| PurposeThe internal anal sphincter (IAS) is the inner layer , involuntary, smooth-muscle component of the anal sphincter complex. Along with the deepening research on its functions, many great advances had been achieved, some of which have been used in clinical practice and changed some therapy of anorectal diseases.The IAS has an ambiguous role in maintaining anal continence. It contributes 80% of resting anal canal pressure. Good function of IAS is very important to defecation. When its integrality having been damaged, anal incontinence may occur.Recent years' research indicated that anal fissures are caused by IAS spasm, which affect the blood supply and induced ischaemic ulcer. IAS spasm makes the resting anal pressure rise and compresses the blood vessel, while the local ischemia makes anal fissure occur and become chronic. Lateral internal sphincterotomy and anal dilatation are common used methods for anal fissure, but both have the risk of permanent incontinence. Studies demonstrated that about one fourth of the anal fissure patients experience various incontinence after manual dilatation. After lateral sphincterotomy, incontinence for flatus occurring in 3%-36%, soiling in 4.4%-21%, and fecal incontinence in 0.4%-4.9%. Even if the patient remain continent following sphincterotomy, the disruption to the muscle is permanent and the individual would theoretically be at risk of incontinence in later life, particularly as resting pressure is known to decrease with age. These complications have driven the search for other methods of reducing anal pressure. The chemical sphincterotomy than appear. There are three kinds medication for chemical sphincterotomy: nitric oxide donor such as glyceryl trinitrate (GTN) and isosorbide dinitrate (ISDN), botulinum toxin (BT) and calcium channel blockers such as nifedipine. GTN and BT can relax the IAS and heal the anal fissure, so some authors suggested using GTN and BT as first and second-line therapy for chronic anal fissure.Despite the fact that GTN and BT have good result in anal fissure treatment, their shortcomings are obvious. GTN has side effect of headache, and its treatment course need 6 to 8 weeks. BT is expensive and need injection. In contrast, Chinese traditional medicine have advantages of high safety and multiple effects. Study on Chineseherbs' effects of sphincterotomy is of great value both in theoretical and clinical.The objective of this study is to observe the effects of liquid film made from blood-quickening and liver-softening Chinese herbs (Anocure film) on IAS and anal fissure, and discuss its act mechanism.MethodsThis study consists of two parts: experimental and clinical study. The experimental research includes four tests.Test one observed Anocure film on rabbit resting anal pressure. Test the resting anal pressure(RAP) before and after the film used.Test two investigated Anocure film on nitric oxide (NO) and substance P (SP) in rabbit blood and local wound tissue. Thirty two back wounds divided into four groups, treated with Anocure film, GTN ointment, Ma Yinglong ointment and normal saline(NS) respectively. NO test use chemical method and SP test use radioimmunoassay method.Test three observed Anocure film on wound healing. The epidermal growth factor(EGF) of the granulation tissue were tested using radioimmunoassay method. The histopathology of the granulation tissue also be studied.Test four studied Anocure film on IAS and small intestine. IAS strips and jejunum obtained from New Zealand rabbits were studied in vitro. The contract curves were recorded using Polygraph System.The clinical research adopt randomized control trial, sixty anal fissure patients divided into trial group and control group. The trial group treated with Anocure film, while the control group treated with Ma Yinglong ointment. Visual healing of fissures, bleeding, anal pain, stool frequency and defecation time were assessed.ResultsResting anal pressure: The mean RAP was significantly lower after using Anocure film. (12.7000 + 3.2046 vs. 9.2063+...
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