四五行。继以二陈汤去甘草，加苍术、泽泻、砂仁，三剂痛顿减。随与苍术为君之大补脾丸，服未旬余，痛即如失。
朱丹溪治吴江王氏子，年三十岁，忽阴挺长肿而痛，脉数而沉实，用朴硝荆芥汤浸洗，又用三一承气汤大
下之，愈。（《本草纲目》。）
姚蒙字以正，巡抚邹来学尝使视脉，蒙既叙病源，因曰∶公根器别有一窍出汗水。来学大惊曰∶此隐疾何
由知？蒙曰∶以脉得之。左关滑而缓，肝第四叶有漏洞下相通。来学改容谢。（雄按∶左关候肝是矣，何以滑
缓主漏洞而断其在某叶？此皆史乘夸美之词，何必选耶？）
薛立斋治一妇人，阴中肿闷，小便涩滞，两胁作痛，内热晡热，月经不调，时或寒热。此因肝脾郁怒，元
气下陷，湿热壅滞。朝用归脾汤加柴胡、升麻解郁结，补脾气，升元气；夕用加味逍遥清肝火，生肝血，除湿
热。各数剂，诸症悉愈。又用四君、芍、归、丹皮调补肝脾，而经水如期。
一妇人阴中寒冷、小便黄涩，内热外寒，口苦胁胀。此因肝经湿热，用龙胆汤祛利湿热，用加味逍遥散调
补气血而安。
一妇人所患同前，更寒热呕吐，两眼肿痛，先用小柴胡加山栀，一剂寒热呕吐顿止。次用龙胆泻肝汤，一
剂肿痛顿消。
一妇人阴中寒冷，小便寒清，腹中亦冷，饮食少思，大便不实，下元虚寒，治以八味丸，月余饮食渐加，
大便渐实，又月余诸症悉愈。
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。此肝脾火症，用小柴胡、车前、
胆草、苓、术、升麻，二剂少愈。又用加味逍遥散加升麻，数帖渐愈。乃以加味归脾加升麻、柴胡，并补中益
气汤加山栀，数剂顿愈。仍用加味逍遥散、加味归脾，二药调理全愈。
一妇人患前症热痛，或用寒凉败毒药，饮食不入，时欲作呕，小便重坠。此脾胃复损，元气下陷，先用补
中益气加炮姜，二剂重坠顿愈。又加茯苓、半夏，二十余剂而愈。乃以归脾汤少加柴胡、升麻，并用六味地黄丸而康。
孙文垣治一妇，当暑月小便不利而痛，玉户肿，又便血发热，左脉弦数，右寸短弱。此肺气不足，肝火大
炽。盖肝为血海，又主疏泄二便，玉户为肝经所络之地，治当疏决肝经壅滞，脾气畅则新血得以归经，热解则
小水可以通，而肿亦可消矣。以滑石三钱，桃仁、当归、白芍各一钱，柴胡、黄连、人参各八分，川芎六分，
甘草、桂枝、白芷各三分，四剂而瘳。
马凤林内子有隐疾，每月汛行，子户傍辄生一肿毒，胀而不痛。过三五日以银簪烧红针破，出白脓盏许而
消，不必膏药，亦无疤痕。初用针刺，近则以指掐之，脓即出，但汛行即发，上下左右无定所，第不离子户。
于今八年，内外科历治不效，且致不孕。孙曰∶此中焦湿痰，随经水下流，壅于子户也。经下而痰凝，则化为
脓。本来非毒，故不痛。（怪病之谓痰。）用白螺蛳壳火 存性为君，南星、半夏为臣，柴胡、甘草为佐，曲糊为丸，
令早晚服之，未终剂而汛行不肿，次年（俞东扶曰∶孙公颖悟，殊不可及。原非毒，故不痛。亦格致名言。）即孕。
一妇有隐疾，其夫二造门而不言，继至欲言而面赭。孙开喻之，乃俯首曰∶言之无任主臣，先生长春谅无
哂。山妻子户中突生一物，初长可三寸，今则五寸许矣，状如坚筋，色赤，大可拱把，胀而且痛，不便起止，
憎寒壮热，寝食俱减，赧于言，欲求自尽，逡巡百日矣。孙曰∶乃阴挺症也。厥阴肝经之脉，女子下系庭孔，
湿热则阴挺，犹木有湿热而生蕈也。（毕竟纵不热，则挺收为是。）与以龙胆泻肝汤及 皮散，当归、黄芩、
牡蛎、 皮、赤芍为末，每用二钱，空心服，米饮汤调下。去后数月来报云∶前症果痊，兹为汛期一月不至，
敢问？曰∶此有身也。彼疑疾甫愈，未必能孕。谓曰∶前恙乃肝经有余之症，肝为血海，女子血盛则孕胎。
据血盛当先期，今汛逾期，实孕耳，非病也。后果足月生子。
尚某言∶昔在粤东，与郡司李某交善，后李没，某妻售濠畔街宅，与尚仍分院而居，两家往来如亲串然。
一日李妻私语尚夫人，有女及笄而病，病者甚异，欲求尚诊之而难于言。夫人告尚曰∶与李君夙交好，言之何
伤？李妻乃言女初患腹痛，久之溲溺甚艰，溲内有物能游泳，或二或三，似有鳞鬣者。取视之，乃比目鱼半体
也，身微黑，止有一目，其背白，置水中果如所云。试诊之，乃肝气久郁所致，投以琉肝之剂而愈。李河南人。
（《居易录》。）
一寡妇患阴中痒，不可告人，渐至委顿。此妇平日虔奉大士，忽有尼僧来，与药一包，曰∶以此洗之。数
洗而愈。其药乃蛇床子、吴茱萸、苦参也。（《采兰杂志》。）
何首乌本名夜交藤，因何首乌服而得名。何首乌者，顺州南河县人，祖能嗣，本名田儿，生而阉弱，年五
十八无妻，醉卧野中，见田中藤两本异生，苗蔓相交，久久而解，解合三四。田儿心异之，掘根持问乡人，无
能识者。遂曝干捣末，酒服七日而思人道，百日而旧病皆愈，十年而生数男，后改名能嗣。又与子庭服，皆寿
一百六十。首乌服药一百三十岁，唐元和七年，曾文象遇茅山老人，遂传其事。李翱因着《方录》云∶此偶遇
灵异之品，故其效如此，亦理之所有。何廉 郡伯精于医理，尝言亲见数人获成形首乌服之，果有乌须延年之
效。又曾在河南购得潞参重十二两，在陕中购得当归重斤余者，其效皆异寻常。又曾亲至西陵山中采沙参，其
大如儿臂，剥之外边黑皮，其中洁白如玉，嚼食一茎，甘芳鲜脆，头目便觉清泰。此皆生于深山穷谷之中，
得天地之灵气，故其效非寻常可及。特无缘者，不能遇耳。（《甘泉蕞残录》。）
富家子唐靖，疮发于阴，至烂人道。周守真曰∶病得之欲泄而不可泄也。治法宜内服龙胆泻肝汤，外以甘
草末糁之。（《延寿书》。）
有人阴冷，渐渐入内，阴囊肿满，昼夜痛闷不已，用上好川椒为末，帛包裹囊。如不觉热，炒热更烘。内
煎大蓟汤汁服妙。阴冷两丸如冰，出汗，两脚痿弱，宜补肝汤。（《千金方》。）
王节斋曰∶男子阴痿不起，古方多云命门火衰，祖气虚弱，固有之矣。然亦有郁火盛而致痿者，经云壮火
食气。譬如人在夏暑而倦怠，遇冬寒而坚强。予尝亲见肾经郁火而有此症，令服黄柏、知母清肾火之药而效。
故须审察，不可遍认为火衰。
薛立斋治一妇人，吐痰发热，遍身作痛，小便频数，阴中作痒，日晡热甚。曰∶此脾肝气血虚，气滞而兼
湿热也。用加味逍遥散加车前子而愈。
马元仪治尤悔侄，患阴茎作痛，痛甚而愤，遂昏迷不醒，几阅月。诊其两脉浮虚而涩。浮为气虚，涩为精
伤，故令作痛。阴阳两虚之候，得之忧思劳郁而伤中也。经云润宗筋者，又阳气，精则养神，柔则养筋。今悒
郁劳倦，气血两伤，故令作痛。以当归补血汤加人参、炙甘草调养气血，桂心、秦艽、红花宣通血脉，一剂而
痛止。复诊两脉沉微，连进大剂参、附，诸症已平。惟彻夜不寐，用归脾汤调理而安。
有人阴肿，医以赤土涂之，令服八味丸而愈。一儿阴肿，医亦以赤土涂之愈。若久病而阴肿，病已不可救，
宜速灸水分穴，盖水分能分水谷。水谷不分，故阴肿，他处亦肿也，尤宜急服禹余粮云。（《既效方》。）
陈良甫家婢患阴蚀，就疮医家疗不瘥。蚀处作两疮，深半寸。良甫于《涓子方》中捡得甘草汤方，仍以自
处蚺蛇胆散，不经七日疮乃平复，甚效。凡救十八人，手下即活。遇斯疾者，请流布而传之。
葛氏云∶比见人患茎头肿攻下，疮欲断者，以猪肉汤渍洗之，并用黄连、黄柏末涂之。又方，蜜煎甘草末
涂之。（《千金方》。）
立斋治一妇人，阴内脓水淋漓，或痒或痛，状似虫行。诊之，少阴脉滑。此阴中有疮也，名曰 。由神思
烦郁，胃气虚弱，气血凝滞所致。与升麻、白芷、黄连、木通、当归、川芎、白术、茯苓、柴胡煎服，用拓肿
汤熏洗，更搽蒲黄、水银，两月余而愈。或有胞络虚，风邪乘阴，血气相搏，令气否塞，致阴肿痛。当以菖蒲
治之，更以枳实炒热，帛裹熨之，冷则再炒。或有子脏虚，冷气下冲，致阴脱出，谓之下脱，或因产弩力而脱
者，以当归散治之。久不愈者，以补中益气汤倍加升麻、柴胡升举之。
蕲阁老子阴茎肿痛，服五苓散等药不应。诊其脉左关弦数，此肝经湿热而成。以小柴胡汤送芦荟丸，一服
势去三四，再服顿愈。
一妇人阴器肿痛，小水涩滞，遇晚寒热交作，此肝经湿热为患。徐灵胎曰∶此湿热轻病。以龙胆泻肝汤，
二服小水通利。又以四物汤兼小柴胡，加花粉、木通、山栀，服之而愈。（《外科正宗》。以下共选六案来入。）
一妇人无故发热月余，忽阴中突出一物，如鸡冠一片，此肝郁脾虚所致。以补中益气汤加青皮、栀、芩、
柴胡、甘草，外以白芷、苍术、紫苏煎汤，每日熏洗，十余日其患渐小。乃用前汤倍参、术，月余而安。（徐灵胎
曰∶所用诸方，皆浮泛不切，全无法度。虽有小益，总非切病之治。此风自立斋开之后，遂不可挽回矣。此
医术之一变也。）
一妇人阴中作痒，遇夜五心烦热，作渴不寐，此思虑太过，致心肾不交。以四物汤加龙胆草、山栀、知母、
黄连，以银杏散纳入阴中，三日其痒渐止。又朝以八味丸，午用归脾汤加银柴胡、茵陈，月余而愈。
一妇人阴器半边肿痛，身发寒热，口干便秘，脉实有力，以内疏黄连汤一剂，大便通利，口干乃止。惟肿
痛尤甚，此湿毒结聚，欲为脓也，以四物汤加角刺、泽泻，二剂脓熟胀痛。又以透脓散一服，出臭脓钟许，痛
止。以八珍汤加丹皮、泽泻，十余剂而安。
一妇人肝经风湿，下流阴器，浮肿痒甚，至抓出血不痛，以消风散加苦参、胆草、泽泻、木通、山栀，外
以蛇床子汤熏洗，擦搽银杏散，十余剂痒止肿消而愈。
一妇人孀居十余载，阴器作痒生虫，含忍不言。后阴器蚀烂，已蚀五内， 羸发热作渴，脉洪而数。询其
痒痛日久，阴器黑腐，小水不禁，五内已坏，不可用药。彼苦求治。曰∶痒者虫也，痛者损也。先用鲫鱼数枚，
以香料糁炙鱼熟，以丝棉薄裹，纳入阴中。夹之良久，取出红虫，长者一寸，短者五六分，细如丝线，约二十
余条，置温汤中，摇摆片时方死。彼家欢悦，以为可治。曰∶再取再有，生化无穷。强投养血诸药，终竟不应而死。
钱国宾曰∶浙湖戴氏生女五岁，胎生双阴，溺从上出，下户亦流，其母病延诊，以私语言及。余曰∶此女
天生双阴也。不闻《棱严经》云？五种不男之人，即此类也。长大经行，生子如常，以上窍为正。彼此勿疑，
抚养待配。
阴宽，肥皂子浸去黑皮，用其白肉，加白芨、五倍子、蛇床子、石榴皮、甘松、三奈、龙骨，煎浓汤，日
日熏洗。宽而冷者，加石硫黄煎。
阴挺，飞矾六两，桃仁一两，五味子、雄黄各五钱，铜绿四钱，末之炼蜜丸，每丸重四钱，即以方内雄黄
为衣，坐入玉门即愈，甚者不过二次。
雄按∶余癸卯秋，视康侯副转之疾，脉滑数而右歇左促，且肝部间有雀啄，气口又兼解索，面色熏黄，
头汗自出，呼吸粗促，似不接续，坐卧无须臾之宁，便溺涩滞，混浊极臭，心下坚硬拒按，形如覆碗，舌
色边紫黄，殊不甚燥，口浊甜腻，不能饮食，合眼即气升欲喘，烦躁不能自持，胸中懊 欲死。此湿热误
补，气机阻塞，津液为之凝滞而成痰饮也。宜用温胆汤加薤白、蒌仁，通其胸中之阳；合小陷胸，为治饮
痞之妙法；参以栀、豉，泄其久郁之恝，以除懊 ；佐以兰草，涤其陈腐之气而醒脾胃。连投二剂，各恙
皆减，脉亦略和。病者欲速，连服大黄丸二次，承气汤半帖。予闻急止之曰∶进补固非，妄攻亦误。此症
湿蒸为热，灼液成痰，以上下分消为是，不比热邪传腑，可一荡而愈也。越日下部渐肿，此犯攻痞太速
之戒也。以前法加黄芩，合泻心意，再配雪羹，投之痞渐消，痰渐吐，而自腹至足，以及肾囊肿势日加。
拟用河间桂苓甘露饮意，或主崇土胜湿之说。余力持不可，乃复进前日药一剂，次日痰中见血甚多。此湿
热熏蒸，自气及营也。以知、柏、生地、犀角、鳖甲、白芍、苡仁、贝母、石斛、茅根、麦冬、滑石、栀
子、藕汁、童便，投之而止。逾数日又吐，且肢冷自汗，心馁畏脱，合家皇皇，或议投归脾。余坚执前议，
仍投前药二剂，血果止。余思血之复吐，由于气分之邪扰及营分。今欲清气道之邪，必先去其邪所根据附之
痰，因投滚痰丸三钱，得下泄一次，病者云四十日来未有之通畅也。连投数日，始解胶痰黑矢多遍，而小
便亦渐清长，寝食渐安。惟下部之肿如故，或议用实脾行水之法。余曰∶谛审脉症，病不在脾，况善饥便
燥，口浊溺多，方患其转消症，亟投甘润之不遑，恶可渗利伤阴、补燥劫液耶？肿势之来，良由湿热所酿
第四种情况。随后使用二陈汤去掉甘草，加入苍术、泽泻、砂仁，服用三剂后疼痛立刻大幅减轻。接着以苍术为主药的大补脾丸，服用不到十天，疼痛就完全消失。
朱丹溪治疗吴江王氏的儿子，三十岁，突然阴部挺出、肿大且疼痛，脉象数而沉实，用朴硝荆芥汤浸泡清洗，又用三一承气汤大力攻下，病愈。（出自《本草纲目》。）
姚蒙字以正，巡抚邹来学曾让他诊脉，姚蒙叙述完病因后，就说：“大人的生殖器旁有一个窍道流出汗水。”邹来学大惊说：“这是隐秘的疾病，怎么知道？”姚蒙说：“通过脉象得知。左关脉滑而缓，肝脏第四叶有漏洞向下相通。”邹来学改变神色表示感谢。（徐灵胎按语：左关候肝是对的，但为什么滑缓主漏洞并断定在某一叶？这都是史书中夸大的美辞，何必选录呢？）
薛立斋治疗一位妇人，阴道内肿胀闷痛，小便涩滞不畅，两胁作痛，体内发热及傍晚发热，月经不调，时而寒热往来。这是因为肝脾郁怒，元气下陷，湿热壅滞。早晨服用归脾汤加柴胡、升麻以解郁结，补脾气，升元气；晚上服用加味逍遥散清肝火，生肝血，除湿热。各服几剂后，各种症状全部痊愈。后来又用四君子汤加芍药、当归、牡丹皮调理补益肝脾，月经如期而至。
另一位妇人阴道寒冷、小便黄且涩滞，内热外寒，口苦胁胀。这是因为肝经湿热，用龙胆汤祛利湿热，用加味逍遥散调补气血而安。
另一位妇人所患与前例相同，更伴有寒热呕吐，两眼肿痛，先用小柴胡汤加山栀，一剂后寒热呕吐立刻停止。接着用龙胆泻肝汤，一剂后肿痛立刻消除。
一位妇人阴道寒冷，小便清冷，腹中也冷，饮食减少不想进食，大便不成形，下元虚寒，治疗用八味丸，一个月后饮食逐渐增加，大便逐渐成形，又过一个月各种症状全部痊愈。
一位妇人阴部肿胀下坠，闷痛出水，胸腹部不适，小便频数，内热傍晚发热，口苦耳鸣。这是肝脾火症，用小柴胡汤加车前子、胆草、茯苓、白术、升麻，两剂后稍见好转。又用加味逍遥散加升麻，几帖后逐渐痊愈。于是用加味归脾汤加升麻、柴胡，并用补中益气汤加山栀，几剂后立刻痊愈。仍然用加味逍遥散、加味归脾汤，两种药物调理全愈。
一位妇人患前述病症热痛，有人用寒凉败毒药，导致饮食不入，时常想呕吐，小便重坠感。这是脾胃再次受损，元气下陷，先用补中益气汤加炮姜，两剂后重坠感立刻痊愈。又加茯苓、半夏，二十多剂后痊愈。于是用归脾汤少加柴胡、升麻，并用六味地黄丸而康复。
孙文垣治疗一位妇人，正值暑月小便不利且疼痛，外阴肿胀，又便血发热，左脉弦数，右寸脉短弱。这是肺气不足，肝火大炽。因为肝为血海，又主管疏泄二便，外阴是肝经所络属的地方，治疗应当疏决肝经的壅滞，脾气畅达则新血得以归经，热解则小便可以通利，而肿胀也可以消除。用滑石三钱，桃仁、当归、白芍各一钱，柴胡、黄连、人参各八分，川芎六分，甘草、桂枝、白芷各三分，四剂后病愈。
马凤林的妻子有隐疾，每月月经来潮时，子宫旁边就会生一个肿毒，胀但不痛。过了三五天用烧红的银簪刺破，流出约一盏白脓后就消退，不需要膏药，也没有疤痕。起初用针刺，近来用手指掐破，脓即流出，但只要月经来潮就会发作，上下左右没有固定位置，只是不离子宫附近。到现在八年，内外各科治疗均无效，且导致不孕。孙文垣说：“这是中焦湿痰，随经水下流，壅塞于子宫。经血下行而痰凝，则化为脓。本来不是毒邪，所以不痛。（怪病多由痰引起。）”用白螺蛳壳煅存性作为主药，南星、半夏作为辅药，柴胡、甘草作为佐药，曲糊为丸，令早晚服用，还没服完一剂，月经来潮时就不肿胀了，第二年（俞东扶说：孙公聪颖悟性极高，实在不可及。原非毒邪，故不痛。这也是格物致知的名言。）就怀孕了。
一位妇人患有隐疾，她的丈夫两次登门却不言语，后来想开口却面红耳赤。孙文垣开导她，她才低头说：“说出来不怕您嘲笑，先生长寿想必不会讥笑。我家媳妇子宫里突然长出一个东西，初时长约三寸，现在大约五寸了，形状像坚硬的筋，颜色赤红，大小可拱手握，胀痛而且疼痛，不便起坐，憎寒壮热，寝食俱减，因害羞不敢言，想要自尽，犹豫拖延已有一百天了。”孙文垣说：“这是阴挺症。厥阴肝经的脉，女子向下系连庭孔，湿热则阴挺，就像树木有湿热而生蘑菇一样。（毕竟如果不热，挺出后会收回才对。）”给予龙胆泻肝汤及某皮散，将当归、黄芩、牡蛎、某皮、赤芍研末，每次用二钱，空腹服用，米饮汤送下。过后几个月来报信说：“前面的病症果然痊愈，现在是经期一个月没到，请问？”回答说：“这是怀孕。”他怀疑病刚愈，未必能怀孕。说道：“前面的病是肝经有余之症，肝为血海，女子血盛则受孕。据血盛当先期，如今经期逾期，确实是怀孕，不是病。”后果然足月生子。
尚某说：“以前在广东东部，与郡司李某交好，后来李去世，李妻出售濠畔街宅院，与尚某仍分院而居，两家往来如亲戚一般。一天李妻私下对尚夫人说，有女儿到了成年年龄却病了，病人很怪异，想求尚某诊治却难以启齿。夫人告诉尚某说：‘与李君向来交好，说出来有什么伤害？’李妻于是说女儿起初患腹痛，久了小便非常困难，尿内有物体能游泳，或两个或三个，似有鳞鬣。取出来看，乃是比目鱼的一半身体，身微黑，只有一只眼，背部白色，放在水中果然如此。试着诊脉，是肝气久郁所致，投以疏肝之剂而愈。李是河南人。”（出自《居易录》。）
一位寡妇患阴道瘙痒，不可告人，渐渐至委顿衰弱。此妇平日虔诚信奉观音大士，忽然有尼姑来，给一包药，说：“用它清洗。”洗了几次就好了。那药是蛇床子、吴茱萸、苦参。（出自《采兰杂志》。）
何首乌本名夜交藤，因何首乌服用而得名。何首乌者，是顺州南河县人，祖辈名为田儿，生来阉弱，五十八岁无妻，醉卧野外，看见田里的藤蔓两本异生，苗蔓相交，久而解开，解开后又合三四次。田儿心中奇异，挖根拿问乡人，无人能识别。于是晒干捣末，酒服七日而思欲，百日旧病皆愈，十年生下几个男孩，后改名能嗣。又与儿子庭服用，都活了一百六十岁。首乌服药一百三十岁时，唐元和七年，曾文象遇到茅山老人，于是传述其事。李翱因此写《方录》说：“这是偶遇灵异之物，所以效果如此，也是情理之中。”何廉臣郡伯精通医理，曾说亲眼见几人获得成形的何首乌服用，果然有乌须延年的效果。又曾在河南购得潞党参重十二两，在陕西购得当归重一斤多的，其效果都异乎寻常。又曾亲自到西陵山中采沙参，大如婴儿手臂，剥去外面黑皮，里面洁白如玉，嚼食一茎，甘芳鲜脆，头目便觉清爽安宁。这些都是生于深山穷谷之中，得天地灵气，所以效果非凡人可比。只是无缘的人，不能遇到罢了。（出自《甘泉蕞残录》。）
富家子弟唐靖，疮发于阴部，直至烂掉生殖器。周守真说：“病得之于欲泄而不可泄。”治法宜内服龙胆泻肝汤，外用甘草末撒敷。（出自《延寿书》。）
有人阴部寒冷，渐渐深入，阴囊肿满，昼夜痛闷不已，用上好的川椒为末，帛包裹阴囊。如果不觉热，炒热再烘。内服大蓟汤汁妙。阴冷两丸如冰，出汗，两脚痿弱，宜用补肝汤。（出自《千金方》。）
王节斋说：“男子阳痿不起，古方多说命门火衰，祖气虚弱，固然有这种情况。然而也有因郁火盛而导致痿的，经云壮火食气。譬如人在夏暑而倦怠，遇冬寒而坚强。我曾亲眼见到肾经郁火而有此症，令其服用黄柏、知母清肾火的药而有效。所以必须审察，不可遍认为火衰。”
薛立斋治疗一位妇人，吐痰发热，遍身作痛，小便频数，阴中作痒，日晡时热甚。说：“这是脾肝气血虚，气滞而兼湿热。”用加味逍遥散加车前子而愈。
马元仪治疗尤悔的侄子，患阴茎作痛，痛甚而愤懑，遂昏迷不醒，经过几个月。诊其两脉浮虚而涩。浮为气虚，涩为精伤，所以令作痛。阴阳两虚之候，得之忧思劳郁而伤中也。经云润宗筋者，又阳气，精则养神，柔则养筋。今悒郁劳倦，气血两伤，所以令作痛。用当归补血汤加人参、炙甘草调养气血，桂心、秦艽、红花宣通血脉，一剂后痛止。复诊两脉沉微，连进大剂人参、附子，诸症已平。惟彻夜不寐，用归脾汤调理而安。
有人阴肿，医生用赤土涂之，令服八味丸而愈。一小儿阴肿，医生也用赤土涂之而愈。若久病而阴肿，病已不可救，宜速灸水分穴，盖水分能分水谷。水谷不分，故阴肿，他处亦肿也，尤宜急服禹余粮云。（出自《既效方》。）
陈良甫家的婢女患阴蚀，找疮科医生治疗不好。蚀处形成两个疮，深半寸。良甫从《涓子方》中捡得甘草汤方，仍以自制的蚺蛇胆散，不经七日疮乃平复，甚效。凡救十八人，手下即活。遇到这种病的，请流传传播它。
葛氏说：“近来见人患阴茎头肿胀攻下，疮欲断者，用猪肉汤浸泡清洗，并用黄连、黄柏末涂之。又一方，蜜煎甘草末涂之。”（出自《千金方》。）
立斋治疗一位妇人，阴内脓水淋漓，或痒或痛，状似虫行。诊之，少阴脉滑。这是阴中有疮，名叫某病。由神思烦郁，胃气虚弱，气血凝滞所致。给予升麻、白芷、黄连、木通、当归、川芎、白术、茯苓、柴胡煎服，用拓肿汤熏洗，更搽蒲黄、水银，两月余而愈。或有胞络虚，风邪乘阴，血气相搏，令气否塞，致阴肿痛。当以菖蒲治之，更以枳实炒热，帛裹熨之，冷则再炒。或有子脏虚，冷气下冲，致阴脱出，谓之下脱，或因产努力而脱者，以当归散治之。久不愈者，以补中益气汤倍加升麻、柴胡升举之。
蕲阁老子阴茎肿痛，服五苓散等药不应。诊其脉左关弦数，这是肝经湿热而成。以小柴胡汤送芦荟丸，一服势去三四，再服顿愈。
一位妇人阴器肿痛，小水涩滞，遇晚寒热交作，这是肝经湿热为患。徐灵胎说：“这是湿热轻病。”用龙胆泻肝汤，二服小水通利。又以四物汤兼小柴胡，加花粉、木通、山栀，服之而愈。（出自《外科正宗》。以下共选六案来入。）
一位妇人无故发热月余，忽阴中突出一物，如鸡冠一片，这是肝郁脾虚所致。以补中益气汤加青皮、栀、芩、柴胡、甘草，外以白芷、苍术、紫苏煎汤，每日熏洗，十余日其患渐小。乃用前汤倍参、术，月余而安。（徐灵胎说：“所用诸方，皆浮泛不切，全无法度。虽有小益，总非切病之治。此风自立斋开之后，遂不可挽回矣。此医术之一变也。”）
一位妇人阴中作痒，遇夜五心烦热，作渴不寐，这是思虑太过，致心肾不交。以四物汤加龙胆草、山栀、知母、黄连，以银杏散纳入阴中，三日其痒渐止。又朝以八味丸，午用归脾汤加银柴胡、茵陈，月余而愈。
一位妇人阴器半边肿痛，身发寒热，口干便秘，脉实有力，以内疏黄连汤一剂，大便通利，口干乃止。惟肿痛尤甚，这是湿毒结聚，欲为脓也，以四物汤加角刺、泽泻，二剂脓熟胀痛。又以透脓散一服，出臭脓钟许，痛止。以八珍汤加丹皮、泽泻，十余剂而安。
一位妇人肝经风湿，下流阴器，浮肿痒甚，至抓出血不痛，以消风散加苦参、胆草、泽泻、木通、山栀，外以蛇床子汤熏洗，擦搽银杏散，十余剂痒止肿消而愈。
一位妇人孀居十余载，阴器作痒生虫，含忍不言。后阴器蚀烂，已蚀五内，羸瘦发热作渴，脉洪而数。询其痒痛日久，阴器黑腐，小水不禁，五内已坏，不可用药。彼苦求治。说：“痒者虫也，痛者损也。”先用鲫鱼数枚，以香料糁炙鱼熟，以丝棉薄裹，纳入阴中。夹之良久，取出红虫，长者一寸，短者五六分，细如丝线，约二十余条，置温汤中，摇摆片时方死。彼家欢悦，以为可治。说：“再取再有，生化无穷。”强投养血诸药，终竟不应而死。
钱国宾说：“浙湖戴氏生女五岁，胎生双阴，溺从上出，下户亦流，其母病延诊，以私语言及。余说：‘此女天生双阴也。不闻《棱严经》云？五种不男之人，即此类也。长大经行，生子如常，以上窍为正。彼此勿疑，抚养待配。’”
阴宽，肥皂子浸去黑皮，用其白肉，加白芨、五倍子、蛇床子、石榴皮、甘松、三奈、龙骨，煎浓汤，日日熏洗。宽而冷者，加石硫黄煎。
阴挺，飞矾六两，桃仁一两，五味子、雄黄各五钱，铜绿四钱，末之炼蜜丸，每丸重四钱，即以方内雄黄为衣，坐入玉门即愈，甚者不过二次。
徐灵胎按语：我癸卯年秋天，诊治康侯副转的疾病，脉滑数而右歇左促，且肝部间有雀啄脉，气口又兼解索脉，面色熏黄，头汗自出，呼吸粗促，似不接续，坐卧无须臾之宁，便溺涩滞，混浊极臭，心下坚硬拒按，形如覆碗，舌色边紫黄，殊不甚燥，口浊甜腻，不能饮食，合眼即气升欲喘，烦躁不能自持，胸中懊憹欲死。这是湿热误补，气机阻塞，津液为之凝滞而成痰饮也。宜用温胆汤加薤白、蒌仁，通其胸中之阳；合小陷胸汤，为治饮痞之妙法；参以栀、豉，泄其久郁之恝，以除懊憹；佐以兰草，涤其陈腐之气而醒脾胃。连投二剂，各恙皆减，脉亦略和。病者欲速，连服大黄丸二次，承气汤半帖。我闻急止之曰：“进补固非，妄攻亦误。此症湿蒸为热，灼液成痰，以上下分消为是，不比热邪传腑，可一荡而愈也。”越日下部渐肿，这是犯攻痞太速之戒也。以前法加黄芩，合泻心汤意，再配雪羹汤，投之痞渐消，痰渐吐，而自腹至足，以及肾囊肿势日加。拟用河间桂苓甘露饮意，或主崇土胜湿之说。我极力坚持不可，乃复进前日药一剂，次日痰中见血甚多。这是湿热熏蒸，自气及营也。以知母、黄柏、生地、犀角、鳖甲、白芍、苡仁、贝母、石斛、茅根、麦冬、滑石、栀子、藕汁、童便，投之而止。逾数日又吐，且肢冷自汗，心馁畏脱，合家皇皇，或议投归脾汤。我坚执前议，仍投前药二剂，血果止。我思血之复吐，由于气分之邪扰及营分。今欲清气道之邪，必先去其邪所根据附之痰，因投滚痰丸三钱，得下泄一次，病者云四十日来未有之通畅也。连投数日，始解胶痰黑矢多遍，而小便亦渐清长，寝食渐安。惟下部之肿如故，或议用实脾行水之法。我说：“谛审脉症，病不在脾，况善饥便燥，口浊溺多，方患其转消症，亟投甘润之不遑，恶可渗利伤阴、补燥劫液耶？肿势之来，良由湿热所酿……”
Fourth case. Subsequently, Erchen Tang (Two-Chen Decoction) was used with licorice removed, and Atractylodis Rhizoma (Cangzhu), Alismatis Rhizoma (Zexie), and Amomi Fructus (Sharen) were added. After three doses, the pain decreased significantly. Then, Dabu Pi Wan (Great Tonification of the Spleen Pill) with Atractylodis Rhizoma as the chief ingredient was administered. Within ten days, the pain completely disappeared.
Zhu Danxi treated the thirty-year-old son of Mr. Wang in Wujiang, who suddenly suffered from prolapse, swelling, and pain in the genitalia. The pulse was rapid, deep, and solid. He prescribed a wash with Natrii Sulfas (Puxiao) and Schizonepetae Herba (Jingjie), followed by San Yi Cheng Qi Tang (Three-One Purging Decoction) to vigorously purge the bowels. The patient recovered. (From *Bencao Gangmu*.)
Yao Meng, courtesy name Yizheng, was once asked by Governor Zou Laixue to diagnose his pulse. After describing the origin of the disease, Yao said, "Your Excellency has an orifice near the genitals that secretes sweat." Zou Laixue was greatly surprised and asked, "How could you know this hidden ailment?" Yao replied, "I deduced it from the pulse. The left Guan position is slippery and slow, indicating a hole in the fourth lobe of the liver connecting downwards." Zou Laixue changed his expression and thanked him. (Xu Lingtai's note: It is correct that the left Guan position corresponds to the liver, but why does slippery and slow indicate a hole and specify its location in a certain lobe? These are exaggerated praises in historical records; why include them?)
Xue Lizhai treated a woman suffering from swelling and stifling sensation in the vagina, difficult and obstructed urination, pain in both hypochondria, internal heat, afternoon fever, irregular menstruation, and occasional chills and fever. This was due to depression and anger affecting the Liver and Spleen, sinking of Yuan Qi, and stagnation of damp-heat. In the morning, Guipi Tang (Restore the Spleen Decoction) was administered with Chai Hu (Bupleuri Radix) and Sheng Ma (Cimicifugae Rhizoma) to resolve stagnation, tonify Spleen Qi, and raise Yuan Qi. In the evening, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) was used to clear Liver fire, generate Liver blood, and dispel damp-heat. After several doses of each, all symptoms resolved. Later, Sijunzi Tang (Four Gentlemen Decoction) combined with Shaoyao (Paeoniae Radix), Danggui (Angelicae Sinensis Radix), and Mudanpi (Moutan Cortex) was used to regulate and tonify the Liver and Spleen, resulting in regular menstruation.
Another woman suffered from coldness in the vagina, yellow and obstructed urination, internal heat with external cold, bitter taste in the mouth, and distension in the hypochondria. This was caused by damp-heat in the Liver channel. Longdan Tang (Gentian Decoction) was used to drain damp-heat, and Jiawei Xiaoyao San was used to regulate and tonify Qi and Blood, leading to recovery.
Another woman had the same condition as above, accompanied by chills, fever, vomiting, and swelling and pain in both eyes. Xiao Chaihu Tang (Minor Bupleurum Decoction) with Zhizi (Gardeniae Fructus) was administered first. After one dose, chills, fever, and vomiting stopped immediately. Then, Longdan Xiegan Tang (Gentian Liver-Draining Decoction) was given. After one dose, swelling and pain disappeared immediately.
A woman suffered from coldness in the vagina, clear and cold urine, coldness in the abdomen, loss of appetite, loose stools, and deficiency-cold of the Lower Origin. She was treated with Bawei Wan (Eight-Ingredient Pill). After one month, her diet gradually increased, and stools became formed. After another month, all symptoms resolved.
A woman suffered from prolapse and swelling of the vulva, stifling pain with discharge, discomfort in the chest and abdomen, frequent urination, internal heat, afternoon fever, bitter taste in the mouth, and tinnitus. This was a Fire syndrome of the Liver and Spleen. Xiao Chaihu Tang was combined with Cheqianzi (Plantaginis Semen), Dancao (Scutellariae Radix), Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma), and Sheng Ma. After two doses, there was slight improvement. Jiawei Xiaoyao San with Sheng Ma was then used. After several doses, she gradually improved. Then, Jiawei Guipi Tang with Sheng Ma and Chai Hu, along with Buzhong Yiqi Tang (Middle-Boosting and Qi-Enhancing Decoction) with Zhizi, was administered. After several doses, she recovered instantly. She continued to use Jiawei Xiaoyao San and Jiawei Guipi Tang for regulation until full recovery.
A woman suffered from hot pain in the genitalia as described previously. Someone used cold-natured detoxifying herbs, which damaged digestion, causing inability to eat, nausea, and a heavy sensation in urination. This indicated further damage to the Spleen and Stomach and sinking of Yuan Qi. Buzhong Yiqi Tang with Paojiang (Prepared Ginger) was administered first. After two doses, the heavy sensation resolved. Fuling and Banxia (Pinelliae Rhizoma) were added. After more than twenty doses, she recovered. Finally, Guipi Tang with small amounts of Chai Hu and Sheng Ma, along with Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia), was used for recovery.
Sun Wen yuan treated a woman during the summer months who suffered from difficult and painful urination, swelling of the external genitalia, hematochezia, fever, a wiry and rapid pulse on the left, and a short and weak pulse at the right Cun position. This was insufficiency of Lung Qi and excessive blazing of Liver Fire. Since the Liver is the Sea of Blood and governs the drainage of urine and feces, and the external genitalia are connected to the Liver channel, treatment should focus on resolving the stagnation in the Liver channel. When Spleen Qi flows freely, new blood returns to its vessels; when heat resolves, urination becomes unobstructed, and swelling subsides. Shihuashi (Talcum) 3 qian, Taoren (Persicae Semen), Danggui, and Baishao (Paeoniae Radix Alba) 1 qian each, Chai Hu, Huanglian (Coptidis Rhizoma), and Renshen (Ginseng Radix) 8 fen each, Chuanxiong (Ligustici Chuanxiong Rhizoma) 6 fen, Gancao (Licorice Root), Guizhi (Cinnamomi Ramulus), and Baizhi (Angelicae Dahuricae Radix) 3 fen each were prescribed. After four doses, the illness was cured.
The wife of Ma Fenglin had a hidden ailment: every time her menstrual period arrived, a swollen boil would appear beside the uterus, causing distension but no pain. After three to five days, it was pierced with a red-hot silver hairpin, draining about a cup of white pus, after which it subsided without scarring or need for plasters. Initially, needles were used; recently, fingers were used to squeeze out the pus. It recurs only during menstruation, appearing anywhere around the uterus but not far from it. This had persisted for eight years, resisting all internal and external treatments, and causing infertility. Sun Wen yuan said, "This is damp-phlegm from the Middle Jiao flowing down with the menstrual blood and stagnating in the uterus. As the blood flows and phlegm condenses, it transforms into pus. It is originally not toxic, hence the lack of pain. (Strange diseases are often due to phlegm.)" Bai Luosi Ke (Concha Melongena) calcined was used as the chief ingredient, with Nanxing (Arisaematis Rhizoma Preparatum) and Banxia as ministers, Chai Hu and Gancao as assistants, formed into pills with Qu paste (fermented dough). Taken morning and evening, the swelling ceased during menstruation before the course was finished. The following year, she conceived. (Yu Dongfu says: Master Sun's insight is unparalleled. Since it is not toxic, there is no pain. This is also a profound statement on investigating things to acquire knowledge.)
A woman had a hidden ailment. Her husband visited twice without speaking, then blushed when he tried to speak. Sun Wen yuan encouraged her, and she bowed her head, saying, "I fear I will be laughed at by your long life. My daughter-in-law suddenly grew something in her uterus. Initially three cun long, now about five cun, resembling a hard tendon, red in color, large enough to grasp with both hands, swollen and painful, making movement difficult. She suffers from aversion to cold and high fever, loss of sleep and appetite, and is too ashamed to speak. She wanted to commit suicide but hesitated for a hundred days." Sun Wen yuan said, "This is Yin Tuo (genital prolapse). The Jueyin Liver channel connects downward to the vaginal opening in women. Damp-heat causes prolapse, just as damp-heat on trees causes mushrooms to grow." He prescribed Longdan Xiegan Tang and a powder containing Danggui, Huangqin (Scutellariae Radix), Muli (Concha Ostreae), [missing character] pi, and Chi Shao (Paeoniae Radix Rubra). Two qian were taken on an empty stomach with rice water. Months later, she reported that the previous symptoms had indeed healed, but her period was delayed by a month. He replied, "This is pregnancy." They doubted she could conceive so soon after illness. He explained, "The previous illness was an excess syndrome of the Liver channel. The Liver is the Sea of Blood; abundant blood leads to conception. Abundant blood usually causes early periods; a delayed period indicates pregnancy, not disease." She subsequently gave birth to a healthy baby at term.
Shang Mou said, "Previously in eastern Guangdong, I was close friends with Li Mou, the prefect. After Li died, his wife sold their house on Haopan Street and moved next door to me. We interacted like relatives. One day, Mrs. Li whispered to my wife that her daughter, now of marriageable age, was ill with a strange condition. She wanted Shang to treat her but found it hard to ask. My wife told me, 'You were close friends with Mr. Li; what harm is there in asking?' Mrs. Li then said her daughter initially had abdominal pain, which later led to severe difficulty in urination. Objects capable of swimming were found in the urine, either two or three, resembling scales and fins. Upon examination, they were half-bodies of flounder, slightly black, with only one eye and a white back. Placed in water, they swam as described. Pulse diagnosis revealed long-standing Liver Qi stagnation. Prescribing herbs to soothe the Liver cured her. Li was from Henan." (From *Yiju Lu*.)
A widow suffered from vaginal itching, which she could not tell anyone about, leading to gradual debility. She devoutly worshipped Guanyin Bodhisattva. Suddenly, a nun came and gave her a packet of medicine, saying, "Wash with this." After several washes, she recovered. The medicine consisted of Chuansuanzi (Cnidii Fructus), Wuzhuyu (Evodiae Fructus), and Kushen (Sophorae Flavescentis Radix). (From *Cailan Zazhi*.)
Heshouwu (Polygoni Multiflori Radix) was originally named Yejiaoteng (Night-Joining Vine), named after Heshouwu who took it. Heshouwu was a man from Nanhe County, Shunzhou. His ancestor, Tian'er, was born impotent and weak. At fifty-eight, he was unmarried. While drunk in the wild, he saw two vines growing separately in a field, their stems intertwining and then separating and rejoining several times. Intrigued, Tian'er dug up the roots and asked villagers, but no one recognized them. He dried and powdered the roots, taking them with wine. After seven days, he regained sexual desire; after one hundred days, his old ailments were cured. Ten years later, he fathered several sons and changed his name to Nengsi. He and his son Ting lived to 160 years. Heshouwu himself lived to 130. In the 7th year of Yuanhe (Tang Dynasty), Zeng Wenxiang met an elder from Maoshan, who transmitted this story. Li Ao wrote in *Fanglu*: "This is a chance encounter with a spiritual substance, hence its extraordinary effect, which is within reason." He Lianchen, Prefect of Jun, was proficient in medical theory. He claimed to have seen several people consume shaped Heshouwu, which indeed darkened hair and prolonged life. He also purchased Luzhu Shen (Codonopsis Radix) weighing 12 liang in Henan and Danggui weighing over 1 jin in Shaanxi, both showing exceptional effects. He personally gathered Shashen (Adenophorae Radix) in the mountains of Xiling, as large as a baby's arm. Peeling off the black outer skin revealed flesh white as jade. Chewing one stem was sweet, fragrant, fresh, and crisp, clearing the head and eyes. These substances, growing in remote valleys, absorb the spirit of heaven and earth, thus achieving effects beyond ordinary herbs. Only those without fate cannot encounter them. (From *Gquan Zui Can Lu*.)
Tang Jing, a wealthy young man, developed a sore on his genitals that rotted away the penis. Zhou Shouzhen said, "The disease arises from suppressed sexual desire." Treatment should involve internal administration of Longdan Xiegan Tang and external application of Gancao (Licorice Root) powder. (From *Yanshou Shu*.)
A man suffered from coldness in the genitals spreading inward, with a swollen and full scrotum, causing day and night pain and stifling sensation. Fine Sichuan pepper (Chuanjiao) was powdered, wrapped in silk, and applied to the scrotum. If not warm enough, it was reheated and reapplied. Internally, a decoction of Daji (Leonuri Herba) was taken with good results. For cold genitals with ice-like testicles, sweating, and flaccid legs, Bugan Tang (Tonify Liver Decoction) was indicated. (From *Qianjin Fang*.)
Wang Jiezhai said, "Impotence in men is often attributed in ancient formulas to decline of Mingmen Fire and weakness of ancestral Qi, which is true. However, some cases are caused by excessive stagnant fire. The Classic states: 'Blazing fire consumes Qi.' Just as people feel fatigued in summer heat but strong in winter cold. I have personally seen cases of Kidney channel stagnant fire causing impotence, which responded well to Huangbai (Phellodendri Cortex) and Zhimu (Anemarrhenae Rhizoma) to clear Kidney fire. Therefore, careful differentiation is necessary; do not assume all cases are due to fire decline."
Xue Lizhai treated a woman with expectoration, fever, generalized body pain, frequent urination, vaginal itching, and severe afternoon fever. He said, "This is deficiency of Qi and Blood in the Spleen and Liver, with Qi stagnation complicated by damp-heat." Jiawei Xiaoyao San with Cheqianzi (Plantaginis Semen) cured her.
Ma Yuanyi treated the nephew of You Hui, who suffered from penile pain. The pain was severe and frustrating, leading to unconsciousness for months. The pulses on both sides were floating, deficient, and choppy. Floating indicates Qi deficiency; choppy indicates Essence injury, causing pain. This is a pattern of dual deficiency of Yin and Yang, caused by worry, thought, fatigue, and depression damaging the Middle Jiao. The Classic states: "Moistening the sinews requires Yang Qi; Essence nourishes the Spirit, and softness nourishes the sinews." Now, depression and fatigue have damaged both Qi and Blood, causing pain. Danggui Buxue Tang (Danggui Tonifies Blood Decoction) with Renshen and Zhi Gancao (Honey-fried Licorice) was used to regulate Qi and Blood. Guixin (Cinnamomi Cortex), Qinjiao (Gentianae Macrophyllae Radix), and Honghua (Carthami Flos) were added to promote blood circulation. After one dose, the pain stopped. On follow-up, the pulses were deep and minute. Large doses of Renshen and Fuzi (Aconiti Lateralis Radix Preparata) were administered continuously. All symptoms subsided except for insomnia, which was resolved with Guipi Tang.
A man with scrotal swelling was treated with red clay applied externally and Bawei Wan internally, resulting in recovery. A child with similar swelling was also cured with red clay. If chronic swelling occurs and is incurable, moxa should be applied urgently to Shuifen (CV9). Shuifen separates water and grain. Failure to separate them causes swelling in the genitals and other areas. Yuyuliang (Halloysitum Rubrum) should be taken urgently. (From *Jixiao Fang*.)
Chen Liangfu's maid suffered from genital ulceration. Treatment by wound specialists failed. The ulcers were half-cun deep. Chen found a Gancao Tang formula in *Juanzi Fang* and used his own Ranshedan San (Rattlesnake Gallbladder Powder). Within seven days, the ulcers healed. It was very effective. He saved eighteen people instantly. Those encountering this disease should spread this method.
Ge Shi said: "Recently, I saw patients with swelling and pain at the glans penis, with ulcers threatening to sever the organ. Washing with pork broth and applying powders of Huanglian and Huangbai was effective. Another formula uses honey-fried Gancao powder applied topically." (From *Qianjin Fang*.)
Lizhai treated a woman with dripping purulent fluid from the vagina, alternating itching and pain, feeling like insects crawling. The Shaoyin pulse was slippery. This indicated an ulcer in the vagina, named [missing character]. It was caused by mental distress, weak Stomach Qi, and stagnation of Qi and Blood. Shengma, Baizhi, Huanglian, Mutong (Akebiae Caulis), Danggui, Chuanxiong, Baizhu, Fuling, and Chai Hu were decocted and taken. Tuozhong Tang (Expand Swelling Decoction) was used for fumigation and washing, and Pulver (Realgar) mixed with Mercury was applied. After more than two months, she recovered. If the Bao Luo (uterine ligaments) are deficient, wind pathogens may invade the Yin, causing Qi and Blood conflict, obstruction, and genital swelling/pain. Shichangpu (Acori Tatarinowii Rhizoma) should be used. Additionally, Zhishi (Aurantii Fructus) heated and wrapped in cloth can be used for warming compresses; repeat if cool. If the Zi Zang (uterus) is deficient, cold Qi rushing downward can cause prolapse (Xia Tuo), possibly due to strain during childbirth. Danggui San (Angelica Powder) treats this. For chronic cases, Buzhong Yiqi Tang with increased Shengma and Chai Hu raises the Qi.
The old man from Qige suffered from penile swelling and pain. Wuling San (Five-Ingredient Powder) and other medicines were ineffective. The left Guan pulse was wiry and rapid, indicating damp-heat in the Liver channel. Luohua Wan (Aloe Pill) was sent down with Xiao Chaihu Tang. After one dose, symptoms reduced by three or four parts; after a second dose, complete recovery occurred.
A woman suffered from vulvar swelling and pain, obstructed urination, and alternating chills and fever in the evening. This was caused by damp-heat in the Liver channel. Xu Lingtai said, "This is a mild damp-heat condition." Longdan Xiegan Tang was used. After two doses, urination became smooth. Siwu Tang (Four-Substance Decoction) combined with Xiao Chaihu Tang, plus Huafen (Trichosanthis Radix), Mutong, and Zhizi, cured her. (From *Waike Zhengzong*. Six cases selected below.)
A woman had unexplained fever for over a month, then suddenly protruded a mass from the vagina resembling a chicken comb. This was due to Liver stagnation and Spleen deficiency. Buzhong Yiqi Tang with Qingpi (Citri Reticulatae Pericarpium Viride), Zhizi, Huangqin, Chai Hu, and Gancao was administered. Externally, Baizhi, Cangzhu, and Zisu (Perillae Folium) decoction was used for daily fumigation and washing. After ten days, the lesion gradually shrank. The previous decoction with doubled Renshen and Baizhu was used for a month until stability. (Xu Lingtai notes: "All formulas used are superficial and lack methodology. Although providing minor benefit, they do not address the root cause. Since Lizhai opened this trend, it has become irreversible. This marks a change in medical practice.")
A woman suffered from vaginal itching, five-palm heat at night, thirst, and insomnia. This was due to excessive thinking causing disharmony between Heart and Kidney. Siwu Tang with Longdancao (Scutellariae Radix), Zhizi, Zhimu, and Huanglian was used. Yinxing San (Ginkgo Powder) was inserted vaginally. After three days, itching subsided. In the morning, Bawei Wan was taken; at noon, Guipi Tang with Yinchaihu (Cistanches Herba) and Yichen (Artemisiae Scopariae Herba) was used. Recovery occurred after a month.
A woman suffered from unilateral vulvar swelling and pain, chills, fever, dry mouth, constipation, and a strong, forceful pulse. Neishu Huanglian Tang (Interior-Purging Coptis Decoction) was administered. After one dose, bowel movements became free, and dry mouth stopped. However, swelling and pain worsened, indicating accumulation of damp-toxin intending to form pus. Siwu Tang with Jiaoci (Urticae Flos) and Zexie was used. After two doses, pus matured with distending pain. Tou Nong San (Penetrating Pus Powder) was administered, expelling foul pus. Pain stopped. Bazhen Tang (Eight-Treasure Decoction) with Mudanpi and Zexie was used for over ten doses until recovery.
A woman with damp-wind in the Liver channel flowing down to the genitals suffered from edema and severe itching, scratching until bleeding without pain. Xiaofeng San (Wind-Expelling Powder) with Kushen, Dancao, Zexie, Mutong, and Zhizi was used. Externally, Chuansuizi decoction was used for fumigation, and Yinxing San was applied. After over ten doses, itching stopped, and swelling subsided.
A widow of over ten years suffered from vaginal itching with worms, enduring it silently. Later, the genitals ulcerated, eroding the internal organs. She became emaciated, febrile, thirsty, with a flooding and rapid pulse. Asking about the long-standing itching and pain, the genitals were black and rotting, with incontinence. The internal organs were destroyed, and medication was deemed useless. She begged for treatment. I said, "Itching is due to worms; pain is due to damage." First, several crucian carps were seasoned, roasted, wrapped in thin silk, and inserted into the vagina. After holding for a while, red worms were extracted: long ones one cun, short ones five to six fen, thread-like, about twenty in number. Placed in warm water, they wriggled before dying. The family rejoiced, thinking it curable. I said, "More will appear; generation is endless." Forced administration of blood-nourishing herbs ultimately failed, and she died.
Qian Guobin said: "In Zhehu, the Dai family had a five-year-old daughter born with double genitals. Urine exited from the upper orifice, and stool from the lower. Her mother, ill, consulted me privately. I said, 'This girl is born with double genitals. Have you not heard the *Lankavatara Sutra* mention five types of hermaphrodites? This is one type. When she matures and menstruates, she will bear children normally. Consider the upper orifice as primary. Do not doubt; raise her for marriage.'"
For lax vagina: Soap nuts soaked to remove black skin, using the white flesh, combined with Baiji (Bletillae Rhizoma), Wubeizi (Terminalia Chebulae Retardatae Fructus), Chuansuizi, Shiliupi (Punicae Cortex), Gansong (Nardostachyos Radix et Rhizoma), Santai (Kaempferiae Galangal Rhizoma), and Longgu (Os Draconis). Decoct into a thick liquid for daily fumigation and washing. If lax and cold, add Shiliuhuang (Sulfur).
For prolapse: Feifan (Calcined Alum) 6 liang, Taoren 1 liang, Wuweizi (Schisandrae Fructus) and Xionghuang (Realgar) 5 qian each, Tonglv (Verdigris) 4 qian. Powdered and formed into honey pills, each weighing 4 qian. Coated with Realgar from the formula. Inserted vaginally. Cure achieved; severe cases require no more than two insertions.
Xu Lingtai's Note: In autumn of the Gui Mao year, I treated Vice-Transport Kang Hou. The pulse was slippery and rapid, with intermittent right pulse and hurried left pulse. The Liver area showed Quezhao (Sparrow-pecking) pulse, and the Qi Kou showed Jiesuo (Untying Rope) pulse. Complexion was sallow-yellow, with spontaneous head sweating, coarse and labored breathing seemingly disconnected, restlessness sitting or lying, difficult and turbid foul-smelling urination, hardness and tenderness under the heart like an inverted bowl, purple-yellow tongue edges not very dry, sweet and greasy bad breath, inability to eat, shortness of breath upon closing eyes, and unbearable irritability with chest oppression. This was mistreatment with tonics for damp-heat, blocking Qi mechanism, congealing fluids into Phlegm-Fluid. Wendan Tang (Warm Gallbladder Decoction) with Xiebai (Allii Macrostemonis Bulbus) and Louren (Trichosanthis Semen) was used to open Yang in the chest; combined with Xiaoxianxiong Tang (Small Trap in the Chest Decoction) for treating Phlegm-fluid痞; Zhizi and Chiyazi (Perillae Fructus) were added to vent long-standing depression and relieve oppression; Lancao (Euphorbiae Humifusa Herba) assisted to cleanse stale Qi and awaken Spleen/Stomach. Two doses reduced symptoms and harmonized the pulse. Impatient, the patient took Dahuang Wan (Rhubarb Pills) twice and half a dose of Chengqi Tang. I urgently stopped him, saying: "Tonifying is wrong, but reckless purging is also a mistake. This case involves damp steaming into heat, burning fluids into phlegm. Upper and lower separation is appropriate, unlike heat pathogens transmitting to Fu organs which can be cleared in one sweep." The next day, lower body swelling appeared, violating the warning against too-rapid purging of痞. Huangqin was added to the previous method, combined with Xiexin Tang (Drain Heart Decoction) intention, and Xuegeng Tang (Snow Soup) matched. Administration gradually reduced痞 and expelled phlegm, but swelling progressed from abdomen to feet and scrotum. I considered Hejian's Guiling Ganlu Yin (Guiling Sweet Dew Drink) or the theory of strengthening Earth to overcome dampness. I firmly opposed this and resumed the previous prescription. The next day, significant blood appeared in phlegm. This indicated damp-heat steaming from Qi to Ying levels. Zhimu, Huangbai, Shengdi (Rehmanniae Radix), Xijiao (Rhinocerotis Cornu - substituted with Buffalo Horn), Biejia (Testudinis Carapax et Plastrum), Baishao, Yiren (Coicis Semen), Beimu (Fritillariae Thunbergii Bulbus), Shihu (Dendrobii Caulis), Maogen (Imperatae Rhizoma), Maidong (Ophiopogonis Radix), Huashi (Talcum), Zhizi, Oujiang (Zizei Juice), and Tongbian (Child's Urine) were administered, stopping the bleeding. Days later, vomiting recurred with cold limbs, spontaneous sweating, and fear of collapse. Family panicked, suggesting Guipi Tang. I insisted on the previous plan, administering two more doses. Bleeding stopped. I reasoned that recurrent bleeding was due to Qi-level pathogens disturbing Ying level. To clear Qi-level pathogens, the phlegm adhering to them must be removed first. Gun Tan Wan (Rolling Phlegm Pill) 3 qian was given, resulting in one bowel movement, described by the patient as the most畅通 (free flow) in forty days. Continued administration for several days resulted in passage of sticky black stools and clearer, longer urination. Sleep and appetite improved. Lower body swelling remained. Some suggested Shipai Xingshui (Solidify Spleen and Promote Water) method. I said: "Carefully examining pulse and symptoms, the disease is not in the Spleen. Moreover, with hunger, dry stools, greasy mouth, and polyuria, we fear conversion to Xiaohe (Consumption-Thirst) syndrome. We hasten to administer sweet-moistening agents; how can we use diuretics to injure Yin or drying tonics to rob fluids? The swelling comes from damp-heat brewing..."