初起形如牛奶，不肿不红，无 无痛，行走不觉者轻。已成肿痛，有时遇劳而发，或软或硬，头出黄水者
轻。久如鸡冠、蜂窠、莲花、翻花等状，流脓出血不止者重。久漏窍通臀腿，脓水淋漓，疼痛不已，粪从孔出
者逆。
初起及已成渐渐大而便涩作痛者，宜润燥及滋阴。肛门下坠，大便去血，时或疼痛坚硬者，宜清火渗湿。
紫色疼痛，大便虚秘兼作痒者，凉血祛风、疏利湿热。肿痛坚硬，后重坠刺，便去难者，外宜熏洗，内当宣利。
内痔去血，登厕脱肛而难上收者，当健脾、升举中气。便前便后下血，面色痿黄，心忪耳鸣者，宜养血健脾。
诸痔欲断其根，必须枯药，当完其窍，必杜房劳乃愈。
一男子患痔六年。每遇酒色劳役，痔则发肿，坚硬疼苦，十余日方得稍可。彼欲断其根，以枯痔散上至七
日外，其痔渐黑裂缝，至十六日痔枯脱落，孔若鸡心，以生肌散逐日用之，内
补养血健脾药而愈。
一男子患痔， 肿作痛，大便结燥，脉数有力。以内疏黄连汤二服，便行痛止。又以四物汤加芩、连、枳
壳、天花粉，数剂而肿消，更以脏连丸一料而不复发。
一男子患痔，凡遇劳发肿作痛，以枳壳汤熏洗，内服防风秦艽汤，数服肿痛俱减，令彼常洗前汤，每月五、
六次，内与六味地黄丸加黄柏、知母服之不发。
一男子好饮多欲，内痔虚坠下血。以四物汤加芩、连，升麻、葛根，数服虚坠乃止。又以当归郁李仁汤二
剂，痔肿亦消；更服脏连丸月余，便血亦止；又月余，兼节酒色不发。大抵醉饱入房，经脉横解，或精气一泄，
脉络必虚，酒食之毒，乘虚流结；或淫极强固精气，以致败精浊血遂传大肠；又或饮食浓味，燥湿流注俱成斯
疾。所受病者燥气也，为病者湿气也。初宜泻火和血、润燥疏风，久宜养血滋阴、健脾渗湿，治之自愈。若
不节酒色，不慎起居，不戒口味，破必成漏，久则穿肠串臀，秽从孔出，臭水淋漓，昼夜无禁。凡得此者，虽
不伤生，每苦瘀污，可叹息哉！
一男子患痔十余年，头已穿溃，未及通肠，每发疼苦。以三品一条枪插至七日，痔变黑色，疮边渐渐裂缝，
至十五日脱落；以凤雏膏搽至半月，敛口而平。
一男子怯弱，内痔便血，面色痿黄。自服凉药、止血药不应，诊之脾脉虚而无力，此中气不足，不能统血，
以补中益气汤十余服，精神顿倍，便血亦少；又以加味四君子汤兼前汤间服，月余不发。大抵此症所致之由不
同，当究其因治之，如元气有余，形黑气盛，先粪而后紫血者，更兼脉实有力，此属有余，法当凉血止血，药
应自效。至若形体瘦弱，面色痿黄，先鲜血而后粪者，更兼脉虚无力，此属不足，岂可反用凉药止之，致伤脾
胃。此症若不温中健脾、升举中气，其血不得归原，故药难效。远其根本也。
初起时形状像牛奶头，不肿不红，无痛感，行走时无不适感的为轻症。已经形成并出现肿痛，有时因劳累而发作，或软或硬，头部流出黄水的为轻症。病程长久，呈现鸡冠、蜂窝、莲花、翻花等形态，流脓出血不止的为重症。久病导致瘘管通向臀部和大腿，脓水淋漓不尽，疼痛不止，粪便从孔洞排出的为逆证（难治）。
初起及已形成后逐渐增大且大便涩滞作痛的，宜用润燥及滋阴之法。肛门下坠，大便带血，时而疼痛且质地坚硬的，宜用清火渗湿之法。颜色紫暗且疼痛，大便虚秘兼有瘙痒的，宜用凉血祛风、疏利湿热之法。肿痛坚硬，伴有里急后重、坠胀刺痛，排便困难的，外用宜熏洗，内服当宣通利导。内痔出血，登厕时脱肛且难以回纳的，应当健脾、升举中气。便前便后下血，面色萎黄，心慌耳鸣的，宜养血健脾。所有痔疮要想断绝病根，必须使用枯痔药物，若要使肛门孔窍完好，必须杜绝房劳才能痊愈。
有一个男子患痔疮六年。每次遇到饮酒、色欲和劳累，痔疮就会发作肿胀，坚硬疼痛痛苦，十多天后才能稍微缓解。他想断绝病根，使用枯痔散外敷至七天以上，痔疮逐渐变黑出现裂缝，到第十六天痔疮干枯脱落，孔洞状如鸡心，每日使用生肌散，内服补益养血健脾的药物而痊愈。
有一个男子患痔疮，肿胀作痛，大便干结，脉象数而有力。服用内疏黄连汤两剂，大便通畅疼痛停止。又服用四物汤加黄芩、黄连、枳壳、天花粉，数剂后肿胀消退，再服用一料脏连丸，不再复发。
有一个男子患痔疮，凡遇劳累就发作肿胀作痛，用枳壳汤熏洗，内服防风秦艽汤，几服后肿痛都减轻，让他经常清洗前面提到的药汤，每月五、六次，内服六味地黄丸加黄柏、知母，不再发作。
有一个男子喜好饮酒且多欲，内痔虚损下坠出血。用四物汤加黄芩、黄连、升麻、葛根，几服后虚损下坠停止。又服用当归郁李仁汤两剂，痔疮肿胀也消退；再服用脏连丸月余，便血也停止；又过月余，加上节制酒色，不再发作。大抵醉酒后饱食行房，经脉松弛，或者精气一旦泄出，脉络必然虚弱，酒食之毒，乘虚流注凝结；或者淫欲强盛固守精气，以致败精浊血传入大肠；又或者饮食浓烈厚味，燥湿流注都形成这种疾病。所感受的病邪是燥气，致病的是湿气。初期宜泻火和血、润燥疏风，久病宜养血滋阴、健脾渗湿，治疗自然痊愈。如果不节制酒色，不注意起居，不戒除口味，破溃必定成为漏症，久了则穿肠串臀，秽物从孔洞排出，臭水淋漓，昼夜不停。凡是得此病的人，虽然不伤性命，但每苦于瘀血污秽，真是可叹息啊！
有一个男子患痔疮十余年，头部已经穿溃，未及穿透肠道，每次发作都疼痛痛苦。用三品一条枪插入至第七天，痔疮变黑，疮口边缘渐渐出现裂缝，到第十五天脱落；用凤雏膏涂抹至半个月，收敛伤口平整。
有一个男子体质怯弱，内痔便血，面色萎黄。自行服用凉药、止血药无效，诊察发现脾脉虚而无力，这是中气不足，不能统摄血液，服用补中益气汤十余剂，精神顿时加倍，便血也减少；又服用加味四君子汤与前一种汤药交替服用，月余不再发作。大抵此症产生的原因不同，应当探究病因进行治疗，如果元气有余，形体壮实气盛，先排粪便后出紫血，更兼脉象实而有力，这属于有余，治法应当凉血止血，药物自然会见效。至于形体瘦弱，面色萎黄，先出鲜血后排粪便，更兼脉象虚而无力，这属于不足，岂可反而用凉药止之，以致损伤脾胃。此症若不温中健脾、升举中气，血液不得归原，所以药物难以见效。这是远离了根本啊。
At the initial stage, if the shape resembles a milk nipple, with no swelling or redness, no pain, and no discomfort during walking, it is considered mild. If it has already formed with swelling and pain, occasionally triggered by labor, appearing either soft or hard, with yellow fluid oozing from the head, it is also mild. If the condition persists for a long time, presenting shapes like a rooster's comb, honeycomb, lotus flower, or everted flower, with continuous pus discharge and bleeding, it is severe. If the fistula tract extends to the buttocks and legs over a long period, with dripping pus and water, unceasing pain, and feces exiting from the opening, it is an adverse (difficult-to-treat) case.
If the lesion gradually enlarges from the initial or formed stage, accompanied by difficult and painful defecation, moistening dryness and nourishing yin are indicated. If there is anal prolapse sensation, blood in stool, intermittent pain, and hardness, clearing heat and leaching out dampness are indicated. If the color is purplish with pain, accompanied by constipation due to deficiency and itching, cooling blood, dispelling wind, and regulating/dispersing damp-heat are indicated. If there is swelling, pain, hardness, tenesmus, dragging sensation, stabbing pain, and difficulty in defecation, external fumigation and washing are indicated, along with internal promotion of bowel movement and drainage. For internal hemorrhoids with bleeding, where the anus prolapses during defecation and is difficult to reduce, strengthening the spleen and raising middle qi is indicated. For bleeding before and after defecation, sallow complexion, palpitations, and tinnitus, nourishing blood and strengthening the spleen is indicated. To eradicate the root of all types of hemorrhoids, caustic medicines must be used; to restore the integrity of the anal aperture, sexual abstinence is necessary for recovery.
A male patient suffered from hemorrhoids for six years. Each time he engaged in drinking, sexual activity, or overwork, the hemorrhoids would swell, become hard, and cause severe pain, taking more than ten days to subside slightly. He sought to eliminate the root cause. After applying Hemorrhoid Caustic Powder externally for over seven days, the hemorrhoids gradually turned black and cracked. By the sixteenth day, the hemorrhoid dried up and fell off, leaving an opening resembling a chicken heart. He applied Muscle Regeneration Powder daily and took internal decoctions to tonify blood and strengthen the spleen, resulting in a cure.
Another male patient suffered from hemorrhoids with swelling, pain, dry stools, and a rapid, forceful pulse. Two doses of Internal Dispersing Coptis Decoction allowed bowel movement and stopped pain. Subsequently, Siwu Tang (Four Substance Decoction) added with Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Aurantii Fructus (Zhike), and Trichosanthis Radix (Tianhuafen) was taken for several doses, reducing the swelling. A course of Zanglian Wan (Intestine-Coated Pill) prevented recurrence.
A third male patient suffered from hemorrhoids that swelled and hurt upon exertion. He used Zhiqiao Tang (Aurantii Fructus Decoction) for external fumigation and washing, and took Fangfeng Qinjiao Tang (Saposhnikovia and Gentian Decoction) internally. After several doses, both swelling and pain decreased. He was instructed to continue washing with the former decoction five to six times a month, and take Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) added with Phellodendri Cortex (Huangbai) and Anemarrhenae Rhizoma (Zhimu) to prevent recurrence.
A fourth male patient, fond of drinking and excessive sexual desire, suffered from internal hemorrhoids with deficiency-type prolapse and bleeding. Siwu Tang (Four Substance Decoction) added with Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Cimicifugae Rhizoma (Shengma), and Puerariae Radix (Gegen) was taken for several doses, stopping the deficiency prolapse. Then, Danggui Yuliren Tang (Angelica and Prunus Decoction) was taken for two doses, eliminating the swelling. After taking Zanglian Wan (Intestine-Coated Pill) for over a month, the rectal bleeding stopped. With continued abstinence from alcohol and sex for another month, no recurrence occurred. Generally, intercourse after drunkenness and full meals causes meridians to relax; once essence is leaked, the collaterals become deficient, allowing toxins from alcohol and food to flow and condense in the deficiency. Or, excessive lust forces the retention of essence, leading to degenerated essence and turbid blood transmitting to the large intestine. Or, rich and heavy dietary flavors cause dryness and dampness to flow and accumulate, forming this disease. The pathogenic factor received is dryness qi, while the pathogenic factor causing illness is dampness qi. Initially, clearing fire, harmonizing blood, moistening dryness, and dispersing wind are appropriate. For chronic cases, nourishing blood, invigorating yin, strengthening the spleen, and leaching out dampness are appropriate, leading to self-healing. If one does not moderate alcohol and sex, neglects daily routine, and fails to guard against rich tastes, ulceration will inevitably become a fistula. Over time, it may penetrate the intestines and buttocks, with foul matter exiting the opening, dripping foul water day and night without cessation. Those who suffer from this, although not life-threatening, suffer greatly from bloody filth, which is truly lamentable!
A fifth male patient had suffered from hemorrhoids for over ten years, with the head already ulcerated but not penetrating the intestine, causing severe pain upon each flare-up. Sanpin Yitiao Qiang (Three-Piece Single-Spear) was inserted for seven days until the hemorrhoid turned black and the wound edges gradually cracked. By the fifteenth day, it detached. Fengchu Gao (Phoenix-Chick Ointment) was applied for half a month, healing the wound flatly.
A sixth male patient, with a weak constitution, suffered from internal hemorrhoids with rectal bleeding and a sallow complexion. Self-medication with cooling and hemostatic drugs was ineffective. Pulse diagnosis revealed a deficient and weak spleen pulse, indicating insufficient middle qi failing to control blood. Ten-plus doses of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) doubled his energy and reduced rectal bleeding. Jiawei Sijunzi Tang (Modified Four Gentlemen Decoction) was then alternated with the previous decoction for over a month, preventing recurrence. Generally, the etiology of this condition varies and requires investigation of the cause. If vital qi is sufficient, the physique is robust, qi is vigorous, feces precede purple blood, and the pulse is full and forceful, this belongs to excess. The method should be cooling blood and stopping bleeding, and the medication will naturally be effective. However, if the physique is emaciated, the complexion is sallow, fresh red blood precedes feces, and the pulse is deficient and weak, this belongs to deficiency. How can cooling drugs be used to stop bleeding, thereby damaging the spleen and stomach? If this condition is not treated by warming the middle, strengthening the spleen, and raising middle qi, the blood cannot return to its source, making medication ineffective. This is deviating from the root.