Hemorrhoids

Hemorrhoids are not a single condition in TCM - they are a family of four distinct patterns, each with its own cause, its own type of bleeding and pain, and its own treatment. Two patterns are driven by excess Heat or Damp-Heat, where spicy food and alcohol create inflammation that swells the veins and makes them bleed.

One is a stagnation pattern, where prolonged sitting and straining trap Qi and Blood, turning the hemorrhoid into a hard, dark, painful lump. The fourth is a deficiency pattern, where a weakened Spleen can no longer hold the tissues up, leading to a heavy, prolapsing sensation and pale bleeding. Understanding which pattern is active explains why the same diet change that helps one person can make another person's hemorrhoids worse.

TCM understands hemorrhoids primarily through the Large Intestine and the Spleen. The Large Intestine is responsible for eliminating waste, and when Heat or Damp-Heat accumulates there - often from a diet rich in spicy, greasy foods and alcohol - it injures the local blood vessels, causing them to swell, burn, and bleed. The color of the blood tells the story: fresh, bright red blood that spurts or drips usually indicates Heat in the Large Intestine, while darker, thicker bleeding with a heavy, burning sensation points to Damp-Heat pouring downward into the lower burner.

But not all hemorrhoids are hot. Prolonged sitting, chronic constipation, and straining create a local traffic jam of Qi and Blood. This stagnation hardens the hemorrhoid, turns it a dark purple color, and produces a fixed, stabbing pain - a pattern called Qi and Blood Stagnation. Here the problem is not so much what you eat but how you sit and move, and the treatment focuses on getting the circulation moving again rather than cooling inflammation.

The Spleen adds a third dimension. In TCM, the Spleen is responsible for holding organs and tissues in place. When Spleen Qi becomes chronically weak - often from overwork, poor diet, or prolonged illness - it loses its lifting power. The veins and tissues in the anal area sag downward, creating a constant heavy, bearing-down sensation and a prolapse that may need to be pushed back manually. The bleeding in this pattern is usually pale and scanty, and the whole body feels tired. This is why the same Western diagnosis can require four entirely different treatment strategies in TCM.

Across all patterns, TCM treatment of hemorrhoids works on two fronts: addressing the local symptoms and correcting the underlying internal imbalance. The local symptoms - bleeding, swelling, pain, prolapse - are managed with acupuncture points that have a specific affinity for the anal region, such as Erbai (EX-UE-2), Chengshan (BL-57), and Changqiang (DU-1). Herbal formulas are then chosen to treat the root pattern.

For Heat patterns, the strategy is to cool the Blood and clear the Large Intestine. For Damp-Heat, the focus is on draining Dampness and clearing Heat simultaneously. For Qi and Blood Stagnation, the goal is to invigorate circulation and break up the local blockage. For Spleen Qi Sinking, the priority is to tonify the Spleen and lift the sinking Qi, restoring the body's ability to hold tissues in place.

Most patients combine weekly acupuncture with daily herbal medicine. You can expect the acute symptoms - pain, burning, and fresh bleeding - to begin improving within the first 1 to 2 weeks. Swelling and prolapse take longer to resolve, especially in deficiency patterns. Your practitioner will adjust your herbal formula as your symptoms change, which is normal and a sign of progress. Dietary changes are essential and will be discussed from the first session. Stool consistency often improves early on, which reduces straining and allows the anal tissues to heal.

The universal dietary rule for hemorrhoids is to keep the stools soft and easy to pass without straining, while avoiding foods that generate Heat and Dampness. Drink plenty of warm water throughout the day. Favor high-fiber, bland foods such as cooked leafy greens, oatmeal, brown rice, barley, sweet potato, and pear. Celery and cucumber are particularly cooling and help move the bowels. Avoid or strictly limit spicy foods (chili, curry, garlic), deep-fried and greasy foods, alcohol, and coffee. If you have a Spleen Qi Sinking pattern with fatigue and loose stools, emphasize warm, cooked meals and reduce raw, cold foods that tax the Spleen.

The evidence base for TCM treatment of hemorrhoids is growing but remains largely concentrated in Chinese-language literature. Several randomized controlled trials have shown that acupuncture can significantly reduce acute hemorrhoidal pain and swelling, with one trial published in Acupuncture in Medicine demonstrating that verum acupuncture was superior to sham for pain relief. Systematic reviews of Chinese herbal medicine report that formulas tailored to pattern differentiation improve bleeding, prolapse, and pain more effectively than conventional fiber therapy alone.

However, many studies have methodological limitations, including small sample sizes and lack of blinding. High-quality, multicenter RCTs published in English are still needed. Despite this, the long history of safe clinical use and the consistency of positive results across studies make TCM a reasonable option, especially for patients who prefer a non-surgical approach or who have not responded to standard care.