北方黑色入通于肾,开窍于二阴,厥阴之脉下循阴器,是前阴之部,乃厥阴肝脉所主,少阴肾气所贯也。故肾
虚湿热乘注则玉门漫肿名曰阴肿。肝郁湿热相搏则阴肿疼痛名曰阴痛,如燥火下乘但痛不肿亦曰阴痛。湿热生虫
则阴中作痒名曰阴痒。湿热伤血则阴内生疮名曰阴疮。元虚下脱则阴挺出名曰阴挺,或湿热下迫,或亏损肝脾亦皆
令人挺出。冷结胞门,元阳暗损则阴中常觉冰冷名曰阴冷。下元虚衰膀胱不约则遗尿名曰遗溺。热伤冲任,血渗膀
胱则尿血曰溺血。湿热乘脬风冷外遏则阴中留结如菌如茄名曰阴痔。胃实脬虚则阴气下泄气迫声喧名曰阴吹。肾
虚肝火凌脾,不能统摄津血而交接出血名曰阴蚀。
风浮热数湿细紧寒,若轻经气滞郁脉必弦涩,瘀脉涩大,洪涩火灼。
调营化气佐以理湿扶元,郁则疏之,瘀则行之,热则清之,冷则温之,虚甚者补而调之,下陷者举而升之,
随证治法则审方酌治。
阴肿四苓汤加青、陈、柴胡稍,阴痛龙胆泻肝汤加知、柏、败龟板,阴痒逍遥散加龟板、栀子、生蛤粉,阴
疮二妙散加萆 、知母、败龟板,阴挺补中益气汤加龙骨牡蛎粉,阴冷八味丸加小茴、巴戟肉,遗溺八味丸去泽
泻加益智、覆盆子,溺血黑逍遥散换生地加地榆炭、荆芥灰,阴痔内服逍遥散,外以铜绿散绢裹纳阴中,阴吹先
服猪肤发煎后以归芍地黄汤调理,阴蚀朝以归芍地黄汤,暮以补阴益气煎,日久兼程,庶可奏绩。
北方对应的颜色是黑色,其气机内通于肾脏,外开窍于前后二阴。足厥阴肝经的经脉向下沿着生殖器部位运行,因此前阴这一区域,是由足厥阴肝脉所主管,并由足少阴肾气所贯通。所以,如果肾虚导致湿热之邪乘虚侵袭注滞,就会引起玉门(女性外阴)弥漫性肿胀,这种情况被称为“阴肿”。如果是肝气郁结,与湿热相互搏结,就会导致阴部肿胀疼痛,这种情况被称为“阴痛”;如果是燥火下行侵袭,仅表现为疼痛而没有肿胀,也称之为“阴痛”。如果湿热滋生虫邪,就会引起阴道内部瘙痒,这种情况被称为“阴痒”。如果湿热损伤血络,就会在阴部内部生疮,这种情况被称为“阴疮”。如果元气虚弱导致脏器下垂脱出,就会引起阴部组织突出体外,这种情况被称为“阴挺”;这可能是因为湿热下迫,或者因为肝脾亏损所致,都会导致阴挺。如果寒邪凝结于胞门(子宫口),元阳暗中受损,就会感到阴中经常冰冷,这种情况被称为“阴冷”。如果下元虚衰,膀胱约束无力,就会出现遗尿,这种情况被称为“遗溺”。如果热邪损伤冲任二脉,血液渗入膀胱,就会出现尿血,这种情况被称为“溺血”。如果湿热侵袭膀胱,同时受到风冷外邪遏制,导致阴中有结块滞留,形状像菌类或茄子,这种情况被称为“阴痔”。如果胃气实而膀胱虚,阴气下泄,气体压迫发出声响,这种情况被称为“阴吹”。如果肾虚且肝火凌犯脾土,导致不能统摄津液和血液,就会在性交时出血,这种情况被称为“阴蚀”。
脉象方面:浮脉主风,数脉主热,细脉主湿,紧脉主寒。如果病情轻微且伴有经气滞郁,脉象必定呈现弦涩之象;瘀血阻滞的脉象表现为涩而大;洪大兼涩则提示火热灼盛。
治疗原则:调理营卫、化生气机,并辅以祛湿扶正的方法。对于气郁者,采用疏解的方法;对于瘀血者,采用行散的方法;对于热证者,采用清泻的方法;对于寒证者,采用温补的方法;对于虚损严重者,采用补益并调和的方法;对于气陷下坠者,采用升提举陷的方法。根据具体证候制定法则,审慎选择方药进行治疗。
针对各种病症的具体方药如下:
阴肿:使用四苓汤,加入青皮、陈皮、少量柴胡。
阴痛:使用龙胆泻肝汤,加入知母、黄柏、败龟板。
阴痒:使用逍遥散,加入龟板、栀子、生蛤粉。
阴疮:使用二妙散,加入萆薢、知母、败龟板。
阴挺:使用补中益气汤,加入龙骨、牡蛎粉。
阴冷:使用八味丸(金匮肾气丸),加入小茴香、巴戟天肉。
遗溺:使用八味丸,去掉泽泻,加入益智仁、覆盆子。
溺血:使用黑逍遥散,将原方中的白芍替换为生地黄,加入地榆炭、荆芥灰。
阴痔:内服逍遥散,外用铜绿散包裹在绢布中纳入阴中。
阴吹:先服用猪肤发煎,随后用归芍地黄汤进行调理。
阴蚀:早晨服用归芍地黄汤,晚上服用补阴益气煎,长期坚持治疗,才能取得疗效。
The color corresponding to the North is black; its qi connects internally with the Kidney (Shen, 肾) and opens externally through the two orifices (er yin, 二阴). The meridian of Jueyin (Jueyin Zhi Mai, 厥阴之脉) descends along the genitalia; thus, this region of the anterior orifice is governed by the Liver meridian of Jueyin (Jueyin Gan Mai, 厥阴肝脉) and penetrated by the Qi of the Kidney meridian of Shaoyin (Shaoyin Shen Qi, 少阴肾气). Therefore, if Kidney deficiency allows damp-heat to invade and stagnate, it causes diffuse swelling of the Yu Men (Yumen, 玉门, female external genitalia), termed "Yin Zhong" (Yin Swelling, 阴肿). If Liver Qi stagnation combines with damp-heat, it causes painful swelling of the genitals, termed "Yin Tong" (Yin Pain, 阴痛); if dry-fire descends to attack, causing pain without swelling, it is also called "Yin Tong". If damp-heat generates parasites, it causes itching within the vagina, termed "Yin Yang" (Yin Itching, 阴痒). If damp-heat damages the blood collaterals, sores form inside the genitals, termed "Yin Chuang" (Yin Sore, 阴疮). If primordial deficiency leads to prolapse, tissues protrude from the vagina, termed "Yin Ting" (Yin Prolapse, 阴挺); this may result from damp-heat pressing downward or from Liver and Spleen deficiency. If cold coagulates at the Bao Men (Bao Men, 胞门, uterine opening) and primordial Yang is secretly damaged, the vagina feels constantly cold, termed "Yin Leng" (Yin Cold, 阴冷). If the lower primordial deficiency fails to constrain the Bladder, enuresis occurs, termed "Yi Ni" (Enuresis, 遗溺). If heat damages the Chong and Ren vessels, blood渗 into the Bladder, resulting in hematuria, termed "Ni Xue" (Hematuria, 溺血). If damp-heat attacks the Paofang (Paofang, 脬, bladder) while wind-cold obstructs externally, nodules resembling mushrooms or eggplants remain in the vagina, termed "Yin Zhi" (Yin Hemorrhoid, 阴痔). If Stomach excess and Bladder deficiency cause Yin Qi to leak downward, forcing gas to make noise, it is termed "Yin Chui" (Yin Blowing, 阴吹). If Kidney deficiency and Liver Fire oppress the Spleen, failing to control fluids and blood, bleeding occurs during intercourse, termed "Yin Shi" (Yin Erosion/Ulceration, 阴蚀).
Regarding pulse diagnosis: Floating pulses indicate Wind, rapid pulses indicate Heat, fine pulses indicate Dampness, and tight pulses indicate Cold. If the condition is mild with Qi stagnation in the meridians, the pulse will likely be Wiry and Choppy (Xian Se, 弦涩). A stasis pulse is Choppy and Large; a Rapid and Choppy pulse indicates scorching Fire.
Treatment principles involve regulating Ying (Nutritive Qi) and transforming Qi, assisted by resolving Dampness and supporting Yuan (Primordial Qi). For stagnation, use dispersing methods; for stasis, use promoting circulation methods; for Heat, use clearing methods; for Cold, use warming methods; for severe deficiency, use tonifying and harmonizing methods; for sinking/collapsing conditions, use lifting and raising methods. Treat according to the syndrome differentiation, carefully selecting formulas.
Specific prescriptions:
For Yin Zhong (Yin Swelling): Si Ling Tang (Four-Poria Decoction) added with Qing Pi (Green Tangerine Peel), Chen Pi (Aged Tangerine Peel), and a small amount of Chai Hu (Bupleurum Root).
For Yin Tong (Yin Pain): Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction) added with Zhi Mu (Anemarrhena Rhizome), Huang Bo (Phellodendron Bark), and Bai Gui Ban (Tortoise Plastron, prepared).
For Yin Yang (Yin Itching): Xiao Yao San (Free and Easy Wanderer Powder) added with Gui Ban (Tortoise Plastron), Zhi Zi (Gardenia Fruit), and Sheng Ha Fen (Raw Concha Meretricis).
For Yin Chuang (Yin Sore): Er Miao San (Two Marvels Powder) added with Bi Xie (Dioscorea Hypoglauca Rhizome), Zhi Mu (Anemarrhena Rhizome), and Bai Gui Ban (Tortoise Plastron, prepared).
For Yin Ting (Yin Prolapse): Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) added with Long Gu (Fossilized Mammoth Tooth/Bone) and Mu Li (Oyster Shell) powder.
For Yin Leng (Yin Cold): Ba Wei Wan (Eight-Ingredient Pill) added with Xiao Hui Xiang (Fennel Fruit) and Ba Ji Tian (Morinda Officinalis Root).
For Yi Ni (Enuresis): Ba Wei Wan (Eight-Ingredient Pill) with Ze Xie (Alisma Rhizome) removed, added with Yi Zhi Ren (Alpinia Oxyphylla Fruit) and Fu Pen Zi (Rubus Fruit).
For Ni Xue (Hematuria): Hei Xiao Yao San (Black Free and Easy Wanderer Powder) with Bai Shao (White Peony Root) replaced by Sheng Di Huang (Rehmannia Root), added with Di Yu Tan (Charred Sanguisorba Root) and Jing Jie Hui (Charred Schizonepeta Spike).
For Yin Zhi (Yin Hemorrhoid): Internal administration of Xiao Yao San (Free and Easy Wanderer Powder); external application of Tong Lv San (Copper Green Powder) wrapped in silk and inserted into the vagina.
For Yin Chui (Yin Blowing): First administer Zhu Fu Fa Jian (Pig Skin and Hair Decoction), then regulate with Gui Shao Di Huang Tang (Angelica and Rehmannia Rehmannia Root Decoction).
For Yin Shi (Yin Erosion): Administer Gui Shao Di Huang Tang (Angelica and Rehmannia Rehmannia Root Decoction) in the morning, and Bu Yin Yi Qi Jian (Tonify Yin and Augment Qi Decoction) in the evening. Persistent treatment over time is required to achieve results.