Is anal fistula easy to cure? Is TCM internal treatment good?

Patients with anal fistula will experience repeated symptoms of pus discharge, and anal pain and itching will also be obvious, which will have a great impact on daily life. Treatment should be sought as soon as possible. Surgery is generally chosen for the treatment of anal fistula, and secondly, the effect of traditional Chinese medicine differentiation and treatment is also very good.

1. TCM internal treatment methods

1. Damp-heat invades the perianal area and often causes pus discharge with thick yellow color, anal distension and pain, local burning sensation, anal ulcers with cord-like openings leading to the anus when pressed; dry and bitter mouth, red tongue, yellow and greasy tongue coating, and a stringy and slippery pulse.

Syndrome differentiation and analysis: The evil dampness and heat accumulate in the anus, causing stagnation of qi and blood. If it is not removed for a long time, the stagnation will turn into heat, causing the flesh to rot and become pus, so pus will flow around the anus, which is yellow and thick. Swelling and pain in the anus, local burning sensation; when the evil toxins spread to the side, they form cord-like tubes; dry and bitter taste in the mouth, red tongue, greasy yellow tongue coating, and slippery and stringy pulse are all signs of damp heat.

Treatment method: clear away heat and remove dampness.

2. Yin deficiency and evil lingering in the perianal area, with repeated discharge of thin pus that does not heal, dull pain and sunken ulcers around the anus, and often five cord-like hard objects can be felt locally; hot flashes, night sweats, irritability and dry mouth; red tongue with little coating, and a thin and rapid pulse.

Syndrome differentiation and analysis: Lung and kidney yin deficiency, insufficient vital energy, damp heat evil accumulated in the anus, lingering, resulting in repeated discharge of thin pus; yin deficiency and internal heat are manifested by hot flashes, night sweats, irritability and dry mouth; red tongue, little coating, and thin and rapid pulse are signs of yin deficiency and hyperactivity of fire.

Treatment method: Nourish yin and clear away heat.

Prescription: Qinghao Biejia Decoction with modifications.

2. Excision therapy

1. Indications: Low-position anal fistula.

2. Contraindications: Fistula history less than 3 months; fistula with pus formation; severe pulmonary tuberculosis and other serious systemic diseases.

3. Operation method: Take the lithotomy position or lateral decubitus position for routine disinfection. Under lumbar anesthesia or local infiltration anesthesia, first insert a piece of saline gauze into the anus, and then use a syringe to inject 1% methylene blue from the outer opening of the leakage tube. If the gauze is stained with color, it will help to find the inner opening. Use a ball-tipped probe to probe from the external opening, and at the same time use the index finger of the other hand to insert into the anus as a guide. Carefully insert the probe from the internal opening, lift both ends of the probe, and use scissors to cut off the wall of the fistula and the surrounding scar tissue to form a wide wound with a small bottom. Fill the wound with Vaseline gauze.

4. Precautions: The direction of the leakage tube should be carefully checked before surgery, and only when it is confirmed to be a low-position anal fistula can a one-time resection therapy be performed. During surgery, the primary internal opening should be carefully explored to avoid excessive force, which may form a false internal opening and lead to recurrence of leakage after surgery. Change the dressing once a day after surgery to allow granulation tissue to gradually grow from the base and prevent bridge-shaped healing.