During the acute flare of thrombotic external hemorrhoids, the primary issue is the filling of the hemorrhoidal nucleus with blood clots, leading to congestion and swelling of the hemorrhoids. Due to edema or excessive pressure inside the hemorrhoidal nucleus, the patient may experience local discomfort or even severe pain. Therefore, the treatment of thrombotic external hemorrhoids first needs to reduce swelling. The methods mainly include local hot compresses, along with the oral administration of medicines that cool the blood, reduce swelling, and relieve pain. However, in some cases of thrombotic external hemorrhoids, where the blood clots are large or cannot be absorbed on their own after repeated attacks, surgery to excise the clots may be necessary to achieve the purpose of reducing swelling. During the acute flare of thrombotic external hemorrhoids, it is recommended that the patient seek medical attention as soon as possible to avoid complications such as repeated attacks or local blood supply disturbances, which could lead to necrosis of the external hemorrhoids.