Case 1

Name: Xu.

Sex: Male.

Age: 55 years.

Occupation: A vice professor.

Chief Complaint: Intermittent hematochezia and herniation of lump from anus for 5 years.

History of Present Illness: Five years ago, a lump herniated from the patient' s anus, accompanied with intermittent hematochezia. At the beginning, it merely herniated when the patient was exerting himself to defecate, after defecation it could retract. At last, the herniation occurred more and more in frequency, and the lump couldn't retract by itself, only by kneading, could it retract with difficulty. The characteristics of the hematochezia was fresh red in colour, less in amount and occurring in drops. It disappeared as soon as he finished defecating. 1 year ago, it became very easy for the lump to herniate when the patient was walking and standing, furthermore, it couldn't retract by kneading. There was a pain caused by friction between the lamp and his underclothes. Then he came to me for treatment on June 15,1995.

Physical Examination: The patient was conscious with a normal general condition. The pulse was thready and uneven. The tongue was red with a thin layer of white fur. There was an erosive soft lump out of the anus, its length was 5era,its diameter was 1. 5cm. Another lump was touched in the area above the dentate line through rectal examination. There was not other abnormal sign.

Diagnosis: Mixed Hemorrhoid.

Differentiation: It was caused by accumulation of damp-heat in large intestine. It caused there was a failure of the large intestine to conduct transmission, then the damp-heat attacked the anus and caused there appeared stagnation of qi and blood stasis in the anus. As a result of a long time of such pathogenesis, the hemorrhoid was caused.

Therapeutic Principle: Clearing away damp-heat from large intestine, removing blood stasis and promoting blood circulation, drawing toxic materials out of the anus and atrophying the hemorrhoid.

Recipe:

BaiFan,Pure Alum 30g

WuBeiZi,Chinese Gall 30g

WuGong, Centipede 20g

LiuHuang, Sulphur 20g

ShiLiuPi,Pomegranate Rind 20g

All the above drugs were to be decocted to make drug liquid, 5 doses were prescribed. He was told to wash the anus in the drug liquid or sit in it, once a day,30 minutes a time. In the same period,2ml of injection of Red Sage Root was injected into the point of GV1, Changqiang, once a day. In addition, he was to1d to take the bolus of Cannabis to lubricate intestine and promote bowel movement. Hot and greasy food was forbidden during the treatment. Drinking was forbidden too.

Effect Observation: After 10 days of the above treatment, the hemorrhoid became a layer of skinny fold. Rectal examination showed that another hemorrhoid which was in the area above dentate line disappeared too. After 10 months' follow-up, the illness didn't recur. Then it's ending.

Case 2

Name: Shi.

Sex: Male.

Age: 22 years.

0ccupation: A college-student.

Chief Complaint: Pain, hematochezia and herniation of lump from anus for 1 week.

History of Present Illness: One week ago, 4 lumps herniated from the patient's anus, accompanied with hematochezia, dyschesia and pain. The hematochezia was fresh red in colour and less in amount, it disappeared as soon as he finished defecating. The stool was dry and hard. The 4 lumps included 3 small ones and a big one, the big one was just like a pigeon egg, the small ones were all like peanuts. They were all pliable in texture. If touched upon, there was immediate bleeding. All the herniated lumps could retract by kneading. The patient got similar trouble half a year ago, at that time, it was cured by injecting sclerosing agent injection into the lumps in hospital, but the sickness recurred now. Then he came to our hospital for treatment on October 15,1996.

Physical Examination: The patient was conscious with a normal general condition. The pulse was thready and uneven. The tongue was red with a thick layer of white fur. 4 pliable lumps were touched in the area above dentate line through rectal examination, the individual position of them was separately at 7 0'clock,ll o'clock,1 o'clock and 4 o'clock. The big one was at 40' clock, its size was like pigeon-egg. The other ones were as big as peanuts. There was not other abnormal sign.

Diagnosis: Internal Hemorrhoid.

Differentiation: In TCM, it belongs to the category of "ChangFengXiaXue" (hematochezia). It was caused by damp-heat which was accumulated in large intestine. When the intestinal fluid was fumigated and evaporated by the damp-heat, the intestine became drier and rougher than normal so that the stool couldn't pass through the large intestine smoothly, then the patient got dyschesia and pain, when the damp-heat attacked the anus, the qi-stagnation and blood stasis which caused hemorrhoid was formed, when the damp-heat got into blood, it caused disturbance of blood flowing, by which the hematochezia was caused.

Therapeutic Principle: Clearing away heat evil and cooling blood, softening hardness and having hemostasis, lubricating the intestine to ease constipation. It's most important to activating blood to resolve stasis to reduce the hemorrhoid.

Recipe:

CegaiYe,Biota Tops 15g

HuaiJiao,Sophora Fruit 12g

WuMei,Black Plum 15g

ZhiKe,Bitter Orange 12g

HuoMaRen, Hemp Seed 10g

DangGui,Chinese Angelica Root 10g

XingRen,Apricot Kernel 10g

ShuDaHuang,Prepared Rhubarb 9g

DiYuTan,Calcined Sanguisorba Root 15g

All the above drugs were to be decocted in water for oral taking. 3 doses were prescribed. Hot and greasy food was forbidden during the treatment. In the same period, 2ml of injection of Red Sage Root was injected into point of Changqiang (GV1),once a day, extending the aching sensation to the anus in order to stimulate the qi of Du-channel. In addition, DanShen (Red Sage Root) can cool blood and remove blood stasis to reduce hemorrhoid.

Effect Observation: After 3 days of above treatment, his stool became loose, and it' s easy for him to defecate. The hematochezia and pain disappeared. The lumps became softer and smaller, they didn't herniate any more. So it's necessary to invigorate middle-Jiao and benefit qi for astringing the lumps, and strengthen clearing away damp-heat for cleaning large intestine.

Recipe:

ZhiHuangQi,Moxa-prepared Milkvetch Root 30g

DangGui,Chinese Angelica Root 15g

DangShen,Pilose Asiabell Root 30g

CaoBaiZhu,Fried Bighead Atractylodes Rhizome 15g

HuoMaRen, Hemp Seed 20g

ShuDaHuang,Prepared Rhubarb 15g

XingRen,Apricot Kernel 1Sg

ShengBaiShao,Raw White Peony Root 15g

ZhiGanCao,Prepared Liquorice Root 10g

HuangLian,Coptis Root 12g

HuangBai,Phellodendron Bark 12g

CangZhu, Atractylodes Rhizome l5g

All the above drugs were to be decocted in water for oral taking. 3 doses were prescribed. Acupoint injection was continuously used as same as before.

After 3 days of the above treatment, all uncomfortable sensation disappeared. Rectal examination showed the big hemorrhoid became smaller than before, it became a bean-like and soft skinny fold, while the 3 small ones had disappeared at all. After 1 year' s follow-up, the sickness didn' t recur. Then it' s ending.

Case 3

Name: Ran.

Sex: Male.

Age: 20 years.

0ecupation: A college student.

Chief Complaint: Hematochezia for 6 days.

History of Present Illness: Six days ago, the patient got hematochezia without pain. The hematochezia was fresh red in co1our and less in amount, it disappeared as soon as he finished defecating. Usually it's difficult for him to defecate smoothly and normally, the stool was hard just like sheep dung. When the patient was defecating, he felt there was no lump herniating. Then he was introduced to me for treatment on December 7,1996 by his classmates.

Physical Examination: The patient was conscious with a normal general condition. The pulse was thready and uneven. The tongue was light red with a thin layer of white fur. 3 lumps were touched above dentate line, the separate position of them was at 80'clock,ll o'clock and 2 o'clock, they were all peanut sized and labile-textured. The gloves was blood-stained. There wasn' t other abnormal sign.

Diagnosis: Internal Hemorrhoid.

Differentiation: It was caused by downward flow of damp heat attacked the large intestine, then there appeared a failure of the large intestine to conduct transmission function, by which the damp-heat was accumulated in anus, then the hemorrhoids were caused. When the damp heat got into blood, it caused disturbance of blood flowing, by which the hematochezia was caused.

Therapeutic Principle: Clearing away heat evil and cooling blood, activating blood to resolve stasis, moistening intestines to relieve constipation.

Recipe:

CeBaiYe,Biota Tops 15g

HuaiJiao,Sophora Fruit 12g

WuMei,Black Plum 15g

ZhiKe, Bitter Orange 12g

HuoMaRen, Hemp Seed 10g

DangGui,Chinese Angelica Root 10g

XingRen,Apricot Kernel 10g

ShuDaHuang,Prepared Rhubarb 9g

DiYuTan,Calcined Sanguisorba Root 15g

All the above drugs were to be decocted in water for oral taking. 3 doses were prescribed. Greasy and hot food was forbidden during the treatment. In the same period, 2ml of injection of Red Sage Root was injected into point of Changqiang (GV1) ,once a day.

Effect Observation: After 1 day of the above treatment, the hematochezia disappeared, the stool became loose, and it was easy for him to defecate. After 10 days of the above acupoint injection, the 3 lumps which were in the area above dentate line couldn't be touched. Then it's ending.

Case 4

Name: Jiang.

Sex: Male.

Age: 39 years.

0ccupation: A peasant.

Chief Complaint: Herniation of lump from anus for 2 years, hematochezia and defecating pain for half a month.

History of Present Illness: Two years ago, a lump herniated from the patient's anus. At the beginning, it herniated intermittently only when he was defecating, it could retract by kneading. At last it herniated constantly and couldn't retract by kneading. The friction between the lump and his underclothes gave him an uncomfortable sensation, accompanied with intermittent defecating-pain, hematochezia and constipation. 1 year ago, he went to Changzhou City, Jiangsu Province for treatment. The sickness was diagnosed as "Hemorrhoid" and he was treated by injecting sclerosing agent into the pile. In a few days, he got better than before. But a few days later, the lump herniated again. Half a month ago, he got hematochezia and defecating pain again because of eating some hot food, the hematochezia was fresh red in colour and less in amount, after defecating the toilet paper was blood stained. The defecating pain was severe prickling like pain. Sometimes the pain made him be afraid of defecating. Then he came to our hospital for treatment on August 10,1998.

Physical Examination: The patient was conscious with a normal general condition. The pulse was thready and sunken, the tongue was dark red with a thin layer of white fur. A lump was seen out of the anus, it seemed like a pigeon egg, it was pliable in texture and it was easy to be abrasive bleeding. No lump could be touched in the area above dentate line. There was not other abnormal sign.

Diagnosis: External Hemorrhoid.

Differentiation: It's caused by downward flow of damp-heat. It caused the qi-stagnation and blood stasis in the anus, then the lump was formed. When the intestine and anus was fumigated and evaporated by the damp-heat, they became relatively dry and rough, so that it caused the defecating pain, hematochezia and constipation.

Therapeutic Principle: Clearing away heat and cooling blood. Softening hardnesses and having hemostasis, lubricating the Intestine to ease constipation.

Recipe:

CeBaiYe,Biota Tops 15g

HuaiJiao, Sophora Fruit 12g

WuMei,Black Plum 15g

ZhiKe,Bitler Orange 12g

HuoMaRen, Hemp Seed 10g

DangGui,Chinese Angelica Root 10g

XingRen,Apricot Kernel 10g

ShuDaHuang,Prepared Rhubarb 9g

DiYuTan,Calcined Sanguisorba Root 15g

All the above drugs were to be decocted in water for oral taking. 3 doses were prescribed. Hot and greasy food was forbidden. In the same period, 2ml of injection of Red Sage Root was injected into point of Changqiang (GVI), once a day, this therapy could activating blood to resolve stasis and reduce the hemorrhoid. In addition, he was told to apply powder of external drugs onto the pile.

Recipe:

LongGu,Calcined Dragon's Bone 60g

ChiShiZhi,Red Halloysite 60g

WuMei,Black Plum 30g

ShiLiuPi,Pomegranate Rind 30g

TianLong,Gecko Domestica 50g

WuBeiZi,Chinese Gall 30g

All the above drugs were to be ground into powder and mixed together, then he should apply a little mixture onto the pile, once a day.

Effect Observation: After 3 days of the above treatment, the hemorrhoid disappeared, the defecating pain and the hematochezia disappeared too. After 2 months' follow-up, the sickness didn't recur. Then it's ending.