【歌】气血脉肠牝牡虫，七般痔状要精通。或因风湿侵于外，醉饱过伤热蕴中。
【论】经云∶因而饱食，筋脉横解，肠 为痔。盖人之脏腑本虚，外伤风湿，内蕴热毒，醉饱交接，多欲
自戕，以故气血坠下，结聚肛门，宿滞不散，冲突为痔，故古人有七痔之目。牡痔者，肛边发，露肉珠，状如
鼠乳，时时滴溃脓血。牝痔者，肛边生疮，肿痛出血，其头反陷入。脉痔者，肠口频频发 ，且疼且痒，出血
淋漓。肠痔者，肠内结核，有血，寒热往来，登圊脱肛。血痔者，每遇大便，清血随下不止。虫痔者，肛门浸
淫湿烂，内有蛲虫蚀其肠为疮。气痔者，大便难，强力努之则肛出不收。此七痔之状虽殊，大抵以解热、凉血、
顺气为主。盖热则血伤，血伤则经滞，经滞则气不运，气与血俱滞，乘虚而坠入大肠，所以为痔。凡诸
痔久不愈，必至穿肠而为漏，此因痔而成漏也，当凉血宽大肠自愈。亦有外伤四气，内窘七情，与夫饮食乖常，
染触蠢动含灵之毒，未有不变为 疮，穿孔一深，脓汁不尽，得冷而风邪并之，涓涓而成漏矣。盖漏者，诸
之溃也。诸痿者，如野狼 、暴 、蚁 、蝼蝈 、砒蜉 、蜂 、蛴螬 、蜉蛆 、转筋 、瘰 之类。
《内经》云∶ 即漏也。所谓漏者，以其穿孔而流脓水与血水，象缸瓮之漏孔故也。 者，如虫豸之穿蠹蛀孔
也。如《巢氏病源》所谓十 、三十六 之说，名虽不同，其理一也，不必悉举。大抵漏有新久，新者带鲜红，
或微肿，或小核。久者上槁，白肉黑烂，淫虫恶臭生焉。丹溪云∶漏疮先须服补养血气药，外用附子饼按疮上，
以艾炷灸之，直至肉平为效。
诸痔疮
痔疮专以凉血为主，参 槐角汤。痔及肠风下血脱肛，槐角丸。翻花痔，荆芥、朴硝煎汤洗，次用木鳖
子、郁金末入龙脑敷；或以熊胆、片脑和匀贴之；或以米醋沃烧红新砖熏之，日三、五次。
参 槐角丸
人参（一钱五分） 黄 （一钱五分） 生地黄（一钱） 川芎（一钱） 当归（一钱二分） 升麻（一钱）
条芩（一钱，炒） 枳壳（一钱，炒） 黄连（一钱，炒） 槐角（一钱）
锉一剂，水煎服。
槐角丸
治诸痔及肠风。
槐角（一两） 防风（五钱，去芦） 地榆（五钱） 当归（五钱） 枳壳（五钱） 黄芩（五钱）
末之，丸，米汤下。
诸漏疮
漏有三十六种，名状极多，而治法则一。丹溪云∶漏须大补气血，人参、白术、黄 、川芎、当归为主，
佐以刺 、蛇蜕、牛角 、蜂房之类，大剂服之。外用附子末，以人津唾和作饼，如钱浓，放疮上，以艾灸之，
令微热，但略觉有微痛即止，每日三、四次，逐次换药饼，直灸至肉平为效。一人原有痔，又于肛边生一块，
皮浓肿痛作脓，就在痔孔中出者，当作食积注下治之，黄连散。
黄连散
痔漏仙方。
黄连（三钱） 阿魏（三钱） 神曲（三钱） 山楂（三钱） 桃仁（三钱） 连翘（三钱） 槐角（三钱）
犀角（三钱）
末之，以少许置掌中，时时舐之，津液咽下。如消，止后服。
[Verse] Qi, Blood, Mai (Pulse), Chang (Intestinal), Pin (Female), Mu (Male), and Chong (Worm) — the seven types of hemorrhoids must be thoroughly understood. Some arise from Wind-Dampness invading externally; others result from excessive drinking and overeating, leading to Heat accumulation internally.
[Discussion] The Classics state: "Due to overeating, tendons and vessels become slack and disordered, resulting in hemorrhoids." Generally, this occurs because the Zang-Fu organs are originally deficient. External invasion by Wind-Dampness and internal accumulation of Heat-Toxins, combined with excessive indulgence in food, drink, and sexual activity, damage the body. Consequently, Qi and Blood sink downward, knotting and gathering at the anus. Stagnant residues fail to dissipate, colliding to form hemorrhoids. Thus, the ancients categorized them into seven types.
Mu Hemorrhoids (Male Hemorrhoids): Sores appear on the side of the anus, protruding fleshy nodules resembling mouse breasts, frequently dripping pus and blood.
Pin Hemorrhoids (Female Hemorrhoids): Sores appear on the side of the anus with swelling, pain, and bleeding, where the opening tends to recede inward.
Mai Hemorrhoids (Pulse Hemorrhoids): Frequent outbreaks around the anal orifice, accompanied by pain and itching, with continuous dripping of blood.
Chang Hemorrhoids (Intestinal Hemorrhoids): Nodular masses within the intestine, accompanied by blood in stool, alternating chills and fever, and prolapse of the rectum during defecation.
Xue Hemorrhoids (Blood Hemorrhoids): Bright red blood flows continuously with every bowel movement.
Chong Hemorrhoids (Worm Hemorrhoids): The anal area becomes macerated and wet due to erosion by pinworms causing ulcers in the intestines.
Qi Hemorrhoids (Qi Hemorrhoids): Difficulty in defecation; straining forcefully causes the anus to prolapse and fail to retract.
Although the manifestations of these seven types differ, the general treatment principle is to clear Heat, cool Blood, and regulate Qi. Heat injures Blood; injured Blood leads to vessel stagnation; stagnant vessels impede Qi movement. When both Qi and Blood stagnate and sink into the Large Intestine due to deficiency, hemorrhoids form. If various hemorrhoids remain untreated for a long time, they inevitably perforate the intestines, forming fistulas. This type of fistula arising from hemorrhoids can heal itself with treatments that cool Blood and relax the Large Intestine.
Other cases involve external contraction of the Four Qi (Wind, Cold, Summer-heat, Dampness), internal distress from the Seven Emotions, irregular diet, or infection with toxins from venomous creatures. These invariably transform into sores. If the perforation is deep and pus does not drain completely, exposure to cold and Wind pathogens results in a chronic leaking fistula. "Lou" (Fistula) refers to the ulceration of various sores. Various "Gan" (Canker/Sores) include conditions like Wolf Gan, Violent Gan, Ant-biting Gan, Mole Cricket Gan, Arsenic Beetle Gan, Bee-sting Gan, Maggot Gan, Fly Larva Gan, Tetanus Gan, and Scrofula. The *Neijing* states: "Gan is equivalent to Lou." It is called "Lou" because it perforates and leaks pus and bloody fluid, resembling a leak in a jar or urn. "Gan" resembles holes bored by insects. As described in *Chao Shi Bing Yuan*, there are Ten Gans and Thirty-Six Gans; although names differ, the underlying principles are identical, so they need not all be listed.
Generally, fistulas are classified as new or old. New fistulas are bright red, slightly swollen, or have small nodules. Old fistulas have dry upper edges, blackened necrotic flesh, and emit foul odors with parasitic growth. Zhu Danxi stated: For fistula sores, one must first administer herbs to tonify and nourish Qi and Blood. Externally, apply a slice of Aconite cake onto the sore and moxa it until the tissue levels out.
Treatment of Various Hemorrhoids
Hemorrhoids are primarily treated by cooling Blood. Refer to Shen Ling Huai Jiao Tang. For hemorrhoids with intestinal wind and bleeding, along with rectal prolapse, use Huai Jiao Wan. For "Fan Hua" hemorrhoids (prolapsed, flower-like hemorrhoids), wash with a decoction of Jing Jie and Po Xiao. Then apply a powder of Mu Bie Zi and Yu Jin mixed with Long Nao (Borneol). Alternatively, apply a mixture of Xiong Dan (Bear Gallbladder) and Pian Nao (Ice Borneol). Or, fumigate with vinegar poured over a newly fired red-hot brick, three to five times daily.
Shen Ling Huai Jiao Wan Formula
Ren Shen (1.5 qian), Huang Qi (1.5 qian), Sheng Di Huang (1 qian), Chuan Xiong (1 qian), Dang Gui (1.2 qian), Sheng Ma (1 qian), Tiao Qin/Coptis (1 qian, stir-fried), Zhi Ke (1 qian, stir-fried), Huang Lian (1 qian, stir-fried), Huai Jiao (1 qian).
Grind into one dose, decoct in water, and take orally.
Huai Jiao Wan Formula
Treats various hemorrhoids and intestinal wind.
Huai Jiao (1 liang), Fang Feng (5 qian, remove rhizome), Di Yu (5 qian), Dang Gui (5 qian), Zhi Ke (5 qian), Huang Qin (5 qian).
Grind into fine powder, make into pills, and swallow with rice broth.
Treatment of Various Fistulas
There are thirty-six types of fistulas with numerous names and presentations, but the treatment principle remains consistent. Zhu Danxi stated: Treating fistulas requires substantial tonification of Qi and Blood. Use Ren Shen, Bai Zhu, Huang Qi, Chuan Xiong, and Dang Gui as main herbs, supplemented by Ci Ji Li, She Tui (Snake Slough), Niu Jiao Sai (Buffalo Horn Sponge), and Feng Fang (Honeycomb). Administer in large doses. Externally, use Huang Fu (Aconite) powder mixed with human saliva to form a cake the thickness of a coin. Place on the sore and moxa until mildly warm. Stop when slight pain is felt. Apply three to four times daily, changing the cake each time, until the tissue levels out.
Case: A patient with existing hemorrhoids developed a mass beside the anus. The skin was thick, swollen, painful, and suppurated, draining through the hemorrhoid hole. This should be treated as Food Stagnation sinking downward, using Huang Lian San.
Huang Lian San Formula
A miraculous formula for hemorrhoids and fistulas.
Huang Lian (3 qian), A Wei (3 qian), Shen Qu (3 qian), Shan Zha (3 qian), Tao Ren (3 qian), Lian Qiao (3 qian), Huai Jiao (3 qian), Xi Jiao (3 qian).
Grind into powder. Take a small amount, place in the palm, lick occasionally, and swallow with saliva. Discontinue if symptoms resolve.