睾丸连小腹急痛，曰疝。或无形无声，或有形如瓜，有声如蛙。小腹、阴囊、
睾丸皆肝经部分，盖肝经筋脉环阴器而上抵小腹也。故张子和谓此为肝经之病，肝
主筋，睾丸非肝筋，环引与玉茎，无由伸缩《经》谓∶足厥阴之经筋聚于阴器，伤
于寒则阴缩入，伤于热则纵挺不收。又言∶足厥阴之别曰蠡沟，循胫上睾结于茎，
其病气逆睾肿卒疝。可见矣。俗称膀胱冷，或曰肾冷，（肾气通于外肾，膀胱系与睾丸系会也。
）或曰小肠气，皆非也。膀胱为水府，小肠为水道，专主渗泄通流，肾统二水，皆与
筋无涉。虽《经》有言邪在小肠，连睾系，属于脊，贯肝肺，络心系，气盛厥逆，
上冲肠胃，熏肝，散于肓，结于脐，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。此其初虽言邪在小肠，至其治法，必曰取厥阴以下之，乃
知疝必关于厥阴无疑。又谓∶三阳（膀胱经）。为病发寒热，其传为 疝。此亦言膀胱非
受病之处，必传于厥阴部分乃为疝也。又言∶脾风传肾，病名曰疝瘕，小腹冤热而
痛，出白，（精浊也。风者热也，精得湿热为败浊。）一名曰蛊。（强中入房，女所惑也。）曰
风，则属之
肝木可知矣。（以上言疝非膀胱、肾、小肠之病。）又云∶厥阴滑为狐风疝，（滑为阳邪，
热则生风也。）
少阴滑为肺风疝，（心火乘肺。）太阴滑为脾风疝，阳明滑为心风疝，（金燥则热，热属
心也。）太
阳滑为肾风疝，（膀胱与肾为表里也。）少阳滑为肝风疝。皆言风者，厥阴木气之所主也。
又云∶心脉滑为心疝，肝脉肾脉滑甚为癃 。亦以滑为疝也。（意谓上条言滑乃风疝之脉，则
此条之滑亦为风脉可知也。）又云∶脉大急则为疝，心脉滑搏为心疝，肺脉沉搏为肺疝。搏急
非肝邪而何？又云∶督脉生病，从少腹上冲心而痛为冲疝。盖足厥阴与冲任督俱会
于前阴也，然则疝为肝病，岂不明哉？（以上言诸经之疝，皆归于肝也。）按子和以疝病属肝部
分，甚是。然各脏腑经脉相通，有由肝经自病者，则亦有由诸经之病传注者，其论
中所举已自可见。况《经》又有云∶足阳明之筋病 疝，腹筋急；足太阴之筋病阴
器纽痛。小肠病者，小腹痛，腰脊控睾而痛，肾下则腰尻病，不可以俯仰，为狐疝。
寸口脉沉而弱曰寒热，及疝瘕少腹痛。黄脉之至也，大而虚，有积气在腹中，有厥
气，曰厥疝。其词不一而足，此当细察。盖肝经为朝宗之地，（少阴、太阴、阳明、少阳、
太阳诸经，亦会于小腹前阴。）各经为发源之区，源流并究可耳。再按张子和以疝属之肝，赵
以德则又属之任脉，谓冲任二脉起于胞中，诸经皆受气于此，因以海名之。二脉通，
则阳气下降，阴气上行，塞则阳壅于上，阴结于下。其所以闭塞者，或任脉之自病，
偏寒偏热。或各经病邪相犯，致任脉结滞，阴气不化使然。引《经》任脉为病，男
子内结七疝，女子带下瘕聚为据，其说甚有理。然冲任督同体，何不并举乎？窃谓
诸经之邪，皆得传注冲任督三脉，而结于肝经部分为疝，则诸说皆会通矣。再按赵
以德谓疝有二，不必小腹痛引睾囊乃名疝，但心腹痛即名为疝。引巢氏七疝为据，
一曰厥疝，厥逆心痛，饮食吐不下也。二曰症疝，腹中气乍满痛，气积如臂也。三
曰寒疝，饮食寒冷即胁下腹中痛也。四曰气疝，腹中乍满乍减而痛也。五曰盘疝，
腹中痛在脐旁也。六曰 疝，腹中脐下有积聚也。七曰野狼疝，小腹与阴相引而痛也。
赵氏盖以上六疝，止言腹胁痛而不及睾囊，故谓心腹痛即名为疝，庸讵知其非省文
乎？今定以小腹痛引阴丸为疝，庶免岐惑。（又子和谓遗癃滑浊，阴痿胞痹，皆男子之疝。血涸不
月，经后腰膝上热，足 嗌干，癃闭，小腹有块或定或移，前阴突出，后阴痔核者，皆女子
之疝。但女子不曰疝而
曰瘕，盖皆肝经任脉之病，故云尔。）疝病之由，人皆以为经络得寒，收引不行而作痛。丹溪谓
是始于湿热郁遏，又感外寒，湿热被郁作痛。其初致湿热之故，固太劳而火起于
筋，醉饱而火起于胃，房劳而火起于肾，大怒而火起于肝。火郁之久，蒸为盛湿，
浊液凝聚，并入血隧，流于厥阴。肝火性最急暴，为外寒所束，宜其痛暴而甚也。
痛者，热气之冲击；肿而重坠，则湿之为耳。（虚亦肿，但不甚坠耳。）左丸属血，诸寒
收引则血泣，故左丸痛多而肿少。右丸属气，诸气郁蒸则湿聚，故右丸痛少而肿多。
张子和分七疝∶一曰寒疝，囊冷结硬如石，阴茎不举，或控引睾丸而痛。得于坐卧
湿地，或寒月涉水，久而无子。宜以温剂下之。二曰水疝，肾囊肿痛，阴汗时
出，或囊肿如水晶，或囊痒，搔出黄水，或小腹按之作水声。得之饮水醉酒，使内
过劳，汗出遇风，寒湿之气结于囊中。宜以逐水之剂下之。三曰筋疝，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。得于房劳，及邪术淫方所致。宜以降心火之剂下之。四曰血疝，状如黄瓜，
在小腹两旁、横骨两端约文中，俗云便痈。得于重感春夏大燠，（热则血流溢。）劳动
使内，气血流溢，渗入脬囊，结成痈肿，脓多血少。宜以和血之剂下之。五曰
气疝，上连肾区，下及阴囊。或因号哭忿怒，则气郁而胀，过后气散则消者是也。
宜以散气之药下之。小儿亦有此疾，得于父已年老，或年虽少而多病，阴痿精怯，
勉强入房有子，此胎中病，不可治也。筑宾穴言之。六曰狐疝，状如瓦，卧则
入小腹，行立则下入囊中，狐昼出穴夜入穴，与相似故名。今人带钩钤者是也。
宜以逐气流经之药下之。七曰 疝，阴囊肿坠，如升如斗，不痒不痛者是也。得之
地气卑湿所生，潮湿之乡多感此疾。宜以去湿之药下之。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，本名曰瘕，宜以苦下之、坚之。
（按子和于七疝皆言下之者，以内有湿热，结聚不通也。然必有此实证乃可下耳，不可泥。）
赵以德云∶予尝病
脾肺湿热流入，右丸肿大，寒热交作，虽张子和言疝病在下，当下不当吐，然脾气
下陷必升举之，因先服调胃之剂一二帖，次早注神使气至下焦，呕逆而上，觉肋下
积动到中焦，则吐而出之，肿减半。次早复吐，吐后和胃气，疏通经络而愈。凡用
此法治伤酒水注右丸肿者，辄效。
治法∶内寒者，当归温疝汤。外寒入腹者，乌桂汤。外寒内热者，川乌头炮、
栀子仁炒各三钱，煎服。湿热受外寒，十味苍柏散。水疝尿不利，茴楝五苓散。
瘕硬血疝，大黄皂刺汤。冲疝、厥疝，夺命汤。气疝、诸疝走注痛者，青木香丸神
效。狐疝及一切疝，茴香楝实丸。妇人产后血分受寒疝者，羊肉汤。诸疝，灸
大敦穴即安。《尊生书》谓∶治法断不宜补，姜、橘同煎补肝，细辛闭肝气，必禁。
（虚亦须补，此太泥。）疝脉必弦急，忌微弱。亦有挟虚者，脉虽沉紧，必豁大无力，
其痛亦轻，但重坠牵引耳，人参、牛膝可用。余皆作实治，破疝汤主之，木香、玄
胡、橘核、荔枝核、茴香、川楝子、没药、地肤子、青皮，马鞭草根煮汁煎。寒疝，
加吴萸、附、桂。亦有睾丸升上入腹者，加飞盐、沉香。或用鸡鹅蛋壳烧灰，空心
酒下三钱，二服压至故所。亦有胁旁动气，横入阴处，响声如蛙，坠下，照前方去
盐、沉。水疝有一丸渐小，竟消尽成独丸者，沉沉牵小腹作痛，水疝汤∶白茯苓、
萆、泽泻、石斛、车前各二钱，临卧及五更各一服。外用带须葱一大把，煎汤洗
睾丸，频添热汤，以手挪之，即在汤内撒尿，其病易去。若囊破水流，灶心土糁之。
狐疝昼病夜安，气病血不病也，不宜辛香流气之剂、补中益气汤（见气）加知、柏、虎
骨治之。血疝睾丸偏大，宜和血，四物（见血）加桃仁、玄胡、橘核，于夜分时，一手
托下，一手按上，由轻至重，丸弄百回，弥月瘀血尽散。筋疝茎筋挈痛，得之
房术者，宜解毒缓急，甘草梢、黑豆、五倍同煎服。 疝，五苓散（见伤湿）加葱白、茴
香、盐。若丸肿如斗，不痒不痛者，得之有生之初，无治法。又有木肾，顽痹硬大，
或痛或不痛者是也，由寒冷凝滞，当温散，破疝汤加海藻、昆布、川椒、附子。外
用艾炒热裹丸，冷则频换。疝由小肠经得者，旧名小肠气，又名横弦、竖
弦，绕脐走注，小腹刺痛，喝起汤、救痛散。由膀胱经得者，旧名膀胱气，毛际上
小腹作痛，五苓散（见伤湿）加川楝子。形如瓜，声如蛙，木香神效散。偏坠，不拘左右，
川楝、木香、茴香、苍术、石菖蒲为丸，每服三钱，空心盐汤下，安卧片时，微汗
既止。左边痛不可忍，茹神散。外肾胀大，麻木痛硬，七治金铃丸。偏坠药不愈，
用蓖麻子每岁一个，研烂贴顶门，以绳缚两足中指，合缝处艾如麦粒大灸七壮，即
时上去，随去蓖麻。肛门、阴囊、肾茎痒甚，抓破好了又痒，人言熬醋洗立愈。外
有发热，忽生 腮， 腮愈睾丸胀者，耳后属胆，胆受风热生 腮，移热于肝故睾
丸肿，加味逍遥（见郁）入防风、荆芥、青皮。
睾丸与小腹突发急痛，称为疝。有的无形无声，有的有形如瓜，有的有声如蛙叫。小腹、阴囊、睾丸都属于肝经所主的部位，因为肝经的筋脉环绕外生殖器向上抵达小腹。所以张子和说这是肝经的病，肝主筋，睾丸并非肝筋本身，但通过环状连接与阴茎相连，没有缘由不能伸缩。《内经》说：足厥阴肝经的经筋聚结于外生殖器，受寒则阴器收缩内陷，受热则松弛挺长不收。又说：足厥阴肝经的别络叫蠡沟，沿小腿上行至睾丸并结于阴茎，其病变为气逆导致睾丸肿胀突然发生疝痛。由此可见了。俗称膀胱冷，或者说肾冷，（肾气通于外肾，膀胱系带与睾丸系带会合。）或者说小肠气，都不正确。膀胱是水液之府，小肠是水液通道，专门主管渗泄通流，肾统管二水，这些都与筋无关。虽然《内经》有言邪气在小肠，连及睾丸系带，归属于脊，贯穿肝肺，联络心系，气盛逆乱，上冲肠胃，熏蒸肝脏，散于肓膜，结于脐部，治疗取肓原穴以消散它，刺手太阴肺经以平复它，取足厥阴肝经以下降它，取巨虚下廉以去除它。这虽然起初说邪在小肠，但到治疗方法时，一定说取足厥阴肝经以下降它，由此可知疝病必定与厥阴肝经有关无疑。又讲：足太阳膀胱经发病出现寒热，传变后成为疝。这也是说膀胱不是受病的部位，必须传变到厥阴部分才成为疝。又讲：脾风传肾，病名叫做疝瘕，小腹冤屈发热而痛，排出白色浊物，（精浊也。风即是热，精液得湿热而成败浊。）一名叫做蛊。（强中症行房事，被女色迷惑。）提到风，就属于肝木可知了。（以上说明疝不是膀胱、肾、小肠的病。）又说：厥阴脉滑为狐风疝，（滑脉为阳邪，热则生风。）少阴脉滑为肺风疝，（心火乘克肺金。）太阴脉滑为脾风疝，阳明脉滑为心风疝，（金燥则热，热归属于心。）太阳脉滑为肾风疝，（膀胱与肾互为表里。）少阳脉滑为肝风疝。都说风，是因为风是厥阴木气所主。又说：心脉滑为心疝，肝脉肾脉滑甚为癃闭。也是以滑脉作为疝的特征。（意思是上一条说滑脉乃是风疝之脉，那么这一条的滑脉也是风脉可知了。）又说：脉大且急则为疝，心脉滑而搏指为心疝，肺脉沉而搏指为肺疝。搏急如果不是肝邪是什么？又说：督脉生病，从少腹上冲心而痛叫做冲疝。因为足厥阴肝经与冲脉、任脉、督脉都交会于前阴，既然这样，疝是肝病，难道还不明白吗？（以上说明各经的疝，都归结于肝。）按张子和将疝病归属于肝经部分，非常正确。然而各脏腑经脉相通，有由肝经自病的，也有由其他各经的病传注而来的，他的论述中已经可以见到。况且《内经》又有云：足阳明胃经的筋病发为疝，腹部筋脉拘急；足太阴脾经的筋病阴器扭转疼痛。小肠病者，小腹痛，腰脊牵引睾丸而痛，肾气下陷则腰尻部患病，不可以俯仰，称为狐疝。寸口脉沉而弱叫做寒热，以及疝瘕少腹痛。黄脉到来，大而虚，腹中有积气，有厥逆之气，叫做厥疝。言辞不一而足，这里应当仔细考察。因为肝经是朝宗之地，（少阴、太阴、阳明、少阳、太阳诸经，也交会于小腹前阴。）各经是发源之区，探究源头和流变就可以了。再按张子和将疝归属于肝，赵以德则将其归属于任脉，说冲任二脉起于胞宫，各经都受气于此，因此称海。二脉通畅，则阳气下降，阴气上行，闭塞则阳气壅滞于上，阴气结聚于下。之所以闭塞，或是任脉自身有病，偏寒或偏热。或是各经病邪相犯，致使任脉结滞，阴气不化所致。引用《内经》任脉为病，男子内结七疝，女子带下瘕聚为依据，他的说法很有道理。然而冲脉、任脉、督脉同体，为什么不并举呢？我认为各经的邪气，都能传注冲任督三脉，而结聚在肝经部分形成疝，那么各种说法都可以融会贯通了。再按赵以德说疝有两种，不一定小腹痛牵引睾丸阴囊才叫疝，只要心腹痛就命名为疝。引用巢元方七疝为依据，一曰厥疝，厥逆心痛，饮食吐不下。二曰症疝，腹中气突然胀满痛，气积聚如手臂。三曰寒疝，饮食寒冷即胁下腹中痛。四曰气疝，腹中突然胀满突然减少而痛。五曰盘疝，腹中痛在脐旁。六曰 疝，腹中脐下有积聚。七曰野狼疝，小腹与阴部相互牵引而痛。赵氏大概以上六疝，只说腹胁痛而不涉及睾丸阴囊，所以说心腹痛就命名为疝，怎么知道这不是省略文字呢？现在确定以小腹痛牵引睾丸为疝，以免歧义困惑。（另外张子和说遗精、癃闭、滑浊、阳痿、胞痹，都是男子的疝。血枯不孕，经后腰膝上部发热，足胫咽喉干燥，癃闭，小腹有块或固定或移动，前阴突出，后阴痔核的，都是女子的疝。只是女子不叫疝而叫瘕，大概都是肝经任脉的病，所以说如此。）疝病的成因，人们都认为经络受寒，收引不通而作痛。朱丹溪说是始于湿热郁遏，又感受外寒，湿热被郁而作痛。其最初导致湿热的缘故，确实是过度劳累而火起于筋，醉饱而火起于胃，房劳而火起于肾，大怒而火起于肝。火郁久了，蒸腾为盛湿，浊液凝聚，并入血脉隧道，流注于厥阴肝经。肝火性最急暴，被外寒束缚，应该疼痛剧烈而严重。痛，是热气冲击；肿而重坠，则是湿气造成的。（虚证也会肿，但不怎么重坠。）左侧睾丸属血，各种寒邪收引则血液凝涩，所以左丸痛多而肿少。右侧睾丸属气，各种气机郁蒸则湿气聚集，所以右丸痛少而肿多。张子和分七疝：一曰寒疝，阴囊冷结硬如石，阴茎不举，或牵引睾丸而痛。得于坐卧湿地，或寒月涉水，久而无子。宜用温剂攻下。二曰水疝，肾囊肿痛，阴汗时时流出，或囊肿如水晶，或囊痒，搔破出黄水，或小腹按压有水声。得之饮水醉酒，使内过劳，汗出遇风，寒湿之气结于囊中。宜用逐水剂攻下。三曰筋疝，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。得于房劳，及邪术淫方所致。宜用降心火剂攻下。四曰血疝，状如黄瓜，在小腹两旁、横骨两端约文中，俗云便痈。得于重感春夏大热，（热则血流溢出。）劳动使内，气血流溢，渗入脬囊，结成痈肿，脓多血少。宜用和血剂攻下。五曰气疝，上连肾区，下及阴囊。或因号哭忿怒，则气郁而胀，过后气散则消的是。宜用散气药攻下。小儿也有此疾，得于父亲已年老，或年虽少而多病，阴痿精怯，勉强入房有子，这是胎中病，不可治。筑宾穴言之。六曰狐疝，状如瓦，卧则入小腹，行立则下入囊中，狐狸昼出穴夜入穴，与此相似故名。今人带钩钤者是。宜用逐气流经药攻下。七曰 疝，阴囊肿坠，如升如斗，不痒不痛的是。得之地气卑湿所生，潮湿之乡多感此疾。宜用去湿药攻下。女子阴户突出虽也类似此类，乃热则不禁固也，不可便谓虚寒而涩之、燥之，本名曰瘕，宜用苦寒攻下、坚之。（按张子和于七疝皆言下之者，以内有湿热，结聚不通也。然必有此实证乃可下耳，不可泥。）赵以德说：我曾患脾肺湿热流入，右丸肿大，寒热交作，虽然张子和说疝病在下，当下不当吐，然而脾气下陷必升举之，因先服调胃之剂一二帖，次早注神使气至下焦，呕逆而上，觉肋下积动到中焦，则吐而出之，肿减半。次早复吐，吐后和胃气，疏通经络而愈。凡用此法治伤酒水注右丸肿者，辄效。
治法：内寒者，用当归温疝汤。外寒入腹者，用乌桂汤。外寒内热者，川乌头炮、栀子仁炒各三钱，煎服。湿热受外寒，用十味苍柏散。水疝尿不利，用茴楝五苓散。瘕硬血疝，用大黄皂刺汤。冲疝、厥疝，用夺命汤。气疝、诸疝走注痛者，青木香丸神效。狐疝及一切疝，用茴香楝实丸。妇人产后血分受寒疝者，用羊肉汤。诸疝，灸大敦穴即安。《尊生书》说：治法断不宜补，姜、橘同煎补肝，细辛闭肝气，必禁。（虚证亦须补，此太拘泥。）疝脉必弦急，忌微弱。亦有挟虚者，脉虽沉紧，必豁大无力，其痛亦轻，但重坠牵引耳，人参、牛膝可用。其余都作实证治，破疝汤主之，木香、玄胡、橘核、荔枝核、茴香、川楝子、没药、地肤子、青皮，马鞭草根煮汁煎。寒疝，加吴茱萸、附子、肉桂。亦有睾丸升上入腹者，加飞盐、沉香。或用鸡鹅蛋壳烧灰，空心酒下三钱，二服压至故所。亦有胁旁动气，横入阴处，响声如蛙，坠下，照前方去盐、沉。水疝有一丸渐小，竟消尽成独丸者，沉沉牵小腹作痛，用水疝汤：白茯苓、萆薢、泽泻、石斛、车前各二钱，临卧及五更各一服。外用带须葱一大把，煎汤洗睾丸，频添热汤，以手挪之，即在汤内撒尿，其病易去。若囊破水流，灶心土糁之。狐疝昼病夜安，气病血不病也，不宜辛香流气之剂、补中益气汤（见气）加知母、黄柏、虎骨治之。血疝睾丸偏大，宜和血，四物汤（见血）加桃仁、玄胡索、橘核，于夜分时，一手托下，一手按上，由轻至重，丸弄百回，弥月瘀血尽散。筋疝茎筋挈痛，得之房术者，宜解毒缓急，甘草梢、黑豆、五倍子同煎服。 疝，五苓散（见伤湿）加葱白、茴香、盐。若丸肿如斗，不痒不痛者，得之有生之初，无治法。又有木肾，顽痹硬大，或痛或不痛的是，由寒冷凝滞，当温散，破疝汤加海藻、昆布、川椒、附子。外用艾炒热裹丸，冷则频换。疝由小肠经得者，旧名小肠气，又名横弦、竖弦，绕脐走注，小腹刺痛，喝起汤、救痛散。由膀胱经得者，旧名膀胱气，毛际上小腹作痛，五苓散（见伤湿）加川楝子。形如瓜，声如蛙，木香神效散。偏坠，不拘左右，川楝、木香、茴香、苍术、石菖蒲为丸，每服三钱，空心盐汤下，安卧片时，微汗既止。左边痛不可忍，茹神散。外肾胀大，麻木痛硬，七治金铃丸。偏坠药不愈，用蓖麻子每岁一个，研烂贴顶门，以绳缚两足中指，合缝处艾如麦粒大灸七壮，即时上去，随去蓖麻。肛门、阴囊、肾茎痒甚，抓破好了又痒，人言熬醋洗立愈。外有发热，忽生 腮， 腮愈睾丸胀者，耳后属胆，胆受风热生 腮，移热于肝故睾丸肿，加味逍遥散（见郁）入防风、荆芥、青皮。
Testicular pain extending to the lower abdomen with sudden urgency is termed Shan (Hernia). Some present without form or sound, some have a form like a melon, and some produce sounds like a frog. The lower abdomen, scrotum, and testes are all parts governed by the Liver Meridian, as the sinews of the Liver Meridian circle the genitalia and ascend to reach the lower abdomen. Therefore, Zhang Zihe stated that this is a disease of the Liver Meridian. The Liver governs the sinews; although the testes themselves are not liver sinews, they are connected in a ring to the penis, lacking the mechanism for extension and retraction. The *Classic* states: "The sinews of the Foot-Jueyin [Liver] meridian gather at the genitalia. Injury by cold causes the yin to shrink inward; injury by heat causes it to hang loose and unretracted." It also says: "The collateral of the Foot-Jueyin is called Ligou, which follows the shin up to the testes and knots at the penis. Its pathology involves qi rebellion causing testicular swelling and sudden onset of Shan." This is evident. Common parlance calls it Bladder Cold, or Kidney Cold, (Kidney qi connects to the external kidneys, and the bladder ligament meets the testicular ligament.) or Small Intestine Qi, all of which are incorrect. The Bladder is the mansion of water, the Small Intestine is the water pathway, specializing in seepage, excretion, and flow. The Kidneys command both waters. None of these involve the sinews. Although the *Classic* mentions pathogenic factors in the Small Intestine connecting to the testicular ligaments, belonging to the spine, penetrating the Liver and Lungs, linking to the Heart system, with excessive qi rebelling upward, rushing into the Stomach and Intestines, steaming the Liver, scattering into the Huang [membrane], and knotting at the umbilicus, treating by selecting the Huangyuan point to dissipate it, needling the Taiyin [Lung] to calm it, selecting the Jueyin [Liver] to descend it, and selecting Julixia to remove it. Although initially mentioning pathogens in the Small Intestine, the treatment method must say "select Jueyin to descend it," indicating that Shan undoubtedly concerns the Jueyin [Liver]. It further states: "Disease of the Three Yang [Bladder] meridian manifests with chills and fever, transmitting to become Shan." This also indicates the Bladder is not the site of disease, but rather transmits to the Jueyin portion to become Shan. It further states: "Spleen Wind transmitting to the Kidney, the disease is named Shan Jia [Shan and Mass], with unjust heat and pain in the lower abdomen, discharging white turbidity, (essence turbidity. Wind is heat; essence obtains damp-heat to become敗浊 [decayed turbidity]). Also named Gu. (Strong middle during intercourse, bewitched by women.) Mentioning wind implies it belongs to Liver Wood, as is clear. (Above explains Shan is not a disease of the Bladder, Kidney, or Small Intestine.) It further states: "Jueyin pulse slippery indicates Hu Wind Shan, (Slippery is yang pathogen, heat generates wind.) Shaoyin pulse slippery indicates Lung Wind Shan, (Heart fire attacks Lung metal.) Taiyin pulse slippery indicates Spleen Wind Shan, Yangming pulse slippery indicates Heart Wind Shan, (Metal dryness leads to heat, heat belongs to Heart.) Taiyang pulse slippery indicates Kidney Wind Shan, (Bladder and Kidney are interior-exterior pairs.) Shaoyang pulse slippery indicates Liver Wind Shan. All mention wind because wind is what the Jueyin Wood qi governs." It further states: "Heart pulse slippery indicates Heart Shan; Liver and Kidney pulses very slippery indicate Long [difficulty urinating]. It also uses slippery pulse as indicative of Shan. (Meaning the previous line said slippery pulse is the pulse of Wind Shan, so the slippery pulse here is also a Wind pulse, as is clear.) It further states: "Pulse large and urgent indicates Shan; Heart pulse slippery and pounding indicates Heart Shan; Lung pulse deep and pounding indicates Lung Shan. Pounding and urgent—if not Liver pathogen, then what?" It further states: "Disease of the Du [Governing] Vessel, rising from the lower abdomen to rush to the heart with pain is called Chong Shan. Because the Foot-Jueyin [Liver] Meridian converges with the Chong, Ren [Conception], and Du vessels at the anterior yin, thus Shan being a Liver disease is obvious. (Above explains various meridians' Shan all return to the Liver.) According to Zhang Zihe attributing Shan disease to the Liver portion is very correct. However, the meridians of each zang-fu are interconnected; there are cases originating from self-disease of the Liver Meridian, and cases transmitted from diseases of other meridians, which can be seen in his discussion. Moreover, the *Classic* also says: "Disease of the sinews of the Foot-Yangming [Stomach] meridian is Shan, with abdominal sinew urgency; disease of the sinews of the Foot-Taiyin [Spleen] meridian is twisting pain in the genitalia. Disease of the Small Intestine involves lower abdominal pain, waist and spine controlling the testes with pain. If Kidney qi descends, the Yao [lower back] and Kao [buttocks] suffer, inability to bend or extend, called Hu Shan. Cun Kou pulse deep and weak indicates Han Re [Cold-Heat], as well as Shan Jia and lower abdominal pain. Yellow pulse arriving, large and empty, with accumulated qi in the abdomen and Jueqi [rebellious qi], is called Jue Shan. The wording varies sufficiently; one must examine carefully. Because the Liver Meridian is a place of convergence, (Shaoyin, Taiyin, Yangming, Shaoyang, Taiyang meridians also converge at the lower abdomen and anterior yin), and each meridian is a source area, investigating both source and flow is sufficient. Furthermore, Zhang Zihe attributed Shan to the Liver, while Zhao Yi-de attributed it to the Ren [Conception] Vessel, stating the Chong and Ren vessels originate from the Baozhong [uterus/middle jiao], receiving qi from all meridians, hence named Hai [Sea]. When these two vessels are open, yang qi descends and yin qi ascends; when blocked, yang stagnates above and yin knots below. The cause of blockage is either self-disease of the Ren vessel, biased cold or heat, or invasion by pathogens from various meridians causing Ren vessel stagnation and failure of yin qi transformation. Citing the *Classic*: "Disease of the Ren vessel, men internally knot seven Shans, women have leukorrhea and Jia masses," his theory is quite reasonable. However, Chong, Ren, and Du are of the same body, why not mention them together? I believe pathogens from all meridians can transmit to the Chong, Ren, and Du vessels, and knot in the Liver Meridian portion to form Shan, thus reconciling all theories. Furthermore, Zhao Yi-de said there are two types of Shan, not necessarily requiring lower abdominal pain radiating to the scrotum and testes to be named Shan; any heart or abdominal pain is named Shan. Citing Chao Yuanfang's Seven Shans as evidence: One is Jue Shan, Jueni [rebellious qi] heart pain, food and drink vomit without descending. Two is Zheng Shan, abdominal qi suddenly full and painful, qi accumulation like an arm. Three is Han Shan, after eating cold food, pain in hypochondrium and abdomen. Four is Qi Shan, abdominal distension suddenly full and suddenly reduced with pain. Five is Pan Shan, abdominal pain beside the umbilicus. Six is Shan, abdominal mass below the umbilicus. Seven is Yelang Shan, lower abdomen and yin mutually pulling with pain. Zhao likely focused on the first six Shans, only discussing abdominal and hypochondriac pain without mentioning testes and scrotum, hence saying heart/abdominal pain is named Shan. How do we know this isn't ellipsis? Now defining Shan as lower abdominal pain radiating to the testicles avoids confusion. (Additionally, Zhang Zihe said enuresis, Long [urinary difficulty], sliding turbidity, impotence, and Bao Bi [bladder obstruction] are all men's Shan. Blood depletion without menstruation, heat above knees and waist after menses, dryness in legs and throat, Long, masses in lower abdomen fixed or moving, protrusion of anterior yin, hemorrhoids at posterior yin are all women's Shan. But women do not call it Shan, but Jia, because they are diseases of the Liver Meridian and Ren Vessel, hence the name.) The cause of Shan disease is generally believed to be meridians contracting due to cold, blocking flow and causing pain. Danxi said it begins with damp-heat stagnation, compounded by external cold, where damp-heat is trapped causing pain. The initial cause of damp-heat is indeed excessive labor generating fire in sinews, drunkenness/full meals generating fire in the Stomach, sexual exhaustion generating fire in the Kidneys, and great anger generating fire in the Liver. Fire stagnated for long steams into abundant dampness, turbid fluids condense, merge into blood vessels, and flow to Jueyin [Liver]. Liver fire nature is most violent; bound by external cold, its pain should be sudden and severe. Pain is impact of hot qi; swelling and heaviness are caused by dampness. (Deficiency also swells, but less heavy.) Left testicle belongs to Blood; various colds contract causing blood stasis, so left testicle has more pain and less swelling. Right testicle belongs to Qi; various qi stagnations steam causing damp gathering, so right testicle has less pain and more swelling. Zhang Zihe divided Seven Shans: One is Han Shan [Cold Hernia], scrotum cold, hard as stone, penis flaccid, or radiating to testes with pain. Caused by sitting/lying on wet ground or wading in cold months, leading to infertility. Treat with warming purgatives. Two is Shui Shan [Water Hernia], kidney/scrotal swelling and pain, sweating from yin, or scrotum like crystal, or itchy scrotum oozing yellow fluid, or water sound upon pressing lower abdomen. Caused by drinking/water intoxication, excessive internal exertion, sweating meeting wind, cold-damp knotting in scrotum. Treat with water-draining purgatives. Three is Jin Shan [Sinew Hernia], penile swelling, ulceration or suppuration, pain with tension and sinew contraction, pain in urethra, extreme pain itching, or erection unretracted, or white substance like semen discharging with urine. Caused by sexual exhaustion and evil arts/libido formulas. Treat with heart-fire-descending purgatives. Four is Xue Shan [Blood Hernia], shape like cucumber, on sides of lower abdomen near ends of Henggu bone, commonly called Bian Yong [soft chancre]. Caused by heavy exposure to spring/summer heat, (heat causes blood overflow), labor and internal exertion, qi-blood overflowing, seeping into Paonang [bladder sac], forming abscess, mostly pus little blood. Treat with blood-harmonizing purgatives. Five is Qi Shan [Qi Hernia], upper connection to Kidney region, lower to scrotum. Or due to crying/anger, qi stagnates and distends, dissipates after time. Treat with qi-scattering purgatives. Children also get this, caused by father old age or frequent illness, impotence/spirit weakness, forced intercourse resulting in pregnancy, this is fetal disease, untreatable. See Zubin acupoint. Six is Hu Shan [Fox Hernia], shape like tile, enters lower abdomen when lying, descends to scrotum when walking/standing, fox exits hole by day enters by night, similar hence named. Those wearing hooks today. Treat with qi-moving meridian-purging purgatives. Seven is Shan, scrotal swelling and drooping, like bucket or斗, non-itchy non-painful. Caused by low-lying damp earth, common in humid regions. Treat with damp-dispelling purgatives. Women's vaginal prolusion is similar, but due to heat failing to secure, cannot simply treat as deficiency-cold with astringents/drying agents; originally named Jia, treat with bitter purgatives and firmers. (Note Zhang Zihe used purgatives for all seven Shans because internal damp-heat knots and blocks. But must have excess syndrome to purge, do not stick rigidly.) Zhao Yi-de said: I once suffered spleen-lung damp-heat flowing down, right testicle swollen, alternating chills and fever. Although Zhang Zihe said Shan is below, should purge not vomit, yet Spleen qi sinking must be lifted. So first took stomach-regulating decoction 1-2 doses, next morning focused spirit to send qi to lower jiao, vomiting reversed upward, felt accumulation moving to middle jiao, then vomited it out, swelling halved. Next morning vomited again, post-vomit harmonized stomach qi, unblocked meridians, cured. Using this method for alcohol/water damage causing right testicle swelling is effective.
Treatment methods: Internal cold, use Danggui Wenshan Tang (Angelica Warm Hernia Decoction). External cold entering abdomen, use Wugui Tang (Aconite Cinnamon Twig Decoction). External cold internal heat, prepared Chuanwu Tou (Prepared Aconite Root) and fried Zhizi Ren (Gardeniae Semen) each 3 qian, decoct and take. Damp-heat affected by external cold, use Shiwei Cangbai San (Ten-Ingredient Cangzhu and Phellodendron Powder). Water Shan with difficult urination, use Huilian Wuling San (Fennel and Melia Evodia Wuling Powder). Jia-hardened Blood Shan, use Dahuang Zaoci Tang (Rhubarb and Gleditsia Spine Decoction). Chong Shan, Jue Shan, use Tuoming Tang (Life-Restoring Decoction). Qi Shan, wandering pain of various Shans, Qingmuxiang Wan (Blue Sandalwood Pill) is miraculous. Hu Shan and all Shans, use Huixiang Lianshi Wan (Fennel and Melia Fruit Pill). Postpartum blood-division cold-afflicted Shan in women, use Yangrou Tang (Mutton Decoction). Various Shans, moxa Dadun acupoint for relief. *Zunsheng Shu* states: Treatment strictly forbids tonification; Jiang [Ginger] and Ju [Tangerine Peel] decocted together tonify Liver, Xixin [Asarum] closes Liver qi, must prohibit. (Deficiency also requires tonification, this is too rigid.) Shan pulse must be Xianji [Wiry-Urgent], avoid Weiruo [Weak-Faint]. There are also cases with deficiency, pulse though Chenjin [Deep-Tight] must be Huoda Wuli [Broad-Forceless], pain is light, only heavy dragging sensation, Renshen [Ginseng] and Niuxi [Achyranthes] usable. Rest treat as excess, Polle Tang (Break-Hernia Decoction) main formula: Muxiang [Aucklandia], Xuanhu [Corydalis], Juzhe [Tangerine Seed], Lizhihe [Lychee Seed], Huixiang [Fennel], Chuanlianzi [Melia Fruit], Moyao [Myrrh], Difuzi [Kochia Seed], Qingpi [Green Tangerine Peel], boiled in Ma Bian Cao Gen [Verbena Root] juice. Cold Shan, add Wuyu [Evodia], Fu [Aconite], Gui [Cinnamon]. If testicles rise into abdomen, add Feiyan [Flying Salt], Chenxiang [Agarwood]. Or burn chicken/goose eggshells to ash, take 3 qian with wine on empty stomach, two doses press back to original place. If qi moves from hypochondrium horizontally into yin, sound like frog, dropping down, follow former formula remove salt, chenxiang. Water Shan where one testicle gradually shrinks, completely disappearing leaving single testicle, heavily dragging lower abdomen with pain, use Shui Shan Tang (Water Hernia Decoction): Baifuling [Poria], Biba [Dioscorea Hypoglauca], Zexie [Alisma], Shihu [Dendrobium], Cheqian [Plantago] each 2 qian, take before sleep and at fifth watch. Externally, large bunch of green onion with roots, decoct soup to wash testicles, frequently add hot soup, massage with hand, urinate in soup, disease easily removed. If scrotum breaks and flows water, apply Zaoxintu [Kitchen Hearth Earth]. Fox Shan sick by day safe by night, Qi disease not Blood disease, should not use pungent-aromatic qi-moving agents, Buyi Qiyi Tang (Tonify Middle and Augment Qi Decoction) add Zhimu [Anemarrhena], Huangbai [Phellodendron], Hubu [Tiger Bone] to treat. Blood Shan testicle enlarged, should harmonize blood, Siwu Tang (Four Substances Decoction) add Taoren [Peach Kernel], Xuanhu [Corydalis], Juzhe [Tangerine Seed], at night, one hand support below, one hand press above, from light to heavy, roll/manipulate hundred times, within a month blood stasis fully disperses. Sinew Shan penile tendon pulling pain, caused by sexual techniques, should detoxify and relax urgency, Gancao Shao [Licorice Tip], Heidou [Black Soybean], Wupeizi [Chinese Gall] decoct together. Shan, Wuling San (Five-Ingredient Powder) add Congbai [Scallion White], Huixiang [Fennel], Yan [Salt]. If testicle swells like bucket, non-itchy non-painful, caused from beginning of life, no treatment method. Also Muren [Wood Kidney], stubborn numbness hard and large, painful or not, caused by cold coagulation stagnation, should warm-disperse, Polle Tang add Haizao [Sargassum], Kunbu [Kelp], Chuanjiao [Sichuan Pepper], Fuzi [Aconite]. Externally stir-fry Aiye [Mugwort Leaf] hot wrap testicle, change frequently when cold. Shan obtained from Small Intestine Meridian, old name Xiaochang Qi [Small Intestine Qi], also Hengxian [Horizontal String], Shuxian [Vertical String], circling umbilicus wandering, stabbing lower abdominal pain, drink Qiji Tang [Startle Soup], Jiutong San [Relieve Pain Powder]. Obtained from Bladder Meridian, old name Pangguang Qi [Bladder Qi], pubic hair area upper lower abdomen pain, Wuling San add Chuanlianzi. Shape like melon, sound like frog, Muxiang Shenxiao San (Blue Sandalwood Miraculous Effect Powder). Oblique descent, regardless of side, Chuanlianzi, Muxiang, Huixiang, Cangzhu, Shichangpu [Acorus] made into pills, take 3 qian each, with salt water on empty stomach, lie quietly for a moment, slight sweat stops. Left side unbearable pain, Rushen San. External kidney swollen, numb painful hard, Qizhi Jinling Wan. Oblique descent medicine ineffective, use Castor Bean one per year of age, grind paste apply to Baihui [Top of Head], tie two feet middle toes with rope, moxa at seam wheat-grain size seven moxa cones, immediately remove, then remove castor bean. Anus, scrotum, penile root very itchy, scratch broken heal then itch again, people say boil vinegar wash instantly cures. Exterior fever, suddenly develops Mumps, mumps heals testicle swells, behind ear belongs to Gallbladder, Gallbladder receives wind-heat generates mumps, transferring heat to Liver causes testicle swelling, Jiawei Xiaoyao San (Modified Free and Easy Wanderer Powder) add Fangfeng [Saposhnikovia], Jingjie [Schizonepeta], Qingpi [Green Tangerine Peel].