bubble_chart Concept

Hemorrhoids, also known as piles, refer to the condition where blood vessels at the end of the rectum and around the anus become congested, forming small protrusions of tissue. This condition is accompanied by symptoms such as bleeding, pain, and prolapse.

Yixue Gangmu．痔 fistula disease》 states: "Just as small hills protrude in a vast marsh, so do hemorrhoids protrude. In humans, any small protrusions of flesh in the nine orifices are called hemorrhoids, not just those around the anus." Therefore, there are several types, including nasal polyps and ear piles. This entry discusses hemorrhoids that occur at the end of the rectum and around the anus.

bubble_chart Pattern Analysis

1. Wind-fire Dryness Accumulation︰When defecating, there is a protrusion from the anus, accompanied by dripping blood or bleeding like an arrow, dry stool, constipation with bowel movements occurring every few days, feces resembling sheep droppings, difficulty in excretion, dry mouth and tongue, restlessness and dizziness, abdominal distension and fullness discomfort, scanty dark urine, a red tongue with little moisture, yellow and dry coating, and a floating rapid or surging pulse. This condition is often caused by the invasion of wind-fire or dryness-heat pathogens accumulating in the rectum and anus. Consequently, hemorrhoids formed in this manner tend to bleed more, manifesting as dripping or spurting blood, and are prone to swelling, heat, and pain, along with dry stool accumulation. Zhang Zhong-jing stated, "Those with heat must have hemorrhoids," referring to this type. Treatment should focus on dispersing wind, purging fire, moistening dryness, and cooling blood. The recommended formula is Saposhnikovia Root and Gentian Decoction. For cases with swelling, heat, and pain, the Pain-Relieving Divine Decoction can be used.
2. Dampness-heat︰During defecation, there may be prolapse, bleeding, anal distension or burning sensation, difficulty in bowel movements, tenesmus, often accompanied by abdominal distension and fullness, anorexia, heavy body fatigue, yellow and greasy tongue coating, and a slippery and rapid pulse. This condition is mostly caused by improper diet, excessive consumption of rich flavors, alcohol, and spicy foods, leading to internal dampness-heat accumulation in the large intestine, blood vessel dysfunction, and stasis forming hemorrhoids. Therefore, Suwen and Shengqi Tongtian Lun state: "Due to overeating, the sinews and vessels become lax, leading to dysentery and hemorrhoids." After expelling the pathogen from the exterior, symptoms such as anal distension or burning sensation, prolapse, bleeding, difficulty in bowel movements, frequent tenesmus, abdominal distension and fullness, anorexia, heavy body fatigue, yellow and greasy tongue coating, and a slippery and rapid pulse are characteristic features. Treatment should focus on clearing heat and draining dampness, removing stasis, and resolving masses. Prescriptions such as Sophora Japonica Pill, Zanglian Pill, and Rice Beans and Angelica Powder can be used. For cases where heat predominates over dampness, with burning anal pain, "Yi" Word Decoction is highly effective.
3. Qi Stagnation and Blood Stasis︰During defecation, there is protrusion of masses with significant bleeding, anal pain, and swelling of mixed internal and external hemorrhoids. There is difficulty in bowel movement with a sensation of incomplete evacuation, accompanied by abdominal distension and fullness. The tongue appears purplish-dark, and the pulse is wiry. This condition often arises from prolonged sitting or standing, carrying heavy loads over long distances, or in women after pregnancy due to uterine pressure on the rectum and anus. It may also result from liver qi depression, leading to qi stagnation and blood stasis in the rectal and anal region, forming protruding hemorrhoids. As stated in the Waike Zhengzong: "Hemorrhoids are caused by accumulated dampness-heat, excessive consumption of fried or grilled foods, prolonged sitting leading to stagnant blood flow, or emotional disturbances that result in overconsumption of cold and raw foods. Additionally, carrying heavy loads or exerting oneself over long distances disrupts qi and blood flow, causing meridian and collateral disorders. Excessive alcohol or sexual activity may also impair the spleen and stomach, leading to turbid qi and static blood accumulating in the anus, all of which can trigger hemorrhoids." The characteristic features include frequent occurrence in individuals who sit or stand for long periods, with mixed internal and external hemorrhoids in the rectal and anal region. The masses are often large, sometimes with thrombus formation, causing severe pain accompanied by abdominal distension, fullness, and distending pain. The tongue appears purplish-dark. Treatment should focus on regulating qi and resolving stasis, reducing swelling, and dispersing blood stasis. Recommended formulas include the Cooling Blood Rehmannia Decoction and the Peach Kernel Purgative Decoction.
4. Qi Sinking︰During defecation, there is a protrusion that requires manual repositioning after bowel movements, with intermittent bleeding, anal prolapse, weak bowel movements, accompanied by shortness of breath and fatigue, poor appetite and reluctance to speak, {|###|}complexion pale{|###|}, pale tongue with white coating, and weak pulse. This is often caused by prolonged bleeding, which damages qi and blood, {|###|}chronic diarrhea{|###|} or prolonged dysentery, impairing the spleen and stomach, excessive sexual activity depleting kidney qi, as well as aging and physical weakness, {|###|}middle qi deficiency{|###|}, leading to an inability to retain and resulting in hemorrhoids. Its characteristic is that the hemorrhoids prolapse during exertion or after bowel movements, requiring manual repositioning, with intermittent bleeding. Over time, qi deficiency and blood weakness develop, {|###|}complexion dull{|###|}, shortness of breath and reluctance to speak, weakness in the limbs, pale tongue, and weak pulse. Treatment should focus on {|###|}tonifying qi{|###|} and nourishing blood, as well as strengthening the spleen and kidneys. Prescriptions include Anal Lifting Powder, Oven Yellow Earth Decoction, and Middle-Tonifying Qi-Replenishing Decoction.

The classification of hemorrhoids is quite extensive, each named according to clinical observations. Wushi'er Bingfang categorizes them into "male hemorrhoids," "female hemorrhoids," "qi hemorrhoids," and "blood hemorrhoids." Zhubing Yuanhou Lun further divides them into "male hemorrhoids," "female hemorrhoids," "qi hemorrhoids," "blood hemorrhoids," and "intestinal hemorrhoids." Waitai Miyao summarizes them into two types: external hemorrhoids and internal hemorrhoids. Later generations have named up to twenty-five or seventy-two types of hemorrhoids. Clinically, pattern differentiation and treatment should be applied. For those caused by wind-fire and dryness accumulation, disperse and purge fire; for those caused by dampness-heat accumulation, drain dampness and clear heat; for those caused by qi and blood stasis, invigorate blood and resolve stasis; for those caused by qi deficiency and sinking, tonify the middle and lift qi. For severe cases of bleeding and prolapse, both internal and external treatments should be applied, including hemorrhoid necrotizing, ligation, and hemorrhoid removal surgery, to achieve a complete cure.

Hemorrhoid prolapse and rectal prolapse are often confused and collectively referred to as prolapse of the rectum. However, hemorrhoid prolapse is the protrusion of a tumor formed by blood stasis, while rectal prolapse is the protrusion of the rectal membrane or the rectum itself. Careful observation is necessary to distinguish between the two.

bubble_chart Documentation

1. Qixiao Liangfang．Intestinal fistula and hemorrhoid disease section: "Although the initial causes of hemorrhoids and fistula disease are the same, the actual conditions of the diseases are different. Initially, when a sore forms at the edge of the anus and does not rupture, it is called a hemorrhoid. When it ruptures and discharges pus and blood, with yellow fluid spreading and dripping continuously for a long time, it is called fistula disease."
2. Puji Fang．Hemorrhoid and fistula disease section: "Heat damages the blood, damaged blood causes stagnation in the meridians, stagnation in the meridians prevents the qi from circulating properly, and both qi and blood stagnate, descending into the large intestine due to deficiency, which is why hemorrhoids occur."