As the saying goes, “nine out of ten people have hemorrhoids”, hemorrhoids are a common disease and the results of a survey organized by the Chinese Society of Proctology in 1977 showed that the hemorrhoid rate in China was 46.26%. The overall trend in the treatment of hemorrhoids today is to use a combination of Chinese medicine and Western medicine, non-surgical therapy and surgical therapy, minimally invasive and painless comprehensive treatment Puyang Hospital of Traditional Chinese Medicine Guizhao Wang At present, the minimally invasive treatment of hemorrhoids The advantages of injection therapy are that the effect of treating internal hemorrhoids can be compared with surgery, less painful, shorter treatment time, suitable for stage I-II internal hemorrhoids, especially for bleeding symptoms are obvious. Injection therapy can be divided into sclerosis and atrophy method, necrosis and withering method according to the effect of the injected drug on the tissue. The most used method is the injection therapy of 5% petrolatum vegetable oil, which has a small postoperative reaction and produces less local scars; and petrolatum itself has a bactericidal effect, which is beneficial to the contaminated parts of the anus. It has been reported that the treatment of internal hemorrhoids by using hemorrhoid elimination spirit is effective. However, the operation requires boldness and carefulness, and the drug is usually injected in the submucosa with a volume of about 2~3 mL, so that the mucosal surface is light pink. If the injection is not much, too shallow or too deep or too large a dose, it can cause serious complications. 2 Physical therapy In recent years, physical therapy for hemorrhoids at home and abroad has gradually increased, such as freezing, laser, infrared, copper ion electrochemical therapy, etc. The operation method is simple, easy to grasp, short treatment time, do not need hospitalization, popular with patients. There are more clinical reports on laser treatment of hemorrhoids, which is short, less invasive, and has light postoperative reactions; the indications for surgery are wide, and patients who are pregnant, elderly, or have other comorbidities are not suitable for more invasive surgery can achieve good results with laser treatment, and some patients with heart disease and hypertension can also be treated with this procedure.Zahir [12] et al. reported that NdYAG laser treatment of hemorrhoids It can improve the quality of life and economic status of patients, and the postoperative recovery is faster. Dai Youjun et al. concluded that laser treatment of hemorrhoids has excellent results that cannot be achieved with classical procedures. Gill [13] et al. reported cases of lethal bleeding after laser treatment of hemorrhoids. Another physical therapy that has been reported clinically is copper ion electrochemical therapy. Some experts use copper ion electrochemical therapy to treat hemorrhoid bleeding and hemorrhoid prolapse simply and easily, with a wide range of indications and precise efficacy, which is worthy of clinical promotion. Some scholars believe that copper ion electrochemical therapy can cure all bleeding hemorrhoids without serious postoperative complications, effectively treat bleeding hemorrhoids and hemorrhoid prolapse, avoid the unsafe factors of laser and injection methods, solve the shortcomings of the previous physical therapy with inaccurate efficacy, and avoid the shortcomings of surgical treatment that brings about a long course of treatment, injury and pain, and high costs. However, the efficacy of this method on external hemorrhoids is not exact. Some scholars believe that although laser can treat stage I-II internal hemorrhoids, the instrument is expensive, easy to damage the muscle, and should not be promoted; infrared coagulation can stop bleeding, but it is not as fast as injection therapy; cryotherapy is ineffective and painful after surgery, and is now rarely used 3 Ligation therapy Ligation therapy is an ancient method of treating hemorrhoids. The ligature method is a development based on traditional ligation, which can be interpreted as an improved elastic ligation therapy. The ligation is done by wrapping a medicated silk thread or paper wrapped thread around the root of the hemorrhoid nucleus, causing it to necrotize and fall off, and the wound to heal by repair. There are fewer reports on the clinical use of drug wire ligation for hemorrhoids, and the one that is used more often is the rubber ring ligation therapy, because the ligation has the characteristics of “simple, convenient, inexpensive and experimental”, and the postoperative anal pain, defecation difficulty and edema are less obvious than other surgical treatment for hemorrhoids. The internal hemorrhoid part of mixed hemorrhoids. The shortcomings of this treatment are the relatively long treatment time, patient pain, and complications still include bleeding, pain, swelling, edema, and difficulty in urination, and even serious infections have been reported [219]. If the ligation and ligature are too much, it can easily cause anal stenosis. It is believed that although ligature therapy is very effective in relieving symptoms, there are complications of pain and vasoneurotic syncope; several cases of death due to tetanus or Clostridium spp. infection have been reported, which should be alarming. This procedure does not remove the hemorrhoid nucleus itself, which is in full compliance with the “anal cushion pathogenesis theory” of hemorrhoids, and has the same efficacy as traditional hemorrhoid ligation and excision, and is significantly more effective in terms of operation time, intraoperative and postoperative bleeding, hospital stay, pain index, anal edema, etc. It is in line with the international trend of minimally invasive, painless and simple hemorrhoid treatment, and has a broad clinical application prospect. 5 Clutch suprahemorrhoid circumcision Clutch suprahemorrhoid circumcision (abbreviated as PPH) is a new technique for hemorrhoid treatment developed in recent years with the rise of the theory of submigration of anal cushion. This procedure has been changed from the past aim of destroying and eliminating the hemorrhoid nucleus to the aim of eliminating the symptoms. In the past, the method of anatomically removing hemorrhoids as thoroughly as possible was changed to surgically resetting the prolapsed anal cushion and preserving the structure of the anal cushion as much as possible in the process of surgery, in order to achieve the goal of not affecting or minimizing the ability of fine bowel control after surgery. The indications for this surgery are: stage III and IV prolapsed internal hemorrhoids and mixed hemorrhoids of the annular type with mainly internal hemorrhoids, embedded internal hemorrhoids should be performed after the inflammation has subsided; stage II and III hemorrhoids that have failed other surgeries; and prolapsed rectal mucosa [22]. The advantages of this procedure compared with traditional surgery are: simple operation, short operation time, less intraoperative bleeding; significant effect in treating prolapsed circumferential internal hemorrhoids and bleeding caused by hemorrhoids; mild postoperative pain in the anal region, short duration, and few long-term complications; short postoperative hospital stay, and early return to normal life and work. Yao Liqing [23] et al. used PPH to treat 36 cases of severe internal hemorrhoids (III degree and IV degree internal hemorrhoids) with an average operation time of 10 min and an average stay of 3-5 days after surgery, 6 cases had blood in the stool on the 27th postoperative day, which improved after conservative treatment. 12 cases had no anal pain on the postoperative day. The results were good at 15 months of follow-up. This procedure is expensive, the long-term efficacy is uncertain, and complications and sequelae such as urinary retention, anal pain, anastomotic bleeding and stricture, urgency, postoperative infection, and perforation can occur. surgery is prone to recurrence, which may be related to the surgical operation technique, suggesting that attention to detail should be paid during the procedure.6 Ultrasound Doppler-guided hemorrhoidal artery ligation Ultrasound Doppler-guided hemorrhoidal artery ligation is a new treatment technique that integrates ultrasound exploration and suture surgery. The location of the hemorrhoidal artery can be quickly determined through a specially designed proctoscope with an ultrasound probe, and the hemorrhoidal artery can be accurately and conveniently sutured through the operating window, thereby blocking blood flow and lowering the internal pressure of the hemorrhoid to achieve rapid hemostasis and shrinkage of the hemorrhoid, which is highly effective for bleeding hemorrhoids. Bursics et al. believe that this procedure is an ideal method for treating hemorrhoids and meets the conditions of minimally invasive surgery, which is simple, safe, effective, mildly painful, with few complications, its hemostatic efficacy is exact, its trauma is small, and its postoperative recovery time is short, which is in line with the trend of minimally invasive surgical development. Domestic scholars such as Wang Yehuang [27] made preliminary clinical observations on Doppler-guided ligation of hemorrhoidal artery for the treatment of internal hemorrhoids, and the results showed that this method has clear efficacy, no bleeding, pain, edema and other common complications of traditional surgery, and if combined with suspension method for hemorrhoids, it has obvious advantages compared with traditional surgery, showing a good development prospect. However, this procedure has been in clinical use for a short time, and although the recent efficacy is satisfactory, the long-term efficacy remains to be observed, and there are some complications, such as postoperative complications such as hemorrhage and pain. Luo Zhanbin et al. reported that the use of this method for the treatment of stage II-III internal hemorrhoids revealed intraoperative complications such as submucosal hematoma of the anal canal, postoperative pain, edema of the external hemorrhoidal tissue or formation of thrombosed external hemorrhoids. From some reports, it has also been found that some complications are quite serious, including intestinal fistula, rectovaginal fistula, pelvic infection leading to sepsis, and death has been reported. Some experts abroad have described that some cases have recurrence after 16 months. Summary The following clinical problems exist in the current treatment of hemorrhoids: (1) Overtreatment According to the modern concept of hemorrhoids, the principle of hemorrhoid treatment is to treat the symptoms of hemorrhoids rather than to eradicate the hemorrhoids themselves, and at the end of the 1979 Hemorrhoid Symposium, Marino, the president of the congress, concluded that it is important not to treat the signs without anal symptoms, and not to treat the symptoms without anal signs, so It is clear that “treating hemorrhoids when you see them” is a misconception that needs to be corrected. The modern view is that hemorrhoids do not need to be treated if they are asymptomatic, but only if they are combined with prolapse, bleeding, impaction and thrombosis. The goal of treatment for symptomatic hemorrhoids is to eliminate or relieve symptoms, not to eradicate the pathologically altered anal cushion. Since the anal cushion plays a role in bowel control, conservative and non-surgical treatment should be intensified from the perspective of maintaining the integrity of the anal cushion and the anal canal mucosa. Surgical treatment should be considered only after conservative treatment is ineffective, and surgical treatment should not destroy or minimize destruction of the anal cushion tissue. Therefore, the general trend in the treatment of hemorrhoids is to use a combination of Chinese medicine and Western medicine, non-surgical therapy and surgical therapy, minimally invasive and painless comprehensive treatment (2) Treatment methods are not standardized. There are many methods of treating hemorrhoids, but each surgical method has its own indications, and various methods have both advantages and disadvantages. How to reasonably choose the surgical method, so that the best treatment efficacy, the least complications, and the least pain, has become an urgent clinical problem to be solved. (3) There is a certain impact on the function of the anus. The commonly used external and internal ligature surgery damages the dentate line and upper and lower mucosa and skin, with large trauma, easy bleeding after surgery, long healing time, and different degrees of anal relaxation, mucosal ectasia, and even anal incontinence or anal canal stenosis, which affects the ability of anal fine stool control and defecation. (4) The degree of patient pain is serious. In the past, surgical treatment of hemorrhoids was more traumatic, with more complications, long hospitalization time for patients, slow wound healing, and unimaginable pain level. Nowadays, minimally invasive surgery has become a trend in the development of surgical clinics, and so has the treatment of hemorrhoids. With the gradual understanding of the etiology of hemorrhoids and the development of research on the treatment of hemorrhoids, combined with the continuous development of the concept of minimally invasive, the treatment of hemorrhoids tends to be minimally invasive. However, how to choose minimally invasive treatment methods for different stages of hemorrhoid disease, reduce the pain of patients, speed up the recovery time after surgery, and study low-invasive surgical treatment methods that are safe, effective and economical, and truly “minimally invasive” is a problem that anorectal specialists need to study and solve urgently.