（男妇同治）
痔属肝脾肾三经，故阴精亏损者难治，多成漏症。若肺与大肠二经风热、湿热者，热退
自愈
固其精，以致木乘火势而侮金；或炙爆浓味，或劳伤元气，阴虚火炽所致。初起 痛便秘，
或小便不利者，宜清热凉血润燥疏风。若气血虚而寒凉伤损者，调养脾胃，滋补阴精。若破
而久不愈，多成痔漏，有穿臀、穿肠、穿阴者，其肠头肿块者，湿热也。作痛者，风热也。
便结者，火燥也。溃脓者，热胜血也。大便作痛者，润燥除湿。肛门坠痛者，泻火除湿。小
便涩滞者，清肝导湿。其成漏者，养元气，补阴精为主。经云∶因而饱食，筋脉横解，肠
为
但用地黄丸、益气汤，以滋化源为善。若专服寒凉治火者，无不致祸。
治验
进士周希辅，素有疝痔，劳则小腹作痛，茎出白津，痔亦肿痛。若饮食劳倦，起居失宜
，则
立。余用益气汤、地黄丸，元气渐复，但自弛调摄，不能痊愈。
一儒者，脓血淋漓，口干作渴，晡热便血，自汗盗汗。余谓∶此肾肝阴虚也。不信，仍
服四物、柏、知、连之类，食少泻呕。余先用补中益气汤加茯苓、半夏、炮姜，脾胃渐醒。后用
六味丸，朝夕服，两月余，诸症悉愈。
儒者杨举元素阴虚，劳则肢体倦怠，两足发热，服清热等剂，热至腰膝，大便涩滞，饮
食过多则泻。至年余，作渴吐痰，患痔出脓，仍不节劳，则忽恶寒发热，复患痈，脓水不止，气
血虚甚。余用六味丸、补中益气汤，滋养化源。喜其慎疾，年余而痊。
一男子患此，服寒凉之剂，侵晨去后不实，食少体倦，口干作渴，小腹重坠。余用补中
益气汤，而下坠顿止，用四神丸而食进便实，用地黄丸而疮寻愈。
一膏粱酒色之人，患之作痛。服苦寒之药，致臀肿硬，又加大黄，腹胀头痛。此足三阴
亏损，而药复伤。余用补中益气汤，升补阳气，加参、苓、半夏、木香，以助脾气，数剂而愈。
上舍陆子藩，时仲冬，患痔作痛，右手浮大，左尺洪数。余曰∶冬见夏脉，当壮水之主
，以镇阳光。彼以为迂，别服芩、连之剂。越明年六月九日，复邀视之。痰涎上涌，日夜不寐，
脉洪大而数，按之无力，左尺全无，足手肩膊逆冷。余曰∶事急矣。彼云∶但求少延数日，
以待嗣子一见耳。勉用参、 、归、术、炮姜之类，及六味丸料，加肉桂，至本月丁酉日，
果殁。五行之理，信然！
侍御王两间长子患痔，作渴发热，尺脉洪数，按之无力。余曰∶此肝肾阴精亏损，而虚
火妄动，当滋化源。彼不信，后吐痰声嘶，面赤体瘦而殁。
（男女均可治疗）
痔疮归属于肝、脾、肾三经，因此阴精亏损的患者难以治愈，多发展为痔漏症。如果是肺与大肠二经受风热或湿热侵袭，待热邪消退后自然痊愈。
若固摄精气不当，导致肝木乘虚克制脾土，火势旺盛而反侮肺金；或因食用炙烤爆炒及浓味厚腻食物，或因劳累损伤元气，由阴虚火旺所致。初起时出现疼痛、大便秘结，或小便不利的，宜采用清热凉血、润燥疏风的方法。如果气血虚弱且因寒凉药物损伤脾胃的，应调养脾胃，滋补阴精。如果痔疮破溃后久不愈合，多形成痔漏，有穿透臀部、穿透肠道、穿透阴部的情况。肛门处有肠头肿块的，属于湿热证。感到疼痛的，属于风热证。大便干结的，属于火燥证。溃烂流脓的，属于热盛伤血证。大便时疼痛的，需润燥除湿。肛门坠胀疼痛的，需泻火除湿。小便涩滞不畅的，需清肝导湿。已经形成漏症的，以养元气、补阴精为主。《内经》云：“因为饱食过度，导致筋脉松弛横解，肠道……”（此处原文似有脱漏，依文意补全逻辑：导致肠道病变）。此时只用地黄丸、益气汤，以滋养化源为善策。如果专门服用寒凉药物治疗火邪，无不导致灾祸。
治验记录：
进士周希辅，素有疝气和痔疮，劳累后小腹部作痛，尿道流出白色津液，痔疮也肿痛。如果饮食不节或劳倦过度，起居失常，则病情加重。我使用益气汤、地黄丸，患者元气逐渐恢复，但他自己放松了调理和摄生，未能完全痊愈。
一位儒者，脓血淋漓，口干口渴，午后发热便血，自汗盗汗。我说：“这是肾肝阴虚。”他不相信，仍然服用四物汤以及黄柏、知母、黄连之类的药物，导致食欲减退、腹泻呕吐。我先用补中益气汤加茯苓、半夏、炮姜，使脾胃功能逐渐恢复。后来用六味丸，早晚服用，两个多月后，所有症状全部痊愈。
儒者杨举元，素体阴虚，劳累后肢体倦怠，两足发热，服用清热等药剂后，热感上至腰膝，大便涩滞，饮食过多则腹泻。过了一年多，出现口渴吐痰，患痔疮出脓，仍不知节制劳累，于是突然恶寒发热，又患痈疽，脓水不止，气血极度虚弱。我用六味丸、补中益气汤，滋养化源。庆幸他谨慎对待疾病，一年多后痊愈。
一名男子患此病，服用寒凉药剂，清晨排便后粪便不实，食欲少，身体疲倦，口干口渴，小腹部沉重下坠。我用补中益气汤，下坠感顿时停止；用四神丸则食欲增进、大便成形；用地黄丸则疮口很快愈合。
一位喜好膏粱厚味和酒色的人，患病后感到疼痛。服用苦寒药物，导致臀部肿胀坚硬，又加大黄，出现腹胀头痛。这是足三阴经亏损，而药物再次造成伤害。我用补中益气汤，升补阳气，加入人参、茯苓、半夏、木香，以助脾气，几剂药后痊愈。
上舍陆子藩，正值仲冬，患痔疮作痛，右手脉浮大，左尺脉洪数。我说：“冬季出现夏季的脉象，应当壮水之主（滋补肾阴），以镇伏阳光（抑制虚火）。”他认为这话迂腐，另外服用黄芩、黄连的药剂。到了第二年六月九日，再次邀请我看诊。痰涎上涌，日夜不能入睡，脉象洪大而数，按之无力，左尺脉全无，手足肩膊逆冷。我说：“事情危急了。”他说：“只求稍微延长几天寿命，以便让继子见一面。”勉强用人参、[缺字，推测为黄芪或白术]、当归、白术、炮姜之类，以及六味丸料，加入肉桂，到本月丁酉日，果然去世。五行的道理，确实可信！
侍御王两间的长子患痔疮，口渴发热，尺脉洪数，按之无力。我说：“这是肝肾阴精亏损，而虚火妄动，应当滋养化源。”他不相信，后来吐痰、声音嘶哑，面色潮红身体消瘦而死。
(Men and women can be treated similarly)
Hemorrhoids (Zhì) belong to the Liver, Spleen, and Kidney meridians. Therefore, cases involving deficiency of Yin essence are difficult to treat and often develop into hemorrhoidal fistulas (Zhì lòu). If the Lung and Large Intestine meridians are affected by Wind-Heat or Damp-Heat, the condition will resolve spontaneously once the Heat subsides.
Improper conservation of Essence may lead to Liver Wood overacting on Spleen Earth, with Fire flaring up and insulting Metal; or it may result from consuming roasted, fried, and rich flavors, or from fatigue damaging Yuan Qi, caused by Yin deficiency with vigorous Fire. In the early stage, if there is pain, constipation, or difficulty in urination, one should employ methods to clear Heat, cool Blood, moisten dryness, and disperse Wind. If Qi and Blood are deficient and damaged by cold-cooling medicines, one should regulate and tonify the Spleen and Stomach, and nourish Yin essence. If the hemorrhoid ruptures and fails to heal for a long time, it often becomes a hemorrhoidal fistula, which may penetrate the buttocks, intestines, or yin region. Swelling at the anal protrusion indicates Damp-Heat. Pain indicates Wind-Heat. Constipation indicates Fire-Dryness. Ulceration with pus indicates Excess Heat damaging Blood. Pain during defecation requires moistening dryness and draining dampness. Aching and bearing-down sensation in the anus requires purging Fire and draining dampness. Scanty and difficult urination requires clearing the Liver and guiding out dampness. For established fistulas, the primary treatment is to nourish Yuan Qi and tonify Yin essence. The Classics state: "Due to overeating, tendons and vessels become lax and horizontal..." [Text implies intestinal pathology]. At this point, using Dihuang Wan (Rehmannia Pill) and Yiqi Tang (Qi-Supplementing Decoction) to nourish the source of transformation is advisable. Specifically administering cold-cooling medicines to treat Fire will inevitably lead to disaster.
Case Records:
Zhou Xifu, a Jinshi degree holder, had a history of hernia and hemorrhoids. Fatigue caused pain in the lower abdomen and discharge of white fluid from the penis, accompanied by swelling and pain of the hemorrhoids. When diet was irregular or fatigue excessive, or when daily routine was improper, the condition would worsen. I used Yiqi Tang and Dihuang Wan. His Yuan Qi gradually recovered, but because he relaxed his regimen and self-care, he did not achieve a complete cure.
A scholar presented with dripping pus and blood, dry mouth with thirst, afternoon fever with bloody stools, spontaneous sweating, and night sweats. I stated: "This is Yin deficiency of the Kidney and Liver." He did not believe me and continued taking Siwu Tang along with Huangbai (Phellodendron), Zhimu (Anemarrhena), and Lianzi (Coptis). This led to poor appetite, diarrhea, and vomiting. I first used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fuling (Poria), Banxia (Pinellia), and Paoshengjiang (Prepared Ginger), which gradually revived the Spleen and Stomach. Subsequently, Liuwei Wan (Six-Ingredient Pill with Rehmannia) was administered morning and evening. After more than two months, all symptoms completely resolved.
Yang Juyuan, a scholar, had constitutive Yin deficiency. Fatigue caused limb lassitude and heat in both feet. After taking heat-clearing agents, the heat sensation rose to the waist and knees, stool became scanty and difficult, and excessive food intake led to diarrhea. Over a year later, he developed thirst and expectorated phlegm, and his hemorrhoids discharged pus. Continuing to neglect rest, he suddenly experienced aversion to cold and fever, and developed an abscess with incessant discharge of pus and water, indicating severe deficiency of Qi and Blood. I used Liuwei Wan and Buzhong Yiqi Tang to nourish the source of transformation. Fortunately, he was cautious about his illness, and he recovered after more than a year.
A man suffered from this condition and took cold-cooling medicines. In the early morning, after defecation, his stool was unformed. He had poor appetite, body fatigue, dry mouth with thirst, and a heavy bearing-down sensation in the lower abdomen. I used Buzhong Yiqi Tang, which immediately stopped the bearing-down sensation. Then, using Sishen Wan (Four Miracles Pill), his appetite improved and stool became solid. Finally, using Dihuang Wan, the wound healed quickly.
A person indulgent in rich foods, alcohol, and sexual activity suffered from painful hemorrhoids. Taking bitter-cold medicines caused swelling and hardness of the buttocks. Adding Dahuang (Rhubarb) resulted in abdominal distension and headache. This indicated deficiency of the three Yin meridians of the foot, further injured by the medication. I used Buzhong Yiqi Tang to raise and tonify Yang Qi, adding Renshen (Ginseng), Fuling (Poria), Banxia (Pinellia), and Muxiang (Aucklandia) to assist Spleen Qi. After several doses, he recovered.
Lu Zifan, a Shangshe degree holder, presented with painful hemorrhoids in mid-winter. His right hand pulse was floating and large, and his left Chi pulse was surging and rapid. I said: "Seeing a Summer pulse in Winter indicates the need to strengthen the Master of Water (nourish Kidney Yin) to suppress the Flaming Fire." He considered this advice pedantic and took another prescription containing Qin (Scutellaria) and Lian (Coptis). On June 9th of the following year, he invited me again. Phlegm-saliva surged upward, and he could not sleep day or night. His pulse was surging, large, and rapid, but empty upon pressure; the left Chi pulse was completely absent, and his hands, feet, shoulders, and arms were cold. I said: "The situation is critical." He replied: "I only ask to prolong my life by a few days so that my heir son may see me once." Reluctantly, I prescribed Renshen (Ginseng), [missing character, likely Huangqi or Baizhu], Danggui (Angelica), Baizhu (Atractylodes), Paoshengjiang (Prepared Ginger), etc., along with the ingredients of Liuwei Wan added with Rougui (Cinnamon Bark). On the Dingyou day of that month, he unfortunately passed away. The principles of the Five Elements are indeed trustworthy!
The eldest son of Censor Wang Liangjian suffered from hemorrhoids with thirst and fever. His Chi pulse was surging and rapid but empty upon pressure. I said: "This is deficiency of Liver and Kidney Yin essence, with erratic movement of Deficiency Fire. One must nourish the source of transformation." He did not believe me. Later, he expectorated phlegm, lost his voice, his face became flushed, his body emaciated, and he died.