小儿阴肿疝气者，多属肝肾气虚，及坐卧寒湿之地；或风邪所伤，血气相搏；或啼叫气逆，
水道不行；或禀父肝经虚热；或妊娠肝气郁结；或乳母怒动肝火而致者。若儿肝经热，用栀
子
作痛，小便涩滞，用龙胆泻肝汤。久坐冷地，小便不利，用四苓散加柴胡、山栀、车前子。
不时寒热者，加味小柴胡汤。经云∶肝气热，则茎痿。宗筋弛纵，肾茎肿胀，或出白液痒痛
，或里急筋缩，挺纵不收，或精随便下者，此名筋疝。俱属肝火不系于肾，宜详治之。
治验
一小儿阴囊赤肿。余作胎毒治，瘥后发热痰盛等症，诊其母素有郁热，用加味归脾、逍遥二
药，子母俱服而愈。后吐泻，小便赤涩，两目 动，视其寅卯二关脉赤，此肝经风热也，用
柴胡清肝散加钩藤钩、木贼草而愈。
一小儿阴茎作痒，小便频数，此属肝火之症，反服五苓散，颈间结核，余用柴胡栀子散、四
味肥儿丸，诸症稍愈，又用虾蟆丸而痊。
一小儿茎痿湿痒后，阴囊 肿，茎中作痛，时出白津，余诊之肝火也，用龙胆泻肝汤、六味
地黄丸而愈。
一小儿睾丸作痛，小便赤涩，寒热作呕，乃肝脾之疝，用小柴胡汤加山栀、车前子、茯苓而
愈。
一小儿睾丸肿硬，小便黄涩，用小柴胡汤加车前子、山栀并芦荟丸而消。
一小儿茎中作痒。一小儿下疳溃烂，作痛发热。一小儿茎中溃痛，小便秘涩，日晡尤盛。一
小儿目痒出水，连札项间结核，阴囊搔痒。俱属肝火之症，俱用九味芦荟丸而愈。
一小儿小便涩滞，阴囊肿痛，寒热，此肝经湿热也，用龙胆泻肝汤而消。但内热倦怠，此兼
脾气虚也，用四君、柴胡、山栀、芎、归而愈。
一小儿阴囊赤肿，因乳母怒气，及饮酒而发，余审之，因于怒则用加味逍遥散，因于酒，则
用加味清胃散并加漏芦、干葛、神曲，与母子服之随愈。
一小儿阴囊肿痛，小便赤涩，用加味小柴胡汤加漏芦，母子并服而愈。
一小子禀肝肾虚弱，睾丸常肿，用六味地黄丸料加柴胡，母子并服，两月余而痊。
刘武库子，睾丸作痛，小便赤涩，寒热作呕，用小柴胡汤加山栀、车前子、茯苓而愈。
一小儿腹内一块攻痛，小便不调，用龙胆泻肝汤、芦荟丸而愈后，形气消燥，发热作渴，此
肝木制脾土也，用补中益气汤，及芦荟丸而愈。
龙胆泻肝汤 治肝经湿热，两拘肿痛，或腹中作痛，或小便涩滞等症。
龙胆草（酒拌炒黄） 泽泻（各二分） 车前子（炒） 木通 生地黄（酒拌） 当归（酒拌） 山栀（炒） 黄
芩（炒
上水煎服。
四君子汤
加味逍遥散
加味清胃散
加味归脾汤（四方见内钓）
五苓散（方见五淋）
九味芦荟丸（方见疳症）
补中益气汤（方见虚羸）
加味小柴胡汤（方见痉症）
六味地黄丸（方见肾脏）
栀子清肝散
柴胡清肝散（二方见发热）
四味肥儿丸（方见寒吐）
四苓散（即五苓散去肉桂）
The condition of scrotal swelling and hernia in children mostly belongs to deficiency of Qi in the Liver and Kidney meridians, as well as sitting or lying on cold and damp places; or injury by Wind pathogen causing Blood and Qi to contend with each other; or crying and shouting leading to counterflow of Qi, resulting in obstruction of the water passages; or inheriting deficient heat from the father's Liver meridian; or maternal Liver Qi stagnation during pregnancy; or caused by the wet nurse's anger stirring up Liver Fire. If the child presents with Heat in the Liver meridian, manifesting as testicular pain and swelling, and astringent and difficult urination, use Longdan Xiegan Tang (Gentian Liver-Draining Decoction). If due to long sitting on cold ground causing difficulty in urination, use Siling San (Four-Powder Powder) added with Chaihu (Bupleuri Radix), Zhizi (Gardeniae Fructus), and Cheqianzi (Plantaginis Semen). If there are intermittent chills and fever, use Jiawei Xiaochaihu Tang (Modified Minor Bupleurum Decoction). The Classic states: "When Liver Qi is hot, the sinews become flaccid." When the tendons hang loose, the penis swells, or white fluid is discharged accompanied by itching and pain, or there is a sensation of urgency with tendon contraction, the penis remains erect or flaccid without returning to normal, or semen flows out with urine, this is named Jinsan (Sinew Hernia). All these conditions belong to Liver Fire failing to be anchored by the Kidney, and should be treated with detailed differentiation.
Case Records:
One child had red and swollen scrotum. I treated it as fetal toxin. After recovery, symptoms of fever and abundant phlegm appeared. Diagnosing that the mother had chronic stagnant heat, I prescribed Jiawei Guipi Tang (Modified Gui Pi Decoction) and Xiaoyao San (Xiao Yao Powder) for both mother and child, resulting in a cure. Later, the child experienced vomiting and diarrhea, red and astringent urine, and twitching of the eyes. Inspection of the Yin and Mao pulse positions revealed redness, indicating Wind-Heat in the Liver meridian. It was cured using Chaihu Qinggan San (Bupleurum Liver-Clearing Powder) added with Gouteng Uncariae Ramulus cum Uncis and Muzeicao (Equiseti Herba).
One child had an itchy penis and frequent urination, which belongs to Liver Fire syndrome. However, Wu Ling San (Five-Ingredient Powder with Poria) was taken instead, leading to tubercles in the neck. I used Chaihu Zhizi San (Bupleurum Gardenia Powder) and Siwei Fei'er Wan (Four-Ingredient Child-Nourishing Pill). Symptoms improved slightly, and after taking Hamawan (Toad Pill), full recovery occurred.
One child, after suffering from penile flaccidity, dampness, and itching, developed scrotal swelling and pain in the urethra, with occasional discharge of white fluid. Diagnosis indicated Liver Fire. Cured using Longdan Xiegan Tang (Gentian Liver-Draining Decoction) and Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill).
One child had painful testicles, red and astringent urine, accompanied by chills, fever, and nausea/vomiting. This was a Liver-Spleen hernia. Cured using Xiaochaihu Tang (Minor Bupleurum Decoction) added with Zhizi (Gardeniae Fructus), Cheqianzi (Plantaginis Semen), and Fuling (Poria).
One child had hard and swollen testicles with yellow, astringent urine. Cured using Xiaochaihu Tang (Minor Bupleurum Decoction) added with Cheqianzi (Plantaginis Semen), Zhizi (Gardeniae Fructus), and Lushui Wan (Aloe Pill).
One child had urethral itching. One child had chancre ulceration with pain and fever. One child had ulcerative pain in the urethra with constipated urine, worsening at dusk. One child had itchy eyes with tearing, linked to tubercles in the neck and itchy scrotum. All belonged to Liver Fire syndromes and were cured using Jiawei Lushui Wan (Nine-Ingredient Aloe Pills).
One child had astringent urine, swollen and painful scrotum, and chills/fever, indicating Damp-Heat in the Liver meridian. Cured using Longdan Xiegan Tang (Gentian Liver-Draining Decoction). However, internal heat and fatigue indicated concurrent Spleen Qi deficiency. Cured using Sijunzi Tang (Four Gentlemen Decoction) added with Chaihu (Bupleuri Radix), Zhizi (Gardeniae Fructus), Xiong (Chuanxiong Rhizoma), and Danggui (Angelicae Sinensis Radix).
One child had red and swollen scrotum, triggered by the wet nurse's anger and alcohol consumption. Upon careful examination, for anger-induced cases, Jiawei Xiaoyao San (Modified Xiao Yao Powder) was used; for alcohol-induced cases, Jiawei Qingwei San (Modified Stomach-Clearing Powder) added with Loulu (Leuzeae Rhizoma), Gan Ge (Puerariae Radix), and Shenqu (Medicated Leaven) were given to both mother and child, resulting in immediate recovery.
One child had swollen and painful scrotum with red, astringent urine. Cured using Jiawei Xiaochaihu Tang (Modified Minor Bupleurum Decoction) added with Loulu (Leuzeae Rhizoma), administered to both mother and child.
One boy with congenital weakness of Liver and Kidney had frequently swollen testicles. Cured using Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) formula added with Chaihu (Bupleuri Radix), taken by both mother and child over two months.
Liu Wuku's son had painful testicles, red and astringent urine, chills, fever, and nausea/vomiting. Cured using Xiaochaihu Tang (Minor Bupleurum Decoction) added with Zhizi (Gardeniae Fructus), Cheqianzi (Plantaginis Semen), and Fuling (Poria).
One child had a mass in the abdomen causing attacking pain and irregular urination. After being cured with Longdan Xiegan Tang (Gentian Liver-Draining Decoction) and Lushui Wan (Aloe Pill), the child exhibited emaciation, dryness, thirst, fever, and irritability, indicating Liver Wood suppressing Spleen Earth. Cured using Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) and Lushui Wan (Aloe Pill).
Longdan Xiegan Tang (Gentian Liver-Draining Decoction): Treats Damp-Heat in the Liver meridian, causing swelling and pain in the hypochondrium, abdominal pain, or astringent urine.
Ingredients: Longdancao (Gentianae Radix et Rhizoma, stir-fried with wine until yellow), Zexie (Alismatis Rhizoma, 2 fen each), Cheqianzi (Plantaginis Semen, fried), Mutong (Akebiae Caulis), Shengdihuang (Rehmanniae Radix, mixed with wine), Danggui (Angelicae Sinensis Radix, mixed with wine), Zhizi (Gardeniae Fructus, fried), Huangqin (Scutellariae Radix, fried). Decoct in water and take orally.
Sijunzi Tang (Four Gentlemen Decoction)
Jiawei Xiaoyao San (Modified Xiao Yao Powder)
Jiawei Qingwei San (Modified Stomach-Clearing Powder)
Jiawei Guipi Tang (Modified Gui Pi Decoction) (See Inner Hook section for formulas)
Wu Ling San (Five-Ingredient Powder with Poria) (See Five Strangury section for formula)
Jiawei Lushui Wan (Nine-Ingredient Aloe Pills) (See Infantile Malnutrition section for formula)
Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) (See Emaciation section for formula)
Jiawei Xiaochaihu Tang (Modified Minor Bupleurum Decoction) (See Spasm section for formula)
Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) (See Kidney section for formula)
Zhizi Qinggan San (Gardenia Liver-Clearing Powder)
Chaihu Qinggan San (Bupleurum Liver-Clearing Powder) (Two formulas see Fever section)
Siwei Fei'er Wan (Four-Ingredient Child-Nourishing Pill) (See Cold Vomiting section for formula)
Siling San (Four-Powder Powder) (i.e., Wu Ling San minus Rougui/Cinnamomi Cortex)