经义
魄门亦为五脏使。（《素问》）
下极为魄门。（《难经》）
哲言
肺与大肠相为表里，肺实则肛藏，肺虚则肛脱。（朱丹溪）
肠风痔漏，久服寒凉，坐努下脱，泻痢后重，窘迫下脱，男子房劳过度，产妇用力太早，小儿号叫伤气，
皆有此证。（《医鉴》）
肛门为大肠之使，大肠者传导之官，肾者作强之官。丈夫酒色过度，肾虚则泄母气，肺虚则大肠无所主，
故肛脱。（《证治准绳》）
补编
脱肛一证，其因不一，有因久痢久泻，脾肾气陷而脱者；有因中气虚寒，不能收摄而脱者；有因酒湿伤
脾，色欲伤肾而脱者；有因肾气本虚，关门不固而脱者；有因湿热下坠而脱者。又肛门为大肠之使，大肠受寒
受热，皆能脱肛。老人气血已衰，小儿气血未旺，皆易脱肛。《经》曰∶下者举之。徐之才曰∶涩可去脱。
先生治此证，亦不越乎升举、固摄、益气三法。如气虚下陷者，宗东垣补中益气汤，举陷为主；肾虚不摄者，
宗仲景禹余粮石脂丸，及熟地、五味、菟丝辈，固摄下焦阴气为主；肝弱气陷、脾胃气虚下陷者，用摄阴益气，
酸苦泄热；老年阳气下陷，肾真不摄者，又有鹿茸、阳起石等，升阳固气。汪 庵云∶有气血热而肛挺出者，
用芩、连、槐、柏及四物、升、柴之类。（《临证指南》）
治脱肛，古人用参、 、归、术、甘草、升麻升补之，或兼
用五味、乌梅固涩之；外用熏洗收涩之药，则无不愈。凡中气微虚而脱者，宜四君子汤、五味异功散；中寒吐
泻而脱者，宜五君子煎、温胃饮；泻痢不止而滑脱者，宜胃关煎加乌梅、五味、文蛤、木香以佐之；脾虚下陷
而脱者，宜补中益气汤、举元煎；阴虚肝肾不足而下陷者，宜补阴益气煎；阴中阳虚而脱者，宜理阴煎或大补
元煎；虚中挟火，热赤肿痛者，宜用补中益气汤加芩、连、槐花之类。然必真有火证火脉，方可酌用寒凉。若
非实火，则大忌苦寒，防其沉降败脾也。若产妇用力太过，肛门脱出者，宜六物煎加升麻，或殿胞煎加人参，
仍用温汤洗而收之。若湿热下坠，疼痛脱肛，甚者宜抽薪饮、大厘清饮，微者约营煎。（张景岳）
脱肛有虚有实，虚者一努便脱，色淡而不甚肿，宜补中益气汤，陷者举之；实者肛门壅肿，努甚脱出，色
如紫李，身热脉大，此为湿热下逼，宜芩、连、山栀，佐以升提之味。○脱肛不可见风、洗冷水，犯之则难收。
宜用温水频洗，软帛托入，再用石榴皮煎水洗之，或用热醋沃新布折坐。（许宣治）
《本草》云∶补可去弱，涩可去脱。肛脱甚者，既补之必兼涩之，不涩于内，亦须涩于外。古方用五倍
子末托而上之，一次未收，至五、七次必收，并可煎汤入白矾温洗。○脱肛，审系寒证，以香附、荆芥煎汤洗
之；热者，以五倍子、朴硝煎汤洗之。（《证治准绳》）
脱肛，绯赤肿痛，不可用热汤熏洗，尤忌五倍子等酸涩收敛。汤气蒸发，则愈肿愈痛。宜熊胆磨水点之，
或用田螺入冰片少许，化水点之，或鳖头烧灰涂之。（张路玉）
选案
一人里急后重，肛脱红肿，百药无效，乃有虫在肛故也。令刮猪肚垢腻入花椒末拌涂肛上，以布袋兜之，
再用温汤熏洗；少顷，肛收，袋上小虫不计其数，从此疾不复发。（《赤水玄珠》）
沈长观肠头忽出寸许，痛苦难忍，干则退落，又出又落，二
十余日，如是者三。外科始称肛痈，继莫能治。一日赴王士林家求治，曰∶此名截肠病。出夏子益奇方，此时
尚可为，再出再落，不可救矣。令以臀坐浸麻油内，饮麻子汁，数日而愈。（《吴医汇讲》）
附方
秘方 用鳖一个，水煮，以汤温洗患处，鳖肉食之，骨 研末，香油调涂，安卧片时，其肛自收。
[Classic Theory]
The anal opening (Pomen) also serves as an envoy for the five zang organs. (Suwen)
The lower extreme is the anal opening. (Nanjing)
[Philosophical Quotes]
The Lung and Large Intestine are exterior-interior related; when Lung qi is substantial, the anal sphincter remains closed; when Lung qi is deficient, prolapse of the rectum occurs. (Zhu Danxi)
Intestinal wind and hemorrhoidal fistulae, long-term use of cold-natured drugs, prolapse due to prolonged sitting and straining during defecation, tenesmus and urgency after dysentery leading to forced prolapse, excessive sexual activity in men, early exertion by postpartum women, and qi injury from crying in infants,
all can result in this condition. (Yijian)
The anus is the envoy of the Large Intestine; the Large Intestine is the official of transmission and transformation; the Kidney is the official of strength and ingenuity. In men, excessive wine and sexual indulgence lead to Kidney deficiency, which depletes the mother organ's qi (Lung); Lung deficiency causes the Large Intestine to lose its governance,
thus resulting in rectal prolapse. (Zhengzhi Zhunsheng)
[Supplementary Compilation]
Rectal prolapse has various etiologies: some cases arise from chronic dysentery or diarrhea causing Spleen and Kidney qi sinking; some from deficiency-cold of the Middle Jiao failing to retain; some from damp-heat damaging the Spleen and desire damaging the Kidney; some from innate Kidney qi deficiency with insecure closure; some from damp-heat sinking downward. Furthermore, the anus is the envoy of the Large Intestine; whether the Large Intestine is affected by cold or heat, it can cause prolapse. The elderly have declining qi and blood; children have unestablished qi and blood; both are prone to prolapse. The Classics state: "Those that sink should be raised." Xu Zhicai stated: "Astringents can treat sliding/prolapse."
Mr. [the author/scholar] treats this condition not exceeding three methods: lifting, astringing, and tonifying qi. For qi deficiency with sinking, follow Li Dongyuan's Buzhong Yiqi Tang (Tonifying the Middle and Augmenting Qi Decoction), focusing on lifting the sunken qi; for Kidney deficiency failing to grasp,
follow Zhang Zhongjing's Yuyuliang Shizhi Wan (Hematite and Kaolin Pill), along with Rehmanniae Radix Preparata (Shudi), Schisandrae Fructus (Wuweizi), Cuscutae Semen (Tusizi), etc., focusing on securing the yin qi of the Lower Jiao; for Liver weakness with qi sinking and Spleen-Stomach qi deficiency with sinking, use methods to secure yin and augment qi, employing sour and bitter flavors to drain heat; for elderly yang qi sinking and failure of true Yuan qi to grasp, employ Cervi Cornu Pantotrichum (Lurong), Actinolite (Yangqishi), etc., to raise yang and consolidate qi. Wang Ang said: "For those with hot qi and blood causing protrusion of the anus,
use Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Sophorae Flos (Huaihua), Platycladi Cacumen (Baiye), Siwu Tang (Four Substances Decoction), Shengma, Chaihu, etc." (Linzheng Zhinan Yian)
To treat rectal prolapse, ancients used Ginseng Radix et Rhizoma (Renshen), Angelicae Sinensis Radix (Danggui), Atractylodis Macrocephalae Rhizoma (Baizhu), Glycyrrhizae Radix et Rhizoma (Gancao), Rhizoma Cyperi (Xiangfu - *Note: Text says ' ', likely missing character or typo for Xiangfu/Baizhu context, but listed herbs are Renshen, Danggui, Baizhu, Gancao, Shengma*), Shengma to lift and tonify, or combined with Schisandrae Fructus (Wuweizi), Fructus Mume (Wumei) to astringe; externally, fumigation and washing with astringent herbs ensure cure. For slight Middle qi deficiency with prolapse, Si Junzi Tang (Four Gentlemen Decoction) or Wuwei Yigong San (Five-Ingredient Powder for Enhancing Function) are suitable; for middle-cold with vomiting/diarrhea and prolapse, Wu Junzi Jian (Five Gentlemen Decoction) or Wenwei Yin (Stomach-Warming Decoction) are suitable; for unremitting diarrhea/dysentery with slipping, Weiguan Jian (Stomach Gate Decoction) added with Wu Mei, Wu Wei Zi, Clam Shell (Wenge), Aucklandiae Radix (Muxiang) as auxiliaries are suitable; for Spleen deficiency with sinking, Buzhong Yiqi Tang or Juyuan Jian (Lifting Origin Decoction) are suitable; for yin deficiency with Liver-Kidney insufficiency and sinking, Buyin Yiqi Jian (Yin-Nourishing and Qi-Augmenting Decoction) is suitable; for yang deficiency within yin with prolapse, Liyin Jian (Yin-Regulating Decoction) or Dabu Yuan Jian (Greatly Tonifying Origin Decoction) are suitable; for deficiency with accompanying fire, redness, swelling, and pain, Buzhong Yiqi Tang added with Huangqin, Huanglian, Huaihua is suitable. However, only if there are truly fire syndromes and pulse signs should cold-natured drugs be considered. If not excess-fire, bitter-cold drugs are strictly contraindicated to prevent sinking and damaging the Spleen. For postpartum women whose excessive effort causes prolapse, Liuwu Jian (Six-Ingredient Decoction) plus Shengma, or Dianbao Jian (Palace Womb Decoction) plus Renshen, followed by washing with warm water and manual reduction, are suitable. For damp-heat sinking with painful prolapse, severe cases require Chouxin Yin (Fire-Withdrawing Drink) or Dali Qing Yin (Greatly Clarifying and Clearing Drink); mild cases require Yueying Jian (Regulating Intestines Decoction). (Zhang Jingyue)
Rectal prolapse can be deficient or excess. Deficient cases prolapse upon slight straining, appear pale and not very swollen; treat with Buzhong Yiqi Tang to lift the sunken qi. Excess cases present with congested swelling of the anus, severe straining causing prolapse, color like a purple plum, fever, and large pulse; this is caused by damp-heat pressing downward; treat with Huangqin, Huanglian, Gardeniae Fructus (Shanzhi), assisted by lifting agents. ○ Rectal prolapse must avoid wind and cold water washing; violating this makes reduction difficult.
Use warm water for frequent washing, support with soft cloth for reduction, then wash with Pomegranate Peel (Shiliupi) decoction, or sit on new cloth soaked in hot vinegar. (Xu Xuanzhi)
Bencao states: "Tonification removes weakness; astringents remove sliding/prolapse." For severe rectal prolapse, after tonification, one must combine astringency; if not internally, then externally. Ancient formulas use Gallnut (Wubeizi) powder applied topically; if not reduced after one application, it will surely reduce after five to seven applications. One can also decoct with Alum (Baifan) for warm washing. ○ For rectal prolapse, if determined to be cold syndrome, wash with Cyperi Rhizoma (Xiangfu) and Schizonepetae Herba (Jingjie) decoction; for heat syndrome, wash with Wubeizi and Natrii Sulfas (Piaoxiao) decoction. (Zhengzhi Zhunsheng)
For rectal prolapse presenting with crimson redness, swelling, and pain, hot water fumigation/washing is contraindicated, especially avoiding astringents like Wubeizi. Steam evaporation increases swelling and pain. Use Bear Bile (Xiongdan) ground in water for application, or Freshwater Snail (Tianluo) with少许 Borax (Bingpian) dissolved in water for application, or burn Turtle Head (Bie Tou) to ash for topical application. (Zhang Luyu)
[Selected Cases]
A patient suffered from tenesmus, rectal prolapse with redness and swelling, unresponsive to hundreds of medicines. It was found that parasites were in the anus. Scrape the greasy residue from pig stomach, mix with Zanthoxyli Pericarpium (Huajiao) powder, apply to the anus, cover with a cloth bag, and fumigate/wash with warm water; shortly after, the anus retracted, and countless small worms were found in the bag. The disease did not recur. (Chishui Xuanzhu)
Shen Changguan's rectum suddenly prolapsed more than one cun, unbearable pain, retracting when dry, recurring repeatedly over twenty days, happening three times. Surgeons initially called it anal abscess, then could not treat it. One day he sought treatment at Wang Shilin's home. The doctor said: "This is called Intermittent Rectal Prolapse Disease." He produced a miraculous formula from Xia Zi Yi, stating it could still be treated now, but if it continues to prolapse and retract, it would be incurable. He instructed the patient to sit in a basin soaked in Sesame Oil (Mamayou), drink Hemp Seed (Mazi) juice, and cured within several days. (Wu Yi Huijiang)
[Attached Formulas]
Secret Formula: Use one turtle, boil in water, wash the affected area with the warm broth, eat the turtle meat, grind the turtle bones into powder, mix with Sesame Oil (Xiangyou) for topical application, lie quietly for a while, and the anus will naturally retract.