澄曰∶凡产妇阴户或一边 肿,或两边均肿,难以起坐,更有阴户两墙烂破出
脓,痛引小腹两股,皆由分娩艰难,或者息胎,稳婆用手分理骨眼,或用手伸入,掐
取胎胞,粗手指甲抓损皮肉而成。殊不知产户皮娇肉嫩,何堪经此损伤。再加瘀血
淋漓,愈淹愈烂。况阴户乃肝、脾、肾、冲任脉络之地,既破之后,所以牵引少阴腰
股作痛也。宜用洗药煎洗破处,用玉红膏、珍珠散搽之,自愈。
阴户肿痛 枳壳一两,煎洗。
阴户肿溃 当归、赤芍、白芷、甘草、苦参各等分,煎汤洗。
产妇阴户肿痛 蛇床子三钱、白萝卜五个扑碎,煎汤熏洗。
陈实功曰∶妇人交接出血者,乃肝虚有火,不能藏血,脾虚不能摄血,当以补
中益气、归脾二汤主之。(《正宗》)
又曰∶或用四物汤加龙胆草、柴胡、山栀、黄芩治之。
冯鲁瞻曰∶凡交接出血者,此肝火太旺而疏泄过度,且肝虚不能藏血,脾虚不
能摄血也。宜补中归脾二法消息用之。若六脉俱洪者,此肾阴虚而不能闭藏也。宜
六味汤加麦冬、五味主之。(《锦囊》)
陈实功曰∶阴户开而不闭者,乃忧思
过度。(《正宗》)
又曰∶治当逍遥散、归脾汤,加柴胡、山栀、白芍药、牡丹皮间服。
陈实功曰∶新嫁伤而肿痛者,宜舒郁和血。(《正宗》)
冯鲁瞻曰∶新嫁孔痛,宜四物汤加香附、红花主之。(《锦囊》)
蒋示吉曰∶新交房事伤而肿痛者,珍珠散、猪脊髓调搽。(《说约》)
顾世澄说:凡是产妇的阴户出现一边肿胀,或者两边都肿胀,难以起身坐立的情况;更有甚者,阴户两侧的皮肉溃烂破损并流出脓液,疼痛牵引至小腹及大腿两侧。这些症状都是由分娩困难,或者是难产时稳婆用手去分理骨缝(产道出口),或者将手伸入产道掐取胎胞,因手指粗糙、指甲抓伤皮肉而造成的。殊不知产户的皮肉娇嫩脆弱,怎能承受这样的损伤?再加上产后瘀血淋漓不尽,伤口被血液浸泡得越来越溃烂。况且阴户是肝、脾、肾以及冲脉、任脉经络循行汇聚的地方,既然皮肉破损,所以会牵引少阴经(足少阴肾经)所过的腰部和腿部产生疼痛。适宜使用洗药煎汤清洗破损处,然后涂抹玉红膏、珍珠散,自然就会痊愈。
阴户肿痛:用枳壳一两,煎汤外洗。
阴户肿胀溃烂:用当归、赤芍、白芷、甘草、苦参各等分,煎汤外洗。
产妇阴户肿痛:用蛇床子三钱、白萝卜五个捣碎,煎汤熏洗。
陈实功说:妇人在性交后出血的,是由于肝虚有火,不能藏血,脾虚不能统摄血液所致,应当以补中益气汤、归脾汤为主进行治疗。(《外科正宗》)
他又说:也可以用四物汤加入龙胆草、柴胡、山栀、黄芩来治疗。
冯鲁瞻说:凡是性交后出血的,这是肝火太旺导致疏泄过度,且肝虚不能藏血,脾虚不能摄血。适宜根据情况斟酌使用补中益气法和归脾法。如果六脉都呈现洪大之象,这是肾阴虚而不能闭藏精血所致。适宜用六味地黄丸加入麦冬、五味子为主治疗。(《外科锦囊》)
陈实功说:阴户张开而不能闭合的,是由于忧思过度所致。(《外科正宗》)
他又说:治疗应当服用逍遥散、归脾汤,并加入柴胡、山栀、白芍药、牡丹皮,交替服用。
陈实功说:新婚初次房事受伤而导致肿痛者,适宜采用舒郁和血的方法。(《外科正宗》)
冯鲁瞻说:新婚阴道疼痛,适宜用四物汤加入香附、红花为主治疗。(《外科锦囊》)
蒋示吉说:新婚房事受伤导致肿痛者,可用珍珠散配合猪脊髓调和后涂抹患处。(《疡医说约》)
Gu Shicheng stated: In cases where a parturient woman's vulva is swollen on one side or both sides, making it difficult to rise or sit, and in more severe instances where the tissues on either side of the vulva ulcerate, break open, and discharge pus with pain radiating to the lower abdomen and thighs, these conditions are caused by difficult labor. They may result from midwives manually separating the bony pelvis at the birth canal exit, inserting hands into the vagina to extract the placenta, or causing abrasions to the skin and flesh due to rough fingers and fingernails. It must be understood that the skin and flesh of the vaginal opening are delicate and tender, unable to withstand such trauma. Furthermore, continuous dripping of blood stasis causes the wounds to become increasingly macerated and ulcerated. Moreover, the vulva is the area where the meridians of the Liver, Spleen, Kidney, Chong Mai (Penetrating Vessel), and Ren Mai (Conception Vessel) converge. Once the tissue is broken, pain is inevitably drawn along the Foot-Shaoyin Kidney Meridian to the waist and thighs. It is advisable to wash the damaged areas with decocted herbal washes, and then apply Yuhong Gao (Jade Red Ointment) and Zhenzhu San (Pearl Powder), which will lead to spontaneous healing.
For vulvar swelling and pain: Decoct 1 liang (approx. 37.5g) of Zhike (Fructus Aurantii) for external washing.
For vulvar swelling and ulceration: Use equal parts of Danggui (Radix Angelicae Sinensis), Chishao (Radix Paeoniae Rubra), Baizhi (Radix Angelicae Dahuricae), Gancao (Radix Glycyrrhizae), and Kushen (Cortex Phellodendri); decoct for external washing.
For postpartum vulvar swelling and pain: Use 3 qian (approx. 11.25g) of Shechuangzi (Fructus Cnidii) and five crushed white radishes; decoct for fumigation and washing.
Chen Shigong stated: Hemorrhage following sexual intercourse in women is due to Liver deficiency with internal heat failing to store blood, and Spleen deficiency failing to control blood. Treatment should primarily utilize Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Guipi Tang (Restore the Spleen Decoction). (*Waike Zhengzong*, Standardized Practice of Surgery)
He further stated: Alternatively, Siwu Tang (Four Substances Decoction) can be used with added Longdancao (Radix Gentianae), Chaihu (Radix Bupleuri), Shanzhi (Fructus Gardeniae), and Huangqin (Radix Scutellariae) for treatment.
Feng Luzhan stated: Hemorrhage after sexual intercourse indicates excessive Liver fire leading to over-dispersal, combined with Liver deficiency failing to store blood and Spleen deficiency failing to control blood. The methods of Buzhong Yiqi (Tonifying the Middle and Augmenting Qi) and Guipi (Restoring the Spleen) should be applied according to the specific situation. If all six pulses are surging (Hong), this indicates Kidney Yin deficiency failing to secure and store essence and blood. Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) with added Maidong (Rhizoma Ophiopogonis) and Wuweizi (Fructus Schisandrae) is appropriate. (*Waike Jinnang*, Surgical Brocade Bag)
Chen Shigong stated: Vulvar laxity and inability to close is caused by excessive worry and overthinking. (*Waike Zhengzong*)
He further stated: Treatment should involve Xiaoyao San (Free and Easy Wanderer Powder) and Guipi Tang, with added Chaihu, Shanzhi, Baishaoyao (Radix Paeoniae Alba), and Mudanpi (Cortex Moutan), administered alternately.
Chen Shigong stated: For pain and swelling caused by injury during first-time marital intercourse, the therapeutic method should focus on soothing stagnation and harmonizing blood. (*Waike Zhengzong*)
Feng Luzhan stated: For vaginal pain in newlywed women, Siwu Tang with added Xiangfu (Rhizoma Cyperi) and Honghua (Flos Carthami) is indicated. (*Waike Jinnang*)
Jiang Shiji stated: For pain and swelling due to injury from marital intercourse, Zhenzhu San (Pearl Powder) mixed with pig spinal cord should be applied topically. (*Yangyi Shuoyue*, Brief Discussion on Surgeon's Medicine)