existing inside or outside the anus is called hemorrhoid in
general. The ancient Chinese practitioners held that it was
a kind of angiopathy which was commonly found among the
people, and a saying goes that "of ten persons nine have
Detailed discuss on
was recorded in the traditional medical literature. In Su
Wen. Sheng Qi Tong Tian Lun (Treatise on Communication of
Vitality with Heaven, Plain Questions) it states: " Too much
food intake causes injury and flaccidity of vessels, leading
to hemorrhoid." This is the initial theory of varicosity. It
was held that the disease cause was related to integrated
internal factors and local external factors.
disharmony of Yin and Yang, Deficiency in the Zang-organs
and Fu-organs, consumption of qi and blood, extreme
excitation of emotions and genetic factors.
1. Interactions of
pathogenic dampness, heat, wind and dryness.
2. Injury of
pathogenic heat, hemorrhage due to blood-heat, and
accumulation of pathogenic heat.
3. Food Influence:
Over-intake of roast, fatty, raw, cold, pungent and hot
food, or drinking of too much alcohol, or improper food
4. Profession and
Life Style: Long-time sitting and standing walking a long
way with heavy load or indulgence in sexual activity.
Persisted constipation or diarrhea, child delivery, etc.
The above causes
were recognized as the etiology of hemorrhoids by the
ancient practitioners. Hemorrhoids only occur in human
beings because man is n animal of erect standing. Modern
medicine usually thinks that hemorrhoids are caused by the
increase of the venous internal pressure of the venous
plexus and the decrease of the resistance of the venous
walls. But through a profound study of hemorrhoids,
different ideas have been put forward. Besides the theory of
varicose vein, there is added the theory of vessel
hyperplasia and that of mucosa slide.
The hemorrhoid area
can be classified into the following according to modern
medicine an d clinical practice.
Hemorrhoid: It is located below the anal dentate line,
covered by skin, and developed by hemorrhoidal venous pleux.
Usually it can directly seen. External hemorrhoids are
classified into variciform external hemorrhoid, connective
tissue external hemorrhoid, thrombosed external hemorrhoid
and inflammatory external hemorrhoid.
External Hemorrhoid: It is often seen, without suffering, On
bowel movements and in the squatting position hemorrhoid is
obvious. A soft swelling is felt and it attacks with he
attack of internal hemorrhoids. In mild cases, a swelling is
seen only on bowel movements.
tissue External Hemorrhoid: It is the proliferous skin tag
of the anal margin usually found in different size. It is
also called "cockscomb" and "lotus seed". No obvious
sufferings occur when there is no acute attack. Local
dampness and itching are felt.
External Hemorrhoid: It is a stagnant spot due to rupture of
the subcutaneous small vessels of the anal margin. The
elasticity of the subcutaneous vessel walls decreases,
resulting form chronic inflammation and other factors, such
as bowel movements with strength, excessive drinking of
alcohol, etc. that rupture blood vessels. Blood escapes to
the subcutaneous layer. Hemorrhage ceases when accumulated
blood oppresses the hemorrhagic area. Because of the
distinct degree of bleeding, the size of the stagnant spots
spots of different size exist separately or with connection
to one another. One to several or a dozen stagnant spots may
e seen. Big stagnant spot occupying 1/3, 1/2 or 2/3 anus or
even the whole anus exists in some patients. The stagnant
hemorrhoid, less hard and movable, is green purple in
color. Thee is tenderness on touching. When it is
complicated by inflammation, no obvious green purple is
seen, ad a hard blood stasis is felt at this moment. It has
an acute attack with or without great sufferings and tends
to cure spontaneously, i.e. several days later, blood stasis
is absorbed naturally and turns to a hard lump. After an
attack, it is advised to wash and steam the anus with warm
water to speed up its absorption.
External Hemorrhoid: It is an acute inflammation of the anal
margin plica with great sufferings. No hard stagnant lump is
felt on palpation.
Hemorrhoid: It is located above the anal dentate line,
covered by mucose and developed by hemorrhoidal venous
plexus. At he initial stage, it is of small size and stays
in the anus. It may come out of the anus when it is growing
bigger. Thee stages are divided, namely the first or initial
sate, the second or medial stage and the third stage, called
the late or advanced stage.
The Initial Stage:
It is a small hemorrhoid within the anus and chiefly
manifested by hematochezia. Different amount of bright red
blood may pour out or drip.
The Second Stage:
Hematochezia and prolapse of hemorrhoid are found at the
same time. The bleeding is the same as in the initial stage
or in large amount. The hemorrhoid becomes bigger ad comes
out on bowel movements. But it can go back spontaneously.
The third State: It
is mainly manifested by prolapse of hemorrhoid. Hematochezia
lessens but the hemorrhoid becomes much bigger. It tends to
fall down on bowel movements, long-time walking, standing
and coughing. It cannot return to normal except with the
help of pushing it back or bed rest.
The chief symptoms
of internal hemorrhoid are hematochezia and prolapse of
hemorrhoid, ad the prolapse is the ground for stage
classification. In the first stage, no prolapse of
hemorrhoid occurs, but in the second stage, it falls down,
yet goes back spontaneously. In the third stage, it falls
down and fails to go back. Sometimes, four stages are
classified and in the last stage, there produces more
serious prolapse of internal hemorrhoid.
Three types can be
divided according to the pathological changes:
Type of Swollen
Blood Vessel: It is as big as a bayberry with thin mucosa,
bright red or dark red in color. It tends to bleed and is
felt soft on touch.
Type of Venous
Aneurysm: The surface of the hemorrhoid appears to be
plexiformly or deflectively projected and is green, purple
or dark red in color. The thickened mucosa of hemorrhoid is
lustrous. It is less bleeding and felt soft.
Type of Fibrous
Swelling: It is produced by proliferation f the connective
tissues. The hemorrhoid is hard, big, light red or white in
color, covered with fibrous membrane, or ulcerous and rough
mucosa. No bleeding is seen.
vascular hemorrhoid and mucosal hemorrhoid are grouped
according to the appearance of hemorrhoid and the pathogenic
age. The former is often seen in young patients and the
latter in aged patients.
Hemorrhoid: It is located above and beneath the dentate
line, covered with mucosa and skin, developed by the venous
pleux inside and outside of the hemorrhoid. There is no
groove between the internal and external hemorrhoids, and
they form a united one.
manifested by hematochezia, prolapse, pain and swelling,
bearing-down sensation, itching, etc.
Meridians ad Their Relationship
related to Meridians of the Large intestine, Lung, Du, Ren,
ladder, Liver, Spleen ad Kidney.
quickly made based on inspection, palpation and anoscopy.
For instance, the internal hemorrhoid is manifested by a
soft prominence above the dentate line, with bright red or
dark red color. Multiple hemorrhoids are separated form each
other. Anterior right, posterior right and middle left are
the primary hemorrhoids or mother hemorrhoids, while those
developed at other sites the secondary hemorrhoids or son
hemorrhoids, It is essential to tell the duration of
hemorrhage, characteristics of hematochezia, color of blood
passed and the difference form other he morrhagic disorders.
(1) Time of
Bleeding: Bleeding followed by bowel movements is a sign of
hemorrhage of the lower part of the large intestine, known
as vicinal bleeding of the upper part of the large
intestine, stomach or small intestine, called remote
of Hematochezia due to Hemorrhoid: Bloody exudate from the
mucosa or bleeding due to mucosal abrasion is called bloody
stools. Dripping or spurting of blood on bowel movements is
caused by the increase of the abdominal pressure, leading to
a sudden rise of the internal pressure f the hemorrhoid
vascular group, which occurs in the case of ulcer of the
hemorrhoidal mucosa. This is called the pressure hemorrhage,
of Blood Color: Bright red blood is seen on the internal
hemorrhoidal hemorrhage; dark red blood indicates colonic
hemorrhage; deep dark red blood shows hemorrhage from the
upper digestive system.
It is mostly
suitable for the first and second stages of hemorrhoids,
prolapse of internal hemorrhoid or aged patients who are
debilitating and have other serious diseases. The principle
of treatment and prescriptions adopted are as follows based
on the information listed in the medical literature and
Blood, Dispelling Dryness, Wind and Pain with Medicinal
Herbs Pungent in Flavor and Warm in Property: Qinjiu Cangzhu
Tang or Zhitong Rusheng Tang is given. This is especially
for hemorrhoids due to pathogenic dampness, heat, wind,
dryness, leading to swelling, pain, prolapse, hematochezia,
local exudate and itching.
2. Replenishing Yin
and Cooling Blood, Expelling Heat and Dampness: Liangxue
Dihuang Tang (40) or Huaijiao Wan (10) is administered to
treat hematochezia due to hemorrhoid, swelling and pain. It
is especially indicated for the excess syndrome, or
hemorrhoid complicated by hypertension and atherosclerosis.
It is not suggested for patients with cold and deficiency in
the intestine and stomach.
3. Purging Intense
Heat and Detoxicating with Medicinal Herbs Bitter in Flavor
and Cold in Property: Huanglian Jiedu Tang or Xijiao Dihuang
Tang is given to eliminate intense heat toxin.
4. Qi Reinforcing
or Qi and Blood Reinforcing: Buzhong yiqi Tang, Shiquan Dabu
Tang, and Guipi Tang are administered, especially for the
is the chief approach for hemorrhoids. It is worthwhile to
study how to use drugs to relieve symptoms. Clinical
manifestations are handled by the following measures.
Based on the excess or deficiency syndrome select the above
recipes. hemorrhage in general may e treated by Heye Wan,
Huaijiao Wan, Huazhi Wan, Zanglian Wan Xiaozhi Pian and
Zhining Jichang San, Zangsuan Fang, and Western drugs such
as Adrenosem Salicylate, Vitamin K and Vitamin C to check
(2) Prolapse of
Rectum: Herbs to invigorate Qi, e.g. Buzhong Yiqi Tang are
(3) Swelling, Pain
and a Bearing-down Sensation: Rusheng Tang, Qinjiu Pian or
Qinjiu Baizhu Wan are administered.
(4) Constipation or
Diarrhea: Catharsis or antidiarrheal is given based on
differentiation of pathological conditions.