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Scrofula (Hernia), specifically referring to diseases of the genital region, requires thorough investigation.
Although there are seven diagrams for upper hernias, Cold Hernia is actually the general term for all hernias; Water Hernia belongs to the category of hernias; Qi Hernia belongs to the category of Fox Hernia; Blood Hernia belongs to the category of Carbuncles and Furuncles (skin suppurative infections); only Sinew Hernia is rare, which probably belongs to the category of Chancre Sores (a type of sexually transmitted ulcer).

Swelling of the testicular sac as large as a Sheng or a Dou is the condition described.
[Zhu Danxi] For lower body Qi stagnation without pain: Upon careful consideration, unless one abstains from sexual intercourse and rich flavors, the pain will not cease; medication can only prolong life. Cangzhu (Atractylodis Rhizoma), Shenqu (Massa Medicata Fermentata), Baizhi (Angelicae Dahuricae Radix), Shanzha (Crataegi Fructus), Chuanxiong (Ligustici Chuanxiong Rhizoma), Zhishi (Aurantii Fructus Immaturus), and Banxia (Pinelliae Rhizoma) are all important herbs. People often despise these medicinal materials, considering them cheap and inferior, thereby developing a dismissive attitude. Furthermore, if one fails to abstain from desires to protect the root, they will not only gain no benefit but suffer harm. These medicines should be adjusted according to the cold and dampness of the seasons, following the principles of Sovereign, Minister, Assistant, and Courier. Generally, hernias are mostly caused by Dampness.
Cangzhu (Atractylodis Rhizoma) Shenqu (Massa Medicata Fermentata) Baizhi (Angelicae Dahuricae Radix) [dispels water-dampness] Shanzha (Crataegi Fructus) Chuanxiong (Ligustici Chuanxiong Rhizoma) Zhishi (Aurantii Fructus Immaturus) Banxia (Pinelliae Rhizoma) Nanting (Arisaematis Rhizoma Praeparatum)
Make pills using Shenqu paste. If there is Heat, add Zhizi (Gardeniae Fructus) 1 liang; if hard, add Poxiao (Natrii Sulfas) 0.5 liang; in autumn and winter, add Wuzhuyu (Evodiae Fructus) 2.5 qian.
For Hernia:
Nanting (Arisaematis Rhizoma Praeparatum) Shanzha (Crataegi Fructus) Cangzhu (Atractylodis Rhizoma) [each 2 liang] Baizhi (Angelicae Dahuricae Radix) Banxia (Pinelliae Rhizoma) Zhishi (Aurantii Fructus Immaturus) Shenqu (Massa Medicata Fermentata) [each 1 liang] Haizao (Sargassum Herba) Kunbu (Eckloniae Herba) [each 0.5 liang]
Xuanmingfen (Natrii Sulfas Exsiccatus) Wuzhuyu (Evodiae Fructus) [each 2 qian]
Grind into powder, make pills with wine paste.
Another prescription for treating Muren (painless testicular swelling):
Nanting (Arisaematis Rhizoma Praeparatum) Banxia (Pinelliae Rhizoma) Huangbai (Phellodendri Cortex) [wine-washed] Cangzhu (Atractylodis Rhizoma) [salt-fried] Zhishi (Aurantii Fructus Immaturus) Shanzha (Crataegi Fructus) Baizhi (Angelicae Dahuricae Radix) Shenqu (Massa Medicata Fermentata) [fried] Huashi (Talcum) [fried] Wuzhuyu (Evodiae Fructus) Kunbu (Eckloniae Herba)
Grind into powder, make pills with wine paste. Take on an empty stomach with salt water. Another formula adds Gouqi Zi (Lycii Fructus).
[Li Dongyuan] Xiangfu San treats Yin swelling.
Take Xiangfu Zi (Cyperi Rhizoma) in any amount, grind into powder. Each time, use 1 zhan of wine and 1 qian of Haizao (Sargassum Herba), decoct until half a zhan remains. First, remove the Haizao, chew it finely, then mix the powder with the decocted wine and take 2 qian.
[Zhang Yuansu] Another prescription for early-stage unilateral scrotal descent: Use Chanshanjia (Manis Squama) and Huixiang (Foeniculi Fructus), grind into fine powder, take with wine, and apply dry pressure to the area.
[Zhu Danxi] For Muren (painless testicular swelling), use male leaves of the Paper Mulberry tree (Broussonetiae Folium), dry them, grind into powder, make pills with wine paste, and take on an empty stomach with salt wine. (*Ben Shi Fang* states: those without fruit are male.)
[Wang Haogu] Hai Ge Wan treats Hernia.
Haige (Concha Meretricis et Cyclinae) [quenched three times in vinegar] Danggui (Angelicae Sinensis Radix) Haijinsha (Spora Lygodii) Qifen (Calomelas) Sharen (Amomi Fructus) [each 1 qian] Haizao (Sargassum Herba) Fenshuang (Sublimated Arsenic Trioxide) [each 5 fen] Shuizhi (Hirudo) [21 pieces, fried] Qingdai (Indigo Naturalis) Huashi (Talcum) Ruxiang (Olibanum) [each 1 qian]
Zhusha (Cinnabaris) [2 qian, ground] Dilong (Pheretima) [21 pieces, head and feet removed]
Grind into fine powder, make pills with salt-boiled wheat flour paste, size of small beans, coat with Zhusha (Cinnabaris). Take 10 pills each time, decoct Dengxincao (Junci Medulla) soup and take on an empty stomach. Effect is seen when cold pus and foul matter are discharged in urine. Afterwards, rinse mouth with decoction of Huanglian (Coptidis Rhizoma), Zihache (Placenta Hominis), and Banlangen (Isatidis Radix) [each 2 qian] to strengthen teeth; if Banlangen is omitted, add Guanzhong (Asari Radix et Rhizoma).
[Worldly Prescription] For large unilateral scrotal descent: Use Ganjiang (Zingiberis Rhizoma) and Guizhi (Cinnamomi Ramulus) [each 1 liang], grind into powder. Take 1 liang of cotton, add 3 bowls of water, boil together for more than 20 boils, remove and dry, then boil again until water is exhausted. Wrap the swollen scrotum with dry cotton; sweating several times leads to gradual recovery.
[Wang Haizang] Dihuang Gaozi Wan treats men and women with Ben Tun Qi masses below the navel, lower abdominal pain, testicular pain resembling testicular retraction, gradually forming swelling, dull pain rushing up to the heart and abdomen, unbearable suffering. This medicine is suitable.
Xuejie (Dragon's Blood) Chenxiang (Aquilariae Lignum Resinatum) Muxiang (Vladimiriae Radix) Ezhu (Curcumae Rhizoma) [processed] Yanhusuo (Corydalis Rhizoma) Gejie (Gecko) Renshen (Ginseng Radix et Rhizoma) Danggui (Angelicae Sinensis Radix) Chuanxiong (Ligustici Chuanxiong Rhizoma) Chuanlianzi (Toosendan Fructus) [bran-fried] Xuduan (Dipsaci Radix) Baizhu (Atractylodis Macrocephalae Rhizoma) Quanxie (Scorpio) Huixiang (Foeniculi Fructus) [fried] Chaihu (Bupleuri Radix) Wuzhuyu (Evodiae Fructus) Moyao (Myrrha) [dosages indefinite, adjust according to symptoms]. Add Qingpi (Citri Reticulatae Pericarpium Viride) for excess Qi. Add Rougui (Cinnamomi Cortex) for excess Blood.
Grind all into fine powder, make pills with Dihuang Gao (Rehmanniae Radix Preparata paste), size of tung seeds. Take 20 pills on an empty stomach with warm wine, increasing by one pill daily up to 30 pills.
*[Jian Yao Ji Zhong Fang]* Anxi Xiang Wan treats sinking pain and distension of Yin Qi, enlarged and stone-hard testicles, unbearable pain.
Yanhusuo (Corydalis Rhizoma) [fried] Haizao (Sargassum Herba) [washed] Kunbu (Eckloniae Herba) [washed] Qingpi (Citri Reticulatae Pericarpium Viride) [white part removed] Huixiang (Foeniculi Fructus) [fried] Chuanlianzi (Toosendan Fructus) [core removed] Malinhua (Iridis Tectorii Flos) [each 1.5 liang] Muxiang (Vladimiriae Radix) [0.5 liang, do not expose to fire] Daji (Euphorbiae Pekinensis Radix) [soaked in wine for three nights, sliced and dried, 3.5 qian]
Grind into fine powder. Separately, take Naosha (Natrii Nitras), Zhen Awei (Asafoetida), and Zhen Anxi Xiang (Benzoinum) [each 2.5 qian]. Use 1 zhan of wine and 1 zhan of vinegar. Wash away sand from Naosha, Awei, and Anxi Xiang. Combine wine and vinegar to 1 zhan, boil into a paste. Add She Xiang (Moschus) 1 qian and Moyao (Myrrha) 2.5 qian, both ground separately. Mix with previous powder, make pills size of mung beans. Take 10-15 pills on an empty stomach, mixed with ash from cotton seeds and wine.
*[Ben Cao Yan Yi]* Treats Bladder Hernia Qi, unbearable external genital swelling and pain, Nian Zhu Wan.
Ruxiang (Olibanum) Naosha (Natrii Nitras) [each 3 qian, refined] Huangla (Beeswax) [1 liang]
Grind Ruxiang and Naosha evenly, melt wax and mix to form pills, divide into 108 pills, string with thread, leave exposed overnight. Next day, coat with Gafen (Concha Tridacnae). Take as needed with Ruxiang soup. Recently, someone sold hernia medicine, selling thousands daily. A national physician bought it for a high price; it was very effective.
[Zhu Danxi] Zheng Zijing, after drinking alcohol, consumed water and fruits, leading to unilateral kidney swelling, making frog-like sounds at times, sometimes painful. Use fried Zhishi (Aurantii Fructus Immaturus) 1 liang, salt-fried Huixiang (Foeniculi Fructus) and fried Zhizi (Gardeniae Fructus) [each 3 qian], grind, decoct, and take Baohe Wan.
Chang Shiguan, bladder Qi sinking with frog-like sounds. Fry 10 stink orange seeds, 20 peach kernels, mix with radish juice, grind, and take 70 Baohe Wan pills.
Brother, age 30, left testicular kernel swelling and pain. This is dampness from diet sinking and turning into heat. Use 5 Ju He (Citri Reticulatae Semen - stink orange seed), 7 peach kernels, grind finely. Decoct in flowing water (1 zhan) until boiling hot, then take Baohe Wan.
*[Ben Cao Yan Yi]* Treats bladder hardness and pulling pain, as well as Small Intestine Qi causing scrotal swelling and weeping between hairs. Jin Ling Wan is suitable.
Jinlingzi Rou (Toosendan Fructus Flesh) [5 liang] Huixiang (Foeniculi Fructus) [fried] Malinhua (Iridis Tectorii Flos) [fried] Tusizi (Cuscutae Semen) Haige (Concha Meretricis et Cyclinae) Poguzhi (Psoraleae Fructus) Haitai (Laminariae Thallus) [each 2 liang] Muxiang (Vladimiriae Radix) Dingxiang (Caryophylli Flos) [each 1 liang]
Grind into fine powder, make pills with paste, size of tung seeds. Take 20-30 pills each time, on an empty stomach before meals with warm wine and salt water.
[Li Dongyuan] Daji Wan treats Yin swelling or Small Intestine Qi pain.
Daji (Euphorbiae Pekinensis Radix) [peeled, cut, fried yellow, 0.5 liang] Huluba (Trigonellae Semen) [fried, 4 liang] Muxiang (Vladimiriae Radix) [1 liang] Fuzi (Aconiti Lateralis Radix Praeparata) [processed, peel and navel removed] Huixiang (Foeniculi Fructus) Hezi (Terminaliae Chebulae Fructus) [baked, core removed] Binglang (Arecae Semen) [each 0.5 liang] Chuanlianzi (Toosendan Fructus) [5 liang] She Xiang (Moschus) [0.5 liang, ground separately]
Grind into powder. Take Chuanlianzi alone, boil in 2 sheng of good wine with 7 green onion whites (3-4 cun long) until soft. Peel, select flesh, and mix with other powders, pound into pills size of tung seeds. Take 10 pills on an empty stomach with warm wine. If pain flares up, take 15 pills with fried ginger and hot wine.
Di Sheng Wan treats Yin swelling and fullness, red swelling, constipation, thirst, and abdominal pain upon pressing.
Xuisui Zi (Euphorbiae Lathyridis Semen) Yiyiren (Coicis Semen) Yuliren (Pruni Semen) Yinyu (Cosmea Herb) Bai Qianniu (Pharbitidis Semen) [each 1 qian, lightly fried]
Grind into powder, make pills with drops of water, size of tung seeds. Take 5 pills each time, swallow with Xiang Jiang San from *Bo Ji Fang*. Take at dusk; effect is seen when foul matter is discharged at dawn.
[Zhang Congzheng] Li Shenyuan, Official of Runan, due to laborious royal duties, drank cold water, sat on wet ground, leading to dampness descending into the bladder sac, causing massive swelling and unbearable pain. Jinling and Chuanlianzi were ineffective. He sought treatment from Dairen (Zhang Congzheng). Dairen said: You can take Xie Shui Wan. Li was confused. A few days later, pain became unbearable, he finally followed Dairen. First, use Zhou Che Wan and Jun Chuan San, draining green-yellow water more than ten times, pain stopped. Then regulate with Huixiang Wan and Wu Ling San. Swelling subsided in three days, never recurred until old age.
[Worldly Prescription] Cotton wrap to induce sweat. (See prescription for painless hernia.)
[Zhu Danxi] For Muren, decoct Pipa Ye (Loquat Leaf), Ye Zisu Ye (Wild Perilla Leaf), Cang Er Ye (Xanthii Folium), and Shuijing Pubo Ye (Pueraria Leaf) strongly, fumigate and wash.
[Li Dongyuan] Xionghuang San treats Yin swelling as large as a Dou, kernel pain, untreatable by others.
Xionghuang (Realgar) [1 liang, ground] Fan (Alumen) [2 liang] Gancao (Glycyrrhizae Radix et Rhizoma) [raw, 0.5 liang]
Cut into pieces, decoct in 5 sheng of water, wash.
[Wang Haogu] Shixiao San treats Kidney swelling.
Jingjie Sui (Schizonepetae Spica) [1 liang] Poxiao (Natrii Sulfas) [2 liang]
Grind into coarse powder, decoct with radish and green onion, wash.
[Mei Shi] Treat sudden external genital swelling and pain. Apply Dahuang (Rhei Radix et Rhizoma) powder mixed with vinegar. Change when dry.
[Jiao Shi] Treat male Yin swelling as large as a Sheng, kernel pain, untreatable by others. Mash Bian Cao (Verbenae Herba) and apply. Male Yin swelling as large as a Dou, kernel pain, untreatable by others. Mash Man Jing Gen (Turnerae Radix) and apply.
In the theory of Six Qi transformations, there is one point on Hernia. The Classics state: When Yangming governs the year, Dryness prevails, men suffer from Hernia, women have lower abdominal pain. It also says: When Yangming wins, external Hernia erupts. This is Dryness attacking the Liver, resulting from Qi deficiency. The treatment method should tonify the Liver and drain Dryness Metal. (Full text see Theory of Six Qi annotations.)
*[Su Wen]* What Jueyin calls Hernia, and women's lower abdominal swelling: Jueyin corresponds to the third month, Yin within Yang. Pathogen in the middle, hence called Hernia and lower abdominal swelling. What is called Long Hernia and skin distension: Yin is also excessive, and meridians are swollen and blocked, hence called Long Hernia. (All from Mai Jie Chapter.)
When San Yang disease occurs, chills and fever develop, lower body suffers carbuncles and swelling, and Wei Jue (flaccidity and cold limbs), transmitting to Hernia. (Full text see Diagnosis of Disease Transmission. Wang Bing notes: , soreness and pain.)
*[Ling Shu]* Yellow Emperor said: The Ci Jie chapter mentions Qu Zhao (Removing Claws), and you mentioned piercing joints and limb collaterals. I wish to hear it fully. Qibo said: The waist and spine are the great joints of the body. The legs and calves are the tubes for walking. The penis and scrotum are the mechanisms of the body, the monitors of Yin Essence, and the pathways of fluids. Therefore, irregular diet and unregulated emotions cause fluids to overflow internally, accumulating downwards in the testes. Blood channels become blocked, enlarging daily without cessation. Bending and stretching become inconvenient, walking becomes impossible. This disease has abundant fluid, neither rising nor falling, requiring Pi Shi (scalpel) treatment. The deformity cannot be hidden, always exposed, hence named Qu Zhao. The Emperor said: Good. (Ci Jie Zhen Xie Chapter)
The *Nei Jing* describes four acupuncture/moxibustion methods for Hernia:
The first is this chapter's text, referring to Pi Shi, removing fluid from the testicular sac. This method is known to many. When the testicular sac is as large as a Dou, it contains foul fluid, likely several Sheng. This confirms its ancient origin. (Pi needle is knife-shaped.)
The second targets the Liver Meridian. The Classics state: When the Foot Jueyin Meridian moves, it causes Hernia in men and lower abdominal swelling in women. On the Foot Jueyin Liver Meridian, observe excess/deficiency, heat/cold, sinking, and apply tonification/reduction, retention/speed, and moxibustion. (Full text see Acupuncture Section, Twelve Meridians.)
The third targets the collateral of the Liver. The Classics state: The collateral of Foot Jueyin is named Ligou, five cun above the medial malleolus, diverging to Shaoyang. Its branch goes up the shin to the testes, connecting to the penis. If Qi rebels, testes swell and acute Hernia occurs. Treat the divergence point. This is Ligou, located five cun above the medial malleolus, posterior to the tibia near the flesh. (Full text see Acupuncture Section, Fifteen Collaterals.)
The fourth targets the sinews of Foot Yangming. The Classics state: The sinews of Foot Yangming gather at the genitals and upper abdomen. Symptoms include spasms, anterior thigh swelling, Hernia, and abdominal tendon tension. Treatment involves burning needles and rapid puncture, using sensation as the count and pain as the point. This means using fire needles at the site of spasms and pain.
[Sang Shi] Treat unilateral scrotal descent. Pierce along the seam of the external genitalia subcutaneously, and it will resolve.
*[Zhen Jiu Ji Cheng]* Muren, red and swollen like a Sheng, painless: Dadun, Sanyinjiao, Haidi, Guilai (2 cun below Shuidao, needle 2.5 cun, moxa 7 cones). Muren, red and swollen.
Yin sweat, unilateral scrotal descent: Lanmen (2 cun lateral to pubic hair line and penis base, needle 2.5 cun). Sanyinjiao.
*[Jia Yi Jing]* Hernia, controlled by Daju, Dizhi, Zhongzhu. Hernia, sudden Yin pain, controlled by Zhongfeng. (*Qian Jin Fang* says: Hernia, Long, sudden pain, Wei Jue, body numbness). Qi Long Hernia, Yin urgency, inner thigh pain, controlled by Jiaoxin. Men's Hernia, jumping Yin pain, drawing to perineum, inability to urinate, abdominal and hypochondriac fullness and blockage, impotence, delayed diarrhea, limbs flaccid, excess body pain, no sweat, eyes dim and unable to see, anger wanting to kill, sudden pain drawing to knee joint, occasional hot Qi, tendon spasms and knee pain, inability to flex/extend, madness like fresh epistaxis, refusal to eat, panting, lower abdominal pain drawing to belching, Foot Jueyin pain, controlled by Yongquan.
*[Zhen Jiu Cuo Yao]* Muren, red, swollen, painful: RanGu (0.5 cun, reduce).
[Worldly Prescription] Moxibustion on Guanyuan can cure. Early moxibustion is effective.
[Li Gao] Discussion on Cold/Heat and Scrotal Descent/Retraction of Anterior Genitals: The *Yin Yang Bie Lun* states: San Yang disease causes chills/fever, lower carbuncles/swelling, Wei Jue, transmitting to Su Ze, then to Hernia. Heat outside, Cold inside causes hanging scrotum (Summer Qi). Cold outside, Heat inside causes retracted testicles (Winter Qi). Foot Taiyang Bladder Meridian rebels upward, Hand Taiyang Small Intestine Meridian descends, reaching Foot Jueyin Liver Meridian which cannot extend. Ren Meridian and Jueyin Meridian rebel like a great river, causing Yang Qi to sink. Wind-Cold-Damp-Heat exits from the scrotum, causing bilateral testicular swelling, called Hernia, severe cases become something else. Foot Jueyin Meridian and Large Intestine/Bladder Cold-Water Meridians meet at the anterior genital end. Shang Han scholars say Foot Jueyin Liver Meridian disease causes irritability, fullness, and scrotal retraction, requiring urgent purgation with Da Cheng Qi Tang to drain Great Heat. *Ling Shu* says: Cold in Foot Jueyin Liver Sinew causes tendon spasm and testicular retraction, indicating Great Cold. Previous theory says retraction is Great Heat, this says Great Cold. This theory says retraction, hanging testes, Hernia, and Hong Kong Foot are Great Cold, wind-damp heaviness is Cold, differing from previous two. Why? Answer: Shang Han scholars' retraction is Great Heat inside, requiring Da Cheng Qi Tang. This matches the Sinew theory's retraction where Cold is outside but Heat is inside, same as Shang Han. Thus, citing healthy people: In Winter, Yang is inside, Yin outside; humans respond. Cold outside makes skin tight, skin tight causes retraction. In Summer, Yin is inside, Yang outside; humans respond. Heat outside makes skin loose, skin loose causes hanging scrotum. This is the sign of Hernia.
Though three theories differ, they share one principle. Prescribers should examine carefully. The above three discussions each have their focus; combining these examinations clarifies the differentiation of pulse/symptoms, Yin/Yang, Cold/Heat, and Excess/Deficiency.