[Examining the origin and evolution of 'Jiao Chang']

Jiao Chang was a disease, recorded in both ancient and contemporary medical literature. However, its conceptual understanding remained inconsistent and even fallacious. This paper systematically examines the origin and evolution of Jiao Chang in terms of connotation by drawing on methodologies from philology, historiography and conceptual history. The concept of Jiao Chang originated from the linguistic descriptions of its physical symptom "hemorrhoids connecting with the Qian Yin (perineum region anterior to acupoint Hui Yin or urogenital triangle)", and the symptom "urinating with feaces or blood". The disease with these symptoms was first named Jiao Chang in the Yuan Dynasty, and was described as "urinating with fecal discharge". The main characteristics of this disease was "translocation of discharging urine and feaces", in particular, postpartum in the Ming Dynasty. The cause of the disease was attributed to "intestinal perforation and bladder rupture" in the Qing Dynasty. The disease was associated with rectourethral or rectovesical fistula in Western medicine at the end of the Qing Dynasty. The disease was explored in integrated medicine in terms of naming, symptoms, pathology and treatment in the Republic of China times. Currently, this disease is predominantly classified as a posnatal disease, relating to multiple biomedical nosology. Jiao Chang, according to historical research, refers to "a disease mainly characterised by feaces discharge through the urethra or vagina, and urine discharge from the anus". It relates to simple or complex fistula formed between or among the urinary, reproductive and digestive tracts, such as rectovaginal fistula, rectourethral fistula, rectovesical fistula and recto-vesico-vaginal fistula in Western medicine.