《难经》云∶虚实出焉，出者为虚，入者为实，肛门之脱，非虚而何哉。盖实则温，温则内气充
而有所蓄；虚则寒，寒则内气馁而不能收。况大肠有浓薄，与肺为表里，肺脏蕴热则闭，虚则脱。本
草有云∶补可以去弱，涩可以去脱。若脱甚者，既补之必兼涩之。设不涩于内，亦须涩于外，古方用
五倍子末托而上之，一次未收，至五
七次必收而不复脱矣。久利、妇人、小儿、老人有此疾者，产育及久痢用力过多，小儿气血未壮，老
人气血已衰，故肛易于出，不得约束禁固也。肛门为大肠之候，大肠受热受寒皆能脱出，当审其因证，
寒者以香附子、荆芥等分，煎汤洗之。热者以五倍子、朴硝煎汤洗之。亦用木贼烧灰，不令烟尽，入
麝香少许，大便了、贴少许。或以五倍子末摊纸上贴肛，缓缓揉入。有肠头作痒，即腹中有虫。丈夫
因酒色过度。大肠者，传导之官。肾者，作强之官。盖肾虚而泄母气，肺因以虚，大肠气无所主，故
自脱肛。治法实元气去蕴热之剂，外用前药洗之，医治无不愈矣。大肠热甚与肠风者，凉血清肠散。
泻痢后大肠气虚，肛门脱出，不肿不痛，属气血虚。宜补气血为主。赤肿有痛，宜凉血祛风为主。补
气血，八珍汤、十全散。凉血，生 、赤芍、槐花、槐角、黄栝蒌、鸡冠花。疏风，防风、羌活、荆
芥。久泻痢者，补养脾胃，宜参术实脾汤。用力过多者，十全大补汤、参术芎归汤、诃子人参汤，内
加升提药。大肠虚而挟热，脱肛红肿，宜缩砂汤、槐花散、薄荷散。大肠虚而挟寒，脱肛不红肿，宜
皮散、香荆散。日久不愈，常宜服收肠养血和气汤。涩脱，龙骨散、
涩肠散。外治∶阳证，蟠龙散。阴证，伏龙肝散。五倍子末煎汤，加白矾洗。五倍、荆芥、小便浓煎
洗。荆芥、龙脑薄荷、朴硝煎汤洗。皂角捶碎，煎汤浸。生栝蒌捣汁浸。葱汤洗软，芭蕉叶托上。生
铁三斤，水一斗，煮取五升，出铁，以汁洗。内服瓷石散。鳖头烧灰涂。
《难经》说：疾病有虚证和实证的区分，脱出属于虚证，内陷属于实证。肛门脱出，难道不是虚证吗？一般来说，实证表现为温热，温热则体内正气充盛而有所蓄积；虚证表现为寒冷，寒冷则体内正气衰败而不能收敛。况且大肠的津液有浓稠与稀薄之分，大肠与肺互为表里，肺脏蕴结热邪则导致便秘，肺气虚弱则导致脱肛。本草书籍中说：补法可以去除虚弱，涩法可以消除滑脱。如果脱出严重的，在补益的同时必须兼用涩法。如果不从内部涩敛，也必须在外部使用涩药。古方常用五倍子粉末托举并收敛，一次未能收回，进行五到七次后必定能收回且不再脱出。长期腹泻、妇女、小儿、老人患有此病的，是因为分娩及久痢用力过多，小儿气血尚未强壮，老人气血已经衰退，所以肛门容易脱出，无法约束固摄。肛门是大肠的外候，大肠受热或受寒都能导致脱出，应当审察病因和证候。属寒证的，用香附子和荆芥各等分，煎汤清洗。属热证的，用五倍子和朴硝煎汤清洗。也可以用木贼烧成灰（不让烟烧尽），加入少许麝香，在大便后贴敷少许。或者用五倍子粉末摊在纸上贴在肛门处，慢慢揉入。如果有肠头作痒，说明腹中有虫。男子因酒色过度所致。大肠是传导之官。肾是作强之官。大概因为肾虚而耗泄母气（肺金为肾水之母，此处指子盗母气或肾精亏虚影响肺气），导致肺虚，大肠之气无所主司，所以自行脱肛。治疗方法应使用补元气、去蕴热的药剂，外用上述药物清洗，医治没有不痊愈的。大肠热甚伴有肠风的，用凉血清肠散。泻痢之后大肠气虚，肛门脱出，不肿不痛，属于气血虚弱。宜以补气血为主。赤肿且有疼痛的，宜以凉血祛风为主。补气血可用八珍汤、十全散。凉血可用生地黄、赤芍、槐花、槐角、黄栝蒌、鸡冠花。疏风可用防风、羌活、荆芥。长期腹泻痢疾者，补养脾胃，宜用参术实脾汤。用力过多者，用十全大补汤、参术芎归汤、诃子人参汤，内部加入升提药物。大肠虚弱而夹杂热邪，脱肛红肿，宜用缩砂汤、槐花散、薄荷散。大肠虚弱而夹杂寒邪，脱肛不红肿，宜用皮散、香荆散。日久不愈，常宜服用收肠养血和气汤。涩肠止脱，可用龙骨散、涩肠散。外治法：阳证用蟠龙散。阴证用伏龙肝散。五倍子粉末煎汤，加白矾清洗。五倍子、荆芥、小便浓煎清洗。荆芥、龙脑薄荷、朴硝煎汤清洗。皂角捶碎，煎汤浸泡。生栝蒌捣汁浸泡。葱汤洗软，芭蕉叶托上。生铁三斤，水一斗，煮取五升，取出铁块，用汁液清洗。内服瓷石散。鳖头烧灰涂敷。
The *Nan Jing* (Classic of Difficult Issues) states: "Deficiency and excess arise from [the nature of the disease]. Protrusion indicates deficiency, while retraction indicates excess." Is rectal prolapse not a case of deficiency? Generally, excess conditions manifest as warmth; warmth implies that internal qi is abundant and retained. Deficiency conditions manifest as cold; cold implies that internal qi is depleted and unable to retain. Moreover, the large intestine's fluids vary in thickness or thinness, and it forms an interior-exterior relationship with the Lung. If heat accumulates in the Lung, constipation occurs; if the Lung is deficient, prolapse ensues. The Materia Medica states: "Tonification can remove weakness, and astringency can eliminate prolapse." In cases of severe prolapse, tonification must be combined with astringency. If internal astringency is insufficient, external astringents are also required. Ancient prescriptions use powder of *Galla Chinensis* (Wubeizi, 五倍子) to support and retract the tissue. If one application fails to reduce it, five to seven applications will surely achieve reduction and prevent recurrence. This condition often affects those with chronic diarrhea, women, children, and the elderly. For women, excessive straining during childbirth and chronic dysentery contributes to it; for children, their qi and blood are not yet robust; for the elderly, their qi and blood have declined. Thus, the anus easily protrudes and cannot be constrained. The anus is the external manifestation of the large intestine. Both heat and cold affecting the large intestine can cause prolapse; therefore, one must examine the etiology and syndrome. For cold syndromes, wash with a decoction of equal parts *Rhizoma Cyperi* (Xiangfu, 香附子) and *Herba Schizonepetae* (Jingjie, 荆芥). For heat syndromes, wash with a decoction of *Galla Chinensis* (Wubeizi, 五倍子) and *Natrii Sulfas* (Puxiao, 朴硝). Alternatively, burn *Herba Equiseti* (Muzei, 木贼) to ash without letting the smoke escape completely, add a small amount of *Moschus* (Shexiang, 麝香), and apply a little after defecation. Or, spread *Galla Chinensis* powder on paper, apply to the anus, and gently massage it in. If the prolapsed tissue itches, it indicates intestinal parasites. In men, this may result from excessive alcohol and sexual indulgence. The large intestine is the official of conduction. The Kidney is the official of strength. Generally, Kidney deficiency depletes the mother qi (referring to the Metal-Water generation cycle where Lung is Mother of Kidney, implying Lung Qi deficiency due to Kidney essence depletion), leading to Lung deficiency. With no master of Qi in the large intestine, spontaneous prolapse occurs. Treatment involves using formulas to tonify primordial qi and clear latent heat, combined with external washing as described above; such treatment is invariably curative. For severe large intestine heat accompanied by wind-intestinal bleeding, use *Liangxue Qingchang San* (Cool Blood and Clear Intestine Powder). After dysentery or diarrhea, if the large intestine qi is deficient and the anus prolapses without swelling or pain, it belongs to qi and blood deficiency. Prioritize tonifying qi and blood. Use *Bazhen Tang* (Eight Treasure Decoction) or *Shiquan San* (Ten Complete Powder). For redness, swelling, and pain, prioritize cooling blood and dispelling wind. Use *Sheng Dihuang* (Radix Rehmanniae Preparata), *Chi Shao* (Radix Paeoniae Rubra), *Flos Sophorae* (Huaihua, 槐花), *Fructus Sophorae* (Huaijiao, 槐角), *Fructus Trichosanthis* (Gualou, 栝蒌), and *Flos Celosiae Cristatae* (Jiguanhua, 鸡冠花) to cool blood. Use *Fangfeng* (Radix Saposhnikoviae), *Qianghuo* (Rhizoma Notopterygii), and *Jingjie* (Herba Schizonepetae) to dispel wind. For chronic diarrhea and dysentery, tonify and nourish the Spleen and Stomach; use *Shenzhu Shipi Tang* (Ginseng and Atractylodes Spleen-Strengthening Decoction). For excessive straining, use *Shiquan Dabu Tang* (Ten Complete Great Tonifying Decoction), *Shenzhu Xiongui Tang* (Ginseng, Atractylodes, Ligusticum, and Angelica Decoction), or *Hezi Renshen Tang* (Chebula and Ginseng Decoction), adding herbs that lift qi internally. For large intestine deficiency with accompanying heat, presenting with red and swollen prolapse, use *Suosha Tang* (Amomum Decoction), *Huaihua San* (Sophora Flower Powder), or *Bohe San* (Mint Powder). For large intestine deficiency with accompanying cold, presenting with non-red, non-swollen prolapse, use *Pi San* (Bark Powder) or *Xiangjing San* (Cyperi and Schizonepeta Powder). For chronic non-healing cases, frequently take *Shouchang Yangxue Heqi Tang* (Intestine-Collecting, Blood-Nourishing, and Qi-Harmonizing Decoction). For astringing prolapse, use *Longgu San* (Dragon Bone Powder) or *Sichang San* (Intestine-Astringing Powder). External treatments: For Yang syndromes, use *Panlong San* (Coiling Dragon Powder). For Yin syndromes, use *Fulonggan San* (Settled Dragon Liver Powder). Wash with decoction of *Galla Chinensis* powder plus *Alumen* (Baifan, 白矾). Wash with strong decoction of *Galla Chinensis*, *Schizonepeta*, and urine. Wash with decoction of *Schizonepeta*, *Mentha Haplocalycis* (Longnao Bohe, 龙脑薄荷), and *Natrii Sulfas*. Crush *Gleditsia Sinensis* (Zaojiao, 皂角), decoct, and soak. Soak in juice of fresh *Trichosanthes kirilowii* (Gualou, 栝蒌). Soften with scallion water, support with *Musa basjoo* leaf (Bajiaoye, 芭蕉叶). Boil three jin (approx. 1.5 kg) of raw iron in ten dou (approx. 10 liters) of water until reduced to five sheng (approx. 2.5 liters), remove the iron, and wash with the liquid. Internally take *Cishi San* (Porcelain Stone Powder). Apply ash from roasted turtle head.