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At the initial stage, if the shape resembles a milk nipple, with no swelling or redness, no pain, and no discomfort during walking, it is considered mild. If it has already formed with swelling and pain, occasionally triggered by labor, appearing either soft or hard, with yellow fluid oozing from the head, it is also mild. If the condition persists for a long time, presenting shapes like a rooster's comb, honeycomb, lotus flower, or everted flower, with continuous pus discharge and bleeding, it is severe. If the fistula tract extends to the buttocks and legs over a long period, with dripping pus and water, unceasing pain, and feces exiting from the opening, it is an adverse (difficult-to-treat) case.

If the lesion gradually enlarges from the initial or formed stage, accompanied by difficult and painful defecation, moistening dryness and nourishing yin are indicated. If there is anal prolapse sensation, blood in stool, intermittent pain, and hardness, clearing heat and leaching out dampness are indicated. If the color is purplish with pain, accompanied by constipation due to deficiency and itching, cooling blood, dispelling wind, and regulating/dispersing damp-heat are indicated. If there is swelling, pain, hardness, tenesmus, dragging sensation, stabbing pain, and difficulty in defecation, external fumigation and washing are indicated, along with internal promotion of bowel movement and drainage. For internal hemorrhoids with bleeding, where the anus prolapses during defecation and is difficult to reduce, strengthening the spleen and raising middle qi is indicated. For bleeding before and after defecation, sallow complexion, palpitations, and tinnitus, nourishing blood and strengthening the spleen is indicated. To eradicate the root of all types of hemorrhoids, caustic medicines must be used; to restore the integrity of the anal aperture, sexual abstinence is necessary for recovery.

A male patient suffered from hemorrhoids for six years. Each time he engaged in drinking, sexual activity, or overwork, the hemorrhoids would swell, become hard, and cause severe pain, taking more than ten days to subside slightly. He sought to eliminate the root cause. After applying Hemorrhoid Caustic Powder externally for over seven days, the hemorrhoids gradually turned black and cracked. By the sixteenth day, the hemorrhoid dried up and fell off, leaving an opening resembling a chicken heart. He applied Muscle Regeneration Powder daily and took internal decoctions to tonify blood and strengthen the spleen, resulting in a cure.

Another male patient suffered from hemorrhoids with swelling, pain, dry stools, and a rapid, forceful pulse. Two doses of Internal Dispersing Coptis Decoction allowed bowel movement and stopped pain. Subsequently, Siwu Tang (Four Substance Decoction) added with Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Aurantii Fructus (Zhike), and Trichosanthis Radix (Tianhuafen) was taken for several doses, reducing the swelling. A course of Zanglian Wan (Intestine-Coated Pill) prevented recurrence.

A third male patient suffered from hemorrhoids that swelled and hurt upon exertion. He used Zhiqiao Tang (Aurantii Fructus Decoction) for external fumigation and washing, and took Fangfeng Qinjiao Tang (Saposhnikovia and Gentian Decoction) internally. After several doses, both swelling and pain decreased. He was instructed to continue washing with the former decoction five to six times a month, and take Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) added with Phellodendri Cortex (Huangbai) and Anemarrhenae Rhizoma (Zhimu) to prevent recurrence.

A fourth male patient, fond of drinking and excessive sexual desire, suffered from internal hemorrhoids with deficiency-type prolapse and bleeding. Siwu Tang (Four Substance Decoction) added with Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Cimicifugae Rhizoma (Shengma), and Puerariae Radix (Gegen) was taken for several doses, stopping the deficiency prolapse. Then, Danggui Yuliren Tang (Angelica and Prunus Decoction) was taken for two doses, eliminating the swelling. After taking Zanglian Wan (Intestine-Coated Pill) for over a month, the rectal bleeding stopped. With continued abstinence from alcohol and sex for another month, no recurrence occurred. Generally, intercourse after drunkenness and full meals causes meridians to relax; once essence is leaked, the collaterals become deficient, allowing toxins from alcohol and food to flow and condense in the deficiency. Or, excessive lust forces the retention of essence, leading to degenerated essence and turbid blood transmitting to the large intestine. Or, rich and heavy dietary flavors cause dryness and dampness to flow and accumulate, forming this disease. The pathogenic factor received is dryness qi, while the pathogenic factor causing illness is dampness qi. Initially, clearing fire, harmonizing blood, moistening dryness, and dispersing wind are appropriate. For chronic cases, nourishing blood, invigorating yin, strengthening the spleen, and leaching out dampness are appropriate, leading to self-healing. If one does not moderate alcohol and sex, neglects daily routine, and fails to guard against rich tastes, ulceration will inevitably become a fistula. Over time, it may penetrate the intestines and buttocks, with foul matter exiting the opening, dripping foul water day and night without cessation. Those who suffer from this, although not life-threatening, suffer greatly from bloody filth, which is truly lamentable!

A fifth male patient had suffered from hemorrhoids for over ten years, with the head already ulcerated but not penetrating the intestine, causing severe pain upon each flare-up. Sanpin Yitiao Qiang (Three-Piece Single-Spear) was inserted for seven days until the hemorrhoid turned black and the wound edges gradually cracked. By the fifteenth day, it detached. Fengchu Gao (Phoenix-Chick Ointment) was applied for half a month, healing the wound flatly.

A sixth male patient, with a weak constitution, suffered from internal hemorrhoids with rectal bleeding and a sallow complexion. Self-medication with cooling and hemostatic drugs was ineffective. Pulse diagnosis revealed a deficient and weak spleen pulse, indicating insufficient middle qi failing to control blood. Ten-plus doses of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) doubled his energy and reduced rectal bleeding. Jiawei Sijunzi Tang (Modified Four Gentlemen Decoction) was then alternated with the previous decoction for over a month, preventing recurrence. Generally, the etiology of this condition varies and requires investigation of the cause. If vital qi is sufficient, the physique is robust, qi is vigorous, feces precede purple blood, and the pulse is full and forceful, this belongs to excess. The method should be cooling blood and stopping bleeding, and the medication will naturally be effective. However, if the physique is emaciated, the complexion is sallow, fresh red blood precedes feces, and the pulse is deficient and weak, this belongs to deficiency. How can cooling drugs be used to stop bleeding, thereby damaging the spleen and stomach? If this condition is not treated by warming the middle, strengthening the spleen, and raising middle qi, the blood cannot return to its source, making medication ineffective. This is deviating from the root.