夫脏毒者，醇酒浓味、勤劳辛苦，蕴毒流注肛门结成肿块。其病有内外之别，虚实之殊。发于外者，多实
多热，脉数有力，肛门突肿，大便秘结，肚腹不宽，小水不利，甚者肛门肉泛如箍，孔头紧闭，此为外发，属
阳易治。宜四顺清凉饮、内消沃雪汤通利大小二便；痛甚者，珍珠散、人中白散搽之；脓胀痛者针之。发于内
者，属阴虚湿热渗入肛门，五内结肿，刺痛如钟，小便淋沥，大便虚秘，咳嗽生痰，脉数虚细，寒热往来，遇
夜尤甚，此为内发，属阴难治。宜四物汤加黄柏、知母、天花粉、甘草，兼以六味地黄丸调治，候五内脓出则
安。又有生平情性暴急，纵食膏粱，或兼补术，蕴毒结于脏腑，火热流注肛门，结而为肿；其患痛连小腹，肛
门坠重，二便乖违，或泻或秘，肛门内蚀，串烂经络，污水流通大孔，无奈饮食不餐，作渴之甚，凡犯此未
得见其有生。又有虚劳久嗽，痰火结肿肛门如栗者，破必成漏，沥尽气血必亡。此二症乃内伤之故，非药可疗，
不可勉治也。
初起肿痛，红色光亮，疼痛有时，肛门不坠、便和者易。已成 赤肿痛，发热不渴，小便不数，展转自便
者顺。已溃脓稠，色鲜不臭， 肿渐消，疼痛渐减、能食者顺。溃后脓水渐止，新肉易生，不疼多痒，疮口易
干者顺。
初起坚硬漫肿，五内闭痛，小便频数，大便秘结者险。已成疼痛日甚，肿连小腹，肛门闭紧，下气不通者
重。已溃臭水淋漓，疼痛不减，肿仍不消，身热唇焦者逆。
所谓脏毒，是由于长期饮用烈酒、食用肥甘厚味，加之过度劳累辛苦，导致蕴积之毒流注于肛门，结成肿块。此病有内发与外发的区别，也有虚证与实证的差异。发于体表的，多属实证、热证，脉象数而有力，肛门突然肿胀，大便秘结，腹部胀满不适，小便不通畅，严重的肛门周围肌肉浮肿如环箍状，肛口紧闭，这属于外发，归属于阳证，容易治疗。适宜使用四顺清凉饮、内消沃雪汤来通利大小二便；疼痛剧烈的，用珍珠散、人中白散外搽；脓成且胀痛明显的，进行针刺排脓。发于体内的，属于阴虚湿热渗入肛门，五脏内部结肿，刺痛剧烈如撞钟，小便淋漓不尽，大便虽秘但属虚秘，咳嗽生痰，脉象数而虚细，寒热往来，夜间症状尤为严重，这属于内发，归属于阴证，难以治疗。适宜使用四物汤加入黄柏、知母、天花粉、甘草，同时配合六味地黄丸调理治疗，等到五脏内部的脓液排出后病情方可安定。又有的人平素性情暴躁急躁，放纵饮食膏粱厚味，或者兼服白术等补药，导致蕴毒结聚于脏腑，火热之邪流注肛门，结聚而成肿块；其病症疼痛牵连小腹，肛门有坠重感，大小便异常，或腹泻或便秘，肛门内部腐蚀溃烂，串连破坏经络，污水从大孔流出，无奈无法进食，极度口渴，凡是患上这种病的，未见有能存活的。又有因虚劳久咳，痰火结聚于肛门如栗子大小的，一旦破溃必然形成瘘管，气血沥尽必死无疑。这两种病症乃是内伤所致，非药物所能治愈，不可勉强治疗。
初起时肿痛，皮肤红色光亮，疼痛有时发作，肛门无坠重感，大便调和的，容易治疗。已成脓时，赤色肿痛，发热但不口渴，小便次数不多，能够辗转自如、大便通畅的，为顺证。已经溃破后，脓液稠厚，颜色鲜红且不臭，肿胀逐渐消退，疼痛逐渐减轻，能够进食的，为顺证。溃破后脓水逐渐停止，新肉容易生长，不疼痛而多瘙痒，疮口容易干燥的，为顺证。
初起时坚硬漫肿，五脏内部闭阻疼痛，小便频数，大便秘结的，为险证。已成脓时，疼痛日益加重，肿胀牵连小腹，肛门闭紧，排气不通的，为重症。已经溃破后，臭水淋漓，疼痛不减，肿胀仍不消退，身体发热嘴唇焦干的，为逆证。
Bazhen Tang (Eight Treasure Decoction), Shiquan Dabuj Tang (Ten Complete Tonifying Decoction), Bawei Wan (Eight-Ingredient Pill) (all see the Ulcer Section).
The disease known as Zangdu (Visceral Toxin) arises from prolonged consumption of strong wine and rich, greasy foods, combined with excessive physical labor and hardship. This leads to accumulated toxins flowing into the anus, forming a mass. The disease is distinguished by internal versus external onset, and by deficiency versus excess patterns. External onset is mostly excess and heat; the pulse is rapid and forceful; the anus swells suddenly; 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 external onset, belonging to Yang patterns, which are easy to treat. It is appropriate to use Sishun Qingliang Yin (Four-Obedience Cooling Clearing Decoction) or Neixiao Woxue Tang (Internal Resolution Snow-Washing Decoction) to unblock both large and small bowels. For severe pain, Zhensan San (Pearl Powder) or Renzhongbai San (Human Tooth Ash Powder) should be applied externally. If pus has formed causing swelling and pain, needle drainage is indicated. Internal onset belongs to Yin deficiency with damp-heat seeping into the anus, causing masses in the five zang organs. Pain is stabbing and severe, like being struck by a bell; urination is dribbling; stool is constipated but due to deficiency; cough produces phlegm; the pulse is rapid, deficient, and thin; there is alternating chills and fever, worsening at night. This is internal onset, belonging to Yin patterns, which are difficult to treat. It is appropriate to use Siwu Tang (Four Substance Decoction) added with Huangbai (Phellodendri Cortex), Zhimu (Anemarrhenae Rhizoma), Tianhuafen (Trichosanthis Radix), and Gancao (Licorice Root), combined with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) for regulation. Condition will stabilize once pus from the five zang organs is discharged.
There are also those whose temperament is irritable and hasty, who indulge in rich foods, or who take tonics such as Baizhu (Atractylodis Macrocephalae Rhizoma). Accumulated toxins knot within the viscera, and fire-heat flows into the anus, forming a swelling. The pain radiates to the lower abdomen; the anus feels heavy and dragging; bowel and bladder functions are abnormal, presenting as either diarrhea or constipation; the interior of the anus erodes, damaging meridians and collaterals; foul fluid drains from the large opening. The patient is unable to eat and suffers extreme thirst. Those contracting this condition have no hope of survival.
Furthermore, chronic deficiency consumption with long-term coughing may cause phlegm-fire to knot in the anus like a chestnut. Once ruptured, it inevitably becomes a fistula; when qi and blood are exhausted, death ensues. These two conditions result from internal injury and cannot be cured by medicine; they must not be treated forcibly.
In the early stage, if swelling and pain present with bright red skin, intermittent pain, no sensation of anal heaviness, and normal bowel movements, the prognosis is good. If pus has formed, presenting with red swelling, fever without thirst, infrequent urination, and the ability to move freely with normal defecation, this is a favorable course. After ulceration, if pus is thick, fresh-colored, and odorless, swelling gradually subsides, pain decreases, and appetite returns, this is a favorable course. After ulceration, if discharge gradually stops, new tissue grows easily, pain is absent with predominant itching, and the wound dries quickly, this is a favorable course.
If in the early stage the swelling is hard and diffuse, accompanied by internal obstruction and pain, frequent urination, and constipation, the prognosis is dangerous. If pus has formed, with increasing pain daily, swelling extending to the lower abdomen, tight closure of the anus, and inability to pass gas, the condition is severe. If after ulceration foul fluid drips continuously, pain persists, swelling does not subside, and the body is hot with dry lips, this is an unfavorable course.