禹粮赤脂以堵截阳明。用五仁汤复从前之肠液养营法善病后之元虚。此皆先生祖古
方而运以匠心。为后学之津梁也。（邵新甫）
徐评 以上诸案。肠红痔血。俱不能分别。人参姜桂一概乱投。此老与此症竟茫然无知。误人
不少。案中不但痔血一症。混入肠红。即知其为痔血矣。而痔血之方又不中病。盖另有治法。
不得与肠红方等也。便血肠中必有受之处。褚氏所谓肠有窍便血杀人是也。当知填窍之
法。今惟知用人参姜附及五味等燥热收敛之药。助其肠中之火。而于脱血之后。更劫其阴。苟
非纯虚。是益其疾矣。
翁（六五） 湿热皆主伤气。气下陷坠肛而痛。溲溺后。阴囊筋牵着于肛。其痛为甚。夫厥阴肝脉绕阴。
按脉濡弱。决非疏泄主治。议进陷者举之。从东垣补中益气汤。（湿热气虚下陷）
孙 面色痿黄。腹痛下血。都因饮食重伤脾胃。气下陷为脱肛。经月不愈。正气已虚。宜甘温益
气。少佐酸苦。务使中焦生旺。而稚年易亏之阴自坚。冀有向安之理。（气虚下陷）
人参 川连 炒归身 炒白芍 炙草 广皮 石莲肉 乌梅
又 肛翻纯血。不但脾弱气陷。下焦之阴亦不摄固。面色唇爪。已无华色。此益气乃一定成法。
摄阴亦不可少。然幼稚补药。须佐宣通。以易虚易实之体也。
人参 焦术 广皮 白芍 炙草 归身 五味 升麻（醋炒） 柴胡（醋炒）
某 便后。少腹痛肛坠。溺则便滑。肾虚不摄。（肾气不摄）
熟地炭 五味 萸肉炭 茯苓 炒远志 炒菟丝子
某 肛坠尻痛。利多伤阴。
熟地炭 五味 茯神 炒山药 炒楂肉 炒菟丝子
煎送禹粮石脂丸。
王（六二） 阳气下陷。肾真不摄。肛坠气泄如风。向老下元阳惫。非升柴能举其陷。
人参 鹿茸 补骨脂 炒大茴香 茯苓
调入阳起石三分。
吴（五六） 脱肛漏血。遇劳即发。病经十六载。色萎黄。背脊痛。诊脉尺中下垂。法当升阳摄阴。兼理奇脉。斑
龙丸加五味子。蜜丸。
脱肛一症。其因不一。有因久痢久泻。脾肾气陷而脱者。有因中气虚寒。不能收摄而脱者。
有因酒湿伤脾色欲伤肾而脱者。有因肾气本虚。关门不固而脱者。有因湿热下坠而脱
者。又肛门为大肠之使。大肠受寒受热。皆能脱肛。老人气血已衰。小儿气血未旺。皆易脱
肛。经曰。下者举之。徐之才曰。涩可去脱。皆治脱肛之法也。观先生治脱肛之症。亦不越乎
升举固摄益气三法。如气虚下陷而脱者。宗东垣补中益气汤。举陷为主。如肾虚不摄而
脱者。宗仲景禹粮石脂丸。及熟地五味菟丝辈。固摄下焦阴气为主。如肝弱气陷。脾胃
气虚下陷而脱者。用摄阴益气。兼以酸苦泄热为主。如老年阳气下陷。肾真不摄而脱者。
又有鹿茸阳起石等。提阳固气一法。汪 庵云。有气热血热而肛反挺出者。宜用芩连槐
柏。及四物升柴之类。愚谓即或间有此症。终非可训之法。存之以质君子。（邹滋九）
徐评 脱肛多由浊气下降。湿痰毒火合并为害。故肿痛异常此实症也。必清其大肠之火。而
用外治之药以收之。无不立愈。其有虚人病后清气下陷。则用补中益气之法以提之。十不得
一者也。乃不论何因。俱用升提收敛之法。肛门之痰火浊气。将升提而置之何地耶。又脱肛
之疾属热多。又用温燥。更非所宜。
邵新甫评：用禹余粮和赤石脂来堵塞阳明经的滑脱。使用五仁汤来恢复从前通过肠液滋养营血的治法，这对于病后元气虚弱的情况是很好的。这些都是先生效法古方而运用匠心，成为后学者的津梁（指引导、入门的途径）啊。
徐灵胎评：以上这些医案，对于“肠红”（便血的一种，血色鲜红，附着于粪便表面或便后滴血）和“痔血”（痔疮出血），都不能加以区分。人参、干姜、肉桂一概乱用。这位医生对此症竟然茫然无知，误人不浅。医案中不仅将痔血混入肠红之中，即使知道是痔血了，所用的治疗痔血的方剂又不对症。因为痔血另有治疗方法，不能与肠红的方子等同。便血在肠道中必定有受邪的部位，正如褚氏所说“肠有窍便血杀人”那样。应当知道填补孔窍的方法。现在只知道用人参、干姜、附子以及五味子等燥热收敛的药物，这会助长肠中的火气，而在大量失血之后，更会劫夺阴液。如果不是纯粹的虚证，这就是加重病情了。
翁某（65岁）：湿热都会主要损伤气机，气机下陷导致肛门坠胀疼痛。小便后，阴囊筋脉牵引至肛门，疼痛非常剧烈。厥阴肝经环绕阴器，诊脉濡弱，决不是疏泄法所能主治的。建议采用“陷者举之”的方法，选用东垣的补中益气汤。（湿热气虚下陷）
孙某：面色萎黄，腹痛便血，都因饮食重伤脾胃，气机下陷导致脱肛。病程一个月未愈，正气已经虚弱，宜用甘温益气之法，稍佐酸苦之品，务必使中焦脾胃之气生发旺盛，那么年幼易亏的阴液自然坚固，希望有向安好转的机理。（气虚下陷）
人参、川黄连、炒当归身、炒白芍、炙甘草、广陈皮、石莲子肉、乌梅。
复诊：肛门翻出纯血，不但脾弱气陷，下焦的阴液也不能固摄。面色、嘴唇、指甲已无光泽。益气是一定的成法，摄纳阴液也不可缺少。然而对幼稚之体的补药，须佐以宣通之品，因为其体质容易虚也容易实。
人参、炒白术、广陈皮、白芍、炙甘草、当归身、五味子、升麻（醋炒）、柴胡（醋炒）。
某人：便后少腹疼痛，肛门下坠，小便时大便滑脱不禁，属肾虚不摄。（肾气不摄）
熟地黄炭、五味子、山茱萸炭、茯苓、炒远志、炒菟丝子。
某人：肛门下坠，尾骶部疼痛，利多伤阴。
熟地黄炭、五味子、茯神、炒山药、炒山楂肉、炒菟丝子。
煎汤送服禹余粮石脂丸。
王某（62岁）：阳气下陷，肾真元不摄，肛门下坠，气泄如风。向来年老下元阳气疲惫，非升麻、柴胡能举起其下陷之气。
人参、鹿茸、补骨脂、炒大茴香、茯苓。
调入阳起石三分。
吴某（56岁）：脱肛漏血，遇劳累即发作，患病十六年，面色萎黄，背脊痛，诊脉尺部下垂。治法当升阳摄阴，兼理奇经八脉。用斑龙丸加五味子，蜜丸。
脱肛一症，其原因不一。有的因久痢久泻，脾肾气陷而脱出的；有的因中气虚寒，不能收摄而脱出的；有的因酒湿伤脾、色欲伤肾而脱出的；有的因肾气本虚，关门不固而脱出的；有的因湿热下坠而脱出的。又肛门是大肠的使者，大肠受寒受热，都能导致脱肛。老人气血已衰，小儿气血未旺，都容易脱肛。《内经》说：“下者举之。”徐之才说：“涩可去脱。”这都是治疗脱肛的方法。看先生治疗脱肛之症，也不超出升举、固摄、益气三法。如气虚下陷而脱者，宗法东垣的补中益气汤，以举陷为主；如肾虚不摄而脱者，宗法仲景的禹粮石脂丸，及熟地、五味、菟丝子之类，以固摄下焦阴气为主；如肝弱气陷，脾胃气虚下陷而脱者，用摄阴益气，兼以酸苦泄热为主；如老年阳气下陷，肾真不摄而脱者，又有鹿茸、阳起石等，提阳固气一法。汪昂说：有气热血热而肛门反而挺出的，宜用黄芩、黄连、槐花、侧柏叶，及四物汤加升麻、柴胡之类。我认为即使偶尔有此症，终究不是可以效法的常规方法，存录此条以请教君子。（邹滋九）
徐灵胎评：脱肛多由浊气下降，湿痰毒火合并为害，所以肿痛异常，这是实证。必须清其大肠之火，并用外治药物来收敛它，没有不立即痊愈的。其中有虚人病后清气下陷的，则用补中益气之法来提升它，这种情况十中无一罢了。乃是不论什么原因，都用升提收敛的方法，肛门中的痰火浊气，将升提而置于何地呢？另外脱肛之疾属热的居多，又用温燥药，更加不适宜。
Shao Xinpu's Commentary: Using Yuliangshi (Hematitum, 禹余粮) and Chishizhi (Calaminis Lapis, 赤石脂) to block the slipping of the Yangming channel. Employing Wuren Tang (Five Seeds Decoction) to restore the previous method of nourishing Ying (Nutritive Qi) via intestinal fluids, which is beneficial for post-illness Yuan (Original) Qi deficiency. These are all instances where Mr. Ye inherited ancient prescriptions but applied them with ingenuity, serving as a bridge for future learners.
Xu Lingtai's Commentary: In the above cases, "Changhong" (Intestinal bleeding, characterized by bright red blood adhering to stool or dripping after defecation) and "Zhixue" (Hemorrhoidal bleeding) were not distinguished. Ren Shen (Ginseng Radix), Gan Jiang (Zingiberis Rhizoma), and Rou Gui (Cinnamomi Cortex) were indiscriminately administered. This physician was completely ignorant of this condition, causing much harm. The case records not only confused hemorrhoidal bleeding with intestinal bleeding, but even when hemorrhoidal bleeding was identified, the prescribed formulas were ineffective. Hemorrhoidal bleeding requires different treatment methods and cannot be treated with the same formulas as intestinal bleeding. Bleeding from the intestines must have a specific site of pathology, as Chu Shi stated, "If there are orifices in the intestine, bleeding leads to death." One must know the method of filling these orifices. Currently, only drying, hot, and astringent drugs such as Ren Shen (Ginseng Radix), Gan Jiang (Zingiberis Rhizoma), Fu Zi (Aconiti Lateralis Radix Praeparata), and Wu Wei Zi (Schisandrae Chinensis Fructus) are used. This aids the fire in the intestines and, after massive blood loss, further depletes Yin. If it is not a pure deficiency pattern, this exacerbates the disease.
Weng (65 years old): Damp-heat primarily damages Qi. Qi sinking causes anal prolapse and pain. After urination, the tendons of the scrotum pull towards the anus, causing severe pain. The Jueyin Liver meridian surrounds the genitalia. The pulse is soft and weak, indicating that draining and dispersing methods are definitely not indicated. It is proposed to use the method of "lifting what has sunk," employing Dongyuan's Buzhong Yiqi Tang (Spleen Qi-Replenishing Decoction). (Damp-heat, Qi deficiency with sinking)
Sun: Sallow complexion, abdominal pain, and bloody stools, all caused by dietary injury damaging the Spleen and Stomach. Qi sinking results in anal prolapse. The condition has persisted for a month without healing, and Zheng Qi (Upright Qi) is already deficient. Sweet-warm Qi-tonifying methods should be used, slightly assisted by sour-bitter agents, to ensure the generation and prosperity of Middle Jiao Qi, so that the easily depleted Yin of childhood will naturally become firm, hoping for recovery. (Qi deficiency with sinking)
Ren Shen (Ginseng Radix), Chuan Lian (Coptidis Rhizoma), Chao Dang Gui Shen (Angelicae Sinensis Radix), Chao Bai Shao (Paeoniae Radix Alba), Zhi Cao (Glycyrrhizae Radix et Rhizoma), Guang Pi (Citri Reticulatae Pericarpium), Shi Lian Rou (Nelumbinis Plumula), Wu Mei (Mume Fructus).
Second visit: Pure blood from the everted anus indicates not only Spleen weakness and Qi sinking, but also failure of Lower Jiao Yin to secure and hold. The complexion, lips, and nails have lost luster. Tonifying Qi is a standard method, but securing Yin is also indispensable. However, tonics for children must be accompanied by promoting circulation, given their constitution prone to both deficiency and excess.
Ren Shen (Ginseng Radix), Jiao Bai Zhu (Atractylodis Macrocephalae Rhizoma), Guang Pi (Citri Reticulatae Pericarpium), Bai Shao (Paeoniae Radix Alba), Zhi Cao (Glycyrrhizae Radix et Rhizoma), Dang Gui Shen (Angelicae Sinensis Radix), Wu Wei Zi (Schisandrae Chinensis Fructus), Sheng Ma (Cimicifugae Rhizoma, vinegar-fried), Chai Hu (Bupleuri Radix, vinegar-fried).
Certain patient: After defecation, lower abdominal pain and anal heaviness; during urination, fecal slippage occurs, due to Kidney deficiency failing to secure. (Kidney Qi insecurity)
Shu Di Tan (Rehmanniae Radix Praeparata carbonized), Wu Wei Zi (Schisandrae Chinensis Fructus), Yu Rou Tan (Corni Fructus carbonized), Fu Ling (Poria), Chao Yuan Zhi (Polygalae Radix), Chao Tu Si Zi (Cuscutae Semen).
Certain patient: Anal heaviness and coccygeal pain; frequent loose stools damage Yin.
Shu Di Tan (Rehmanniae Radix Praeparata carbonized), Wu Wei Zi (Schisandrae Chinensis Fructus), Fu Shen (Poria cum Radice et Ramis), Chao Shan Yao (Dioscoreae Rhizoma), Chao Zha Rou (Crataegi Fructus), Chao Tu Si Zi (Cuscutae Semen).
Decocted and taken with Youliang Shizhi Wan (Yuliang and Chishizhi Pills).
Wang (62 years old): Yang Qi sinks, Kidney True Yuan fails to secure; anal prolapse and Qi leakage feel like wind. Elderly individuals often suffer from exhaustion of Lower Yuan Yang. Sheng Ma and Chai Hu alone cannot lift the sinking Qi.
Ren Shen (Ginseng Radix), Lu Rong (Cervi Cornu Pantotrichum), Bu Gu Zhi (Psoraleae Fructus), Chao Da Hui Xiang (Foeniculi Fructus), Fu Ling (Poria).
Mixed with Yang Qi Shi (Quartzum, 3 fen).
Wu (56 years old): Anal prolapse with leaking blood, triggered by fatigue, lasting sixteen years. Sallow complexion, back pain, pulse at the Chi position is drooping. The method should be raising Yang and securing Yin, simultaneously regulating the Extraordinary Vessels. Banlong Wan (Banlong Pill) with added Wu Wei Zi (Schisandrae Chinensis Fructus), honey pills.
Anal prolapse has various causes. Some result from chronic dysentery or diarrhea leading to Spleen-Kidney Qi sinking. Some result from Middle Qi deficiency and cold, unable to retain. Some result from alcohol-damp injuring the Spleen and sexual indulgence injuring the Kidney. Some result from inherent Kidney Qi deficiency with insecure gates. Some result from damp-heat sinking downward. Furthermore, the anus serves the Large Intestine; whether the Large Intestine is affected by cold or heat, prolapse can occur. The elderly have declining Qi and Blood; children have immature Qi and Blood; both are prone to prolapse. The Classics state: "What is below, lift it." Xu Zhicai said: "Astringency removes prolapse." These are methods for treating prolapse. Observing Mr. Ye's treatment of prolapse, he does not exceed three methods: lifting, securing, and tonifying Qi. For prolapse due to Qi deficiency sinking, he follows Dongyuan's Buzhong Yiqi Tang (Spleen Qi-Replenishing Decoction), focusing on lifting. For prolapse due to Kidney deficiency failing to secure, he follows Zhongjing's Youliang Shizhi Wan (Youliang and Chishizhi Pills) and herbs like Shu Di Huang (Rehmanniae Radix Praeparata), Wu Wei Zi (Schisandrae Chinensis Fructus), and Tu Si Zi (Cuscutae Semen), focusing on securing Lower Jiao Yin. For Liver weakness with Qi sinking, and Spleen-Stomach Qi deficiency sinking, he uses securing Yin and tonifying Qi, combined with sour-bitter clearing of heat. For elderly Yang Qi sinking and Kidney True Yuan failing to secure, he uses herbs like Lu Rong (Cervi Cornu Pantotrichum) and Yang Qi Shi (Quartzum) to raise Yang and consolidate Qi. Wang Ang stated: There are cases where Qi and Blood heat cause the anus to protrude; one should use Huang Qin (Scutellariae Radix), Huang Lian (Coptidis Rhizoma), Huai Hua (Sophorae Flos), Ce Bai Ye (Biota Tops), and Si Wu Tang (Four Substances Decoction) plus Sheng Ma (Cimicifugae Rhizoma) and Chai Hu (Bupleuri Radix). I believe that even if such cases occasionally exist, they are not standard methods to follow. I record this to consult gentlemen. (Zou Zijiu)
Xu Lingtai's Commentary: Prolapse is mostly caused by turbid Qi descending, combined with damp-phlegm, toxic fire, causing abnormal swelling and pain; this is an Excess pattern. One must clear the fire of the Large Intestine and use external treatments to retract it; recovery is immediate. In cases of deficiency patients post-illness with Clear Qi sinking, Buzhong Yiqi methods are used to lift it, but this accounts for less than one in ten cases. To use lifting and astringent methods regardless of the cause, where would the phlegm-fire and turbid Qi in the anus go? Moreover, prolapse is mostly heat-related; using warming-drying herbs is even more inappropriate.