（附脱肛）
孙文垣治周文川，肛上生一肿毒，月余脓溃矣，但少动则出鲜血不止，大便结燥，胸膈饱闷，饮
食不思。脉之，两寸短弱，关弦尺洪滑，此气虚血热，陷于下部。宜补而升提，不然痔漏将作，可虑
也。黄 二钱，归身、地榆、槐花、枳壳各一钱，升麻、秦艽各七分，荆芥穗五分，甘草三分，服后
胸膈宽。惟口苦甚，前方加酒连、连翘各五分而愈。
高仰山内人痔血，里急后重，饮食入腹，大便即行，昼夜五六度，五更咳嗽痰 ，肌肉脱，口作
渴，由服凉血之剂过多，致脾气虚不能统血也。脉之，六部皆软弱无力。以六君子汤加荆芥穗、秦艽、
陈皮、炮姜，四帖而饮食进，血全止，嗽亦定。减炮姜，倍加何首乌，又四帖，遂数年不发。
徐检老发寒热，臀近肛硬处生一毒，红肿而痛，坐卧为难。外科以 针点开，插药线于内，涂以
烂药，使脓血急溃。又与敷生肌药，使易收口。受谢而去，未半月，硬处之旁，又红肿痛，寒热交作。
召前医，治法如前，受谢以去，递医递患，几半年矣。诊之，面色青惨，脉皆濡弱，手足如冰，饮食
减半。究所服，则槐角、生地、黄柏之属。曰∶此痔痈，非痔漏也。痔漏当用挂线，以五灰膏点之可
愈。今肿硬无定处，离肛门且远，其初只可大补气血，即有毒亦宜托出，一脓而愈。此王道之治，不
胜于针刀万万哉？乃内用寒凉，外用收口，动辄挂线，致凝滞流注，愈而屡发，非禀浓气强，六旬余
人安能当此？与十全大补四帖，饮食加，手足暖。大便艰涩，向润之而不行者，今亦通利。再以首乌
四两，人参、枸杞、当归、黄 、熟地各二两，槐角、秦艽各一两，蜜丸服之，肿处出少脓全瘳。徐
喜而谑曰∶予非孙君，诸外科视此臀为金穴矣。呵呵。
医学博士齐德之云∶予读《养生必效方》，见干义传僧觉海，少年患痔疾，其行业比冰霜，此缘
饱食久坐。知痔疾者，不必酒色过度矣。故《素问》云∶因而饱食，筋脉横解，肠癖为痔，治之故不
同也。三神丸∶
枳壳、皂角、五倍，蜜丸，每服二三十丸。（《精义》）
黄履素曰∶予中年患痔，点洗都不效，惟白萝卜煎汤频洗差佳。近读《环中集》，载冬瓜皮同朴
硝煎洗翻花痔立愈。又曰∶以萝卜代冬瓜亦效。冬瓜未之试，萝卜已验矣。
薛立斋治儒者杨举元，素阴虚，劳则体肢倦怠，两足发热。服清热等药，热至腰膝，大便涩滞。
饮食过多，则泻至年余，作渴吐痰，患痔出脓。仍不节劳，则忽恶寒发热。后患痈，脓水不止，气血
虚甚，乃用六味丸、补中益气汤，滋养化源。喜其慎疾，年余而痊。
陈自明治一男子患痔，未成脓，苦痛，大便难，与神仙太乙丹一锭，去后二次，痛即止，不日而
消。（见蛊门。）
薛立斋治一男子患痔，大便燥结， 痛作渴，脉数，按之则热，以秦艽苍术汤，二帖少愈。更以
四物汤加芩、连、槐花、枳壳，四剂而愈。
一男子素不慎酒色，患痔 肿，肛门坠痛，兼下血，大便干燥，脉洪大，按之则涩，以当归郁李
仁汤加桃仁，四剂少愈。更以四物汤加红花、桃仁、条芩、槐花，数帖而愈。大抵醉饱入房，则筋脉
横解，或精气脱滞。脉络一虚，酒食之毒，乘虚流注，或淫极强固，精气遂传大肠，以致木乘火热而
毁金。或食浓味过多，必成斯疾。夫受病者，燥气也；为病者，湿热也。宜以泻火和血润燥疏风之剂
治之。若破而不愈，即成漏矣。有串臀者，有串阴者，有穿肠者，有秽从疮口而出者，形虽不同，治
法颇似。其肠头肿成块者，湿热也；作痛者，风也；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。
一男子患痔成漏，每登厕则痛，以秦艽防风汤加条芩、芎、归，一帖即痊。如肛门下脱，作痛良
久，加以大黄汁、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，良久方止。以秦艽防风汤，数剂少愈。乃去大黄，加黄
、川芎、白芍而痛止。更以补中益气汤，二十余帖，再不脱。
一妇人患痔，肿 痛甚，以四物汤加芩、连、桃仁、红花、丹皮，四帖少止，又数帖而愈。
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，疮肿痛，经水不
止，脉洪大，按之无力，此劳伤血气，血动而然也。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。丹溪云∶妇人崩中者，由脏腑伤损冲任二脉，血气俱虚故也。二脉为
脉经之海，血气之行，外循经络，内经脏腑。若血气调适，经下根据时。若劳动过极，脏腑俱伤，冲任
之气虚，不能约制其经血，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
火之药，治其心，补阴泻阳，经自正矣。
一男子有痔漏，每发如厕肛脱，良久方上。诊其脉细而微，用补中益气汤三十余剂，遂不再作。
丹溪曰∶脱肛属气热气虚，血虚血热。气虚者补气，参、 、芎、归、升麻；血虚者四物汤；血热者
凉血，四物汤加黄柏。肺与大肠为表里，故肺脏蕴热，则肛门闭结，肺脏虚寒，则肛门脱出。故妇人
产育用力，小儿久痢，均致此病。治之必须温补肺脏肠胃，久则自然收矣。（雄按∶此症必见此脉，
始可用此药。）
临安曹五方，黄院荐引为高宗取痔得效，后封曹，官至察使。用好信石色黄明者三钱，打如豆大，
明矾一两为末，好黄丹水飞炒紫色五钱，蝎梢七个，净水瓦上焙干研末，草乌紧实光滑者，去皮，生
研末一钱。右用紫泥罐，先将炭火 ，放冷拭净，先下明矾烧令沸，次下信，入矾内拌匀，文武火 ，
候沸再搅匀，看罐通红，烟起为度。将罐掇下待冷，取研末，方入草乌、黄丹、蝎梢三味，再同研极
细末，瓷罐内收贮。如欲敷药，先以甘草煎汤，或葱椒煎汤，洗净患处，然后用生麻油调前药，以鹅
毛扫药痔上，每日敷药三次，必去黄水如胶汁然，痔头渐消。看痔病年深浅，年远者，不出十日可取
尽。日近者，俱化黄水，连根去尽，更搽生好肉药。（名如神千金方。）
李防御方，五痔者，贫富男女皆有之，富者酒色财气，贫者担轻负重，饥露早行，皆在心肝二经。
喜则伤心，怒则伤肝，喜怒无常，风血浸于大肠，到谷道，无出路，结积成块。出血生乳，各有形相。
妇人因经后伤冷，月事伤风，余血在心经，血流于大肠。小儿因利后，或母腹中受热也。先用水澄膏护其内，郁
金、白芨各一两，或加黄连，右二味为末。如内痔，候登厕翻出在外，用温汤洗净，不须坐，侧卧于
床即出，用蜜水调令得中，篾挑涂谷道四边好肉上，留痔在外，以纸盖药上。良久方用枯药搽痔上，
用笔蘸温水于纸上不令药干及四散。枯药用好白矾四两，生信石二钱半，朱砂一钱，生研极细。右各
研为细末，先用砒入紫泥罐，次用白矾末盖之，用火 令烟断，其砒尽随烟去，止借砒气于矾中耳。
用矾为细末，看痔头大小，取矾末在掌中，更入朱砂少许，以唾调稀，用篦头涂痔上周遍，一日三上，
候看痔头颜色焦黑为度。至夜有黄水出，切勿他疑，水尽为妙。至中夜，上药一遍，来日依然药三次，
有小痛，不妨换药。时以碗盛新水或温汤，在边用笔轻洗痔上旧药，更上新药，仍用护肉药，次用荆
芥汤洗之。三两日后黄水出将尽，却于药中增朱砂，减白矾，则药力即缓。三两日方可增减，渐渐取
之，庶不惊人。全在用药人看痔头转色，增减浓薄敷药，方是活法。此药只是借砒信耳，又有朱砂解
之。一方士将此二方，在京治人多效，致富。一富商因验，以百金求得之，录于予。予虽未用，传人
无不言效，但枯药赵宜真炼师以刊于《青囊杂纂》，如神。《千金方》未见刊传。大抵今人言能取痔
者，皆此方也。恐气血虚，或内邪者，还当兼治其内，庶不有失。（二条皆《外科发挥》）
薛立斋治一男子，痔疮肿痛，便血尤甚，脉洪且涩。经云∶因而饱食，筋脉横解，肠 为痔。盖
风气通于肝，肝生风，风生热，风客则淫气伤精，而成斯疾。遂与黄连、当归、黄 、生地、防风、
枳壳、白芷、柴胡、槐花、地榆、甘草，治之渐愈，次以黄连丸而瘥。
一男子患痔，脉浮鼓，午后发热作痛。以八珍汤加黄 、柴胡、地骨皮，治之稍可。彼欲速效，
用劫药蚀之，痛甚绝食而殁。（凡用枯药者，宜先治其内，内愈而后可治其外也。）夫疮之溃敛，气
血使然也。脉浮鼓，日晡痛，此气血虚也。丹溪云∶疮口不合，大剂参、 、术、归、芎补之，外以
附子饼灸之，更以补药作膏贴之。
一男子年逾四十，有痔漏，大便不实，服五苓散，愈加泄泻，饮食少思。此非湿毒，乃肠脾胃虚
也，当以理中汤治之。不信，乃服五苓散愈甚，乃以理中汤及二神丸，月余而平。
李逵因痔疮怯弱，以补中益气汤，少加芩、连、枳壳治之，稍愈。后因怒加甚，时仲冬，脉得洪
大，谓脉不应病，此乃肾水不足，火来乘之，药不能治。果殁于火旺之月。常见患痔者，肾脉不足，
俱难治。
刘商有痔，肛门脱出，此湿热下注，真气不能升举。诊其脉果虚，遂以四君子汤加黄芩、芎、归、
苍术、黄柏、升麻、柴胡服之，更以五倍子煎汤熏洗。彼以为缓，乃用砒霜等毒药蚀之而殁。劫药特
治其末，且能伐真元，鲜不害人。慎之。
徐生因痔，气血愈虚，饮食不甘，小便不禁，夜或遗精，此气虚兼湿热而然，非疮故也。以补中
益气汤加茱萸、山药、五味，兼还少丹治之而愈。
一男子患痔漏，脓出大便，诸药不应。诊其脉颇实，令用猪腰一个切开，入黑牵牛末五分，线扎，
以荷叶包煨熟，空心细嚼，温盐酒送下，数服顿退。更以托里药而愈。（即煨肾散。）
朱丹溪治一人，肛门生疖，后不收口，针穷三孔穴边血脓，用黄 、条芩、连翘、秦艽。右末之，
神曲丸服。（治法）
予庚子除夕痔作，时官舍合肥，难得医者，取官局钓肠丸一百二十粒，分为二服，热酒并服之。
中夜腹间微痛，下少结屎，旦起已安。治证具载本方，所以作效速者，以服多故耳。（《百乙方》）
葱青内刮取涎，对停入蜜调匀，先以木鳖子煎汤熏洗，然后敷药，其冷如冰。唐仲举云∶常有一
吏人苦此，渠族弟亲合与之，早饭前敷，午后以榜纸来谢，拜于庭下，疾已安矣。
郑器先用之，亲曾得效。其法鸠尾骨尖少偃处即是穴，麦粒大艾炷灸七壮，或十四壮，甚者二十
一壮，上疮发即安，可除根本。（并《百乙方》）
薛立斋治一人，痔漏口干，胃脉弱，此中气不足，津液短少，不能上润而然。以黄 六一汤，七
味白术散治之。或曰∶诸痛痒疮，皆属心火。遂服苦寒之药，大便不禁而殁。夫诸痛痒皆属心火，言
其常也，始热终寒则反常也，可泥此而不察乎？
许叔微治一人肠风，脱肛不收，有血下，用皂角三茎，槌碎，水一碗，揉令皂角消尽，用绢二重，
滤去清汁数分，将脱肛肠浸在药中，其肠自收，不用手托。如大肠收了，更用汤荡其脱肛上，令皂角
气行，则不再作，三次荡愈。
龚子才治小儿脱肛，因久患泻利所致，宜用葱汤熏洗令软送上。或以五倍子末敷而托入，又以五
倍子煎汤洗亦可。又以鳖头烧存性，香油调敷。一云∶此物烟熏之久自收，又以东壁土泡汤，先熏后
洗亦效。
苏东坡与程正甫书云∶凡痔疾，宜断酒肉与盐酪酱菜浓味，及粳米饭，惟宜食淡面一味，及以九
蒸胡麻，即黑芝麻，同煎去皮茯苓，少入白蜜，为面食之。日久气力不衰，百病自去，而痔渐退。此
乃长生要诀，但易知而难行耳。
江夏铁佛寺蔡和尚，病肛门痔痛不可忍，有人教用木鳖仁带润者，雌雄各五个，乳细作七丸，碗
覆温处，勿令干，每以一丸唾化开，贴痔上，其痛即止，一夜一丸自消也。后用治数人皆效。（《濒
湖集》酒方）
张子和治赵君玉常，病痔。凤眼草、刺 皮、槐根、狸首之类，皆用之。或以干姜作末，涂猪肉
炙食之，大便燥结不利，且瘤疑痿。后数日因病黄，大涌泻数次，不言痔作矣。
徐灵胎曰∶脱肛多由浊气下降，湿痰毒火合并为害，故肿痛异常，此实症也，必清其大肠之火，
而用外治之药以收之，无不立愈。其有虚人病后，清气下陷，则用补中益气以提之，乃十不得一者也。
若不论何因，俱用升提收敛之法，肛门之痰火浊气，将升提而置之何地耶？且脱肛之疾，属实者多，
又用温燥更非所宜。
(Attached: Rectal Prolapse)
Sun Wen Yuan treated Zhou Wen Chuan, who had a swelling and toxin above the anus. After more than a month, it suppurated and ruptured, but slight movement caused continuous bleeding of fresh blood. The stool was dry and hard, the chest and diaphragm felt full and stifled, and there was no desire for food or drink. Upon palpating the pulse, the Cun (inch) positions on both sides were short and weak, the Guan (bar) position was wiry, and the Chi (cubit) position was surging and slippery. This indicated Qi deficiency with Blood heat, sinking to the lower part of the body. It was appropriate to tonify and lift; otherwise, hemorrhoidal fistula would develop, which was worrying. Prescription: Huangqi (Astragali Radix) 2 qian, Dangguishen (Radix Angelicae Sinensis - root portion), Diyü (Sanguisorbae Radix), Huaihua (Flos Sophorae), Zhike (Fructus Aurantii Immaturus) each 1 qian, Shengma (Cimicifugae Rhizoma), Qinjiao (Gentianae Macrophyllae Radix) each 7 fen, Jingjiesui (Herba Schizonepetae Spica) 5 fen, Gancao (Glycyrrhizae Radix et Rhizoma) 3 fen. After taking the medicine, the chest and diaphragm felt relaxed. However, bitter taste in the mouth was severe, so Jiulian (Rhizoma Coptidis prepared with wine) and Lianqiao (Fructus Forsythiae) each 5 fen were added to the previous prescription, and the patient recovered.
The wife of Gao Yangshan suffered from hemorrhoidal bleeding, tenesmus (urgent need to defecate with little result), and immediate defecation after eating. She defecated five or six times a day and night, coughed with phlegm at dawn, emaciated, and had thirst in the mouth. This was due to excessive intake of cooling-blood medicines, causing Spleen Qi deficiency and failure to control the blood. Palpating the pulse, all six positions were soft and weak. Liu Jun Zi Tang (Six Gentlemen Decoction) was prescribed with added Jingjiesui, Qinjiao, Chenpi (Pericarpium Citri Reticulatae), and Paojiang (Prepared Zingiberis Rhizoma). After four doses, appetite improved, bleeding stopped completely, and cough subsided. The dosage of Paojiang was reduced, and He Shou Wu (Polygoni Multiflori Radix) was doubled. After another four doses, she did not relapse for several years.
Xu Jian Lao experienced alternating chills and fever. A toxic swelling appeared near the anus on the buttocks, red, swollen, and painful, making sitting and lying difficult. A surgeon punctured it with a needle, inserted a medicinal thread inside, applied corrosive medicine to induce rapid suppuration and drainage, and then applied flesh-regenerating medicine to facilitate healing. After receiving payment, the surgeon left. Within half a month, redness, swelling, and pain recurred next to the hardened area, with alternating chills and fever. The previous doctor was summoned, treated as before, received payment, and left. Doctors changed repeatedly, and the condition persisted for nearly half a year. Examination revealed a dark greenish complexion, a soggy and weak pulse throughout, ice-cold hands and feet, and half the usual food intake. Investigating the medications taken, they included Huaijiao (Fructus Staphyleae), Shengdi (Rehmanniae Radix), and Huangbai (Phellodendri Cortex). Sun said: "This is a hemorrhoidal carbuncle, not a hemorrhoidal fistula. Hemorrhoidal fistula should be treated with ligature therapy and application of Wuhui Gao (Five Ashes Ointment) for cure. Currently, the swelling is hard and ill-defined, far from the anus. Initially, one must greatly tonify Qi and Blood. Even if there is toxin, it should be expelled outward. One course of suppuration will lead to recovery. This is the 'King's Way' of treatment, vastly superior to needles and knives, isn't it? Now, internal use of cold-natured medicines and external use of astringents, coupled with frequent ligatures, cause stagnation and flow obstruction. Recurrence happens because the patient, despite being over sixty, has strong constitution. How else could he endure this?" Prescribed Shiquan Dabu Tang (Ten Great Tonifying Decoction) for four doses. Appetite increased, hands and feet warmed. Bowel movements remained difficult; previously, moistening laxatives were ineffective, but now they worked. Then, He Shou Wu 4 liang, Ren Shen (Ginseng Radix), Gouqi (Lycii Fructus), Danggui (Angelicae Sinensis Radix), Huangqi, Shudi (Prepared Rehmanniae Radix) each 2 liang, Huaijiao, Qinjiao each 1 liang, were made into honey pills. A small amount of pus discharged from the swelling, and the patient fully recovered. Xu happily joked: "If I weren't Mr. Sun, all these surgeons would view this buttock as a gold mine." Hahaha.
Medical Doctor Qi Dezhi said: "I read *Yangsheng Bixiao Fang* (Essential Formulas for Health Preservation) and saw that Monk Jiehai, disciple of Gan Yichuan, suffered from hemorrhoids in his youth. His moral conduct was pure as ice and frost. This arose from overeating and prolonged sitting. Knowing that hemorrhoids are not necessarily caused by excess alcohol and sex, as stated in *Suwen*: 'Due to overeating, sinews and vessels relax transversely, leading to intestinal dysentery and hemorrhoids.' Therefore, treatments differ. Sanshen Wan (Three Spirits Pill): Zhike, Zaojiao (Gleditsia Sinensis Fruit), Wubeizi (Galla Chinensis), honey pills. Take 20-30 pills per dose. (*Jingyi*)"
Huang Lv Su said: "In middle age, I suffered from hemorrhoids. Point applications and washes were ineffective. Only frequent washing with decoction of white radish showed improvement. Recently, I read *Huanzhong Ji*, which records that washing with decoction of winter melon peel and Mirabilite cured prolapsed hemorrhoids immediately. It also states that radish can replace winter melon effectively. I have not tried winter melon, but radish has been verified."
Xue Lizhai treated scholar Yang Juyuan, who had Yin deficiency. Fatigue and limb weakness occurred upon exertion, with heat in both feet. After taking clearing-heat medicines, heat extended to waist and knees, and stools became constipated. Overeating led to diarrhea for over a year, accompanied by thirst and expectoration. Hemorrhoids exuded pus. Continued overexertion led to sudden chills and fever. Later, an abscess developed with non-stop discharge, causing severe Qi and Blood deficiency. Xue used Liuwei Wan (Six-Ingredient Pill with Rehmannia) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) to nourish the source of transformation. Fortunately, he was cautious about his illness, and recovered after more than a year.
Chen Ziming treated a man with hemorrhoids that had not yet suppurated. He suffered severe pain and difficulty defecating. One锭 (cake) of Shenxian Taiyi Dan (Immortal Supreme Unity Pill) was given. After two bowel movements, pain ceased, and the swelling disappeared within days. (See Gu Men.)
Xue Lizhai treated a man with hemorrhoids, dry and hard stools, swelling, pain, thirst, rapid pulse, and heat upon pressure. Qinjiao Cangzhu Tang (Qinjiao and Atractylodes Macrocephala Decoction) was prescribed. After two doses, slight improvement occurred. Then, Siwu Tang (Four Substances Decoction) was modified with Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Huaihua, and Zhike. After four doses, he recovered.
A man who neglected moderation in alcohol and sex developed hemorrhoidal swelling, anal heaviness and pain, bleeding, dry stools, surging pulse that felt choppy upon pressure. Danggui Yuliren Tang (Danggui and Prunus Decorata Seed Decoction) with Taoren (Pruni Semen) was prescribed. After four doses, slight improvement. Then, Siwu Tang modified with Honghua (Carthami Flos), Taoren, Tiaoqin (Scutellariae Radix), and Huaihua. After several doses, he recovered. Generally, indulgence in alcohol and food or sexual activity causes sinews and vessels to relax transversely, or essence and Qi to become stagnant. When meridians are deficient, toxins from food and drink flow in vacuities. Or, excessive sexual activity transmits essence to the Large Intestine, causing Liver Wood to attack Lung Metal via Fire-Heat. Or, excessive rich food leads to this disease. The pathogenic factor is Dryness; the disease nature is Damp-Heat. Treat with formulas that purge fire, harmonize blood, moisten dryness, and dispel wind. If rupture does not heal, fistula forms. It may track to the buttocks, genitals, intestines, or discharge foul matter. Though shapes differ, treatments are similar. Swelling at the anal verge indicates Damp-Heat; pain indicates Wind; dry stools indicate Fire; suppuration indicates Heat damaging Blood. Investigate the cause and treat accordingly.
A man with hemorrhoidal fistula experienced pain upon defecation. Qinjiao Fangfeng Tang (Qinjiao and Saposhnikovia Decoction) modified with Tiaoqin, Chuanxiong (Ligustici Chuanxiong Rhizoma), and Danggui cured him in one dose. If the anus prolapsed with prolonged pain, add Dahuang (Rhei Radix et Rhizoma) juice and Zhike. Four doses cured him. Siwu Tang modified with Shengma, Huangqin, Huanglian, Jingjie (Schizonepetae Herba), and Fangfeng (Saposhnikoviae Radix) prevented recurrence.
A man with hemorrhoidal fistula experienced anal prolapse and pain upon defecation, lasting a long time. Qinjiao Fangfeng Tang provided slight improvement after several doses. Dahuang was removed, and Huangqi, Chuanxiong, and Baishao (Paeoniae Radix Alba) were added to stop pain. Then, Buzhong Yiqi Tang was taken for over twenty doses, preventing further prolapse.
A woman with hemorrhoids had severe swelling and pain. Siwu Tang modified with Huangqin, Huanglian, Taoren, Honghua, and Danpi (Moutan Cortex) stopped symptoms after four doses and cured her after several more.
A woman with chronic hemorrhoidal fistula bled slightly when heated. Siwu Tang modified with Huanglian cured her. Later, due to overexertion, the wound swelled and hurt, and menstruation did not stop. Pulse was surging and large but empty upon pressure. This was Qi and Blood injury from labor, causing blood to move. Bazhen Tang (Eight Treasures Decoction) modified with Huangqin, Huanglian, and Puhuang (Pollen Typhae) stopped bleeding in two doses. Later, Puhuang, Huangqin, and Huanglian were removed, and Digupi (Lycii Cortex) was added. Several doses brought stability. Zhu Danxi said: "Metrorrhagia in women results from damage to Zang-Fu organs and the Chong and Ren vessels, leading to Qi and Blood deficiency. These vessels are the sea of pulses. Blood and Qi circulate externally through meridians and internally through Zang-Fu. If balanced, menses are regular. If overexerted, Zang-Fu are damaged, Chong and Ren Qi becomes deficient, failing to constrain menstrual blood, causing sudden heavy flow, called Metrorrhagia. Treatment requires great tonification of Qi and Blood, raising and nurturing Spleen and Stomach, slightly adding sedatives for Heart Fire, treating the Heart, tonifying Yin and purging Yang, so menses normalize."
A man with hemorrhoidal fistula experienced anal prolapse upon defecation, requiring long time to reduce. Pulse was fine and faint. Buzhong Yiqi Tang was taken for over thirty doses, preventing recurrence.
Zhu Danxi said: "Rectal prolapse belongs to Excess Heat and Qi Deficiency, Blood Deficiency and Blood Heat. For Qi deficiency, tonify Qi with Renshen, Huangqi, Chuanxiong, Danggui, Shengma; for Blood deficiency, use Siwu Tang; for Blood heat, cool blood with Siwu Tang plus Huangbai. Lung and Large Intestine are exterior-interior pairs. Thus, Lung heat causes anal constriction; Lung deficiency-cold causes prolapse. Childbirth strain and chronic dysentery in children cause this. Treatment must warm and tonify Lung and Intestines; eventually, it will retract naturally. (Zhao Xianke notes: This method is only applicable if these specific pulses are present.)"
The formula of Cao Wu from Lin'an, recommended by Huang Yuan Yin to Emperor Gaozong, successfully treated hemorrhoids. Cao was later enfeoffed and rose to Inspector. Use 3 qian of high-quality yellow Xinshi (Realgar/Arsenic), crushed to bean size; 1 liang of Mingfan (Alumen) powdered; 5 qian of good Huangdan (Minium) water-ground and fried purple; 7 Scorpion tails; dried on tile with clean water and powdered; 1 qian of Caowu (Aconitum Carmichaelii Radix Preparata) peeled and raw-powdered. Use a purple clay pot. Heat charcoal, let cool, wipe clean. Add Mingfan first, boil. Add Xinshi, mix well. Use mild heat, boil again, stir evenly. When pot glows red and smoke rises, remove. Cool, powder. Add Caowu, Huangdan, Scorpion tails, grind extremely fine. Store in porcelain jar. To apply: Wash lesion with Gancao decoction or Congjiao (Green Onion and Pepper) decoction. Mix powder with raw sesame oil. Apply with goose feather to hemorrhoid three times daily. Yellow fluid like glue will discharge, and hemorrhoid shrinks. Depending on duration, old cases resolve in ten days; recent cases dissolve completely. Apply flesh-generating medicine afterwards. (Named Rushen Qianjin Fang / Divine Like Thousand Gold Formula.)
Li Fangyu's formula: Five types of hemorrhoids affect rich and poor alike. Rich suffer from alcohol, sex, wealth, anger; poor from carrying loads, hunger, exposure. Pathology lies in Heart and Liver meridians. Joy damages Heart; Anger damages Liver. Unregulated emotions allow Wind-Blood to infiltrate Large Intestine, reaching the anus, accumulating into masses. Bleeding and lactation vary by type. Women suffer from cold after menstruation or wind invasion, residual blood in Heart meridian flows to Large Intestine. Children suffer from post-dysentery conditions or maternal womb heat. First, apply Shuicheng Gao (Water-Clearing Ointment) to protect healthy skin. Yujin (Curcumae Radix) and Baiji (Bletillae Rhizoma) each 1 liang, optionally add Huanglian. Powder these. For internal hemorrhoids, after defecation when prolapsed, wash with warm water. Lie on side. Mix powder with honey water to medium consistency. Apply around anus with bamboo splint, leaving hemorrhoid exposed. Cover with paper. Wait, then apply Kuge (Withering Medicine) to hemorrhoid. Keep wet with brush dipped in water. Kuge formula: 4 liang Mingfan, 2.5 qian raw Xinshi, 1 qian Zhusha (Cinnabar), raw-powdered finely. Put arsenic in purple clay pot, cover with alum powder. Heat until smoke stops. Arsenic sublimates, leaving its qi in alum. Alum powder is used according to hemorrhoid size. Mix with little Zhusha and saliva. Apply around hemorrhoid three times daily until blackened. Yellow fluid discharges at night; do not doubt. When fluid stops, apply again at midnight. Next day, apply three times. Mild pain is acceptable. Wash old medicine with new water/warm water, apply new medicine, protect surrounding skin with Shourou Gao, wash with Jingjie decoction. After 2-3 days, as fluid decreases, increase Zhusha, decrease alum to slow action. Adjust gradually. Success depends on observing color change and adjusting thickness. This relies on arsenic and realgar, neutralized by cinnabar. A Daoist used these formulas in Beijing with great success, becoming wealthy. A merchant bought them for 100 taels. I recorded them though I haven't used them. Practitioners report efficacy. The withering medicine was published by Zhao Yizhen in *Qingnang Zazu*. *Qianjin Fang* version not seen. Most modern hemorrhoid removal formulas derive from this. If Qi/Blood is deficient or internal pathogens exist, treat internally as well. (Both from *Waike Faxui*.)
Xue Lizhai treated a man with hemorrhoidal swelling, pain, severe bleeding, surging and choppy pulse. Classic says: "Overeating causes vessel relaxation, leading to hemorrhoids." Wind connects to Liver; Liver generates Wind; Wind generates Heat. Wind invasion damages essence, causing this disease. Prescribed Huanglian, Danggui, Huangqi, Shengdi, Fangfeng, Zhike, Baizhi (Angelicae Dahuricae Radix), Chaihu (Bupleuri Radix), Huaihua, Diyü, Gancao. Gradual improvement, then cured with Huanglian Wan (Coptis Pill).
A man with hemorrhoids had floating and drum-like pulse, afternoon fever and pain. Bazhen Tang modified with Huangqi, Chaihu, Digupi cured slightly. Patient wanted quick results, used corrosive medicine, suffered severe pain, refused food, and died. (Note: When using withering medicines, treat internally first. External treatment follows internal cure.) Ulcer healing depends on Qi and Blood. Floating/drum pulse and afternoon pain indicate Qi/Blood deficiency. Danxi said: "For unhealed ulcers, heavily tonify with Renshen, Huangqi, Baizhu, Danggui, Chuanxiong. Moxibustion with Fuzi (Aconiti Lateralis Radix Preparata) cake externally, apply tonic paste."
A man over forty with hemorrhoidal fistula had loose stools. Wuling San (Five-Ingredient Powder with Poria) worsened diarrhea and appetite. This was not damp-toxin, but Spleen/Stomach/Intestine deficiency. Should use Lizhong Tang (Regulate the Middle Decoction). He didn't believe, took Wuling San, condition worsened. Then took Lizhong Tang and Ershen Wan (Two Gods Pill), recovered in a month.
Li Kui had hemorrhoids with weakness. Buzhong Yiqi Tang with slight Huangqin, Huanglian, Zhike improved him slightly. Later, anger exacerbated it. In mid-winter, pulse was surging and large. Pulse did not match disease; Kidney Water insufficient, Fire attacking. Medication failed. Died in peak Fire month. Often, hemorrhoid patients with deficient Kidney pulse are hard to treat.
Liu Shang had hemorrhoids with anal prolapse. Damp-Heat sinking, True Qi unable to rise. Pulse confirmed deficiency. Sizijunzi Tang modified with Huangqin, Chuanxiong, Danggui, Cangzhu, Huangbai, Shengma, Chaihu administered. Also fumigated/washed with Wubeizi decoction. Patient thought it too slow, used arsenic poison, corroded tissue, and died. Corrosives treat only symptoms and destroy True Yuan, harming people. Be careful.
Xu Sheng had hemorrhoids, worsening Qi/Blood deficiency, poor appetite, urinary incontinence, nocturnal emission. Qi deficiency with Damp-Heat, not ulcer-related. Buzhong Yiqi Tang modified with Zhuyu (Corni Fructus), Shanyao (Dioscoreae Rhizoma), Wuweizi (Schisandrae Fructus), combined with Huan Shao Dan, cured him.
A man with hemorrhoidal fistula had pus in stool. All medicines failed. Pulse was solid. Ordered one pig kidney sliced, filled with 5 fen Heiqianniu (Pharbitidis Semen), tied, wrapped in lotus leaf, stewed. Chewed on empty stomach, washed down with warm salt wine. Few doses cleared it. Then, Tuoli medicine (Support Interior) cured him. (Wei Shen San / Roasted Kidney Powder.)
Zhu Danxi treated a man with anal furuncle that wouldn't heal. Punctured three holes near the edge, drained blood/pus. Used Huangqi, Tiaoqin, Lianqiao, Qinjiao. Powdered, formed into pills with Shenqu (Massa Medicata Fermentata). (Treatment Method)
On New Year's Eve of Gengzi year, my hemorrhoids flared. In Hefei official residence, doctors scarce. Took 120 pills of Guanju Diaochang Wan (Official Bureau Hook-Intestine Pill), divided into two doses, taken with hot wine. Midnight: mild abdominal pain, passed some hard stool. Morning: recovered. Symptoms detailed in original formula. Rapid effect due to high dosage. (*Baibai Fang*)
Scrape slime from green onion, mix with honey. Fumigate/wash with Muguaizi (Momordicae Semen) decoction first, then apply. Feels ice-cold. Tang Zhongju said: An official suffered this. His cousin prepared it. Applied before breakfast. Resolved by afternoon. (From *Baibai Fang*)
Zheng Qi used this, personally effective. Acupoint: tip of sternocostal angle (Jiawei bone). Moxa with wheat-grain sized cone, 7, 14, or 21 moxa cones. Abscess erupts, pain stops, root removed. (From *Baibai Fang*)
Xue Lizhai treated a man with hemorrhoidal fistula, dry mouth, weak Stomach pulse. Middle Qi insufficient, fluids scant, unable to moisten upper body. Huangqi Liuyi Tang (Astragalus Six-to-One Decoction) and Qiwei Baizhu San (Seven-Ingredient Atractylodes Powder) treated him. Someone said: "All pain, itching, sores belong to Heart Fire." He took bitter-cold medicines, suffered fecal incontinence, and died. "All pain/itching belongs to Heart Fire" refers to normal cases. Starting hot ending cold is abnormal. Do not rigidly adhere without observation?
Xu Shuwei treated a man with Changfeng (Wind in Intestines), rectal prolapse, bleeding. Three stalks of Zaojiao, crushed, soaked in one bowl water, rubbed until dissolved. Filter through double silk cloth. Soak prolapsed anus in filtrate. Intestine retracts without manual pushing. Once retracted, rinse with decoction to circulate Zaojiao qi. Prevents recurrence. Cured in three rinses.
Gong Zicai treated pediatric rectal prolapse due to chronic diarrhea. Fumigate/wash with Green Onion decoction to soften, then push back. Or apply Wubeizi powder to support. Or wash with Wubeizi decoction. Or burn Turtle head to retain char, mix with sesame oil, apply. Another method: Smoke with this substance until retracted. Or soak Eastern Wall Earth in water, fumigate then wash. Effective.
Su Dongpo wrote to Cheng Zhengfu: For hemorrhoids, abstain from alcohol, meat, salty/cheesy/pickled foods, and glutinous rice. Eat bland noodles only. Steamed Sesame (Huama) boiled with peeled Poria, little honey, eaten as noodle dough. Long-term use maintains strength, eliminates diseases, reduces hemorrhoids. Vital secret for longevity, easy to know, hard to practice.
Cai Heshang of Tifo Temple in Jiangxia suffered unbearable anal hemorrhoid pain. Advice: Use moist Mumubiren (Momordicae Semen), male and female, 5 each. Grind fine, make 7 pills. Cover with bowl in warm place, keep moist. Dissolve one pill in saliva, apply to hemorrhoid. Pain stops immediately. One pill overnight resolves it. Treated several others successfully. (*Binhu Ji* Wine Recipes)
Zi Hezi treated Zhao Jun Yu Chang with hemorrhoids. Fengyancao (Celosia Cristata), Ci Pi (Urticae Folium?), Huaigen (Sophorae Root), Lishou (Fox Head?) used. Or dry ginger powder applied to pork, roasted and eaten. Stool became dry/hard, suspected tumor/atrophy. Days later, jaundice developed, severe diarrhea several times. Hemorrhoid complaint ceased.
Xu Lingtai said: Rectal prolapse mostly due to turbid Qi sinking, Damp-Phlegm, Toxic Fire combining. Severe swelling/pain, this is Excess syndrome. Must clear Large Intestine Fire, use external astringents. Immediate cure. For deficient patients post-illness, Clear Qi sinks, use Buzhong Yiqi to lift. Rarely one in ten cases. Regardless of cause, using lifting/astringent methods traps Phlegm/Fire/Turbid Qi in anus. Prolapse is mostly Excess; warming/drying is inappropriate.