温法有二,外入之寒,温必兼散。内生之寒,温必以补。子和论疝多从劳内得之,然并
补法。愚谓寒从外入者,其病多实。寒从内生者,其病多虚。设不能辨而概与散法,难免虚
虚之咎矣。余采当归、萸肉等方,以补子和之未备。且遵仲景之旧法也。
《和剂》胡卢巴丸 治疝气偏坠,痛不可忍,甚则呕吐闷乱。
胡卢巴(炒,一斤) 川楝子(去核,炒,一斤二两) 川乌(炮去皮) 巴戟(去心,炒、
各六两) 茴香(盐水炒,十二两) 吴茱萸(洗,炒,十两)
上为末,酒糊丸如梧子大,每服十五丸至二十丸,空心温酒下,食前。一方有黑牵牛。
乌头桂枝汤(仲景) 治寒疝,腹中痛,逆冷,手足不仁。
乌头
上一味,以蜜二斤,煎减半,去滓,以桂枝汤五合解之,得一升,初服二合,不知即服
三分
,又不知,复加至五合。其知者如醉状,得吐者为中病。桂枝汤和营卫,散寒邪,止痛。乌
头直入厥阴,逐寒气,用蜜煎者,缓其毒也。一方只用乌头,水煮去滓,内蜜煎,令水气
尽服之,名乌头煎。
当归生姜羊肉汤
当归(三两) 生姜(五两) 羊肉(一斤,精者)
水八升,煮取三升,温服七合,日三服。若寒多者,加生姜十片;痛多而呕者,加陈皮
二两,白术一两。
《金匮》治寒疝,腹中痛,及胁痛里急者,当归生姜羊肉汤主之。
《衍义》云,服之无不应验。有一妇人产当寒月,寒气入产门,脐以下胀满,手不欲犯
,此寒疝也。师将与抵当汤,谓有瘀血,非其治也,与仲景羊肉汤,二服而愈。
海藏附子建中汤
桂 白芍 甘草 饴糖 附子(制) 白蜜 生姜
此温养营血之剂,亦有虚在气分者。丹溪云∶疝有挟虚而发者,其脉不甚沉紧,而豁大
无力
者是也。然其痛亦轻,唯觉重坠牵引耳。当以参术为君,疏导药佐之,如桃仁、川楝、茱萸
、木香、橘核之类是也。
The method of warming is divided into two categories: for cold invading from the exterior, the warming method must be combined with dispersing; for cold generated from within, the warming method must primarily employ tonification. Zhang Hezi discussed hernia (Shan Qi) as mostly arising from internal labor and injury, yet his discussion did not include tonification methods. I believe that when cold pathogen invades from the exterior, the disease pattern is mostly excess; when cold is generated internally, the disease pattern is mostly deficiency. If one fails to distinguish between them and indiscriminately applies dispersing methods, one inevitably commits the error of "making the deficient more deficient." I have collected formulas such as Danggui and Shanzhuyu to supplement the inadequacies in Zhang Hezi's theories, and to follow the established methods of Zhang Zhongjing.
Huluba Wan (from *Heji Jufang*): Treats hernia with unilateral descent, unbearable pain, and in severe cases, vomiting and mental restlessness.
Ingredients: Huluba (Stemonae Rhizoma, stir-fried, 1 jin), Chuanlianzi (Fructus Toosendan, pitted, stir-fried, 1 jin 2 liang), Chuanwu (Aconiti Radix, processed, skin removed), Bajitian (Morindae Officinalis Radix, heart removed, stir-fried), Huixiang (Foeniculi Fructus, salt-water stir-fried, 12 liang), Wuzhuyu (Evodiae Fructus, washed, stir-fried, 10 liang). Grind all ingredients into fine powder, make pills using wine paste, size of wu-tzu (Cibotii Semen). Take 15–20 pills per dose, administered with warm wine on an empty stomach before meals. Another version includes Heiqianniussub (Pleurostellae Semen).
Wutou Guizhi Tang (by Zhang Zhongjing): Treats cold hernia (Han Shan) with abdominal pain, cold limbs, and numbness in hands and feet.
Ingredients and Method: One ingredient, Wutou (Aconiti Radix). Boil with 2 jin of honey until reduced by half, filter out dregs, add 5 he of Guizhi Tang to dissolve, yielding 1 sheng. Initial dose is 2 he. If no effect, take another 3 fen (approx. 1 he); if still no effect, increase to 5 he. A sensation like drunkenness or vomiting indicates the medicine has struck the disease (Zhong Bing). Guizhi Tang harmonizes Ying and Wei, disperses cold pathogen, and alleviates pain. Wutou enters directly into the Jueyin channel to expel cold qi; honey is used to moderate its toxicity. Another version uses only Wutou, boiled in water, filtered, then mixed with honey and boiled until water vapor is gone, named Wutou Jian.
Danggui Shengyang Yangrou Tang
Ingredients: Danggui (Angelicae Sinensis Radix, 3 liang), Shengjiang (Zingiberis Rhizoma Recens, 5 liang), Yangrou (Ovis/Capra Meat, 1 jin, lean).
Method: Add 8 sheng of water, boil to obtain 3 sheng of decoction. Take 7 he warm, three times daily. If cold is severe, add 10 slices of Shengjiang; if pain is severe with vomiting, add Chenpi (Citri Reticulatae Pericarpium, 2 liang) and Baizhu (Atractylodis Macrocephalae Rhizoma, 1 liang).
*Jinkui Yaolue* states: For cold hernia with abdominal pain, and hypochondriac pain with internal urgency, Danggui Shengyang Yangrou Tang is the primary formula.
*Bencao Yan Yi* records: This formula is invariably effective. A woman gave birth during a cold month; cold pathogen entered the birth canal, causing distension below the umbilicus, which she feared to touch. This was cold hernia. The physician initially intended to prescribe Didang Tang due to suspected blood stasis, but recognized this was incorrect treatment. Instead, he prescribed Zhongjing's Mutton Soup. After two doses, she recovered.
Haizang Fuzi Jianzhong Tang
Ingredients: Guizhi (Cinnamomi Ramulus), Baishao (Paeoniae Radix Alba), Gancao (Glycyrrhizae Radix et Rhizoma), Yitang (Maltose), Fuzi (Aconiti Lateralis Radix Praeparata), Baimi (Apis Mellifera), Shengjiang (Zingiberis Rhizoma Recens).
This is a formula for warming and nourishing Ying blood. There are also cases of deficiency in the Qi level. Zhu Danxi stated: Hernia can occur accompanied by deficiency, characterized by a pulse that is not deeply tight, but rather wide and forceless. However, the pain is mild, manifesting mainly as a sensation of heaviness, dragging, and traction. Treatment should prioritize Renshen (Ginseng Radix) and Baizhu as sovereign drugs, assisted by dredging herbs such as Taoren (Persicae Semen), Chuanlianzi, Wuzhuyu, Muxiang (Aucklandiae Radix), and Juzhe (Citri Grandis Exocarpium Viride).