## A small hill
Hemorrhoids are one of the most common problems people never mention. Bright red blood on the paper. Itching that won't stop. A swelling that comes and goes, or a lump that won't go back. Pain on every trip to the bathroom. Most people wait months — sometimes years — before saying anything, and by then they have tried every cream on the pharmacy shelf.
The Donguibogam, the 1613 master text, gives this part of the body its own chapter, and it is more practical than its subject might suggest. It explains where hemorrhoids come from, how to read the bleeding, what to do at home, and what not to eat. We translated it in full.
[→ The Posterior Yin — full translated chapter]
## Why a pile is called a hill
The chapter explains the old character for hemorrhoid by its sound: it is the same as the word for a small hill standing up out of a marsh. Any small piece of flesh that stands out at one of the body's openings, it says, is a "pile" — there are nose piles and tooth piles too. The image is a good one. A hemorrhoid is not a foreign growth. It is the body's own tissue, swollen and pushed out of place.
## Where they come from
The chapter names its causes plainly: eating to fullness, wine, and overindulgence. It describes heavy food the digestion can't move, gathering low in the bowel, and heat pouring downward into the vessels there. One of its formulas is written specifically for monks, in whom long sitting and full eating had brought on hemorrhoids of every kind.
Four hundred years later the list is nearly the same: constipation and straining, long hours sitting, heavy meals and alcohol, low fiber, pregnancy and childbirth, and heavy lifting. Most hemorrhoids are made — and unmade — by what happens day to day.
## Read the blood
The chapter's most useful passage is about bleeding. Blood that comes before the stool, clear and bright red, it calls "intestinal wind": something that has just arrived, seen as soon as it happens. Blood that comes after the stool, dark and turbid, it calls "visceral toxin": heat that has been building for a long time, seen only after long.
The modern reading follows the same line for a different reason. Bright red blood on the paper or dripping into the bowl usually comes from close to the opening — most often hemorrhoids or a small tear. Dark, maroon, or black blood, or blood mixed into the stool itself, comes from higher up and must always be checked by a physician. The 1613 text understood that the colour of the blood tells you where — and how long — the problem has been.
## Read the symptoms
The chapter reads each symptom as a clue to what is driving it. A firm lump points to damp. A swollen, sagging one, to damp with heat. Severe pain, to fire. Itching, to wind and heat. A hard, dry stool, to dry heat. Treatment follows the clue, which is why two people with "hemorrhoids" can leave with different plans.
It also warns against the obvious move. Bleeding from the bowel, it says, is on no account simply to be stopped and held in: look for the root, treat that, and the bleeding stops of itself.
## Inside and outside together
The chapter's governing rule comes from Dongwon: treat from the inside and the outside at the same time. Medicine is taken to settle the bowel and cool the blood, and at the same time the area is bathed to calm it from without.
Its simplest instruction is still the best one: after every bowel movement, wash once with warm water. That is a sitz bath, and it remains one of the most effective things anyone with hemorrhoids can do — a few minutes in warm water after the bathroom and before bed, gentler than any wipe.
## When it won't go back in
The chapter treats prolapse — tissue that slips out and won't return — as a sign of weakness rather than excess: what comes out is depletion. It names the same causes we see now: straining too hard in childbirth, a child crying and straining, and long-standing diarrhoea. Treatment lifts and strengthens rather than cools.
## What to avoid
The chapter's food advice is short and firm, and it says that ignoring it makes any medicine useless: avoid wine, heavy and greasy food, hot spices, and raw, cold, hard food. Its closing counsel adds the rest: keep the stool soft, eat moderately, and take care of your strength, or nothing else will hold.
## What treatment looks like here
Acupuncture is used to reduce swelling, pain, and bleeding and to support healthy bowel function. The chapter uses moxibustion at GV1 Changqiang at the tip of the tailbone and GV4 Mingmen on the low back, and for prolapse, GV20 Baihui at the crown — a point at the top of the body to lift what has fallen. We also use BL57 Chengshan on the calf, one of the classic points for hemorrhoids.
Herbal medicine follows the pattern. From the chapter:
[Goegak-won 槐角元] — the chapter's first choice at the first outbreak
[Goehwa-san 槐花散] — for bleeding with heat
[Jingugangchul-tang 秦艽蒼朮湯] — for swollen, painful hemorrhoids with damp and heat
[Jinguganghwal-tang 秦艽羌活湯] — for itching
[Bojungikgi-tang 補中益氣湯] — for prolapse, to lift and strengthen
[Heukjihwang-hwan 黑地黃丸] — for long-standing hemorrhoids in someone run down
The chapter also contains a long list of caustic pastes and powders for burning hemorrhoids off. Many of them are dangerous, and we do not use them.
A flare usually settles within days to a couple of weeks. Hemorrhoids that keep coming back are a sign that something underneath — constipation, sitting, diet, or depletion — needs attention, and that is where longer-term treatment goes.
If constipation is part of the picture, read more here — [Digestive health]
## Please read this part
Rectal bleeding should always be evaluated by a physician at least once, even if you are sure it is hemorrhoids.
**Get prompt medical care if you have:** dark, maroon, or black blood, or blood mixed into the stool; heavy bleeding, or bleeding with dizziness or weakness; a sudden, very painful, hard bluish lump at the anus, which can be a clotted hemorrhoid and is best treated within the first few days; fever with pain and swelling around the anus, which can be an abscess; or tissue that has come out and will not go back.
**Get evaluated before starting here if you have:** any change in your bowel habits that lasts more than a few weeks, unexplained weight loss or fatigue, a family history of colon cancer, or you are 45 or older and have not had colon cancer screening.
The 1613 chapter draws the same line in its own way. Its dark blood that comes after the stool is a heat that has been building a long time, and it ends with a short section of ominous signs — a long-standing pile that has opened a passage elsewhere is, it says, fatal. A problem that has gone on long and changed its character deserves a proper look first.
**This approach may help if you're dealing with:** bleeding hemorrhoids, once evaluated · itching around the anus · swollen or painful hemorrhoids · hemorrhoids during or after pregnancy · hemorrhoids that keep coming back · mild prolapse · hemorrhoids with constipation · discomfort from long hours sitting.
The Donguibogam translation project at formulas.raahacupuncture.com is researched and translated by Eui Young (Justin) Chung, L.Ac., Dipl. O.M. — the same clinician you'll see in the treatment room.