疗痔之方，如敷败熏洗等，则责有外科，故《观聚方》一概不录，此编亦遵其例云。
名义 经云∶肠癖为痔。如大泽中有小小突出为峙，人于九窍中，凡有小肉突出者皆曰痔。不特于肛门
边生，亦有鼻痔、眼痔、牙痔等。（《三因》）
源候总说 诸痔者，谓牡痔、牝痔、脉痔、肠痔、血痔也，其形证各条如后章。诸痔皆由伤风，房室不
慎，醉饱合阴阳，致劳扰血气，而经脉流溢，渗溢肠间，冲发下部，有一方而治之者，名为诸痔，非为诸病共成
一痔。痔久不瘥，变为 也。（《病源论》）
《内经》谓因而饱食，筋脉横解，肠 为痔。夫痔病之候亦多矣，类而知也。（《圣济》）
大凡五痔，皆因虚惫，恣食五辛五味鸡鱼而成，热毒壅入大肠，津液不通，气血凝滞，久坐久忍不粪，水冷
入河水洗，酒后行房，及暑月行路，坐诸热又移坐冷，种种能成斯疾。（《本事续》）
盖热则血伤，血伤则经滞，经滞则气不营运，气与血俱滞，乘虚而坠入大肠，此其所以为痔也。（《直指》）
痔之疾五种，牡痔、肠痔、血痔、牝痔、脉痔是也。究其所由，皆是素蕴热毒，或过食烧炙新酒，久坐血脉
不流，或因七情之气，郁结于脏腑之间，其毒不能消散，发而为痔。
或藏于肛门之内，或突出于外，大者如莲花、鸡冠、核桃之状，小者如牛奶、鸡心、鼠尾、樱桃之类，名状更
多，其实皆由藏毒所致。故蕴毒深者其状大，蕴毒小者其形小，或流脓水，或出鲜血，行坐之间，病者殊为之
苦。久而不治，血气衰弱，必然成漏。（《大成》）
大抵醉饱入房，则经脉横解，或精气泄脱，脉络一虚，酒食之毒，乘虚流注，或淫极强固精气，遂传大肠，
或食浓味过多，必成斯疾。夫受病者，燥气也。为病者，湿热也。（按∶此二句本出《兰室秘藏》，湿热作胃
湿。）宜以泻火，和血、润燥、疏风之剂治之。（《外科发挥》）
夫痔者，乃素积湿热，过食炙 ，或因久坐而血脉不行，又因七情而过伤生冷，以及担轻负重，竭力远行，
气血纵横，经络交错，又因酒色过度，肠胃受伤，以致浊气瘀血，流注肛门，俱能发痔。此患不论老幼男妇皆
然，盖有生于肛门之内，又突于肛外之旁，治分内外，各自提防。大者若莲花、蜂窠、翻花、鸡冠、菱角、珊
瑚等状，小者如樱桃、鼠尾、牛奶、鸡心、核桃、蚬肉之形。故积毒深者，其形异而顽恶；毒浅者，其形正而
平常。久则崩溃成漏，新则坠肿刺疼。甚者粪从孔出，血从窍流，气血日有所伤，形容渐有所削，若不早治。终
至伤人。（《外科正宗》）
病由下焦蓄血 凡痔皆因酒面炙 ，蓄热伤血，恶血结聚于下焦，不得疏通，于是下坠而为痔。患痔
之人，下部留蓄血热，多致大小便不通，小腹结急，才得一通，又复闭塞，且有漱水之证，此下焦留蓄血热明
矣。其下焦蓄血，亦以尺脉洪盛见之。合用逐瘀汤主治，须得大小便通快。（《直指》）（按∶逐瘀汤用芎、
芷、生干地、芍、五灵脂、枳、壳、胶、莪、茯苓、茯神，木通、生甘、大黄、桃仁、姜、
枣，水煎，）
脉候 脉沉小实者，易治；浮洪而软弱者，难愈。（《正传》）
诸痔证状 牡痔候，肛边生鼠乳出在外者，时时出脓血者是也。肛边肿生疮而出血者，牝痔（按∶《外
台》引崔氏作酒痔）。肛边生疮，痒而复痛，出血者，脉痔也。肛边肿核痛，发寒热而血出者，肠痔也。因便而清
血随出者，血痔也。（《病源论》）（按∶崔氏五痔，有气痔，无脉痔，气痔证与下文同。）
又有酒痔，肛边生疮，亦有血出。又有气痔，大便难而血出，肛亦出外，良久不肯入。（同上）
夫五痔者，一曰牡痔，二曰牝痔，三曰脉痔，四曰肠痔，五曰血痔云云。又五痔有气痔，寒温劳湿即发，蛇
蜕皮主之。牡痔，生肉如鼠乳在孔中，颇出见外，妨于更衣，鳖甲主之。牝痔（《集验》作酒痔），从孔中
起，外肿，五六日自溃出脓血， 皮主之。肠痔，更衣挺出，久乃缩，母猪左足悬蹄甲主之。脉痔，更衣出清血，
蜂房主之。（《千金》）（按∶《外台》引《集验》同，《医心》引《龙门方》有少异。又原文此下载五药皆下
筛，等分，随其病倍其主药。）
一者，肛肠生肉，肾痔鼠奶，或似樱桃，或如大豆，时时出血，又如出脓，名曰鼠奶痔。二者，肛边大乳，
痛肿无脓血，名曰酒痔，饮酒便发。三者，肛边努核，疼痛难忍，粪则有血，或因忧愁思虑，冷热不调，无时而
发，名曰气痔；或大便涩难，气结不通，下血面黄，食少无味，名曰劳痔。四者，大便后下诸脓血，更加痛涩，
肛肠努出，名曰脱肛痔。五者，气攻两肾 ，大便不通，粪血，色下赤黑，毒热不消，肛门湿痒，一似虫行，名
曰风热内痔。（《本事
续》）
诸痔方论其二十一般 翻花 脱肛 内肠 热痔 莲子 鼠奶 鸡冠 外肠 樱桃 风痔 气痔 食痔
雀舌 般蛇 蜂窠 山桃 穿肠（《事证》）（按∶原文每证有详说，然多立名类，不切事为，仍不具录。）
内痔外痔（宜参后外治法） 许仁则曰，此病有内痔，有外痔。内但便即有血，外有异。外痔下部有
孔，每出血从孔中出。内痔每便即有血。下血甚者，下血击地成孔，出血
过多，身体无复血色。有痛者，有不痛者。（《外台》）
难易看法 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，过劳而发，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，浓水淋漓，疼
痛不已，粪从孔出者逆。（《正宗》）
治例 治之之法，切不可用以毒药，亦不可轻易割取，多致淹忽，惟当用以稳重汤剂，徐徐取效，不
可不知。（《济生》）
治法总要，大抵以解热调血顺气先之。（《直指》）
痔漏证状颇多，自属外科，不复繁引。既血自内出，不可全仗外敷，宜枳芷散（方阙。先君子曰∶当是柏芷
散，用侧柏、白芷，出《魏氏》，治便血）吞钓肠丸（见《和剂》）。痔正发而血多者，亦宜自里托之，宜《千
金》内补散，减桂之半，加鳖头灰尤妙。（《要诀》）
初起 痛便秘，或小便不利者，宜清热凉血，润燥疏风。若气血虚而寒凉伤损者，调养脾胃，滋补阴精。若
破而久不愈，多成痔漏，有穿臀、穿阴、穿肠者，宜养元气、补
阴精为主。大便秘涩或作痛者，润燥除湿。肛门下坠或作痛者，泻火除湿。下坠肿痛或作痒者，祛风胜湿。肿痛
小便涩滞者，清肝导湿。若有患而兼疝，患疝而兼下疳，皆属肝肾不足之变症，但用地黄丸、益气汤滋化源为
善。若专服寒凉治火者，无不致祸。（《外科枢要》）（从《准绳》删订录）
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。（《正宗》）
诸药总考 治法以苦寒泻火，芩、连、栀子、槐花之类。以辛温和血，用归、川芎、桃仁之类。风邪在
下，以秦艽、防风、升麻之类提之。燥热怫郁，以大黄、麻仁、枳壳之类主之。（《正传》）
昆按∶古方医痔漏下血，有用槐角灰者，有用柏叶灰者，有用 皮灰者，有用露蜂房灰者，有用牛角腮灰者，
有用胡桃灰者，俱以方寸匕酒调下，此皆枯痔之法也。汤液之中，有用防风者，有用秦艽者，有用皂角仁者，
有用荆芥、白芷者，此皆责之风热入脏也。有用芒硝、大黄者，有用槟榔、枳实者，此皆责之实热可下也。有
用胡黄连者，有用酒苦参者，有用石莲肉者，有用番木鳖者，此皆责之实热可清也。有用桃仁、红花者，有用
蒲黄、苏木者，此皆责之瘀血未消也。有用杏仁、麻仁者，有用地黄、黄柏者，此皆责其燥金无液也。有用地榆、
蕲艾者，有用枯龙骨、鹿角霜者，此
欲强止其血也。有用象牙、蜣螂者，有用人爪、蟹爪者，此欲放出其肛而外施药以愈之也。有用熏法者，有用
洗法者，有用药坐者，无非枯痔止血之品也。有用插药者，有用挂线者，无非烂肌去腐之辈也。呜呼！任医犹
任将，用药犹用兵。神于兵者，迭石可以为营，驱牛可以破敌；神于药者，心解而机自灵，见超而术自神，有
不拘拘于纸上之陈言矣。（《方考》）
痔证之方不一，东垣虽分湿、热、风、燥四治（按∶《兰室》分此四证，宜参），大都不离荡涤瘀热之药，
如皮、皂角、槟榔、大黄、桃仁之类在所必用，兼风毒则加羌、防、升、柴。甚则麻黄、 本汗之，兼燥气
则加秦艽、当归、黄 ，湿胜则加苍术、黄柏、泽泻、茯苓，兼热甚则加芩、连、郁李、生地，脓血则加甲片、
归尾，酒痔则加葛根、赤小豆、地、芍、苓、半，气痔则加枳、橘、木香、紫苏，食积则加黄连、枳实、曲、
柏，痛极则加乳、没，血多则加发灰，气虚则加参、 ，血虚则加胶、艾，不必拘执古方也。惟血痔诸药不应，
石煤、槐花空心乌梅汤服神效。（《医通》）
外治例 今之治法，多用刀线割剔其痔，虽药可以封固，然其毒在肉，无由而去，必有再作之理，否
则成漏，转而为难治之证。诸方多有服食敷贴之药，今人用之，少见有效。揆度其理，其病既有形于外，非服
药之能愈，必须用去毒消痔之药点之，候其毒尽痔消，方可为愈。切不可用砒霜等毒药，恐致人奄忽，慎之慎
之。（《大成》）
凡疗内痔者，先用通利药荡涤脏腑，然后用唤痔散涂入肛门，片时内痔自然泛出，即用葱汤洗净，擦枯痔
散，早午晚每日三次，次次温汤洗净搽药，轻者七日，重者十一日，其痔
自然枯黑干硬，停止枯药，其时痔边缝裂流脓，换用起痔汤日洗一次，待痔落之后，换搽生肌散或凤雏膏等药，
生肌敛口，虚者兼服补药，其口半月自可完矣。外痔者，用消毒散煎洗，随用枯痔散，照内痔搽法用之，首尾至
终无异，完口百日入房乃吉。又至于穿肠久漏者，此则另有二方，亦具于后，以致深患者服之，又不用针刀挂
线，效如拾芥耳。（《正宗》）（按∶久漏二方为追毒丸、闭管丸，其他诸方宜就原书而遵用焉。）
其外治法，须分内外。内痔，以唤痔、枯痔之法治之。外痔，痛甚者清之洗之，头大蒂小者线结之，头小
根大者枯之。（《医宗说约》）（从《疡医大全》删订录）
变 诸治（互见上诸条， 或作漏。）变漏三种∶冷漏，瘀脓漏，血漏。（《事证》）
诸痔出血，肛门间另有小窍，下如血线，不与便物共道。痔久不愈，必致穿穴，疮口不合，漏无已时，此
则变而为 矣。（《直指》）
又有无痔者，肛门左右另有一窍，流出脓血，名为单漏。治之须用温暖之药补其内，又以生肌肉之药敷于外，
其窍在皮肤者易愈，脏腑有损而生窍者未易治也。（《大成》）
痔漏之源，由乎酒色过度，湿而生热，充于脏腑，溢于经络，坠乎谷道，冲突为痔，久而成漏者也。痔轻而
漏重，痔实而漏虚。治痔之法，不过凉血清热而已；至于治漏，初则宜凉血清热燥湿，久则宜涩窍杀虫而兼乎温
散也。或曰∶痔漏火是根源，何故而用温涩？殊不知痔止出血，始终是热；漏流脓水，始是湿热，终是湿寒，
不用温药，何以去湿而散寒乎。非止痔漏，百病之中多有始热而终寒者，如泻利，如呕吐，初作则肠胃气实为热，
久作则肠胃气虚而为寒矣。
丹溪下血条云∶下血久不愈者，后用温剂。正此义也。（《丹溪附余》）
经云∶陷脉为 ，留连肉腠。因疮穿脓汁不尽，复感七情四气而成。近则常淡红，或微肿，或小核。久则
上而槁白，内而黑烂，淫虫恶臭生焉。治法宜补气生血，外以黑附子为末，唾津和作饼，如钱浓，以艾灸之，随
漏大小作炷，但灸微热，不可使痛，干则易，困倦则止，来日再灸，直至内平为效，仍须补药常服。（《医通》）
既溃之后，每每多成漏管，不能收口者，非内服外洗，纯用苦寒，致令脾元日损，肌肉难生；即系医家妄
用刀针，药线系扎，熔丸悬坠，利剪割切，良肉受伤，日施药 ，插入拔出，日逐将疮内四旁新肉磨成硬管，
愈插愈深。此固医者之过，然病家见痔疮溃后，虽流脓血，不疼不痛，嗜饮者依然畅饮，好色者仍复贪欢，善
啖者辛辣煎炒，全不禁戒，虽无刀剪药线之害，亦断无不成漏者，所以致漏之源又伙。更有一等自愚之辈，
每言痔漏不可医痊，留此门户为湿热外渗之地，若收功完口，湿热反无门可出矣。殊不知肾开窍于二阴，谷道
即肾之门户，若使终年破流血水，则真阴由此而耗，正气从此而亏，安能保其不成痨瘵乎。况湿热若果由大肠
治疗痔疮的方剂，如外敷、熏蒸、清洗等方法，属于外科范畴，因此《观聚方》一概不予收录，本编也遵循这一先例。
【名称与定义】
《黄帝内经》说：肠风下血称为痔。就像大泽中微微突起的小山岗叫“峙”，人体九窍中凡是有小肉突出的都称为痔。不仅肛门边会长，还有鼻痔、眼痔、牙痔等。（出自《三因极一病证方论》）
【病因总述】
各种痔疮，分为牡痔、牝痔、脉痔、肠痔、血痔五种，其具体形态和症状详见后文章节。各种痔疮都是由伤风、房事不慎、醉酒后行房等原因，导致气血劳扰，经脉血液溢出，渗入肠道之间，冲击下部所致。有一个部位发病就称为诸痔，并非多种疾病共同形成一种痔疮。痔疮日久不愈，会转变为漏症。（出自《诸病源候论》）
《黄帝内经》说：因为饱食过度，导致筋脉松弛横解，肠道发生病变成为痔疮。痔疮病的症状表现也很多，可以类推而知。（出自《圣济总录》）
大抵五种痔疮，都是因为身体虚弱疲惫，放纵食用五辛（葱蒜韭薤兴渠）、五味以及鸡鱼肉等食物，导致热毒壅塞进入大肠，津液不通，气血凝滞，加上久坐、久忍大便不解、用冷水或河水洗下身、酒后行房，以及在暑天走路、坐热后又坐冷处等，种种因素都能造成这种疾病。（出自《本事续集》）
大概热邪会损伤血液，血液受损则经脉阻滞，经脉阻滞则气机不能运行，气与血都停滞，乘虚下坠进入大肠，这就是痔疮形成的原因。（出自《医学正传》引《直指方》）
痔疮这种疾病有五种，即牡痔、肠痔、血痔、牝痔、脉痔。探究其成因，都是由于素来蕴藏热毒，或者过吃烧烤、新酿的酒，久坐导致血脉不流通，或者因为七情之气郁结在脏腑之间，毒气无法消散，发作而成痔疮。
有的藏在肛门内部，有的突出于外部，大的像莲花、鸡冠、核桃的形状，小的像牛奶头、鸡心、鼠尾、樱桃之类，名称形状更多，其实都是由体内蕴藏毒气所致。所以蕴毒深的形状大，蕴毒浅的形状小，有的流脓水，有的出鲜血，行走坐卧之间，患者非常痛苦。时间久了如果不治疗，气血衰弱，必然变成漏症。（出自《外科大成》）
大致醉酒后行房，会导致经脉松弛，或者精气泄脱，脉络一旦空虚，酒食之毒乘虚流注；或者淫欲强固精气，随即传入大肠；或者食用浓味过多，必定造成这种疾病。受病的是燥气，致病的是湿热。（按：这两句原本出自《兰室秘藏》，原文作“胃湿”。）应当用泻火、和血、润燥、疏风的药剂来治疗。（出自《外科发挥》）
所谓痔疮，是因为素来积聚湿热，过吃炙烤食物，或者因为久坐导致血脉不行，又因为七情过度损伤生冷饮食，以及担轻负重、竭力远行，导致气血纵横交错，经络紊乱，再加上酒色过度，肠胃受伤，以致浊气和瘀血流注肛门，都能引发痔疮。这个病患不论老幼男女都会得，有的生于肛门内部，有的突出于肛门外侧，治疗分内治和外治，各自提防。大的像莲花、蜂窠、翻花、鸡冠、菱角、珊瑚等形状，小的像樱桃、鼠尾、牛奶、鸡心、核桃、蚬肉等形状。所以积毒深的，形状怪异而顽固恶毒；毒浅的，形状端正而平常。时间久了会崩溃成漏症，新发的则肿胀刺痛。严重的粪便从孔洞排出，血液从窍道流出，气血每天受到损伤，形体逐渐消瘦，如果不早点治疗，最终会伤人性命。（出自《外科正宗》）
【病机：下焦蓄血】
凡是痔疮都是因为饮酒、面食、炙烤食物，积蓄热邪损伤血液，恶血结聚在下焦，不得疏通，于是下坠而形成痔疮。患痔疮的人，下部留蓄血热，多导致大小便不通，小腹拘急疼痛，刚通利一次，又再次闭塞，且有想漱口但不咽下的症状，这是下焦留蓄血热的明证。其下焦蓄血，也可以通过尺脉洪盛表现出来。合适用逐瘀汤主治，必须使大小便通利顺畅。（出自《直指方》）（按：逐瘀汤由川芎、白芷、生干地黄、芍药、五灵脂、枳壳、阿胶、莪术、茯苓、茯神、木通、生甘草、大黄、桃仁、生姜、大枣组成，水煎服。）
【脉象】
脉象沉小实的，容易治疗；脉象浮洪而软弱无力的，难以痊愈。（出自《医学正传》）
【各种痔疮的症状】
牡痔的症状：肛门边长出像老鼠乳房一样的肉赘突出在外面，时常流出脓血。
牝痔：肛门边肿胀生疮而出血（按：《外台秘要》引崔氏观点作“酒痔”）。
脉痔：肛门边生疮，痒而复痛，出血。
肠痔：肛门边肿核疼痛，发寒热且出血。
血痔：排便时清血随之流出。（出自《诸病源候论》）（按：崔氏的五痔中有气痔，没有脉痔，气痔的症状与下文相同。）
又有酒痔：肛门边生疮，也有血液流出。
又有气痔：大便困难且出血，肛门也会脱出，很久不肯缩回。（同上）
所谓五痔，一是牡痔，二是牝痔，三是脉痔，四是肠痔，五是血痔。另外五痔中还有气痔，遇寒温劳湿就会发作，可用蛇蜕皮主治。牡痔，生长像老鼠乳房一样的肉在孔中，稍微突出外面，妨碍上厕所，可用鳖甲主治。牝痔（《集验方》作酒痔），从孔中起，外部肿胀，五六天后自行溃破流出脓血，可用蛴螬皮主治。肠痔，上厕所时挺出，很久才收缩，可用母猪左足悬蹄甲主治。脉痔，上厕所时流出清血，可用露蜂房主治。（出自《千金要方》）（按：《外台秘要》引用《集验方》内容相同，《医心方》引用《龙门方》略有差异。另外原文此处记载五种药物都要研筛，等分服用，根据病情加倍使用主药。）
第一种，肛肠生长肉赘，肾痔鼠奶，有的像樱桃，有的像大豆，时常出血，又像流出脓水，名叫鼠奶痔。第二种，肛门边有大乳状物，肿痛但没有脓血，名叫酒痔，饮酒后就发作。第三种，肛门边努出硬结，疼痛难忍，排便时有血，或者因为忧愁思虑，冷热不调，无时不发作，名叫气痔；或者大便涩滞困难，气结不通，下血面色黄，食少无味，名叫劳痔。第四种，大便后落下各种脓血，更加疼痛涩滞，肛肠努出，名叫脱肛痔。第五种，气攻两肾，大便不通，粪中带血，颜色黑赤，毒热不消，肛门湿痒，好像虫子爬行，名叫风热内痔。（出自《本事续集》）
【诸痔方论二十一般】
翻花、脱肛、内肠、热痔、莲子、鼠奶、鸡冠、外肠、樱桃、风痔、气痔、食痔、雀舌、般蛇、蜂窠、山桃、穿肠。（出自《事证类备急外科精要》）（按：原文每种病症都有详细说明，但大多立名分类，不切实际，故不全录。）
【内痔与外痔】（宜参考后文外治法）
许仁则说，这个病有内痔，有外痔。内痔只是排便时有血，外痔有所不同。外痔下部有孔，每次出血从孔中流出。内痔每次排便就有血。下血严重的，血液击地能打出坑，出血过多，身体失去血色。有的疼痛，有的不疼痛。（出自《外台秘要》）
【难易判断】
初起时，形状像牛奶头，不肿不红，无脓无痛，行走时无感觉的属轻症。已成症，肿痛有时，劳累后发作，或软或硬，头出黄水的属轻症。久了像鸡冠、蜂窠、莲花、翻花等形状，流脓出血不止的属重症。久漏，窍道通向臀部腿部，脓水淋漓，疼痛不已，粪便从孔中排出的属逆症（难治）。（出自《外科正宗》）
【治疗原则】
治疗的方法，切不可使用毒药，也不可轻易割取，多导致延误病情，只应当使用稳重的汤剂，徐徐见效，不可不知道这一点。（出自《济生方》）
治疗方法的要领，大致以清热、调血、顺气为先。（出自《直指方》）
痔漏的症状很多，自属外科范畴，不再繁复引用。既然血液从内部流出，不能完全依赖外敷，宜用枳芷散（方子缺失。先父说：应当是柏芷散，用侧柏、白芷，出自《魏氏》，治疗便血）吞服钓肠丸（见《太平惠民和剂局方》）。痔疮正发作且出血多的，也宜从内部托毒，宜用《千金要方》的内补散，减去一半桂枝，加鳖甲灰尤其妙。（出自《外科枢要》）
【初起阶段】
疼痛便秘，或者小便不利的，宜清热凉血，润燥疏风。如果气血虚寒凉伤损的，调养脾胃，滋补阴精。如果破溃后长久不愈，多成痔漏，有穿臀、穿阴、穿肠的，宜以养元气、补阴精为主。大便秘涩或作痛的，润燥除湿。肛门下坠或作痛的，泻火除湿。下坠肿痛或作痒的，祛风胜湿。肿痛小便涩滞的，清肝导湿。如果有患痔疮兼疝气，患疝气兼下疳的，都属于肝肾不足的变症，只用六味地黄丸、补中益气汤滋生化源为好。如果专服寒凉治火的，无不招致祸害。（出自《外科枢要》）（从《医学入门》删订录入）
初起及已成，渐渐变大且大便涩滞作痛的，宜润燥及滋阴。肛门下坠，大便去血，时而疼痛坚硬的，宜清火渗湿。紫色疼痛，大便虚秘兼作痒的，凉血祛风，疏利湿热。肿痛坚硬，后重坠刺，排便困难的，外宜熏洗，内当宣利。内痔去血，登厕脱肛且难以上收的，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。各种痔疮想要断根，必须用枯痔药，要想让创口愈合，必须杜绝房劳才能痊愈。（出自《外科正宗》）
【诸药总考】
治疗方法以苦寒泻火为主，如黄芩、黄连、栀子、槐花之类。以辛温和血为主，用当归、川芎、桃仁之类。风邪在下，用秦艽、防风、升麻之类提升。燥热怫郁，用大黄、麻仁、枳壳之类主治。（出自《医学正传》）
昆冈按：古方医治痔漏下血，有用槐角灰的，有用柏叶灰的，有用蛴螬皮灰的，有用露蜂房灰的，有用牛角腮灰的，有用胡桃灰的，都用方寸匕量，酒调服下，这都是枯痔之法。汤液中，有用防风的，有用秦艽的，有用皂角仁的，有用荆芥、白芷的，这都是针对风热入脏。有用芒硝、大黄的，有用槟榔、枳实的，这都是针对实热可下。有用胡黄连的，有用酒浸苦参的，有用石莲肉的，有用番木鳖的，这都是针对实热可清。有用桃仁、红花的，有用蒲黄、苏木的，这都是针对瘀血未消。有用杏仁、麻仁的，有用地黄、黄柏的，这都是针对燥金无液。有用地榆、蕲艾的，有用枯龙骨、鹿角霜的，这都是为了强力止血。有用象牙、蜣螂的，有用的人爪、蟹爪的，这都是为了放出肛门并外用药物治愈。有用熏法的，有用洗法的，有用药坐的，无非是枯痔止血的药物。有用插药的，有用挂线的，无非是烂肌去腐的药物。唉！任用医生如同任用将领，用药如同用兵。精通兵法的人，堆石头可以扎营，驱赶牛群可以破敌；精通药理的人，心中理解机理自然灵敏，见识高超技术自然神奇，就不必拘泥于纸上的陈词滥调了。（出自《本草纲目·方考》）
痔疮的方剂不一，李东垣虽然分为湿、热、风、燥四种治法（按：《兰室秘藏》分此四证，宜参考），大都不离荡涤瘀热的药物，如蛴螬皮、皂角、槟榔、大黄、桃仁之类在所必用，兼风毒则加羌活、防风、升麻、柴胡。严重时加麻黄、藁本发汗，兼燥气则加秦艽、当归、黄芪，湿胜则加苍术、黄柏、泽泻、茯苓，兼热甚则加黄芩、黄连、郁李仁、生地，有脓血则加穿山甲片、当归尾，酒痔则加葛根、赤小豆、生地、芍药、茯苓、半夏，气痔则加枳壳、橘皮、木香、紫苏，食积则加黄连、枳实、神曲、黄柏，痛极则加乳香、没药，血多则加血余炭，气虚则加人参、黄芪，血虚则加阿胶、艾叶，不必拘执古方。只有血痔诸药无效时，用石煤、槐花空腹乌梅汤服用有神效。（出自《医宗金鉴·外科心法要诀》）
【外治例】
现在的治法，多用刀线割剔痔疮，虽然药物可以封固，但毒气在肉中，无处去除，必定有再发的道理，否则变成漏症，转而成为难治之证。各方多有服食敷贴的药物，今人使用，少见有效。推究其理，病既有形于外，非服药能愈，必须用去毒消痔的药物点涂，等到毒尽痔消，才可以痊愈。切不可用砒霜等毒药，恐怕导致人突然死亡，慎之又慎。（出自《外科大成》）
凡是治疗内痔者，先用通利药荡涤脏腑，然后用唤痔散涂入肛门，片刻后内痔自然泛出，即用葱汤洗净，擦枯痔散，早午晚每日三次，次次用温汤洗净搽药，轻者七日，重者十一日，痔疮自然枯黑干硬，停止用枯药，此时痔边缝裂流脓，换用起痔汤日洗一次，待痔脱落之后，换搽生肌散或凤雏膏等药，生肌敛口，体虚者兼服补药，创口半月自然愈合。外痔者，用消毒散煎洗，随用枯痔散，照内痔搽法使用，首尾始终无异，创口愈合百日后方可行房才吉利。至于穿肠久漏者，这另有二方，也列在后面，供深病患者服用，又不用针刀挂线，效果如拾取小草一样容易。（出自《外科正宗》）（按：久漏二方为追毒丸、闭管丸，其他诸方宜就原书而遵用焉。）
其外治法，须分内外。内痔，用唤痔、枯痔法治之。外痔，痛甚的用清凉药洗之，头大蒂小的用线结扎，头小根大的用枯痔法。（出自《医宗说约》）（从《疡医大全》删订录入）
【变证】
各种治疗（互见上诸条，“瘘”或作“漏”）。变漏三种：冷漏，瘀脓漏，血漏。（出自《事证类备急外科精要》）
各种痔疮出血，肛门间另有小窍，下如血线，不与大便共道。痔疮久不愈，必致穿孔，疮口不合，漏无休止，这就变成了漏症。（出自《直指方》）
又有无痔疮者，肛门左右另有一窍，流出脓血，名为单漏。治疗需用温暖之药补其内，又以生肌肉之药敷于外，其窍在皮肤者易愈，脏腑有损而生窍者未易治也。（出自《外科大成》）
痔漏的源头，由于酒色过度，湿而生热，充于脏腑，溢于经络，坠乎谷道，冲突为痔，久而成漏。痔轻而漏重，痔实而漏虚。治痔之法，不过凉血清热而已；至于治漏，初则宜凉血清热燥湿，久则宜涩窍杀虫而兼乎温散也。有人说：痔漏火是根源，何故而用温涩？殊不知痔只出血，始终是热；漏流脓水，始是湿热，终是湿寒，不用温药，何以去湿而散寒乎。不仅痔漏，百病之中多有始热而终寒者，如泻利，如呕吐，初作则肠胃气实为热，久作则肠胃气虚而为寒矣。
朱丹溪在下血条中说：下血久不愈者，后用温剂。正是这个意思。（出自《丹溪附余》）
《黄帝内经》说：陷脉为漏，留连肉腠。因为疮口穿破脓汁不尽，又感受七情四气而成。近则常淡红，或微肿，或小核。久则上而槁白，内而黑烂，淫虫恶臭生焉。治法宜补气生血，外以黑附子为末，唾津和作饼，如钱厚，以艾灸之，随漏大小作炷，但灸微热，不可使痛，干则换，困倦则止，来日再灸，直至内平为效，仍须补药常服。（出自《医宗金鉴》）
既溃之后，每每多成漏管，不能收口者，非内服外洗，纯用苦寒，致令脾元日损，肌肉难生；即系医家妄用刀针，药线系扎，熔丸悬坠，利剪割切，良肉受伤，日施药，插入拔出，日逐将疮内四旁新肉磨成硬管，愈插愈深。这固然是医者的过错，然而病人见痔疮溃后，虽流脓血，不疼不痛，嗜饮者依然畅饮，好色者仍复贪欢，善啖者辛辣煎炒，全不禁戒，虽无刀剪药线之害，亦断无不成漏者，所以致漏之源又多。更有一等自愚之辈，每言痔漏不可医痊，留此门户为湿热外渗之地，若收功完口，湿热反无门可出矣。殊不知肾开窍于二阴，谷道即肾之门户，若使终年破流血水，则真阴由此而耗，正气从此而亏，安能保其不成痨瘵乎。况湿热若果由大肠……
The formulas for treating hemorrhoids, such as external application, fumigation, and washing, fall under the jurisdiction of surgery; therefore, *Guan Ju Fang* (Observation of Formulas) does not record them at all. This compilation also follows this precedent.
**Nomenclature and Definition**
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: Intestinal dysentery with bleeding is called hemorrhoid. Just as a small protrusion in a large marsh is called a "peak" (Zhi), any small flesh protrusion in the nine orifices of the human body is called a hemorrhoid. They are not only found around the anus but also include nasal hemorrhoids, ocular hemorrhoids, and dental hemorrhoids. (*San Yin Ji Yi Bing Zheng Fang Lun*)
**General Etiology**
Various hemorrhoids are categorized into Male Hemorrhoids (Mu Zhi), Female Hemorrhoids (Pin Zhi), Vascular Hemorrhoids (Mai Zhi), Intestinal Hemorrhoids (Chang Zhi), and Blood Hemorrhoids (Xue Zhi). Their specific morphological signs and symptoms are detailed in subsequent chapters. All hemorrhoids result from wind injury, imprudent sexual activity, or coitus after drunkenness and fullness. These factors disturb Qi and Blood, causing meridians to overflow and blood to seep into the intestines, rushing to the lower part. A lesion in one area is termed various hemorrhoids, not a single hemorrhoid formed by multiple diseases. If hemorrhoids persist without healing, they transform into fistulas. (*Zhu Bing Yuan Hou Lun*)
The *Neijing* states: Due to overeating, tendons and veins become relaxed and transverse, leading to intestinal pathology that becomes hemorrhoids. The manifestations of hemorrhoidal disease are numerous and can be inferred by analogy. (*Shengji Zonglu*)
Generally, the five types of hemorrhoids arise from physical debility and indulgence in the Five Pungents, Five Flavors, chicken, fish, and meat. Heat toxins congest into the Large Intestine, fluids fail to circulate, and Qi and Blood stagnate. Other causes include prolonged sitting, holding stool for too long, washing with cold water or river water, coitus after drinking alcohol, walking in summer heat, and sitting on hot surfaces then moving to cold ones. Various factors contribute to this disease. (*Benshi Xuji*)
Heat damages Blood; damaged Blood causes meridian stagnation; stagnant meridians prevent Qi circulation. When both Qi and Blood stagnate and sink due to deficiency into the Large Intestine, hemorrhoids form. (*Zhizhi Fang*)
There are five types of hemorrhoids: Mu Zhi, Chang Zhi, Xue Zhi, Pin Zhi, and Mai Zhi. Investigating their origin, they are all caused by pre-existing heat toxins, excessive consumption of roasted foods and new wine, prolonged sitting leading to poor blood circulation, or emotional stagnation (Seven Emotions) blocking the Zang-Fu organs. The toxin cannot dissipate and erupts as hemorrhoids.
Some hide inside the anus, while others protrude externally. Large ones resemble lotus flowers, rooster combs, or walnuts; small ones resemble nipples, chicken hearts, rat tails, or cherries. There are many names and shapes, but essentially all are caused by internal toxin accumulation. Deep toxin accumulation results in larger shapes; shallow accumulation results in smaller shapes. Some discharge pus and fluid, others bleed fresh blood. Patients suffer greatly during movement and rest. If untreated for a long time, Qi and Blood weaken, inevitably leading to fistulas. (*Waike Dacheng*)
Roughly, coitus after drunkenness and fullness causes meridians to relax, or essence and Qi to leak. Once meridians are deficient, toxins from food and drink flow in due to deficiency. Or, excessive sexual desire consolidates essence, transmitting it to the Large Intestine. Or, excessive intake of rich flavors causes this disease. The pathogen involves Dryness Qi, while the disease nature is Damp-Heat. (Note: These two sentences originate from *Lanshi Micang*, where "Damp-Heat" is written as "Stomach Dampness".) Treatment should employ agents to purge Fire, harmonize Blood, moisten Dryness, and disperse Wind. (*Waike Fahui*)
Hemorrhoids arise from accumulated Damp-Heat, excessive consumption of roasted foods, prolonged sitting obstructing blood vessels, emotional excess damaging cold/raw foods, carrying heavy loads, strenuous travel causing chaotic Qi and Blood and intersecting meridians, and excessive alcohol and sex injuring the intestines and stomach. This leads to turbid Qi and stasis flowing to the anus, triggering hemorrhoids. This condition affects men and women of all ages. Some originate internally and protrude externally. Treatment distinguishes between internal and external approaches. Large lesions resemble lotus flowers, honeycombs, flipping flowers, rooster combs, water caltrops, or coral. Small lesions resemble cherries, rat tails, nipples, chicken hearts, walnuts, or clam meat. Deep toxin accumulation yields strange and stubborn shapes; shallow accumulation yields normal shapes. Long-term cases collapse into fistulas; new cases present with swelling, pain, and stabbing sensations. Severe cases involve feces exiting through holes and blood flowing from orifices, daily damaging Qi and Blood and wasting the physique. Without early treatment, it eventually harms life. (*Waike Zhengzong*)
**Pathogenesis: Accumulated Blood in the Lower Jiao**
All hemorrhoids result from alcohol, wheat products, and roasted foods accumulating heat and damaging Blood. Evil blood clusters in the Lower Jiao, failing to unblock, and sinks to form hemorrhoids. Patients often experience obstruction of urination and defecation, abdominal urgency, and a sensation of wanting to rinse the mouth without swallowing, indicating clear evidence of accumulated heat-blood in the Lower Jiao. This is also reflected by a surging pulse at the Chi position. The appropriate formula is Zhuyu Tang (Blood Stasis Expelling Decoction), provided bowel and bladder movements are unobstructed. (*Zhizhi Fang*) (Note: Zhuyu Tang contains Chuanxiong Rhizoma, Angelicae Dahuricae Radix, Rehmanniae Radix Preparata, Paeoniae Radix Rubra, Trogopteri Dung, Aurantii Fructus, Colla Corii Asini, Curcumae Radix, Poria, Polyporus, Akebiae Caulis, Glycyrrhizae Radix et Rhizoma Preparata, Rheomi Radix et Rhizoma, Persic Semen, Zingiberis Rhizoma Recens, and Jujubae Fructus, decocted in water.)
**Pulse Diagnosis**
A deep, small, and solid pulse indicates easy treatment; a floating, surging, weak, and soft pulse indicates difficult recovery. (*Yixue Zhengchuan*)
**Symptoms of Various Hemorrhoids**
* **Mu Zhi (Male Hemorrhoid):** Flesh protruding outside the anus like a rat's teat, frequently discharging pus and blood.
* **Pin Zhi (Female Hemorrhoid):** Swelling and sores at the anus with bleeding. (Note: *Waitai Mi Yao* cites Cui Shi calling this "Jiu Zhi" / Alcohol Hemorrhoid).
* **Mai Zhi (Vascular Hemorrhoid):** Sores at the anus, alternating itching and pain, with bleeding.
* **Chang Zhi (Intestinal Hemorrhoid):** Swollen nodules at the anus, pain, chills, fever, and bleeding.
* **Xue Zhi (Blood Hemorrhoid):** Clear blood flows out during defecation. (*Zhu Bing Yuan Hou Lun*) (Note: Cui Shi's five types include Qi Hemorrhoid but exclude Vascular Hemorrhoid; Qi Hemorrhoid symptoms match the following description.)
Additionally, there is **Jiu Zhi (Alcohol Hemorrhoid)**: sores at the anus with bleeding.
And **Qi Hemorrhoid**: difficulty in defecation with bleeding, anal prolapse that remains out for a long time. (*Ibid.*)
The five hemorrhoids are: 1. Mu Zhi, 2. Pin Zhi, 3. Mai Zhi, 4. Chang Zhi, 5. Xue Zhi. Additionally, there is Qi Hemorrhoid, which flares up with changes in temperature, labor, dampness, and humidity; treated with Snake Slough.
* **Mu Zhi:** Flesh grows like a rat's teat inside the orifice, protruding slightly, hindering defecation; treated with Turtle Carapace.
* **Pin Zhi:** (*Jiyan Fang* calls it Jiu Zhi): Arises from the orifice, external swelling, self-ulcerates after 5-6 days discharging pus and blood; treated with Ground Beetle Skin.
* **Chang Zhi:** Prolapses during defecation, retracts slowly; treated with Pig's Left Hind Hoof Suspended Nail.
* **Mai Zhi:** Clear blood flows during defecation; treated with Honeycomb. (*Qianjin Yaofang*) (Note: *Waitai Mi Yao* cites *Jiyan Fang* similarly; *Yixin Fang* cites *Longmen Fang* with slight differences. The original text specifies these five medicines be sifted, taken in equal parts, doubling the main herb according to the disease.)
1. Rectal growth resembling a rat's teat or cherry/soybean, bleeding or discharging pus, named Rat Teat Hemorrhoid.
2. Large teat-like swelling at the anus, painful and swollen without pus/blood, named Alcohol Hemorrhoid, triggered by drinking.
3. Hard nodule at the anus, unbearable pain, blood in stool, triggered by worry/thought or cold/heat imbalance, named Qi Hemorrhoid; or constipation with Qi blockage, bloody stool, sallow complexion, anorexia, named Labor Hemorrhoid.
4. Pus and blood after defecation, severe pain/stinging, rectal prolapse, named Prolapsed Rectum Hemorrhoid.
5. Qi attacking the kidneys, constipation, bloody stool, dark red/black color, unrelenting heat/toxin, anal dampness/itching feeling like insects crawling, named Wind-Heat Internal Hemorrhoid. (*Benshi Xuji*)
**Discussion on Twenty Types of Hemorrhoid Formulas**
Flipping Flower, Prolapsed Rectum, Internal Intestine, Heat Hemorrhoid, Lotus Seed, Rat Teat, Rooster Comb, External Intestine, Cherry, Wind Hemorrhoid, Qi Hemorrhoid, Food Hemorrhoid, Sparrow Tongue, Coiling Snake, Honeycomb, Mountain Peach, Penetrating Intestine. (*Shizheng Lei Bei Ji Waike Jingyao*) (Note: Original text details each, but names are often abstract and impractical, so not fully recorded.)
**Internal vs. External Hemorrhoids** (Refer to external treatments below)
Xu Renze states: This disease has internal and external hemorrhoids. Internal hemorrhoids bleed upon defecation. External hemorrhoids differ: they have pores at the lower part, bleeding from the pore. Internal hemorrhoids bleed every time one defecates. Severe bleeding can hit the ground creating a hole; excessive bleeding causes pallor. Some are painful, some are not. (*Waitai Mi Yao*)
**Prognosis: Difficulty and Severity**
Early stage: Shape like a nipple, no swelling/redness, no pus/pain, asymptomatic during walking = Mild.
Established: Periodic swelling/pain, triggered by fatigue, soft or hard, yellow fluid at tip = Mild.
Long-term: Shapes like rooster comb, honeycomb, lotus, flipping flower, continuous pus/blood discharge = Severe.
Chronic Fistula: Orifice connects to buttocks/legs, dripping pus, unceasing pain, feces exiting through orifice = Adverse/Difficult. (*Waike Zhengzong*)
**Treatment Principles**
Treatment must strictly avoid toxic drugs or immediate surgical excision, which often cause delays. One should use stable decoctions for gradual effect. (*Jisheng Fang*)
The general principle is to first clear heat, harmonize blood, and regulate Qi. (*Zhizhi Fang*)
Hemorrhoid fistula symptoms are numerous and belong to surgery, so citations are omitted. Since blood comes from within, external applications alone are insufficient. Use Zhizhi San (Formula missing; Father suggests Baizhi San using Platycladi Cacumen and Angelicae Dahuricae Radix from *Wei Shi* for hematochezia) swallowed with Diaochang Wan (*Heji Jufang*). For active hemorrhoids with heavy bleeding, internal support is needed: use Qianjin Neibu San, reducing Guizhi by half and adding Testudo Carapax Ash. (*Waike Shuyao*)
**Early Stage Treatment**
If painful with constipation or difficult urination: Clear heat, cool blood, moisten dryness, disperse wind.
If Qi/Blood deficiency with cold damage: Regulate Spleen/Stomach, nourish Yin/Essence.
If ulcerated and chronic, becoming fistulas (penetrating buttocks, yin, or intestine): Nourish Yuan Qi and Yin Essence primarily.
Constipation/pain: Moisten dryness, drain dampness.
Anal heaviness/pain: Purge fire, drain dampness.
Heaviness/swelling/itching: Disperse wind, overcome dampness.
Swelling/pain with difficult urination: Clear Liver, guide dampness.
Hemorrhoids with hernia, or hernia with chancre: Deficiency of Liver/Kidney. Use Liuwei Dihuang Wan and Buzhong Yiqi Tang to nourish the source. Pure cold/cool herbs for fire will cause disaster. (*Waike Shuyao*) (Edited from *Yixue Rumen*)
For early/established stages enlarging with painful constipation: Moisten dryness, nourish Yin.
Anal heaviness, blood loss, intermittent hard pain: Clear fire,渗 dampness.
Purple pain, virtual constipation with itching: Cool blood, disperse wind, vent Damp-Heat.
Swelling/hardness, tenesmus, difficult defecation: External fumigation/washing, internal purgation.
Internal hemorrhoids with blood loss and irreducible prolapse: Strengthen Spleen, raise Middle Qi.
Pre/Post-defecation bleeding, sallow complexion, palpitations/tinnitus: Nourish Blood, strengthen Spleen.
To cure hemorrhoids permanently, caustic agents are necessary; to heal the orifice, sexual abstinence is required. (*Waike Zhengzong*)
**Comprehensive Drug Review**
Methods: Bitter-Cold to purge Fire (Scutellariae Radix, Coptidis Rhizoma, Gardeniae Fructus, Sophorae Flos). Acrid-Warm to harmonize Blood (Angelicae Sinensis Radix, Chuanxiong Rhizoma, Persic Semen). Wind below: Lift with Ginseng Radix, Saposhnikoviae Radix, Cimicifugae Rhizoma. Dryness-Heat constraint: Rheomi Radix et Rhizoma, Hemp Seed, Aurantii Fructus. (*Yixue Zhengchuan*)
Kun Gang notes: Ancient formulas for hemorrhoid fistula bleeding used ashes of Sophorae Fructus, Artemisiae Argyi Folium, Trogopteri Dung, Honeycomb, Ox Horn Scale, Juglans Semen, mixed with wine. These are Caustic Hemorrhoid methods. Decoctions use Saposhnikoviae Radix, Gentianae Macrophyllae Radix, Gleditsiae Sinensis Spina, Schizonepetae Herba, Angelicae Dahuricae Radix for Wind-Heat entering Zang. Mangxiao, Dahuang, Arecae Semen, Zhaishi for Excess Heat requiring purgation. Picrasmae Rhizoma, Sophorae Flavescentis Radix, Nelumbinis Semen, Strychni Semen for Excess Heat requiring clearing. Persic Semen, Carthami Flos, Pseudolewisiae Herba, Sappan Lignum for unresolved Blood Stasis. Armeniacae Semen Amarum, Cannabis Fructus, Rehmanniae Radix, Phellodendri Cortex for Dryness lacking fluids. Sanguisorbae Radix, Ai Ye, Calcitum, Cornu Cervi Degelatinatum to stop bleeding strongly. Elephant Tusk, Silphae Mummia, Human Hair, Cancer Claws to reduce prolapse and apply external meds. Fumigation, washing, suppositories for caustic/hemostatic effects. Suppositories, thread ligation for removing necrotic tissue. Medicine is like warfare; masters adapt flexibly beyond rigid texts. (*Bencao Gangmu*)
Li Dongyuan divided treatment into Damp, Heat, Wind, Dryness. Generally, purging stasis-heat herbs like Trogopteri Dung, Gleditsiae Sinensis Spina, Arecae Semen, Dahuang, Persic Semen are essential. Add Qianghuo, Fangfeng, Shengma, Chaihu for Wind-Toxin. Ma Huang, Ligustici Rhizoma et Radix for sweating if severe. Qinjiao, Danggui, Huangqi for Dryness. Cangzhu, Huangbai, Ze Xie, Fuling for Damp. Huangqin, Huanglian, Yuliren, Shengdihuang for Heat. Shan Zha Pian, Danggui Wei for Pus/Blood. Gegen, Xiaodou, Shengdihuang, Shaoyao, Fuling, Banxia for Alcohol Hemorrhoid. Zhike, Chenpi, Muxiang, Zisuye for Qi Hemorrhoid. Huanglian, Zhishi, Shenqu, Huangbai for Food Stagnation. Rush Xiang, Moyao for extreme pain. Xuyutan for heavy bleeding. Renshen, Huangqi for Qi deficiency. Ejiao, Aiyi for Blood deficiency. Do not stick to ancient formulas. For refractory Blood Hemorrhoids, Shimai (Stone Coal) and Xiaohua taken with Wumei Decoction on an empty stomach are miraculous. (*Yizong Jinjian*)
**External Treatment Examples**
Modern methods often cut ligate hemorrhoids. Drugs alone cannot remove toxins from flesh, leading to recurrence or fistulas. Oral/topical drugs show little efficacy. Reason: External manifestation requires topical caustic/anti-hemorrhoid agents until toxin clears. Avoid Arsenic (Pishuang) to prevent sudden death. (*Waike Dacheng*)
For Internal Hemorrhoids: First purge bowels. Apply Huanzhi San to anus to induce prolapse. Wash with Scallion Soup. Apply Kuzhi San (Caustic Hemorrhoid Powder) morning, noon, night. Wash with warm water before each application. Light cases: 7 days; Heavy: 11 days. Hemorrhoid turns black/hard. Stop caustic agent. Pus drains from fissures. Switch to Qizhi Tang wash once daily. After shedding, apply Shengji San or Fengchu Gao to regenerate tissue. Weak patients take tonics. Healing in 15 days.
For External Hemorrhoids: Wash with Xiaodu San, apply Kuzhi San same as internal. Healing takes 100 days before resuming intercourse.
For penetrating chronic fistulas: Two special formulas (Zhidu Wan, Bi Guan Wan) follow. No needles/knives/thread needed. Effect is swift. (*Waike Zhengzong*)
External treatment distinguishes internal/external. Internal: Huanzhi (Inducing) and Kuzhi (Caustic) methods. External: Wash/Cool if painful; Ligature if head large/stalk small; Caustic if head small/root large. (*Yizong Shuoyue*) (Edited from *Yangyi Daquan*)
**Complications**
Treatments vary (see above). Fistula types: Cold Fistula, Stasis-Pus Fistula, Blood Fistula. (*Shizheng*)
Hemorrhoid bleeding may have a separate small orifice near the anus, leaking blood like a thread, distinct from the bowel channel. Chronic hemorrhoids perforate, leaving open wounds that never close, becoming fistulas. (*Zhizhi Fang*)
Single Fistula: No hemorrhoid, but a separate orifice left/right of anus discharging pus/blood. Treat internally with warming tonics, externally with tissue-regenerating ointments. Cutaneous fistulas heal easily; visceral involvement is difficult. (*Waike Dacheng*)
Etiology: Excessive alcohol/sex generates Damp-Heat, filling Zang-Fu, overflowing meridians, sinking to the anus, forming hemorrhoids, which become fistulas over time. Hemorrhoids are mild/excess; Fistulas are severe/deficient. Treating hemorrhoids: Cool blood/clear heat. Treating fistulas: Initially cool blood/clear heat/dry damp; later astringe orifice/expel parasites/warm-disperse. Why use warm/astringent if Fire is root? Hemorrhoids bleed (Heat); Fistulas drain pus (Initially Damp-Heat, finally Damp-Cold). Warm herbs are needed to resolve Damp/Cold. Many diseases start Hot and end Cold (e.g., diarrhea/vomiting: initially Excess-Heat, finally Deficiency-Cold). Zhu Danxi noted: Chronic bleeding requires warm agents later. (*Danxi Fuyu*)
*Neijing*: "Veins sinking become fistulas, lingering in muscle layers." Caused by incomplete drainage of ulcers plus emotional/climatic factors. Early: Pale red, slight swelling/nodules. Late: Dry white exterior, black rot interior, foul-smelling parasites. Treatment: Tonify Qi/Blood. Externally, mix Black Aconite Root powder with saliva into coins, moxa burn according to fistula size. Keep mildly warm, not painful. Change when dry, stop if fatigued. Resume next day until flat. Continue oral tonics. (*Yizong Jinjian*)
Post-ulceration, fistulas often fail to close due to pure bitter-cold internal/external use damaging Spleen Yang, preventing tissue growth. Or, physicians misuse knives/needles/thread/lithotripsy/scissors, damaging healthy flesh, grinding new tissue into hard tubes via repeated insertion. This is physician error. However, patients who continue drinking, sexual indulgence, and spicy/fried diets despite painless pus/blood drainage also cause fistulas. Even without surgical harm, fistulas form. Ignorant people claim fistulas cannot be cured, suggesting keeping the orifice open for Damp-Heat exit. This is wrong. Kidney opens to the two yin orifices; the anus is the Kidney's gate. Chronic bleeding drains True Yin and Righteous Qi, leading to Consumption Disease (Lao Zhai). If Damp-Heat originates from the Large Intestine...