bubble_chart Concept

Anal fissure, also known as anal fissure, refers to the rupture of the skin of the anal canal, which does not heal for a long time, forming a fissure, causing pain and bleeding. The fissure commonly occurs in the front center of the anal canal opening, less frequently on the sides, and is more common in women and young adults.

This condition is listed as a type of hemorrhoid in books such as "The Complete Book of Sore and Ulcer Experience Prescriptions," referred to as "hook bowel hemorrhoid," "fissure hemorrhoid," etc. Later generations also called it "fissure" or "anal fissure." Although a long-unhealed anal fissure can form a "sentinel hemorrhoid" at the anal margin, it is a secondary symptom and differs in nature from hemorrhoids. Additionally, anal rhagades occur at the anal skin margin, are superficial and painful, with minimal bleeding, and often heal on their own, which should be distinguished.

bubble_chart Pattern Analysis

1. Dry Fire Constipation︰Severe constipation with hard stools causes intense anal pain during defecation, which slightly subsides afterward but persists for several hours or even the entire day. Bright red blood drips with the stool, and the pain often leads to restlessness, irritability, a bitter taste in the mouth, dry throat, and reluctance to eat. The tongue coating is yellow and dry, and the pulse is rapid. This condition is usually caused by exposure to wind-fire and dryness-heat pathogens or excessive consumption of spicy, sweet, and rich foods, leading to dryness-fire accumulation in the stomach and intestines. This depletes fluids, resulting in hard, dry stools that are difficult to pass. Straining damages the anus, forming an anal fissure. Repeated constipation deepens the fissure, making it slow to heal, and is characterized by severe pain and dripping bright red blood. Treatment should focus on purging fire and clearing heat, as well as moistening the intestines to relieve constipation. The recommended formula is Gardenia Golden Flower Pill. For external use, detoxifying decoction sitz baths and Granulation-Promoting Jade and Red Paste can be applied. Dampness-heat accumulation anal fissure and dryness-fire constipation anal fissure both involve heat affecting the anus. However, the former is due to dampness-heat pouring downward, leading to sticky stool and anal distension, while the latter involves internal dryness-fire, resulting in hard stools, dripping bright red blood, and severe pain.
2. Dampness-heat︰During defecation, there is severe abdominal pain, with fresh blood dripping, difficulty in passing stool, anal distension, and occasional discharge of sticky stool. In severe cases, there may be a small amount of pus in the fissure, accompanied by fever and chills, poor appetite, and a thick, greasy tongue coating. This is mostly caused by exposure to dampness-heat or excessive consumption of alcohol and rich, fatty foods, leading to the accumulation of dampness-heat in the stomach and intestines, which then descends to the anus. The characteristic symptoms include anal pain and bleeding, a small amount of pus in the fissure, a constant feeling of dampness around the anus, and intermittent itching. Treatment should focus on clearing and resolving dampness-heat, as well as moistening the intestines to relieve constipation. The recommended formula is the internal use of Coptis Decoction, along with external sitz baths using Detoxifying Decoction and the application of Granulation-Promoting Jade and Red Paste or Four-Yellow Ointment. $Dampness-heat accumulation anal fissure$ and dry-fire constipation anal fissure! Both conditions involve a sensation of heat pressing on the anus. However, one is due to dampness-heat pouring downward, resulting in sticky stool and anal distension, while the other is due to dry-fire accumulating internally, leading to hard, constipated stool, dripping fresh blood, and severe pain.
3. Intestinal Dryness Due to Blood Deficiency︰Pain during defecation, bleeding, dry stool accumulation, difficulty in passing stool, dry mouth and tongue, restlessness and insomnia, afternoon tidal fever, red tongue with scant coating, thin and rapid pulse. Mostly caused by yin deficiency in the elderly, postpartum blood deficiency, or anger damaging the liver, qi depression transforming into fire, blood deficiency leading to dryness, resulting in depleted fluids and dry intestines, loss of nourishment to the anal skin, constipation and dryness accumulation, and abrasion of the anal canal. Symptoms include pain during defecation, heavy bleeding, dry stool resembling sheep feces, accompanied by dry mouth and tongue, and restlessness and insomnia as its characteristics. Treatment should focus on cooling blood and nourishing blood, moistening intestines to relieve constipation. Prescriptions include Hemp Seed Pill, Jiren Pill, Fluid-Replenishing Decoction, with external application of Granulation-Promoting Jade and Red Paste.

Blood deficiency and intestinal dryness leading to anal fissure, as well as dry fire causing constipation and anal fissure, both result in dry stool and constipation. However, one is due to the decline of body fluids and blood, leading to dryness and loss of moisture in the intestines, commonly seen in the elderly or postpartum, and is classified as a deficiency pattern. The other is due to excess heat and dry fire, causing hard stool, often seen in individuals with yang exuberance, and is classified as an excess pattern. These should be differentiated.

The condition of anal fissure is always related to the accumulation of dryness. Clinically, it is essential to distinguish between deficiency and excess, and not to treat all cases as excess pattern. If the condition is caught early, maintaining smooth bowel movements, daily sitz baths, and the external application of Granulation-Promoting Jade and Red Paste can often lead to timely healing. If the condition recurs and does not heal over time, leading to chronic wounds or secondary subcutaneous anal fistulas and sentinel hemorrhoids, surgical therapy should be considered.

bubble_chart Documentation

1. Waike Dacheng．Lower part: "Hook intestine hemorrhoids: There are hemorrhoids inside and outside the anus, the folds are broken and rotten, the stool is like sheep dung, there is bleeding after stool, it is foul-smelling and very painful."
2. Yizong Jinjian Waike Xinfa Key points. Buttocks: "Around the anus, the folds are cracked, and the stool is dry due to fire and dryness. At the beginning, take the Pain Relief Divine Decoction to relieve it."