bubble_chart Concept

Vaginal pain refers to the symptom of pain occurring on the inner side of the thigh, which can be unilateral or bilateral. Due to the connection of the Jingmai, it often affects the vulva.

As far back asNeijing, there are records of vaginal pain, such as in the Lingshu．Jingjin chapter, which states: "The sinews of the Foot Taiyin... ascend along the inner thigh, knot at the hip, and gather at the genitals." It also says: "Its disease... the inner thigh pulls the hip and causes pain, and the genitals twist in pain." This condition is frequently discussed in medical cases throughout history, and clinically, cases with vaginal pain as the main symptom are not uncommon. Once the disease occurs, it is often very stubborn, with a prolonged course, and over time, it may be accompanied by weakness and flaccidity of the lower limb muscles. Bilateral vaginal pain involving the vulva has a very special pain area, forming a saddle-shaped pain zone.

Numbness of the inner thigh is different from pain in the inner thigh; the former involves skin that does not feel pain or itch, while the latter has normal sensation. However, sometimes pain in the inner thigh is accompanied by numbness, and the skin does not feel pain or itch. In cases of severe numbness, the numbness may feel like pain, making it difficult to distinguish between the two. However, by determining which came first, numbness or pain, and which is predominant, they can be differentiated and treated accordingly.

bubble_chart Pattern Analysis

1. Dampness-heat︰The symptoms include cutting and burning pain in the groin, often extending to the external genitalia, accompanied by hiding fever, heavy and fatigued limbs, a puffy and swollen face, and in women, there may be reddish yellowish leukorrhea. Additionally, redness and swelling of the painful area or yellow discharge from the external genitalia may occur, often accompanied by numbness of the skin. If bilateral, it forms a saddle-shaped area of pain and numbness. The tongue is red, swollen, and large with a yellow, greasy coating, and the pulse is slippery and rapid. Over time, lower wilting impediment and weakness may appear, along with painful and difficult urination or dribbling. This is mostly caused by external contraction of dampness-heat pathogens, where dampness-heat accumulates in the three yin meridians of the foot, leading to blocked meridians and resulting in pain. In cases of dampness-heat, the groin exhibits cutting pain that is slightly relieved by cooling, and women may have reddish yellowish leukorrhea. In cases of cold-dampness, the groin shows spasmodic and constricting cold pain that is relieved by warmth, and women may have thin and clear leukorrhea. For dampness-heat cases, there is body heat, a red tongue with a yellow, greasy coating, and a slippery, rapid pulse. For cold-dampness cases, there is aversion to cold, a pale, swollen tongue with a white, thick, greasy coating, and a deep, slow pulse. For dampness-heat invasion, use methods to clear heat, dry dampness, and harmonize the collaterals. The formula Two Wonderful Herbs Powder with modifications can be used, incorporating herbs such as Coix Seed, Skullcap Root, Achyranthes Root, Hypoglaucous Yam, Suberect Spatholobus Stem, Salvia, Sichuan Lovage Rhizome, Earthworm, Alisma, and Indian Bread Tuckahoe, among others. For cold-dampness invasion, use methods to warm the meridians, drain dampness, and harmonize the collaterals. The formula Stomach Poria Decoction or Dehumidification Decoction with modifications can be used, optionally adding Cinnamon Twig, Aconite Lateral Root, Earthworm, etc.
2. Cold-dampness Invasion︰Cold pain in the groin with spasms or cramping, accompanied by a heavy sensation in the head as if wrapped, fatigue and heaviness in the limbs, dull complexion, facial puffiness, pale and cold hands and feet. Women may also experience thin and clear leukorrhea, and some patients may develop numbness of the skin. A few patients may develop yin abscesses on the inner thighs, which can also affect both groins, causing numbness and pain. Over time, swelling of the feet and weakness in both lower limbs may occur. The tongue is enlarged, pale or dull, with a thick, greasy white coating, and the pulse is deep, slippery, and slow. This is due to the invasion of external contraction cold-dampness or prolonged illness leading to the decline of yang qi, causing cold-dampness to stagnate in the meridians, resulting in pain due to obstruction. Both dampness-heat and cold-dampness blocking the meridians can lead to numbness.
3. Qi Deficiency and Blood Stasis︰Chronic qi deficiency, pale complexion, pale lips and nails, pale tongue, aversion to wind with spontaneous sweating, shortness of qi with reluctance to speak, mental fatigue, stabbing pain in the groin, or possible numbness, pale skin, loss of body hair, or dark red and rough skin, thin and choppy pulse, may be accompanied by urinary incontinence. Often due to chronic qi and blood deficiency, meridians lacking nourishment leading to sluggish blood flow, resulting in static blood obstruction; those with kidney yang deficiency are mostly due to prolonged illness causing yang qi decline, meridians losing the warming function of yang qi, leading to cold congealing and meridian blockage. Those with qi deficiency and blood stasis experience pain like锥刺, accompanied by signs of static blood, such as dark purple and rough skin in the groin area, along with qi deficiency symptoms (shortness of qi with reluctance to speak, faint low voice, mental fatigue, aversion to wind with spontaneous sweating, pale complexion, pale tongue with weak pulse); while those with kidney yang deficiency experience pulling cold pain in the groin, local pale skin, pain relieved by warmth and aggravated by cold, accompanied by kidney deficiency symptoms (chills and cold limbs, sore waist and weak legs, cold pain in the waist and knees, tinnitus, seminal emission, weak chi pulse, etc.). Over time, both may lead to muscle wasting or weakness. For qi deficiency and blood stasis, replenishing qi and invigorating blood to resolve stasis can be used, such as Astragalus and Cinnamon Twig Five Ingredients Decoction with modifications, adding Peach Kernel, Carthamus, Salvia, suberect spatholobus stem, Sichuan Lovage Rhizome, Earthworm, etc.; for kidney yang deficiency, warming meridians and unblocking collaterals should be applied, such as Kidney Qi Pill from the Golden Cabinet with modifications, adding suberect spatholobus stem, Salvia, Carthamus, Earthworm, etc.
4. Kidney Yang Deficiency︰Patients often experience prolonged pain in the groin, soreness in the lower back, weakness in the legs and knees, and cramping cold pain in the groin area, which may extend to the scrotum. Sometimes, there may be enuresis or prolapse of the rectum. In severe cases, there may be weakness in the lower limbs or muscle wasting, tinnitus, hearing loss, and a weak chi pulse. $Qi deficiency and blood stasis combined with kidney yang deficiency can lead to vaginal pain! Those with qi deficiency and blood stasis often have an inherent deficiency of qi and blood, leading to poor nourishment of the meridians and sluggish blood flow, resulting in static blood obstruction. Those with kidney yang deficiency are typically affected by prolonged illness leading to the decline of yang qi, causing the meridians to lose the warming influence of yang qi, leading to cold stagnation and blockage of the channels. For those with qi deficiency and blood stasis, the pain is sharp like a needle prick, accompanied by signs of static blood, such as dark purple and rough skin in the groin area, along with symptoms of qi deficiency (shortness of breath, reluctance to speak, faint low voice, mental fatigue, aversion to wind, spontaneous sweating, pale complexion, pale tongue, and weak pulse). In contrast, those with kidney yang deficiency experience cramping cold pain in the groin area, with pale local skin color, pain relief upon warming, and worsening upon exposure to cold, along with symptoms of kidney deficiency (chills and cold limbs, soreness and weakness in the lower back and legs, cold pain in the lower back and knees, tinnitus, seminal emission, weak chi pulse, etc.). Over time, both conditions may lead to muscle wasting or weakness. For qi deficiency and blood stasis, the treatment focuses on replenishing qi and invigorating blood to resolve stasis, using modified Astragalus and Cinnamon Twig Five Ingredients Decoction, with additions such as Peach Kernel, Carthamus, Salvia, suberect spatholobus stem, Sichuan Lovage Rhizome, and Earthworm. For kidney yang deficiency, the approach involves warming the meridians and unblocking collaterals, using modified Kidney Qi Pill from the Golden Cabinet, with additions such as suberect spatholobus stem, Salvia, Carthamus, and Earthworm.

The condition of vaginal pain primarily involves distinguishing between external contraction or internal damage, dampness-heat or cold-dampness. For prolonged pain, attention should be paid to whether it is due to qi deficiency and blood stasis or kidney yang deficiency. However, in clinical practice, it is common to see a combination of the above syndromes, such as dampness-heat obstructing the collaterals accompanied by static blood; kidney yang deficiency may also be accompanied by static blood, and careful differentiation is required.

bubble_chart Documentation

1. 《Chinese Medicine Clinical Essentials: Thigh and Vaginal Pain》: "Thigh and vaginal pain is rarely found alone. If it occurs on one side, with pain like a锥刺, inability to move, no external changes, skin not hot to the touch, and a fixed pain point upon heavy pressure, accompanied by alternating chills and fever, one must beware of 'bone-attaching carbuncle (suppurative osteomyelitis)'. Take Wan Ling Dan internally. If it suppurates and erodes internally over time, and external observation is still difficult, a long needle can be used for probing. There are also cases that occur on the outer side of the thigh, without redness or heat, known as 'bone-attaching carbuncle (suppurative osteomyelitis)', with a diffuse swelling phenomenon, which is easier to diagnose."