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The *Neijing* states: Due to overeating, the sinews and vessels become lax and relaxed, leading to hemorrhoids in the large intestine. It also states: When the Du Meridian is diseased, it causes strangury (difficulty in urination) and hemorrhoids. Or, after indulging in alcohol and sexual intercourse, the essence and qi are depleted and lost, the pulse becomes empty, and the toxicity of alcohol takes advantage of this condition, flowing into the vessels. Or, due to excessive sexual desire but forcibly suppressing ejaculation, the qi of the anterior yin returns to the large intestine, causing hemorrhoids. Or, by using drugs to consolidate the essence, which remains stagnant and fails to transform, flowing and settling between the anus; following its pathway through the anus, hemorrhoids form.

There are seven types of symptoms for hemorrhoids: Flesh nodules protruding at the anal margin, resembling mouse breasts, with frequent discharge of pus and blood, obstructing defecation, is called *Mu Zhi* (Yang Hemorrhoid). Swelling and pain at the anal margin, with sores protruding, swelling for five to six days before spontaneously ulcerating and discharging pus and blood, is called *Pin Zhi* (Yin Hemorrhoid). Sores growing at the anal margin, granular protrusions that itch then hurt, with clear blood discharged during defecation, is called *Mai Zhi* (Vessel Hemorrhoid). Nodules within the intestine, painful with blood, accompanied by alternating chills and fever, and rectal prolapse during defecation, is called *Chang Zhi* (Intestinal Hemorrhoid). Clear blood continuously flowing down upon defecation, is called *Xue Zhi* (Blood Hemorrhoid). Triggered by drinking alcohol, with soreness and bleeding from sores, is called *Jiu Zhi* (Alcohol Hemorrhoid). Arising from worry, fear, depression, or anger, immediately presenting with swelling and pain, difficult defecation, and rectal prolapse upon exertion that cannot be retracted, is called *Qi Zhi* (Qi Hemorrhoid). The names and appearances vary; one must carefully examine the cause to treat accordingly. Their shapes may resemble lotus flowers, cockscombs, walnuts, cow's milk, chicken hearts, mouse breasts, or cherries; some hide inside the anus, others protrude outside. If not healed for a long time, they transform into fistulas (*Lou*). Ulcerations discharging blood and pus indicate extreme heat; if yellow fluid is discharged, it indicates damp-heat. Prolonged non-healing leads to weakness of blood and qi, resulting in perforation and fistula formation. Additionally, if there are no hemorrhoids but another opening exists on either side of the anus discharging pus and blood, one must abstain from alcohol and sex, reduce labor, and eat bland food for recovery.

Xue Lizhai stated: For hemorrhoidal pain with constipation and difficulty in urination, clear heat, cool blood, moisten dryness, and dispel wind. If cold-natured herbs damage the middle jiao, regulate the spleen and stomach, and nourish yin essence. For fistulas penetrating the buttocks or intestines, tonify primordial qi and nourish yin essence. For constipation, moisten dryness and nourish blood. For anal heaviness and pain, drain fire and remove dampness. For itching, dispel wind and overcome dampness. For swelling and pain without dysuria, drain the liver and guide out dampness. If hernia and hemorrhoids occur simultaneously, use *Liuwei Wan* (Six-Ingredient Pill with Rehmannia) and *Buzhong Yiqi Tang* (Tonify the Middle and Augment the Qi Decoction) together. There are various formulas for hemorrhoids. Although Li Dongyuan divided treatments into four categories based on damp-heat, wind, and dryness, they generally do not depart from herbs that purge stasis and heat. Herbs such as *Di Yu* (Sanguisorbae Radix), *Zao Jiao* (Gleditsiae Fructus Spina), *Bing Lang* (Arecae Semen), *Da Huang* (Rhei Radix et Rhizoma), and *Tao Ren* (Persicae Semen) are essential. If complicated by wind-toxin, add *Qiang Huo* (Notopterygii Rhizoma et Radix), *Fang Feng* (Saposhnikoviae Radix), *Sheng Ma* (Cimicifugae Rhizoma), and *Chai Hu* (Bupleuri Radix). In severe cases, induce sweating with *Ma Huang* (Ephedrae Herba) and *Gao Ben* (Ligustici Rhizoma et Radix). If complicated by dryness, add *Qin Jiao* (Gentianae Macrophyllae Radix), *Dang Gui* (Angelicae Sinensis Radix), and *Huang Qi* (Astragali Radix). If dampness prevails, add *Cang Zhu* (Atractylodis Rhizoma), *Huang Bai* (Phellodendri Cortex), *Ze Xie* (Alismatis Rhizoma), and *Fu Ling* (Poria). If heat is extreme, add *Huang Qin* (Scutellariae Radix), *Lian Zi* (Nelumbinis Semen - *Note: Context suggests Lian Qiao or similar, but text says Lian Zi/Lian? Text says "Qin, Lian", likely Huang Qin and Huang Lian*, Huang Lian (Coptidis Rhizoma)), *Yu Li Ren* (Prunus Armeniaca Seed), and *Sheng Di* (Rehmanniae Radix). For pus and blood, add *Jia Pian* (Testudinis Carapax et Plastrum / Pangolin Scales - *Context implies Pangolin scales usually, but Jia Pian can refer to turtle shell; in hemorrhoid context often Chuan Shan Jia*), and *Gui Wei* (Angelicae Sinensis Radix Tail). For alcohol hemorrhoids, add *Ge Gen* (Puerariae Lobatae Radix), *Chi Xiao Dou* (Adzuki Bean), *Di Huang* (Rehmanniae Radix), *Bai Shao* (Paeoniae Radix Alba), *Fu Ling* (Poria), and *Ban Xia* (Pinelliae Rhizoma). For qi hemorrhoids, add *Zhi Ke* (Aurantii Fructus), *Chen Pi* (Citri Reticulatae Pericarpium), *Mu Xiang* (Aucklandiae Radix), and *Zi Su* (Perillae Folium). For food stagnation, add *Huang Lian* (Coptidis Rhizoma), *Zhi Shi* (Aurantii Fructus Immaturus), *Qu* (Medicated Leaven), and *Mai Ya* (Hordei Fructus Germinatus). For severe pain, add *Ru Xiang* (Olibanum) and *Mo Yao* (Myrrha). For heavy bleeding, add *Fa Hui* (Capillis Carbonisatum). For qi deficiency, add *Ren Shen* (Ginseng Radix) and *Bai Zhu* (Atractylodis Macrocephalae Rhizoma). For blood deficiency, add *E Jiao* (Colla Corii Asini) and *Ai Ye* (Artemisiae Argyi Folium). Do not rigidly adhere to ancient formulas. Only when all medicines fail for blood hemorrhoids, use *Shi Mei* (Coal Stone) and *Huai Hua* (Sophorae Flos), taken on an empty stomach with *Wu Mei* (Mume Fructus) decoction, yielding miraculous effects. Chen Yuren said: To completely eradicate hemorrhoids, one must use cauterizing agents. To close the orifice, one must abstain from sexual activity for 100 days.

For internal hemorrhoids, first use purgative herbs to cleanse the zang-fu organs, then insert *Huan Zhi San* (Hemorrhoid Summoning Powder) into the anus to make the hemorrhoid protrude. Before applying *Ku Zhi San* (Hemorrhoid Cauterizing Powder), surround the healthy surrounding flesh with *Hu Zhi Gao* (Hemorrhoid Protecting Ointment), then apply the powder. After application, if the tissue turns black, hard, and cracks, wash with *Luo Zhi Tang* (Hemorrhoid Falling Decoction). If the orifice fails to contract after falling off, sprinkle *Sheng Ji San* (Tissue Regenerating Powder). For fistulas penetrating the intestine and persisting for a long time, use *Hu Lian Zhui Du Wan* (Coptis Pursuing Toxin Pill) and *Huang Lian Bi Guan Wan* (Coptis Closing Tube Pill). For various hemorrhoids and five goiters/six tumors where the stalk is small and the head is large, use the *Zhu Xian Fang* (Boiled Thread Method). For washing hemorrhoids, split a fresh freshwater mussel (*Sheng Bang*) and use the water to apply/drop; fumigation and washing with boiled water is also effective. For red, swollen, and painful hemorrhoids, grind real bear bile (*Xiong Dan*) in water and apply; swelling and pain will subside. For dropping treatment: Take one large snail, remove the operculum, add a little musk (*She Xiang*) and borneol (*Bing Pian*), leave overnight until liquefied, then apply. Another method: Take one large garden snail, remove the shell, take one raw ginkgo nut (*Yin Xing*), grind them together until smooth, add half a fen of borneol, grind evenly, and apply; it will resolve quickly.

The *Jingmai* chapter states: Pathogenic factors sinking into the meridians form fistulas, lingering in the muscle interstices. Because pus from sores is not fully drained, and combined with emotional disturbances and external climatic factors, it forms. Initially, it appears pale red, slightly swollen, or with small nodules; later, the upper part becomes dry and white, the interior black and rotting, producing foul-smelling parasites. Treatment should tonify qi and generate blood. Externally, use black aconite (*Hei Fu Zi*) powder mixed with saliva to form cakes as thick as coins, and moxibustion. Make moxa cones according to the size of the fistula. Moxa only until mildly warm, avoiding pain. Replace when dry, stop if fatigued, resume the next day, until the interior flattens. Continue taking tonic herbs. A folk prescription for hemorrhoids/fistulas: Clean old glazed tiles (*Liuli*) to remove grease, calcine and grind finely, take 4 qian with red wine. Within seven days, the tract will naturally fall off. Another prescription: Use only fish maw (*Biao Jiao*), stir-fry and grind into powder, take one teaspoon daily with sugar water. Long-term use causes hemorrhoids to wither and fall off. Another method: Insert paper strips soaked in precipitant medicine (*Jiang Yao*) into the tract, cover with black ointment to facilitate detachment; inserting dry lacquer ash (*Gan Xi Hui*) also works. Applying raw lacquer (*Sheng Qi*) also works because lacquer breaks up blood stasis.

Generally, fistula openings contain foul matter. Fumigate and wash with decoctions of honeycomb (*Lu Feng Fang*), angelica dahurica (*Bai Zhi*), and sophora root (*Ku Shen*) in a windless place, three times daily, which is beneficial. Patients with hemorrhoids/fistulas should eat dog meat every morning without interruption. Dog meat is warm and benefits the kidneys; the kidneys govern the two lower orifices. Within 100 days, it will naturally disappear and heal without medication. Another method: Heat clay bricks (*Tu Ji*) until red, place in a jar, burn rags (*Luan Fa*) to produce smoke, fumigate twice or thrice daily. Regardless of new or old hemorrhoids/fistulas, the tracts will gradually detach, scorch, and heal.