甲、概况
小儿疝气，多由先天所致，后天则或感寒湿，或伤生冷，亦间有之。此证多脐下绞痛，或阴核肿大，或
偏一边而坠下，引痛则啼哭不止，颇为受累。若任其迁延，往往至长成病，至阴囊肿
大，数倍于寻常，而顽木不痛者，则成为终身痼疾，无法治疗矣。
乙、治法
疝气初起，头疼身热，或恶寒状热者，宜参苏饮加木香；脐下绞痛者，宜茱萸内消丸；阴核肿大而成疝
者，宜桂枝汤加细辛、当归、木香、蝎尾；睾丸偏一边而坠下，宜用四黄散烧存性，研为细末，雄猪胆汁调敷
之，或用灸法，于茎下肾囊前中间弦子上，灸之七壮，颇较服药为效也。
附方
（一）茱萸内消丸 治小儿阴 偏大，上攻脐腹 痛，阴囊肿胀，或生疮疡，时出黄水。
吴茱萸 食茱萸（各五钱） 山茱萸 桔梗 青皮（各一两） 川楝子（
一两五钱） 大腹皮 五味子 海藻 延胡索（各一两二钱五分） 木香（七钱
五分） 茴香 桂心 川乌头 桃仁（各五钱）
共研细末，为丸如麻子大，每服三十丸。
（二）桂枝汤 见第四章第四节。
（三）四黄散 外用。治小儿疝气，睾丸偏坠。
黄连 黄芩 大黄 黄柏（各二钱）
烧存性为极细末。
（四）参苏饮 见第五章第二节。
（五）包敷法 外用。治寒热疼痛，欲成囊痈者。
鲜地骨皮 生姜（各四两）
共捣如泥，用绢包于囊上，其痒异常，一夕即消。
A. Overview
Pediatric hernia (Shan Qi) is mostly caused by congenital factors; acquired causes include exposure to cold-dampness or injury from raw and cold foods, though the latter are less common. This condition often presents with colicky pain below the umbilicus, enlargement of the scrotum, or descent to one side. When traction pain occurs, the infant cries incessantly, suffering considerably. If left untreated and allowed to persist, it may become a chronic illness into adulthood, resulting in scrotal swelling several times larger than normal, hard and numb without pain, becoming a lifelong stubborn disease that is incurable.
B. Treatment Methods
In the early stage of hernia, if headache and fever occur, or if there is aversion to cold accompanied by heat sensations, Shen Su Yin (Ginseng and Perilla Decoction) added with Muxiang (Aucklandiae Radix) is appropriate. For colicky pain below the umbilicus, Zhuyu Neixiao Wan (Evodia Internal-Resolving Pill) is appropriate. For enlargement of the genitalia leading to hernia, Guizhi Tang (Cinnamon Twig Decoction) added with Xixin (Asari Radix et Rhizoma), Danggui (Angelicae Sinensis Radix), Muxiang (Aucklandiae Radix), and Xiwei (Scorpio tail) is appropriate. For testicular descent to one side, Sihuang San (Four-Yellow Powder) should be calcined to retain its properties, ground into a fine powder, and applied with bile from a male pig. Alternatively, moxibustion can be used: apply seven moxa cones on the ligamentous line between the front of the scrotum and below the penis. This method is often more effective than oral medication.
Appendix Formulas
(1) Zhuyu Neixiao Wan (Evodia Internal-Resolving Pill): Treats pediatric scrotal asymmetry, upward attacking pain in the umbilical and abdominal regions, scrotal swelling, or sores producing yellow discharge.
Ingredients: Wu Zhu Yu (Euodiae Fructus) and Shi Zhu Yu (Zanthoxyli Fructus) (each 5 qian); Shan Zhu Yu (Corni Fructus), Jie Geng (Platycodonis Radix), Qing Pi (Citri Reticulatae Pericarpium Viride) (each 1 liang); Chuan Lian Zi (Toosendan Fructus) (1.5 liang); Da Fu Pi (Arecae Pericarpium), Wu Wei Zi (Schisandrae Fructus), Hai Zao (Sargassum), Yan Hu Suo (Corydalis Rhizoma) (each 1.25 liang); Mu Xiang (Aucklandiae Radix) (0.75 qian); Hui Xiang (Foeniculi Fructus), Gui Xin (Cinnamomi Cortex), Chuan Wu Tou (Aconiti Radix Lateralis Preparata), Tao Ren (Persicae Semen) (each 5 qian).
Grind all ingredients into a fine powder and form pills the size of hemp seeds. Take 30 pills per dose.
(2) Guizhi Tang (Cinnamon Twig Decoction): See Chapter 4, Section 4.
(3) Sihuang San (Four-Yellow Powder): For external use. Treats pediatric hernia and testicular descent.
Ingredients: Huang Lian (Coptidis Rhizoma), Huang Qin (Scutellariae Radix), Da Huang (Rhei Radix et Rhizoma), Huang Bai (Phellodendri Cortex) (each 2 qian).
Calcine until the original properties are retained, then grind into an extremely fine powder.
(4) Shen Su Yin (Ginseng and Perilla Decoction): See Chapter 5, Section 2.
(5) Poultice Method: For external use. Treats cold-heat pain and impending scrotal abscess (Nang Yong).
Ingredients: Xian Di Gu Pi (Lycii Cortex) and Sheng Jiang (Zingiberis Rhizoma Recens) (each 4 liang).
Pound together into a paste, wrap in silk cloth, and apply to the scrotum. It will cause intense itching but resolve within one night.