Teikosan is an herbal medicine that was developed from the Japanese herbal (Kampo) medicine hochuekkito. Unlike hochuekkito, teikosan does not include Zizyphi fructus and Zingiberis rhizoma. Instead, Cnidii rhizoma, Scutellariae radix, Coptidis rhizoma, Angelicae dahuricae radix, and shakusekishi are included as constituents of teikosan. The clinical indication of teikosan is anal prolapse with pain that is more severe than that considered appropriate for hochuekkito treatment, but there have been few clinical reports before. Here, we describe a case of anal prolapse with anal pain, which was successfully treated with teikosan. A case was a 47-year-old woman whose chief complaint was anal prolapse of internal hemorrhoids with pain. She was considered as indication for hochuekkito, but her symptoms including anal pain were so severe that we prescribed teikosan, especially because Angelicae dahuricae radix, Scutellariae radix, Coptidis rhizome in teikosan were expected to improve her anal pain. After the administration of teikosan, her symptoms including anal pain have much improved. Teikosan should be considered as a therapeutic option for anal prolapse with severe anal pain or inflammation.