Clinical Observation And Mechanism Of The Effect Of Guangxiao Xiaoya Oil On Anal Fissure And Analgesia

Anal pain is the cause of many patients with anal fissure awkward and painful,seriously influences people’s normal life and work,decreases their life quality obviously.The cause of anal fissure pain includes anus sphincter spasm,local blood supply decreases and local inflammatory stimulation and so on.All of these factors interact together and eventually form a vicious circle.In order to cure the anal fissure pain,more and more anorectal doctors pay attention to it,andmany related research were reported at home and abroad. In general,the treatment of anal fissure mainly includes two parts in clinical,surgery method and drug treatment For example,the anus sphincter side cut、chemical "sphincter incision" method (nitr-ic oxide donor,botulinum toxin,calcium blockers)、traditional Chinese medicine treatment and so on.However,according to the clinical study and interview the anal pain patients,there was some risk of postoperative anal incontinence with surgery treatment of anal fissure.Chemical "sphincter incision" methodin the treatment of anal fissure can lead to patients uncomfortable with dizziness,headache and so on.Although there are various ways for the treatment of anal fissure,but clinical doctors pursue the direction which can help patients relieve pain and avoid unnecessary risk.Traditio-nal Chinese medicine treatment meets this standard.Chinese medicine external preparation Guangtongxiao has a topical effect of activating blood and removing stasis analgesic, anti-infl-ammatory,loosen sphincter,relieve pain and has good curative effect to the anal fissure.Previo-us animal and clinical trials prove that Guangtongxiao has the same role and curative effect in the treatment of anal fissure with nitroglycerin,and has the advantages of work fast. This may have a certain relationship with its volatile oil components.Guangtongxiao volatile oil(Angeli-ca,Magnolia officinalis,asarum etc)is an important part of Guangtongxiao, and is also the most cumbersome procedures part in Guangtongxiao preparation process,relatively time-consumin-g.Whether from itsrole for the overall effect or the economic cost,it’sworth for further research of its effect and value.This research through clinical observation and the related animal experiments to evaluate the role of Guangtongxiao volatile oil on relieving pain,anti-inflammatory and spasmolysis effect.Part 1The clinical research for the effect of Guangtongxiao volatile oil on anal fissure painObjective Research the relieve pain effect of Guangtongxiao volatile oil on anal fissure patients.Methods 112 patients with anal fissure patients were randomly divided into Guangtongxiao treatment group、volatile oil treatment group、Guangtongxiao without volatile oil treatment group and GTN treatment group.Guangtongxiao each group were given corresponding medicine external treatment;GTN group treatment with 0.2% Nitroglycerin Ointment for local wound. Then evaluate therelief of anal pain degree, pain duration and the adverse reactionafter treatment.Results After one week treatment,comparing the curative effect,difference has statistical significance(P<0.05);Guangtongxiao treatment group and GTN treatment group has no statistical differences(P>0.05).Both the curative effects surpass the volatile oil group and without oil group;without oil group is better than the volatile oil group. To compare pain VAS score,after treatment,the four groups have difference with statistical significance(P<0.05),pain were relieved after treatment,Guangtongxiao group and GTN group are better than the other two groups.Compared duration of pain, after treatment,the four groups have difference with statistical significance (P<0.05),Guangtongxiao group and GTN group are the best,then without oil group,volatile oil group is the worstDuring treatment,volatile oil group use the amount of analgesic drugs more than other groups,GTN group appear dizziness, headacheprobability is higher than the other groups.Conclusion Guangtongxiao volatile oil can ease the pain of anal fissure in a certain extent,and it’s safety.The effect of combinatingoil part and the other part are significantly enhanced,Guangtongxiao volatile oil played an important collaborative role in Guangtongxiao is indispensable part in the whole medicine.Part 2Establishment of the rat model of anal fissure painObjective The research of the feasibility wieh the model.Methods After the rats were anesthetized,make an incisionat 6 point from the anal margin about 5mm to the internal anal direction,about 5 mm long,2 mm deep and glacial acetic acid daub wound,stimulation for 3 days.After it respectively measure the TWLat 6 hours later,24 hourslater,48 hours and 72 hours later,and compared with before modeling numeric,the local tissue for pathological examination.Results After modeling,rats TWLwas differences compared with before modeling (P<0.05);after modeling at other time point are different with the 6 hour TWL (P<0.05);but between the model after 24 hours,48 hours and 72 hours time point,no statistically significant difference.There is obvious differences in the local pathological changes of rats in the modeling group and normal group.Conclusion The rat of anal fissure pain model in a certain extent meets clinical anal fissure pain,it is suitable for evaluating the medicine effect.Part 3The observation of Guangtongxiao volatile oil analgesic effect on rats with anal fissure painObjective Research thepain reliefeffect of Guangtongxiao volatile oil.Methods Through above-mentioned animal model,observe the effect of Guangtongxiao volatile oil group,without oil group,Guangtongxiao group with different doses on rat anal fissure pain,and compared with the control group.All groups were measured TWLbefore modeling 1 hours,administered 1 hour before and after the last administrationl hour.Results There was a statistically significant difference (P<0.01),Guangtongxiao group comparedwith GTN group administered before and after the last administrationl hour TWL; volatile oil and without oil groups also can relieve the pain of anal fissure to some extent,but the effect obviously reduced.Comparison with Guangtongxiao group, GTN group, high dose without oil group and volatile oil group,there are statistically significant difference (P0<.05).Conclusion Guangtongxiao volatile oil can ease the pain of anal fissure in rats in a certain extent. The effect was more significant with combination of other parts. The volatile oil in Guangtongxiao has significant synergistic effect.Part 4The research of the inhibition effect of Guangtongxiao volatile oil on inflammatory cytokines of rats with anal fissureObjective Research the effect of Guangtongxiao volatile oil on anal fissure inflammator-y factor of IL-1β、IL-6 and TNF-αMethods After completion of the third section of the test,anaesthetizing after 2 hours of the last administration,extract abdominal aortic blood,centrifugal serum,analysis in strict accordance with the IL-6 and IL-1β ELISA steps, then detect of relevant indicators,cutting the local fissure organization of rats,according to the immunohistochemical testing method of TNF-a,detect of relevant indicators.Results The difference of IL-1β, IL-6 concentrations and TNF-α positive cell numbers of local fissure organization were statistically significant differences (P<0.05) between the treatment groups and the normal group;Guangtongxiao high, middle dose groups and without oil groups were statistically significant differences compared with model group, volatile oil group and GTN group in serum IL-1β and IL-6 concentration positive cell numbers of local fissure organization (P<0.05),they can effectively reduce the rats serum IL-1β and IL-6 and TNF-α concentration.The other groups have no significant effect.Conclusion Guangtongxiao volatile oil and without oil composition could reduce the serum inflammatory factor concentration of IL-1β, IL-6 and TNF-α expression of rats local tissue with anal fissure,but the effect is weak,the compatibility of them constitute the full Guangtongxiao which effect was significant. The Guangtongxiao volatile oil plays an important role in the whole prescription.Part 5The spasmolysis effect of Guangtongxiao volatile oil on rat rectal ring tensionObjective Research of Guangtongxiao volatile oil antispasmodic effects on rat rectal ring.Methods Prepare of rat rectal ring,connected to the tissue-organ bath-record ing system,using ACh on rectal ring preshrinking,after stable,orderly adding each group therapy drug in the bath (Guangtongxiao volatile oil,etc.),the effect were observed at different time point (10,30,60 and 120min points) on rectal ring tension.Results In addition to the volatile oil group, the effects of diastole activity in other groups at10,30,60and120min points gradually increased,with a certain time effect relationship. The rectal relaxation activity of high dose group is enhanced than the middle dose group,with a dose-response relationship.Comparison between each groups,Guangtongxiao has the best effect.The volatile oil group in the starting phase has certain spasmolysis effect,with the extension of time,the durability effect was poor. The group without volatile oil was somewhere in the middle.Conclusion Guangtongxiao volatile oil has antispasmodic effects on vitro rat rectal ring,but has poor duration.which coordinated with other components,the effect of antispasmo-dic was more obvious,volatile oil is significant part of Guangtongxiao.