按七疝治法。最详子和。其旨辛香以泄肝。得气疏泄。而病缓矣。按法调理
不愈。七味导引。纳肾益气。升举脾阳。而坠气仍然。艾灸蒸脐。原得小安。内经任
脉为病。男子内结七疝。女子带下瘕聚。同为奇经主之。故疏泄诸方。能治气实。
参术升补。仅治中虚下陷。与元海奇经中病无补。壮岁至老。病根不辍。下焦日
衰。可知升阳一法。体症颇合。衰年仅可撑持。勿使病加可矣。
生鹿茸 鹿角霜 当归 生菟丝子 沙蒺藜 川桂枝尖
肝病。络虚气聚。少腹滞胀。前用河间金铃子散。加牡蛎橘叶。合咸辛苦胜
法。小效。加食。述饥则胁腹鸣盛。而浊气下泄颇安。乃络虚不足中之有余。形质
瘦怯。不可纯攻。
桃仁 当归梢 炒小茴 橘核 郁李仁 南山楂 葱白汁丸
脉右弦左涩。当脐痛连少腹。已属凝聚有形。呕吐黄浊。大便欲解不通。若
患处有漉漉声。痛势稍减。惟外着体不转移。其痛更加。此属肝气疝瘕。辛香流
气。所称通则不痛耳。
炒桃仁 炒橘核 金铃子 炒延胡 韭白汁 两头尖 小茴 青皮
疝结少腹。按之坚。凡过饥必冲突至脘。吐酸 胀。述病从怒劳而得。内应
乎肝。肝逆犯胃。饥则胃弱肝乘。上嗳下泄气则减。
肉桂 真橘核 青木香 小茴 穿山甲 粗桂枝 李根白皮
七疝在肝。内经谓冲脉为病。但冲脉隶于阳明。肝木必乘克胃土。胃翻涌
逆。致吐蛔呕吐。汤饮不入。呃忒不止。皆逆乱无已。为脏厥危 矣。肝体本刚。相
火内寄。一派热燥药饵。以刚济刚。竟有缺折之虞。欲泄其浊。拟用朱南阳法。
韭白根 两头尖 金铃子 延胡 归须 肉桂心
痛自肾囊。渐踞少腹之左。夫厥阴之脉绕乎阴器。操持谋虑。都主伤肝。一
气结聚。变幻形象而痛。病名曰疝。疝分有七暴疝多寒。久疝多热。泄气痛缓。宣
通可以却病。只因下焦乃深远之乡。气热湿郁。概可知矣。
川连 小茴 黑山栀 橘核 川楝子 青木香 郁李仁 冬葵子
疟母十年。沉痼宿 。药不能效。夫疟邪既久。邪与气血两凝。结聚络脉。药
难入络耳。疟不离乎肝胆。疝不外乎肝病。七疝子和分部大着。虚质不可专以
辛香。下坠为甚。议有情温通。以培生气。
鹿茸 大茴香 穿山甲 当归 水安息香 炮黑川乌 全蝎
脉沉痰多。手体赤疮。宿疝在下。右胁气坠少腹。前议控涎丹逐痹未应。想
久聚湿热沉痼。非皮膜经脉之壅。用浚川丸四十粒。匀二服。间日一进。竟通腑
聚。惟通腑宣壅。粘痰既下。其疝仍聚于右。且盛于寒天冬月。卧安必有声。自能
行走。劳动必有形。直坠阴囊。久病急攻无效。议辛甘化风方法。古人以疝为肝
病。十居八九。
当归 鹿角 桂枝 肉桂 小香茴 川芎 炙草 茯苓 生姜 羊肉胶丸
男子结疝。在内经则曰冲任为病。子和统论疏肝。今疝未愈。脐右腹高突
硬起。乃由疝渐至瘕聚肠覃之属。夫肠覃者。寒气客于大肠。与胃气相搏大肠
与肺表里。传送肺气。寒则气凝不行。清气散而浊气结为瘕。迁延日久。如怀胎
妊。按之坚。推之移。气病而血不病也。
穿山甲 椒目 桂枝 川楝子 小茴香 茯苓 麝香 白芥子
高年疝症。是下元虚气冷凝 。结聚攻坠。乃沉痼之疾。药难取效。暖气助
阳鼓动。俾阴邪浊气稍解。不过临时小安耳。病在肝肾。道路纡远。药必从咽入
胃。由胃入肠。始达病所。而上中无病之处。必受疝药攻克之累。倘胃减妨食。何
以救疗。夫阴浊盘踞成形。例取纯阳气雄之药。昔胡大封翁高年宿疝。用十全
大补不效。喻氏驳其半阴半阳非法。议以姜附为丸。参苓为衣。喉间知有参苓。
过胃始露猛烈之威灵。恰攻病所。此议甚正。
生炮附子 淡干姜 大茴香炒 研为细末真水安息香捣为小丸以人参末为衣
关于七种疝气的治疗方法，张子和的论述最为详尽。其主旨在于使用辛香药物以疏泄肝气，使气机得以疏泄通畅，病情因此缓解。按照此法调理若无效，可采用七味导引法，以纳肾益气、升举脾阳，但下坠之气依然无法解决。艾灸蒸脐虽能带来片刻安宁，但《内经》指出任脉为病时，男子患内结七疝，女子患带下瘕聚，这些病症均由奇经八脉主导。因此，疏泄类的方剂只能治疗气实之证；人参、白术等升补类药物，仅适用于中气虚弱、清气下陷之证，对于元海（肾间动气）及奇经八脉的疾病并无补益作用。从壮年直至老年，病根未除，下焦日益衰弱，由此可见“升阳”一法，虽然体症相符，但在衰年只能勉强支撑，只要不使病情加重即可。
肝病导致络脉空虚、气机郁聚，表现为少腹部滞胀。此前使用河间氏的金铃子散，加入牡蛎和橘叶，结合咸、辛、苦胜法，取得微小疗效，食欲有所增加。患者自述饥饿时胁腹鸣响剧烈，随后浊气下行则感到舒适。这属于络脉虚损不足中的有余之邪，形体瘦弱怯懦，不可单纯使用攻伐之法。
处方：桃仁、当归梢、炒小茴香、橘核、郁李仁、南山楂、葱白汁丸。
脉象右弦左涩，肚脐周围疼痛牵连少腹，已属凝聚成形的病证。呕吐黄浊液体，大便想解却解不通。如果患处有漉漉的水声，痛势会稍减；只有身体外部固定不动时，疼痛反而加剧。这属于肝气疝瘕，采用辛香行气的方法，即所谓“通则不痛”。
处方：炒桃仁、炒橘核、金铃子、炒延胡索、韭白汁、两头尖、小茴香、青皮。
疝气结于少腹，按压感觉坚硬。凡是过度饥饿时，气必冲撞至胃脘部，出现吐酸水、腹胀。患者自述病由愤怒和劳累引起，内应肝脏。肝气逆乱侵犯胃腑，饥饿时胃气虚弱，肝木乘虚而入，上嗳气、下排气则症状减轻。
处方：肉桂、真橘核、青木香、小茴香、穿山甲、粗桂枝、李根白皮。
七种疝气均与肝脏有关，《内经》称冲脉为病。但冲脉隶属于阳明胃经，肝木必然克制胃土，导致胃气翻涌逆乱，出现吐蛔虫、呕吐，汤药饮食无法入口，呃逆不止。这都是气机逆乱无休止的表现，会导致脏厥危证。肝体本刚，相火内寄，若一派使用热燥药物，以刚济刚，竟有折伤的危险。欲泄其浊气，拟用朱南阳的方法。
处方：韭白根、两头尖、金铃子、延胡索、归须、肉桂心。
疼痛自阴囊开始，逐渐占据少腹左侧。厥阴肝经环绕阴器，操持谋虑过度都会损伤肝脏。一气结聚，变幻形态而痛，病名曰疝。疝分七种，暴疝多寒，久疝多热，泄气后疼痛缓解，宣通可以祛病。只因下焦是深远之地，气热湿郁，概可知矣。
处方：川黄连、小茴香、黑山栀、橘核、川楝子、青木香、郁李仁、冬葵子。
疟母十年，沉痼宿疾，药物难以见效。疟邪日久，邪气与气血两相凝结，结聚在络脉，药物难以进入络脉。疟疾不离肝胆，疝气不外乎肝病。张子和对七疝的分部论述很详细，但体质虚弱者不可专门使用辛香药物。下坠感严重，议用有情之品温通，以培补生气。
处方：鹿茸、大茴香、穿山甲、当归、水安息香、炮黑川乌、全蝎。
脉沉痰多，手足皮肤赤疮，宿疝在下，右胁气坠至少腹。前议使用控涎丹逐痹未见效。想必是久聚的湿热沉痼，并非皮膜经脉的壅塞。使用浚川丸四十粒，分两次服用，隔日进服一次，竟然通了腑气积聚。只是通过通腑宣壅，粘痰既下，疝气仍然聚于右侧，且在寒冷冬季更加严重。卧床安静时必有声响，自行行走时可见有形之物，直接坠入阴囊。久病急攻无效，议用辛甘化风的方法。古人认为疝气十居八九属于肝病。
处方：当归、鹿角、桂枝、肉桂、小茴香、川芎、炙甘草、茯苓、生姜、羊肉胶丸。
男子结疝，《内经》称为冲任为病。张子和统论疏肝。如今疝气未愈，脐右腹部高突硬起，这是由疝逐渐发展为瘕聚、肠覃之类的疾病。所谓肠覃，是寒气客居于大肠，与胃气相搏。大肠与肺相表里，传送肺气，寒则气凝不行，清气散失而浊气结聚形成瘕。迁延日久，如同怀孕，按压坚硬，推动可移，这是气病而血未病。
处方：穿山甲、椒目、桂枝、川楝子、小茴香、茯苓、麝香、白芥子。
高龄疝症，是下元虚气冷凝结聚攻坠，乃沉痼之疾，药物难取效。暖气助阳鼓动，使阴邪浊气稍解，不过是临时的小安而已。病在肝肾，道路迂远，药物必须从咽入胃，由胃入肠，才能到达病所。而上中焦无病之处，必受疝药攻克的连累。倘若胃气减弱妨碍进食，何以救疗？阴浊盘踞成形，例取纯阳气雄的药物。昔日胡大封翁高龄宿疝，使用十全大补汤无效，喻嘉言驳斥其半阴半阳非法，议用姜附为丸，参苓为衣，喉间知有参苓，过胃始露猛烈之威灵，恰攻病所。此议甚正。
Regarding the treatment of the seven types of hernia (Shan), Zhang Hezi's discussion is the most detailed. The gist lies in using acrid and aromatic herbs to drain the Liver, allowing Qi to be dispersed and unblocked, thereby alleviating the disease. If regulation according to this method fails, one may employ a seven-herb guiding method to gather Kidney Qi and boost Spleen Yang, yet the sinking Qi remains unresolved. Moxibustion steaming the navel provides only temporary relief. The *Neijing* states that when the Ren Mai (Conception Vessel) is diseased, men suffer from internal knotting of the seven hernias, while women suffer from leukorrhea and mass accumulation (Jia Ju). These conditions are all governed by the extraordinary vessels. Therefore, formulas for draining and dispersing can only treat Qi excess; Ginseng and Atractylodes macrocephala tonifying formulas only treat middle deficiency with sinking of clear Yang, offering no benefit to diseases of the Yuan Hai (Root Sea/Kidney Qi) and extraordinary vessels. From prime age to old age, if the root of the disease persists, the lower Jiao declines daily. Thus, it can be seen that although the "boosting Yang" method matches the presentation, in old age it can only barely sustain the condition, provided the disease does not worsen.
Prescription: Lu Rong (Deer Antler without Bone), Lu Jiao Shuang (Deer Horn Frost), Dang Gui (Angelica Sinensis), Sheng Tu Si Zi (Dodder Seed), Sha Ji Li (Tribulus Terrestris), Chuan Gui Zhi Jian (Cinnamon Twig Tip).
Liver disease causes collateral deficiency and Qi aggregation, manifesting as stagnation and distension in the lower abdomen. Previously, Hejian's Jin Ling Zi San was used, added with Mu Li (Oyster Shell) and Ju Ye (Citrus Leaf), combined with the salty, acrid, and bitter overcoming method, yielding slight efficacy and improved appetite. The patient describes that when hungry, there is intense borborygmus in the hypochondrium and abdomen, followed by relief as turbid Qi descends. This belongs to the category of surplus within collateral deficiency. Given the emaciated and frail physique, pure attacking methods should not be used.
Prescription: Tao Ren (Peach Kernel), Dang Gui Shao (Tip of Angelica Root), Chao Xiao Hui Xiang (Fennel Fruit), Ju He (Tangerine Seed), Yu Li Ren (Bush Cherry Pit), Nan Shan Zha (Crataegus Pinnatifida), Cong Bai Zhi Wan (Scallion White Juice Pill).
The pulse is wiry on the right and choppy on the left. Pain at the umbilicus radiates to the lower abdomen, indicating solidified formation. Vomiting of yellow turbid fluid, inability to pass stool despite the urge. If a gurgling sound is heard in the affected area, pain slightly decreases; however, pain intensifies when the body is externally fixed and immobile. This belongs to Liver Qi Hernia and Mass (Xian Zha). Using acrid and aromatic Qi-moving methods follows the principle that "patency prevents pain."
Prescription: Chao Tao Ren (Peach Kernel), Chao Ju He (Tangerine Seed), Jin Ling Zi (Melia Toosendan), Chao Yan Hu Suo (Corydalis Rhizome), Jiu Bai Zhi (Garlic Chive White Part), Liang Tou Jian (Asparagus Fern Stem), Xiao Hui Xiang (Fennel Fruit), Qing Pi (Green Tangerine Peel).
Hernia knots in the lower abdomen, feeling hard upon pressure. Whenever overly hungry, Qi rushes to the epigastrium, causing acid regurgitation and distension. The patient reports the disease originated from anger and fatigue, internally corresponding to the Liver. Liver rebellion invades the Stomach; when hungry, Stomach Qi is weak and Liver Wood overacts. Upper belching and lower flatulence provide relief.
Prescription: Rou Gui (Cinnamon Bark), Zhen Ju He (True Tangerine Seed), Qing Mu Xiang (Vladimiria Root), Xiao Hui Xiang (Fennel Fruit), Chuan Shan Jia (Pangolin Scale), Cu Gui Zhi (Coarse Cinnamon Twig), Li Gen Bai Pi (Mulberry Root Bark).
The seven hernias relate to the Liver. The *Neijing* mentions Chong Mai (Penetrating Vessel) disease. However, the Chong Mai belongs to the Yangming Stomach. Liver Wood inevitably overacts on Stomach Earth, causing Stomach Qi to churn and rebel, leading to vomiting of roundworms, retching, inability to ingest fluids or food, and incessant hiccups. All these indicate chaotic Qi reversal without end, leading to critical Zang Cold (Zang Jue). The Liver substance is inherently rigid, with Minister Fire residing within. Using a series of hot and dry medications to reinforce rigidity with rigidity risks fracture. To drain turbidity, Zhu Nanyang's method is proposed.
Prescription: Jiu Bai Gen (Garlic Chive Root), Liang Tou Jian (Asparagus Fern Stem), Jin Ling Zi (Melia Toosendan), Yan Hu Suo (Corydalis Rhizome), Gui Xu (Angelica Root Tip), Rou Gui Xin (Cinnamon Heart).
Pain starts from the scrotum and gradually occupies the left side of the lower abdomen. The Jueyin Liver Meridian surrounds the genital organs. Excessive mental exertion and planning damage the Liver. Qi aggregates and changes form, causing pain. The disease is named Hernia. Hernias are divided into seven types: acute hernias are mostly cold, chronic hernias are mostly heat. Relief comes from venting Qi; promotion of circulation can dispel disease. Since the lower Jiao is a deep and distant region, Qi heat and dampness stagnation can be inferred.
Prescription: Chuan Lian Zi (Melia Fruit), Xiao Hui Xiang (Fennel Fruit), Hei Shan Zhi (Black Gardenia), Ju He (Tangerine Seed), Chuan Lian Zi (Toosendan Fruit), Qing Mu Xiang (Vladimiria Root), Yu Li Ren (Bush Cherry Pit), Dong Kui Zi (Okra Seed).
Malaria mother (mass due to malaria) for ten years, a chronic stubborn disease, drugs are ineffective. After prolonged malaria pathogen, evil combines with Qi and Blood, knotting in the collaterals, making it difficult for drugs to enter. Malaria stays within Liver and Gallbladder; hernias do not go beyond Liver disease. Zhang Hezi's classification of the seven hernias is detailed, but for deficient constitutions, one cannot solely use acrid and aromatic herbs. Severe sinking suggests using animal-derived substances for warming and unblocking to nurture vital Qi.
Prescription: Lu Rong (Deer Antler without Bone), Da Hui Xiang (Star Anise), Chuan Shan Jia (Pangolin Scale), Dang Gui (Angelica Sinensis), Shui An Xi Xiang (Water Asafoetida), Pao Hei Chuan Wu (Processed Black Aconite), Quan Xie (Scorpion).
Pulse is deep with much phlegm; hands and body have red sores. Chronic hernia is below; Qi sinks from the right hypochondrium to the lower abdomen. Previous proposal of Kong Xian Dan to drive out bi syndrome failed. Likely long-standing damp-heat accumulation is not merely in membranes and meridians. Use Jun Chuan Wan (40 pills), divided into two doses, taken every other day. It successfully cleared bowel accumulation. However, after clearing bowels and unblocking congestion, once sticky phlegm is down, the hernia still gathers on the right, worsening in cold winter months. Resting produces sounds; walking reveals visible forms directly dropping into the scrotum. Acute attack on chronic disease is ineffective. Proposal uses acrid-sweet wind-transforming method. Ancients believed 80-90% of hernias are Liver diseases.
Prescription: Dang Gui (Angelica Sinensis), Lu Jiao (Deer Horn), Gui Zhi (Cinnamon Twig), Rou Gui (Cinnamon Bark), Xiao Hui Xiang (Fennel Fruit), Chuan Xiong (Sichuan Lovage Rhizome), Zhi Gan Cao (Prepared Licorice), Fu Ling (Poria), Sheng Jiang (Fresh Ginger), Yang Rou Jiao Wan (Mutton Gelatin Pill).
Men's hernia knotting is described in the *Neijing* as Chong and Ren vessel disease. Zhang Hezi generally discusses draining the Liver. Now the hernia is unresolved, with a high, protruding hardness on the right of the umbilicus. This has progressed from hernia to mass accumulation (Jia Ju) and intestinal tumefaction (Chang Qun). Chang Qun refers to cold pathogen lodging in the Large Intestine, fighting with Stomach Qi. Large Intestine and Lung are exterior-interior; they transmit Lung Qi. Cold causes Qi stagnation; clear Qi scatters and turbid Qi knots to form masses. Prolonged, it resembles pregnancy, hard upon pressure, movable upon pushing. This is Qi disease without Blood disease.
Prescription: Chuan Shan Jia (Pangolin Scale), Jiao Mu (Sesame Seed), Gui Zhi (Cinnamon Twig), Chuan Lian Zi (Toosendan Fruit), Xiao Hui Xiang (Fennel Fruit), Fu Ling (Poria), She Xiang (Musk), Bai Jie Zi (White Mustard Seed).
Elderly hernia symptoms result from lower origin deficiency, cold condensation, and knotting attacks. It is a chronic stubborn disease; drugs are hard to effect. Warm qi assists Yang to move, slightly resolving Yin evil and turbid Qi, providing only temporary minor relief. The disease is in Liver and Kidney, the pathway is circuitous. Drugs must enter via throat to Stomach, then to Intestines to reach the disease site. Places without disease in upper and middle Jiao will suffer from the harsh attack of hernia drugs. If Stomach Qi weakens and hinders eating, how can treatment proceed? Yin turbidity coagulates into form; pure Yang and vigorous medicines are typically chosen. Formerly, Elder Hu suffered chronic hernia in old age; Shi Quan Da Bu Tang was ineffective. Yu Jiayan refuted the half-Yin half-Yang illegality, proposing Ginger and Aconite pills coated with Ginseng and Poria. The taste of Ginseng and Poria is perceived in the throat, but only after passing the Stomach does the fierce potency reveal itself, precisely attacking the disease site. This proposal is very correct.
Prescription: Sheng Pao Fu Zi (Raw Processed Aconite), Dan Gan Jiang (Light Dried Ginger), Da Hui Xiang (Star Anise) stir-fried and ground to fine powder; Zhen Shui An Xi Xiang (Real Water Asafoetida) pounded into small pills, coated with Ginseng powder.