DISCUSSION
postoperative pain, fever, swelling, toxicity, edema, anorectal disorder, necrotic, pain, anorectal disorders, pruritus, fistula, dryness, sores
HEAT, EDEMA, ANORECTAL DISORDER, NECROTIC, ANORECTAL DISORDERS, PERIANAL ABSCESS, STASIS, DISEASES, COMPLICATIONS, INFLAMMATORY RESPONSE
Anal fistula is an anorectal disorder with high incidence, characterized by the formation of an abnormal tunnel between the rectum or anal canal and surrounding skin. Perianal abscess, pruritus, and pain are some of its clinical signs. Systemic inflammatory reactions, fever, and other symptoms may also be present in more severe cases. Due to the impossibility of self‐healing, surgical intervention is the therapeutic treatment of choice.Apoptotic processes are regulated by antiapoptotic (Bcl‐2) family proteins and Caspase family proteins by regulating the transduction of apoptotic signals, and their mutual checks and balances form a complete and efficient apoptosis mechanism network system.In the Bcl‐2 gene family, the apoptosis‐promoting gene Bax has been researched extensively due to its high degree of similarity with Bcl‐2. Bax has the ability to suppress Bcl‐2 by forming homodimers or heterodimers with Bcl‐2. Consequently, the antiapoptotic proteins Bcl‐2 and Bax are essential for regulating cell apoptosis.According to TCM, anorectal diseases are caused by stagnation of qi and blood and the downward flow of damp‐heat. Many TCM remedies aim to activate blood, remove stasis, alleviate pain, clear heat, dryness, and dampness, and reduce swelling. External therapies with these TCM remedies are widely used for the treatment of postoperative pain and edema complications in anorectal disorders due to their direct effect, minimal toxicity and side‐effects, safety, and convenience.Research has demonstrated the effectiveness of TCM in promoting wound healing, reducing pain, and suppressing the inflammatory response in patients after anal fistula surgery.Borneol, used as an adjuvant drug, clears heat, reduces swelling, relieves pain, and eliminates stagnation. According to TCM principles, the combination of these herbs in Zibai ointment helps to clear heat, dries out dampness, invigorates blood circulation, eliminates stasis, removes necrotic tissue, promotes granulation, heals sores, and fosters healing of wounds.The results of our study revealed statistically significant differences in the expression levels of Bcl‐2 and Bax between the Zibai ointment and petroleum jelly groups on Day 21 postsurgery (There is some preliminary evidence that Zibai ointment can promote wound healing following anal fistula surgery by controlling cell apoptosis. However, Zibai ointment induces an increase in the Bcl‐2/Bax ratio by regulating upstream factors of the Bcl‐2/Bax signaling pathway. Wound healing is aided by the ability of Zibai ointment to directly regulate the expression of Bcl‐2 and Bax, thereby promoting cell apoptosis during wound healing. All these issues need to be explored in greater detail. Using either multicenter studies or animal models, the study team can delve more deeply into the underlying mechanism of Zibai ointment in future investigations, providing a more objective basis for its clinical application.Study limitation: Due to uncertain factors such as the time limit of the study and patient compliance, the clinical sample size of this study is relatively small, but some significant differences have also been initially found. In subsequent studies, the research team can conduct multicenter studies or use animal models to deeply explore the internal mechanism of Zibai ointment, providing a more objective basis for its clinical application.