叙曰∶察痔漏者，疡医之事也，君子鄙谈之。然择疾而疗，非医之任者也。故考二方，
以大其规，详论药物，以要其变。
当归 芍药 川芎 生地黄 酒黄芩 酒黄柏 炒槐花
内热痔漏下血者，此方主之。
痔漏，广肠之毒也。《内经》曰∶因而饱食。经脉横解，肠癖为痔。是以痔漏之疾，多
见于膏粱富贵之人，而藜藿之腹，未见其多也。一有病根，则劳思便作，饮酒便用，所以然
者，内热而血妄行也。是方也，生地、槐花、黄芩、黄柏，清其热也；当归、芍药、川芎，
调其
人参 白术（炒） 茯苓 甘草（炙）
年高气弱，痔血不止者，此方主之。误服攻痔之药，致血大下不止而虚脱者，亦此方主
之。血，有形之阴也，必赖无形之气以固之。故年高而气弱，则血下。久药损气，则血下。
是方也，人参、白术、茯苓、甘草，皆甘温益气之品也。大气充盈，自足以固有形之血，譬
之干元充溢于两间，自能举乎大地，而无倾陷之危者也。
昆按∶古方医痔漏下血，有用槐角灰者，有用柏叶灰者，有用 皮灰者，有用露蜂房灰
者，有用牛角腮灰者，有用胡桃灰者，俱以方寸匕酒调下，此皆枯痔之法也。汤液之中，有
用防风者，有用秦艽者，有用皂角仁者，有用荆芥、白芷者，此皆责之风热入脏也；有用芒
硝、大黄者，有用槟榔、枳实者，此皆责之实热可下也；有用胡黄连者，有用酒苦参者，有
用石莲肉者，有用番木鳖者，此皆责之实热可清也。有用桃仁、红花者，有用蒲黄、苏木者，
此皆责之瘀血未消也。有用杏仁、麻仁者，有用地黄、黄柏者，此皆责其燥金无液也。有用
地榆、蕲艾者，有用枯龙骨、鹿角霜者，此欲强止其血也。有用象牙、螳螂者，有用人爪、
蟹爪者，此欲放出其肛而外施药以愈之也。有用熏法者，有用洗法者，有用药坐者，无非枯
痔止血之品也。有用插药者，有用挂线者，无非烂肌去腐之辈也。呜呼！任医犹任将，用药
犹用兵。神于兵者，叠石可以为营，驱牛可以破敌。神于药者，心解而机自灵，见超而术自
神，有不拘拘于纸上之陈言矣。
Preface states: Examining hemorrhoids and fistulas is the duty of a surgeon (Yang Yi, external medicine physician), and gentlemen disdain to discuss it. However, selecting diseases for treatment is not the responsibility of a physician. Therefore, these two formulas are examined to expand their therapeutic scope, and the drugs are discussed in detail to grasp their variations.
Dang Gui (Angelicae Sinensis Radix), Shao Yao (Paeoniae Radix Alba), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Sheng Di Huang (Rehmanniae Radix), Jiu Huang Qin (Scutellariae Radix prepared with wine), Jiu Huang Bo (Phellodendri Cortex prepared with wine), Chao Huai Hua (Sophorae Flos stir-fried).
For cases of hemorrhoids and fistulas with bleeding due to internal heat, this formula is indicated.
Hemorrhoids and fistulas are toxins in the Changchang (broad intestine/rectum). The *Neijing* (Inner Canon) states: "Due to overeating, the meridians become slack horizontally, leading to intestinal dysentery which manifests as hemorrhoids." Thus, diseases of hemorrhoids and fistulas are mostly seen in wealthy individuals who consume rich and greasy foods (Gaoliang), while those who eat coarse grains (Lihuo) rarely suffer from them. Once the root cause exists, labor and worry trigger an attack, and alcohol consumption induces it. The reason is that internal heat causes blood to move recklessly. In this formula, Sheng Di Huang, Huai Hua, Huang Qin, and Huang Bo clear the heat; Dang Gui, Shao Yao, and Chuan Xiong regulate the [blood/qi].
Ren Shen (Ginseng Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma, stir-fried), Fu Ling (Poria), Zhi Gan Cao (Licorice Root, honey-fried).
For the elderly with weak qi and persistent hemorrhoidal bleeding, this formula is indicated. For cases where mistaken use of purgative drugs for hemorrhoids leads to massive bleeding and collapse (Xu Tuo), this formula is also indicated. Blood is tangible Yin, which must rely on intangible Qi to consolidate it. Therefore, when one is old and qi is weak, blood descends. Long-term medication damages qi, causing blood to descend. In this formula, Ren Shen, Bai Zhu, Fu Ling, and Gan Cao are all sweet-warm herbs that tonify qi. When great qi is abundant, it is sufficient to hold the tangible blood, just as Yuan Qi (Original Qi) fills the universe and naturally supports the earth, avoiding the danger of collapse or sinking.
Wu Kun notes: Ancient formulas for treating hemorrhoidal bleeding used cinder of Huai Jiao (Stylocarpi Fructus), cinder of Bai Ye (Membranaceae Folium), cinder of [tree] bark, cinder of Lu Feng Fang (Apis Nidus), cinder of Niu Jiao Sai (Bovis Cornu), or cinder of Tao Ren (Juglandis Semen), all taken with wine using a Fang Cun Bi measure. These are all methods of drying up hemorrhoids (Ku Zhi). In decoctions, Fang Feng (Saposhnikoviae Radix), Qin Jiao (Gentianae Macrophyllae Radix), Zao Jiao Ren (Gleditsiae Sinensis Semen), Jing Jie (Schizonepetae Herba), and Bai Zhi (Angelicae Dahuricae Radix) are used; these address wind-heat entering the zang organs. Mang Xiao (Natrii Sulfas), Da Huang (Rhei Radix et Rhizoma), Bing Lang (Arecae Semen), and Zhi Shi (Aurantii Fructus Immaturus) are used; these address excess heat suitable for purging. Hu Huang Lian (Coptidis Chinensis Rhizoma alternative/Berberis), Jiu Ku Shen (Sophorae Flavescentis Radix prepared with wine), Shi Lian Rou (Nelumbinis Plumula), and Fan Mu Die (Strychni Semen) are used; these address excess heat suitable for clearing. Tao Ren (Persicae Semen), Hong Hua (Carthami Flos), Pu Huang (Typhae Pollen), and Su Mu (Sappan Lignum) are used; these address unresolved blood stasis (Yu Xue). Xing Ren (Armeniacae Semen Amarum), Ma Ren (Cannabis Semen), Di Huang (Rehmanniae Radix), and Huang Bo (Phellodendri Cortex) are used; these address dryness of Metal lacking fluids. Di Yu (Sanguisorbae Radix), Qi Ai (Artemisiae Argyi Folium), Ku Long Gu (Fossilia Ossis Maxillaris carbonized), and Lu Jiao Shuang (Cornu Cervi Degelatinatum pulverized) are used; these aim to strongly stop bleeding. Xiang Ya (Elephantis Dentis Os), Tang Lang (Mantidis Ootheca), Ren Zhao (Unguis Humani), and Xie Zhua (Carcinis Manus) are used; these aim to dilate the anus to apply external medicine for cure. Moxibustion fumigation (Xun Fa), washing (Xi Fa), and sitting baths (Zuo Yao) are used; none are other than herbs for drying hemorrhoids and stopping bleeding. Suppositories (Cha Yao) and thread ligation (Gua Xian) are used; none are other than agents to rot muscle and remove necrotic tissue. Alas! Appointing a physician is like appointing a general; using medicine is like using troops. Those skilled in warfare can stack stones to form camps and drive cattle to defeat enemies. Those skilled in pharmacology understand principles in their hearts and their ingenuity becomes agile; with superior insight, their techniques become miraculous, no longer bound by stale theories on paper.