* Hemorrhoids: internal or external, with or without swelling, inflammation or bleeding
WESTERN THERAPEUTIC ACTIONS
* Anti-inflammatory effect to reduce the swelling and inflammation of hemorrhoid tissues
* Hemostatic effect to stop rectal bleeding
* Mild laxative effect to relieve constipation
CHINESE THERAPEUTIC ACTIONS
* Clears damp-heat and eliminates toxic-heat from the Intestines
* Stops bleeding
* Regulates bowel movements
Take 4 capsules three times daily on an empty stomach with warm water.
Chun Pi (Cortex Ailanthi)
Dang Gui (Radix Angelicae Sinensis)
Di Yu Tan (Radix Sanguisorbae Carbonisatum)
He Zi (Fructus Chebulae)
Huai Hua Tan (Flos Sophorae Carbonisatum)
Huang Qin (Radix Scutellariae)
Jin Yin Hua (Flos Lonicerae Japonicae)
Lian Qiao (Fructus Forsythiae)
Pu Gong Ying (Herba Taraxaci)
Wu Bei Zi (Galla Chinensis)
Xian He Cao (Herba Agrimoniae)
Yu Li Ren (Semen Pruni)
Hemorrhoids are painful, swollen veins in the lower portion of the rectum or anus. Hemorrhoids are usually asymptomatic, but may also cause pain while sitting, itching, and bleeding. Hemorrhoids can be caused by straining during bowel movements, constipation, sitting for long periods of time, and certain diseases, such as liver cirrhosis.
GI Care (HMR) is designed as a first-line therapy to treat various presentations of hemorrhoids, including internal and external hemorrhoids, and with or without swelling, inflammation and bleeding. In traditional Chinese medicine, hemorrhoids are generally considered as a condition characterized by damp-heat and toxic-heat attacking the Intestines, leading to signs and symptoms such as enlarged and protruding tissues in the rectum, constipation, and rectal bleeding.
In this formula, Jin Yin Hua (Flos Lonicerae Japonicae), Lian Qiao (Fructus Forsythiae), Pu Gong Ying (Herba Taraxaci), and Huang Qin (Radix Scutellariae) clear damp-heat and eliminate toxic-heat from the Intestines. Huai Hua Tan (Flos Sophorae Carbonisatum), Di Yu Tan (Radix Sanguisorbae Carbonisatum), Chun Pi (Cortex Ailanthi) and Xian He Cao (Herba Agrimoniae) clear heat, cool the blood, and stop rectal bleeding. Dang Gui (Radix Angelicae Sinensis) tonifies blood and replenishes blood lost through rectal bleeding. It also moves blood to treat the blood clots around the anus that are associated with the hemorrhoidal condition. Yu Li Ren (Semen Pruni) moistens the Intestines and relieves constipation. He Zi (Fructus Chebulae) and Wu Bei Zi (Galla Chinensis) have an astringent effect to reduce inflammation of swollen hemorrhoid tissues.
Overall, GI Care (HMR) is an excellent formula that treats various presentations of hemorrhoids, including internal or external hemorrhoids, with or without swelling, inflammation or bleeding.
CAUTIONS & CONTRAINDICATIONS
* This formula is contraindicated during pregnancy.
* Individuals with bleeding hemorrhoids should not take drugs with anticoagulant or antiplatelet effects, such as aspirin, Motrin/Advil (ibuprofen) and Aleve (naproxen). These drugs may cause more bleeding.
* This herbal formula contains herbs that invigorate blood circulation, such as Dang Gui (Radix Angelicae Sinensis). Therefore, patients who are on anticoagulant or antiplatelet therapies, such as Coumadin (warfarin), should use this formula with caution, or not at all, as there may be a higher risk of bleeding and bruising.,,
Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:
* Yinqiao pulse is a thin, straight, wiry pulse that extends proximally to the chi positions. It is one of the eight extra meridian pulses.
* With mild to moderate constipation, combine with Gentle Lax (Deficient).
* With moderate to severe constipation, combine with Gentle Lax (Excess) .
* With severe and profuse bleeding, combine with Notoginseng 9.
* For hemorrhoids in individuals with extreme weakness and deficiency, use with Imperial Tonic .
* With blood deficiency, add Schisandra ZZZ.
* With ulcerative colitis, add GI Care (UC).
* With irritable bowel syndrome, add GI Harmony.
* With severe inflammation, combine with Astringent Complex.
* Changqiang (GV 1), Chengshan (BL 57), Sanyinjiao (SP 6), Kunlun (BL 60), Huiyang (BL 35), Erbai, Taichong (LR 3), Ciliao (BL 32), Fuliu (KI 7), Yaoyangguan (GV 3), Weizhong (BL 40), Qihai (CV 6), Dachangshu (BL 25), Shangqiu (SP 5)
Classic Master Tung's Points:
* Qimen (T 33.01), Qijiao (T 33.02), Qizheng (T 33.03), Waisanguan (T 77.27), Yizhong (T 77.05), Erzhong (T 77.06), Sanzhong (T 77.07), Kongzui (LU 6), Huofu (T 88.41)*, Huoliang (T 88.42)*, and Huochang (T 88.43)*. Bleed dark veins on the back of the knees. Bleed dark veins on the KI channel of the lower limb. Bleed before needling for best result.
Master Tung’s Points by Dr. Chuan-Min Wang:
* Hemorrhoids: Bleed the popliteal fossa. Needle Qimen (T 33.01), Qijiao (T 33.02), Qizheng (T 33.03) toward the TH channel.
Balance Method by Dr. Richard Tan:
* Left side: Houxi (SI 3), Xiaohai (SI 8), Taichong (LR 3), Ququan (LR 8)
* Right side: Shaohai (HT 3), Shenmen (HT 7), Yanglingquan (GB 34), Zulinqi (GB 41)
* Place 12 needles around the umbilicus at 0.5 to 1 cun deep.
* Left and right sides can be alternated from treatment to treatment.
* Large Intestine, Rectum, Spleen, Adrenals, Subcortex
Auricular Medicine by Dr. Li-Chun Huang:
* Anus, Rectum, Spleen, Large Intestine, Diaphragm, Pituitary, Adrenal Gland. Bleed Ear Apex and Anus area.
* It is very beneficial to eat foods that are high in fiber to ensure regular bowel movements, such as wheat bran, fresh fruits, and nearly all vegetables. A diet high in fiber is one of the most important factors for the prevention and treatment of hemorrhoids.
* It is important to make sure the diet contains an adequate amount of vitamins and minerals, as many of them are essential for blood clotting and coagulation. Vitamins and minerals that are especially important are vitamin B complex, vitamin C, vitamin K, and calcium.
* Advise the patient to increase water intake.
* A folk remedy that may be helpful in treating hemorrhoids involves eating one fresh cucumber (not peeled with ends removed) each morning and evening.
* Another folk remedy states to eat two to three pieces of banana (the riper the better) with wild honey daily. Treatment course is 30 to 50 days.
* Foods that should be avoided include fats, animal products, coffee, alcohol, pepper, mustard, and things that are spicy or pungent. These foods are generally harder to digest, and are more likely to irritate the digestive system. Alcohol consumption may worsen the pain and cause further bleeding.
* Warm and hot natured foods that damage qi and yin should be avoided, such as:
§ certain fruits like mango and durian that produce heat.
§ stimulants like coffee, alcohol, and energy drinks.
§ spicy/pungent/aromatic vegetables such as pepper, garlic, onions, basil, rosemary, cumin, funnel, anise, leeks, chives, scallions, thyme, saffron, wormwood, mustard, chili pepper, and wasabi.
* Avoid food and drinks with artificial coloring.
* Consume as few meat products as possible. Do not eat processed meats, such as lunch meats, hot dogs and sausages, as they contain nitrites that are associated with inflammation and chronic disease.
The Tao of Nutrition by Dr. Maoshing Ni and Cathy McNease:
§ Recommendations: sea cucumber, black fungus, water chestnut, buckwheat, tangerines, figs, plums, fish, prunes, guavas, bamboo shoots, mung beans, winter melon, black sesame seeds, persimmons, bananas, squash, cucumbers, taro, tofu, and cooling foods.
§ Avoid stimulating foods, spicy foods, alcohol, smoking, constipation, stress, lack of exercise, and standing or sitting too long.
* It is important to maintain normal and soft bowel movements on a regular basis, as straining during bowel movement will often worsen hemorrhoids. Empty the bowels as soon as the urge to defecate occurs to avoid unnecessary straining. Bowel movements should take no more than three to five minutes. Refrain from reading on the toilet.
* Avoid excessive wiping after a bowel movement. Avoid using rough toilet paper, since it may cause more irritation and bleeding. Use soft and moist toilet paper or baby wipes.
* Regular walking helps to stimulate peristalsis and promote normal bowel movements.
* Soak in a sitz bath with hot water for 20 minutes each night to focus blood circulation in the area of the anus. This helps clear the blue, ballooned veins. It also helps disperse the blood clots that cause the firm, tender mass in the anal area.
* Prolonged sitting or standing is not recommended as it may aggravate the condition. Rest face down on a bed whenever possible in times of flare-ups.
* Sit on soft cushions or surfaces whenever possible. Avoid sitting on hard surfaces, which increases pressure upon the hemorrhoidal blood vessels and tissues. Also, when it is necessary to sit for a long period of time, always try to leave the seat for five minutes each hour or shift the buttocks often from side to side to help relieve the constant rectal pressure.
* Patients should learn to exhale and not hold their breath when straining or lifting heavy objects.
* B.R., a 38-year-old female, complained of an acute hemorrhoid after a short bout of constipation. Blood pressure was 116/78 mmHg with a heart rate of 62 beats per minute. Even when her normal bowel movements were present, the hemorrhoid remained along with itching and constant discomfort. Her first hemorrhoid occurred after giving birth to her baby two years prior to this treatment. The TCM diagnosis was damp-heat. Patient was given GI Care (HMR) at 3 grams twice a day. After one dose the hemorrhoid receded completely and all discomfort, itching, and swelling was resolved. Patient took one more dose twelve hours later to solidify the effect. Her hemorrhoid did not return. Submitted by E.R., Kula, Hawaii.
* A.R., a 53-year-old male, presented with constipation and hemorrhoids. His pulse was slippery and wiry and his tongue was scalloped with a dry center. The patient had recently had surgery for his shoulder and as a result he had spent a considerable amount of time sitting. Excess sitting coupled with his long term Spleen qi deficiency lead to hemorrhoids. The practitioner diagnosed this condition as Spleen qi deficiency with dampness and slight heat. After taking GI Care (HMR) for one week, the patient resumed normal bowel movement and no longer suffered from hemorrhoids. Submitted by L.H., Chicago, Illinois.
* A 65-year-old woman has a seven to eight year history of constipation and occasional rectal bleeding. In the last 10 days, the passing of stools has become increasingly more difficult, with severe pain and straining, and accompanied by rectal bleeding of bright red blood. The tongue coat was yellow and greasy, and the pulse was wiry and fine. The patient was diagnosed with damp-heat and toxic-heat in the Intestines, with stagnation of qi and blood. After taking GI Care (HMR) for seven days, the patient reported complete recovery with normal bowel movement, absence of bleeding, and resolution of hemorrhoids. Submitted Anonymously.
* A.R., a 50-year-male, presented with hemorrhoids due to a lifestyle consisting of sitting constantly and rarely taking part in any exercise. He has had long term Spleen qi deficiency with poor dietary habits and bowel movements only two to three times per week. Pulse was thin and wiry and his tongue showed a thick sticky yellow coating. The practitioner diagnosed this condition as Spleen qi deficiency with damp-heat obstruction in the lower jiao. After two weeks of taking GI Care (HMR), the hemorrhoid had greatly reduced in size, discomfort, and itching; however, very little effect on his bowel movements was noted. Submitted by L.H., Chicago, Illinois.
* B.K., an 85-year-old female, presented with hemorrhoids including the symptoms of itching and distending pain. Pulse was irregular and her tongue had a thick, turbid coating. The practitioner diagnosed this condition as Kidney qi deficiency with damp-heat accumulation in the lower jiao. For treatment, the patient was prescribed GI Care (HMR), and received acupuncture and dietary recommendations as well. After taking the herbs for two days, the patient reported relief of distending pain, and itching was reduced but not eliminated. Submitted by L.H., Chicago, Illinois.
PHARMACOLOGICAL AND CLINICAL RESEARCH
GI Care (HMR) is a formula developed specifically to treat hemorrhoids. It contains many herbs with a marked anti-inflammatory effect to reduce the swelling and inflammation of hemorrhoidal tissues, a hemostatic effect to stop rectal bleeding, and a mild laxative effect to relieve constipation.
Di Yu (Radix Sanguisorbae), Huang Qin (Radix Scutellariae), Jin Yin Hua (Flos Lonicerae Japonicae) and Lian Qiao (Fructus Forsythiae) are four herbs in this formula that have an anti-inflammatory effect to reduce the swelling and inflammation of hemorrhoidal tissues.,, The mechanism of this action has been attributed in part to the decreased permeability of the blood vessels and subsequent reduction of swelling and inflammation. Specifically, the extract of Di Yu (Radix Sanguisorbae) has a significant effect to suppress the production of nitric oxide and prostaglandin from lipopolysaccharide-activated cells and peritoneal macrophages in a dose-dependent manner. Huang Qin (Radix Scutellariae) exerts significant and potent anti-inflammatory properties via inhibition of nitric oxide, cyclo-oxygenase-2, prostaglandin E2, and proinflammatory cytokines. He Zi (Fructus Chebulae) has potent activity to inhibit both cyclo-oxygenase and 5-lipoxygenase, the key enzymes involved in inflammation and carcinogenesis. Clinically, use of herbs has shown excellent success to treat hemorrhoids. In one study, 400 patients with hemorrhoids were treated with an herbal decoction once daily with good success. The study reported that 61% showed significant improvement, 31% showed moderate improvement and 8% experienced no improvement. The formula contained Huai Hua (Flos Sophorae), Dang Gui (Radix Angelicae Sinensis), Huang Qin (Radix Scutellariae), and others. In another study, hemorrhoids were treated with an 84.3% rate of effectiveness using a formula that contained Wu Bei Zi (Galla Chinensis), Di Yu (Radix Sanguisorbae), and others.
In addition to reducing inflammation, GI Care (HMR) uses herbs to relieve pain associated with hemorrhoids. Lian Qiao (Fructus Forsythiae) and Dang Gui (Radix Angelicae Sinensis) both have analgesic and anti-inflammatory effects. In fact, the anti-inflammatory effect of Dang Gui (Radix Angelicae Sinensis) is approximately 1.1 times stronger than acetylsalicylic acid, and its analgesic effect is approximately 1.7 times stronger than acetylsalicylic acid. ,
Bleeding is a typical symptom that occurs after a bowel movement, producing blood-streaked stools or blood on the toilet paper. Therefore, GI Care (HMR) contains several herbs with marked hemostatic function to stop bleeding, such as Huai Hua (Flos Sophorae), Di Yu (Radix Sanguisorbae), Chun Pi (Cortex Ailanthi), and Xian He Cao (Herba Agrimoniae). Specifically, Huai Hua (Flos Sophorae) and Di Yu (Radix Sanguisorbae) have a marked hemostatic effect to stop bleeding, and have been shown to reduce time of bleeding by as much as 31.9 to 45.5% when ingested orally., For clinical applications, use of Di Yu (Radix Sanguisorbae) and Xian He Cao (Herba Agrimoniae) has been shown to effectively treat gastrointestinal bleeding., Chun Pi (Cortex Ailanthi), Di Yu (Radix Sanguisorbae), Huai Hua (Flos Sophorae) and Xian He Cao (Herba Agrimoniae) have an excellent effect to stop bleeding among patients with hematochezia due to various causes.,,,,
Furthermore, individuals with hemorrhoids often have constipation, and straining during a bowel movement will often make hemorrhoids worse. Therefore, GI Care (HMR) includes two herbs to lubricate the intestines and restore normal bowel movement. Dang Gui (Radix Angelicae Sinensis) and Yu Li Ren (Semen Pruni) both have mild to moderate laxative effects to increase intestinal peristalsis and promote bowel movement. Lastly, Lian Qiao (Fructus Forsythiae) has antipruritic activity and is helpful to relieve itching associated with hemorrhoids.
In summary, GI Care (HMR) is an excellent formula to treat hemorrhoids as it contains herbs that address both the causes and the complications of hemorrhoids.
In Western medicine, hemorrhoids are generally not treated except with use of over-the-counter (OTC) stool softeners and soothing agents. These methods offer only temporary and symptomatic relief. In more severe cases, invasive treatments may be performed, such as injection sclerotherapy, rubber-band ligation, laser destruction, infrared photocoagulation, and surgical hemorrhoidectomy. In other words, there are few options between mild OTC drugs that offer only temporary and symptomatic relief, and serious invasive treatments that completely eradicate body tissues.
Herbs offer effective treatment options for various presentations of hemorrhoids, including internal and/or external hemorrhoids, with or without swelling, inflammation or bleeding, and in both acute and chronic conditions. As described above, herbs have been shown to have a mild laxative effect to relieve constipation, an anti-inflammatory effect to reduce the swelling and inflammation of hemorrhoid tissues, and a hemostatic effect to stop rectal bleeding. Therefore, not only are the herbs beneficial, they provide additional treatment options not available in Western medicine.
The therapeutic benefits of herbs should be explored for the treatment of hemorrhoids, as they offer great relief with few or no side effects. When necessary, and only in the most severe cases of hemorrhoids that do not respond to any other therapies, should the patient consider invasive treatment options.
 Chan K, Lo AC, Yeung JH, Woo KS. Journal of Pharmacy and Pharmacology 1995 May;47(5):402-6.
 Pharmacotherapy 1999 July;19(7):870-876.
 European Journal of Drug Metabolism and Pharmacokinetics 1995; 20(1):55-60.
 Shan Xi
 Ke Yan Tong Xun (Journal of Science and Research), 1982; (3):35.
 Chem Pharm Bull, 1984; 32(7):2724.
 Ke Yan Tong Xun (Journal of Science and Research), 1982; (3):35.
 Yu T, Lee YJ, Yang HM, Han S, Kim JH, Lee Y, Kim C, Han MH, Kim MY, Lee J, Cho JY. Inhibitory effect of Sanguisorba officinalis ethanol extract on NO and PGE(2) production is mediated by suppression of NF-κB and AP-1 activation signaling cascade. J Ethnopharmacol. 2010 Sep 9.
 Kim EH, Shim B, Kang S, Jeong G, Lee JS, Yu YB, Chun
M. Anti-inflammatory effects of Scutellaria baicalensis extract via suppression
of immune modulators and MAP kinase signaling molecules. Department of
 Reddy DB, Reddy TC, Jyotsna G, Sharan S, Priya N,
Lakshmipathi V, Reddanna P. Chebulagic acid, a COX-LOX dual inhibitor isolated
from the fruits of Terminalia chebula Retz., induces apoptosis in COLO-205 cell
line. Department of Animal Sciences, School of Life Sciences,
 Si Chuan Zhong Yi (
 Zhe Jiang Zhong Yi Za Zhi (
 Ozaki Y, Rui J, Tang YT. Antiinflammatory effect of Forsythia suspensa V(AHL) and its active principle. Biol Pharm Bull. 2000 Mar;23(3):365-7.
 Guang Xi Zhong Yi
 Zhong Yao
 Zhe Jiang Zhong Yi Xue Yuan Xue Bao (Journal of
 Shang Hai Zhong Yi
 An Hui Zhong Yi Xue Yuan Xue Bao (Journal of
 Zhong Yao Xue (Chinese Herbology), 1988; 469-473.
 Shang Hai Zhong Yi
 Zhong Yao Tong Bao (Journal of Chinese Herbology), 1988; 13(8):43.
 Tohda C, Kakihara Y, Komatsu K, Kuraishi Y. Inhibitory
effects of methanol extracts of herbal medicines on substance P-induced