内经曰。因而饱食。筋脉横解。肠 为痔。又曰。督脉生病。癃痔。或醉饱入房。精气脱舍。
其脉空虚。酒毒乘之。流注于脉。或淫极而强忍不泄。前阴之气。归于大肠而痔。或以药固精。
停留不化。流着篡间。从其所过肛门而为痔也。其证有七。肛边发露肉珠。状如鼠乳。时出脓血。
妨于更衣者。曰牡痔。肛边肿痛。生疮突出。肿五六日自溃。出脓血者。曰牝痔。肛边生疮。颗
颗发 。痒而复痛。更衣出清血者。曰脉痔。肠内结核。痛而有血。寒热往来。登溷脱肛者。曰
肠痔。因便而清血随下不止者。曰血痔。每遇饮酒发动。疮痛流血。曰酒痔。忧恐郁怒。立见肿
痛。大便艰难。强力肛出而不收。曰气痔。名色种种。各当审其因而治之。其形有如莲花鸡冠核
桃。或如牛乳鸡心鼠乳樱桃之状。或藏肛门之内。或突出于外。久而不瘥。变为 也。溃有血脓。
都为热甚。至若溃出黄水。则为湿热矣。久而不愈。血气衰弱。以致穿穴成漏。又无痔而肛门左
右。别有一窍。流出脓血者。俱当戒酒远色。少劳茹淡方妙。立斋云。 痛二便秘。宜清热凉血
润燥疏风。若寒凉损中者。调养脾胃。滋补阴精。若漏而穿臀穿肠者。宜养元气。补阴精。大便
秘者。润燥养血。肛门坠下作痛。泻火除湿。或作痒者。祛风胜湿。肿痛小便不涩。泻肝导湿。
若疝与痔俱患。用六味丸、补中益气并进。痔证之方不一。东垣虽分湿热风燥四治。大都不离荡
涤瘀热之药。如 皮、皂角、槟榔、大黄、桃仁之类在所必用。兼风毒则加
羌、防、升、柴。甚则麻黄、 本汗之。兼燥气则加秦艽、当归、黄 。湿胜则加苍术、黄柏、
泽泻、茯苓。兼热甚则加芩、连、郁李、生地。脓血则加甲片、归尾。酒痔则加葛根、赤小豆、
地、芍、苓、半。气痔则加枳、橘、木香、紫苏。食积则加黄连、枳实、曲、 。痛极则加乳、
没。血多则加发灰。气虚则加参、 。血虚则加胶、艾。不必拘执古方也。惟血痔诸药不应。石
煤、槐花。空心乌梅汤服神效。陈毓仁云。诸痔欲断其根。必须枯药。当实其窍。必戒房劳百日
方妙。凡治内痔。先用通利药。荡涤脏腑。后以唤痔散填入肛门。其痔即出。欲用枯痔散。先以
护痔膏围护四边好肉。然后上之。上枯药后。色黑坚硬裂缝。则以落痔汤洗之。脱落后孔窍不收
者。以生肌散掺之。至于穿肠久漏者。另有胡连追毒丸、黄连闭管丸主之。诸痔及五瘿六瘤。凡
蒂小而头大者。俱用煮线方治之。洗痔法。用生蚌劈开取水点。即用煮汤熏洗效。痔 赤肿痛。
以真熊胆研水点之。肿痛自消。点痔。用大蛳螺一个挑去靥。入麝香、冰片少许。过一宿。化水
点之。又法。用大蜗牛一个去壳。生银杏肉一枚。同研烂。入冰片半分研匀。点上即收。
漏 经云。陷脉为 。留连肉腠。因疮穿脓汁不尽。复感七情四气而成。近则常淡红。或微
肿。或小核。久则上而槁白。内而黑烂。淫虫恶臭生焉。治法宜补气生血。外以黑附子为末。唾
津和作饼如钱浓。以艾灸之。随漏大小作炷。但灸微热。不可使痛。干则易。困倦则止。来日再
灸。直至内平为效。仍须补药常服。丹方治痔漏。以积年琉璃洗净油腻。火 研细。以红酒服四
钱。不过七日。其管自去。丹方。以鳔胶一味。炒研为散。日用一钱匙。砂糖调服。服久痔自
枯落。一法。以降药纸条捻进。黑膏掩之自脱。以干漆灰捻进亦脱。或生漆涂入亦脱。以漆能破
瘀血也。大抵漏疮。孔中多有恶秽之物。以露蜂房、白芷、苦参煎汤无风处熏洗。日三次良。有
痔漏人。每日侵晨食狗肉。勿令间断。取其
性温益肾。肾主二便。百日中管自消。不药而愈。又法。外用土墼烧赤。放罐中。以乱发烧烟。
日熏二三次。无论新久痔漏。日渐管脱焦枯而愈。
《黄帝内经》说：因为饱食过度，导致筋脉松弛弛缓，大肠发生痔疮。又说：督脉生病，会出现小便不通和痔疮。或者是醉酒后行房事，精气耗散脱失，脉象空虚，酒毒趁机侵袭，流注于血脉之中；或者是淫欲过度而强行忍耐不泄精，前阴的气机归于大肠从而引发痔疮；或者是服用药物固涩精气，停留体内无法消化，流注积聚在肛门之间，顺着经络经过肛门而形成痔疮。
痔疮的症状有七种：肛门口长出肉珠，形状像老鼠的乳房，时常流出脓血，妨碍排便的，称为牡痔；肛旁肿痛，生疮突出，肿胀五六日后自行溃破，流出脓血的，称为牝痔；肛旁生疮，颗粒状突起，发痒后又疼痛，排便时流出清稀血液的，称为脉痔；肠内有结块，疼痛且带血，寒热往来，如厕时脱肛的，称为肠痔；因排便而清血不断下流的，称为血痔；每次饮酒后发作，疮口疼痛流血，称为酒痔；因忧恐郁怒，立刻出现肿痛，大便艰难，用力时肛门脱出而不能回纳的，称为气痔。名称花色各种各样，应当仔细审查病因进行治疗。其形态有的像莲花、鸡冠、核桃，有的像牛乳、鸡心、鼠乳、樱桃的形状；有的藏在肛门内部，有的突出于外部，日久不愈，转变为瘘管。溃烂流出血脓，都属于热邪极盛；如果溃烂流出黄水，则是湿热所致。日久不愈，气血衰弱，以致穿透形成漏症。另外，没有痔疮但肛门左右另有一个孔窍，流出脓血的，都应当戒酒远色，减少劳累，饮食清淡才好。
薛立斋说：痔疮疼痛伴二便不通，宜清热凉血、润燥疏风；如果寒凉药损伤了中焦脾胃，则调养脾胃，滋补阴精；如果是漏症且穿透臀部或肠道，宜补养元气，滋补阴精；大便干结者，润燥养血；肛门坠胀作痛者，泻火除湿；如果发痒者，祛风胜湿；肿痛但小便不涩滞者，泻肝导湿；如果疝气和痔疮同时患病，用六味丸和补中益气汤并进治疗。治疗痔疮的方剂不一，李东垣虽然分为湿热、风燥四种治法，大都不离清除瘀热的药物。如地榆皮、皂角、槟榔、大黄、桃仁之类是必须使用的。兼有风毒则加羌活、防风、升麻、柴胡；严重时用麻黄、藁本发汗；兼有燥气则加秦艽、当归、黄芪；湿气重则加苍术、黄柏、泽泻、茯苓；兼热邪极盛则加黄芩、黄连、郁李仁、生地；有脓血则加穿山甲片、当归尾；酒痔则加葛根、赤小豆、地黄、白芍、茯苓、半夏；气痔则加枳壳、陈皮、木香、紫苏；食积则加黄连、枳实、神曲、麦芽；疼痛剧烈则加乳香、没药；出血多则加血余炭；气虚则加人参、白术；血虚则加阿胶、艾叶。不必拘泥于古方。只有血痔用各种药物无效时，用石煤、槐花，空腹用乌梅汤送服，效果神奇。陈毓仁说：想要彻底断绝痔疮病根，必须使用枯痔药。要使孔窍闭合，必须戒除房事一百天才好。
凡是治疗内痔，先用通利药，荡涤脏腑，然后用唤痔散填入肛门，痔疮就会脱出。想要使用枯痔散，先用护痔膏围护四周好肉，然后敷上枯痔药。敷上枯药后，颜色变黑坚硬并出现裂缝，就用落痔汤清洗。脱落之后孔窍不能收敛的，撒上生肌散。至于穿透肠道久治不愈的漏症，另有胡连追毒丸、黄连闭管丸主治。各种痔疮及五瘿六瘤，凡是蒂小而头大的，都用煮线方治疗。洗痔法：用生蚌劈开取水点眼（此处原文可能有误，结合语境应为点患处或泛指用药），即用煮汤熏洗也有效。痔疮红肿疼痛，用真熊胆研水点涂，肿痛自消。点痔法：用大田螺一个挑去厣（盖），放入麝香、冰片少许，过一夜，化水点涂。又一种方法：用大蜗牛一个去壳，生银杏肉一枚，同研烂，加入冰片半分研匀，点上即可收效。
《灵枢·经别》说：邪气陷入脉络成为瘘，留连在肌肉腠理之间，因为疮口脓汁排不尽，又感受七情四气而成。近期常呈淡红色，或微肿，或有小核；日久则上部干枯发白，内部黑烂，生出淫虫恶臭。治疗方法宜补气生血，外用黑附子为末，用唾液调和做成如铜钱厚的饼，用艾灸之。根据漏管大小制作艾炷，只灸到微微发热，不可使患者感到疼痛。干了就更换，困倦了就停止，第二天再灸，直到内部平复为效。仍须常服补药。丹方治疗痔漏：将积年的琉璃洗净油腻，火煅后研细，用红酒送服四钱，不超过七天，瘘管自然脱落。另一丹方：只用鳔胶一味，炒后研为散剂，每天用一钱匙，砂糖调服，服久了痔疮自然枯萎脱落。还有一种方法：将降真香药纸条捻进瘘管，用黑膏覆盖使其自脱；用干漆灰捻进也能脱落；或者用生漆涂入也能脱落，因为漆能破除瘀血。
大体上漏疮，孔中多有秽浊之物，用露蜂房、白芷、苦参煎汤在无风处熏洗，每天三次很好。有痔漏的人，每天清晨吃狗肉，不要间断，取其性温益肾，肾主二便，一百天中自然会消除，不用药也能痊愈。又一种方法：外用土坯烧红，放入罐中，用乱发烧烟，每天熏二三次，无论新旧痔漏，日渐瘘管脱落焦枯而痊愈。
The *Neijing* states: Due to overeating, the sinews and vessels become lax and relaxed, leading to hemorrhoids in the large intestine. It also states: When the Du Meridian is diseased, it causes strangury (difficulty in urination) and hemorrhoids. Or, after indulging in alcohol and sexual intercourse, the essence and qi are depleted and lost, the pulse becomes empty, and the toxicity of alcohol takes advantage of this condition, flowing into the vessels. Or, due to excessive sexual desire but forcibly suppressing ejaculation, the qi of the anterior yin returns to the large intestine, causing hemorrhoids. Or, by using drugs to consolidate the essence, which remains stagnant and fails to transform, flowing and settling between the anus; following its pathway through the anus, hemorrhoids form.
There are seven types of symptoms for hemorrhoids: Flesh nodules protruding at the anal margin, resembling mouse breasts, with frequent discharge of pus and blood, obstructing defecation, is called *Mu Zhi* (Yang Hemorrhoid). Swelling and pain at the anal margin, with sores protruding, swelling for five to six days before spontaneously ulcerating and discharging pus and blood, is called *Pin Zhi* (Yin Hemorrhoid). Sores growing at the anal margin, granular protrusions that itch then hurt, with clear blood discharged during defecation, is called *Mai Zhi* (Vessel Hemorrhoid). Nodules within the intestine, painful with blood, accompanied by alternating chills and fever, and rectal prolapse during defecation, is called *Chang Zhi* (Intestinal Hemorrhoid). Clear blood continuously flowing down upon defecation, is called *Xue Zhi* (Blood Hemorrhoid). Triggered by drinking alcohol, with soreness and bleeding from sores, is called *Jiu Zhi* (Alcohol Hemorrhoid). Arising from worry, fear, depression, or anger, immediately presenting with swelling and pain, difficult defecation, and rectal prolapse upon exertion that cannot be retracted, is called *Qi Zhi* (Qi Hemorrhoid). The names and appearances vary; one must carefully examine the cause to treat accordingly. Their shapes may resemble lotus flowers, cockscombs, walnuts, cow's milk, chicken hearts, mouse breasts, or cherries; some hide inside the anus, others protrude outside. If not healed for a long time, they transform into fistulas (*Lou*). Ulcerations discharging blood and pus indicate extreme heat; if yellow fluid is discharged, it indicates damp-heat. Prolonged non-healing leads to weakness of blood and qi, resulting in perforation and fistula formation. Additionally, if there are no hemorrhoids but another opening exists on either side of the anus discharging pus and blood, one must abstain from alcohol and sex, reduce labor, and eat bland food for recovery.
Xue Lizhai stated: For hemorrhoidal pain with constipation and difficulty in urination, clear heat, cool blood, moisten dryness, and dispel wind. If cold-natured herbs damage the middle jiao, regulate the spleen and stomach, and nourish yin essence. For fistulas penetrating the buttocks or intestines, tonify primordial qi and nourish yin essence. For constipation, moisten dryness and nourish blood. For anal heaviness and pain, drain fire and remove dampness. For itching, dispel wind and overcome dampness. For swelling and pain without dysuria, drain the liver and guide out dampness. If hernia and hemorrhoids occur simultaneously, use *Liuwei Wan* (Six-Ingredient Pill with Rehmannia) and *Buzhong Yiqi Tang* (Tonify the Middle and Augment the Qi Decoction) together. There are various formulas for hemorrhoids. Although Li Dongyuan divided treatments into four categories based on damp-heat, wind, and dryness, they generally do not depart from herbs that purge stasis and heat. Herbs such as *Di Yu* (Sanguisorbae Radix), *Zao Jiao* (Gleditsiae Fructus Spina), *Bing Lang* (Arecae Semen), *Da Huang* (Rhei Radix et Rhizoma), and *Tao Ren* (Persicae Semen) are essential. If complicated by wind-toxin, add *Qiang Huo* (Notopterygii Rhizoma et Radix), *Fang Feng* (Saposhnikoviae Radix), *Sheng Ma* (Cimicifugae Rhizoma), and *Chai Hu* (Bupleuri Radix). In severe cases, induce sweating with *Ma Huang* (Ephedrae Herba) and *Gao Ben* (Ligustici Rhizoma et Radix). If complicated by dryness, add *Qin Jiao* (Gentianae Macrophyllae Radix), *Dang Gui* (Angelicae Sinensis Radix), and *Huang Qi* (Astragali Radix). If dampness prevails, add *Cang Zhu* (Atractylodis Rhizoma), *Huang Bai* (Phellodendri Cortex), *Ze Xie* (Alismatis Rhizoma), and *Fu Ling* (Poria). If heat is extreme, add *Huang Qin* (Scutellariae Radix), *Lian Zi* (Nelumbinis Semen - *Note: Context suggests Lian Qiao or similar, but text says Lian Zi/Lian? Text says "Qin, Lian", likely Huang Qin and Huang Lian*, Huang Lian (Coptidis Rhizoma)), *Yu Li Ren* (Prunus Armeniaca Seed), and *Sheng Di* (Rehmanniae Radix). For pus and blood, add *Jia Pian* (Testudinis Carapax et Plastrum / Pangolin Scales - *Context implies Pangolin scales usually, but Jia Pian can refer to turtle shell; in hemorrhoid context often Chuan Shan Jia*), and *Gui Wei* (Angelicae Sinensis Radix Tail). For alcohol hemorrhoids, add *Ge Gen* (Puerariae Lobatae Radix), *Chi Xiao Dou* (Adzuki Bean), *Di Huang* (Rehmanniae Radix), *Bai Shao* (Paeoniae Radix Alba), *Fu Ling* (Poria), and *Ban Xia* (Pinelliae Rhizoma). For qi hemorrhoids, add *Zhi Ke* (Aurantii Fructus), *Chen Pi* (Citri Reticulatae Pericarpium), *Mu Xiang* (Aucklandiae Radix), and *Zi Su* (Perillae Folium). For food stagnation, add *Huang Lian* (Coptidis Rhizoma), *Zhi Shi* (Aurantii Fructus Immaturus), *Qu* (Medicated Leaven), and *Mai Ya* (Hordei Fructus Germinatus). For severe pain, add *Ru Xiang* (Olibanum) and *Mo Yao* (Myrrha). For heavy bleeding, add *Fa Hui* (Capillis Carbonisatum). For qi deficiency, add *Ren Shen* (Ginseng Radix) and *Bai Zhu* (Atractylodis Macrocephalae Rhizoma). For blood deficiency, add *E Jiao* (Colla Corii Asini) and *Ai Ye* (Artemisiae Argyi Folium). Do not rigidly adhere to ancient formulas. Only when all medicines fail for blood hemorrhoids, use *Shi Mei* (Coal Stone) and *Huai Hua* (Sophorae Flos), taken on an empty stomach with *Wu Mei* (Mume Fructus) decoction, yielding miraculous effects. Chen Yuren said: To completely eradicate hemorrhoids, one must use cauterizing agents. To close the orifice, one must abstain from sexual activity for 100 days.
For internal hemorrhoids, first use purgative herbs to cleanse the zang-fu organs, then insert *Huan Zhi San* (Hemorrhoid Summoning Powder) into the anus to make the hemorrhoid protrude. Before applying *Ku Zhi San* (Hemorrhoid Cauterizing Powder), surround the healthy surrounding flesh with *Hu Zhi Gao* (Hemorrhoid Protecting Ointment), then apply the powder. After application, if the tissue turns black, hard, and cracks, wash with *Luo Zhi Tang* (Hemorrhoid Falling Decoction). If the orifice fails to contract after falling off, sprinkle *Sheng Ji San* (Tissue Regenerating Powder). For fistulas penetrating the intestine and persisting for a long time, use *Hu Lian Zhui Du Wan* (Coptis Pursuing Toxin Pill) and *Huang Lian Bi Guan Wan* (Coptis Closing Tube Pill). For various hemorrhoids and five goiters/six tumors where the stalk is small and the head is large, use the *Zhu Xian Fang* (Boiled Thread Method). For washing hemorrhoids, split a fresh freshwater mussel (*Sheng Bang*) and use the water to apply/drop; fumigation and washing with boiled water is also effective. For red, swollen, and painful hemorrhoids, grind real bear bile (*Xiong Dan*) in water and apply; swelling and pain will subside. For dropping treatment: Take one large snail, remove the operculum, add a little musk (*She Xiang*) and borneol (*Bing Pian*), leave overnight until liquefied, then apply. Another method: Take one large garden snail, remove the shell, take one raw ginkgo nut (*Yin Xing*), grind them together until smooth, add half a fen of borneol, grind evenly, and apply; it will resolve quickly.
The *Jingmai* chapter states: Pathogenic factors sinking into the meridians form fistulas, lingering in the muscle interstices. Because pus from sores is not fully drained, and combined with emotional disturbances and external climatic factors, it forms. Initially, it appears pale red, slightly swollen, or with small nodules; later, the upper part becomes dry and white, the interior black and rotting, producing foul-smelling parasites. Treatment should tonify qi and generate blood. Externally, use black aconite (*Hei Fu Zi*) powder mixed with saliva to form cakes as thick as coins, and moxibustion. Make moxa cones according to the size of the fistula. Moxa only until mildly warm, avoiding pain. Replace when dry, stop if fatigued, resume the next day, until the interior flattens. Continue taking tonic herbs. A folk prescription for hemorrhoids/fistulas: Clean old glazed tiles (*Liuli*) to remove grease, calcine and grind finely, take 4 qian with red wine. Within seven days, the tract will naturally fall off. Another prescription: Use only fish maw (*Biao Jiao*), stir-fry and grind into powder, take one teaspoon daily with sugar water. Long-term use causes hemorrhoids to wither and fall off. Another method: Insert paper strips soaked in precipitant medicine (*Jiang Yao*) into the tract, cover with black ointment to facilitate detachment; inserting dry lacquer ash (*Gan Xi Hui*) also works. Applying raw lacquer (*Sheng Qi*) also works because lacquer breaks up blood stasis.
Generally, fistula openings contain foul matter. Fumigate and wash with decoctions of honeycomb (*Lu Feng Fang*), angelica dahurica (*Bai Zhi*), and sophora root (*Ku Shen*) in a windless place, three times daily, which is beneficial. Patients with hemorrhoids/fistulas should eat dog meat every morning without interruption. Dog meat is warm and benefits the kidneys; the kidneys govern the two lower orifices. Within 100 days, it will naturally disappear and heal without medication. Another method: Heat clay bricks (*Tu Ji*) until red, place in a jar, burn rags (*Luan Fa*) to produce smoke, fumigate twice or thrice daily. Regardless of new or old hemorrhoids/fistulas, the tracts will gradually detach, scorch, and heal.