【歌】寒水 血气狐筋，先哲空留七疝名。盖是肝经原有热，外边却被湿寒侵。或因死血并痰饮，郁在囊
中气不行。控引睾丸生肿痛，或如瓜瓠或蛙声。要将标本分寒热，感受仍评重与轻。勿指膀胱心肾气，当知正
属厥阴经。
【论】古有七疝之名，不按七疝而治，概用局方辛热燥剂，是泥标而忘本也。或指为小肠气、肾与膀胱气，
皆非也。殊不知厥阴之脉循阴器，然其地位皆肝经所主，与小肠、膀胱、肾子无相干，至戴人始辨之详也。丹
溪云∶疝痛甚者，睾丸连少腹急痛也。或有形，或无形，或有声，或无声，自《素问》以下，皆以为寒，盖经
络得寒则收引不行，所以作痛。世有得寒而无疝者，内无热也。余屡踢冰徙涉，不曾病此，以余素无热故也。
若醉饱劳役，房室大怒，发动五志之火，郁久湿气便盛，浊液凝聚，并入血隧，流于厥阴肝经，木性急速，火
性又暴，为寒所束，宜其痛甚而暴也，此湿热被寒郁而痛明矣，若只作寒治，恐为未备。又云∶痰饮、食积、
死血郁结为病，及因水气为肿，肿多为湿 ，亦有挟虚者，其脉沉紧而豁大，当以参、术为君，佐以疏导，若
概行决裂之法，祸不旋踵。此皆前人所未及，学人引而伸之，今将七疝之形状，开具于后。
【脉】疝脉弦急，积聚在里。牢急者生，弱急者死。沉迟浮涩，疝瘕寒痛。痛甚则伏，或细或动。
寒疝
经云∶足厥阴肝经筋中寒，以寒则筋挛卵缩，此寒郁于外也。《原病式》云∶ 疝，少腹控卵肿，急绞痛。
寒主拘缩，寒极则土化制之，或肿满，则知其疝为寒者，是外受寒
邪也，而内实非寒，丹溪所谓标寒本热明矣。
寒疝手足厥冷不仁，疝胀痛及身痛，乌头桂枝汤。寒疝入腹痛，少腹引睾丸痛，泄利胸满，补肾汤；或肾
虚，寒疝偏大者，茱萸内消丸。
乌头桂枝汤
乌头（五分） 白蜜（一斤，煎减半，去滓）
每用桂枝汤五钱，入蜜半两，水煎，每服二合，得吐为中病。（桂枝汤方见恶寒证。）
补肾汤
治寒疝入腹痛。
人参（一两，去芦） 白茯苓（一两） 黄 （蜜炙，一两） 附子（炮，一两） 白术（炒，一两） 沉
香（四钱） 木瓜（一两五钱） 羌活（去芦，半两） 甘草（炙，二钱） 川芎（二钱） 紫苏（三钱）
上锉，每服五钱，姜三片，枣二枚，水二盏，煎八分服。
茱萸内消丸
山茱萸（六两） 吴茱萸（四两） 马兰花（四两） 木香（四两） 陈皮（四两） 肉桂（四两） 干
山药（六两） 川楝子（四两） 青皮（炒，四两） 茴香（四两，炒）
酒丸，温酒送下。
木肾
心火下降，则肾水不患其不温，真阳下行，则肾气不患其不和。温而且和，安有所谓木强者哉？盖木肾不
可绝用燥药，当行温和散利以逐其邪，则邪自消，荣卫流转则愈，枸杞子丸。又方∶用楮树叶雄者，曝干为
细末，酒糊丸如梧桐子大，每服五十丸，空心盐、酒吞下。（楮树不结子者，雄也。）
枸杞子丸
枸杞子（四两） 南星（二两） 半夏（二两） 黄柏（酒炒，三两） 苍术（盐
炒，三两） 山楂（二两，去核） 白芷（二两） 神曲（炒，二两） 滑石（炒，三两） 昆布（四两） 吴
茱萸（四两）
末之，酒糊丸如梧桐子大，每七十丸，空心盐汤下。
食积 湿痰 死血
食积与死血成痛疝，栀子、桃仁、山楂、枳实、茱萸、姜汁，顺流水煎，或加香附、茴香。痰饮流下，
壅滞囊中作疝，苍术、山栀、海石、南星、山楂、橘核、青皮，姜煎服。湿盛小便涩，五苓散加楝实。（方见
脾胃。）湿痰热疝，橘核散。
橘核散
湿热寒郁作疝。
橘核（一两） 桃仁（五钱） 栀子（三钱） 吴茱萸（一两） 茴香（一两）
每服七钱，水二盏，煎热服。
湿热疝
素有湿热人，或涉水受寒，坐卧湿地，外受寒气所来，其痛甚而暴者，古方以乌头、栀子等分作汤、丸最
效。湿热疝痛小便不通者，葵子汤、消疝散选用。
济生葵子汤
赤茯苓（一两） 猪苓（一两） 葵子（一两） 枳实（炒，五钱） 瞿麦（五钱） 木通（五钱） 黄
芩（五钱） 车前子（一两） 滑石（一两，研） 甘草（五钱）
每五钱，姜煎服。
消疝散
治湿热疝痛。
苍术（炒，半两） 木通（半两） 黄柏（半两，炒） 青皮（炒，半两） 浓朴（炒，三钱）
末之，每二钱，陈皮泡汤下。
虚疝
诸疝挟虚者，其脉沉弦滑大，参、术为君，佐以疏导，
如∶枳实、青皮、山楂、川楝子，橘核。按之不定属虚，桂枝、炒山栀、乌头，末之，糊丸服，或橘核散加苍
术。（方见前。）虚而挟热疝，栀子饮。
栀子饮
虚而挟热疝。
山栀（炒，半两） 桃仁（炒，半两） 枳壳（炒，半两） 山楂（半两）
姜汁同顺流水煎服。
一方加吴茱萸。
七疝之形状
寒疝者，囊冷结硬如石，阴茎不举，或控睾丸痛。得于坐卧湿地、涉水，以湿剂下之。
水疝者，囊肿如水晶，阴汗痒，搔出黄水，或小腹按之作水声。得于醉酒行房，汗出遇风，寒湿结于囊中，
以逐水之剂下之。
筋疝者，阴茎肿胀，或溃、或脓、或痛，而里急筋缩，或茎中痛，痛极则痒，或挺然不收，白物如精随溺
出。得于房中邪术所使而成，宜降心火之剂下之。
血疝者，其状如黄瓜，在小腹两旁横骨两端，俗名便痈。得之重感春、夏大燠，劳于使内，其气流溢，渗
入脬囊，结为痈肿，以和血药下之。
气疝者，上连肾区，下及阴囊。或号哭、忿怒，气郁而胀，以散气药下之。
狐疝者，状如瓦，卧则入腹，行则出，上下无定，如狐之惑也，故名之。以逐气流经之剂下之。
疝者，阴囊肿大如升斗，不痒不痛。以受湿气之所生，宜去湿之剂下之。
附 治疝诸方
五叶汤
枇杷叶 椒叶 苍耳叶 野紫苏叶 水晶葡萄叶
水煎，洗。
疝气神方
硫黄（火中熔化，即投水中去毒，研细） 荔枝核（为末，炒焦黄） 陈皮（等分）
为末，饭丸，每用十四、五丸，酒下，其疼立止。自觉已疼甚，不能支持，略用六丸，再不可多也。
治疝用仙人对坐草、青木香捣汁，和酒少许服之，神效。
[Song] Cold water, blood qi, and Hu Jin (Fox Tendon) hernias: The sages left behind only the empty name of "Seven Hernias." This is because the Liver Meridian originally harbors heat, while externally it is invaded by damp-cold. It may also be due to dead blood (blood stasis) and phlegm-fluids stagnating in the scrotum, causing Qi mechanism to fail to circulate. This pulls on the testicles, generating swelling and pain; sometimes resembling a gourd, sometimes producing sounds like frogs. One must distinguish the root and branch, cold and heat; regarding the pathogenic invasion, one must still evaluate its severity and lightness. Do not attribute it to Bladder, Heart, or Kidney Qi; rather, know that it truly belongs to the Jueyin Liver Meridian.
[Discussion] In ancient times, there were names for seven types of hernia, but treatment was not administered according to these seven types. Instead, the pungent, hot, and drying agents from the *Ju Fang* (Formulas of the Imperial Medical Bureau) were used indiscriminately. This is adhering to the superficial symptoms while forgetting the root cause. Some point to them as Small Intestine Qi, Kidney Qi, or Bladder Qi, all of which are incorrect. Little do they know that the Jueyin meridian courses through the genital organs, yet their location is governed by the Liver Meridian, having no connection with the Small Intestine, Bladder, or Kidneys. It was not until Dairen (Zhang Congzheng) that this was distinguished in detail. Danxi (Zhu Zhenheng) said: Severe hernia pain involves the testicles connected to the lower abdomen with urgent pain. There may be form or no form, sound or no sound. Since the *Su Wen*, it has been considered cold, because when meridians encounter cold, they contract and fail to flow smoothly, thus causing pain. In the world, there are those who suffer from cold but do not develop hernia; this is because there is no internal heat. I have often kicked ice and waded through water without suffering from this, precisely because I naturally lack internal heat. However, if one indulges in alcohol and heavy meals, overworks, engages in excessive sexual activity, or becomes extremely angry, the fire of the five emotions is stirred up. After long stagnation, dampness becomes abundant, turbid fluids condense, enter the blood vessels, and flow into the Jueyin Liver Meridian. The nature of Wood is swift, and the nature of Fire is violent; constrained by cold, the pain should be severe and sudden. This clearly indicates that damp-heat is constrained by cold, causing pain. If treated solely as cold, it would likely be incomplete. Furthermore, he stated: Phlegm-fluids, food retention, and blood stasis stagnating cause disease; and edema caused by water-qi is mostly due to dampness. There are also cases complicated by deficiency. The pulse is deep, tight, and large/hollow. One should use Ginseng (*Ren Shen*) and Atractylodes Macrocephala (*Bai Zhu*) as the sovereign drugs, assisted by draining and guiding agents. If one indiscriminately uses purging and breaking methods, disaster will follow immediately. These are matters not previously addressed by predecessors; students should extend and elaborate upon them. Now, the manifestations of the seven hernias are listed below.
[Pulse Diagnosis] The pulse of hernia is wiry and urgent, indicating accumulation inside. A firm and urgent pulse indicates survival; a weak and urgent pulse indicates death. Deep, slow, floating, and choppy pulses indicate hernia masses and cold pain. When pain is severe, the pulse may vanish, become fine, or be restless.
Cold Hernia
The classics state: Cold in the sinews of the Foot Jueyin Liver Meridian causes sinew contraction and testicular retraction due to cold; this is cold stagnating externally. The *Yuan Bing Shi* states: Hernia presents as lower abdominal pain radiating to swollen testicles, with urgent and colicky pain. Cold governs contraction and retraction. When cold reaches its extreme, Earth element controls it, leading to swelling and fullness. Knowing the hernia is due to cold indicates external invasion of cold pathogens, while internally it is not cold. This clarifies Danxi's statement of "superficial cold and fundamental heat."
For Cold Hernia with cold and numb extremities, hernia distending pain, and body pain, use **Wutou Guizhi Tang** (Aconite and Cinnamon Twig Decoction). For Cold Hernia invading abdominal pain, lower abdominal pain radiating to testicles, diarrhea with chest fullness, use **Bushen Tang** (Kidney Tonifying Decoction); or for Kidney deficiency with unilateral Cold Hernia enlargement, use **Zhuyu Neixiao Wan** (Cornus Internal Resolving Pill).
**Wutou Guizhi Tang**
Aconiti Lateralis Radix Praeparata (*Wutou*, 5 fen)
White Honey (*Bai Mi*, 1 jin, decocted until half remains, strained)
Take 5 qian of Guizhi Tang per dose, add 0.5 liang of honey, decoct in water. Take 2 he per dose. Vomiting indicates the therapeutic effect has been reached. (See Guizhi Tang formula under Chills Syndrome.)
**Bushen Tang**
Treats Cold Hernia invading abdominal pain.
Ginseng Radix (*Ren Shen*, 1 liang, remove rhizome)
Poria (*Fu Ling*, 1 liang)
Astragali Radix (*Huang Qi*, 1 liang, honey-fried)
Aconiti Radix Praeparata (*Fuzi*, 1 liang, processed)
Atractylodis Macrocephalae Rhizoma (*Bai Zhu*, 1 liang, stir-fried)
Aquilariae Lignum Resinatum (*Chen Xiang*, 4 qian)
Chaenomelis Fructus (*Mu Gua*, 1.5 liang)
Notopterygii Rhizoma et Radix (*Qiang Huo*, 0.5 liang, remove rhizome)
Glycyrrhizae Radix et Rhizoma (*Gan Cao*, 2 qian, honey-fried)
Chuanxiong Rhizoma (*Chuan Xiong*, 2 qian)
Perillae Folium (*Zi Su*, 3 qian)
Crush the above ingredients. Take 5 qian per dose with 3 slices of ginger and 2 jujubes, decoct in 2 cups of water until 0.8 cup remains.
**Zhuyu Neixiao Wan**
Corni Fructus (*Shan Zhu Yu*, 6 liang)
Evodiae Fructus (*Wu Zhu Yu*, 4 liang)
Iris Tectorii Rhizoma (*Ma Lan Hua*, 4 liang)
Costi Root (*Mu Xiang*, 4 liang)
Citri Reticulatae Pericarpium (*Chen Pi*, 4 liang)
Cinnamomi Cortex (*Rou Gui*, 4 liang)
Dioscoreae Rhizoma Dryum (*Shan Yao*, 6 liang)
Toosendan Fructus (*Chuan Lian Zi*, 4 liang)
Citri Reticulatae Pericarpium Viride (*Qing Pi*, 4 liang, stir-fried)
Foeniculi Fructus (*Hui Xiang*, 4 liang, stir-fried)
Make pills with wine. Take with warm wine.
Wood Hernia (Induration of Scrotum)
When Heart Fire descends, Kidney Water is warmed; when True Yang descends, Kidney Qi harmonizes. With warmth and harmony, how could there be "Wood Excess" (induration)? Generally, Wood Hernia should not absolutely exclude drying herbs. One should employ mild, warming, dispersing, and draining methods to expel the pathogen, allowing it to dissipate naturally. As Ying and Wei circulate, recovery occurs. Use **Gouqizi Wan** (Lycium Pill). Another method: Use male Mulberry leaves (*Chu Ye*), dry them in the sun, grind into fine powder, make pills with wine paste the size of paulownia seeds. Take 50 pills per dose, swallowed with salt and wine on an empty stomach. (Mulberry trees that do not bear fruit are male.)
**Gouqizi Wan**
Lycii Cortex (*Di Gu Pi* - Note: Text says Gouqizi/Fructus, usually Lycii Fructus) (*Gou Qi Zi*, 4 liang)
Arisaematis Rhizoma (*Nan Xing*, 2 liang)
Pinelliae Rhizoma (*Ban Xia*, 2 liang)
Phellodendri Cortex (*Huang Bo*, 3 liang, wine-fried)
Atractylodis Rhizoma (*Cang Zhu*, 3 liang, salt-fried)
Crataegi Fructus (*Shan Zha*, 2 liang, remove pits)
Angelicae Dahuricae Radix (*Bai Zhi*, 2 liang)
Massae Fermentatae Medicinalis (*Shen Qu*, 2 liang, stir-fried)
Talcum (*Hua Shi*, 3 liang, stir-fried)
Laminaria Thallus (*Kun Bu*, 4 liang)
Evodiae Fructus (*Wu Zhu Yu*, 4 liang)
Grind into powder, make pills with wine paste the size of paulownia seeds. Take 70 pills per dose with salt water on an empty stomach.
Food Retention, Damp Phlegm, Dead Blood
Food retention and dead blood causing painful hernia: Use Gardeniae Fructus (*Zhi Zi*), Persicae Semen (*Tao Ren*), Crataegi Fructus (*Shan Zha*), Immaturus Citri Fructus (*Zhi Shi*), Evodiae Fructus (*Wu Zhu Yu*), Ginger Juice. Decoct with smooth-flowing water. Or add Cyperi Rhizoma (*Xiang Fu*) and Foeniculi Fructus (*Hui Xiang*).
Phlegm-fluids flowing downward, obstructing the scrotum causing hernia: Use Atractylodis Rhizoma (*Cang Zhu*), Gardeniae Fructus (*Zhi Zi*), Aragonitum (*Hai Shi*), Arisaematis Rhizoma (*Nan Xing*), Crataegi Fructus (*Shan Zha*), Apricot Kernel (*Ju He*), Citri Reticulatae Pericarpium Viride (*Qing Pi*). Decoct with ginger.
Excessive dampness causing difficult urination: Use **Wuling San** (*Five-Ling Powder*) plus Toosendan Fructus (*Lian Shi*). (Formula see Spleen/Stomach section.)
Damp-phlegm Heat Hernia: Use **Juhe San** (Apricot Kernel Powder).
**Juhe San**
Damp-heat and cold constraint causing hernia.
Apricot Kernel (*Ju He*, 1 liang)
Persicae Semen (*Tao Ren*, 5 qian)
Gardeniae Fructus (*Zhi Zi*, 3 qian)
Evodiae Fructus (*Wu Zhu Yu*, 1 liang)
Foeniculi Fructus (*Hui Xiang*, 1 liang)
Take 7 qian per dose, decoct in 2 cups of water, take hot.
Damp-Heat Hernia
Those who habitually have damp-heat, or who wade in water and catch cold, or sit/lie on damp ground, suffer external cold invasion. If the pain is severe and sudden, ancient formulas using equal parts of Aconite (*Wutou*) and Gardeniae (*Zhi Zi*) as decoctions or pills are most effective. For Damp-Heat Hernia pain with urinary obstruction, choose **Kuizi Tang** (Abutilon Seed Decoction) or **Xiaoshen San** (Hernia Resolving Powder).
**Jisheng Kuizi Tang**
Red Poria (*Chi Fu Ling*, 1 liang)
Polyporus (*Zhu Ling*, 1 liang)
Abutili Semen (*Kui Zi*, 1 liang)
Immaturus Citri Fructus (*Zhi Shi*, 5 qian, stir-fried)
Descurainiae Herba (*Qu Mai*, 5 qian)
Akebiae Caulis (*Mu Tong*, 5 qian)
Scutellariae Radix (*Huang Qin*, 5 qian)
Plantaginis Semen (*Che Qian Zi*, 1 liang)
Talcum (*Hua Shi*, 1 liang, ground)
Glycyrrhizae Radix et Rhizoma (*Gan Cao*, 5 qian)
Take 5 qian per dose, decoct with ginger.
**Xiaoshen San**
Treats Damp-Heat Hernia pain.
Atractylodis Rhizoma (*Cang Zhu*, 0.5 liang, stir-fried)
Akebiae Caulis (*Mu Tong*, 0.5 liang)
Phellodendri Cortex (*Huang Bo*, 0.5 liang, stir-fried)
Citri Reticulatae Pericarpium Viride (*Qing Pi*, 0.5 liang, stir-fried)
Moutan Cortex? No, Magnoliae Officinalis Cortex (*Hou Po*, 3 qian, stir-fried) - *Note: Text says Nong Po, likely Hou Po.*
Grind into powder. Take 2 qian per dose with decoction of Citri Reticulatae Pericarpium (*Chen Pi*).
Deficiency Hernia
Hernias complicated by deficiency present with a deep, wiry, slippery, and large pulse. Use Ginseng (*Ren Shen*) and Atractylodes Macrocephala (*Bai Zhu*) as sovereign drugs, assisted by draining and guiding agents such as Immaturus Citri Fructus (*Zhi Shi*), Citri Reticulatae Pericarpium Viride (*Qing Pi*), Crataegi Fructus (*Shan Zha*), Toosendan Fructus (*Chuan Lian Zi*), and Apricot Kernel (*Ju He*). If indeterminate upon pressure, it belongs to deficiency. Use Cinnamon Twig (*Gui Zhi*), stir-fried Gardeniae (*Chao Shan Zhi*), and Aconite (*Wutou*), grind into powder, make pill with paste, or use Juhe San with added Atractylodis Rhizoma (*Cang Zhu*). (Formula see above.)
For Deficiency complicated by Heat Hernia, use **Zhizi Yin** (Gardenia Drink).
**Zhizi Yin**
Treats Deficiency complicated by Heat Hernia.
Gardeniae Fructus (*Zhi Zi*, 0.5 liang, stir-fried)
Persicae Semen (*Tao Ren*, 0.5 liang, stir-fried)
Aurantii Fructus (*Zhi Ke*, 0.5 liang, stir-fried)
Crataegi Fructus (*Shan Zha*, 0.5 liang)
Decoct with Ginger Juice and smooth-flowing water.
One variation adds Evodiae Fructus (*Wu Zhu Yu*).
Manifestations of the Seven Hernias
**Cold Hernia**: Scrotum is cold, hard like stone, penis does not erect, or pain radiates to testicles. Caused by sitting/lying on damp ground or wading in water. Treat with damp-draining agents.
**Water Hernia**: Scrotum swells like crystal, sweating and itching in the yin area, yellow fluid exudes upon scratching, or water sound is heard upon pressing the lower abdomen. Caused by sexual intercourse after drunkenness, sweat exposed to wind, cold-damp knotting in the scrotum. Treat with water-expelling agents.
**Sinew Hernia**: Penis swells, or ulcerates, suppurates, or hurts, with tenesmus and sinew contraction, or pain in the urethra. Extreme pain leads to itching, or persistent erection without detumescence. White substance like semen discharges with urine. Caused by evil arts in sexual practices. Treat with Heart-Fire-descending agents.
**Blood Hernia**: Shape resembles a cucumber, located at both ends of the transverse bone on either side of the lower abdomen, commonly called "Bian Yong" (Sojourning Abscess). Caused by repeated exposure to summer heat, labor during sexual activity, Qi overflow seeping into the bladder sac, forming an abscess. Treat with blood-harmonizing agents.
**Qi Hernia**: Extends upward to the kidney region, downward to the scrotum. Distension occurs due to crying or anger causing Qi stagnation. Treat with Qi-scattering agents.
**Fox Hernia**: Shape resembles a tile. Enters the abdomen when lying down, exits when walking. Moves up and down unpredictably, confusing like a fox, hence the name. Treat with Qi-flowing and meridian-penetrating agents.
**(Unnamed/General) Hernia**: Scrotum swells large as a measuring vessel, without itching or pain. Caused by dampness. Treat with damp-removing agents.
Appendix: Various Formulas for Treating Hernia
**Wuye Tang** (Five-Leaf Decoction)
Loquat Leaf (*Pi Pa Ye*)
Pepper Leaf (*Jiao Ye*)
Cocklebur Leaf (*Cang Er Ye*)
Wild Perilla Leaf (*Ye Zi Su Ye*)
Crystal Grape Leaf (*Shui Jing Pu Tao Ye*)
Decoct in water, wash externally.
**Shenqi Shenfang** (Divine Formula for Hernia Qi)
Sulfur (*Liu Huang*, melted in fire, immediately thrown into water to remove toxicity, ground fine)
Lychee Seed (*Li Zhi He*, ground to powder, stir-fried until dark yellow)
Citri Reticulatae Pericarpium (*Chen Pi*, equal parts)
Grind into powder, make pills with rice paste. Take 14-15 pills per dose with wine; pain stops immediately. If pain is severe and unbearable, take only 6 pills; do not exceed this amount.
Treating hernia with *Xianren Duizuo Cao* (Herb of Immortals Sitting Face-to-Face) and *Qing Mu Xiang* (Magnolia Bark/Aucklandia), crush to extract juice, mix with a little wine and ingest. Miraculous effect.