(1) Disease diagnosis
1. Diagnostic criteria of traditional Chinese medicine: refer to the standard of the Chinese medicine industry of the People's Republic of China "Standards for Diagnosis and Efficacy of Diseases and Syndromes of Traditional Chinese Medicine" (ZY/T001.
(1) Main symptoms: Pain is obvious during defecation, and the pain can be aggravated after defecation, often with constipation and a small amount of blood in the stool. It usually occurs in the middle of the anus.
(2) Main signs:
The skin of the anal canal has a superficial longitudinal fissure, neat wound margins, fresh base, red color, obvious tenderness, and elastic wound surface. More common in initial anal fissures: a history of repeated attacks. Irregular wound margin, thickening, poor elasticity, ulcer base purplish red or purulent secretions, anal papilla hypertrophy near the anal sinus at the upper end; sentinel hemorrhoids or subcutaneous fistula formation at the lower end of the wound margin. Anal fissures are more common in old age.
2. Western medicine diagnostic criteria: refer to the seventh edition of "Surgery" (edited by Wu Zaide et al., People's Medical Publishing House, 2008).
The diagnosis of anal fissure should have the main symptoms such as pain in the anus, blood in the stool or accompanied by constipation. The pain of anal fissure is a typical periodic pain. The pain during defecation can be relieved after a few minutes after the bowel movement, and the pain can be repeated for several hours afterwards. Remission afterwards; blood in the stool is dripping blood or stained with toilet paper, and the amount of blood is small. Diagnosis can be made by anal examination with signs of cracked skin in the anal canal, enlarged nipples and sentinel hemorrhoids.
(2) Disease stages
1. Acute stage: short course, fresh cracks, red color, shallow ground, neat and elastic edges, severe pain.
2. Chronic stage: Long course of disease, recurring attacks, deep fissure bottom, irregular edges, or hypertrophy of the anal papilla near the anal sinus at the upper end of purulent secretions, sentinel hemorrhoids at the lower end of the wound edge, or formation of subcutaneous fistula, and the bottom of the fissure wound. It becomes thicker and harder, forming a combo belt.
(3) Syndrome diagnosis
1. Blood heat and intestinal dryness syndrome: one line of stool for two or three days, dry and hard, dripping blood or stained blood on toilet paper, pain in the anus, fullness of the abdomen, and yellowing. Lip color is red. The tongue is reddish, the coating is yellow and dry, and the pulse is chords.
2. Yin deficiency and body fluid deficiency syndrome: dry stools for a few days, one line for a few days, painful dripping of blood during stool, dry mouth and throat, five upset and hot. The rips are crimson. Red tongue, little or no coating, thin pulse.
3. Qi stagnation and blood stasis syndrome: anal tingling, especially after defecation. The anus is tightened, and the cleft is dark and purple. The tongue is dark and purple, and the pulse is stringy or astringent.
2. Treatment plan
(1) Anal fissure resection and internal sphincter lysis
1. Indications: Chronic anal fissure
2. Operation method:
The patient takes the lithotomy position, and routinely disinfects after sacral or local anesthesia. A shuttle incision is made at 5 or 7 o’clock about 1.5 cm from the anal edge in the posterior position of the anus, and the index finger is extended into the anus to touch the intersphincteric groove. For the site, hold the curved forceps from the incision, go subcutaneously into the anal canal of the intersphincter groove, and under the guidance of the index finger, pick up and cut off part of the internal sphincter, check the anus loosely, and the obvious crack can be reached above the intersphincter groove; anal The fractured part was resectioned to expose the fresh wound; compression bandage. Surgery completed.
3. Postoperative treatment:
(1) Fumigating and washing the sitz bath twice a day after the operation, or after each bowel movement.
(2) Change the dressing on the wound surface 12 times a day.
(3) According to the condition and clinical reality, anorectal comprehensive treatment device, ultrasonic atomization fumigation and washing device, fumigation bed (sitting), intelligent perianal fumigation and washing device can be selected.
(2) Choosing oral Chinese medicine decoctions and proprietary Chinese medicines
1. Chinese medicine decoction
(1) Blood heat and dry intestine syndrome
Treatment: clearing away heat and purging fire, increasing fluid and laxative.
Recommended prescriptions: Scutellaria baicalensis Georgi, Phellodendron amurense, Rehmannia, Raw gypsum, Yuanhu, Diyu charcoal, Sophora japonica, Panax notoginseng powder, Raw rhubarb (last part).
(2) Yin deficiency and Jin deficiency syndrome
Treatment method: cooling blood and nourishing blood, increasing fluid and laxative.
Recommended prescriptions: Anemarrhena, Phellodendron, Scrophulariaceae, Shengdi, Ophiopogon, White Peony, Angelica, Ejiao (A), Peach Kernel, Safflower, Rehmannia, Chuanxiong, Yuanhu.
(3) Qi stagnation and blood stasis syndrome
Treatment method: promoting qi and blood circulation, moistening the intestines and laxative.
Recommended prescriptions: Angelica, Langfang Tablet, Magnolia officinalis, Cassia Seed, Peach Kernel, Safflower, Maren, Trichosanthis, Yu Liren, Tangerine Peel, Yuanhu.
2. Chinese patent medicine
(1) Suppositories: Mayinglong Musk Hemorrhoid Suppository, Puji Hemorrhoid Suppository, Kangtai Suppository, etc. can be used.
(2) External use of traditional Chinese medicine ointment: Kangtai ointment, dragon ball ointment, Mayinglong musk hemorrhoid ointment, etc.
(3) Chinese medicine fumigation and washing
Jinxuan lotion can be used for fumigation and washing.
(4) Acupuncture therapy
Choose acupuncture to treat postoperative complications according to the condition
1. Pain: Acupuncture at Changqiang, Chengshan, Zusanli and Huantiao points.
2. Urinary retention: Acupuncture Guanyuan, Zhongji, Qihai, Sanyinjiao, Waterway, Yangling Spring and Touyinling Spring.
3. Fecal impaction: Needling Zhigou, Zusanli, Qihai, Hegu, Quchi.
(5) Basic treatment
Treatment of complications such as infection, fever, pain, and constipation.
(6) Nursing: Nursing based on syndrome differentiation.
1. Postoperative care
Instruct patients to fumigate with traditional Chinese medicine, sit bath, apply medicine to the affected area, and physiotherapy to promote wound healing.
2. Diet care
(1) Eat more vegetables and fruits
(2) It is advisable to consume more products that nourish yin and increase liquid
(3) Qi stagnation and blood stasis syndrome is given to regulate qi and promote blood circulation
3. Efficacy evaluation
(1) Evaluation criteria
Refer to the "Guiding Principles for Clinical Research of New Chinese Medicines" promulgated by the Ministry of Health in 2004.
Healed: The symptoms disappeared and the signs disappeared.
Significantly effective: The symptoms are significantly improved, and the score is reduced by ≥ 2/3 compared with before treatment.
Effective: The symptoms are improved, and the score is reduced by ≥ 1/3 compared with before treatment.
Ineffective: The symptoms are not improved, and the score is less than 1/3 lower than before treatment.
(2) Evaluation method
Symptom evaluation indicators: refer to the "Guiding Principles for Clinical Research of New Chinese Medicines" promulgated by the Ministry of Health in 2004.
Blood in stool
Level 0: Normal 0 points
Level 1: Mild 2 points with blood
Level 2: Moderate 4 points Drop of blood
Level 3: Severe 6 points ejection
Level 0: Normal 0 points
Level 1: Mild 2 points Mild pain, tolerable
Level 2: Moderate 4 points Obvious pain, relieved by medication
Level 3: Severe 6 points Severe pain, unbearable
Dry or secret stools
Level 0: None 0 points
Level 1: Yes 1 point
② Syndrome evaluation indicators: refer to the "Guiding Principles for Clinical Research of New Chinese Medicines" promulgated by the Ministry of Health in 2004
Red tongue, yellow coating
Level 0: None
Level 1: Yes
Pulse or slip
Level 0: None
Level l: Yes