Hemorrhoids are a relatively common disease and are divided into four stages according to the 2000 Chinese Medical Association Surgical Group Hemorrhoid Treatment Specification. Stage IV internal hemorrhoids are generally manifested as hemorrhoids that have prolapsed from the anus and cannot be returned, and are often associated with impaction, thrombosis, and strangulation. Stage IV hemorrhoids should be treated surgically in a timely manner, and can be treated by external and internal ligation of mixed hemorrhoids. If local thrombosis is formed, thrombus stripping can be performed. Minimally invasive surgery, such as PPH, or supra-hemorrhoidal mucosal circumferential stapling, can fundamentally remove the loose rectal mucosa and move the anal cushion upward to fundamentally solve the hemorrhoid, and then anti-inflammatory, hemostatic, and pain-relieving treatment should be given after surgery. Perianal fumigation can be performed, such as Wu Bei Zi Tang, Bitter Ginseng Soup or Pain Relief like Shen Tang, which is first smoked and then washed around the anus to reduce edema and promote wound healing.