王肯堂曰∶寒火疮生肛门外，溃烂如破，时流脂水，每晚发寒，继如火燎，多痒少痛是也。（《准绳》）
澄曰∶曾见江西班粮艘周姓患此，每晚必用矾末掺之，方能定痒安睡，想风湿相乘，湿邪化虫使然也。
林氏曰∶或问方书云∶脱肛有气虚者，有血虚者，有血热或火盛者，人患此四者
甚多，何遂至于脱肛也？答曰∶肛乃大肠之尽处，凡有形之糟粕从此而出，为人一
身之门户，虚滑则滞下不收，枯燥则坚涩而难于转出，皆足以致病，而必责之于一
气。盖凡有形之物，全赖无形之元气以转运出入，且肺与大肠为表里，而肺正统一
身之元气，故人之登圊，亦由元气为之传导，使大肠有形之糟粕，得以传导而出，出
已则清升之气复自下而上达于脏腑腠理四肢，是为常度。若脾肺久虚，气血亏损，则
统运转输之机不利，全藉勉力努送而出。久久气滞，则肛门因之脱下矣。其次有病久
气虚，气陷而自脱者；亦有气虚不能传导，而血随因之枯涩，于是努力挣脱者；有阳
明燥火亢极而热结便燥难出，因用力强挣，火性下迫肛门脱出者；有老年血燥，或产
后血虚，液燥结滞难下，气弱无力以送，勉强挣脱者。有久泻或久痢，气血两虚，湿
热下陷于大肠，因而滑脱者；有小儿亦因泻痢气虚，湿火下迫而脱者，总由气血不
和，失其转输传导出入升降之常度，则有是证。自在医者参其脉证，体其虚实以治
之。（《活人录汇编》）
又曰∶久病虚陷自脱者，脉必虚微无力，以补气升提为主；气虚血竭，努力挣
脱者，脉必涩弱而虚数，当以益气之中，加补血润燥升清之剂；大肠实火燥结，肛门
肿痛而下迫者，其脉洪大而数，或沉实有力，以清火解毒之中，佐以升提；老年产
后，总由气虚血少，脉必涩数无力，当以滋补升提；久泻久痢，无论大小脉，必虚
微沉弱，虽主补益升提；倘余病未清，则清补相兼。（《活人录汇编》）
《医论选要》曰∶脱肛治法，内宜温胃浓肠，收敛解毒之剂，外宜温汤频洗令和软，然后摩挲而入，则自愈矣。
冯鲁瞻曰∶夫肺与大肠为表里，肛者大肠之门也，肺实则温，温则内气充而有
所蓄。虚则寒，寒则内气馁而不能收。是以肠头出露矣。多得于久痢不止，里急后
重，努力肛开，外风所吹而致者；或伏暑暴注洞泻，肠头不禁者；或禀赋怯弱，易
于感冷，啼叫努气，大肠虚脱者。盖泻痢未有不因风、暑、湿、热伤脾，脾虚则肺
气即弱，大肠亦虚，土为金母，母虚不能生金，是以少被风冷，则肠头即为虚脱。治
宜补脾温胃，使金受母之益而上升，次投固肠之剂。外用熏掺等方，若久出而坚者，先以温暖药汤浇软，渐渐纳入。
又曰∶肛门为大肠之使，大肠受热受寒，皆能脱肛。且大肠者传导之官，肾者
作强之官，酒色过度，则肾虚而盗泄母气，肺因以虚，大肠气无所主，故令脱肛。小
儿血气未壮，老人血气已衰，皆有此证。
按丹溪所论，脱肛因气虚血虚者固多，亦有因气热血热者，宜兼脉候详察。气虚
者补气，参、 、术、草、制升麻之类；血虚者四物汤；血热者凉血，四物汤加炒柏；
气热者条芩、升麻之类，并宜升提。
王肯堂说：寒火疮生在肛门外，溃烂如同破损，时常流出脂水，每晚发作时先感到寒冷，随后又如火烧般灼热，大多瘙痒而疼痛轻微。这是所说的寒火疮。（出自《医学准绳六要》）
顾世澄说：我曾见过江西班粮船上一位姓周的人患此病，每晚必须用明矾末撒在患处，才能止痒安睡，我想这是因为风湿邪气相互侵袭，湿邪化生虫体所致。
林氏说：有人问医书说：脱肛有因气虚的，有因血虚的，有因血热或火盛的，人患这四种情况很多，为什么最终会导致脱肛呢？回答说：肛门是大肠的尽头，所有有形的糟粕都从这里排出，是人体一身的重要门户，如果虚弱滑利就会导致痢疾不止、肛门不收；如果干枯燥涩就会导致大便坚硬难出，这些都足以致病，但归根结底都要归责于“气”。因为凡是有的形体之物，全赖无形的元气来转运出入，而且肺与大肠互为表里，而肺正统一身之元气，所以人上厕所排便，也是由元气来传导，使大肠中有形的糟粕得以传导排出，排完后清升之气又从下向上通达于脏腑、腠理和四肢，这是正常的规律。如果脾肺长久虚弱，气血亏损，那么统摄运转输布的机能就不利，全靠勉强用力努挣才能排出。久而久之气机阻滞，肛门就会因此脱出。其次，有病久气虚，气陷导致自然脱出的；也有气虚不能传导，导致血液随之枯涩，于是努力挣脱而出的；有阳明经燥火亢盛至极导致热结便秘难以排出，因用力强挣，火性向下逼迫导致肛门脱出的；有老年人血燥，或产后血虚，津液干燥结滞难下，气弱无力推送，勉强挣脱而出的。有久泻或久痢，气血两虚，湿热下陷于大肠，因而滑脱的；有小儿也因泻痢气虚，湿火下迫而脱出的。总归都是由气血不和，失去了转输、传导、出入、升降的正常规律，才出现这种证候。自然应由医生参合脉象和证候，体察虚实来进行治疗。（出自《活人录汇编》）
又说：对于久病虚陷导致自然脱出的，脉象必定虚微无力，治疗以补气升提为主；气虚血竭，努力挣脱而出的，脉象必定涩弱而虚数，应当在益气之中，加入补血润燥升清的药剂；大肠实火燥结，肛门肿痛且伴有下迫感的，其脉象洪大而数，或沉实有力，治疗应在清火解毒之中，佐以升提之法；老年人或产后，总归是气虚血少，脉象必定涩数无力，应当以滋补升提为主；久泻久痢，无论大小脉象，必定虚微沉弱，虽然主补益升提；倘若余病未清，则清补兼施。（出自《活人录汇编》）
《医论选要》说：脱肛的治疗方法，内服宜用温胃厚肠、收敛解毒的药剂，外用宜用温水频繁清洗使其变软，然后按摩推入，就能自愈了。
冯鲁瞻说：肺与大肠互为表里，肛门是大肠的门户，肺实则温暖，温暖则内气充盛而有蓄积。肺虚则寒冷，寒冷则内气馁败而不能收敛。所以肠头就露出来了。多因久痢不止，里急后重，努力努挣导致肛门张开，被外风吹袭而致；或因伏暑暴注洞泻，肠头不能自持；或因禀赋怯弱，易于感受寒冷，啼叫努气，导致大肠虚脱。大概泻痢没有不是因为风、暑、湿、热损伤脾胃，脾虚则肺气即弱，大肠也虚，土为金之母，母虚不能生金，所以稍微受到风冷，肠头就会虚脱。治疗宜补脾温胃，使金（肺）受到母（脾）的益处而上升，其次投用固肠的药剂。外用熏洗、掺药等方子，如果久出且变硬的，先用温热药汤浇淋软化，渐渐纳入。
又说：肛门是大肠的使者，大肠受热或受寒，都能导致脱肛。而且大肠是传导之官，肾是作强之官，酒色过度，则肾虚而盗泄母气（脾土），肺因此虚弱，大肠气无所主，所以导致脱肛。小儿血气未壮，老人血气已衰，都有这种证候。
按丹溪所论述，脱肛因气虚血虚者固然多，也有因气热血热者，应当兼看脉候详细考察。气虚者补气，用人参、白术、甘草、制升麻之类；血虚者用四物汤；血热者凉血，用四物汤加炒黄柏；气热者用条芩、升麻之类，并宜升提。
Wang Kentang stated: Cold-fire sores (Hanhuo Chuang) arise outside the anus, ulcerating like broken skin, with intermittent discharge of serous fluid. Every night, chills occur first, followed by a sensation of burning heat; there is usually more itching and less pain. This is what is referred to as cold-fire sores. (From *Yixue Zhunsheng Liuyao*)
Cheng stated: I once saw a Mr. Zhou on a Jiangxi grain transport boat suffering from this condition. He had to apply alum powder (Fenmo) to the affected area every night to relieve itching and sleep peacefully. I believe this is caused by wind-dampness pathogens attacking each other, where dampness transforms into parasites.
Lin stated: Someone asked: Medical texts state that prolapse of the rectum (Tuogang) can be due to Qi deficiency, Blood deficiency, Blood heat, or excessive Fire. Many people suffer from these four conditions, so why does it lead to rectal prolapse? The answer is: The anus is the end of the large intestine. All有形 (tangible) waste exits through here. It serves as a gateway for the body. If deficient and slippery, dysentery occurs and the anus cannot close; if dry and rough, stool becomes hard and difficult to pass. Both can cause disease, but ultimately, responsibility lies with "Qi." Tangible objects rely entirely on intangible Yuan Qi (Original Qi) for transportation and entry/exit. Furthermore, the Lung and Large Intestine are exterior-interior partners. The Lung governs the Yuan Qi of the whole body. Therefore, defecation relies on Yuan Qi for transmission, allowing tangible waste in the Large Intestine to be expelled. After expulsion, clear ascending Qi rises from below to reach the Zang-Fu organs, interstices, and limbs. This is the normal pattern. If the Spleen and Lung are chronically deficient, and Qi and Blood are depleted, the mechanism of governance, transportation, and distribution becomes unfavorable. One must rely on forced straining to expel stool. Over time, Qi stagnation causes the anus to prolapse. Secondly, there are cases of chronic illness leading to Qi deficiency and sinking, causing spontaneous prolapse; cases where Qi deficiency fails to transmit, leading to dry and rough Blood, requiring forceful straining; cases where Yangming Dryness-Fire is extreme, causing heat accumulation and constipation, leading to prolapse due to forceful straining and the downward-pushing nature of Fire; elderly individuals with dry Blood or postpartum women with Blood deficiency and dry fluids, where weak Qi cannot push, requiring forced straining; cases of chronic diarrhea or dysentery with dual Qi and Blood deficiency, where damp-heat sinks into the Large Intestine causing sliding prolapse; and children with Qi deficiency from diarrhea/dysentery, where damp-fire pushes downward causing prolapse. In summary, all result from disharmony of Qi and Blood, losing the normal rhythm of transportation, transmission, entry/exit, and ascending-descending. Physicians should naturally examine pulse and symptoms to determine deficiency or excess and treat accordingly. (From *Huorenlu Huibian*)
It further states: For prolapse due to chronic deficiency and sinking, the pulse will be deficient, minute, and powerless; treatment focuses on tonifying Qi and lifting. For Qi deficiency and Blood exhaustion with forceful straining, the pulse will be choppy, weak, deficient, and rapid; treatment involves adding herbs for tonifying Blood, moistening dryness, and clearing/lifting to the Qi-tonifying formula. For excess Fire and dryness accumulation in the Large Intestine with painful swelling and tenesmus, the pulse will be surging and rapid, or deep and solid/powerful; treatment involves clearing Fire and resolving toxicity, assisted by lifting methods. For the elderly or postpartum, generally due to Qi deficiency and Blood scarcity, the pulse will be choppy, rapid, and powerless; treatment focuses on nourishing and lifting. For chronic diarrhea/dysentery, regardless of pulse size, it will be deficient, minute, deep, and weak; although tonification and lifting are primary, if residual pathogens remain, clearing and tonifying should be combined. (From *Huorenlu Huibian*)
*Yilun Xuanyao* states: The treatment for rectal prolapse involves internal administration of formulas that warm the Stomach, thicken the intestines, astringe, and resolve toxicity. Externally, frequent washing with warm water to soften the tissue, followed by massage and reduction, leads to self-healing.
Feng Luzhan stated: The Lung and Large Intestine are exterior-interior partners; the anus is the gate of the Large Intestine. When the Lung is Excess, it is warm; warmth means internal Qi is abundant and stored. When the Lung is Deficient, it is cold; cold means internal Qi is exhausted and cannot retract. Thus, the rectal mucosa protrudes. This often results from chronic dysentery without cessation, tenesmus, forceful straining opening the anus, and exposure to external wind; or from sudden violent diarrhea due to latent summerheat, causing loss of control over the rectal mucosa; or from constitutional weakness, susceptibility to cold, crying and straining, leading to Large Intestine deficiency prolapse. Generally, diarrhea and dysentery are caused by Wind, Summerheat, Dampness, or Heat damaging the Spleen. Spleen deficiency leads to weak Lung Qi and a deficient Large Intestine. Earth is the mother of Metal; if the mother is deficient, it cannot generate Metal. Therefore, slight exposure to wind-cold causes the rectal mucosa to prolapse due to deficiency. Treatment should focus on tonifying the Spleen and warming the Stomach, allowing Metal (Lung) to benefit from its Mother (Spleen) and ascend, followed by administering intestinal-astringing formulas. Externally, use fumigation and powder application. If the prolapsed tissue is long-standing and hardened, first soften it with warm medicinal decoctions, then gradually reduce it.
It further states: The anus is the envoy of the Large Intestine. Whether the Large Intestine is heated or chilled, it can cause prolapse. The Large Intestine is the official of transmission; the Kidney is the official of strength. Excessive alcohol and sexual activity lead to Kidney deficiency, which steals Qi from the Mother organ (Spleen), causing Lung deficiency. With no Qi governing the Large Intestine, prolapse occurs. Children with unconsolidated Qi and Blood, and the elderly with declining Qi and Blood, both present this syndrome.
According to Danxi's discussion, while prolapse is mostly due to Qi and Blood deficiency, it can also be due to Qi and Blood heat. One must carefully observe the pulse. For Qi deficiency, tonify Qi using Ginseng, Atractylodes macrocephala, Licorice, processed Cimicifuga, etc.; for Blood deficiency, use Siwu Decoction; for Blood heat, cool the Blood using Siwu Decoction plus fried Phellodendron bark; for Qi heat, use Scutellaria baicalensis and Cimicifuga, along with lifting methods.