Disease and Condition Overview
Hemorrhoids are characterized by inflamed and swollen veins in the rectum and anus area. In Chinese medicine, it is often caused by deficiency of the zang fu organs, prolonged period of sitting or standing, carrying heavy loads over a long distance, irregular diet, or overindulgence in spicy, fatty, heavy and sweet foods. Prolonged periods of constipation, diarrhea, exhaustion and labor can cause the irregularities of qi and blood in the intestines, which then lead to blockage and stagnation in channels and collaterals, creating damp heat, resulting in hemorrhoids.
Clinically, it is differentiated into internal hemorrhoids, external hemorrhoids or a combination of the two.

Pair-point Treatment Combinations

(1) Kongzui (LU6), Hegu (LI4) (Fig 74)
Kongzui (LU6), the xi-cleft point of the hand-taiyin channel, clears lung heat. Hegu (LI4), the yuan-source point of the hand- yangming channel, reduces large intestine heat. This pair point combination, one exterior and one interior, dispels wind, clears heat, promotes lung and opens fu organs. This treatment is appropriate for hemorrhoids or bleeding hemorrhoids caused by descending of lung heat or heat in the large intestine.

Needling techniques:
1. Kongzui (LU6) perpendicular insertion to a depth of 1 cun.
2. Hegu (LI4) perpendicular insertion to a depth of 1 cun.

(2) Chengshan (BL57), Yinlingquan (SP9) (Fig 129)
Chengshan (BL57): on the posterior midline of the leg, on the line connecting Weizhong (BL40) and Kunlun (BL60), in a depression formed inferior to the prominence of the gastrocnemius muscle when the leg is stretched or the heel is lifted.
Yinlingquan (SP9): on the medial side of the lower leg, in the depression posterior and inferior to the medial condyle of the tibia, level with the tuberosity of the tibia.
Chengshan (BL57) soothes tendons, activates luo-connecting channels, harmonizes and regulates intestine and cools blood in the hemorrhoids. Yinlingquan (SP9) regulates water and reduces swelling. This pair point combination elevates clear, lowers turbid, soothes tendons, activates luo-connecting channels, clears heat and regulates water. This treatment is appropriate for hemorrhoids caused by lower draining of damp heat.

Needling techniques:
1. Chengshan (BL57) perpendicular insertion to a depth of 1 cun or prick for blood.
2. Yinlingquan (SP9) towards Yanglingquan (GB34) direction perpendicular insertion to a depth of 1.5 cun.

(3) Chengshan (BL57), Sanyinjiao (SP6) (Fig 130)
Chengshan (BL57): on the posterior midline of the leg, on the line connecting Weizhong (BL40) and Kunlun (BL60), in a depression formed inferior to the prominence of the gastrocnemius muscle when the leg is stretched or the heel is lifted.
Sanyinjiao (SP6): on the medial side of the lower leg, 3 cun superior to the prominence of the medial malleolus, in the depression near the posterior border of the tibia.
Chengshan (BL57) employs the collaterals to the foot-taiyang channel to connect to anus and opens fu organs to stop bleeding. Sanyinjiao (SP6) regulates and harmonizes qi and blood of the lower jiao, opens channels and invigorates luo-connecting channels. This pair point combination, one yin and one yang, one tonifying and one reducing, clears heats, resolves poison, reduces swelling and stops pain. This treatment is appropriate for hemorrhoids accompanied by swollen and painful anus.

Needling techniques:
1. Chengshan (BL57) perpendicular insertion to a depth of 1 cun.
2. Sanyinjiao (SP6) perpendicular insertion to a depth of 1 cun.

(4) Weizhong (BL40), Chengshan (BL57) (Fig 131)
Weizhong (BL40) : at the back of the knee, on the midpoint of the popliteal crease, between the tendons of biceps femoris and semitendinosus.
Chengshan (BL57): on the postenor midline of the leg, on the line connecting Weizhong (BL40) and Kunlun (BL60), in a depression formed inferior to the promience of the gastrocnemius muscle when the leg is stretched or the heel is lifted.
Weizhong (BL40) regulates the qi of the bladder channel, clears heat, resolves poison, reduces swelling and stops pain. Chengshan (BL57) leverages the collaterals of the foot-taiyang channel to connect to anus and opens fu organs. This pair point combination soothes tendons, activates luo-connecting channels, reduces swelling and stops pain. This treatment is appropriate for hemorrhoids accompanied by swollen and painful anus.

Needling techniques:
1. Weizhong (BL40) perpendicular insertion to a depth of 1 cun or prick blood.
2. Chengshan (BL57) perpendicular insertion to a depth of 1 cun or prick blood.

(5) Changqiang (DU1), Chengshan (BL57) (Fig 132)
Changqiang (DU1): below the tip of the coccyx, at the midpoint of the line connecting the tip of the coccyx and the anus.
Chengshan (BL57): on the posterior midline of the leg, on the line connecting Weizhong (BL40) and Kunlun (BL60), in a depression formed inferior to the prominence of the gastrocnemius muscle when the leg is stretched or the heel is lifted.
Changqiang (DU1), the Luo-connecting point of the Du channel, is located next to the anus. Chengshan (BL57) leverages the collaterals of the foot-taiyang channel to connect to anus and opens fu organs. This pair point combination, one superior and one inferior, opens channels, invigorates luo-connecting channels, clears heat and stops bleeding and pain. This treatment is appropriate for bleeding hemorrhoids accompanied by swollen and painful anus.

Needling techniques:
1. Changqiang (DU1) towards anterior superior direction, needle to a depth of 1 cun.
2. Chengshan (BL57) perpendicular insertion to a depth of 1 cun or prick blood.

Commentaries
Acupuncture has good effects in the treatment of hemorrhoids and is especially effective in reducing symptoms of pain and bleeding.
In applying clinical treatment, it is important to differentiate between various syndromes.
Hemorrhoids caused by descending of lung heat, heat in large intestine, select Kongzui (LU6), Hegu (LI4).
Descending of damp heat, select Chengshan (BL57), Yinlingquan (SP9).
Hemorrhoids accompanied by painful and swollen anus, select Chengshan (BL57), Sanyinjiao (SP6), or Weizhong (BL40), Chengshan (BL57) to obtain better results.
Changqiang (DU1), Chengshan (BL57), this pair-point combination is appropriate for bleeding hemorrhoids and swollen and painful anus.
In addition, patients must form the habits of eating fiber rich foods, drinking more fluids, exercising and avoiding spicy, fatty and rich foods in order to keep bowel movements regular.