〔曾〕按《内经》大奇论曰∶肾脉大急沉，肝脉大急沉，皆为疝证。心脉搏滑急
为心疝。肺脉沉搏为肺疝。盖疝者，寒气结聚之所为，故令脐腹绞痛者是也。又，
巢元方曰∶诸疝者，阴气积于内，复为寒气所伤，荣卫不调，二气虚弱，风冷入腹
而成。故《脉经》云∶急者，紧也，紧则为寒，为实，为痛，血为寒泣（音涩）则为瘕，
气为寒聚则为疝，皆因本脏气虚，外感于寒湿，内伤于生冷，遂使脐腹绞刺激搏而
痛，无有定处，仓卒之际不堪忍者，谓之疝也。并宜先用五苓散沸汤调服和解，轻
则但以白芍药汤、乌梅散、钓藤膏为治，重者金茱丸、散气丸，未有不愈也。〔仁
斋〕 疝者，阴核气结肿大而钓痛也，多因小儿啼怒不止，动阴气，故阴气下系，
结聚不散而得之，或胎妇啼泣过伤，令儿生下，小肠气闭，亦变此证，惟是阴气不
得流行，加以风冷入焉，白水聚焉，故水气上乘于肺，先喘急而后疝痛，其状有如
李者，亦有稀软者，亦有并肾肿大者，亦有大硬者，脐下痛楚，皆不能忍，用药行
心气逐肾邪、利其大小二便，更无补法。〔薛〕小儿阴肿疝气者，多属肝肾气虚，
及坐卧寒湿之地，或风邪所伤，血气相搏，或啼叫气逆，水道不行，或禀父肝经虚热，
或妊娠肝气郁结，或乳母怒动肝火而致者。若儿肝经热，用栀子清肝散。儿啼躁怒，
用匀气散。乳母恚怒，用柴胡清肝散。肝火气逆，用加味逍遥散。小腹作痛，小便
涩滞，用龙胆泻肝汤。久坐冷地，小便不利，用四苓散加柴胡、山栀、车前子。不
时寒热者，加味小柴胡汤。经云∶肝气热则茎痿，宗筋弛纵，肾茎肿胀，或出白液
痒痛，或里急筋缩，挺纵不收，或精随便下者，此名筋疝，俱属肝火，不系于肾，
宜详治之。
茱萸内消丸 治小儿阴 ，偏大上攻，脐腹 痛，肤囊肿胀，或生疮疡，时出黄水。
川楝子（炒，一两半） 大腹皮 五味子 海藻（洗） 玄胡索（各一两二钱半） 桔梗
青皮 山茱萸（去核，各一两） 木香（七钱半） 香（炒） 桂心 川乌头（炮，去皮脐）
吴茱萸 桃仁（麸炒，另研） 食茱萸（各五钱）
上为细末，酒糊为丸，如麻子大。每服三十丸，空心，温酒送下。
当归散 治小儿 疝。
牵牛（微炒，取仁） 辣桂（各半两） 当归 大黄（各二钱半） 全蝎（一钱半）
桃仁（汤泡，去皮尖，二钱半）
上锉碎。每服三钱，水一钟，入蜜半匙，煎至五分，食前服。以利为度。
川楝丸 治小儿 疝，小腹痛引腰脊，挛曲身不能直。
木香 槟榔 三棱 蓬莪术（炮） 青皮（去白） 陈皮（去白） 川楝肉 芫花（米醋浸，
炒。各半两） 辣桂 牵牛（生，取仁。各三钱） 巴豆（不去油，一钱）
上为细末，飞面糊为丸，如麻子大。每服三丸，空心，用生姜汤送下。
五苓散（方见惊搐）
〔曾〕白芍药汤 治冷疝腹痛，及误汗误下，即坏证伤寒是也，并宜先服，次投对证
之剂。
白芍药（一两半） 泽泻（去粗皮，七钱半） 甘草（二钱，炙） 薄桂（去粗皮，一钱半）
上件， 咀。每服二钱，水一盏，煎七分，空心，温服。误汗、误下，加人参、
南木香各二钱，脐下痛，入生姜及盐同煎，或加钓藤亦好。
乌梅散 治腹疼，及初生婴孩脐下冷痛，疝气等疾。
乌梅（去核） 玄胡索 粉草（半生半炙。各五钱） 乳香 没药 钓藤（各二钱半）
上件， 咀。每服二钱，水一盏，煎七分，空心、温服。
金铃散 治疝气腹痛，投诸药后，愈而复作，宜服。
金铃子肉（六钱） 三棱（炮，锉） 莪术（醋煮，锉） 青皮（去白） 陈皮（去白。各二钱半）
赤茯苓（去皮） 香（各半两） 南木香（二钱） 甘草（炙，四钱） 槟榔 枳壳（去瓤，
麸炒黄） 钓藤（和钩。各三钱）
上，除槟榔、木香、不过火，余锉焙，仍同槟榔、木香为末。每服半钱至一
钱，仍用炒 香煎无灰酒，空心，调服。不饮酒者，煎炒 香汤调下。
钓藤膏（方见夜啼）
金茱丸 治冷疝气痛及肤囊浮肿。
金铃子肉（一两） 家园茱萸（半两）
上研末，酒煮面糊丸，麻仁大。每服三十丸至五十丸，空心，温盐汤下。温酒
亦可。儿小者丸粟粒大，丸数、下法、同前。
散气丸 理诸疝气小便利或不通，脐下作痛、不可忍者。
海藻（汤浸洗七次，焙干） 泽泻（去粗皮） 香（炒） 车前子（焙） 萝卜子（瓦上、
慢火干焙） 川楝肉（用斑蝥九枚去翅足，同炒、少时，去斑蝥） 大腹皮（净洗，焙干。各一两）
上，锉焙为末，酒煮面糊丸，绿豆大。每服三十丸至五十丸，南木香煎酒，空
心下，或防风、牡丹皮、煎酒下，不能饮者，于木香汤、防风、丹皮汤中，各
少入酒，并空心投，亦可。再，用盐炒 香煎汤尤妙。
〔汤〕治小肠疝气家传妙方
芫花（醋浸，炒） 木香 槟榔 三棱（各半两） 茯苓 青皮 全蝎 桂枝 附子 砂（各二钱半）
上为末，将 砂浸，澄去土，顿在汤瓶上，候成膏子，和糖醋打面糊为丸，如
豆大。每服三十丸，空心、温酒下。未效，再服。
匀气散 主调补通利后及冷疝腹痛，气滞不和。
桔梗（二两，锉，炒） 陈皮（去白，一两） 缩砂仁 香（各半两） 白姜（二钱半，炮）
粉草（四钱炙）
上，锉焙为末。每服半钱或一钱，空心，沸汤调服。冷疝腹痛，烧盐汤调下。
木香饮 治小儿小肠气痛。
川楝肉（十个，用巴豆七粒，同炒令黄色，去巴豆不用，入 香半两） 玄胡索（半两） 南木香（二钱） 使君
子（五枚，去壳）
上，为极细末。用米饮，食前调服。
栀子清肝散 柴胡清肝散（二方并见发热）
龙胆泻肝汤 治肝经湿热不利，下部生疮，两拗肿痛，或腹中作痛，小便涩滞等证。
龙胆草（酒拌，炒黄） 泽泻 车前子（炒） 木通 生地黄（酒拌） 当归（酒拌） 山
栀黄芩（炒） 甘草（各三分）
上，水煎，食前服。
四苓散即五苓去桂
小柴胡汤（方见发热）
[Zeng] According to the "Da Qi Lun" (Great Strange Discussions) of the *Neijing* (Classic of Internal Medicine): If the Kidney pulse is large, urgent, and deep, and the Liver pulse is large, urgent, and deep, both manifest as Shan syndrome (hernia). If the Heart pulse is slippery and urgent, it indicates Xin Shan (Heart hernia). If the Lung pulse is deep and forceful, it indicates Fei Shan (Lung hernia). Generally, Shan disease is caused by the accumulation and knotting of Cold pathogenic factors, leading to colicky pain in the umbilical and abdominal regions. Furthermore, Chao Yuanfang stated: Various types of Shan are due to the accumulation of Yin Qi internally, compounded by injury from Cold, resulting in disharmony of Ying (Nutrient) and Wei (Defensive) Qi, weakness of both Qi aspects, and the invasion of Wind-Cold into the abdomen. Thus, the *Mai Jing* (Pulse Classic) states: An urgent pulse is a tight pulse; a tight pulse indicates Cold, Excess, and Pain. Blood stagnates due to Cold, forming Jia masses (abdominal masses); Qi gathers due to Cold, forming Shan. All these arise from deficiency of the Zang organ's Qi, external contraction of Cold-Dampness, and internal injury from raw or cold foods, causing colicky, throbbing pain in the umbilical and abdominal regions without fixed location, unbearable during sudden attacks, which is termed Shan. It is appropriate to first use Wu Ling San (Five-Ingredient Poria Pill) mixed with boiling water for harmonization. For mild cases, only Bai Shao Yao Tang (White Peony Decoction), Wu Mei San (Mume Powder), or Diao Teng Gao (Uncaria Paste) should be used. For severe cases, Jin Zhu Wan (Evodia and Chaenomeles Pill) or San Qi Wan (Qi-Dispersing Pill) should be used, and there will be no case that does not heal.
[Renzhai] Shan refers to the swelling and enlargement of the scrotum due to Qi knotting, accompanied by drawing pain. It is mostly caused by prolonged crying and anger in infants, disturbing Yin Qi, causing it to sink and accumulate without dispersing. Alternatively, if a pregnant woman cries excessively and suffers injury, it may cause closure of Small Intestine Qi after birth, also transforming into this syndrome. This occurs because Yin Qi fails to circulate freely, combined with the invasion of Wind-Cold and accumulation of Water Fluids. Consequently, Water Qi rises to attack the Lungs, causing wheezing and urgency first, followed by Shan pain. The shape may resemble a plum, be soft, involve simultaneous swelling of the kidneys, or be very hard. There is unbearable pain below the umbilicus. Medication should move Heart Qi, expel Kidney pathogens, and promote urination and defecation; tonification methods should not be used.
[Xue Ji] Infantile scrotal swelling and Shan Qi mostly belong to deficiency of Liver and Kidney Qi, sitting or lying on cold and damp ground, injury by Wind pathogens, struggle between Blood and Qi, crying causing Qi rebellion and obstruction of the Water passages, inheriting paternal Liver channel Empty Heat, maternal Liver Qi stagnation during pregnancy, or maternal anger stirring Liver Fire. If the child has Heat in the Liver channel, use Zhi Zi Qing Gan San (Gardenia Clearing Liver Powder). If the child cries restlessly and angrily, use Yun Qi San (Harmonizing Qi Powder). If the wet nurse is angry, use Chai Hu Qing Gan San (Bupleurum Clearing Liver Powder). If Liver Fire causes Qi rebellion, use Jia Wei Xiao Yao San (Modified Free Wanderer Powder). If there is lower abdominal pain and astringent urination, use Long Dan Xie Gan Tang (Gentian Draining Liver Decoction). If urination is difficult due to long sitting on cold ground, use Si Ling San (Four-Poria Powder) added with Chai Hu, Shan Zhi, and Che Qian Zi. If there are intermittent chills and fever, use Jia Wei Xiao Chai Hu Tang (Modified Minor Bupleurum Decoction). The Classics state: When Liver Qi is hot, the penis becomes flaccid, the sinews relax, the kidney glans swells, white discharge may occur with itching and pain, there may be tenesmus and sinew contraction, erection or flaccidity without return, or semen discharging with stool; this is named Jin Shan (Sinew Hernia), belonging entirely to Liver Fire, unrelated to the Kidney, and should be treated carefully.
Zhu Yu Nei Xiao Wan treats infantile scrotal swelling, unilateral enlargement attacking upwards, umbilical and abdominal pain, skin cyst swelling, or sores producing yellow fluid.
Chuan Lian Zi (Stemonae Semen, stir-fried, 1.5 liang) Da Fu Pi (Arecae Pericarpium) Wu Wei Zi (Schisandrae Fructus) Hai Zao (Sargassum, washed) Yan Hu Suo (Corydalis Rhizoma, each 1.25 liang) Jie Geng (Platycodonis Radix) Qing Pi (Citri Reticulatae Pericarpium Viride) Shan Zhu Yu (Corni Fructus, pitted, each 1 liang) Mu Xiang (Aucklandiae Radix, 0.75 liang) Ding Xiang (Caryophylli Flos, stir-fried) Gui Xin (Cinnamomi Ramulus) Chuan Wu Tou (Aconiti Radix, processed, skin and rootlet removed) Wu Zhu Yu (Evodiae Fructus) Tao Ren (Persicae Semen, bran-fried, separately ground) Shi Zhu Yu (Zanthoxyli Fructus, each 0.5 liang).
Grind all into fine powder, make pills with wine paste, size of hemp seeds. Take 30 pills per dose, fasting, with warm wine.
Dang Gui San treats infantile Shan.
Qian Niu Zi (Pharbitidis Semen, lightly fried, kernel taken) La Gui (Cinnamomi Ramulus, each 0.5 liang) Dang Gui (Angelicae Sinensis Radix) Da Huang (Rhei Radix et Rhizoma, each 0.25 liang) Quan Xie (Scorpio, 0.15 liang) Tao Ren (Persicae Semen, soaked in water, skin and tip removed, 0.25 liang).
Cut into pieces. Take 3 qian per dose, with one zhong of water, add half spoon of honey, decoct to 0.5 zhong, take before meals. Stop when bowel movement occurs.
Chuan Lian Wan treats infantile Shan, lower abdominal pain radiating to the lumbar spine, body curling unable to straighten.
Mu Xiang (Aucklandiae Radix) Bing Lang (Arecae Semen) San Leng (Sparganii Rhizoma) E Zhu (Curcumae Rhizoma, processed) Qing Pi (Citri Reticulatae Pericarpium Viride, white part removed) Chen Pi (Citri Reticulatae Pericarpium, white part removed) Chuan Lian Rou (Toosendan Fructus) Yuan Hua (Genkwa Flos, soaked in rice vinegar, stir-fried, each 0.5 liang) La Gui (Cinnamomi Ramulus) Qian Niu Zi (Pharbitidis Semen, raw, kernel taken, each 0.3 liang) Ba Dou (Crotonis Fructus, oil not removed, 0.1 liang).
Grind into fine powder, make pills with sifted flour paste, size of hemp seeds. Take 3 pills per dose, fasting, with ginger soup.
Wu Ling San (Formula seen under Convulsions chapter).
[Zeng] Bai Shao Yao Tang treats Cold Shan abdominal pain, and damaged syndromes of Shang Han due to mistaken sweating or purging. These should be treated with this formula first, followed by syndrome-specific formulas.
Bai Shao Yao (Paeoniae Radix Alba, 1.5 liang) Ze Xie (Alismatis Rhizoma, coarse skin removed, 0.75 liang) Gan Cao (Licorice Root, 2 qian, honey-fried) Bo Gui (Cinnamomi Ramulus, coarse skin removed, 0.15 liang).
Crush ingredients. Take 2 qian per dose, with one zhong of water, decoct to 0.7 zhong, take warm fasting. For mistaken sweating/purging, add Ren Shen (Ginseng Radix) and Nan Mu Xiang (Costi Radix) 2 qian each. For pain below the umbilicus, add fresh ginger and salt to decoct, or add Diao Teng (Uncariae Ramulus cum Uncis) is also good.
Wu Mei San treats abdominal pain, and cold pain below the umbilicus, Shan Qi, etc., in newborn infants.
Wu Mei (Mume Fructus, pitted) Yan Hu Suo (Corydalis Rhizoma) Fen Cao (Licorice Root, half raw half honey-fried, each 0.5 liang) Ru Xiang (Olibanum) Mo Yao (Myrrha) Diao Teng (Uncariae Ramulus cum Uncis, each 0.25 liang).
Crush ingredients. Take 2 qian per dose, with one zhong of water, decoct to 0.7 zhong, take warm fasting.
Jin Ling San treats Shan Qi abdominal pain, suitable for use if symptoms recur after taking other medicines.
Jin Ling Zi Rou (Toosendan Fructus flesh, 6 qian) San Leng (Sparganii Rhizoma, processed, crushed) E Zhu (Curcumae Rhizoma, vinegar-boiled, crushed) Qing Pi (Citri Reticulatae Pericarpium Viride, white part removed) Chen Pi (Citri Reticulatae Pericarpium, white part removed, each 0.25 liang) Chi Fu Ling (Poria with Red Skin, skin removed) Ding Xiang (Caryophylli Flos, each 0.5 liang) Nan Mu Xiang (Costi Radix, 2 qian) Gan Cao (Licorice Root, honey-fried, 4 qian) Bing Lang (Arecae Semen) Zhi Ke (Aurantii Fructus, pulp removed, bran-fried yellow) Diao Teng (Uncariae Ramulus cum Uncis, with hooks, each 3 qian).
For the above, except Bing Lang and Mu Xiang which are not overheated, crush and bake the rest, then grind together with Bing Lang and Mu Xiang into powder. Take 0.5 to 1 qian per dose, mixed with decoction of fried Ding Xiang in non-grain alcohol, take fasting. For those who do not drink alcohol, mix with decoction of fried Ding Xiang in water.
Diao Teng Gao (Formula seen under Night Crying chapter).
Jin Zhu Wan treats Cold Shan Qi pain and scrotal edema.
Jin Ling Zi Rou (Toosendan Fructus flesh, 1 liang) Jia Yuan Zhu Yu (Euodiae Fructus, 0.5 liang).
Grind into powder, make pills with wine-boiled flour paste, size of hemp seed. Take 30 to 50 pills per dose, fasting, with warm salt water. Warm wine is also acceptable. For small children, make pills size of millet grains; dosage and administration method same as above.
San Qi Wan regulates various Shan Qi, whether urination is free or obstructed, and unbearable pain below the umbilicus.
Hai Zao (Sargassum, soaked in water and washed seven times, baked dry) Ze Xie (Alismatis Rhizoma, coarse skin removed) Ding Xiang (Caryophylli Flos, stir-fried) Che Qian Zi (Plantaginis Semen, baked) Luo Bo Zi (Brassicae Semen, slowly baked dry on tile) Chuan Lian Rou (Toosendan Fructus, stir-fried with nine Ban Mao [Mylabris], remove Ban Mao afterwards) Da Fu Pi (Arecae Pericarpium, clean washed, baked dry, each 1 liang).
Crush and bake into powder, make pills with wine-boiled flour paste, size of mung bean. Take 30 to 50 pills per dose, with Nan Mu Xiang decocted wine, fasting. Or take with Feng Wei (Saposhnikoviae Radix) and Mu Dan Pi (Moutan Cortex) decocted wine. For those who cannot drink alcohol, add a little wine to Mu Xiang soup or Feng Wei/Dan Pi soup, take fasting. Additionally, decoction of salt-fried Ding Xiang is excellent.
[Tang] Family secret recipe for treating Small Intestine Shan Qi.
Yuan Hua (Genkwa Flos, soaked in vinegar, stir-fried) Mu Xiang (Aucklandiae Radix) Bing Lang (Arecae Semen) San Leng (Sparganii Rhizoma, each 0.5 liang) Fu Ling (Poria) Qing Pi (Citri Reticulatae Pericarpium Viride) Quan Xie (Scorpio) Gui Zhi (Cinnamomi Ramulus) Fu Zi (Aconiti Lateralis Radix Praeparata) Sha (Sand, each 0.25 liang).
Grind into powder. Soak Sha, let sediment settle, remove earth, place on top of the teapot until it forms a paste. Mix with sugar and vinegar, make dough into pills, size of beans. Take 30 pills per dose, fasting, with warm wine. If ineffective, take again.
Yun Qi San mainly regulates after tonifying and promoting circulation, and treats Cold Shan abdominal pain with Qi stagnation and disharmony.
Jie Geng (Platycodonis Radix, 2 liang, crushed, stir-fried) Chen Pi (Citri Reticulatae Pericarpium, white part removed, 1 liang) Suo Sha Ren (Amomi Fructus Rotundus) Ding Xiang (Caryophylli Flos, each 0.5 liang) Bai Jiang (Zingiberis Rhizoma, 0.25 liang, processed) Fen Cao (Licorice Root, 4 qian, honey-fried).
Crush, bake, and grind into powder. Take 0.5 or 1 qian per dose, fasting, mixed with boiling water. For Cold Shan abdominal pain, mix with burnt salt water.
Mu Xiang Yin treats infantile Small Intestine Qi pain.
Chuan Lian Rou (Toosendan Fructus, 10 pieces, stir-fried with seven Ba Dou seeds until yellow, remove Ba Dou, add Ding Xiang 0.5 liang) Yan Hu Suo (Corydalis Rhizoma, 0.5 liang) Nan Mu Xiang (Costi Radix, 2 qian) Shi Jun Zi (Quisqualis Fructus, 5 pieces, shelled).
Grind into extremely fine powder. Mix with rice water, take before meals.
Zhi Zi Qing Gan San (Gardenia Clearing Liver Powder) and Chai Hu Qing Gan San (Bupleurum Clearing Liver Powder) (Both formulas seen under Fever chapter).
Long Dan Xie Gan Tang treats Damp-Heat in the Liver channel causing obstruction, sores in the lower body, swelling and pain of the genitals, abdominal pain, astringent urination, etc.
Long Dan Cao (Gentianae Radix, mixed with wine, stir-fried yellow) Ze Xie (Alismatis Rhizoma) Che Qian Zi (Plantaginis Semen, stir-fried) Mu Tong (Akebiae Caulis) Sheng Di Huang (Rehmanniae Radix, mixed with wine) Dang Gui (Angelicae Sinensis Radix, mixed with wine) Shan Zhi (Gardeniae Fructus) Huang Qin (Scutellariae Radix, stir-fried) Gan Cao (Licorice Root, each 0.3 fen).
Decoct in water, take before meals.
Si Ling San is Wu Ling San minus Gui Zhi.
Xiao Chai Hu Tang (Minor Bupleurum Decoction) (Formula seen under Fever chapter).