Experience with Ermiao Wan for Scrotal Itching and Excessive Leukorrhea

Ermiao Wan (Two-Marvel Pill) comes from Yixue Gangmu (Outline of Medicine) and is said to have been created by Zhu Danxi. Its composition and preparation are very simple: equal parts of Phellodendron bark (Huangbai) powder and Atractylodes rhizome (Cangzhu) powder are formed with refined honey into pills.

By traditional TCM theory, this formula clears heat and dries dampness, and may be used for swollen and painful feet and knees, atrophy syndrome, damp sores, eczema, erysipelas, excessive leukorrhea, lower-back pain, and scrotal eczema caused by damp-heat pouring downward.

Phellodendron is the dried bark of Phellodendron chinense (Rutaceae) after removal of cork; TCM holds it bitter and cold in nature, entering the kidney, bladder and large-intestine channels. It clears heat and dries dampness, drains fire and resolves toxicity, and vacates deficiency heat. It is used for vaginal discharge, strangury and turbid urine, beriberi edema, red swollen feet and knees, damp-heat jaundice, diarrhea and dysentery, sores and eruptions, heat-toxin abscesses, mouth ulcers, bleeding from blood heat, night sweats from yin deficiency, seminal emission, and steaming bone fever—all due to damp-heat pouring downward.

Phellodendron combined with Asparagus (Tianmen Dong) nourishes yin, drains fire, clears heat and generates fluids; combined with Atractylodes (Cangzhu), it clears lower-jiao damp-heat; combined with Gentiana macrophylla (Qinjiao), it clears damp-heat, removes deficiency heat, and fades jaundice.

Atractylodes (Cangzhu) is the dried rhizome of Atractylodes lancea (Compositae), an aromatic damp-resolving herb in TCM, acrid, bitter and warm, entering the spleen and stomach channels. It dries dampness and strengthens the spleen, dispels wind-damp, induces sweating, and brightens the eyes. It is used for epigastric and abdominal fullness and diarrhea due to damp obstruction in the middle jiao, phlegm-rheum, edema, wind-cold-damp bi, exterior patterns with dampness, night blindness, and dim, dry eyes.

The pairing of Cangzhu and Huangbai achieves the effect of treating damp-heat pouring downward. This TCM pattern is hard to match in modern medicine. TCM holds that it arises when water-damp or phlegm-damp combines with heat and acts together on the lower jiao, producing a series of symptoms below the waist that involve both dampness and heat.

I have recently seen two patients and advised both to use Ermiao Wan, with results.

One was a woman with excessive leukorrhea, which had persisted for some time; she had previously taken other Chinese and Western medicines for it, all without effect. She also had steaming bone fever. I judged her pattern as damp-heat pouring downward and advised Ermiao Wan; the effect was immediate, and the excessive leukorrhea disappeared. But continued use led to recurrence, so I switched her to the modified Simiao Wan (Four-Marvel Pill).

The other was a patient with scrotal pruritus. His scrotal skin looked normal, but pruritus began that spring and had persisted ever since. The itching appeared whenever his body warmed and vanished when he cooled, so he dared not wear enough clothes or cover himself with a thick quilt. Later the itchy area tended to spread, and his face felt as if insects were crawling over it. Oral Hismanal (astemizole) helped briefly but stopped working; external treatments such as Pifukang lotion and miconazole were unsatisfactory.

I suspected infection by some microorganism and consulted a dermatology professor I know, who told me this kind of pruritus is not caused by pathogens and often has an unknown cause. The patient was in great distress. I suspected scrotal eczema, but his scrotal skin was dry, though it felt hot when itched. Putting these together, I judged this as TCM damp-heat pouring downward and advised Ermiao Wan. On the very day he took it, the itching markedly lessened; continued use basically resolved the symptoms.

These two patients are hard to explain by a clear etiology or pathology in modern medicine, but under TCM pattern differentiation, the predecessors' clinical experience offers a matching treatment that relieves or solves the problem.

Ermiao Wan has a strong diuretic effect; after taking it, patients pass noticeably more urine and feel relief after each voiding. Traditional TCM holds that this is because dampness is removed and heat recedes, so the illness resolves. In my experience, some patients develop constipation after taking Ermiao Wan; brewing some dandelion tea alongside can relieve it.

Incidentally, Ermiao Wan has two modified versions. One is Sanmiao Wan (Three-Marvel Pill), which adds Achyranthes (Niuxi) and treats anal eczema due to damp-heat pouring downward. The other is Simiao Wan, which adds Achyranthes and Coix seed (Yiyiren), and treats red swollen feet and knees and leg neuralgia due to damp-heat pouring downward. I have used it for sciatica, ankylosing spondylitis and gout, with some effect.