2020年10月19日星期一

hemorrhoids and anal fissures,Experiences in Diagnosis and Treatment of Anal Diseases

    Experiences in Diagnosis and Treatment of Anal Diseases

    [Keywords] Anal Diseases

    Wang Tao's "Secrets of Foreign Taiwan" [1] summarized the prescriptions and proven prescriptions used to treat various diseases before the early Tang Dynasty, including of course anal diseases. It contains "five hemorrhoids and 12 prescriptions", "five hemorrhoids six prescriptions that will not heal for a few years", "five hemorrhoids prolapsed anus prescriptions two prescriptions", "intestinal hemorrhoids prescriptions 15 prescriptions", and "all hemorrhoids prescriptions 28 "First", "Nine prescriptions for the lower part of hemorrhoids such as Chongjiang", "Three prescriptions for hemorrhoids when the blood and wind accumulate under the stool", "Two prescriptions for moxibustion and hemorrhoids", "Five prescriptions for miscellaneous hemorrhoids", and "Prescriptions for prolapse of anus" Three prescriptions, “three prescriptions for protruding anus”, “six prescriptions for a bowel and anus prolapse”, “two prescriptions for a bowel and anus” and “three prescriptions for anus prolapse over the years”, a total of 99 prescriptions; At the same time, the pathogenesis and clinical manifestations of anorectal diseases are also described in detail. It is of great significance for later generations to study the diagnosis, treatment and development history of anorectal diseases.

    1 Anatomy, physiology, pathology and treatment of the anus

    1.1 Anatomy of the Anus In terms of anatomy, the "Waitai Mi Yao" quoted and deleted complicated prescriptions, saying: The anus "weighs twelve taels, is one foot and two inches long, and is two inches wide." It is the same as that recorded in "A Thousand Gold Essential Prescriptions" [2] of a similar era. However, according to the anal examination in "Difficulty", "the anus weighs twelve taels, eight inches larger, two inches more than two inches in diameter, two feet eight inches long, and three-eighths of three-eighths of Sugu Jiusheng" and one foot two inches shorter. Combining "Lingshu Gastrointestinal Treatise", "Broad Intestine Fu Ji, to receive the ileum, left ring leaf ridge, upper and lower piping, eight inches in diameter, more than half of two inches in diameter, two feet and eight inches in length", "Lingshu flat people's absolute valley" The record of “Guangchang is eight inches large, two inches larger than two inches in diameter, two feet eight inches long, two feet and eight inches long, and one of three eighths by Gu Jiusheng” shows that the “anus” mentioned in "Waitai Secret Yao" includes only the anal canal The rectum does not include the sigmoid colon, which is a step further than "Lingshu" and "Difficult Classics".

    1.2 The physiology of the anus In terms of physiology, the theory of quotation and deletion of complex prescriptions in "Secrets of the Outside Taiwan" holds that "the anus is responsible for the bowel tract. The lungs and the large intestine are united for the general order history" and "should be twelve o'clock." It is the same as that recorded in the Anal Theory of Qianjin Yaofang. Check "Internal Classics · Yin and Yang Ying Xiang Da Lun" has "clear yang out of the upper orifice, turbid yin out of the lower orifice", "Five Internal Organs" has "Pal Gate is also an agent of the five internal organs, water valleys cannot be hidden for long", "Linglan Secret Code" There are "the big intestine, the preacher, change out of Yan", "The Six Section Zangxiang Theory" contains "the entrance of the five flavors, hidden in the stomach and intestines, the taste is hidden to nourish the five qi", etc., which can be described as the same line.

    1.3 Pathology of the anus In terms of pathology, the theory of quotation and deletion of complex prescriptions in "Waitai Miyao" believes that "if the heat is hidden, it means that the anus is occluded, the stool is blocked, or it swells and shrinks and causes sores." Anal cold, diarrhea in stool, protruding anus for a long time, then enter." It is basically the same as the anal theory in Qianjin Yaofang, except that the text is slightly different, "If you hide the heat, it means that the anus is occluded, it will not work, or it will swell and shrink and cause sores; if you have typhoid, the anus will open wide. Daxing diarrhea, the anus protrudes for a long time to enter", among which "daxing" means "stool". It can be seen that the lesions of the viscera can be reflected in the anus, and the lesions in the anus are first reflected in the changes in the function of the anus, that is, changes in stool discharge, such as constipation and diarrhea; further development, the anus itself may have organic lesions, such as sores. , Prolapse, etc.

    1.4 Understanding of anal diseases "Waitai Mi Yao" believes that there are five hemorrhoids, and the five hemorrhoids have different clinical manifestations, which are derived from the "Theory of Disease Sources" [3], which is the same as "Qian Jin Yao Fang". At the same time, special mention To intestinal hemorrhoids. His greatest contribution is to quote Xu Renze's argument, dividing hemorrhoids into internal hemorrhoids and external hemorrhoids, which is the earliest recorded classification method of internal and external hemorrhoids. In the prolapse of the anus, we will observe in detail the difference between the age and the severity.

    1.5 The treatment principle of anal disease In the treatment, it is emphasized that the treatment of anal disease should follow the principle of "heat to relieve it, cold to replenish it, not deficiency or truth, according to the meridian". It is the same as that recorded in the Anal Theory of Qianjin Yaofang.

    2 Discussion of anal diseases

    2.1 Hemorrhoids

    2.1.1 Classification and clinical manifestations of hemorrhoids

    2.1.1.1 There are five hemorrhoids. The five hemorrhoids are considered to include male hemorrhoids, alcoholic hemorrhoids, intestinal hemorrhoids, blood hemorrhoids and air hemorrhoids. Different from "Prescriptions for Thousand Golds", it is "One is male hemorrhoids, second is hemorrhoids, third is pulse hemorrhoids, fourth is intestinal hemorrhoids, and fifth is blood hemorrhoids". Cui's theory is quoted in "Waitai Secret Yao": "There are five hemorrhoids. If the anal side is raw meat like mouse milk, it is out of the hole, and if the pus and blood are constantly released, the hemorrhoids are also; if the anus is swollen and sore If there is a nucleus near the anus, those with illness, cold and heat are called intestinal hemorrhoids; if the stool turns to clear blood, the name is blood hemorrhoids; if the stool is difficult, those who are willing to enter the anus for a long time, the famous hemorrhoids are also." However, in the "WaiTai MiYao" cited Ji Yan also discussed hemorrhoids and pulse hemorrhoids. "Hemorrhoids, longitudinal, external swelling in the hole, ulceration of pus and blood in five or six days", "Pulse hemorrhoids, clear blood from changing clothes".It can be seen that the five hemorrhoids actually include seven hemorrhoids, namely, male hemorrhoids, hemorrhoids, alcohol hemorrhoids, intestinal hemorrhoids, pulse hemorrhoids, blood hemorrhoids and air hemorrhoids, which are summarized as follows. Hemorrhoids: redness and swelling of the skin on the anal margin, lumps in the anus, small, milky like mice, often prolapse, affecting defecation. It is equivalent to inflammatory external hemorrhoids and second-degree internal hemorrhoids of mixed hemorrhoids. That is, "acne grows on the side of the anus, and in the transverse anus, this hemorrhoids." Ji Yan, Qian Jin said that "the raw meat of the hemorrhoids is like mouse milk in the hole, which is quite visible, which prevents changing clothes." The other symptom is described as anal leak, such as the deletion of "deficiency of fatigue, cold, diarrhea, and raw meat from the anus, such as mouse milk, which is next to the large hole, often pus, and the name is called hemorrhoids." Hemorrhoids: epidermis around the anus, the anus swells and pains during the attack, and the mass prolapses. After 5 or 6 days, pus and blood may be ruptured. The internal hemorrhoids, which is equivalent to the present mixed hemorrhoids, are prolapsed and the external hemorrhoids are edema. That is, "hemorrhoids, anal swelling and sores" in "Prescriptions for Thousand Golds", and "milk near the anus, hemorrhoids" in ancient and modern records. Alcohol hemorrhoids: the same as the clinical manifestations of hemorrhoids, but there are often typical drinking inducements. That is, "outside Taiwan wine hemorrhoids, anal swelling, sores, fatigue caused by alcohol, diarrhea clear blood, anal pain". Cui's "If the anus is swollen and sore, the famous wine hemorrhoid is also". Intestinal hemorrhoids: The skin of the anal margin is granular and painful. The anus protrudes during defecation, and it is difficult to take it back on its own. It often requires rest or hand rest. It is accompanied by more blood after the stool. Equivalent to mixed hemorrhoids in three stages. That is to say "intestinal hemorrhoids, change clothes to stand out, but shrink for a long time", combined with the "intestinal hemorrhoids in the intestines, the name is intestinal hemorrhoids, there are nuclei in the anus, pain, cold and heat, so it can stand out for a long time. "Shrink, and sore", "If there is a nucleus in the anus, sick and hot, it is called intestinal hemorrhoids", "Bleeding after stool, this disease of intestinal hemorrhoids", ancient and modern records of "anal out, down Blood is like chicken liver, this intestinal hemorrhoid" and so on. Pulse hemorrhoids: Anal itching, pain from time to time, blood in the anus when stool. Equivalent to early hemorrhoids. From "Principles of Hemorrhoids, Patients with Pulse and Hemorrhoids, Sores on the Anus, Itching Pain", and "Pulse Hemorrhoids, Clearing Blood by Changing Clothes" in Collecting Medicine and Collecting Tests. Blood hemorrhoids: Bleeding during stool, a lot of bright red, no pain, and often contaminate underwear. It is equivalent to one-stage hemorrhoids, with more bleeding. That is, Cui's "If the stool turns to clear the blood, the name is blood hemorrhoids", and the "Stool clears the blood, and the stool is dirty." Air hemorrhoids: Normally asymptomatic, they often occur due to cold, warm, fatigue, and dampness, causing difficulty in defecation, poor discharge, and uplift of the anal skin. Equivalent to varicose external hemorrhoids. That is, "Qihemorrhoids can be caused by warm cold and dampness" in "The Essential Prescriptions for One Thousand Golds", and "If it is difficult to have a bowel movement, those who are willing to enter the anus for a long time, they are famous for hemorrhoids".

    2.1.1.2 Hemorrhoids are divided into internal and external parts. As early as "Qianjinyifang", there are records of external hemorrhoids. However, the history of Chinese medicine surgery unanimously believes that the "External Taiwan Secret Yao" first contains the classification of internal hemorrhoids and external hemorrhoids. The basis is that Xu Renze quoted in the "External Hemorrhoids": "This disease has internal hemorrhoids and external hemorrhoids, but there is blood in the inside but the stool, and the outside is different; there are holes in the lower part of the external hemorrhoids, and every bleeding out of the hole. Internal hemorrhoids, There is blood in every stool, and if the blood is heavy, the blood is thrown into the ground, and the bleeding is excessive, the body is not red, there is pain, and there is no pain." In fact, the concept of internal and external hemorrhoids is completely different from today.

    2.1.1.3 There are male and female hemorrhoids. In the "Waitai Secret Yao", the teacher said: "Dampness hemorrhoids, hemorrhoids have male and female, which are violent diseases, have dryness, swelling and pain, have countless blood collapses, and have rat milk with nucleus. , There are those with itching in the intestines." It is the same as "Huaizi Pills for damp-drying hemorrhoids, and hemorrhoids have a prescription for both male and female". That is, "dryness, swelling and pain is dryness, countless bleeding is wetness, rat's milk with nucleus is female, and intestinal itch is male".

    2.1.2 The pathogenesis of hemorrhoids The five hemorrhoids quoted and deleted complex prescriptions in the "Waitai Mi Yao": "These are all sitting in the middle of cold and dampness, or atrioventricular disorder, or excessive income from drunk and fullness. At that time, it was not a problem, and it will not suffer for a long time. Intestinal hemorrhoids and mu hemorrhoids are quoted from the ancient and modern records in the "Waitai Secret Yao", saying: "All are born of fatigue." Intestinal hemorrhoids have "lung fatigue, cold damage, to intestines". Medium-life hemorrhoids are called intestinal hemorrhoids. Mu hemorrhoids are deleted as "deficiency of fatigue, cold, more diarrhea, and raw meat on the anus side, such as rat milk, which is next to the large hole, often pus, called Mu hemorrhoids", which may refer to anal leakage. Alcohol and hemorrhoids are deleted and complicated "Kidney fatigue, or drunkenness in the wind, the damaged kidney disease, the cause of alcohol hemorrhoids, anal swelling, sores, fatigue caused by alcohol, diarrhea and clear blood, anal pain".

    2.2 Prolapse

    2.2.1 The etiology and pathogenesis of anal prolapse In the "Secrets of the Outside Taiwan", it is believed that the main etiology and pathogenesis of anal prolapse is the cold of the large intestine, coupled with chronic diarrhea and chronic dysentery, the anus is not solid and prolapsed. Quoting from "Source of Disease": "Those who have prolapsed the anus will also prolapse from the anus. It is mostly caused by the deficiency and coldness of the large intestine after a long period of dysentery. The anus is the condition of the large intestine. Then the anus prolapses, because it is called prolapse of the anus." In the quotation and deletion of the complex theory, "If the organs are typhoid, then the anus will be cold, the stool will diarrhea, and the anus will protrude for a long time and enter." "Cold intestine, if the anus is cold, the diarrhea will protrude."

    2.2.2 The clinical manifestations of prolapsed rectal prolapse "External Taiwan Secret Essentials" is extremely detailed in the observation of clinical manifestations of prolapsed rectal. It is believed that there are new and serious differences in the severity of prolapse, the lighter is "anus protruding" or "anal out", the more severe is "intestinal and anus out", the newer is "defecation prolapse", and the longest is "prolapse of the anus over the years." ". The main symptom associated with prolapse is "hole diarrhea." Severe prolapse, "intestines with anus", specifically "intestines with the anus" or "intestines with the anus, widening, inaccessible, one foot".

    3 Treatment of anal diseases

    The characteristics of "Waitai Mi Yao" for the treatment of anal diseases are mainly manifested in the obvious direction to the symptoms, including common blood in the stool, anal swelling and pain, anal itching, prolapse, etc., which still have reference significance for today's treatment.

    3.1 Treatment of blood in the stool as the main symptom

    3.1.1 Guangji's prescription for treating non-stop bleeding under five hemorrhoids (1) Name of prescription: none. Composition: Sophora japonicus 6 points, keel 6 points, mistleaf 6 points, dried ginger 6 points, Xiongqiong 6 points, angelica 6 points, madder 6 points, evodia 6 points, white cypress 5 points, paofuzi 5 points, astragalus 8 points Points, 10 points for rhubarb, 14 points for pigtails, 4 points for graying. Usage: Honey pills are as big as Wutongzi, take it orally on an empty stomach, with water, 2 times a day, 20-40 pills each time. Indications: bleeding under five hemorrhoids. Efficacy: tonic, stop bleeding, laxative. Taboo: fish, hot noodles, etc. (2) Party name: Huangqi Pills. Source: Guangji. Composition: Astragalus 3 taels, Citrus aurantium 3 taels, Black snake 2 taels, Angelica 2 taels, Akaishizhi 2 taels, Hedgehog peel 2 taels. Usage: Honey pills are as big as Wutongzi, take orally with wine on an empty stomach, 2 times a day, 20 pills each time. Indications: blood under hemorrhoids.

    3.1.2 Essays for the treatment of blood under the five hemorrhoids (1) Fang name: Wuzhi San. Source: Essay, Wenzhong, Emergency Preparedness, and Drug Test. Composition: Chixiaodou 4 points, Astragalus 3 points, Paofuzi 1 point, Baiji 1 point, Guixin 1 point, Peony 2 points, Scutellaria baicalensis 2 points. Usage: powder, alcohol delivery, 3 times a day, each time. Indications: The lower part of the hole, the blood flow out vertically and horizontally. Effect: Hemostatic test. (2) Party name: Zi Shen Wan. Source: Essays, collection of inspections, emergency preparations, and the same daughter. Composition: 1 tael of purple ginseng, 1 tael of gentian, 1 tael of milky gray, 1 tael of asters, 1 tael of Magnolia officinalis, 2 tael of Ligusticum vulgare, 1 tael of Lei Wan, 1 tael of Angelica dahurica, half tael of sting insect, 3 tael of Guanzhong, There are 14 pigtails, half two for horsefly and half two for heather. Usage: Decoction with half a liter of sheep spinal cord and pork fat. The pill is as big as Wutongzi. It is taken orally with wine before meals, 2 times a day, 15 pills each time. Indications: Clear blood from the anus in stool. He also treated prolapse and rectal prolapse. Effect: On the 4th, the itching of the anal side stops; on the 8th, the pus and blood are exhausted, and the rat milk is healed; on the 60th, it does not appear for life.

    3.1.3 Ancient and modern prescriptions for the treatment of anal bleeding (1) Name of prescription: no source: ancient and modern records. Composition: 10 taels of rhubarb, 7 taels of talc, 3 taels of Glauber's salt, 2 taels of Mulberry bark, 30 dates, 5 taels of Scutellaria baicalensis Georgi, 2 taels of almonds. Usage: decoction, decoction into 2 liters with a bucket of two liters of wine, orally. Indications: Blood from the anus is like chicken liver. Efficacy: diarrhea to stop bleeding. (2) Name of the party: Bai Susan. Provenance: Recorded Examination of Ancient and Modern. Composition: 4 points for Chixiaodou, 3 points for Astragalus, 2 points for Peony, 2 points for Baiji, 3 points for Scutellaria baicalensis, 3 points for Guixin, 2 points for Aconite, 2 points for Oyster. Usage: powder, alcohol delivery, 3 times a day, each time. Indications: Ten years of hemorrhoids, such as rat milk, pus, then blood, drama. Efficacy: A prescription for suspected treatment of anal leakage.

    3.1.4 Qianjin's prescriptions for treating five hemorrhoids bleeding See prescriptions for treating anal swelling and pain.

    3.1.5 Cui's prescription for treating various hemorrhoids (1) Name of prescription: Xiebaitang. Source: Cui's. Composition: Scallion White Qihe, one liter of sheep kidney fat. Usage: Decoction, orally. Indications: Intestinal hemorrhoids bleeding after stool. Effect: Pus and blood are in harmony with feces, which means scum. (2) Party name: None. Source: Cui's. Composition: 1 tael each of alum, paofuzi and dried ginger. Usage: honey pill, orally. Indications: Intestinal hemorrhoids bleeding after stool. (3) Party name: None. Source: Cui's. Composition: 2 halves of Astragalus, 2 halves of Citrus aurantium, 1 tael of alumite. Usage: for the end, and honey for the pill, fasting alcohol delivery, 2 times a day, each time 20-30 pills. Indications: All hemorrhoids and lower blood flow will not stop, and turn to virtual lean. Taboo: Buckwheat, pork, garlic, fish, labor. Effect: Nothing fails. Long service, recovery in one and a half years, good experience. (4) Party name: None. Composition: 5 points for rhubarb, 3 points for kansui, 2 points for Scutellaria baicalensis, 4 points for dried ginger, 4 points for Aconite, 21 peach kernels, 7 white stems. Usage: Decoction orally. Indications: Urgent defecation of blood in the stool, or to a number of liters, two less bloody. This is an internal injury and cold, which can become hemorrhoids over the years. Taboo: pork, etc. Effect: but 3 doses, scum.

    3.1.6 Xu Ren's prescriptions for the treatment of various hemorrhoids that have not stopped bleeding. Name: Huangqi Shiwei San. Source: Xu Renze. Composition: Astragalus 5 taels, Sophora flavescens 6 taels, Scrophulariaceae 6 taels, Paofuzi 3 taels, Rhubarb 3 taels, Dried ginger 2 taels, Hedgehog skin 2 taels, Coptis chinensis 4 taels, Sophora japonicus 6 taels, Pig Xanthelastus 1 tael , Usage: for powder, orally on an empty stomach, 2 times a day, each square inch dagger, can be added to 2 yuan dagger. Taboo: pork, cold water.

    3.1.7 Fan Wang's prescription for treating blood under hemorrhoids. Name: Huanglianqu San. Composition: Huanglian 2 taels, Qu 1 tael. Usage: Thin honey is loose, orally before eating, 3 times a day, each half inch dagger, can be added to square inch dagger.

    3.1.8 The single prescription for the treatment of hematochezia as the main syndrome is taken orally with Puhuang water after the elbow, alumite, paofuzi honey pills, carp, crucian carp, and eel diet therapy for intestinal hemorrhoids. There is often blood in each stool. Prepare for emergencies. Wenzhong, ancient and modern records are the same. Guangji contains snake meat decoction orally to treat hemorrhoid blood. For emergency use, use rice straw ash decoction for hot soaking. For daughters, use peach peel, plum peel, dichotoma, and sophora flavescens to extract juice. It is effective.

    3.2 Treatment of anal swelling and pain as the main symptom

    3.2.1 Composition of Qianjin Huaibei paste: 2 taels of Sophora japonicus, half taupes of lavender, half taels of Xinyi, half taels of licorice, half taels of Angelica dahurica, kudzu 6 baht, 7 crotons, 6 lacquer seeds, 10 peach kernels. Half a catty of pork fat. Usage: Decoction of pig fat and anus, 4 or 5 times a day. Zhang Wenzhong is used as sitting medicine. Indications: Anal itching and bleeding. Effect: Insects die off and relieve pain and itching.

    3.2.2 Deleting the multiplication honeycomb cream Composition: 3 taels of roasted honeycombs, 10 taels of raw locust white bark, 50 lotus seeds, 50 peach kernels, 2 taels of Angelica dahurica, 1 combination of chixiaodou, 1.5 liters of pig paste, 1 liter of bitter wine. Usage: Decoction into a cream, take the apricots and take them into the anus. It can also be given to drink orally, one inch at a time. Indications: Anal swelling and sores caused by alcohol and hemorrhoids, fatigue caused by alcohol, diarrhea and anal pain.

    3.2.3 The composition of the five raw ointment of the red pig Xuanhu Qinglong: 3 pig Xuanhuo, 4 taels of raw sycamore white skin, 5 points for raw gentian, 5 points for raw mulberry white skin, 5 points for snake sloughing, 5 points for realgar, raw Green bamboo skin is 6 points, raw cypress skin is 7 points, sunroasted honeycomb is 3 points, shochu pepper sweat is 3 points, hedgehog skin is 4 points, bonzi 4 points, 20 almonds, pork fat 3 liters, bitter wine 2 liters. Usage: Decoction at low heat into thin sugar-like shape and apply externally. It can also be given to drink orally, each time as big as a date. Indications: Intestinal hemorrhoids have nucleus around the anus, pain, cold and heat, so that they can stand out, shrink for a long time, and sores.

    3.2.4 Guangji Fang Wuming Composition: bright sand, musk (dangmenzi), snake skin each in equal parts. Usage: grind the powder and apply honey tones externally. Indications: hemorrhoids, fistulas, gangrene, sores.

    3.2.5 A single prescription for the treatment of hemorrhoid pain Cui Shizai sits and soaks with green onion plus fat decoction, squash roots, stems and leaves add scopole to coat jujube meat, ginger orally, dead bamboo burning ash orally, and raccoon diet can all relieve pain.

    3.3 Treatment with anal itching as the main syndrome

    3.3.1 Essay Sophora Peel Paste Composition: 5 taels of Sophorae peel, 2 taels of licorice, 2 taels of angelica, 2 taels of Angelica dahurica, 50 pieces of Chenzhi, 50 pieces of peach kernels, 2 pieces of red beans, 2 liters of pork fat. Usage: Make a cream and apply externally. Indications: Itching and hemorrhoids in the valley. Set the same test.

    3.3.2 A single prescription for treating anal itching, containing Hu powder, mercury and jujube ointment at the back of the elbow and mixing thoroughly, and taking in the anus, it belongs to the guiding method, and the effect is the same as that of Cui's; , Wenzhong, Fan Wangtong; Almonds are boiled black to form a cream, and externally applied, Jiyan, Preparatory Emergency, Wenzhong, Cui Shitong; Hedgehog skin or pork belly burnt ash for external application, Cui Shitong. Wen Zhongzai peach leaves (or add ebony) or evodia mashed juice and fumigated, elbow, Cui Shi, Bei Ji Tong; 1 liter of red beans, 5 liters of bitter wine, boiled dry for the end, oral, Cui Shi, Bei Ji Tong; pig Drink 1 liter of pepper with 1 liter of wine and drink after 5 days, Cui's.

    3.4 Treatment with pus as the main syndrome Delete Fan Biejia Fang. Composition: turtle shell 7 points, dried rehmannia 7 points, coptis 7 points, forsythia 7 points, melon root 6 points, astragalus 6 points, dried ginger 6 points, 5 honeycombs, hedgehog skin 5 points, dipsatus 5 points, aconite 4 points, 4 points for Huaizi and 4 points for alumite. Usage: Honey is as big as a pill. 2 times a day, 20 pills each time, up to 30 pills. Indications: The hemorrhoids are caused by fatigue, cold, and diarrhea. The anus turns raw meat, such as rat milk, and pus will come out from time to time by the large hole.

    3.5 Treatment of anal prolapse as the main syndrome

    3.5.1 Treatment of sudden prolapse during defecation: After elbow, use bean paste and wine to coat (Wen Zhong, Bei Ji Tong), burn tiger bone powder and take it orally. Fan Wangyong green mulberry stick snails burned with pork fat and external application (the same text). For daughters, use Puhuang He pig ointment for external application (Wen Zhong, Bei Ji).

    3.5.2 Treatment of protruding anus (1) Deleting Fan Zhugan San (the same as Qianjin) Composition: 1 catty of pig liver, 2 taels of Coptis, 2 taels of donkey-hide gelatin, 2 taels of Xiongqiong, 5 taels of black plum meat, 1 tael of Chinese mugwort leaves, usage : At the end, oral. (2) Qianjin wall soil scattered. Composition: 1 liter of soil on the east wall of the old house, 3 acacia. Usage: To loosen, wrap the anus. The base of Qianjin Malu is composed according to the prescription: 1 hemp and 1 glans. Usage: the glans is loose and externally applied, and the hemp is ironed.

    3.5.3 Treatment of severe prolapse: Take raw melon and loupe juice orally after the elbow, add pork juice to wash hands, and follow the restraint to make it easy (Fan Wang, Xiaopin, Wenzhong, Beiji, Qianjin same). Prepare an emergency with lime, hot cloth wrapped in ironing method, followed by orders (Small, Prepare an emergency, Wen Zhong the same).

    3.5.4 Treatment of prolonged rectal prolapse. Collect 3 catties of pig iron for decoction and wash outside (Fan Wang, Xiao Pin, Wen Zhong, Bei Ji, Qian Jin Tong). For the daughter, use 1 piece of dead turtle head to apply burned ash to the anus, press the order and add moxibustion for 100 strong transverse bones; or use fine iron powder for external application and press in by hand.

    3.6 General Party

    3.6.1 Guangji Five Hemorrhoid Recipe Composition: Shenghuai Jian 5 points, saponins 2 taels, musk 2 points, realgar 2 points, hyoscyamine 2 points, cloves 2 points, and woody 2 points. Usage: Make 5 pills, fumigation method, anal method, 1 pill each time. Indications: Five hemorrhoids. Taboo: fish, hot bran, etc. Effect: establish effect.

    3.6.2 The composition of Guangji hedgehog skin powder: 6 points for hedgehog skin, 6 points for tortoise shell, 6 points for angelica, 8 points for astragalus, 8 points for Sophora japonica, 5 inches for snake skin, 5 points for exposed honeycomb, 5 points for lily root, 5 points for Guixin There are 14 pigtails. Usage: for powder, orally, 2 times a day, each time one cun dagger can be added to one cun dagger and a half. Remarks: No diarrhea after use.

    3.6.3 Collect and test five hemorrhoids prescriptions: Snake molting, tortoise shell, hedgehog skin, hive, and pig left xanthosoma. Usage: The main medicine is 3 times different with the five hemorrhoids. Take orally 1 to 5 times a day, square inch dagger each time. It can also be applied to the anus and sores. Indications: Five hemorrhoids. Taboo: Do ​​not have intercourse within 100 days after recovery. Remarks: "The Essential Prescriptions for Daughters" elaborated, according to supplementary bans on cold, pork, fish, and sex.

    3.6.4 The composition of Shenshi Huaizi pills: 4 taels of Sophora japonicus, 4 taels of dry varnish, 4 taels of wood root bark (Tilia), 2 taels of cornus, 2 taels of Gentiana, 2 taels of Scutellaria baicalensis, 2 taels of Baikun, 2 taels of green wood fragrance , Oyster 2 taels, keel 2 taels, paofuzi 2 taels, star anise 2 taels, Lei Wan 2 taels, Tribulus terrestris 2 taels, Angelica dahurica 2 taels, Guixin 2 taels, chicken tongue 2 taels, Astragalus 2 taels. Usage: honey pill, orally. Indications: Dampness and hemorrhoids. Remarks: Same as Huaiziwan in "A Thousand Gold Essentials".

    3.6.5 Qianjin Xiaohuai Pills Composition: Sophora japonica 3 jin, keel 10 taels, alumite 1 jin, sulfur 1 jin, sugar 2 jin, rhubarb 10 taels, and dry paint 10 taels. Usage: as a pill, orally. Remarks: Shenshi.

    3.6.6 The composition of Hedgehog Skin Pills: 3 taels of Sophora japonica, 2 taels of Paofuzi, 2 taels of Angelica, 2 taels of Forsythia, 5 taels of dried rehmannia, 2 taels of dried ginger, 2 taels of alumite, 1 tael of Dipsacus, Astragalus 1 tael, 1 hedgehog skin. Usage: Honey pills are as big as Wutongzi, orally, 2 times a day, 15 pills each time, up to 30 pills. Indications: Hemorrhoids, fistula. Effect: Commonly used big test. Remarks: elbow back, emergency preparation, text, delete complex, daughter, ancient and modern records are the same.

    3.6.7 Composition of Astragalus Pills: 5 points for Astragalus, 5 points for Green Rice, 5 points for Leu Lu, 5 points for Seared Turtles, 5 points for Spikes, 4 points for Cork, 8 points for Rhino Horns, 4 points for Cantharidae, 4 points for Hedgehog Skin Points, 10 points for alum, 10 coriander green, 10 gall bladder, 10 centipede, 7 pigeon hooves. Usage: Honey pills are as big as Wutongzi, 2 times a day, 2 pills each time, can be increased. Effect: Increase to the degree of unobstructed stool.

    3.6.8 Single prescription (1) The composition of the peach leaf steamed hemorrhoids: 1 Dendrobium peach leaf, 1 bucket of fine chaff, and 1 bucket of flax. Usage: fumigation effect: insects come out and die. (2) Qianjin five hemorrhoids prescription: Hedgehog skin 3 fingers large, cooked Ai 1 bedroom. Usage: smoked method. Effect: Three days of rest, more smoked by 3 degrees, forever. Taboo: Do ​​not offend the thick taste of cold wind, be careful with chicken, pig, fish, raw cold. (3) Huai wine composition: 1 stone from the southeast branch of Huai, 2 stones from the southeast root of Huai, 1 stone from Huaibaipi, 1 stone from Sophorae, 2 stones from Jimi, and 2 stones from Qu. Usage: Take clear drink, 3 or 4 times a day. Taboo: raw water. (4) Wenzhong intestinal hemorrhoid prescription: Sophora japonicus, pounding the powder, drinking the square inch dagger, three times a day. White rose 2 points, wolfberry root 2 points, pounding and sieving as the end, three times a day. 1 catty of raw land, 2 buckets of wine, drink in moderation. Citrus aurantium bark was taken with a square inch knife each time, three times a day. (5) Preparing acute intestinal hemorrhoids prescription: shell, applying and guiding methods, with Wenzhong and Cuishi. The amount of Huaibaipi is right, and the sitting bath is only three times, and the insects will come out. Huai Baipi powder guide method, Wen Zhong, Cui Shi, Qian Jin Tong. Medicine slag burned ash and alumite are powder. Wen Zhong, Cui Shi, Fan Wangtong. (6) Hedgehog skin pills: 10 taels of raw sophorae skin, big marbles, accept anus, great effect, prepare emergency, daughter with the same gold, Huai Chi Chicken (Huai Nuo) 1 catty orally. (7) Qianjin Hemorrhoids Recipe: Source: Jiuji, Cui's, and ancient and modern records. Sophora japonicus, decoction, is as big as rat feces, and it is mainly used for anus: hemorrhoids, fistula, hundreds of sores. (8) Cui's hemorrhoids prescription: carp intestines, sitting method, worm out. (9) The source of the nameless (ointment): Essay, the same record and experience. Two halves of Veratrum, Rhubarb, and Coptis, 14 pieces of chain wood, 14 pieces of peach kernels, 4 pieces of crotons, and 14 pieces of nettles (dog hedgehog). Preparation method: lard into cream. Usage topical.

    4 Summary of Treatment of Anal Diseases

    4.1 There are many types of oral medicines, and medicines have expertise. Oral medicines include pill powder decoction. Long-term medication is suitable for pills such as Huaizi Pill, Qianjin Xiaohuaishi Pill, Zishen Pill, Huangqi Pill, etc. For emergency use, such as Wuzhi San, Huanglian Qu San, Bai Susan, Huangqi Shiwei San, etc., decoction is used less , But also use the decoction to cleanse, such as scallion white soup.The analysis uses each medicine, the characteristic is obvious, the medicine has expertise. The treatment of five hemorrhoids inherits the experience of using Huaizi in the "Qianjin Yaofang", which contains Huaizi Jian Huaizi pills, Xiaohuaishi pills, Huaijiu, Huaipi ointment, etc. The Huaijiao pills formed on this basis are still widely used today use. Pay attention to the application of animal medicine, and put forward the principle of five drugs to treat five hemorrhoids, so that the pig Xuanjiao, turtle shell, tortoise shell, hedgehog skin, and snake can treat five hemorrhoids at the same time. , Crucian carp, carp, eel, catfish and intestines, etc., have enlightenment on the use of animal protein to treat anal diseases in later generations. Good use of mineral drugs, such as alumite, Glauber's salt, talc, sulfur, etc., will provide sufficient evidence for the development of alum preparations to treat hemorrhoids in later generations. Compatible well, can be called a model for later generations. Astragalus and Angelica are commonly used for blood loss, which fits the meaning of Angelica nourishing soup for later generations and is still used today. To treat the disease and seek the cause, use both cold and heat. Commonly used Citrus aurantium, rhubarb, and Qinlian are used in combination with paofuzi, dried ginger, and guixin to reduce heat from the internal organs, which is the "benefit" and "unfavorable" methods mentioned in the article. For example, Hedgehog Pisan is "unfavorable", and "the prescription for treating five hemorrhoids does not stop bleeding" is "beneficial."

    4.2 Outstanding effects of external use spread to later generations Bathing method, decoction with Sophora japonicus root, peach root, Sophora japonicus peel, green onion, messy hair, etc., sit in a bath for fumigation. Although the drugs used are no longer the same, this method is widely used in anorectal diseases and has become one of the main methods for the treatment of anal diseases. Smoke method, using peach leaves, fine chaff, flax, scorpion peel, scopole, straw, etc., to smoke the anus, mainly for curing insects and hemorrhoids. At present, it is less used, mainly due to medical conditions and environmental restrictions. The ironing method is mainly to heat the big and small beans or citrus aurantium, put it in the bag, and sit on it to iron and steam. In modern times, it has been replaced by various anal physiotherapy equipment such as infrared and microwave. The topical application method is to grind the medicine into a fine powder, and use pig fat or pig bone marrow to make an ointment and apply it to the anus locally to treat anal diseases, such as Huapi ointment, honeycomb ointment, Qinglong Wusheng ointment, etc. Become the main treatment for anal diseases in the future. Sit medicine, make different medicines such as Sophora japonica, Sophora japonicus, carp intestines, shells, or compound medicines of suitable size and different shapes, some like rat feces, some as big as apricots, and some like pellets Some are as big as jujube nucleus, put into the anus, can play the role of clearing heat and detoxification, venting heat and laxative, astringent, hemostasis, swelling and pain relief, such as hedgehog skin pills. Modern suppositories have been developed into various kinds of suppositories, which are widely used in clinics.

    4.3 The special moxibustion method needs to be excavated. Two methods of Cui's moxibustion of hemorrhoids are recorded in detail. The first is the item of "taking the rope disease, so that the two ends are held together, the rope is stretched, and the rope is measured from the middle of Dazhui, and one end of the rope, when the spine is directly down, is dotted with ink. Then measure the patient's mouth with two mouths, and the front muzzle Lower the rope, repeat the point, look at all three places, and start the fire. The heavier is 500 strong, and the lighter is 300 strong, and it is healed." The first is to "make the patient sit flat and undress, use the rope to measure down from the large vertebrae to the tip of the tail vertebrae, and then fold the rope to measure upwards from the tip of the tail vertebrae. When the rope head is directly down, click it, high Moxibustion at the beginning of Guozhou became a hundred strong, but it relapsed in the next three years. After moxibustion, it was broken." In addition, the treatment of prolapse of the anus over the years does not heal, can "moxibustion of the transverse bone 100 strong."

    【references】

    1 Tian Zhenguo. Collection of ancient Chinese medical literature on anorectal diseases. Shenyang: Liaoning Science and Technology Press, 2007, 31-45.

    2 Sun Simiao. Essential prescriptions for emergency preparedness. Beijing: People's Medical Publishing House, 1964, 169-178.

    3 Ding Guangdi. Annotations on the origin of various diseases. Beijing: People's Medical Publishing House, 1982, 975-978.

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