按∶ ，《玉篇》徒回切，下肿也。盖 即 之从 者，颓与 音义相同，非有差异。
源由 病之状，阴核肿大，有时小歇，歇时终大于常，劳冷阴雨便发，发则胀大，使人腰脊挛急，
身体恶寒，骨节沉重，此病由于损肾也。足少阴之经，肾之脉也，其气下通于阴。阴，宗脉之所聚，积阴之气
也。劳伤举重，伤于少阴之经，其气不冲于阴，气胀不通，故成 也。（《病源论》）（按∶ 字《医心方》
引并作颓。又不冲《医心方》作下冲，是。通行本作不卫，亦通。）
虚劳阴疝肿缩候 疝者气痛也，众筋会于阴器，邪客于厥阴、少阴之经，与冷气相搏，则阴痛肿而挛
缩。（同上）（按∶《外台》引无肿字。）
虚劳阴痛候 肾气虚损，为风邪所侵，气流入于肾经，与阴气相击，真邪交争，故令阴痛。但冷者惟
痛，挟热则肿。（同上）
心火下降，则肾水不患其不温，真阳下行，则肾气不患其不和，温温其和，安有所谓木强者哉。惟夫嗜欲
内戕，肾家虚惫，故阴阳不相交，水火不相济，而沉寒痼冷凝滞其间，胀大作疼，顽痹结硬，势所必至矣。（《直
指》）
《黄帝针经》曰∶足厥阴之脉，环阴器，抵少腹，是动则病丈夫 疝。即阴疝也。嗜欲劳伤，肾水涸竭，
无以滋荣肝气，故留滞内结，发为阴疝之病。世俗论阴疝者为肾余气，殊不知邪实又本于肝经也。治法宜泻邪气
之实，补肝经之虚。（《圣济》）
，湿多。（《丹溪》）
囊缩之理 伤寒家囊卵缩，大热在内，宜承气汤急下之。与《经筋》说囊卵缩，大寒在外，亦是热在内，
与伤寒家同。故再引平康之人以证之，冬天阳气在内，阴气在外，人亦应之，故寒在外则皮急，皮急则囊缩。
夏月阴气在内，阳气在外，人亦应之，故热在外则皮缓，皮缓则囊垂，此 疝之象也。（《微义》）
脉候 疝之病，尺脉紧而动，按之即虚。（《史载之方》）
有四种 《短剧方》云∶男颓有肠颓、卵胀、水颓、气 、四种。肠颓、卵胀，难瘥；气颓、水颓，
针灸则易瘥也。（《医心》）（《千金》同）
疝者痛也，邪气聚于阴，致阴器肿大而痛者，阴疝也，一名 疝，其类有四，即肠 、卵胀、气 、水
是也。世俗云疝气，亦云小肠气，或曰膀胱气。原其病本，缘肾气通于阴，与膀胱为表里，胞囊者膀胱之候，
此二经不足，下焦受寒，皆能致阴卵肿大，或发疝痛，故通称曰阴疝。若寒湿之气有连于小肠者，即少腹控睾
而痛，阴丸上下，谓之肠 。寒气客于经筋，足厥阴脉受邪，脉胀不通，邪结于睾卵，谓之卵胀。肾虚之人，
因饮食不节，喜怒不时，津液内溢，下流于睾，寒气结聚不散，谓之气 。水气盛则津液内结，谓之水 。水
、气 ，病生于标，故针灸可治，其病易愈。肠 、卵胀，病生于本，邪气入深，其治难瘥。（《圣济》）
夫阴 ，属肝系宗筋（按∶此以 为阴囊之名，深误），胃阳明养之。世多不识，谓之外肾，非特名义差
错，亦使五内不分，其可不辨。古方虽出四证，但曰肠 、气 、水 、卵胀，殊不别其所因。如肠 则因房
室过度，元脏虚冷，肠边HT 系不收，坠入 中，上下无定，谓之肠 ，属不内外因。病者久蓄忧思，恐怒兼并，
随脏气下坠阴 ，肿胀急痛，名曰气 ，属内所因。病者久坐冷湿，湿气下袭，致阴肿胀，名曰水 ，属外所
因。病者劳役无度，及跨马坐车，致卵核肿胀，或偏有大小，上下无常，名曰卵胀，亦属不内外因。有小儿生
来便如此者，乃宿疾也。卵胀、肠 皆难治，气 、水 治之易愈。又寒疝下注，入于 中，名为狐疝，亦属
病。世人因此并以 病为疝气，不审之甚。妇人阴门挺出，亦称 病，名义不分，有如此者。（《三因》）
凡 病，惟肠 无问贵贱多有之。有睡卧 系延入胁下者，有坠入囊中者，或遇疲劳及天色变动，逼上囊
根，肿急
胀痛，过于寒疝，得暖则下。其如卵胀，有作热生脓为痈溃烂者，比比有之。（同上）
阴 之证，其种有四。究其所因，皆是肾经虚寒，或为劳役所伤，或为风湿之气所侵，结而不散，久则肾虚
惫而成此证。外肾肿胀者，偏有小大，或坚硬如石，或脐腹绞痛，甚则肤囊肿胀成疮，时出黄水，病而至此，
未易治也。肠 亦然。惟气 、水 ，关元灸之可。（《大成》）
七疝 寒疝，其状囊冷，结硬如石，阴茎不举，或控睾丸而痛。得于坐卧湿地，或寒月涉水，或冒雨
雪，或卧坐砖石，或风冷处使内过劳，宜以温剂下之，久而无子。水疝，其状肾囊肿痛，阴汗时出，或囊肿而
状如水晶，或囊痒而搔出黄水，或少腹中按之作水声。得于饮水醉酒，使内过劳，汗出而遇风，寒湿之气聚于
囊中，故水多，令人为卒疝。宜以逐水之剂下之，有漏针去水者，人多不得其法。筋疝，其状阴茎肿胀，或溃
或脓，或痛而里急筋缩，或茎中痛，痛极则痒，或挺纵不收，或白物如精，随溲而下。得于房室劳伤，及邪术
所使，宜以降心之剂下之。血疝，其状如黄瓜。在少腹两旁，横骨两端约中，俗云便痈。得于重感春夏大燠，
劳于使内，气血流溢，渗入脬囊，留而不去，结成痈肿，脓少血多，宜以和血之剂下之。（《治法杂论》曰∶
治以导水丸、桃仁承气汤或抵当汤投之，同瘀血法。聚而不散，可以大作剂料，大泻一二十行，次以玉烛散和
血通经之类是也。）气疝，其状上连肾区，下及阴囊，或因号哭忿怒，则气郁之而胀，怒哭号罢则气散者是也。
有一治法，以针出气而愈者，然针有得失，宜以散气之药下之。或小儿亦有此疾，俗曰偏气，得于父已年老，
或年少多病，阴痿精怯，强力入房，因而有子，胎中病也，此疝不治，惟筑宾一
穴针之。狐疝，其状如瓦，卧则入小腹，行立则出小腹入囊中，狐则昼出穴而溺，夜则入穴而不溺，此病出入
上下往来，正与狐相类也，亦与气疝大同小异，今人带钩钤是也，宜以逐气流经之药下之。 疝，其状阴囊
肿缒，如升如斗，不痒不痛者是也。得之地气卑湿所生，故江淮之间，湫塘之处，多感此疾，宜以去湿之药下
之。女子阴户突出，虽亦此类，乃热则不禁固也，不可便谓虚寒，而涩之燥之补之，本名曰瘕，宜以苦下之，
以苦坚之。王冰云∶阳气下坠，阴气上争，上争则寒多，下坠则筋缓，故睾垂纵缓，因作 疝也。以上七疝，
下去其病之后，可调则调，可补则补，各量病势，勿拘俗法，经所谓阴盛而腹胀不通者， 癃疝也，不可不下。
（《儒门事亲》）（《纲目》曰∶在《疝图》虽七，然寒疝即疝之总名，水疝即 疝之属，气疝即狐疝之属，
血疝即痈疖之属，惟筋疝罕见之，盖下疳疮之属也。《金匮翼》曰∶此皆痛在睾丸之疝也。按∶二说俱是，盖
此寒疝犹是 之类，故并列于此。）
一种水疝，皮色光亮，无热。无红肿痛，有时内有聚水，宜用针从便处，引去水气则安。（《外科正宗》）
证治诸说 制剂之法，不可纯用燥热，当温散温利以逐其邪，邪气内消，荣卫流转，盎盎如寒谷回春
，盖有不疾而速，不行而至者矣。外此又有一种升高坠下，外肾跌伤，惊气与败血交攻，亦有木强胀痛之证，
治法大要则同，于中更为之消瘀。（《直指》）
胡新恩云∶曾于夏间，阴囊肿大，妨碍起居，医药未及，偶仆者持汤一杯至，谩饮之，似觉疾宽，呼问之，
乃曰香薷汤也，遂再啜一盏，疾顿减。及夫医至，亦只用五苓散、青木香丸奏效。乃知夏月此疾作者，多由
中虚及坐卧暑
气而致也。（《澹寮》）
一核偏坠，或俱肿胀，或一核缩入小腹，痛不可忍，用手按捺，方得还旧，是为 气，宜蟠葱散，吞下茱萸
内消丸。若痛入腹，逆上攻心，至成呕逆，先用盐酒下养正丹，次用生料五积散，加吴茱萸、 香、桃仁、延
胡索各炒入半钱。有因登高颠伤外核，以致肿疼，或小便出血，或小便不通，宜五苓散和复元通气散服。有阴
大如斗，诸药不能效者，宜当归四逆汤加生姜、茱萸，效。（《要诀》）
疝者，少腹控卵，肿急绞痛，《灵枢·刺节篇》所谓去爪是也，睾囊肿大，如斗如栲栳，甚者与身齐等，
而不作痛，中藏秽液甚多，此湿邪也，最为难治，但觉微痛者可治，桂苓丸（系桂、苓二味）加苍术、浓朴、黄柏、川
乌。
水疝（证与《事亲》同），五苓散，换苍术，加楝实、柏皮。木肾，则阴丸肿大作痛，顽痹结硬，皆嗜欲内戕，
肾经虚惫，湿热凝滞其间，故顽痹结硬，肿大作痛，二妙散（系黄柏、苍术为散，姜汁调，温酒服）加肉桂、
吴茱萸、半夏、枳实、生姜。荆芥穗一两，朴硝、萝卜各二两，葱七茎，煎汤淋洗。偏坠初起，香橘散（系茴
香、 香、橘核、山楂肉）加穿山甲，或穿山甲、茴香二味为末，酒调下，干物压之。患久，药之不效，或一
核缩入小腹，痛不可忍，用手按捺，方得还旧者，木香楝子散。外用牡蛎灰、良姜等分为末，唾津调涂肿大一
边，须臾如火热，痛即安。（《医通》）
死证 卵 ，玉茎肿硬，引脐绞痛，甚则阴缩肢冷，囊上生疮成痈，二症出水不止者死。（《入门》）
类证 凡疝为患，小腹作疼，牵引肾子，多寒少热，好饮热汤。此症乃恼怒伤肝，阴虚湿热为患，
其囊红肿发热，小便赤涩，内热口干，坠重作痛，此为囊痈之候。（《外科
正宗》）
通气诸方 橘核丸，治四种 病，卵核肿胀，偏有大小，或坚硬如石，或引脐腹绞痛，甚则肤囊肿胀，
或成疮毒，轻则时出黄水，甚则成痈溃烂。
橘核（炒） 海藻（洗） 昆布（洗） 海带（洗） 川楝子（取肉炒） 桃仁（麸炒各一两） 浓朴（去
皮姜汁制炒） 木通 枳实（麸炒） 玄胡索（炒去皮） 桂心（不见火） 木香（不见火各半两）
上为细末，酒糊为丸，如梧桐子大，每服七十丸，空心温酒、盐汤任下。虚寒甚者，加炮川乌一两。坚胀
久不消者，加 砂二钱，醋煮旋入。（《济生》）
香附散，治 胀。
香附子（不拘多少）
上为末，每用酒一盏，煎海藻一钱重，至半盏，先捞海藻嚼细，用所煎酒调香附末二钱服。（《三因》）
外肾赤肿，以金橘核，舶上茴香，等分炒香，碾为细末，空心酒调下，须多饮则药力易至。患处却以木鳖
肉，研如泥，涂之立效。久患者，频用之。（《琐碎录》）
荔核散，治肾大如斗，不过二剂除根。
舶上茴香 青皮（全者） 荔枝核
上等分锉散炒，出火毒为末，酒下二钱，日三服。（《得效》）
木香楝子散，治小肠疝气，膀胱偏坠，久患药不效者，服此药其效如神。（燕同知秘传）
川楝子（二十个为末，未碾前先用巴豆二十粒，同楝子炒黄赤色，去巴豆不用。） 萆 （半两） 石菖蒲（一两炒）
青木香（一两炒） 荔枝核（二十个炒）
上为细末，每服二钱重，入麝香少许，空心炒茴香盐酒
下。（《瑞竹》）
行气香苏散，治偏坠气，初起疼痛，憎寒壮热。
根据本方（按∶此系香苏散加柴胡、乌药、川芎、羌活、枳壳、苍术、麻黄）加小茴香、木香、三棱、莪术、
木通。（《医鉴》）
溃结诸方 《古今录验》牡丹五等散，疗 疝，阴卵偏大，有气上下胀大，行走肿大，服此良验方。
牡丹皮 防风 黄柏（炙） 桂心（各一分） 桃仁（二分去皮尖研）
上五味捣为散，以酒服一刀圭，二十日愈。少小 疝最良，小儿以乳汁和，如一大豆与之。（《外台》）《医心》∶
《短剧方》牡丹五痔散（主治同），于本方去桃仁，加豉熬。
兼金丸，治热入膀胱，脐腹上下兼胁肋疼痛，便燥，欲饮水，按之痛者。
大黄（湿纸裹煨八钱） 硝石 桂心 甘草（炙各四两） 桃仁（四十个去皮尖）
上为末，蜜丸梧子大，米饮下五七丸至十丸。（《三因》）吉氏家传胜金丸，治小儿疝气偏坠方。
川楝子（去复选肉） 续随子肉（七十个去皮） 轻粉（一钱）
上为末，稀面糊为丸，每服七丸至十丸，葱白薄荷汤吞下。（《幼幼》）
三白散，治膀胱蕴热，风湿相乘，阴 肿胀。大小便不利。
白牵牛（略炒二两） 白术（半两） 桑白皮 陈皮 木通（各半两）
上为末，每服二钱，姜汤调下，空心服。初进一服未觉，再进。此药不损脏气，只导利留滞。疝方大率多用
热药，此方惟壅热证宜服之。（《三因》）
解钳丸，治小肠气，及膀胱气，横弦竖弦，木肾偏坠，下部诸疝气痛。
木鳖子（二两净去油） 茴香（二两） 黑丑（二两） 半夏（二两） 补骨脂（二两）
酒糊丸，梧子大，空心服三十丸，炒姜盐灯心酒下，午后临睡各一服。（《赤水》）（按∶此方修制颇繁，
今省不录。）
应痛丸，治败精恶物不去，结在阴囊成疝，疼痛不可忍。
阿魏（二两，醋和，用荞麦面作饼，浓三指，裹阿魏，慢火煨熟。） 槟榔（大者二个，刮作瓮子，满盛滴
Note: The character "tui" (𦚧) is pronounced "tu hui qie" in *Yu Pian*, referring to swelling of the lower scrotum. Essentially, "tui" (𦚧) is a variant of "tui" (颓) with the "ye" (page/head) radical; "tui" (颓) and "tui" (𦚧) have identical pronunciation and meaning, with no difference.
Etiology and Pathogenesis The symptoms of this disease include enlargement of the testicles, which may temporarily subside but ultimately remain larger than normal. It tends to flare up due to fatigue, cold exposure, or rainy weather. Upon onset, swelling increases, causing stiffness and urgency in the waist and spine, aversion to cold in the body, and heaviness in the bone joints. This disease arises from damage to the Kidney. The Foot-Shaoyin Meridian is the meridian of the Kidney, and its Qi flows downward to the genitalia. The genitalia are the convergence point of numerous meridians and accumulate Yin Qi. Injury to the Foot-Shaoyin Meridian due to overexertion or lifting heavy objects prevents Qi from ascending to the genital region, leading to Qi distension and obstruction, thus forming this condition (*Zhubing Yuanhou Lun*). (Note: In *Ishinpo*, the character "tui" (𦚧) is cited as "tui" (颓). Also, "bu chong" (not rushing) is written as "xia chong" (rushing downward) in *Ishinpo*, which is correct. The circulating version writes "bu wei" (not guarding), which is also acceptable.)
Prognosis and Symptoms of Deficiency-Empirement Genital Hernia with Swelling and Contraction "Shan" refers to pain caused by Qi stagnation. The sinews converge at the genitalia. When pathogenic factors lodge in the Foot-Jueyin and Foot-Shaoyin meridians and contend with Cold Qi, it results in pain, swelling, and contraction of the genitalia (*Zhubing Yuanhou Lun*). (Note: *Waitai Miyao* omits the character "swelling".)
Prognosis and Symptoms of Deficiency-Empirement Genital Pain When Kidney Qi is deficient and damaged, Wind pathogens invade. Qi flows into the Kidney meridian and clashes with Yin Qi, causing a struggle between True Qi and Evil Qi, resulting in genital pain. Pure Cold conditions cause only pain, while conditions involving Heat cause swelling (*Zhubing Yuanhou Lun*).
When Heart Fire descends, Kidney Water need not worry about being unwarmed; when True Yang descends, Kidney Qi need not worry about being disharmonious. With gentle harmony, how could there be an excess of Liver Wood? However, excessive desires internally damage the body, leading to Kidney deficiency and exhaustion. Consequently, Yin and Yang fail to interact, and Water and Fire fail to balance. Deep-seated Cold and stubborn stagnation accumulate within, inevitably leading to distension, pain, stubborn bi-syndrome, and induration (*Zhizhi Fang*).
The *Huangdi Zhenjing* states: The Foot-Jueyin meridian circles the genitalia and reaches the lower abdomen. When this meridian is disturbed, it causes hernia in men. This is essentially Yin Hernia. Excessive desires and fatigue deplete Kidney Water, failing to nourish Liver Qi, leading to internal stagnation and knotting, manifesting as Yin Hernia. Laypeople attribute Yin Hernia to residual Qi of the Kidney, unaware that the pathogenic excess actually originates from the Liver meridian. Treatment should involve draining the excess of pathogenic factors and tonifying the deficiency of the Liver meridian (*Shengji Zonglu*).
This condition involves significant Dampness (*Danxi Xinfa*).
Mechanism of Scrotal Retraction In patients with Shanghan (Cold Damage), retraction of the scrotum and testicles indicates intense internal Heat; Chengqi Tang should be used urgently to purge. This aligns with the *Jingjin* chapter's description of scrotal retraction due to external Cold, which also implies internal Heat, similar to Shanghan cases. To verify this, consider healthy individuals: in winter, Yang Qi resides internally and Yin externally; humans mirror this, so external Cold causes skin tension, leading to scrotal retraction. In summer, Yin resides internally and Yang externally; humans mirror this, so external Heat causes skin relaxation, leading to scrotal hanging. This is the manifestation of Tui Hernia (*Wei Yi*).
Pulse Diagnosis For hernia diseases, the Chi pulse is tight and pulsating, feeling empty upon pressure (*Shi Zaizhi Fang*).
Four Types of Hernia According to *Duanju Fang*, male Tui hernia is divided into four types: Chang Tui (Intestinal Hernia), Luan Zhang (Testicular Swelling), Shui Tui (Water Hernia), and Qi Shan (Qi Hernia). Chang Tui and Luan Zhang are difficult to cure; Qi Shan and Shui Tui are easily cured via acupuncture (*Ishinpo*). (*Qianjin Fang* agrees.)
Shan denotes pain. When pathogenic factors gather in the yin region, causing swelling and pain in the genitalia, it is called Yin Hernia, also known as Tui Hernia. There are four categories: Chang Tui, Luan Zhang, Qi Shan, and Shui Tui. Laypeople call it Qi Hernia, Small Intestine Qi, or Bladder Qi. Tracing the root, Kidney Qi connects to the genitalia and forms exterior-interior relationships with the Bladder. The bladder sac reflects the Bladder's status. Deficiency in these two meridians and Cold invasion in the Lower Jiao can cause scrotal and testicular swelling or hernia pain, hence the general term Yin Hernia. If Cold-Dampness affects the Small Intestine, it causes lower abdominal pain radiating to the testicles, with the testicles moving up and down, termed Chang Tui. If Cold Qi lodges in the sinews and invades the Foot-Jueyin meridian, causing vessel distension and obstruction with pathogenic knots in the testicles, it is called Luan Zhang. In Kidney-deficient individuals, irregular diet and emotions cause fluids to overflow and flow downward to the testicles, where Cold Qi accumulates without dispersing, termed Qi Hernia. Excess Water Qi causes fluid accumulation internally, termed Shui Tui. Shui Hernia and Qi Hernia arise from branch manifestations, so acupuncture is effective and recovery is easy. Chang Tui and Luan Zhang arise from root manifestations with deep pathogenic invasion, making them difficult to cure (*Shengji Zonglu*).
Regarding Yin Tui, it belongs to the Liver system and the Zongjin (Gathering Sinews) (Note: Interpreting "Tui" here as the name for the scrotum is a profound error). It is nourished by the Stomach and Yangming meridians. Most people do not understand this, calling it the "External Kidney." This not only misnames it but also confuses the internal organs, necessitating clarification. Although ancient formulas list four syndromes—Chang Tui, Qi Hernia, Shui Hernia, Luan Zhang—they do not distinguish the etiology. Chang Tui results from excessive sexual activity and primordial organ coldness, causing the mesentery to fail in holding the intestine, which drops into the scrotum unpredictably; this is an neither-internal-nor-external cause. Chronic worry and anger cause Qi to sink into the scrotum, causing swelling and acute pain, named Qi Hernia, an internal cause. Prolonged sitting in cold dampness allows Dampness to attack downward, causing scrotal swelling, named Shui Hernia, an external cause. Overwork and riding horses/carts cause testicular swelling or asymmetry, named Luan Zhang, also an neither-internal-nor-external cause. Some infants are born with this, a congenital condition. Luan Zhang and Chang Tui are hard to treat; Qi Hernia and Shui Hernia are easier to cure. Additionally, Cold Hernia sinking into the scrotum is called Hu Hernia (Fox Hernia). People mistakenly group all Tui diseases under Qi Hernia, showing poor diagnostic scrutiny. Women with prolapsed labia are also sometimes called Tui disease, further confusing terminology (*Sanyin Fanglun*).
Among all Tui diseases, Chang Tui is common regardless of social status. Some have the mesentery extending into the hypochondrium during sleep, or dropping into the scrotum. Fatigue or weather changes can force swelling upward to the scrotal base, causing acute pain exceeding Cold Hernia, which subsides with warmth. Luan Zhang may develop heat, pus, and ulceration frequently (*Sanyin Fanglun*).
Yin Tui syndromes have four types. Investigating the causes, they all stem from Kidney meridian deficiency-cold, injury from overwork, or invasion by Wind-Damp, leading to stagnation. Long-term Kidney deficiency results in these syndromes. External kidney swelling may be asymmetric, stone-hard, or accompanied by umbilical/abdominal colic. Severe cases develop skin ulcers oozing yellow fluid, which are difficult to treat. Chang Tui is similarly difficult. Only Qi Hernia and Shui Hernia can be treated effectively by moxibustion on Guanyuan (*Zhen Da Cheng*).
Seven Types of Hernia:
1. Cold Hernia: Scrotum is cold, hard as stone, flaccid penis, or pain radiating to testicles. Caused by sitting on wet ground, wading in winter, exposure to snow/rain, sleeping on bricks, or excessive intercourse in cold/windy places. Treat with warming purgatives. Prolonged use may cause infertility.
2. Water Hernia: Scrotal swelling and pain, sweating in the groin, translucent scrotum like crystal, itching with yellow discharge, or water sound upon pressing the lower abdomen. Caused by drinking alcohol, excessive intercourse, sweating followed by wind exposure, leading to Cold-Damp accumulation. Treat with diuretic purgatives. Acupuncture drainage is often performed incorrectly.
3. Sinew Hernia: Penile swelling, ulceration, suppuration, pain with tenesmus and sinew contraction, penile pain, extreme pain causing itching, persistent erection, or white discharge resembling semen during urination. Caused by sexual fatigue or malicious spells. Treat with Heart-calming purgatives.
4. Blood Hernia: Resembles a cucumber. Located in the lateral lower abdomen near the transverse bone. Commonly called "pudendal abscess." Caused by severe heat in spring/summer combined with sexual exertion, causing Qi and Blood to overflow into the bladder sac and form an abscess with more blood than pus. Treat with blood-invigorating purgatives. (*Zhifa Zalun* suggests Daoshui Wan, Taoren Chengqi Tang, or Didang Tang for blood stasis. If stagnation persists, large doses to purge 10-20 times, then Yuzhu San to harmonize blood and unblock meridians.)
5. Qi Hernia: Extends from the Kidney region to the scrotum. Distension occurs due to crying or anger, resolving when calm. Acupuncture can release Qi, but herbal dispersants are safer. Children may inherit this ("One-sided Qi") if the father was old, sick, impotent, or engaged in forced intercourse; it is a fetal disease. Unresponsive to standard treatment; only needle Zhubin (KI9).
6. Fox Hernia: Shape like a tile. Enters the lower abdomen when lying down, exits into the scrotum when standing/walking. Named for its similarity to a fox's behavior. Similar to Qi Hernia. Treated with Qi-moving herbs.
7. Tui Hernia: Scrotal swelling and hanging, large as a measuring cup, non-itchy and non-painful. Caused by low-lying damp climates (e.g., Jianghuai region). Treat with damp-draining herbs. Female vaginal prolapse is similar but due to Heat failing to secure, not deficiency-cold. Do not use astringents/drying tonics. Originally called Jia (Mass). Treat with bitter purgatives and bitter firming agents. Wang Bing stated: Yang Qi sinks, Yin Qi contends upward. Upward contention causes Cold; sinking causes sinew laxity, leading to pendulous testicles and Tui Hernia. After treating these seven hernias, adjust or tonify based on the condition, avoiding rigid folk methods. As the Classics state: Yin excess causing abdominal distension and obstruction is Long-Hernia (Urinary retention/Hernia), requiring purgation (*Rumen Shiqin*). (*Bencao Gangmu* notes: In *Shan Tu*, although seven are listed, Cold Hernia is the general term for Tui Hernia; Water Hernia is a subtype of Tui; Qi Hernia is a subtype of Fox Hernia; Blood Hernia is a subtype of Abscess/Furuncle; Sinew Hernia is rare, likely related to Chancre/Gu Syndrome. *Jinkui Yi* states these are all hernias painful in the testicles. Both views are valid as Cold Hernia is akin to Tui Hernia, hence grouped here.)
A specific type of Water Hernia presents with shiny skin, no heat, redness, or pain, but internal fluid accumulation. Puncture at a convenient site to drain fluid (*Waike Zhengzong*).
Treatment Principles Formulations should not rely solely on drying-hot herbs. Use warming-dispersing and warming-diuretic methods to expel pathogens. Once pathogens dissipate, Ying and Wei circulate freely, bringing vitality like spring returning to a cold valley. Additionally, injuries from falling or trauma to the external kidneys, where Shock Qi and Stagnant Blood attack each other, present with Wood-excess distension/pain. The general treatment principle is similar, focusing on resolving blood stasis (*Zhizhi Fang*).
Hu Xin'en reported: In summer, he suffered massive scrotal swelling hindering movement. A servant offered Xiangru Tang (Elsholtzia Decoction), which provided relief. The doctor later prescribed Wuling San and Qingmuxiang Wan, which were effective. This confirms that summer-onset cases are often due to Middle Jiao deficiency and exposure to Summer-Heat (*Danliao Fang*).
Unilateral testicular drooping, bilateral swelling, or one testicle retracting into the lower abdomen with unbearable pain (reducible by manual pressure) is Tui Qi. Use Pancong San and Zhuyu Neixiao Wan. If pain radiates to the heart causing vomiting, first use Yangzheng Dan with salt-wine, then Shengliao Wuji San plus Wu Zhu Yu, Muxiang, Taoren, and Yanhusuo (each half qian, stir-fried). Trauma from heights causing swelling/pain/hematuria/retention: Use Wuling San combined with Fuyuan Tongqi San. Massive scrotal swelling unresponsive to other drugs: Use Danggui Sini Tang plus Shengjiang and Zhuyu (*Yaojue*).
Hernia involves lower abdominal pain radiating to the testicles, acute swelling/pain. This corresponds to "Qu Zhao" (Removing Claws) in *Lingshu·Ciji Pian*. Massive testicular/scrotal swelling equal to the body size without pain, containing foul fluid, indicates Dampness, which is very difficult to treat. Mild pain is treatable with Guiling Wan (Guizhi + Fuling) plus Cangzhu, Houpo, Huangbai, Chuanwu.
Water Hernia (same as *Rumen Shiqin*): Wuling San, replace Cangzhu with Cangzhu (wait, original says swap Cangzhu? No, "Huan Cangzhu" implies replacing another herb with Cangzhu or modifying. Text says "Wuling San, Huan Cangzhu", likely meaning modify the formula to emphasize Cangzhu), add Liashi, Baipi. Mu Shen (Wood Kidney/Testicular Hardness): Testicular swelling/pain, stubborn bi, induration due to sexual excess damaging Kidney, Damp-Heat stagnation. ErMiao San (Huangbai + Cangzhu, mixed with Ginger Juice, taken with warm wine) plus Rougui, Wu Zhu Yu, Banxia, Zhishi, Shengjiang. External wash: Jingjie Sui, Xiaosha, Luobo, Congjian decocted. Early unilateral drooping: Xiangju San (Huixiang, Muxiang, Juhe, Shanzha) plus Chanshunjia, or Chanshunjia + Huixiang powder with wine. Chronic cases unresponsive to herbs or reducible only by pressure: Muxiang Lianzi San. External: Musli Hui + Liangjiang powder mixed with saliva applied to swollen side; causes burning sensation relieving pain (*Yitong*).
Death Signs Testicular atrophy, glans hardness, umbilical colic, Yin retraction, limb coldness, scrotal ulcers/abscesses with continuous oozing indicate death (*Rumen*).
Differentiation All hernias typically cause lower abdominal pain radiating to the testicles, favoring Cold over Heat, preferring hot drinks. However, if caused by Anger injuring Liver, Yin deficiency, and Damp-Heat, symptoms include red/swollen/hot scrotum, dark/scanty urine, internal heat, dry mouth, heavy dragging pain. This is Scrotal Abscess (*Waike Zhengzong*).
Formulas for Promoting Qi circulation:
Juhe Wan: Treats four types of Tui disease, testicular swelling/asymmetry/hardness, umbilical pain, skin ulcers/yellow discharge/abscess.
Ingredients: Juhe (stir-fried), Haizao (washed), Kunbu (washed), Kaidai (washed), Chuanlianzi (flesh, stir-fried), Taoren (bran-fried, 1 liang each), Houpo (peeled, ginger juice processed, stir-fried), Mutong, Zhishi (bran-fried, 1 liang each), Xuansuh (stir-fried, peeled), Guixin (avoid fire), Muxiang (avoid fire, 0.5 liang each).
Preparation: Fine powder, wine paste pills, size of Sophora seeds. Dosage: 70 pills, morning empty stomach with warm wine or salt water. For severe deficiency-cold, add Paocuanwu (1 liang). For long-standing hardness/distension, add Naosha (2 qian), cooked in vinegar. (*Jisheng Fang*)
Xiangfu San: Treats Tui distension.
Ingredients: Xiangfu (any amount).
Preparation: Powder. Dosage: Decoct Haizao (1 qian) in 1 cup wine until half remains. Chew Haizao finely, mix with Xiangfu powder (2 qian) and the wine. (*Sanyin Fang*)
External Red/Swollen Scrotum: Jinjuhe + Bobo Huixiang (equal parts, stir-fried, powdered). Take with wine on empty stomach, drink plenty to enhance efficacy. Apply Mumie pulp topically for immediate effect. Repeat for chronic cases (*Suipilu*).
Lihe San: Treats enlarged Kidney/Scrotum like a bucket. Root cure in two doses.
Ingredients: Bobo Huixiang, Qingpi (whole), Lizhihe.
Preparation: Equal parts, chopped, stir-fried, remove fire toxicity, powder. Dosage: 2 qian with wine, three times daily. (*Defang*)
Muxiang Lianzi San: Treats Small Intestine Qi Hernia, Bladder unilateral drooping, chronic cases unresponsive to other drugs. Divine efficacy. (Secret recipe of Yan Tongzhi).
Ingredients: Chuanlianzi (20, powder; stir-fried with 20 Badou until yellow/red, discard Badou), Bixie (0.5 liang), Shichangpu (1 liang, stir-fried), Qingmuxiang (1 liang, stir-fried), Lizhihe (20, stir-fried).
Preparation: Fine powder. Dosage: 2 qian with a little Shexiang, morning empty stomach with stir-fried Huixiang salt-wine. (*Ruizhu Tang*)
Xingqi Xiangsu San: Treats unilateral drooping Qi, early stage pain, aversion to cold with high fever.
Base Formula (Xiangsu San plus Chaihu, Wuyao, Chuanxiong, Qianghuo, Zhiqiao, Cangzhu, Mahuang) plus Xiaohuixiang, Muxiang, Sanleng, Ezhu, Mutong. (*Yijian*)
Formulas for Ulceration/Knotting:
*Mudan Wedeng San* (*Gujin Luyan*): Treats Tui Hernia, asymmetric large testicles, Qi distension moving up/down, walking-induced swelling. Good efficacy.
Ingredients: Mudanpi, Fangfeng, Huangbai (roasted), Guixin (1 fen each), Taoren (2 fen, peeled, crushed).
Preparation: Powder. Dosage: 1 Dao Gui with wine. Cure in 20 days. Best for children. Mix with breast milk for infants (size of a soybean). (*Waitai Miyao*). *Ishinpo* cites *Duanju Fang* Mudan Wuzhi San (same indication), omitting Taoren, adding fermented soybeans.
Jianjin Wan: Treats Heat entering Bladder, upper/lower abdominal and hypochondriac pain, dry stool, thirst, tenderness on pressure.
Ingredients: Dahuang (wrapped in wet paper, baked, 8 qian), Xiaoshi, Guixin, Gancao (roasted, 4 liang each), Taoren (40, peeled).
Preparation: Powder, honey pills, Sophora seed size. Dosage: 5-10 pills with rice water. (*Sanyin Fang*)
Jishi Family Shengjin Wan: Treats pediatric hernia unilateral drooping.
Ingredients: Chuanlianzi (flesh), Xusuisi (flesh, 70, peeled), Qingfen (1 qian).
Preparation: Powder, thin flour paste pills. Dosage: 7-10 pills, swallow with Scallion White and Bohe soup. (*Youyou Xinshu*)
Sanbai San: Treats Bladder Heat accumulation, Wind-Damp interaction, Yin Tui swelling, difficult urination/defecation.
Ingredients: Baiqianniu (lightly fried, 2 liang), Baizhu (0.5 liang), Sangbaipi, Chenpi, Mutong (0.5 liang each).
Preparation: Powder. Dosage: 2 qian with Ginger Soup, morning empty stomach. If no effect after first dose, repeat. This formula does not damage Zang Qi but guides out stagnation. While hernia formulas usually use hot herbs, this is suitable for Heat stagnation syndromes. (*Sanyin Fang*)
Xieqian Wan: Treats Small Intestine Qi, Bladder Qi, horizontal/vertical strings, Mu Shen unilateral drooping, lower hernia pain.
Ingredients: Mubiezi (de-oiled, 2 liang), Huixiang (2 liang), Heiqiu (2 liang), Banxia (2 liang), Buguzhi (2 liang).
Preparation: Wine paste pills, Sophora seed size. Dosage: 30 pills morning empty stomach, then afternoon/evening with Stir-fried Ginger Salt Dengxin Wine. (*Chishui Xuanzhu*). (Note: Preparation is complex, omitted here.)
Yingtong Wan: Treats failed essence/evil matter stuck in scrotum forming hernia, unbearable pain.
Ingredients:awei (2 liang, mixed with vinegar, wrapped in Buckwheat noodle饼 3 fingers thick, slow-fire baked ripe). Binlang (2 large, hollowed out... [Text cuts off])