难经云。出者为虚。肛门之脱。非虚而何。况大肠与肺为表里。肺脏蕴热则闭。虚则脱。须
升举而补之。慎不可用坠气之药。产育及久痢用力过多。小儿气血未壮。老人气血已衰。故多患
此疾。是气虚不能约束禁固也。大剂补中益气汤为主。升麻须用醋煮。泻痢后大肠气虚。肛门脱
出。不肿不痛。属气血虚。补中益气加伏龙肝。赤肿有痛。宜兼凉血祛风。加羌、防、芍药。里
急下重有脓血。加木香、乌梅。大肠热甚而脱。升麻汤加羌、防、芩、连。肠风下血而脱。人参
胃风汤。老人虚人。用力过度而脱者。十全大补汤。肠胃燥涩。大便秘结。努挣太过。因而脱肛
者。人参固本丸加槐角凉补以润之。有肠头作痒。即腹中有虫。丈夫因酒色过度所致。大肠者传
道之官。肾者作强之官。盖肾虚则泄母气。肺热则大肠不收。故成脱肛。治法。内服黄连犀角散。
外用朴硝煎汤洗之。大肠虚而挟热。肛门红肿。槐花、槐角等分。羊血拌。炙熟为末。以酒送下。
大肠受热则赤肿。受寒则白滑。皆能脱出。当审其因证。寒者。以香附、荆芥、胡葱煎汤洗之。
热者。以五倍子、朴硝、白矾煎汤洗之。风热。以荆芥、薄荷、朴硝煎汤洗之。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。或田螺去靥。
入冰片少许。埋地一宿。化水点之。病劳人脱肛。骨肉相失。声散呕血。阳事不禁。梦寐交侵。
呼吸不相从。昼凉夜热者死。唾脓血者亦死。其脉不数而有根蒂。及颊不赤者生。小儿脱肛。鳖
头烧灰涂之。
谷道痒痛。多因湿热生虫。欲成痔 。宜以雄黄入艾绵烧烟熏之。治谷道虫赤肿。或痒或痛。
用杏仁捣作膏敷之。
或炒令黄。以绵蘸。涂谷道中。外台治下部虫啮。杵桃叶一斛蒸之。令极热。内小口器中。坐定
熏之。虫立死。治肛门肿痛。用木鳖子肉四五枚。研极细。沸汤泡洗。另用少许涂患处。
The *Nan Jing* (Classic of Difficult Issues) states: "Protrusion outward indicates deficiency." Rectal prolapse is, if not a deficiency, then what? Moreover, the Large Intestine and Lung are exterior-interiorly related. If the Lung organ harbors heat, it leads to constipation; if deficient, it leads to prolapse. Treatment must involve lifting and tonifying. One must absolutely avoid using herbs that descend Qi. Due to excessive effort during childbirth or chronic dysentery, because children's Qi and Blood are not yet robust, and the elderly's Qi and Blood have declined, this disease occurs frequently. This is due to Qi deficiency failing to constrain and secure. The primary treatment is a large dose of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction). The Shengma (Cimicifugae Rhizoma) must be processed with vinegar. After diarrhea or dysentery, if rectal prolapse occurs due to Large Intestine Qi deficiency, presenting without swelling or pain, it belongs to Qi and Blood deficiency; add Fulonggan (Furnacis Cinereus) to Buzhong Yiqi Tang. If there is redness, swelling, and pain, one should simultaneously cool the Blood and dispel Wind, adding Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), and Shaoyao (Paeoniae Radix). If there is tenesmus with pus and blood in the stool, add Muxiang (Aucklandiae Radix) and Wumei (Mume Fructus). If prolapse is caused by excessive heat in the Large Intestine, use Shengma Tang (Cimicifuga Decoction) added with Qianghuo, Fangfeng, Huangqin (Scutellariae Radix), and Lianzi (Coptidis Rhizoma). If prolapse is caused by wind-intestinal bleeding, use Renshen Weifeng Tang (Ginseng Wind-Protecting Decoction). For the elderly or debilitated individuals whose prolapse results from excessive effort, use Shiquan Dabu Tang (Comprehensive Great Tonifying Decoction). If dryness and astringency in the Stomach and Intestines lead to constipation, and prolapse occurs due to excessive straining, use Rengu Guben Wan (Ginseng Solidify the Root Pill) added with Huaijiao (Gleditsiae Sinensis Fructus Immaturus) to cool-tonify and moisten. If the protruding tissue itches, it indicates intestinal parasites. In men, this is often caused by excess alcohol and sexual indulgence. The Large Intestine is the official of transmission and transformation; the Kidney is the official of strength and vigor. Generally, Kidney deficiency depletes the Qi of its mother organ (Lung), and Lung heat causes the Large Intestine to fail in its receiving function, resulting in rectal prolapse. Treatment methods: Internally administer Huanglian Xijiao San (Coptis and Rhinoceros Horn Powder); externally wash with a decoction of Xiaofanshi (Mirabilite). If the Large Intestine is deficient and accompanied by heat, causing redness and swelling of the anus, mix equal parts of Huaihua (Sophorae Flos) and Huaijiao with sheep blood, roast until cooked, grind into powder, and take with wine. When the Large Intestine receives heat, it becomes red and swollen; when it receives cold, it becomes white and slippery; both can cause prolapse. One must examine the cause and syndrome. For cold syndromes, wash with a decoction of Xiangfu (Cyperi Rhizoma), Jingjie (Schizonepetae Herba), and Hucong (Allium fistulosum bulb). For heat syndromes, wash with a decoction of Wubeizi (Galla Chinensis), Xiaofanshi, and Baifan (Alumen). For wind-heat, wash with a decoction of Jingjie, Bohe (Menthae Haplocalycis Herba), and Xiaofanshi. If the area is crimson, swollen, and painful, do not use hot water for fumigation and washing. Especially avoid astringent收敛 herbs like Wubeizi, as evaporating heat will worsen swelling and pain. It is suitable to apply bear gallbladder dissolved in water. Alternatively, remove the operculum of a snail, add a small amount of Bingpian (Borneolum Syntheticum), bury it in the ground overnight until it liquefies, and apply the liquid. For patients with consumption disease suffering from rectal prolapse, accompanied by emaciation, hoarseness, hematemesis, seminal emission, vivid dreams, irregular respiration, chills during the day and fever at night, the prognosis is fatal. Hemoptysis of pus and blood is also fatal. However, if the pulse is not rapid but has a root, and the cheeks are not red, the patient will survive. For pediatric rectal prolapse, burn turtle head to ash and apply topically.
Anal itching and pain are mostly caused by damp-heat generating parasites, potentially developing into hemorrhoids. It is suitable to fumigate the area with smoke generated by burning Xionghuang (Realgar) mixed with Aiye (Artemisiae Argyi Folium). To treat anal redness, swelling, itching, or pain caused by parasites, apply a paste made from crushed Xingren (Prunus Armeniacae Semen). Alternatively, stir-fry until yellow, dip cotton wool in it, and apply inside the anus. The *Waitai Mi Yao* (Essential Prescriptions Worth a Thousand Gold for Emergencies) treats lower body parasitic biting by pounding one hu (a unit of volume) of peach leaves, steaming them until extremely hot, placing them in a small-mouthed vessel, having the patient sit over it to fumigate, which kills the parasites immediately. To treat anal swelling and pain, use four or five Muiezi (Momordicae Semen), grind them to an extremely fine powder, soak/wash with boiling water, and apply a small amount separately to the affected area.