Library

[Da] Women suffering from hemorrhoids are often caused by emotional depression and anger, invasion of wind-heat, or excessive consumption of rich and greasy foods. There are five types: those protruding like nipples at the anal margin with pus discharge are called Pin Zhi (Female Hemorrhoid); those with swelling and bleeding are called Mu Zhi (Male Hemorrhoid); those with itching and pain are called Mai Zhi (Pulse Hemorrhoid); those with nodules are called Chang Zhi (Intestinal Hemorrhoid); and those with bleeding during defecation are called Xue Zhi (Blood Hemorrhoid). Treatment requires careful differentiation.

[Xue] The aforementioned conditions in women are mostly caused by pregnancy and childbirth, menstruation, improper diet and lifestyle, and imbalance of the Six Evils (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) and Seven Emotions (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright). In men, it is often caused by sexual intercourse after drunkenness or overeating, leading to flaccidity of tendons and vessels, depletion of essence and Qi, and invasion of heat-toxin due to deficiency. Or, forcibly retaining semen during intercourse causes Liver Wood to overact on Spleen Earth and insult Lung Metal; or consuming roasted, fried, and strong-flavored foods leads to Yin deficiency with damp-heat. Treatment should involve cooling blood, moistening dryness, and dispersing wind. After ulceration, one must nourish Yuan Qi and tonify Yin essence; otherwise, it may become a fistula, spreading to the buttocks, yin organs, or penetrating the intestine. Nodules at the anus indicate damp-heat; pain indicates wind; dry stool indicates fire; ulceration with pus indicates heat overwhelming blood. Pain during defecation requires moistening dryness and draining dampness. Heaviness and pain in the anus require clearing fire and guiding out dampness. Astringent and stagnant urination requires clearing the Liver and guiding out dampness. The Classics state: "Due to overeating, tendons and vessels become flaccid, and the intestines transform into hemorrhoids." This syndrome belongs to Liver and Kidney deficiency, so Jia Wei Di Huang Wan (Supplemental Rehmannia Pill) and Liu Wei Wan (Six-Ingredient Pill with Rehmannia) are effective. Do not apply toxic drugs or take cold-natured medicines.

Bie Jia San (Turtle Shell Powder) treats the five types of hemorrhoidal fistulas with dripping pus and blood, or hard swelling and pain with a sensation of bearing down.
Ingredients: Bie Jia (Testudinis Carapax et Plastrum), Lu Feng Fang (Vespae Nidus), She Tui (Bombyx Batryticatus), Zhu Hou Xuan Ti Pi (Skin of the posterior suspended hoof of pig) (the above five ingredients are calcined until the original nature remains preserved, each 2 qian), She Xiang (Moschus) (1 fen).
Preparation and Administration: Grind into powder. Take 1 qian per dose, mixed with decoction of Sheng Di Huang (Rehmanniae Radix) taken on an empty stomach, accompanied by external application.

Another prescription: For heat and pain, use Han Shui Shi (Halitum) and Po Xiao (Natrii Sulfas) ground into powder, mixed with saliva for topical application.

Treatment methods and prescriptions are detailed in the Hemorrhoid section of *Miscellaneous Diseases*, so they are not repeated here.

[Da] Rectal prolapse is a manifestation of Large Intestine pathology. Deficiency-cold of the Large Intestine causes Qi to sink, resulting in the eversion of the anus; it can also be caused by excessive straining during childbirth.

[Xue] If the aforementioned condition involves damp-heat in the Large Intestine, use Sheng Yang Chu Shi Tang (Ascending Yang and Draining Dampness Decoction). If it involves Blood Heat, use Si Wu Tang (Four Substances Decoction) with Huang Qin (Scutellariae Radix) and Huai Hua (Sophorae Flos). If it involves Blood Deficiency, use Si Wu Tang with Bai Zhu (Atractylodis Macrocephalae Rhizoma) and Fu Ling (Poria). If accompanied by hemorrhoidal pain, use Si Wu Tang with Huai Hua, Huang Lian (Coptidis Rhizoma), and Sheng Ma (Cimicifugae Rhizoma). For weakness after stroke, use Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with Shao Yao (Paeoniae Radix Alba) and Bai Zhu. For deficiency-cold of Middle Qi, add Ban Xia (Pinelliae Rhizoma), Pao Jiang (Zingiberis Rhizoma Preparatum), and Wu Wei Zi (Schisandrae Fructus). For Kidney deficiency, use Liu Wei Wan. For deficiency-cold, use Ba Wei Wan (Eight-Ingredient Pill with Rehmannia). The Lung and Large Intestine are exterior-interior pairs; the anus is the gate of the Large Intestine. Excess-heat in the Lung causes constipation, while deficiency-cold in the Lung causes prolapse. The Kidneys govern defecation; therefore, this condition is common in cases of Lung and Kidney deficiency. One woman with rectal prolapse was cured after taking Bu Zhong Yi Qi Tang and Jia Wei Gui Pi Tang (Supplemental Spleen-Restoring Decoction) for more than a hundred doses each. Later, due to delivery, it recurred, and she was cured again after taking more than two hundred doses of the same medicines.

Sheng Yang Chu Shi Tang (Ascending Yang and Draining Dampness Decoction) is used for conditions where the pathogenic factor moves upward from below, employing the method of "guiding and exhausting" (draining downward).
Ingredients: Sheng Ma (Cimicifugae Rhizoma), Chai Hu (Bupleuri Radix), Fang Feng (Saposhnikoviae Radix), Shen Qu (Massa Medicata Fermentata) (stir-fried), Ze Xie (Alismatis Rhizoma), Zhu Ling (Poria), Cang Zhu (Atractylodis Rhizoma) (1 liang), Chen Pi (Citri Reticulatae Pericarpium), Gan Cao (Glycyrrhizae Radix et Rhizoma Preparata) (honey-fried), Da Mai (Hordei Fructus Germinatus) (each 3 qian; Sheng Ma, Chai Hu, Fang Feng, Shen Qu, Ze Xie, Zhu Ling are each half liang).
Preparation and Administration: Take 5 qian per dose, decocted in water, taken on an empty stomach. If there is Stomach cold with borborygmus, add Yi Zhi Ren (Alpiniae Oxyphyllae Fructus) and Ban Xia (each half qian), decocted with Sheng Jiang (Zingiberis Rhizoma Recens) and Da Zao (Jujubae Fructus).

Yao Hezhong recommended applying Iron Powder (Tie Fen) externally with good results. (*Sheng Hui Fang* also treats vaginal prolapse and vulvar swelling.)

*Ji Yan Fang* prescribes boiling three jin of raw iron in ten dou of water until reduced to five sheng, using the liquid to wash the affected area twice daily.

Sun Taizhen (Sun Simiao) used the skin of a toad burned in a bottle to produce smoke for fumigation, achieving subtle and profound effects.

Another prescription: Wash with decoction of Wu Bei Zi (Galla Chinensis), then sprinkle Chi Shi Zhi (Kaolinite) powder on the prolapsed part to push it back. If the prolapse is long, place two beds side by side leaving a gap of about one chi, fill a porcelain bottle with the decoction, and have the patient lie supine immersing the bottle between their legs. Change the decoction daily until fully retracted.