初起寒热交作，大便坠痛，脉浮数者，宜用轻剂解散。已成内热口干，大便秘结，脉沉实而有力者，当下
之。肛门肿痛，常欲便而下坠作痛者，导湿热兼泻邪火。肛门 肿疼痛，小便涩滞，小腹急胀者，清肝、利小
水。出脓腥臭，疼痛不减、身热者，养血、健脾胃，更兼渗湿。脓水清稀，脾胃虚弱，不能收敛者，滋肾气、
急补脾胃。
一男子肛门肿突，红紫痛甚。以内消沃雪汤二服，大便已通数次，疼痛稍减；外肿上以珍珠散清蜜调搽，
早晚二次，其肿渐消，更风凉血地黄汤而痊愈。
一妇人产后用力太过，肛门坠肿，疼苦之甚。先以枳壳、紫苏煎汤熏洗，后以珍珠散加冰片、猪脊髓调搽，
内以四物汤加升麻、苍术、丹皮、枳壳服之而消。
一男子夏月好饮火酒，热毒流入肛门，结肿坚硬，形色紫黑，坠痛便秘。以黄连解毒汤加大黄、枳壳，二
剂便通，疼痛稍
止；又以四物汤合前汤数剂，其肿渐消。存坚肿栗大不散，以脏连丸服至月余而愈。
一妇人肛门肿突，坚硬痛极。用攻利、解毒药俱不应，以神灯照法照之，早晚二次，其疼方减。以蟾酥锭
磨浓涂之，坚硬渐腐为脓；仍服内消沃雪汤，二剂便通，疼苦减其大半。又以四物汤加黄柏、知母、浓朴、苍术
，外以珍珠散加冰片、猪髓调搽，月余而平。
一男子素有内痔便血，常欲脱肛。一朝肛门坠重不收，肿痛突起，光亮紫色，此湿热流注结肿。固难收入，
以黄连除湿汤二剂，外用珍珠散加冰片清蜜调涂，其肿痛渐减；后以补中益气汤加生地、黄连、苍术、天花粉、
牡丹皮，服之数剂，其肿痛渐减而平。
一监生素性急暴，每纵膏粱，因积毒流于大肠，内如针刺，外肛不肿，常欲后重，便则秘结，诊之脉空数
而无力，此真气不足，邪火有余，五内亏损症也。后必难痊，辞不可治。后请别医，用药月余，肛门内腐，败
水无禁，复请视之。予曰∶决不可疗也。脉来虚数，邪胜正也；手掌不泽，脾气败也；至夜发热，阴虚火旺；
败水无禁，幽门已坏；面若涂脂，元气走散；鼻如烟煤，肺气将绝；口干舌燥，肾水已竭，犯此岂有不死之理？
患者不服，强用解毒、滋阴药饵，不效而死。
初起时寒热交替发作，大便时有下坠感且疼痛，脉象浮而数，适宜使用轻剂的方药来解散表邪。若病情已发展至内部热盛、口干舌燥、大便秘结不通，脉象沉实有力者，应当采用攻下的方法治疗。肛门肿胀疼痛，常有便意但排便时下坠作痛者，需疏导湿热并兼泻邪火。肛门肿痛，小便涩滞不畅，小腹部急胀者，需清肝火、利小便。脓液排出且气味腥臭，疼痛未减、身体发热者，需养血、健脾胃，同时兼以渗湿。脓水清稀，脾胃虚弱，无法收敛疮口者，需滋肾气、紧急补益脾胃。
一个男子肛门肿胀突起，颜色红紫，疼痛剧烈。内服二剂“内消沃雪汤”，大便已通数次，疼痛稍减；外肿处用“珍珠散”加清蜜调匀涂抹，早晚各一次，其肿逐渐消退，再服用“风凉血地黄汤”而痊愈。
一个妇人产后用力过度，肛门下坠肿胀，痛苦不堪。先用枳壳、紫苏煎汤熏洗患处，后用“珍珠散”加冰片、猪脊髓调匀涂抹，内服“四物汤”加升麻、苍术、丹皮、枳壳，症状得以消除。
一个男子夏季喜好饮用烈性酒，热毒流入肛门，结成肿块坚硬，颜色紫黑，下坠疼痛且便秘。用“黄连解毒汤”加大黄、枳壳，两剂后大便通畅，疼痛稍止；又用“四物汤”合前汤连服数剂，肿块逐渐消退。仍有坚硬肿大不散，服用“脏连丸”一个月左右而痊愈。
一个妇人肛门肿胀突起，坚硬且疼痛至极。使用攻下、解毒药物均无效，用“神灯照法”照射，早晚各两次，疼痛才减轻。用“蟾酥锭”磨浓汁涂抹，坚硬处逐渐腐烂化为脓液；仍内服“内消沃雪汤”，两剂后大便通畅，痛苦减少大半。又用“四物汤”加黄柏、知母、厚朴、苍术，外用“珍珠散”加冰片、猪髓调匀涂抹，一个月左右平复。
一个男子素有内痔便血，经常有脱肛之感。一天突然肛门下坠沉重不能收回，肿痛突起，光亮呈紫色，这是湿热流注凝结成肿。难以回纳，用“黄连除湿汤”两剂，外用“珍珠散”加冰片、清蜜调涂，肿痛逐渐减轻；后用“补中益气汤”加生地、黄连、苍术、天花粉、牡丹皮，服用数剂，肿痛逐渐减轻而平复。
一个监生性格急躁暴戾，每餐纵情于肥甘厚味，因积毒流于大肠，内部如针刺般疼痛，外部肛门不肿，常有里急后重感，排便则秘结不通，诊其脉象空数而无力，这是真气不足，邪火有余，五脏亏损的病症。后来必定难以治愈，推辞说不可治。后来请其他医生诊治，用药一个月，肛门内部腐烂，失禁无法控制，再次请我诊治。我说：绝对不可治疗了。脉象虚数，是邪胜正衰；手掌无光泽，是脾气败坏；夜间发热，是阴虚火旺；失禁无法控制，是幽门已坏；面色红润如涂脂，是元气走散；鼻如烟煤，是肺气将绝；口干舌燥，是肾水已竭，犯此诸症，岂有不死的道理？患者不服从，强行使用解毒、滋阴药物，无效而死。
At the initial stage, with alternating chills and fever, a sensation of bearing down and pain during defecation, and a floating and rapid pulse, it is appropriate to use mild agents to resolve the exterior. If the condition has progressed to internal heat, dry mouth, constipation, and a deep, full, and forceful pulse, purgative methods should be employed. For swelling and pain in the anus with a frequent urge to defecate accompanied by bearing down and pain, guide out damp-heat and simultaneously purge pathogenic fire. For swelling and pain in the anus, with astringent and difficult urination, and acute distension in the lower abdomen, clear Liver heat and promote diuresis. When pus discharges with a foul odor, pain persists, and there is body heat, nourish Blood, strengthen Spleen and Stomach, and simultaneously promote dampness leaching. When pus and water are clear and thin, due to Spleen and Stomach deficiency failing to consolidate the wound, tonify Kidney Qi and urgently supplement Spleen and Stomach.
A male patient presented with protruding swelling in the anus, red-purple in color, with severe pain. After taking two doses of Neixiao Woxue Tang (Snow-Melting Decoction for Internal Resolution), he had several bowel movements, and the pain slightly subsided; the external swelling was applied with Zhenzhu San (Pearl Powder) mixed with clear honey, twice morning and evening, leading to gradual reduction of the swelling. He was then treated with Fengliang Xue Dihuang Tang (Wind-Cooling Rehmannia Decoction) and recovered.
A female patient suffered from bearing down and swelling of the anus after excessive exertion postpartum, experiencing extreme pain. The area was first fumigated and washed with a decoction of Zhiqiao (Fructus Aurantii) and Zisu (Perilla Leaf). Then, Zhenzhu San (Pearl Powder) mixed with Bingpian (Borneol) and pig spinal cord was applied topically. Internally, Siwu Tang (Four Substances Decoction) added with Shengma (Cimicifugae Rhizoma), Cangzhu (Atractylodis Rhizoma), Danpi (Moutan Cortex), and Zhiqiao (Fructus Aurantii) was administered, resulting in resolution.
A male patient, fond of drinking strong liquor in summer, developed hot-toxin flowing into the anus, forming a hard, purple-black, painful, and constipated mass. Huanglian Jiedu Tang (Coptis Decoction for Resolving Toxins) added with Dahuang (Rhei Radix et Rhizoma) and Zhiqiao (Fructus Aurantii) was used; after two doses, bowel movement resumed, and pain subsided slightly. Subsequently, Siwu Tang (Four Substances Decoction) combined with the previous decoction was taken for several doses, gradually reducing the swelling. For the remaining hard and large lump, Zanglian Wan (Intestine-Lining Pill) was taken for over a month until recovery.
A female patient presented with protruding, hard, and extremely painful swelling in the anus. Purgative and detoxifying herbs were ineffective. Shen Deng Zhao Fa (Divine Lamp Illumination Method) was applied twice daily, which alleviated the pain. Chansu Ding (Toad Venom Tablet) ground into thick paste was applied, causing the hardness to gradually suppurate. She continued taking Neixiao Woxue Tang (Snow-Melting Decoction for Internal Resolution); after two doses, bowel movement resumed, and suffering reduced by more than half. Siwu Tang (Four Substances Decoction) added with Huangbai (Phellodendri Cortex), Zhimu (Anemarrhenae Rhizoma), Houpo (Magnoliae Officinalis Cortex), and Cangzhu (Atractylodis Rhizoma) was taken internally, while Zhenzhu San (Pearl Powder) mixed with Bingpian (Borneol) and pig marrow was applied externally. Recovery occurred within a month.
A male patient with a history of internal hemorrhoids and rectal bleeding often experienced rectal prolapse. Suddenly, his anus became heavy, irreducible, swollen, painful, bright, and purple, indicating damp-heat accumulation and swelling. It was difficult to reduce. Two doses of Huanglian Chushi Tang (Coptis Dampness-Removing Decoction) were given, and Zhenzhu San (Pearl Powder) mixed with Bingpian (Borneol) and clear honey was applied externally, gradually reducing swelling and pain. Later, Buzhong Yiqi Tang (Decoction for Supplementing the Middle and Augmenting Qi) added with Shengdi (Rehmanniae Radix), Huanglian (Coptidis Rhizoma), Cangzhu (Atractylodis Rhizoma), Tianhuafen (Trichosanthis Radix), and Mudanpi (Moutan Cortex) was taken for several doses, leading to gradual reduction and resolution of swelling and pain.
A Jian Sheng (Imperial Student) had an irritable temperament and indulged in rich foods. Accumulated toxin flowed into the Large Intestine, causing internal needle-like pain. Externally, the anus was not swollen, but he frequently felt tenesmus, and defecation resulted in constipation. His pulse was empty, rapid, and weak, indicating insufficient True Qi, excess pathogenic fire, and depletion of the Five Viscera. This condition would likely be incurable, so I declined treatment. Another physician treated him for a month, leading to internal rotting of the anus and uncontrollable diarrhea. Upon re-examination, I stated: "It is absolutely untreatable." The void and rapid pulse indicates pathogen overcoming healthy Qi; lack luster on palms indicates failure of Spleen Qi; night fever indicates Yin deficiency with Fire hyperactivity; uncontrollable diarrhea indicates damage to the pylorus; a ruddy complexion like painted fat indicates scattering of Yuan Qi; a nose resembling coal smoke indicates impending exhaustion of Lung Qi; dry mouth and tongue indicate exhaustion of Kidney Water. Who could survive such conditions? The patient refused to listen, insisted on using detoxifying and Yin-nourishing drugs, and died ineffectively.