上八味。末之。炼蜜和丸。梧子大。酒下十五丸。加至二十五丸。日再服。（详于虚劳。及消渴中。当参考。）
〔鉴〕赵良曰。此方在虚劳中。治腰痛小便不利。小腹拘急。此亦用之何也。盖因肾虚用之也。用此
补肾则气化。气化则水行而愈矣。然转胞之病。岂尽由下焦肾虚。气不化出致耶。或中焦脾虚。不能散精归
于胞。及上焦肺虚。不能下输布于胞。或胎重压其胞。或忍溺入房。皆足成此病。必求其所因。以治之也。
李曰。方名肾气丸者。气属阳。补肾中真阳之气也。内具六味丸。壮肾水。以滋小便之源。附桂
益命门火。以化膀胱之气。则熏蒸津液。水道以通。而小便自利。此所以不用五苓散。而用肾气丸也。
蛇床子散方。温阴中坐药。（脉经。作妇人阴寒。温阴中作药。蛇床子散主之。徐程魏尤金鉴并同。）
蛇床子仁
上一味。末之。以白粉少许。和合相得。如枣大。绵裹内之。自然温。（合。赵作令。是。）
〔徐〕坐。谓内入阴中。如生产谓坐草之坐也。
〔程〕
白粉。即米粉。借之以和合也。
〔尤〕阴寒阴中寒也。寒则
生湿。蛇床子温以去寒。合白粉燥以除湿也。此病在阴中。而不关脏腑。故但内药阴中自愈。
案千金注云。坐药。即下着坐导药。
少阴脉滑而数者。阴中即生疮。阴中蚀疮烂者。野狼牙汤洗之。
〔尤〕脉滑者湿也。脉数者热也。湿热相合。而系在少阴。
故阴中即生疮。甚则蚀烂不已。野狼牙味酸苦。除邪热气疥疮恶疮。去白虫。故取治是病。
案龚氏外科百效云。如因妇人子宫。有败精带浊。或月水未净。与之交合。后又未洗。男子肾虚。邪秽
滞气。遂令阴茎连睾丸肿疮。小便如淋。名阴蚀疮。然妇人亦有之。据此则阴蚀。乃霉疮之属已。
野狼牙汤方（外台引千金云。疗人阴虫疮方。案千金云。治阴中痒入骨困方。与外台所引异。）
野狼牙（三两○千金作两把）
上一味。以水四升。煮取半升。以绵缠箸。如茧浸汤沥阴中。日四遍。
外台古今录验。妇人阴蚀。苦中烂伤。野狼牙汤。
野狼牙三两。 咀以水四升。煮取半升。去滓内苦酒。如
鸡子中黄一杯煎沸。适寒温。以绵濡汤。以沥疮中。日四五度即愈。
胃气下泄。阴吹而正喧。此谷气之实也。膏发煎导之。
〔尤〕阴吹。阴中出声。如大便失气之状。连续不绝。故曰正喧。谷气实者。大便结而不通。是以阳明下
行之气。不得从其故道。而乃别走旁窍也。猪膏发煎。润导大便。便通气自归矣。
案金鉴云。膏发煎导之五字。当是衍文。此谷气之实也之下。当有长服诃黎勒丸之六字。后阴下气。谓之
气利。用诃黎勒散。前阴下气。谓之阴吹。用诃黎勒丸。文义始属。药病相对。盖诃黎勒丸。以诃黎勒固下
气之虚。以浓朴陈皮平谷气之实。亦相允合。方错简在杂疗篇内。此说未知是否。姑附之。
萧氏女科经论云。按妇人阴吹证。仲景以为谷气实。胃气下泄所致。此之病机。有不可解。云来注云。
胃实肠虚。气走胞门。亦是随仲景之文。而诠之也。夫人谷气胃中。何尝一日不实。而见阴吹之证者。未之
尝闻。千百年之书。其缺疑可也。予甲寅岁。游峡右。有友吴禹仲来询云。此镇有一富室女。阴户中时簌簌有
声。如后阴之转失气状。遍访医者。不晓此何病也。予曰。阴吹证也。仲景之书有之。禹仲因叹予之读书
之博。案阴吹非罕见之病。简前年疗一诸侯夫人患此证。寻为瘵。药罔效而没。
膏发煎方（见黄胆中。）
小儿疳虫蚀齿方（〔原注〕疑非仲景方。）
雄黄 葶苈
上二味。末之。取腊日猪脂。熔以槐枝。绵裹头四五枚。点药烙之。（案本草纲目。二味等分。日。作月。）
〔程〕小儿胃中有疳热。则虫生。而牙断蚀烂。雄黄味辛。葶苈味苦。辛苦能杀虫故也。按张仲景有口
齿论一卷。（案见宋艺文志。）今未之见。岂被处简脱于此耶。而妇人方后。不应有小儿方也。
案玉函经第八卷末。亦载治小儿药三方。盖另有幼科书。而亡佚者。此类岂其遣方耶。
以上八味药，研成细末。用炼蜜调和制成丸剂，大小如梧桐子。每次用酒送服十五丸，逐渐增加至二十五丸，每日服用两次。（详细内容见虚劳病篇，以及消渴病篇，应当参考。）
〔赵良鉴〕赵良说：这个方剂在虚劳病中，用于治疗腰痛、小便不利、小腹拘急疼痛。这里也使用它的原因是什么呢？大概是因为肾虚而使用的吧。使用此方补肾，则肾的气化功能恢复；气化功能恢复，则水液运行正常，疾病痊愈。然而，转胞（膀胱受压导致排尿困难）这种病，难道全都是由下焦肾虚、气不化水导致的吗？或者是中焦脾虚，不能将精微物质散布归于膀胱；以及上焦肺虚，不能向下输布津液于膀胱；或者是胎儿过重压迫膀胱；或者是有憋尿后行房事的情况，这些都足以造成这种病。必须探求其病因，然后进行治疗。
李氏说：方名“肾气丸”，因为气属于阳，是补益肾中真阳之气。方中包含六味地黄丸，以壮盛肾水，滋润小便的源头；附子、肉桂益助命门之火，以化生膀胱之气。这样熏蒸津液，水道得以通畅，小便自然通利。这就是为什么不用五苓散，而用肾气丸的原因。
蛇床子散方：作为温煦阴部的坐药。（《脉经》记载为妇人阴寒，温阴中作药，蛇床子散主之。徐灵胎、程国彭、尤在泾及《医宗金鉴》均同此说。）
蛇床子仁
以上一味药，研成细末。加入少许白粉（米粉），调和均匀。做成如枣核大小的丸剂，用棉布包裹，纳入阴道内，自然会感到温热。（“和合”二字，赵良本作“令”，是正确的。）
〔徐灵胎〕坐，指放入阴道内，如同分娩时说的“坐草”中的“坐”。
〔尤在泾〕阴寒，指阴部寒冷。寒则生湿，蛇床子性温以驱寒，配合白粉性燥以除湿。此病位在阴中，与脏腑无关，所以只需将药物纳入阴中即可自愈。
按《千金方》注解说：坐药，就是置于下部使用的导药。
少阴脉象滑而数的，阴中就会生疮；如果阴中腐蚀溃烂的，用野狼牙汤清洗。
〔尤在泾〕脉滑代表湿，脉数代表热。湿热相结合，且病系于少阴经，所以阴中生疮。严重时腐蚀溃烂不止。野狼牙味酸苦，能清除邪热、治疗疥疮恶疮，去除白虫（寄生虫），所以取用它来治疗此病。
按龚氏《外科百效》记载：如果是由于妇女子宫内有败精带浊，或者月经未净就进行性交，事后又未清洗，男子肾虚，邪秽滞气滞留，导致阴茎连同睾丸肿胀生疮，小便像淋证一样，名叫阴蚀疮。然而妇女也有这种情况。据此来看，阴蚀属于霉疮一类了。
野狼牙汤方（《外台秘要》引用《千金方》说是治疗人阴虫疮的方子。按《千金方》说是治疗阴中痒入骨困的方子，与《外台》所引不同。）
野狼牙（三两○《千金方》作两把）
以上一味药，用水四升，煮取半升。用棉条缠绕筷子头，如蚕茧大小，浸入药汤中，沥取药汁滴入阴中，每日四次。
《外台秘要》引《古今录验》：妇人阴蚀，痛苦在于中间腐烂受伤。野狼牙汤。
野狼牙三两。切碎，用水四升，煮取半升，去渣，加入醋一杯，如鸡蛋黄大小，煎沸。待温度适宜，用棉蘸药汤，滴沥于疮口中，每日四五次即可痊愈。
胃气下泄，前阴出声而且声音喧闹，这是谷气实盛的表现，用膏发煎引导治疗。
〔尤在泾〕阴吹，指前阴发出声音，像大便失气的样子，连续不断，所以说“正喧”。谷气实，是指大便干结不通。因此阳明下行之气，不能从原来的通道（肛门）排出，而是另走旁窍（前阴）。猪膏发煎，润肠通便，大便通畅，气体自然回归正道。
按《医宗金鉴》说：“膏发煎导之”五个字，可能是衍文。在“此谷气之实也”之下，应当有“长服诃黎勒丸”六个字。后阴下气，叫做气利，用诃黎勒散；前阴下气，叫做阴吹，用诃黎勒丸。这样文义才连贯，药病相对。大概诃黎勒丸，用诃黎勒固摄下气之虚，用厚朴、陈皮平抑谷气之实，也是相吻合的。原方错简在杂疗篇内，这种说法不知是否正确，姑且附记于此。
萧氏《女科经论》说：按妇人阴吹证，张仲景认为是谷气实、胃气下泄所致。这个病机，有不可理解之处。云来注解也说：胃实肠虚，气走胞门，也是顺着张仲景的文字来诠释的。人吃进谷物在胃中，何尝有一天不是实的，但见到阴吹证的，我从未听说过。千年的书籍，存在缺漏疑惑是可以理解的。我在甲寅年，游历峡右地区，有位朋友吴禹仲来询问说：这镇上有一富贵人家的女儿，阴户中时常簌簌有声，像后阴放屁的样子。遍访医生，不知道这是什么病。我说：这是阴吹证，张仲景的书里有记载。禹仲于是感叹我读书广博。按阴吹并非罕见之病，我前年治疗一位诸侯夫人患此证，不久因痨病去世，用药无效。
以上二味药，研成细末。取腊日熬化的猪脂，用槐枝搅拌熔化。用棉裹住头端四五枚，蘸药点烙患处。（按《本草纲目》，二味等分，“日”字当作“月”字。）
〔程国彭〕小儿胃中有疳热，则生虫，导致牙齿断裂腐蚀溃烂。雄黄味辛，葶苈味苦，辛苦味能杀虫，所以如此。按张仲景有《口齿论》一卷。（按见于《宋艺文志》。）如今未见此书，难道是散佚在这里了吗？而在妇人方之后，不应该出现小儿方。
按《玉函经》第八卷末尾，也记载治疗小儿药的三方。大概另有儿科书，已经亡佚了。这类方子难道是其中的遗方吗？
The above eight herbs are ground into fine powder. Honey is refined and used to bind the powder into pills, sized like *Semen Ceviae* (Chinese Chestnut) seeds. Administer fifteen pills per dose with wine, gradually increasing to twenty-five pills, taken twice daily. (For details, refer to the chapter on Deficiency Consumption, as well as the chapter on Wasting-Thirst; cross-reference is advised.)
[Zhaoliang's Commentary] Zhaoliang stated: This formula is used in the context of Deficiency Consumption (Xu Lao, a syndrome characterized by chronic weakness and wasting) to treat lower back pain, difficulty in urination, and spasm/tightness in the lower abdomen. Why is it also used here? It is likely employed due to Kidney deficiency. By using this formula to tonify the Kidney, the Qi transformation function is restored; once Qi transformation is restored, water metabolism proceeds normally, and the disease resolves. However, is the condition of "Zhuan Bao" (displacement of the bladder causing urinary retention) entirely caused by lower Jiao Kidney deficiency leading to failure of Qi transformation? Or could it be due to middle Jiao Spleen deficiency, failing to distribute essence to the bladder; or upper Jiao Lung deficiency, failing to descend fluids to the bladder; or the weight of the fetus compressing the bladder; or holding urine while engaging in sexual intercourse? All these can cause this disease. One must seek the underlying cause to treat it accordingly.
Li stated: The formula is named Shenqi Wan (Kidney Qi Pill) because Qi belongs to Yang; it tonifies the True Yang Qi of the Kidney. It contains Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) to strengthen Kidney Water and nourish the source of urine; Fuzi (Prepared Aconite Root) and Rougui (Cinnamon Bark) benefit the Fire of the Gate of Vitality (Mingmen) to transform Bladder Qi. This steams and vaporizes body fluids, unblocking the water passages, so urination becomes free. This is why Wu Ling San (Five-Ingredient Powder with Poria) is not used, but rather Shenqi Wan.
Shechuangzi San (Cnidium Monier Powder): Used as a vaginal suppository for warming the Yin organs. (*Mai Jing* records it for female genital coldness, used as a warming agent for the Yin organs, primarily Shechuangzi San. Xu Lingtai, Cheng Guopeng, You Zaijing, and *Yizong Jinjian* agree.*)
Shechuangzi Ren (Fructus Cnidii)
The above single herb is ground into powder. Mix with a small amount of Baifen (Rice Flour) until well combined. Shape into pills the size of a jujube. Wrap in cotton and insert into the vagina; warmth will naturally ensue. ("Hehe" [mix/combine], Zhao Liang's version reads "Ling" [make/cause], which is correct.)
[Xu Lingtai's Commentary] "Zuo" refers to inserting into the vagina, similar to the term "zuo cao" [sitting on grass] used for childbirth.
[Cheng Guopeng's Commentary] Baifen is rice flour, used here to aid in binding the mixture.
[You Zaijing's Commentary] "Yin Han" refers to coldness in the Yin organs. Cold generates dampness. Shechuangzi is warm to dispel cold, and Baifen is drying to remove dampness. Since the pathology is located in the Yin organs and does not involve the Zang-Fu organs, inserting the medicine directly into the Yin organs allows self-healing.
Note from *Qianjin Fang*: "Zuo yao" refers to suppositories placed in the lower orifices.
If the Shaoyin pulse is slippery and rapid, ulcers will form in the Yin organs. If the Yin organs are eroded and ulcerated, wash them with Yelangya Tang (Wolf Bane Decoction).
[You Zaijing's Commentary] A slippery pulse indicates Dampness; a rapid pulse indicates Heat. When Dampness and Heat combine and affect the Shaoyin channel, ulcers form in the Yin organs. In severe cases, erosion and ulceration persist. Yelangya (Aconitum carmichaelii root, processed differently or referring to *Consolida orientalis* depending on historical context, often associated with clearing heat/toxins) has sour and bitter flavors, clears pathogenic heat, treats scabies and malignant sores, and expels white worms (parasites). Hence, it is selected to treat this condition.
Note from Gong Shi's *Waike Bai Xiao*: If a woman has retained semen or turbid discharge in the uterus, or engages in intercourse before menstruation has fully ceased, and fails to clean afterwards, combined with male Kidney deficiency and stagnation of pathogenic filth, it can cause swelling and sores of the penis and testicles, with urination resembling strangury. This is called "Yin Shi Chuang" (Genital Erosion Sores). However, women can also suffer from this. Based on this, "Yin Shi" belongs to the category of chancroid/syphilitic sores.
Yelangya Tang Formula (cited in *Waitai Miyao* from *Qianjin Fang* as treating genital worm sores. Note: *Qianjin Fang* cites it for treating intense itching in the Yin organs penetrating to the bone, differing from *Waitai*'s citation.)
Yelangya (3 liang ○ *Qianjin Fang* records 2 bundles)
The above single herb is boiled in 4 sheng of water until reduced to half a sheng. Wrap cotton around the end of a chopstick, the size of a silkworm cocoon, dip it into the decoction, and drip the liquid into the Yin organs four times daily.
*Waitai Miyao* citing *Gujin Luyanjian*: For women with genital erosion, suffering from central ulceration and injury. Yelangya Tang.
Yelangya 3 liang. Coarsely crush, boil in 4 sheng of water until reduced to half a sheng. Remove dregs, add vinegar (Ku Jiu), equivalent to one egg yolk, and boil until bubbling. When temperature is suitable, soak cotton in the decoction and drip onto the sores four to five times daily until healed.
When Stomach Qi descends improperly, causing flatulence through the anterior orifice with audible noise, this is due to excess Grain Qi. Guide the treatment with Gaofa Jian (Pig Fat and Hair Decoction).
[You Zaijing's Commentary] "Yinchui" refers to sound emanating from the anterior orifice, resembling flatus from defecation, continuous and unremitting, hence termed "Zheng Xuan" [truly noisy]. Excess Grain Qi implies constipation and blockage. Consequently, the descending Qi of the Yangming channel cannot follow its normal pathway (the anus) and instead exits through an alternative orifice (the anterior orifice). Pig fat and hair decoction moistens and guides the bowels; once stool passes freely, Qi returns to its proper course.
Note from *Yizong Jinjian*: The phrase "Guide with Gaofa Jian" may be a later interpolation. Below "This is due to excess Grain Qi," there should likely be six characters: "Long-term use of Helile Wan." Downward expulsion of Qi from the posterior orifice is called "Qi Li" [Flatus Diarrhea], treated with Helile San. Downward expulsion of Qi from the anterior orifice is called "Yinchui," treated with Helile Wan. This makes the text coherent and matches medicine to disease. Helile Wan uses Helile (Chebula Fruit) to secure deficient downward Qi, and Houpo (Magnolia Bark) and Chenpi (Tangerine Peel) to regulate excess Grain Qi, which is consistent. The formula was misplaced in the Miscellaneous Treatments chapter. Whether this theory is correct remains unknown; it is recorded here tentatively.
Xiao Shi's *Nuke Jinglun* states: Regarding the Yinchui syndrome in women, Zhang Zhongjing attributes it to excess Grain Qi and descending Stomach Qi. The pathogenesis here is inexplicable. Yunlai's annotation also follows Zhang Zhongjing's text, interpreting it as "Stomach excess and Intestine deficiency, Qi moves to the Bao Men [Gate of the Uterus]." But Grain Qi in the Stomach is never without excess; yet I have never heard of anyone presenting with Yinchui solely due to this. Books from thousands of years ago inevitably have gaps and doubts. In the year Jiayin, traveling in the Xiyou region, a friend, Wu Yuzhong, asked me: "There is a daughter of a wealthy family in this town who occasionally hears rustling sounds from her vulva, similar to anal flatus. Doctors everywhere do not know what disease this is." I said: "This is Yinchui syndrome, documented in Zhang Zhongjing's book." Yuzhong sighed at my extensive reading. Note that Yinchui is not a rare disease. Last year, I treated a marquis's wife with this syndrome; she soon died of consumption (tuberculosis), and medicines were ineffective.
Gaofa Jian Formula (See the chapter on Jaundice.)
Xiao'er Gan Chong Shi Chi Fang (Pediatric Worm-Eroded Teeth Formula) ([Original Note: Suspected not to be Zhang Zhongjing's formula.])
Xionghuang (Realgar) Tingli (Seed of Lepidium / Descurainia)
The above two herbs are ground into powder. Take lard rendered on the eighth day of the twelfth lunar month, melt it using a locust branch. Wrap the tip of a applicator with cotton (approx. 4-5 units), dip in the powder, and apply/cauterize the lesion. (Note: *Bencao Gangmu* states equal parts of the two herbs; "Day" should be read as "Month".)
[Cheng Guopeng's Commentary] When children have Gan heat in the Stomach, worms generate, causing teeth to break, erode, and rot. Xionghuang is pungent, Tingli is bitter; the pungent and bitter flavors kill worms. According to records, Zhang Zhongjing wrote a volume titled *Kouchi Lun* [Treatise on Mouth and Teeth] (Recorded in *Song Yiwen Zhi*). This text is now lost; perhaps it was scattered or omitted here? Furthermore, pediatric formulas should not appear after gynecological formulas.
Note: The end of Volume Eight of *Yuhan Jing* also records three formulas for treating children. Perhaps there was a separate Pediatric text that has been lost. These formulas might be remnants from such a text.