Library

Xu Xueshi said: Generally, this disease arises from deficiency, but one cannot abruptly tonify due to deficiency. The *Neijing* states: "Where pathogenic factors gather, Qi must be deficient; if they remain and do not depart, the pathology becomes excess." Therefore, one must first cleanse the accumulated heat before tonifying. Hence, many prescriptions borrow the qi of *Crotonis Fructus* (Badou, 巴豆), which is precisely for this reason.

I respectfully note: Although hernia syndromes (*Shan Zheng*, 疝证) originate from deficiency, they inevitably involve excess pathogenic factors causing severe pain that has not yet been expelled via purgation. Thus, one should purge first and then tonify. However, in cases where deficiency is extreme, accompanied by severe pain leading to vomiting and regurgitation upwards, or seminal emission downwards, this represents a condition of extreme excess pathogenic factors and extreme deficiency of healthy Qi. In such situations, can one refrain from tonification? The concern is that tonification may be ineffective, while purgation may cause further collapse of healthy Qi. Few survive such mishandling.

Zi Hezi said: Hernias are classified into seven types. While predecessors have discussed them extensively, I only accept the discussions found in the *Lingshu*, *Suwen*, and *Tongren Shuxue Zhenjiu Tujing*. I do not adopt others, not because I enjoy being different, but to trace the origin. Unskilled physicians fail to recognize the etiology and establish erroneous names, such as "Bladder Qi," "Shenshu Qi," or "Small Intestine Qi." Since the naming is erroneous, the essence of the disease is lost. Why? Because once physicians diagnose it as Bladder, Shenshu, or Small Intestine Qi, they invariably attribute it to deficiency-cold. Their medications consist mainly of *Aconiti Lateralis Radix Preparata* (Fuzi, 附子), *Aconiti Radix* (Wutou, 乌头), *Zingiberis Rhizoma* (Ganjiang, 干姜), or *Cinnamomi Cortex* (Guangui, 官桂). These yield no special efficacy, gradually leading to grave errors unnoticed by all. They do not realize that all hernias belong to the Liver Meridian. Unfortunately, vulgar practitioners attribute them to the Small Intestine and Bladder (Pao Nang). The Bladder is the water reservoir, responsible for seepage and excretion; the Small Intestine is the water pathway, responsible for flow; the Kidney is Shaoyin, commanding both waters. Human urine enters the Small Intestine from the Stomach, seeps into the Bladder. The Bladder is the Pao Nang; through Qi transformation, urine exits from the urethral tip. This is the normal pathway. When hernia occurs, it belongs to the Foot-Jueyin Liver Meridian, as this meridian circles the genitalia and ascends into the Small Intestine. The Liver and Kidney are located inferiorly and connect with the Chong, Ren, and Du vessels. However, the *Lingshu Jing* states that diseases of the Foot-Jueyin Liver Meridian include enuresis, strangury, and fox hernia, whereas the three meridians governing the Kidney, Bladder, and Small Intestine do not mention hernia. This indicates that the site receiving hernia is the domain of the Liver. Furthermore, the *Neijing* states that the male Zongjin (tendons) is the gathering point of bones, and the Liver governs tendons. The testicles are the balls within the scrotum; although called external kidneys, without the circling and guiding of the Jueyin meridian, the penis cannot extend or retract. In females, this is the vaginal opening, with two internal and external apertures: one called Ting Kong, the other Yao Lou. These are the convergence points of the Jueyin, Chong, Ren, and Du vessels. The *Lingshu* states that the sinews of the Foot-Jueyin meridian gather at the genitalia. If injured by cold, the yin retracts inward; if injured by heat, it becomes flaccid and protrudes irretractably. Treatment involves acupuncture, moxibustion, or soaking the genitalia. Thus, the sinews of Yangming, Taiyin, and Jueyin all converge at the genitalia, but only Jueyin governs tendons. Therefore, those suffering from hernia must base their treatment on Jueyin. The *Lingshu* also states that the collateral branch of the Foot-Jueyin meridian is named Ligou, located five cun above the medial malleolus, diverging to the Shaoyang meridian, ascending along the tibia to the testicle, and knotting at the penis. Its symptoms include qi rebellion, testicular swelling, sudden hernia; excess presents with penile erection and elongation, deficiency with sudden itching. Treating its divergence confirms that Jueyin is the site of disease. The *Lingshu* further states that pathogenic factors in the Small Intestine connect to the testicles, attach to the Kidney, penetrate the Liver, link to the Lung, and affect the Heart. Excess Qi rebels and rushes upward to the Stomach and Intestines, steams the Liver, disperses into the Huang membrane, and knots at the umbilicus. Treatment involves needling Mangyuan to dissipate it, puncturing Taiyin to calm it, taking Jueyin to descend it, and taking Juliu Xia Lian to remove it, adjusting according to the affected meridian. Although initially described as pathogenic factors in the Small Intestine, the treatment method emphasizes "taking Jueyin to descend it," proving that all hernias relate to Jueyin beyond doubt.

Examining the pulse, the *Suwen* discusses six types of hernia appearing in various pulses, stating that Feng Hernia is caused by Qi of the Foot-Jueyin Liver Meridian. The *Lingshu* also states that hernias associated with the three Zang organs present with slippery pulses, urgency in the three Yin meridians indicates hernia, and urgency in the three Yang meridians indicates mass formation. Wang Taipu stated that Cold invading Taiyang causes blood stasis forming masses; Cold invading Taiyin causes Qi aggregation forming hernia. This means Taiyin Cold transmits to the Liver Meridian. It can be driven out with warming herbs, but not treated with warming tonics. Tonification would attempt to expel the pathogen while forcibly retaining it. Reviewing the *Suwen*, diseases of the three Yang meridians involving chills and fever transmit to hernia, indicating the Bladder is not the primary site of disease but must transmit to the Jueyin portion to become hernia. It also states that disease in the lower abdomen with pain and inability to pass urine or stool is named hernia, caused by cold. Urgent pulses indicate hernia and masses with lower abdominal pain. Whenever the lower abdomen is mentioned, is it not the domain of the Jueyin meridian? It also states that Spleen Wind transmitting to the Stomach is named Shanxia, meaning non-Liver Wood cannot generate wind patterns, named Jue Hernia. This is because Spleen Earth is deficient and cannot control Water, being overwhelmed by Liver Wood. It also states the Du Meridian is involved in Chong Hernia, as Jueyin converges with Chong, Ren, and Du at the anterior yin. Is this not clear? I have also reviewed the acupoints in the *Tongren Shuxue Zhenjiu Tujing*; they are exterior-interior related, but only the Jueyin meridian mentions hernia most frequently, serving as the primary meridian for hernia treatment. Other meridians' acupoints may treat hernia but are not the primary sites of reception, merely connected to the Foot-Jueyin. For instance, in climate theory, if Cold dominates during the ruling phase, it causes spasms restricted to this meridian; if Dryness dominates during the governing phase, Wood Qi is depressed here; if anger, sorrow, or depression causes stagnation, it knots here; if medicinal dampness or external retention causes closure and sperm congestion, it obstructs here. The pathological differences are thus. Moreover, enuresis, strangury, impotence, bladder bi, spermatorrhea, and leukorrhea are all male hernias and should not be wrongly attributed to Kidney Cold. Blood depletion causing amenorrhea or cessation, upper waist and knee heat, dry throat, strangury, lower abdominal masses that are fixed or migratory, prolapse of the anterior yin, and posterior yin hemorrhoidal nodules are all female hernias. Females do not call them Seven Hernias but rather masses (Jia). If contracted in youth, regardless of gender, it leads to infertility. Thus, matters concerning the concealed and complex do not pertain to the Bladder, Kidney, or Small Intestine, but are the duty of the Foot-Jueyin Liver Meridian. Unfortunately, vulgar formulas only discuss the Bladder, Kidney, and Small Intestine, never mentioning Liver Wood, greatly confusing people. The Liver Meridian is Yi Wood, belonging to the East, and is the mother of Heart Fire. Any hernia results either from Liver Wood being invaded by pathogens or from Liver Wood becoming excessive itself. One should not hastily claim deficiency and tonify. As the *Nanjing* states: "East is excess, West is deficient; drain South, tonify North." This means draining Fire levels Wood, clearing Metal allows Water to flourish. After treating the Seven Hernias and removing the pathogen, one may adjust or tonify as appropriate, measuring the disease trend without adhering to vulgar methods. The *Jing* states that when Yin is excessive causing abdominal distension and obstruction, it falls under strangury and hernia, and purgation is necessary.