许学士云大抵此疾因虚得之不可以虚而骤补经云邪之所凑其气必虚留而不去其病则实故
必先涤所蓄之热然后补是以诸方多借巴豆气者盖谓此也
谨按疝证虽始为因虚而得必邪实迫痛而未下故当先泻而后补也至有虚甚迫痛上为吐逆或
下
有遗精者此邪实正虚之甚矣此欲不补可乎但恐补之则无益泻之则正气转陷幸而获生者鲜矣
子和曰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俗工
不识
因立谬名或曰膀胱或曰肾俞或曰小肠气立名既谬并丧其实何哉盖医者既断为膀胱肾俞小肠气
必曰虚寒所致其药之用也不附子乌头则干姜官桂之类饵之曾无殊效浸成大错曾无觉者岂知诸
疝皆归肝经其奈庸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肠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是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卧渍阴器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心系气盛厥逆上冲肠胃熏肝散于肓结于脐故取之盲原以散之刺太阴以
平之取厥阴以下之取巨虚下廉以去之按其所遇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论六疝虽见于他脉中皆言风疝者足厥
阴肝经之气也灵枢亦云三脏脉之疝皆以滑为疝也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又尝遍阅
铜人俞穴亦相表里惟厥阴言疝独多为疝之主也其它经穴虽亦治疝终非受疝之地但与足厥阴相
连耳如运气或在泉寒胜术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锉结
于此经或药淋外固闭尾缩精壅于此经其病差别如此且夫遗溺闭癃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
核皆女子之疝也但女子不谓七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
许学士说：大抵这种病是因为虚损而得的，但不能因为虚就骤然进补。《内经》说：“邪气聚集的地方，正气必然虚弱；邪气停留不去，病势就会转为实证。”所以必须先清除体内蓄积的热邪，然后才能进行补益。因此，许多方剂中多借用巴豆的辛热之气，大概就是这个道理。
我谨按：疝证虽然起始于因虚致病，但必定是邪气实盛、逼迫疼痛，且尚未通过下法排出，所以应当先泻后补。至于那些极度虚弱、疼痛剧烈导致上吐下逆，或者下泄遗精的患者，这是邪气实盛而正气极度虚弱的表现。这种情况下，想要不补益可以吗？只是担心如果补益则无益于病，如果泻下则正气会更加下陷。侥幸能存活的人很少了。
张子和说：疝分为七种，前人论述很多，但我认为除了《灵枢》、《素问》和《铜人腧穴针灸图经》中的论述外，其他的都不采纳。这并不是我喜欢标新立异，而是要探究其本源。世俗医生不认识病因，创立了错误的名称，有的叫“膀胱气”，有的叫“肾俞气”，有的叫“小肠气”。既然命名错误，也就丧失了疾病的实质。为什么呢？因为医生既然判定为膀胱、肾俞、小肠气，必定认为是虚寒所致，用药不是附子、乌头，就是干姜、官桂之类，服用后毫无特殊疗效，逐渐酿成大错，却无人察觉。哪里知道各种疝气都归属于肝经呢？无奈庸俗之辈将其归之于小肠和膀胱（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；肾为少阴，统管二水。人的小便从胃进入小肠，渗入膀胱。膀胱就是脬囊，经过气化作用，尿液从尿道排出，这是正常的生理规律。等到发生疝气时，就属于足厥阴肝经了。因为足厥阴肝经环绕阴器，向上进入小肠。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，而主肾、膀胱、小肠的三经则没有提及疝气。这说明受疝的部位乃是肝经所主的区域。况且《内经》说男子的宗筋是骨骼汇聚之处，而肝主筋。睾丸是阴囊中的丸状物，虽然被称为外肾，但如果非厥阴肝经环绕牵引，阴茎就无法伸缩。在女子则是阴户，内外共有两个开口，一个称为廷孔，一个称为窈漏。这些都是厥阴经与冲脉、任脉、督脉交会的地方。《灵枢》说足厥阴经的经筋聚于阴器，其病症若受寒则阴器收缩入腹，受热则纵挺不收，治疗在于行针、卧针或浸泡阴器。所以阳明、太阴、厥阴的经筋都交会于阴器，只有厥阴主筋，所以患疝气的人必须以厥阴为本。《灵枢》又说足厥阴经的别络叫做蠡沟，在内踝上五寸处，别走少阳经，沿胫骨上行至睾丸，结于阴茎。其病症表现为气逆、睾丸肿胀、突发疝气，实证则阴茎挺长，虚证则突然瘙痒，取该别络治疗。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，心系气盛，厥逆之气上冲肠胃，熏蒸肝脏，散布于肓膜，结于脐部。所以治疗取盲原穴以消散它，刺太阴经以平复它，取厥阴经以下降它，取巨虚下廉以去除它，根据邪气所在的经脉来调理它。这起初虽然说是邪气在小肠，但其治法一定要说“取厥阴以下之”，由此可知各种疝气都与厥阴有关，可以不必怀疑。
从脉象来考察，《素问》论述六种疝气，虽然见于其他脉象中，但都说风疝是足厥阴肝经之气所致。《灵枢》也说三脏脉的疝都以滑脉为特征，三阴脉急为疝，三阳脉急为瘕。王太仆说太阳经受寒，血凝滞形成瘕；太阴受寒气聚形成疝。这是说太阴受寒传变到肝经，可以用温药驱逐，不可以用温药补益。如果补益，是想让病邪离去却强行挽留它啊。遍考《素问》，三阳经发病发寒热，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才成为疝。又说要病在小腹，腹痛，大小便不通，病名叫做疝，得自寒邪。说脉象急的叫做疝瘕，小腹疼痛。凡是提到小腹的，难道不是厥阴经所主的区域吗？又说脾风传胃，名叫疝瘝，这是说非肝木不能产生风气，名叫厥疝。盖因脾土虚弱不能制水，又被肝木所克制。又说督脉为冲疝，因为厥阴与冲脉、任脉、督脉都交会于前阴，这不是很明白吗？我又曾遍阅《铜人腧穴针灸图经》的穴位，也相互表里，只有厥阴经提及疝气最多，独多为疝气的主治经脉。其它经的穴位虽然也能治疗疝气，终究不是受疝的地方，只是与足厥阴相连接罢了。比如运气学说中，或在泉之时寒胜，术气导致挛缩，禁于此经；或司天之时燥胜，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，闭尾缩精壅塞于此经。其病情差别如此。况且遗尿、闭癃、阳痿、胞痹、精滑、白淫，都是男子的疝气，不可妄归于肾冷。血枯导致月经不来或停闭，腰膝上部发热，咽喉干燥，癃闭，小腹有肿块或固定或移动，前阴突出，后阴痔核，都是女子的疝气。只是女子不称七疝而称之为瘕。如果是年少而得此病，不论男女都不能生育。所以隐蔽委曲的事情，完全不关乎膀胱、肾脏、小肠的事，而是足厥阴肝经的职责。无奈世俗的方书只谈论膀胱、肾脏、小肠，绝不说肝木一句，迷惑人很严重了。况且肝经属乙木，木属东方，为心火之母。凡疝气，如果不是肝木受邪，就是肝木自盛。不可以轻易说是虚而进行补益。《难经》所谓“东方实，西方虚，泻南方，补北方”，这是说泻火则木自平，金自清，水自旺。七疝在下，去除病邪之后，可调则调，可补则补，各自衡量病势，不要拘泥于世俗的方法。《内经》所谓阴盛而腹胀不通的，属于癃疝，不可以不下法。
Xu Xueshi said: Generally, this disease arises from deficiency, but one cannot abruptly tonify due to deficiency. The *Neijing* states: "Where pathogenic factors gather, Qi must be deficient; if they remain and do not depart, the pathology becomes excess." Therefore, one must first cleanse the accumulated heat before tonifying. Hence, many prescriptions borrow the qi of *Crotonis Fructus* (Badou, 巴豆), which is precisely for this reason.
I respectfully note: Although hernia syndromes (*Shan Zheng*, 疝证) originate from deficiency, they inevitably involve excess pathogenic factors causing severe pain that has not yet been expelled via purgation. Thus, one should purge first and then tonify. However, in cases where deficiency is extreme, accompanied by severe pain leading to vomiting and regurgitation upwards, or seminal emission downwards, this represents a condition of extreme excess pathogenic factors and extreme deficiency of healthy Qi. In such situations, can one refrain from tonification? The concern is that tonification may be ineffective, while purgation may cause further collapse of healthy Qi. Few survive such mishandling.
Zi Hezi said: Hernias are classified into seven types. While predecessors have discussed them extensively, I only accept the discussions found in the *Lingshu*, *Suwen*, and *Tongren Shuxue Zhenjiu Tujing*. I do not adopt others, not because I enjoy being different, but to trace the origin. Unskilled physicians fail to recognize the etiology and establish erroneous names, such as "Bladder Qi," "Shenshu Qi," or "Small Intestine Qi." Since the naming is erroneous, the essence of the disease is lost. Why? Because once physicians diagnose it as Bladder, Shenshu, or Small Intestine Qi, they invariably attribute it to deficiency-cold. Their medications consist mainly of *Aconiti Lateralis Radix Preparata* (Fuzi, 附子), *Aconiti Radix* (Wutou, 乌头), *Zingiberis Rhizoma* (Ganjiang, 干姜), or *Cinnamomi Cortex* (Guangui, 官桂). These yield no special efficacy, gradually leading to grave errors unnoticed by all. They do not realize that all hernias belong to the Liver Meridian. Unfortunately, vulgar practitioners attribute them to the Small Intestine and Bladder (Pao Nang). The Bladder is the water reservoir, responsible for seepage and excretion; the Small Intestine is the water pathway, responsible for flow; the Kidney is Shaoyin, commanding both waters. Human urine enters the Small Intestine from the Stomach, seeps into the Bladder. The Bladder is the Pao Nang; through Qi transformation, urine exits from the urethral tip. This is the normal pathway. When hernia occurs, it belongs to the Foot-Jueyin Liver Meridian, as this meridian circles the genitalia and ascends into the Small Intestine. The Liver and Kidney are located inferiorly and connect with the Chong, Ren, and Du vessels. However, the *Lingshu Jing* states that diseases of the Foot-Jueyin Liver Meridian include enuresis, strangury, and fox hernia, whereas the three meridians governing the Kidney, Bladder, and Small Intestine do not mention hernia. This indicates that the site receiving hernia is the domain of the Liver. Furthermore, the *Neijing* states that the male Zongjin (tendons) is the gathering point of bones, and the Liver governs tendons. The testicles are the balls within the scrotum; although called external kidneys, without the circling and guiding of the Jueyin meridian, the penis cannot extend or retract. In females, this is the vaginal opening, with two internal and external apertures: one called Ting Kong, the other Yao Lou. These are the convergence points of the Jueyin, Chong, Ren, and Du vessels. The *Lingshu* states that the sinews of the Foot-Jueyin meridian gather at the genitalia. If injured by cold, the yin retracts inward; if injured by heat, it becomes flaccid and protrudes irretractably. Treatment involves acupuncture, moxibustion, or soaking the genitalia. Thus, the sinews of Yangming, Taiyin, and Jueyin all converge at the genitalia, but only Jueyin governs tendons. Therefore, those suffering from hernia must base their treatment on Jueyin. The *Lingshu* also states that the collateral branch of the Foot-Jueyin meridian is named Ligou, located five cun above the medial malleolus, diverging to the Shaoyang meridian, ascending along the tibia to the testicle, and knotting at the penis. Its symptoms include qi rebellion, testicular swelling, sudden hernia; excess presents with penile erection and elongation, deficiency with sudden itching. Treating its divergence confirms that Jueyin is the site of disease. The *Lingshu* further states that pathogenic factors in the Small Intestine connect to the testicles, attach to the Kidney, penetrate the Liver, link to the Lung, and affect the Heart. Excess Qi rebels and rushes upward to the Stomach and Intestines, steams the Liver, disperses into the Huang membrane, and knots at the umbilicus. Treatment involves needling Mangyuan to dissipate it, puncturing Taiyin to calm it, taking Jueyin to descend it, and taking Juliu Xia Lian to remove it, adjusting according to the affected meridian. Although initially described as pathogenic factors in the Small Intestine, the treatment method emphasizes "taking Jueyin to descend it," proving that all hernias relate to Jueyin beyond doubt.
Examining the pulse, the *Suwen* discusses six types of hernia appearing in various pulses, stating that Feng Hernia is caused by Qi of the Foot-Jueyin Liver Meridian. The *Lingshu* also states that hernias associated with the three Zang organs present with slippery pulses, urgency in the three Yin meridians indicates hernia, and urgency in the three Yang meridians indicates mass formation. Wang Taipu stated that Cold invading Taiyang causes blood stasis forming masses; Cold invading Taiyin causes Qi aggregation forming hernia. This means Taiyin Cold transmits to the Liver Meridian. It can be driven out with warming herbs, but not treated with warming tonics. Tonification would attempt to expel the pathogen while forcibly retaining it. Reviewing the *Suwen*, diseases of the three Yang meridians involving chills and fever transmit to hernia, indicating the Bladder is not the primary site of disease but must transmit to the Jueyin portion to become hernia. It also states that disease in the lower abdomen with pain and inability to pass urine or stool is named hernia, caused by cold. Urgent pulses indicate hernia and masses with lower abdominal pain. Whenever the lower abdomen is mentioned, is it not the domain of the Jueyin meridian? It also states that Spleen Wind transmitting to the Stomach is named Shanxia, meaning non-Liver Wood cannot generate wind patterns, named Jue Hernia. This is because Spleen Earth is deficient and cannot control Water, being overwhelmed by Liver Wood. It also states the Du Meridian is involved in Chong Hernia, as Jueyin converges with Chong, Ren, and Du at the anterior yin. Is this not clear? I have also reviewed the acupoints in the *Tongren Shuxue Zhenjiu Tujing*; they are exterior-interior related, but only the Jueyin meridian mentions hernia most frequently, serving as the primary meridian for hernia treatment. Other meridians' acupoints may treat hernia but are not the primary sites of reception, merely connected to the Foot-Jueyin. For instance, in climate theory, if Cold dominates during the ruling phase, it causes spasms restricted to this meridian; if Dryness dominates during the governing phase, Wood Qi is depressed here; if anger, sorrow, or depression causes stagnation, it knots here; if medicinal dampness or external retention causes closure and sperm congestion, it obstructs here. The pathological differences are thus. Moreover, enuresis, strangury, impotence, bladder bi, spermatorrhea, and leukorrhea are all male hernias and should not be wrongly attributed to Kidney Cold. Blood depletion causing amenorrhea or cessation, upper waist and knee heat, dry throat, strangury, lower abdominal masses that are fixed or migratory, prolapse of the anterior yin, and posterior yin hemorrhoidal nodules are all female hernias. Females do not call them Seven Hernias but rather masses (Jia). If contracted in youth, regardless of gender, it leads to infertility. Thus, matters concerning the concealed and complex do not pertain to the Bladder, Kidney, or Small Intestine, but are the duty of the Foot-Jueyin Liver Meridian. Unfortunately, vulgar formulas only discuss the Bladder, Kidney, and Small Intestine, never mentioning Liver Wood, greatly confusing people. The Liver Meridian is Yi Wood, belonging to the East, and is the mother of Heart Fire. Any hernia results either from Liver Wood being invaded by pathogens or from Liver Wood becoming excessive itself. One should not hastily claim deficiency and tonify. As the *Nanjing* states: "East is excess, West is deficient; drain South, tonify North." This means draining Fire levels Wood, clearing Metal allows Water to flourish. After treating the Seven Hernias and removing the pathogen, one may adjust or tonify as appropriate, measuring the disease trend without adhering to vulgar methods. The *Jing* states that when Yin is excessive causing abdominal distension and obstruction, it falls under strangury and hernia, and purgation is necessary.