东垣治一人。前阴臊臭。又因连日饮酒。腹中不和。求治。曰。夫前阴者。足厥阴肝之
脉络循阴器出其挺末。凡臭者。心之所主。散入五方为五臭。入肝为臊。当于肝经泻行间。
是治其本。后于心经泻少冲。乃治其标。如恶针。当用药除之。酒者气味俱阳。能生里之湿
热。是风燥热合于下焦为邪。经云。下焦如渎。又云。在下者引而竭之。酒是湿热之物。亦
宜决前阴以去之。治以龙胆泻肝汤。又治阴邪热痒。柴胡梢二钱。泽泻二钱。车前子二钱。
木通五分。生地黄、当归梢、草龙胆各三分。作一服水煎。以美膳压之。
震按龙胆泻肝汤治前阴病之由于湿热者。今人亦因此案而知之。然此案分量之轻重。与
此病则为恰合。非不可移易之数。又当随病情损益为妥。
丹溪治一人。年少玉茎挺长。肿而痿。皮塌常润。磨股不能行。二胁气上冲。先以小柴
胡加黄连。大剂行其湿热。次又加黄柏。降其逆上之气。挺肿渐收及半。但茎中有一坚块未
消。遂以青皮为君。佐以散风之剂。为末服之。外以丝瓜汁调五倍子末敷之而愈。
一人色苍黑。年五十余。素善饮。忽玉茎坚挺。莫能沾裳。不可屈腰作揖。常以竹篦为
弯弓状。拦于玉茎之前。但小溲后即欲饮酒。否则气不相接。盖湿热流入厥阴经而然也。专
治厥阴湿热而愈。
震按此亦龙胆泻肝汤证。上案之用小柴胡加黄连者。以两胁气上冲也。下案不认作肝火
湿热。洵是高手。于此见辨病宜详细。不容少涉模糊。
一妇产后。因子死。经断不行者半年。一日少腹忽痛。阴户内有物如石硬塞之而痛不
禁。众医不识。青林曰。此石瘕病也。用四物加桃仁、大黄、三棱、槟榔、元胡索、附子、
泽泻、血竭为汤。二剂而愈。
薛立斋治一妇人。胸膈不利。内热作渴。饮食不甘。肢体倦怠。阴中闷痒。小便赤涩。
此郁怒所致。用归脾加山栀、芎、归、芍药而愈。但内热晡热。用逍遥散加山栀。亦愈。后因
劳役发热。患处胀肿。小便仍涩。用补中益气加山栀、茯苓、丹皮而愈。
一妇人阴中突出如菌。四围肿痛。小便频数。内热晡热。似痒似痛。此肝脾郁结之病。
盖肝火湿热而肿痛。脾虚下陷而重坠也。先以补中益气加山栀、茯苓、车前、青皮。以清肝
火。升脾气。渐愈。更以归脾汤加山栀、茯苓、川芎调理。更以生猪脂和藜芦末涂之。而收
一妇人阴中挺出一条。五寸许。闷痛重坠。水出淋涩。小便涩滞。夕与龙胆泻肝汤分利
湿热。朝与补中益气汤升补脾气。诸证渐愈。再与归脾加山栀、茯苓、川芎、黄柏间服。调
理而愈。后因劳役。或怒气。下部湿痒。小水不利。仍用前药而愈。亦有尺许者。亦有生诸
虫物者。用此法治之。
一妇人阴内痛痒。内热倦怠。饮食少思。用参、 、归、术、陈皮、柴胡、炒栀、车前
升麻、芍药、丹皮、茯苓。治之而愈。若阴中有虫痒痛。亦属肝木。以桃仁研和雄黄末。
纳阴中以杀之。仍用清肝解郁。或以鸡肝纳之。取虫之法也。
立斋又曰。余奉侍武庙汤药。劳役过甚。饮食失节。复兼怒气。次年春。茎中作痒。时
出白津。时或痛甚。急以手紧捻乃止。此肝脾之气虚也。服地黄丸及补中益气加黄柏、柴胡
山栀、茯苓、木通而愈。丁酉九月。又因劳役。小便淋沥。茎痒窍痛。仍服前汤加木通、
茯苓、胆草、泽泻及地黄丸而愈。
一男子茎中痛。出白津。小便秘。时作痒。用小柴胡加山栀、泽泻、炒连、木通、胆草
茯苓。二剂顿愈。又兼六味地黄丸而瘥。
震按立斋诸案。治法详备。可补东垣丹溪之未逮。且以补药解郁平肝。又开一局。盖院
使擅长于补。其用参、 、归、术。如布射僚丸。百发百中也。末案纯用清理。又知其非一
味蛮补者。
〔附〕一男子阴肿大如升。核痛。医莫能治。捣马鞭草涂之而愈。
一人茎头肿大如升。光如水泡。以二陈加升麻、青黛、牡蛎。二剂而愈。
一人玉茎硬不痿。精流不歇。时如针刺。捏之则胀。乃为肾满漏疾。用韭子、破故纸各
一两为末。每三钱。日三服。即止。
一人在山亭裸体而卧。其阴茎被飞丝缠绕。阴头肿欲断。以威灵仙汁入水浸洗而愈。
李东垣治疗一个人。前阴部位散发臊臭味。又因为连续几天饮酒，导致腹部不适，前来求治。李东垣说：前阴部位，是足厥阴肝经的脉络循行经过之处，其经脉出于生殖器末端。凡是气味，由心所主宰，散布到五个方位形成五种气味，进入肝脏则表现为臊味。应当在肝经上泻行间穴，这是治本的方法。随后在心经上泻少冲穴，这是治标的方法。如果患者厌恶针刺，应当用药来治疗。酒的气味和性质都属于阳，能够产生体内的湿热。这是风、燥、热三种邪气结合在下焦形成的病邪。医经说：“下焦如同沟渠。”又说：“病位在下方的，应当用通利的方法使其排尽。”酒是湿热之物，也适宜通过从前阴排泄的方法来去除它。治疗方法使用龙胆泻肝汤。另外治疗阴部因邪热引起的瘙痒，处方为：柴胡梢二钱，泽泻二钱，车前子二钱，木通五分，生地黄、当归梢、草龙胆各三分。作为一剂，用水煎煮。服药后用美味的食物压住药力（以防苦寒伤胃）。
俞震按语：龙胆泻肝汤治疗由于湿热引起的前阴疾病。现在的人也是通过这个医案才知道这个方子的。然而这个案例中药物剂量的轻重，与此病恰好吻合，并不是不可更改的固定数字。还应当根据病情的变化适当增减剂量才妥当。
朱丹溪治疗一个人。年轻男子阴茎挺长，肿胀且痿软，皮肤松弛湿润，摩擦大腿无法行走，两侧胁肋部有气向上冲逆。先用小柴胡汤加入黄连，大剂量运行清除湿热。接着又加入黄柏，以降逆上冲之气。阴茎肿胀逐渐消退了一半，但茎中仍有一块坚硬的肿块未消除。于是以青皮为主药，辅以疏散风邪的药物，研成粉末服用。外用丝瓜汁调和五倍子末敷贴患处而痊愈。
另有一人面色苍黑，五十多岁，平时喜欢喝酒。忽然阴茎坚硬挺立，不能沾湿衣物，腰部不能弯曲作揖。常常把竹篦弯成弓的形状，挡在阴茎前面。只是在小便后就想喝酒，否则感觉气息不相接续。这是由于湿热流入厥阴经所致。专门治疗厥阴经湿热而痊愈。
俞震按语：这也是龙胆泻肝汤的适应证。上一个案例使用小柴胡汤加黄连，是因为有两侧胁肋气上冲的症状。下一个案例不将其认定为肝火湿热，确实是高明的医生。从这里可以看出辨证疾病应当详细，不容许丝毫模糊。
一位妇女产后，因为孩子死亡，月经停止半年没有来潮。一天突然少腹疼痛，阴道内有物体像石头一样坚硬堵塞，疼痛难以忍受。众位医生不认识这是什么病。青林医生说：这是石瘕病。使用四物汤加入桃仁、大黄、三棱、槟榔、元胡索、附子、泽泻、血竭煎汤。服用两剂后痊愈。
薛立斋治疗一位妇人。胸膈部不利，内部发热口渴，饮食无味，肢体倦怠，阴中闷痒，小便赤涩。这是由郁怒所致。使用归脾汤加入山栀、川芎、当归、芍药而痊愈。后来出现内热及傍晚发热，使用逍遥散加入山栀，也痊愈了。之后因为劳累过度发热，患处肿胀，小便仍然涩滞，使用补中益气汤加入山栀、茯苓、丹皮而痊愈。
另一位妇人阴道内突出如菌状，四周肿痛，小便频数，内热及傍晚发热，似痒似痛。这是肝脾郁结的疾病。说是肝火湿热导致肿痛，脾虚下陷导致重坠感。先用补中益气汤加入山栀、茯苓、车前子、青皮，以清肝火，升脾气，逐渐好转。再用归脾汤加入山栀、茯苓、川芎调理。再用生猪脂调和藜芦末涂抹患处，而收效。
还有一位妇人阴道内挺出一条长约五寸左右的组织，闷痛重坠，流出水样液体，淋沥涩滞，小便不畅。晚上服用龙胆泻肝汤分利湿热，早上服用补中益气汤升补脾气，各种症状逐渐好转。再让服用归脾汤加入山栀、茯苓、川芎、黄柏交替服用，调理而痊愈。之后因为劳累，或者发怒，下部出现湿痒，小便不利，仍然使用前面的药物而痊愈。也有长达一尺的，也有生出各种虫物的，用这种方法治疗。
一位妇人阴内疼痛瘙痒，内热倦怠，饮食减少思食。用人参、白术、当归、白术、陈皮、柴胡、炒山栀、车前子、升麻、芍药、丹皮、茯苓治疗而痊愈。如果阴中有虫导致痒痛，也属于肝木问题，将桃仁研磨混合雄黄末，纳入阴中以杀死虫子。仍然使用清肝解郁的方法，或者将鸡肝纳入阴中，这是取虫的方法。
薛立斋又说：我侍奉武庙皇帝进献汤药，劳累过度，饮食失节，再加上怒气。第二年春天，阴茎中瘙痒，时常流出白色津液，有时疼痛剧烈，急忙用手紧紧捏住才停止。这是肝脾之气虚弱。服用地黄丸以及补中益气汤加入黄柏、柴胡、山栀、茯苓、木通而痊愈。丁酉年九月，又因为劳累，小便淋沥，阴茎瘙痒窍道疼痛，仍然服用前面的汤药加入木通、茯苓、胆草、泽泻以及地黄丸而痊愈。
一名男子阴茎中疼痛，流出白色津液，小便闭塞不通，时常瘙痒。用小柴胡汤加入山栀、泽泻、炒黄连、木通、胆草、茯苓。服用两剂立刻痊愈。又兼服六味地黄丸而康复。
俞震按语：薛立斋的这些医案，治疗方法详尽完备，可以弥补李东垣和朱丹溪医案的不足。而且用补药来解郁平肝，又开创了一种新的局面。大概是因为他擅长于补法，他使用人参、白术、当归、白术，就像吕布射箭、由基射箭一样，百发百中。最后的医案纯用清理之法，又知道他不是那种一味蛮补的人。
〔附〕一名男子阴囊肿大如升，睾丸疼痛，医生们都不能治愈。捣碎马鞭草外涂而痊愈。
一人阴茎头肿大如升，光亮如水泡，使用二陈汤加入升麻、青黛、牡蛎。服用两剂而痊愈。
一人阴茎坚硬不痿，精液流出不止，时常像针刺一样疼痛，捏之则胀痛，这是肾满漏疾。使用韭菜子、破故纸各一两研成粉末。每次三钱，每天三次服用，立即停止。
Li Dongyuan treated a patient. The external genitalia emitted a fishy odor. Additionally, due to consecutive days of drinking alcohol, the abdomen felt uncomfortable, prompting him to seek treatment. Li Dongyuan stated: "The external genitalia are traversed by the Foot Jueyin Liver Meridian, which emerges at the tip of the penis. All odors are governed by the Heart; when dispersed into the five directions, they form five distinct odors. When entering the Liver, it manifests as a fishy odor. One should drain Xingjian (LR2) on the Liver Meridian to treat the root cause. Subsequently, one should drain Shaochong (HT9) on the Heart Meridian to treat the branch manifestation. If the patient dislikes acupuncture, medication should be used instead. Alcohol possesses both flavor and nature that are Yang; it can generate damp-heat within the interior. This represents wind, dryness, and heat pathogens combining in the Lower Jiao. The Classics state: 'The Lower Jiao is like a drainage ditch.' It also states: 'For pathologies located below, employ methods to drain them completely.' Since alcohol is a damp-heat substance, it is appropriate to eliminate it through excretion from the anterior yin. The treatment employed was Longdan Xiegan Tang (Gentian Liver-Draining Decoction). Furthermore, for treating itching caused by evil heat in the yin region, the prescription consisted of: Chaihu Shao (Bupleurum Tip) 2 qian, Zexie (Alisma Rhizome) 2 qian, Cheqianzi (Plantago Seed) 2 qian, Mutong (Akebia Caulis) 0.5 fen, Sheng Dihuang (Rehmanniae Radix Recens) 3 fen, Danggui Shao (Angelicae Sinensis Radix Tip) 3 fen, and Caolongdan (Gentianae Scabrae Radix) 3 fen. Prepared as one dose, decocted in water. After ingestion, consume a nutritious meal to moderate the harsh cold nature of the herbs."
Yu Zhen commented: "Longdan Xiegan Tang treats anterior yin diseases caused by damp-heat. People nowadays learned of this formula largely through this case record. However, the dosage weights in this case were precisely matched to the disease and were not immutable numbers. Dosages should be adjusted appropriately according to changes in the condition."
Zhu Danxi treated a young man whose penis was erect, swollen, and flaccid, with loose, moist skin, making walking difficult due to friction against the thighs. There was a sensation of Qi rushing upward in both hypochondriac regions. Initially, Xiao Chaihu Tang (Minor Bupleurum Decoction) was administered with added Huanglian (Coptidis Rhizoma) in large doses to circulate and clear damp-heat. Subsequently, Huangbai (Phellodendri Cortex) was added to descend the rebellious Qi. The penile swelling gradually subsided by half, but a hard mass remained inside the shaft. Therefore, Qingpi (Citri Reticulatae Pericarpium Viride) was used as the sovereign herb, assisted by wind-dispersing agents, ground into powder for oral administration. Externally, Luggua juice (Luffa Fruit Juice) was mixed with Wubeizi powder (Galla Chinensis Powder) and applied to the area, resulting in a cure.
Another patient, with dark complexion and over fifty years old, who habitually drank alcohol, suddenly experienced an erection that prevented clothing from touching the penis, and he could not bend his waist to bow. He often held a bamboo strip bent like a bow in front of his penis. He desired to drink alcohol immediately after urination; otherwise, he felt a disconnect in his Qi. This was caused by damp-heat flowing into the Jueyin Meridian. Specialized treatment for Jueyin damp-heat resulted in recovery.
Yu Zhen commented: "This is also a syndrome suitable for Longdan Xiegan Tang. The previous case used Xiao Chaihu Tang plus Huanglian because of the Qi rushing upward in the hypochondrium. The latter case did not identify it as Liver Fire damp-heat, demonstrating true expertise. This illustrates that disease differentiation must be detailed, allowing no ambiguity."
A postpartum woman, whose child had died, had ceased menstruating for half a year. One day, she suddenly suffered lower abdominal pain, with a stone-hard object blocking the vagina causing unbearable pain. Many physicians did not recognize the condition. Qing Lin said: "This is Shi Xia (Stone Mass). Use Siwu Tang (Four Substances Decoction) added with Taoren (Persicae Semen), Dahuang (Rhei Radix et Rhizoma), Sanleng (Sparganii Rhizoma), Binglang (Arecae Semen), Yuanhusuo (Corydalis Rhizoma), Fuzi (Aconiti Lateralis Radix Praeparata), Zexie (Alismatis Rhizoma), and Xuexie (Draconis Sanguis). Decoct as a soup. Two doses resulted in a cure."
Xue Lizhai treated a woman with chest and diaphragm discomfort, internal heat with thirst, lack of taste in food, limb fatigue, vaginal stuffiness and itching, and red, scanty, painful urination. This was caused by depression and anger. Guipi Tang (Restore the Spleen Decoction) added with Zhizi (Gardeniae Fructus), Xiong (Ligustici Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix), and Shaoyao (Paeoniae Radix) cured her. Later, when internal heat and afternoon fever occurred, Xiaoyao San (Free and Easy Wanderer Powder) added with Zhizi (Gardeniae Fructus) also cured her. Subsequently, due to labor-induced fever, swelling occurred at the affected site with continued urinary difficulty. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Zhizi (Gardeniae Fructus), Fuling (Poria), and Mudanpi (Moutan Cortex) cured her.
Another woman had tissue protruding from the vagina like a mushroom, with surrounding swelling and pain, frequent urination, internal heat, afternoon fever, and sensations of itching and pain. This was a disease of Liver-Spleen stagnation. It was attributed to Liver Fire damp-heat causing swelling and pain, and Spleen deficiency sinking causing heaviness. Initially, Buzhong Yiqi Tang added with Zhizi (Gardeniae Fructus), Fuling (Poria), Cheqianzi (Plantaginis Semen), and Qingpi (Citri Reticulatae Pericarpium Viride) was used to clear Liver Fire and raise Spleen Qi, leading to gradual improvement. Then, Guipi Tang added with Zhizi (Gardeniae Fructus), Fuling (Poria), and Chuanxiong (Ligustici Chuanxiong Rhizoma) was used for regulation. Finally, fresh pig fat mixed with Lilu powder (Veratrum Nigrum Powder) was applied topically, achieving a cure.
Another woman had a projection of about five cun extending from the vagina, accompanied by stifling pain, heaviness, discharge of fluid, dysuria, and urinary retention. In the evening, Longdan Xiegan Tang (Gentian Liver-Draining Decoction) was taken to separate and drain damp-heat; in the morning, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was taken to raise and tonify Spleen Qi. Various symptoms gradually improved. Subsequently, Guipi Tang added with Zhizi (Gardeniae Fructus), Fuling (Poria), Chuanxiong (Ligustici Chuanxiong Rhizoma), and Huangbai (Phellodendri Cortex) was taken alternately for regulation, resulting in a cure. Later, due to labor or anger, damp itching in the lower part and difficult urination recurred; the previous medications were used again, resulting in recovery. Cases with projections up to one chi long, or even growths of various parasites, were treated with this method.
A woman suffered from internal vaginal pain and itching, internal heat, fatigue, and poor appetite. She was treated with Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Chenpi (Citri Reticulatae Pericarpium), Chaihu (Bupleuri Radix), Chao Zhizi (Fried Gardeniae Fructus), Cheqianzi (Plantaginis Semen), Shengma ( Cimicifugae Rhizoma), Shaoyao (Paeoniae Radix), Mudanpi (Moutan Cortex), and Fuling (Poria), resulting in a cure. If there were parasites in the vagina causing itching and pain, this also belongs to Liver Wood pathology. Tao Ren (Persicae Semen) was ground and mixed with Xionghuang (Realgar) powder, inserted into the vagina to kill the parasites. Clearing Liver Fire and resolving stagnation was still employed, or chicken liver was inserted into the vagina, which is a method for extracting parasites.
Xue Lizhai further stated: "While attending to the Emperor Wu's medicinal needs, I suffered from excessive labor, irregular diet, and compounded anger. In the spring of the following year, my penis itched, occasionally discharging white fluid, and sometimes suffering severe pain, which stopped only when tightly pinched by hand. This indicated deficiency of Liver and Spleen Qi. I took Dihuang Wan (Rehmannia Pill) and Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Huangbai (Phellodendri Cortex), Chaihu (Bupleuri Radix), Zhizi (Gardeniae Fructus), Fuling (Poria), and Mutong (Akebiae Caulis), resulting in recovery. In September of the Dingyou year, due to labor, I experienced dribbling urine, penile itching, and orifice pain. I again took the previous decoction added with Mutong (Akebiae Caulis), Fuling (Poria), Danshen (Scutellariae Radix - *Note: Text says Dancao/Chanshao likely referring to Longdan/Gentiana*), Zexie (Alismatis Rhizoma), and Dihuang Wan (Rehmannia Pill), resulting in recovery."
A male patient suffered from penile pain, discharge of white fluid, urinary retention, and occasional itching. Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Zhizi (Gardeniae Fructus), Zexie (Alismatis Rhizoma), Chao Lian (Fried Coptidis Rhizoma), Mutong (Akebiae Caulis), Danshen (Scutellariae Radix - *Note: Text says Danshen/Chanshao likely referring to Longdan/Gentiana*), and Fuling (Poria) was used. Two doses led to immediate recovery. Sixwei Dihuang Wan (Six-Ingredient Rehmannia Pill) was also taken concurrently, leading to convalescence.
Yu Zhen commented: "Xue Lizhai's cases are detailed and comprehensive, supplementing the deficiencies of Li Dongyuan and Zhu Danxi. Moreover, using tonics to resolve stagnation and calm the Liver opens a new approach. Generally, he excelled in tonification; his use of Renshen (Ginseng Radix), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui (Angelicae Sinensis Radix), and Baizhu (Atractylodis Macrocephalae Rhizoma) was as accurate as Lu Bu shooting arrows or Yi shooting birds, hitting the target every time. The final case relied purely on clearing and regulating, showing he was not someone who blindly used tonics."
[Appendix] A male patient had scrotal swelling as large as a sheng (unit of volume), with testicular pain, untreatable by other doctors. Crushed Mabiancao (Verbena officinalis) was applied topically, resulting in a cure.
One patient had a glans penis swollen as large as a sheng, shiny like a blister. Erchen Tang (Two-Cured Decoction) added with Shengma (Cimicifugae Rhizoma), Qingdai (Indigo Naturalis), and Muli (Ostrea Concha) was used. Two doses resulted in a cure.
One patient had a rigid, non-flaccid penis with continuous seminal flow, occasional needle-like pain, and distension upon pressure. This was identified as Shen Man Lou Ji (Kidney Fullness and Leakage Disease). Jiu Zi (Allii Tuberosi Semen) and Po Gu Zhi (Psoraleae Fructus), each 1 liang, were ground into powder. Three qian were taken three times daily, stopping the symptoms immediately.
One person lay naked in a mountain pavilion. His penis was entangled by flying silk, causing the glans to swell nearly to the point of rupture. Weilingxian juice (Clematidis Radix et Rhizoma Juice) diluted in water was used for soaking and washing, resulting in a cure.