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Hemorrhoids (痔疮):

Hemorrhoids can be internal or external depending on whether they have formed above or below the pectinate line (齿状线) aka verge. Internal hemorrhoids form above the pectinate line and are rectal varices (直肠静脉曲张). External hemorrhoids form below the petinate line, some of which are the varices of the anal canal (肛门静脉曲张). Beside being varices, external hemorrhoids can also be due to blood clots forming after a vein ruptures – thrombosed external hemorrhoid (血栓性外痔). It can also be caused by inflammation and subsequent creation of fibrous tissue on the wall of the anal canal (结缔组织外痔).

How I’ve come to look at external vs internal hemorrhoids is as follows. Because we have skin below the pectinate line, the kind of tissue injury that presents here is different than that presented above the dentate line (membrane tissue). For example, there is less bleeding below than above.  And it’s usually painful when below, and below the pectinate line, sensations like droopiness or the presence of a foreign object are possible.

Using TCM for external hemorrhoids:

Which is also why TCM treatments can be suitable for external hemorrhoids, because we can take away the inflammation and pain using external treatment like warm washes (熏洗) where you first let the hot vapors work wonders on the anal region before giving that area an herbal rinse. Kushen Tang (苦参汤) is representative formula for treating dampness and itch, and wubeizi tang (五倍子汤) is representative for treating inflammations and swelling.

What about TCM for internal hemorrhoids?

If it’s internal hemorrhoids we’re talking about, there’ll be no pain in the rectal area governed by autonomic nerves. It’s more bloody here though, and hence more dangerous in some way. But it’s not by the quantity of blood that we measure the severity of internal hemorrhoids.

Rather we talk about the degree of ptosis/prolapse.

Now, it’s worthwhile here to compare the measuring sticks for internal hemorrhoids against that of rectal prolapse not due to hemorrhoids. There we have three grades.

Here we have four:

1. Grade 1: There is no prolapse, but there is still bleeding.
2. Grade 2: Prolapse which recedes on its own after you’re done with your toilet business.
3. Grade 3: Prolapse which needs to be pushed back in with your hands. Can happen not just when shitting, but also when tired, after sneezing etc.
4. Grade 4: Prolapse that you cannot push back.

Internal hemorrhoids are serious because the membrane and the layers below are super elastic and can stretch all the way down. This is what makes internal hemorrhiods so much more troublesome than the skin tissue below the pectinate line. This elasticity makes prolapse possible and now we have to deal with not just the varices themselves, but everything else they have dragged down with them.

That was my view of things, which makes it clear that the problem is no longer functional, about some sensation (pain or otherwise) or the extent of inflammation. We have to get rid of this physical deformity. Which is why sclerotherapy (injection) or surgery is recommended when prolapse starts becoming more than a bother.

That said, we must recognize the the main issues with internal hemorrhoids are first, the prolapse, and second, the bleeding.

Treating the Prolapse of Internal Hemorrhoids:

As we saw above, prolapse when serious is best treated non-medicinally. That said, Chinese Medicine offers options for “drying up” the hemorrhoid. This is akin to dessicating it via electric current, or cauterizing it using lasers, but despite being less precise, it’s very non-invasive. In the past, the use to just apply Hemorrhoid Drying Powder (枯痔散) over the affected areas, and then wait for the hemorrhoid to drop off on its own. Now, we have an evolved version, which is to “poke” into the hemorrhiods with “medicinal needles” made of similar substances – this is the method of ’stuffing medicines’ (插药疗法) which uses ku zhi ding (枯痔钉.)  We only need to be careful not to poke too deep (lest the needles, usually 4 to 6 of them, hits the tunica adventia) nor too shallow (lest it causes bleeding because the remaining portions have not died off). It is also not useful when fibrous tissue has formed, because these tissues will not absorb the medicines.

Treating the Bleeding of Internal Hemorrhoids:

Bleeding is associated with inflammation, and both can be treated using chinese medicines, both externally and internally.

1. First, take away the constipation. This can be implemented with a diet change. And if an herbal formula is used, it is often done in the spirit of runchang tang (润肠汤).
2. Then we can talk about stemming the bleeding. Liangxue dihuang tang (凉血地黄汤) is an evolved version of huaijiao wan (槐角丸). And if you think you know better, other blood stemming herbs can be added.
3. If the bleeding comes with pain, stasis is often brought into consideration. Zhitong rushen tang (止痛如神汤) is a standard here.
4. If the bleeding is accompanied by a feeling of heat in the anus, then lower-jiao coolants and blood coolers of stasis can be brought to use. Example formulas include bixie shenshi tang (萆薢渗湿汤) and huoxue sanyu tang (活血散瘀汤).

Summary:

I hope that this makes it clear to the reader the limited extent to which Chinese medicine may help with the treatment of hemorrhoids. It is limited, but if you think again, it does help quite a bit. The issue is with the ptosis/prolapse. Once the walls of your rectum and even parts of the sigmoid colon are pulled down, try as you may to “dry up” all the varices, but the prolapse will still remain. Also do check out PPH, an operation where the area above the dentate line is operated upon, meaning much much less pain.

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