Effects of Tongyangxiao lotion bidet therapy combined with Ziyu ointment on postpartum hemorrhoidal pain, oedema, anxiety, and depression

Abstract

BACKGROUND

Postpartum hemorrhoids are common complications in women after childbirth, with an incidence rate of 37.9%. Progesterone levels increase during pregnancy, which can lead to constipation. Abdominal pressure surges sharply during delivery, which can block the venous return of the rectum and result in hemorrhoids, pain, and edema. Tongyangxiao lotion and Ziyu ointment, traditional Chinese medicinal preparations, have the efficacy of subduing swelling, relieving itching, and promoting healing; however, their combined application in treating postpartum hemorrhoids is less studied.

AIM

To investigate effects of Tongyangxiao lotion sitz bath therapy combined with Ziyu ointment on postpartum hemorrhoidal pain, edema, anxiety, and depression.

METHODS

A retrospective analysis was conducted at Hebei Hospital of Traditional Chinese Medicine on 268 patients with hemorrhoids (September 2023 to February 2025). They were divided according to treatment method into control (wet compress with magnesium sulfate + Ziyu ointment) and observation (Tongyangxiao lotion sitz bath therapy + Ziyu ointment) groups (n = 134 in each group). Degree of pain, comfort level, compliance behavior with medical care, psychological state, therapeutic effect, hemorrhoid edema score, incidence of adverse reactions, and hemorrhoid diameter were compared.

RESULTS

No statistically significant difference was observed in the diameter of the hemorrhoids or edema between the two groups before treatment. Hemorrhoid diameter and degree of edema were significantly smaller in the observation group than those in the control group 14 days post treatment. No statistically significant difference was observed in the scores of the General Comfort Questionnaire (GCQ) dimensions and participants’ compliance before treatment. All GCQ dimension scores were significantly higher in the observation group than those in the control group 7 and 14 days post treatment. The compliance rate was significantly higher in the observation group than that of the control group. No statistically significant difference was observed in the incidence of adverse reactions between the two groups (P > 0.05).

CONCLUSION

Tongyangxiao lotion combined with Ziyu ointment can improve patients’ surface edema, postpartum hemorrhoid pain, treatment adherence, and comfort, reducing negative emotions. This is relatively safe and worthy of clinical promotion.

Key Words: Postpartum hemorrhoids; Tongyangxiao lotion; Ziyu ointment; Chinese medicine fumigation; Pain

Core Tip: This study investigated the efficacy of Tongyangxiao lotion combined with Ziyu ointment in 268 patients with postpartum hemorrhoids. Results indicated that this combined therapy significantly reduced the diameter of hemorrhoids, alleviated edema and pain, and improved patients’ comfort, compliance, and psychological state. The mechanism may involve the anti-inflammatory effects of multiple components of traditional Chinese medicine and improved local blood circulation. These results highlight the synergistic advantages of integrated traditional Chinese and Western medicine therapies for postpartum hemorrhoids, and provide a safe and effective treatment strategy for clinical practice.

INTRODUCTION

Hemorrhoids are soft venous masses formed by the downward movement of the anal cushion and varicose venous plexus at the edge of the anus. They more commonly occur in young people, and symptoms include local masses around the anus, difficulty in retracting, mucus secretions, and even bleeding during defecation, etc.[1]. Its global incidence rate is approximately 49.14%. In China, 51.14% of adults had anorectal diseases among the total population, with a 50.28% incidence rate of hemorrhoids[2]. Women's progesterone levels increase during pregnancy, making them prone to constipation. Arterial blood flow increases and the uterus enlarges, directly compressing the rectal veins. During delivery, the patient holds their breath and exerts force, which significantly increases abdominal pressure and blocks the return of the rectal veins. This often leads to hemorrhoid edema, which can cause severe pain and discomfort and affect the patient's rest and breastfeeding. According to statistics[3], 37.9% of women develop hemorrhoids after their first pregnancy, and childbirth increases this risk by nearly eight times. Magnesium sulfate wet compress and external application of Mayinglong Musk Hemorrhoid ointment are common hemorrhoids treatment options in Western medicine, and can improve symptoms to a certain extent.

However, patients with postpartum hemorrhoids are unique. Common treatment plans cannot achieve early control, and the therapeutic effects are not ideal. According to traditional Chinese medicine[4], a woman's vital energy is lacking after giving birth, and her blood and qi are insufficient, which can lead to the accumulation of heat toxins around the anus, thereby causing hemorrhoids. Therefore, treatment should mainly focus on promoting qi circulation to relieve pain, activating blood circulation to remove blood stasis, and warming Yang to unblock the meridians. Fumigation and washing therapy are common for treating postpartum hemorrhoids in traditional Chinese medicine[5]. It dilates the local capillaries at the affected area through the dual effects of heat and power. This effectively increases the permeability of the capillaries and fully exerts the active ingredients of traditional Chinese medicine that play a role in anti-inflammation, antibacterial, analgesic, and edema reduction. Tongyangxiao lotion is a clinical prescription obtained from the Hebei Provincial Hospital of Traditional Chinese Medicine. It reduces swelling, itching, inflammation, and pain, and promotes muscle growth and healing. Ziyu ointment is an in-house preparation at the Hebei Hospital of Traditional Chinese Medicine. It comprises Lithospermum erythrorhizon, Sanguisorba officinalis, Angelica dahurica, and borneol, and has shown remarkable therapeutic effects on wound healing in clinical practice. However, studies on the use of Tongyangxiao lotion combined with Ziyu ointment for the treatment of postpartum hemorrhoids are limited. Therefore, this study investigated the effects of Tongyangxiao lotion combined with Ziyu ointment on pain, edema, anxiety, and depression in patients with postpartum hemorrhoids to provide a scientific basis for the application of traditional Chinese medicine in modern obstetrics and gynecology.

MATERIALS AND METHODS

Patient characteristics

A retrospective analysis was conducted on clinical data from 268 patients with hemorrhoids who delivered at Hebei Hospital of Traditional Chinese Medicine between September 2023 to February 2025. This study was a non-randomized historical controlled study. The patients were divided into two groups according to the actual treatment plans they received: The control (n = 134) and observation (n = 134) groups.

Inclusion criteria were patients who had: (1) A vaginal delivery (full-term parturients); (2) No obvious hemorrhoids before delivery, but hemorrhoids appeared within 24 hours after vaginal delivery; (3) A smooth labor process without forceps delivery or lateral episiotomy, with no perineal laceration of grade II or above; and (4) Complete clinical data. Exclusion criteria were those who had: (1) Undergone hemorrhoid surgery in the past; (2) Hematological diseases; (3) Underlying diseases, such as hypertension, coronary heart disease, and diabetes; or (4) Other obstetric complications. This study was approved by the Medical Ethics Committee of Hebei Hospital of Traditional Chinese Medicine.

Treatment method

The control group was treated with 50% magnesium sulfate wet compress + Ziyu Ointment. Patients were placed in a supine position with both legs flexed and maintained in an abducted position. A disposable medical pad was placed beneath the buttocks. The perineal and anal skin were disinfected with 0.5% povidone-iodine. Medical gauze was soaked in 50% magnesium sulfate solution, and after absorbing sufficient liquid, it was applied as a wet compress to the perineal and hemorrhoidal surfaces. The gauze was replaced every 15 minutes, with the wet compress maintained for 30 minutes, three times daily. Subsequently, 10 mL of Ziyu ointment was administered to the anus to change the medicine routine, twice daily, once in the morning and evening. Treatment was continued for seven days as a course, with continuous treatment for two courses (14 days in total). During the treatment, the patient was asked to eat more vegetables and exercise properly to promote intestinal peristalsis, avoid spicy diet, and keep defecation unblocked.

The observation group was treated with Tongyangxiao lotion fumigation combined with Tongyangxiao lotion and Ziyu ointment in the anus based on the control group. Every day, 200 mL of Tongyangxiao lotion (15 g mirabilite, 15 g Sichuan pepper, 15 g matrine, 6 g Asarum, 15 g alum, 15 g Phellodendron, 15 g Gentiana pall, 15 g Angelica sinensis, 15 g Galla chinensis, and 15 g windstorm) was added to 1500 mL warm water. After fumigation and washing for 15-20 minutes, a disposable syringe was used to extract 10 mL of Ziyu ointment (the main drugs comprised Arnebia root, Sanguis officinalis, Angelica Dahurica, borneol, and was a hospital preparation of the First Affiliated Hospital of Hebei University of Traditional Chinese Medicine, Ji Yao Zi Zi Z20051134) for anal treatment. It was administered twice a day, once in the morning and evening. The treatment course lasted for seven days per course and was performed for two courses.

Data collection and results measurement

Clinical efficacy: The therapeutic effects were statistically analyzed after 14 days of treatment. The diameter of the hemorrhoids decreased by 70%. Anal endoscopy revealed mild congestion of the hemorrhoid mucosa, and symptoms, such as pain and swelling, significantly improved, which indicated a marked effect. Diameter of the hemorrhoids decreased by 40%-69%. The relief of pain and swelling symptoms indicated that it was effective. Those who failed to meet these conditions were considered invalid. The total effective rate was the number of markedly effective cases + number of effective cases)/total number of cases × 100%.

Hemorrhoid diameter and edema: Before treatment and 14 days after treatment, an anoscope examination was conducted, and the maximum diameter of hemorrhoids was measured using the built-in ruler of the anoscope. A 4-point scale was used to evaluate the degree of edema: 1, 2, 3, and 4 points for no, mild, moderate, and severe edema, respectively, with internal hemorrhoid mucosal necrosis and erosion.

Pain score: A Visual Analogue Scale (VAS)[6] was used to evaluate the degree of pain before treatment and on the 7^th and 14^th days of treatment. The scale ranged from 1 to 10, and higher scores indicated more severe pain. The overall Cronbach's α coefficient of the scale was 0.873, the α coefficient values of each dimension were > 0.85, and split-half reliability coefficient was 0.901.

Comfort score: The General Comfort Questionnaire (GCQ)[7] was used to evaluate patients’ comfort before treatment and on the 7^th and 14^th day of treatment. The scale included 28 items in four dimensions: Psychology, physiology, social culture, and environment. Each item was scored from 0 to 4. The total score was 112 points, and higher scores indicated greater comfort. The overall Cronbach's α coefficient of the scale was 0.960, the α coefficient values of each dimension were > 0.85, and split-half reliability coefficient was 0.864.

Compliance judgment: According to the results of the questionnaire, patient compliance was judged based on doctor's advice after discharge. Daily exercise with doctors’ advice, occasional exercise with doctors’ advice, and not taking the doctor's advice and no exercise were classified as full, partial, and non-compliance, respectively. Compliance rate was complete compliance rate + relative compliance rate.

Psychological status scores: The Self-rating Anxiety Scale (SAS)[8] and Self-rating Depression scale (SDS)[9] were used to evaluate patients’ anxiety and depression, respectively, before treatment and 7 and 14 days after treatment. The total SAS and SDS scores were 100, and a higher score indicated a higher degree of anxiety and depression. The overall Cronbach's α coefficients of the SAS and SDS were 0.824 and 0.787, α coefficient values of each dimension were > 0.85 for both, and split-half reliability coefficients were 0.726 and 0.867, respectively.

Occurrence of adverse reactions: The occurrence of adverse reactions in the two groups of patients were observed and recorded, including pruritus, redness and swelling, skin damage and abnormal pain.

Statistical analysis

SPSS version 23.0 was used for statistical analysis. Measurement data with normal distribution were expressed as mean ± SD. An independent sample t-test was used to compare the two groups. Non-normally distributed data were presented as quartiles, and the rank-sum test was used to compare the two groups. Repeated-measures analysis of variance (ANOVA) was used to compare the data at different time points between the two groups. Count data were expressed as the number of cases and percentage, and χ² test was used. P-values of < 0.05 were considered statistically significant.

RESULTS

Comparison of general data

No statistically significant difference was observed in the comparison of general data between the two groups, as shown in Table 1.

Table 1 Comparison of participants’ general information, n (%).

Group	Age (years)	Gestational weeks (weeks)	Neonatal gender		Newborn weight (kg)
			Female	Male
Control group (n = 134)	25.60 ± 3.39	39.98 ± 0.92	69 (51.49)	65 (48.51)	3.49 ± 0.17
Observation group (n = 134)	26.28 ± 3.08	39.96 ± 0.95	75 (55.97)	59 (44.03)	3.52 ± 0.23
t/χ2	1.715	0.196	0.540		1.298
P value	0.087	0.845	0.462		0.196

Comparison of clinical efficacy between the groups

The total effective rate was higher in the observation group than that of the control group, and the difference was statistically significant (P < 0.05), as shown in Table 2.

Table 2 Comparison of clinical efficacy between the two groups, n (%).

Group	n	Markedly effective	Effective	Invalid	Total effective rate
Control group	134	31 (23.13)	82 (61.19)	21 (15.67)	113 (84.33)
Observation group	134	91 (67.91)	36 (26.87)	7 (5.22)	127 (94.78)
χ2					7.817
P value					0.005

Diameter and edema of hemorrhoids compared between the groups

No statistically significant difference was observed in hemorrhoid diameter and edema degree between the two groups before treatment (P > 0.05). The diameter of hemorrhoids and degree of edema were significantly smaller in the observation group than those in the control group after 14 days of treatment, and the differences were statistically significant (P < 0.05), as shown in Table 3.

Table 3 Comparison of hemorrhoid diameter and edema in patients (mean ± SD).

Group	n	Diameter of hemorrhoids (cm)		Edema degree (points)
		Before treatment	Treatment for 14 days	Before treatment	Treatment for 14 days
Control group	134	1.70 ± 0.31	0.75 ± 0.22	3.05 ± 0.69	1.57 ± 0.50
Observation group	134	1.71 ± 0.31	0.46 ± 0.12	3.08 ± 0.81	1.37 ± 0.49
χ2		0.138	13.399	0.325	3.232
P value		0.890	< 0.001	0.746	0.001

Degree of pain compared between the groups

No statistically significant difference was observed in VAS scores between the two groups before treatment (P > 0.05). The VAS scores were significantly lower in the observation group than those of the control group after 7 and 14 days of treatment, and the differences were statistically significant (P < 0.05), as shown in Figure 1. Results of the repeated-measures ANOVA revealed that the VAS score was lower in the observation group than that the control group, and the difference was statistically significant (intergroup effect: F = 18.888, P < 0.001), which demonstrated a decreasing trend with time (time effect: F = 956.781, P < 0.001), and an interaction effect was observed between group and time (interaction effect: F = 16.445, P < 0.001).

Figure 1  Comparison of the Visual analogue scoring scores between the two patient groups.

Comfort scores of the groups

No statistically significant difference was observed in the GCQ scores between the two groups before treatment (P > 0.05). The GCQ scores were significantly higher in the observation group than those in the control group after 7 and 14 days of treatment (all P < 0.05), as shown in Figure 2. Repeated-measures ANOVA revealed statistically significant differences in psychology, physiology, social culture, and environment scores between the two groups (between-group effect: F = 21.465, P < 0.001; F = 24.402, P < 0.001; F = 28.680, P < 0.001; F = 9.031, P = 0.003), which demonstrated an increasing trend with time (time effect: F = 738.769, P < 0.001; F = 663.001, P < 0.001; F = 699.223, P < 0.001; F = 792.338, P < 0.001). An interaction effect was observed between group and time (interaction effect: F = 7.545, P < 0.001; F = 15.162, P < 0.001; F = 32.973, P < 0.001; F = 21.847, P < 0.001).

Figure 2 Comparison of the scores of each dimension of the General Comfort Questionnaire scale between the two groups. A: Psychological; B: Physiological; C: Socioculture; D: Environmental.

Compliance of the groups

The compliance rate was significantly higher in the observation group (95.52%) than that of the control group (84.33%), and the difference was statistically significant (P < 0.05), as shown in Table 4.

Table 4 Comparison of compliance between the two groups, n (%).

Group	n	Full compliance	Partial compliance	Noncompliance	Total adherence rate
Control group	134	78 (58.21)	35 (26.12)	21 (15.67)	113 (84.33)
Observation group	134	94 (70.15)	34 (25.37)	6 (4.48)	128 (95.52)
χ2					9.267
P value					0.002

Psychological state of the groups

No statistically significant differences were observed in the SAS and SDS scores between the two groups before treatment (P > 0.05). The SAS and SDS scores were significantly lower in the observation group than those of the control group after 7 and 14 days of treatment (P < 0.05), as shown in Table 5. Repeated-measures ANOVA revealed statistically significant differences in the SAS and SDS scores between the two groups (between-group effect: F = 46.318, P < 0.001; F = 40.071, P < 0.001). The SAS and SDS scores of the two groups decreased over time (time effect: F = 707.697, P < 0.001; F = 640.483, P < 0.001). An interaction effect was observed between group and time (interaction effect: F = 9.591, P < 0.001; F = 7.609, P < 0.001).

Table 5 Comparison of the Self-rating Anxiety Scale and Self-rating Depression Scale scores between the groups (mean ± SD).

Group	n	SAS			SDS
		Before treatment	Treatment for 7 days	Treatment for 14 days	Before treatment	Treatment for 7 days	Treatment for 14 days
Control group	134	39.42 ± 3.44	35.98 ± 2.07	30.38 ± 2.15	37.63 ± 3.72	33.96 ± 2.22	29.35 ± 2.87
Observation group	134	39.22 ± 3.51	33.54 ± 2.76	28.93 ± 3.29	37.40 ± 3.52	31.86 ± 2.46	27.64 ± 2.63
t		0.457	8.200	4.267	0.540	7.355	5.082
P value		0.648	< 0.001	< 0.001	0.590	< 0.001	< 0.001

SAS: Self-rating Anxiety Scale; SDS: Self-rating Depression Scale.

Incidence of adverse reactions

There was no statistically significant difference in the incidence of adverse reactions between the two groups (P > 0.05), as shown in Table 6.

Table 6 Comparison of the incidence of adverse reactions between the two groups, n (%).

Group	n	Itching	Redness and swelling	Skin damage	Abnormal pain	Overall incidence rate
Control group	134	3 (2.24)	4 (2.99)	1 (0.75)	2 (1.49)	10 (7.46)
Observation group	134	2 (1.49)	3 (2.24)	1 (0.75)	1 (0.75)	7 (5.22)
χ2						0.565
P value						0.452

DISCUSSION

Uterine enlargement after pregnancy leads to compression of the inferior vena cava, whereas progesterone, a pregnancy hormone, relaxes the smooth muscle of the venous wall, resulting in hypokinesia and slow intestinal peristalsis, which can lead to constipation[10]. In addition, fetal delivery is prone to cause compression of the terminal rectum and anal canal, wherein the lymph and local veins cannot return to normal, resulting in anal tissue damage and postpartum hemorrhoids[11]. Postpartum hemorrhoids significantly increase patients’ discomfort and pain. In mild cases, it affects their treatment compliance; however, in severe cases, it can lead to partial necrosis of hemorrhoids, which can increase the occurrence of complications, cause inconvenient mobility and difficulties in defecation, and affect breastfeeding and uterine involution[12]. Owing to the particularity of parturient women, clinics usually use conservative treatment to relieve pain and curb disease progression. According to traditional Chinese medicine[13], poor operation of qi machine, qi and blood block, and obstruction of blood vessels are the causes of postpartum hemorrhoids. Therefore, treatments should focus on promoting blood circulation, removing blood stasis, promoting qi, relieving pain, dredging collaterals, and warming Yang.

Fumigation and washing therapy with traditional Chinese medicine is an important treatment for postpartum hemorrhoids; this can ensure that the drug is in direct contact with the lesion and can continuously play a role in optimizing local blood circulation and reducing pain and edema[14]. Tongyangxiao lotion is a topical lotion developed from many years of clinical experience in the Department of Anus and Intestines of Hebei Provincial Hospital of Traditional Chinese Medicine. The prescription comprises Phellodendron amurense for clearing heat and drying dampness. Mirnitus and Gentiana scabra can reduce swelling, relieve pain, and promote pus discharge and detoxify. Sichuan pepper can dry dampness, relieve itching, kill parasites, and relieve pain. Angelica sinensis promotes blood circulation and reduces blood stasis. Siler, white fresh bark, gallnuts, and Sophora flavescens dispel wind and relieve itching. Their combined use can clear heat and promote diuresis, remove blood stasis and detoxifying, and activate blood circulation and unblock the meridians[15]. Shi et al[16] confirmed that Tongyangxiao lotion can inhibit local inflammatory responses by downregulating the levels of pro-inflammatory factors such as IL-6, TNF-α, and IL-8, while reducing the stimulation of nerve endings by inflammatory mediators and promoting wound healing, thereby relieving pain. This suggests that the anti-inflammatory and analgesic effects of Tongyangxiao lotion may be related to the synergistic inhibition of inflammatory signaling pathways by its multiple components. In addition, the active ingredients in Tongyangxiao lotion exert their effects through the dual action of warming and drug penetration. Berberine in Phellodendron bark has broad-spectrum antibacterial and anti-inflammatory activity, inhibiting local bacterial proliferation and reducing inflammatory infiltration; the hyperosmotic properties of sodium sulphate promote the resolution of local tissue oedema through osmotic pressure; components such as ferulic acid in Angelica sinensis improve local microcirculation, increase vascular perfusion, promote venous return, and facilitate the clearance of metabolic byproducts. Ziyu ointment is an in-house preparation of Hebei Provincial Hospital of Traditional Chinese Medicine. It contains purple grass and Sanguisorba officinalis, which promote blood circulation, stop bleeding, detoxify, reduce swelling, cool the blood, and remove spots. Angelica dahurica and sinensis can reduce swelling, replenish blood, and moisten the intestines. Borneol clears heat and relieves pain[17]. Therefore, in this study, pain-itching and decontamination agent fumigation and washing combined with Ziyu ointment were applied to patients with postpartum hemorrhoids to explore its therapeutic effect.

According to our results, no statistically significant difference was observed in the diameter of the hemorrhoids or degree of edema among the patients before treatment (P > 0.05). However, the diameter of the hemorrhoids and degree of edema were significantly smaller in the observation group than that in the control group after 7 and 14 days of treatment; furthermore, the compliance rate was significantly higher in the observation group (all P < 0.05). This result was consistent with those of Xu et al[18]. This suggests that the combination of fumigation and washing with a pain and itching decontamination agent and Ziyu ointment can significantly reduce the edema of hemorrhoids, thereby controlling disease progression in patients with postpartum hemorrhoids. This is because Chinese medicine fumigation therapy is guided by the theory of Chinese medicine organs and meridians, and Tongyangxiao lotion can reduce swelling and relieve itching, anti-inflammatory and analgesic, and promote the healing of muscle growth[19]. Furthermore, fumigation of the drugs can synergize with the effect of warmth and heat and prompt the drugs to act rapidly through the mucous membrane and skin inside the organism; thus, the patient’s local blood vessels in the anus are fully dilated to optimize its lymphatic and blood circulation, which can reduce the connective tissues and muscle tension, improve the spasticity of the anal sphincter muscle, promote the absorption of edema, and effectively curb disease progression[20,21]. The herbs, such as Lithospermum officinale L. and Sanguisorba officinalis L., in Ziyu ointment play a crucial role in promoting blood circulation, removing blood stasis, detoxifying, and reducing swelling, and provide strong support for alleviating the symptoms of hemorrhoids[22].

Warm medicinal liquid fumigation and washing can accelerate blood circulation, improve local microcirculation, and increase vascular permeability, which can reduce inflammatory responses, improve the edema of hemorrhoids, and indirectly promote the absorption of drugs[23]. Ziyu ointment is an oily paste-like substance, which can reach deep into the lumen when performing anal enema treatment. Its presence forms a natural physical barrier, which can reduce the contamination of the wound by feces and provide an excellent environment for wound repair. The patient should first fumigate and wash, and apply the Ziyu ointment into the anus. This allows the medicine to directly act in the affected area, fully exerting its efficacy while avoiding its first-pass effect on the liver. Our results revealed that the pain scores of patients in the observation group were significantly lower than those in the control group after 7 and 14 days of treatment. This result was consistent with those of Tian et al[24], which suggested that Tongyangxiao lotion fumigation combined with Ziyu ointment treatment significantly reduced pain. Shen et al[25] reported that a fumigation sitz bath could effectively improve local blood circulation and reduce the inflammatory response, which could relieve pain from the root cause. Simultaneously, the borneol component in the Ziyu ointment has significant heat-clearing and pain-relieving effects, and the two have synergistic effects, which is lasting and effectively provides pain relief to patients. Tang et al[26] reported that the external application of Ziyu ointment combined with a traditional Chinese medicine decoction could significantly alleviate incision pain in parturients after lateral episiotomy, and can promote incision healing, reduce infection, and improve edema. In addition, the incidence of adverse reactions in both groups was low and mild, indicating that the combination of Tongyangxiao lotion sitz bath therapy and Ziyu ointment is relatively safe for use in postpartum patients, but individual allergy risks should still be monitored.

Scores of patients for each dimension of comfort were significantly higher in the observation group than those in the control group. This result was consistent with those of Li et al[27]. Fumigation and washing sitz baths directly relieved physical discomfort and enhanced physiological comfort by regulating the local microcirculation and reducing inflammation and edema[28]. As physical symptoms improved, the patient's psychological stress was effectively relieved, anxiety and depression significantly improved, and psychological comfort was further enhanced. Our results revealed that the degree of anxiety and depression was significantly lower in the observation group than in the control group. This result was consistent with those of a previous study[29] that found that traditional Chinese medicine fumigation and washing therapy were helpful in improving patients’ psychological state. According to traditional Chinese medicine, emotions are closely associated with physical health. Hence, improving physical symptoms and reducing patients' pain and discomfort can effectively alleviate their anxiety and depression. Meanwhile, during the fumigation and washing process, the unique aroma of traditional Chinese medicine can be transmitted to the central nervous system through the olfactory pathway, triggering a relaxation response. The sense of ritual formed by the daily regular fumigation and washing operation can enhance the patient's sense of control over the treatment process and reduce the anxiety of uncertainty brought by the disease. In addition, the quality of doctor-patient communication cannot be ignored in psychological adjustment. Frequent health education during the treatment process enhanced the interaction between doctors and patients. This continuous professional support not only enhances patients' treatment compliance but also alleviates the psychological burden of postpartum women caused by their role transition and illness discomfort through the establishment of a trust relationship.

CONCLUSION

Tongyangxiao lotion combined with Ziyu ointment can effectively alleviate the pain and edema of patients with postpartum hemorrhoids through the synergistic effect of multiple medicinal ingredients. It can improve microcirculation, have anti-inflammatory and analgesic effects, enhance the quality of life and treatment compliance of patients, effectively alleviate patients' anxiety and depression, and has good safety. This provides a new choice and basis for the clinical treatment of postpartum hemorrhoids.

However, this study has certain limitations. First, the retrospective design may have led to selection bias. Hence, future prospective randomized controlled trials should verify these results. Furthermore, this study lacked long-term follow-up data, and long-term efficacy indicators, such as recurrence rate, remain unclear. Hence, further in-depth research and multicenter clinical studies are warranted to promote the standardized application of this protocol in obstetrics and gynecology.