bubble_chart Concept

Perianal abscess, abbreviated as anal abscess, refers to the accumulation of heat toxin around the anus and rectum, forming an abscess that can ulcerate and lead to fistula disease.

Lingshu．Carbuncle and Gangrene refers to anal abscess as "sharp gangrene," Chuangyang Jingyan Quanshu calls it "perianal abscess" or "penetrating groin abscess," Yizong Jinjian categorizes it into "sitting horse abscess," "dismounting horse abscess," "mounting horse abscess," etc., Waike Zhengzong refers to it as "vulva carbuncle."

An abscess is a blockage. Toxic qi can accumulate and form abscesses both inside and outside the human body. This condition discusses abscesses formed by the accumulation of toxic qi around the anus and rectum. Boils, sores, and other lesions occurring in other areas are not within the scope of this discussion.

bubble_chart Pattern Analysis

1. Excessive Heat Accumulation︰The onset is sudden, with a peach- or plum-shaped swelling suddenly appearing around the anus, accompanied by redness, swelling, heat, pain, and tenderness. It rapidly swells and protrudes, and in most cases, pus forms within 5–7 days. Upon spontaneous rupture or incision, the pus is thick and dense, yellow-green in color, mixed with blood, and accompanied by {|###|}fever and chills{|###|}, severe {|###|}constipation{|###|}, scanty dark urine, {|###|}thirst{|###|} with a desire to drink, a red tongue with yellow coating, and a slippery, rapid, and surging pulse. This condition is mostly caused by exposure to wind-fire {|###|}dampness-heat{|###|} toxins, excessive consumption of rich foods and alcohol, leading to the accumulation of excess heat around the anus and rectum. Its characteristics include: sudden onset, aggressive progression, high and protruding swelling, intense redness and {|###|}severe pain{|###|}, rapid pus formation, easy dispersion after rupture, thick yellow-green pus, {|###|}constipation{|###|} and dark urine, alternating chills and fever, a red tongue with yellow coating, and a slippery, rapid, and surging pulse. Treatment should focus on clearing and purging excess {|###|}heat toxin{|###|} qi. In the early stage, dispersing methods should be used to promote internal resolution, with oral administration of Internal Dissipation Powder and Double-Resolving Revival Powder, external application of As Wish Golden Yellow Powder, and internal moxibustion with moxa cones. When pus forms, the treatment should aim at {|###|}expelling the internal to drain pus{|###|}, allowing the {|###|}heat toxin{|###|} to discharge along with the pus and blood. Do not trap the pus and nurture the sore, as this may lead to toxin invasion of the heart. Administer {|###|}Pus-Draining Powder{|###|} and Toxin-Resolving Detoxification Powder internally, and apply Taiyi Plaster externally. Once pus has formed and fluctuation is evident upon palpation, a knife or needle should be used to incise and {|###|}expelling pus{|###|}.
2. Deficiency-heat Accumulation︰The onset is slow, and the course is prolonged. The perianal mass is severely red and swollen, with mild pain and slight low-grade fever. It takes about 10 to 30 days to form pus, which is thin, white, dull, and foul-smelling, resembling rice porridge or starchy liquid, dripping continuously and mixed with cotton-like necrotic material. The ulcer is flat and sunken, accompanied by tidal fever, night sweats, fatigue, poor appetite, consumptive cough, hemoptysis, a thin, rapid, and weak pulse, etc. It is mostly caused by prolonged pulmonary tuberculosis spreading downward to the perianal and rectal areas, or excessive sexual activity leading to liver and kidney yin deficiency, or excessive worry and melancholy damaging the heart and spleen, allowing heat toxin to invade and accumulate around the anus. The characteristics include a slow onset, prolonged course, low and flat swelling, mild skin redness, mild pain, low-grade fever, delayed pus formation, thin and white pus after rupture resembling rice porridge or starchy liquid, tidal fever, night sweats, consumptive cough, hemoptysis, emaciation, flushed cheeks, and a thin, rapid pulse. Treatment should focus on clearing deficient heat, dispersing toxic qi, and strengthening the lungs and kidneys. If pus has not yet formed, expel the internal to drain pus, internally administer Tuoli Xiaodu Powder, and externally apply Taiyi Plaster. If pus has already formed, incise to expel pus and concurrently take Bone-Clearing Powder or Anemarrhena, Phelloendron and Rehmannia Pill to nourish yin and consolidate the root.
3. Cold Evil Congealing and Stagnating︰The disease develops over years, with slow formation of perianal masses that are neither red nor warm to the touch, hard as stone upon palpation. After spontaneous rupture, the pus is clear like sewage, intermittently draining, accompanied by cold limbs and body, fatigue, poor appetite, shortage of qi, reluctance to speak, and a deep, tight pulse. It is mostly caused by excessive worry damaging the spleen, sexual overexhaustion injuring the kidneys, leading first to impairment of primordial yang, with cold evil and yin toxin congealing and stagnating around the anus. The disease develops over years, with slow formation of masses that are neither red nor warm, hard as stone upon palpation. After rupture, the pus is clear like sewage, with cold limbs and body, fatigue, shortage of qi, and a deep, tight pulse—these are its characteristics. Treatment should focus on dispelling cold and dissipating nodules, warming yang to consolidate the root. Internally, take Yang-Harmonizing Decoction, and externally apply Cinnamon and Musk Powder.

Perianal abscesses are commonly seen clinically due to pathogenic heat and toxic qi. There are also cases caused by the stagnation of cold evil and yin toxins. Prolonged stagnation of excess heat or cold can transform from excess heat to deficiency, resulting in deficiency heat or deficiency cold syndromes.

bubble_chart Documentation

1. Qixiao Liangfang: "If the intestines form lumps, it is due to dampness. If there is pain, it is due to wind. If pus and blood are discharged, it is due to excessive heat causing blood to rot. If it ulcerates into yellow fluid, it is due to dampness-heat and wind-dryness. If there is severe constipation and great pain, it is due to wind-heat stasis and stagnation, unable to be discharged, causing the qi to press on the large intestine and thus creating the condition."
2. Waike Zhengzong．Volume Three．On Perianal Abscess: "At the initial stage, there is swelling and pain, with a bright red color, intermittent pain, and the anus does not prolapse; if the stool is normal, it is easy to treat. If it has already formed with intense redness, swelling, and pain, fever without thirst, infrequent urination, and the ability to move around freely, it is favorable. If it has ulcerated with thick pus, bright color, and no foul smell, the swelling gradually subsides, the pain gradually decreases, and the patient can eat, it is favorable. After ulceration, if the pus discharge gradually stops, new flesh easily grows, there is more itching than pain, and the wound easily opens, it is favorable. At the initial stage, if there is hard and diffuse swelling, internal organ pain, frequent urination, and severe constipation, it is dangerous. If it has already formed with increasing pain, swelling extending to the lower abdomen, tight closure of the anus, and inability to lower qi, it is severe. If after ulceration there is continuous discharge of foul fluid, unrelenting pain, persistent swelling, and fever with dry lips, it is adverse."