源由证治诸说 《删繁论》曰∶肛者，主大便道，肺、大
肠合也，号为通事令史，重十二两，长一尺二寸，广二寸二分，应十二时。若脏伤热，即肛闭塞，大便不通，
或肿，缩入生疮，若腑伤寒，则肛寒，大肠洞泻，肛门凸出，良久乃入。热则通之，寒则补之，不虚不实，根据经
调之。（《外台》）
《四十八难》曰∶病之虚实，出者为虚，入者为实。肛门之脱，非虚无故然哉。盖惟实则温，温则内气充而
有所蓄；惟虚则寒，寒则内气馁而不能收。而况大肠之浓薄，膏脂之瘠肥，亦视夫内气之虚实何如耳。大凡脱
肛，须以温汤浇令和软，然后摩挲而入，治法以温敛行之。具有产妇用力过多，及小儿叫号弩气，久痢不止，风
邪袭虚，亦有此证。（《直指》）
脱肛一证，气聚不散故也，里急而不得出，外胀而不得入。先以枳壳散（用枳壳、甘草）作剂，又以枳壳烧
灰存性，细末掺敷，或津唾调敷，气散则肿消矣。仍用生姜汁调五苓散如膏，入新水研散略煎，吞黄连阿胶丸
（用黄连、茯苓、阿胶）。虽然，此论肛门挟热而肿胀也。其或肠中虚薄不收，则理中汤、钓肠丸（系收涩大方）、
养脏汤辈主治，乌贼骨、木贼草敷之。（同上）
脱肛属气热，气虚，血虚，血热。气虚者补气，参、 、芎、归、升麻。血虚，四物汤。血热者凉血，四物
汤加炒柏。气热者，条芩六两，升麻一两，曲糊丸。（《丹溪》）
气虚不能收敛，脉虚或久病后脱肛，补中益气汤。（《指掌》）
脱肛者，乃大肠热甚也。或久洞泄，或肠风下血，小儿叫呼，并久痢，妇人产育，用力过多，皆致肛门脱
出。热甚与肠风者，用凉血清肠散。久泻痢者，补养脾胃，参术实脾汤。用力过多者，十全大补汤。俱加升提
之药。然亦有脏寒
而致者，此由脏腑（按∶谓肺、大肠）气虚生寒，不能禁故也。必须温肺藏，补脾胃，久则必收矣。（《统
旨》）
脱肛之症，多由肠内有积而清气不升，如痢疾里急后重而下脱也。治当从《滞下》门，先推去积滞，然后
升补，积滞去而清气自升，不复脱下。其或因下血，及痢疾之后，脱而不收者，为虚，升补之药，看气血孰重。
脱之已久，当以涩剂收之。肠胃有风，脱而下血者，以风药举之。脱久亦有虚寒者，当温药微洗，内服大补之
剂。（《赤水》）
黄桂峰云∶亲见一人，里急后重，肛脱红肿，百药皆试，乃有虫在肛故也。（《同上》）（按∶《直指》曰∶
凡肠头作痒，即是腹中有虫，生艾、苦楝根煎汤熏洗，仍以干艾、生姜煎服。）
《内经》曰∶下者举之。徐之才曰∶涩可去脱。皆治脱肛之法也。故古人之治此者，多用参、 、归、术、
川芎、甘草、升麻之类以升之补之，或兼用北五味、乌梅之类以固之涩之，仍外用熏洗收涩之药，则无有不愈。泻
痢不止而滑脱者，胃关煎（见《泄泻》），或加乌梅、北五味、文蛤、木香之属以佐之。凡虚中挟火，或热赤，
或肿痛，宜用补中益气汤，加黄芩、黄连、槐花之类，加减治之。（《景岳》）（节录）
大肠受热则赤肿，受寒则白滑，当审其因证。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。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。（《医通》）
治方 香荆散，治脱肛。
大香附 荆芥穗（半两） 缩砂（二钱半）
上末，每服三钱，食前，新水煎数沸即服。小儿通用。（《直指》）
缩砂汤，治大肠虚而挟热，脱肛红肿。
缩砂 黄连 木贼（各等分）
上为细末，每服二钱，空心用米饮调下。（《奇效》）
凉血清肠散。
生地黄 当归（各二分） 防风 升麻 荆芥（各一钱） 黄芩（炒） 黄连 香附（炒） 川芎（各八分）
甘草（五分）
水煎服。（《统旨》）《回春》治痔漏秘方，于本方去香附、甘草，加芍药、乌梅、枳壳、槐角。
提肛散，治气虚肛门下坠，及脱肛便血，脾胃虚弱等症。
川芎 归身 白术 人参 黄 陈皮 甘草（各一钱） 升麻 柴胡 条芩 黄连 白芷（各五分）
水二钟，煎八分，食远服，渣再煎服。（《正宗》）《寿世》提气散，治脱肛虚寒，于本方去川芎、陈皮、
芩、连、白芷，加白芍、干姜、羌活。
参术芎归汤，治泻痢后及产育，气虚脱肛，脉濡而弦者，即补中益气汤去柴胡，加白芍、川芎、白茯、生姜煎
服。（《六要》）
诃子人参汤，治泻痢产育，气虚脱肛，脉濡而弦者。
诃子（煨去核） 人参 白茯苓 白术 炙甘草 莲肉 升麻 柴胡（各等分）
上水加生姜煎服。（《准绳》）
参术实脾汤。
白术（黄土炒） 人参（二钱） 肉果（面煨一钱半） 白茯苓 白芍药（炒各一钱） 附子（炮八分）
炙甘草（七分） 陈皮（一钱）
水二钟，姜三片，枣二枚，煎八分服。下陷，加升麻。（《统旨》）
治肛出方。
磁石（四两） 桂心（一尺） 皮（一枚，按∶《外台》炙黄。）
上三味治下筛，饮服方寸匕，日一服即缩（《外台》作一日服，十服即缩）。慎举重及急带衣，断房室周
年乃佳。（《千金》）《三因》名 皮散。《圣惠》治经年下痢，脱肛不收，鳖甲丸，于本方加鳖甲，炼蜜和
丸。
治大肠虚冷脱肛，宜服此方。
干蜗牛子（一百枚微炒捣罗为末） 磁石（二两捣碎淘去赤汁）
上件药，以水一大盏，煎磁石五钱，至五分去滓，调蜗牛末一钱服之，日三服。（《圣惠》）《十便》名
缩肠散。（按∶《要诀》治脱肛，磁石末，每二钱，食前米饮调下，外用铁锈磨汤温洗。此法过巧，难信。）
龙骨散，治大肠虚，肛门脱出。
龙骨 诃子（各一钱半） 没石子（二枚） 粟壳 赤石脂（各二钱）
上末之，每服一钱，米饮调下。（《准绳》）
Background Information:
Book: Zabing Guangyao (Comprehensive Requirements for Miscellaneous Diseases)
Author: Danbo Yuanjian (Japan)
Dynasty: Qing Dynasty
Chapter: [Appendix] Rectal Prolapse
Category: Comprehensive
Theories on Etiology, Symptoms, and Treatment:
*Shanfan Lun* states: The anus is the organ governing the passage of stool, combined with the Lung and Large Intestine, known as the "Tongshi Lingshi" (Messenger Official), weighing two taels, one chi in length, and two cun and two fen in width, corresponding to the twelve double-hours of a day. If the Zang and Fu organs are injured by heat, the anus will become blocked, feces will not pass, or it may swell, retract, and develop sores. If the Fu organs are injured by cold, the anus will become cold, the Large Intestine will suffer from severe diarrhea (Dongxie), and the anus will protrude outside, only returning after a long time. For heat conditions, use unblocking methods; for cold conditions, use tonifying methods. For conditions that are neither deficient nor excess, regulate according to the meridians. (From *Waitai Miyao*)
*Nan Jing · Chapter 48* states: Regarding the deficiency and excess of diseases, outward movement indicates deficiency, inward sinking indicates excess. Is rectal prolapse not caused by deficiency? Generally, only excess requires warming; warming fills the internal Qi with accumulation. Only deficiency involves cold; cold causes internal Qi to fail and cannot retain. Furthermore, the thickness of the Large Intestine and the plumpness of the fat depend on the state of internal Qi's deficiency or excess. Generally, treating rectal prolapse requires pouring warm water over it to soften it, then massaging it back in. The treatment method should be warming and astringent. Additionally, this condition can occur due to excessive effort during childbirth, children straining while crying, prolonged dysentery, or wind pathogens attacking a deficient body. (From *Zhizhi Fang*)
Rectal prolapse is caused by Qi gathering and failing to disperse, presenting as tenesmus without evacuation and external distension without retraction. First, administer Zhike San (composed of Zhike and Gancao). Then, burn Zhike to charcoal, preserve its nature, grind into fine powder, and apply externally, or mix with saliva for application. When Qi disperses, swelling subsides. Continue using Shengjiang juice to mix Wuling San into a paste, add fresh water, grind slightly, decoct, and swallow Huanglian Ejiao Wan (composed of Huanglian, Fuling, and Ejiao). However, this discusses cases where the anus is swollen due to夾热 (mixed heat). If the intestine is deficient and thin, unable to retain, Lizhong Tang, Diaochang Wan (a large astringent formula), and Yangzang Tang are indicated. External application of Hai'ougu and Muzeicao is used. (Ibid.)
Rectal prolapse belongs to categories of Qi Heat, Qi Deficiency, Blood Deficiency, and Blood Heat. For Qi Deficiency, tonify Qi using Renshen, [Missing Character], Chuanxiong, Danggui, and Shengma. For Blood Deficiency, use Siwu Tang. For Blood Heat, cool the blood using Siwu Tang plus Chao Baihuo. For Qi Heat, use Liuhuang Qin (6 liang) and Shengma (1 liang), made into pills with Qu paste. (From Zhu Danxi)
For Qi Deficiency failing to converge, weak pulse, or rectal prolapse after prolonged illness, use Buzhong Yiqi Tang. (From *Zhangzhi Tu*)
Rectal prolapse is caused by severe heat in the Large Intestine. It can result from chronic diarrhea, intestinal wind with bleeding, children shouting/straining, prolonged dysentery, or women exerting too much force during childbirth. For severe heat and intestinal wind, use Liangxue Qingchang San. For chronic diarrhea/dysentery, tonify and nourish the Spleen and Stomach using Shen Shishi Pi Tang. For excessive effort, use Shiquan Dabu Tang. All formulas should include herbs that lift. However, some cases are caused by Zang Cold, due to Qi deficiency generating cold in the Zang-Fu (specifically Lung and Large Intestine), leading to inability to hold. One must warm the Lung and tonify the Spleen and Stomach; over time, it will retract. (From *Jingyue Quanshu · Tongzhi*)
Symptoms of rectal prolapse often arise from accumulation in the intestines preventing the ascent of Clear Qi, such as in dysentery with tenesmus and heaviness in the rectum causing prolapse. Treatment should follow the *Zhixia* chapter: first eliminate stagnation, then ascend and tonify. Once stagnation is removed, Clear Qi ascends naturally, and prolapse ceases. If prolapse occurs after bleeding or dysentery and cannot retract, it is deficiency; ascending and tonifying herbs should be selected based on whether Qi or Blood is more severely affected. For long-standing prolapse, use astringents. If Wind affects the intestines causing prolapse and bleeding, use Wind-expelling herbs to lift. Long-standing prolapse may also involve Deficiency-Cold; treat with mild warming washes and internal major tonics. (From *Chuishui Xuanzhu*)
Huang Guifeng said: I personally saw a case of tenesmus, rectal prolapse with redness and swelling. After trying all medicines, it was found that there were parasites in the anus. (Ibid.) (Note: *Zhizhi Fang* states: If the anal area itches, there are parasites in the abdomen. Use Aiye and Kulian Gen decoction for fumigation and washing, and take dried Aiye and Shengjiang internally.)
*Neijing* states: What sinks should be lifted. Xu Zhicai stated: Astringency removes prolapse. These are methods for treating rectal prolapse. Therefore, ancients often used Renshen, [Missing Character], Danggui, Baizhu, Chuanxiong, Gancao, Shengma, etc., to lift and tonify, or combined with Bei Wuweizi and Wumei to secure and astringe, along with external fumigation/washing astringents, ensuring cure. For persistent diarrhea/dysentery with sliding prolapse, use Weiguan Jian (see *Xiexie*), possibly adding Wumei, Bei Wuweizi, Wen Ge, and Muxiang. For deficiency with mixed fire, redness, or swelling/pain, use Buzhong Yiqi Tang added with Huangqin, Huanglian, and Huaihua, adjusted accordingly. (From Zhang Jingyue, excerpted)
When the Large Intestine is heated, it becomes red and swollen; when cooled, it becomes white and slippery. One must examine the cause and symptoms. For redness, swelling, and pain, do not use hot water for fumigation/washing, and especially avoid astringents like Wubeizi, as steam evaporation will worsen swelling and pain. Instead, use Xiongdan (Bear Gallbladder) ground in water for application. For patients with consumption disease (Lao Bing) suffering rectal prolapse, emaciation, hoarseness, hematemesis, loss of Yang control, vivid dreams, irregular breathing, daytime chill, and nighttime fever, death ensues. Hemoptysis of pus and blood also leads to death. Survival is indicated if the pulse is not rapid but has root, and the cheeks are not red. (From *Yitong*)
**Treatment Formulas:**
**Xiangjing San**, treats rectal prolapse.
Da Xiangfu, Jingjie Sui (0.5 liang each), Suosha (2.5 qian).
Grind into powder. Take 3 qian before meals, decoct in fresh water for a few boils, then drink. Universal for children. (From *Zhizhi Fang*)
**Suosha Tang**, treats Large Intestine deficiency with mixed heat, causing rectal prolapse with redness and swelling.
Suosha, Huanglian, Muzei (equal parts).
Grind into fine powder. Take 2 qian on an empty stomach, mixed with rice water. (From *Qixiao Liangfang*)
**Liangxue Qingchang San**.
Sheng Dihuang, Danggui (2 fen each), Fangfeng, Shengma, Jingjie (1 qian each), Huangqin (stir-fried), Huanglian, Xiangfu (stir-fried), Chuanxiong (8 fen each), Gancao (5 fen).
Decoct in water and drink. (From *Zabing Guangyao · Tongzhi*). *Huichun*'s secret recipe for hemorrhoids and fistula modifies this formula by removing Xiangfu and Gancao, adding Shaoyao, Wumei, Zhike, and Huaijiao.
**Tigan San**, treats Qi deficiency causing anal heaviness/prolapse, rectal prolapse with bleeding, and Spleen/Stomach weakness.
Chuanxiong, Danggui Shen, Baizhu, Renshen, Huangqi, Chenpi, Gancao (1 qian each), Shengma, Chaihu, Tiaoqin, Huanglian, Baizhi (5 fen each).
Use 2 zhong of water, decoct to 8 fen. Take after meals. Decoct residue again. (From *Waike Zhengzong*). *Shoushi Baoyuan*'s Tiqi San treats deficiency-cold rectal prolapse by modifying this formula: remove Chuanxiong, Chenpi, Huangqin, Huanglian, Baizhi; add Baishaoyao, Ganjiang, Qianghuo.
**Shenzhu Xiong Gui Tang**, treats post-dysentery/childbirth Qi-deficient rectal prolapse with soft and wiry pulse. This is Buzhong Yiqi Tang minus Chaihu, plus Baishaoyao, Chuanxiong, Baifuling, and Shengjiang. (From *Jingyue Quanshu · Liuyao*)
**Hezi Renshen Tang**, treats post-dysentery/childbirth Qi-deficient rectal prolapse with soft and wiry pulse.
Hezi (roasted, pitted), Renshen, Baifuling, Baizhu, Zhi Gancao, Lianrou, Shengma, Chaihu (equal parts).
Add water and Shengjiang, decoct and drink. (From *Yixue Zhunsheng*)
**Shenzhu Shipi Tang**.
Baizhu (soil-stir-fried), Renshen (2 qian), Rou Doukou (flour-roasted, 1.5 qian), Baifuling, Baishaoyao (stir-fried, 1 qian each), Fuzi (processed, 8 fen), Zhi Gancao (7 fen), Chenpi (1 qian).
Use 2 zhong water, 3 slices Shengjiang, 2 Jujubes. Decoct to 8 fen. Add Shengma if there is sinking sensation. (From *Zabing Guangyao · Tongzhi*)
**Formula for Anal Prolapse**.
Cishi (4 liang), Guixin (1 chi), [Missing Character, likely Diyup or similar, text says "Pi"] (1 piece, note: *Waitai* says processed Huangqi).
Grind the three ingredients, sieve, and take 1 fangcun bi with wine, once daily, until retracted (*Waitai* says 10 doses). Avoid heavy lifting, tight belts, and sexual abstinence for one year. (From *Qianjin Yaofang*). *Sanyin Fang* names this [Missing Character] Pi San. *Taiping Shenghui Fang*'s Biejia Wan for chronic dysentery and irretractable prolapse adds Biejia to this formula, made into honey pills.
**Formula for Large Intestine Deficiency-Cold Rectal Prolapse**.
Gan Wonniuzi (100 pieces, lightly stir-fried and ground), Cishi (2 liang, crushed and washed to remove red liquid).
Take 1 da zhan of water, decoct 5 qian of Cishi until reduced to 5 fen, strain, and mix with 1 qian of Wonniu powder. Take 3 times daily. (From *Taiping Shenghui Fang*). *Shibian Liangfang* names this Suochang San. (Note: *Yaojue* uses Cishi powder, 2 qian, taken with rice water before meals, and external iron rust water wash. This method is considered overly clever and unreliable.)
**Longgu San**, treats Large Intestine deficiency and rectal prolapse.
Longgu, Hezi (1.5 qian each), Meishizi (2 pieces), Sushe, Chishizhi (2 qian each).
Grind into powder. Take 1 qian, mixed with rice water. (From *Yixue Zhunsheng*)