大便秘涩，或作痛者，润燥除湿。肛门下坠，或作痛者，泻火导湿。下坠肿痛或作痒者
，祛风胜湿。肿痛小便涩滞者，清肝导湿。
一男子患痔，大便燥结， 痛作渴，脉数按之则实，以秦艽苍术汤，二剂少愈；更以四
物汤加芩、连、槐花、枳壳，四剂而愈。
一男子素不慎酒色，患痔 肿，肛门坠痛，兼下血，大便干燥，脉洪大，按之则涩，以
当归
则经脉横解；或精气脱泄，脉络一虚，酒食之毒，乘虚流注；或淫极，强固精气，遂传大肠
，以致木乘火势而毁金；或食浓味过多，必成斯
疾。夫受病者，燥气也；为病者，湿热也；宜以泻火和血润燥疏风之剂治之。若破而不愈，
即成漏矣。有串臀者，有串阴者，有穿肠者，有秽从疮口而出者，形虽不同，治法颇似。其
肠头肿成块者湿热也，作痛者风也，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。
一男子患痔成漏，每登厕，则痛，以秦艽防风汤加条芩、枳壳，四剂而愈，以四物汤加
升麻、芩、连、荆防，不复作。
一男子患痔漏，每登厕则肛门下脱作痛，良久方收，以秦艽防风汤，数剂少愈，乃去大
黄，加黄 、川芎、芍药而痛止，更以补中益气汤，二十余剂，后再不脱。
一妇人患痔，肿 痛甚，以四物汤加芩、连、红花、桃仁、牡丹皮，数剂稍止，又数剂
而愈。
一妇人粪后下血，面色萎黄，耳鸣嗜卧，饮食不甘，服凉血药愈甚。诊之右关脉浮而弱
，以
不应，必因中气虚，不能摄血，非补中升阳之药不能愈，切忌寒凉之剂。亦有伤湿热之食，
成肠癖而下脓血者，宜苦寒之剂，以内疏之。脉弦绝涩者难治，滑大柔和者易治。
一男子便血，过劳益甚，饮食无味，以六君子汤加黄 、地黄、地榆，治之而愈。
一男子便血，每春间尤甚，兼腹痛，以除湿和血汤，治之而愈。
一男子素有湿热便血，以槐花散治之而愈。
一男子粪后下血，诸药久不愈，甚危，诊之乃湿热，用黄连丸二服顿止，数剂而痊。
一男子粪后下血，久而不愈，中气不足，以补中益气汤数剂，更以黄连丸数服血止
；又服前汤，月余不再作。
一男子脏毒下血，服凉血败毒药，不惟血不能止，且饮食少思，肢体愈倦，脉数，按之
则涩
归
或参苓白术散补之即效。
一男子脏毒下血，脾气素弱，用六君子汤加芎、归、枳壳、地榆、槐花，治之而愈。后
因谋
究其因而治之。丹溪云∶芎归汤一剂，又调血之上品，热加茯苓、槐花；冷加白茯苓、木香
，此则自根自本之论也。虽然精气血出于谷气，惟大肠下血，以胃药收功，以四君子汤、参
白术散，以枳壳散、小乌沉汤和之，胃气一回，血自循经络矣。肠风者，邪气外入，随感
随见，脏毒者，蕴积毒久而始见。又云∶人惟坐卧风湿，醉饱房劳，生冷停寒，酒面积热，
以致荣血失道，渗入大肠，此肠风脏毒之所作也。挟热下血，清而色鲜，腹中有痛；挟冷下
血，浊而色暗，腹内略痛。清则为肠风，浊则为脏毒。有先便而后血者，其来也远；有先血
而后便者，其来也近。世俗粪前粪后之说，非也！治法大要∶先当解散肠胃风邪，热则败毒
散，冷则不换金正气散加川芎、当归，后随其冷热治之。
一河间云∶“起居不节，用力过度，则络脉伤，阳络伤则血外溢，血外溢则衄血。阴络
伤则
不得
生。诸方皆谓风热侵于大肠而然，若饮食有节，起居有时，肠胃不虚，邪气从何而入。
一妇人素患痔漏，每因热则下血数滴，以四物汤加黄连，治之即愈。后为大劳疮肿痛，
经水
后去蒲黄、芩、连，加地骨皮数剂而安。丹溪云∶妇人崩中者，由脏腑伤损，冲任二脉，血
气俱虚，故也。二脉为脉经之海，血气之行，外循经络卫营脏腑，若气血调适，经下根据时，
若劳动过极，脏腑俱伤，冲任之气虚，不能约制其经血，故忽然而下，谓之崩中暴下。治宜
大补气血之药，举养脾胃，微加镇坠心火之药治其心，补阴泻阳，则自正矣。
一男子有痔漏，每登厕肛脱，良久方上，诊其脉，细而滑，用补中益气汤，三十余剂，
遂不
虚者四物汤。血热者凉血，四物汤加黄柏。肺与大肠为表里，故肺脏蕴热，则肛闭结。肺
脏虚
收矣。
附方
秦艽苍术汤 治肠风痔漏，大小便秘涩。
秦艽 苍术（米泔水浸炒） 皂角仁（烧存性） 桃仁（各一钱半） 黄柏（酒制） 泽泻 当
归尾
。
当归郁李仁汤 治痔漏，大便结硬，大肠下坠出血，若痛，不能忍者。
当归尾（酒拌） 郁李仁 泽泻 生地黄 大黄（煨） 枳壳 苍术 秦艽（各一钱） 麻子
仁
加减龙胆泻肝汤（方见下疳门） 治痔疮，小便涩滞，或痔肿痛。
四物汤（方见瘰 门）
秦艽防风汤 治痔漏结燥，每次大便作痛。
秦艽 防风 当归（酒拌） 白术（各四钱半） 黄柏 陈皮 柴胡 大黄（煨） 泽泻（各
一
八珍汤（方见溃疡发热门）
加味四君子汤 治痔漏下血，面色痿黄，心忪耳鸣，脚弱气乏，及一切脾胃虚，
口淡，食不知味。又治中气虚不能摄血，致便血不禁。
人参 白术（炒） 茯苓 白扁豆（蒸） 黄 （炙） 甘草 为末，每服三钱，白滚汤点服
四君子汤 治脾胃虚弱，便血不止。
人参 白术（炒） 白茯苓（各一钱） 甘草（炙，五分） 作一剂，水二钟，姜三片，枣一
枚，煎八分，食远服。
黄连丸 治大肠有热下血。
用黄连、吴茱萸等分，用热汤拌湿，罨三日同炒，拣出，各另为末，亦各米糊丸，梧子
大。每服二三钱，粪前红，服茱萸丸，粪后红，服黄连丸，俱酒下。
六君子汤（方见作呕门）
除湿和血汤 治阳明经湿热，便血腹痛。
生地黄 牡丹皮 生甘草（各五分） 熟甘草 黄 （各一钱，炙） 白芍药（一钱五分）
升麻
水二钟，煎八分，空心候宿食消尽，热服。
槐花散 治肠风脏毒下血。
槐花（炒） 生地黄（酒拌，铜器蒸半日） 青皮 白术（炒） 荆芥穗（各六分） 川芎（四
分炙）当归身（酒拌） 升麻（各一钱） 为末，每服三钱，空心米饮调下，水煎服亦可。
补中益气汤
人参败毒散（二方见溃疡发热门）
参苓白术散 治脾胃不和，饮食不进，或呕吐泄泻。凡大病后，皆宜服此药，以
人参 茯苓 白扁豆（去皮姜汁拌炒） 白术（炒） 莲肉（去心皮） 砂仁（炒） 薏苡仁（
炒） 桔梗（炒） 山药 甘草（炙，各二两） 为细末，每服三钱，用石菖蒲煎汤下。
归脾汤 治思虑伤脾，不能统摄，心血以此妄行，或吐血下血，或健忘怔忡，惊悸少寐，或心脾作痛。
白术（炒） 茯神 黄 （蜜炙） 龙眼肉 酸枣仁（蒸，各一钱） 人参 木香（各五分）
甘草（炙，二分半） 作一剂，水一钟，姜一片，枣一枚，煎六分，食远并临卧服。
小乌沉汤 治气不调和，便血不止。
乌药（一两） 甘草（炙，二钱） 香附（四两，酒制） 每服二钱，食前盐汤下。
不换金正气散（方见作呕门）
枳壳散 治便血，或妇人经候不调，手足烦热，夜多盗汗，胸膈不利。
枳壳（麸炒，一钱） 半夏曲 赤芍药（炒，各一钱） 柴胡 黄芩（各一钱五分） 作一剂
，水二钟，姜三片，枣二枚，煎八分，食远服。
芎归汤 治便血，或失血过多眩晕。
芎 （五钱） 当归（酒拌，五钱） 作一剂，水一钟半，煎六分，食后服。
如神千金方 治痔无有不效。
好信石（色黄明者三钱，打如豆大） 明白矾（一两为末） 好黄丹（水飞，炒变色，五钱）
蝎梢（七个，净洗瓦上焙干，研末） 草乌（紧实光滑者，去皮生研末，一钱） 上用紫泥罐，先
将炭火 红，放冷拭净；先下明矾烧令沸，次下信石，入矾内拌匀，文武火 候沸，再搅匀
；次看罐通红烟起为度，将罐掇下，待冷取研末，方入草乌、黄丹、蝎梢三味，再同研极细
，入瓷罐内收贮。如欲敷药，先煎甘草汤，或葱椒煎汤，洗净患处，然后用生麻油调前药，
以鹅毛扫药痔上，每日敷药三次。之后，必去黄水如胶汁，然痔头渐消，看痔病年深浅，
年
乃是临安曹五方，黄院 引为高宗，取痔得效，后封曹官至察使。
李防御五痔方
原痔者，贫富男女皆有之。富者酒色财气，贫者担轻负重，饥露早行，皆心肝二血。喜
则伤
。妇人因经后伤冷，月事伤风，余血在心，经血流于大肠。小儿因利后，或母腹中受热也。
治方于后∶
水澄膏 治痔护肉。
郁金 白芨（各一两） 一方加黄连。上二味，为细末。如内痔，候登厕翻出在外，用温
汤洗
盖药上良久，方用枯药搽痔上，用笔蘸温水于纸上，不令药干及四散。
好白矾（四两） 生信石（二钱半） 朱砂（一钱，生研极细） 上各研为细末，先用砒入紫
泥罐
看痔头大小，取矾末在掌中，更入朱砂少许，以唾调稀，用篦头涂痔上周遍，一日三上。候
看痔头颜色焦黑为效，至夜自黄水出，切无他疑，水尽为妙，至中夜上药一遍，来日依然上
药三次，有小痛不妨。换药时，以碗盛新水或温汤，在痔边用笔轻洗去痔上旧药，更上新药
，仍用护肉药，次用荆芥汤洗之，三两日之后，黄水出将尽，却于药中增朱砂减白矾，则药
力即缓，三两日方可增减，渐渐取之。庶不惊人，全在用药人，看痔头转色，增减浓薄敷药
，方是活法，此药只是借砒信耳，又有朱砂解之。一方士将此二方在京治人多效，致富。一
富人因验以百金求得之录于余，余虽未用，传人无不言效，但枯药赵宜真炼师已刊于《青囊
杂纂》，如神千金方，未见刊传，大抵今人言能取痔者，皆此方也。恐气血虚或内邪者，还
当兼治其内，庶不有失。
大便秘结干燥，或者伴有疼痛的，采用润燥除湿的方法治疗。肛门有下坠感，或者伴有疼痛的，采用泻火导湿的方法治疗。肛门下坠、肿痛或者发痒的，采用祛风胜湿的方法治疗。肿痛且小便涩滞不畅的，采用清肝导湿的方法治疗。
有一个男子患痔疮，大便干燥结硬，发作时疼痛并口渴，脉象数而按之有力（实），用秦艽苍术汤，服用两剂后症状稍有好转；接着改用四物汤加黄芩、黄连、槐花、枳壳，服用四剂后痊愈。
有一个男子平素不节制饮酒和房事，患痔疮肿胀，肛门坠痛，兼有便血，大便干燥，脉象洪大但按之涩滞，这是因为经脉横解松弛；或者是精气耗损泄脱，脉络虚弱，酒食之毒乘虚流注于体内；或者是纵欲过度，强行固摄精气，导致邪气传变至大肠，致使肝木乘火势而克制肺金；或者是食用浓味食物过多，必然导致此病。受病的根本在于燥气，致病的原因在于湿热；应当使用泻火、和血、润燥、疏风的方剂治疗。如果痔疮破溃而不愈合，就会形成肛漏。有的瘘管通向臀部，有的通向阴部，有的穿透肠道，有的秽物从疮口流出，虽然形态不同，但治疗方法大致相似。肛门肿成块状的是湿热，作痛的是风邪，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。
有一个男子患痔疮并形成肛漏，每次上厕所就疼痛，用秦艽防风汤加条芩、枳壳，服用四剂后痊愈，再用四物汤加升麻、黄芩、黄连、荆芥、防风，之后不再复发。
有一个男子患痔漏，每次上厕所肛门就脱出并疼痛，很久才能收回，用秦艽防风汤，服用数剂后症状稍减，于是去掉大黄，加入黄芪、川芎、芍药使疼痛停止，再用补中益气汤，服用二十多剂，后来不再脱出。
有一个妇人患痔疮，肿痛严重，用四物汤加黄芩、黄连、红花、桃仁、牡丹皮，服用数剂后稍止，又服数剂后痊愈。
有一个妇人在排便后下血，面色萎黄，耳鸣嗜睡，饮食无味，服用凉血药后病情反而加重。诊察发现右关脉浮而弱，这是因为中气虚弱，不能统摄血液，非用补中升阳的药物不能治愈，切忌使用寒凉药剂。也有因损伤湿热饮食，导致肠癖而下脓血的，宜用苦寒药剂内疏。脉象弦绝涩滞的难治，滑大柔和的易治。
有一个男子便血，劳累后加重，饮食无味，用六君子汤加黄芪、地黄、地榆，治疗而愈。
有一个男子便血，每年春季尤其严重，兼有腹痛，用除湿和血汤，治疗而愈。
有一个男子排便后下血，久治不愈，情况危急，诊察认为是湿热，用黄连丸服用两次即止住，数剂后康复。
有一个男子排便后下血，久而不愈，中气不足，用补中益气汤数剂，再用黄连丸数服血止；又服用前汤，月余后不再发作。
有一个男子患脏毒下血，服用凉血败毒药，不仅血不能止，而且饮食减少，肢体更加疲倦，脉数，按之则涩，应当先用参苓白术散补益脾胃即见效。
有一个男子患脏毒下血，脾气素来虚弱，用六君子汤加川芎、当归、枳壳、地榆、槐花，治疗而愈。后来因为谋虑过度……（原文此处似有缺漏或语意未完，依文意推测为后续调理）……推究其病因进行治疗。丹溪说：芎归汤一剂，又是调血的上品，热证加茯苓、槐花；冷证加白茯苓、木香，这是从根源上治疗的理论。虽然精气血都源于谷气，唯独大肠下血，以调理胃药收功，用四君子汤、参苓白术散，配合枳壳散、小乌沉汤调和，胃气恢复，血液自然循行经络。肠风是邪气外入，随感随见；脏毒是蕴积毒久而始见。又说：人只有坐卧风湿，醉饱房劳，生冷停寒，酒面积热，导致营血失道，渗入大肠，这就是肠风脏毒产生的原因。挟热下血，血色清鲜，腹中有痛；挟冷下血，血色浊暗，腹内略痛。清则为肠风，浊则为脏毒。有先大便后出血的，病位较远；有先出血后大便的，病位较近。世俗所说的粪前粪后之说，是不正确的！治疗的大要：首先应当解散肠胃风邪，热证用败毒散，冷证用不换金正气散加川芎、当归，随后根据其冷热性质治疗。
一个河间（刘完素）说：“起居不节，用力过度，则络脉受伤，阳络受伤则血外溢，血外溢则衄血。阴络受伤则……（原文此处似有缺漏）……不得生。各方都认为风热侵袭大肠所致，如果饮食有节，起居有时，肠胃不虚，邪气从何而入。”
有一个妇人素患痔漏，每次受热则下血几滴，用四物汤加黄连，治疗即愈。后来患大劳疮肿痛，月经结束后去掉蒲黄、黄芩、黄连，加地骨皮数剂而安。丹溪说：妇人崩中，是由于脏腑伤损，冲任二脉气血俱虚的缘故。二脉为脉经之海，气血运行，外循经络卫护脏腑，若气血调适，月经按时来潮，若劳动过极，脏腑俱伤，冲任之气虚，不能约束经血，所以忽然大量下血，称为崩中暴下。治疗宜用大补气血的药物，举养脾胃，微加镇坠心火的药物治其心，补阴泻阳，则自然恢复正常。
有一个男子有痔漏，每次上厕所肛门脱出，很久才能收回，诊其脉细而滑，用补中益气汤，三十多剂，遂不再脱出。虚者用四物汤。血热者凉血，四物汤加黄柏。肺与大肠相表里，故肺脏蕴热，则肛门闭塞结硬。肺脏虚……（原文此处似有缺漏）……收回了。
附方
秦艽苍术汤 治疗肠风痔漏，大小便秘涩。
秦艽、苍术（米泔水浸炒）、皂角仁（烧存性）、桃仁（各一钱半）、黄柏（酒制）、泽泻、当归尾。
当归郁李仁汤 治疗痔漏，大便结硬，大肠下坠出血，若疼痛，不能忍受。
当归尾（酒拌）、郁李仁、泽泻、生地黄、大黄（煨）、枳壳、苍术、秦艽（各一钱）、麻子仁。
加减龙胆泻肝汤（方见下疳门） 治疗痔疮，小便涩滞，或痔肿痛。
四物汤（方见瘰疬门）
秦艽防风汤 治疗痔漏结燥，每次大便作痛。
秦艽、防风、当归（酒拌）、白术（各四钱半）、黄柏、陈皮、柴胡、大黄（煨）、泽泻（各一钱）。
八珍汤（方见溃疡发热门）
加味四君子汤 治疗痔漏下血，面色萎黄，心悸耳鸣，脚弱气乏，及一切脾胃虚，口淡，食不知味。又治中气虚不能摄血，致便血不禁。
人参、白术（炒）、茯苓、白扁豆（蒸）、黄芪（炙）、甘草，研为末，每服三钱，白滚汤点服。
四君子汤 治疗脾胃虚弱，便血不止。
人参、白术（炒）、白茯苓（各一钱）、甘草（炙，五分），作一剂，水二钟，姜三片，枣一枚，煎八分，食远服。
黄连丸 治疗大肠有热下血。
用黄连、吴茱萸等分，用热汤拌湿，罨三日同炒，拣出，各另为末，亦各米糊丸，梧子大。每服二三钱，粪前红，服茱萸丸，粪后红，服黄连丸，俱酒下。
六君子汤（方见作呕门）
除湿和血汤 治疗阳明经湿热，便血腹痛。
生地黄、牡丹皮、生甘草（各五分）、熟甘草、黄芪（各一钱，炙）、白芍药（一钱五分）、升麻。水二钟，煎八分，空心候宿食消尽，热服。
槐花散 治疗肠风脏毒下血。
槐花（炒）、生地黄（酒拌，铜器蒸半日）、青皮、白术（炒）、荆芥穗（各六分）、川芎（四分炙）、当归身（酒拌）、升麻（各一钱），研为末，每服三钱，空心米饮调下，水煎服亦可。
参苓白术散 治疗脾胃不和，饮食不进，或呕吐泄泻。凡大病后，皆宜服此药，以……
人参、茯苓、白扁豆（去皮姜汁拌炒）、白术（炒）、莲肉（去心皮）、砂仁（炒）、薏苡仁（炒）、桔梗（炒）、山药、甘草（炙，各二两），为细末，每服三钱，用石菖蒲煎汤下。
归脾汤 治疗思虑伤脾，不能统摄，心血以此妄行，或吐血下血，或健忘怔忡，惊悸少寐，或心脾作痛。
白术（炒）、茯神、黄芪（蜜炙）、龙眼肉、酸枣仁（蒸，各一钱）、人参、木香（各五分）、甘草（炙，二分半），作一剂，水一钟，姜一片，枣一枚，煎六分，食远并临卧服。
小乌沉汤 治疗气不调和，便血不止。
乌药（一两）、甘草（炙，二钱）、香附（四两，酒制），每服二钱，食前盐汤下。
不换金正气散（方见作呕门）
枳壳散 治疗便血，或妇人经候不调，手足烦热，夜多盗汗，胸膈不利。
枳壳（麸炒，一钱）、半夏曲、赤芍药（炒，各一钱）、柴胡、黄芩（各一钱五分），作一剂，水二钟，姜三片，枣二枚，煎八分，食远服。
芎归汤 治疗便血，或失血过多眩晕。
川芎（五钱）、当归（酒拌，五钱），作一剂，水一钟半，煎六分，食后服。
如神千金方 治疗痔无有不效。
好信石（色黄明者三钱，打如豆大）、明白矾（一两为末）、好黄丹（水飞，炒变色，五钱）、蝎梢（七个，净洗瓦上焙干，研末）、草乌（紧实光滑者，去皮生研末，一钱）。上用紫泥罐，先将炭火烧红，放冷拭净；先下明矾烧令沸，次下信石，入矾内拌匀，文武火候沸，再搅匀；次看罐通红烟起为度，将罐掇下，待冷取研末，方入草乌、黄丹、蝎梢三味，再同研极细，入瓷罐内收贮。如欲敷药，先煎甘草汤，或葱椒煎汤，洗净患处，然后用生麻油调前药，以鹅毛扫药痔上，每日敷药三次。之后，必去黄水如胶汁，然痔头渐消，看痔病年深浅，年……（原文此处似有缺漏）……乃是临安曹五方，黄院……引为高宗，取痔得效，后封曹官至察使。
李防御五痔方
原痔者，贫富男女皆有之。富者酒色财气，贫者担轻负重，饥露早行，皆心肝二血。喜则伤……（原文此处似有缺漏）……。妇人因经后伤冷，月事伤风，余血在心，经血流于大肠。小儿因利后，或母腹中受热也。
治方于后：
水澄膏 治疗痔护肉。
郁金、白芨（各一两），一方加黄连。上二味，为细末。如内痔，候登厕翻出在外，用温汤洗……（原文此处似有缺漏）……盖药上良久，方用枯药搽痔上，用笔蘸温水于纸上，不令药干及四散。
好白矾（四两）、生信石（二钱半）、朱砂（一钱，生研极细），上各研为细末，先用砒入紫泥罐……（原文此处似有缺漏）……看痔头大小，取矾末在掌中，更入朱砂少许，以唾调稀，用篦头涂痔上周遍，一日三上。候看痔头颜色焦黑为效，至夜自黄水出，切无他疑，水尽为妙，至中夜上药一遍，来日依然上药三次，有小痛不妨。换药时，以碗盛新水或温汤，在痔边用笔轻洗去痔上旧药，更上新药，仍用护肉药，次用荆芥汤洗之，三两日之后，黄水出将尽，却于药中增朱砂减白矾，则药力即缓，三两日方可增减，渐渐取之。庶不惊人，全在用药人，看痔头转色，增减浓薄敷药，方是活法，此药只是借砒信耳，又有朱砂解之。一方士将此二方在京治人多效，致富。一富人因验以百金求得之录于余，余虽未用，传人无不言效，但枯药赵宜真炼师已刊于《青囊杂纂》，如神千金方，未见刊传，大抵今人言能取痔者，皆此方也。恐气血虚或内邪者，还当兼治其内，庶不有失。
Constipation with dryness or pain is treated by moistening dryness and draining dampness. A sensation of rectal prolapse or pain in the anus is treated by purging fire and guiding out dampness. Prolapse, swelling, pain, or itching in the anus are treated by dispelling wind and overcoming dampness. Swelling, pain, and difficult urination are treated by clearing the Liver and guiding out dampness.
A man suffered from hemorrhoids with dry and hard stools, pain upon defecation, thirst, a rapid pulse that felt solid on deep pressure. He was prescribed Qinjiao Cangzhu Tang (Gentian and Atractylodes Decoction) for two doses, after which symptoms slightly improved; subsequently, Siwu Tang (Four Substances Decoction) added with Huangqin (Scutellariae Radix), Lianzi (Coptidis Rhizoma), Huaihua (Sophorae Flos), and Zhike (Aurantii Fructus) was given for four doses, resulting in a cure.
Another man, who had been immoderate in drinking and sexual activity, developed swollen hemorrhoids with anal prolapse and pain, accompanied by bleeding and dry stools. His pulse was surging and large but felt choppy on deep pressure. This condition arises because the meridians have become lax; or due to depletion of essence and Qi, causing weakness in the collaterals, allowing toxins from alcohol and food to flow into the deficiency; or from excessive sexual indulgence where one forcibly retains essence, leading to transmission to the Large Intestine, causing Wood to overact on Fire and destroy Metal; or from excessive consumption of rich flavors, inevitably causing this disease. The root of the pathology lies in Dryness, while the pathogenic factor is Damp-Heat. It should be treated with formulas that purge fire, harmonize blood, moisten dryness, and disperse wind. If the hemorrhoid ulcerates and fails to heal, it becomes an anal fistula. Fistulas may track to the buttocks, genitals, or penetrate the intestine, with foul matter discharging from the wound. Although the manifestations differ, the treatment principles are similar. Anal swelling forming a mass indicates Damp-Heat; pain indicates Wind; dry and hard stools indicate Fire; ulceration with pus indicates Heat damaging Blood. One must investigate the specific cause to treat accordingly.
A man with hemorrhoids complicated by an anal fistula experienced pain every time he used the toilet. He was treated with Qinjiao Fangfeng Tang (Gentian and Saposhnikovia Decoction) added with Tiaohuangqin (Scutellariae Radix) and Zhike (Aurantii Fructus) for four doses, resulting in a cure. He then took Siwu Tang (Four Substances Decoction) added with Shengma (Cimicifugae Rhizoma), Huangqin (Scutellariae Radix), Lianzi (Coptidis Rhizoma), Jingjie (Schizonepetae Herba), and Fangfeng (Saposhnikoviae Radix), preventing recurrence.
A man with a hemorrhoidal fistula experienced anal prolapse and pain upon defecation, requiring a long time to reduce. He was treated with Qinjiao Fangfeng Tang (Gentian and Saposhnikovia Decoction) for several doses until symptoms slightly subsided. Dahuang (Rhei Radix et Rhizoma) was then removed, and Huangqi (Astragali Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), and Shaoyao (Paeoniae Radix) were added to stop the pain. Finally, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was administered for over twenty doses, after which prolapse did not recur.
A woman suffered from severe swelling and pain of hemorrhoids. She was treated with Siwu Tang (Four Substances Decoction) added with Huangqin (Scutellariae Radix), Lianzi (Coptidis Rhizoma), Honghua (Carthami Flos), Taoren (Persicae Semen), and Mudanpi (Moutan Cortex) for several doses until symptoms subsided, and continued for several more doses until cured.
A woman experienced post-defecation bleeding, sallow complexion, tinnitus, lethargy, and poor appetite. Her condition worsened with cooling-blood herbs. Her Right Guan pulse was floating and weak. This indicated that Spleen Qi deficiency failed to control the blood; only tonifying Spleen Qi and raising Yang could cure it. Cold-natured herbs must be strictly avoided. However, if bleeding with pus and blood results from damaging Damp-Heat through diet, bitter-cold herbs should be used to internally clear it. A string-tight, extreme, or choppy pulse is difficult to treat, whereas a slippery, large, and soft pulse is easy to treat.
A man with hematochezia found his condition worsened with overwork, accompanied by loss of taste. He was treated with Liujunzi Tang (Six Gentlemen Decoction) added with Huangqi (Astragali Radix), Dihuang (Rehmanniae Radix), and Diyuyu (Sanguisorbae Radix), resulting in a cure.
A man with hematochezia found it particularly severe in spring, accompanied by abdominal pain. He was treated with Chushi Hexue Tang (Drain Dampness and Harmonize Blood Decoction), resulting in a cure.
A man with chronic Damp-Heat hematochezia was cured using Huaihua San (Sophora Powder).
A man with post-defecation bleeding had been unresponsive to various medications for a long time and was in critical condition. Diagnosis revealed Damp-Heat. He was treated with Huanglian Wan (Coptis Pill) twice, which stopped the bleeding immediately, and he recovered after several doses.
A man with chronic post-defecation bleeding due to insufficient Middle Qi was treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) for several doses, followed by Huanglian Wan (Coptis Pill) to stop the bleeding. He then resumed the previous decoction, and no recurrence occurred for over a month.
A man with Zangdu (Visceral Toxin) bleeding took cooling-blood and detoxifying herbs. Not only did the bleeding not stop, but his appetite decreased, limbs became more fatigued, and his pulse was rapid and choppy on deep pressure. He should first take Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) to tonify the Spleen and Stomach, which would yield effective results.
A man with Zangdu (Visceral Toxin) bleeding and inherently weak Spleen Qi was treated with Liujunzi Tang (Six Gentlemen Decoction) added with Xiong (Chuanxiong Rhizoma), Gui (Angelicae Sinensis Radix), Zhike (Aurantii Fructus), Diyuyu (Sanguisorbae Radix), and Huaihua (Sophorae Flos), resulting in a cure. Later, due to excessive mental exertion... [text implies further treatment logic] ...investigate the cause and treat. Danxi stated: Xionggui Tang (Ligusticum and Angelica Decoction) is one dose, and also a superior herb for regulating blood. For Heat, add Fuling (Poria) and Huaihua (Sophorae Flos); for Cold, add Baifuling (Poria) and Muxiang (Aucklandiae Radix). This is a theory of treating from the root. Although Essence, Qi, and Blood originate from Grain Qi, specifically for Large Intestine bleeding, success is achieved by treating the Stomach. Using Sijunzi Tang (Four Gentlemen Decoction) or Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder), harmonized with Zhike San (Aurantium Powder) and Xiao Wuchen Tang (Minor Black Stagnation Decoction), once Stomach Qi returns, blood naturally follows the meridians. Changfeng (Intestinal Wind) is external evil entering, appearing immediately upon exposure. Zangdu (Visceral Toxin) appears only after accumulation of toxin over time. Furthermore: Sitting or lying in wind-dampness, drunkenness and fullness, sexual fatigue, retention of cold from raw/cold foods, and accumulation of heat from alcohol lead to Nutritive Blood deviating from its course and seeping into the Large Intestine, causing Changfeng and Zangdu. Bleeding with Heat is clear and bright red, with abdominal pain. Bleeding with Cold is turbid and dark, with slight abdominal pain. Clear indicates Changfeng; turbid indicates Zangdu. Bleeding after defecation indicates a distant source; bleeding before defecation indicates a near source. The popular distinction between pre- and post-defecation bleeding is incorrect! The general treatment principle: First, resolve Wind-Evil in the intestines and stomach. For Heat, use Renshen Baidu San (Ginseng and Ten-Ingredient Powder); for Cold, use Buhuanjin Zhengqi San (Golden-Replacing Upright Qi Powder) added with Chuanxiong (Ligustici Chuanxiong Rhizoma) and Danggui (Angelicae Sinensis Radix), then treat according to Cold or Heat.
Hejian (Liu Wansu) said: "Irregular living habits and excessive effort damage the collaterals. Damage to Yang collaterals causes external bleeding (epistaxis). Damage to Yin collaterals causes..." [text incomplete] "...cannot generate." All formulas attribute this to Wind-Heat invading the Large Intestine. If diet is regulated and living habits regular, and the intestines and stomach are not deficient, how can evil enter?
A woman with chronic hemorrhoidal fistula experienced slight bleeding when exposed to heat. She was treated with Siwu Tang (Four Substances Decoction) added with Huanglian (Coptidis Rhizoma), resulting in a cure. Later, she developed painful swelling from labor exhaustion. After menstruation, Puhuang (Typhae Pollen), Huangqin (Scutellariae Radix), and Lianzi (Coptidis Rhizoma) were removed, and Digupi (Phellodendri Cortex) was added for several doses, bringing relief. Danxi said: Metrorrhagia in women results from damage to the Zang-Fu organs and deficiency of Qi and Blood in the Chong and Ren vessels. These two vessels are the sea of pulses. Qi and Blood circulate externally along the meridians and protect the Zang-Fu organs. If Qi and Blood are balanced, menstruation occurs on time. If labor is excessive, Zang-Fu organs are damaged, Chong and Ren Qi become deficient, failing to constrain menstrual blood, causing sudden heavy bleeding, known as Metrorrhagia or Profuse Downward Flow. Treatment requires major tonification of Qi and Blood, supporting the Spleen and Stomach, with minor addition of herbs to settle Heart Fire, tonifying Yin and purging Yang, restoring balance.
A man with hemorrhoidal fistula experienced anal prolapse upon defecation, taking a long time to reduce. His pulse was fine and slippery. He was treated with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) for over thirty doses, after which prolapse ceased. Deficiency is treated with Siwu Tang (Four Substances Decoction). Blood Heat is cooled with Siwu Tang (Four Substances Decoction) added with Huangbai (Phellodendri Cortex). The Lung and Large Intestine are exterior-interior pairs; thus, Lung Heat causes anal constipation. Lung deficiency..." [text incomplete] "...was reduced.
Attached Formulas
Qinjiao Cangzhu Tang (Gentian and Atractylodes Decoction): Treats Intestinal Wind and hemorrhoidal fistula with constipation.
Ingredients: Qinjiao (Gentianae Radix), Cangzhu (Atractylodis Rhizoma, soaked in rice water and stir-fried), Zaojiaoren (Gleditsiae Sinensis Spina, burned to retain nature), Tao-ren (Persicae Semen, each 1.5 qian), Huangbai (Phellodendri Cortex, wine-processed), Zexie (Alismatis Rhizoma), Dangguiwei (Angelicae Sinensis Radix tail).
Danggui Yuliren Tang (Angelica and Prunus Decoction): Treats hemorrhoidal fistula with hard stools, rectal prolapse, bleeding, severe pain.
Ingredients: Dangguiwei (Angelicae Sinensis Radix tail, mixed with wine), Yuliren (Pruni Semen), Zexie (Alismatis Rhizoma), Shengdihuang (Rehmanniae Radix), Dahuang (Rhei Radix et Rhizoma, baked), Zhike (Aurantii Fructus), Cangzhu (Atractylodis Rhizoma), Qinjiao (Gentianae Radix, each 1 qian), Maziren (Cannabis Seed).
Jiawei Longdan Xiegan Tang (Modified Gardenia and Gentian Decoction - see Xiaogan Section): Treats hemorrhoids with difficult urination or swelling/pain.
Siwu Tang (Four Substances Decoction - see Luoli Section).
Qinjiao Fangfeng Tang (Gentian and Saposhnikovia Decoction): Treats hemorrhoidal fistula with dryness and pain during defecation.
Ingredients: Qinjiao (Gentianae Radix), Fangfeng (Saposhnikoviae Radix), Danggui (Angelicae Sinensis Radix, mixed with wine), Baizhu (Atractylodis Macrocephalae Rhizoma, each 4.5 qian), Huangbai (Phellodendri Cortex), Chenpi (Citri Reticulatae Pericarpium), Chaihu (Bupleuri Radix), Dahuang (Rhei Radix et Rhizoma, baked), Zexie (Alismatis Rhizoma, each 1 qian).
Bazhen Tang (Eight Treasures Decoction - see Ulcer Fever Section).
Jiawei Sijunzi Tang (Modified Four Gentlemen Decoction): Treats hemorrhoidal fistula bleeding, sallow complexion, palpitations, tinnitus, weak legs, Qi deficiency, and all Spleen-Stomach deficiency with bland taste and loss of appetite. Also treats inability to control blood due to Middle Qi deficiency causing uncontrollable hematochezia.
Ingredients: Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried), Fuling (Poria), Baiddoudou (Vigna Angularis Seed, steamed), Huangqi (Astragali Radix, honey-roasted), Gancao (Licorice Root). Grind into powder, take 3 qian per dose, dissolved in boiling water.
Sijunzi Tang (Four Gentlemen Decoction): Treats Spleen-Stomach weakness with continuous hematochezia.
Ingredients: Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried), Baifuling (Poria, each 1 qian), Gancao (Licorice Root, roasted, 0.5 qian). Make one dose, add 2 zhong of water, 3 slices of ginger, 1 jujube. Decoct to 0.8 zhong, take away from meals.
Huanglian Wan (Coptis Pill): Treats Large Intestine Heat with bleeding.
Ingredients: Equal parts Huanglian (Coptidis Rhizoma) and Wuzhuyu (Evodiae Fructus). Moisten with hot water, cover for three days, then stir-fry together. Remove and grind separately. Make pills with rice paste, size of wuizi (wheat grain). Take 2-3 qian per dose. If blood is bright red before stool, take Evodia pill; if dark red after stool, take Coptis pill. Both taken with wine.
Liujunzi Tang (Six Gentlemen Decoction - see Vomiting Section).
Chushi Hexue Tang (Drain Dampness and Harmonize Blood Decoction): Treats Yangming Channel Damp-Heat with hematochezia and abdominal pain.
Ingredients: Shengdihuang (Rehmanniae Radix), Mudanpi (Moutan Cortex), Shenggancao (Raw Licorice Root, each 0.5 fen), Shugancao (Cooked Licorice Root), Huangqi (Astragali Radix, each 1 qian, roasted), Baishaoyao (White Peony Root, 1.5 qian), Shengma (Cimicifugae Rhizoma). Add 2 zhong of water, decoct to 0.8 zhong. Take hot on an empty stomach after digestion of previous meal.
Huaihua San (Sophora Powder): Treats Intestinal Wind and Visceral Toxin bleeding.
Ingredients: Huaihua (Sophorae Flos, stir-fried), Shengdihuang (Rehmanniae Radix, wine-mixed, steamed in copper vessel for half day), Qingpi (Citri Reticulatae Pericarpium Viride), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried), Jingjiesui (Schizonepetae Spica, each 0.6 qian), Chuanxiong (Ligustici Chuanxiong Rhizoma, roasted, 0.4 qian), Dangguishen (Angelicae Sinensis Radix head, wine-mixed), Shengma (Cimicifugae Rhizoma, each 1 qian). Grind into powder, take 3 qian per dose with rice drink on empty stomach. Can also be decocted in water.
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction).
Renshen Baidu San (Ginseng and Ten-Ingredient Powder) [Two formulas see Ulcer Fever Section].
Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder): Treats Spleen-Stomach disharmony, poor appetite, vomiting, or diarrhea. Suitable for recovery after major illness.
Ingredients: Renshen (Ginseng Radix), Fuling (Poria), Baiddoudou (Vigna Angularis Seed, peeled and stir-fried with ginger juice), Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried), Lianrou (Nelumbinis Semen, heart and skin removed), Sharen (Amomi Fructus, stir-fried), Yiyiren (Coicis Semen, stir-fried), Jiegeng (Platycodonis Radix, stir-fried), Shanyao (Dioscoreae Rhizoma), Gancao (Licorice Root, roasted, each 2 liang). Grind into fine powder, take 3 qian per dose with Stone Calamus decoction.
Guipi Tang (Restore the Spleen Decoction): Treats Spleen damage from overthinking, failure to control blood,妄行 (wild flow) of Heart Blood causing hematemesis or hematochezia, forgetfulness, palpitations, insomnia, or Heart-Spleen pain.
Ingredients: Baizhu (Atractylodis Macrocephalae Rhizoma, stir-fried), Fushen (Poria with Hostwood), Huangqi (Astragali Radix, honey-roasted), Longyanrou (Longan Aril), Suanzaoren (Ziziphi Spinosae Semen, steamed, each 1 qian), Renshen (Ginseng Radix), Muxiang (Aucklandiae Radix, each 0.5 qian), Gancao (Licorice Root, roasted, 0.25 qian). Make one dose, add 1 zhong of water, 1 slice of ginger, 1 jujube. Decoct to 0.6 zhong. Take away from meals and before bed.
Xiao Wuchen Tang (Minor Black Stagnation Decoction): Treats Qi disharmony with continuous hematochezia.
Ingredients: Wuyao (Linderae Radix, 1 liang), Gancao (Licorice Root, roasted, 2 qian), Xiangfu (Cyperi Rhizoma, wine-processed, 4 liang). Take 2 qian per dose before meals with salt water.
Buhuanjin Zhengqi San (Golden-Replacing Upright Qi Powder - see Vomiting Section).
Zhike San (Aurantium Powder): Treats hematochezia, irregular menstruation in women, vexing heat in hands/feet, night sweats, chest/stomach discomfort.
Ingredients: Zhike (Aurantii Fructus, bran-stir-fried, 1 qian), Banxiaqu (Pinelliae Fermented Paste), ChiShaoyao (Red Peony Root, stir-fried, each 1 qian), Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix, each 1.5 qian). Make one dose, add 2 zhong of water, 3 slices of ginger, 2 jujubes. Decoct to 0.8 zhong, take away from meals.
Xionggui Tang (Ligusticum and Angelica Decoction): Treats hematochezia or dizziness from excessive blood loss.
Ingredients: Xiong (Chuanxiong Rhizoma, 5 qian), Danggui (Angelicae Sinensis Radix, wine-mixed, 5 qian). Make one dose, add 1.5 zhong of water. Decoct to 0.6 zhong, take after meals.
Rushen Qianjin Fang (Miraculous Thousand Gold Formula): Highly effective for hemorrhoids.
Ingredients: Hao Xinshi (Good Realgar/Stibnite, yellow and bright, 3 qian, crushed to bean size), Ming Bai Fan (Clear White Alum, 1 liang ground), Hao Huang Dan (Good Yellow Lead Oxide, water-triturated, stir-fried until color changes, 5 qian), Xie Shao (Scorpion Tail, seven pieces, washed clean, dried on tile, ground), Cao Wu (Aconitum Kusnezoffii Root, firm and smooth, peeled and raw-ground, 1 qian). Use a purple clay pot. Heat charcoal until red, let cool and wipe clean. First add White Alum and boil, then add Stibnite, mix well in Alum. Use medium-low heat until boiling, stir again. When the pot glows red and smoke rises, remove from heat. Let cool, grind to powder. Then add Cao Wu, Huang Dan, and Xie Shao, grind extremely fine. Store in porcelain jar. To apply: First decoct Licorice water or Scallion/Pepper water to wash the area. Mix powder with raw sesame oil. Apply to hemorrhoid with goose feather brush, three times daily. Afterwards, yellow fluid like glue will discharge. Hemorrhoid head will gradually shrink. Depending on duration, [text incomplete]... This is the Cao Wu formula from Lin'an. Huang Yuan... introduced it to Emperor Gaozong, curing hemorrhoids. Cao was later appointed Inspector.
Li Fangyu's Five Hemorrhoid Formula
Originally, hemorrhoids affect both rich and poor, men and women. The rich suffer from alcohol, sex, wealth, and anger; the poor from carrying light/heavy loads, hunger, dew, and early travel. All relate to Heart and Liver Blood. Joy damages... [text incomplete].... Women suffer from cold after menstruation, wind during menses, residual blood in Heart, flowing to Large Intestine. Children suffer from diarrhea aftermath or maternal womb heat.
Treatment formulas follow:
Shuicheng Gao (Water-Clear Paste): Protects flesh for hemorrhoids.
Ingredients: Yujin (Curcumae Radix), Baiji (Bletillae Rhizoma, each 1 liang). One variation adds Huanglian (Coptidis Rhizoma). Grind these two into fine powder. For internal hemorrhoids, after defecation when they protrude, wash with warm water... [text incomplete]... Cover with medicine for a long time, then apply Kugu (Withering) medicine to the hemorrhoid head. Dip brush in warm water on paper to prevent drying and spreading.
Hao Bai Fan (Good White Alum, 4 liang), Sheng Xinshi (Raw Stibnite, 2.5 qian), Zhusha (Cinnabar, 1 qian, raw-ground extremely fine). Grind each separately into fine powder. First put Arsenic (Stibnite) into purple clay pot... [text incomplete]... Assess hemorrhoid size. Take Alum powder in palm, add a little Cinnabar, mix with saliva to thin consistency. Apply around hemorrhoid with comb handle, three times daily. Effect indicated by blackening of hemorrhoid head. Yellow fluid will discharge at night. Do not doubt. When fluid stops, ideal. Apply medicine once at midnight, three times next day. Mild pain is acceptable. When changing medicine, hold bowl of fresh/warm water, gently wash old medicine off hemorrhoid edge with brush, apply new medicine. Still use protective flesh medicine, then wash with Schizonepeta water. After 2-3 days, when yellow fluid nearly stops, increase Cinnabar and decrease Alum in the mixture to slow potency. Adjustments can be made every few days, gradually reducing. This avoids shock. Success depends on the practitioner observing color changes and adjusting thickness. This medicine relies on Arsenic/Stibnite, neutralized by Cinnabar. A Daoist priest used these two formulas in the capital with great effect, gaining wealth. A rich man verified them and bought them for 100 gold taels, recording them for me. Although I haven't used them, transmitters say they are effective. However, Kugu medicine was already published by Alchemist Zhao Yizhen in *Qingnang Zazu*. Rushen Qianjin Fang has not been published. Generally, those claiming to cure hemorrhoids today use these formulas. Fearful of Qi/Blood deficiency or internal evil, one should simultaneously treat internally to avoid loss.