Anal fistula

　　Anal fistula has primary internal orifices, fistulae, branches, and secondary external orifices. The internal orifice is the entrance of the infection source, usually located in the anal sinuses and nearby, commonly seen on both sides of the posterior median line, but can also be in the lower rectum or any part of the anal canal. Fistulae can be straight or curved, and a few have branches. The external orifice is the site of abscess rupture or incision and drainage, usually located around the anal canal skin. Since pathogenic bacteria continuously enter the canal through the internal orifice, and the canal twists and turns near the internal and external sphincters, the wall is composed of fibrous tissue, and there is granulation tissue inside, so it does not heal for a long time. Traditional Chinese medicine believes that the cause is due to the anal and rectal abscess after rupture, the residual toxins are not exhausted, and the blood circulation is not smooth, or due to deficiency of the lung and spleen.

　　Before receiving radical surgical treatment, anal fistula may repeatedly appear infected and suppurate, or develop more severe complex anal fistula. If repeated episodes occur, the fistula may branch out like branches of a tree, causing multiple external openings, so long-standing fistulae often cause difficulties in treatment. Due to the stimulation of fistula secretions, especially in women, it is easy to cause urinary and (or) vaginal infections.

　　Clinical manifestations

　　Anal pus, itching, and pain. An epidermal prominence can be felt near the anal orifice. It may be accompanied by systemic symptoms such as fever, anemia, weight loss, and loss of appetite.

　　During the acute stage, patients with abscesses mainly complain of anal pain, with symptoms of inflammation such as redness, swelling, and heat. If fistulae form, they often complain of purulent discharge and anal nodules.

　　The normal human body structure has seven or eight anal glands, which have no function in the body. The opening of these anal glands is located about one and a half centimeters from the anal orifice, at the position of the anal papilla. Early infection of these anal glands may form abscesses, some of which may rupture spontaneously, or improve through incision and drainage by a physician. After the inflammation improves, some may form hard crusts, and some may appear with external openings resembling bloodwater secretions, at this point forming what is called 'anal fistula'.

　　Firstly, it is important to know that appropriate cleanliness is hygiene. The anal mucosa needs to be protected by mucus, and do not completely wipe off the mucus (such as using toilet paper, soap, or repeatedly washing with clean water). Once you feel discomfort around the anus, you can take a hot bath for 15 minutes after defecation and before going to bed. If you have diarrhea and defecate frequently, it can cause damage to the anal mucosa, so you should increase the frequency of sitting baths, adopt a light diet, and try to avoid spicy, pungent, and greasy foods. To avoid constipation, maintain a balanced diet, including appropriate amounts of fat, water, and fiber-rich foods. Wear comfortable, breathable underwear to avoid local excessive moisture due to prolonged sitting.

　　A small hard lump is found under the skin near the anus, and there is a slight fever. The hard lump similar to 'grain' gradually becomes larger, and it is painful when touched locally. There is no effect in daily life. This condition is often perianal abscess (abscess), which is the precursor of anal fistula. More than 90% of perianal abscesses are caused by inflammation of the anal orifice glands (small glands on the anal orifice) and outward expansion to form abscesses ('abscess' or 'grain'), and the inflamed gland is the internal opening of the anal fistula.

　　I. Therapeutic diet for anal fistula

　　1. Winter Melon Double Bean Soup:From the name of the soup, we need to prepare winter melon, and 'double beans' refers to broad beans and mung beans. When making it, wash the winter melon, peel and cut it into pieces, and put it together with broad beans and mung beans in a pot, add an appropriate amount of water.

　　2. Kelp Mung Bean Porridge

　　(1) Ingredients: 30g of kelp, 30g of mung beans, appropriate amount of sugar, and 100g of glutinous rice.

　　(2) Preparation method: First, wash and chop the kelp, soak the mung beans for half a day, wash the glutinous rice clean, and cook them into porridge. Add sugar to taste when it is about to be done.

　　(3) Usage: Take twice a day, in the morning and evening, and it is recommended to continue for 7 to 10 days.

　　(4) Effect: Clear heat and detoxify, promote diuresis and release heat.

　　3. Job's tears Red Date Porridge:30g of Job's tears, 10 red dates, and 50g of rice. Washed clean, cooked into porridge for consumption. It has the effect of clearing heat and invigorating the spleen.

　　4. Polygonum multiflorum Mulberry Sesame Porridge:30g ofPolygonum multiflorum, 10g of mulberry fruit, 10g of black sesame, and 50g of rice. Washed clean, cooked into porridge for consumption. It has the effect of clearing heat and detoxifying.

　　II. What foods are good for anal fistula?

　　1. High-fiber vegetables:For example, vegetables such as spinach, celery, winter melon, luffa, pumpkin, mung beans, soybeans, rapeseed, cauliflower, mushrooms, kelp, and radish are light and contain a lot of fiber. They can clear heat and detoxify. Regularly using these vegetables can alleviate symptoms such as local swelling and pain around the anus, as well as the symptoms of pus and water secretion.

　　2. Fruits:Fruits are an indispensable part of our lives, and the same is true for friends with perianal abscess. However, when eating fruits, you must be selective, and you should choose fruits like watermelons, apples, pineapples, oranges, pears, etc. Because they all have the effect of moistening intestines and defecating.

　　3. Suitable for cooling blood and detoxifying foods:Mung beans, glutinous rice, cucumber, bitter melon, purslane, green tea, etc.

　　Thirdly, Foods to Avoid for Anal Fistula

　　1. Avoid eating or eating spicy foods less:Such as alcohol, chili, ginger, garlic, cinnamon, etc., they can all stimulate local inflammation and worsen the condition.

　　2. When taking medication for perianal abscess, some drugs and some foods cannot be eaten at the same time:If taking heat-clearing and detoxifying agents, it is advisable to avoid eating fish, shrimp, lamb, coriander, chive, etc., and it is best not to eat foods such as bamboo shoots, dog meat, seafood, etc. When taking blood and Qi tonifying agents, it is advisable to avoid eating radishes, peaches, plums, etc., otherwise they will affect the efficacy of the medicine.

　　Firstly, Western Medicine Treatment

　　Surgical Treatment:Surgical treatment is inevitable, whether it is an abscess or a fistula, because they are all connected to the rectum, and feces and bacteria will continue to contaminate. Therefore, drug conservative treatment alone cannot cure the disease. During fistula surgery, in addition to the need to treat the external opening and the fistula diameter, the internal opening must also be treated to prevent recurrence in the future. In the past, surgery often advocated that fistula resection must be performed during surgery in order to cure the disease. However, resection of the entire fistula will cause a large wound, and healing will take a longer time, and the damage to the anal sphincter will be greater. Recently, it is more advocated to perform fistula incision surgery, which not only causes less damage to the sphincter, heals faster, has a smaller wound, and has the same chance of cure.

　　Secondly, Traditional Chinese Medicine Treatment

　　1. Internal Treatment:

　　(1) For patients with实证 syndrome, it is advisable to clear heat and promote diuresis, and use Er Bao Wan, Bai Shen Shen Shi Decoction with modifications.

　　(2) For patients with deficiency syndrome, it is advisable to nourish yin and clear heat, and use Qinghao Jiaojia Decoction with modifications.

　　2. External Treatment:

　　(1) Fumigation and Washing: Quedao Decoction or Kushen Decoction.

　　(2) Application of Medicine: Apply Golden Powder or Coptis Ointment externally to the red and swollen area.

　　(3) Medicinal Cotton: Use medicated cotton to drain from the external orifice.