【脉】 寸口弦紧，为寒疝。弦则卫气不行，卫气不行则恶寒，紧则不欲食。寸
口迟缓，迟
则为寒，缓为气之虚，虚寒相搏而痛。脉沉紧豁大者，为虚。脉滑为疝，急为疝，搏为疝，
见于何部而知其何脏。
【因证】 盖全在肝经。因湿热在经，抑遏至久，又感外寒，湿被郁而作痛；或
大劳则火起于筋，醉饱则火起于胃，房则火起于肾，大怒则火起于本经。
火郁之甚，湿热便盛，浊液凝聚，并入血隧，流于肝经，为寒所束，宜其痛甚。因痰饮
积流入厥阴，聚结成核。因瘀结其本经，因虚而感，或内火外寒郁之。肝经与冲、任、督所
会，聚于阴器，伤于寒则阴缩入，伤于热纵挺不收。属木，性速急，火性暴而痛亦暴矣。
张论七疝∶
寒疝 因湿地、雨水、风冷处，使内过多。其状囊结硬如石，阴茎不举，或控睾
丸而痛，宜以温剂下之。久而无子。
水疝 因醉过内，汗出遇风湿之气聚于囊中。其状肾囊肿痛如水晶，或痒搔出黄
水，小腹或按之作水声，阴汗，治宜逐水。
筋疝 因房劳及邪术所使。阴茎肿或溃脓，或痛而里急，筋速缩，或挺不收，或
白物如精，或茎痛之极则痒，宜降火下之。
血疝 因使内气血流溢，渗入脬囊，留而不去，结成痈脓。多血，状如黄瓜，在
小腹两旁，横骨约中，俗云便痈，治宜和血。
气疝 因号哭忿怒，气郁而胀，哭怒罢则散。其状上连肾区，下及阴囊，宜以散
气药下之。小儿有此，因父精怯，故不治。
狐疝 与气疝大同小异。状如仰瓦，卧则入小腹，行之则出入囊中，宜逐气流经
之剂下之。
疝 因地卑湿，江淮间所生。其状如升、斗，不痒不痛，宜去湿之药下之。女
子阴户突出，虽相类，乃热不禁固也。
《三因》有四 ∶
肠 因房室过度，元脏虚冷，肠边 系不收，坠入 中，上下无定，此难治。
气 因七情脏气下坠，阴 肿胀急痛，易治。
水 因湿气得之，则肿胀其阴，易治之。
卵 因劳役坐马，致卵核肿胀，或偏有大小，上下无常，此难治也。
外有妇人阴门挺出，亦名 病。
丁香楝实丸 已下出李。
当归（酒制，去芦） 炮附 川楝 茴香（以上各一两）
锉，好酒三升，同煮。酒尽焙干作末，入下药∶丁香 木香（各五分） 全蝎（十三个）
玄胡索（五钱）
上同为末，酒糊丸，梧子大。每服三十丸至百丸，温酒下。
参术汤 治虚疝脉豁大者是。
人参 白术 山栀 香附
仓卒散 治寒疝入腹卒痛，小肠膀胱气绞，腹冷重如石，出白汗。
山栀（四十九个，烧半过） 生附子
酒煎二钱。
又一方 乌代附。
神应散 治诸疝心腹绞痛不忍，此方能散气开结。
玄胡索 胡椒 或加茴香。酒煎二钱。
牡丹丸 治寒疝心腹刺痛及血。
川乌（炮，去皮尖） 牡丹皮（四两） 桃仁（炒，去皮尖） 桂（各五两） 青皮（一两）
蜜丸，酒下。
桃仁汤 治 疝。
大桃仁（如法） 茱萸 桂枝 蒺藜 青皮 白茯苓 槟榔 木香 海藻 三棱 莪术（
任意加减）
张用导水、禹功、猪肾、通经等散下之。
秘方 治诸疝。
枳实（治痛） 山栀 茱萸 橘子 山楂（去核积） 桃仁（瘀血加之） 川乌（劫痛同栀）
桂枝（不定必用） 荔枝核（湿则加之） 青皮
守丸 治 要药，不痛。
苍术 南星 半夏 白芷（散水） 川芎 枳实 山楂
应痛丸 治败精恶物不出，结成疝，痛不忍。
阿魏二两，醋和荞麦面裹，火煨熟；槟榔大者二个，刮空，滴乳香满盛，将刮下末，用
荞麦
拌作饼，慢火煨。上细末，入 砂一钱，赤芍一两，同为末，面糊搜和，丸如梧子大，盐酒
下。
雄黄散 治阴肿大如斗，核痛不治。
雄黄（一两） 明矾（五钱） 甘草（五钱）
煎洗。
又方 天萝筋烧灰，治疝妙。
【脉象】
寸口脉呈现弦紧之象，是寒疝的表现。脉弦说明卫气运行不畅，卫气运行不畅则出现恶寒；脉紧说明食欲不振。寸口脉迟缓，迟脉主寒，缓脉主气虚，虚与寒相互搏结而导致疼痛。脉象沉紧且豁大（中空无力）的，属于虚证。脉滑、脉急、脉搏动有力的，都是疝气的表现，需要根据脉象出现的部位来判断是哪一脏腑受病。
【病因与证候】
疝气的病变主要在于肝经。由于湿热蕴结在经脉中，郁遏日久，又感受了外寒，湿气被郁滞而引发疼痛；或者在大劳累时，火气生于筋脉；醉酒后饱食，火气生于胃；房事过度，火气生于肾；大怒时，火气生于本经（肝经）。火郁积得很严重，湿热便旺盛，浊液凝聚，并入血脉通道，流注于肝经，被寒气束缚，所以疼痛剧烈。因为痰饮积聚流入厥阴肝经，聚结形成肿块。因为瘀血结滞在本经，因正气虚弱而感邪，或者是内火与外寒相互郁结。肝经与冲脉、任脉、督脉交会，汇聚于阴器部位，受到寒邪侵袭则阴茎收缩入腹，受到热邪侵袭则纵挺不收。肝属木，其性急速紧急，火性暴烈，所以疼痛也来得猛烈。
张仲景论述七种疝气：
寒疝：因居住在潮湿之地、雨水之中或风冷之处，加上房事过多所致。症状表现为阴囊结硬如石，阴茎不能勃起，或者牵引睾丸疼痛，应当用温里攻下的药物治疗。久治不愈会导致不育。
水疝：因醉酒后面色红润行房，汗出后遭遇风湿之气，聚集于阴囊中。症状表现为肾囊肿痛如同水晶般透明，或者瘙痒抓挠流出黄水，小腹按压时有水声，阴部多汗，治疗应当逐水。
筋疝：因房劳过度及邪术所致。阴茎肿胀或溃烂流脓，或者疼痛伴有里急后重，筋脉迅速收缩，或者纵挺不收，或者有白色分泌物如精液，或者茎部疼痛至极则发痒，应当降火攻下。
血疝：因行房时气血流溢，渗入膀胱和阴囊，停留不去，结成痈脓。多血，形状像黄瓜，位于小腹两旁，横骨中间，俗称“便痈”，治疗应当调和血液。
气疝：因大声哭叫或愤怒，导致气机郁滞而胀满，哭怒停止后胀满消散。症状表现为上连肾区，下及阴囊，应当用理气药攻下。小儿有此病，是因为父亲精气怯弱，故难以治愈。
狐疝：与气疝大同小异。形状像仰放的瓦片，躺下时进入小腹，行走时出入于阴囊中，应当用逐气流经的药物攻下。
㿗（wāi）疝：因地势低洼潮湿，江淮地区所生。症状如升、斗状，不痒不痛，应当用祛湿药攻下。女子阴户突出，虽然相似，却是热邪导致固摄不禁所致。
《三因方》中有四种疝：
肠疝：因房室过度，元脏虚冷，肠边的系膜松弛不收，坠入阴囊中，上下移动不定，此症难治。
气疝：因七情导致脏气下坠，阴囊肿胀急痛，容易治疗。
水疝：因湿气侵袭，导致阴囊肿胀，容易治疗。
卵疝：因劳累、骑马，导致睾丸肿胀，或者偏大偏小，上下无常，此症难治。
此外还有妇人阴门挺出，也称为疝病。
丁香楝实丸：此前已列出李氏方。
当归（酒制，去芦头）、炮附子、川楝子、茴香（以上各一两）。
切碎，用好酒三升，同煮。酒干后焙干研末，加入以下药物：丁香、木香（各五分）、全蝎（十三个）、玄胡索（五钱）。
以上共同研为细末，用酒糊制作成梧桐子大小的丸剂。每次服用三十丸至一百丸，温酒送服。
参术汤：治疗虚疝，脉象豁大的适用此方。
人参、白术、山栀、香附。
仓卒散：治疗寒疝入腹突然剧痛，小肠膀胱气绞，腹部冰冷沉重如石，出冷汗。
山栀（四十九个，烧至半焦）、生附子。
酒煎二钱。
另一方法是用乌头代附子。
神应散：治疗各种疝气引起的心腹绞痛难以忍受，此方能散气开结。
玄胡索、胡椒。也可以加茴香。酒煎二钱。
牡丹丸：治疗寒疝引起的心腹刺痛及血瘀。
川乌（炮制，去皮尖）、牡丹皮（四两）、桃仁（炒，去皮尖）、桂枝（各五两）、青皮（一两）。
蜜丸，酒送服。
桃仁汤：治疗㿗疝。
大桃仁（依法处理）、吴茱萸、桂枝、蒺藜、青皮、白茯苓、槟榔、木香、海藻、三棱、莪术（任意加减）。
张氏主张用导水散、禹功散、猪肾散、通经散等配合使用。
秘方：治疗各种疝气。
枳实（用于止痛）、山栀、吴茱萸、橘子、山楂（去核积）、桃仁（有瘀血时加）、川乌（劫痛同山栀一起用）、桂枝（不一定必用）、荔枝核（有湿时加）、青皮。
守丸：治疗㿗疝的要药，主治不痛的类型。
苍术、南星、半夏、白芷（散水湿）、川芎、枳实、山楂。
应痛丸：治疗败精恶物不出，结成疝气，疼痛难忍。
阿魏二两，用醋和荞麦面包裹，火煨熟；大槟榔两个，刮空，滴入乳香盛满，将刮下的粉末，用荞麦拌作饼，慢火煨。以上研为细末，加入砂仁一钱，赤芍一两，共同研末，用面糊调和，制成梧桐子大小的丸剂，盐酒送服。
雄黄散：治疗阴囊肿大如斗，睾丸疼痛难治。
雄黄（一两）、明矾（五钱）、甘草（五钱）。
煎水清洗。
另一方：天萝筋烧成灰，治疗疝气效果奇妙。
[Pulse]
The pulse at the Cun Kou (radial artery) appearing wiry and tight indicates Cold Hernia (Han She). A wiry pulse suggests that Wei Qi (Defensive Qi) is not circulating freely; when Wei Qi circulation is obstructed, aversion to cold occurs. A tight pulse indicates loss of appetite. A slow and moderate pulse at the Cun Kou: slowness indicates cold, while moderation indicates deficiency of Qi. The interplay of deficiency and cold leads to pain. A deep, tight, and hollow (large and empty upon pressure) pulse indicates a deficiency pattern. Slippery, rapid, or forceful pulses are signs of hernia; the specific organ involved can be determined by the location where these pulses are felt.
[Etiology and Symptoms]
The pathology of hernia primarily resides in the Liver Meridian. Damp-heat accumulates in the meridians, stagnating for a long time, and is further constrained by external cold, causing dampness to stagnate and generate pain. Alternatively, excessive labor causes fire to arise from the sinews; drunkenness and overeating cause fire to arise from the Stomach; sexual excess causes fire to arise from the Kidney; and extreme anger causes fire to arise from this meridian (Liver). When fire stagnation becomes severe, damp-heat flourishes, turbid fluids condense, enter the blood vessels, flow into the Liver Meridian, and are bound by cold, resulting in severe pain. Phlegm-fluids accumulate and flow into the Jueyin (Liver) meridian, gathering to form nodules. Blood stasis knots within this meridian; due to deficiency, pathogens invade, or internal fire and external cold constrain each other. The Liver Meridian intersects with the Chong, Ren, and Du vessels, converging at the genital organs. Injury by cold causes retraction of the penis; injury by heat causes protrusion and inability to retract. The Liver belongs to Wood, its nature is swift and urgent; Fire nature is violent, so the pain is also sudden and severe.
Zhang Zhongjing discusses seven types of hernia:
Cold Hernia (Han She): Caused by living in damp places, rain, or windy/cold areas, combined with excessive sexual activity. Symptoms include a scrotum hard as stone, impotence, or pain radiating to the testicles. Treatment requires warming and purgative agents. If untreated for a long time, it may lead to infertility.
Water Hernia (Shui She): Caused by sexual activity after drunkenness, followed by exposure to wind-dampness while sweating. Symptoms include swelling and pain in the scrotum resembling crystal, itching with yellow discharge, or water sounds upon pressing the lower abdomen, along with sweaty genitals. Treatment requires draining water.
Sinew Hernia (Jin She): Caused by sexual exhaustion and evil arts. Symptoms include penile swelling, ulceration with pus, pain with tenesmus, rapid contraction of sinews, or protrusion without retraction, white discharge resembling semen, or extreme penile pain turning into itching. Treatment requires clearing fire and purging.
Blood Hernia (Xue She): Caused by the overflow of Qi and Blood during sexual activity, seeping into the bladder and scrotum, remaining and forming abscesses/pus. It involves much blood, resembling a cucumber, located on both sides of the lower abdomen near the pubic bone, commonly called "Bian Yong" (Perineal Abscess). Treatment requires harmonizing blood.
Qi Hernia (Qi She): Caused by loud crying or anger, leading to Qi stagnation and distension, which dissipates when crying/anger ceases. Symptoms extend from the kidney region to the scrotum. Treatment requires dispersing Qi agents. In children, this is caused by the father's weak essence and is difficult to treat.
Fox Hernia (Hu She): Similar to Qi Hernia but with slight differences. It resembles an inverted tile; it enters the lower abdomen when lying down and moves into the scrotum when walking. Treatment requires agents that drain Qi and unblock meridians.
Wa Hernia (Wai She): Occurs in low-lying, damp areas like the Jianghuai region. Symptoms resemble a measuring cup or bucket, with no itching or pain. Treatment requires damp-dispelling agents. In women, prolapse of the vagina, though similar, is due to heat failing to secure and hold.
The *San Yin Fang* describes four types:
Intestinal Hernia: Caused by excessive sexual activity and deficiency-cold of the Yuan Zang (Primordial Organ), causing the mesenteric ligaments to relax and fail to retain the intestine, which drops into the scrotum, moving up and down unpredictably. This is difficult to treat.
Qi Hernia: Caused by the downward sinking of Zang Qi due to the Seven Emotions, leading to swollen, painful, and tense scrotum. This is easy to treat.
Water Hernia: Caused by dampness invading, leading to scrotal swelling. This is easy to treat.
Testicular Hernia: Caused by fatigue or horse riding, resulting in swollen testicles, unequal size, or unpredictable movement up and down. This is difficult to treat.
Additionally, prolapse of the female vulva is also named Hernia Disease.
Dingxiang Lianshi Wan (Clove and Toosendan Pill): Previously listed by Li.
Dang Gui (prepared with wine, remove radicle), Pao Fu Zi (processed Aconite), Chuan Lian Zi (Sichuan Toosendan), Huixiang (Fennel) (each 1 liang).
Chop, boil together in 3 sheng of good wine until dry, then dry and powder. Add the following drugs: Ding Xiang (Cloves), Mu Xiang (Aucklandia) (each 5 fen), Quan Xie (Whole Scorpion) (13 pieces), Yan Hu Suo (Corydalis) (5 qian).
Grind all into fine powder, mix with wine paste to make pills the size of wu zi (wu berry). Take 30 to 100 pills per dose, washed down with warm wine.
Shen Zhu Tang (Ginseng and Atractylodes Decoction): Treats deficiency hernia with a hollow-large pulse.
Ren Shen (Ginseng), Bai Zhu (Atractylodes), Shan Zhi (Gardenia), Xiang Fu (Cyperus).
Cang Cu San (Hasty Powder): Treats cold hernia entering the abdomen causing sudden severe pain, twisting qi in the small intestine and bladder, cold and heavy abdomen like stone, and cold sweat.
Shan Zhi (49 pods, roasted half-way), Sheng Fu Zi (Raw Aconite).
Decoct 2 qian in wine.
Alternative method: Use Wu Dai Fu Zi (Black-processed Aconite).
Shen Ying San (Divine Response Powder): Treats various hernias causing unbearable heart and abdominal colic; this formula disperses Qi and resolves knots.
Yan Hu Suo (Corydalis), Hu Jiao (Pepper). Can add Huixiang (Fennel). Decoct 2 qian in wine.
Mudan Wan (Tree Peony Pill): Treats cold hernia causing stabbing heart/abdominal pain and blood stasis.
Chuan Wu (Processed Sichuan Aconite, skin and tip removed), Mu Dan Pi (Tree Peony Bark) (4 liang), Tao Ren (Peach Kernel, fried, skin and tip removed), Gui Zhi (Cinnamon Twig) (each 5 liang), Qing Pi (Green Tangerina Peel) (1 liang).
Make honey pills, take with wine.
Tao Ren Tang (Peach Kernel Decoction): Treats Wa Hernia.
Da Tao Ren (Large Peach Kernel, processed), Zhu Yu (Evodia), Gui Zhi (Cinnamon Twig), Ji Li (Tribulus), Qing Pi (Green Tangerina Peel), Bai Fu Ling (Poria), Bing Lang (Areca Nut), Mu Xiang (Aucklandia), Hai Zao (Seaweed), San Leng (Burreed Rhizome), E Zhu (Curcuma Rhizome) (adjust as needed).
Zhang recommends using Dao Shui San, Yu Gong San, Zhu Shen San, Tong Jing San, etc., to assist.
Secret Formula: Treats various hernias.
Zhi Shi (Immature Bitter Orange) (for pain), Shan Zhi (Gardenia), Zhu Yu (Evodia), Ju Zi (Tangerine), Shan Zha (Hawthorn) (remove pits/stagnation), Tao Ren (Peach Kernel) (add for blood stasis), Chuan Wu (Sichuan Aconite) (for seizing pain, use with Gardenia), Gui Zhi (Cinnamon Twig) (not always necessary), Li Zhi He (Lychee Seed) (add if damp), Qing Pi (Green Tangerina Peel).
Shou Wan (Guard Pill): Key medicine for Wa Hernia, treating non-painful cases.
Cang Zhu (Atractylodes), Nan Xing (Arisaema), Ban Xia (Pinellia), Bai Zhi (Angelica Dahurica) (disperses water), Chuan Xiong (Ligusticum), Zhi Shi (Immature Bitter Orange), Shan Zha (Hawthorn).
Ying Tong Wan (Responding Pain Pill): Treats hernia formed by retained bad essence and foul matter that cannot exit, causing unbearable pain.
A Wei (Asafoetida) 2 liang, wrapped in buckwheat flour mixed with vinegar, roasted in fire; two large Bing Lang (Areca Nuts), hollowed out, filled with Ru Xiang (Frankincense), mixed with the scraped powder and buckwheat to form cakes, slowly roasted. Grind into fine powder, add Sha Ren (Amomum) 1 qian, Chi Shao (Red Peony Root) 1 liang, grind together, mix with flour paste to make pills the size of wu zi. Take with salted wine.
Xiong Huang San (Realgar Powder): Treats massive scrotal swelling like a bucket and testicular pain that is difficult to cure.
Xiong Huang (Realgar) (1 liang), Ming Fan (Alum) (5 qian), Gan Cao (Licorice) (5 qian).
Decoct for washing.
Another method: Burn Tian Luo Jin (Trichosanthes Vine) to ash; excellent for treating hernia.