（耳痔 鼻痔 脑漏 偷粪鼠疮 跨马痈附）
凡泽旁突起高阜为峙，窍中突出 肉为痔。故有眼痔、鼻痔、
牙痔等名。至肛边肿痛发疮，经谓∶醉饱入房，筋脉横解，肠 为痔。又督脉生病，癃痔，言精气脱泄，
阴火流注篡间，两阴之交。多患痔疾。然阴虚生热，或服饵辛毒，如椒酒及固精等药。盖川椒烧酒，最能发痔。
或用热药，固精不泄，毒瓦斯流注，势必至穿漏矣。大肠燥秘，及忧恐气结，奔走劳动，致疮孔生管流脓，斯成
漏矣。痔有七∶肛外发露肉珠，状如鼠奶，曰牡痔。即外痔。肛内肿突，脓溃即散，曰牝痔。肛边痛痒，颗
颗发 ，更衣辄出清血，曰脉痔。肠内结核，痛而登厕肛脱，曰肠痔。因便血注不止，曰血痔。忧思恐怒，
立见肿痛，大便艰难，曰气痔。皆内痔。饮酒发动，疮痛流血，曰酒痔。其形有鸡冠、莲花、樱桃、胡桃、
鸡心、鼠奶之状。久而生虫，便前血射一缕为痔 。 即漏也，经云∶陷脉为 。近旁穿穴，中生脆管，流脓
不止，即为漏。有串臀者，有串肠者，有串阴者，有秽从疮口出者，漏卮不塞，精血日枯，渐成损怯难治。
宜戒酒色，节劳茹淡，滋填精血。如鱼鳔、熟地、龟胶、鹿胶、猪脊髓之类。立斋论治痔 痛便秘，宜清热凉
血，润燥疏风。治漏宜养元气，补阴精。大便秘，宜润燥养血。红坠作痛，宜泻火除湿。作痒宜祛风胜湿。
肿痛溺涩，宜泻肝导湿。若疝与痔兼患，六味地黄丸、补中益气汤，并服。按痔初起，肠头肿成块者，大肠湿
热也，渗而清之。如生地、槐米、黄芩、甲片、归尾、茯苓、枳壳、泽泻等。作痛者，肺大肠风热也，宣而散
之。如荆芥、元参、当归、杏仁、乳香、木香、枳壳、银花等。大便秘结者，脾肾燥火也。清以润之。滋燥养
营汤去防风，加麻仁、白蜜等。溃脓者，热胜血也，凉以和之。秦艽白术汤去术，加生地、槐角等。痛兼血者，
阴虚有火也，滋而养之。四物汤加阿胶、黄芩、乌梅、地榆等。痔血漏脓，久不止者，元气不固也，升而摄之。补
中益气汤 术用生，去柴胡，或暂用樗皮散。血痔诸药不应，黑以止之。石煤、槐花、空心乌梅汤下，神效。
气痔内因七情者调其郁，归脾汤 术用生，加枳壳、广皮。酒痔多因湿热酿火者，解其毒。芩连四物汤，槐
角丸加金银花、甘草。不拘痔漏肠红，通用梅连丸。以止其血。不论痔 虫痔，通用水银枣子膏。以绝其虫。
肿痛用洗痔法，以鱼腥草、苦楝根、
马齿苋、朴硝煎汤熏洗，洗翻花痔，以荆芥、防风、朴硝、煎洗，次以木鳖子、郁金等分，加冰片研细，水调
敷。点痔法∶以蜗牛胶、熊胆胶、或用田螺水等。缩痔法∶用大鳖头火 研细，搽效。枯痔法∶以鳔胶一味，
炒研为末，日用一钱，砂糖调服。久自枯落。敷痔法∶用蚕茧纳男子指甲填满，外用童发缠裹。烧存性，蜜水
调敷。经云∶陷脉为 （音漏），留连肉腠。言寒气陷入血中而生疡漏。因疮穿脓溃不已，初则淡红微肿，或小核，
久则上面槁白，内已黑腐，淫虫恶臭生焉。故治漏先须透脓，用追毒丸，再用闭管丸。如漏之四边有硬肉突起，
闭管丸中加蚕茧二十个，炒末，和入药内。此方治遍身诸漏皆效。治穿肠漏，用水安息香搽之，十日全消。水
安息香，出波斯国，以椰子盛香，形似膏药稀粘，黄黑色。着手其香透爪甲者为真。治漏退管，用 皮丸。去
管兼能生肌，用圣祖御赐方，及明太祖亲验方。倘管退漏眼未平，宜生肌膏。大抵漏疮孔中，必有恶秽之物，
先用洗药，以露蜂房、白芷、苦参煎汤熏洗，日三次。嗣用透管，管退，嗣用生肌。近日专门治漏，用韭叶弯
刀，披开其孔，量漏之浅深，捻入线药烂管。续用生肌散敷平疮口，待愈。愈后仍须滋填精血，兼戒房劳奔走，
及辛热动风诸发物。每见不守禁忌，创愈复溃，或转成怯症者有之，亟当慎也。
〔耳痔〕耳中生如羊奶。内服栀子清肝汤。外点 砂一钱，轻粉、雄黄各三钱，冰片五厘，水调和，
点之效。
〔鼻痔〕鼻中生出 肉。用甜瓜蒂、甘遂炒各四钱，枯矾五分，共研细，净松香五分为衣，香油调为丸。
每用一丸，入鼻内点痔。日一次，即化臭水而愈。
〔脑痔〕脑中时流臭涕，用辛夷二钱，羌活、独活、防风、 本、细辛各五分，蕲艾一两，将药末掺艾
内，卷作条，点火熏鼻，即愈。或用黄荆树叶，搓塞鼻中，效。
〔偷粪鼠疮〕生近肛门，溃脓后极易穿漏。肿痛时，用屋上干猫屎、金鱼同捣烂，敷患处立消。或用猫
头骨炙灰研，同酒服，亦效。
〔跨马痈〕一名悬痈。生肛门前阴根后交界处，初起如松子
大，渐如莲子，后如桃李。用甘草梢四两，水煎服，即愈。外用生大黄三钱，熟石膏一两，紫金锭一块，同
捣碎，水调敷，立止痛。若肝经湿热，用龙胆泻肝汤。已成脓者，用生黄 、人参、川芎、当归各一钱，白芷、
官桂、甘草、防风各五分，一服痛止，再服内溃，十服肉便生。
(Ear Hemorrhoids, Nasal Hemorrhoids, Brain Leakage, Thief Feces Rat Sore, Cross-Horse Carbuncle [Appendix])
Wherever high mounds protrude beside water marshes, they are called "Zhi" (peaks); fleshy protuberances protruding from orifices are called "Zhi" (hemorrhoids/polyps). Hence there are names such as Eye Zhi, Nasal Zhi, and Dental Zhi. Regarding swelling, pain, and sores at the anus, the classics state: "After drunkenness and full meals followed by sexual intercourse, the sinews and vessels become relaxed and transverse, leading to hemorrhoids in the large intestine." Additionally, when the Du Meridian is diseased, it causes strangury and hemorrhoids; this refers to the depletion of essence and qi, with Yin Fire flowing into the perineum (the junction of the two yin organs). Thus, hemorrhoidal diseases are common. However, Yin deficiency generates heat, or one may ingest pungent and toxic substances, such as Sichuan pepper wine or astringent medicines for securing essence. For instance, Sichuan pepper steeped in liquor is particularly capable of inducing hemorrhoids. Or, if hot-natured medicines are used to secure essence without emission, toxic vapors flow and accumulate, inevitably leading to perforation and leakage. Dry constipation of the large intestine, along with emotional stagnation due to worry and fear, or excessive physical exertion, can cause sores to develop tubes that discharge pus, forming "Lou" (fistula).
There are seven types of hemorrhoids: fleshy nodules exposed outside the anus, resembling rat's teats, are called Male Hemorrhoids (Mu Zhi), i.e., external hemorrhoids. Swelling and protrusion inside the anus that dissipates after suppuration and ulceration are called Female Hemorrhoids (Pin Zhi). Pain and itching at the anal margin with granular protrusions and clear blood discharged upon defecation are called Pulse Hemorrhoids (Mai Zhi). Hard nodules within the intestines causing pain and prolapse of the rectum during defecation are called Intestinal Hemorrhoids (Chang Zhi). Continuous bleeding from the stool is called Blood Hemorrhoids (Xue Zhi). Immediate onset of swelling, pain, and difficult defecation triggered by worry, thought, fear, or anger is called Qi Hemorrhoids (Qi Zhi); these all belong to internal hemorrhoids. Hemorrhoids triggered by alcohol consumption, characterized by sore pain and bleeding, are called Wine Hemorrhoids (Jiu Zhi). Their shapes resemble chicken combs, lotus flowers, cherries, walnuts, chicken hearts, or rat teats. Over time, parasites may grow; a stream of blood shooting out before defecation indicates hemorrhoids.
If pathogens sink into the collaterals, creating nearby perforations and fragile tubes that continuously discharge pus, it is termed "Lou" (fistula). These may track towards the buttocks, intestines, or genitals, or foul matter may discharge from the wound opening. If the leak is not sealed, essence and blood will gradually diminish, slowly developing into a consumptive and debilitated condition that is difficult to treat. One should abstain from alcohol and sex, conserve energy, eat bland foods, and nourish and replenish essence and blood, using substances like fish swim bladders, prepared Rehmannia root (Shu Di Huang), tortoise shell glue, deer antler glue, and pig spinal cords. Li Chan (Lizai) discussed treating hemorrhoid pain with constipation by clearing heat and cooling blood, moistening dryness and dispersing wind. Treating fistulas requires nourishing primordial qi and tonifying Yin essence. For constipation, moisten dryness and nourish blood. For redness, swelling, and pain, clear fire and drain dampness. For itching, dispel wind and overcome dampness. For swelling, pain, and dysuria, clear the Liver and guide out dampness. If hernia and hemorrhoids occur simultaneously, Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) can be taken together.
Note: When hemorrhoids first appear with swelling and lump formation at the anus, it is Damp-Heat in the Large Intestine; treat by渗利 (percolating/drainage) and clearing. Use Sheng Di Huang (Rehmannia Root), Huai Mi (Sophora Flower), Huang Qin (Scutellaria Root), Chuan Shan Jia (Pangolin Scales), Dang Gui Wei (Angelica Sinensis Tail), Fu Ling (Poria), Zhi Ke (Aurantium Fruit), and Ze Xie (Alisma Rhizome). For pain, it is Wind-Heat in the Lung and Large Intestine; treat by diffusing and dispersing. Use Jing Jie (Schizonepeta Spike), Yuan Shen (Polymnia Radix), Dang Gui (Angelica Sinensis), Xing Ren (Apricot Seed), Ru Xiang (Frankincense), Mu Xiang (Aucklandia Root), Zhi Ke (Aurantium Fruit), and Jin Yin Hua (Honeysuckle Flower). For severe constipation, it is Dry-Fire in the Spleen and Kidney; treat by clearing and moistening. Use Zao Zao Yang Ying Tang (Moisten Dryness and Nourish the Ying Decoction), removing Fang Feng (Siler Root), adding Ma Ren (Hemp Seed) and Bai Mi (White Honey). For suppuration, Heat has prevailed over Blood; treat by cooling and harmonizing. Use Qin Jiao Bai Zhu Tang (Gentian and Atractylodes Macrocephala Decoction), removing Bai Zhu (Atractylodes Macrocephala), adding Sheng Di Huang (Rehmannia Root) and Huai Jiao (Sophora Fruit). For pain accompanied by bleeding, Yin Deficiency with Fire prevails; treat by nourishing and tonifying. Use Si Wu Tang (Four Substances Decoction) plus E Jiao (Donkey-Hide Gelatin), Huang Qin (Scutellaria Root), Wu Mei (Mume Fruit), and Di Yu (Sanguisorba Root). For persistent hemorrhoidal bleeding and fistulous discharge due to insecure Primordial Qi, treat by ascending and securing. Use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with raw Bai Zhu (Atractylodes Macrocephala), removing Chai Hu (Bupleurum Root), or temporarily use Chu Pi San (Toona Bark Powder). If various medicines fail for Blood Hemorrhoids, use black-colored agents to stop bleeding. Shi Mei (Coal Dust) and Huai Hua (Sophora Flower), taken with empty stomach using Wumei Tang (Mume Decoction), are miraculous.
For Qi Hemorrhoids caused internally by the Seven Emotions, regulate the depression; use Guipi Tang (Restore the Spleen Decoction) with raw Bai Zhu (Atractylodes Macrocephala), adding Zhi Ke (Aurantium Fruit) and Guang Pi (Tangerine Peel). For Wine Hemorrhoids caused by Damp-Heat brewing into Fire, resolve the toxicity; use Qin Lian Si Wu Tang (Scutellaria, Coptis, and Four Substances Decoction) or Huai Jiao Wan (Sophora Fruit Pill) plus Jin Yin Hua (Honeysuckle Flower) and Gan Cao (Licorice Root). Regardless of the type of hemorrhoid, fistula, or intestinal redness, Meilian Wan (Plum and Coptis Pill) is generally used to stop bleeding. Regardless of whether there are parasitic hemorrhoids, Yong Shui Zao Zi Gao (Mercury Date Paste) is universally applied to eliminate parasites.
For swelling and pain, use the Hemorrhoid Washing Method: decoct Yu Xing Cao (Houttuynia Herb), Ku Lian Gen (Melia Root Bark), Chi Xian Tiao (Purslane), and Xiao Ming Fan (Mirabilite) for fumigation and washing. For inverted flower hemorrhoids, wash with Jing Jie (Schizonepeta Spike), Fang Feng (Siler Root), and Xiao Ming Fan (Mirabilite), then apply a mixture of Mu Bie Zi (Momordica Seed), Yu Jin (Curcuma Rhizome) in equal parts, plus Bing Pian (Borneol), ground fine and mixed with water. For Pointing Hemorrhoids: use Snail Glue, Bear Gallbladder Glue, or Water Snail Juice. For Shrinking Hemorrhoids: roast and grind the head of a large softshell turtle until fine, and apply externally for efficacy. Withering Hemorrhoids: use only Fish Swim Bladder Glue, stir-fried and ground into powder, take one qian daily mixed with sugar water; it will naturally wither and fall off after prolonged use. For Applying Hemorrhoids: fill a silkworm cocoon with a man's fingernail, wrap it externally with hair from a young boy, burn until carbonized but retaining nature, mix with honey water, and apply.
The classics state: "Sinking into collaterals leads to Lou (fistula/leakage), lingering in the muscle layers." This means cold pathogens sinking into the blood generate ulcers and fistulas. Because the wound perforates and suppurates continuously, initially there is pale redness and slight swelling, or small nodules; later, the surface becomes dry and white, while the interior turns black and putrid, generating foul-smelling parasites. Therefore, treating fistulas first requires promoting suppuration using Zhidu Wan (Pursue Toxin Pill), followed by Bituan Wan (Close Tube Pill). If hard flesh protrudes around the four sides of the fistula, add twenty roasted and powdered silkworm cocoons to Bituan Wan and incorporate them into the medicine. This formula is effective for fistulas all over the body. For intestinal perforation fistulas, apply Shui An Xi Xiang (Liquid Asafoetida); it resolves completely in ten days. Liquid Asafoetida comes from Persia, stored in coconuts; it resembles a sticky plaster, yellow-black in color. The genuine product has an aroma that penetrates the fingernails upon touch. To retreat the tube in fistulas, use Chun Pi Wan (Toona Bark Pill). To remove the tube and promote tissue regeneration, use formulas bestowed by the Holy Ancestor (Emperor Kangxi/Qianlong) or verified personally by Emperor Taizu (Hongwu). If the tube recedes but the fistula opening remains uneven, apply Shengji Gao (Generate Flesh Ointment). Generally, foul and turbid matter must exist within the fistula hole; first use washing herbs, decocting Lu Feng Fang (Honeycomb), Bai Zhi (Angelica Dahurica), and Ku Shen (Sophora Root) for fumigation and washing three times daily. Then use tube-penetrating medicine; after the tube recedes, subsequently use flesh-generating medicine. Recently, specialists treating fistulas use a leek-leaf shaped curved knife to open the hole, measure the depth of the fistula, insert thread medicaments to rot the tube, then apply Shengji San (Generate Flesh Powder) to flatten the wound until healed. After healing, one must still nourish and replenish essence and blood, while abstaining from sexual exertion, physical labor, and pungent, hot, wind-moving dietary triggers. It is often seen that those who do not observe taboos suffer recurrent ulceration after healing, or develop consumptive diseases; extreme caution is required.
[Ear Hemorrhoids] Growth in the ear resembling a goat's teat. Internally take Zhizi Qinggan Tang (Gardenia Clearing Liver Decoction). Externally point with 1 qian of Nao Sha (Sal Ammoniac), 3 qian each of Qing Fen (Calomel) and Xiong Huang (Realgar), and 5 li of Bing Pian (Borneol), mixed with water for application; this is effective.
[Nasal Hemorrhoids] Polyp growth in the nose. Use 4 qian each of Tian Gua Di (Melon Seed) and Gan Sui (Euphorbia Root) stir-fried, and 5 fen of Ku Fan (Alum), ground finely together. Coat with 5 fen of pure Pine Rosin, and form pills with sesame oil. Use one pill per application, inserting it into the nose to treat the hemorrhoid. Once daily, it will dissolve into foul-smelling water and heal.
[Brain Leakage] Frequent discharge of foul-smelling nasal mucus from the brain area. Use 2 qian of Xin Yi (Magnolia Flower), and 5 fen each of Qiang Huo (Notopterygium Rhizome), Du Huo (Angelica Pubescens Root), Fang Feng (Siler Root), Gao Ben (Ligusticum Rhizome), and Xi Xin (Asarum Root), plus 1 liang of Qi Ai (Artemisia Argyi). Mix the herbal powder with mugwort, roll into sticks, ignite, and fumigate the nose; this heals immediately. Alternatively, roll Huang Jing Ye (Vitex Negundo Leaf) and insert it into the nose; this is also effective.
[Thief Feces Rat Sore] Occurs near the anus; easily forms fistulas after suppuration. During swelling and pain, crush dried cat feces from the roof with goldfish and apply to the affected area for immediate resolution. Alternatively, roast cat skull bones to ash, grind, and take with wine; this is also effective.
[Cross-Horse Carbuncle] Also known as Xuan Yong (Hanging Abscess). Occurs at the junction behind the root of the anterior genitalia and the anus. Initially the size of a pine nut, gradually growing to the size of a lotus seed, then like plums or peaches. Use 4 liang of Gan Cao Shao (Licorice Tip), decoct in water and drink; this heals immediately. Externally, mix 3 qian of Sheng Da Huang (Raw Rhubarb), 1 liang of Shu Shi Gao (Prepared Gypsum), and one piece of Zijin Ding (Purple Gold锭), crush together, mix with water, and apply for immediate pain relief. If caused by Damp-Heat in the Liver Meridian, use Long Dan Xie Gan Tang (Gentian Clearing Liver Decoction). If suppuration has formed, use 1 qian each of Sheng Huang Qi (Raw Astragalus Root), Ren Shen (Ginseng Root), Chuan Xiong (Ligusticum Chuanxiong Rhizome), and Dang Gui (Angelica Sinensis), and 5 fen each of Bai Zhi (Angelica Dahurica), Guan Gui (Cinnamon Bark), Gan Cao (Licorice Root), and Fang Feng (Siler Root). Pain stops after one dose; internal suppuration occurs after the second dose; flesh regenerates after ten doses.