Jiang ZZ, Yu S, Zhu ZF. Association of topical Tongxuekang Fumigation-washing with early wound recovery after hemorrhoidectomy: A retrospective cohort study. World J Gastroenterol 2026; 32(33): 118686 [DOI: 10.3748/wjg.118686]
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Zhi-Fa Zhu, MD, Department of Integrated Traditional Chinese and Western Medicine Oncology, The First Affiliated Hospital of Anhui Medical University, No. 120 Wanshui Road, High Tech Zone, Hefei 230022, Anhui Province, China. yfy1922248@fy.ahmu.edu.cn
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Jiang ZZ, Yu S, Zhu ZF. Association of topical Tongxuekang Fumigation-washing with early wound recovery after hemorrhoidectomy: A retrospective cohort study. World J Gastroenterol 2026; 32(33): 118686 [DOI: 10.3748/wjg.118686]
Zhen-Zhen Jiang, Sheng Yu, Department of Traditional Chinese Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
Zhi-Fa Zhu, Department of Integrated Traditional Chinese and Western Medicine Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
Author contributions: Jiang ZZ contributed to the study conception and design, data acquisition, data analysis and interpretation, and drafting of the manuscript; Yu S participated in data collection, follow-up coordination, outcome assessment, and critical revision of the manuscript for important intellectual content; Zhu ZF contributed to methodological guidance, statistical analysis supervision, interpretation of results, and final approval of the version to be published; all authors have read and approved the final manuscript and agree to be accountable for all aspects of the work.
AI contribution statement: The manuscript was written by the us, and that no part of the main text, including the Abstract, Introduction, Materials and Methods, Results, Discussion, and Conclusion, was generated by ChatGPT, Grammarly, DeepL, or any other AI tools. No AI tool was used for language polishing, translation, data analysis, writing assistance, study design, interpretation of results, or image generation.
Institutional review board statement: This study has been reviewed and approved by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University (No. PJ2025-02-25).
Informed consent statement: Given the retrospective nature of the study, the requirement for informed consent was waived.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Data sharing statement: There are no additional data available.
Corresponding author: Zhi-Fa Zhu, MD, Department of Integrated Traditional Chinese and Western Medicine Oncology, The First Affiliated Hospital of Anhui Medical University, No. 120 Wanshui Road, High Tech Zone, Hefei 230022, Anhui Province, China. yfy1922248@fy.ahmu.edu.cn
Received: February 27, 2026 Revised: March 20, 2026 Accepted: April 21, 2026 Published online: September 7, 2026 Processing time: 164 Days and 22.3 Hours
Abstract
BACKGROUND
Topical Tongxuekang fumigation-washing is used in some centers as local care after hemorrhoidectomy; however, its incremental benefit beyond thermal sitz baths and its mechanism remain unclear.
AIM
To assess whether Tongxuekang fumigation-washing improves early wound healing, pain, and short-term complications after hemorrhoidectomy in routine practice.
METHODS
This retrospective cohort study included 300 patients who underwent hemorrhoidectomy for mixed hemorrhoids or grade III-IV internal hemorrhoids at the First Affiliated Hospital of Anhui Medical University (January-December 2023) and completed follow-up. Patients were assigned by post-discharge care to either the Tongxuekang group (n = 150) or a control group (n = 150) receiving warm water/potassium permanganate sitz baths plus standard dressing changes. Data on demographics, perioperative variables, and outcomes were collected. The primary outcome was time to complete epithelialization. Secondary outcomes included pain (visual analog scale) on postoperative days 3, 7, and 14; edema and exudation scores; granulation tissue quality; complications (infection, bleeding, urinary retention); and healthcare utilization. Between-group comparisons were performed. Multivariable linear regression (epithelialization time) and logistic regression (infection, secondary hemorrhage) adjusted for confounders.
RESULTS
Baseline characteristics were comparable. Median time to epithelialization was shorter in the Tongxuekang group [18 (16, 21) days vs 21 (19, 24) days; P < 0.001]. Visual analog scale pain scores were consistently lower on days 3, 7, and 14, with faster improvement in edema and exudation. On day 14, good/excellent granulation tissue was more frequent in the Tongxuekang group (84.0% vs 68.0%; P = 0.001). Crude infection (4.0% vs 10.0%; P = 0.039) and secondary hemorrhage rates (2.0% vs 6.7%; P = 0.044) were lower with Tongxuekang, while urinary retention did not differ. Multivariable analysis showed Tongxuekang was independently associated with shorter epithelialization time (β = -2.3 days; 95%CI: -3.1 to -1.5) and lower infection risk (adjusted odds ratio = 0.36; 95%CI: 0.14-0.93). The reduction in secondary hemorrhage did not reach statistical significance (adjusted odds ratio = 0.28; 95%CI: 0.07-1.03; P = 0.054).
CONCLUSION
Tongxuekang fumigation-washing was associated with faster healing, better pain control, and reduced infection risk after hemorrhoidectomy. Findings reflect regimen-level associations rather than a defined mechanism. The apparent reduction in secondary hemorrhage requires confirmation in prospective studies.
Core Tip: Postoperative wound management after hemorrhoidectomy remains challenging due to pain, exudation, edema, and infection risk in the perianal region. This retrospective cohort study evaluated the effectiveness of topical Tongxuekang in routine postoperative care fumigation-washing in 300 patients evaluated the effectiveness of topical Tongxuekang fumigation-washing in routine postoperative care among 300 patients following hemorrhoidectomy. following hemorrhoidectomy. Compared with conventional sitz bath care, Tongxuekang fumigation-washing was associated with faster wound epithelization, lower postoperative pain scores, improved local edema and exudation, and reduced rates of infection and secondary hemorrhage. Multivariate analyses confirmed its independent association with shortened healing time and lower infection risk, supporting Tongxuekang fumigation-washing as a practical adjunct in postoperative local care pathways.
Citation: Jiang ZZ, Yu S, Zhu ZF. Association of topical Tongxuekang Fumigation-washing with early wound recovery after hemorrhoidectomy: A retrospective cohort study. World J Gastroenterol 2026; 32(33): 118686
Hemorrhoids are a common anorectal disorder. Patients with severe internal or mixed hemorrhoids often require surgical resection to alleviate prolapse and recurrent bleeding[1]. Postoperative recovery is frequently complicated by pain, edema, exudation, delayed wound healing, infection, and secondary hemorrhage. These complications arise because the perianal wound is exposed to fecal contamination, repeated mechanical stress during defecation, and high local tension, thereby impairing quality of life and increasing follow-up burden[2,3]. Warm sitz baths or cleansing with diluted potassium permanganate have long been used in routine postoperative care to improve local comfort and hygiene. However, the incremental benefit of adding Tongxuekang fumigation-washing beyond a thermal sitz bath alone remains uncertain[4]. Several clinically relevant questions also remain unresolved: (1) Whether any observed benefit reflects pharmacologic activity at the wound surface, nonspecific contextual or placebo effects, or both; (2) Whether the formulation and safety parameters of the external preparation have been adequately standardized; (3) Whether reduced re-visit rates truly indicate faster recovery; and (4) Whether early reductions in bleeding persist after adjustment for confounding factors[5,6]. Contemporary postoperative management may include multimodal symptom-control strategies, such as stool regulation, oral analgesics, and selected topical agents. Accordingly, conventional sitz-bath care should not be regarded as a universal gold standard[7-9]. Therefore, this study was designed as a real-world retrospective cohort analysis to evaluate whether Tongxuekang fumigation-washing is associated with improved early wound healing and short-term outcomes after hemorrhoidectomy, while explicitly acknowledging the mechanistic, formulation-related, and long-term uncertainties that require prospective validation.
MATERIALS AND METHODS
Study design and participants
This single-center retrospective cohort study evaluated real-world post-discharge local care pathways following hemorrhoidectomy. Medical records and follow-up data of patients who underwent hemorrhoidectomy between January and December 2023 were reviewed. Eligible patients were 18-75 years of age and had undergone hemorrhoidectomy for mixed hemorrhoids or grade III-IV internal hemorrhoids, with complete follow-up data available. Exclusion criteria included concomitant perianal infectious disease, inflammatory bowel disease, immunosuppression, poorly controlled diabetes, or a known allergy to fumigation-washing ingredients. A total of 342 patients were screened; 42 were excluded, and 300 were included in the final analysis. Treatment allocation was determined by routine discharge local care instructions rather than randomization. This study was approved by the Ethics Committee of the First Affiliated Hospital of Anhui Medical University (No. PJ2025-02-25). The requirement for written informed consent was waived due to the retrospective study design.
Methods
Both groups received standard postoperative guidance, including analgesia, stool softening, dietary recommendations, perianal hygiene, and follow-up dressing changes. In the Tongxuekang fumigation-washing group, patients performed fumigation-washing twice daily starting on postoperative day 2 (or the day of discharge), for 15-20 minutes per session at 40-42 °C, for 14 days or until exudation was markedly reduced. The control group received a twice-daily sitz bath with warm water or diluted potassium permanganate, for 15-20 minutes per session over 14 days. All procedures were performed by experienced colorectal surgeons following standardized operative techniques. As this was a retrospective study of routine clinical care, detailed information on the preparation of the Tongxuekang external solution (e.g., whether derived from capsule contents or provided as a pre-prepared hospital formulation), its concentration, and batch-specific composition was not consistently available in the medical records. Accordingly, exposure was analyzed at the regimen level rather than as a standardized pharmaceutical formulation.
Outcome measures
The primary outcome was time to complete epithelialization (days). Secondary outcomes included pain intensity (visual analog scale, 0-10), circumferential edema score (0-3), exudation score (0-3), and granulation tissue quality, assessed on postoperative days 3, 7, and 14. Additional outcomes included complications (infection, secondary hemorrhage, and urinary retention), need for additional analgesia, and post-discharge follow-up contacts. Re-visits occurring more than once within 14 days were considered indicators of healthcare utilization rather than direct surrogates for symptom resolution, treatment adherence, or recovery.
Statistical analysis
Data were analyzed using SPSS version 26.0 (IBM Corp., Armonk, NY, United States). Between-group comparisons were performed using the Student’s t-test, Mann-Whitney U test, χ2 test, or Fisher’s exact test, as appropriate. Multivariable linear regression was used to identify independent predictors of time to complete epithelialization, and multivariable logistic regression was applied to assess factors associated with infection and secondary hemorrhage. Covariates included age, sex, body mass index (BMI), history of constipation, hemorrhoid severity, number of resections, surgical method, and comorbid diabetes or hypertension. Because anesthesia modality and detailed formulation characteristics were not consistently available in the retrospective dataset, they were not included in the adjusted models and are acknowledged as study limitations. A two-sided P value < 0.05 was considered statistically significant.
RESULTS
General data of patients
The baseline characteristics, including demographics and disease-related factors, did not differ between the two groups (P > 0.05), indicating comparability (Table 1).
Table 1 Comparison of baseline characteristics between groups, mean ± SD/n (%).
In the Tongxuekang fumigation-washing group, complete epithelialization occurred more rapidly, postoperative pain scores on days 3, 7, and 14 were lower, the proportion of patients requiring additional analgesia was reduced, and the number of post-discharge follow-up contacts was decreased (all P < 0.05; Table 2, Figures 1 and 2).
Scores for circumferential edema and exudation in the Tongxuekang fumigation-washing group were markedly lower than those in the control group on days 7 and 14 (P < 0.05). The proportion of patients with excellent or good granulation tissue quality on day 14 was higher in the Tongxuekang fumigation-washing group (P < 0.05; Table 3).
Table 3 Comparison of local wound signs and granulation tissue quality between groups, n (%)/mean (interquartile range).
Group
Edema score
Exudation score
Granulation on the 14th day (excellent and good rate)
Complications and healthcare utilization within 14 days
The crude incidences of infection and secondary hemorrhage were lower in the Tongxuekang fumigation-washing group. No differences were observed for urinary retention or anal marginal dermatophytosis/cicatrix discomfort. Patients in the Tongxuekang group were less likely to have more than one re-visit within 14 days. As re-visit frequency reflects healthcare utilization, this outcome should not be interpreted as a direct measure of recovery or treatment adherence (Table 4, Figure 3).
Multiple factor linear regression analysis of complete epithelization time
To account for potential confounding factors affecting complete epithelization time, a multivariable linear regression model was constructed. Binary variables were coded as yes/no, with predefined reference categories. After adjusting for age, sex, BMI, constipation history, hemorrhoid severity, number of resections, and comorbidities, Tongxuekang fumigation-washing remained independently associated with shorter healing time (P < 0.05; Table 5).
Table 5 Multivariate analysis of effect on complete epithelization time.
Multivariate logistic regression analysis of postoperative infection
After adjustment for age, sex, BMI, constipation history, severe (grade IV) hemorrhoids, number of resections ≥ 3, diabetes, hypertension, and surgical approach, Tongxuekang fumigation-washing was independently associated with a lower risk of postoperative infection (β = -1.02, Wald χ2 = 4.54, P = 0.033). The odds of infection were approximately 0.36 times that of the control group [odds ratio (OR) = 0.36, 95%CI: 0.14-0.93]. Diabetes mellitus was associated with increased infection risk (OR = 2.50, 95%CI: 1.00-6.27; P = 0.050), whereas other covariates were not statistically significant (Table 6).
Table 6 Multivariate Logistic regression analysis of postoperative infection.
Multivariate logistic regression analysis of secondary hemorrhage
Analysis of secondary hemorrhage suggested a protective trend for Tongxuekang fumigation-washing; however, this association did not reach conventional statistical significance (P = 0.054; OR = 0.28, 95%CI: 0.07-1.03). Therefore, the lower crude hemorrhage rate should be interpreted cautiously. Other covariates, including age, sex, BMI, constipation history, severe disease, number of resections ≥ 3, diabetes, hypertension, and surgical approach, were not associated with secondary hemorrhage (all P > 0.05; Table 7).
Table 7 Multivariate logistic regression analysis of secondary hemorrhage.
Hemorrhoidectomy effectively relieves prolapse and bleeding; however, postoperative perianal wounds heal in a contaminated, high-tension environment and are frequently complicated by pain, edema, exudation, delayed healing, infection, and bleeding[10,11]. Local sitz bathing or fumigation is widely used because it is simple and well accepted by patients[12]. Nevertheless, local-care regimens differ in mechanism and evidentiary support. Accordingly, this study addressed a pragmatic, real-world question: Whether a Tongxuekang fumigation-washing regimen used after discharge is associated with improved early wound recovery compared with the conventional sitz-bath pathway employed at our center. This comparison should be interpreted as a regimen-level association in routine practice, not as proof that Tongxuekang is superior to all contemporary postoperative strategies or that a single pharmacologic pathway has been established[13-15].
Our findings indicate that Tongxuekang fumigation-washing was associated with faster complete epithelialization, lower early pain scores, reduced edema and exudation, improved granulation quality at day 14, and a lower risk of infection. After multivariable adjustment for measured confounders, the associations with shorter healing time and reduced infection remained statistically significant. Although crude rates of secondary hemorrhage were lower in the Tongxuekang group, the adjusted analysis demonstrated only a protective trend (P = 0.054), which does not meet conventional thresholds for statistical significance and should be interpreted cautiously. Delayed bleeding after hemorrhoidectomy may occur during early follow-up and can be influenced by eschar shedding, constipation, infection, operative factors, and patient behavior[16-18]. Therefore, the present findings support a hypothesis of potential early benefit but do not justify strong causal inference regarding bleeding prevention.
Interpretation of the underlying mechanisms also requires caution. Warm sitz bathing alone can enhance local perfusion, facilitate cleansing, and reduce internal sphincter spasm; thus, any incremental benefit of Tongxuekang fumigation-washing cannot be attributed solely to pharmacologic effects. A plausible explanation is that the intervention functions as a composite of thermal stimulation, repeated wound cleansing, optimization of the local microenvironment, and potential ingredient-related anti-inflammatory or analgesic activity, thereby reducing edema and exudation and promoting granulation maturation. However, this study did not assess tissue drug concentrations, trans-mucosal absorption, inflammatory biomarkers, microbiological burden, or contextual effects such as patient expectations. Consequently, it cannot determine whether the observed benefits derive from pharmacologic activity, nonspecific effects, or both. In addition, the retrospective record did not consistently document the external preparation process, concentration, solvent composition, or batch-specific formulation details; therefore, no ingredient-specific efficacy or safety claims can be made, including those related to potentially bioactive alkaloids in commercial preparations. These questions warrant standardized formulation studies with dedicated safety and pharmacokinetic evaluations.
Post-hemorrhoidectomy pain is multifactorial and influenced by incision-related inflammation, defecatory strain, and sphincter spasm[19,20]. In this cohort, Tongxuekang fumigation-washing was associated with lower visual analog scale scores and reduced use of additional analgesics, potentially reflecting attenuation of local inflammation and sphincter-related discomfort. However, the control group represented routine local care at our center in 2023 rather than a universal, optimized multimodal analgesia protocol. Contemporary postoperative management may include stool regulation, systemic analgesics, and selected topical agents such as calcium-channel blockers or glyceryl trinitrate[21,22]. Thus, a clinically relevant next step is to determine whether Tongxuekang provides incremental benefit when added to a standardized, contemporary multimodal regimen, rather than compared only with sitz bathing alone.
The observed reduction in follow-up contacts and 14-day re-visits is clinically noteworthy but should be interpreted as decreased early healthcare utilization rather than definitive evidence of accelerated recovery. A retrospective design cannot distinguish whether fewer re-visits reflect true symptom resolution, differences in adherence, barriers to care, or altered help-seeking behavior. Similarly, the absence of a between-group difference in urinary retention should be interpreted cautiously, as this outcome is strongly influenced by anesthesia modality and perioperative management[23,24]. Anesthesia type was not consistently available in the retrospective dataset and could not be included in adjusted analyses, representing an important residual confounder, particularly for urinary retention outcomes.
This study’s strengths include the evaluation of a post-discharge care pathway in routine practice and adjustment for measured confounders using multivariable analysis. However, several limitations warrant emphasis: (1) The single-center retrospective design is susceptible to selection bias, temporal bias, and unmeasured confounding; (2) Wound assessments relied in part on follow-up documentation; (3) The Tongxuekang formulation and preparation were not standardized; and (4) Follow-up was limited to 14 days. Accordingly, the study addresses only early postoperative outcomes and cannot assess scar formation, anal stenosis, anorectal function, recurrence, or long-term quality of life. Future studies should standardize the external preparation, comprehensively document anesthesia and concomitant multimodal analgesia, incorporate objective wound and biomarker assessments, and extend follow-up to long-term anorectal outcomes[25].
CONCLUSION
In this single-center retrospective cohort study, Tongxuekang fumigation–washing was associated with faster early wound healing, improved pain control, better local wound characteristics, and a reduced risk of postoperative infection following hemorrhoidectomy. However, the study does not elucidate a specific mechanism of action; the apparent reduction in secondary hemorrhage was not statistically significant after multivariable adjustment, and long-term outcomes were not evaluated. These findings are hypothesis-generating and suggest a potential role for optimizing postoperative local care; however, well-designed prospective studies are needed before definitive causal inferences or formulation-specific recommendations can be made.
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