-- People's Republic of China Traditional Chinese Medicine Industry Standard
An anal fistula is the cavity left after an abscess around the anus has spontaneously ruptured or been incised. It is also known as hemorrhoid fistula or hemorrhoids.
7.1 Diagnostic Criteria
7.1.1 History of perianal abscess. The lesion has an external opening, a channel, and an internal opening that can be detected.
7.1.2 Classification
a. Low simple anal fistula: Only one channel exists, located below the anorectal ring.
b. Low complex anal fistula: There are two or more channels, located below the anorectal ring, with two or more external openings or internal openings.
c. High simple anal fistula: Only one channel exists, crossing or located above the anorectal ring.
d. High complex anal fistula: There are two or more channels, located above the anorectal ring, with two or more external openings or internal openings.
7.1.3 Perianal ulcers discharging pus, which may temporarily heal externally, leading to pus accumulation and acute episodes of perianal abscess.
7.2 Syndrome Differentiation Classification
7.2.1 Damp-heat descending: Frequent discharge of thick pus from the perianal area, anal distension and pain, local burning sensation. Ulceration in the perianal area, palpation reveals cord-like structures extending into the anus. Red tongue, yellow coating, wiry or slippery pulse.
7.2.2 Deficiency of righteous qi with lingering pathogenic factors: Discharge of thin pus from the perianal area, dull anal pain, pale color of the external opening, intermittent healing and ulceration of the fistula opening. Ulceration in the perianal area, palpation feels hard, or pus discharges from the ulcerated opening, with cord-like structures extending into the anus. Accompanied by fatigue and weakness. Pale tongue, thin coating, soft pulse.
7.2.3 Yin fluid deficiency: Ulceration in the perianal area, light red in color, palpation reveals cord-like structures extending into the anus. May be accompanied by tidal fever, night sweats, irritability, and dry mouth. Red tongue, little coating, fine rapid pulse.
7.3 Efficacy Evaluation
7.3.1 Cured: Symptoms and signs disappear, wound heals.
7.3.2 Improved: Symptoms and signs improve, wound not healed.
7.3.3 Not cured: No change in symptoms and signs.