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Xu Chunfu stated: Vulvar pruritus in women is mostly caused by erosion from parasites. Initially, it arises from persistent damp-heat, leading to the generation of three types of worms within the intestines and stomach. These worms erode the external genitalia, causing itching; in severe cases, there may be pain accompanied by discharge, ulceration, and deep swelling. For unmarried women, widows, and nuns, this condition often results from unfulfilled sexual desires and excessive rumination or licentious thoughts, causing Qi and Blood to stagnate in the genital region. This accumulation forms damp-heat, which eventually diffuses downward, generating the three types of worms and thus causing this disease. It may also result from excessive sexual activity leading to heat obstruction, causing swelling, itching, and internal pain, manifesting externally as bubo (lymphadenitis). None of these are not caused by damage from sexual excess.

Xue Lizai commented: The aforementioned symptoms belong to transformations of the Liver Meridian. One should use Longdan Xiegan Tang (Gentian Decoction to Drain the Liver) and Xiaoyao San (Free and Easy Wanderer Powder) to treat both internal and external aspects. Crush peach kernels into a paste, mix with realgar powder, combine with chicken liver, grind into cakes, and insert into the vagina to control the parasites. Simultaneously, employ herbs that clear the Liver and resolve depression. If this syndrome is caused by anger injuring the Liver and Spleen, presenting with limb fatigue, heavy itching in the vagina, and red, scanty, painful urination, use Guipi Tang (Restore the Spleen Decoction) added with Gardenia, Bupleurum, and Moutan Bark. If it is due to deficiency of Liver and Spleen Qi with damp-heat pouring downward, presenting with internal vaginal pain and itching, frequent discharge, poor appetite, and body fatigue, use Guipi Tang added with Gardenia, White Peony Root, Licorice Root, and Moutan Bark.

Li commented: Parasites resembling small maggots appearing in the vagina arise from severe damp-heat combined with Heart Qi depression and Qi-Blood stagnation. Suitable treatments include Huoxiang Yangwei Tang (Agastache Decoction to Nourish the Stomach), Buxin Tang (Tonify the Heart Decoction), and Liuqi Wan (Sulfur and Carp Pill). Externally, decoct mugwort, mix the juice with realgar powder, and fumigate the area. Additionally, frequently wash with a decoction of Cnidium Fruit. Mix roasted Catalpa Bark powder with Alum and a small amount of Musk, apply topically for immediate effect.

Shenzhai commented: The above two paragraphs describe the syndrome of vulvar pruritus with parasitic infection in women. Jueyin (Foot-Jueyin Liver Meridian) belongs to the Wind-Wood organ. When wood rots, termites breed; similarly, when Liver Blood is deficient and Body Fluids are exhausted, Qi and Blood cannot nourish and circulate properly. This leads to stagnation and depression generating Dampness; Dampness generates Heat; Heat generates Parasites. This is logically inevitable. Therefore, treatment methods primarily involve leaching out Dampness and clearing Heat, while externally using methods to kill parasites. However, addressing the root cause requires nourishing Liver Blood, supporting Earth (Spleen), and benefiting Yin while drying Dampness. Regarding Xu Chunfu’s discussion on causes related to unfulfilled sexual desire, this is also an aspect of pathology that must not be overlooked.