〔大〕妇人痔 ，因郁怒、风热、浓味膏粱所致。其名有五∶肛边如乳出脓者为牝
痔。肿胀出血者为牡痔。痒痛者为脉痔。肿核者为肠痔。登厕出血者为血痔。治宜审之。
〔薛〕前证，妇人多因胎产、经行、饮食起居、六淫七情失调所致。男子多因醉饱
入房，筋脉横解，精气脱泄，热毒乘虚而患。或入房强固其精，木乘火势而侮金，或炙爆
浓味，阴虚湿热，宜凉血润燥疏风，溃后当养元气，补阴精，不愈即成痔漏，有串臀、串
阴、穿肠者。其肠头肿块者，湿热也，作痛者风也，便燥者火也，溃脓者热胜血也。大
便作痛者，润燥除湿。肛门坠痛者，泻火导湿。小便涩滞者，清肝导湿。经云∶因而饱
食，筋脉横解，肠 为痔。证属肝肾不足，故用加味地黄及六味丸有效。慎勿敷毒药及服
寒凉之剂。
鳖甲散 治五种痔漏，脓血淋漓，或肿痛坚硬下坠。
鳖甲 露蜂房 蛇蜕 猪后悬蹄 皮（五味烧存性，各二钱） 麝香（一分）
上为末，每服一钱，空心生地黄煎汤调下，更敷之。
又方∶热痛用寒水石、朴硝为末，以津调搽。
治法并方，详《杂病》痔门，兹不重录。
〔大〕脱肛者，大肠之候也。大肠虚寒，其气下陷则肛门翻出，或因产努力，其肛亦
然也。
〔薛〕前证若大肠湿热，用升阳除湿汤。若血热，用四物、条芩、槐花。血虚，用四
物、白术、茯苓。兼痔痛，用四物、槐花、黄连、升麻。中风虚弱，用补中益气汤加芍药、
白术。中气虚寒，加半夏、炮姜、五味。肾虚，用六味丸。虚寒，用八味丸。夫肺与大
肠为表里，肛者大肠之门，肺实热则秘结，肺虚寒则脱出。肾主大便，故肺肾虚者，多用
此证。一妇人脱肛，用补中益气、加味归脾各百余剂而愈。后因分娩复脱，仍以前药
各二百余剂始愈。
升阳除湿汤 自下而上者，引而竭之。
升麻 柴胡 防风 神曲（炒） 泽泻 猪苓（各半两） 苍术（一两） 陈皮 甘草（炙）
大麦 （各三钱）
上每服五钱，水煎空心服。胃寒肠鸣，加益智仁、半夏各半钱，姜枣同煎服。
姚和众以铁粉敷之良。（《圣惠方》亦治阴脱、阴肿。）
《集验方》以生铁三斤，水一斗，煮至五升，取水洗，日二次。
孙真人用蛤蟆皮瓶中烧多烟熏，功效玄微。
一方 用五倍子煎汤洗，以赤石脂末掺上托入。或脱长者，以两床相并，中空尺许，
以瓷瓶盛汤，令病患仰卧浸瓶中，逐日易之，收尽为度。
【大】妇女患痔疮，多因情绪抑郁愤怒、风热侵袭、或过食肥甘厚味所致。痔疮的名称有五种：肛门边缘如乳头状突出并流脓的称为牝痔（雌性痔）。肿胀且出血的称为牡痔（雄性痔）。瘙痒疼痛的称为脉痔。有肿块的称为肠痔。排便时出血的称为血痔。治疗时应仔细辨别。
【薛】上述病症，妇女多因怀孕生产、月经来潮、饮食起居不当、以及六淫（风、寒、暑、湿、燥、火）和七情（喜、怒、忧、思、悲、恐、惊）失调所导致。男子多因醉酒后行房事，导致筋脉松弛，精气耗泄，热毒乘虚而入而患病。或者在房事中强行固摄精液，导致肝木克制脾土并反侮肺金，或者食用炙烤爆裂及浓烈厚味的食物，导致阴虚湿热。治疗宜凉血润燥、疏风解表；溃破后应当补养元气、滋补阴精，否则不愈即形成痔漏，有的蔓延至臀部、外阴，甚至穿透肠道。肛门处肿块者，属湿热；疼痛者，属风邪；大便干燥者，属火邪；溃烂流脓者，属热盛伤血。大便时疼痛者，宜润燥除湿。肛门坠胀疼痛者，宜泻火导湿。小便涩滞者，宜清肝导湿。经云：“因饱食过度，导致筋脉松弛，肠道变为痔疮。”此证属于肝肾不足，因此使用加味地黄丸及六味丸有效。切勿敷用毒药及服用寒凉药物。
鳖甲散 治疗五种痔漏，脓血淋漓不止，或肿痛坚硬伴下坠感。
药材：鳖甲、露蜂房、蛇蜕、猪后悬蹄皮（以上五味烧至存性，各二钱）、麝香（一分）。
制法与用法：上药研为细末，每次服用一钱，空腹时用生地黄煎汤调服，并配合外敷。
又一方：若热痛明显，用寒水石、朴硝研为细末，以唾液调和后涂抹患处。
治疗方法及方剂详见《杂病》卷的痔门部分，此处不再重复记录。
〔大〕脱肛，是大肠的病变表现。大肠虚寒，气机下陷，则肛门翻出体外；或因分娩用力过度，也会导致肛门脱出。
〔薛〕上述病症，若属大肠湿热，使用升阳除湿汤。若属血热，使用四物汤加黄芩、槐花。若属血虚，使用四物汤加白术、茯苓。兼有痔疮疼痛，使用四物汤加槐花、黄连、升麻。中风后体弱，使用补中益气汤加芍药、白术。中气虚寒，加半夏、炮姜、五味子。肾虚，使用六味丸。虚寒证，使用八味丸。肺与大肠互为表里，肛门是大肠的门户，肺实热则导致便秘，肺虚寒则导致脱肛。肾主司大便，因此肺肾两虚者，多患此证。有一位妇女患脱肛，使用补中益气汤和加味归脾汤各一百多剂后痊愈。后来因分娩再次脱出，仍用前药各二百多剂才治愈。
升阳除湿汤 针对病势自下而上者，采用引而竭之（引导邪气排出）的方法。
药材：升麻、柴胡、防风、神曲（炒）、泽泻、猪苓（各半两）、苍术（一两）、陈皮、甘草（炙）、大麦（各三钱）。
制法与用法：每次服用五钱，水煎，空腹服用。若胃寒肠鸣，加益智仁、半夏各半钱，加生姜、大枣同煎服用。
姚和众建议用铁粉外敷效果良好。（《圣惠方》也用于治疗阴户脱垂、阴户肿胀。）
《集验方》用生铁三斤，水一斗，煮至五升，取汁清洗患处，每日两次。
孙真人（孙思邈）用蛤蟆皮在瓶中燃烧产生浓烟熏蒸，功效玄妙微妙。
另一方：用五倍子煎汤清洗，将赤石脂粉末撒在患处托入肛门。如果脱出较长，可将两张床并排，中间留出约一尺的空隙，用瓷瓶盛装药汤，让患者仰卧浸泡在瓶中，每天更换，直至完全收回为止。
[Da] Women suffering from hemorrhoids are often caused by emotional depression and anger, invasion of wind-heat, or excessive consumption of rich and greasy foods. There are five types: those protruding like nipples at the anal margin with pus discharge are called Pin Zhi (Female Hemorrhoid); those with swelling and bleeding are called Mu Zhi (Male Hemorrhoid); those with itching and pain are called Mai Zhi (Pulse Hemorrhoid); those with nodules are called Chang Zhi (Intestinal Hemorrhoid); and those with bleeding during defecation are called Xue Zhi (Blood Hemorrhoid). Treatment requires careful differentiation.
[Xue] The aforementioned conditions in women are mostly caused by pregnancy and childbirth, menstruation, improper diet and lifestyle, and imbalance of the Six Evils (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) and Seven Emotions (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright). In men, it is often caused by sexual intercourse after drunkenness or overeating, leading to flaccidity of tendons and vessels, depletion of essence and Qi, and invasion of heat-toxin due to deficiency. Or, forcibly retaining semen during intercourse causes Liver Wood to overact on Spleen Earth and insult Lung Metal; or consuming roasted, fried, and strong-flavored foods leads to Yin deficiency with damp-heat. Treatment should involve cooling blood, moistening dryness, and dispersing wind. After ulceration, one must nourish Yuan Qi and tonify Yin essence; otherwise, it may become a fistula, spreading to the buttocks, yin organs, or penetrating the intestine. Nodules at the anus indicate damp-heat; pain indicates wind; dry stool indicates fire; ulceration with pus indicates heat overwhelming blood. Pain during defecation requires moistening dryness and draining dampness. Heaviness and pain in the anus require clearing fire and guiding out dampness. Astringent and stagnant urination requires clearing the Liver and guiding out dampness. The Classics state: "Due to overeating, tendons and vessels become flaccid, and the intestines transform into hemorrhoids." This syndrome belongs to Liver and Kidney deficiency, so Jia Wei Di Huang Wan (Supplemental Rehmannia Pill) and Liu Wei Wan (Six-Ingredient Pill with Rehmannia) are effective. Do not apply toxic drugs or take cold-natured medicines.
Bie Jia San (Turtle Shell Powder) treats the five types of hemorrhoidal fistulas with dripping pus and blood, or hard swelling and pain with a sensation of bearing down.
Ingredients: Bie Jia (Testudinis Carapax et Plastrum), Lu Feng Fang (Vespae Nidus), She Tui (Bombyx Batryticatus), Zhu Hou Xuan Ti Pi (Skin of the posterior suspended hoof of pig) (the above five ingredients are calcined until the original nature remains preserved, each 2 qian), She Xiang (Moschus) (1 fen).
Preparation and Administration: Grind into powder. Take 1 qian per dose, mixed with decoction of Sheng Di Huang (Rehmanniae Radix) taken on an empty stomach, accompanied by external application.
Another prescription: For heat and pain, use Han Shui Shi (Halitum) and Po Xiao (Natrii Sulfas) ground into powder, mixed with saliva for topical application.
Treatment methods and prescriptions are detailed in the Hemorrhoid section of *Miscellaneous Diseases*, so they are not repeated here.
[Da] Rectal prolapse is a manifestation of Large Intestine pathology. Deficiency-cold of the Large Intestine causes Qi to sink, resulting in the eversion of the anus; it can also be caused by excessive straining during childbirth.
[Xue] If the aforementioned condition involves damp-heat in the Large Intestine, use Sheng Yang Chu Shi Tang (Ascending Yang and Draining Dampness Decoction). If it involves Blood Heat, use Si Wu Tang (Four Substances Decoction) with Huang Qin (Scutellariae Radix) and Huai Hua (Sophorae Flos). If it involves Blood Deficiency, use Si Wu Tang with Bai Zhu (Atractylodis Macrocephalae Rhizoma) and Fu Ling (Poria). If accompanied by hemorrhoidal pain, use Si Wu Tang with Huai Hua, Huang Lian (Coptidis Rhizoma), and Sheng Ma (Cimicifugae Rhizoma). For weakness after stroke, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with Shao Yao (Paeoniae Radix Alba) and Bai Zhu. For deficiency-cold of Middle Qi, add Ban Xia (Pinelliae Rhizoma), Pao Jiang (Zingiberis Rhizoma Preparatum), and Wu Wei Zi (Schisandrae Fructus). For Kidney deficiency, use Liu Wei Wan. For deficiency-cold, use Ba Wei Wan (Eight-Ingredient Pill with Rehmannia). The Lung and Large Intestine are exterior-interior pairs; the anus is the gate of the Large Intestine. Excess-heat in the Lung causes constipation, while deficiency-cold in the Lung causes prolapse. The Kidneys govern defecation; therefore, this condition is common in cases of Lung and Kidney deficiency. One woman with rectal prolapse was cured after taking Bu Zhong Yi Qi Tang and Jia Wei Gui Pi Tang (Supplemental Spleen-Restoring Decoction) for more than a hundred doses each. Later, due to delivery, it recurred, and she was cured again after taking more than two hundred doses of the same medicines.
Sheng Yang Chu Shi Tang (Ascending Yang and Draining Dampness Decoction) is used for conditions where the pathogenic factor moves upward from below, employing the method of "guiding and exhausting" (draining downward).
Ingredients: Sheng Ma (Cimicifugae Rhizoma), Chai Hu (Bupleuri Radix), Fang Feng (Saposhnikoviae Radix), Shen Qu (Massa Medicata Fermentata) (stir-fried), Ze Xie (Alismatis Rhizoma), Zhu Ling (Poria), Cang Zhu (Atractylodis Rhizoma) (1 liang), Chen Pi (Citri Reticulatae Pericarpium), Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata) (honey-fried), Da Mai (Hordei Fructus Germinatus) (each 3 qian; Sheng Ma, Chai Hu, Fang Feng, Shen Qu, Ze Xie, Zhu Ling are each half liang).
Preparation and Administration: Take 5 qian per dose, decocted in water, taken on an empty stomach. If there is Stomach cold with borborygmus, add Yi Zhi Ren (Alpiniae Oxyphyllae Fructus) and Ban Xia (each half qian), decocted with Sheng Jiang (Zingiberis Rhizoma Recens) and Da Zao (Jujubae Fructus).
Yao Hezhong recommended applying Iron Powder (Tie Fen) externally with good results. (*Sheng Hui Fang* also treats vaginal prolapse and vulvar swelling.)
*Ji Yan Fang* prescribes boiling three jin of raw iron in ten dou of water until reduced to five sheng, using the liquid to wash the affected area twice daily.
Sun Taizhen (Sun Simiao) used the skin of a toad burned in a bottle to produce smoke for fumigation, achieving subtle and profound effects.
Another prescription: Wash with decoction of Wu Bei Zi (Galla Chinensis), then sprinkle Chi Shi Zhi (Kaolinite) powder on the prolapsed part to push it back. If the prolapse is long, place two beds side by side leaving a gap of about one chi, fill a porcelain bottle with the decoction, and have the patient lie supine immersing the bottle between their legs. Change the decoction daily until fully retracted.