Study On TCM Pathological Characteristics Of Different Types Of Perianal Abscess Based On Identification Of Evidence Elements

Objective:This study investigated the TCM pathological characteristics of different types of perianal abscesses(pus-forming stage)by the method of evidence element identification,to understand the correlation between the site of perianal abscess and TCM pathology,to explore the distribution patterns and differences of TCM evidence elements between patients with superficial and deep perianal abscesses,and to provide reference for clinical identification,treatment and prevention of different types of perianal abscesses.Methods:Patients who met the inclusion criteria for perianal abscess(pus-forming stage)and were seen in the Department of Anorectal Medicine of the People’s Hospital of Fujian University of Traditional Chinese Medicine from October 2021 to October 2022 were collected,and based on clinical symptoms,specialist examination,combined with CT of the patient’s buttocks or anal canal ultrasound,and with reference to the classification criteria for perianal abscess,the collected cases were divided into two groups according to the relationship between the site of abscess onset and the anal tract muscle: supra-anal tract muscle(deep abscess)and subanal tract muscle(superficial abscess).By collecting patients’ medical history and information of the four diagnoses of TCM(referring to the information collection form of the four diagnoses of TCM developed by the TCM evidence research base of Fujian University of Traditional Chinese Medicine),the questionnaires were comprehensively analyzed and entered into the TCM health state identification system to establish a database.SPSS23.0 software was used for statistical analysis to summarize the pathological characteristics of the two groups in terms of TCM disease nature and disease location evidence,and also to analyze the differences.Results:1.128 patients with perianal abscess were included in the subject,including 108 cases in the superficial perianal abscess group and 20 cases in the deep perianal abscess group,with a minimum age of 18 years and a maximum age of 60 years and a mean age of 39.05±11.08 years.There were more young people than middle-aged people.There were 90 male cases and38 female cases,with a male to female ratio of about 2.37:1.2.Distribution of evidence elements:(1)Patients with perianal abscesses were mainly located in the spleen,large intestine,liver,mind,and stomach;the main pathological evidence elements were heat,qi stagnation,dampness,phlegm,qi deficiency,yin deficiency,and blood stasis.(2)In the superficial perianal abscess group,the main pathological factors are: spleen,large intestine,liver,mind,and stomach;the main pathological factors are heat,gas stagnation,dampness,phlegm,gas deficiency,and yin deficiency;in the deep perianal abscess group,the main pathological factors are: large intestine,spleen,liver,mind,and stomach;the main pathological factors are: dampness,phlegm,gas stagnation,heat,gas deficiency,and yin deficiency.3.Comparison of the evidence elements in the superficial perianal abscess group and the deep perianal abscess group: there was a statistical difference in the distribution of the rank of deficiency and actual evidence elements between the two groups(P < 0.05).The first 30% of the overall evidence elements were included in the statistics,in which there was no statistical difference in the distribution of the common deficiency evidence elements Qi deficiency,Yin deficiency and Yang deficiency(P > 0.05),and there was a statistical difference in the distribution of the actual evidence elements Phlegm and Blood stasis in the two groups(P <0.05),while there was no statistical difference in the distribution of Heat,Dampness,Qi stagnation and Food accumulation(P > 0.05).Among the pathological evidence elements,liver and spleen were statistically different in the distribution of the two groups(P < 0.05),while large intestine,heart and mind,and stomach were not statistically different(P > 0.05)4.Cluster analysis: When the scale is at 5,the cluster analysis is 5 categories,Qi deficiency,Qi stagnation,large intestine as one category,Dampness and heat as one category,Liver and spleen as one category,Phlegm as one category,Yin deficiency as one category.Conclusion:1.Patients with perianal abscess have a wide range of TCM pathological factors,mixed with deficiency and real,with real pathological factors predominating.2.The distribution of deficiency and actual evidence elements in superficial perianal abscesses and deep perianal abscesses were different in grade.Among them,four evidence elements,that is,liver,spleen,phlegm and blood stasis,had different grade distribution in the two groups.From the proportional point of view,liver is more pathological in the superficial perianal abscess group than in the deep perianal abscess group,while spleen,phlegm and blood stasis are more pathological in the deep perianal abscess group than in the superficial perianal abscess group,so the application of soothing liver,strengthening spleen,resolving phlegm and eliminating blood stasis can be emphasized in the treatment.3.Clinical evidence of perianal abscess can refer to the results of cluster analysis,with qi deficiency,qi stagnation and large intestine as one group,dampness and heatas one group,liver and spleen as one group,phlegm as one group and yin deficiencyas one group.