人有脱肛者，一至大便，则直肠脱下，而不肯收，久则涩痛，人以为肠虚下陷
也，谁知阳气之衰，不能升提乎。夫脱肛之症，半成于脾泄，泄多则亡阴，阴亡必至下
坠，而气亦下陷，肠中湿热之污秽，反不能速去为快，于是用力虚努，过于用力，直肠随努
而下矣。迨至湿热之邪已尽，脱肛之病已成，必须升提阳气，佐之去湿去热之剂。然而，提
气非用补气之药则气不易升，补气不用润肠之味则肛无难脱，要在兼用之为妙也。方用提肠汤∶
人参（三钱） 黄 （五钱） 当归（三钱） 白芍（一两） 升麻（一钱） 茯苓（三
钱） 槐米（一钱） 薏仁（五钱）
水煎服。连服四剂，肛肠渐升而入。再服四剂，不再脱。
此方补气以升提，则气举于上焦，一身之滞气自散。润肠则肠滑，湿热自行矣。
此症亦可用加味补血汤∶
黄 当归（各五钱） 升麻（一钱） 北五味子（十粒）连服十剂全愈。
人有不必大便而脱肛者，疼痛非常，人以为气虚下陷也，谁知大肠之火奔迫而出之乎。
夫大肠属金，原属于肺，肺与大肠为表里，休戚相关。大肠不胜火气之炎烧，不得已欲求救
于肺，而肺居膈上，远不可救，乃下走肛门，聊为避火之计。肛
门既属于肺，大肠畏火，岂肛门独不畏火耶。况魄门与大肠，既有同气之好，祸难相救，
宁忍坐弃，故以己之地方甘心让客，而己身越境，以避其气，此肛门、直肠所以脱出于粪
门之外也。疼痛者，火焚被创，无水以养，故干燥而益疼也。此等之病，用升提之法，全然
不效，反增其苦楚。盖升提之药，多是阳分之品，阳旺则阴虚，阴虚则火益胜，安有取效之
日哉。治法宜急泻其肠中之火，火息而金自出矣。然而大肠之火不生于大肠也。胃火盛而
大肠之火亦盛，肾水干而大肠之水亦干，单治大肠之火，而不泻胃中之火，单治大肠之水，
而不益肾中之水，则大肠之水不生，而大肠之火亦不息，何以使大肠之气返于腹中，肛门之
肠归于肠内哉？方用归肠汤∶
玄参（一两） 石膏（三钱） 熟地（一两） 丹皮（三钱） 当归（三钱） 地榆（
三钱） 槐花（二钱） 荆芥（炒黑，三钱）水煎服。一剂痛安，再剂肠升，三剂全愈。
此方胃肾同治，兼去清大肠之火。水源不断，则火气自消，有不急返者乎。客去而
主归，此必然之理也。
此症用榆地玄归汤亦效。
地榆（三钱） 当归（一两） 玄参（一两） 生地（一两）水煎服。连用十剂全愈。
有人患脱肛症，每次大便时，直肠就会脱出体外，无法自行收回。时间久了会出现涩痛感。人们认为这是肠道虚弱导致下陷，但谁知道这是因为阳气衰弱，不能升提呢？
脱肛这种病症，多半是由脾虚泄泻发展而来的。腹泻次数多会导致阴液耗损，阴液亡失必然引起下坠感，同时气机也随之陷入。此时，肠中湿热产生的污秽之物，反而不能迅速排出而感到不快。于是患者因正气虚弱而勉强努责用力，如果用力过猛，直肠就会随着努责的动作而脱出。
等到湿热之邪已经排尽，脱肛的病情已经形成，必须使用升提阳气的药物，并配合祛湿清热的药剂。然而，提升气机如果不使用补气药，气就不容易上升；使用补气药如果不配合润肠的药物，肛门就容易再次脱出。关键在于兼用这些药物才为妙法。方剂使用提肠汤：人参（三钱）、黄芪（五钱）、当归（三钱）、白芍（一两）、升麻（一钱）、茯苓（三钱）、槐米（一钱）、薏苡仁（五钱）。水煎服。连续服用四剂，肛肠逐渐回升并纳入体内。再服用四剂，就不再脱出了。
此方通过补气来升提，气机举于上焦，全身的气滞自然消散。润肠则使肠道滑利，湿热之邪自然消除。
此症也可以使用加味补血汤：黄芪、当归（各五钱）、升麻（一钱）、北五味子（十粒）。连续服用十剂即可痊愈。
还有的人即使不需要大便也会发生脱肛，疼痛非常剧烈。人们认为是气虚下陷，但谁知道这是大肠之火奔迫逼迫所致呢？
大肠属金，原本归属于肺，肺与大肠互为表里，关系密切。大肠承受不住火气的焚烧，不得已想要向肺求救，但肺位于膈肌之上，距离太远无法救援，于是火气向下走向肛门，姑且作为躲避火势的办法。既然肛门属于肺所主，大肠畏惧火邪，难道肛门就独自不畏惧火邪吗？况且魄门（肛门）与大肠，既有同气相求的关系，在祸难面前互相救助，哪里忍心坐视不管而抛弃它呢？所以肛门甘愿让出自己的位置，自身越界而出，以避开火气，这就是肛门和直肠从肛门内脱出于体外的原因。之所以疼痛，是因为火焚造成了损伤，没有津液滋养，所以干燥而更加疼痛。
这类疾病，如果使用升提的方法，完全无效，反而会增加痛苦。因为升提的药物，大多是阳分性质的药材，阳气旺盛则阴液更虚，阴液虚则火邪更盛，怎么会有见效的日子呢？治疗方法应当急于泻除肠中的火邪，火熄灭后，金（肺/大肠之气）自然回归。然而，大肠的火并非产生于大肠本身。胃火旺盛，大肠的火也旺盛；肾水干枯，大肠的水也干枯。如果只治疗大肠的火，而不泻胃中的火；只补大肠的水，而不益肾中的水，那么大肠的水就无法生成，大肠的火也无法平息，怎么能使大肠之气返回腹中，肛门的肠管回归肠内呢？方剂使用归肠汤：玄参（一两）、石膏（三钱）、熟地黄（一两）、牡丹皮（三钱）、当归（三钱）、地榆（三钱）、槐花（二钱）、荆芥（炒黑，三钱）。水煎服。服用一剂疼痛安定，两剂肠管回升，三剂完全痊愈。
There are cases of rectal prolapse where, upon defecation, the rectum protrudes and refuses to retract. Over time, this leads to a sensation of obstruction and pain. People attribute this to intestinal deficiency causing sinking, but who knows that it is actually due to the decline of Yang Qi (vital energy), which fails to lift and support?
The condition of rectal prolapse often originates from Spleen Deficiency Diarrhea (chronic diarrhea due to spleen weakness). Frequent diarrhea consumes Yin fluids (body fluids and essence). When Yin is depleted, it inevitably leads to a sensation of bearing down, and Qi also sinks. Consequently, the damp-heat filth within the intestines cannot be expelled quickly, causing discomfort. The patient then strains with weak effort; if the straining is excessive, the rectum follows the strain and prolapses.
Once the damp-heat pathogenic factors have been exhausted and the rectal prolapse is established, it is necessary to lift and raise Yang Qi, assisted by agents that remove dampness and clear heat. However, lifting Qi requires Qi-tonifying herbs for effective elevation; tonifying Qi without lubricating the intestines leaves the anus prone to prolapse. The key lies in combining these approaches. The prescription Ti Chang Tang (Intestine-Lifting Decoction) is used: Ren Shen (Ginseng Radix, 3 qian), Huang Qi (Astragali Radix, 5 qian), Dang Gui (Angelicae Sinensis Radix, 3 qian), Bai Shao (Paeoniae Radix Alba, 1 liang), Sheng Ma (Cimicifugae Rhizoma, 1 qian), Fu Ling (Poria, 3 qian), Huai Mi (Sophorae Flos, 1 qian), Yi Ren (Coicis Semen, 5 qian). Decoct in water and take orally. After four doses, the anal canal gradually rises and retracts. After another four doses, prolapse ceases.
This formula tonifies Qi to lift it, raising Qi to the Upper Jiao (Upper Burner), thereby dispersing stagnation throughout the body. Lubricating the intestines makes them smooth, allowing damp-heat to dissipate naturally.
This condition can also be treated with Jia Wei Bu Xue Tang (Modified Blood-Nourishing Decoction): Huang Qi (Astragali Radix, 5 qian), Dang Gui (Angelicae Sinensis Radix, 5 qian), Sheng Ma (Cimicifugae Rhizoma, 1 qian), Bei Wu Wei Zi (Schisandrae Chinensis Fructus, 10 grains). Take continuously for ten doses for complete recovery.
In some cases, rectal prolapse occurs even without defecation, accompanied by severe pain. People attribute this to Qi deficiency and sinking, but who knows that it is caused by the rushing and forcing action of Fire in the Large Intestine?
The Large Intestine belongs to Metal and is originally associated with the Lung. The Lung and Large Intestine are exterior-interior pairs, closely related. Unable to withstand the burning of Fire, the Large Intestine seeks relief from the Lung. However, the Lung resides above the diaphragm, too distant to provide immediate aid. Thus, the Fire descends to the anus as a temporary refuge. Since the anus is governed by the Lung, and the Large Intestine fears Fire, does the anus not fear Fire as well? Moreover, the Po Men (Anal Orifice) and the Large Intestine share similar Qi and help each other in distress. How could they bear to abandon each other? Therefore, the anus willingly yields its space, moving out of bounds to avoid the Fire, which explains why the anus and rectum protrude outside the anal opening. The pain arises because the Fire burns and damages the tissue, lacking fluid nourishment, leading to dryness and increased pain.
For such diseases, using lifting methods is completely ineffective and only increases suffering. Lifting herbs are mostly Yang-natured substances; increasing Yang exacerbates Yin deficiency, and Yin deficiency intensifies Fire. How could there be any hope of efficacy? The treatment should urgently purge the Fire in the intestines. Once the Fire subsides, the Metal element (Lung/Large Intestine Qi) will naturally return. However, the Fire in the Large Intestine does not originate solely within it. Stomach Fire excess leads to Large Intestine Fire excess; Kidney Water dryness leads to Large Intestine Water dryness. If one treats only the Large Intestine Fire without purging Stomach Fire, or treats only Large Intestine Water without nourishing Kidney Water, the Large Intestine Water will not generate, and the Fire will not cease. How can Large Intestine Qi return to the abdomen and the rectal tube return inside? The prescription Gui Chang Tang (Intestine-Returning Decoction) is used: Xuan Shen (Scrophulariae Radix, 1 liang), Shi Gao (Gypsum Fibrosum, 3 qian), Shu Di Huang (Rehmanniae Radix Preparata, 1 liang), Dan Pi (Moutan Cortex, 3 qian), Dang Gui (Angelicae Sinensis Radix, 3 qian), Di Yu (Sanguisorbae Radix, 3 qian), Huai Hua (Sophorae Flos, 2 qian), Jing Jie (Schizonepetae Spica, stir-fried black, 3 qian). Decoct in water and take orally. Pain stabilizes after one dose, the intestine rises after two doses, and full recovery occurs after three doses.
This formula treats both the Stomach and Kidney simultaneously, clearing Fire from the Large Intestine. As long as the source of water is uninterrupted, Fire will naturally dissipate. Is it not inevitable that the guest (Fire) departs and the host (Qi) returns? This is a necessary principle.
Yu Di Xuan Gui Tang (Diyu-Xuanshen-Danggui Decoction) is also effective for this condition: Di Yu (Sanguisorbae Radix, 3 qian), Dang Gui (Angelicae Sinensis Radix, 1 liang), Xuan Shen (Scrophulariae Radix, 1 liang), Sheng Di Huang (Rehmanniae Radix Recens, 1 liang). Decoct in water and take orally. Continuous use for ten doses results in complete recovery.