阴挺证。坊刻外科论之颇详。大抵不外湿热下注为病。薜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。
而究治无一效。何也。盖为前人温热二字误之也。予在籍时。医道颇许可于人。治疗
三十七载。阅历不为不多。而阴挺证。从未一见。意者古人用心周到。不过得所闻而备其
病名乎。迨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。或顽麻不一。以致经水渐闭。
面黄食少。羸瘦咳嗽吐血。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。余亦尝按前人之法而
治之。亦未见效。未知何故。后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。因知此证南人不患。即偶有之。治亦
易愈。北人常患。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。夜卧土炕。寒湿渐积。固不待言。男子劳动而散泄。妇人则静而常伏。至春
夏以及长夏。湿得暑气之蒸。上腾有如蒸饭。妇女值经水之适来。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。湿随人气以内入。即金匮胞门寒伤之义。
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。凡妇女不用马桶。蹲于厕中而便溺。厕中为污秽幽隐之处。更多湿虫之
潜伏。其毒瓦斯皆能随其血腥之气而上乘之也。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。予于此证之初患者。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。而龟版鳖甲
蒺藜之类。随证出入加减。亦有愈者。笔楮难尽。惟于金匮妇人杂病及全部中。属词比
事。得其一言一字。以启悟机。断无不可治之证矣。
阴挺证。坊间刻印的外科书籍对此论述颇为详细。大抵不外乎湿热下注致病。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、龙胆泻肝汤之类为辅助，可谓高人一筹。然而究其治疗效果，却无一见效。为什么呢？大概是被前人所说的“温热”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，但阴挺证，从未见过一例。我想古人用心周到，不过是听闻过而备录病名罢了。等到辛酉年，我以县令身份发往直隶候补，在公余之暇，时常也兼理此道，才知道直隶妇女，十人中患此病的约有三四。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，有的痛痒，有的麻木顽钝，不一而足。以致月经逐渐闭止，面色萎黄，饮食减少，消瘦咳嗽吐血，寒热往来，自汗盗汗，最终病成劳伤而死。轻者只觉阴中有滞碍感，而没有外形；或有外形也不甚明显，没有严重的痛苦危害。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。有的用刀割除，一时稍好，随即更加严重。我也曾按照前人的方法治疗，也未见效，不知是何缘故。后来阅读《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。因而知道此证南方人不患，即使偶有，治疗也容易痊愈；北方人常患，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，按法多有效验；北方人的阴挺，是由于气习（生活习惯与环境）所致，病象虽然相同，而病源则不同，所以无效。所谓气习是什么呢？北方习俗，白天坐在湿地上，晚上睡在土炕上，寒湿逐渐积聚，这固然是不言而喻的。男子劳动而精气散泄，妇人则静止而常伏卧。到了春夏以及长夏季节，湿气得到暑气的蒸腾，上腾有如蒸饭。妇女正值月经适来之时，血海空虚，虚则容易受邪。且终日坐于湿地，又勤于女红（针线活），人体热气使地面渐干，湿气随人气进入体内，这就是《金匮要略》中“胞门寒伤”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。虫属阴类，血属阴汁，以阴从阴，毒瓦斯并合，就成为阴挺的病根。推而言之，即使不坐湿地，凡是妇女不用马桶，蹲在厕所中大小便，厕所是污秽幽隐之处，更多湿虫潜伏，其毒瓦斯都能随着血腥之气而上乘侵袭。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，因为花椒能胜寒，白矾能除湿。知道了这些，那么阴挺的病根就更了然于掌中了。医者不察其缘由，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、攻毒的峻烈药物制成丸剂内服，又以蟾酥、硼砂、芒硝、麝香、雄黄、冰片、阿魏、白砒之类外敷，危害更加剧烈。我因此不忍沉默坐视。我对初患此证的病人，用五苓散原方料，加蜀椒、黄柏、小茴香、附子、沙参、川芎、红花之类，炼蜜为丸，每服四钱，一日两次。外用花椒、苦参、苍术、槐花煎汤，加入芒硝熏洗。又以飞矾六两、铜绿四钱、五味子、雄黄各五钱、桃仁一两，共研细末，炼蜜为丸，每重四钱，以雄黄为衣，纳入阴中，效果奇特。或者日久成为劳损，月经不利，以温经汤、肾气丸主治，而龟版、鳖甲、蒺藜之类，随证出入加减，也有治愈的。笔墨难以尽述，只是在《金匮要略》妇人杂病篇及全书中，连缀词句，比较事理，得到其中一言一字，以启发悟性，断没有不可治的病证了。
Yin Ting Syndrome. Surgical texts printed in bookshops discuss this in considerable detail. Generally, it is not beyond the pathology of Damp-Heat pouring downward. Xue Lizhai used Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction), Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder), Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), and Zhibai Bawei Wan (Anemarrhena, Phellodendron, and Eight-Ingredient Pill) as main prescriptions, with Danggui Lvwana Wan (Angelica Sinensis and Gardenia Pill) and Longdan Xiegan Tang (Gentian Liver-Draining Decoction) as auxiliaries. This could be considered a step ahead of others. However, upon investigation, none of the treatments yielded any effect. Why? It is likely that they were misled by the previous generations' emphasis on "Warmth" and "Heat." When I was at home, my medical skills were quite acceptable to others. Having practiced medicine for thirty-seven years, my experience was not insignificant, yet I had never seen a single case of Yin Ting syndrome. I suppose the ancients were thorough in their thinking; they merely recorded the disease name based on what they had heard. Later, in the Xin You year, I was dispatched to Zhili as a county magistrate awaiting appointment. During my spare time from official duties, I occasionally attended to this branch of medicine. 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 or two cun, or even three or four cun, thick as a finger or large as a fist. The shape varied like a snake, a melon, an edible fungus, or a toad. Some had continuous bleeding and discharge, some were dry and unmoistened, some experienced pain and itching, while others felt numbness and insensitivity. This led to menstrual cessation, sallow complexion, poor appetite, emaciation, coughing, hemoptysis, alternating chills and fever, spontaneous sweating, and night sweats, eventually resulting in death due to consumption and injury. In mild cases, there was only a sensation of obstruction in the vagina without visible prolapse; if visible, it was not prominent, causing little pain or harm. If menstruation was regular, fertility remained possible. Contemporary physicians named this condition "Yin Zhi" (Yin Hemorrhoid), also known as "Chi Xue Lao" (Blood-Eating Consumption). None of the medications used proved effective. Some resorted to surgical excision, which provided temporary relief but soon worsened. I too attempted treatment according to previous methods without success, wondering why. Later, after reading classics such as *Neijing* (The Inner Canon), *Jinkui Yaolue* (Essential Prescriptions of the Golden Cabinet), and *Qianjin Fang* (Prescriptions Worth a Thousand Gold), as well as various secret manuscripts, and seeking their underlying meanings while combining them with my observations, I gained significant insight. I came to know that people in the South do not suffer from this disease; even if they do, it is easily cured. People in the North often suffer from it, and treatments are invariably ineffective, for specific reasons. The Yin Ting of Southerners arises from pathological changes; books contain formulas for it, and following the methods yields frequent results. The Yin Ting of Northerners arises from "Qi Xi" (habitual lifestyle and environmental factors). Although the clinical manifestations are similar, the etiology differs, hence the ineffectiveness. What is meant by "Qi Xi"? Northern customs involve sitting on damp ground during the day 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 dissipate essence, while women remain static and often lie prone. During spring, summer, and late summer, dampness is steamed by summer heat, rising like steam from cooking rice. When women have their menses, the Blood Sea is empty; emptiness makes one susceptible to pathogens. Sitting on damp ground all day and diligently doing needlework generates body heat that dries the ground, allowing dampness to enter the body along with the body's qi. This aligns with the concept of "Cold Injury to the Bao Men (Uterine Gate)" in *Jinkui Yaolue*. Even more so, in late summer, dry soil, after rain, causes worms within the earth to wriggle. Upon smelling blood, these worms raise their heads and inhale the air. Worms belong to the Yin category, and blood is Yin fluid. Yin follows Yin, and toxic vapors combine, becoming the root cause of Yin Ting. Extending this logic, even without sitting on damp ground, if women squat in toilets to defecate or urinate instead of using chamber pots, the toilet, being a filthy and hidden place, harbors many damp worms. Their toxic vapors can ascend and invade along with the scent of blood. In my mountain residence, I often see children sitting on damp ground suffering from penile swelling, pain, or itching, commonly called "Earthworm Blowing." Treaters would open a duck's bill and let the child suckle it, as ducks like earthworms; or wash with a decoction of Sichuan pepper and alum, as pepper overcomes cold and alum dries dampness. Understanding this, the root cause of Yin Ting becomes clear as day. Physicians who fail to investigate the cause and merely apply standard formulas cannot be blamed for the worsening condition. Furthermore, there are profit-seeking individuals who administer harsh pills containing drugs for draining water, reducing swelling, and attacking toxins internally, and apply external pastes made of Toad Venom, Borax, Mirabilite, Musk, Realgar, Borneol, Asafoetida, and White Arsenic, causing even greater harm. Therefore, I could not bear to sit idly by. For patients newly afflicted with this syndrome, I used the ingredients of Wuling San (Five-Ingredient Powder with Poria), adding Sichuan Pepper, Phellodendron Bark, Fennel Seed, Aconite Root, Glehnia Root, Ligusticum Chuanxiong Rhizome, and Safflower, processed into honey pills. Each dose was 4 qian, taken twice daily. Externally, I used a decoction of Sichuan Pepper, Sophora Root, Atractylodes Macrocephala Rhizome, and Sophora Flower, added with Mirabilite, for fumigation and washing. Additionally, I prepared pills from Calcined Alum (6 liang), Copper Green (4 qian), Schisandra Berry (5 qian), Realgar (5 qian), and Peach Kernel (1 liang), finely powdered and bound with refined honey into 4-qian pills, coated with Realgar, inserted into the vagina, yielding miraculous effects. For chronic cases progressing to consumption with irregular menstruation, I treated with Wenjing Tang (Warming the Menses Decoction) or Shenqi Wan (Kidney Qi Pill), modifying with Tortoise Shell, Turtle Shell, and Tribulus Fruit according to symptoms, achieving cures. Words on paper cannot fully exhaust this topic. By carefully analyzing the text of the *Jinkui Yaolue*, specifically the chapters on miscellaneous diseases of women and the entire work, extracting even a single word or phrase to inspire understanding, there is no doubt that no case is incurable.