Hemorrhoids are classified as internal, external and mixed hemorrhoids. Internal hemorrhoids are pathological changes and downward migration of the supporting structures of the anal cushion, vascular plexus and arteriovenous anastomosis, external hemorrhoids are dilated subcutaneous vascular plexus under the dentate line, blood flow stagnation, thrombosis or tissue proliferation, and mixed hemorrhoids are the fusion of internal hemorrhoids and external hemorrhoids in the same area. It is a common and frequent disease. The pathogenesis is not fully understood. In Chinese medicine, it is thought to be related to external wind, dampness, dryness, heat, uncontrolled diet, emotional disorders, prolonged diarrhea, prolonged sitting, prolonged constipation, pregnancy and other factors. I. Diagnosis This disease is diagnosed with reference to the diagnostic criteria for hemorrhoids established by the Chinese Society of Traditional Chinese Medicine, Anorectal Branch in 2002. Or refer to the Guidelines for Clinical Diagnosis and Treatment of Hemorrhoids jointly formulated by the Colorectal and Anal Surgery Group of the Chinese Medical Association, the Chinese Society of Traditional Chinese Medicine, and the Chinese Society of Integrative Medicine, Anorectal Branch in 2006. (1) General treatment includes paying attention to dietary structure, drinking more water, avoiding alcohol and spicy stimulating food; keeping bowel movements smooth, regular bowel movements, not squatting for too long; insisting on warm water sitz bath, keeping perineum clean; preventing and controlling diarrhea, etc. (2) Internal treatment method Mainly used for Ⅰ and Ⅱ degree internal hemorrhoids; with serious heart disease, diabetes, blood disease, liver stiffness and other systemic disorders; old and frail who can not tolerate surgery; women during pregnancy; psychiatric patients who can not cooperate with surgery and some post-operative patients. (1) Wind injury to intestinal ligaments Symptoms: Blood in the stool, dripping blood or jet bleeding, bright red blood, or itching in the anus. Red tongue, thin white or thin yellow coating, floating pulse. Treatment: Clearing heat and cooling the Blood to dispel wind. Representative formula: Cool Blood, Dihuang Tang with addition and subtraction. Commonly used drugs: Radix Rehmanniae 15g, Radix Angelicae Sinensis 15g, Diyu 15g, Sophora japonicae 15g, Huang Lian 6g, Radix Glycyrrhiza Uralensis 6g, Fructus Fructus 12g, Radix Paeoniae Alba 12g, Citrus Aurantium 12g, Scutellaria Baicalensis 10g. (2) Damp-Heat Infusion Symptoms: Blood in the stool is bright in color, with a large amount, with external detachment of the anal matter, which can retract on its own, and burning in the anus. Red tongue, yellowish greasy coating, slippery pulse. Treatment: Clearing heat and cooling the blood, dispelling wind and relieving dampness. Representative formula: Sophora jiao pill with reduction. Commonly used drugs: Sophora Jiao 15g, Citrus Aurantium 15g, Radix Angelicae Sinensis 12g, Radix Scutellariae 6g, Radix Bupleurum 12g, Radix Elm 15g, Atractylodes Macrocephala 15g. (3) Qi stagnation and blood stasis Symptoms: Prolapse of swelling in the anus, or even entrapment, constriction of the anal canal, painful swelling, or even blood clots at the anal verge, edema, obvious pain to touch. The tongue is dark red, with white or yellow fur and thin and astringent pulse. Treatment: Promoting circulation of Qi, activating Blood circulation and resolving blood stasis. Representative formula: Promoting Blood circulation and dispersing blood stasis, plus reduction. Commonly used drugs: Radix Angelicae Sinensis 12g, Radix Paeoniae Alba 12g, Peach kernel 12g, Rhubarb 3g, Sumac 15g, Dampi 12g, Citrus aurantium 12g, Psidium guajava 15g. (4) Spleen deficiency and Qi trapping Symptoms: anal swelling, prolapse of swelling in the anus, requiring manual repositioning. Blood in stool is bright or light in color, may appear anemic, with a pale complexion, dizziness and fatigue, little breath and lazy speech, and loose stools. The tongue is pale and fat, with teeth marks on the side, thin white tongue coating and weak pulse. Treatment: Benefit Qi and nourish Blood, consolidate the spleen and stomach. Representative formula: tonifying Zhong Yi Qi Tang plus reduction. Commonly used drugs: Astragalus membranaceus 15g, Radix Codonopsis pilosulae 15g, Radix Glycyrrhiza glabra 6g, Radix Angelicae Sinensis 12g, Radix Angelicae Sinensis 12g, Rhizoma Atractylodis Macrocephalae 10g, Radix Bupleurum Chinense 10g, Rhizoma Atractylodis Macrocephalae 15g. ⑤ Liver and Kidney Yin Deficiency Symptoms: Difficult stool, difficult defecation, one line for several days, or blood in stool, blood is obscure but not fresh, in the form of drops, accompanied by low fever and night sweats, heat in the heart of the hands and feet, insomnia and dreaminess, red tongue, thin coating, string pulse. Treatment: Nourishing Yin and moistening dryness. Formula: Liu Wei Di Huang Tang and Huang Lian A Gou Tang with addition and reduction. Huanglian 3g, Scutellaria Baicalensis 9g, Colla Corii Asini 9g (melted), Radix Paeoniae Alba 12g, Radix Angelicae Sinensis 12g, Salviae Miltiorrhizae 10g, Jiao Shan Gardenia 6g, Xianhe Cao 15g, Diyu Tan 15g, Phellodendron Bark 10g, Shengcao 6g. Addition and subtraction: If the stool is dry and difficult to be relieved, add Radix et Rhizoma Macrocephalae 10-15g each. (C) External treatment method 1. Fumigation method: This method has the function of activating blood, subduing swelling, relieving pain and astringency, applicable to internal hemorrhoids prolapse It is often used in the form of toxin removal soup, Wu Bei Zi soup, bitter ginseng soup, and hemorrhoid elimination and stasis relief lotion (our agreement formula). Drugs such as Wu Bei Zi 30g, Serpentine 30g Bitter Ginseng 30g, Angelica dahurica 15g Cypress 20g Wild Chrysanthemum 20g Park Nit 15g Red Vine 20g, etc. (2009, 2010 with) 2, external application method: external application of ointment and so on to the affected area. Commonly used drugs are Ma Yinglong hemorrhoid cream, four yellow cream, etc. Effects: Clearing heat and swelling, relieving pain and itching. Main treatment: hemorrhoid swelling and pain, internal hemorrhoid bleeding. 3.Plugging method: the suppository, ointment into the anus. Commonly used drugs are Ma Yinglong hemorrhoid suppositories, anal tide suppositories or creams, compound hemorrhoid suppositories (agreement formula). Usage and dosage: Incorporate one into the anus after stool or/and before bedtime, 1-2 times a day. Effects: Clearing heat and swelling, relieving pain and stopping bleeding. (IV) Surgery 1. Treatment principle Surgery is considered only when conservative treatment is ineffective or for severe hemorrhoids, to remove the lesion and eliminate symptoms while preserving the normal anal cushion and minimizing damage. 2.Surgical method Scope of application: Surgical treatment is still a commonly used and effective treatment method. For hemorrhoids whose symptoms cannot be relieved by non-surgical treatment, surgical treatment can be considered. This method is especially suitable for Ⅲ and Ⅳ degree internal hemorrhoids, all types of external hemorrhoids, annular mixed hemorrhoids, and acute hemorrhoid attacks. Usage: Preoperative preparation Individualized principles for selecting the surgical approach to hemorrhoids Postoperative disposition. ① Preoperative preparation Auxiliary examinations: routine blood, urine, stool, blood coagulation, liver and kidney function, hepatitis B and C syphilis and AIDS testing, chest X-ray, electrocardiogram, ultrasound of the liver. Patients under local anesthesia may not fast, while patients under other anesthesia must fast for more than 4 hours before surgery. Preoperative local skin preparation and rectal evacuation. Fill in the surgical consent form. (1) Injection therapy: Indications: Stage I internal hemorrhoids, Stage II and III internal hemorrhoids used in conjunction with ligation. Drug: Antihemorrhoid injection. Operation method: After pulling the hook to fully expose and disinfection, inject 1:1 elimination hemorrhoid spirit injection into the hemorrhoid nucleus or simply into the hemorrhoid nucleus according to the four-step method. (2) Penetrating ligation method: Indications: Stage II and III internal hemorrhoids. The operation method: curved vascular forceps clamp the base of the internal hemorrhoid nucleus, “8” through the suture. Pay attention to the preservation of the anal cushion during the operation. (3) External peeling and internal injection ligation method Indications: Mixed hemorrhoids. Operation method: Firstly, inject the internal hemorrhoid, then peel the external hemorrhoid and ligate the internal hemorrhoid, and minimize the damage to the dentate line and the skin of the anal canal during the operation. For those with spastic hypertrophy of the sphincter, part of the internal sphincter is cut off. (4) Chinese medicine surgical method used in our hospital Small incision segmental external peeling (cutting) internal injection ligation method Indications: Circumferential mixed hemorrhoids Operation method: The segmental external peeling internal ligation method is combined with the external cutting internal ligation method, and the external hemorrhoid incision is a small willow-shaped incision. If the internal and external hemorrhoids are tightly connected after segmentation, external excision and internal ligation will be performed; if the connection is not tight, external excision and internal ligation will be performed; if the skin bridge is long, the skin bridge will be truncated and sutured. pph surgery: It is suitable for stage III and IV internal hemorrhoids, especially circumferential internal hemorrhoids or circumferential mixed hemorrhoids (mainly internal treatment). A circular anastomosis is used to remove a section of the lower rectal mucosa and suspend the hemorrhoid nucleus from the rectal wall, and block the blood vessels on the hemorrhoid so that the prolapsed hemorrhoid nucleus retracts into the anus. Segmental dentate ligation or incision: For circumferential mixed hemorrhoids. The procedure should be carried out by cutting and ligating the hemorrhoids in sections according to the condition, paying attention to the fact that the internal hemorrhoids should not be ligated in the same plane but in a serrated shape, and retaining enough skin and mucosal bridges. 3, hemorrhoid surgery precautions (1) injection must be sterilized each injection, the application of dental 5 slender needle, do not inject the drug into the muscle layer or under the tooth line. (2)When there are many ligature points, each point should be staggered in height and not on a plane. (3) Circumferential mixed hemorrhoid surgery should preserve enough skin bridge and mucosal bridge with sufficient width. 4, post-operative treatment (1) light and nutritious diet, control stool 2-3 days, keep the stool soft and fluent. Give laxatives for dry stools. (2) Use antibiotics as appropriate to prevent infection, and give painkillers to patients with heavy postoperative pain. (3) Observe the wound bleeding, avoid strenuous or excessive activities in the early postoperative period and when the ligature is off, if there is active bleeding from the wound, sutures should be taken immediately to stop the bleeding. (4) Take a sitz bath after stool and change the medication daily. Observe the wound to prevent bridge row healing, and treat the granulation found to affect the wound healing in time to facilitate healing. (5) Observe the anal condition by elective finger diagnosis one week after surgery to prevent the formation of anal stricture. (5) Care and regulation: 1. Eat a diet rich in fiber, regular diet, and avoid spicy and stimulating foods. 2, regular living, avoid exertion, long standing, long squatting, moderate participation in physical exercise. 3, regular defecation, 1-2 days to ensure a bowel movement, each defecation < 10 minutes, avoid the toilet to struggle, after the stool to perform anal lifting exercise. 4.Keep the perianal area clean and dry. 5.Postoperatively, some elderly male patients should focus on observation, timely relaxation of tourniquet and compression dressing, early hot compress and physiotherapy to make urine discharge smoothly. The treatment of hemorrhoids can be effective for bleeding, prolapse and painful symptoms, but it can not eliminate the nucleus of hemorrhoids. The treatment of internal hemorrhoids with the injection of hemorrhoid spirit has the advantages of less pain and better efficacy. The four-step injection method has better efficacy on third-stage internal hemorrhoids and circumferential mixed hemorrhoids. Surgery is still the fundamental method to cure hemorrhoids, but there is still a possibility of recurrence. In particular, cricoid mixed hemorrhoids, purely external and internal ligation to retain the skin bridge and mucosal bridge has the possibility of posterior hemorrhoids. The treatment principle of hemorrhoids is that asymptomatic hemorrhoids do not require treatment, and the treatment of symptomatic hemorrhoids is aimed at eliminating and reducing their main symptoms, clinical treatment is divided into non-surgical and surgical therapies, and non-surgical therapies should be used as the first choice for treating hemorrhoids on the basis of general therapies because of their simplicity and certain efficacy, but severe hemorrhoids or non-surgical therapies If the treatment is not effective, surgical treatment is needed. Surgery is the ultimate method of non-surgical treatment and is relatively curative. Our department uses the small incision segmental external peeling (cutting) and internal injection ligation method to treat cricoid mixed hemorrhoids, which can effectively prevent complications and sequelae such as edema and anal canal stenosis, but its trauma to the anal canal and postoperative complications such as pain and edema still cause greater pain to patients. 1, postoperative complications: pain, edema Solution: mainly comprehensive therapy (1) postoperative and daily medication changes anal plug compound hemorrhoid suppository 1 per time. Metronidazole to prevent inflammatory pain and Panax notoginseng to activate blood circulation and relieve pain. (2) After each stool, fumigate the hemorrhoid with the Anti-Hemorrhoid and Stasis Relief Lotion (our agreement formula), which has the effect of clearing heat and dampness, activating blood circulation and removing blood stasis, reducing swelling, relieving pain and itching. (3) Careful operation, reasonable incision, unobstructed drainage, and reduction of side injuries. (4) Cut off part of the internal sphincter for anal canal stenosis to relieve postoperative spasmodic pain. (5) Postoperative supplementation with physical therapy. (6) Post-operative oral "hemorrhoid health combination" The impact of hemorrhoid surgery trauma on the human body, pre-operative and post-operative control of diet, damage to the vital energy to reduce the resistance to disease, post-operative control of bowel movements to make the stool easy to dry, these will aggravate complications and affect wound healing. According to the postoperative clinical characteristics of hemorrhoids, our department summarized the traditional Chinese medicine formula "Hemorrhoid Health Combination", which has achieved certain curative effects. Composition: Radix Codonopsis pilosulae 15g Radix Angelicae Sinensis 15g Radix Astragali 30g Rhizoma Atractylodes Macrocephala 15g Radix Rehmanniae 15g Radix Paeoniae Alba 15g Radix Glycyrrhiza Uralensis 10g Citrus Aurantium 10g Dosage: Decoction with water, one dose per day, divided into morning and evening. Effects: Strengthening the spleen and benefiting Qi, promoting Qi circulation and relaxation of the bowels Main treatment: postoperative weakness and sweating of hemorrhoids, abdominal distension and dryness of the bowels. (7) Baihuan Yu electroacupuncture for pain relief. (8) Oral or intramuscular injection of painkillers if necessary. 2.Postoperative complications: urinary retention Solution: mainly comprehensive therapy (1) Careful operation of anesthesia to reduce side injuries and decrease pain. (2)Massage and physiotherapy. (3)Oral administration of Chinese herbal medicine. (2) About residual hemorrhoids Solution: individualized principle to choose the surgical method of hemorrhoids, improve the quality of surgery and enhance postoperative care. Pph surgery is mainly used for mixed hemorrhoids with mainly internal hemorrhoids. It can be supplemented with sclerotherapy injection, external peeling (internal ligation). Segmental dentate ligation or cut-and-inject procedure is mainly used for circumferential mixed hemorrhoids.