溃烂（宜逍遥散）；或肿痛湿痒出水（宜归脾汤加柴胡、山栀、丹皮、白芍）。总之，阴户肿痛，薛氏谓即妇
人便毒，有在小腹两拗者，有在玉门内外者，治法不同，概投散血攻毒之药可乎？○又有阴痒，《大全》云∶
妇女阴痒者，是虫蚀于阴内，
微则痒，重乃痛。此虫属肝风所化，治以清肝为主（宜柴胡清肝汤、逍遥散）。外用药纳阴中（宜桃仁泥、雄
黄末、鸡肝纳阴中）。有痒而无虫者，或由郁怒伤于肝脾，证兼胸膈不快，内热作渴，饮食无味，肢体倦怠，
小水赤涩（宜归脾汤加山栀，或逍遥散加山栀）。或由脾虚湿热下注（宜归脾汤加丹皮、山栀、白芍）；或由
肝脾郁怒，元气亏损，兼有湿热（宜参、苓、归、芍、 、术、升、柴、丹、栀、车前、陈皮）。○又有下疽，
痛痒腐烂生蛆，下如柿汁臭秽，心中 痛，闷饱虚烦甚者，不治。○又有阴冷，由肝经本有湿热，风冷又外乘
之。如冷而小腹痞痛，小便赤涩（宜龙胆泻肝汤）。冷而寒热，经候不调（宜加味逍遥散）。冷而寒热，体倦
食少（宜加味四君汤）。冷而郁怒发热，少寐懒食（宜加味归脾汤）。冷而口苦，胁胀寒热，小便黄涩，先清
利湿热（宜龙胆汤），再调补气血（宜加味逍遥散）。冷而便清腹冷，食少便溏（宜八味丸）。或谓阴冷之证，
因劳伤子脏，风冷客之，亦然。○又有阴 ，硬肿如卵，痛极难忍，皆由湿凝血结，宜用攻散之剂。○又有阴吹，
由胃虚浊气下泄，注于阴中，喧声不绝者（宜膏发煎）。○又有交接出血阴痛，乃肝火动而脾不摄血也（宜补中
汤）。若交接阳道违理，及他物所伤，血淋不止（宜釜底墨纳之）；或童女交接，血出不止（宜发灰、青布灰
涂之）。○又有阴痔，阴中有肉突出（宜枳壳末煎汤熏洗，将帛包渣纳阴中即消）。○又有阴脱，由努力太过，
如脱肛状，逼迫肿痛，小便淋沥，急用补托（宜当归黄 饮）；外以药敷（宜硫磺、乌贼骨、五倍子为末敷患
处即效）。○又有阴挺，阴中突出如菌，四围肿痛，由肝郁脾虚下陷所致（先以补中汤加山栀、茯苓、车前、
青皮以清肝火，升脾气。更以归脾汤加山栀、茯苓、川芎调理。外涂藜芦膏）。或阴中挺出一条，长尺许，痛
坠尿涩。（《沈氏尊生书》）
选案
一妇，每临经必先腰腹胀痛，玉门虫出，如鼠粘子状，绿色
者数十枚，后经水随至。其夫问故，予曰∶厥阴风木生虫。妇人血海，属于厥阴。此风木自盛，更兼脾胃湿热
而然。如春夏木盛湿热之时，而生诸虫是也。令以酒煮黄连为君，白术、香附为臣，研末粥丸，空腹吞之。月
余经至，无虫而妊。（汪石山）
乳疾
乳痈者，乳房肿痛，数日之外， 肿而溃，稠脓涌出，此属胆胃热毒，气血壅滞所致，犹为易治。乳岩
者，初起内结小核如棋子，不赤不痛，积久渐大，崩溃形如熟榴，内溃深洞，血水淋沥，有 岩之势，故曰乳
岩。此属脾肺郁结，气亏血损，最为难治。乳痈初起，服栝蒌散，敷香附饼，即消。如已成脓，则以神仙太乙
膏贴之，脓尽自愈。乳岩初起，用加味逍遥散、加味归脾汤，二方间服，亦可内消。病势已成，虽有卢扁，亦
难为力。但服前方，补养气血，亦可延生，妄用行气破血，速其危也。更有乳卸，乳头拖长一、二尺，此肝经
风热发泄，用小柴胡汤加防风、羌活，外用羌活、防风、白蔹烧烟熏之，仍以蓖麻子四十九粒、麝香一分，研
涂顶心，乳收洗去。此证，女人盛怒者多得之。（薛立斋）
乳 者，女子十三四岁，经水将行，或一月二次，或过月不行，致生此疾。多生于寡薄虚弱之人。每乳
上止有一核，犹或可治；若串成三、四个，即难疗矣。通用逍遥调经汤。（《沈氏尊生书》）
妒乳者，因无儿饮乳，或儿未能饮，余乳蓄结作胀；或妇人血气方盛，乳房作胀，以致肿痛、憎寒、发
热；不吮通之，必致成痈。若肿不消，用麦芽二、三两，炒热煎服，立消。（《景岳全书》）
吹乳者，因母睡着，为儿口气所吹，致令乳汁不通，蓄积在内，肿硬疼痛。亦有不痒不痛，肿硬如石者。
若不急治，痛甚成脓，宜服栝蒌散，敷以南星散，更以手揉之，则散。（《女科大全》）
选案
一妇产后，两乳长垂过腹，痛不可忍，名曰乳悬。用芎、归各一斤，半用水煎服，半锉烧烟，令病患吸之。
未愈，再作一料。（《同寿录》）
溃烂（适宜使用逍遥散）；或者肿痛、湿痒、流水（适宜使用归脾汤，加柴胡、山栀、丹皮、白芍）。总之，阴户肿痛，薛氏认为就是妇女的便毒，有的在小腹两侧的凹陷处，有的在玉门内外，治疗方法不同，一概投用散血攻毒的药物可以吗？○又有阴部瘙痒，《大全》说：妇女阴部瘙痒的，是虫在阴内侵蚀，轻微则痒，严重则痛。这种虫属于肝风所化生，治疗以清肝为主（适宜使用柴胡清肝汤、逍遥散）。外用药纳入阴中（适宜使用桃仁泥、雄黄末、鸡肝纳入阴中）。有痒而没有虫的，或许是由于郁怒伤及肝脾，证候兼有胸膈不快，内热作渴，饮食无味，肢体倦怠，小便赤涩（适宜使用归脾汤加山栀，或逍遥散加山栀）。或许是由于脾虚湿热下注（适宜使用归脾汤加丹皮、山栀、白芍）；或许是由于肝脾郁怒，元气亏损，兼有湿热（适宜用人参、茯苓、当归、白芍、[缺失字]、术、升麻、柴胡、丹皮、山栀、车前子、陈皮）。○又有下疽，痛痒腐烂生蛆，下部像柿汁一样臭秽，心中[缺失字]痛，闷饱虚烦严重的，无法治愈。○又有阴冷，由肝经本有湿热，风冷又外乘之。如果冷而小腹痞痛，小便赤涩（适宜使用龙胆泻肝汤）。冷而寒热往来，月经不调（适宜使用加味逍遥散）。冷而寒热，身体疲倦，食少（适宜使用加味四君汤）。冷而郁怒发热，睡眠少，懒食（适宜使用加味归脾汤）。冷而口苦，胁胀寒热，小便黄涩，先清利湿热（适宜使用龙胆汤），再调补气血（适宜使用加味逍遥散）。冷而大便清稀腹部冷，食少便溏（适宜使用八味丸）。有人说阴冷的证候，是因为劳伤子宫，风冷客居其中，也是这样。○又有阴[缺失字]，硬肿如卵，痛极难忍，都是由湿凝血结所致，适宜使用攻散的药剂。○又有阴吹，由于胃虚浊气下泄，注入阴中，喧声不绝者（适宜使用膏发煎）。○又有性交出血阴痛，这是肝火动而脾不摄血所致（适宜使用补中汤）。如果性交阳道违理，以及他物所伤，血淋不止（适宜使用釜底墨纳入）；或者童女性交，血出不止（适宜使用发灰、青布灰涂敷）。○又有阴痔，阴中有肉突出（适宜使用枳壳末煎汤熏洗，将帛包裹药渣纳入阴中即消）。○又有阴脱，由于努力太过，像脱肛的样子，逼迫肿痛，小便淋沥，急用补托（适宜使用当归黄芪饮）；外用药物敷贴（适宜使用硫磺、乌贼骨、五倍子为末敷患处即效）。○又有阴挺，阴中突出如菌状，四周肿痛，由肝郁脾虚下陷所致（先用补中汤加山栀、茯苓、车前子、青皮以清肝火，升脾气。再用归脾汤加山栀、茯苓、川芎调理。外涂藜芦膏）。或者阴中挺出一条，长一尺左右，痛坠尿涩。（《沈氏尊生书》）
选案
一位妇人，每次来月经之前必定腰腹胀痛，玉门出虫，像鼠粘子形状，绿色的数十枚，随后经水随至。她的丈夫问原因，我说：厥阴风木生虫。妇人的血海，属于厥阴。这是风木自盛，再加上脾胃湿热所致。就像春夏木盛湿热的时候，而生各种虫子一样。令其用酒煮黄连为君药，白术、香附为臣药，研末用粥做成丸剂，空腹吞服。一个多月后来月经，没有虫而怀孕。（汪石山）
乳疾
乳痈，乳房肿痛，数日之后，红肿而溃破，稠脓涌出，这属于胆胃热毒，气血壅滞所致，还算容易治疗。乳岩，初起内部结成小核如棋子大小，不红不痛，积久逐渐变大，崩溃形状像熟透的石榴，内部溃烂深洞，血水淋沥，有岩石之势，所以叫乳岩。这属于脾肺郁结，气亏血损，最为难治。乳痈初起，服用栝蒌散，敷香附饼，即可消除。如果已经成脓，则用神仙太乙膏贴敷，脓尽自然痊愈。乳岩初起，用加味逍遥散、加味归脾汤，两方交替服用，也可以内消。病势已成，虽然有卢医和扁鹊，也难以出力。但服用前方，补养气血，也可以延长生命，妄用行气破血，会加速危险。更有乳卸，乳头拖长一、二尺，这是肝经风热发泄所致，用小柴胡汤加防风、羌活，外用羌活、防风、白蔹烧烟熏之，仍以蓖麻子四十九粒、麝香一分，研碎涂于顶心，乳收后洗去。此证，女人盛怒者多得之。（薛立斋）
乳[缺失字]，女子十三四岁，经水将要行，或者一月两次，或者过月不行，导致生此疾。多生于寡薄虚弱之人。每乳上只有一核，或许还可以治疗；如果串成三、四个，就难以疗治了。通用逍遥调经汤。（《沈氏尊生书》）
妒乳，因为没有婴儿吃奶，或者婴儿未能吃，余乳蓄结作胀；或者妇人血气方盛，乳房作胀，以致肿痛、憎寒、发热；如果不吮吸通之，必然导致成痈。如果肿不消，用麦芽二、三两，炒热煎服，立即消除。（《景岳全书》）
吹乳，因为母亲睡着，被婴儿口气所吹，致使乳汁不通，蓄积在内，肿硬疼痛。也有不痒不痛，肿硬如石的。如果不急治，痛甚成脓，宜服用栝蒌散，敷以南星散，更用手揉之，则消散。（《女科大全》）
选案
一位产妇产后，两乳长垂过腹，痛不可忍，名叫乳悬。用川芎、当归各一斤，一半用水煎服，一半锉碎烧烟，让病患吸入。未愈，再做一料。（《同寿录》）
Ulceration (suitable for Xiaoyao San); or swelling, pain, dampness, itching, and discharge (suitable for Guipi Tang added with Chaihu, Shanzhi, Danpi, Baishao). In short, vulvar swelling and pain, Xue believed to be the same as "biandu" (perineal abscess) in women. Some occur in the depressions on both sides of the lower abdomen, some inside and outside the Yumen (vaginal opening), with different treatment methods. Is it appropriate to indiscriminately administer blood-dispersing and toxin-attacking medicines? ○ There is also vulvar pruritus. The *Daquan* states: Vulvar pruritus in women is caused by worms eroding the interior of the vagina. Mild cases present with itching, severe cases with pain. These worms are transformed from Liver Wind. Treatment focuses on clearing the Liver (suitable for Chaihu Qinggan Tang, Xiaoyao San). External medications inserted into the vagina (suitable for Tao Ren Ni [Peach Kernel Paste], Xionghuang Mo [Realgar Powder], Ji Gan [Chicken Liver] inserted into the vagina). Cases with itching but no worms may result from depression and anger injuring the Liver and Spleen, accompanied by chest and diaphragm discomfort, internal heat with thirst, loss of appetite, limb fatigue, and dark, scanty urination (suitable for Guipi Tang added with Shanzhi, or Xiaoyao San added with Shanzhi). It may also result from Damp-Heat pouring downward due to Spleen Deficiency (suitable for Guipi Tang added with Danpi, Shanzhi, Baishao); or from Liver-Spleen depression and anger, Qi and Yuan depletion, combined with Damp-Heat (suitable for Renshen, Fuling, Danggui, Baishao, [missing character], Baizhu, Shengma, Chaihu, Danpi, Shanzhi, Cheqianzi, Chenpi). ○ There is also lower abscess, characterized by pain, itching, rotting, maggot generation, foul-smelling discharge like persimmon juice, chest pain [missing character], severe stuffiness, fullness, and empty irritability; this is incurable. ○ There is also cold sensation in the yin, caused by pre-existing Damp-Heat in the Liver Meridian compounded by external invasion of Wind-Cold. If cold with lower abdominal distension and pain, dark scanty urination (suitable for Longdan Xiegan Tang). If cold with alternating chills and fever, irregular menstruation (suitable for Jia Wei Xiaoyao San). If cold with alternating chills and fever, body fatigue, poor appetite (suitable for Jia Wei Sijun Tang). If cold with depression/anger-induced fever, insomnia, reluctance to eat (suitable for Jia Wei Guipi Tang). If cold with bitter taste, hypochondriac distension, alternating chills and fever, yellow scanty urination, first clear and drain Damp-Heat (suitable for Longdan Tang), then regulate and tonify Qi and Blood (suitable for Jia Wei Xiaoyao San). If cold with clear stools, cold abdomen, poor appetite, loose stools (suitable for Bawei Wan). Some say the syndrome of yin cold is due to labor injury to the Zi Zang (uterus), with Wind-Cold lodging there, which is also the case. ○ There is also yin [missing character], hard and swollen like an egg, unbearable pain, all caused by Dampness coagulating and Blood binding; suitable for attacking and dispersing agents. ○ There is also Yin Chui (flatulence through the vagina), caused by Stomach Deficiency allowing turbid Qi to descend and enter the yin, with continuous noise (suitable for Gao Fa Jian). ○ There is also bleeding and vulvar pain during intercourse, caused by Liver Fire moving and Spleen failing to control blood (suitable for Buzhong Tang). If intercourse violates propriety or injury occurs from other objects, leading to unceasing bloody strangury (suitable for inserting Fudi Mo [soot from the bottom of a cauldron]); or if a virgin has intercourse with unceasing bleeding (suitable for applying Fahui [burnt hair], Qingbu Hui [ash of blue cloth]). ○ There is also Yin Zhi (vulvar hemorrhoid), with flesh protruding from the yin (suitable for fumigating and washing with decoction of Zhike Mo [Aurantii Fructus Powder], then wrapping the dregs in silk and inserting them into the yin to resolve). ○ There is also Yin Tuo (vaginal prolapse), caused by excessive straining, resembling rectal prolapse, with pressing pain and swelling, dribbling urination; urgently use tonification and support (suitable for Danggui Huangqi Yin); externally apply medication (suitable for applying powder of Liuhuang [Sulfur], Wuzeigu [Cuttlefish Bone], Wubeizi [Galla Chinensis] to the affected area for immediate effect). ○ There is also Yin Ting (procidentia/vaginal tumor), with mushroom-like protrusion from the yin, surrounding swelling and pain, caused by Liver Depression and Spleen Deficiency with sinking (first use Buzhong Tang added with Shanzhi, Fuling, Cheqianzi, Qingpi to clear Liver Fire and raise Spleen Qi. Then use Guipi Tang added with Shanzhi, Fuling, Chuanxiong for regulation. Externally apply Lili Gao [Veratrum Ointment]). Or a strand protrudes from the yin, about one chi long, with painful dragging and difficult urination. (*Shen Shi Zunsheng Shu*)
Selected Case
A woman experienced lower back and abdominal pain before every menstruation, with worms emerging from the Yumen (vaginal opening), resembling seeds of Arctium lappa, green in color, dozens in number, followed immediately by menstruation. Her husband asked for the cause. I said: Jueyin Wind-Wood generates worms. The woman's Sea of Blood belongs to Jueyin. This is due to excess Wind-Wood combined with Spleen-Stomach Damp-Heat. Just as various worms are born during the damp-heat season when Wood is abundant in spring and summer. She was instructed to take wine-boiled Huanglian [Coptidis Rhizoma] as the sovereign herb, Baizhu [Atractylodis Macrocephalae Rhizoma], Xiangfu [Cyperi Rhizoma] as ministers, ground into powder, made into pills with congee, and swallowed on an empty stomach. After more than a month, her menses arrived without worms, and she conceived. (Wang Shishan)
Breast Diseases
Ru Yong (Mastitis) presents with breast swelling and pain. After several days, redness, swelling, and ulceration occur with thick pus flowing out. This is caused by Heat-Toxin in the Gallbladder and Stomach, with Qi and Blood stagnation; it is relatively easy to treat. Ru Yan (Breast Cancer) begins with a small nodule inside, like a chess piece, not red or painful. Over time, it grows larger, eventually ulcerating like a ripe pomegranate, with deep internal cavities and dripping blood and fluid, resembling rock, hence called Ru Yan. This is caused by Spleen-Lung depression and constriction, Qi deficiency, and Blood damage; it is very difficult to treat. For early-stage Ru Yong, take Gualou San [Trichosanthes Powder], apply Xiangfu Bing [Cyperi Cake]; it will resolve. If pus has formed, apply Shenxian Taiyi Gao [Immortal Great One Plaster]; it will heal naturally when pus is exhausted. For early-stage Ru Yan, alternate between Jia Wei Xiaoyao San and Jia Wei Guipi Tang; internal resolution is possible. Once the disease is established, even with the skills of Lu Yi and Bian Que, little can be done. Taking the former formulas to tonify and nourish Qi and Blood can prolong life; recklessly using Qi-moving and Blood-breaking herbs accelerates danger. There is also Ru Xie (Breast Prolapse), where the nipple drags down one or two chi long. This is caused by the venting of Wind-Heat in the Liver Meridian. Use Xiao Chaihu Tang added with Fangfeng, Qianghuo. Externally, smoke with Qianghuo, Fangfeng, Bailian [Radix Angelicae Pubescentis]. Also, grind 49 Sesame Seeds [Ricini Semen] and 1 fen Muxiang [Moschus] and apply to the top of the head; wash off after the breast retracts. This syndrome is commonly obtained by women who suffer from intense anger. (Xue Lizhai)
Ru [Missing Character] occurs in girls aged thirteen or fourteen, when menstruation is about to begin, or occurs twice a month, or is delayed, causing this disease. It mostly affects those who are thin and weak. Usually, only one nodule appears on the breast, which might be treatable; if three or four nodules form in a chain, it becomes difficult to cure. Generally use Xiaoyao Tiaojing Tang. (*Shen Shi Zunsheng Shu*)
Du Ru (Jealous Breast) occurs because there is no infant to suckle, or the infant cannot suckle, causing residual milk to accumulate and swell; or because a woman's Qi and Blood are vigorous, causing breast swelling, leading to pain, aversion to cold, and fever. If not sucked and drained, it will inevitably become an abscess. If the swelling does not subside, use 2-3 liang of Maiya [Hordei Fructus Germinatus], stir-fried hot and decocted for drinking; it resolves immediately. (*Jingyue Quanshu*)
Chui Ru (Blown Breast) occurs because the mother falls asleep and is blown upon by the infant's breath, causing milk stasis, accumulation internally, resulting in swelling, hardness, and pain. There are also cases that are not itchy or painful, but swollen and hard as stone. If not treated urgently, severe pain leads to suppuration. Suitable to take Gualou San, apply Nanxing San [Arisaematis Rhizoma Powder], and massage with hands to disperse. (*Nuke Daquan*)
Selected Case
A postpartum woman had breasts hanging down past her abdomen, unbearable pain, named Ru Xuan (Breast Suspension). Use Xiong [Chuanxiong Rhizoma], Gui [Danggui Radix] each one jin. Half decocted in water for oral administration, half crushed and smoked for inhalation by the patient. If not cured, prepare another dose. (*Tongshou Lu*)