内经大奇论曰肾脉大急沉肝脉大急皆沉为疝证心脉弦滑急为心疝肺脉沉弦为肺疝盖疝者
寒气结
聚之所为故令腹脐绞痛者是也又巢元方曰诸疝者阴气积于内复为寒疝所伤荣卫不调二气虚弱
风冷入腹而成故脉经云急者紧也紧则为寒为实为痛血为寒泣则为瘕气为寒聚为疝仁斋曰 疝
者阴核气结肿大而吊痛也多因小儿啼怒不止伤动阴气故阴气下结聚而不散得之或胎妇啼泣过
伤令儿生下小肠气闭亦变此候惟是不得流行加以风冷入焉血水聚焉故水气上乘于肺先喘急以
后疝痛其状有如桃核者亦有稀软者亦有外肾肿大者亦有木硬者脐下痛楚皆不能忍用药行心气
逐肾邪利其大小便更无补法并用五苓散当归散川楝散主之
小儿疝卵偏肿者灸囊后缝十字纹上三壮春灸夏较夏灸秋较秋灸冬较冬灸春较
小儿阴肿灸内昆仑二穴各三壮取法在内踝后五分筋骨间陷中是穴灸小便淋沥法炒盐不以
多少热填满病患脐内是神关穴也却用小麦大艾炷灸七壮良验或灸三阴交穴
香芎丸 治小儿诸淋证若患风闭尤妙
香附 川芎 赤茯苓(各半两) 海金沙 滑石(各一两) 枳壳 泽泻 石苇 槟榔(各
二钱半)
上为末糯米粉煮为清糊丸麻子大每服三十三丸至五十五丸或七十七丸并用麦门冬熟水送
下若小便涩痛滴三五点者取长江顺流水用火微温入盐少许调匀空心咽服
葵子散 治小儿诸淋
葵子 车前子 木通 桑白皮(炒) 瞿麦 赤茯苓 山栀子 甘草(炙等分)
上水一盏煎服
导赤散 治小儿血淋
生干地黄 木通(各二钱) 黄芩 甘草(生各二钱)
上为末每服一钱井水入灯心煎服仍以米饮调油发灰空心灌下
局方五淋散 治膀胱有热水道不通淋沥不出或尿如豆汁或成沙石或如膏或热怫便血
赤茯苓(六钱) 赤芍药 山栀子(各二钱) 当归 甘草(各五钱)
上 咀每服三钱水一小盏入灯心煎服
《黄帝内经·大奇论》中说:肾脉大而紧急、沉取有力,肝脉大而紧急且沉取有力,这些都是疝证的脉象;心脉弦、滑、急,是心疝的脉象;肺脉沉而弦,是肺疝的脉象。大概疝证是由于寒气凝结积聚所致,因此会出现腹部和脐周的绞痛。
又据巢元方所说:各种疝证,是因为阴气积滞于体内,又受到寒疝的伤害,导致营卫不调,阴阳二气虚弱,风冷之邪侵入腹部而形成。所以《脉经》说:脉象急就是紧脉,紧脉主寒、主实、主痛;血液因寒而凝涩则形成瘕块,气因寒而聚结则形成疝气。
仁斋说:疝证表现为阴囊核团气结肿大并伴有牵引性疼痛。多因为小儿哭闹不止,损伤了阴气,导致阴气下结聚而不散。有的因为孕妇在怀孕期间啼哭过度,伤及胎儿,致使孩子出生后小肠气闭,也变成这种病候。只是由于气机不得流通,加上风冷侵入,血水聚积,所以水气上乘于肺,先出现气喘急促,随后出现疝痛。其症状表现有像桃核形状的,也有质地稀软的,也有外肾(睾丸)肿大的,也有质地木硬的,脐下疼痛剧烈,难以忍受。治疗用药需行心气、逐肾邪、通利大小便,没有补益的方法。主要使用五苓散、当归散、川楝散来主治。
小儿疝气导致阴囊肿偏一侧肿胀的,可灸阴囊后缝十字纹上三壮。春季施灸夏季见效,夏季施灸秋季见效,秋季施灸冬季见效,冬季施灸次年春季见效。
小儿阴囊肿胀的,灸内昆仑穴(即太溪穴附近区域,此处指代特定位置)两个穴位,各灸三壮。取穴方法在内踝后方五分处,筋骨之间的凹陷中。
治疗小便淋沥不尽的方法:用炒热的盐,不限多少,热着填满患者肚脐内,这是神阙穴。然后用小麦大小的艾炷灸七壮,疗效良好。或者灸三阴交穴。
香芎丸:治疗小儿各种淋证,如果是风邪闭塞引起的尤其妙效。
药材:香附、川芎、赤茯苓(各半两)、海金沙、滑石(各一两)、枳壳、泽泻、石苇、槟榔(各二钱半)。
制法与用法:以上药物研为细末,用糯米粉煮成清糊作为粘合剂,制成如麻子大小的丸药。每次服用三十三丸至五十五丸,或七十七丸,均用麦门冬煎成的熟水送服。如果小便涩痛,只能滴出三五点的,取长江顺流水,用火微微加热,加入少许盐调匀,空腹咽服。
葵子散:治疗小儿各种淋证。
药材:葵子、车前子、木通、桑白皮(炒)、瞿麦、赤茯苓、山栀子、甘草(炙,等分)。
制法与用法:以上用水一盏煎服。
导赤散:治疗小儿血淋。
药材:生干地黄、木通(各二钱)、黄芩、甘草(生,各二钱)。
制法与用法:以上研为细末,每次服用一钱,用井水加灯心草煎服。同时仍用米饮调匀油发灰,空腹灌服。
局方五淋散:治疗膀胱有热、水道不通导致的淋沥不出,或者尿如豆汁,或结成沙石,或如膏状,或热郁便血。
药材:赤茯苓(六钱)、赤芍药、山栀子(各二钱)、当归、甘草(各五钱)。
制法与用法:以上切碎,每次服用三钱,用水一小盏,加入灯心草煎服。
The *Da Qi Lun* (Great Wonders Chapter) of the *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: A kidney pulse that is large, urgent, and deep indicates a hernia syndrome; a liver pulse that is large, urgent, and deep also indicates a hernia syndrome; a heart pulse that is wiry, slippery, and urgent indicates Heart Hernia; a lung pulse that is deep and wiry indicates Lung Hernia. Generally, hernia syndromes are caused by the condensation and accumulation of Cold Evil, resulting in severe pain in the abdomen and around the umbilicus.
Furthermore, Chao Yuanfang stated: Various hernia syndromes arise from the accumulation of Yin Qi internally, compounded by injury from Cold Hernia, leading to disharmony between Ying (Nutritive) and Wei (Defensive) Qi, weakness of Yin and Yang Qi, and the invasion of Wind-Cold into the abdomen. Thus, the *Mai Jing* (Pulse Classic) says: An urgent pulse is a tight pulse; a tight pulse indicates Cold, Excess, and Pain. Blood coagulating due to Cold forms masses (Jia), while Qi aggregating due to Cold forms Hernias.
Ren Zhai stated: Hernia syndrome manifests as swelling and enlargement of the scrotal sac with Qi stagnation, accompanied by pulling pain. It is often caused by prolonged crying and anger in children, which injures Yin Qi, causing it to descend and aggregate without dispersing. In some cases, excessive crying by the pregnant mother injures the fetus, leading to closure of Qi in the small intestine after birth, which transforms into this condition. Due to the obstruction of Qi flow, combined with the invasion of Wind-Cold, blood and fluids accumulate. Consequently, Water Qi ascends to attack the Lungs, first causing panting and urgency, followed by hernia pain. The presentation may resemble a peach pit, be soft, involve swelling of the external genitalia (testes), or feel woody and hard. There is unbearable pain below the umbilicus. Treatment involves regulating Heart Qi, expelling Kidney pathogenic factors, and promoting urination and defecation; no tonification methods are used. The primary formulas for treatment are Wu Ling San (Five-Ingredient Poria Pill), Dang Gui San (Angelica Decoction), and Chuan Lian San (Toosendan Fruit Powder).
For pediatric hernia presenting with unilateral scrotal swelling, moxibustion should be applied to three burns on the cross-shaped line at the posterior seam of the scrotum. Spring moxibustion yields results in summer; summer moxibustion yields results in autumn; autumn moxibustion yields results in winter; winter moxibustion yields results in the following spring.
For pediatric scrotal swelling, moxibustion is applied to two points named Nei Kunlun (referring to the area near Taixi), three burns each. The location is five fen behind the medial malleolus, in the depression between the bone and tendon.
For treating dribbling urine (Lin syndrome), stir-fried salt is used in an unspecified amount, filled hot into the patient's umbilicus (Shenque Point). Then, moxa cones the size of wheat grains are applied for seven burns, which is highly effective. Alternatively, Sanyinjiao (SP6) can be moxibusted.
Xiang Xiong Wan (Fragrant Ligusticum Pill): Treats various Lin syndromes in children; it is especially excellent for cases caused by Wind obstruction.
Ingredients: Xiang Fu (Cyperus Rhizome), Chuan Xiong (Ligusticum Rhizome), Chi Fu Ling (Red Poria), Hai Jin Sha (Lygodium Spore), Hua Shi (Talcum), Zhi Qiao (Aurantium Fructus), Ze Xie (Alisma Rhizome), Shi Wei (Pyrrosiae Folium), Bing Lang (Areca Seed) (each half liang for the first two pairs, each 2.5 qian for the latter four).
Preparation and Administration: Grind the above ingredients into fine powder. Use glutinous rice flour paste as a binder to form pills the size of hemp seeds. Take 33 to 55 pills, or up to 77 pills per dose, washed down with prepared water from Ophiopogon japonicus (Maidong). If urinary difficulty presents with only a few drops and pain, take smooth flowing water from the Yangtze River, warm it slightly over fire, add a little salt, mix well, and swallow on an empty stomach.
Kui Zi San (Abutilon Seed Powder): Treats various Lin syndromes in children.
Ingredients: Kui Zi (Abutilon Seed), Che Qian Zi (Plantago Seed), Mu Tong (Akebia Caulis), Sang Bai Pi (Morus Root Bark, stir-fried), Qu Mai (Dianthus Herba), Chi Fu Ling (Red Poria), Shan Zhi Zi (Gardenia Fruit), Gan Cao (Licorice Root, honey-fried) in equal proportions.
Preparation and Administration: Decoct one cup of water and drink.
Dao Chi San (Guide Out the Red Powder): Treats pediatric Hematuric Lin Syndrome.
Ingredients: Sheng Gan Di Huang (Raw Rehmannia Root), Mu Tong (Akebia Caulis) (each 2 qian); Huang Qin (Scutellaria Root), Gan Cao (Licorice Root, raw) (each 2 qian).
Preparation and Administration: Grind into fine powder. Take one qian per dose, decocted with well water and Deng Xin Cao (Juncus Medullary). Additionally, mix You Fa Hui (Ash of Human Hair) with Mi Yin (Rice Drink) and administer orally on an empty stomach.
Ju Fang Wu Lin San (Bureau Formula Five-Lin Powder): Treats Lin syndrome caused by Heat in the Bladder and obstruction of the urinary pathway, resulting in dribbling inability to urinate, urine resembling bean juice, formation of sand/stones, pasty consistency, heat retention, or hematochezia/hematuria.
Ingredients: Chi Fu Ling (Red Poria) (6 qian); Chi Shao Yao (Red Peony Root), Shan Zhi Zi (Gardenia Fruit) (each 2 qian); Dang Gui (Angelica Sinensis), Gan Cao (Licorice Root) (each 5 qian).
Preparation and Administration: Coarsely crush the ingredients. Take 3 qian per dose, decocted with a small cup of water and Deng Xin Cao (Juncus Medullary).