Hemorrhoids are pathologic hypertrophy and displacement of the anal cushion and pathologic dilatation or thrombosis of the subrectal venous plexus under the skin on the distal side of the dentate line. Hemorrhoids are the most common of all anorectal diseases and can develop at any age, with the incidence increasing with age. The clinical features of this disease are hemorrhoids, prolapsed nucleus and anal discomfort, and it belongs to the category of “hemorrhoids” in Chinese medicine. 1. Diagnosis 1. Symptoms (1) Intermittent blood in the stool, blood dripping or shooting during defecation, large amount, bright red color, can also be manifested as blood on hand paper. (2) Prolapse of the hemorrhoid nucleus out of the anus after defecation, the initial stage can be self-reversible, later need to be rested by hand or bed rest to reset, serious cases can be squatting, walking, coughing when prolapse. (3) Anal discomfort may include anal swelling, itching, dampness or foreign body sensation. (4) Anal pain Anal pain can occur if there is anal edema or thrombosis. (2) Physical signs (1) Anal visual examination should be performed in both prone and squatting positions, and the anal verge can be seen as a skin flap or semicircular bulge or hemorrhoid nucleus prolapse. (2) Rectal finger examination is not significant for the diagnosis of hemorrhoids, but can understand whether there are other lesions in the rectum, such as rectal cancer, rectal polyps, etc. (3) Anal microscopy can see the mucous membrane above the dentate line elevated, varying in size, with a congested and eroded surface or a grayish thickening. (1) Internal hemorrhoids are located above the dentate line and covered by rectal mucosa, commonly on the left, right front and right back. It can be divided into four stages. (1) Internal hemorrhoids are located above the tooth line and covered by the rectal mucosa. Stage II internal hemorrhoids: the nucleus of the hemorrhoid prolapses out of the anus during defecation, and can be retracted by itself after defecation. Stage III internal hemorrhoids: the nucleus of the hemorrhoid is prolapsed outside the anus and needs to be retracted with the assistance of hands. Stage IV internal hemorrhoids: The nucleus is outside the anus for a long time and cannot be retracted or can be retracted and then immediately prolapsed. (2) External hemorrhoids are located below the dentate line and covered by the skin of the anal canal, and can be divided into three types. (2) External hemorrhoids are located below the dentate line and covered by the skin of the anal canal. Varicose external hemorrhoids: when the abdominal pressure is increased, the subcutaneous plexus of the anal verge expands and stagnates. Thrombosed external hemorrhoids: there is a thrombus formation under the skin of the anal verge. (3) Mixed hemorrhoids: The internal and external hemorrhoids are connected as a whole below the dentate line. 4. Differential diagnosis Hemorrhoids with bleeding as the main manifestation should be distinguished from anal fissures, rectal cancer and rectal polyps: (1) Anal fissures with bright red blood in stool, mostly blood on the surface of stool and hand paper, or a small amount of dripping blood, with burning pain in the anus or typical periodic pain, longitudinal ulcers or fissured hemorrhoids can be seen in the front and back of the anal canal. (2) Rectal cancer stool with blood and mucus, dark red color, change in the number and nature of bowel movements. The rectal finger examination can palpate a hard mass with uneven surface. Endoscopic examination shows that the mass is cauliflower-like, surface erosion, brittle and bleeds easily when touched. Pathological examination is mostly adenocarcinoma. (3) Rectal polyp Blood in stool is mostly blood or mucus on the surface of stool, usually without dripping or shooting blood. Rectal finger examination may reveal a soft mass with a band texture and large mobility. Pathological examination is mostly adenoma. 5.Common complications: including anemia, embedded internal hemorrhoids, etc. The overall treatment principle: Asymptomatic hemorrhoids do not require treatment. The aim of treatment for hemorrhoids is to eliminate and reduce the main symptoms, not to “cure” them. The relief of the symptoms of hemorrhoids should be considered the standard of treatment effectiveness. The doctor should use the appropriate non-surgical or surgical treatment according to the patient’s condition, his experience and equipment.