立斋曰∶翻花疮者，由疮疡溃后，肝火血燥生风所致。或疮口 肉突出，如菌大小不
同，或出如蛇头长短不一治法，当滋肝补气，外涂藜芦膏， 肉自入。须候元气渐复，脓
毒将尽，涂之有效，不然虽入而复溃。若误用刀针、蚀药、灸火，其势益甚，或出血不止，
必致寒热呕吐等证，须大补脾胃为善。
判官张承恩，内股患痈将愈，翻出一肉如菌。余曰∶此属肝经风热血燥，当清肝热，养
肝血。彼为不然，乃内用降火，外用追蚀而复翻，翻而复蚀，其肉益大，元气益虚，始信余
言。遂内用栀子清肝散，外用藜芦膏而痊。
一上舍，素膏粱善怒，耳下结一核，从溃，而疮口翻张如菌， 连头痛，或胸胁作胀
，或内热寒热。或用清热消毒之药，年余未瘥。余用补中益气汤、六味地黄丸而寻愈。
一男子背疮，敛如豆许，翻出肉寸余。用消浊割击法，屡去屡大，此肝经血虚风热。余
用加味逍遥散三十余剂，涂藜芦膏而消，又用八珍汤，倍用参 归术而敛。
一妇人，素善怒，臂患痈，疮口出肉，长二寸许，此肝肾郁怒，气血虚而风内动也。用
加味逍遥散，涂藜芦膏而愈。后因怒患处胀闷，遍身汗出如雨，此肝经风热，风能散气故耳
。仍用前散，并八珍汤而愈。（俱薛按）
丹溪曰∶漏疮，须先服补药，以生气血，即参 归术芎，大剂为主。外以炮附子为末，
唾津和为饼，如三钱浓，安疮上，以艾炷灸之。漏大艾炷亦大，漏小艾炷亦小，但灸令微热
，不可令痛，干前易之，如因则止，来日如前，再灸直至肉平为效。亦有用附片灸之，以补
气血药作膏贴之。
立斋曰∶痔，属肝脾肾三经，凡阴经亏损者难治，多成漏证。若肺与大肠二经，风热
湿热者，热退自愈。若不守禁忌者，亦成漏证。此因醉饱入房，筋脉横解，精气脱泄，热毒
乘虚流注。或淫极强固其精，以致木乘火势而侮金。或炙爆浓味过多，或劳伤元气，阴虚
火炽，皆成斯疾。若破而不愈，即成漏矣。有串臀者，有患阴者，有患肠者，有秽从疮口而出
者，形虽不同，治颇相似。其肠头肿成块者，湿热也。作痛者，风热也。大便燥结者，火也
。溃而为脓者，热胜血也。当各推其所因而治之。
《治法》曰∶初起 痛便秘，小便不利者，宜清热凉血，润燥疏风。若气血虚，而为
寒凉伤损者，宜调养脾胃，滋补阴精。大便秘涩，或作痛者，润燥除湿。肛门坠痛者，泻火
导湿。下坠肿痛而痒者，祛风胜湿。小便涩滞肿痛者，清肝导湿。其成漏者，养元气，补阴
精为主。大凡痔漏下血，服凉血药不应者，必因中气虚不能摄血，非补中升阳之药不能愈，切忌
寒凉之剂。亦有伤湿热之食，成肠 而下脓血者，
宜苦寒之剂内疏之。脉弦绝涩者，难治，滑大柔和者，易治。经云∶因而饱食，筋脉横解
，肠 为痔。其属肝脾肾也明矣。若有患痔而兼疝，患疝而兼下疳，皆属肝肾不足之变证
，但用地黄丸、益气汤，以滋化源为善。若专服寒凉治火者，无不致祸。
一男子，患痔成漏，每登厕则痛，以秦艽防风汤加条芩、枳壳，四剂而愈。以四物加升
麻、芩、连、荆、防，不复作。
一男子，患痔漏，每登厕则肛门下脱作痛，良久方收，以秦艽防风汤，数剂少愈。乃去
大黄加黄 、川芎、芍药，而痛止。更以补中益气汤，二十余剂后，再不脱。
一儒者，脓血淋漓，口干作渴，晡热便血，自汗盗汗。余谓此肝肾阴虚也，不信。仍服
四物芩连知柏之类，食少泄呕。余先用补中益气汤加茯苓、半夏、炮姜，脾胃渐醒。后用六
味丸朝夕服，两月余，诸证悉愈。
一男子患此，服寒凉之剂，清晨去后不实，食少体倦，口干作渴，小腹重坠。余用补中益气汤而下坠顿止
，用四神丸而食进便实，用地黄丸
而疮寻愈。（俱薛按）
一男子，脏毒下血，服寒凉败毒药，不惟不能止，且饮食日减，肢体愈倦，脉数而涩。
先以补中益气汤，数剂少止。更以六君子汤加升麻、炮姜，四剂而止。乃去炮姜加芎、归，
月余脾胃亦愈。尝治积热成风下血者，先以败毒散散之。胃寒气弱者，用四君子汤，或参苓
白术散补之，并效。
一男子，脏毒下血，脾气素弱，用六君子汤加芎归、枳壳、地榆、槐花，治之而愈。后
因谋事血复下，诸药不应。余意，思虑伤脾所致，遂投以归脾汤，四剂而痊。大抵此证所致
之由不一，当究其因而治之。丹溪云芎归汤一剂，乃调血之上品。热加赤茯苓、槐花，冷加
白茯苓、木香，此则自根自本之论也。虽然血气出于谷气，故大肠下血，以胃药收功，宜四
君子汤，或参苓白术散，以枳壳散、小乌沉汤和之，胃气一回，血自循经络矣。
凡肠风者，邪气外入，随感随见。脏毒者，蕴积毒久而始见。又云，人惟坐卧风湿，醉
饱房劳，生冷停寒，酒面积热，以致营血失道，渗入大肠，此肠风脏毒之所由作也。挟热下
血者，清而色鲜。挟冷下血者，浊而色黯。清则为肠风，浊者为脏毒。先便而后血者，其来
远。先血而后便者，其来近。治法大要，先当解散脾胃风邪。热则败毒散；冷则不换金正气
散，加川芎当归，后随其冷热治之。
一妇人，素患痔漏，每因热则下血数滴，以四物汤加黄连，治之即愈。后为大劳，疮发
肿痛，经水不止，脉洪大无力。此劳伤血气，火动而然也。用八珍汤加芩、连、蒲黄，二剂
而止。后去蒲黄芩连加地骨皮，数剂而安。丹溪曰∶妇人崩中者，由脏府伤损冲任二脉，血
气俱虚故也。若劳动过极，脏府俱伤，以致冲任气虚，不能约制经血，故忽然而下，谓之崩
中暴下，治宜大补气血之药，举养脾胃，微加镇坠心火之剂，以治其心，补阴泻阳，经自正
矣。（俱薛按）
Xue Lizhai stated: Fan Hua Chuang (Flower-Overturning Sores) is caused by liver fire and dry blood generating wind after the ulceration of sores. In some cases, flesh protrudes from the wound like mushrooms of varying sizes; in others, it resembles snake heads of different lengths. The treatment method should focus on nourishing the liver and tonifying primordial qi, while applying Lili Gao (Veratrum Ointment) externally, which will cause the protruding flesh to retract naturally. This is effective only when primordial qi has gradually recovered and pus/toxins are nearly exhausted; otherwise, even if retracted, it will ulcerate again. If mistakenly treated with knives/needles, caustic medicines, or moxibustion/fire, the condition will worsen, potentially causing uncontrolled bleeding, alternating chills and fever, vomiting, etc. In such cases, greatly tonifying the spleen and stomach is the best approach.
Zhang Cheng'en, a judge, had an abscess on his inner thigh that was about to heal but produced a mushroom-like fleshy growth. I said: "This belongs to wind-heat and dry blood in the Liver Meridian; one should clear liver heat and nourish liver blood." He did not listen, instead taking internal fire-draining medicines and using external caustic treatments. Consequently, the flesh grew larger and his primordial qi became more deficient through repeated cycles of protrusion and erosion, until he finally believed my advice. He then took Zhizi Qinggan San (Gardenia Decoction to Clear the Liver) internally and applied Lili Gao externally, resulting in a cure.
A student at the Imperial Academy, accustomed to rich foods and prone to anger, developed a nodule below his ear. After it ulcerated, the wound edges everted like a mushroom, accompanied by headache, occasional chest/hypochondriac distension, and internal heat or alternating chills and fever. Treatment with heat-clearing and detoxifying herbs failed for over a year. I used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), leading to recovery shortly thereafter.
A male patient had a back sore that contracted to the size of a bean but produced a piece of flesh over one inch long. Using methods to eliminate turbidity and cutting/cauterizing, the flesh repeatedly regrew. This indicated blood deficiency and wind-heat in the Liver Meridian. I prescribed Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) for over thirty doses and applied Lili Gao externally to resolve the swelling. Subsequently, I used Bazhen Tang (Eight-Treasure Decoction) with increased amounts of Renshen (Ginseng), Danggui (Angelica Sinensis), and Baizhu (Atractylodes Macrocephala) to promote healing.
A female patient, prone to anger, developed an arm abscess with two-inch-long fleshy protrusions from the wound. This was due to liver-kidney depression and anger, resulting in qi-blood deficiency and internal wind movement. She was cured using Jiawei Xiaoyao San and topical Lili Gao. Later, anger caused distension in the affected area and profuse sweating resembling rain. This was attributed to liver-meridian wind-heat, as wind disperses qi. She recovered using the previous formula combined with Bazhen Tang. (All cases noted by Xue Ji)
Zhu Danxi stated: For Lou Chuang (Fistulous Sores), one must first administer tonic medicines to generate qi and blood, primarily using large doses of Renshen (Ginseng), Danggui (Angelica Sinensis), Baizhu (Atractylodes Macrocephala), and Chuanxiong (Sichuan Lovage Rhizome). Externally, use Pao Fuzi (Processed Aconite Root) powder mixed with saliva to form a cake approximately three qian thick, place it on the sore, and apply moxa moxibustion. The size of the moxa cone should correspond to the size of the fistula; ensure mild warmth without pain. Replace when dry. If blisters form, stop and resume the next day. Continue until the tissue levels out. Alternatively, use sliced Aconite for moxibustion followed by application of a qi-and-blood-tonifying plaster.
Xue Lizhai stated: Hemorrhoids belong to the Liver, Spleen, and Kidney meridians. Cases involving yin meridian deficiency are difficult to treat and often progress to fistulas. If caused by wind-heat or damp-heat in the Lung and Large Intestine meridians, they may resolve spontaneously once the heat subsides. However, failure to observe dietary/lifestyle taboos can lead to fistulas. Etiologies include sexual activity after heavy meals, leading to relaxed sinews/vessels and loss of essence, allowing heat-toxins to flow into deficiencies. Other causes include excessive sexual desire retaining essence, causing Wood (Liver) to overwhelm Fire and insult Metal (Lung); excessive consumption of roasted/spicy foods; or labor injuring primordial qi, leading to yin deficiency and blazing fire. All these result in this disease. If ulcers fail to heal, they become fistulas. Manifestations vary (gluteal, genital, intestinal, discharge of foul matter), but treatments are similar. Swelling at the anal verge indicates damp-heat; pain indicates wind-heat; dry stool indicates fire excess; purulent discharge indicates heat overcoming blood. Treatment must address the specific cause.
"Zhi Fa" (Treatment Methods) states: For early-stage symptoms with pain, constipation, and dysuria, employ heat-clearing, blood-cooling, dryness-moistening, and wind-dispersing methods. For qi-blood deficiency injured by cold-cold herbs, regulate the spleen/stomach and nourish yin essence. For dry/sticky stools or pain, moisten dryness and drain dampness. For anal bearing-down pain, purge fire and guide out dampness. For bearing-down pain with itching, dispel wind and overcome dampness. For painful/dysuric urine, clear liver heat and guide out dampness. For established fistulas, prioritize nourishing primordial qi and replenishing yin essence. Generally, if hemorrhoidal bleeding does not respond to blood-cooling herbs, it is likely due to middle-jiao qi deficiency failing to control blood; only qi-tonifying and yang-raising herbs will work. Cold-cold agents are contraindicated. For intestinal discharges of pus/blood due to damp-heat food injury, bitter-cold internal purgatives are appropriate. Pulse wiry/extinct/choppy indicates difficulty; slippery/large/gentle indicates ease of treatment. The Classic states: "Due to overeating, sinews relax, leading to intestinal prolapse/hemorrhoids." This clearly links the condition to the Liver, Spleen, and Kidney. Conditions combining hemorrhoids with hernias or chancre indicate liver-kidney insufficiency; treat with Dihuang Wan (Rehmannia Pill) and Yiqi Tang (Qi-Augmenting Decoction) to nourish the source of transformation. Exclusive use of cold-cold fire-treatments leads to disaster.
A male patient with hemorrhoidal fistula experienced pain during defecation. He was cured in four doses using Qinjiao Fangfeng Tang (Gastrodia and Saposhnikovia Decoction) modified with Huangqin (Scutellaria Baicalensis) and Zhike (Aurantii Fructus). Recurrence was prevented using Siwu Tang (Four-Substance Decoction) modified with Shengma (Cimicifugae Rhizoma), Huangqin, Huanglian (Coptidis Rhizoma), Jingjie (Schizonepetae Herba), and Fangfeng (Saposhnikoviae Radix).
Another male patient suffered from hemorrhoidal fistula with anal prolapse and pain during defecation, requiring time to reduce. Initial treatment with Qinjiao Fangfeng Tang provided slight relief. Da Huang (Rhei Radix et Rhizoma) was removed, and Huangqi (Astragali Radix), Chuanxiong, and Shaoyao (Paeoniae Radix Alba) were added to stop pain. Subsequent administration of Buzhong Yiqi Tang for over twenty doses prevented further prolapse.
A scholar presented with dripping pus/blood, dry mouth/thirst, afternoon fever, hematochezia, spontaneous sweating, and night sweats. I diagnosed liver-kidney yin deficiency. Disregarding this, he continued taking Siwu Tang modified with Huangqin, Huanglian, Zhimu (Anemarrhenae Rhizoma), and Huangbai (Phellodendri Cortex), resulting in poor appetite, diarrhea, and vomiting. I first used Buzhong Yiqi Tang plus Fuling (Poria), Banxia (Pinelliae Rhizoma), and Paojiang (Prepared Ginger) to restore the spleen/stomach. Thereafter, Liuwang Wan was taken morning and evening for over two months, resolving all symptoms.
A male patient treated with cold-cold herbs presented with loose morning stools, poor appetite, fatigue, dry mouth/thirst, and lower abdominal heaviness/prolapse sensation. Buzhong Yiqi Tang immediately relieved the prolapse sensation. Sixun Wan (Six-Ginger Pill) improved appetite and solidified stools. Dihuang Wan healed the sore. (All cases noted by Xue Ji)
A male patient with Zangdu Xiaxue (Visceral Toxin Lower Bleeding) took cold-cold detoxifying herbs, which failed to stop bleeding and reduced appetite/increased fatigue. His pulse was rapid and choppy. Buzhong Yiqi Tang stopped bleeding slightly after several doses. Liujunzi Tang (Six-Gentlemen Decoction) modified with Shengma and Paojiang stopped bleeding completely after four doses. Paojiang was then removed, and Chuanxiong and Danggui were added; spleen/stomach function recovered within a month. I also treated lower bleeding due to accumulated heat generating wind using Baidu San (Detoxification Powder) for dispersion. For stomach cold/qi weakness, Sizijunzi Tang or Shenling Baizhu San (Ginseng, Poria, and Atractylodes Macrocephala Powder) were effective.
Another male patient with Zangdu Xiaxue and weak spleen qi was cured using Liujunzi Tang modified with Chuanxiong, Danggui, Zhike, Diyü (Sanguisorbae Radix), and Huaihua (Sophorae Flos). When bleeding recurred due to mental exertion despite other treatments, I attributed it to worry injuring the spleen and prescribed Guipi Tang (Restore the Spleen Decoction), resulting in recovery in four doses. Various etiologies require specific investigation. Danxi noted that Xionggui Tang (Ligusticum and Angelica Decoction) is a premier blood-regulating formula. Add Chi Fuling (Red Poria) and Huaihua for heat; add Bai Fuling (White Poria) and Muxiang (Aucklandiae Radix) for cold. Although blood/qi originate from grain qi, treating large intestine bleeding via stomach-tonifying herbs is ideal. Sizijunzi Tang or Shenling Baizhu San, harmonized with Zhike San (Bitter Orange Powder) or Xiao Wuchen Tang (Minor Black Stagnation Decoction), restore stomach qi, allowing blood to return to normal circulation.
Changfeng (Intestinal Wind) involves external pathogens appearing immediately upon exposure. Zangdu involves accumulated toxins manifesting after a long period. Sitting/lying in wind-dampness, excessive eating/drinking/sex, consuming raw/cold foods, or accumulating alcohol-heat causes nutritive blood to deviate and seep into the large intestine, creating Changfeng and Zangdu. Heat-associated bleeding presents as bright red; cold-associated bleeding as dark/turbid. Bright red is Changfeng; dark is Zangdu. Blood after stool indicates distant origin; blood before stool indicates proximate origin. General treatment first disperses spleen/stomach wind pathogens. Use Baidu San for heat; Huanjin Zhengqi San (Golden Exchange Upright Qi Decoction) modified with Chuanxiong and Danggui for cold, followed by heat/cold-specific treatments.
A female patient with chronic hemorrhoidal fistula experienced minor bleeding upon heat exposure. Siwu Tang modified with Huanglian (Coptidis Rhizoma) cured her. Later, severe labor triggered swelling/pain and menorrhagia with a forceful yet empty pulse. This was labor-injured blood/qi with hyperactive fire. Bazhen Tang modified with Huangqin, Huanglian, and Puhuang (Lygodii Spora) stopped bleeding in two doses. Removing Puhuang, Huangqin, and Huanglian, and adding Gudupi (Lycii Cortex), stabilized her in several doses. Danxi stated: Femoral flooding (Bengzhong) results from zorg-fu damage to the Chong and Ren meridians and qi-blood deficiency. Extreme labor damages zang-fu, weakening Chong/Ren qi and failing to constrain menstrual blood, causing sudden heavy flow (Bengzhong Baoxia). Treatment requires major qi-blood tonics, spleen/stomach support, and mild heart-calming agents to balance yin/yang, restoring regular menstruation. (All cases noted by Xue Ji)