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Asympt omatic hemorrhoids are present in half of the population over fifty years old. It is not

common between the ages of 25-50, with the exception of women after pregnancy.

Symptomatic hemorrhoids result in bleeding, prolapse and sometimes pain, to various degrees.

Other symptoms could be "fecal soilage", mucus production, itching and localized infection.

Symptoms usually resolve themselves spontaneously within several days to several weeks but

most patient develop recurrent episodes. Treatment will usually aim at relieving symptoms,

while allowing spontaneous recovery. A more aggressive intervention, including surgery, is

required in case of severe pain, severe bleeding (more a result of a fissure) or hemorrhoids that

do not resolve.

The hemorrhoidal veins provide a pathway of communication between the systemic venous

system and the portal venous system. These veins, which due to their location go under

tremendous pressures and strains, have a tendency to dilate and develop into a twisted and

turned plexus. The anal cushions are a part of the normal anatomy of the anal canal. These

cushions, containing the hemorrhoidal veins, the arterial plexuses, smooth muscles and

connective tissue, permit the passage of variable sizes of stools, without disruption of the of

the rectal mucosa. Hemorrhoidal disease is thought to be a result of the displacement of one ormore of three vascular anal cushions, mainly: the right anterior cushion, the right posterior

cushion and the left lateral portion of the anal canal. there are external and internal

hemorrhoids:

external hemorrhoids arise from the inferior hemorrhoidal plexus, exterior to the anal verge.

They are covered by a layer of skin, which is very sensitive to pain. Thrombosis in this

structure may cause a severe pain.

Internal hemorrhoids have four categories:

First degree- a bulging into the lumen of the anal canal that causes bleeding

Second degree- a prolapse during defecation that reduces spontaneously

Third degree- a prolapse that requires manual reduction

Fourth degree- A prolapse so severe that it cannot be reduced

SOURCES

Barker, L.R, Burton, J.R and Zieve, P.D, Principals of Ambulatory Medicine, fourth edition,

pages: 1351-1352

Deadman, P and Al-Khafaji, M with Baker, K. (2007) A Manual of Acupuncture

Flaws, B. and Sionneau, P. (2001) The Treatment of Modern Western Medical Diseases with

Chinese Medicine, 2nd Edition

OConnor, J. and Bensky D. editors (1981) Acupuncture: A Comprehensive Text

Image: http://www.hemroidharry.com/blog/71/hemorrhoids-home-treatment/

CLINICAL MANIFESTATION- Patterns of Disharmony

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Rectal Discomfort, Hemorrhoid

Blood Stasis, Qi Stagnation.

May include: Heat, Dampness or Dryness, Liver Depression, Collapsed Spleen QiTREATMENT PRINCIPLES

Move Blood and Qi,

Clear Heat, Resolve Damp or Dry, Soothe Liver Qi, Raise Spleen QiTREATMENT- Points

Primary treatment: Bl 57, Er Bai, GV1 to raise qi and circulate blood to the region

Additional points may include:

St44 to clear heat Sp9 to drain if damp Sp6, Kd6 to moisten if dry Lv3 to move Liver qi Sp3 to tonify Spleen qi TH6 to regulate the qi in the three heatersPATIENT EDUCATION / RECOMMENDATIONS

Patient is recommended to avoid extended sitting or standing. Kegels, or exercises that

strengthen the pelvic floor are prescribed.

PROGNOSIS

Treatment can be extremely effective.

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