大全云∶妇人少阴脉数而滑者,阴中有
疮,名曰 ,或痛或痒,如虫行状,脓水淋沥,亦有阴蚀几尽者,皆由心神烦郁,脾胃虚弱,
致血气流滞耳。故经云∶诸痛痒疮,皆属于心(若论诸痛痒疮,当从手少阴,若以疮在下部,
当从足少阴)。又云∶阳明主肌肉,治之当补心养胃,外以熏洗坐导药治之乃可。薛氏曰∶
妇人阴中生疮,乃七情郁火,伤损肝脾,湿热下注。其外证,有阴中舒如蛇,俗呼阴挺,有翻
突如饼,俗呼阴菌,亦有如鸡冠花,亦有生诸虫,亦有肿痛湿痒,溃烂出水,胀闷脱坠者(俱
属肝胆之火,少分虚实求治);其内证,口干内热,体倦,经候不调,或饮食无味,晡热发热,
胸膈不利,胁肋不调,小腹痞胀,赤白带下,小水淋涩。其治法,肿痛者,宜用四物汤加柴胡、
山栀、牡丹皮;龙胆草;湿痒者,宜用归脾汤加山栀、牡丹皮、柴胡;淋涩者,宜用龙胆泻肝汤
加白术、牡丹皮,溃腐者,宜用加味逍遥散;肿闷脱坠者,宜用补中益气汤加山栀、牡丹皮,
佐以外治之法。(以肿痛属血虚肝热,湿痒为脾虚肝热,淋涩属肝肾有热,腐溃属肝脾,肿
脱为不足有火,故其立方如此)
大全云∶妇人阴挺下脱,或因胞络伤损,或因子脏虚冷,或因分娩用力所致(此即阴
,有谓 本一味,能治妇人 疝,以其升举太阳之气也。但与虚而下坠者非宜)。薛氏
曰∶阴挺下脱,当升补元气为主,若肝脾郁结,气虚下陷,用补中益气汤;若肝火湿热,小便
涩滞,用龙胆泻肝汤。一妇人阴中突出如菌,四围肿痛,小便频数,内热晡热,似痒似
痛,小便重坠,此肝脾郁结。盖肝火湿热而肿痛,脾虚下陷而重坠也。先以补中益气加山
栀、茯苓、车前子、青皮以清肝火,升脾气,更以加味归脾汤调理脾郁,外以生猪脂和藜芦
末涂之而收。一妇人阴中挺五寸许,闷痛重
坠,水出淋沥,小便涩滞,夕与龙胆泻肝汤,分利湿热,朝与补中益气汤,升补脾气,诸证渐
愈。再与归脾汤加山栀、川芎、茯苓、黄柏间服,调理而愈。后因劳役,或怒气,下部湿痒,
小水不利,仍用前药即愈。
《女科撮要》记载:妇女少阴脉象数而滑的,阴户中生疮,名为“阴蚀”,或者疼痛或者瘙痒,感觉像虫子爬行一样,脓水淋漓不断,也有阴户被腐蚀殆尽的情况,这都是因为心神烦闷抑郁,脾胃虚弱,导致气血运行阻滞所致。所以医经说:各种疼痛、瘙痒、疮疡,都归属于心(如果论述各种疼痛、瘙痒、疮疡,应当从手少阴心经论治;如果疮疡在下部,应当从足少阴肾经论治)。又说:阳明经主司肌肉,治疗时应当补益心气、养胃气,外用熏洗、坐药或导药进行治疗才可以。薛己说:妇女阴户中生疮,是由于七情郁结化火,损伤肝脾,湿热下注所致。其外在症状,有阴户中松弛下垂如蛇状,俗称“阴挺”;有翻出突起如饼状,俗称“阴菌”;也有像鸡冠花形状的;也有生出各种虫子的;也有肿痛湿痒、溃烂流水、胀闷脱坠的(这些都属于肝胆之火,需分辨虚实进行治疗);其内在症状,有口干内热、身体疲倦、月经不调,或者饮食无味、午后发热、胸膈不畅、胁肋不适、小腹痞满胀气、赤白带下、小便淋沥涩痛。其治疗方法,肿痛的,适宜用四物汤加柴胡、山栀、牡丹皮、龙胆草;湿痒的,适宜用归脾汤加山栀、牡丹皮、柴胡;淋涩的,适宜用龙胆泻肝汤加白术、牡丹皮;溃烂腐坏的,适宜用加味逍遥散;肿胀闷痛脱坠的,适宜用补中益气汤加山栀、牡丹皮,配合外治法。(因为肿痛属于血虚肝热,湿痒属于脾虚肝热,淋涩属于肝肾有热,腐溃属于肝脾受损,肿胀脱坠属于正气不足而有虚火,所以制定方剂如此)
《女科撮要》记载:妇女阴挺下脱,可能是因为胞络受损,可能是因为子脏虚冷,可能是因为分娩用力所致(这就是所谓的“阴疝”,有人说“升麻”一味药,能治疗妇女阴疝,因为它能升举太阳经之气。但对于虚证而下坠的情况并不适宜)。薛己说:阴挺下脱,应当以升提补益元气为主,如果是肝脾郁结、气虚下陷,使用补中益气汤;如果是肝火湿热、小便涩滞,使用龙胆泻肝汤。有一位妇女阴户中突出如菌状,四周肿痛,小便频数,内热午后发热,似痒似痛,小便重坠感,这是肝脾郁结。因为肝火湿热导致肿痛,脾虚下陷导致重坠。先用补中益气汤加山栀、茯苓、车前子、青皮来清肝火、升脾气,再用加味归脾汤调理脾郁,外用生猪脂调和藜芦末涂抹而痊愈。另一位妇女阴户挺出约五寸长,闷痛重坠,水流淋漓,小便涩滞,晚上服用龙胆泻肝汤,分利湿热,早上服用补中益气汤,升提补益脾气,各种症状逐渐痊愈。再服用归脾汤加山栀、川芎、茯苓、黄柏交替服用,调理后痊愈。后来因为劳累过度,或者发怒,下部湿痒,小便不利,仍然使用前药即愈。
*Nüke Cuoyao* records: When a woman's Shaoyin pulse is rapid and slippery, sores appear in the vagina, termed "Yin Shi" (Vaginal Erosion). There may be pain or itching, feeling as if insects are crawling. Pus and fluid drip continuously; in severe cases, the vulva may be almost entirely eroded. These conditions are caused by mental distress and depression, spleen and stomach weakness, leading to stagnation of Qi and blood flow. Thus, the classics state: "All pain, itching, and sores belong to the Heart" (If discussing all pain, itching, and sores, one should refer to the Hand Shaoyin Heart Meridian; if the sores are in the lower part, one should refer to the Foot Shaoyin Kidney Meridian). It also states: "The Yangming governs the muscles." Treatment should involve tonifying the Heart and nourishing the Stomach, combined with external fumigation, washing, sitz baths, or vaginal suppositories. Xue Ji stated: Sores in the vagina of women result from emotional stagnation transforming into fire, damaging the Liver and Spleen, with damp-heat pouring downward. External symptoms include prolapse resembling a snake, commonly called "Yin Ting" (Uterine Prolapse); protrusions like a cake, commonly called "Yin Jun"; shapes resembling cockscomb flowers; growth of various parasites; swelling, pain, dampness, itching, ulceration with discharge, distension, and heaviness/prolapse (all belong to Liver-Gallbladder Fire; treatment must distinguish between deficiency and excess). Internal symptoms include dry mouth with internal heat, fatigue, irregular menstruation, loss of appetite, afternoon fever, chest and diaphragm discomfort, hypochondriac discomfort, abdominal fullness and distension, red and white leukorrhea, and dysuria with strangury. Treatment methods: For swelling and pain, Siwu Tang (Four Substances Decoction) added with Chaihu (Bupleuri Radix), Shanzhi (Gardeniae Fructus), Mudanpi (Moutan Cortex), and Longdancao (Gentianae Radix) is suitable. For dampness and itching, Guipi Tang (Restore the Spleen Decoction) added with Shanzhi, Mudanpi, and Chaihu is suitable. For strangury, Longdan Xiegan Tang (Gentian Liver-Draining Decoction) added with Baizhu (Atractylodis Macrocephalae Rhizoma) and Mudanpi is suitable. For ulceration and putrefaction, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) is suitable. For swelling, distension, and prolapse, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Shanzhi and Mudanpi, assisted by external treatments, is suitable. (Swelling and pain belong to Blood deficiency with Liver Heat; dampness and itching belong to Spleen deficiency with Liver Heat; strangury belongs to Heat in the Liver and Kidney; ulceration belongs to Liver and Spleen dysfunction; swelling and prolapse belong to insufficiency with deficient fire; hence the prescription formulation.)
*Nüke Cuoyao* records: Uterine prolapse (Yin Ting Xia Tuo) may be due to damage to the uterine collaterals, cold deficiency of the Zi Zang (uterus), or excessive effort during childbirth (this is referred to as "Yin Shan"; some claim that Shengma (Cimicifugae Rhizoma) alone can treat female Yin Shan because it raises Taiyang Qi. However, it is not suitable for cases of deficiency with sinking). Xue Ji stated: For uterine prolapse, the primary approach should be raising and tonifying Yuan Qi. If there is Liver-Spleen stagnation with Qi deficiency and sinking, use Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction); if there is Liver Fire and damp-heat with urinary obstruction, use Longdan Xiegan Tang (Gentian Liver-Draining Decoction). A woman had a fungal-like protrusion from the vagina, with surrounding swelling and pain, frequent urination, internal heat, afternoon fever, sensation of itching and pain, and heavy sensation in urination. This was Liver-Spleen stagnation. The swelling and pain were due to Liver Fire and damp-heat; the heavy sensation was due to Spleen deficiency and sinking. Initially, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Shanzhi, Fuling (Poria), Cheqianzi (Plantaginis Semen), and Qingpi (Citri Reticulatae Pericarpium Viride) was used to clear Liver Fire and raise Spleen Qi. Subsequently, Jiawei Guipi Tang (Modified Restore the Spleen Decoction) was used to regulate Spleen stagnation. Externally, fresh pork lard mixed with Lili powder (Veratrum Nigrum Powder) was applied, resulting in recovery. Another woman had a five-cun protrusion from the vagina, with stifling pain, heavy sensation, dripping fluid, and urinary obstruction. She took Longdan Xiegan Tang (Gentian Liver-Draining Decoction) in the evening to separate and drain damp-heat, and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) in the morning to raise and tonify Spleen Qi. Symptoms gradually improved. Then, Guipi Tang (Restore the Spleen Decoction) added with Shanzhi, Chuanxiong (Chuanxiong Rhizoma), Fuling, and Huangbai (Phellodendri Cortex) was taken alternately for regulation until cured. Later, due to overwork or anger, she experienced dampness and itching in the lower part with difficult urination. Using the previous medicines again led to recovery.