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Chen Shigong stated: Zangdu (Visceral Toxin) arises on both sides of the anus. It is formed by damp-heat and ministerial fire internally scorching the Lung Metal. It may result from consuming strong wine and rich, greasy foods, combined with hard labor and hardship, causing accumulated toxin to flow into the anus and form a mass. When it manifests externally, it is mostly excess and heat; the pulse is rapid and forceful; the anus suddenly swells; stool is constipated; the abdomen feels distended and uncomfortable; urination is difficult. In severe cases, the flesh around the anus swells like a hoop, and the anal orifice is tightly closed. This is called external manifestation, belonging to the category of easy-to-treat conditions. Treatment should focus on promoting the free flow of urine and defecation. Apply Zhenzhu San (Pearl Powder) or Renzhongbai San (Human Urine Deposit Powder) topically. Once pus has matured, puncture with a needle to drain it. When it manifests internally, it belongs to Yin deficiency. Damp-heat infiltrates the anus, causing swelling and nodules within the five viscera. The pain is stabbing like a awl; urination is dribbling; stool is vacuously constipated; cough produces phlegm; the pulse is rapid, deficient, and fine; there are alternating chills and fever, worsening at night. This is called internal manifestation, belonging to the Yin category, which is difficult to treat. One should use Siwu Tang (Four Substances Decoction) added with Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark), Huafen (Trichosanthes Root), and Gancao (Licorice Root), combined with Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) for regulation and treatment. Condition stabilizes only after pus from the internal organs is discharged. There are also those whose temperament is irritable and impatient, who indulge in rich foods, or take tonics such as Baizhu (Atractylodes Macrocephala Rhizome). Accumulated toxin knots in the viscera, and fiery heat flows into the anus, knotting to form a swelling. The pain radiates to the lower abdomen; the anus feels heavy and dragging; bowel and bladder functions are disordered, presenting as either diarrhea or constipation; the interior of the anus erodes, spreading through meridians and collaterals; foul fluid flows out; the anal sphincter loses control; food is not digested properly; thirst is extreme. For those suffering from this syndrome, survival is unlikely. There are also cases of chronic consumption with long-term coughing, where phlegm-fire knots and forms a swelling; the anus resembles millet grains; once ruptured, it inevitably becomes a fistula. This is named Laozhu (Consumption Miasma), a deteriorated condition of internal injury, which cannot be treated forcibly. (From *Waike Zhengzong*)

*Yizong Xinfa* states: Zangdu has distinctions between internal/external and Yin/Yang. External manifestations arise from strong wine, rich flavors, and hard labor, accumulating on both sides of the anus. Swelling protrudes like peaches or plums; stool is constipated; urine is scanty and dark red. In severe cases, the anus feels heavy, drooping, tightly closed, with no passage of gas, and stabbing pain like an awl. The pulse is rapid and forceful, indicating excess and heat, belonging to Yang, which is easy to treat. Internal manifestations involve Yin deficiency, with damp-heat sinking downward. Internally, the anus becomes knotted, obstructed, and swollen, with stabbing pain like an awl. Stool is vacuously closed; urine is dribbling; there are alternating chills and fever, worsening at night. The pulse is faint and fine, indicating deficiency and dampness, belonging to Yin, which is difficult to treat.

Feng Luzhan stated: Among internal syndromes, what is called Zangdu results from Changfeng (Intestinal Wind) persisting for a long time, leading to deficiency of both Qi and Blood, with sinking becoming increasingly severe. Damp-heat accumulates in the Large Intestine, forming cavities that become vessels for stagnant blood. Blood comes before and after defecation; the abdomen hurts; the blood is turbid and dark in color, named Zangdu. This is a condition arising from long-standing internal accumulation and injury. It is referred to as "Xiere Xiexue" (Lower Bleeding Accompanied by Heat). Although it bears the name "toxin," it is essentially not toxic. Changfeng refers to wind pathogen overflowing in the intestines and stomach; Zangdu refers to damp pathogen overflowing in the intestines and stomach. If blood sprays like a thread, it is Chongzhi (Insect Hemorrhoid). The blood from Changfeng and Zangdu originates from the intestinal viscera; the blood from the Five Hemorrhoids (Wuzhi) emerges from the eroded openings of the anus.