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Hemorrhoids and fistulas (Zhi Lou) occur at the side of the anus and are governed by the Lower Jiao (Lower Burner). Individuals who indulge in alcohol and sexual activity are prone to this condition. It is caused by fire qi descending and accumulating heat in the intestines and stomach. There are seven types named: Pin Hemorrhoids (Female Hemorrhoids), Mu Hemorrhoids (Male Hemorrhoids), Chicken Comb Hemorrhoids, Sheep's Milk Hemorrhoids, Tong Chang Hemorrhoids (Intestinal Fistula), Fan Hua Hemorrhoids (Cauliflower-like Hemorrhoids), and Mai Hemorrhoids (Vein Hemorrhoids). Among these, only Tong Chang and Fan Hua are difficult to treat.

For treating external hemorrhoids: In the early stage, moxibustion with mugwort (Ai Ye) separated by garlic slices for three to four moxa cones (Zhuang) should be applied; after removing the garlic, direct moxibustion on the skin for three to four cones can lead to recovery without much effort. Alternatively, treated silk threads can be used to ligate and sever the head of the hemorrhoid, followed by applying topical medication. Additionally, one should take Huanglian Siwu Tang (Coptis Four Substances Decoction), Pi Wan (Bark Pill), Liangxue Dihuang Tang (Cooling Blood Rehmannia Decoction), and Gegen Tang (Kudzu Decoction).

For treating internal hemorrhoids: The method should focus on cooling blood, resolving toxicity, and lifting sinking Qi, which leads to recovery.

If it is a fistula due to deep bone abscesses (Fugu Zhen) or an open hemorrhoidal cavity that fails to generate muscle and flesh, leading to internal ulceration with dripping pus and blood, one should use La Fen Zhen (Wax Alum Needle) inserted into the fistula opening, take the aforementioned decoctions and pills to extract toxins, continue applying Wanling Gao (Ten Thousand Spirits Plaster) to thoroughly drain pus and blood, and finally apply Shengji San (Muscle-Generating Powder) for recovery. For Tong Chang and Fan Hua hemorrhoids, internal elimination methods combined with topical prescriptions are required. The above formulas can all be taken to achieve recovery.

**Five-Ingredient Huanglian Siwu Tang**
Danggui (washed with wine) 1 qian, Huanglian 7 fen, Chuanxiong, Baishao, and Shengdi each 2 qian.
Take on an empty stomach.

**Two-Ingredient Pi Wan**
Huai Pi (soaked in wine, then baked dry) 4 liang, Huaijiao (frost-exposed, then baked dry) 1 jin.
Grind these two ingredients into powder, mix evenly, and form pills with honey, sized like paulownia seeds. Take 100 pills every morning on an empty stomach with light wine.

**External Washing and Steaming Method**
Liji Zi (i.e., Discocarpus plant) 10 branches, Sangbaipi 1 branch.
Decoct in water for steaming and washing; recovery occurs within three to four treatments.

**Five-Ingredient Huaijiao Wan**
Huaijiao (processed) 0.5 jin, Huaihua (processed) 0.5 jin, Binglang 4 pieces, Huapi (soaked in wine and baked dry) 1 liang, Huangqin 2 liang.
Grind all into fine powder, refine honey to make pills sized like paulownia seeds. Take with wine or water.

**Ten-Ingredient Liangxue Dihuang Tang**
Shengdi, Chishao, Danpi, Huaijiao, Honghua, Zhike, Zhizi, Huangbai, Lianqiao, Huanglian.
Take on an empty stomach.

**Two-Ingredient Ligature Method for Hemorrhoids**
Use processed artificial silk mixed with natural silk thread. Wrap around the hemorrhoid head six to seven times. Place a slice of garlic (neither too thick nor too thin) on top, perform moxibustion on the garlic for three cones, then apply Shengji San for recovery.

**Two-Ingredient Wax Alum Needle**
Melt yellow wax with a small amount of calcined alum powder, roll into a long strip, insert into the fistula tract. After pus and blood are completely drained, apply Shengji San.

**Two-Ingredient Wash Hemorrhoid Decoction**
Decoct Portulaca oleracea (Maxinchixiancao) for washing, then decoct Stephania tetrandra (Baihuacai) for washing.