（交接出血、阴挺、阴痒、阴虫附）
妇人阴疮，乃七情郁火，伤损肝脾，湿热下注。其外症有阴中舒出如蛇，俗呼阴挺；有翻突
如饼，俗呼阴菌；亦有如鸡冠花，亦有生诸虫，亦有肿痛湿痒，溃烂出水，胀闷脱坠者。其
内症口干，内热，体倦，经候不调，饮食无味，晡热发热，胸膈不利，胁肋不调，小腹痞胀
，赤白带下，小水淋涩。其治法∶肿痛者，宜用四物加柴胡、山栀、丹皮、胆草；湿痒者，
宜用归脾加山栀、丹皮、柴胡；淋涩者，宜用龙胆泻肝加白术、丹皮；溃腐者，宜用加味逍
遥散；肿闷脱坠者，宜用补中益气加山栀、丹皮，佐以外治之法，备见治验。
治验
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
归脾加山栀而愈。后因怒，患处并小腹胀痛，用小柴胡加山栀、芎、归、芍药而愈。但内热
晡热，用逍遥散加山栀而愈。后因劳役发热，患处肿胀，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，小腹重坠，此肝脾郁结
之症，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，涂之而收入。
一妇人阴中挺出一条五寸许，闷痛重坠，水出淋漓，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，诸症渐愈，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，仍用前药即愈。亦有尺许者，亦有生诸虫物者，皆
用此治。
一妇人腐溃，脓水淋漓，肿痛寒热，小便赤涩，内热作渴，肢体倦怠，胸胁不利，饮食少思
，三月余矣，用补中益气，内柴胡、升麻各用一钱，加茯苓一钱，炒山栀二钱，数剂少愈，
又与归脾加山栀、川芎、茯苓，三十余剂，诸症悉退。惟内热尚在，再与逍遥散倍用山栀而
一妇人素性急，阴中或痛，小便赤涩，怒则益甚，或发热，或寒热，治以芎、归、炒栀、柴
胡、苓、术、丹皮、泽泻、炒芍、炒车前、炒连、生草，数剂渐愈，乃去黄连、泽泻，又数
剂而痊愈。
一妇人素郁闷，阴内痛痒，不时出水，饮食少思，肢体倦怠，用归脾加丹皮、山栀、芍药、
柴胡、生草主之而安。
一妇人阴内痒痛，内热倦怠，饮食少思，用参、 、归、术、陈皮、柴胡、炒栀、炒车前、
升麻、芍药、丹皮、茯苓，治之而瘥。若阴中有虫痒痛，亦属肝木，以桃仁研膏，和雄黄末
纳阴中以杀之，仍用清肝解郁。有以鸡肝纳之者，乃取虫之法也。
一妇人交接违理，出血作痛，发热口干，误服寒凉之剂，前症益甚，不时欲呕，饮食少思，
此症属肝经，而药复伤脾也，先用六君子加柴胡，而脾胃渐愈，乃用加味逍遥散，而患处亦痊。
一妇人每交接，辄出血作痛，敷服皆凉血止痛之剂，不时出血甚多，此肝伤而不能藏血，脾
伤而不能摄血也，用补中益气、济生归脾二汤而愈。若交接出血，用熟艾热裹入阴中。若交
接违理而出血，用乱发青布烧为末敷之，血自止。若出血过多，而见他症，但用前药，调补
肝脾，诸症自愈矣。
一妇人阴肿下坠，闷痛出水，胸腹不利，小便频数，内热晡热，口苦耳鸣，先用小柴胡加车
前、胆草、苓、术、升麻，二剂稍缓，又用加味逍遥加升麻，数剂稍愈，乃以加味归脾加升
麻、柴胡，并补中益气加山栀，数剂渐愈，仍用加味逍遥、加味归脾二药，调理而瘥。
一妇人热痛，用寒凉败毒，饮食不入，时欲呕吐，小腹重坠，似欲去后，此脾胃亏损，元气
下陷，症属虚寒，先用补中益气加炮姜二剂，重坠若失，再用前汤加茯苓、半夏，二十余剂
而愈，乃以归脾少加柴胡、升麻、六味地黄丸，调理两月余而康。
妇女阴疮，是由于七情郁结化火，损伤肝脾，导致湿热下注所致。其外部症状表现为：阴道中突出如蛇状者，俗称“阴挺”；翻出如饼状者，俗称“阴菌”；也有像鸡冠花形状的；也有生出各种寄生虫的；也有出现肿痛、湿痒、溃烂流水、腹胀闷及脱坠感的。其内部症状表现为：口干、内热、身体疲倦、月经不调、饮食无味、午后发热、胸膈不畅、胁肋不适、小腹胀满、赤白带下、小便淋沥涩痛。治疗方法：对于肿痛者，适宜使用四物汤加入柴胡、山栀、丹皮、龙胆草；对于湿痒者，适宜使用归脾汤加入山栀、丹皮、柴胡；对于小便淋涩者，适宜使用龙胆泻肝汤加入白术、丹皮；对于溃烂腐坏者，适宜使用加味逍遥散；对于肿胀闷痛及脱坠者，适宜使用补中益气汤加入山栀、丹皮，并配合外治法，这些方法在临床验证中均有疗效。
治疗案例
一位妇人胸膈不畅，内热口渴，饮食不甘，肢体倦怠，阴道内闷痒，小便赤涩，这是由郁怒所致，使用归脾汤加入山栀而痊愈。后来因发怒，患处及小腹胀痛，使用小柴胡汤加入山栀、川芎、当归、芍药而痊愈。但仍有内热和午后发热，使用逍遥散加入山栀而痊愈。后来因劳累过度发热，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。
一位妇人阴道中突出如菌状，四周肿痛，小便频数，内热午后发热，似痒似痛，小腹重坠，这是肝脾郁结的症状，因为肝火湿热导致肿痛，脾虚下陷导致重坠。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、川芎进行调理，最后用生猪脂调和藜芦末，涂抹患处使其缩回。
一位妇人阴道中挺出一条约五寸长的肉状物，闷痛重坠，水液淋漓流出，小便涩滞，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，诸症逐渐好转，再服用归脾汤加入山栀、茯苓、川芎、黄柏，交替服用调理而痊愈。后来因劳累或怒气，下部湿痒，小便不利，仍用前面的药物即痊愈。也有长达一尺的，也有生出各种虫物的，都用此法治疗。
一位妇人阴部腐烂溃破，脓水淋漓，肿痛伴寒热，小便赤涩，内热口渴，肢体倦怠，胸胁不畅，饮食少思，病程已三月有余，使用补中益气汤，其中柴胡、升麻各用一钱，加入茯苓一钱，炒山栀二钱，数剂后稍有好转，又给予归脾汤加入山栀、川芎、茯苓，三十余剂后，诸症全部消退。惟独内热仍在，再给予逍遥散加倍使用山栀，[原文此处缺失谓语，意为]而痊愈。
一位妇人平素性情急躁，阴道时而疼痛，小便赤涩，发怒时加重，有时发热，有时寒热往来，治疗用川芎、当归、炒山栀、柴胡、茯苓、白术、丹皮、泽泻、炒芍药、炒车前子、炒黄连、生甘草，数剂后逐渐好转，于是去掉黄连、泽泻，又服数剂而痊愈。
一位妇人平素郁闷，阴道内部痛痒，不时出水，饮食少思，肢体倦怠，使用归脾汤加入丹皮、山栀、芍药、柴胡、生甘草为主方而安愈。
一位妇人阴道内部痒痛，内热倦怠，饮食少思，用人参、[原文缺字，推测为黄芪或类似补气药]、当归、白术、陈皮、柴胡、炒山栀、炒车前子、升麻、芍药、丹皮、茯苓治疗而病愈。若阴中有虫导致痒痛，也属于肝木问题，将桃仁研成膏，调和雄黄末纳入阴道中以杀灭虫子，同时仍用清肝解郁之法。有人用鸡肝纳入阴道，这是取虫的方法。
一位妇人在性交违背常理后，出血作痛，发热口干，误服寒凉药物，前述症状更加严重，不时想呕吐，饮食少思，此症属于肝经，而药物又伤了脾胃，先用六君子汤加入柴胡，使脾胃逐渐恢复，再用加味逍遥散，患处也随之痊愈。
一位妇人每次性交，就出血作痛，敷贴和服用皆为凉血止痛的药物，不时出血甚多，这是肝受伤而不能藏血，脾受伤而不能摄血，使用补中益气汤、济生归脾汤两方而痊愈。若性交出血，可用熟艾绒热裹入阴道中。若性交违背常理而出血，可用乱发、青布烧成末敷之，血自止。若出血过多而出现其他症状，只需使用前面的药物，调补肝脾，诸症自愈。
一位妇人阴部肿胀下坠，闷痛出水，胸腹不畅，小便频数，内热午后发热，口苦耳鸣，先用小柴胡汤加入车前子、龙胆草、茯苓、白术、升麻，两剂后稍缓解，又用加味逍遥散加入升麻，数剂后稍好转，再用加味归脾汤加入升麻、柴胡，以及补中益气汤加入山栀，数剂后逐渐好转，仍用加味逍遥散、加味归脾汤两种药物调理而痊愈。
一位妇人热痛，使用寒凉败毒药物，导致饮食不入，时时欲呕吐，小腹重坠，似有便意，这是脾胃亏损，元气下陷，症属虚寒，先用补中益气汤加入炮姜两剂，重坠感消失，再用前方加入茯苓、半夏，二十余剂而痊愈，后用归脾汤少加柴胡、升麻，配合六味地黄丸，调理两个多月而康复。
(Notes on Bleeding during Intercourse, Uterine Prolapse, Vulvar Itching, and Parasites)
Vulvar sores (Yin Chuang) in women are caused by emotional stagnation transforming into fire, damaging the Liver and Spleen, leading to damp-heat pouring downward. External symptoms include: protrusion from the vagina like a snake, commonly called "Yin Ting" (Uterine Prolapse); protrusion like a cake, commonly called "Yin Jun"; shapes resembling cockscomb flowers; growth of various parasites; swelling, pain, dampness, itching, ulceration with discharge, abdominal distension, heaviness, and prolapse. Internal symptoms include: dry mouth, internal heat, fatigue, irregular menstruation, loss of taste, afternoon fever, chest and diaphragm discomfort, hypochondriac discomfort, lower abdominal fullness, red and white leukorrhea, and dysuria with strangury. Treatment methods: For swelling and pain, Siwu Tang (Four Substances Decoction) added with Chai Hu (Bupleuri Radix), Shan Zhi (Gardeniae Fructus), Dan Pi (Moutan Cortex), and Dan Cao (Gentianae Radix) is suitable; for dampness and itching, Guipi Tang (Restore the Spleen Decoction) added with Shan Zhi, Dan Pi, and Chai Hu is suitable; for dysuria with strangury, Longdan Xiegan Tang (Gentian Liver-Draining Decoction) added with Bai Zhu (Atractylodis Macrocephalae Rhizoma) and Dan Pi is suitable; for ulceration and putrefaction, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) is suitable; for swelling, distension, and prolapse, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Shan Zhi and Dan Pi, combined with external treatments, which have been verified clinically.
Clinical Cases
A woman suffered from chest and diaphragm discomfort, internal heat with thirst, aversion to food, limb fatigue, vulvar stuffiness and itching, and red, scanty urine. This was caused by depression and anger. She recovered after taking Guipi Tang (Restore the Spleen Decoction) added with Shan Zhi (Gardeniae Fructus). Later, due to anger, she experienced pain and distension in the affected area and lower abdomen. She recovered after taking Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Shan Zhi, Xiong (Ligustici Chuanxiong Rhizoma), Gui (Angelicae Sinensis Radix), and Shaoyao (Paeoniae Radix). However, internal heat and afternoon fever persisted, and she recovered after taking Xiaoyao San (Free and Easy Wanderer Powder) added with Shan Zhi. Later, due to overexertion and fever, the affected area swelled, and urine remained scanty and difficult to pass. She recovered after taking Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Shan Zhi, Fu Ling (Poria), and Dan Pi.
A woman had a mushroom-like protrusion from the vagina, surrounded by swelling and pain, frequent urination, internal heat with afternoon fever, sensation of itching and pain, and heavy bearing down in the lower abdomen. This was a syndrome of Liver and Spleen stagnation: Liver fire and damp-heat caused swelling and pain, while Spleen deficiency and sinking caused the heavy bearing down. Initially, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Shan Zhi, Fu Ling, Che Qian Zi (Plantaginis Semen), and Qing Pi (Citri Reticulatae Pericarpium Viride) was used to clear Liver fire and raise Spleen Qi, leading to gradual improvement. Then, Guipi Tang (Restore the Spleen Decoction) added with Shan Zhi, Fu Ling, and Xiong was used for regulation. Finally, pig lard mixed with Li Lu (Veratri Nigrum Rhizoma) powder was applied topically to retract the protrusion.
A woman had a five-cun long tissue protruding from the vagina, causing stuffiness, pain, heavy bearing down, dripping discharge, and obstructed urination. In the evening, Longdan Xiegan Tang (Gentian Liver-Draining Decoction) was administered to drain damp-heat; in the morning, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was administered to raise and tonify Spleen Qi. Symptoms gradually improved. Subsequently, Guipi Tang (Restore the Spleen Decoction) added with Shan Zhi, Fu Ling, Xiong, and Huang Bo (Phellodendri Cortex) was taken intermittently for regulation until recovery. Later, due to overexertion or anger, she experienced dampness and itching in the lower part and difficulty in urination. The previous prescriptions were used again, resulting in recovery. Cases with protrusions up to one chi long or those involving parasites were also treated with this method.
A woman suffered from ulceration and putrefaction, with dripping pus and fluid, swelling, pain, chills, and fever, red and scanty urine, internal heat with thirst, limb fatigue, chest and hypochondriac discomfort, and poor appetite for over three months. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) was used, with Chai Hu (Bupleuri Radix) and Sheng Ma (Cimicifugae Rhizoma) at 1 qian each, plus Fu Ling (Poria) at 1 qian and fried Shan Zhi (Gardeniae Fructus) at 2 qian. After several doses, slight improvement was seen. Then, Guipi Tang (Restore the Spleen Decoction) added with Shan Zhi, Xiong, and Fu Ling was given for over thirty doses, resolving all symptoms except internal heat. Xiaoyao San (Free and Easy Wanderer Powder) with doubled Shan Zhi was then administered, leading to recovery.
A woman with an irritable temper experienced occasional vulvar pain, red and scanty urine, worsening with anger, sometimes with fever or alternating chills and fever. Treatment involved Xiong (Ligustici Chuanxiong Rhizoma), Gui (Angelicae Sinensis Radix), fried Shan Zhi (Gardeniae Fructus), Chai Hu (Bupleuri Radix), Fu Ling (Poria), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Dan Pi (Moutan Cortex), Ze Xie (Alismatis Rhizoma), fried Shaoyao (Paeoniae Radix), fried Che Qian Zi (Plantaginis Semen), fried Lian (Coptidis Rhizoma), and raw Gan Cao (Glycyrrhizae Radix et Rhizoma). After several doses, gradual improvement occurred. Lian (Coptidis Rhizoma) and Ze Xie (Alismatis Rhizoma) were then removed, and after several more doses, full recovery was achieved.
A woman prone to depression suffered from internal vulvar pain and itching, intermittent discharge, poor appetite, and limb fatigue. Guipi Tang (Restore the Spleen Decoction) added with Dan Pi (Moutan Cortex), Shan Zhi (Gardeniae Fructus), Shaoyao (Paeoniae Radix), Chai Hu (Bupleuri Radix), and raw Gan Cao (Glycyrrhizae Radix et Rhizoma) was prescribed as the main formula, leading to stabilization.
A woman suffered from internal vulvar itching and pain, internal heat, fatigue, and poor appetite. Treatment included Ren Shen (Ginseng Radix), [missing character, likely Huang Qi], Gui (Angelicae Sinensis Radix), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Chen Pi (Citri Reticulatae Pericarpium), Chai Hu (Bupleuri Radix), fried Shan Zhi (Gardeniae Fructus), fried Che Qian Zi (Plantaginis Semen), Sheng Ma (Cimicifugae Rhizoma), Shaoyao (Paeoniae Radix), Dan Pi (Moutan Cortex), and Fu Ling (Poria), resulting in recovery. If itching and pain were caused by parasites in the vagina, it was also attributed to Liver Wood. Tao Ren (Persicae Semen) was ground into a paste, mixed with Xiong Huang (Realgar), and inserted into the vagina to kill parasites, while simultaneously using methods to clear Liver heat and resolve stagnation. Some used chicken liver inserted into the vagina as a method to extract parasites.
A woman experienced bleeding and pain after improper intercourse, followed by fever and dry mouth. Misuse of cold-natured drugs exacerbated these symptoms, causing nausea and poor appetite. This syndrome belonged to the Liver Meridian, but the drugs injured the Spleen and Stomach. Liu Junzi Tang (Six Gentlemen Decoction) added with Chai Hu (Bupleuri Radix) was used first to gradually restore the Spleen and Stomach, followed by Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder), which cured the affected area.
A woman experienced bleeding and pain upon every intercourse. Topical and oral administration of blood-cooling and pain-relieving agents led to excessive bleeding. This indicated that the Liver was injured and unable to store blood, and the Spleen was injured and unable to control blood. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Jisheng Guipi Tang (Jisheng Restore the Spleen Decoction) were used, leading to recovery. For bleeding during intercourse, hot-wrapped Shu Ai (Artemisiae Argyi Folium) could be inserted into the vagina. For bleeding due to improper intercourse, powder made from burning loose hair and green cloth could be applied to stop bleeding. If excessive bleeding occurred with other symptoms, simply using the aforementioned drugs to regulate and tonify the Liver and Spleen would allow all symptoms to resolve spontaneously.
A woman suffered from vulvar swelling and prolapse, stuffiness, pain, discharge, chest and abdominal discomfort, frequent urination, internal heat with afternoon fever, bitter taste, and tinnitus. Initially, Xiao Chaihu Tang (Minor Bupleurum Decoction) added with Che Qian Zi (Plantaginis Semen), Dan Cao (Gentianae Radix), Fu Ling (Poria), Bai Zhu (Atractylodis Macrocephalae Rhizoma), and Sheng Ma (Cimicifugae Rhizoma) was used. After two doses, slight relief was observed. Then, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) added with Sheng Ma (Cimicifugae Rhizoma) was used for several doses, showing slight improvement. Subsequently, Jiawei Guipi Tang (Modified Restore the Spleen Decoction) added with Sheng Ma (Cimicifugae Rhizoma) and Chai Hu (Bupleuri Radix), along with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Shan Zhi (Gardeniae Fructus), were used for several doses, leading to gradual improvement. Finally, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) and Jiawei Guipi Tang (Modified Restore the Spleen Decoction) were used for regulation until recovery.
A woman suffered from heat and pain. Use of cold-natured detoxifying drugs prevented food intake, caused frequent vomiting, lower abdominal heavy bearing down, and a sensation of defecation. This indicated Spleen and Stomach deficiency, sinking of Yuan Qi, and a deficiency-cold syndrome. Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Pao Jiang (Zingiberis Rhizoma Preparatum) was used for two doses, eliminating the heavy bearing down. The previous decoction was then continued with Fu Ling (Poria) and Ban Xia (Pinelliae Rhizoma) for over twenty doses, leading to recovery. Finally, Guipi Tang (Restore the Spleen Decoction) with small amounts of Chai Hu (Bupleuri Radix) and Sheng Ma (Cimicifugae Rhizoma), combined with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), was used for regulation for over two months, resulting in health.