1. Excess Heat︰Redness and swelling Rebing are evident, with thick and yellow pus that is bright in color, easily dispersing and resolving. The stage of attack is often accompanied by chills, fever, thirst, dry tongue, severe constipation, scanty dark urine, a red tongue with yellow coating, and a surging, rapid pulse. This condition is mostly caused by stagnation of wind-heat and dryness-fire or excessive consumption of rich, greasy food and alcohol, leading to the accumulation of excess heat around the rectum and anus, forming an anal abscess that ruptures and discharges. During the attack, the onset is sudden and violent, with rapid rupture, accompanied by redness, swelling, heat, pain, and thick yellow pus, along with fever and chills, constipation, and dark urine as its characteristics. Treatment should focus on clearing and purging excess heat, resolving abscesses, and expelling pus. The recommended formula is the Internal Clearing Coptis Decoction. However, care must be taken to avoid excessive use of cold and cooling herbs, which may damage the primordial yang. Once the heat signs subside, the focus should shift to supporting the interior to gradually close the wound. The recommended formula is the Coptis Rhizome Tube-Closing Pill.
2. Deficiency Heat︰The redness, swelling, heat, and pain are not severe. The pus is thin and clear, resembling rice water in color, with a fishy and dull odor, and it drains continuously. The sore is sunken, often contaminated with cotton-like debris on the skin, accompanied by tidal fever, flushed cheeks, fatigue, poor appetite, night sweats, or laborious cough with hemoptysis. The tongue is red with scant coating, and the pulse is thin and rapid. It is mostly caused by overexertion, excessive worry, or sexual overindulgence, with pulmonary tuberculosis spreading downward to the anus and rectum. The onset is slow, and the sore does not rupture for a long time. After rupture, the pus is clear like rice water and drains continuously, with the sore failing to heal over time. It is characterized by laborious cough with hemoptysis, night sweats, tidal fever, and a thin, rapid pulse. The treatment should focus on clearing deficient heat and enriching yin to expel pus. The recommended formulas are Bone-Clearing Powder and Anemarrhena, Phelloendron and Rehmannia Pill, supplemented with powdered ivory, pangolin scales, scorpion, etc.
3. Deficiency Cold︰Fistula disease persists for a long time without healing, with a flat and sunken wound opening, bluish skin around it, thin and watery pus discharge, absence of redness or ripening, and surrounding areas as hard as stone or as soft as cotton. The patient experiences general fatigue and weakness, shortage of qi, reluctance to speak, a complexion that is pale and sallow, cold limbs, a pale tongue, and a weak pulse. This condition is often caused by prolonged fistula disease, injury to qi and blood, improper use of cold and cooling treatments that damage yang qi, and impairment of the spleen and stomach, leading to pudendal coldness and stagnation in the rectum and anus. Fistula disease that persists for years without resolution, with cold and clear pus discharge or a mixture of pus and fecal matter, surrounding areas as hard as stone or soft to the touch, cold limbs, shortage of qi and weakness, fatigue, and reluctance to speak are its characteristic features. The treatment should focus on tonifying and replenishing qi and blood, harmonizing yin and supporting yang. Recommended formulas include the Major Tonifying Pill and the Kidney Qi Pill from the Golden Cabinet.

The treatment of anal fistula requires both internal and external approaches, along with surgery. The Gujin Yitong Daquan records the Yonglei Qianfang anal fistula thread-drawing technique, which is particularly ingenious and safe for treating anal fistula, without the risk of causing fecal incontinence.