Perianal Crohn’s Disease
When perianal lesions are the predominant manifestation of Crohn’s disease, the condition is referred to as perianal Crohn’s disease (CD). It commonly presents with anal fistulas, perianal abscesses, superficial fissures, ulcers, perianal skin tags, and anorectal strictures. Its clinical presentation is complex, and it is frequently misdiagnosed. The disease is primarily associated with Crohn’s disease. In traditional Chinese medicine (TCM), it falls within the categories of “intestinal binding,” “diarrhea,” “anal fistula,” and “stricture of the intestinal passage.”
TCM Pattern Differentiation and Medication Reference
| Common Symptoms
Clinical Description:
Perianal abscesses and anal fistulas are common. There may be thick pus or discharge around the anus, or localized distending pain and a burning sensation. Abdominal pain, bloating, and fever may also occur. The tongue is red with a yellow, greasy coating, and the pulse is slippery and rapid.
In Plain Language:
- Abscesses or anal fistulas commonly occur around the anus and may cause discomfort.
- Thick, sticky pus or discharge may frequently drain from around the anus.
- The area around the anus may feel swollen and painful, with a burning sensation.
- Abdominal pain and bloating may occur, and fever may develop.
- The tongue may appear somewhat red.
- The tongue coating may be yellow and greasy.
- The pulse may feel slippery and relatively rapid.
| Treatment Approach
Clinical Description:
Clear heat and drain dampness
In Plain Language:
- In TCM terms, this approach aims to reduce excessive internal heat, which may be associated with discomfort such as redness, a burning sensation, dry mouth, and irritability.
- It aims to promote the processing and elimination of dampness, which may help address sensations of stickiness and heaviness, swelling, or increased discharge.
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| Common Symptoms
Clinical Description:
Perianal skin tags associated with external hemorrhoids and anorectal strictures are common. A lump may protrude around the anus and feel firm to the touch. There may be distending or dragging pain in the anus, or difficulty passing stool. An abdominal mass or stabbing pain may also occur. The tongue is dusky purple with a thin, yellow coating, and the pulse is wiry and choppy.
In Plain Language:
- External hemorrhoidal skin tags and narrowing of the anus or rectum are common.
- A lump may protrude around the anus and feel firm when pressed.
- There may be distending or dragging pain in the anus, or difficulty passing stool.
- A lump that can be felt in the abdomen or stabbing abdominal pain may also occur.
- The tongue may appear dark purple.
- The tongue coating may be thin and yellow.
- The pulse may feel taut and uneven, with a choppy quality.
| Treatment Approach
Clinical Description:
Regulate qi and invigorate blood
In Plain Language:
- In TCM terms, this approach aims to promote the smooth flow of qi and ease stagnation, which may help address fullness, chest tightness, belching, and discomfort that shifts from place to place.
- It aims to promote blood circulation and resolve stasis, which may help with stabbing or localized pain and support the gradual resolution of bruising and swelling.
| Related Products
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| Common Symptoms
Clinical Description:
There may be distending pain in the lower left abdomen or around the navel, with an urge to defecate when the pain occurs and relief after a bowel movement. Stools may be loose. There may be distending discomfort in the chest and flanks, belching, and poor appetite. Abdominal pain and diarrhea may worsen with low mood, anger, or emotional tension, and frequent passing of gas may occur. The tongue is pale with a thin coating, and the pulse is wiry.
In Plain Language:
- There may be distending pain in the lower left abdomen or around the navel. The pain may bring an urge to have a bowel movement and ease afterward.
- Stools may be loose and soft, with poor form.
- There may be a feeling of fullness and discomfort in the chest and flanks.
- Belching and poor appetite may occur, with reduced food intake.
- Abdominal pain and diarrhea may worsen when feeling low or angry, or when under emotional stress.
- There may be a noticeable increase in gas and frequent passing of wind.
- The tongue may appear pale, with a somewhat washed-out color.
- The tongue coating may be thin.
- The pulse may feel taut, like a stretched string.
| Treatment Approach
Clinical Description:
Soothe the liver and strengthen the spleen
In Plain Language:
- In TCM terms, this approach aims to ease liver qi constraint and promote the smooth flow of qi, which may help address feelings of fullness and discomfort.
- It aims to strengthen the spleen’s digestive and transport functions, support appetite and digestion, and address symptoms such as fatigue and loose stools.
| Related Products
The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a physician or pharmacist.
| Common Symptoms
Clinical Description:
Superficial anal canal ulcers and fissures may be seen, often with mild pain. Thin pus or discharge may drain from around the anus, recurring and persisting without healing. Recurrent abdominal pain and diarrhea, poor appetite, fatigue, weakness, and soreness and weakness in the lower back and knees may also occur. The tongue is pale with a thin white coating, and the pulse is thready.
In Plain Language:
- There may be superficial sores and fissures in the anal canal, usually with mild, dull pain.
- Thin pus or sticky discharge may drain from around the anus over a prolonged period, with recurrent episodes that are slow to heal.
- Abdominal pain and diarrhea may recur in episodes.
- Appetite may be poor, with little desire to eat and a noticeable reduction in food intake.
- There may be low energy, easy fatigability, and weakness in the limbs.
- The lower back and knees may feel sore and weak, with weakness more noticeable during everyday activities.
- The tongue may appear pale or whitish.
- There may be only a thin layer of white coating on the tongue.
- The pulse may feel fine and weak.
| Treatment Approach
Clinical Description:
Strengthen the spleen and nourish the kidneys
In Plain Language:
- In TCM terms, this approach aims to strengthen the spleen’s digestive and transport functions, support appetite and digestion, and address symptoms such as bloating, loose stools, and fatigue.
- It aims to replenish the kidneys’ “foundational energy” and vitality, and address discomfort such as soreness and weakness in the lower back and knees, feeling unusually cold, and frequent urination or nighttime urination.
| Related Products
The products below are provided for informational reference only and do not constitute medical advice or a prescription. Follow the product packaging and instructions, and use under the guidance of a physician or pharmacist.
References
- Ng C，Tang W，Ching JY，et al. Inicidence and phenotype of inflammatory bowel disease based on results from the Asia-pacific Crohn’s and colitis epidemiology study[J]. Gastroenterology，2013，145(1)：158-165.
- Chow DK，Leong RW，Lai LH，et al. Changes in Crohn’s disease phenotype over time in the Chinese population: validation of the Montreal classification system[J]. Inflamm Bowel Dis，2008，14(4)：536-541.
- APDW 2004 Chinese IBD Working Group. Retrospective analysis of 515 Cases of Crohn’s disease hospitalization in China: nationwide study from 1990 to 2003[J]. J Gastroenterol Hepatol，2006，21(6)：1009-1015.
- Li Chunyu. Anorectal Diseases[M]. Beijing: Higher Education Press, 2013.
- He Yongheng. TCM Anorectal Medicine[M]. Beijing: Tsinghua University Press, 2013.