〔大〕妇人痔 ，因郁怒、风热、浓味膏粱所致。其名有五∶肛边如乳出脓者为牝
痔。肿胀出血者为牡痔。痒痛者为脉痔。肿核者为肠痔。登厕出血者为血痔。治宜审之。
〔薛〕前证，妇人多因胎产、经行、饮食起居、六淫七情失调所致。男子多因醉饱
入房，筋脉横解，精气脱泄，热毒乘虚而患。或入房强固其精，木乘火势而侮金，或炙爆
浓味，阴虚湿热，宜凉血润燥疏风，溃后当养元气，补阴精，不愈即成痔漏，有串臀、串
阴、穿肠者。其肠头肿块者，湿热也，作痛者风也，便燥者火也，溃脓者热胜血也。大
便作痛者，润燥除湿。肛门坠痛者，泻火导湿。小便涩滞者，清肝导湿。经云∶因而饱
食，筋脉横解，肠 为痔。证属肝肾不足，故用加味地黄及六味丸有效。慎勿敷毒药及服
寒凉之剂。
鳖甲散 治五种痔漏，脓血淋漓，或肿痛坚硬下坠。
鳖甲 露蜂房 蛇蜕 猪后悬蹄 皮（五味烧存性，各二钱） 麝香（一分）
上为末，每服一钱，空心生地黄煎汤调下，更敷之。
又方∶热痛用寒水石、朴硝为末，以津调搽。
治法并方，详《杂病》痔门，兹不重录。
〔大〕脱肛者，大肠之候也。大肠虚寒，其气下陷则肛门翻出，或因产努力，其肛亦
然也。
〔薛〕前证若大肠湿热，用升阳除湿汤。若血热，用四物、条芩、槐花。血虚，用四
物、白术、茯苓。兼痔痛，用四物、槐花、黄连、升麻。中风虚弱，用补中益气汤加芍药、
白术。中气虚寒，加半夏、炮姜、五味。肾虚，用六味丸。虚寒，用八味丸。夫肺与大
肠为表里，肛者大肠之门，肺实热则秘结，肺虚寒则脱出。肾主大便，故肺肾虚者，多用
此证。一妇人脱肛，用补中益气、加味归脾各百余剂而愈。后因分娩复脱，仍以前药
各二百余剂始愈。
升阳除湿汤 自下而上者，引而竭之。
升麻 柴胡 防风 神曲（炒） 泽泻 猪苓（各半两） 苍术（一两） 陈皮 甘草（炙）
大麦 （各三钱）
上每服五钱，水煎空心服。胃寒肠鸣，加益智仁、半夏各半钱，姜枣同煎服。
姚和众以铁粉敷之良。（《圣惠方》亦治阴脱、阴肿。）
《集验方》以生铁三斤，水一斗，煮至五升，取水洗，日二次。
孙真人用蛤蟆皮瓶中烧多烟熏，功效玄微。
一方 用五倍子煎汤洗，以赤石脂末掺上托入。或脱长者，以两床相并，中空尺许，
以瓷瓶盛汤，令病患仰卧浸瓶中，逐日易之，收尽为度。
【大】妇女患痔疮，多因情绪抑郁愤怒、风热侵袭、以及过食肥甘厚味所致。痔疮的名称有五种：肛门边缘如乳头状突出并流脓的称为牝痔（雌性痔）；肿胀且出血的称为牡痔（雄性痔）；瘙痒疼痛的称为脉痔；有肿块的称为肠痔；排便时出血的称为血痔。治疗应当仔细辨别。
【薛】上述病症，妇女多因怀孕生产、月经期间、饮食起居不当、以及六淫（风、寒、暑、湿、燥、火）和七情（喜、怒、忧、思、悲、恐、惊）失调所导致。男子多因醉酒后行房事，导致筋脉松弛，精气耗泄，热毒乘虚而入而患病。或者在房事中强行固摄精气，导致肝木之气乘火势而克制肺金；或者食用炙烤爆裂及浓烈厚味的食物，导致阴虚湿热。治疗宜采用凉血润燥、疏风的方法；溃破后应当补养元气，滋补阴精。若久治不愈，就会形成痔漏，有的蔓延至臀部，有的蔓延至外阴，有的穿透肠道。肛门处肿块者，属于湿热；疼痛者，属于风邪；大便干燥者，属于火邪；溃破流脓者，属于热盛伤血。大便疼痛者，宜润燥除湿。肛门坠痛者，宜泻火导湿。小便涩滞者，宜清肝导湿。经云：“因为饱食过度，导致筋脉松弛，肠道变为痔疮。”此证属于肝肾不足，所以使用加味地黄丸及六味地黄丸有效。切勿敷用毒药及服用寒凉药物。
鳖甲散 治疗五种痔漏，脓血淋漓不尽，或肿痛坚硬伴有下坠感。
鳖甲、露蜂房、蛇蜕、猪后悬蹄皮（以上五味烧至存性，各二钱）、麝香（一分）。
以上研为细末，每次服用一钱，空腹时用生地黄煎汤调服，并配合外敷。
又一方：热痛者，用寒水石、朴硝研为细末，以唾液调和后涂抹患处。
治疗方法及方剂详见《杂病》卷痔疮门，此处不再重复记录。
〔大〕脱肛，是大肠的病变表现。大肠虚寒，气机下陷，则肛门翻出体外；或因分娩用力努挣，也会导致肛门脱出。
〔薛〕上述病症，若属大肠湿热，使用升阳除湿汤。若属血热，使用四物汤加条芩、槐花。若属血虚，使用四物汤加白术、茯苓。兼有痔疮疼痛，使用四物汤加槐花、黄连、升麻。中风虚弱者，使用补中益气汤加芍药、白术。中气虚寒者，加半夏、炮姜、五味子。肾虚者，使用六味地黄丸。虚寒者，使用八味地黄丸。肺与大肠互为表里，肛门是大肠的门户，肺实热则导致便秘，肺虚寒则导致脱出。肾主司大便，所以肺肾两虚的人，多患此证。有一位妇人脱肛，使用补中益气汤和加味归脾汤各百余剂后痊愈。后来因分娩再次脱出，仍用前药各二百余剂才治愈。
升阳除湿汤 针对病势向下发展的症状，采用提升引导的方法。
升麻、柴胡、防风、神曲（炒）、泽泻、猪苓（各半两）、苍术（一两）、陈皮、甘草（炙）、大麦（各三钱）。
以上每次服用五钱，水煎，空腹服用。若胃寒肠鸣，加益智仁、半夏各半钱，加生姜、大枣同煎服用。
姚和众建议用铁粉外敷效果良好。（《圣惠方》也用于治疗阴户脱出、阴户肿胀。）
《集验方》用生铁三斤，水一斗，煮至五升，取汁清洗患处，每日两次。
孙真人用蛤蟆皮在瓶中燃烧产生浓烟熏蒸，功效玄妙微妙。
另一方：用五倍子煎汤清洗，将赤石脂粉末撒在患处托回。如果脱出较长，可将两张床并排，中间留出约一尺的空隙，用瓷瓶盛装药汤，让患者仰卧浸泡在瓶中，每天更换，直到完全收回为止。
[Da] Women suffering from hemorrhoids are often caused by emotional depression and anger, invasion of wind-heat, and excessive consumption of rich and greasy foods. There are five types: those with protrusions like nipples at the anal verge accompanied by pus discharge are called Pin Zhì (Female Hemorrhoid); those with swelling and bleeding are called Mu Zhì (Male Hemorrhoid); those with itching and pain are called Mai Zhì (Pulse Hemorrhoid); those with nodules are called Chang Zhì (Intestinal Hemorrhoid); and those with bleeding during defecation are called Xue Zhì (Blood Hemorrhoid). Treatment requires careful differentiation.
[Xue] The aforementioned conditions in women are often caused by pregnancy and childbirth, menstruation, improper diet and lifestyle, and imbalance of the Six Evils (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) and Seven Emotions (Joy, Anger, Worry, Pensiveness, Sorrow, Fear, Fright). In men, they are often caused by sexual intercourse after drunkenness or overeating, leading to flaccidity of tendons and vessels, depletion of essence and qi, and invasion of heat-toxin due to deficiency. Or, forcing retention of essence during intercourse causes Liver Wood to overcome Lung Metal due to fire; or consuming roasted, fried, and strong-flavored foods leads to Yin deficiency with damp-heat. Treatment should employ cooling blood, moistening dryness, and dispersing wind. After ulceration, one must nourish Yuan Qi (Primal Qi) and tonify Yin essence. If not cured, it may become a fistula, spreading to the buttocks, genitals, or penetrating the intestine. Nodules at the anus indicate damp-heat; pain indicates wind; dry stool indicates fire; ulceration with pus indicates heat overwhelming blood. Pain during defecation requires moistening dryness and draining dampness. Heaviness and pain in the anus require purging fire and guiding out dampness. Astringent and stagnant urination requires clearing the Liver and guiding out dampness. The Classics state: "Due to overeating, tendons and vessels become flaccid, and the intestines transform into hemorrhoids." This syndrome belongs to insufficiency of the Liver and Kidney, so Jia Wei Di Huang Wan (Modified Rehmannia Pill) and Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) are effective. Do not apply toxic medicines or take cold-cooling agents.
Bie Jia San (Turtle Shell Powder) treats the five types of hemorrhoidal fistulas with dripping pus and blood, or hard swelling and pain with a bearing-down sensation.
Bie Jia (Testudo Skin), Lu Feng Fang (Honeycomb), She Tui (Snake Slough), Zhu Hou Xuan Ti Pi (Skin of Pig's Hind Hoof) (these five ingredients calcined until the original nature remains, each 2 qian), She Xiang (Musk) (0.1 fen).
Grind into powder. Take 1 qian per dose, mixed with decoction of Sheng Di Huang (Raw Rehmannia Root) taken on an empty stomach, combined with external application.
Another prescription: For heat and pain, use Han Shui Shi (Halloysitum Rubrum) and Po Xiao (Mirabilite) ground into powder, applied with saliva.
Treatment methods and prescriptions are detailed in the "Miscellaneous Diseases" section under Hemorrhoids; they are not repeated here.
[Da] Rectal prolapse is a manifestation of Large Intestine pathology. Deficient-cold of the Large Intestine causes Qi to sink, resulting in eversion of the anus; or straining during childbirth can also cause rectal prolapse.
[Xue] For the aforementioned condition, if it is damp-heat of the Large Intestine, use Sheng Yang Chu Shi Tang (Yang-Raising Damp-Draining Decoction). If it is blood-heat, use Si Wu Tang (Four-Substance Decoction) with Tiao Qin (Scutellariae Radix prepared strips) and Huai Hua (Sophorae Flos). If it is blood deficiency, use Si Wu Tang with Bai Zhu (Atractylodis Macrocephalae Rhizoma) and Fu Ling (Poria). If accompanied by hemorrhoidal pain, use Si Wu Tang with Huai Hua, Huang Lian (Coptidis Rhizoma), and Sheng Ma (Cimicifugae Rhizoma). For weakness due to wind-stroke, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with Shao Yao (Paeoniae Radix Alba) and Bai Zhu. For deficiency-cold of the Middle Qi, add Ban Xia (Pinelliae Rhizoma), Pao Jiang (Prepared Zingiberis Rhizoma), and Wu Wei Zi (Schisandrae Fructus). For Kidney deficiency, use Liu Wei Di Huang Wan. For deficiency-cold, use Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill). The Lung and Large Intestine are exterior-interior partners; the anus is the gate of the Large Intestine. Lung excess-heat causes constipation; Lung deficiency-cold causes prolapse. The Kidneys govern defecation; thus, this condition is common in cases of Lung and Kidney deficiency. A woman with rectal prolapse was cured after taking Bu Zhong Yi Qi Tang and Jia Wei Gui Pi Tang (Modified Spleen-Tonifying Decoction) for over a hundred doses each. Later, she suffered recurrence after delivery and was cured again after taking each prescription for over two hundred doses.
Sheng Yang Chu Shi Tang (Yang-Raising Damp-Draining Decoction) For symptoms manifesting downward, guide them upward.
Sheng Ma (Cimicifugae Rhizoma), Chai Hu (Bupleuri Radix), Fang Feng (Saposhnikoviae Radix), Shen Qu (Massa Medicata Fermentata) (stir-fried), Ze Xie (Alismatis Rhizoma), Zhu Ling (Polyporus), Cang Zhu (Atractylodis Rhizoma) (1 liang), Chen Pi (Citri Reticulatae Pericarpium), Gan Cao (Licorice Root) (honey-fried), Da Mai (Hordei Fructus) (each 3 qian; Sheng Ma, Chai Hu, Fang Feng, Shen Qu, Ze Xie, Zhu Ling each 0.5 liang).
Take 5 qian per dose, decocted in water, taken on an empty stomach. If there is Stomach cold with borborygmus, add Yi Zhi Ren (Alpiniae Oxyphyllae Fructus) and Ban Xia (0.5 qian each), decocted with Sheng Jiang (Zingiberis Rhizoma Recens) and Da Zao (Jujubae Fructus).
Yao Hezhong recommended applying Iron Powder (Tie Fen) externally for good results. (Sheng Hui Fang also treats vaginal prolapse and vulvar swelling.)
Ji Yan Fang uses three jin of raw iron boiled in ten dou of water down to five sheng; wash the area with the liquid twice daily.
Sun Simiao used Toad skin burned in a bottle to generate smoke for fumigation, which has profound efficacy.
Another prescription: Wash with decoction of Wu Bei Zi (Galla Chinensis), sprinkle Chi Shi Zhi (Kaolinite) powder on the area, and push it back in. If the prolapse is long, place two beds side by side leaving a gap of about one chi, fill a porcelain bottle with soup, and have the patient lie supine immersing the area in the bottle. Change daily until fully retracted.