Chronotherapeutic Herbal Sitz Bath at the Mao Hour (05:00–07:00) for Post-Hemorrhoidectomy Care

Abstract

Post‑hemorrhoidectomy recovery is often dominated by nociceptive pain, internal anal sphincter spasm, difficult first evacuations, reactive edema, minor bleeding, and the ever‑present risk of fecal contamination over an unepithelialized wound. Warm sitz bathing is ubiquitous in patient education, yet randomized evidence for robust analgesic or healing benefits remains inconsistent across studies that vary in water temperature, duration, timing, flow characteristics, and comparator care. In Chinese clinical practice, external washing with multi‑herbal preparations—here rationalized under the archetype Zhiyan Chongxi San (ZCS)—is commonly paired with warm water exposure, aiming to add antimicrobial, anti‑inflammatory, astringent, and epithelializing actions. In parallel, circadian chronobiology demonstrates pronounced morning peaks in colonic motor activity (high‑amplitude propagated contractions and the post‑breakfast gastrocolic reflex) and reveals time‑of‑day differences in pain processing and cutaneous wound repair. This review synthesizes guidance statements and randomized trials; reframes sitz bathing as a dose‑controlled, engineered hydro‑thermotherapy with defined temperature, time, and flow; integrates a quality‑controlled ZCS formula with pharmacognosy and microbiology; and proposes a pragmatic randomized trial comparing Mao‑hour (≈05:00–07:00) versus evening bathing within standardized care bundles. We argue that a morning‑timed, single‑use, thermometer‑verified 40–42°C soak for 10–15 minutes, sequenced immediately before the day’s first evacuation, followed by a brief rinse, pat‑dry, and application of evidence‑based topicals (diltiazem, metronidazole, or sucralfate) is physiologically coherent, operationally feasible, and culturally consonant. Herbal washing is mechanistically plausible but requires GMP‑style quality control and rigorous randomized evaluation before broad recommendation. The paper concludes with a Quality‑by‑Design framework, safety safeguards, health‑economic considerations, and a full trial blueprint.