【歌】气血脉肠牝牡虫，七般痔状要精通。或因风湿侵于外，醉饱过伤热蕴中。
【论】经云∶因而饱食，筋脉横解，肠 为痔。盖人之脏腑本虚，外伤风湿，内蕴热毒，醉饱交接，多欲
自戕，以故气血坠下，结聚肛门，宿滞不散，冲突为痔，故古人有七痔之目。牡痔者，肛边发，露肉珠，状如
鼠乳，时时滴溃脓血。牝痔者，肛边生疮，肿痛出血，其头反陷入。脉痔者，肠口频频发 ，且疼且痒，出血
淋漓。肠痔者，肠内结核，有血，寒热往来，登圊脱肛。血痔者，每遇大便，清血随下不止。虫痔者，肛门浸
淫湿烂，内有蛲虫蚀其肠为疮。气痔者，大便难，强力努之则肛出不收。此七痔之状虽殊，大抵以解热、凉血、
顺气为主。盖热则血伤，血伤则经滞，经滞则气不运，气与血俱滞，乘虚而坠入大肠，所以为痔。凡诸
痔久不愈，必至穿肠而为漏，此因痔而成漏也，当凉血宽大肠自愈。亦有外伤四气，内窘七情，与夫饮食乖常，
染触蠢动含灵之毒，未有不变为 疮，穿孔一深，脓汁不尽，得冷而风邪并之，涓涓而成漏矣。盖漏者，诸
之溃也。诸痿者，如野狼 、暴 、蚁 、蝼蝈 、砒蜉 、蜂 、蛴螬 、蜉蛆 、转筋 、瘰 之类。
《内经》云∶ 即漏也。所谓漏者，以其穿孔而流脓水与血水，象缸瓮之漏孔故也。 者，如虫豸之穿蠹蛀孔
也。如《巢氏病源》所谓十 、三十六 之说，名虽不同，其理一也，不必悉举。大抵漏有新久，新者带鲜红，
或微肿，或小核。久者上槁，白肉黑烂，淫虫恶臭生焉。丹溪云∶漏疮先须服补养血气药，外用附子饼按疮上，
以艾炷灸之，直至肉平为效。
诸痔疮
痔疮专以凉血为主，参 槐角汤。痔及肠风下血脱肛，槐角丸。翻花痔，荆芥、朴硝煎汤洗，次用木鳖
子、郁金末入龙脑敷；或以熊胆、片脑和匀贴之；或以米醋沃烧红新砖熏之，日三、五次。
参 槐角丸
人参（一钱五分） 黄 （一钱五分） 生地黄（一钱） 川芎（一钱） 当归（一钱二分） 升麻（一钱）
条芩（一钱，炒） 枳壳（一钱，炒） 黄连（一钱，炒） 槐角（一钱）
锉一剂，水煎服。
槐角丸
治诸痔及肠风。
槐角（一两） 防风（五钱，去芦） 地榆（五钱） 当归（五钱） 枳壳（五钱） 黄芩（五钱）
末之，丸，米汤下。
诸漏疮
漏有三十六种，名状极多，而治法则一。丹溪云∶漏须大补气血，人参、白术、黄 、川芎、当归为主，
佐以刺 、蛇蜕、牛角 、蜂房之类，大剂服之。外用附子末，以人津唾和作饼，如钱浓，放疮上，以艾灸之，
令微热，但略觉有微痛即止，每日三、四次，逐次换药饼，直灸至肉平为效。一人原有痔，又于肛边生一块，
皮浓肿痛作脓，就在痔孔中出者，当作食积注下治之，黄连散。
黄连散
痔漏仙方。
黄连（三钱） 阿魏（三钱） 神曲（三钱） 山楂（三钱） 桃仁（三钱） 连翘（三钱） 槐角（三钱）
犀角（三钱）
末之，以少许置掌中，时时舐之，津液咽下。如消，止后服。
【歌诀】气血、脉、肠、牝、牡、虫，这七种痔疮的形态必须精通。有的因为风湿侵袭体表，有的因为醉酒饱食过度导致热邪蕴结于体内。
【论述】医经说：因为饱食过度，导致筋脉松弛横解，肠道发生病变而形成痔疮。大概是因为人的脏腑本来虚弱，外受风湿侵袭，内蕴热毒，加上醉酒饱食、房事不节，多欲自伤身体，因此气血下坠，结聚在肛门处，宿存的积滞不散，冲撞形成痔疮，所以古人有“七痔”的分类。牡痔，是指肛门旁边生疮，露出肉珠，形状像老鼠乳房，时常滴漏溃烂的脓血。牝痔，是指肛门旁边生疮，肿痛出血，疮口反而陷入内部。脉痔，是指肛门周围频繁发作，既疼痛又瘙痒，出血淋漓不断。肠痔，是指肠内有结核肿块，伴有便血，寒热往来，排便时脱肛。血痔，是指每次大便时，清亮的血液随之下泄不止。虫痔，是指肛门浸淫湿烂，里面有蛲虫侵蚀肠道形成疮疡。气痔，是指大便困难，用力努挣时肛门脱出无法收回。这七种痔疮的症状虽然不同，但大体上以清热、凉血、顺气为主要治疗原则。因为热邪会损伤血液，血液受损则经脉阻滞，经脉阻滞则气机运行不畅，气和血都停滞，乘虚下坠进入大肠，所以形成痔疮。凡是各种痔疮长久不愈，必然会导致穿破肠道形成瘘管，这是因痔疮而发展成瘘管的情况，应当用凉血宽肠的方法治疗即可自愈。也有因为外受风寒暑湿四气，内受喜怒忧思悲恐惊七情困扰，以及饮食失常，感染有毒生物（如昆虫等）的毒素，没有不变成疮疡的。如果穿孔很深，脓汁排不尽，遇到寒冷且风邪夹杂其中，就会涓涓流出形成瘘管。所谓“漏”，就是各种疮疡溃破后形成的瘘管。各种“痿”病，比如野狼疳、暴疳、蚁啮疳、蝼蝈疳、砒蜉疳、蜂螫疳、蛴螬疳、蜉蛆疳、转筋疳、瘰疬等。《内经》说：“疳”就是“漏”。所说的“漏”，是因为穿孔流出脓水和血水，就像缸瓮上的漏孔一样。“疳”，就像虫豸穿蛀造成的孔洞一样。如《巢氏病源》中所谓的十疳、三十六疳的说法，名称虽然不同，但道理是一样的，不必全部列举。大体上瘘管有新久之分，新发的瘘管颜色鲜红，或者轻微肿胀，或者有小结节。久病的瘘管上部干枯，白肉变黑腐烂，滋生恶臭的寄生虫。朱丹溪说：治疗瘘疮必须先服用补益养血气的药物，外用附子饼按在疮口上，用艾炷灸它，直到肌肉长平才算见效。
各种痔疮的治疗
痔疮专门以凉血为主，参考参苓槐角汤。痔疮伴有肠风下血、脱肛的，使用槐角丸。翻花痔（痔疮突出如花状），用荆芥、朴硝煎汤清洗，然后使用木鳖子、郁金粉末加入龙脑敷贴；或者用熊胆、片脑（冰片）混合均匀贴敷；或者用米醋浇在烧红的新砖上熏蒸，每天三到五次。
参苓槐角丸方
人参（一钱五分） 黄芪（一钱五分） 生地黄（一钱） 川芎（一钱） 当归（一钱二分） 升麻（一钱） 黄芩（条芩，一钱，炒制） 枳壳（一钱，炒制） 黄连（一钱，炒制） 槐角（一钱）
锉碎成一剂，用水煎服。
槐角丸方
治疗各种痔疮及肠风。
槐角（一两） 防风（五钱，去芦头） 地榆（五钱） 当归（五钱） 枳壳（五钱） 黄芩（五钱）
研成细末，制成丸药，用米汤送服。
各种瘘疮的治疗
瘘管有三十六种，名称和形态极多，但治疗法则是一致的。朱丹溪说：治疗瘘管必须大补气血，以人参、白术、黄芪、川芎、当归为主药，佐以刺蒺藜、蛇蜕、牛角腮、蜂房等类药物，大剂量服用。外用附子末，用人唾液调和做成饼，厚度如铜钱，放在疮口上，用艾灸它，令其微热，只要略微感到有一点疼痛就停止，每天三到四次，每次更换药饼，一直灸到肌肉长平才算见效。有一人原本患有痔疮，又在肛门旁边长了一块，皮肤厚实、肿痛化脓，脓液从痔疮孔中排出，这种情况应当当作食积注下证来治疗，使用黄连散。
黄连散方
痔疮瘘管的仙方。
黄连（三钱） 阿魏（三钱） 神曲（三钱） 山楂（三钱） 桃仁（三钱） 连翘（三钱） 槐角（三钱） 犀角（三钱）
研成细末，取少许放在手掌中，不时舔舐，让津液咽下。如果症状消除，就停止后续服药。
[Verse] Qi, Blood, Mai (Pulse), Chang (Intestinal), Pin (Female), Mu (Male), and Chong (Worm) — the seven types of hemorrhoids must be thoroughly understood. Some arise from Wind-Dampness invading externally; others result from excessive drinking and overeating, leading to Heat accumulation internally.
[Discussion] The Classics state: "Due to overeating, tendons and vessels become slack and disordered, resulting in hemorrhoids." Generally, this occurs because the Zang-Fu organs are originally deficient. External invasion by Wind-Dampness and internal accumulation of Heat-Toxins, combined with excessive indulgence in food, drink, and sexual activity, damage the body. Consequently, Qi and Blood sink downward, knotting and gathering at the anus. Stagnant residues fail to dissipate, colliding to form hemorrhoids. Thus, the ancients categorized them into seven types.
Mu Hemorrhoids (Male Hemorrhoids): Sores appear on the side of the anus, protruding fleshy nodules resembling mouse breasts, frequently dripping pus and blood.
Pin Hemorrhoids (Female Hemorrhoids): Sores appear on the side of the anus with swelling, pain, and bleeding, where the opening tends to recede inward.
Mai Hemorrhoids (Pulse Hemorrhoids): Frequent outbreaks around the anal orifice, accompanied by pain and itching, with continuous dripping of blood.
Chang Hemorrhoids (Intestinal Hemorrhoids): Nodular masses within the intestine, accompanied by blood in stool, alternating chills and fever, and prolapse of the rectum during defecation.
Xue Hemorrhoids (Blood Hemorrhoids): Bright red blood flows continuously with every bowel movement.
Chong Hemorrhoids (Worm Hemorrhoids): The anal area becomes macerated and wet due to erosion by pinworms causing ulcers in the intestines.
Qi Hemorrhoids (Qi Hemorrhoids): Difficulty in defecation; straining forcefully causes the anus to prolapse and fail to retract.
Although the manifestations of these seven types differ, the general treatment principle is to clear Heat, cool Blood, and regulate Qi. Heat injures Blood; injured Blood leads to vessel stagnation; stagnant vessels impede Qi movement. When both Qi and Blood stagnate and sink into the Large Intestine due to deficiency, hemorrhoids form. If various hemorrhoids remain untreated for a long time, they inevitably perforate the intestines, forming fistulas. This type of fistula arising from hemorrhoids can heal itself with treatments that cool Blood and relax the Large Intestine.
Other cases involve external contraction of the Four Qi (Wind, Cold, Summer-heat, Dampness), internal distress from the Seven Emotions, irregular diet, or infection with toxins from venomous creatures. These invariably transform into sores. If the perforation is deep and pus does not drain completely, exposure to cold and Wind pathogens results in a chronic leaking fistula. "Lou" (Fistula) refers to the ulceration of various sores. Various "Gan" (Canker/Sores) include conditions like Wolf Gan, Violent Gan, Ant-biting Gan, Mole Cricket Gan, Arsenic Beetle Gan, Bee-sting Gan, Maggot Gan, Fly Larva Gan, Tetanus Gan, and Scrofula. The *Neijing* states: "Gan is equivalent to Lou." It is called "Lou" because it perforates and leaks pus and bloody fluid, resembling a leak in a jar or urn. "Gan" resembles holes bored by insects. As described in *Chao Shi Bing Yuan*, there are Ten Gans and Thirty-Six Gans; although names differ, the underlying principles are identical, so they need not all be listed.
Generally, fistulas are classified as new or old. New fistulas are bright red, slightly swollen, or have small nodules. Old fistulas have dry upper edges, blackened necrotic flesh, and emit foul odors with parasitic growth. Zhu Danxi stated: For fistula sores, one must first administer herbs to tonify and nourish Qi and Blood. Externally, apply a slice of Aconite cake onto the sore and moxa it until the tissue levels out.
Treatment of Various Hemorrhoids
Hemorrhoids are primarily treated by cooling Blood. Refer to Shen Ling Huai Jiao Tang. For hemorrhoids with intestinal wind and bleeding, along with rectal prolapse, use Huai Jiao Wan. For "Fan Hua" hemorrhoids (prolapsed, flower-like hemorrhoids), wash with a decoction of Jing Jie and Po Xiao. Then apply a powder of Mu Bie Zi and Yu Jin mixed with Long Nao (Borneol). Alternatively, apply a mixture of Xiong Dan (Bear Gallbladder) and Pian Nao (Ice Borneol). Or, fumigate with vinegar poured over a newly fired red-hot brick, three to five times daily.
Shen Ling Huai Jiao Wan Formula
Ren Shen (1.5 qian), Huang Qi (1.5 qian), Sheng Di Huang (1 qian), Chuan Xiong (1 qian), Dang Gui (1.2 qian), Sheng Ma (1 qian), Tiao Qin/Coptis (1 qian, stir-fried), Zhi Ke (1 qian, stir-fried), Huang Lian (1 qian, stir-fried), Huai Jiao (1 qian).
Grind into one dose, decoct in water, and take orally.
Huai Jiao Wan Formula
Treats various hemorrhoids and intestinal wind.
Huai Jiao (1 liang), Fang Feng (5 qian, remove rhizome), Di Yu (5 qian), Dang Gui (5 qian), Zhi Ke (5 qian), Huang Qin (5 qian).
Grind into fine powder, make into pills, and swallow with rice broth.
Treatment of Various Fistulas
There are thirty-six types of fistulas with numerous names and presentations, but the treatment principle remains consistent. Zhu Danxi stated: Treating fistulas requires substantial tonification of Qi and Blood. Use Ren Shen, Bai Zhu, Huang Qi, Chuan Xiong, and Dang Gui as main herbs, supplemented by Ci Ji Li, She Tui (Snake Slough), Niu Jiao Sai (Buffalo Horn Sponge), and Feng Fang (Honeycomb). Administer in large doses. Externally, use Huang Fu (Aconite) powder mixed with human saliva to form a cake the thickness of a coin. Place on the sore and moxa until mildly warm. Stop when slight pain is felt. Apply three to four times daily, changing the cake each time, until the tissue levels out.
Case: A patient with existing hemorrhoids developed a mass beside the anus. The skin was thick, swollen, painful, and suppurated, draining through the hemorrhoid hole. This should be treated as Food Stagnation sinking downward, using Huang Lian San.
Huang Lian San Formula
A miraculous formula for hemorrhoids and fistulas.
Huang Lian (3 qian), A Wei (3 qian), Shen Qu (3 qian), Shan Zha (3 qian), Tao Ren (3 qian), Lian Qiao (3 qian), Huai Jiao (3 qian), Xi Jiao (3 qian).
Grind into powder. Take a small amount, place in the palm, lick occasionally, and swallow with saliva. Discontinue if symptoms resolve.