\r痔疮\p04-a41a180.bmp\r
陈实功曰∶夫痔者，乃素有湿热，过
食炙 ，或因久坐而血脉不行；又有七情，过伤生冷，以及担轻负重，竭力远行，气血纵横，经络交错；又或酒色过度，
肠胃
受伤，以致浊气瘀血流注肛门；又有妇人临产用力过甚，血逆肛门，亦能致此。初起为痔，久则成漏。（《正宗》）
陈远公曰∶人肛门内外四旁忽生红瘰，先痒后疼，后成为痔。日久不愈，此用湿热所致也。而得之纵饮者为多，江
南人常
多患此，皆由地之湿热，加之酒热之毒，所以结于肛门不能遽化也。夫肛门通于大肠，
凡有湿热应随大便同出，何以积而成痔？盖湿在大汤，不能久留，必尽趋肛门，而肛门为大肠锁钥，有防范之司，不容
湿热出
于门外，于是蓄积既久，而湿热之毒肛门独受之矣。有毒必然外形，不生肛门之内，必生肛门之外，虽内外少殊，而作
楚
则一也。治法乌可舍湿热而他求乎！但肛门去脾胃甚远，化湿热之毒，必假道于脾胃，肛门未必受益，而脾胃先损，所
以无
功耳。故用药必须毋损于脾胃，有益于肛门者，始可奏功。益后汤治之∶白芍、茯苓、山药、薏仁各一两，地榆三钱，
穿山甲
一片土炒，水煎服，四剂肛门宽快，又四剂内外痔消，再以此方十倍蜜丸，每日开水下五钱，服完一料不再发。（《冰鉴》。
此方利水去
湿，既无损于脾胃，又有益于脾与肛门两得也。）
又曰∶有肛门边先生小疖，因不戒酒色，以致腐烂变成痔漏，不能收口，长成肉管，每年一管，
流脓淌血，甚以为苦。世人治法多用刀针挂线，徒受苦楚而内毒未除，外口难长，经年累月，难以奏功，岂
漏疮终不可治乎？抑犯酒色之戒乎？皆治不得法耳。夫肛门之肉，不比他处，肛门
之皮，亦不比他处，他处肌肉非横生即直生，惟肛门肌肉有纵有横，最难生合，况
大便不时出入，加以刀针挂线是已伤又伤，安能遽长皮肉乎！故刀针挂线，切戒轻试，
惟消湿热之毒内治为佳，然漏卮既久，勿论漏不可止，而气血反伤，终难奏效也。当
于补中兼消，则何患漏之不痊哉！青龟丸∶乌龟一个，茯苓五两，黄 八两，当归三
两，人参二两，薏仁六钱，穿山甲五钱土
炒，瓦松二条，阴干不可见火，白芷、槐米、干青苔各一两，羊蹄后爪四副，土炒，
研末。将龟石臼内捣死，以药末拌之，饭锅内蒸熟，将龟肉与甲火焙干为末，同前
药蜜丸，每日服三钱。一月漏痔干，二月漏痔满，服完全愈不复发。但服丸时，必
戒酒色三月，倘犯之不能奏功。（此方治漏神效，非俗方可比，有不可思议之炒，去湿而不散气，败毒又
不损血，补破于无形，填隙于有孔，愿人敬信此方，坚三月之戒，以去宿疾也。）
又曰∶有大便时，先射血几许，始下粪者，人以为便血证，谁知肛门暗生血痔
乎！夫痔久必变漏，宜流脓血，殊不知受病不同，见证亦异，此多得过饮火酒，热
走直肠而不得遽泄，乃结成小痔，久则皮破血出，此血乃外出直肠之外，非出直肠
之中，乃膀胱之血也。夫膀胱化气而不化血，酒毒渗入膀胱，将酒气化水出于阴器，
而酒毒烁血不能从阴器而出，不得趋大肠肛门而出矣。无奈门径各别，户口牢闭，无
可出路，而酒毒结直肠之外，毒向内攻而直肠之痔生矣。痔生必破，有隙可乘，而
膀胱之血注之，久则以血引血，不但膀胱之血尽归之也，乘大便之开关，血先夺门
而出耳。治当急填其隙，使血出而无路，然私窦既开，漏卮易泄，不急清上游之源，而
但截下流之隙，非计之善也。清源散∶黄连、槐花、地榆、人参各三钱，茯苓、白
术各五钱，车前子、葛根各三钱，白芷三分，穿山甲土炒一钱，研末，三七根研末
三钱，水煎调末服，三剂血较前更多，减去黄连，又三剂血止痔愈。必须戒酒，终
身勿服也。若女色只忌三月，永不再发。倘不能禁，不必徒治渎吾方也。此方炒在多
用黄连以解酒热之毒，所谓清源也。上游无病，下流自安，各药又分派得宜，无非
去湿化热，堵截有方，故庆平成，何患洪流冲决哉。
蒋示吉曰∶痔类不一，有牛奶痔、鸡心痔、鸡冠痔、菱角痔、莲花痔、珍珠痔、
珊瑚痔、蜂窝痔、鸡肝痔、翻花痔、穿肠痔、鼠奶痔、樱桃痔、鼠尾痔、核桃痔、蚬
肉痔、内痔、外痔，因形定名，总不外乎醉饱入房，膏粱醇酒，负重致远，以致湿
热风燥，浊气瘀血流注肛门，俱能生痔。妇人产后用力太过，瘀血凝滞，亦能致此。毒
浅者其形正而平常，毒深者其形异而顽恶。久则崩溃成漏，新则坠重刺疼，甚者粪从
孔出，血自窍流。气血日亏，形容日削，治法当以凉血行气为主，其外治法，须分内
外，内痔以唤痔、枯痔之法治之，外痔疼甚者清之，头大蒂小者线结之，头小根大者枯之。（《说约》）
又曰∶凡疮久不收口，日流脓水，甚而医家任意以纸捻 入，日逐磨 ，渐生
脓管，如灯草葱管，遂名曰漏证。此皆气血亏损，热毒郁结，使荣卫营运而失职也。
遍身虚怯处多有之，惟痔疮成漏最易。若用刀针挂线，徒受痛楚，不若以推车客散
内消之为妙也。内服十全大补汤、补中益气汤以培助之。
冯鲁瞻曰∶痔漏其名有五∶曰牡，曰牝，曰气，曰血，曰酒。又有肠风痔、脉
痔、雌雄痔，皆五痔之别名也。初生具在肛边，状如鼠乳，或结小核，痒痛注闷，甚
者身热恶寒，皆由房劳饮酒过度，久嗜甘肥，不慎醉饱，以致阴阳劳挠血脉，肠
渗漏，冲注下部而成。治法，始觉便服秦艽、槐角、连翘、土贝之类，外用熏洗以
取内消，倘仍姿情嗜欲，则腐溃脓血，逗留日久，傍穿窍穴，即变为漏。必须补气
血，慎调摄，方可以渐收功。（《锦囊》）
又曰∶痔者，肛门之傍生疮肿痛者是也。亦有生疮有孔，恶水不干，而为漏者。
皆由母食酒面 炙，在胎受之，或因后天失调，心经蕴热，热传于肺，注于大肠而
成者。治小儿痔疮，宜内服凉血解毒，外用熏洗可也。
又曰∶痔漏之源，受病者，燥气也，为病者，湿热也。皆由酒色过度，湿而生热，
充于脏腑，溢于经络，坠乎谷道左右，冲突为痔。虽见证于大肠，实阴虚而火实所
致，经所谓开窍于二阴，久则溃而成漏。然痔轻而漏重，痔实而漏虚。治痔不过凉血
清热，治漏初则凉血清热燥湿，久则涩窍杀虫，兼乎温散。或曰痔漏，火是根源，何
故而用湿涩？殊不知痔只出血，始终是热，漏流脓水，始是湿热，终是湿寒，不用温
药，何以去湿而散寒乎！非止痔漏，百病中多有始热而终寒者，即如泻利呕吐，初
则肠胃气实而热，久则肠胃虚为寒。丹溪下血条云∶下血久不愈者，后用温剂，正此义也。
朱丹溪曰∶漏疮须先服补药生气血，参、术、 、归为主大剂服之，随以附子
末唾和作饼如钱浓，以艾炙之，漏大炷大，漏小炷小，灸令微热，不可使痛，干则易
饼再灸，如困则止，来日又灸，直至肉平为效。亦有用附子片灸，仍用前补剂膏贴之，尤妙。（治漏法。）
李东垣曰∶肠头成块者，湿也；作大痛者，风也；大便燥结者，兼受火热也。是
湿热风燥四气合邪，法当泻火润燥，疏风和血止痛，是其治也。（《十书》）
冯鲁瞻曰∶痔漏初起，须用芩、连之类，以凉大肠，枳壳以宽大肠。涩窍用赤
白石脂、枯矾、黄丹、脑子之类。（《锦囊》）
又曰∶痔漏若能味无味之味，正味足矣，事无事之事，百事备矣。若服饵调节
谨慎合宜，未有不瘥者也，若不知谨慎，强治无功。
窦汉卿曰∶大法治痔以凉血为主，如肛旁别有一窍出脓血，名曰单漏。治之宜
温暖之剂补其内，生肌之药敷其外。
窦梦麟曰∶窍在皮肤者易愈，脏腑有损而致窍者，未易治也。
《养生必效方》载∶干义传，僧觉海少年患痔疾，其行业比冰霜，缘此饱食久坐，
知痔疾者，不必酒色过度矣。故《素问》云∶因而饱食，筋脉横解，肠 为痔。三神丸
治僧道痔疾，故治有不同也。
岐天师曰∶人有粪门内拖出一条，似蛇非蛇，或进或出，便粪之时，又安然无
碍，此乃大肠湿热之极，生此怪物，长于直肠之间，非蛇也乃肉也。但伸缩如意，又
似乎蛇，法当用逐邪杀蛇丹服之，外用好木耳一两煎汤洗之，洗后用冰片一分，研
末扫上，扫尽即缩进而愈，神验。（《秘录》）
澄曰∶治痔漏鹳口等证，患者欲坐不能，须用定铺极浓芦花坐垫，中开一洞，将
患处坐向洞中，自无压挤伤疮之患。
陈实功说：所谓痔，是因为患者素来体内有湿热，又因过量食用烧烤炙烤的食物，或者因为长时间久坐导致血脉运行不畅；也有因七情内伤、过度食用生冷食物，以及挑担负重、竭力远行，导致气血紊乱、经络交错；还有因酒色过度，损伤肠胃，致使浊气和瘀血流注到肛门部位；又有妇女分娩时用力过猛，血液逆乱于肛门，也能导致此病。初期表现为痔，日久则演变为漏。（《外科正宗》）
陈远公说：人的肛门内外及四周忽然生出红色肿块，先痒后痛，随后形成痔。日久不愈，这是由湿热引起的。其中因纵欲饮酒而得病的居多，江南人常患此病，都是由于当地气候湿热，加上饮酒产生的热毒，所以结聚在肛门处不能迅速化解。肛门与大肠相通，凡是有湿热应当随大便一同排出，为何会积聚而成痔呢？这是因为湿气在大肠中不能久留，必然全部趋向肛门，而肛门是大肠的门户关口，有防范的功能，不允许湿热从门外随意排出，于是蓄积久了，湿热的毒邪便独自在肛门受之。有毒邪必然表现在外形上，不会生在肛门内部，一定生在肛门外部，虽然内外略有不同，但造成的痛苦是一样的。治疗法则怎么能舍弃湿热而从其他方面寻求呢！只是肛门距离脾胃很远，化解湿热的毒邪，必须借助脾胃的功能，如果肛门未必受益，反而先损伤了脾胃，所以往往无效。因此用药必须不损伤脾胃，又能有益于肛门的，才能见效。益后汤治疗此症：白芍、茯苓、山药、薏苡仁各一两，地榆三钱，穿山甲一片（土炒），水煎服，服用四剂后肛门感到宽松舒适，再服四剂内外痔消退，接着将此方制成十倍量的蜜丸，每日用开水送服五钱，服完一料药不再复发。（《辨证录》。此方利水祛湿，既无损于脾胃，又有益于脾脏和肛门两全其美。）
又说：有肛门旁边先生小疖子，因为不戒除酒色，导致腐烂变成痔漏，伤口不能愈合，长成肉管，每年一根管子流脓淌血，非常痛苦。世人治疗方法多用刀针挂线，徒然受苦楚而体内的毒邪未除，外口难以生长，经年累月，难以见效，难道漏疮终究不可治吗？还是必须犯酒色之戒呢？这都是治疗不得法罢了。肛门的肌肉，不同于身体其他部位，肛门的皮肤，也不同于其他部位，其他处的肌肉非横生即直生，只有肛门处的肌肉有纵有横，最难愈合，况且大便不时出入，再加上刀针挂线是已经受伤又再次受伤，怎么能让皮肉迅速生长呢！所以刀针挂线，切忌轻易尝试，只有消除湿热的毒邪进行内治才是上策，然而漏孔既然存在已久，不论漏孔能否止住，气血反而受损，终究难见效效。应当在补益的同时兼以消导，还担心漏疮不能痊愈吗！青龟丸：乌龟一只，茯苓五两，黄柏八两，当归三两，人参二两，薏苡仁六钱，穿山甲五钱（土炒），瓦松两条（阴干，不可见火），白芷、槐米、干青苔各一两，羊后蹄爪四副（土炒），研成末。将龟放在石臼中捣死，用药物粉末拌合，在饭锅内蒸熟，将龟肉和龟甲用火焙干研成末，同前面的药粉混合，用蜂蜜做成丸药，每日服用三钱。一个月后漏痔干枯，两个月后漏痔填满，服完全疗程痊愈且不复发。但在服用丸药期间，必须戒除酒色三个月，如果犯了就不能见效。（此方治疗漏疮神效，不是普通方剂能比的，有不可思议的功效，祛湿而不耗散正气，败毒又不损伤血液，在无形中修补破损，在有孔处填补缝隙，希望人们敬信此方，坚持三个月的禁忌，以去除宿疾。）
又说：有大便时，先喷射出一些血，然后才排便的人，人们以为是便血证，谁知道是肛门暗生血痔呢！痔日久必然变成漏，应该流脓血，殊不知病因不同，症状表现也不同，这大多是因为过量饮用烈性酒，热气走窜直肠而不能迅速宣泄，于是结成小痔，日久皮肤破裂出血，这种血是从直肠外面流出，而不是从直肠里面流出，实际上是膀胱的血。膀胱主化气而不化血，酒毒渗入膀胱，将酒气化成的水从生殖器排出，而酒毒灼烧血液不能从生殖器排出，又不能趋向大肠肛门排出。无奈门径各自有别，户口牢闭，没有出路，酒毒结聚在直肠外面，毒邪向内攻冲，直肠的痔就生成了。痔生成必然破裂，有了空隙可乘，膀胱的血注入其中，日久以血引血，不仅膀胱的血全部归于此，趁着大便开关之际，血先夺门而出。治疗应当紧急填补空隙，使血流出无路，然而私窦既然已开，漏孔容易泄泻，如果不紧急清理上游的源头，只是截断下流的空隙，不是好的计策。清源散：黄连、槐花、地榆、人参各三钱，茯苓、白术各五钱，车前子、葛根各三钱，白芷三分，穿山甲（土炒）一钱，研成末，三七根研末三钱，水煎调服粉末，服用三剂后血量比之前更多，减去黄连，再服三剂血止痔愈。必须戒酒，终身不要服用酒类。如果是女色只忌三个月，永不再发。如果不能禁止，不必徒劳地治疗我的方子了。此方炒制多用黄连以解酒热之毒，这就是所谓的“清源”。上游没有病，下流自然安宁，各药分配得当，无非是去湿化热，堵截有方，所以平安达成，何必担心洪流冲决呢。
蒋示吉说：痔的种类不一，有牛奶痔、鸡心痔、鸡冠痔、菱角痔、莲花痔、珍珠痔、珊瑚痔、蜂窝痔、鸡肝痔、翻花痔、穿肠痔、鼠奶痔、樱桃痔、鼠尾痔、核桃痔、蚬肉痔、内痔、外痔，根据形状命名，总不外乎醉酒后入房事、食用膏粱醇酒、负重致远，导致湿热风燥，浊气瘀血流注肛门，都能生痔。妇女产后用力太过，瘀血凝滞，也能导致此病。毒邪浅的形态端正平常，毒邪深的形态怪异顽恶。日久则崩溃成漏，新发的则坠重刺痛，严重的粪便从孔洞排出，血液从窍道流出。气血日渐亏损，形体日渐消瘦，治疗法则应当以凉血行气为主，其外治法，须分内外，内痔用唤痔、枯痔法治之，外痔疼痛剧烈的用清热法，头大蒂小的用线结扎法，头小根大的用枯痔法。（《疡医说约》）
又说：凡是疮口日久不收敛，每日流脓水，甚至医生任意用纸捻插入，每日摩擦，逐渐生出脓管，像灯草葱管一样，遂命名为漏证。这都是气血亏损，热毒郁结，使营卫运行失职所致。遍身虚弱之处多有发生，惟独痔疮成漏最容易。如果用刀针挂线，徒受痛苦，不如以内服推车客散消散为妙。内服十全大补汤、补中益气汤以培补助益。
冯鲁瞻说：痔漏的名称有五类：曰牡，曰牝，曰气，曰血，曰酒。又有肠风痔、脉痔、雌雄痔，都是五痔的别名。初生都在肛门旁边，形状像鼠乳，或结成小核，痒痛闷胀，严重的身体发热恶寒，都是由房劳饮酒过度，长期嗜好甘甜肥腻，不慎醉酒饱食，导致阴阳劳损血脉，肠道渗漏，冲注下部而成。治疗法则，刚开始觉得不适就服用秦艽、槐角、连翘、土贝母之类，外用熏洗以求内消，如果仍然放纵情欲嗜欲，则腐溃脓血，逗留日久，旁穿窍穴，即刻变为漏。必须补益气血，谨慎调养摄生，才可以逐渐收效。（《疡医锦囊》）
又说：痔，是指肛门旁边生疮肿痛的情况。也有生疮有孔，恶水不干，成为漏的。都是由母亲怀孕时食用酒面炙烤之物，在胎中受之，或因后天失调，心经蕴藏热毒，热传于肺，注于大肠而成。治疗小儿痔疮，宜内服凉血解毒，外用熏洗即可。
又说：痔漏的根源，致病者是燥气，发病者是湿热。皆由酒色过度，湿而生热，充塞脏腑，溢于经络，坠落于谷道左右，冲突形成痔。虽然症状表现在大肠，实际上是阴虚而火实所致，经书所说“开窍于二阴”，日久则溃烂而成漏。然而痔轻而漏重，痔实而漏虚。治疗痔不过凉血清热，治疗漏初期则凉血清热燥湿，日久则涩窍杀虫，兼用温散。有人说痔漏，火是根源，为什么用湿涩之法？殊不知痔只出血，始终是热，漏流脓水，开始是湿热，终局是湿寒，不用温药，怎么能去湿散寒呢！不止痔漏，百病中多有始热而终寒的，就像腹泻呕吐，起初肠胃气实而热，日久肠胃虚而为寒。丹溪在下血条文中说：下血久不愈者，后用温剂，正是这个意思。
朱丹溪说：漏疮必须先服用补药生气血，人参、白术、[空缺]、当归为主的大剂量服用，随后用附子末唾沫调和作饼如铜钱厚，用艾炷灸之，漏大炷大，漏小炷小，灸至微热，不可使疼痛，干了则换饼再灸，如果困倦则停止，第二天再灸，直到肉平为止。也有用附子片灸，仍用前面的补剂膏药贴敷，尤其奇妙。（治疗漏疮的方法。）
李东垣说：肠头成块的，是湿邪；产生剧烈疼痛的，是风邪；大便干燥结硬的，是兼受火热。这是湿热风燥四种邪气合而为病，治法应当泻火润燥，疏风和血止痛，这是它的治疗法则。（《东垣十书》）
冯鲁瞻说：痔漏初起，须用黄芩、黄连之类，以凉大肠，枳壳以宽大肠。涩窍用赤白石脂、枯矾、黄丹、冰片之类。（《疡医锦囊》）
又说：痔漏如果能品味无味之味，正味就足够了，做事不做无事之事，百事都具备了。如果服药饮食调节谨慎合宜，没有不痊愈的，如果不知道谨慎，强行治疗也无功。
窦汉卿说：大法治痔以凉血为主，如果肛门旁边另有一个窍道流出脓血，名叫单漏。治疗宜用温暖之剂补其内，生肌之药敷其外。
窦梦麟说：窍在皮肤上的容易治愈，脏腑有损而导致窍道的，不容易治愈。
《养生必效方》记载：干义传，僧人觉海年轻时患痔疾，他的品行比冰霜还高洁，因为此病是由于饱食久坐导致的，知道痔疾的人，不一定非要酒色过度才行。所以《素问》说：因而饱食，筋脉横解，肠澼为痔。三神丸治疗僧道人的痔疾，所以治疗有所不同。
岐天师说：有人粪门内拖出一条，似蛇非蛇，或进或出，排便时又安然无碍，这是大肠湿热之极，生出此怪物，长于直肠之间，不是蛇而是肉。但伸缩如意，又似乎蛇，治法应当用逐邪杀蛇丹内服，外用上好木耳一两煎汤清洗，洗后用冰片一分，研末扫在上面，扫尽即缩进而愈，神验。（《疡医秘录》）
顾澄说：治疗痔漏鹳口等证，患者想坐不能坐，须用定铺极浓芦花坐垫，中间开一个洞，将患处坐在洞中，自然没有压挤伤疮的祸患。
Hemorrhoids
Chen Shigong stated: Hemorrhoids arise from a pre-existing condition of damp-heat in the body, excessive consumption of roasted or grilled foods, or prolonged sitting leading to stagnant blood circulation. They can also result from emotional disturbances (Seven Emotions), excessive intake of raw and cold foods, carrying heavy loads, or strenuous long-distance travel, causing chaotic Qi and blood and interlaced meridians. Additionally, excessive indulgence in alcohol and sexual activity damages the intestines and stomach, allowing turbid Qi and stasis to flow into the anus. Women may also develop this condition due to excessive exertion during childbirth, causing blood to reverse into the anus. Initially presenting as hemorrhoids, if left untreated for a long time, they evolve into fistulas (Zhenzong).
Chen Yuan Gong stated: Red nodules suddenly appear inside, outside, and around the anus, starting with itching followed by pain, eventually forming hemorrhoids. Chronic non-healing cases are caused by damp-heat. This is most common among those who indulge in drinking; people in Jiangnan frequently suffer from it due to local damp-heat combined with the toxicity of alcohol heat, which accumulates in the anus and cannot dissipate quickly. The anus connects to the large intestine; damp-heat should normally exit with stool. Why does it accumulate? Dampness cannot stay long in the large intestine but flows entirely toward the anus. The anus acts as the lock and key of the large intestine, preventing damp-heat from escaping freely. Thus, after long accumulation, the toxic damp-heat is borne solely by the anus. Toxicity must manifest externally, not internally within the anus, so it appears on the outside. Though internal and external presentations differ slightly, the suffering is the same. How can treatment ignore damp-heat? However, the anus is far from the Spleen and Stomach. Resolving damp-heat toxicity requires passing through the Spleen and Stomach; if the anus benefits little while the Spleen and Stomach are damaged first, treatment fails. Therefore, medicines must not harm the Spleen and Stomach but benefit the anus to be effective. Yihou Tang treats this: Bai Shao (White Peony Root), Fu Ling (Poria), Shan Yao (Chinese Yam), Yi Ren (Coix Seed) each 1 liang, Di Yu (Sanguisorba Root) 3 qian, Chuan Shan Jia (Pangolin Scale) 1 slice (soil-fried), decocted in water and taken orally. After four doses, the anus feels relaxed; after another four doses, internal and external hemorrhoids disappear. Then, make pills ten times the dose with honey, taking 5 qian daily with warm water. One course prevents recurrence (Bingjian). This formula promotes urination and removes dampness, benefiting both the Spleen and the anus without harming them.
He further stated: A small boil may appear at the edge of the anus. If one does not abstain from alcohol and sex, it rots and becomes a hemorrhoidal fistula that cannot close, forming a flesh tube. Each year, a tube forms, discharging pus and blood, causing great suffering. People often treat this with knives, needles, and hanging threads, enduring pain while internal toxins remain, making external healing difficult over years. Are fistulas incurable, or must one abstain from alcohol and sex? It is merely improper treatment. Anal tissue differs from other parts; its muscles run both longitudinally and transversely, making healing hardest. Frequent bowel movements plus knife/needle/thread treatments cause repeated injury, hindering rapid tissue growth. Thus, avoid knives and threads lightly. Internal treatment to eliminate damp-heat toxicity is best. However, for chronic fistulas, even if bleeding stops, Qi and Blood are damaged, making efficacy low. Treatment should combine tonification with elimination. Qing Gui Wan: One turtle, Fu Ling 5 liang, Huang Bo (Phellodendron Bark) 8 liang, Dang Gui (Angelica Sinensis) 3 liang, Ren Shen (Ginseng) 2 liang, Yi Ren 6 qian, Chuan Shan Jia 5 qian (soil-fried), Wa Song (Cladonia) 2 strips (air-dried, no fire), Bai Zhi (Angelica Dahurica), Huai Mi (Sophora Flower), Gan Qing Tai (Dry Moss) each 1 liang, four sheep hind hooves (soil-fried). Pound the turtle in a stone mortar, mix with powder, steam in a rice cooker. Dry the meat and shell, grind to powder, mix with previous powders, form honey pills. Take 3 qian daily. In one month, the fistula dries; in two months, it fills. Complete cure follows. Abstain from alcohol and sex for three months during treatment; otherwise, it fails. This formula is miraculous for fistulas, removing dampness without dispersing Qi, defeating toxins without damaging Blood, repairing invisibly, and filling holes effectively.
He also stated: Some patients spray a little blood before defecation. Laypeople think it is hematochezia, but it is actually hidden blood hemorrhoids. Long-standing hemorrhoids become fistulas discharging pus and blood. However, different causes yield different symptoms. This case often results from excessive strong wine, where heat travels to the rectum but cannot vent quickly, forming small hemorrhoids. Later, skin breaks, and blood exits from outside the rectum, specifically from the Bladder. The Bladder transforms Qi, not Blood. Wine toxin enters the Bladder; wine-Qi turns to water and exits via the genitalia, but wine-toxin scorched blood cannot exit there nor flow to the large intestine/anus. With blocked pathways, wine-toxin accumulates outside the rectum, attacking inward, generating rectal hemorrhoids. Once broken, the Bladder's blood flows in. Over time, blood attracts blood, and during defecation, blood bursts out. Treatment must urgently fill the gap to block blood exit. However, since the channel is open, simply blocking the lower outlet is insufficient. One must clear the upper source. Qingyuan San: Huang Lian (Coptis), Huai Hua (Sophora Flower), Di Yu, Ren Shen each 3 qian, Fu Ling, Bai Zhu (Atractylodes Macrocephala) each 5 qian, Che Qian Zi (Plantago Seed), Ge Gen (Kudzu Root) each 3 qian, Bai Zhi 3 fen, Chuan Shan Jia 1 qian (soil-fried), all ground. Mix with San Qi (Notoginseng) powder 3 qian. Decoct and take with powder. After three doses, bleeding increases; remove Huang Lian. After three more doses, bleeding stops and hemorrhoids heal. Must abstain from alcohol lifelong. For sexual abstinence, three months suffices to prevent recurrence. If unable to abstain, do not use my formula. This formula uses much Huang Lian to resolve wine-heat toxicity, clearing the source. If the source is healthy, the flow is safe.
Jiang Shiji stated: Hemorrhoids vary in type: Milk Hemorrhoid, Chicken Heart Hemorrhoid, Chicken Comb Hemorrhoid, Water Chestnut Hemorrhoid, Lotus Hemorrhoid, Pearl Hemorrhoid, Coral Hemorrhoid, Honeycomb Hemorrhoid, Chicken Liver Hemorrhoid, Fan-flower Hemorrhoid, Intestinal-Piercing Hemorrhoid, Rat Milk Hemorrhoid, Cherry Hemorrhoid, Rat Tail Hemorrhoid, Walnut Hemorrhoid, Clam Meat Hemorrhoid, Internal Hemorrhoid, External Hemorrhoid. Names are based on shape. Causes include post-coital indulgence, rich food and alcohol, carrying heavy loads, leading to damp-wind-heat-dryness, turbid Qi, and stasis flowing to the anus. Postpartum women with excessive exertion and blood stasis also get this. Mild toxicity has normal shapes; deep toxicity has abnormal, stubborn shapes. Long-term leads to fistulas; new onset causes heaviness and stabbing pain. Severe cases have feces exiting pores and blood flowing from orifices. Qi and Blood decline daily. Treatment focuses on cooling Blood and moving Qi. External treatment distinguishes internal and external: Internal hemorrhoids treated with "Awakening" and "Withering" methods; painful external hemorrhoids cleared; large-head/small-stalk ones ligated; small-head/large-base ones withered (Shuoyue).
He further stated: Sores that do not heal for a long time discharge pus daily. Doctors inserting paper wicks cause friction, forming pus tubes like rush stems, named Fistula Syndrome. This is due to Qi and Blood deficiency and heat-toxin stagnation disrupting Ying and Wei circulation. It occurs in weak areas of the body, especially easily in hemorrhoidal fistulas. Knife/thread treatments cause pain; internal dissolution with Tuche Ke San is better. Tonify with Shiquan Dabu Tang and Buzhong Yiqi Tang.
Feng Luzhan stated: Five names for hemorrhoids/fistulas: Male (Mu), Female (Pin), Qi, Blood, Wine. Also Intestinal Wind Hemorrhoid, Pulse Hemorrhoid, Yin-Yang Hemorrhoid are aliases. Initial stage: lumps near anus like rat milk or small nodes, itchy/painful/distended. Severe cases have fever/chills. Causes: sexual fatigue, alcohol excess, sweet/greasy diet, drunkenness. These damage Yin-Yang and vessels, causing intestinal leakage to the lower body. Early treatment: Qin Jiao, Huai Jiao, Lian Qiao, Tu Bei Mu. External fumigation/washing for internal resolution. If desires continue, rotting/pus/blood occur, penetrating orifices to become fistulas. Must tonify Qi/Blood and regulate lifestyle gradually.
He also stated: Hemorrhoids are sores/swelling/pain near the anus. Fistulas have sores with holes, weeping fluid. Causes: maternal diet of alcohol/noodles/roasted food in utero, or postnatal imbalance causing Heart Heat transmitting to Lung, then Large Intestine. Pediatric hemorrhoids: internal cooling Blood/detoxifying, external fumigation/washing.
He further stated: Origin of hemorrhoids/fistulas: Pathogenic factor is Dryness; Disease manifestation is Damp-Heat. Caused by alcohol/sex excess, dampness generating heat, filling organs/meridians, dropping to the anal region, conflicting to form hemorrhoids. Though appearing in Large Intestine, it is actually Yin Deficiency with Fire Excess. Orifices open to the two yin; long-term ulceration becomes fistula. Hemorrhoids are mild/solid; Fistulas are severe/deficient. Treat hemorrhoids by cooling Blood/clearing Heat. Treat fistulas initially by cooling Blood/clearing Heat/drying Dampness; later by astringing orifices/killing parasites/warming dispersing. Some say Fire is the root, why use drying/astringent? Hemorrhoids bleed (always Heat); Fistulas discharge pus (initially Damp-Heat, finally Damp-Cold). Without warming herbs, how to dispel Cold? Many diseases start Hot and end Cold (e.g., diarrhea/vomiting starts Intestine/Stomach Excess-Heat, ends Deficiency-Cold). Danxi noted: Chronic bleeding treated later with warming agents confirms this.
Zhu Danxi stated: Fistulas require initial tonification to generate Qi/Blood using large doses of Ren Shen, Bai Zhu, [missing], Dang Gui. Then apply Moxibustion with Aconite cakes (Aconite powder mixed with saliva, coin-thick). Large fistula/large moxa cone; small fistula/small cone. Moxa until slightly warm, not painful. Replace when dry. Stop if tired, resume next day until flesh levels. Alternatively, use Aconite slices with tonic paste.
Li Dongyuan stated: Intestinal mass = Dampness; Severe pain = Wind; Dry stool = Fire-Heat. Four pathogens (Damp, Heat, Wind, Dryness) combine. Treatment: Purge Fire, moisten Dryness, soothe Wind, harmonize Blood, stop pain.
Feng Luzhan stated: Early hemorrhoids/fistulas: Huang Qin, Huang Lian to cool Large Intestine; Zhi Qiao to widen Large Intestine. Astringent orifices: Chi Shi Zhi, Bai Shi Zhi, Ku Fan, Huang Dan, Bing Pian.
He also stated: To cure hemorrhoids/fistulas, taste the flavorless, do the effortless. Careful regulation ensures recovery; negligence makes treatment futile.
Dou Hanqing stated: Main treatment cools Blood. If an extra orifice near anus discharges pus/blood, it is Single Fistula. Treat internally with warming tonics, externally with flesh-generating ointments.
Dou Menglin stated: Orifices in skin heal easily; those from organ damage are hard to treat.
Yangsheng Bixiao Fang recorded: Monk Jiehai had hemorrhoids despite high moral conduct, caused by overeating and sitting too long. *Suwen* states: Overeating relaxes sinews/vessels, causing intestinal hemorrhoids. Sanshen Wan treats monk/Daoist hemorrhoids differently.
Qi Tian Shi stated: A snake-like protrusion from the anus, entering/exiting, painless during defecation, is extreme Large Intestine Damp-Heat creating flesh (not snake) in the rectum. Treat with Zhuxie Sheshedan internally. Externally wash with 1 liang Good Black Fungus decoction. Apply Bing Pian powder after washing. Shrinks and heals miraculously.
Cheng stated: For hemorrhoids/fistulas/Guan Kou lesions where sitting is impossible, use a thick reed-flower cushion with a central hole. Sit with the lesion in the hole to avoid pressure injury.