（附便血脱肛）
大便秘涩或作痛者。滋躁除湿。
下坠肿痛或作痒者。祛风胜湿。
肛门下坠或作痛。泻火导湿。
肿痛小便秘涩者。清肝导湿。
一人患痔。大便燥结。 痛作渴。脉数。按之则实。以秦艽、苍术汤一剂少愈。更以四
物加芩、连槐花、枳壳四剂而愈。
一人素不慎酒色。患痔 痛。肛门坠痛。兼下血。大便干燥。脉洪。按之则涩。以当归
、郁李仁汤加桃仁。四剂少愈。更以四物加红花、桃仁、条芩、槐花。数剂而愈。
大抵醉饱入房则经脉横。解则精气脱泄。脉络一虚。酒食之毒乘虚流注。或淫极强固。
精气遂传大肠。以致木乘火势而毁金。或食浓味过多。必成斯疾。
夫受病者燥湿也。为病者湿热也。宜以泻火和血润躁疏风之剂治之。若破而不愈。即成
。有串臀者。有串阴者。有串阳者。有秽从疮口出者。形虽不同。治法颇似。其肠头肿成块
者湿热也。作痛者风也。大便燥结者火也。溃而为脓者热盛血也。当各推其所因而治之。
一人患痔成漏。登侧则痛。以秦艽防风汤加条芩、枳壳。四剂而愈。以四物加升麻、芩
、连、荆、防不复作。
一人患痔漏。登侧则肛门下脱作痛。良久方收。以秦艽防风汤数剂少愈。乃去大黄加黄
芩、川芎、芍药而痛止。更以补中益气汤二十余剂。后再不脱。
一妇患痔漏 痛甚。以四物加芩、连、红花、桃仁、牡丹皮。四剂少止。又数剂而愈。
一人便血。春间尤甚。兼腹痛。以和血除湿汤而愈。
一人素有湿热。便血。治以槐花散而愈。
一人粪后下血。诸药久而不愈。甚危。诊之乃湿热。用黄连丸二服顿止。数服而痊。
一妇素患痔漏而安。因热则下血数滴。以四物加黄连治之而愈。后因大劳疮肿痛。经水
。脉洪大。按之无力。此劳伤血气火动而然也。用八珍加黄芩、连、蒲二剂而止。后去蒲、
黄、芩、连、加地骨皮数剂而安。
丹溪曰。妇人崩中者。由脏腑伤损。冲任二脉血气俱虚故也。二脉为经脉之海。血气之
外循经络。内营脏腑。若气血调适。经下根据时。若劳动过极。脏腑俱伤。冲任之气虚。不能
约制其经血。故忽然而下。谓之崩中暴下。治宜大补气血之药。举养脾胃。微加镇坠心火之
药治其心。补阴泻阳。经自止矣。
一人因饮法酒。肛门肿痛。便秘脉实。用黄连内疏汤而愈。
一人便血。过劳益甚。饮食无味。以六君子加黄 、地黄、地榆而愈。
一人粪后下血久不愈。中气不足。以补中益气汤数剂。更以黄连丸数服。血止。又服前
汤月余。不再作。
一人脏毒下血。服凉血败毒药。不惟血不止。且饮食少思。肢体愈倦。脉数。按之则涩
以补中益气汤数剂。少止。更以六君子加升麻、炮姜。四剂而止。乃去炮姜加芎归。月余脾
胃亦愈。常治积热。或风热下血者。先以败毒散散之。胃寒者。气弱者。用四君子或参苓白
术散补之。并效。
一人脏毒下血。脾气素弱。用六君子加芎、归、枳壳、地榆、槐花而愈。后因谋事。
血复下。诸药不应。予意思虑伤脾所致。投归脾汤四剂而痊。
大抵此症所致之由不一。当究其因而治之。丹溪云。芎归汤调血之上品。热加茯苓、槐
冷加茯苓、木香。此自根自本而论也。盖精气生于谷气。惟大肠下血。以胃气收功。或四君
子。或参苓白术散。或枳壳散。小乌沉汤以和之。胃气一回。血自循经络矣。
肠风者。邪气外入。随感随见。脏毒者。蕴积毒久而始见。人惟坐卧。风湿。醉饱。房
生冷停寒。酒面。积热。以致荣血失道。渗入大肠。此肠风藏毒之所作也。挟热下血。清
而色鲜。腹中有痛。挟冷下血。浊而色黯。腹内略痛。清则为肠风。浊则脏毒。有先便而后
血者。其来也远。有先血而后便者。其来也近。世俗粪前粪后之说。非也。治法先当解散肠
胃之邪。热则攻毒散。冷则不换金正气散加芎归。后随其症冷热治之。河间云。起居不节。
用力过度。则络脉伤。阳络伤则血外溢而衄血。阴络伤则血内溢而便血。肠胃之络伤则血溢
肠外。有寒。汁沫与血相转。则并合凝聚不得散而成积矣。经云。肠癖下脓血。脉弦绝者死
。滑大者生。血溢身热者死。身凉者生。诸方皆谓风热侵于大肠而然。若饮食有节。起居有
时。肠胃不虚。邪气何从而入。
一人痔漏。每登厕脱肛。良久方上。脉细而微。用补中益气汤（十六）三十余剂。遂不再
丹溪曰。脱肛属气热气虚。血虚血热。气虚者补气。参、 、芎、归、升麻。血虚者四
。（九）血热者凉血四物汤加黄柏。肺与大肠为表里。故肺脏蕴热则肛闭结。肺脏虚寒则肛脱
出。○有妇人产育用力。及小儿久痢。亦致此症洽宜温肺腑肠胃。久自然收矣。
人痔者。贫富男女皆有之。富者酒色财气。贫者担轻负重。饥露早行。皆心肝二血。喜
心。怒则伤肝。喜怒无常。风血侵于大肠。致谷道无出路。结积成块。出血生乳。各有形用
。妇人因经后伤冷。月事伤风。余血在心经。血流于大肠。小儿痢后。或母腹中受热也。治
水登膏 治痔护肉
郁金 白芨（各一两） 一方加黄连
上二味为细末。如内痔。候登厕翻出在外。用温汤洗净。侧卧于床。用温水调令得中。
谷道四边好肉上。以纸盖药。留痔在外。良久方用枯药搽痔上。时时笔蘸。温水润之。不令
药干。亦勿使四散。
好白矾（四两） 生信石（二钱五分） 朱砂（一钱生研极细）
上各研细末。先用砒入瓷泥罐。次用白矾末盖之。 令烟断。其砒尽随烟去。止借砒气
中耳。用矾为极细末。看痔大小。取矾末在掌中。更以朱砂少许。以唾调稀。篦挑涂痔上
周遍。一日三五上。候痔颜色焦黑为效。至夜有黄水出尽为妙。至中夜上药一遍。来日依然
上药三次。有小痛不妨。换药时以碗盛新水或温汤。在痔边用笔轻洗去痔上旧药。再上新药
。仍用护肉膏。次用荆芥汤浇之。三两日后黄水出将尽。却于药中增朱砂减白矾。则药力缓
矣。三两日方可增减。渐渐取之。庶不惊人。全在用药人看痔头转色。增减浓薄敷之。此药
只借砒气。又有朱砂解之。有将此二方在京治人多效。一富人痔漏。口干。胃脉弱。此中气
不足。津液短少。不能上润而然。治以黄 六一汤。（三十）七味白术散。（三十一）或曰。诸
痛疮疡。皆属心火。宜服苦寒以泄火。因致大便不禁而殁。
夫诸痛疮疡皆属心火。言其常也。始热终寒。则反常矣。
一妇粪后下血。面色痿黄。耳鸣嗜卧。饮食不甘。服凉血药愈甚。右关脉浮而弱。以加
味四君子汤。加升麻、柴胡数剂。脾气已腥。兼黄连丸数剂而愈。
大凡下血服凉血药不应。必因中气虚不能摄血。非补中益阳之药不能愈。切忌寒凉之剂
有伤湿热之食成肠癖而下脓血者。宜苦寒之剂以内疏之。脉弦绝涩者难治。滑大柔和者易治
一人年五十。每至秋。脉沉涩而粪后下红。饮食少进。倦怠无力。面色痿黄。夫病每至
作者。盖天令至此。肃气乃行。阳气下降。人身之阳气衰不能升举。故阴血亦顺天时而下
陷矣。盖脾具坤静之德。而有干健之运。故能使心肺之阳降。肝肾之阴升。自然天地和而万
物育。则无以上之症矣。其原盖因饱食筋脉横解。则脾气倦甚。不能运化精微。故食积下流
于大肠之间。而阴血亦下陷矣。或欲用凉血清热之剂。予曰。不惟胃气重伤。兼又愈助降下
之令。理宜用升阳益胃之剂。则阴血自循经隧矣。数十剂后不复作。
一人痔疮肿痛。便血尤甚。脉洪且涩。经曰。因而饱食。筋脉横解。肠 为痔。盖风气
。肝生风。风生热。风客则淫气伤精而成斯疾、与黄 、黄连、当归、生 、防风、枳壳、
白芷、柴胡、槐花、地榆、甘草渐愈。次以黄连丸（九四）而瘥。又有便血数年。百药不应。
面色痿黄。眼花头晕。亦用黄连丸而愈。
一人患痔。脉浮鼓。午后发热作痛。以八珍汤加黄 、柴胡、地骨皮稍可。彼欲速效。
以劫药蚀之。痛甚。绝食而殁。
夫疮之贵敛。气血使然也。脉浮鼓。日晡痛。此气血虚也。丹溪曰。疮口不合。补以大
剂参、 、归、术。灸以附子饼。贴以补药膏是也。
一人年逾四十有痔漏。大便不实。服五苓散愈加泄泻。饮食少思。予谓非湿毒。乃肠胃
。宜理中汤。彼不为然。仍服五苓散愈盛。复请治。以理中汤及二神丸月余而愈。（此因治
而知中虚。）
一人因痔疮怯弱。以补中益气汤（十六）少加芩、连、枳壳稍愈。后因怒加甚。时仲冬脉
大。予谓脉不应时。乃肾水不足。火来乘之。药不能治。果殁。火旺之月。常见患痔者肾脉
不足。俱难治。
一人有痔。肛门脱出。此湿热下注。真气不能外举。其脉果虚。以四君子加芎、归、黄
苍术、黄柏、升麻、柴胡治之。更以五味子煎汤熏洗。彼以为缓。乃用砒霜等毒药蚀之而殁
。夫劫药特治其未耳。能伐真元。鲜不害人。戒之。
一人因痔。气血愈虚。饮食不甘。小便不禁。夜或遗精。此气虚兼湿热。非疮也。用补
中益气汤（十六）加山药、山茱萸、五味子。兼还少丹（九四）治之而愈。
一人痔漏。脓出大便。诸药不应。其脉颇实。令用猪腰一个切开。用黑牛末五分线扎。
用荷叶包煨熟。空心细嚼。温温盐酒送下。数服顿退。更服托里药而愈。
（附便血脱肛）
大便秘结干燥或伴有疼痛的，采用滋阴润燥、除湿的方法。
肛门下坠、肿痛或伴有瘙痒的，采用祛风胜湿的方法。
肛门下坠或伴有疼痛的，采用泻火导湿的方法。
肿痛且小便短赤涩痛的，采用清肝导湿的方法。
有一人患痔疮，大便燥结，疼痛并口渴，脉数，重按有力。用秦艽苍术汤一剂后症状稍减，再用四物汤加黄芩、黄连、槐花、枳壳四剂而痊愈。
有一人平素不节制酒色，患痔疮疼痛，肛门坠痛，兼有便血，大便干燥，脉洪大，重按则涩。用当归郁李仁汤加桃仁，四剂后症状稍减，再用四物汤加红花、桃仁、条芩、槐花，数剂后痊愈。
大抵醉酒饱食后行房事，则经脉横逆；醉酒后解衣受凉，则精气脱泄。脉络一旦虚弱，酒食之毒乘虚流注体内。或者淫欲过强导致精气固摄不住，精气遂传入大肠，致使木气乘火势而毁坏金气（肺与大肠相表里，此处指湿热伤及大肠）。或者饮食浓味过多，必然形成此病。
受病的根源在于燥与湿，发病的性质属于湿热。适宜用泻火、和血、润燥、疏风的方剂治疗。如果破溃后不愈，即成为漏症。有的串连臀部，有的串连阴部，有的串连阳器，有的疮口流出秽浊之物。形态虽然不同，治疗方法颇为相似。肛门头肿成块的，属于湿热；作痛的，属于风邪；大便燥结的，属于火邪；溃烂化脓的，属于热盛血腐。应当分别推究其病因进行治疗。
有一人患痔疮成漏，侧卧时疼痛。用秦艽防风汤加条芩、枳壳，四剂后痊愈。再用四物汤加升麻、黄芩、黄连、荆芥、防风，不再复发。
有一人患痔漏，侧卧时肛门下脱作痛，良久才能收回。用秦艽防风汤数剂后症状稍减，于是去掉大黄，加入黄芩、川芎、芍药，疼痛停止。再用补中益气汤二十余剂，之后不再脱出。
一妇人患痔漏，疼痛剧烈。用四物汤加黄芩、黄连、红花、桃仁、牡丹皮，四剂后疼痛稍止，又服数剂而痊愈。
有一人排便后下血，服用各种药物久治不愈，病情危重。诊察发现是湿热，用黄连丸两服后立刻止血，数服后康复。
一妇人平素患痔漏但病情平稳，因受热则下血几滴。用四物汤加黄连治疗而痊愈。后来因过度劳累导致疮疡肿痛，月经来潮，脉洪大，重按无力。这是劳损伤及气血，火动所致。用八珍汤加黄芩、黄连、蒲黄，两剂后出血停止。后来去掉蒲黄、黄芩、黄连，加入地骨皮，数剂后安宁。
朱丹溪说：妇女崩中（大量阴道出血），是由于脏腑受损，冲任二脉气血俱虚的缘故。冲任二脉为经脉之海，血气之外循经络，内营脏腑。若气血调适，月经按时来潮。若劳动过度，脏腑俱伤，冲任之气虚弱，不能约束经血，所以突然大量下泄，称为崩中暴下。治疗宜用大补气血的药物，提升养护脾胃，微加镇降心火的药物以治心，补阴泻阳，月经自然停止。
有一人因饮过量烈性酒，肛门肿痛，便秘，脉实。用黄连内疏汤而痊愈。
有一人便血，过度劳累后加重，饮食无味。用六君子汤加黄芪、地黄、地榆而痊愈。
有一人排便后下血久治不愈，中气不足。用补中益气汤数剂，再用黄连丸数服，血止。又服用前汤月余，不再发作。
有一人脏毒下血，服用凉血败毒药，不仅血不止，而且饮食减少，肢体更加疲倦，脉数，重按则涩。用补中益气汤数剂，稍止。再用六君子汤加升麻、炮姜，四剂后止血。然后去掉炮姜，加入川芎、当归，月余后脾胃也痊愈了。通常治疗积热或风热下血者，先用败毒散发散。胃寒者，气弱者，用四君子汤或参苓白术散补益，都有效。
有一人脏毒下血，脾气素弱。用六君子汤加川芎、当归、枳壳、地榆、槐花而痊愈。后来因为谋虑事情，血再次下泄，各种药物无效。我认为是思虑伤脾所致，投予归脾汤四剂而痊愈。
大抵此症成因不一，应当探究病因进行治疗。朱丹溪说：芎归汤是调和血液的上品。热证加茯苓、槐花；冷证加茯苓、木香。这是从根本上来论述的。大概精气生于谷气，只有大肠下血，是以恢复胃气为收功之法。或用四君子汤，或参苓白术散，或枳壳散，或小乌沉汤来调和它。胃气一回复，血自然循行于经络之中。
肠风，是邪气外入，随感随见；脏毒，是蕴积毒素久而始见。人们只是坐卧之间，感受风湿，醉酒饱食，房事不慎，生冷停寒，酒面积热，以致营血失道，渗入大肠。这就是肠风脏毒产生的原因。挟热下血，血色清亮鲜红，腹中有痛感；挟冷下血，血色浑浊黯黑，腹内略微疼痛。清亮的是肠风，浑浊的是脏毒。有先排便后出血的，病位较远；有先出血后排便的，病位较近。世俗所说的粪前粪后之说，是不正确的。治疗方法应当先解散肠胃之邪，热证用攻毒散，冷证用不换金正气散加川芎、当归。随后根据病症的冷热进行治疗。刘河间说：起居不节，用力过度，则络脉受伤。阳络受伤则血外溢而鼻衄，阴络受伤则血内溢而便血。肠胃之络受伤则血溢于肠外。若有寒气，汁沫与血相搏，则并合凝聚不得消散而成积聚。《内经》说：肠癖下脓血，脉弦绝者死，滑大者生。血溢身热者死，身凉者生。各方书都认为风热侵于大肠所致。如果饮食有节制，起居有定时，肠胃不虚，邪气从何而入？
有一人痔漏，每次登厕脱肛，良久才能收回。脉细而微。用补中益气汤三十余剂，遂不再脱出。
朱丹溪说：脱肛属于气热气虚，血虚血热。气虚者补气，用人参、黄芪、川芎、当归、升麻。血虚者用四物汤。血热者用凉血四物汤加黄柏。肺与大肠互为表里，所以肺脏蕴热则肛门闭塞结滞，肺脏虚寒则肛门脱出。○有妇人产育用力，以及小儿久痢，也会导致此症，适宜温补肺腑肠胃，久了自然收敛。
患痔疮的人，无论贫富男女都有。富者因酒色财气，贫者因担轻负重，饥露早行，皆耗伤心肝二经之血。喜则伤心，怒则伤肝。喜怒无常，风血侵于大肠，致使谷道无出路，结积成块，出血生乳，各有形态用途。妇人因经后伤冷，月事伤风，余血在心经，血流于大肠。小儿痢后，或母腹中受热所致。治痔护肉膏方：
郁金、白芨（各一两），一方加黄连。
上二味研为细末。如果是内痔，候登厕翻出在外，用温汤洗净，侧卧于床，用温水调药令适中，涂在谷道四边好肉上，以纸盖药，留痔在外，良久后用枯药搽痔上，时时笔蘸温水润之，不让药干，也不要使药四散。
好白矾（四两）、生信石（二钱五分）、朱砂（一钱，生研极细）。
上各研细末。先用砒霜放入瓷泥罐，次用白矾末覆盖之，封口令烟断，其砒尽随烟去，只借砒气入药中耳。用矾为极细末，看痔大小，取矾末在掌中，再加少许朱砂，以唾液调稀，用篦子挑涂痔上周遍。一日三五次，候痔颜色焦黑为效。至夜有黄水出尽为妙。至中夜上药一遍，来日依然上药三次。有小痛不妨。换药时用碗盛新水或温汤，在痔边用笔轻洗去痔上旧药，再上新药。仍用护肉膏，次用荆芥汤浇之。三两日后黄水出将尽，却于药中增朱砂减白矾，则药力缓矣。三两日方可增减，渐渐取之，庶不惊人。全在用药人看痔头转色，增减浓薄敷之。此药只借砒气，又有朱砂解之。有将此二方在京治人多效。一富人痔漏，口干，胃脉弱，此中气不足，津液短少，不能上润而然。治以黄芪六一汤、七味白术散。或曰：诸痛疮疡，皆属心火，宜服苦寒以泄火，因致大便不禁而殁。
一妇人排便后下血，面色萎黄，耳鸣嗜卧，饮食不甘，服凉血药愈甚。右关脉浮而弱，用加味四君子汤，加升麻、柴胡数剂，脾气已醒，兼服黄连丸数剂而痊愈。
大凡下血服凉血药不应，必因中气虚不能摄血，非补中益气之药不能愈。切忌寒凉之剂。有伤湿热之食成肠癖而下脓血者，宜苦寒之剂以内疏之。脉弦绝涩者难治，滑大柔和者易治。
一人年五十，每至秋季，脉沉涩而排便后下红，饮食少进，倦怠无力，面色萎黄。夫病每至作者，盖天令至此，肃气乃行，阳气下降，人身之阳气衰不能升举，故阴血亦顺天时而下陷矣。盖脾具坤静之德，而有乾健之运，故能使心肺之阳降，肝肾之阴升，自然天地和而万物育，则无以上之症矣。其原盖因饱食筋脉横解，则脾气倦甚，不能运化精微，故食积下流于大肠之间，而阴血亦下陷矣。或欲用凉血清热之剂，我说：不惟胃气重伤，兼又愈助降下之令，理宜用升阳益胃之剂，则阴血自循经隧矣。数十剂后不复作。
一人痔疮肿痛，便血尤甚，脉洪且涩。《内经》说：因而饱食，筋脉横解，肠澼为痔。盖风气客于肝，肝生风，风生热，风客则淫气伤精而成斯疾。与黄芪、黄连、当归、生地黄、防风、枳壳、白芷、柴胡、槐花、地榆、甘草，渐愈。次以黄连丸而瘥。又有便血数年，百药不应，面色萎黄，眼花头晕，亦用黄连丸而愈。
一人患痔，脉浮鼓，午后发热作痛，用八珍汤加黄芪、柴胡、地骨皮稍可。彼欲速效，以劫药蚀之，痛甚，绝食而殁。
夫疮之贵敛，气血使然也。脉浮鼓，日晡痛，此气血虚也。朱丹溪说：疮口不合，补以大剂人参、黄芪、当归、白术，灸以附子饼，贴以补药膏是也。
一人年逾四十有痔漏，大便不实，服五苓散愈加泄泻，饮食少思。我说不是湿毒，乃是肠胃虚寒，宜理中汤。彼不为然，仍服五苓散愈盛。复请治，以理中汤及二神丸月余而愈。（此因治而知中虚。）
一人因痔疮怯弱，用补中益气汤少加黄芩、黄连、枳壳稍愈。后因怒加甚，时仲冬脉大。我说脉不应时，乃肾水不足，火来乘之，药不能治，果殁。火旺之月，常见患痔者肾脉不足，俱难治。
一人有痔，肛门脱出，此湿热下注，真气不能外举，其脉果虚，用四君子汤加川芎、当归、黄芪、苍术、黄柏、升麻、柴胡治之。更以五味子煎汤熏洗。彼以为缓，乃用砒霜等毒药蚀之而殁。夫劫药特治其未耳，能伐真元，鲜不害人。戒之。
一人因痔，气血愈虚，饮食不甘，小便不禁，夜或遗精，此气虚兼湿热，非疮也。用补中益气汤加山药、山茱萸、五味子，兼还少丹治之而愈。
一人痔漏，脓出大便，诸药不应，其脉颇实。令用猪腰一个切开，用黑牛末五分线扎，用荷叶包煨熟，空心细嚼，温温盐酒送下。数服顿退，更服托里药而愈。
(Attached: Hematochezia and Rectal Prolapse)
When stool is dry, difficult to pass, or accompanied by pain, employ the method of nourishing yin, moistening dryness, and removing dampness.
When there is a sensation of bearing down, swelling, pain, or itching in the anus, employ the method of dispelling wind and overcoming dampness.
When there is a sensation of bearing down or pain in the anus, employ the method of purging fire and guiding out dampness.
When there is swelling, pain, and scanty, difficult urination, employ the method of clearing the Liver and guiding out dampness.
A patient suffered from hemorrhoids with dry, hard stools, pain, thirst, a rapid pulse, and firmness upon deep palpation. One dose of Qinjiao Cangzhu Tang (Gentian and Atractylodes Decoction) alleviated symptoms slightly. Subsequently, four doses of Siwu Tang (Four Substances Decoction) added with Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Huaihua (Sophorae Flos), and Zhike (Aurantii Fructus) cured the condition.
Another patient, who had been immoderate in alcohol and sexual activity, suffered from painful hemorrhoids, anal bearing down and pain, hematochezia, dry stools, a surging pulse that felt choppy upon deep palpation. Four doses of Danggui Yuliren Tang (Angelica and Prunus Decoction) added with Taoren (Persicae Semen) alleviated symptoms slightly. Subsequently, several doses of Siwu Tang (Four Substances Decoction) added with Honghua (Carthami Flos), Taoren (Persicae Semen), Tiaoqin (Scutellariae Radix), and Huaihua (Sophorae Flos) cured the condition.
Generally speaking, engaging in sexual intercourse after excessive drinking and eating causes the meridians to become disordered; undressing after drinking leads to the leakage of essence and qi. Once the collaterals are deficient, toxins from food and alcohol flow into the deficiency. Or, excessive sexual activity fails to secure the essence, which then transmits to the Large Intestine, causing Wood to overact on Fire and destroy Metal (referring to the pathological interaction affecting the Lung and Large Intestine). Alternatively, excessive consumption of rich flavors inevitably leads to this disease.
The root of the pathology lies in dryness and dampness, while the nature of the disease is damp-heat. It is appropriate to treat with formulas that purge fire, harmonize blood, moisten dryness, and dispel wind. If ulceration does not heal, it becomes a fistula (Lou). Some extend to the buttocks, some to the genitalia, some discharge foul matter from the wound. Although the manifestations differ, the treatment methods are similar. Swelling forming a mass at the anal head indicates damp-heat; pain indicates Wind; dry stools indicate Fire; ulceration with pus indicates excess heat and blood corruption. One should investigate the specific cause for each case.
A patient had hemorrhoids progressing to a fistula, experiencing pain when lying on his side. Four doses of Qinjiao Fangfeng Tang (Gentian and Saposhnikovia Decoction) added with Tiaoqin (Scutellariae Radix) and Zhike (Aurantii Fructus) cured the condition. Subsequently, Siwu Tang (Four Substances Decoction) added with Shengma (Cimicifugae Rhizoma), Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Jingjie (Schizonepetae Herba), and Fangfeng (Saposhnikoviae Radix) prevented recurrence.
A patient with hemorrhoidal fistula experienced anal prolapse and pain when lying on his side, which took a long time to reduce. Several doses of Qinjiao Fangfeng Tang (Gentian and Saposhnikovia Decoction) alleviated symptoms slightly. Dahuang (Rhei Radix et Rhizoma) was removed, and Huangqin (Scutellariae Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), and Shaoyao (Paeoniae Radix) were added, stopping the pain. Subsequently, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) administered for over twenty doses prevented further prolapse.
A woman suffered from severe pain due to hemorrhoidal fistula. Four doses of Siwu Tang (Four Substances Decoction) added with Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Honghua (Carthami Flos), Taoren (Persicae Semen), and Mudanpi (Moutan Cortex) stopped the pain slightly. Several more doses cured the condition.
A patient suffered from hematochezia, worse in spring, accompanied by abdominal pain. He was cured with Hexue Chushi Tang (Harmonize Blood and Remove Dampness Decoction).
A patient with chronic damp-heat suffered from hematochezia and was cured with Huaihua San (Sophora Powder).
A patient suffered from post-defecation bleeding that had resisted prolonged medication and was critical. Diagnosis revealed damp-heat. Two doses of Huanglian Wan (Coptis Pill) stopped bleeding immediately, and several doses led to recovery.
A woman with stable hemorrhoidal fistula experienced slight bleeding due to heat. She was cured with Siwu Tang (Four Substances Decoction) added with Huanglian (Coptidis Rhizoma). Later, due to overexertion, she developed painful swelling of the sores and menstruation. The pulse was surging and large but empty upon deep palpation, indicating Qi and Blood injury with Fire agitation. Two doses of Bazhen Tang (Eight Treasures Decoction) added with Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), and Puhuang (Typhae Pollen) stopped bleeding. Later, Puhuang, Huangqin, and Huanglian were removed, and Digupi (Lycii Cortex) was added for several doses, leading to stability.
Zhu Danxi said: Female metrorrhagia (Bengzhong) results from damage to the Zang-Fu organs and deficiency of Qi and Blood in the Chong and Ren vessels. These vessels are the sea of meridians, circulating externally along the meridians and internally nourishing the organs. When Qi and Blood are balanced, menstruation occurs on time. Excessive labor damages the organs, weakening the Qi of Chong and Ren, which can no longer constrain menstrual blood, causing sudden heavy flow, known as Bengzhong Baoxia. Treatment requires major tonification of Qi and Blood, raising and nurturing the Spleen and Stomach, with slight addition of herbs to settle Heart Fire, tonifying Yin and purging Yang, so menstruation stops naturally.
A patient suffering from excessive strong liquor consumption had swollen, painful anus, constipation, and a firm pulse. He was cured with Huanglian Neishu Tang (Coptis Internal Purging Decoction).
A patient with hematochezia worsened by overexertion and loss of appetite was cured with Liujunzi Tang (Six Gentlemen Decoction) added with Huangqi (Astragali Radix), Dihuang (Rehmanniae Radix), and Diyü (Sanguisorbae Radix).
A patient with chronic post-defecation bleeding due to insufficient Middle Qi was treated with several doses of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and several doses of Huanglian Wan (Coptis Pill), stopping the bleeding. Continued use of the former decoction for over a month prevented recurrence.
A patient with Zangdu (visceral toxin) hematochezia took cooling blood-purging drugs, which failed to stop bleeding and caused loss of appetite and fatigue. The pulse was rapid and choppy upon deep palpation. Several doses of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) slightly reduced symptoms. Then, Liujunzi Tang (Six Gentlemen Decoction) added with Shengma (Cimicifugae Rhizoma) and Paojiang (Prepared Zingiberis Rhizoma) for four doses stopped bleeding. Paojiang was then removed, and Xiong (Chuanxiong) and Gui (Danggui) were added. After a month, the Spleen and Stomach recovered. Generally, for accumulation-heat or Wind-heat hematochezia, start with Bai Du San (Eliminate Toxin Powder). For Stomach Cold or Qi deficiency, use Sijunzi Tang (Four Gentlemen Decoction) or Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) to tonify; both are effective.
A patient with Zangdu hematochezia and weak Spleen Qi was cured with Liujunzi Tang (Six Gentlemen Decoction) added with Xiong (Chuanxiong), Gui (Danggui), Zhike (Aurantii Fructus), Diyü (Sanguisorbae Radix), and Huaihua (Sophorae Flos). Later, due to mental strain, bleeding recurred and resisted other medicines. I attributed it to worry damaging the Spleen and prescribed Guipi Tang (Restore the Spleen Decoction) for four doses, resulting in recovery.
Generally, the causes of this condition vary; one must investigate the cause for treatment. Zhu Danxi stated: Xiong Gui Tang (Ligusticum and Angelica Decoction) is a premier formula for regulating blood. Add Fuling (Poria) and Huaihua (Sophorae Flos) for Heat; add Fuling (Poria) and Muxiang (Aucklandiae Radix) for Cold. This discusses the root. Essence and Qi are generated from Grain Qi. In cases of Large Intestine bleeding, restoring Stomach Qi is key. Use Sijunzi Tang (Four Gentlemen Decoction), Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder), Zhike San (Aurantii Fructus Powder), or Xiao Wuchen Tang (Minor Black Stagnation Decoction) to harmonize. Once Stomach Qi returns, blood flows normally in the meridians.
Changfeng (Intestinal Wind) involves external pathogens appearing immediately upon exposure. Zangdu (Visceral Toxin) involves accumulated toxins manifesting after a long time. Sitting or lying improperly, exposure to Wind-Damp, excessive drinking/eating, improper sexual conduct, cold/raw foods, or accumulation of heat from alcohol and flour can cause Nutritive Blood to deviate and seep into the Large Intestine, creating Changfeng and Zangdu. Bleeding with Heat is clear and bright red with abdominal pain; bleeding with Cold is turbid and dark with slight abdominal pain. Clear indicates Changfeng; turbid indicates Zangdu. Bleeding after defecation indicates a distant source; bleeding before defecation indicates a near source. The popular theory distinguishing based on pre- or post-stool bleeding is incorrect. Treatment should first resolve external pathogens in the intestines and stomach: use Gongdu San (Attack Toxin Powder) for Heat, or Buhuanjin Zhengqi San (Unchanging Golden Upright Qi Powder) added with Xiong (Chuanxiong) and Gui (Danggui) for Cold. Then treat according to Heat or Cold. Liu Hejian said: Irregular lifestyle and excessive effort injure collaterals. Injury to Yang collaterals causes external bleeding (epistaxis); injury to Yin collaterals causes internal bleeding (hematochezia). Injury to intestinal collaterals causes blood overflow outside the intestine. With Cold, fluids and blood coagulate into masses. The Classic states: In dysentery with pus and blood, a string-like or absent pulse indicates death; a slippery and large pulse indicates survival. Bleeding with body heat indicates death; cool body indicates survival. Most texts attribute this to Wind-Heat invading the Large Intestine. If diet and lifestyle are regulated and the intestines/stomach are not deficient, how can pathogens enter?
A patient with hemorrhoidal fistula experienced anal prolapse during defecation, taking a long time to reduce. The pulse was fine and faint. Thirty-plus doses of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) cured the prolapse.
Zhu Danxi said: Rectal prolapse belongs to Qi Heat/Qi Deficiency and Blood Deficiency/Blood Heat. Tonify Qi deficiency with Renshen (Ginseng), Huangqi (Astragali Radix), Xiong (Chuanxiong), Gui (Danggui), and Shengma (Cimicifugae Rhizoma). Treat Blood Deficiency with Siwu Tang (Four Substances Decoction). Treat Blood Heat with Liangxue Siwu Tang (Cooling Blood Four Substances Decoction) added with Huangbai (Phellodendri Cortex). The Lung and Large Intestine are exterior-interior partners. Lung Heat causes anal constriction; Lung Cold causes prolapse. ○ Prolapse also results from exertion during childbirth or chronic dysentery in children. Warm the Lung, Spleen, and Intestines, and it will naturally retract.
Hemorrhoids affect men and women, rich and poor alike. The rich suffer from wine, sex, wealth, and anger; the poor from carrying loads, hunger, and exposure. All deplete Heart and Liver Blood. Joy injures the Heart; anger injures the Liver. Uncontrolled emotions allow Wind and Blood to invade the Large Intestine, blocking the anal passage, forming masses, bleeding, and producing various shapes. Women may suffer from cold invasion after menstruation or Wind during menses, with residual blood in the Heart channel flowing to the Large Intestine. Children may suffer from post-dysentery conditions or maternal intrauterine heat.
Formula for Protecting Flesh in Hemorrhoid Treatment:
Jinyu (Curcumae Radix) and Baiji (Bletillae Rhizoma) (1 liang each), optionally add Huanglian (Coptidis Rhizoma).
Grind these two into fine powder. For internal hemorrhoids protruding during defecation, wash with warm water, lie on side, mix powder with warm water to appropriate consistency, apply to healthy skin around the anus, cover with paper leaving the hemorrhoid exposed. After a while, apply the cauterizing powder to the hemorrhoid, dipping brush in warm water frequently to keep it moist but not spreading.
Formula for Cauterizing Powder:
Good Baijian (Alumen) (4 liang), Sheng Xinshi (Realgar processed with Alum) (2.5 qian), Zhusha (Cinnabar) (1 qian, raw ground extremely fine).
Grind each finely. Place Arsenic (Pi) in a porcelain jar, cover with Baijian powder, seal until smoke ceases, ensuring all Arsenic volatilizes, leaving only its qi in the alum. Take the fine alum powder, measure according to hemorrhoid size, place in palm, add a little Zhusha (Cinnabar), mix with saliva to a thin paste, apply thoroughly to the hemorrhoid using a comb. Apply 3-5 times daily. Effect is seen when the hemorrhoid turns dark black. Ideally, yellow fluid drains completely by night. Apply once at midnight, three times next day. Mild pain is acceptable. When changing dressing, wash old medicine gently with fresh warm water using a brush, reapply new medicine, cover with protecting flesh ointment, and pour Jingjie Tang (Schizonepeta Decoction) over it. After 2-3 days, as yellow fluid decreases, increase Zhusha and decrease Baijian to slow the action. Adjust every few days gradually to avoid shock. Success depends on observing color changes and adjusting thickness. This formula relies on Arsenic qi, mitigated by Cinnabar. Many effective cases in Beijing used these two formulas. A wealthy patient with hemorrhoidal fistula, dry mouth, and weak Stomach pulse had insufficient Middle Qi and fluids. Treated with Huangqi Liuyi Tang (Astragalus Six-to-One Decoction) or Qiwei Baizhu San (Seven-Ingredient Atractylodes Powder). Some say: "All pain and sores belong to Heart Fire, so bitter-cold herbs should purge fire." This led to incontinence and death.
"All pain and sores belong to Heart Fire" refers to the general rule. Starting with Heat and ending with Cold is contrary to the norm.
A woman with post-defecation bleeding, sallow complexion, tinnitus, lethargy, and poor appetite worsened with cooling blood herbs. Right Guan pulse was floating and weak. Jia Wei Sijunzi Tang (Modified Four Gentlemen Decoction) added with Shengma (Cimicifugae Rhizoma) and Chaihu (Bupleuri Radix) for several doses revived Spleen Qi, combined with Huanglian Wan (Coptis Pill) for several doses, curing the condition.
Generally, if cooling blood herbs fail for hematochezia, it is due to Middle Qi deficiency failing to control blood. Only tonifying Middle and augmenting Yang will cure it. Avoid cold-cold agents. For dysentery with pus and blood due to damaged damp-heat food, use bitter-cold agents to purge internally. String-like, absent, or choppy pulses are difficult to treat; slippery, large, and gentle pulses are easy to treat.
A 50-year-old patient had deep, choppy pulse and post-defecation red blood every autumn, with poor appetite, fatigue, and sallow complexion. Disease recurs because autumn's肃 (clear/descending) energy causes Yang Qi to descend. When bodily Yang Qi declines and cannot rise, Yin Blood follows the seasonal trend and sinks. The Spleen has the stillness of Kun but the movement of Qian, allowing Heart/Lung Yang to descend and Liver/Kidney Yin to rise, harmonizing Heaven and Earth. The root cause is often overeating causing meridian disorder, exhausting Spleen Qi, failing to transform essences, leading to food stagnation sinking to the Large Intestine and Yin Blood sinking. Using cooling/clearing herbs would injure Stomach Qi further. Instead, use Shengyang Yiwet Tang (Raise Yang and Benefit Stomach Decoction) so Yin Blood returns to meridians. Dozens of doses prevented recurrence.
A patient with painful hemorrhoids and severe hematochezia had a surging and choppy pulse. The Classic says: Overeating causes meridian disorder, leading to hemorrhoids. Wind invades the Liver, generating Heat. Wind pathogens cause excessive fluids to injure essence. Treated with Huangqi (Astragali Radix), Huanglian (Coptidis Rhizoma), Danggui (Angelicae Sinensis Radix), Shengdihuang (Rehmanniae Radix), Fangfeng (Saposhnikoviae Radix), Zhike (Aurantii Fructus), Baizhi (Angelicae Dahuricae Radix), Chaihu (Bupleuri Radix), Huaihua (Sophorae Flos), Diyü (Sanguisorbae Radix), and Gancao (Glycyrrhizae Radix) for gradual improvement, followed by Huanglian Wan (Coptis Pill) for cure. Another patient with years of hematochezia resistant to many medicines, with sallow complexion, blurred vision, and dizziness, was also cured with Huanglian Wan (Coptis Pill).
A patient with hemorrhoids had a floating, drum-like pulse and afternoon fever/pain. Bazhen Tang (Eight Treasures Decoction) added with Huangqi (Astragali Radix), Chaihu (Bupleuri Radix), and Digupi (Lycii Cortex) provided slight relief. Desiring quick results, he used corrosive drugs, leading to severe pain, starvation, and death.
Sores require healing through Qi and Blood. Floating, drum-like pulse and evening pain indicate Qi and Blood deficiency. Zhu Danxi said: For non-healing sores, tonify heavily with Renshen (Ginseng), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma); moxa with Fuzi Bing (Aconite Cake); apply tonifying plasters.
A patient over 40 with hemorrhoidal fistula had loose stools. Wuz Ling San (Five-Ingredient Powder with Poria) worsened diarrhea and appetite. I diagnosed intestinal cold deficiency, recommending Lizhong Tang (Regulate the Middle Decoction). He refused, continuing Wuz Ling San, worsening symptoms. Upon reconsultation, Lizhong Tang (Regulate the Middle Decoction) and Ershen Wan (Two Divine Pills) for over a month cured him. (This revealed Middle deficiency through treatment.)
A patient with weak constitution due to hemorrhoids improved slightly with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), and Zhike (Aurantii Fructus). Anger later worsened it. In mid-winter, the pulse was large. I stated the pulse did not match the season, indicating Kidney Water deficiency with Fire encroachment; medicine could not help. He died. In months of strong Fire, patients with hemorrhoids often show insufficient Kidney pulse, which is difficult to treat.
A patient with hemorrhoids had anal prolapse due to Damp-Heat sinking and inability of True Qi to raise. Pulse was deficient. Treated with Sijunzi Tang (Four Gentlemen Decoction) added with Xiong (Chuanxiong), Gui (Danggui), Huangqi (Astragali Radix), Cangzhu (Atractylodis Rhizoma), Huangbai (Phellodendri Cortex), Shengma (Cimicifugae Rhizoma), and Chaihu (Bupleuri Radix), plus Wweizi Tang (Schisandra Decoction) for fumigation/washing. Disliking the slow pace, he used arsenic poisons to cauterize and died. Corrosive drugs only treat the branch, destroying True Yuan, harming people. Beware.
A patient with hemorrhoids had worsening Qi/Blood deficiency, poor appetite, urinary incontinence, and nocturnal emissions. This was Qi deficiency with Damp-Heat, not a sore. Treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Shanyao (Dioscoreae Rhizoma), Shanzhuyu (Corni Fructus), and Wuweizi (Schisandrae Fructus), combined with Huan Shao Dan (Restore Youth Pill), resulting in cure.
A patient with hemorrhoidal fistula had pus mixed with stool, resisting all medicines. Pulse was somewhat firm. Ordered one pig kidney cut open, stuffed with 5 fen of Black Cow powder, tied, wrapped in lotus leaf, stewed熟, chewed slowly on an empty stomach, swallowed with warm salty wine. Several doses brought rapid improvement, followed by Tuoli (Support Interior) medicines for cure.