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VAGINAL ITCH, PRURITIS VULVA

GENERAL

Clinical Manifestations	Persistent itching of the vulva and / or vagina May be excessive vaginal discharge
Treatment Principle
Herb Formulas	For vulvar itch with ulceration: Vulvar Itch #1 Topical: 1. She Chuang Zi San 2. Grind 3g Pulvis Concha Meretricis/Cyclinae Ge Qiao into a fine powder. Apply to the external genitalia. Use 1-2 times per day for 10 days. 3. Decoct 1 bulb of garlic and use as a fumigant and wash for 10 days. For pruritis vulva due to trichomonas vaginitis: Decoct 10g Sm. Cnidii She Chuang Zi, 10 grams Cx. Phellodendri Huang Bai and 6g Alumen Ming Fan and use as a wash. For pruritis vulva due to haemophilus vaginitis: Decoct 15g Cx. Pseudolaricis Tu Jing Pi, 15g Rx. Sophorae Flavescentis Ku Shen and 2g Borneolum Bing Pian and use as a wash
Points	For general itching, aching, pain fatigue, tired limbs and dribbling urination: LIV-1, REN-3, REN-4, SP-10, UB-31, UB-32, UB-33, UB-34, UB-40, UB-67 For Heat vexation with extreme itching: + HT-8, LIV-2 For Damp-Heat: + Baichongwo, SP-9 For itching of the external genitalia: 1. LIV-5, LIV-11, REN-3, SP-9, SP-10 2. LIV-8, SP-6, UB-67 3. LIV-11, REN-1, REN-2, SP-6, SP-9

WIND-DAMP-HEAT

Clinical Manifestations	Itching can be severe. Sparsely or densely distribute papules on flushed skin Desquamation after scratching Mild erosion Flushed skin Papules Blisters Erosion Effusion Thick yellow crusts
Treatment Principle	Eliminate Wind Clear Heat Dispel Damp
Herb Formulas	Topical: Ta Yang Tang
Points	LIV-3, REN-3, REN-7, SP-6, SP-9 Secondary points: + REN-4, REN-6, UB-67 With Spleen and Kidney Deficiency: + ST-36, UB-23 With low back soreness and pain: + GB-26, UB-32, UB-52 With unbearable itching of the genitalia + LIV-8

SPLEEN NOT GOVERNING BLOOD

Clinical Manifestations	Sallow or pale complexion Anorexia Four limbs feel tired and heavy Physical and mental exhaustion Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose or unformed stools Shortness of breath Dizziness Palpitations Functional Uterine Bleeding Purpura Epistaxis Hemafecia Hematuria Menorrhagia Metrorrhagia Vaginal itching T: Pale and flabby - may have teethmarks C: White P: Thready and weak
Treatment Principle	Benefit Qi Conserve Blood
Herb Formulas	Bu Zhong Yi Qi Tang modified
Points	SP-1, SP-3, ST-36, UB-20 For Deficiency type uterine bleeding: DU-20, LI-11, REN-4, SP-4, SP-10, SP-14, UB-17

LIVER QI STANATION WITH HEAT

Clinical Manifestations	Itching of the external genitalia Irritability Short temper Restlessness Fever or tidal fever Red eyes Dry mouth and throat Palpitations Lower abdominal pain Difficult urination Painful urination Increased menstrual flow Uterine bleeding Early menstruation Aching in limbs Dizziness Mental instability Red face Thirst Turbid urine Alternating chills and fever Red cheeks Wheezing Nervousness Headache Dry mouth Anorexia Infertility Abdominal pain Spontaneous sweating or night sweats with fever Anxiety Dry eyes Hypochondriac pain Somnolence Insomnia Aching shoulders Five Sole Heat Earache Premenstrual tension Hot flashes Fatigue Lassitude Depression Constipation with flushing up Pale complexion Bitter taste in mouth Vertigo Abdominal distention near the umbilicus Epistaxis Irregular menstruation Heaviness in the lower abdomen T: Red or Red edges C: Thin and yellow P: Thready, rapid and wiry or Wiry and tight and rapid
Treatment Principle	Clear Heat Eliminate Dampness Kill parasites
Herb Formulas	Jia Wei Xiao Yao San modified
Points

DAMP-HEAT IN THE LIVER CHANNEL

Clinical Manifestations	Persistent hot itching of the vulva and / or vagina Profuse yellow, thick and smelly discharge Red vulva with fluid covering Hypochondriac pain Headache Dizziness Red sore eyes Hearing loss Swelling in the ears Bitter taste in the mouth Irritability Short temper Difficult and painful urination with a heat sensation in the urethra Swollen and itchy genitalia Short menstrual cycle with reddish-purple blood Ear discharge Yellow urine Chest pain Constipation Turbid urine Dry throat Hematuria Pain in the armpits Sweating in the groin T: Red or Red edges C: Yellow or Yellow and greasy P: Wiry, Excess and rapid
Treatment Principle	Clear Damp-Heat from the Liver channel
Herb Formulas	Long Dan Xie Gan Tang modified With more Heat than Dampness: Long Dan Xie Gan Tang With more Dampness than Heat: Bei Xie Fen Qing Yin Topical: San Huang Xi Ji
Points	LIV-3, LIV-5, REN-2, REN-3 With profuse vaginal discharge: + SP-9, ST-29

LIVER AND HEART FIRE

Clinical Manifestations	Persistent itching of the vulva and / or vagina May be excessive vaginal discharge Neurosis Worse at night Ulceration, erosion, and pain of mouth and tongue Thirst with a desire for cold drinks Irritability Feeling of Heat and disturbance in HT Insomnia Flushed face Bitter taste in mouth Severe, splitting headaches with dizziness Sudden tinnitus or deafness Flushed face Red, swollen, painful eyes Irascibility with violent angry outbursts Dry mouth Vomiting sour or bitter liquid Insomnia Restlessness Constipation or dry stools Maybe rib pain T: Red tip, ulcers especially on tip or Red tip and edges C: Thick, yellow, dry and rough P: Excess and rapid
Treatment Principle	Clear Heart Clear Liver Purge Fire
Herb Formulas	With Liver symptoms more prominent: Jia Wei Xiao Yao San With Liver symptoms more prominent: Gui Pi Tang modified
Points	GB-12, GB-34, GB-37, HT-7, HT-8, LIV-2, PC-7, PC-8, UB-15, UB-18, UB-19

LIVER AND KIDNEY YIN DEFICIENCY

Clinical Manifestations	Persistent itching of the vulva and / or vagina Worse at night Night sweats Dry mouth and tongue Lower back and knee pain Urinary difficulty Weakness of the lower back, knees and extremities Steaming bones Light-headedness Vertigo Tinnitus Diminished hearing Five sole heat Chronic dry, sore throat Toothache Wasting and thirsting disorder (Xiao Ke) Dizziness Muscular weakness Irritability	Dry skin Deafness Spontaneous and nocturnal emissions Tidal fevers Loose teeth Dripping urine Thirst Swollen gums, painful and light red in color Numbness and weakness at the waist and knees Heel pain Urinary incontinence Pain at midline and in lower back Sore throat T: Red C: Little or None or or Yellow P: Thready and rapid (large at the Kidney positions)
Treatment Principle	Nourish Yin Clear Heat
Herb Formulas	Zhi Bai Di Huang Wan modified With Jing and Blood Deficiency: Zhi Bai Di Huang Wan modified
Points	UB-23, UB-18, KI-3, LIV-3, SP-6 KI-7, KI-12, LIV-5, REN-2, SP-6

BLOOD DEFICIENCY

Clinical Manifestations	Persistent itching of the vulva and / or vagina Worse at night Weakness Blurred vision Dizziness Pale face Insomnia Anxiety Forgetfulness T: Pale C: White P: Thready and deep
Treatment Principle	Tonify Blood
Herb Formulas	Yang Xue Sheng Feng Tang
Points

DAMP-HEAT IN THE LOWER JIAO

Clinical Manifestations	Itching and pain of both the inside and outside of the vagina which is difficult to bear Abdominal pain due to Blood Stasis Vaginal discharge which is foul-smelling and purulent Uterine bleeding Bleeding hemorrhoids (slight) Fever Thirst A preference for cold drinks Five-Sole-Heat A dry throat A stuffy oppressed chest A red face Heart vexation Periumbilical pain Vaginal bleeding with dark Blood and clots Prolapsed rectum Anal ache Yellow, watery exudate Swelling Dry stools Constipation Severe local pain T: Red C: Yellow P: Slippery and rapid
Treatment Principle	Clear Heat Drain Stagnation Cool the Blood Resolve toxicity Remove Damp-Heat in the lower abdomen
Herb Formulas	Yi Zi Tang Bei Xie Sheng Shi Tang Long Dan Xie Gan Tang Medicinal wine: Ku Shen Wei Pi Jiu
Points

TOXIC HEAT

Clinical Manifestations	Pain and itch both inside and outside the vagina which is difficult to bear Watery, yellow exudate Possible bloody Fluid exudate Heart vexation Thirst with a preference for cold drinks Dry mouth Possible alternating Heat and Cold Constipation Feces possibly gluey and sticky Muddy, turbid urination Internal vagina swollen and distended Red face T: Red C: Yellow and greasy P: Wiry and slow or Wiry and rapid
Treatment Principle	Clear Heat Resolve toxicity Eliminate Dampness
Herb Formulas	Qing Re Jie Du Qu Shi Tang
Points

TOXIC DAMP-HEAT

Clinical Manifestations	Thick yellow or green vaginal discharge Discharge may be mixed with Blood May have a fishy stench Vaginal ulceration Itch Short, red urine Bitter taste in the mouth Dry throat T: Red C: Yellow P: Slippery and rapid
Treatment Principle	Clear Heat Resolve Toxins Resolve Dampness Stop discharge Stop itch
Herb Formulas	Jia Wei Dai Xia Tang Qing Gong Li Dai Tang Douche: Dai Xia Quan Xi Qi
Points

PARASITES

Clinical Manifestations	Persistent itching of the vulva and / or vagina Yellow pus or discharge
Treatment Principle	Kill parasites
Herb Formulas	Zhi Dai Tang Topical: She Chuang Zi San
Points