Hemorrhoids (Piles)

WESTERN MEDICINE: Hemorrhoids are varicosities of the veins of the hemorrhoidal plexus, often complicated by inflammation, thrombosis, and bleeding. Under the mucosa of the anus and the lower rectum are a number of veins which act as collateral connections between the portal and the systemic venous systems. The internal hemorrhoidal veins lie above the anal mucocutaneous junction; the external hemorrhoidal veins lie beneath the stratified squamous epithelium of the lower anal canal. Since the portal venous system has no valves, increases in intra-abdominal pressure are transmitted directly to these dependent veins. The increased pressure may cause distention of the veins and ultimately varicosities: these varicosities are called hemorrhoids. Causes of increased portal vein pressure include pregnancy, obesity, coughing, sneezing, straining to defecate, portal hypertension, and abdominal tumors. Hemorrhoids are an extremely common disease.

SYMPTOMS AND SIGNS

External hemorrhoids appear as small rounded purplish masses covered with skin and becoming more prominent when the patient strains during defecation. Unless thrombosed, they are soft and seldom painful, though they may produce a sense of fullness at the anus. Occasionally, due to acute local stress (e.g., straining during defecation), the external hemorrhoidal veins suddenly enlarge and the lumens fill with thrombi. These thrombosed hemorrhoids, may become inflamed, break down, and bleed profusely. Defecation is accompanied by tenesmus and pain. The condition is very painful for about 5 days, after which absorption of the clot begins and the mass subsides, leading only a skin tag. External hemorrhoids tend to undergo spontaneous remission, at which time they appear at the mucocutaneous junction as tabs of hypertrophied tissue which may be asymptomatic, annoying the patient by protrusion, or itching severely. 

Internal hemorrhoids are multiple, soft, purple, irregular in shape, and covered by a thin layer of mucous membrane. Minor injuries cause bleeding
and superficial ulceration. Bleeding is the principal symptom, but a sense of incomplete rectal evacuation may characterize the presence of large hemorrhoids. Prolapse may occur, it is precipitated by straining during defecation and is accompanied by pain, thrombosis, and in severe cases, strangulation. Leakage of mucus from the anus, and itching, are frequent complications. 

ETIOLOGY AND PATHOLOGY: The causative factors for the internal hemorrhoids are due to the following: 
  1. Interior intestine dry heat due to the irregular diet, or excessive fried, hot and spicy food intake: the interior heat combined with other  factors, such as dampness or stagnated blood, accumulate in the  intestine and cause abnormal circulations of Qi and blood causing  internal hemorrhoids. 
  2. Long time sitting or walking, or heavy duty carrying all lead to the abnormal circulation of blood at the local area causing internal hemorrhoids. The causative factors for the external hemorrhoids are mostly due to the damp - heat, or other external pathogenic factors, fissure in anus or interior heat.

DIFFERENTIATIONS

Internal treatment of hemorrhoids is mostly for the internal hemorrhoids at the first or second stage, or internal hemorrhoids accompanied with other chronic diseases, or for the elderly or children with internal hemorrhoids. External hemorrhoids are usually treated by the external methods, such as external applications or external washing. 

1. The Excessive Type:

Indications: Internal hemorrhoids with bright red bleeding before or after stool, profuse or small amount, dropping or heavy dirty bleeding due to the damp - heat. 

Treatment & Formulas: Clear the heat, cool the blood and dispel wind and damp factors. 

Products:

    • Yi Zhi Tang (Cimicifuga Combination, Item No. 2001): This is very good formula for hemorrhoidal pain and bleeding, constipation, or rectal prolapse due to the internal heat and damp - heat factors. 
    • Xiao Zhi Wan (Sophora and Scute Formula, Item No. 2149): This formula is good for both internal and external hemorrhoids with symptoms of constipation, fresh bleeding or with pain by its cooling and laxative functions. 
    • Da Chai Hu Tang (Major Bupleurum Combination, Item. No. 2036): This is a formula for liver and gallbladder diseases, such as hepatitis and cholecystitis by its regulating, clearing and laxative functions. It also can be applied for hemorrhoids caused from liver and gallbladder disorders and with constipation. 
    • Xiao Cheng Chi Tang (Minor Rhubarb Combination, Item No. 2028): This is very good for the hemorrhoids due to the strong interior heat by its laxative function to reduce the internal heat. 
    • Shang Huang Xie Xin Tang (Coptis and Rhubarb Combination, Item No. 2026): This is also a strong formula to clear the interior heat. Both Xiao Cheng Chi Tang and Shang Huang Xie Xin Tang ban be used individually or combined with the previous formulas. 

2. The Deficiency Type:

Indications: Internal hemorrhoids with pale and light bleeding, accompanied with pale complexion, fatigue, dizziness, palpitation, short of breath, insomnia, poor appetite, pale tongue, thready and weak pulse. 

Treatment & Formulas: Tonify the Qi and blood by promoting the functions of heart and spleen. 

Products:

    • Shi Quan Da Bu Tang (Ginseng and Tang - kuei Ten Combination, Item No. 2015):This is atypical Qi and blood tonic formula. So it can be applied for hemorrhoids at a late stage when it shows both Qi and blood deficiency. 
    • Gui Pi Tang (Ginseng and Longan Combination, Item
      No. 2261 ): This is a tonic formula that promotes the functions of spleen and heart.
    • Bu Zhong Yi Qi Tang (Ginseng and Astragalus Combination, Item No. 2225): This is formula for hemorrhoids at a chronic stage with Qi deficiency symptoms. 
    • Si Wu Tang (Tang - kuei Four Combination, Item No. 2060): This formula benefits hemorrhoids at the chronic stage with blood deficiency due to the bleeding. 
    • Ma Zi Ren Wan (Apricot Seed and Unum Formula, Item No. 2175): This formula benefits habitual constipation by its moisturizing and cooling functions for the intestines. So it can be used to prevent hemorrhoids in mild type or late stage, or for the elderly with constipation. 

COMMENT: 

  1. For all kinds of hemorrhoids, external washing methods or other external applications are highly recommended.
  2. Some other surgeries may be used when necessary.
  3. Some common used herbs for external washing are:
    • Ku Shen Gen (Sophora Radix, Item No. 1108)
    • Mang Xiao (Natrii Sulfas, Item No. 1125)
    • Huan Lian (Coptis Rhizoma, Item No. 1073) 
    • Jin Chien Cao (Lysimachia Herba, Item No. 1326)
    • E Zhu (Zedoariae Rhizoma, Item No. 1170) 
    • Di Yu (Sanguisorba Radix, Item No. 1084) 

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