of anal fissure, early anal fissure without timely and appropriate treatment, the ulcer is pale white, with a deep base, the wound edge is irregular, and is thickened in the shape of a cylinder mouth, and the bottom of the wound forms a flat and hard grayish-white tissue (pectineal band), which is poor in elasticity and difficult to be healed. The treatment of anal fissure is based on the principle of clearing the bowels and eliminating the fissure sores. Soften the stool, keep the bowel movement, stop the pain, lift the spasm of the sphincter, interrupt the vicious circle, promote the healing of the wound. The treatment of anal fissure is more, such as early lesions, as long as the active treatment of constipation, to keep the stool unobstructed, to protect the ulcerated wounds, to prevent infection, can be cured. Early anal fissure failure to timely treatment, recurrent attacks, the formation of local pathologic changes, often conservative treatment is ineffective, the need to use surgical therapy treatment. (I) General treatment 1. Dietary modification Foods rich in dietary fiber should be consumed to increase the amount of stool, such as coarse cereal products, beans, potatoes, vegetables, fruits, etc.; try to avoid or reduce spicy foods and condiments, such as chili, cumin, curry, pepper, white wine, etc.. 2. Appropriate use of laxatives laxatives can soften the stool, such as liquid paraffin, laxative, hemp pill, rhubarb tablets, senna, phenolphthalein, mushroom, etc., pay attention to the application of the dosage must be mastered, because the amount of less than play a role in the amount of diarrhea caused by a large number of easy. Dosage of individual differences, should be used according to each patient’s situation is different and discretionary. 3. Develop the habit of regular defecation Generally advocate defecation before and after breakfast. For patients with constipation for a long time, you can perform self-massage. Massage method: start from the right lower abdomen, gradually up to the right upper abdomen, epigastric, left upper abdomen, left lower abdomen in the order of the technique first heavy and then light, to the left lower abdomen when completely relaxed, generally repeat 10 ~ 20 times. Can also do some other movements that are conducive to accelerate peristalsis. 4. Relieve mental tension Most of the anal fissure patients have the fear of defecation psychology, in the absence of defecation, the first to hold back the stool is not discharged, appeared many times after the intention to defecate, only had to defecate, resulting in dry stool, fecal diameter coarsening, difficult to discharge, anal pain aggravation. In fact, in most cases, the stools of anal fissure patients are only dry and hard at the beginning, and the stools are normal afterwards. Therefore, it is the doctor’s responsibility to explain the process of defecation clearly to the patient in order to relieve the patient’s nervousness, which is very important. The author found that there are many patients after anal fissure surgery who still have this psychological barrier of defecation, which leads to the patients feeling that the surgery is not satisfactory. (B) Internal treatment 1. Blood-heat and intestinal dryness Symptoms: constipation, a line of 2-3 days, dry and hard texture, anal pain, blood-stained handkerchiefs or dripping blood during defecation, red fissure; accompanied by abdominal distension, ulceration and yellow ulcers; tongue reddish in color, with yellowish dryness of the tongue, and number of strings in the pulse. Treatment: clearing heat and cooling blood, moistening the intestines and laxative. Formula: increase liquid Cheng Qi Tang plus subtractions. If the bleeding is severe, add Diyu, Sophora japonica, Pu Huang charcoal, etc.; if the pain is severe, add Yin Qiao, Yan Hu Suo, and if the constipation is severe, add Ma Ren, Quan Gua Pou. 2. Yin deficiency and fluid deficiency Symptoms: dry stools, a line for several days, periodic anal pain, dripping blood, deep red fissures, traumatic margins are not complete; with dry mouth and throat, five heart heat; tongue red, tongue with little or yellow greasy coating, pulse number. Treatment: nourishing yin and clearing heat, laxative. Prescription: consistent decoction or laxative soup plus reduction. For those who are upset, add maitong, farzhi, etc., and for those who have difficulty in passing stools, add hemp kernel, Quan gua vulgaris, etc. 3. Qi stagnation and blood stasis Symptoms: obvious stabbing pain in the anus, especially after the bowel movement; anal tightness, crack color purple; purple tongue, yellow tongue coating, stringy or astringent pulse. Treatment: regulate qi and activate blood circulation, dissolve blood stasis and open the channels. Prescription: Six-mill Tang plus subtractions. If the pain is severe, add dandelion, safflower, peach kernel, red peony, etc.; if the stool is constipated, add Citrus aurantium, manganese, etc. (C) External treatment 1. Fumigation is suitable for all stages of anal fissure. It mainly has the functions of activating blood circulation, removing blood stasis, reducing swelling and relieving pain. Commonly used formulas are Jingwu Fang, bitter ginseng soup, expectorant soup, peppercorns, or 1:5000 potassium permanganate solution, etc. Smoking first and then washing can keep the local cleanliness and hygiene, and also can promote blood circulation, reduce stimulation, and accelerate the healing process. 2. Compresses are suitable for all stages of anal fissure. It has the function of clearing away heat and detoxification, relieving pain and stopping bleeding. Commonly used are Jiuhua ointment, muscle jade red ointment, anus tai ointment, taining ointment (keratine), ma yinglong musk hemorrhoid ointment, longzhu ointment, wet burns ointment, etc., 1~2 times a day. 3. Plugging medicine is suitable for all stages of anal fissure. It has the function of clearing away heat and detoxification, reducing swelling, relieving pain and stopping bleeding. Commonly used anti-inflammatory pain suppository (indomethacin), hemorrhoids Ning suppository (beauty Xinzuoone), Puji hemorrhoids suppository, solution to the Thai suppository, too Ning suppository (keratine acid fat) and so on. 4. Corrosion is suitable for recurrent old anal fissure. It has the effect of activating blood circulation and removing blood stasis, taking off the rot and generating muscle. Commonly used drugs are eighty-two dan, seven three dan, red ascending dan, withered hemorrhoids scattered. Or use 5% glycerin carbolic acid to rub the affected area and then wipe it off with 75% alcohol. The main use: apply a little Dan externally on the stale fissure, 1~2 times a day, when the wound is fresh, it can be changed to Shengmisan, which makes the wound healed. (D) Other therapies 1. Expanding the anus method is suitable for early anal fissure, no connective tissue hemorrhoids, papillary hypertrophy and other comorbidities. 2. Closure therapy is suitable for those who have old anal fissure with obvious pain. (e) Surgical treatment is applicable to old anal fissure, or early anal fissure for which non-surgical treatment is ineffective. 1. Sphincter lateral incision method is suitable for early anal fissure without external hemorrhoids, papillary hypertrophy, subcutaneous fistula and other comorbidities. 2. incision therapy for old anal fissure, with connective tissue hemorrhoids, papillary hypertrophy and so on. 3. Longitudinal cutting and transverse suture method is suitable for old anal fissure, accompanied by anal canal stenosis. Prevention and care of anal fissure 1. Develop good defecation habit, treat constipation in time, eliminate inflammation and avoid mechanical injury. 2. 2. Diet should be light and vegetarian, eat more fresh vegetables and fruits, and avoid spicy and stimulating food. 3. Adopt good living habits, pay attention to the combination of work and rest, and actively exercise to enhance physical fitness. 4. Pay attention to maintaining the cleanliness and hygiene of the anus, wash the anus in time after bowel movement to avoid infection. Once diagnosed with anal fissure, it should be treated as early as possible to prevent other anal diseases. 5. Local massage and moderate anal exercises are effective ways to prevent this disease.