Hemorrhoids are soft venous masses formed by congestion and varicosity of the venous plexus under the mucous membrane at the end of the rectum and under the skin of the anal canal. Hemorrhoids are divided into internal, external, and mixed hemorrhoids. Internal hemorrhoids are pathological changes and displacement of the supporting structures of the anal cushion (vascular cushion of the anal canal), vascular plexus and arteriovenous anastomosis; external hemorrhoids are dilated, stagnant blood flow, thrombosis or tissue hyperplasia of the subcutaneous vascular plexus distal to the dentate line; mixed hemorrhoids are the mutual fusion of internal hemorrhoids and external vascular plexus in the corresponding area. The clinical symptoms and signs mainly include bleeding in stool, prolapse of swelling in the anus after stool, difficulty in retraction of prolapsed material, anal swelling, anal itching, and leakage of anal secretion. In Western medicine, internal, external and mixed hemorrhoids can be treated with reference to this disease. The disease can be caused by the attack of wind, heat and dampness, and the dysfunction of liver, gallbladder, spleen and kidney. Clinical manifestations 1. Internal hemorrhoids. The main clinical manifestations of internal hemorrhoids are bleeding and prolapse, which can lead to thrombosis, impaction, strangulation and difficulty in defecation. Internal hemorrhoids are divided into 4 degrees according to the severity of their symptoms. Degree I: blood in stool, dripping blood, bleeding can stop on its own after stool; no hemorrhoid prolapse. Anoscopic examination shows elevated mucous membrane on the dentate line with dark red surface. Grade II: Blood in the stool is often present; hemorrhoid prolapses during defecation and can be retracted on its own after defecation. Anoscopy shows a mucosal elevation above the dentate line with a dark red surface. Grade III: Blood in the stool may be present; the hemorrhoid may prolapse during defecation or prolonged standing, coughing, exertion or weight-bearing, and needs to be retracted by hand. Anoscopic examination shows a mucosal elevation above the dentate line, and the surface is mostly fibrotic. Grade IV: There can be blood in the stool; the hemorrhoid continues to prolapse or is easily prolapsed after retraction. 2.External hemorrhoid. According to the histopathological characteristics, external hemorrhoids are divided into four categories: connective tissue external hemorrhoids, thrombotic external hemorrhoids, varicose veins external hemorrhoids and inflammatory external hemorrhoids. The main clinical manifestations are soft tissue masses in the anus, anal discomfort, moist itching, foreign body sensation, and pain if thrombosis and inflammation occur. 3.Mixed hemorrhoids. The symptoms of internal hemorrhoids and external hemorrhoids exist at the same time, and in severe cases, it shows the prolapse of annular hemorrhoids. Differential diagnosis 1.Anal rectal cancer. Unexplained anemia, blood in the stool, sudden changes in bowel habits and stool properties, alternating constipation and diarrhea, abdominal pain and abdominal masses, etc. Anorectal diagnosis and anorectoscopy can exclude anorectal tumors and other diseases; fecal occult blood test is a common screening tool to exclude whole gastrointestinal tumors; those who visit the clinic with blood, those with family history of gastrointestinal tumors or their own history of polyps, those who are over 50 years old, and those with fecal occult blood test. For those who visit the clinic with blood, those with family history of GI tumors or their own history of polyps, those over 50 years old, those with positive fecal occult blood test and hemorrhoid patients with iron deficiency anemia, full colonoscopy is recommended. 2. Anal fissure. Pain during stool, small amount of bleeding, and common flab at the base of the fissure. 3.Prolapsed rectum. The prolapsed material is pink and bright red, ring-shaped, wrinkled, soft, generally not bleeding, can be retracted after a light stool, but in severe cases need to be pushed by hand to return, there is a ring-shaped mucosal groove, while the prolapsed hemorrhoid is radiating mucosal groove. 4.Anal papillae hypertrophy. The surface of the prolapsed material is migrating anal canal epithelium, often with a tip, and the surface rarely bleeds. But there is anal discomfort, no pressure pain, can be one or several. 5. Rectal polyp. It comes out during defecation and can be retracted by itself, and the surface is mucous membrane. When the mucous membrane is inflamed, it is strawberry-shaped, some with a tip, some without a tip, often accompanied by bleeding symptoms. In children, rectal polyps can be seen as blood in the anus or on the stool, with a red round tubercle coming out of the anus. 6.Thrombosed external hemorrhoid. It is located in the anal canal with a sudden swelling and obvious pain. Pressing the external hemorrhoid, there are hard nodules under the skin, purple-blue. 7.Acute proctitis. The main manifestations are rapid onset, swelling and burning pain in the anus, frequent bowel movements, urgency, abdominal pain, blood and mucus mixed in the stool, often accompanied by fever, loss of appetite and other systemic symptoms. Microscopic examination can see rectal mucosa congestion, edema, erosion, dotted or flaky bleeding spots, the surface may have yellow pus moss or dotted ulcers. Treatment 1. Internal treatment (1) Wind injury to intestinal ligaments Symptoms: blood dripping, shooting or with blood in the stool, bright red, dry stool, anal itching, dry mouth and throat. Red tongue, yellow coating, floating pulse. Treatment: Clearing the intestines and removing wind, cooling the blood and stopping bleeding. The tongue is red, the coating is yellow and greasy, and the pulse is stringent and slippery. Treatment: Clearing the intestines and stopping bleeding Prescription: Doulian Pill plus reduction Huang Lian 3g Scutellaria 15g Radix Rehmanniae 9g Radix Paeoniae 9g Angelicae 9g Sophora Japonicae 12g Sophora Flos 9g Di Yu Char 9g Thornbush 6g Aconite 6g Commonly used Chinese medicines: Hemorrhoid Ning Tablets, Ma Ren Wan Soft Capsules. (3) Spleen deficiency and qi trapping evidence Symptoms: swelling of the anus, swelling of the anus, weakness of defecation, light-colored blood in the stool, less colorful face, dizziness and fatigue, weakness of food, less breath and lazy speech. The tongue is light and fat, the fur is thin and white, and the pulse is thin and stringent. Treatment: Benefit Qi, promote and elevate the Qi. Treatment: Tonic Zhong Yi Qi Pill plus or minus Astragalus 9g Ginseng 9g Atractylodes Macrocephala 9g roasted licorice 6g Angelica Sinensis 6g Chen Pi 6g Sheng Ma 9g Chai Hu 9g Commonly used Chinese medicine: Tonic Zhong Yi Qi Pill (4) Qi stagnation and blood stasis symptoms: swelling prolapsing outside the anus, edema, thrombus formation inside, or embedded, purple surface, erosion, oozing, severe pain, obvious tenderness, constriction of anal canal, constipation, unfavorable urination. The tongue is purple and dark or with stasis. The tongue is purple and dark or with petechiae, and the pulse is stringent or astringent. Treatment: Invigorate blood circulation and reduce swelling. The effect of medicine and heat, direct or indirect contact with the lesion, so that the coup d’état, qi and blood flow, so as to achieve the effect of activating blood to cure pain, astringent and swelling. It is commonly used to treat pain, astringency and swelling. (2) External application method: Apply the medicine on the affected area to relieve swelling and pain, astringent and stop bleeding, dispel decay and create muscle. Commonly used to eliminate the hemorrhoid cream, five times the seeds of the powder, etc. (3) Plugging method: the drug is made into a suppository and inserted into the anus, which can be slowly absorbed by the rectal mucosa and has the effect of reducing swelling, relieving pain and stopping bleeding. Such as compound anti-hemorrhoid suppository. 3.Surgical method surgery is mainly used for Ⅲ and Ⅳ degree internal hemorrhoids and mixed hemorrhoids, which requires strict control of surgical indications, and surgical adaptation to try to protect the anal cushion and preserve the function of the anus in order to avoid complications such as postoperative bleeding and anal stenosis. Surgical treatment is suitable for those for whom non-surgical treatment is ineffective and there are no contraindications to surgery. Indications: Internal hemorrhoids that have developed to degree III or IV or acute embedded hemorrhoids, necrotic hemorrhoids, mixed hemorrhoids, as well as external hemorrhoids with significant symptoms and signs, and degree II internal hemorrhoids with severe bleeding. (1) Ligation therapy: Ligation therapy is the main therapy for hemorrhoids. It is a treatment method to block the flow of air and blood to the hemorrhoid nucleus by wrapping it with silk threads or medicated silk threads or paper-wrapped medicated threads, so that the hemorrhoid nucleus can be necrotic and fall off and the wound can be healed by repair. The latter is a method of ligating the hemorrhoid with a suture lead through the root of the nucleus and then ligating it. The ligation method is mainly applied to internal hemorrhoids of III and IV degrees or mixed hemorrhoids. (2) Gum ring ligation therapy: Gum ring ligation therapy is applicable to the internal hemorrhoid part of each degree of internal hemorrhoids and mixed hemorrhoids, especially, III degree internal hemorrhoids bleeding with prolapse. The basic principle is to put a small ligature into the root of the internal hemorrhoid through an instrument, and then use an elastic rubber ring to tighten and strangle the root of the hemorrhoid continuously and gradually, thus blocking the blood supply of the internal hemorrhoid, causing ischemia, necrosis and detachment of the hemorrhoid tissue, and repairing and healing the wound tissue, leaving a mucosal scar. At present, the commonly used ligatures are broadly divided into two types of ligatures: the former first uses clamping forceps to pull the hemorrhoid body into the ligature sleeve, and then pushes the rubber ring from the sleeve to the root of the hemorrhoid nucleus; the latter uses an attraction device to draw the internal hemorrhoid into the ligature sleeve, and then pushes the rubber ring from the ligature to the root of the hemorrhoid nucleus. This method is easy to operate, effective, relatively thorough, less painful for the patient, fewer complications, and relatively inexpensive to treat. A few patients may experience anal cramps, urinary disorders and secondary hemorrhage. (3) Sclerotherapy: submucosal muscle sclerotherapy is an effective method commonly used to treat internal hemorrhoids. It is through the injection of drugs into the hemorrhoid nucleus site, which produces a local sterile inflammatory response, resulting in the formation of fibrous tissue, on the one hand, can wrap around or restrict the submucosal venous plexus, so that the hemorrhoid nucleus gradually atrophy disappears, and colleagues of the scar contracture of fibrous tissue can make the hemorrhoid tissue and its surrounding tissue fixed in the submucosal muscle layer, so as to achieve the purpose of hemostasis and prevent the prolapse of the hemorrhoid nucleus. The advantage of this method is that the recent efficacy is remarkable, easy to operate, less painful, clear efficacy, does not affect daily life and work, mainly for Ⅰ, Ⅱ degree internal hemorrhoids blood in the stool or mild internal hemorrhoid prolapse patients, but patients with combined infection generally should not use sclerotherapy injection. External hemorrhoids and hemorrhoids during pregnancy should be prohibited. (4) Withered hemorrhoid nail therapy: withered hemorrhoid nail therapy is one of the traditional treatments for hemorrhoids in Chinese medicine. The mechanism of action is: ① foreign body stimulates inflammatory response. The nail as a foreign body placed in the submucosa of the anal canal in the hemorrhoidal plexus and its interstitial, can cause a series of foreign body stimulation inflammatory response, resulting in thrombosis, prompting local vascular occlusion, interstitial fibrous tissue contraction, so that the nucleus of hemorrhoids atrophy and achieve to the effect. ② Drainage and hemostatic effect. Part of the nail is placed under the mucous membrane of the anal canal and part of it is left outside the mucous membrane, which can form a loose filling and achieve the effect of drainage and hemostasis, which can not only prevent the formation of abscess, but also facilitate the discharge of the nail. ③The role of the drug itself. Since the drug nail dissolves slowly in the tissue, the process of dead hemorrhoids is also relatively slow, and the inflammatory reaction it causes is not too violent, which is also relatively beneficial to the repair of the tissue, thus avoiding severe pain and preventing hemorrhage caused by rapid destruction of blood vessels. Since the withered hemorrhoid nail acts directly on the hemorrhoid nucleus, its dosage is small and easy to operate, so it has long been a traditional and effective treatment for hemorrhoids in China. (5) Hemorrhoidectomy method: In principle, the hemorrhoid nucleus will be completely or partially removed, and the site and number of skin bridges and mucosal bridges should be reasonably preserved during surgery to shorten the wound healing time. Commonly used surgical methods: external peel and tie trauma open surgery; trauma semi-open surgery; trauma closed surgery; external peel and tie plus sclerotherapy injection; circumferential hemorrhoidectomy, including semi-closed circumferential hemorrhoidectomy, but because of the many complications, the current clinical has been largely abandoned. (6) supra-hemorrhoidal mucosal circumferential stapling (PPH): this procedure uses an anastomosis to remove part of the rectal mucosa and submucosal tissues through the anus circumferentially. It is suitable for Ⅲ and Ⅳ degree internal hemorrhoids with circumferential prolapse and Ⅱ degree internal hemorrhoids with repeated bleeding. Postoperative care should be taken to prevent complications such as bleeding, swelling, anal stenosis and infection. (7) Doppler-guided hemorrhoid artery ligation: This method uses a special Doppler probe to detect the artery above the hemorrhoid at 2~75px above the dentate line and ligate it directly, so that the blood supply of the hemorrhoid is blocked, thus achieving relief of symptoms. It is suitable for II~IV degree internal hemorrhoids. 4.Other therapies (1) Acupuncture: Using acupuncture for gingival junction, Erbai, Baihuangyu or perianal electrical stimulation treatment can activate the blood to relieve swelling and pain. If postoperative urinary retention occurs, acupuncture can be used for Guan Yuan, San Yin Jiao and Zhi Yin points, and ear pressure can also be used for treatment. (2) Physical therapy: The indications are Ⅰ, Ⅱ and Ⅲ degree internal hemorrhoids. Physical therapy includes laser therapy, cryotherapy, copper ion electrochemical therapy, microwave thermal coagulation therapy and infrared coagulation therapy. The main complications are bleeding, edema, delayed wound healing and infection. Principles of referral 1.If the diagnosis is unknown and further colonoscopy is needed at a higher level hospital. 2.I, II degree hemorrhoids conventional treatment is ineffective or the condition is aggravated with anemia. 3.Those who need surgery for Ⅲ or Ⅳ degree hemorrhoids. 4.Acute embedded hemorrhoids that have failed to be repositioned manually. Health and rehabilitation 1. Food therapy. There are many health foods that are effective for hemorrhoid prevention and treatment, including turtle, snail, loach, adzuki beans, black sesame, pecan meat, cistanche, lotus root, black fungus, radish, figs, acacia flowers, pig intestine, sheep intestine, turtle meat, honey, etc. Patients can choose according to the different seasons. Chinese medicine believes that animals such as pigs and sheep can be intestinal tonic intestines, with hemostatic, pain and swelling effect; turtle meat is used for hemorrhoids bleeding for a long time, qi and blood deficiency of patients, with the effect of tonifying qi and blood; red beans and angelica decoction, can treat hemorrhoids blood, swelling and pain; new acacia flowers can make cold dishes, wrapped dumplings, with cool blood, hemostatic, hemorrhoid effect, can also drink as tea; black sesame long-term use, with laxative, reduce hemorrhoids bleeding The effect of the pecan meat can moisten the bowels and make up for the deficiency, reducing the symptoms of hemorrhoid prolapse and blood in the stool; honey can play the role of tonic and moisten the bowels for hemorrhoid patients. 2.Anal lifting exercise. Patients contract the anus by themselves for 5 seconds, then stretch for 5 seconds, deep inhalation when contracting the anus, deep exhalation when stretching the anus, and so on for 5 minutes, 2~3 times a day. 3.Guiding method. The left lower limb foot on the ground, the right lower limb bend the knee, both hands hold the right knee joint below the calf nose to the foot three miles area, and then both hands and both upper limbs force the right leg knee as far as possible to the body pull. After a short pause for a moment to switch, the right lower limb foot on the ground, the left lower limb knee flexion, 28 times in a row. Health education 1. Pay attention to local hygiene, warm water sitz bath, keep the perineum clean. 2.Change the diet structure, eat more vegetables, fruits, roughage, increase the intake of dietary fiber, avoid drinking alcohol or eating spicy things, ensure sufficient daily fluid intake (drink cool water or light salt water on an empty stomach in the morning, which can stimulate rectal emptying), and keep the bowels unobstructed. Avoid cold and unclean food to prevent diarrhea; for patients with dry stools, take some laxatives and do not use food with stimulating properties. 3, develop good habits of regular bowel movements, do not read books and newspapers during bowel movements. Don’t prostrate yourself, avoid squatting as much as possible, and don’t spend more than five minutes each time you have a bowel movement. 4, avoid sitting, standing, overwork, appropriate physical activity is necessary, such as interval boxing, swimming or gymnastics, etc., out of the whole body exercise, but also pay attention to the local functional exercise, often do anal exercise. For old and weak patients, they can take raw ginseng reed for a long time to replenish the qi and raise it. For pregnant women should try to avoid diarrhea, constipation and other triggering factors, avoid the toilet to earn, preventive ointment external, once the birth of hemorrhoids, treatment should be very cautious, can sit in the bath external symptomatic treatment can be, should not be surgical treatment. The common western medicine reference 1, grass rhinoceros infusion tablets (elimination of stop) each time 1 ~ 4 tablets, 3 times a day, oral. The dosage can be increased or decreased according to the age and symptoms. 2.Mai Zhi Ling 1~2 tablets per time, 1 time each morning and evening, taken orally after meals. For serious illness or early treatment, take 2 tablets each time, twice a day, orally after meals. Suitable for long-term use, or take as prescribed by your doctor. 3.Eviron is used for acute attacks of hemorrhoids, 6 tablets daily for the first 4 days, 4 tablets daily for the next 3 days, taken orally, then take 2 tablets daily to maintain until the symptoms disappear. 4.Jingkofu is used for the treatment of acute hemorrhoid attacks, 2 capsules twice a day for 7 days, taken with meals. 5.Compound Keratin Suppositories (Tai Ning Suppositories) 3.4g per capsule, 1~2 capsules per day, administered through the rectum. 6.Mesinazolone suppository (hemorrhoidal suppository) Each capsule weighs 2g, 1 capsule once a day, and is inserted into the anus before sleep or after stool. 7.Taining cream Each 20g, twice a day, once in the morning and once in the evening, each time with 3~4g of medicine, administered intra-anally.