Anal Fissure

Question 1

What is an anal fissure?

Answer 1

An anal fissure is a longitudinal tear or ulceration in the epithelium of the anal canal, below the dentate line.

Question 2

In which patients do anal fissures usually occur?

Answer 2

They usually occur in patients with a history of constipation and repeated straining during bowel movements.

Question 3

What symptoms are associated with anal fissures?

Answer 3

Anal fissures often cause bleeding and pain.

Question 4

What are the 3 causes of anal fissures?

Answer 4

Constipation + dry stools
Straining of BM
Local trauma

Question 5

What are the pathogenesis causing anal fissures?

Answer 5

Excess heat of fire dries fluid –> dry, hard stools tears anus –> bleeding

Damp-Heat –> impairs LI –> tenemus –> tearing anus

Blood & Yin deficiency fail to
moisten LI dry stool

Question 6

The following are patterns of _____________?

Heat/Fire
Damp-Heat
Blood + Yin Xu

Answer 6

Anal Fissures

Question 7

The following are S/sx of Anal Fissures due to ________.

Recurrent anal pain, aggravated during BM,
dry hard stools that may be streaked
with fresh red blood, thirst and dry mouth
T: Red w/ dry-yellow coating
P: Rapid or Surging

Answer 7

Heat/Fire

Question 8

The following are S/sx of Anal Fissures due to ________.

Recurrent anal pain, aggravated during BM, accompanied by itching, discomfort, distension, burning, tenesmus, and irritation, may be blood-streaked or/and pus, stool may be dry and hard or soft, sluggish, difficult to expel and foul smell, abdominal distention, thirst, dark urine, tendency to constipation or loose stools
T: Red w/ greasy-yellow coating
P: Rapid + Slippery or Wiry + Slippery

Answer 8

Damp-Heat

Question 9

The following are S/sx of Anal Fissures due to ________.

Recurrent anal pain, aggravated during BM,
chronic constipation with dry stool that
may be pellet-like, dry skin, dry hair, dry eyes, dry mouth and throat, insomnia, postural dizziness, blurred vision, palpitation, fatigue
T: Pale or pink w/ scanty coating
P: Thready + Weak

Answer 9

Blood + Yin Xu

Question 10

What are the main points for treating Anal Fissures due to Heat/Fire?

Answer 10

Clear Heat + Regulate LI + Moisten Body Fluids:

SJ-6 + ST-25 + SP-15
DU-1 + BL-30
BL-57 + ST-37 + BL-25 + Er Bai
KI-6 + LI-11

Question 11

What are the main points for treating Anal Fissures due to Damp-Heat?

Answer 11

LI-11 + SP-15 +ST-37
BL-57 + Er Bai
Baliao (BL-31-34) Local for anus + LI
BL-54: Regulates urination + treats
hemorrhoids
BL-58: Luo-Connecting + treats hemorrhoids
SP-10: Cool Blood Heat

Question 12

What are the main points for treating Anal Fissures due to Blood + Yin Xu?

Answer 12

Nourish Yin + Blood + Resolve constipation:

BL-57 + Er Bai
REN-4 + ST-36 + SP-10 + BL-17 + BL-20 + BL-23 + BL-25

SP-6 + KI-3 + KI-6