Pudendal sore refers to the occurrence of sores on the external genitalia. The surface of the sores often has filthy turbidity, with clear edges and pain upon touch.

This condition has various names in classical medical texts, such as "pudendal sore" and "pruritus of vaginal orifice." The disease "erosion of throat, anus and genitalia" in the "Jingui Yaolue" primarily involves sores in the mouth and external genitalia, thus it also falls within the scope of discussion for this condition.

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1. Liver-gallbladder Dampness-heat︰The onset is relatively acute, with multiple sores of varying sizes on the external genitalia, accompanied by burning pain and the discharge of yellow filthy turbidity. It is often associated with symptoms such as dry and uncomfortable eyes, tinnitus and deafness, a bitter taste in the mouth, dry throat, distending pain in the hypochondriac region, yellow and foul-smelling leukorrhea, turbid yellow urine, and difficulty in bowel movements. The tongue coating is yellow and greasy, and the pulse is wiry and rapid. The Jingmai of the liver connects downward to the external genitalia. When dampness-heat of the liver-gallbladder descends and stagnates unresolved, it erodes the external genitalia, leading to sores and the discharge of yellow filthy turbidity, as well as symptoms like yellow and foul-smelling leukorrhea and turbid yellow urine. The liver meridian spreads across the hypochondrium and ascends to the throat, connecting with the eye connector, which can result in accompanying symptoms such as dry throat, dry eyes, bitter taste in the mouth, and distending pain in the hypochondriac region. Treatment should focus on clearing and disinhibiting the liver and gallbladder, using Gentian Liver-Draining Decoction with modifications.
2. Spleen-Stomach Heat Accumulation︰The onset is relatively acute, with severe burning pain in the pudendal sore. Aphthae of varying sizes may also be observed, accompanied by intense heat and pain. It is often associated with symptoms such as dry mouth, fetid mouth odor, thirst with a desire for cold drinks, swollen and painful gums, vexing heat in the heart, a red face, red eyes, dark urine, and dry stools. The tongue is red with a yellow coating, and the pulse is surging and rapid or slippery and rapid. Suwen．Jue Lun states: "The external genitalia are where all tendons converge and where the taiyin and yangming meet." Therefore, diseases of the external genitalia can also result from disorders of the spleen and stomach. The spleen opens into the mouth, and the Yangming stomach meridian encircles the lips. Disorders of the spleen and stomach can also affect the mouth. When accumulated heat in the spleen and stomach erodes downward to the yin regions, sores may form, while upward scorching to the mouth can also cause sores, with particularly pronounced burning pain. Other symptoms of accumulated heat in the spleen and stomach, such as dry mouth, fetid mouth odor, thirst with a desire for cold drinks, and swollen and painful gums, are also common. The treatment should focus on clearing the stomach and enriching yin, using Jade Lady Decoction with modifications.
3. Liver-kidney Yin Deficiency︰The onset is gradual, with pudendal sore that fluctuates in severity and lingers without healing, often accompanied by dizziness, dizzy vision, dry eyes, blurred vision, flushed cheeks, dry mouth, vexing heat, night sweat, tinnitus, deafness, soreness and weakness in the lower back and knees, menstrual irregularities, and other symptoms. The tongue is red with scant coating, and the pulse is deep, thin, and rapid. This is a deficiency pattern. The kidney orifice opens into the two yin, and the liver's Jingmai connects downward to the external genitalia. Liver-kidney yin deficiency with internal heat scorching can also lead to pudendal sore. The prolonged and persistent course of the illness is the main characteristic of this condition. Due to liver-kidney yin deficiency, insufficient essence and blood, and deficiency fire flaming upward, symptoms such as dizziness, dry eyes, vexing heat in the chest, palms, and soles, flushed cheeks, and dry throat may appear. The treatment should focus on tonifying the liver and kidney, enriching yin and clearing heat. The recommended formula is Anemarrhena Rehmannia Pill with modifications.
4. External Injury with Pathogenic Toxin︰First, there is vulvar damage, followed by sores at the damaged area, swelling and fever at the sore site, severe pain, occasional discharge of pus and blood, and in severe cases, the formation of a fistula. Symptoms may also include fever, body pain, dry mouth, and a bitter taste in the mouth. The tongue is red with thin yellow coating, and the pulse is slippery and rapid. This condition is often caused by scratching due to pruritus vulvae, careless riding, or rough sexual intercourse, leading to vulvar damage and the invasion of pathogenic toxins through the broken skin, resulting in pudendal sore. The clinical features are: vulvar damage occurs first, followed by pudendal sore. In mild cases, only local sores appear, while severe cases may be accompanied by systemic symptoms such as fever and shivering; if left untreated for a long time, the pudendal sore may erode the surrounding healthy skin and form a fistula. Treatment should focus on clearing heat and removing toxins, as well as eliminating dampness and turbidity. The prescription involves decocting Cnidium Fruit for external washing; if pruritus vulvae is severe, add Fischer Euphorbia Root and Litharge; for redness, swelling, heat, and pain in the vulva with discharge of filthy turbidity, apply Qing White Powder externally after grinding it into powder; for internal use, take Five-Ingredient Toxin-Eliminating Decoction combined with Two Wonderful Herbs Powder.

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1. Nyuke Zhengzhi Zhunsheng-Yin Erosion: "For women, when the shaoyin pulse is rapid and slippery, sores will inevitably arise in the private parts, called ni sores. They may be painful or itchy, as if insects are crawling, with pus and discharge, nearly eroding the private parts entirely. These conditions all stem from mental vexation and depression, as well as weakness of stomach qi leading to stagnation of qi and blood. Therefore, the classics state: 'All pain, itching, and sores belong to the heart.' It is also said: yangming governs the muscles, and pain and itching all belong to the heart. Treatment should focus on nourishing the heart and stomach, supplemented by external fumigation, washing, and suppository medications to achieve a cure."