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World J Gastrointest Surg. Jul 27, 2026; 18(7): 121387
Published online Jul 27, 2026. doi: 10.4240/wjgs.v18.i7.121387
Published online Jul 27, 2026. doi: 10.4240/wjgs.v18.i7.121387
Ziwu-Liuzhu-guided combined external therapy promotes wound healing in postoperative perianal fistulizing Crohn’s disease
Shao-Yan Zhao, Shi-Jie Ma, Chen-Xi Ouyang, Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
Shi-Lin Zhu, Department of Nursing, The Second Affiliated Hospital of Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
Xiang-Bin Xiao, Department of Rehabilitation, The Second Affiliated Hospital of Hunan University of Chinese Medicine, Changsha 410007, Hunan Province, China
Co-corresponding authors: Shi-Lin Zhu and Xiang-Bin Xiao.
Author contributions: Zhao SY, Zhu SL and Xiao XB designed the research study; Zhao SY, Ma SJ and Ouyang CX performed the research, analyzed the data; Zhu SL and Xiao XB, as co-corresponding authors, jointly conceived and designed the study, supervised the implementation of the Ziwu-Liuzhu time-specific external therapy protocol, and verified the clinical data; Zhao SY drafted the manuscript; Zhu SL and Xiao XB revised the manuscript critically for important intellectual content; and all authors have read and approved the final manuscript.
AI contribution statement: We used an AI tool (DeepL) for language polishing on a few individual sentences. I only used AI to help polish a few sentences that I had not expressed very well. For the file “121387-answering-reviewers”, I didn’t use any AI tools.
Supported by Hunan Provincial Traditional Chinese Medicine Scientific Research Project, No. 20255711.
Institutional review board statement: This study was approved by the ethics committee of The Second Affiliated Hospital of Hunan University of Chinese Medicine (No. 2025-KY-060-01).
Informed consent statement: For cases analyzed solely on the basis of historical medical records, informed consent could be waived in accordance with institutional ethics regulations, provided that patient privacy was not compromised and clinical care was not affected.
Conflict-of-interest statement: The authors declare that they have no commercial, personal, political, intellectual, or religious conflicts of interest related to the work submitted for consideration of publication.
Data sharing statement: Technical appendix, statistical code, and dataset are available from the corresponding authors at
Corresponding author: Shi-Lin Zhu, MD, Researcher, Department of Nursing, The Second Affiliated Hospital of Hunan University of Chinese Medicine, No. 233 Caie North Road, Kaifu District, Changsha 410007, Hunan Province, China. lin_6359s@163.com
Received: March 24, 2026
Revised: April 14, 2026
Accepted: May 22, 2026
Published online: July 27, 2026
Processing time: 126 Days and 3 Hours
Revised: April 14, 2026
Accepted: May 22, 2026
Published online: July 27, 2026
Processing time: 126 Days and 3 Hours
Core Tip
Core Tip: Perianal fistulizing Crohn’s disease (PFCD) is difficult to manage after surgery because delayed wound healing and persistent inflammation are common. In this retrospective cohort study, a Ziwu-Liuzhu-guided time-specific traditional Chinese medicine external therapy was associated with better postoperative recovery than sitz bath alone or non-time-specific combined therapy. Patients in the time-specific group showed faster wound healing, lower inflammatory marker levels, greater improvement in Crohn’s Disease Activity Index and Perianal Disease Activity Index scores, and better anxiety outcomes. These findings suggest that treatment timing may be an important adjunct in integrated postoperative PFCD management.