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Background The incidence of internal hemorrhoids is high. Internal hemorrhoids often cause hematochezia. Medication and minimally invasive surgery are effective therapies for internal hemorrhoids, but these two treatments have high rates of recurrence. Objective To evaluate the efficacy of a Chinese medicine, Huazhi suppository, combined with cap assisted endoscopic sclerotherapy (CAES) for symptomatic internal hemorrhoids and its long-term recurrence rate. Methods This study selected 104 patients (older than 18 years) with grade Ⅰ-Ⅲ internal hemorrhoids admitted to Guangdong Provincial People's Hospital from January 2018 to June 2020. These patients were randomly assigned into 3 groups by using the single-blind envelope method: medication group (n=31) , CAES group (n=38) and combined group (n=35) . Patients in the medication group received one Huazhi Suppository per time, twice daily for 7 days. Patients in the CAES group received sclerosing agent injection into the hemorrhoidal vein or hemorrhoids exposed by a short transparent cap under the direct vision of flexible endoscope. Patients in the combination group received one Huazhi Suppositoryper time, twice daily for 7 days after the CAES treatment. This study collected the data about clinical efficacy, complications and the satisfaction degree of these three groups, and followed up the recurrence of internal hemorrhoids at one year after treatment. Results The rates of overall symptom remission in medication group, CAES group and combined group were 71.0% (22/31) , 100.0% (38/38) and 100.0% (35/35) , respectively. The CAES group and combined group had significant higher rates of overall symptom remission compared with medication group (P