疝有七，前人论者甚多，非《灵枢》、《素问》、《铜人》之论，余皆不取。非
余好异也，但要穷
其原耳！七疝者何？寒疝、水疝、筋疝、血疝、气疝、狐疝、 疝，是谓七疝。俗工不识，
因立谬名，或曰膀胱，或曰肾冷，或曰小肠气，小儿曰偏气。立名既谬，并丧其实，何哉？
盖医者既断为膀胱、肾冷、小肠气，又曰虚寒所致，其药之用也，不鹿茸、巴戟，则杜仲、
苁蓉；不附子、乌头，则干姜、官桂；不楝实、 香，则金铃、补骨脂。朝吞暮饵，曾无殊效，三
、二
相传，曾无觉者。
岂知诸疝，皆归肝经。其奈通流，归之小肠脬囊。夫膀胱水府，专司渗泄；小肠
水道，专主通流。肾为少阴，总统二水，人之小溲，自胃入小肠，渗入膀胱。膀胱者，脬囊
也，气化则水出茎端，此常道也，及其为疝，乃属足厥阴肝经。盖环阴器而上入小腹者，足
厥阴肝经也。夫肝肾皆属于下，与冲、任、督相附，然《灵枢经》言∶足厥阴肝经病，则有
遗溺、癃闭、狐疝，主肾与膀胱、小肠三经，则不言疝，是受疝之处，乃肝之部分也。且《内经》男子宗筋
，为束骨之会也。而肝主筋，睾者囊中之丸，虽主外肾，非厥阴环而引之，与玉茎无由伸缩。在女
子则为篡户。其内外为二∶其一曰廷孔，其二曰窈漏，此足厥阴与冲任督之所会也。《灵枢
》言∶足厥阴之经筋聚于阴器，其病伤于寒则阴缩入，伤于热则纵挺不收。治在行水清阴气。故阳
明与太阴厥阴之筋，皆会于阴器，惟厥阴主筋，故为疝者，必本之厥阴。《灵枢》又言∶足
厥阴之别，名曰“蠡沟”，去内踝五寸，别走少阳，循胫上睾，结于茎。其病气逆、睾肿、卒疝，实则
挺长，虚则暴痒，取之所别矣。岂非厥阴为受病之处耶？《灵枢》又言∶邪在小肠，连睾系，属
于肾，贯肝络肺，结心系。气盛厥逆，上冲肠胃，熏肝散于肓，结于脐。故取之肓原以散之，刺太阴以
平之，取厥阴以下之，取巨虚下 以去之，按其所过之经以调之。此其初，虽言邪在小肠，
至其治法，必曰取厥阴以下之，乃知诸疝关于厥阴，可以无疑。以脉考之，《素问》云∶厥
阴滑，为狐疝；少阳滑，为肺风疝；太阴滑，为脾风疝；阳明滑，为心风疝；太阳滑，为肾风疝；
少阴滑，为肝风疝。凡此六疝，虽见于他脉中，皆言风疝者，足厥阴肝经之气也。《灵枢》亦曰∶心
脉微滑，为心疝；肝脉滑甚，为溃癃；肾脉滑甚，为癃 。凡此三脏脉之疝，亦以滑为疝也。《素问
》又云∶脉大急，皆为疝。心脉滑，传为心疝；肺脉沉，传为肺疝。三阴急为疝，三阳急为瘕。王太
仆云∶太阳受寒，血凝为瘕；太阴受寒，气聚为疝。此言太阴受寒，传之肝经也。可以温药逐之，
不可以温药补之。若补之者，是欲病去而强挽留之也。历考《素问》∶三阳为病，发寒热，
其传为 疝。此亦言膀胱非受病之处，必传于厥阴部分，然后为疝也。又言病在少腹，腹痛，不得大
小便，病名曰疝。得之寒，言脉急者曰疝瘕。少腹痛，凡言少腹者，岂非厥阴之部分耶？又
言脾风传胃，名曰疝瘕。此谓非肝木不能为风气，名曰厥疝。盖脾土虚而不能制水，又为肝
木所凌也。又言督脉为冲疝。盖厥阴与冲、任、督，俱会于前阴也。岂不明哉？至如运气中
，又言岁太阳在泉，寒淫所胜，民病少腹控睾。盖寒客于小肠、膀胱，则肝木缩而不得伸行，母
传之子也。阳明司天，燥淫所胜，丈夫 疝，妇人少腹痛，此言肝气不得上行，为金所抑，鬼
贼故也。又言太阴在泉，土胜则寒气逆满，食饮不下，甚则为疝。此亦言寒客太阴湿土，土
不胜水，水传之肝经也。又尝遍阅《铜人》俞穴，亦相表里。如背上十三椎俞，肝经，言寒
疝，腹部中行。惟阴交一穴，言寒疝，任脉之所发也；关元一穴，言暴疝，小肠之募，足三阴任
脉之会也；中极一穴，言疝瘕，膀胱之募，亦足三阴任脉之会也；曲骨一穴，言 疝，任脉
足厥阴之会也；其腹部第二行肓 二穴，言寒疝，冲脉足少阴之会也；四病上穴，言疝瘕
，冲任脉足少阴肾之会也；其腹部第三行大巨二穴，言 疝，足阳明脉气之所发也；气冲二
穴，言 疝，茎中痛，两丸寒痛，亦足阳明脉气之所发也；其腹部第四行府合二穴，言
疝痛，足太阴厥阴阴维之交会也，亦太阴部三阴阳明之别也；冲门二穴，言阴疝，足太阴厥
阴之会也；其在侧胁者，五枢二穴，言寒疝，阴邪上入少腹，带脉下三寸也。其在足六经
者，足厥阴穴十名，言疝者七，谓大敦、行间、太冲、中封、蠡沟、中都、曲泉。足少阳穴
十四名，言疝者一，谓丘墟穴也。足太阴穴十一名，言疝者一，谓阴陵泉也。足阳明穴十五名，言疝者一
，谓阴市穴也。足少阴穴十名，言疝者五，谓然谷、大溪、照海、交信、筑宾也。足太阳穴
十八名，言疝者二，谓金门、合阳也。由是言之，惟厥阴言疝独多，为疝之主也。其余经穴，虽亦治
疝，终非受疝之地，但与足厥阴相连耳。或在泉寒胜，木气挛缩禁于此经；或司天燥胜，木气
抑郁于此经；或忿怒悲哀，忧抑顿挫，结于此经；或药淋外固闭，尾缩精壅于此经。其病差
别如此。
不知世间之药多热补，从谁而受其方也？信其方，则《素问》《灵枢》《铜人》皆
非也。信《素问》《灵枢》《铜人》，则俗方亦皆非也。不知后之君子，以孰为是？呜呼！
余立于医四十余岁，使世俗
之方，人人可疗，余亦莫知敢废也。谙练日久，因经识病，然后不惑。且夫遗溺、闭隆
，阴痿、脬痹，精滑、白淫，皆男子之疝也，不可妄归之肾冷。血涸不月，月罢腰膝上热，足
，嗌干，癃闭，少腹有块，或定或移，前阴突出，后阴痔核，皆女子之
之疝，而谓之瘕。若年少而得之，不计男子妇人皆无子。故隐蔽委曲之事，了不干脬肾小肠
之事，乃足厥阴肝经之职也。奈俗方止言脬、肾、小肠，殊不言肝木一句，惑人甚矣！且肝经，乙木也
。木属东方，为心火之母也。凡疝者，非肝木受邪，则肝木自甚也，不可便言虚而补之。
《难经》所谓“东方实，西方虚；泻南方，补北方。”此言泻火，木自平，金自清，水自旺也。
昔审言为蔡
之参军也，因坐湿地，疝痛不可堪，诸药莫救。余急以导水丸、禹功散，泻三十余行，肿立消，
痛立减。又项关一男子，病卒疝暴痛不任，倒于街衢，人莫能动，呼予救之。余引经证
之∶邪气客于足厥阴之络，令人卒疝，故病阴丸痛也。余急泻大敦二穴，大痛立已。夫大敦穴者，
乃是厥阴之二穴也。殄寇镇一夫，病 疟发渴，痛饮
蜜浆，剧伤冰水。医者莫知泻去其湿，
反杂进姜、附。湿为燥热所壅，三焦闭涩，水道不行，阴道不兴，阴囊肿坠，大于升斗。余
先以导水百余丸，少顷，以猪肾散投之，是夜泻青赤水一斗，遂失痛之所在。近颖尾一夫，
病卒疝，赤肿大痛，数日不止，诸药如水投石。余以导水一百五十丸，令三次咽之；次以通经
散三钱，空腹淡酒调下，五更下脏腑壅积之物数行，痛肿皆去。不三日，平复如故。《内经
》曰∶木郁则达之。达，谓吐也，令条达。肝之郁，本当吐者，然观其病之上下，以顺为贵。仲景
所谓上宜吐，下宜泻者，此也。敢列七疝图于下，以示后之君子，庶几有所凭借者焉。
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，或囊痒而燥出黄水，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。久而得于房室劳伤，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，劳动使内
，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。
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。
此疝出入，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。
颓疝，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。宜以祛湿之药下之。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。
疝病有七种，前人论述很多，但除了《灵枢》、《素问》、《铜人腧穴针灸图经》中的论述外，其他的我都不采纳。这并不是我喜欢标新立异，而是要探求疾病的本源！哪七种疝呢？寒疝、水疝、筋疝、血疝、气疝、狐疝、颓疝，这就叫作七疝。世俗的医生不认识这些，于是创立了错误的名称，有的叫膀胱病，有的叫肾冷，有的叫小肠气，小儿则叫偏气。既然命名错误，就丧失了疾病的实质，为什么呢？因为医生既然判定为膀胱、肾冷、小肠气，又说是虚寒所致，那么用药方面，不是鹿茸、巴戟天，就是杜仲、肉苁蓉；不是附子、乌头，就是干姜、官桂；不是川楝子、木香，就是金铃子、补骨脂。早晚吞服，从未见到特殊疗效，代代相传，从未有人察觉。
哪里知道各种疝病，都归属于足厥阴肝经。然而要疏通流滞，归于小肠和膀胱（脬囊）。膀胱是水液之府，专门主管渗泄；小肠是水道，专门主管通流。肾属于少阴，统管二水，人的小便，从胃进入小肠，渗入膀胱。膀胱就是脬囊，气化后水液从尿道排出，这是正常的生理规律。等到成为疝病时，就属于足厥阴肝经了。环绕阴器而上入小腹的，正是足厥阴肝经。肝肾都位于下部，与冲脉、任脉、督脉相连附，然而《灵枢经》说：足厥阴肝经发病，会有遗尿、癃闭、狐疝等症状，主治肾、膀胱、小肠三经，却不说疝，这说明受疝的部位，乃是肝经所主的部分。而且《内经》说：男子的宗筋，是束骨的会合处。而肝主筋，睾丸是囊中的丸状物，虽然属于外肾，但如果不是厥阴肝经环绕牵引它，阴茎就无法伸缩。在女子则是阴户。其内外分为两部分：其一叫廷孔，其二叫窈漏，这是足厥阴肝经与冲脉、任脉、督脉相会合的地方。《灵枢》说：足厥阴经的经筋聚于阴器，其病伤于寒则阴囊收缩内入，伤于热则纵挺不收。治疗在于行水清利阴气。所以阳明、太阴、厥阴的经筋，都交会于阴器，只有厥阴主筋，所以患疝病的人，必定以厥阴为本。《灵枢》又说：足厥阴的别络，名叫“蠡沟”，在内踝上五寸处，别走少阳经，沿胫骨上行至睾丸，结于阴茎。其病气逆、睾丸肿胀、突发疝痛，实证则阴茎挺长，虚证则突然瘙痒，取用该别络即可。这难道不是厥阴经受病的部位吗？《灵枢》又说：邪气在小肠，连系睾丸，归属于肾，贯穿肝脏，联络肺脏，结于心系。气盛导致气逆，向上冲击肠胃，熏蒸肝脏，散于肓膜，结于脐部。所以取用肓原穴以消散邪气，针刺太阴经以平复病情，取用厥阴经以下降气机，取用巨虚下廉以祛除病邪，按压其所经过的经脉以调理。这起初虽然说是邪气在小肠，但到了治疗方法上，一定说取用厥阴经以下降气机，由此可知各种疝病都与厥阴经有关，可以毫无疑问。通过脉象来考证，《素问》说：厥阴脉滑，为狐疝；少阳脉滑，为肺风疝；太阴脉滑，为脾风疝；阳明脉滑，为心风疝；太阳脉滑，为肾风疝；少阴脉滑，为肝风疝。凡此六种疝，虽然见于其他脉象中，但都称为风疝的，都是足厥阴肝经之气的影响。《灵枢》也说：心脉微滑，为心疝；肝脉滑甚，为溃癃；肾脉滑甚，为癃闭。凡此三脏脉象的疝病，也是以滑脉为疝的特征。《素问》又说：脉大且急，都是疝病。心脉滑，传变为心疝；肺脉沉，传变为肺疝。三阴脉急为疝，三阳脉急为瘕。王冰注解说：太阳经受寒，血凝滞形成瘕；太阴经受寒，气聚集形成疝。这是说太阴受寒，传变到肝经。可以用温药驱逐，不可以用温药进补。如果进补，是想让病邪离去却强行挽留它啊。遍考《素问》：三阳经发病，出现寒热，其传变为疝。这也是说膀胱不是受病的部位，必须传变到厥阴部分，然后才成为疝。又说病在少腹，腹痛，不能大小便，病名叫做疝。得自寒冷，说脉急的叫做疝瘕。少腹痛，凡是说少腹的，难道不是厥阴经的部分吗？又说脾风传胃，名叫疝瘕。这是说非肝木不能生风气，名叫厥疝。大概是脾土虚弱而不能制水，又被肝木所克制。又说督脉为冲疝。大概厥阴与冲、任、督，都交会于前阴。这难道还不明白吗？至于运气学说中，又说岁支太阳在泉，寒气盛行，百姓病少腹牵引睾丸。大概是寒邪客于小肠、膀胱，则肝木收缩而不能伸展，这是母传子的关系。阳明司天，燥气盛行，男子患疝，妇人少腹痛，这是说肝气不得上行，被金气抑制，是贼邪的关系。又说太阴在泉，土胜则寒气逆满，饮食不下，严重则为疝。这也是说寒邪客于太阴湿土，土不胜水，水传变到肝经。我又曾遍阅《铜人腧穴针灸图经》的穴位，也相互表里。如背上十三椎旁的俞穴，属肝经，言治寒疝，在腹部中行。只有阴交一穴，言治寒疝，是任脉所发出的；关元一穴，言治暴疝，是小肠的募穴，足三阴经与任脉的会合处；中极一穴，言治疝瘕，是膀胱的募穴，也是足三阴经与任脉的会合处；曲骨一穴，言治颓疝，是任脉与足厥阴经的会合处；腹部第二行的肓俞二穴，言治寒疝，是冲脉与足少阴经的会合处；四满二穴，言治疝瘕，是冲脉、任脉与足少阴肾经的会合处；腹部第三行的大巨二穴，言治疝，是足阳明脉气所发出的；气冲二穴，言治疝，阴茎中痛，两睾丸寒痛，也是足阳明脉气所发出的；腹部第四行的府舍二穴，言治疝痛，是足太阴、厥阴及阴维脉的交会处，也是太阴部三阴阳明的别络；冲门二穴，言治阴疝，是足太阴、厥阴经的会合处；在侧胁部的，有五枢二穴，言治寒疝，阴邪上入少腹，带脉下三寸处。在足六经中，足厥阴穴十个，言治疝的有七个，即大敦、行间、太冲、中封、蠡沟、中都、曲泉。足少阳穴十四个，言治疝的有一个，即丘墟穴。足太阴穴十一个，言治疝的有一个，即阴陵泉。足阳明穴十五个，言治疝的有一个，即阴市穴。足少阴穴十个，言治疝的有五个，即然谷、大溪、照海、交信、筑宾。足太阳穴十八个，言治疝的有两个，即金门、合阳。由此而言，只有厥阴经言治疝独多，是治疝的主经。其余经络穴位，虽然也能治疝，终究不是受疝的地方，只是与足厥阴经相连罢了。或在泉寒气胜，木气挛缩禁固于此经；或司天燥气胜，木气抑郁于此经；或愤怒悲哀，忧抑顿挫，结聚于此经；或药淋外固闭，尾缩精壅塞于此经。病情差别如此。
不知道世间的药物多温热补益，是从谁那里接受这个方子的呢？相信这些方子，那么《素问》《灵枢》《铜人》就都不对了。相信《素问》《灵枢》《铜人》，那么世俗的方子也都不对了。不知道后来的君子，认为哪个是对的？唉！我从事医学四十多年，如果让世俗的方子人人都能治愈，我也就不敢废除它们了。熟悉练习日久，通过经络认识疾病，然后才不迷惑。况且遗尿、闭癃，阳痿、脬痹，精滑、白淫，都是男子的疝病，不可以妄归咎于肾冷。血枯不来月经，月经停止后腰膝上部发热，足跟痛，咽喉干燥，癃闭，少腹有肿块，或固定或移动，前阴突出，后阴痔核，都是女子的疝病，而称之为瘕。如果年少而得此病，不论男女都不能生育。所以隐蔽委曲的事情，完全与膀胱、肾、小肠无关，而是足厥阴肝经的职责。然而世俗方子只说膀胱、肾、小肠，全然不提肝木一句，迷惑人太厉害了！而且肝经，是乙木。木属于东方，是心火之母。凡是疝病，不是肝木受邪，就是肝木自盛，不可以就说虚而进补。《难经》所谓“东方实，西方虚；泻南方，补北方。”这是说泻火，木气自然平和，金气自然清净，水气自然旺盛。
从前审言担任蔡州的参军，因为坐在潮湿地上，疝痛不可忍受，各种药物无法救治。我急忙用导水丸、禹功散，泻下三十多次，肿胀立即消除，疼痛立减。又有项关的一个男子，患突发疝暴痛不能忍受，倒在街衢，别人无法移动他，呼叫我去救治。我引经据典分析：邪气客居足厥阴之络，使人突发疝，所以病在阴丸疼痛。我急忙针刺大敦穴两个，剧痛立即停止。大敦穴，乃是厥阴经的井穴。消灭寇贼镇守一方，病人患疟疾发渴，痛饮蜂蜜水浆，剧烈损伤喝冰水。医生不知道泻去湿气，反而混杂进用姜、附子。湿气被燥热壅塞，三焦闭塞涩滞，水道不行，阴道不起，阴囊肿胀下垂，大于升斗。我先用导水丸一百多粒，一会儿，用猪肾散投服，当晚泻下青赤水一斗，于是失去了疼痛所在。靠近颍尾的一个男子，患突发疝，赤肿大痛，数日不止，各种药物像水投石头一样无效。我用导水丸一百五十粒，令分三次咽下；接着用通经散三钱，空腹淡酒调下，五更时分泻下脏腑壅积之物数次，肿痛皆去。不到三天，恢复如初。《内经》说：木郁则达之。达，谓吐法，使条达。肝之郁，本当用吐法，然而观察病位的上下，以顺为贵。张仲景所说上宜吐，下宜泻的，就是这个道理。敢于列出七疝图在下面，以显示给后来的君子，希望有所凭借。
寒疝，其症状是阴囊冷，结硬如石，阴茎不举，或牵引睾丸而痛。得自坐卧湿地，或寒冬月涉水，或冒雨雪，或卧坐砖石，或风冷处行房过劳。宜用温剂攻下。久则无子。
水疝，其症状是肾囊肿痛，阴汗时常流出，或囊肿如水晶状，或囊痒而干燥出黄水，或少腹中按之作水声。得自饮水醉酒，行房过劳，汗出而遇风寒湿之气，聚于囊中，所以水多，令人突发疝。宜用逐水剂攻下，有漏针去水的，人多不得其法。
筋疝，其症状是阴茎肿胀，或溃烂或化脓，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，随小便而下。久则得自房室劳伤，及邪术所致。宜用降心火剂攻下。
血疝，其症状如黄瓜状，在少腹两旁，横骨两端约中处，俗云便痈。得自重感春夏大热，劳动行房，气血流溢，渗入脬囊，留而不去，结成痈肿，脓少血多。宜用和血剂攻下。
气疝，其症状上连肾区，下及阴囊，或因号哭愤怒，则气郁而胀，怒哭号罢，则气散的就是。有一种治法，用针出气而愈。然而针刺有得失，宜用散气药攻下。或小儿也有此疾，俗曰偏气。得自父亲已年老，或年少多病，阳痿精怯，强力入房，因而有子，胎中病也。此疝不治，只有筑宾一穴可针刺。
狐疝，其症状如瓦片状，卧则入小腹，行立则出小腹入囊中。狐狸则昼出穴而溺，夜则入穴而不溺。此疝出入，上下往来，正与狐狸相似。也与气疝大同小异。今人带钩钤是也。宜用逐气流经药攻下。
颓疝，其症状阴囊肿坠，如升如斗，不痒不痛的是。得自地气卑湿所生。所以江淮之间，低洼池塘之处，多感此疾。宜用祛湿药攻下。女子阴户突出，虽也类似此类，乃是热则不禁固也。不可以就说虚寒而涩之、燥之、补之。本名曰瘕，宜用苦味攻下，用苦味坚之。王冰说：阳气下坠，阴气上争，上争则寒多，下坠则筋缓，所以睾丸垂纵缓，因此作颓疝也。
以上七疝，下去病邪之后，可调则调，可补则补，各量病势，不要拘泥世俗之法。《经》所谓阴盛而腹胀不通者，是癃疝，不可以不攻下。
There are seven types of Shan (hernia), and predecessors have discussed them extensively. However, I do not accept any discussions other than those found in the *Ling Shu* (Spiritual Pivot), *Su Wen* (Basic Questions), and *Tong Ren* (Illustrated Manual of Acupoints). This is not because I like to be different, but because I seek to trace the origin! What are the seven Shan? Cold Shan, Water Shan, Sinew Shan, Blood Shan, Qi Shan, Fox Shan, and Tui Shan, these are called the Seven Shan. Quack doctors do not recognize them, so they create erroneous names, calling them Bladder disease, Kidney Cold, Small Intestine Qi, or in children, Biased Qi. Since the naming is wrong, the reality of the disease is lost. Why? Because once doctors diagnose it as Bladder, Kidney Cold, or Small Intestine Qi, and attribute it to deficiency-cold, their medications will be either Deer Antler (Lu Rong) and Morinda Root (Ba Ji Tian), or Eucommia Bark (Du Zhong) and Cistanche (Rong Rong); or Aconite (Fu Zi) and Aconite Lateral Root (Wu Tou), or Dried Ginger (Gan Jiang) and Cassia Twig (Guan Gui); or Chinaberry Fruit (Lian Shi) and Costus Root (Mu Xiang), or Melia Fruit (Jin Ling Zi) and Psoralea Seed (Bu Gu Zhi). Swallowed in the morning and taken at night, there is never a special effect. Passed down for generations, no one realizes this.
How could they know that all Shan diseases belong to the Foot Jueyin Liver Meridian? Yet, one must promote flow and return to the Small Intestine and Bladder (Pao Nang). The Bladder is the mansion of water, specifically responsible for seepage and excretion; the Small Intestine is the waterway, specifically responsible for flow. The Kidney belongs to Shaoyin, commanding the two waters. Human urine enters the Small Intestine from the Stomach, seeps into the Bladder. The Bladder is the Pao Nang; when Qi transforms, water exits from the tip of the penis. This is the normal pathway. When it becomes Shan, it belongs to the Foot Jueyin Liver Meridian. The Foot Jueyin Liver Meridian circles the genitalia and enters the lower abdomen. The Liver and Kidney both belong to the lower region, attaching to the Chong, Ren, and Du meridians. However, the *Ling Shu Jing* states: Diseases of the Foot Jueyin Liver Meridian include enuresis, strangury, and Fox Shan. It does not mention Shan regarding the Kidney, Bladder, and Small Intestine meridians. Thus, the place receiving Shan is the domain of the Liver. Furthermore, the *Nei Jing* states: The Zong Jin (tendons of the male organ) of men is the gathering point of the bones. The Liver governs the tendons. The testicles are the balls within the scrotum; although they belong to the external kidneys, without the circling and drawing of the Jueyin meridian, the penis would have no way to extend or retract. In women, this is the Yin Hu (vulva). Internally and externally, it is divided into two parts: one is called Ting Kong, the other Yao Lou. These are where the Foot Jueyin, Chong, Ren, and Du meridians meet. The *Ling Shu* says: The sinews of the Foot Jueyin meridian gather at the genitalia. If injured by cold, the yin retracts inward; if injured by heat, it hangs flaccid and cannot retract. Treatment involves promoting water flow and clearing Yin Qi. Therefore, the sinews of Yangming, Taiyin, and Jueyin all meet at the genitalia, but only Jueyin governs the sinews. Thus, those with Shan must base their condition on Jueyin. The *Ling Shu* also says: The collateral of the Foot Jueyin is named "Ligou" (Cleft Groove), five cun above the medial malleolus, diverging to the Shaoyang, running up the tibia to the testicle, and knotting at the penis. Its symptoms include rebellious Qi, swollen testicles, and sudden Shan. Excess manifests as prolonged erection; deficiency manifests as sudden itching. Treating its divergence resolves it. Is this not the site where Jueyin receives the disease? The *Ling Shu* further states: Pathogens in the Small Intestine connect to the testicular ligaments, attach to the Kidney, penetrate the Liver, network the Lung, and knot at the Heart system. Excessive Qi causes rebellion, rushing upward to attack the stomach and intestines, steaming the Liver, scattering into the Huang (membrane), and knotting at the umbilicus. Therefore, treat by selecting the Huangyuan point to dissipate it, puncture the Taiyin to calm it, select the Jueyin to descend it, select Juliu Xia (Lower He-Sea of Small Intestine) to remove it, and press the meridians it passes through to regulate it. Although initially stating the pathogen is in the Small Intestine, the treatment method insists on selecting the Jueyin to descend Qi. Thus, it is undeniable that all Shan relate to Jueyin.
Examining the pulse, the *Su Wen* states: Jueyin pulse slippery indicates Fox Shan; Shaoyang pulse slippery indicates Lung Wind Shan; Taiyin pulse slippery indicates Spleen Wind Shan; Yangming pulse slippery indicates Heart Wind Shan; Taiyang pulse slippery indicates Kidney Wind Shan; Shaoyin pulse slippery indicates Liver Wind Shan. All these six Shan, though appearing in other pulses, are called Wind Shan because they involve the Qi of the Foot Jueyin Liver Meridian. The *Ling Shu* also says: Heart pulse slightly slippery indicates Heart Shan; Liver pulse very slippery indicates ulcerative strangury; Kidney pulse very slippery indicates strangury. For these three zang organs' Shan, slippery pulse indicates Shan. The *Su Wen* again states: Large and urgent pulses all indicate Shan. Heart pulse slippery transmits to Heart Shan; Lung pulse deep transmits to Lung Shan. Three Yin urgent pulses indicate Shan; Three Yang urgent pulses indicate Jia (masses). Wang Bing notes: Taiyang receiving cold causes blood coagulation forming Jia; Taiyin receiving cold causes Qi aggregation forming Shan. This means Taiyin cold transmits to the Liver Meridian. One can use warm herbs to drive it out, but not to tonify. Tonifying would be trying to keep the disease while wishing it away. Examining the *Su Wen*: Diseases of the Three Yang present with chills and fever, transmitting to Shan. This also says the Bladder is not the site of disease, but must transmit to the Jueyin portion before becoming Shan. It also states: Disease in the lower abdomen, abdominal pain, inability to urinate or defecate, is named Shan. Caused by cold, urgent pulse indicates Shan Jia. Lower abdominal pain—does "lower abdomen" not refer to the Jueyin portion? It also states: Spleen wind transmitting to the Stomach is named Shan Jia. This means non-Liver Wood cannot generate wind qi, named Jue Shan. Presumably, Spleen Earth is deficient and cannot control Water, and is overwhelmed by Liver Wood. It also states: The Du Mai is Chong Shan. Presumably, Jueyin, Chong, Ren, and Du all meet at the anterior yin. Is this not clear? Regarding Yunqi (Five Movements and Six Qi): When Sun (Taiyang) is in the lower position, excessive cold makes people suffer from lower abdomen pulling to the testicle. Presumably, cold pathogens lodge in the Small Intestine and Bladder, causing Liver Wood to contract and fail to extend; this is mother transmitting to son. When Yangming governs the upper position, excessive dryness causes men to suffer Shan and women lower abdominal pain. This means Liver Qi fails to ascend, suppressed by Metal, constituting a thief-pathogen relationship. It also states: When Taiyin is in the lower position, Earth excess causes cold Qi rebellion and fullness, inability to eat or drink, severe cases become Shan. This also means cold pathogens lodge in Taiyin damp-earth; Earth fails to overcome Water, and Water transmits to the Liver Meridian.
I have also reviewed the acupoints in the *Tong Ren*. They correspond internally and externally. For example, the Shu points at the 13th thoracic vertebra on the back belong to the Liver Meridian and treat Cold Shan. In the midline of the abdomen: Only the Yinjiao point treats Cold Shan, originating from the Ren Mai; the Guanyuan point treats sudden Shan, being the Mu point of the Small Intestine and the meeting of the Three Yin and Ren Mai; the Zhongji point treats Shan Jia, being the Mu point of the Bladder and the meeting of the Three Yin and Ren Mai; the Qugu point treats Tui Shan, being the meeting of the Ren Mai and Foot Jueyin. In the second row of the abdomen: The Huangshu points treat Cold Shan, being the meeting of the Chong Mai and Foot Shaoyin; the Siman points treat Shan Jia, being the meeting of the Chong, Ren, and Foot Shaoyin Kidney. In the third row: The Daju points treat Shan, where Foot Yangming Qi emerges; the Qichong points treat Shan, penile pain, and bilateral testicular cold pain, also where Foot Yangming Qi emerges. In the fourth row: The Fushe points treat Shan pain, being the intersection of Foot Taiyin, Jueyin, and Yin Wei Mai, and also the branch of Taiyin, Three Yang, and Yangming. The Chongmen points treat Yin Shan, being the meeting of Foot Taiyin and Jueyin. On the side ribs: The Wushu points treat Cold Shan, where Yin pathogens enter the lower abdomen, three cun below the Dai Mai. Among the foot six meridians: Ten Foot Jueyin points, seven treat Shan: Dadun, Xingjian, Taichong, Zhongfeng, Ligou, Zhongdu, Ququan. Fourteen Foot Shaoyang points, one treats Shan: Qiuxu. Eleven Foot Taiyin points, one treats Shan: Yinlingquan. Fifteen Foot Yangming points, one treats Shan: Yinshi. Ten Foot Shaoyin points, five treat Shan: RanGu, DaXi, Zhaohai, Jiaoxin, Zubin. Eighteen Foot Taiyang points, two treat Shan: Jinmen, Heyang. Thus, only Jueyin mentions Shan most frequently, making it the master of Shan. Other meridian points may also treat Shan, but ultimately they are not the site receiving Shan, merely connected to the Foot Jueyin. Whether due to cold excess in the lower position contracting Wood Qi, dry excess in the upper position depressing Wood Qi, anger or sorrow causing Qi stagnation, or drug-induced retention causing essence congestion, the pathology differs thus.
Who taught the world that medicines are mostly hot and tonifying? Believing these prescriptions renders the *Su Wen*, *Ling Shu*, and *Tong Ren* incorrect. Believing the classics renders popular prescriptions incorrect. I wonder which future scholars will deem correct? Alas! I have practiced medicine for over forty years. If popular prescriptions could cure everyone, I would dare not discard them. After long experience, understanding disease through meridians, I became unconfused. Enuresis, strangury, impotence, bladder bi, spermatorrhea, and leukorrhea are all men's Shan; they should not be wrongly attributed to Kidney Cold. Blood depletion with amenorrhea, heat above the waist and knees after menstruation ceases, heel pain, dry throat, strangury, masses in the lower abdomen (fixed or moving), protrusion of the anterior yin, and hemorrhoids at the posterior yin are all women's Shan, termed Jia. If contracted in youth, neither men nor women will have offspring. Thus, hidden matters have nothing to do with the bladder, kidney, or small intestine; they are the duty of the Foot Jueyin Liver Meridian. Yet popular prescriptions only mention bladder, kidney, and small intestine, never mentioning Liver Wood, confusing people greatly! The Liver Meridian is Yi Wood. Wood belongs to the East and is the mother of Heart Fire. Any Shan is either Liver Wood receiving pathogens or Liver Wood becoming excessive; one should not simply say it is deficiency and tonify. The *Nan Jing* states: "East is excess, West is deficiency; drain South, tonify North." This means draining fire allows Wood to level itself, Metal to clear itself, and Water to flourish.
Formerly, Shen Yan served as a staff officer in Cai Prefecture. Sitting on wet ground, he suffered unbearable Shan pain, and all drugs failed. I urgently used Dao Shui Wan and Yu Gong San, inducing more than thirty bowel movements. The swelling vanished immediately, and pain subsided instantly. Another man, Guan, suffered sudden severe Shan pain, collapsing on the street, unable to move. I summoned me for help. I cited the classics: Pathogens lodging in the collateral of the Foot Jueyin cause sudden Shan, hence pain in the testicles. I urgently punctured Dadun (two points). Severe pain ceased immediately. Dadun is the Jing-Well point of Jueyin. Eliminating the bandit protects the individual. A patient suffered malaria with thirst, drinking honey water excessively, and severely injuring himself with ice water. Doctors did not know to drain the dampness but instead mixed Ginger and Aconite. Dampness was blocked by dry-heat, the Triple Burner became obstructed, water pathways failed, and the yin channels did not rise. The scrotum swelled and hung, larger than a sheng or dou. I first gave over one hundred pills of Dao Shui Wan, then administered Zhu Shen San. That night, he discharged a bucket of greenish water, and the pain location disappeared. Near Yingwei, a man suffered sudden Shan with red, swollen, severe pain lasting days, resisting all treatments. I gave one hundred and fifty pills of Dao Shui Wan, taken in three doses; then three qian of Tong Jing San, taken on an empty stomach with light wine. At dawn, he passed several bowel movements of accumulated matter, and pain and swelling disappeared. Within three days, he recovered completely. The *Nei Jing* says: When Wood is depressed, promote its flow. Promotion refers to vomiting, allowing free expression. Liver depression should ideally be treated with vomiting, but observing the location of the disease, following the natural order is paramount. Zhang Zhongjing said: Upper locations suit vomiting, lower locations suit purgation. This is what he meant. I dare to list the diagram of the Seven Shan below to show future scholars, hoping they will have something to rely upon.
Cold Shan: Symptoms include a cold scrotum, hard as stone, flaccid penis, or pain radiating to the testicles. Caused by sitting/lying on wet ground, wading in winter, exposure to rain/snow, lying on bricks/stone, or intercourse in cold/windy places with overexertion. Treat with warm purgatives. Long-term infertility results.
Water Shan: Symptoms include painful scrotal swelling, frequent sweating from the yin, cysts resembling crystal, itchy dry cysts oozing yellow fluid, or water sounds upon pressing the lower abdomen. Caused by drinking alcohol/intoxicants, excessive intercourse, sweating followed by wind-cold-dampness gathering in the scrotum, leading to excess water and sudden Shan. Treat with water-draining purgatives. Some use needle drainage, but few know the method.
Sinew Shan: Symptoms include penile swelling, ulceration/pus, pain with internal tension and tendon contraction, penile pain (extreme pain leads to itching), prolonged erection/flaccidity, or white substance like semen discharging with urine. Caused long-term by sexual exhaustion or evil arts. Treat with heart-calming purgatives.
Blood Shan: Symptoms resemble a cucumber, located in the lower abdomen sides, near the midpoint of the horizontal bone ends, commonly called Bian Yong (abscess). Caused by heavy exposure to spring/summer heat, labor, and intercourse, causing Qi and blood to overflow, seep into the bladder sac, remain, and form an abscess with little pus and much blood. Treat with blood-nourishing purgatives.
Qi Shan: Symptoms extend from the kidney region to the scrotum. Distension occurs due to crying or anger (Qi stagnation); relief occurs when crying/anger stops (Qi disperses). One treatment is needle release of Qi. However, acupuncture has risks; using Qi-dispersing purgatives is better. Children may also get this, called Pian Qi. Caused by fathers who are old, sick, impotent, or weak in essence, engaging in forced intercourse to conceive, resulting in fetal disease. This Shan is untreatable except by needling the Zubin point.
Fox Shan: Symptoms resemble a tile. Enters the lower abdomen when lying down; exits to the scrotum when standing/walking. Foxes urinate when leaving dens by day and do not urinate when entering by night. This Shan's entry/exit resembles foxes. Similar to Qi Shan but with minor differences. Currently treated with hooks/clasps. Treat with Qi-moving and meridian-purging herbs.
Tui Shan: Symptoms include scrotal swelling hanging like a sheng or dou, without itch or pain. Caused by low-lying damp earth. Common in Jianghuai regions and marshes. Treat with damp-resolving herbs. Women with vaginal prolapse are similar but caused by heat failing to secure. Do not treat as deficiency-cold with astringents/drying/tonics. Originally named Jia. Treat with bitter purgatives and bitter firming agents. Wang Bing says: Yang Qi sinks, Yin Qi rises. Rising Yin causes cold; sinking Yang causes tendon laxity, leading to hanging testes, thus Tui Shan.
After treating the Seven Shan, adjust or tonify according to the condition, do not stick to vulgar methods. The Classics state: Yin excess with abdominal distension and blockage is Long Shan; it must be purged.