Miao medicine－Duo Yang Fa Jiu Yi (Women’s Vulvar Itching)

Duo Yang Fa Jiu Yi (Women’s Vulvar Itching)

Overview
In Miao medicine, vulvar itching in women is called Duo Yang Fa Jiu Yi. It most often arises from living in damp conditions or neglecting personal hygiene. Pathogenic factors include insect toxins, dampness, heat toxins, and constitutional weakness due to aging. Pathogenesis: the kidneys govern the two Yin regions; qi and blood deficiency lead to reduced essence and blood, causing vulvar skin to lose nourishment. Clinically this presents as unbearable itching or pain, restlessness when sitting or lying, often accompanied by increased vaginal discharge.

In TCM, vulvar itching arises internally from organ deficiency—particularly liver–kidney dysfunction—and externally from invasion of damp or heat pathogens or damp-heat–generated parasites. In Western medicine, conditions such as vulvitis, vaginal candidiasis, or leukoplakia presenting with itching may be managed by analogous principles.

Miao Classification
A minor vaginal syndrome with two patterns:

Heat-channel external-pathogen itching
Heat-channel internal-pathogen itching

Etiology
Prolonged damp exposure, poor hygiene, insect toxins, dampness, heat, unregulated sexual activity, overwork, and constitutional weakness allow pathogens to invade the vulvar region or impair qi–blood nourishment, resulting in itching.

Pathogenesis
Heat toxins (external or internal) or constitutional qi–blood deficiency damage essence and blood, leading to dryness and loss of lubrication in the vulvar skin. Pathogenic damp or heat further injures the Ren and Dai vessels, resulting in persistent itching and abnormal discharge.

Diagnosis

History of poor hygiene, damp living conditions, unregulated sexual activity, or prior vulvitis/vaginitis.
Severe vulvar itching, restlessness, possible spread to perianal or inner thigh areas; may accompany increased or abnormal vaginal discharge, burning, pain, or urinary symptoms.
Examination: rough or thickened vulvar skin with scratches, hypopigmentation, fissures, erosion, or yellow exudate; vaginal smear as needed.

Differential Diagnosis

Fa Jiang Dian (Vaginal ulcer): Presents with urinary frequency, urgency, pain, purulent or bloody malodorous discharge due to damp-heat toxins and blood stasis, distinguished by ulcerative lesions rather than simple itching.

1. Heat-Channel External-Pathogen Itching

Symptoms: Intense vulvar itching, restlessness, rough thickened vulvar skin with scratch marks, mucosal congestion or erosion, heavy yellow purulent or foamy or greyish-white foul-smelling discharge; irritability, flank pain, bitter or greasy taste, poor appetite.
Pattern: Heat-channel, external-pathogen.
Principle: Clear heat and drain dampness; kill parasites and relieve itching.

Formula (decoction):

Gentiana scabra, long dan cao 20 g
Sophora flavescens, ku shen 20 g
Lysimachia christinae, jin qian cao 20 g
Phellodendron amurense bark, huang bai 15 g
Rheum palmatum root, tu da huang 8 g

 

Actions: All herbs are cold and bitter to clear heat, drain dampness, detoxify; Sophora and Lysimachia kill parasites and relieve itching; Phellodendron and Rheum clear heat and cool blood.

2. Heat-Channel Internal-Pathogen Itching

Symptoms: Vulvar dryness with burning itching, scanty yellow or blood-tinged discharge, hot palms and soles, dizziness, occasional flushing and sweating, tinnitus, back soreness, dry mouth, poor appetite.
Pattern: Heat-channel, internal-pathogen.
Principle: Tonify liver and kidney; kill parasites and relieve itching.

Formula (decoction):

Gentiana scabra, long dan cao 20 g
Phellodendron amurense bark, huang bai 15 g
Dryopteris crassirhizoma, guan zhong 12 g
Eucommia ulmoides, du zhong 20 g
Dictamnus dasycarpus, bai xian pi 15 g
Cynanchum paniculatum, xin yi 15 g

 

Actions: Herbs clear heat, drain dampness, kill parasites, cool blood, and tonify yin.

Prevention & Care

Keep the vulvar area clean; maintain personal hygiene.
Avoid excessive mechanical or chemical irritation.
Limit sexual activity.
Eat a light diet; avoid overwork.

Note
Miao medicine attributes Duo Yang Fa Jiu Yi to internal deficiency and external invasion. Pathogenic heat or damp invading the vulvar region, combined with qi–blood deficiency, injures the Ren and Dai vessels and leads to itching. Treatment emphasizes clearing heat, draining dampness, killing parasites, and nourishing yin.