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Wang Kentang stated: Cold-fire sores (Hanhuo Chuang) arise outside the anus, ulcerating like broken skin, with intermittent discharge of serous fluid. Every night, chills occur first, followed by a sensation of burning heat; there is usually more itching and less pain. This is what is referred to as cold-fire sores. (From *Yixue Zhunsheng Liuyao*)

Cheng stated: I once saw a Mr. Zhou on a Jiangxi grain transport boat suffering from this condition. He had to apply alum powder (Fenmo) to the affected area every night to relieve itching and sleep peacefully. I believe this is caused by wind-dampness pathogens attacking each other, where dampness transforms into parasites.

Lin stated: Someone asked: Medical texts state that prolapse of the rectum (Tuogang) can be due to Qi deficiency, Blood deficiency, Blood heat, or excessive Fire. Many people suffer from these four conditions, so why does it lead to rectal prolapse? The answer is: The anus is the end of the large intestine. All有形 (tangible) waste exits through here. It serves as a gateway for the body. If deficient and slippery, dysentery occurs and the anus cannot close; if dry and rough, stool becomes hard and difficult to pass. Both can cause disease, but ultimately, responsibility lies with "Qi." Tangible objects rely entirely on intangible Yuan Qi (Original Qi) for transportation and entry/exit. Furthermore, the Lung and Large Intestine are exterior-interior partners. The Lung governs the Yuan Qi of the whole body. Therefore, defecation relies on Yuan Qi for transmission, allowing tangible waste in the Large Intestine to be expelled. After expulsion, clear ascending Qi rises from below to reach the Zang-Fu organs, interstices, and limbs. This is the normal pattern. If the Spleen and Lung are chronically deficient, and Qi and Blood are depleted, the mechanism of governance, transportation, and distribution becomes unfavorable. One must rely on forced straining to expel stool. Over time, Qi stagnation causes the anus to prolapse. Secondly, there are cases of chronic illness leading to Qi deficiency and sinking, causing spontaneous prolapse; cases where Qi deficiency fails to transmit, leading to dry and rough Blood, requiring forceful straining; cases where Yangming Dryness-Fire is extreme, causing heat accumulation and constipation, leading to prolapse due to forceful straining and the downward-pushing nature of Fire; elderly individuals with dry Blood or postpartum women with Blood deficiency and dry fluids, where weak Qi cannot push, requiring forced straining; cases of chronic diarrhea or dysentery with dual Qi and Blood deficiency, where damp-heat sinks into the Large Intestine causing sliding prolapse; and children with Qi deficiency from diarrhea/dysentery, where damp-fire pushes downward causing prolapse. In summary, all result from disharmony of Qi and Blood, losing the normal rhythm of transportation, transmission, entry/exit, and ascending-descending. Physicians should naturally examine pulse and symptoms to determine deficiency or excess and treat accordingly. (From *Huorenlu Huibian*)

It further states: For prolapse due to chronic deficiency and sinking, the pulse will be deficient, minute, and powerless; treatment focuses on tonifying Qi and lifting. For Qi deficiency and Blood exhaustion with forceful straining, the pulse will be choppy, weak, deficient, and rapid; treatment involves adding herbs for tonifying Blood, moistening dryness, and clearing/lifting to the Qi-tonifying formula. For excess Fire and dryness accumulation in the Large Intestine with painful swelling and tenesmus, the pulse will be surging and rapid, or deep and solid/powerful; treatment involves clearing Fire and resolving toxicity, assisted by lifting methods. For the elderly or postpartum, generally due to Qi deficiency and Blood scarcity, the pulse will be choppy, rapid, and powerless; treatment focuses on nourishing and lifting. For chronic diarrhea/dysentery, regardless of pulse size, it will be deficient, minute, deep, and weak; although tonification and lifting are primary, if residual pathogens remain, clearing and tonifying should be combined. (From *Huorenlu Huibian*)

*Yilun Xuanyao* states: The treatment for rectal prolapse involves internal administration of formulas that warm the Stomach, thicken the intestines, astringe, and resolve toxicity. Externally, frequent washing with warm water to soften the tissue, followed by massage and reduction, leads to self-healing.

Feng Luzhan stated: The Lung and Large Intestine are exterior-interior partners; the anus is the gate of the Large Intestine. When the Lung is Excess, it is warm; warmth means internal Qi is abundant and stored. When the Lung is Deficient, it is cold; cold means internal Qi is exhausted and cannot retract. Thus, the rectal mucosa protrudes. This often results from chronic dysentery without cessation, tenesmus, forceful straining opening the anus, and exposure to external wind; or from sudden violent diarrhea due to latent summerheat, causing loss of control over the rectal mucosa; or from constitutional weakness, susceptibility to cold, crying and straining, leading to Large Intestine deficiency prolapse. Generally, diarrhea and dysentery are caused by Wind, Summerheat, Dampness, or Heat damaging the Spleen. Spleen deficiency leads to weak Lung Qi and a deficient Large Intestine. Earth is the mother of Metal; if the mother is deficient, it cannot generate Metal. Therefore, slight exposure to wind-cold causes the rectal mucosa to prolapse due to deficiency. Treatment should focus on tonifying the Spleen and warming the Stomach, allowing Metal (Lung) to benefit from its Mother (Spleen) and ascend, followed by administering intestinal-astringing formulas. Externally, use fumigation and powder application. If the prolapsed tissue is long-standing and hardened, first soften it with warm medicinal decoctions, then gradually reduce it.

It further states: The anus is the envoy of the Large Intestine. Whether the Large Intestine is heated or chilled, it can cause prolapse. The Large Intestine is the official of transmission; the Kidney is the official of strength. Excessive alcohol and sexual activity lead to Kidney deficiency, which steals Qi from the Mother organ (Spleen), causing Lung deficiency. With no Qi governing the Large Intestine, prolapse occurs. Children with unconsolidated Qi and Blood, and the elderly with declining Qi and Blood, both present this syndrome.

According to Danxi's discussion, while prolapse is mostly due to Qi and Blood deficiency, it can also be due to Qi and Blood heat. One must carefully observe the pulse. For Qi deficiency, tonify Qi using Ginseng, Atractylodes macrocephala, Licorice, processed Cimicifuga, etc.; for Blood deficiency, use Siwu Decoction; for Blood heat, cool the Blood using Siwu Decoction plus fried Phellodendron bark; for Qi heat, use Scutellaria baicalensis and Cimicifuga, along with lifting methods.