丹溪曰∶妇人崩中者，由脏腑伤损、冲任二脉血气俱虚故也。若劳动过极，脏腑俱伤，
以致冲任气虚不能约制经血，故忽然而下，谓之崩中暴下。治宜大补气血之药，举养脾胃，
微加镇坠心火之剂，以治其心，补阴泻阳，经自止矣。
夫脱肛之证，有因久痢久泻，脾肾气陷而脱者；有因中气虚寒，不能收 而脱者；有因
酒湿伤脾，色欲伤肾而脱者；有因肾气本虚，关门不固而脱者；有因湿热下坠而脱者。又肛
门为大肠之使，大肠受寒受热，皆能脱肛。老人气血已衰，小儿气血未旺，皆易脱肛。经曰
∶陷者举之。徐之才曰∶涩可去脱。皆治脱肛之法也。考叶天士先生治脱肛之证，不越乎升
举、固 、益气三法。如气虚下陷而脱者，宗东垣补中益气汤举陷为主；如肾虚不 而脱者
，宗仲景禹余粮石脂丸及熟地、五味、菟丝辈，固 下焦阴气为主；如肝弱气陷，脾胃气虚
下陷而脱者，用 阴益气，兼以酸苦泄热为主；如老年阳气下陷，肾真不 而脱者，又有鹿
茸、阳起石、补骨脂、人参等提阳固气一法，观其案中所载诸条，亦云备矣。医者宜奉以为
宗也。又汪 庵云∶有气热血热而肛反挺出者，宜用芩、连、槐、柏及四物、升、柴之
类，苦味坚阴。然斯证虽多，但苦寒之味不可恃为常法耳。
痔疮者，肛门内外四旁忽生红瘰，先痒后疼，后成为痔。或因其人素有湿热，过食炙
浓味；或因醉饱入房，筋脉横解，精气脱泄，热毒乘虚流注；或因淫极强固其精，以致
木乘火势，而反侮金；或因担轻负重，竭力远行，气血纵横，经络交错；或因阴虚火炽；又
妇人临产，用力过甚，血逆肛门，亦能致此。若破而不愈，则成漏矣。此证属肝、脾、肾三
经。凡阴精亏损者难治，多成漏证；若肺与大肠二经风热湿热者，热退自愈；若不守禁忌者
，亦成漏证。至成漏后，有串臀者，有串阴者，有串肠者，有秽从疮口而出者，形虽不同，
治颇相似。其初起时，肠头肿而成块者，湿热也；作痛者，风热也；大便燥结者，火也；溃
而为脓者，热胜血也，当各推其所因而治之。凡遇 痛便秘，小便不利者，宜清热凉血、
润燥疏风；若气血虚而为寒凉伤损者，宜调养脾胃、滋补阴精；若大便秘涩，或作痛者，润
燥除湿；肛门坠痛者，泻火导湿；下坠肿痛而痒者，祛风胜湿；小便涩滞肿痛者，清肝导湿
；其成漏者，养元气、补阴精为主。大凡痔漏下血，服凉药不应者，必因中气虚不能 血，
非补中升阳之药不能愈也，切忌寒凉之剂。亦有伤湿热之食，或肠 而下脓血者，宜苦寒之
剂内疏之。凡痔漏脉弦绝涩者难治；滑大柔和者易治。经云∶因而饱食，筋脉横解，肠
为痔。其属肝脾肾明矣。若有患痔而兼疝，患疝而兼下疳，皆属肝肾不足之变证，但用黑
地黄丸、益气汤，以滋化源为善。若专服寒凉治火者，无不致祸。凡痔疮溃久不愈，而成漏
管者，若内服外洗，纯用苦寒，必致脾元日损，肌肉难生。若妄用刀针，药线系扎，铅丸悬
坠，利剪割切，良肉受伤，反以致害。又或日将药 插入拔出，致疮内四傍新肉磨成硬
管，愈插愈深，遂成痼疾，此皆医之过也。
朱丹溪说：妇人崩中（指非经期阴道大量出血或持续淋漓不尽的病证），是由于脏腑受损、冲任二脉气血俱虚所致。如果过度劳累，导致脏腑均受损伤，致使冲任之气虚弱，不能约束经血，因此突然大量下泄，称为崩中暴下。治疗应当使用大补气血的药物，培补滋养脾胃，稍微加入镇降心火的药剂，以调理心脏，通过补阴泻阳的方法，月经自然就会停止。
至于脱肛的病症，有因长期痢疾或腹泻，脾肾气陷而导致直肠脱出的；有因中气虚寒，无法收敛固摄而脱出的；有因饮酒湿邪损伤脾脏，色欲过度损伤肾脏而脱出的；有因肾气本虚，肛门括约功能不固而脱出的；有因湿热下注坠积而脱出的。另外，肛门是大肠的门户，大肠感受寒邪或热邪，都能引起脱肛。老年人气血已经衰退，小儿气血尚未旺盛，都容易发生脱肛。《内经》说：“下陷的病症要用升举的方法治疗。”徐之才说：“涩味药物可以去除滑脱之症。”这些都是治疗脱肛的方法。考察叶天士先生治疗脱肛的病症，不离乎升举、固涩、益气这三种方法。如果是气虚下陷而导致的脱出，遵循李东垣的补中益气汤，以升举下陷之气为主；如果是肾虚不固而导致的脱出，遵循张仲景的禹余粮石脂丸以及熟地黄、五味子、菟丝子等药物，以固涩下焦阴气为主；如果是肝弱气陷，脾胃气虚下陷而导致的脱出，用滋阴益气，兼以酸苦之品清泄热邪为主；如果是老年阳气下陷，肾真元不固而导致的脱出，又有鹿茸、阳起石、补骨脂、人参等提升阳气、固护元气的方法，观察他医案中所记载的各种情况，可以说非常完备了。医生应当奉为准则。另外汪昂说：有气热血热而肛门反而挺出者，适宜使用黄芩、黄连、槐花、黄柏以及四物汤、升麻、柴胡之类的药物，利用苦味来坚阴。然而这种病症虽然多样，但苦寒性质的药物不可作为常规治法依赖。
痔疮，是指肛门内外四周忽然生出红色结节，先痒后痛，后来形成痔疮。或者因为患者平素就有湿热，过食煎炸浓腻的食物；或者因为醉酒后行房事，筋脉松弛，精气耗泄，热毒乘虚流注；或者因为淫欲强烈强行固精，导致肝木乘火势而上炎，反而侮害肺金；或者因为挑担负重，竭力远行，导致气血运行紊乱，经络交错阻滞；或者因为阴虚火旺；又或者是妇女临产时用力过甚，血液逆乱于肛门，也能导致此病。如果破溃后不愈合，就形成了漏证。此病属于肝、脾、肾三经。凡是阴精亏损的患者难治，多会形成漏证；如果是肺与大肠二经受风热湿热侵袭，热退后自愈；如果不遵守禁忌，也会形成漏证。等到形成漏证后，有的窜连到臀部，有的窜连到阴部，有的窜连到肠道，有的秽浊之物从疮口流出，形态虽然不同，治疗方法颇为相似。在初起阶段，肠头肿胀成块的，是湿热；感到疼痛的，是风热；大便干燥结硬的，是火邪；溃烂化脓的，是热盛伤血，应当分别推究其病因进行治疗。凡是遇到腹痛便秘，小便不利的，适宜清热凉血、润燥疏风；如果是气血虚弱而被寒凉药物损伤的，适宜调养脾胃、滋补阴精；如果是大便秘涩，或者疼痛的，适宜润燥除湿；肛门坠胀疼痛的，适宜泻火导湿；下坠肿痛且瘙痒的，适宜祛风胜湿；小便涩滞肿痛者，适宜清肝导湿；已经形成漏证的，以养元气、补阴精为主。大凡痔漏下血，服用凉药无效的，必定是因为中气虚弱不能统摄血液，不是补中升阳的药物不能治愈，切忌使用寒凉药剂。也有因饮食损伤湿热，或者肠道腐烂而下脓血的，适宜用苦寒药剂内服疏导。凡是痔漏脉象弦绝涩滞的难治；脉象滑大柔和的易治。《内经》说：“因为饱食过度，筋脉松弛，肠道腐败而成痔疮。”这明确属于肝脾肾的问题。如果有患痔疮兼患疝气的，患疝气兼患下疳的，都属于肝肾不足的变证，只需用黑地黄丸、益气汤，以滋生化之源为好。如果专门服用寒凉药物治疗火邪，没有不招致祸患的。凡是痔疮溃烂日久不愈，形成漏管的，如果内服外洗，纯用苦寒药物，必定导致脾胃元气日渐受损，肌肉难以生长。如果妄用刀针、药线系扎、铅丸悬坠、利剪割切，会使良肉受伤，反而招致危害。又或者每天将药捻插入拔出，导致疮口四周新长出的肉被磨成硬管，越插越深，遂成顽固疾病，这都是医生的过错。
Zhu Danxi stated: Females suffering from *Bengzhong* (sudden heavy vaginal bleeding or prolonged spotting outside the menstrual period) are caused by damage to the Zang-Fu organs and deficiency of Qi and Blood in the Chong and Ren meridians. If physical exertion is excessive, damaging all Zang-Fu organs, the Qi of the Chong and Ren meridians becomes deficient and fails to constrain the menstrual blood, resulting in sudden profuse discharge, termed "Bengzhong Baoxia" (sudden severe flooding). Treatment should employ herbs that greatly tonify Qi and Blood, nourish and support the Spleen and Stomach, and slightly add agents that settle and subdue Heart Fire to regulate the Heart. By tonifying Yin and draining Yang, the menses will naturally cease.
Regarding prolapse of the rectum (*Tuogang*), there are cases caused by chronic dysentery or diarrhea leading to sinking of Spleen and Kidney Qi; cases due to deficiency-cold of the Middle Jiao failing to consolidate and hold; cases where dampness from alcohol damages the Spleen and sexual excess injures the Kidney; cases where innate Kidney Qi is deficient and the anal sphincter lacks firmness; and cases where damp-heat sinks downward. Furthermore, the anus serves as the gate of the Large Intestine; whether the Large Intestine is affected by Cold or Heat, prolapse can occur. The elderly have declining Qi and Blood, while children have unestablished Qi and Blood; both are prone to rectal prolapse. The Classics state: "For sinking conditions, use lifting methods." Xu Zhicai said: "Astringents can treat prolapse." These are methods for treating rectal prolapse. Examining Mr. Ye Tianshi’s treatment of rectal prolapse, he did not deviate from three methods: lifting, astringing, and tonifying Qi. For prolapse due to Qi deficiency and sinking, he followed Li Dongyuan’s *Buzhong Yiqi Tang* (Tonify the Middle and Augment the Qi Decoction), focusing on lifting the sunken Qi. For prolapse due to Kidney deficiency and failure to consolidate, he followed Zhang Zhongjing’s *Yuyuliang Shizhi Wan* (Hematitum et Halloysitum Pill) along with *Shudihuang* (Prepared Rehmannia Root), *Wuweizi* (Schisandra Fruit), and *Tusizi* (Cuscuta Seed), focusing on consolidating the Yin Qi of the Lower Jiao. For prolapse due to Liver weakness and Qi sinking, combined with Spleen-Stomach Qi deficiency, he used methods to nourish Yin and tonify Qi, supplemented by sour and bitter agents to drain heat. For elderly patients with sinking Yang and unstable Kidney Essence, he employed herbs like *Lurong* (Deer Antler Velvet), *Yangqishi* (Quiescens Lapis), *Buguzhi* (Psoralea Fruit), and *Renshen* (Ginseng Root) to raise Yang and secure Qi. Observing his medical records, these approaches were comprehensive. Physicians should take these as their guide. Additionally, Wang Ang noted: In cases where Qi and Blood Heat cause the anus to protrude, one should use *Huangqin* (Scutellaria Root), *Huanglian* (Coptis Rhizome), *Huaihua* (Sophora Flower), *Huangbai* (Phellodendron Bark), along with *Siwu Tang* (Four Substances Decoction), *Shengma* (Cimicifugae Rhizoma), and *Chaihu* (Bupleuri Radix), utilizing bitter flavors to firm the Yin. However, although this condition has many variations, bitter-cold medicines should not be relied upon as a routine method.
Hemorrhoids (*Zhichuang*) refer to red nodules suddenly appearing around the inside and outside of the anus, initially itching then becoming painful, eventually forming hemorrhoids. This may arise from pre-existing damp-heat in the patient, overconsumption of fried and rich foods; or from sexual activity after drunkenness, causing tendons and vessels to relax, essence and Qi to leak, allowing heat-toxin to flow in vacuity; or from forcing retention of semen during intense lust, causing Liver Wood to exploit Fire and insult Lung Metal; or from carrying heavy loads and traveling far with great effort, causing chaotic Qi and Blood flow and intersecting meridians; or from Yin deficiency with blazing Fire; or from women exerting themselves excessively during childbirth, causing blood to rebel into the anus. If ulceration does not heal, it becomes a fistula (*Lou*). This condition belongs to the Liver, Spleen, and Kidney meridians. Cases with depletion of Yin Essence are difficult to treat and often become fistulas. If caused by Wind-Heat and Damp-Heat in the Lung and Large Intestine meridians, it heals spontaneously when the heat subsides. Failure to observe dietary and lifestyle taboos also leads to fistulas. Once a fistula forms, it may track to the buttocks, genitals, or intestines, or discharge foul matter from the wound opening. Although the manifestations differ, treatments are similar. In the early stage, swelling of the anal verge into a mass indicates damp-heat; pain indicates wind-heat; dry and hard stool indicates fire; ulceration with pus indicates heat overwhelming blood. One must investigate the cause and treat accordingly. For cases with abdominal pain, constipation, and difficult urination, clear heat, cool blood, moisten dryness, and disperse wind. For Qi and Blood deficiency injured by cold-cold medicines, regulate the Spleen and Stomach and tonify Yin Essence. For dry, sticky stool or pain, moisten dryness and drain dampness. For anal dragging pain, drain fire and guide out dampness. For dragging, swelling, pain, and itching, dispel wind and overcome dampness. For sticky, painful, swollen urination, clear the Liver and guide out dampness. For established fistulas, primarily nourish Yuan Qi and tonify Yin Essence. Generally, if hemorrhoidal bleeding does not respond to cooling medicines, it is likely due to Middle Qi deficiency failing to control blood; only warming and lifting Middle Qi medicines can cure it. Avoid cold-cold preparations. For cases involving damaged damp-heat food or intestinal rotting with pus and blood, use bitter-cold internal purgatives. Fistulas with wiry, extreme, or choppy pulses are difficult to treat; those with slippery, large, and gentle pulses are easy to treat. The Classics say: "Due to overeating, tendons and vessels relax, and the intestine rots to form hemorrhoids." This clearly belongs to the Liver, Spleen, and Kidney. Hemorrhoids accompanied by hernia, or hernia with chancre, are variations of Liver-Kidney insufficiency; treat with *Heidi Huangdi Wan* (Black Earth Yellow Earth Pill) and *Yiqi Tang* (Augment Qi Decoction) to nourish the source of transformation. Specializing in cold-cold fire-draining treatments inevitably brings disaster. For long-standing ulcerated hemorrhoids forming fistula tracts, using purely bitter-cold internal and external washes will daily damage Spleen-Yuan, making muscle regeneration difficult. Reckless use of knives, needles, medicinal threads, lead weights, or sharp scissors damages healthy flesh and causes harm. Daily insertion and withdrawal of medicated wicks grinds new tissue into hard tubes, deepening the lesion and creating stubborn disease. These are all faults of the physician.