夫肺与大肠相为表里。肛者，大肠之魄门是也。巢氏云∶实热则大便秘结，虚寒则肛门脱出
。此多因吐泻，脾气虚，肺无所养，故大肠之气虚脱而下陷也。用补中益气或四君子为主。
若脱出绯赤，或作痛者，血虚而有热也，用补中益气汤，佐以四物、牡丹皮。微者或作痛者
，气虚而有热也，佐以四君、牡丹皮。大凡手足指热者，属胃气热；手足指寒者，属胃气寒。
治验
一小儿痢后脱肛，饮食少思，面色青黄，余谓脾土亏损，肝木所胜也。不信，另服消导克滞
之剂，腹痛膨胀，倦怠作呕，余曰∶脾气虚甚矣。又不信，恪服前药，腹益胀重坠，四肢浮
肿。复请治之，仍欲克滞。余曰∶腹胀重坠，脾气下陷也。先用五味异功散加木香、四剂，
更手足冷，又加干姜，四剂而腹胀诸症渐愈。后因饮食过多，作泻脱肛，用补中益气汤加木
香及五味异功散而愈。
一小儿脱肛半载，侵晨便泄，两目白多，用升补脾气之剂，不应。余曰∶肾开窍于二阴，此
属肾虚也。用四神、地黄二丸及补中益气汤，月余而愈。
一小儿痢久脱肛，目睛多白，面色渐黄，余用补中益气汤、六味地黄丸，调补脾肾而痊。
一小儿小便先频数涩滞，次下痢脱肛，久而不愈，余以为禀父肾虚，用六味地黄丸寻愈，后
患泄泻咳嗽声喑，亦用前丸而瘥。
一小儿脱肛，用寒凉之药，肢体倦怠，饮食少思，肛门重坠，此脾气虚而中气下陷也，用补
中益气汤加酒炒芍药、白术、茯苓而瘥。
一小儿肛门肿痛，出血水，年余未愈，忽吐血便血，皆成紫块，此肠胃积热，用圣济犀角地
黄丸顿止。更用金银花、甘草为末，白汤调服，半载而痊。
一小儿脱肛，杂用除湿祛风收涩等药，面黄体倦，少食便血，余欲升补脾气以摄其血，反服
四物、槐花之类，而血亦甚，更加作呕，余先用四君、木香治之，形气渐充，便血顿止。又
用补中益气汤，更以萆麻仁涂顶心而愈。
一小儿因咳嗽，服化痰等药，或作或彻，服滚痰丸，更吐泻，手足指冷，眉目发搐，肛门脱
而不赤，余朝用补中益气汤，夕用六君子汤治之，诸症渐愈；但脱肛未入，恪服补中益气汤
而愈。
一小儿患痢脱肛，色赤或痛，用补中益气汤送香连丸而愈。后伤食用泻，肛复脱不入，仍用
前汤，更以萆麻仁研涂顶门而愈。
涩肠散 治小儿久痢，肠头脱出。
诃子（泡） 赤石脂 龙骨（各等分）
上为末，腊茶少许，和掺肠头上，绵帛揉入。
四神丸（方见惊泻）
地黄丸（方见肾脏）
补中益气汤（方见虚羸）
圣济犀角地黄汤（方见便血尿血，即济生犀角地黄汤）
四君子汤（方见内钓）
龙胆泻肝汤（方见疝气）
The Lung and Large Intestine are exteriorly-interiorly related. The anus is the "Gate of Po" (魄门) of the Large Intestine. Chao Yuanfang stated: Excess-Heat leads to constipation, while Deficiency-Cold leads to rectal prolapse. This condition often arises from vomiting and diarrhea, which damage Spleen Qi, causing Lung Qi to lose nourishment; consequently, the Qi of the Large Intestine becomes deficient and sinks downward. Treatment should primarily utilize Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) or Si Jun Zi Tang (Four Gentlemen Decoction).
If the prolapsed tissue appears crimson or is painful, it indicates Blood Deficiency with Heat. Use Bu Zhong Yi Qi Tang, assisted by Si Wu Tang (Four Substances Decoction) and Mu Dan Pi (Moutan Cortex). If symptoms are mild but accompanied by pain, it indicates Qi Deficiency with Heat; assist with Si Jun Zi Tang and Mu Dan Pi. Generally, heat in the fingers and toes of the hands and feet belongs to Stomach Qi Heat; cold in the fingers and toes belongs to Stomach Qi Cold.
Case Record 1: A child presented with rectal prolapse after dysentery, decreased appetite, and a bluish-yellow complexion. I diagnosed this as Spleen Earth deficiency overpowered by Liver Wood. The family disagreed and administered digestive-promoting agents, resulting in abdominal pain, distension, fatigue, and vomiting. I stated, "Spleen Qi is extremely deficient." They still disagreed and persisted with the previous medication, leading to increased abdominal distension, heaviness, and lower sensation, along with edema of the four limbs. Upon re-consultation, they still desired digestive-promoting treatment. I explained, "Abdominal distension with heaviness and sinking sensation indicates Sinking of Spleen Qi." I first prescribed Wu Wei Yi Gong San (Five Agents with Efficacy Powder) added with Mu Xiang (Aucklandiae Radix), for four doses. Subsequently, the extremities became cold, so Gan Jiang (Dried Ginger) was added. After another four doses, the abdominal distension and other symptoms gradually improved. Later, due to overeating, diarrhea and rectal prolapse recurred. He was cured using Bu Zhong Yi Qi Tang added with Mu Xiang and Wu Wei Yi Gong San.
Case Record 2: A child suffered from rectal prolapse for half a year, with morning diarrhea and eyes showing more white than black. Treatment with herbs to raise and tonify Spleen Qi was ineffective. I stated, "The Kidney opens into the two yin orifices; this belongs to Kidney Deficiency." He was treated with Si Shen Wan (Four Spirits Pill), Di Huang Wan (Rehmannia Pill), and Bu Zhong Yi Qi Tang, recovering after more than a month.
Case Record 3: A child had prolonged dysentery leading to rectal prolapse, with eyes showing more white and a gradually yellowish complexion. I used Bu Zhong Yi Qi Tang and Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) to harmonize and tonify the Spleen and Kidney, resulting in recovery.
Case Record 4: A child first experienced frequent and difficult urination, followed by dysentery and rectal prolapse, which persisted for a long time. I attributed this to congenital Kidney Deficiency inherited from the father. He recovered quickly after taking Liu Wei Di Huang Wan. Later, he suffered from diarrhea, cough, and hoarseness, which also resolved with the same pill.
Case Record 5: A child with rectal prolapse was mistakenly treated with cold-natured medicines, resulting in limb fatigue, poor appetite, and a heavy, sinking sensation in the anus. This indicated Spleen Qi Deficiency and Sinking of Central Qi. He was cured using Bu Zhong Yi Qi Tang added with Jiu Chao Shao Yao (Wine-fried Paeoniae Radix Alba), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Fu Ling (Poria).
Case Record 6: A child had painful swelling of the anus with bloody discharge for over a year without healing. Suddenly, he vomited blood and passed blood in stool, both forming purple clots. This indicated Accumulated Heat in the Intestines and Stomach. Sheng Ji Xi Jiao Di Huang Wan (Sheng Ji Rhinoceros Horn and Rehmannia Pill) stopped the bleeding immediately. Then, Jin Yin Hua (Lonicerae Japonicae Flos) and Gan Cao (Glycyrrhizae Radix et Rhizoma) were powdered and taken with warm water, resulting in recovery after six months.
Case Record 7: A child with rectal prolapse had been miscellaneously treated with dampness-draining, wind-dispelling, and astringent herbs, presenting with a yellow complexion, fatigue, poor intake, and bloody stools. I intended to raise and tonify Spleen Qi to control the bleeding, but the patient instead took Si Wu Tang and Huai Hua (Sophorae Flos), causing severe bleeding and worsened vomiting. I first treated him with Si Jun Zi Tang and Mu Xiang. As his physical constitution and Qi gradually strengthened, the bloody stools stopped. Then, Bu Zhong Yi Qi Tang was used, and Bi Ma Ren (Cannabis Semen) was applied to the vertex, leading to recovery.
Case Record 8: A child, due to cough, took phlegm-resolving herbs with intermittent results. He then took Gun Tan Wan (Rolling Phlegm Pill), which caused vomiting and diarrhea, cold fingers and toes, and twitching of the eyebrows and eyes. The anus prolapsed but was not red. I prescribed Bu Zhong Yi Qi Tang in the morning and Liu Jun Zi Tang (Six Gentlemen Decoction) in the evening. All symptoms gradually improved; however, the prolapsed anus did not reduce. Persisting with Bu Zhong Yi Qi Tang led to recovery.
Case Record 9: A child with dysentery-induced rectal prolapse had reddish tissue or pain. He was cured using Bu Zhong Yi Qi Tang to deliver Xiang Lian Wan (Fragrant Coptis Pill). Later, food stagnation caused diarrhea, and the anus prolapsed again and could not be reduced. The previous decoction was used again, and Bi Ma Ren paste was applied to the vertex, resulting in recovery.
Se Chang San (Intestine-Astringing Powder): Treats pediatric chronic dysentery with intestinal prolapse.
He Zi (Arecae Semen, soaked), Chi Shi Zhi (Halloysit Rubrum), Long Gu (Fossilized Bones) (equal parts).
Grind into powder. Mix with a small amount of La Cha (Winter Tea). Apply to the prolapsed intestine and gently push it back using silk cloth.
Si Shen Wan (See Jing Xie for formula)
Di Huang Wan (See Shen Zang for formula)
Bu Zhong Yi Qi Tang (See Xu Lei for formula)
Sheng Ji Xi Jiao Di Huang Tang (See Bian Xue Niao Xue for formula, i.e., Ji Sheng Xi Jiao Di Huang Tang)
Si Jun Zi Tang (See Nei Diao for formula)
Long Dan Xie Gan Tang (See Shan Qi for formula)