There are data showing that mixed hemorrhoids are a common clinical condition among patients with hemorrhoids. Among them, mixed hemorrhoids are the most common, and some data show that about 65.9% of hemorrhoid patients have mixed hemorrhoids. The treatment of hemorrhoids is constantly changing as the understanding of hemorrhoids is updated and the methods are innovative. Prolapse, bleeding, and pain are the main symptoms of hemorrhoids. The Milligan-Morgan procedure used to be the most commonly used surgical procedure, but it is simple, has severe postoperative pain, slow healing, long hospital stay, and may produce complications such as anal stenosis, which affects the ability to control and defecate finely, and requires a high degree of patient tolerance, which cannot be tolerated by elderly, frail, or seriously ill patients. It is not tolerated by the elderly, frail, or patients with severe comorbidities. In the past 10 years, supraclavicular mucosal hemorrhoidopexy (PPH) has been widely used in clinical practice, but its cost, postoperative rectal stricture and discomfort have been criticized. In 1998, electro-chemical therapy by cupric ion (ECTCI) was used to treat hemorrhoids, and many experts have subsequently studied it and concluded that it is less painful and has fewer complications. We have improved ECTCI with external hemorrhoidectomy (referred to as external hemorrhoidectomy) to achieve better results, and also conducted a randomized controlled study with the efficacy of external peel and internal ligation and PPH with external hemorrhoidectomy. 1. Treatment method Two preoperative enemas and sacral tube anesthesia. ECTCI treatment: insert the flail anoscope, examine and determine the bleeding and prolapsed hemorrhoidal area, insert 4 sets of copper needle electrodes simultaneously into the tissue of the hemorrhoidal area near the tooth line at a depth of 15 mm in 4 places, and treat for 280 s. Remove the electrodes and compress the needle eye with a cotton ball to prevent the copper ion fluid from overflowing. The remaining hemorrhoid areas are treated in the same way one at a time. The same hemorrhoidal area can be treated repeatedly at the same time depending on the bleeding and congestion status. Usually, the treatment is not less than 3 times. At the end of the treatment, remove the anoscope and observe the reaction of the hemorrhoid area during the treatment, and you can usually see the blue-green change in the tissue around the electrode that appears with ECTCI treatment. After the operation, the hemorrhoid nin pessary was inserted in the anus and a pressure dressing was applied externally to stop bleeding. Postoperative treatment: all 3 groups of patients applied antibiotics for 3 days after surgery, a normal diet on the day of surgery, cleansed with expectorant Erhuang Tang after defecation, and routine drug changes until healing. 2. Results: (1) hemostatic efficacy: 100% hemostatic cure rate after surgery; (2) postoperative pain: by t-test, the pain score (24 hours after surgery, postoperative defecation) was significantly lower in the treatment group than in control group 1 and control group 2 The number of times painkillers were used in the treatment group was significantly less than in control group 1 and control group 2, and the difference was statistically significant (P<0.01). 4. occurrence of various complications: in postoperative bleeding, edema, urinary retention, delayed healing, anal stenosis, anal swelling, and decreased bowel control, the number of cases occurred in the treatment group was significantly less than that in control group 1 and control group 2, and the difference was statistically significant (P<0.05); (3) Comparison of hospitalization days, return to work time, and costs: the number of hospitalization days, return to work time, and costs in the treatment group were significantly less than those in control group 1 and control group 2, and the difference was statistically significant ( P<0.05). According to the clinical efficacy observation over the years, the long-term effect of drugs as well as non-incisional surgical methods is not as good as incisional surgical treatment can achieve the effect of radical cure. However, the significant pain and complications of incisional surgery have always been the key issues affecting the direction of treatment. In the past, the fear of surgical treatment of hemorrhoids was mainly painful and prone to sequelae. Instead, the essence is to address (1) control of bleeding, (2) resolution of infection, and (3) protection of the skin. Based on the above considerations, in the past, the external peeling and internal ligature method was adopted to solve the problem of infection and bleeding. However, it is necessary to simultaneously reduce the local damage of the operation and try to preserve the integrity of the skin in the anal region without causing complications such as anal canal defect and anal stenosis. The core of the contradictions and limitations of this treatment approach is limited by the historical conditions that fuse internal and external hemorrhoids together and consider mixed treatment of mixed hemorrhoids. Possible responses are (1) reduction of the trauma, (2) surgery in a painless area, and (3) suturing of the trauma. Based on the above ideas, the different conditions of hemorrhoids should be treated separately and accordingly. The basic tips are: internal treatment of internal hemorrhoids; external treatment of external hemorrhoids; slight attention to the anal verge; and protection of the anal canal. Under the guidance of this idea, we have utilized and continuously innovated the present two major techniques (ECTCI and PPH anastomosis) for the treatment of internal hemorrhoids and completed the removal of external hemorrhoids with the electric knife, while administering the necessary anal dilation method. This study showed that the hospital stay of the treatment group was significantly shorter than that of the control group, and successfully solved all the surgical problems of hemorrhoids. 3. Classification and grading of hemorrhoids. Since the principle of internal treatment of internal hemorrhoids and external treatment of external hemorrhoids was adopted, from the point of view of guiding treatment, the hemorrhoids were classified according to the location of the hemorrhoids: (1) Internal hemorrhoids. They are classified into 4 degrees according to the degree of bleeding and prolapse. (2) External hemorrhoids. They are divided into 4 categories: (1) Thrombosed. (2) Varicose veins. (3) Connective tissue. (4) Inflammatory. The common domestic term of mixed hemorrhoids is no longer very meaningful. From the perspective of guiding treatment, the classification of internal and external hemorrhoids is more practical. From the clinical experience, the degree of bleeding and prolapse is the main indicator to guide treatment, and circumferential prolapse and non-circumferential prolapse should be the main basis for choosing treatment methods. And the diagnosis of mixed hemorrhoids has lost its significance for clinical guidance. ECTCI is based on the principle of hemorrhoid nail therapy, combined with modern technology, the use of copper needle electrodes can quickly release the complex similar to the foreign body stimulation of the hemorrhoid nail, and with the help of electrochemical therapy methods and theories, the technology of ECTCI. ECTCI is a treatment by ion introduction and electrification, the complexes formed as foreign body stimulation and electric current together cause local microthrombosis and edema of epithelial cells of the vascular wall, promote sterile inflammation, tissue mechanization, vascular occlusion and lead to fibrosis of surrounding tissues, thus achieving the elimination of submucosal vascular hemorrhagic The aim is to eliminate the hemorrhagic lesions of the submucosal vessels and to stop prolapse. The therapy is effective under the combined effects of physical, chemical, foreign body stimulation and other biological effects. This includes: (1) blockage of small blood vessels leads to a cut-off effect on the blood supply to the hemorrhoid, promoting atrophy of the congested, distended hemorrhoid and achieving hemorrhoidectomy in a hemostatic sense; (2) effectively and safely causing sterile inflammation and further promoting fibrosis of the Treitz muscle break, which causes adhesion, fixation, and lifting of the loose supporting tissue, leading to further atrophy of the hemorrhoid tissue or anal cushion. The trace copper ion itself is non-toxic, stable and safe in its therapeutic effect, which makes up for the shortcomings of traditional methods. Therefore, copper ion electrochemical treatment is suitable for the treatment of the internal part of mixed hemorrhoids. For the external part of hemorrhoids, we advocate removing them together, which is the same as the treatment of PPH.