Also pile. A protuberance on the inside or outside of the anus, often accompanied by constipation and the passage of fresh blood. A biomedical distinction between internal, external, and mixed hemorrhoids, often seen in modern literature. In traditional medicine, a broad distinction is made between repletion and vacuity.
Patterns
Vacuity patterns arise when long sitting or standing or walking, enduring dysentery or diarrhea, constipation and straining, or pregnancy cause general depletion and center qì fall that causes loosening of the sinews and vessels. The hemorrhoids usually hang out of the anus and cannot be retracted; they are accompanied by a sensation of sagging distension in the anus. Attending signs may include shortness of breath, laziness to speak, reduced food intake, lack of strength, pale tongue, and weak pulse.
Medicinal therapy: Treat with Center-Supplementing Qì-Boosting Decoction (补中益气汤bǔ zhōng yì qì tāng). If there is bleeding, use Spleen-Returning Decoction (归脾汤guī pí tāng). If there is constipation, use Straitened Spleen Hemp Seed Pill (脾约麻仁丸pí yuē má rén wán).
Acumoxatherapy: Base treatment mainly on BL and empirical points. Main points for hemorrhoids: BL-32 (Second Bone-Hole, 次髎 cì liáo), GV-1 (Long Strong, 长强 cháng qiáng), BL-35 (Meeting of Yáng, 会阳 huì yáng), BL-57 (Mountain Support, 承山 chéng shān), and Two Whites (二白èr bái); needle with supplementation and add moxa. To address the vacuity, add GV-20 (Hundred Convergences, 百会 bǎi huì), and CV-8 (Spirit Gate Tower, 神阙 shén què), and apply moxa.
Point selection according signs: For bloody stool, add SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), SP-1 (Hidden White, 隐白 yǐn bái), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), and CV-4 (Pass Head, 关元 guān yuán). For constipation, add BL-25 (Large Intestine Transport, 大肠俞 dà cháng shù), ST-25 (Celestial Pivot, 天枢 tiān shū), TB-6 (Branch Ditch, 支沟 zhī gōu), and CV-4 (Pass Head, 关元 guān yuán).
Repletion patterns arise when dietary irregularities such as excessive consumption of hot acrid foods, enduring constipation, or wind, dampness, dryness, or heat external contractions either cause congestion of qì and blood and engender wind and transform into dryness, or give rise to damp-heat stagnation and turbid qì and static blood pouring down to the anus. Attending signs include thirst, constipation, reddish urine, red tongue and yellow fur, and slippery rapid pulse.
Medicinal therapy: Congestion of qì and blood engendering wind and transforming into dryness is treated by clearing heat and cooling the blood and by moistening dryness and coursing wind. Use Blood-Cooling Rehmannia Decoction (凉血地黄汤liáng xuè dì huáng tāng). Treat damp-heat by clearing heat and disinhibiting dampness with Pig’s Intestines and Coptis Pill (脏连丸zàng lián wán). If there is constipation, use Major Qì-Coordinating Decoction (大承气汤dà chéng qì tāng).
Acumoxatherapy: Use the same main points for hemorrhoids as given above, but needle with drainage. To clear heat and cool the blood, and moisten dryness and course wind, add GB-20 (Wind Pool, 风池 fēng chí), LR-3 (Supreme Surge, 太冲 tài chōng), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), KI-6 (Shining Sea, 照海 zhào hǎi), KI-3 (Great Ravine, 太溪 tài xī), and ST-44 (Inner Court, 内庭 nèi tíng), needling with drainage. To clear heat and disinhibit dampness, add SP-5 (Shang Hill, 商丘 shāng qiū) and SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), needling with drainage.
Point selection according to signs: For sore swollen anus, add BL-54 (Sequential Limit, 秩边 zhì biān), BL-2 (Bamboo Gathering, 攒竹 zǎn zhú), and BL-58 (Taking Flight, 飞扬 fēi yáng). For red sore, add PC-8 (Palace of Toil, 劳宫 láo gōng). For bloody stool, add LU-6 (Collection Hole, 孔最 kǒng zuì) and SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo). For constipation, add BL-25 (Large Intestine Transport, 大肠俞 dà cháng shù), ST-25 (Celestial Pivot, 天枢 tiān shū), TB-6 (Branch Ditch, 支沟 zhī gōu), LI-4 (Union Valley, 合谷 hé gǔ), and LI-11 (Pool at the Bend, 曲池 qū chí). Other methods of treating hemorrhoids include hemorrhoid desiccation and hemorrhoid point picking. For severe cases, modern surgical ligature replaces the traditional treatments. See also everted-flower hemorrhoids.