Perianal sores and ulcers refer to the condition of swelling and ulceration near the anus.

This condition, due to the different locations of swelling and ulceration, has been recorded under various names in ancient medical texts, such as perianal abscess for abscesses inside and outside the anus, anal abscess; vulva carbuncle for those occurring at the perineum, and protruding bone for those on the tailbone; those slightly above the tailbone are called saddle abscess; those on either side of the scrotum, near the thigh crease, are called thigh abscess, etc. These diseases are generally similar in terms of disease cause and treatment, and after ulceration, they often do not heal for a long time, potentially leading to fistula disease or being prone to recurrence even after healing. For the treatment of anal fistula, refer to the section on anal fistula.

bubble_chart Pattern Analysis

1. Heat Toxin Dampness Pouring︰The affected area is locally swollen, elevated, red, and painful, resembling a peach or plum in shape, with noticeable skin heat upon palpation, and typically suppurates within five to seven days. After ulceration, the pus is thick, yellow-green, foul-smelling, and the wound appears convex and firm. Systemic symptoms may include alternating chills and fever, severe constipation, scanty dark urine, a yellow and greasy tongue coating, and a wiry, slippery, and rapid pulse. This condition is often caused by excessive consumption of alcohol and rich foods, leading to the stagnation of dampness and turbidity, resulting in blocked meridians and static blood stasis. It may also be triggered by internal hemorrhoids or anal fissures, representing an excess-heat syndrome. Key diagnostic points: localized swelling, elevation, redness, pain, and skin heat in the affected area, suppurating within five to seven days. After ulceration, the pus is thick, yellow-green, and foul-smelling, with a convex and firm wound opening. Systemic symptoms include alternating chills and fever, constipation, and dark urine. Treatment should focus on clearing heat and draining dampness, as well as cooling blood to remove toxins. For unruptured cases, use Modified Cooling Blood Rehmannia Decoction (removing Cimicifuga Rhizome and Schizonepeta) combined with Three Marvel Pill. For post-ulceration cases, external treatment is recommended. For excessive pus, use Five-Five Vermilion Pill strips for drainage.
2. Lung-Spleen-Kidney Deficiency︰The affected area presents with a flat and sunken swelling, the skin color is dark red or not red, it is not warm to the touch, and the pain is mild, forming pus in about ten to twenty days. After ulceration, the pus is pale, thin, and odorless, with a sunken and hollow-like wound. Generally, there is no fever or only slight deficiency-heat, with a thin and greasy tongue coating, and a wiry-thin or soggy-slow pulse. If it is due to {|###|}lung deficiency{|###|}, it may be accompanied by {|###|}cough hemoptysis{|###|}, {|###|}steaming bone fever night sweat{|###|}; if due to {|###|}spleen deficiency{|###|}, it may be accompanied by {|###|}mental fatigue anorexia{|###|}, {|###|}loose stool{|###|}; if due to {|###|}kidney deficiency{|###|}, it may be accompanied by {|###|}lumbago seminal emission{|###|}, {|###|}tinnitus{|###|}, and {|###|}insomnia{|###|}. It is mostly caused by deficiency of the lung, spleen, and kidney, with {|###|}dampness-heat{|###|} taking advantage of the deficiency to flow downward, leading to obstruction of the meridians and stagnation of {|###|}static blood{|###|}, or it may occur as a complication after {|###|}measles{|###|} or {|###|}cold-damage disease{|###|}, manifesting as deficiency-heat syndrome. Key points for differentiation: The affected area has a flat and sunken swelling, the skin color is dark red or not red, it is not warm to the touch, and the pain is mild, forming pus in about ten to twenty days. After ulceration, the pus is pale, thin, and odorless, with a sunken and hollow-like wound, and generally no fever or only slight deficiency-heat. Treatment should focus on {|###|}enriching yin and resolving dampness{|###|}, while clearing deficiency-heat, and {|###|}enriching yin{|###|} Dampness-Resolving Decoction can be used. For {|###|}lung deficiency{|###|}, {|###|}Coastal Glehnia Root{|###|} and {|###|}Ophiopogon Tuber{|###|} can be added; for {|###|}spleen deficiency{|###|}, {|###|}Tortoise Carapace{|###|} and {|###|}turtle carapace{|###|} can be added. After ulceration, treatment should focus on {|###|}tonifying and replenishing qi and blood{|###|}, and Eight Precious Ingredients Decoction can be used.

bubble_chart Documentation

1. Waike Dacheng．Guan Kou Ju: "It occurs at the tip of the protruding bone at the base of the spine, also known as Rui Ju. Lingshu states, it originates at the base of the spine, initially resembling a fish bladder, and over time, it looks like a stork's beak. It is caused by damp phlegm congealing due to the Maijing of the Governor Vessel. Symptoms include morning chills and evening fever, with the condition being more severe at night and milder during the day. When it ulcerates, it discharges thin pus or fresh blood. While it may be treatable in the young and strong, it is difficult to cure in the elderly and weak."