内经曰小腹控睾引腰脊上冲心唾出清水及为哕噫甚则入心善忘善悲甲乙经曰邪在小肠也
小肠
病者小腹痛引腰脊贯肝肺其经虚不足则风冷乘间而入邪气既入则冷之证上冲肝肺客冷散于胸
结于脐控引睾丸上而不下痛而入腹甚则冲于心胸盖其经络所系属也启玄予曰控引也睾丸阴丸
也
谨按寒邪始客于小肠因经络并于厥阴故下控引睾丸为痛虽亦如疝然止言小肠气所以古人
治法往往相类但自有所兼之证殊尔
原病式曰 疝少腹控卵肿急绞痛也寒主拘缩故也寒极而土化制之故肿满也经言大夫 疝
谓阴
器连少腹急痛也故言妇人少腹肿皆肝足厥阴之脉也经注曰寒气聚而为疝也又按经言五脏皆主
疝但脉急也注言脉急者寒之象也然寒则脉当短小而迟今言急者非急数而洪也由紧脉主痛急为
痛甚病寒虽急亦短小也所以有痛而脉紧急者脉为心之所养也凡六气为痛则心神不宁而紧急不
得
舒缓故脉亦从之而见也欲知何气为其病者适其紧急相兼之脉而可知也如紧急洪数则为热痛之
类也又经言脾传之肾病名曰疝瘕少腹烦冤而痛出白蛊注言少腹痛溲出白液也一作客热内结销
烁脂肉如蛊之食故名白蛊也然经之复言热为疝瘕则亦不可止言为寒当以脉证别之
丹溪曰疝痛之甚者睾丸连小腹急痛也或有形或无形或有声或无声自素问以下皆以为寒盖
经络
得寒收引不行所以作痛世有得寒而无疝者又必有说以通之可也予屡踢冰徒涉不曾病此以予素
无热也因而思此病始于湿热在经郁遏至久又感外寒湿热被郁而作痛若只作寒论恐为未备或曰
此证多客厥阴一经湿热之积何由而致予曰夫劳则火起于筋醉饱则火起于胃房劳则火起于肾大
怒
则火起于本经火郁之久湿气便盛浊液凝聚并入血隧流于厥阴肝属木性速急火性暴为寒束宜其
痛甚而暴也愚见古方以乌头栀子等分作汤用之其效亦速后因此方随形证加减无有不应又须分
湿热多少而治之但肿多为湿 是也却有水气而肿又有挟虚而发者当以参术为君而佐以疏导诊
其脉沉紧而豁大者是也若不以补剂而行决裂之法祸不旋踵
《黄帝内经》说：小腹部牵引睾丸，牵连腰脊，气向上冲至心胸，吐出清水，并出现呃逆、嗳气等症状；病情严重时，邪气上犯于心，导致健忘、悲伤。《甲乙经》说：邪气侵犯小肠。
小肠发生病变时，小腹痛并牵引腰脊，疼痛贯穿肝、肺部位。如果该经脉虚弱不足，风冷之邪便会乘虚而入。邪气侵入后，寒证表现向上冲击肝、肺，寒气散于胸中，结聚于脐部，牵引睾丸，使其上提而不能下降，疼痛深入腹内，严重时甚至冲犯心胸。这是因为经络相互关联所属的缘故。启玄子（王冰）注解说：“控”即牵引之意，“睾”即睾丸。
谨按：寒邪起初客居于小肠，因为经络与足厥阴肝经相通并合，所以下部牵引睾丸产生疼痛。虽然这也类似于疝病，但古人只称之为“小肠气”，所以古人的治疗方法往往相似，只是各自兼夹的症状有所不同罢了。
《原病式》说：疝病表现为少腹部牵引睾丸肿胀、拘急、绞痛，这是因为寒性主收缩的缘故。寒邪极盛而土气（脾土）试图制约它，所以出现肿胀满闷。经文说“大夫疝”，是指阴器连接少腹部急痛。所以说妇人少腹部肿胀，都是足厥阴肝经的病变。经文注解说：寒气积聚而形成疝病。又按经文所说，五脏都主司疝病，但脉象表现为紧急。注解认为脉紧急是寒邪的表现。然而寒邪通常使脉象短小且迟缓，现在所说的“急”，并非指脉率急促、洪大，而是由紧脉主痛所致，“急”表示疼痛剧烈。病属寒邪，脉象虽显急象，但仍以短小为主。所以有疼痛且脉象紧急的情况，是因为脉为心之所养。凡是六气致病引起疼痛，心神就会不安，导致脉象紧急不得舒缓，因此脉象也随之显现出紧急之象。想要知道是何种邪气致病，只需观察脉象紧急兼夹的其他特征即可知晓。例如，若脉象紧急、洪大且数，则属于热痛之类。又经文说：脾脏的病传变给肾脏，病名叫做疝瘕，症状为少腹部烦闷冤结而疼痛，排出白色液体。蛊注注解说：少腹痛，小便排出白色液体。另一种解释是：客热内结，消烁脂肉，如同蛊虫食肉一样，所以称为白蛊。然而经文再次提到热邪也可导致疝瘕，所以不能仅仅将其归结为寒邪，应当通过脉象和症状来辨别。
朱丹溪说：疝痛严重的，睾丸连带少腹部急痛。有的有形，有的无形；有的有声，有的无声。自《素问》以来，都认为这是寒邪所致，因为经络遇到寒邪会收缩牵引，气血不行，所以产生疼痛。世间有人感受了寒邪却没有患疝病，这一定有其他的解释可以通达。我曾经多次踢踏冰块、徒步涉水，却未曾患病，这是因为我不素有内热。由此思考，此病起始于湿热在经络中郁遏已久，又感受外寒，湿热被寒邪郁闭而发作疼痛。如果只从寒邪角度论述，恐怕不够全面。有人问：此证多客居于厥阴一经，湿热之积是如何形成的？我说：劳累则火起于筋脉，醉酒饱食则火起于胃，房劳过度则火起于肾，大怒则火起于本经。火郁积久了，湿气便旺盛，浊液凝聚，并入血隧，流注于厥阴肝经。肝属木，其性急速；火性暴烈，被寒邪束缚，所以疼痛剧烈且突然发作。我的见解是，古方用乌头、栀子各等分煎汤服用，疗效也很快。后来我根据这个方子随证加减，没有不奏效的。但又必须分辨湿热的多少进行治疗。如果肿胀明显，多为湿邪所致；也有因水气而肿，又有因正气虚弱而发作者，此时当以人参、白术为君药，辅以疏导之法。诊察其脉象沉紧而豁大的，就是这种情况。如果不使用补剂而采用决裂攻伐的方法，灾祸将立刻降临。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: The lower abdomen pulls on the testicles, radiating to the lumbar spine and sacrum, with qi rushing upward to the heart and chest, accompanied by vomiting of clear fluids, hiccups (e), and belching. In severe cases, the pathogen invades the heart, leading to forgetfulness and sadness. The *Jiayi Jing* (Essential Classic of the Mysterious Monograph) states: When pathogenic factors invade the Small Intestine...
When disease occurs in the Small Intestine, there is pain in the lower abdomen radiating to the lumbar spine, penetrating through the Liver and Lung regions. If the meridians are deficient and insufficient, Wind-Cold will enter during intervals of vulnerability. Once the pathogen enters, cold manifestations rush upward to the Liver and Lungs; cold pathogens scatter in the chest, knot at the umbilicus, pull on the testicles causing them to ascend without descending, with pain entering the abdomen. In severe cases, it rushes to the heart and chest, due to the interconnection of the meridians. Qixuanzi (Wang Bing) annotates: "Kong" means pulling or dragging; "Gao" refers to the testicles.
Respectfully noting: Cold pathogens initially lodge in the Small Intestine. Because the meridians connect and merge with the Jueyin (Liver) channel, the lower part pulls on the testicles causing pain. Although this resembles Shan (hernia/testicular swelling), it was historically referred to as "Small Intestine Qi." Thus, ancient treatment methods were often similar, though the accompanying symptoms differed.
The *Yuanbing Shi* (Treatise on the Origins of Disease) states: Shan involves the lower abdomen pulling on the scrotum, causing swelling, urgency, and colicky pain. This is because Cold governs contraction. When Cold reaches its extreme, Earth (Spleen) attempts to restrain it, resulting in swelling and fullness. The classics mention "Daifu Shan," referring to acute pain connecting the genital organs to the lower abdomen. Therefore, it is said that swelling in the lower abdomen of women is a disorder of the Foot Jueyin Liver Meridian. Classical annotations state: Accumulation of Cold Qi forms Shan. Furthermore, the classics state that all five Zang organs can be associated with Shan, characterized by a tight pulse. Annotations explain that a tight pulse is a sign of Cold. However, Cold typically presents with a short, small, and slow pulse. The "tightness" mentioned here does not refer to rapidity or surging volume but rather to the Jin (tight) pulse which governs pain; "tight" indicates severe pain. Although the disease is caused by Cold, the pulse may appear tight yet remains fundamentally short and small. Thus, pain accompanied by a tight pulse occurs because the pulse is nourished by the Heart. When any of the Six Qi causes pain, the Heart Spirit becomes unsettled, leading to tension and inability to relax; consequently, the pulse reflects this tension. To determine which pathogen is responsible, one must observe the characteristics accompanying the tightness. For instance, if the pulse is tight, surging, and rapid, it belongs to the category of Heat-pain. Additionally, the classics state: When Spleen disease transmits to the Kidney, it is named Shanxia, characterized by vexation, oppression, and pain in the lower abdomen, with discharge of white fluid. Gu Zhu annotation explains: Pain in the lower abdomen with discharge of white urine. Another interpretation suggests: Internal accumulation of exogenous Heat consumes flesh and fat like a parasite, hence called Baigu (White Parasite). However, since the classics also mention Heat causing Shanxia, one cannot attribute it solely to Cold; differentiation must be made based on pulse and symptoms.
Zhu Danxi stated: Severe Shan pain involves the testicles connected to the lower abdomen with acute pain. It may present with form or without form, with sound or without sound. Since the *Suwen*, it has been considered Cold, because meridians contract and stagnate when exposed to Cold, causing pain. Yet, some people suffer from Cold exposure without developing Shan; there must be an explanation for this. I have frequently kicked ice and waded through water without illness, because I naturally lack internal Heat. Reflecting on this, I believe this disease originates from Damp-Heat stagnating in the meridians for a long time, compounded by external Cold. The Damp-Heat is constrained by the Cold, leading to pain. If one only considers it as Cold, the analysis is incomplete. Someone asked: This syndrome mostly affects the Jueyin channel; how is the accumulation of Damp-Heat formed? I replied: Labor generates Fire in the sinews; drunkenness and overeating generate Fire in the Stomach; sexual excess generates Fire in the Kidneys; extreme anger generates Fire in the respective meridian. After Fire stagnates for a long time, Dampness becomes abundant. Turbid fluids condense and enter the blood vessels, flowing into the Jueyin Liver channel. The Liver belongs to Wood and is swift and urgent in nature; Fire is violent. Constrained by Cold, the pain becomes severe and sudden. My view is that ancient prescriptions used Aconite (Fuzi) and Gardenia (Zhizi) in equal parts as a decoction, which yielded rapid results. Later, I modified this formula according to specific syndromes, achieving consistent efficacy. However, treatment must distinguish between the degrees of Dampness and Heat. Prominent swelling usually indicates Dampness; however, swelling can also result from Water-Qi or occur in deficiency patterns. In such deficiency cases, Ginseng (Renshen) and Atractylodes Macrocephala (Baizhu) should be the sovereign herbs, assisted by draining and guiding agents. If the pulse is deep, tight, yet hollow and large, it indicates this pattern. Without using tonifying formulas and instead employing drastic purgative methods, disaster will follow immediately.