Anal pruritus refers to a skin jump without primary skin damage and only itching symptoms. In the process of scratching, various secondary skin changes may occur, such as scratching, scabbing, skin hypertrophy and lichen-like changes, which may spread to perineum, scrotum or labia. Traditional Chinese medicine called it "itch wind" and "Gu Dao itch", and later doctors called it "anal itch", which was caused by worshipping common cold. "The Complete Book of Surgical Diagnosis and Treatment" says: "I have itching all over, no rash and no scratching." Clinically, it can be divided into primary and secondary. The former has unknown etiology, stubborn symptoms and is difficult to cure, accounting for about 45% of pruritus cases. Most of the latter are secondary to other diseases and are cured with the cure of the primary disease. This disease is better than that of people over middle age. Men are more than women, and they are more common in people who usually don't like sports.

Etiology and pathology

Traditional Chinese Medicine (TCM) recognizes that the external causes of this disease are mainly wind, dampness, heat pathogen and insect poison intrusion, so there is a saying that "all itching belongs to deficiency wind, excess heat causes pain, and slight heat causes itching", and the internal causes are often blood deficiency, wind dryness, deficiency of liver and kidney, weakness of viscera, and downward flow of damp heat. Therefore, the predecessors said: "Blood deficiency produces wind, and wind accumulation itches."

1. Feel the exogenous evil: the evil of wind, cold, dampness and heat stays on the skin, and itches for a long time. As the Theory of Staging Diseases and Pathogens says, "The pathogen is in the skin, and the wind-cold will break again, and the wind will itch and the rash will be hidden."

2. Blood deficiency leads to wind: the viscera is easy to be deficient, the qi and blood are insufficient, or the qi and blood fail after a long illness, which can't nourish the skin, and the wind, the sun and the sun are dry and itchy, or it is caused by common cold's invasion of deficiency and the combination of internal and external evils.

3. Damp-heat betting on the liver meridian: Foot Jue Yin liver meridian, along the pubic hair, around the yin organ and collaterals. If the liver meridian is damp-heat, you can bet along the meridian, and the yin stays on the anal skin and itches.

4. Blood stasis causing wind: due to various reasons, viscera dysfunction, blood stasis blocking collaterals, long-term skin stagnation, meridian obstruction, and exogenous wind poison occur.

5. Insect venom harassment: The Theory of Disease and Syndrome says: "Except for pinworm, one of them is very small, which is caused by weakness of viscera, even hemorrhoids, fistula and tinea." The ringworm here refers to the itching of anal skin. Insect venom harassment is one of the important reasons for anal pruritus.

Understanding of modern medicine: The real cause of anal pruritus is not clear at present, but it is related to the following factors.

1. System factors:

⑴ Spicy food stimulation: peppers, spices, alcohol, etc. Too much can induce the disease.

⑵ Allergic reaction: Some protein (fish, shrimp, crab, etc. ), drugs, pollen, raw lacquer, etc. Can cause some people to be allergic, so that the body produces too much histamine, which acts on peripheral nerves and causes itching.

⑶ Endocrine energy disorders: such as diabetes, hyperthyroidism or hypothyroidism, pituitary insufficiency, menopause, aging, sex hormone deficiency, etc.

⑷ Mental factors: excessive mental excitement, depression, neurasthenia, hysteria, etc.

5. Drug stimulation: such as morphine, quinine, arsenic, anesthetic, antibiotics, etc.

[6] In the case of hepatic and renal insufficiency, metabolites such as cholic acid and urea accumulate in the body.

(7) Gastrointestinal dysfunction: malnutrition and some blood diseases.

(8) Genetic factors: Clinical observation shows that the incidence of anal pruritus can reach about 60% in those with family genetic history.

2. Local factors:

(1) Local friction, acid and alkali substances, chemical fibers and cold and hot stimulation.

⑵ Abnormal secretion of sweat glands and sebaceous glands around anus: Indolol in feces makes residues accumulate in anal folds to stimulate the skin.

⑶ Anorectal diseases: such as anal fistula, hemorrhoids, proctoptosis, anal sinusitis, anal papillitis, anal incontinence, etc. Stimulate anal gland, increase secretion of glandular fluid, make anus moist and stimulate skin itching.

(4) pinworm, trichomonas vaginalis, vaginitis, uterine prolapse, prostatic hypertrophy, etc. , also has a certain relationship with anal pruritus.

3. Environmental factors: cold or hot weather, as well as changes in humidity, some chemical particles in the air and other stimuli can also cause systemic or local itching.

Symptoms and signs

At the initial stage of the disease, it is limited to itching around the anus, ranging from light to heavy, sometimes stinging or burning, sometimes like insects walking ants, sometimes like mosquitoes biting and baking, sometimes itching is unbearable, and it is even worse at night, which makes people uneasy. Itching causes skin ulceration, exudation and scabbing, which will not heal for a long time, leading to perianal skin thickening, thick and rough wall of folds, radial wrinkles, lichen-like transformation, pigmentation or loss, and spreading to perineum, scrotum, labia or sacrococcygeal region. Long-term illness is prone to secondary chapping. Over time, it will cause neurasthenia, mental atrophy, tasteless eating and sleepless nights.

Diagnosis and differential diagnosis

According to the above clinical manifestations, it can be diagnosed as anal pruritus. However, for primary itching and secondary damage, we should try our best to find the relevant factors.

This disease should be differentiated from neurodermatitis, which usually occurs in the back of the neck and the flexion of limbs and has typical lichenoid lesions.

treat cordially

A Chinese medicine therapy:

1. Internal treatment:

(1) Wind-heat attacks the lung and moves to the anus of the large intestine, which makes it slightly itchy and cool when exposed to heat, or red millet appears when exposed to body heat, or blood spots appear after phlegm, with yellow and dry fur and floating pulse. Treatment should be clearing away heat and purging fire, moistening intestines and relaxing bowels, and Geliang powder should be used.

⑵ If pathogenic wind and dampness or liver and gallbladder are damp and hot, bets will be placed along the meridian, and the skin of anal wrinkles will swell, and local eczema will be soaked in water, which will smell fishy. Patients may be fidgety because of itching and scratching, and can't sleep at night. The tongue coating is yellow and thick, and the pulse is slippery. The treatment should be dispersing wind, clearing heat and promoting diuresis, and the prescription should be Xiaofeng San combined with Ermiao San or Longdan Xiegan Decoction.

(3) Weathering and drying due to blood deficiency, skin dystrophy, dry skin or white spots, itching after scratching, blood stains after scratching, itching can be slightly reduced, dull tongue and weak pulse. It is advisable to nourish blood and calm the wind, nourish yin and moisten dryness, and then drink it with angelica.

(4) Blood stasis wind, skin thickening, lichenization, dark red tongue, ecchymosis and blood stasis, and pulse string. It is advisable to dispel blood stasis and dispel wind, and only use Shufeng Jiedu Decoction.

5] Insect poison disturbs and invades perianal skin, or itches like a bug after wet poison or drug poison blocks vagina, and itches badly at night. Therefore, Wu Mei Pill is used to kill insects, detoxify and relieve itching.

2. Extraterritorial jurisdiction:

⑴ For those with moist skin, dry alum powder can be sprinkled on the affected area three times a day, 1.

⑵ Dry skin can be externally applied with Huanglian ointment or indigo naturalis ointment, 3 times a day.

3. Enema method: If it is caused by pinworm, 30g Stemona can be decocted into 80ml with 250ml of water, and enema should be kept every night before going to bed. 1 week. Or mash garlic and add 200 ml of water, fry it to 70 ml, and enema with warm water every night for 5 days. ggg

4. Acupuncture method: Acupoints such as Changqiang, Shu Yao, Chengshan, Sanyinjiao and Yinling Gland can be selected for strong stimulation once a day.

Second, western medicine treatment:

1. antihistamine treatment: diphenhydramine, chlorpheniramine and cimetidine can be selected. For those with severe itching, you can choose 105 calcium gluconate 10ml or 5 ~ 10 ml of Yang Kuiming, and take vitamins B 2, B 6, C, K and cod liver oil.

2. Hormone therapy: For menopausal and elderly patients with severe illness, hormone therapy can be used. Female patients were given diethylstilbestrol 0.5 ~ 1mg, intramuscular injection, 2 ~ 3 times each time, or phenylpropionate 25 ~ 50mg, intramuscular injection, 2 ~ 3 times a week.

3. Antibiotic treatment: Patients with bacterial infection can use antibiotics as appropriate according to their condition. For patients with pinworm or trichomonas, propagulin or metronidazole can be taken orally.

4. Drug external washing treatment: 0.5% ~ 2% calamine lotion (gouache) can be used with camphor or mint, thymol, etc. Has the effects of local cooling, diminishing inflammation, drying and relieving itching.

5. External use: The following drugs can be selected as appropriate: 8% camphor powder, 2% carbolic acid ointment, 30% Stemona tincture, 2% camphor cream, 5% benzocaine cream, 5% sulfur coal tar ointment, 2% ~ 3% salicylic acid, cortisone acetate ointment and triamcinolone acetonide ointment.

6. Blocking therapy: 2ml of 2% methylene blue plus 0.5% procaine 10ml, or 0.5% quinine urea solution 5 ~ 10 ml, or 3% procaine sesame oil 5 ~ 10 ml is injected into the intradermal area with perianal itching, so that the nerve endings in the intradermal area lose sensation.

7. Physiotherapy: The perianal affected area can be irradiated with ultraviolet rays and infrared rays, or treated with X-rays, isotopes of 32 phosphorus and 90 strontium.

8. Surgical treatment: perianal nerve endings amputation: skin preparation before operation, and after cleaning enema, the patient takes the lithotomy position or lateral position, and routinely disinfects the perianal skin and spreads towels. After Yaoshu or local anesthesia, make arc incisions on both sides of anus, dive into the skin of anus to separate, expose the fibers of external sphincter, completely cut off the sensory nerve endings, restore the skin flap, and suture intermittently with silk thread. After operation, the stool was controlled 2 ~ 3 times, the stitches were removed for 5 ~ 7 days, and the dressing was changed by sitting bath after defecation. In addition, the use of oval skin incision and suture, skin flap transplantation and perianal subcutaneous incision can also achieve the purpose of relieving itching.