title: Management for fistula-in-ano with Ginseng and Tang-kuei Ten Combination.
abstract: BACKGROUND
  Non-operative management for patients with fistula-in-ano in infancy using a traditional herbal medicine Ginseng and Tang-kuei Ten Combination (GTTC) is described.
  
  
  METHODS
  A total of 22 patients with peri-anal abscess or fistula-in-ano were treated with GTTC. Eighteen patients showed no improvement using the conventional non-operative management (frequent curettage of abscess cavity), after which administration of GTTC was commenced. The other four patients received GTTC from the beginning of their treatment. A dose of 0.1-0.2 g/kg of GTTC was given orally twice a day. The period between onset of peri-anal abscess and the commencement of GTTC (pre-GTTC period) was compared to the period until remission after administration of GTTC (post-GTTC period). The relationship between the GTTC dose, age at onset of peri-anal abscess, post-GTTC period, and relapse rates were investigated.
  
  
  RESULTS
  Twenty-one patients reached remission, but a 4-year-old boy failed to reach remission and he required fistelectomy. Pre-GTTC periods were from 11 days to 3 years (median 50 days) and statistically longer than post-GTTC periods (4-65 days, median 7 days). There was a reverse correlation between the age at onset of peri-anal abscess and post-GTTC period (r = -044, P < 0.05). There was no statistical correlation between the dose of GTTC and post-GTTC period. Five patients showed relapse after discontinuing GTTC, all of them could be resolved with augmentation of the dose. The onset of peri-anal abscess in patients who relapsed were all < 3 months of age.
  
  
  CONCLUSIONS
  Ginseng and Tang-kuei Ten Combination seemed to accelerate the recovery of patients with fistula-in-ano in infancy.
authors.affiliation: Department of Surgery and Pediatric Surgery, Tokyo Medical & Dental University, Tokyo, Japan. ohya.srgl@tmd.ac.jp
authors.forename: Toshiki
authors.initials: T
authors.lastname: Ohya
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Usui
authors.forename: Kentaro
authors.initials: K
authors.lastname: Okamoto
authors.forename: Yumi
authors.initials: Y
authors.lastname: Inoue
authors.forename: Shigeki
authors.initials: S
authors.lastname: Arii
authors.forename: Takehisa
authors.initials: T
authors.lastname: Iwai
mesh_terms: D000038:Abscess / Q000188:drug therapy; D029971:Angelica sinensis; D001004:Anus Diseases / Q000188:drug therapy; D004365:Drugs, Chinese Herbal / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D005894:Panax; D008517:Phytotherapy / Q000379:methods*; D012003:Rectal Fistula / Q000188:drug therapy*; D012008:Recurrence
chemical_list: D004365:Drugs, Chinese Herbal; C044613:angelicae sinensis extract