疝任病 归厥阴 经云∶任脉为病，外结七疝，女子带下瘕聚。丹溪专治厥阴者，以肝
主筋，又主痛也。
寒筋水 气血寻 寒疝、水疝、筋疝、气疝、血疝。
狐出入 顽麻 狐疝∶卧则入腹，立则出腹。 疝∶大如升斗，顽麻不痛。
治气 景岳箴 景岳云∶疝而曰气者，病在气也。寒有寒气，热有热气，湿有湿
气，逆有逆气，俱当兼用气药也。
五苓散 加减斟 《别录》以此方加川楝子、木通、橘核、木香，通治诸疝。
茴香料 着医林 三层茴香丸治久疝，虽三十年之久，大如栲栳，皆可消散。
痛不已 须洗淋 阴肿核中痛，《千金翼》用雄黄一两、矾石二两、甘草一尺，水一斗
，煮二升洗之，如神。
痰饮源 水气作 水气上逆，得阳煎熬则稠而成痰，得阴凝聚则稀而成饮。然水归于肾
，而受制于脾，治者必以脾肾为主。
燥湿分 治痰略 方书支离不可听。只以燥湿为辨，燥痰宜润肺，湿痰宜温脾，握要之
法也。宜参之虚痨、咳嗽等篇。或老痰宜王节斋化痰丸，实痰怪症，宜滚痰丸之类。
四饮名 宜斟酌 《金匮》云∶其人素盛今瘦，水走肠间，沥沥有声，谓之痰饮。注∶
即今之久咳痰喘是也。饮后水流在胁下，咳唾引痛，谓之悬饮。注∶即今之停饮胁痛症也。
饮水流行，归于四肢，当汗出而不汗出，身体疼重，谓之溢饮。注∶即今之风水、水肿症也
。咳逆倚息，气短不得卧，其形如肿，谓之支饮。注∶今之停饮喘满不得卧症也。又支饮，
偏而不中正也。
参五脏 细量度 四饮犹未尽饮邪之为病也，凡五脏有偏虚之处，而饮留之。言脏不及
腑者，腑属阳，在腑则行矣。《金匮》曰∶水在心，心下坚筑短气，恶水不欲饮。水在肺，
吐涎沫欲饮水。水在脾，少气身重。水在肝，胁下支满，嚏而痛。水在肾，心下悸。
补和攻 视强弱 宜补、宜攻、宜和，视乎病情，亦视乎人之本体强弱而施治也。
十六方 各凿凿 苓桂术甘汤、肾气丸、甘遂半夏汤、十枣汤、大青龙汤、小青龙汤、
木防己汤、木防己加茯苓芒硝汤、泽泻汤、浓朴大黄汤、葶苈大枣泻肺汤、小半夏汤、己椒
葶苈丸、小半夏加茯苓汤、五苓散、《外台》茯苓饮。
温药和 博返约 《金匮》云∶病痰饮者，当以温药和之。忽揭出温药和之四字，即金
针之度也。盖痰饮，水病也，水归于肾，而受制于脾；欲水由地中行而归其壑者，非用温药
以化气不可也；欲水不泛溢而筑以堤防者，非用温药以补脾不可也。如苓桂术甘汤、肾气丸
、小半夏汤、五苓散之类，皆温药也。即如十枣汤之十枚大枣，甘遂半夏汤之半升白蜜，木
防己汤之参、桂，葶苈汤之大枣，亦寓温和之意。至于攻下之法，不过一时之权宜，而始终
不可离温药之旨也。
阴霾除 阳光灼 饮为阴邪，必使离照当空，而群阴方能退散。余每用参苓术附加生姜
汁之类取效。
滋润流 时医错 方中若杂以地黄、麦冬、五味附和其阴，则阴霾冲逆肆空，饮邪滔天
莫救矣，即肾气丸亦宜慎用。
真武汤 水归壑 方中以茯苓之淡以导之，白术之燥以制之，生姜之辛以行之，白芍之
苦以泄之，得附子本经之药，领之以归其壑。
白散方 窥秘钥 《三因》白散之妙，喻嘉言解之甚详。见于《医门法律·中风门》
疝气这一病症，归属于足厥阴肝经。医经记载：任脉发生病变，会在体表结聚成七种疝气，女子则会出现带下病和腹内包块（瘕聚）。朱丹溪专门从治疗厥阴肝经入手，是因为肝主司筋脉，又主司疼痛。
寒疝、水疝、筋疝、气疝、血疝这五种疝气，其病因需从寒气、水湿以及气血运行中寻找。
狐疝的特点是：平卧时肿物回纳入腹，站立时则脱出腹外。还有一种疝气表现为肿块大如升斗，质地坚硬麻木且不疼痛。
治疗气疝，可参考张景岳的论述。张景岳说：称为“气疝”的，说明病机在于气。无论是寒气、热气、湿气还是逆气，都应当兼用理气药物进行治疗。
五苓散可以加减使用进行斟酌。《名医别录》记载在此方基础上加入川楝子、木通、橘核、木香，可以通治各种疝气。
茴香类药物在医学界备受推崇。三层茴香丸可以治疗久治不愈的疝气，即使是患病三十年之久、肿块大如栲栳者，也能使其消散。
如果疼痛不止，必须采用熏洗或淋洗的方法。对于阴囊肿胀及睾丸疼痛，《千金翼方》使用雄黄一两、矾石二两、甘草一尺，加水一斗，煎煮至二升，用来清洗患处，效果神妙。
痰饮的源头，是由水气异常所致。水气上逆，受到阳热煎熬则变得粘稠而成痰；受到阴寒凝聚则变得稀薄而成饮。然而水液归于肾脏，同时受脾脏制约，因此治疗必须以调理脾肾为主。
治疗痰饮的原则是区分燥湿。许多方书说法支离破碎不可听信。只需以燥湿作为辨别关键：燥痰适宜润肺，湿痰适宜温脾，这是抓住要领的方法。可以参考虚劳、咳嗽等篇章的内容。如果是老痰，适宜使用王节斋的化痰丸；如果是实痰引起的怪症，适宜使用滚痰丸之类的方剂。
饮邪分为四种类型，需要仔细斟酌。《金匮要略》说：一个人原本身体壮盛现在却消瘦，水液流注于肠间，发出沥沥声响，这叫做痰饮。注释：即现在的久咳痰喘病症。饮水后水流停滞在胁下，咳嗽吐唾沫牵引疼痛，这叫做悬饮。注释：即现在的停饮胁痛症。饮水流行，滞留于四肢，本该出汗却不出汗，身体疼痛沉重，这叫做溢饮。注释：即现在的风水、水肿症。咳嗽气逆，倚靠呼吸，气短不能平卧，身形浮肿，这叫做支饮。注释：即现在的停饮喘满不得卧症。另外，“支”字意为偏斜而不中正。
参合五脏情况，细细衡量。上述四种饮邪并未穷尽饮邪致病的情况，凡是五脏有偏虚之处，就会导致饮邪停留。之所以只言五脏不及六腑，是因为腑属阳，病在腑则容易行散。《金匮要略》说：水气在心，心下坚硬悸动，气短，厌恶水而不想喝水。水气在肺，吐出涎沫，想要喝水。水气在脾，少气，身体沉重。水气在肝，胁下支撑胀满，打喷嚏时牵引疼痛。水气在肾，心下悸动。
补法与攻法，需视患者体质强弱而定。适宜补益、适宜攻下、适宜调和，要根据病情，也要根据患者本身体质的强弱来施治。
书中列出了十六个方剂，各个确切有效：苓桂术甘汤、肾气丸、甘遂半夏汤、十枣汤、大青龙汤、小青龙汤、木防己汤、木防己加茯苓芒硝汤、泽泻汤、浓朴大黄汤、葶苈大枣泻肺汤、小半夏汤、己椒葶苈丸、小半夏加茯苓汤、五苓散、《外台秘要》茯苓饮。
使用温药调和，由博返约。《金匮要略》说：患有痰饮病的人，应当用温药来调和它。忽然揭示出“温药和之”这四个字，就是治疗的精髓所在。因为痰饮属于水病，水液归于肾脏而受脾脏制约；想要让水液像在地中流动一样回归其应有的壅滞之处，不用温药来化气是不行的；想要防止水液泛溢并用堤坝加以约束，不用温药来补脾也是不行的。像苓桂术甘汤、肾气丸、小半夏汤、五苓散这类，都是温药。就像十枣汤中的十枚大枣，甘遂半夏汤中的半升白蜜，木防己汤中的人参、桂枝，葶苈大枣泻肺汤中的大枣，也都蕴含温和之意。至于攻下的方法，不过是一时的权宜之计，而始终不能脱离温药的宗旨。
阴霾得以清除，如同阳光灼照。饮邪属于阴邪，必须使阳气如离火当空照耀，群阴才能退散。我常用参苓术附加上生姜汁之类的方法取得疗效。
若滥用滋润之法，是时医的错误。方剂中如果混杂地黄、麦冬、五味子等来附和其阴，那么阴霾之气就会冲逆肆虐，饮邪滔天无法挽救了，即便是肾气丸也应当慎用。
真武汤能使水归其壑。该方中以茯苓的淡味来引导水湿，白术的燥性来制约水湿，生姜的辛味来行散水气，白芍的苦味来泄降水气，再得附子这本经药材统领，引导水液回归其壅滞之处。
Shan Qi (Hernia) diseases are attributed to the Jueyin Liver Meridian. The Classics state: When the Ren Mai (Conception Vessel) is diseased, it manifests externally as seven types of Shan Qi (hernias), and in women, it presents with Dai Xia (leukorrhea) and Jia Ju (abdominal masses). Zhu Danxi specifically treats the Jueyin meridian because the Liver governs the sinews and is also responsible for pain.
Cold Shan Qi, Water Shan Qi, Sinew Shan Qi, Qi Shan Qi, and Blood Shan Qi require investigation into cold pathogens, water-dampness, and the movement of Qi and Blood.
Hu Shan Qi (Fox Hernia): The mass retracts into the abdomen when lying down, and protrudes out when standing. Another type of Shan Qi presents as a large mass, like a sheng or dou measure, which is hard, numb, and painless.
To treat Qi Shan Qi, refer to the advice of Zhang Jingyue. Zhang Jingyue stated: When referred to as "Qi Hernia," the pathology lies in Qi. Whether it involves Cold Qi, Heat Qi, Damp Qi, or Rebellious Qi, Qi-regulating herbs should be used concurrently.
Wu Ling San (Five-Ingredient Powder with Poria) can be modified. *Bie Lu* records adding Chuan Lian Zi (Fructus Toosendan), Mu Tong (Akebiae Caulis), Ju He (Pericarpium Citri Reticulatae Viride), and Mu Xiang (Radix Aucklandiae) to this formula to treat various hernias universally.
Fennel preparations are highly regarded in medical circles. San Ceng Hui Xiang Wan (Three-Layer Fennel Pill) treats chronic hernias; even those lasting thirty years with masses as large as a basket can be dissipated.
If pain persists, washing or fumigation is necessary. For swelling of the yin and pain in the testicles, *Qian Jin Yi Fang* prescribes using Xiong Huang (Realgar), Fan Shi (Alumen), and Gan Cao (Licorice Root) boiled in water for external washing, yielding miraculous results.
The source of Tan Yin (Phlegm-Fluid) is abnormal Water-Qi. When Water-Qi rebels upward and is scorched by Yang heat, it becomes thick and forms Tan (Phlegm); when condensed by Yin cold, it becomes thin and forms Yin (Fluid). However, water returns to the Kidney and is controlled by the Spleen; therefore, treatment must focus on the Spleen and Kidney.
Treatment distinguishes between Dryness and Dampness. Fragmented theories in prescription books should not be heeded. One should distinguish primarily by Dryness and Dampness: Dry Phlegm suits moistening the Lung, while Damp Phlegm suits warming the Spleen; this is the essential method. Refer to chapters on Xu Lao (Consumptive Disease) and Ke Sou (Cough). For old phlegm, Wang Jiezai's Hua Tan Wan (Phlegm-Resolving Pill) is suitable; for strange symptoms caused by excess phlegm, Gun Tan Wan (Rolling Phlegm Pill) and similar formulas are appropriate.
There are four names for Yin (Fluid), which require careful consideration. *Jin Gui Yao Lue* states: A person who was previously robust but is now emaciated, with water flowing between the intestines making a gurgling sound, is called Tan Yin (Phlegm-Fluid). Note: This corresponds to current chronic cough with phlegm and wheezing. After drinking, if water flows and stagnates under the hypochondrium, causing pain upon coughing and spitting, it is called Xuan Yin (Suspended Fluid). Note: This corresponds to current fluid retention with hypochondriac pain. If drinking water flows and accumulates in the four limbs, sweating should occur but does not, resulting in body ache and heaviness, it is called Yi Yin (Overflowing Fluid). Note: This corresponds to current Feng Shui (Wind Edema) and Shui Zhong (Edema). With coughing and rebellious Qi, shortness of breath preventing lying flat, and a swollen appearance, it is called Zhi Yin (Supporting Fluid). Note: This corresponds to current fluid retention with wheezing, fullness, and inability to lie flat. Furthermore, "Zhi" implies deviation from the center.
Consult the Five Zang organs and measure carefully. The four types of Yin do not exhaust all pathologies of fluid retention; whenever any of the Five Zang organs has a localized deficiency, fluid remains. The reason only Zang organs are mentioned, excluding Fu organs, is that Fu organs belong to Yang, and disease in the Fu organs tends to disperse. *Jin Gui* says: Water in the Heart causes hardness and palpitations below the epigastrium, shortness of breath, aversion to water, and reluctance to drink. Water in the Lung causes expectoration of saliva and foam, with a desire to drink. Water in the Spleen causes Qi deficiency and bodily heaviness. Water in the Liver causes distension and fullness under the hypochondrium, with pain upon sneezing. Water in the Kidney causes palpitations below the heart.
Tonification and Purging depend on strength. Whether to tonify, purge, or harmonize depends on the condition of the disease and the patient's constitutional strength.
Sixteen formulas are listed, each precise: Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes Macrocephala, and Licorice Decoction), Shen Qi Wan (Kidney Qi Pill), Gan Sui Ban Xia Tang (Kansui and Pinellia Decoction), Shi Zao Tang (Ten Jujube Date Decoction), Da Qing Long Tang (Major Green Dragon Decoction), Xiao Qing Long Tang (Minor Green Dragon Decoction), Mu Fang Ji Tang (Stephania Tetrandra Decoction), Mu Fang Ji plus Fu Ling and Mang Xiao Tang, Ze Xie Tang (Alisma Decoction), Niu Po Da Huang Tang (Magnolia Bark and Rhubarb Decoction), Ting Li Da Zao Xie Fei Tang (Descurainia Seed and Jujube Decoction to Drain the Lung), Xiao Ban Xia Tang (Minor Pinellia Decoction), Ji Jiao Ting Li Wan (Prunella and Descurainia Pill), Xiao Ban Xia plus Fu Ling Tang, Wu Ling San (Five-Ingredient Powder with Poria), and Wai Tai Fu Ling Yin (External Treasury Poria Drink).
Warm herbs harmonize, returning from complexity to simplicity. *Jin Gui* states: For patients with Tan Yin, warm herbs should be used to harmonize. Suddenly revealing these four characters, "Warm Herbs Harmonize," is the golden needle of treatment. Since Tan Yin is a water disease, returning to the Kidney and controlled by the Spleen; to make water flow within the earth and return to its channel, one must use warm herbs to transform Qi; to prevent water from overflowing and build dikes, one must use warm herbs to tonify the Spleen. Formulas like Ling Gui Zhu Gan Tang, Shen Qi Wan, Xiao Ban Xia Tang, and Wu Ling San are all warm herbs. Even the ten jujube dates in Shi Zao Tang, the half-sheng of white honey in Gan Sui Ban Xia Tang, the Ginseng and Cinnamon Twig in Mu Fang Ji Tang, and the jujube dates in Ting Li Tang, all imply mildness and harmony. Methods of purging are merely temporary expedients, and the principle of warm herbs cannot be abandoned throughout.
Dark clouds are removed by scorching sunlight. Yin (Fluid) is a Yin pathogen; it requires the sun (Yang Qi) to shine brightly so that the group of Yins can retreat. I often achieve efficacy using formulas containing Ginseng, Poria, Atractylodes, Aconite, plus ginger juice.
Moistening flow is an error of contemporary physicians. If herbs like Di Huang (Rehmannia Root), Mai Dong (Ophiopogon Tuber), and Wu Wei Zi (Schisandra Fruit) are mixed into prescriptions to harmonize Yin, dark clouds will rebel and rage, and Yin pathogens will rise uncontrollably, beyond rescue. Even Shen Qi Wan should be used with caution.
Zhen Wu Tang (True Warrior Decoction) guides water back to its reservoir. In this formula, the bland nature of Fu Ling (Poria) guides it, the drying nature of Bai Zhu (Atractylodes Macrocephala) controls it, the acrid nature of Sheng Jiang (Fresh Ginger) moves it, the bitter nature of Bai Shao (White Peony Root) drains it, and with the guidance of Fu Zi (Aconite Root) from its own classic text, it leads the water back to its reservoir.
Bai San Fang (White Powder Formula) reveals the secret key. The subtlety of Bai San in *San Yin Fang* is explained in detail by Yu Jiayan. It appears in *Yi Men Fa Lv · Zhong Feng Men*.