Extended Abstract
Introduction
Hemorrhoids, resulted from the dilation of veins in the submucosal layer of the lower rectum, are a common cause of lower gastrointestinal bleeding [1, 2]. In common medicine, the main cause of hemorrhoids is weakness of the anal connective tissue and increased pressure inside the arteriovenous anastomoses, which may bleed due to fecal excretion and increased pressure [3], while from the point of view of Iranian Traditional Medicine (ITM), hemorrhoidal bleeding is not only a organic disease, but also indicates the quality and quantity of blood and temperaments in the body. According to this view, bleeding from different parts of the body has different causes, two important causes of which are: a. vascular hyperemia and consequent bleeding in bleeding-prone areas; and b. change in blood quality that causes the arteries to open and bleed [8-14]. This study, by reporting a case of hemorrhoidal bleeding, is evidence of a series of therapeutic principles in ITM.
Case report
The patient was a 39-year-old married woman with five children complaining of heavy menstrual bleeding for a year. The patient did not take any special medication. Her blood pressure was 180/80 mm Hg, with occasional increases in blood pressure. She noted the history of hemorrhoidal bleeding before severe menstrual bleeding. According to the diagnosis of an ITM specialist, the patient’s temperament was warm and wet. In order to control menstrual bleeding for three months, symptomatic treatment was performed without considering the main cause of bleeding by using one of the herbal medicines for hemorrhage called “Shepherd’s Purse”.
After three months of medication, menstrual bleeding returned to normal state. One month after healing of menstrual bleeding, the patient experienced clear bleeding from the anus without a history of trauma to the hemorrhoid site or severe constipation following defecation and anal pain. On examination, several swollen and non-thrombotic external hemorrhoids were observed. According to a general surgeon, no surgery was needed. According to an ITM specialist, the patient was given an oral medication for her melancholic temperament, phlebotomy and leech therapy around the anus for a month, which relieved the pain and bleeding and reduced the hemorrhoids.
Results
Hyperemia-related diseases, including those expressed in ITM, are caused by changes in the quantity and quality of temperaments in the body [16]. Increasing the volume of fillers in body spaces can cause these spaces to stretch and tear. Arteries are one of these spaces that rupture and bleed if the volume and blood pressure increase in low-resistance areas. According to ITM, blood is composed of four humors, and any change in their quality and quantity can cause disease. One of these types is melancholy humor. According to the principles of ITM, the cause of hemorrhoids is an increase in abnormal melancholic temperament. Blood containing abnormal melancholic temperament tends to be excreted from different parts of the body during circulation. Substances with lower concentrations and higher sharpness cause bleeding in various places such as the nose, by stimulating and contaminating the walls of the arteries. 
More concentrated substances cannot pass through the arterial pores and tend to the lower parts of the body, causing swelling or bleeding in susceptible areas such as the uterus and anus [11, 17]. In ITM, it is emphasized that bleeding from these areas prevents many diseases and should not be stopped suddenly [10]. If prevented, other parts of the body will get sick. In other words, some diseases can be cured by shifting to another disease. For example, menstrual bleeding is beneficial for a patient with hemorrhoids, because the blood is expelled from the uterus instead of hemorrhoids, and on the other hand, rectal bleeding is beneficial for uterine diseases [18]. 
In the study patient, there were both signs of vascular hyperemia and increased blood amount, as well as signs of a change in its quality. Both of these factors contributed to the patient’s heavy menstrual bleeding. By stopping menstrual bleeding with medication, the blood tends to come out of a duct that was previously prone to bleeding. The presence of hemorrhoidal vessels in this patient is a protective factor against damage caused by vascular hyperemia and high blood pressure. It prevents the elimination of substances cause melancholic temperament, and is also able to relieve menstrual bleeding symptoms. In the study patient, by regulating the quality and quantity of blood, phlebotomy (Fasd) controlled both hemorrhoidal and menstrual bleeding.
The main purpose of this study is not to express the method of hemorrhoid treatment based on ITM, but to suggest the cleansing of the body for radical treatment of many diseases by indicating one of the most common medical errors, i.e. symptomatic treatment of the disease.
Discussion
In treatment based on the principles of ITM, eliminating the main cause of the disease is a priority over eliminating the complications of the disease. It may trigger another disease by eliminating the complications of one disease. On the other hand, having one disease makes one immune to another disease. Therefore, paying close attention to the participation of members in the development of the disease and the relationship between the diseases are of great importance in treatment. It is recommended that it is not enough just to eliminate the symptoms in the treatment of diseases, but also, by considering the main cause of the disease, the relationship between the symptoms created in one organ and the development or prevention of the disease in other organs should be taken into account.





Ethical Considerations
Compliance with ethical guidelines
This study has been approved by the research ethics committee of Arak University of Medical Sciences with Code: IR.MUQ.REC.1396.110.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Authors' contributions
All authors met the writing standards based on the recommendations of the International Committee of Medical Journal Editors (ICMJE).
Conflicts of interest
The authors declare no conflict of interest.
Acknowledgements
The authors would like to thank the School of Traditional Iranian Medicine, Qom University of Medical Sciences for their cooperation.