阴挺证，坊刻《外科》论之颇详，大抵不外湿热下注为病。薛立斋以补中益气汤、加味逍遥散、六味地黄丸、知柏
八味丸为主，以当归芦荟丸、龙胆泻肝汤之类为辅，可谓高人一着，而治之无一效，何也？盖为前人湿热二字误之也。
余在籍时，医道颇许可于人，治疗三十七载，阅历不为不多，而阴挺症久未一见，意者古人用心周到，不过所闻而备其
病名乎？迨至辛酉，以县令发直候补。公余之顷，时亦兼理斯道，方知直隶妇女，十中患此病者约有三、四。甚者突出
一二寸及三四寸，大如指，或大如拳，其形如蛇、如瓜、如香菌、如虾蟆不一；或出血水不断，或干枯不润，或痛痒，
或顽麻者，以致经水渐闭、面黄少食、羸瘦、咳嗽、吐血而寒热往来、自汗盗汗，病成劳伤而死。轻者但觉阴中滞碍，
而无其形，或有形亦不甚显，无甚痛害。若经水匀适，尚能生育，时医名之曰 ，又名吃血劳。所用之药，均无一效；
或用刀割，一时稍愈，旋且更甚。余常按前人之法而治之，亦未见效。未知何故？余读《内经》、《金匮》、《千金》等书，
及各家秘藏等本，寻其言外之旨，而参以所见所闻，颇有所悟。因知此症，南人不患，即偶有之，治亦易愈；北人亦常
患，治皆罔效，自有其故。盖以南人之阴挺，由于病变，书有其方，按法多效；北人之阴挺，由于气习，病象虽同，而
病源则异，所以弗效。其云∶气习奈何？北俗日坐湿地，夜卧土坑，寒湿渐积，固不待言。男子劳动而散泄，妇人则静
而常佚，至春夏以及长夏，湿得暑气之蒸上腾，有如蒸饭、妇人值经水之适来，血海空虚，虚则善受，且终日坐于湿地，
而勤女红，土得人气而渐干，湿随入气而内入，即《金匮》胞门伤寒之义。更有甚者，长夏干土，得雨之后，则土中之
虫无不蠕动，一闻血腥之气，虫头上仰，嘘吸其气。虫为阴类，血为阴汁，以阴从阴，毒瓦斯并之，即为阴挺之病根。推
而言之，即不坐湿地，凡妇人不用便桶，蹲于厕中而便溺，厕中为污秽幽隐之处，更多湿虫之潜伏，其毒瓦斯皆能随其腥
血之气而上乘之也。余家山中，每见小儿坐于湿地，多患阴茎肿胀，或作痛痒，俗谓蚯蚓吹也。治者揭开鸭嘴含之，以
鸭喜食蚓也。或以花椒白矾汤洗之，以椒能胜寒，矾能除湿也。知此而阴挺之病根，更了如指掌矣。医者不察其由，止
按成方以施治，无怪病日增剧。更有一种渔利之徒，以下水消肿攻毒之峻药，为丸内服；又以蟾酥、硼砂、芒硝、麝香、
雄黄、冰片、阿魏、白砒之类外敷，为害更烈，余所以不忍默然而坐视也。余于此治之，初患者以五苓散料，加蜀椒、
黄柏、小茴、附子、沙参、川芎、红花之类，蜜丸，每服四钱，一日两服；外以花椒、苦参、苍术，槐花煎汤，入芒硝
熏洗；又以飞矾六两，铜绿四钱，五味子、雄黄各五钱，桃仁一两，共为细末，炼蜜为丸，每重四钱，雄黄为衣，纳入
阴中，奇效。或久而成劳，经水不利，以温经汤、肾气丸主之。而龟板、鳖甲、蒺藜之类，随症出入加减，亦有愈者，
笔楮难尽。惟于《金匮·妇人杂病》，及全部中属词此事，得其一言一字，以启悟机，断无不治之证矣。
阴挺证，坊间刻印的《外科》书籍论述得颇为详细，大抵不外乎是湿热下注导致的疾病。薛立斋以补中益气汤、加味逍遥散、六味地黄丸、知柏八味丸为主方，以当归芦荟丸、龙胆泻肝汤等为辅方，可以说是高人一筹，但治疗却无一见效，为什么呢？这是因为被前人所说的“湿热”二字误导了。
我在家乡时，医术颇受他人认可，行医三十七年，阅历不算不多，但阴挺症很久未曾一见，我想古人用心周到，或许只是听闻而备录其病名罢了？到了辛酉年，我以县令身份发往直隶候补。在公务之余，时常也兼理此道，才知道直隶妇女中，十人里患此病的约有三四。严重的突出达一二寸甚至三四寸，粗如手指，或大如拳头，形状像蛇、像瓜、像香菌、像蛤蟆不一而足；有的出血水不断，有的干枯不润，有的疼痛瘙痒，有的麻木无知，以致月经逐渐闭止、面色萎黄、食欲不振、身体消瘦、咳嗽、吐血且寒热往来、自汗盗汗，最终病成劳伤而死。轻者只感觉阴中有阻滞感，而没有外形，或有外形也不甚明显，没有太大的痛苦危害。如果月经调匀适当，尚能生育，当时的医生称之为“阴痔”，又名吃血劳。所用的药物，均无一效；或用刀割，暂时稍好，随即更加严重。我常按照前人的方法治疗，也未见效。不知是何缘故？我研读《内经》、《金匮要略》、《千金方》等书，以及各家秘藏的本子，探寻其言外之意，并结合所见所闻，颇有领悟。因此知道此症，南方人不患病，即使偶有发生，治疗也容易痊愈；北方人也常患病，治疗都无效，自有其原因。因为南方人的阴挺，是由于病变所致，书中已有方剂，按法治疗多有效；北方人的阴挺，是由于气习（风俗习惯）所致，病象虽然相同，但病源则不同，所以无效。所谓气习是什么呢？北方习俗每日坐在湿地上，夜间睡在土炕上，寒湿逐渐积聚，这不必多说。男子劳作而精气散泄，妇人则静止而经常安逸，到了春夏以及长夏季节，湿气得到暑气的蒸腾上升，就像蒸饭一样；妇人在月经适来之时，血海空虚，虚则容易受邪，况且终日坐在湿地上，又勤于女红（针线活），土地的人气使土壤渐干，湿气随着人气内入，这就是《金匮要略》中胞门伤寒的含义。更有甚者，长夏时节干燥的土地，下雨之后，土中的虫子无不蠕动，一闻到血腥之气，虫头向上仰，吸食其气。虫为阴类，血为阴汁，以阴从阴，毒瓦斯并合，就成为阴挺的病根。推而言之，即是不坐湿地，凡是妇人不用便桶，蹲在厕所中大小便，厕所是污秽幽隐之处，更多湿虫潜伏，其毒瓦斯都能随着腥血之气而上乘侵袭。我家住在山中，常见小儿坐在湿地上，多患阴茎肿胀，或作痛痒，俗谓蚯蚓吹。治疗者揭开鸭嘴含之，因为鸭子喜食蚯蚓。或用花椒白矾汤清洗，因为椒能胜寒，矾能除湿。知晓这些，阴挺的病根就更了然于掌心了。医者不考察其缘由，只按成方施治，难怪病情日益加重。更有一种唯利是图之徒，以下水消肿攻毒的峻猛药物，制成丸剂内服；又以蟾酥、硼砂、芒硝、麝香、雄黄、冰片、阿魏、白砒之类外敷，危害更为剧烈，所以我忍心默然坐视不管。我对此病的治疗，初病患者用五苓散药料，加蜀椒、黄柏、小茴、附子、沙参、川芎、红花之类，炼蜜为丸，每次服用四钱，一日两次；外用花椒、苦参、苍术、槐花煎汤，加入芒硝熏洗；又用飞矾六两，铜绿四钱，五味子、雄黄各五钱，桃仁一两，共研为细末，炼蜜为丸，每丸重四钱，以雄黄为衣，纳入阴中，效果奇特。或者日久成劳，月经不利，以温经汤、肾气丸为主治。而龟板、鳖甲、蒺藜之类，随症状出入加减，也有治愈的，笔墨难以尽述。只要在《金匮要略·妇人杂病》，及全书中属于描述此事的文字，能得到一言一字，以启发悟性，断没有不能治愈的证候了。
Yin Ting (Prolapse of the Uterus or Vaginal Wall), as discussed in detail in the commercially printed *Waike* (External Medicine) texts, is generally attributed to Damp-Heat pouring downward. Xue Lizhai used Buzhong Yiqi Tang (Spleen-Strengthening Qi-Supplementing Decoction), Jia Wei Xiaoyao San (Modified Free and Easy Wanderer Powder), Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), and Zhibai Bawei Wan (Anemarrhena and Phellodendron Eight-Ingredient Pill) as primary formulas, with Danggui Lvhua Wan (Angelica and Gardenia Pill) and Longdan Xiegan Tang (Gentian Liver-Draining Decoction) as auxiliary formulas. This approach could be considered superior, yet no treatment yielded any effect. Why? Because it was misled by the predecessors' concept of "Damp-Heat."
When I was in my hometown, my medical skills were quite well-regarded. Having practiced for thirty-seven years, my experience was not insignificant, yet I had rarely seen a case of Yin Ting for a long time. I suspect that ancient physicians were thorough in their attention to detail, merely recording disease names based on hearsay. It was not until the Xin You year, when I was dispatched to Zhili as a county magistrate awaiting appointment, that I had the opportunity to practice this specialty during spare time. I then learned that among women in Zhili, about three or four out of ten suffered from this disease. In severe cases, the prolapse protruded one to two cun or even three to four cun, thick as a finger or large as a fist, taking shapes resembling snakes, melons, mushrooms, or toads. Some presented with continuous bleeding and discharge, some with dryness and lack of moisture, some with pain and itching, and some with numbness. This led to gradual amenorrhea, sallow complexion, poor appetite, emaciation, cough, hemoptysis, alternating chills and fever, spontaneous sweating, and night sweats, ultimately resulting in death due to consumption and injury. In mild cases, there was only a sensation of obstruction in the vagina without visible protrusion, or the protrusion was slight and caused little pain or harm. If menstruation was regular and adequate, fertility could still be maintained. Contemporary physicians named this condition "Yin Zhi" (Yin Hemorrhoids), also known as "Chi Xue Lao" (Blood-Eating Consumption). None of the prescribed medications were effective; surgical excision provided temporary relief but the condition soon worsened. I often treated according to previous methods but saw no results. I wondered why. After studying the *Neijing* (Classic of Internal Medicine), *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), *Qianjin Fang* (Prescriptions Worth a Thousand Gold), and various secret manuscripts, seeking their underlying meanings and combining them with my observations, I gained considerable insight. I realized that people in the South do not suffer from this disease, or if they do, it is easily cured; whereas people in the North frequently suffer from it, and treatments are invariably ineffective. There is a specific reason for this. Southern cases of Yin Ting arise from pathological changes, for which books provide formulas that are mostly effective when applied correctly; Northern cases arise from "Qi Xi" (habitual environmental exposure). Although the clinical manifestations are similar, the etiology differs, hence the ineffectiveness. What is meant by "Qi Xi"? The local custom involves sitting on damp ground daily and sleeping on earthen kang beds at night, leading to the gradual accumulation of Cold-Dampness, which goes without saying. Men engage in labor and disperse their essence, while women remain sedentary and often idle. During spring, summer, and late summer, dampness is steamed upward by heat, akin to steaming rice. When a woman's menstruation arrives, her Blood Sea is empty; emptiness makes one susceptible to pathogens. Furthermore, sitting on damp ground all day while engaging in needlework causes the earth's qi to dry the soil slightly, allowing dampness to enter internally along with the human qi. This aligns with the concept of "Baomen Shanghan" (Cold Damage to the Womb Gate) in the *Jingui Yaolue*. Even more severely, in late summer, after rain, worms in the dry earth become active. Upon smelling blood, they raise their heads and inhale the scent. Worms belong to the Yin category, and blood is Yin fluid. Yin follows Yin, and toxic vapors combine, forming the root cause of Yin Ting. Extending this logic, even without sitting on damp ground, if a woman squats in a toilet to defecate or urinate instead of using a chamber pot, she exposes herself to hidden dampness and worms in this filthy, secluded place. Their toxic vapors can ascend and invade along with the bloody scent. In my mountain home, I often see children sitting on damp ground suffering from penile swelling or painful itching, commonly called "Earthworm Blowing." Treatment involves placing a duck's mouth over the area, as ducks eat earthworms, or washing with a decoction of Sichuan pepper (*Zhuojiao*) and alum (*Binfan*), because pepper dispels cold and alum dries dampness. Understanding this makes the root cause of Yin Ting clear as day. Physicians who fail to investigate the cause and merely apply standard formulas cannot be blamed for the worsening condition. Moreover, some profit-driven practitioners administer harsh purgative and detoxifying pills internally, and apply external pastes containing toad venom (*Chansu*), borax (*Pengsha*), mirabilite (*Mangxiao*), musk (*Shexiang*), realgar (*Xionghuang*), borneol (*Bingpian*), olibanum alternative (*awei*), and white arsenic (*Baipi*), causing even greater harm. I could not bear to sit idly by.
For initial cases, I treated patients with a pill made from Wuling San (Five-Ingredient Powder for Promoting Urination) ingredients, added with Sichuan pepper (*Shujiao*), Phellodendron bark (*Huangbai*), small fennel (*Xiaohui*), Aconite (*Fuzi*), Codonopsis (*Shashen*), Ligusticum (*Chuanxiong*), and Safflower (*Honghua*), bound with honey. Each dose was 4 qian, taken twice daily. Externally, I used a decoction of Sichuan pepper, Sophora root (*Kushen*), Atractylodes (*Cangzhu*), and Sophora flower (*Huaihua*) with added mirabilite for fumigation and washing. Additionally, I prepared a suppository using calcined alum (6 liang), verdigris (4 qian), Schisandra fruit (*Wuweizi*), and realgar (5 qian each), and peach kernels (1 liang), ground into fine powder and bound with honey into 4-qian pills coated with realgar, inserted into the vagina, yielding miraculous effects. For chronic cases complicated by consumption and irregular menstruation, I primarily used Wenjing Tang (Warming the Menses Decoction) and Shenqi Wan (Kidney Qi Pill), adjusting with turtle shell (*Guiban*), softshell turtle shell (*Biejia*), and Tribulus (*Jili*) as needed. Many recovered, though details are too numerous to record here. Had I found even a single word or phrase in the *Jingui Yaolue: Women's Miscellaneous Diseases* chapter or elsewhere in the complete text to enlighten me regarding this matter, I would have been certain that no case was incurable.