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(Men and women can be treated similarly)
Hemorrhoids (Zhì) belong to the Liver, Spleen, and Kidney meridians. Therefore, cases involving deficiency of Yin essence are difficult to treat and often develop into hemorrhoidal fistulas (Zhì lòu). If the Lung and Large Intestine meridians are affected by Wind-Heat or Damp-Heat, the condition will resolve spontaneously once the Heat subsides.

Improper conservation of Essence may lead to Liver Wood overacting on Spleen Earth, with Fire flaring up and insulting Metal; or it may result from consuming roasted, fried, and rich flavors, or from fatigue damaging Yuan Qi, caused by Yin deficiency with vigorous Fire. In the early stage, if there is pain, constipation, or difficulty in urination, one should employ methods to clear Heat, cool Blood, moisten dryness, and disperse Wind. If Qi and Blood are deficient and damaged by cold-cooling medicines, one should regulate and tonify the Spleen and Stomach, and nourish Yin essence. If the hemorrhoid ruptures and fails to heal for a long time, it often becomes a hemorrhoidal fistula, which may penetrate the buttocks, intestines, or yin region. Swelling at the anal protrusion indicates Damp-Heat. Pain indicates Wind-Heat. Constipation indicates Fire-Dryness. Ulceration with pus indicates Excess Heat damaging Blood. Pain during defecation requires moistening dryness and draining dampness. Aching and bearing-down sensation in the anus requires purging Fire and draining dampness. Scanty and difficult urination requires clearing the Liver and guiding out dampness. For established fistulas, the primary treatment is to nourish Yuan Qi and tonify Yin essence. The Classics state: "Due to overeating, tendons and vessels become lax and horizontal..." [Text implies intestinal pathology]. At this point, using Dihuang Wan (Rehmannia Pill) and Yiqi Tang (Qi-Supplementing Decoction) to nourish the source of transformation is advisable. Specifically administering cold-cooling medicines to treat Fire will inevitably lead to disaster.

Case Records:
Zhou Xifu, a Jinshi degree holder, had a history of hernia and hemorrhoids. Fatigue caused pain in the lower abdomen and discharge of white fluid from the penis, accompanied by swelling and pain of the hemorrhoids. When diet was irregular or fatigue excessive, or when daily routine was improper, the condition would worsen. I used Yiqi Tang and Dihuang Wan. His Yuan Qi gradually recovered, but because he relaxed his regimen and self-care, he did not achieve a complete cure.

A scholar presented with dripping pus and blood, dry mouth with thirst, afternoon fever with bloody stools, spontaneous sweating, and night sweats. I stated: "This is Yin deficiency of the Kidney and Liver." He did not believe me and continued taking Siwu Tang along with Huangbai (Phellodendron), Zhimu (Anemarrhena), and Lianzi (Coptis). This led to poor appetite, diarrhea, and vomiting. I first used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Fuling (Poria), Banxia (Pinellia), and Paoshengjiang (Prepared Ginger), which gradually revived the Spleen and Stomach. Subsequently, Liuwei Wan (Six-Ingredient Pill with Rehmannia) was administered morning and evening. After more than two months, all symptoms completely resolved.

Yang Juyuan, a scholar, had constitutive Yin deficiency. Fatigue caused limb lassitude and heat in both feet. After taking heat-clearing agents, the heat sensation rose to the waist and knees, stool became scanty and difficult, and excessive food intake led to diarrhea. Over a year later, he developed thirst and expectorated phlegm, and his hemorrhoids discharged pus. Continuing to neglect rest, he suddenly experienced aversion to cold and fever, and developed an abscess with incessant discharge of pus and water, indicating severe deficiency of Qi and Blood. I used Liuwei Wan and Buzhong Yiqi Tang to nourish the source of transformation. Fortunately, he was cautious about his illness, and he recovered after more than a year.

A man suffered from this condition and took cold-cooling medicines. In the early morning, after defecation, his stool was unformed. He had poor appetite, body fatigue, dry mouth with thirst, and a heavy bearing-down sensation in the lower abdomen. I used Buzhong Yiqi Tang, which immediately stopped the bearing-down sensation. Then, using Sishen Wan (Four Miracles Pill), his appetite improved and stool became solid. Finally, using Dihuang Wan, the wound healed quickly.

A person indulgent in rich foods, alcohol, and sexual activity suffered from painful hemorrhoids. Taking bitter-cold medicines caused swelling and hardness of the buttocks. Adding Dahuang (Rhubarb) resulted in abdominal distension and headache. This indicated deficiency of the three Yin meridians of the foot, further injured by the medication. I used Buzhong Yiqi Tang to raise and tonify Yang Qi, adding Renshen (Ginseng), Fuling (Poria), Banxia (Pinellia), and Muxiang (Aucklandia) to assist Spleen Qi. After several doses, he recovered.

Lu Zifan, a Shangshe degree holder, presented with painful hemorrhoids in mid-winter. His right hand pulse was floating and large, and his left Chi pulse was surging and rapid. I said: "Seeing a Summer pulse in Winter indicates the need to strengthen the Master of Water (nourish Kidney Yin) to suppress the Flaming Fire." He considered this advice pedantic and took another prescription containing Qin (Scutellaria) and Lian (Coptis). On June 9th of the following year, he invited me again. Phlegm-saliva surged upward, and he could not sleep day or night. His pulse was surging, large, and rapid, but empty upon pressure; the left Chi pulse was completely absent, and his hands, feet, shoulders, and arms were cold. I said: "The situation is critical." He replied: "I only ask to prolong my life by a few days so that my heir son may see me once." Reluctantly, I prescribed Renshen (Ginseng), [missing character, likely Huangqi or Baizhu], Danggui (Angelica), Baizhu (Atractylodes), Paoshengjiang (Prepared Ginger), etc., along with the ingredients of Liuwei Wan added with Rougui (Cinnamon Bark). On the Dingyou day of that month, he unfortunately passed away. The principles of the Five Elements are indeed trustworthy!

The eldest son of Censor Wang Liangjian suffered from hemorrhoids with thirst and fever. His Chi pulse was surging and rapid but empty upon pressure. I said: "This is deficiency of Liver and Kidney Yin essence, with erratic movement of Deficiency Fire. One must nourish the source of transformation." He did not believe me. Later, he expectorated phlegm, lost his voice, his face became flushed, his body emaciated, and he died.