Preliminary Clinical Observation on the Treatment of Anorectal Diseases with Compound Huangbai Liquid
According to the composition and characteristics of the traditional Chinese medicine liquid for the treatment of Yang syndrome after sore ulceration, the author believes that it can be used in anorectal medicine. In order to observe the clinical effect, 130 patients with anorectal diseases and some post-surgery patients from October 2007 to April 2008 were clinically observed.
1. Materials and Methods
1.1 General information
130 patients, gender: 86 males and 34 females; ages from 18 to 72 years, average 42 years old. The 45 post-operative cases were from the seven wards of the Anorectal Department, and the other 75 were from outpatients. Distribution of disease types: 15 cases of hemorrhoids without operation and 15 cases after operation; 20 cases of anal fistula without operation and 20 cases after operation; 10 cases of anal fissure without operation and 10 cases after operation; 10 cases of perianal eczema, including around the left lower abdominal stoma There were 2 cases of eczema; 10 cases of anal itching; 10 cases of ulcerative rectal inflammation and 10 cases of radiation proctitis. Disease diagnosis is in accordance with "People's Republic of China Traditional Chinese Medicine Industry Standards." Criteria for Diagnosis and Efficacy of TCM Diseases.
1.2 Selection criteria
Patients with anorectal diseases who were treated in our department without a history of allergies to the drugs contained in the complex and agreed to use the drugs were selected. If an adverse reaction is found during the course of treatment, the drug should be stopped immediately, treated symptomatically, or switched to other drugs.
1.3 Observation method
1.3.1 Medicine: Compound Huangbai Liquid, provided by Shandong Hanfang Pharmaceutical Co., Ltd., (foreign) National Medicine Standard Z10950097, patent number: ZL96106739, main international patent sub-number: A61K 35/78, batch number: 0705146, 0705222, 0708152, 0804141.
1.3.2 Usage: For patients with anal diseases who have not undergone surgery, including hemorrhoids, anal fistulas, anal fissures, perianal eczema (including 2 cases of eczema around the left lower abdominal stoma), and anal itching, use a sterile absorbent cotton ball to soak in the original drug solution. Apply to the affected area 2 times a day for 7 consecutive days. After surgery, patients with anal diseases, including mixed hemorrhoids after external peeling and internal ligation, anal fistula incision, high anal fistula incision and threading, and anal fissure posterior sphincter partial incision, use the tissue paper provided by the manufacturer to dip Medication, wet compress the wound, until the wound heals. For ulcerative rectal inflammation and radiation proctitis, use 1:1 compound phellodendron solution 100ml of normal saline retention enema, once a day for 7 consecutive days.
1.3.3 Scoring criteria before and after symptom treatment
According to the common and unique symptoms of anal diseases, clinical observations were made for anal pain, itching, edema, blood in the stool (pus), and wound healing time. The grading standards for each symptom are as follows.
Table 1 Clinical symptom grade scoring standard
Clinical symptoms 0 points 1 point 2 points 3 points
Pain None Tolerable Unbearable Need to take painkillers Restricted movement and walking
Itching None Tolerable Intermittent attacks, medication is required, accompanied by obvious skin lesions
Edema None <1cm3 1~2cm3 >2cm3
Stool (pus) blood No blood in the toilet paper Dripping blood/mucus in the stool Spurting blood/pus in the stool
Cure: The symptoms and signs disappear.
Improvement: Symptoms and signs improved.
Unhealed: No improvement in symptoms and signs, or the patient abandons medication.
3.1 Effective record
The purpose of recording the onset time is to observe the effect time of compound Huangbaiye on the clinical symptoms and signs of anorectal diseases, and to guide and improve the methods and methods of clinical medication. It can be seen from Table 2 that the improvement of anal pain is earlier, mostly in the first to 3 days, anal itching is more in the second to 3 days, anal edema is more in the third day, and pus and blood in the stool are mostly in the third to third days. 4 days.
Table 2 Record of effective time within one week
Symptoms (number of cases) After treatment (number of cases)
1 2 3 4 5 6 7
Pain (75) 12 30 26 2 0 0 0
Itching (98) 3 12 35 22 3 3 1
Edema (42) 0 3 33 2 1 1 0
Stool (pus) blood (36) 1 2 15 14 0 0 2
3.2 Record of wound healing time
The purpose of recording the wound healing time is to reflect whether the compound Huangbai liquid can promote wound healing. From Table 3, it can be seen that the mixed hemorrhoids external dissection and internal ligation, and partial sphincterotomy for anal fissure usually heal within 21 days, and anal fistula incision Most of the operations healed within 28 days, and 2 cases of high anal fistula incision and thread-drawing healed more than 28 days.
Table 3 Record of wound healing time
-14d -21d -28d >28d
External stripping and internal ligation of mixed hemorrhoids (15) 3 10 2 0
Anal fistula incision (16) 2 6 5 3
High anal fistula incision and threading (4) 0 1 1 2
Partial incision of posterior sphincter of anal fissure (10) 1 6 3 0
3.3 Adverse reactions and abandonment of medication treatment records
Adverse reactions and abandonment of medication The purpose of treatment records is to observe the adverse reactions of the compound Huangbaiye to the affected area and surrounding skin and the patient's awareness of the drug. In this group of cases, 4 cases of skin adverse reactions occurred, and the drug was stopped immediately. There are 18 patients who think that the curative effect is not satisfied and give up the medication.
Table 4 Adverse reactions and abandonment of medication treatment table
Perianal tingling 2
Perianal skin papules 2
Give up medication 18
3.4 Comparison of symptom scores before and after treatment
Through the comparison of symptom scores, it is reflected that the compound Huangbaiye has a significant effect on improving the main symptoms and signs of the anus (P<0.01).
Table 5 Comparison of symptom scores before and after treatment
Before treatment After treatment
Pain 2.4±0.5 0.5±0.3
Itching 1.8±1.1 0.25±0.2
Edema 2.7±1.1 0.3±0.2
Stool (pus) blood 2.8±1.2 0.72±1.2
3.5 Treatment effect
The effect is observed after 6 months of follow-up, see the table below.
Table 6 Treatment effect
Hemorrhoid 15 2 11 2
Anal fistula 20 0 16 4
Anal fissure 10 6 3 1
Perianal eczema 10 4 2 4
Anal itching 10 3 2 5
Mixed hemorrhoids after external stripping and internal ligation 15 15 0 0
After anal fistula incision 16 16 0 0
After high anal fistula incision and threading 4 3 1 0
After partial incision of the posterior sphincter of anal fissure 10 8 2 0
Ulcerative direct inflammation 10 3 5 2
Radiation proctitis 10 2 4 4
The main pharmaceutical composition of the compound Huangbaiye is forsythia, cork, honeysuckle, dandelion, and centipede. It has the effects of clearing away heat, detoxifying, reducing swelling and removing rot. Its pharmacological effects include anti-Gram-positive bacteria, anti-inflammatory and promoting wound healing. It can also enhance the phagocytic function of mononuclear giant cells and improve non-specific immunity. The original medicine is a reddish brown liquid, which can be applied to wounds or deep ulcers for washing. The general dosage is 10-20ml. It is suitable for common diseases such as ulcer ulceration, osteomyelitis, bone tuberculosis sinus, vasculitis, and trauma infection after sore ulceration. It is a clinically effective drug for purulent infection.
In the composition of the drug, forsythia has the effect of detoxification, eliminating carbuncle and dispelling lumps, and is known as the sacred medicine of the sore family. The "Shen Nong's Materia Medica" says "mainly cold and heat, rat atrophy, scrofula, carbuncle malignant sores, galls, tumors, and heat. "Honeysuckle, cold in nature, sweet in taste, and calm in taste, and its effect of clearing away heat and detoxification, can treat fever, ulcer, carbuncle and boils. Pharmacologically confirmed that honeysuckle contains cyclohexanol, flavonoids, inositol, saponins and tannins, etc., and its water and wine extracts have broad-spectrum antibacterial effects against Staphylococcus aureus, Shigella and other pathogenic bacteria. It has a strong inhibitory effect, and it also has an inhibitory effect on a variety of pathogenic microorganisms such as Leptospira, influenza virus and pathogenic molds. Drugs with flavonoids as the main components have been widely used in clinical practice. Both Yinhua and Forsythia have good heat-clearing and detoxifying effects, which can not only dilute heat to reach the surface, but also clear internal heat and detoxify sores. Therefore, the two drugs are often used together in clinical practice. Phellodendron has a long history of being used in anorectal diseases, and the treatment of perianal eczema has been proven. "Jihu Jijian Prescription" to treat carbuncle and swollen poison is divided into acerola bark (stir-fried) and Sichuan aconite (cannon), which are not applied, keep the head, and frequently use rice bath to moisturize; For men’s vulva sores, use cork to wash with water, or use Coptis and Phellodendron to divide it into powder; "The Secret Record of the Son and Mother" is not suitable for treating umbilical ulcers in children. It is not suitable to use cork powder to treat children with abscesses. For the body not dry, add a little orange alum with cork powder. Experiments have proved that dandelion can kill Staphylococcus aureus, hemolytic streptococcus, pneumococcus, meningococcus, diphtheria, Pseudomonas aeruginosa, dysentery, typhoid bacillus, catarrhalis, etc. Mycobacterium tuberculosis, certain fungi and viruses also have a certain inhibitory effect. Therefore, it can replace antibiotics to a certain extent. In the "Compendium of Medicine", the centipede stated that "treatment of convulsions and convulsions in children, umbilical vents, erysipelas, baldness, scrofula, defecation, hemorrhoids, and snake wounds." For example, the treatment of constipation in the "Jisheng Secret View" , "Ren Zhai Zhi Zhi Fang", "Sun Tianren Ji Xiao Fang" in the treatment of hemorrhoid pain.
Preliminary clinical observation results show that compound Huangbaiye can significantly improve the symptoms of anorectal diseases and some anal diseases after surgery, such as pain, itching, edema, pus and blood in the stool, etc., for hemorrhoids, anal fistulas, ulcerative colorectitis and external hemorrhoids. Postoperative and postoperative treatment of anal fistula incision, the effect is ideal, and it also has good effects on other anorectal diseases.
According to its drug composition and preparation process, it is applied to anorectal diseases without ethical obstacles and drug contraindications. In order to expand the scope of its clinical application, the author conducted preliminary clinical observations on common anorectal diseases, and felt satisfied with the effect. It has the effects of anti-infection, anti-ulcer, promoting tissue repair, and promoting wound healing. Its preparation is convenient to apply, and has a fast onset time. Because of the remarkable curative effect and other characteristics, the author believes that the compound Huangbaiye can be used externally for anorectal diseases and after surgery.