或问疝病，古方有以为小肠气者，有以为膀胱气者。唯子和、丹溪专主肝经而言，其说不同，何
以辨之？曰∶小肠气，小肠之病。膀胱气，膀胱之病。疝气，肝经之病。三者自是不一，昔人以小肠、
膀胱气为疝者误也。殊不知足厥阴之经，环阴器，抵少腹，人之病此者，其发睾丸胀痛，连及少腹，
则疝气之系于肝经可知矣。小肠气，俗谓之横弦竖弦，绕脐走注，少腹攻刺。而膀胱气则在毛际之上，
小腹之分作痛，与疝气之有形如瓜，有声如蛙，或上于腹，或下于囊者不同也。但小肠、膀胱因经络
并于厥阴之经，所以受病连及于肝，则亦下控引睾丸为痛，然止是二经之病，不可以为疝也。赵以德
曰∶此条本为睾丸之症立名，然《内经》以疝者痛也，有腹中脏腑之痛，一以疝而名者，故通叙于此。
其腹中五脏之疝，得以就此而考焉，
有睾丸之痛。《内经》谓任脉为病，男子内结七疝，女子带下瘕聚。冲脉为病，逆气里急。然称任脉
有七疝名、无疝之状，及按诸篇以双字命其名者，曰 疝者，以三阳为病，发寒热，痿厥，其传为
疝。及阳明司天与之胜，肝是动病，足阳明筋病，皆为 疝。谓厥疝者，面黄，脉之至，大而虚，有
积气在腹中，有厥气，名曰厥疝。谓疝瘕者，脾传之肾，病名疝瘕，少腹冤热而痛，出白，一名曰蛊。
谓冲疝者，以冲、任、督生病，上冲心痛，不得前后。谓卒疝者，邪客厥阴之络，则卒疝暴痛，与厥
阴别，蠡沟气逆，亦睾丸卒痛。谓 癃疝者，厥阴之阴盛而脉胀不通。谓狐疝者，肝所生病也。殆非
及此双字之名者，由任脉行诸经之会，而有七疝者欤。此外独称一字疝者，则有太阴在泉，主胜寒气
厥阳，甚则为疝；有太阳在泉，小腹控睾，上引心痛；有小腹痛，不得大小便，名曰疝，得之寒；有足
太阴筋，病阴器纽痛，上引脐；有心疝脉急，小肠为使，少腹当有形；有肾脉
大急沉，皆为疝。心脉搏滑急为心疝。肺脉沉搏为肺疝。三阴急为疝。《灵枢》有谓心脉微滑为心疝。
肝脉滑甚为 疝。脾脉微大为疝气，腹中裹大脓血在肠胃之外。滑甚为 癃。肾脉滑甚为癃 。诸脉
之滑者，为阳气甚盛，微有热。夫如是者，名为七疝，中分邪气之寒热者也。《内经》又云∶少阳脉
滑，病肺风疝。太阴脉滑，病脾风疝。阳明脉滑，病心风疝。太阳脉滑，病肾风疝。少阳脉滑，病肝
风疝。所言风者，非外人之风，由肝木阳脏动之风也。故经云∶脉滑曰风。然连以疝称者，盖肾肝同
居下焦，而足厥阴佐任脉之生化，因肝肾之气并逆，所以任之阴气为疝，肝之阳气为风，所以风疝连
称也。李东垣谓脉滑者为丙丁火，热并于下，不胜壬癸，从寒水之化，故生 疝，亦用热治。《内经》
初不见于尺部而言也，岂不为外寒郁内热之故，乃曰热火从寒化，恐理未当。而经更有茎垂者，身中
之机，阴阳之候，津液之道也。或饮食不节，喜怒不时，津液内溢，下流于睾，血道
不通，日久不休，俯仰不便， 翔不能，此病荥然有水，不上不下，若此者，亦 疝之一也。张仲景
言疝，皆由寒邪得之，亦同《内经》之云，脉者当温散之。或曰《内经》言疝，似若各从诸经脉所生，
今子何为尽属于任脉乎。曰∶任脉是疝病之本源，各经是疝病之支流。何以言之？盖肾脏以四方分部
者言，则属五行之寒水。以居在下位者言，则属地道之阴。阴形偶，故肾有两，两其形则地道之刚柔
立焉。胞居两形之间，出纳肾脏之精血，以行坤土之化，生成百骸万象，及夫生长壮者已之，天癸与
作强伎巧之用悉在于斯。然而坤土居尊，不自司其职，司其职者乃冲任二脉，起于胞中者，行其化也。
是故五脏六腑之经，皆受气于六脉，因以海名之。所以二脉贵乎流通，而恶闭塞，流通则天之阳气下
降，与之从事，故施化之道行，闭塞则天之阳绝，故地之阴亦结，而百病作矣。疝者是其二也，所致
任脉之病者，若刚柔自相胜负，与内外邪之感伤，皆得使其阴阳不和，阴偏胜则寒气冲击，阳偏胜则
热气内入，阴反之外，悉致任脉为疝。纵其邪不自任脉而起，初由各
经所受而得者，亦必与任脉相犯故也。所犯者何？或所胜之经脉相传，或受不以次所乘，或任脉过处
与受邪之经相会，或六经受气之际，挟邪犯其海，则皆足以感动任脉，内舍结固不化之阴，上击脏腑，
则为腹中之疝，下入厥阴，会于阴器，则为睾丸之疝。盖疝自立名，独为任脉所职，在地之阴，特然
起击者而命之也。若诸经受邪，不与任脉相干，则不名为疝矣。不然，何《内经》举痛篇、《灵枢》
百病始生篇专为发明经脉腹中诸痛者，乃无一字名其疝也。始可见任脉者，是疝病之本源，诸经所云
疝者，是其支流余裔耳。若夫巢氏所叙七疝者，曰∶厥疝、 疝、寒疝、气疝、盘疝、 疝、野狼疝也。
其厥逆心痛，诸饮食吐不下，名曰厥疝。腹中气乍满，心下尽痛，气积如臂，名曰 疝。寒饮食即胁
下腹中尽痛，名曰寒疝。腹中乍满乍减而痛，名曰气疝。腹中痛在脐旁，名曰盘疝。腹中脐下有积聚，
名曰 疝。小腹与阴相引而痛，大便难，名曰野狼疝。及言诸疝之候，止以阴气积于内，为寒气所加，
使荣卫不调，血气虚弱，故风冷入于腹内而成疝也。小儿 者，阴核肿大，由啼哭 气不止，动于阴
气，结聚不散所致者也。观于五疝，皆是痛在心腹之疝也。独举 疝属小儿病者耳。后人述其说，更
举《内经》谓脾风传之于肾，名曰疝瘕，
少腹冤热而痛，一名曰蛊者，谓之蛊病。又立阴疝条，即 疝也。将以足七疝之数。此言五条为心腹
痛者之治疗，则曰∶若因七情所伤者，当调气安其五脏。外邪所干者，当温散之。治之不当，内外之
气交入于肾者为肾气，入于膀胱者为膀胱气，入于小肠者为小肠气。肾与膀胱一脏一腑，其气通于外
肾，小肠系于睾丸，系会故也。又谓阴疝一名 疝，其种有四积，肠 、气 、卵胀、水 是也。若
寒温之气，有连于小肠者，即小腹控睾丸而痛，阴丸上下，谓之肠 。寒气客于经筋，足厥阴脉受邪，
脉胀不通，邪结于睾卵，谓之卵胀。肾虚之人，因饮食不节，喜怒不时，津液内结，谓之水 。至张
戴人非之曰，此俗工所立谬名也。盖环阴器上抵少腹，乃属足厥阴肝经之部分，是受疝之处也。或在
泉寒胜，水气挛缩郁于此经。或司天燥胜，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，闭尾缩精壅于此经。了不相干膀胱、肾、小肠之事，乃厥阴肝经之职也。凡疝者，非肝木受
邪，则肝木自甚也。由是于阴疝中亦立七疝之名，曰寒疝、水疝、筋疝、血
疝、气疝、狐疝、 疝也。寒疝，其状囊冷结硬如石，阴茎不举，或连控睾丸而痛。得于坐卧湿地及
砖石，或冬月涉水，或值雨雪，或风冷处使内过劳。宜以温剂下之。久而无子。水疝，其状肾囊肿痛，
阴汗时出，或囊肿状如水晶，或囊痒搔出黄水，或小腹按之作水声。得之饮水醉酒，使内过劳，汗出
而遇风，寒湿之气聚于囊中，故水多令人为卒疝，宜以逐水之剂下之。筋疝，其状阴茎肿胀，或溃、
或脓、或痛，而里急筋缩，或茎中痛，痛极则痒，或挺纵不收，或白物如精随溲而下。得于房室劳伤，
及邪术所使。宜以降心火之药下之。血疝，其状如黄瓜，在小腹两旁，横骨两端约中，俗云便痈。得
于春夏重感大燠，劳于使内，气血流溢，渗入脬囊，留而不去，结成痈肿，脓少血多。宜以和血之剂
下之。气疝，其状上连肾区，下及阴囊，或因号哭忿怒，则气郁乏而胀，怒哭号罢，则气散者是也。
宜以散气之剂下之。或小儿亦有此疾，俗曰偏气。得于父已年老，或年少多病，阴痿精怯，强力入房，
因而有子，胎中病也。此病不治。狐疝，其状如瓦，卧则入小腹，行立则出小腹入囊中。狐则昼出穴
而溺，夜入穴而不溺。此疝出入上下往来，正与狐相类，亦与
气疝大同小异，令人带钩钤是也。宜以逐气流经之药下之。 疝，其状阴囊肿缒，如升如斗，不痒不
痛是也。得之地气卑湿所生。故江淮之间，湫塘之处，多感此疾。宜以去湿之药下之。诸疝下去之后，
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，其论
如此。戴人既曰用《内经》、《灵枢》、《明堂》之论，要穷疝病之源，而不及于任脉生病之源何也？
盖因力辨阴器与小肠、肾、膀胱了不相干，是属足厥阴部分受病之原立说，所以不及于任脉。然已三
见于论中矣。其间引治疝之穴，多与任脉所会一也。又称冲、任、督与厥阴会于曲骨，环阴器二也。
复言凡精滑白淫，皆男子之疝也。血涸不月，罢腰，膝上热，嗌干，少腹有块，女子之疝也。但女子
不谓之疝而谓之瘕，即任脉内结之病尤明者三也。凡戴人辩论之词，强直专主其一，则不复顾其二，
在疝中有无六经外证之可辨，若果有膀胱、小肠之证者，又安得不从之。如《灵枢》谓小肠病者，
小腹痛，腰脊控睾丸而痛之类。论治法亦然。因病在下必先下之，更不问虚弱之人于首尾，不可下者
下之，有不旋踵之祸，岂待下后始补，而可回其生乎。然而戴人之书，其词直，其义明，读之使人豁
然，以去胸中之茅塞，诚是诸医书之冠，及乎详
玩之，则少温润反复之意。且夫阴阳变化，生病于无穷，治法亦无穷，非一人所能究学人。当因其已
明，益其未至，然后得为善用其书者。丹溪先生尝论睾丸连小腹急痛者，或有形，或无形，或有声，
或无声，人皆以为经络得寒收引不行而作痛，不知此病始于湿热，郁遏至久，又感外寒，湿热被郁而
作痛也。其初致湿热之故，盖大劳则火起于筋，醉饱则火起于胃，房劳则火起于肾，大怒则火起于肝。
火郁之久，湿气便盛，浊液凝聚，并入血隧，流于厥阴。肝属木，性急速，火性又暴烈，为寒所束，
宜其痛甚而暴也。此论亦就厥阴受病处发明戴人之未至者也，诚有功于后学。盖 疝不离此三者之邪，
热则纵，寒则痛，湿则肿，须分三者多少而治之。两丸俱病固然也，设有偏于一者，予又不能无其说
焉。肾有两，分左右，其左肾属水，水生肝木，木生心火，三部皆司血，统纳左之血者，肝术之职也。
其右属火，火生脾土，土生肺金，三部皆司气，统纳右之气者，肺金之职也。是故诸寒收引则血泣，
所以寒血从而归肝，下注于左丸。诸气愤郁则湿聚，所以气湿从而归肺，下注于右丸。且夫睾丸所络
之筋，非尽由厥阴，而太阴、阳明之筋亦入络也。往往见人偏患于左丸者，则痛多肿少。偏于右丸者，
则痛少肿多。此便可验也。姑书治效
者一二症以明之。予壮年啖柑橘过多，积成饮癖，在右胁下隐隐然，不敢复啖数年已。一日山行，大
劳饥渴甚，遇橘芋食之，橘动旧积，芋复滞气，实时右丸肿大，寒热交作，因而思之，脾肺皆主右，
故积饮滞气下陷，太阴、阳明之经筋俱伤，其邪从而入于囊中，着在睾丸筋膜而为肿胀。张戴人有言，
病分上下治，虽是木郁为疝，在下则不可吐，亦当从下引而竭之。窃念病有不同，治可同乎。今犯饥
劳伤脾，脾气下陷，必升举之，则胃气不复下陷而积可行，若用药下之，恐重陷胃气也。先服调胃剂
一二帖，次早注神使气至下焦，呕逆而上，觉肋下积动到中焦，则吐而出之，吐后 肿减半，次早复
吐，吐后和胃气疏通经络，二三日愈。凡用此法治酒伤与饮水注右丸肿者皆效。又治一人病后饮水，
患左丸痛甚，灸大敦，用摩腰膏，内用乌、附、丁、麝者，以摩其囊上，抵横骨端，炙温帛覆之，痛
即止，一宿肿亦全消矣。
历代独治外束之寒《发明》云∶男子七疝痛不可忍者，妇人瘕聚带下，皆任脉所主阴经也。乃肝
肾受病，治法同归于一，宜丁香楝实丸。凡疝气带下，皆属于风，全蝎治风之圣药也。川楝、茴香皆
入小肠经，当归、玄胡索活血止痛。疝气带下，皆积寒邪入于小肠之间，故用附子佐之。丁香、木香
为引导药也。罗谦甫治火儿赤
纽邻久病疝气，复因七月间饥饱劳役，过饮潼乳所发，甚如初，面色青黄不泽，脐腹阵痛，搐撮不可
忍，腰曲不能伸，热物熨之稍缓，脉得细小而急。《难经》云∶任之为病，男子内结七疝，皆积寒于
小肠之间所致也。非大热之剂，即不能愈。遂制一方，名之曰沉香桂附丸。脐下撮急疼痛，并脐下周
身一遭皆急痛，小便频数清，其五脉急洪缓涩沉，按之皆虚，独肾脉按之不急，皆虚无力，名曰肾疝。
宜丁香疝气丸。男子妇女疝气，脐下冷痛，相引腰胯而痛，宜当归四逆汤。《发明》天台乌药散、川
苦楝散、《简易》木香楝子散，皆用巴豆炒药。许学士云∶大抵此疾，因虚而得之，不可以虚骤补。
邪之所凑，其气必虚，留而不去，其病则实。故必先涤去所蓄之邪热，然后补之。是以诸药多借巴豆
有人问疝病，古代医方有的认为是小肠气，有的认为是膀胱气。只有刘完素（字守真，号子和）和朱震亨（字彦修，号丹溪）专门从肝经的角度来论述，他们的说法不同，如何辨别呢？回答说：小肠气，是小肠的病变；膀胱气，是膀胱的病变；疝气，是肝经的病变。这三者本来就不一样，古人把小肠、膀胱气当作疝气是错误的。殊不知足厥阴肝经，环绕外生殖器，抵达少腹部，人患此病时，发作起来睾丸胀痛，牵连到少腹，那么疝气归属于肝经就可以知道了。小肠气，俗称横弦或竖弦，疼痛绕着肚脐游走窜动，少腹部有攻刺样的疼痛。而膀胱气的疼痛则在耻骨联合上方、小腹部位，与疝气有形如瓜状、有声如蛙鸣，或者肿物上至于腹、下坠于阴囊的情况是不同的。但是小肠、膀胱因为经络并入足厥阴肝经，所以患病时会牵连到肝，也会出现向下牵引睾丸疼痛的症状，但这只是这两条经脉的病变，不能称为疝气。赵以德说：这一条原本是为睾丸症状立名的，然而《黄帝内经》说“疝”就是痛的意思，有腹中脏腑的疼痛，一概以“疝”来命名，所以通篇叙述于此。其中的腹中五脏之疝，可以借此考证。
有睾丸疼痛的病症。《黄帝内经》说任脉发病，男子体内结聚成七种疝，女子带下及瘕聚。冲脉发病，气逆且里急。然而称任脉有七种疝的名称，却没有疝的具体形态描述，以及查阅各篇章中以双字命名的疝，如“痃疝”，说是三阳经发病，发作时寒热往来，痿软厥冷，传变后成为痃疝。以及阳明司天与其胜气相搏，肝经变动之病，足阳明筋病，都称为痃疝。所谓厥疝，面色黄，脉搏大而虚，腹中有积气，有厥逆之气，名叫厥疝。所谓疝瘕，脾病传肾，病名疝瘕，少腹冤热而痛，排出白色分泌物，一名叫蛊。所谓冲疝，因冲、任、督脉生病，气上冲心痛，大小便不通。所谓卒疝，邪气客居厥阴络脉，则突然发生疝暴痛，与厥阴别络蠡沟气逆，也会导致睾丸突然疼痛。所谓癃疝，厥阴阴气盛而脉胀不通。所谓狐疝，是肝经所生的疾病。大概不是这些双字命名的疝，是因为任脉行于诸经交会之处，而有七疝的说法吗？此外单独称一字疝的，则有太阴在泉，主气胜寒气厥阳，严重时则为疝；有太阳在泉，小腹牵引睾丸，向上牵引心痛；有小腹痛，不能大小便，名叫疝，得自寒邪；有足太阴筋病，阴器扭转疼痛，向上牵引脐部；有心疝脉象紧急，小肠为使道，少腹部应当有形块；有肾脉大急沉，都称为疝。心脉搏动滑利紧急为心疝。肺脉沉搏为肺疝。三阴脉紧急为疝。《灵枢》说心脉微滑为心疝。肝脉滑甚为痃疝。脾脉微大为疝气，腹中包裹大脓血在肠胃之外。滑甚为癃。肾脉滑甚为癃。各种脉象滑利的，表示阳气极盛，微有热。像这样命名的七疝，中间区分了邪气的寒热。《黄帝内经》又说：少阳脉滑，病肺风疝。太阴脉滑，病脾风疝。阳明脉滑，病心风疝。太阳脉滑，病肾风疝。少阳脉滑，病肝风疝。所说的风，不是外来的风，是由肝木阳脏发动的风。所以经文说：脉滑叫做风。然而连用疝称呼的，大概因为肝肾同居下焦，而足厥阴肝经辅助任脉的生化，因肝肾之气并逆，所以任脉的阴气表现为疝，肝的阳气表现为风，所以风疝连称。李东垣说脉滑者为丙丁火，热并于下，不胜壬癸水，从寒水之化，所以生痃疝，也用热药治疗。《黄帝内经》起初并没有在尺部提到这一点，难道不是因为外寒郁闭内热的原因，却说热火从寒化，恐怕道理不当。而且经文还有关于茎垂的描述，这是身体的机关，阴阳的征候，津液的道路。如果饮食不节制，喜怒不及时，津液内溢，向下流注于睾，血道不通，日久不愈，俯仰不便，行走困难，这种病荥然有水，不上不下，像这样的情况，也是痃疝的一种。张仲景说疝，都是由寒邪引起的，也同《黄帝内经》所说，脉象应当温散。有人说《黄帝内经》说疝，似乎各自从各经脉产生，现在您为什么全都归属于任脉呢？回答说：任脉是疝病的本源，各经是疝病的支流。为什么这样说？肾脏以四方分部来说，属于五行之寒水。以居于下位来说，属于地道之阴。阴形偶，所以肾有两个，两其形则地道之刚柔确立。胞宫居于两肾之间，出纳肾脏的精血，以行坤土之化，生成百骸万象，以及生长壮老已的过程，天癸与作强伎巧的作用全在于此。然而坤土居尊位，不自己掌管其职，掌管其职的是冲任二脉，起于胞中，行其化育。所以五脏六腑的经脉，都受气于六脉，因此称之为海。所以二脉贵在流通，而厌恶闭塞，流通则天之阳气下降，与之从事，所以施化之道行，闭塞则天之阳绝，所以地之阴也结滞，而百病产生了。疝就是其中之一。导致任脉生病的，如果刚柔自相胜负，与内外邪气的感伤，都能使其阴阳不和，阴偏胜则寒气冲击，阳偏胜则热气内入，阴反之外，都致使任脉成为疝。纵然邪气不从任脉而起，初由各经受邪而得，也必然与任脉相犯。所犯的是什么？或是所胜的经脉相传，或是不以次所乘，或任脉经过处与受邪之经相会，或六经受气之际，挟邪侵犯其海，都足以感动任脉，内舍结固不化的阴气，上击脏腑，则为腹中之疝，下入厥阴，会于阴器，则为睾丸之疝。大概疝自立名，独为任脉所职，在地之阴，特然起击者而命之。如果诸经受邪，不与任脉相干，则不名为疝了。不然，为什么《黄帝内经·举痛篇》、《灵枢·百病始生篇》专为发明经脉腹中诸痛，却没有一个字命名为疝呢。开始可以看出任脉是疝病的本源，诸经所说的疝，是其支流余裔罢了。至于巢元方所叙述的七疝，说：厥疝、痃疝、寒疝、气疝、盘疝、瘕疝、野狼疝。其厥逆心痛，各种饮食吐不下，名叫厥疝。腹中气乍满，心下尽痛，气积如臂，名叫痃疝。寒饮食即胁下腹中尽痛，名叫寒疝。腹中乍满乍减而痛，名叫气疝。腹中痛在脐旁，名叫盘疝。腹中脐下有积聚，名叫瘕疝。小腹与阴相引而痛，大便难，名叫野狼疝。以及说诸疝的证候，只以阴气积于内，为寒气所加，使营卫不调，血气虚弱，所以风冷入于腹内而成疝。小儿疝，是阴核肿大，由啼哭气不止，动于阴气，结聚不散所致。观察这五疝，都是痛在心腹的疝。唯独举出疝属于小儿病。后人阐述他的说法，更举《黄帝内经》说脾风传之于肾，名叫疝瘕，少腹冤热而痛，一名叫蛊的，叫做蛊病。又立阴疝条，即瘕疝。用来凑足七疝之数。这里说五条为心腹痛者的治疗，就说：如果因七情所伤的，当调气安其五脏。外邪所干的，当温散之。治疗不当，内外之气交入于肾的为肾气，入于膀胱的为膀胱气，入于小肠的为小肠气。肾与膀胱一脏一腑，其气通于外肾，小肠系于睾丸，系会故也。又说阴疝一名瘕疝，其种有四积，肠覃、气瘕、卵胀、水疝是也。如果寒温之气，有连于小肠的，即小腹控睾丸而痛，阴丸上下，谓之肠覃。寒气客于经筋，足厥阴脉受邪，脉胀不通，邪结于睾卵，谓之卵胀。肾虚之人，因饮食不节，喜怒不时，津液内结，谓之水疝。至张从正（字戴人）非议说，这是俗工所立的谬名。大概环阴器上抵少腹，乃属足厥阴肝经的部分，是受疝的地方。或在泉寒胜，水气挛缩郁于此经。或司天燥胜，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，闭尾缩精壅于此经。完全不相干膀胱、肾、小肠的事，乃是厥阴肝经的职掌。凡疝，不是肝木受邪，就是肝木自甚。由此在阴疝中也立七疝之名，说寒疝、水疝、筋疝、血疝、气疝、狐疝、瘕疝。寒疝，其状囊冷结硬如石，阴茎不举，或连控睾丸而痛。得于坐卧湿地及砖石，或冬月涉水，或值雨雪，或风冷处使内过劳。宜以温剂下之。久而无子。水疝，其状肾囊肿痛，阴汗时出，或囊肿状如水晶，或囊痒搔出黄水，或小腹按之作水声。得之饮水醉酒，使内过劳，汗出而遇风，寒湿之气聚于囊中，故水多令人为卒疝，宜以逐水之剂下之。筋疝，其状阴茎肿胀，或溃、或脓、或痛，而里急筋缩，或茎中痛，痛极则痒，或挺纵不收，或白物如精随溲而下。得于房室劳伤，及邪术所使。宜以降心火之药下之。血疝，其状如黄瓜，在小腹两旁，横骨两端约中，俗云便痈。得于春夏重感大燠，劳于使内，气血流溢，渗入脬囊，留而不去，结成痈肿，脓少血多。宜以和血之剂下之。气疝，其状上连肾区，下及阴囊，或因号哭忿怒，则气郁乏而胀，怒哭号罢，则气散者是也。宜以散气之剂下之。或小儿亦有此疾，俗曰偏气。得于父已年老，或年少多病，阴痿精怯，强力入房，因而有子，胎中病也。此病不治。狐疝，其状如瓦，卧则入小腹，行立则出小腹入囊中。狐则昼出穴而溺，夜入穴而不溺。此疝出入上下往来，正与狐相类，亦与气疝大同小异，令人带钩钤是也。宜以逐气流经之药下之。瘕疝，其状阴囊肿缒，如升如斗，不痒不痛是也。得之地气卑湿所生。故江淮之间，湫塘之处，多感此疾。宜以去湿之药下之。诸疝下去之后，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，其论如此。戴人既曰用《内经》、《灵枢》、《明堂》之论，要穷疝病之源，而不及于任脉生病之源何也？盖因力辨阴器与小肠、肾、膀胱了不相干，是属足厥阴部分受病之原立说，所以不及于任脉。然已三见于论中矣。其间引治疝之穴，多与任脉所会一也。又称冲、任、督与厥阴会于曲骨，环阴器二也。复言凡精滑白淫，皆男子之疝也。血涸不月，罢腰，膝上热，嗌干，少腹有块，女子之疝也。但女子不谓之疝而谓之瘕，即任脉内结之病尤明者三也。凡戴人辩论之词，强直专主其一，则不复顾其二，在疝中有无六经外证之可辨，若果有膀胱、小肠之证者，又安得不从之。如《灵枢》谓小肠病者，小腹痛，腰脊控睾丸而痛之类。论治法亦然。因病在下必先下之，更不问虚弱之人于首尾，不可下者下之，有不旋踵之祸，岂待下后始补，而可回其生乎。然而戴人之书，其词直，其义明，读之使人豁然，以去胸中之茅塞，诚是诸医书之冠，及乎详玩之，则少温润反复之意。且夫阴阳变化，生病于无穷，治法亦无穷，非一人所能究学人。当因其已明，益其未至，然后得为善用其书者。丹溪先生尝论睾丸连小腹急痛者，或有形，或无形，或有声，或无声，人皆以为经络得寒收引不行而作痛，不知此病始于湿热，郁遏至久，又感外寒，湿热被郁而作痛也。其初致湿热之故，盖大劳则火起于筋，醉饱则火起于胃，房劳则火起于肾，大怒则火起于肝。火郁之久，湿气便盛，浊液凝聚，并入血隧，流于厥阴。肝属木，性急速，火性又暴烈，为寒所束，宜其痛甚而暴也。此论亦就厥阴受病处发明戴人之未至者也，诚有功于后学。盖疝不离此三者之邪，热则纵，寒则痛，湿则肿，须分三者多少而治之。两丸俱病固然也，设有偏于一者，予又不能无其说焉。肾有两，分左右，其左肾属水，水生肝木，木生心火，三部皆司血，统纳左之血者，肝术之职也。其右属火，火生脾土，土生肺金，三部皆司气，统纳右之气者，肺金之职也。是故诸寒收引则血泣，所以寒血从而归肝，下注于左丸。诸气愤郁则湿聚，所以气湿从而归肺，下注于右丸。且夫睾丸所络之筋，非尽由厥阴，而太阴、阳明之筋亦入络也。往往见人偏患于左丸者，则痛多肿少。偏于右丸者，则痛少肿多。此便可验也。姑书治效者一二症以明之。予壮年啖柑橘过多，积成饮癖，在右胁下隐隐然，不敢复啖数年已。一日山行，大劳饥渴甚，遇橘芋食之，橘动旧积，芋复滞气，实时右丸肿大，寒热交作，因而思之，脾肺皆主右，故积饮滞气下陷，太阴、阳明之经筋俱伤，其邪从而入于囊中，着在睾丸筋膜而为肿胀。张戴人有言，病分上下治，虽是木郁为疝，在下则不可吐，亦当从下引而竭之。窃念病有不同，治可同乎。今犯饥劳伤脾，脾气下陷，必升举之，则胃气不复下陷而积可行，若用药下之，恐重陷胃气也。先服调胃剂一二帖，次早注神使气至下焦，呕逆而上，觉肋下积动到中焦，则吐而出之，吐后肿减半，次早复吐，吐后和胃气疏通经络，二三日愈。凡用此法治酒伤与饮水注右丸肿者皆效。又治一人病后饮水，患左丸痛甚，灸大敦，用摩腰膏，内用乌、附、丁、麝者，以摩其囊上，抵横骨端，炙温帛覆之，痛即止，一宿肿亦全消矣。
历代独治外束之寒。《本草发明》说：男子七疝痛不可忍者，妇人瘕聚带下，皆任脉所主阴经也。乃肝肾受病，治法同归于一，宜丁香楝实丸。凡疝气带下，皆属于风，全蝎治风之圣药也。川楝、茴香皆入小肠经，当归、玄胡索活血止痛。疝气带下，皆积寒邪入于小肠之间，故用附子佐之。丁香、木香为引导药也。罗谦甫治火儿赤纽邻久病疝气，复因七月间饥饱劳役，过饮潼乳所发，甚如初，面色青黄不泽，脐腹阵痛，搐撮不可忍，腰曲不能伸，热物熨之稍缓，脉得细小而急。《难经》说：任之为病，男子内结七疝，皆积寒于小肠之间所致也。非大热之剂，即不能愈。遂制一方，名之曰沉香桂附丸。脐下撮急疼痛，并脐下周身一遭皆急痛，小便频数清，其五脉急洪缓涩沉，按之皆虚，独肾脉按之不急，皆虚无力，名曰肾疝。宜丁香疝气丸。男子妇女疝气，脐下冷痛，相引腰胯而痛，宜当归四逆汤。《本草发明》天台乌药散、川苦楝散、《简易方》木香楝子散，皆用巴豆炒药。许学士说：大抵此疾，因虚而得之，不可以虚骤补。邪之所凑，其气必虚，留而不去，其病则实。故必先涤去所蓄之邪热，然后补之。是以诸药多借巴豆
A question was raised regarding hernia (Shan disease). Ancient prescriptions considered it either as Small Intestine Qi disorder or Bladder Qi disorder. Only Liu Wansu (courtesy name Shouzhen, pseudonym Hezi) and Zhu Zhenheng (courtesy name Yanxiu, pseudonym Danxi) exclusively focused on the Liver Meridian in their discussions. Their theories differ; how can they be distinguished? The answer is: Small Intestine Qi disorder is a pathology of the Small Intestine; Bladder Qi disorder is a pathology of the Bladder; Hernia (Shan Qi) is a pathology of the Liver Meridian. These three are inherently distinct. It was erroneous for ancients to classify Small Intestine and Bladder Qi disorders as Hernia. Little did they know that the Foot Jueyin Liver Meridian circles the external genitalia and reaches the lower abdomen. When people suffer from this disease, attacks manifest as swelling and pain in the testicles radiating to the lower abdomen, indicating that Hernia is associated with the Liver Meridian. Small Intestine Qi disorder, commonly known as horizontal or vertical string-like pain, involves wandering pain around the umbilicus and stabbing pain in the lower abdomen. In contrast, Bladder Qi disorder causes pain above the pubic symphysis and in the lower abdomen, which differs from Hernia characterized by tangible masses like melons, sounds like frogs, or masses moving up to the abdomen or down into the scrotum. However, because the meridians of the Small Intestine and Bladder merge with the Foot Jueyin Liver Meridian, diseases in these organs can affect the Liver, causing downward traction pain in the testicles. Nevertheless, these remain pathologies of those two meridians and should not be classified as Hernia. Zhao Yi-de stated: This section was originally named for testicular symptoms. However, *Huangdi Neijing* states that "Shan" means pain, encompassing abdominal organ pains all named under "Shan," hence included here. The abdominal five-organ Shan can be examined through this.
Regarding testicular pain, *Huangdi Neijing* states that Ren Mai (Conception Vessel) pathology causes seven types of internal Hernia in men and leukorrhea with mass accumulation in women. Chong Mai (Penetrating Vessel) pathology causes rebellious Qi and internal urgency. Although Ren Mai has names for seven Hernias, specific morphological descriptions are lacking. Reviewing various chapters, double-character named Hernias include "Xuan Shan," attributed to Three Yang Meridians pathology, presenting with chills and fever, flaccidity and cold extremities, transmitting to Xuan Shan. Also, when Yangming governs the year and interacts with its overcoming qi, Liver Jing movement disorders, and Foot Yangming tendon disorders are all called Xuan Shan. "Jue Shan" presents with yellow complexion, pulse large and empty, accumulated Qi in the abdomen, and rebellious Qi. "Shan Xia" occurs when Spleen disease transmits to Kidney, causing heat and pain in the lower abdomen with white discharge, also called Gu. "Chong Shan" arises from Chong, Ren, and Du vessel pathology, with Qi rushing upward causing heart pain and inability to pass stool or urine. "Cu Shan" results from evil invading Jueyin collaterals, causing sudden severe pain, similar to rebellious Qi in the Luigou point affecting the testicles. "Long Shan" involves excessive Yin in Jueyin leading to vascular distension and obstruction. "Hu Shan" is a disease generated by the Liver. Perhaps these double-character names exist because Ren Mai intersects with various meridians, giving rise to the Seven Hernias. Additionally, single-character Hernias include those from Taiyin governing the earth with cold overcoming Yang, causing Hernia; Taiyang governing the earth causing lower abdomen pulling testicle pain up to the heart; lower abdomen pain preventing urination/defecation due to cold; Foot Taiyin tendon disease causing twisting pain in genitals radiating to the umbilicus; Heart Shan with urgent pulse where Small Intestine acts as the envoy, showing form in lower abdomen; Kidney pulse large, urgent, and deep indicating Shan. Heart pulse slippery and urgent indicates Heart Shan. Lung pulse deep and pounding indicates Lung Shan. Three Yin pulses urgent indicate Shan. *Lingshu* states slight slipperiness in Heart pulse indicates Heart Shan. Very slippery Liver pulse indicates Xuan Shan. Slightly large Spleen pulse indicates Shan Qi with pus and blood in intestines. Very slippery indicates Long. Very slippery Kidney pulse indicates Long. Slippery pulses indicate excessive Yang Qi and slight heat. Such cases constitute the Seven Hernias, distinguishing cold and heat evils. *Huangdi Neijing* further states: Slippery Shaoyang pulse indicates Lung Wind Shan; Slippery Taiyin pulse indicates Spleen Wind Shan; Slippery Yangming pulse indicates Heart Wind Shan; Slippery Taiyang pulse indicates Kidney Wind Shan; Slippery Shaoyang pulse indicates Liver Wind Shan. The "Wind" mentioned is not external wind but wind generated by the Liver Wood (Yang Organ). Thus, "Slippery pulse is Wind." The combination of Wind and Shan exists because Liver and Kidney reside in the Lower Jiao, and Foot Jueyin assists Ren Mai's transformation. With rebellious Qi in Liver and Kidney, Ren Yin manifests as Shan, while Liver Yang manifests as Wind, hence "Wind-Shan." Li Dongyuan argued that slippery pulses represent Bing-Ding Fire, heat sinking below, unable to overcome Ren-Gui Water, transforming into cold water, thus generating Xuan Shan, treated with hot herbs. *Huangdi Neijing* initially did not mention this in the Chi (Cun-Kun-Guan positions, specifically Chi) region. Could it be due to external cold suppressing internal heat, making fire transform from cold? This reasoning seems flawed. Furthermore, the scripture mentions the penis and scrotum as bodily mechanisms, indicators of Yin-Yang, and pathways for fluids. Irregular diet and emotions cause fluids to overflow downward to the testicles, blocking blood channels. Over time, movement becomes difficult. This condition, with fluid stagnation neither rising nor falling, is also a type of Xuan Shan. Zhang Zhongjing stated that Hernia is caused by cold evil, consistent with *Neijing*, suggesting warming and dispersing methods. Some ask: If *Neijing* attributes Hernia to various meridians, why do you attribute it entirely to Ren Mai? I reply: Ren Mai is the root of Hernia disease, while other meridians are branches. Why? Kidneys, viewed spatially, belong to Cold Water in Five Elements. Located inferiorly, they belong to Earth's Yin. Yin is paired, hence two kidneys establish Earth's rigidity and flexibility. The uterus lies between them, managing Kidney essence and blood, executing Kun Earth transformation to generate the body. Growth and development rely on Tian Gui and Kidney strength. Kun Earth does not act alone; Chong and Ren vessels, originating in the uterus, execute this transformation. Thus, all viscera and bowels receive Qi from these vessels, termed "Sea." These vessels must flow freely and avoid blockage. Flow allows Heaven's Yang to descend and interact, enabling transformation. Blockage cuts off Heaven's Yang, causing Earth's Yin to knot and diseases to arise. Hernia is one such disease. Imbalances in Ren Mai, whether from internal rigidity/flexibility conflicts or external/internal evils, disrupt Yin-Yang. Excess Yin brings cold冲击; excess Yang brings heat inward. Even if evil originates elsewhere, it must invade Ren Mai. How? Through meridian transmission, non-sequential overcoming, intersection at Ren Mai passages, or Six Meridians carrying evil into the Sea. This moves Ren Mai's stagnant Yin, striking viscera (abdominal Hernia) or descending to Jueyin/genitals (testicular Hernia). Hernia is uniquely governed by Ren Mai, arising from Earth's Yin striking violently. If other meridians are affected without involving Ren Mai, it is not called Hernia. Otherwise, why do *Ju Tong Pian* and *Bai Bing Shi Sheng Pian* describe abdominal pains without naming any as Hernia? Thus, Ren Mai is the root; other meridians' Hernias are merely branches.
Chao Yuanfang described Seven Hernias: Jue Shan, Xuan Shan, Han Shan, Qi Shan, Pan Shan, Xia Shan, Ye Lang Shan. Jue Shan involves rebellious heart pain and vomiting. Xuan Shan involves abdominal fullness and heart pain with Qi accumulation like an arm. Han Shan involves pain after cold food/drink. Qi Shan involves fluctuating abdominal fullness/pain. Pan Shan involves pain near the umbilicus. Xia Shan involves lower abdominal masses. Ye Lang Shan involves lower abdomen-genital牵引 pain and constipation. Chao attributed all Hernias to Yin accumulation, cold addition, disharmony of Ying-Wei, and weak Qi/Blood allowing wind-cold to enter. Pediatric Hernia involves scrotal swelling from crying, moving Yin Qi and causing knotting. Observing these, five involve heart/abdominal pain. Only Xuan Shan is specified for children. Later scholars added *Neijing*'s "Spleen Wind transmitting to Kidney... called Gu Disease" and established Yin Shan (Xia Shan) to complete the count of seven. Treatments for the five heart/abdominal pains suggest regulating Qi for emotional injury and warming/dispersing for external evil. Improper treatment leads to Qi entering Kidney (Kidney Qi), Bladder (Bladder Qi), or Small Intestine (Small Intestine Qi). Kidney/Bladder connect to external genitals; Small Intestine connects to testicles via ligaments. Yin Shan/Xia Shan has four subtypes: Chang Tan (Intestinal Mass), Qi Xia (Qi Mass), Luan Zhang (Testicular Swelling), Shui Shan (Water Hernia). Cold/warm evil connecting to Small Intestine causes lower abdomen-pulling testicle pain (Chang Tan). Cold evil in tendons/Jueyin causes testicular knotting (Luan Zhang). Kidney deficiency with dietary/emotional irregularity causes fluid knotting (Shui Shan). Zhang Congzheng (Dai-ren) criticized these as vulgar errors. He argued the area circling genitals to lower abdomen belongs to Foot Jueyin Liver Meridian. Causes include cold/water contraction, dryness/wood depression, anger/sorrow knotting, or medication/sexual retention blocking the meridian. It has nothing to do with Bladder, Kidney, or Small Intestine. All Hernia involves Liver Wood being invaded or becoming excessive. He established Seven Hernias within Yin Shan: Han Shan, Shui Shan, Jin Shan, Xue Shan, Qi Shan, Hu Shan, Xia Shan.
Han Shan: Scrotum cold, hard as stone, impotence, testicular pain. Caused by damp/cold exposure or sexual exertion in cold. Treated with warming purgatives. May cause infertility.
Shui Shan: Scrotal swelling/pain, sweating, crystal-like cysts, itching with yellow fluid, water sound in abdomen. Caused by drinking/alcohol/sexual exertion followed by wind-cold. Treated with water-draining purgatives.
Jin Shan: Penile swelling, ulceration, pus, pain, tight tendons, urethral pain/itching, prolapse, white discharge. Caused by sexual exhaustion or sorcery. Treated with Heart-Fire-descending purgatives.
Xue Shan: Melon-shaped mass in lower abdomen sides (near Henggu). Commonly called "soft chancre." Caused by summer heat and sexual exertion causing Qi/Blood overflow into bladder/scrotum, forming abscesses with more blood than pus. Treated with blood-nourishing purgatives.
Qi Shan: Extends from kidney region to scrotum. Distension from crying/anger, resolving when calm. Treated with Qi-scattering purgatives. Pediatric version ("Pian Qi") may result from parental age/weakness. Untreatable.
Hu Shan: Tile-shaped, enters abdomen when lying, exits to scrotum when standing/walking. Resembles fox behavior. Similar to Qi Shan but requires hook support. Treated with Qi-flow purgatives.
Xia Shan: Scrotum hangs large like a bucket, no itch/pain. Caused by damp-earth environments (Jianghuai region). Treated with damp-dispelling purgatives. After purging, adjust or tonify based on condition. *Jing* states "Yin excess with abdominal distension/blockage is Long Shan," requiring purging.
Why did Dai-ren use *Neijing/Lingshu/Mingtang* to trace Hernia origins yet omit Ren Mai pathology? Because he strongly argued genitals are unrelated to Small Intestine/Kidney/Bladder, focusing solely on Jueyin origin. However, he mentioned Ren Mai three times: 1. Acupoints for Hernia intersect with Ren Mai. 2. Chong/Ren/Du intersect with Jueyin at Qugu, circling genitals. 3. Men's sperm leakage/white discharge is Hernia; Women's amenorrhea/lower abdominal mass is "Xia" (Ren Mai internal knotting). Dai-ren's arguments were rigid, ignoring other aspects. If Bladder/Small Intestine symptoms exist, they must be addressed. *Lingshu* describes Small Intestine disease as lower abdominal pain radiating to testicles. Treatment logic applies: treat lower lesions first. However, purging weak patients without regard to timing is dangerous. Can life be saved by tonifying only after purging? Dai-ren's book is clear and enlightening, a masterpiece, but lacks nuance. Yin-Yang changes and treatments are infinite; one cannot master all. Use what is clear and supplement what is missing.
Danxi discussed testicular/lower abdominal pain (tangible/intangible, audible/inaudible). People attribute it to cold contracting meridians. Actually, it starts with Damp-Heat, suppressed long-term, then exposed to external cold, causing pain. Causes of Damp-Heat: Labor generates fire in tendons; overeating/drinking generates fire in Stomach; sexual excess generates fire in Kidney; anger generates fire in Liver. Suppressed fire leads to dampness, turbid fluids condense, enter blood channels, flow to Jueyin. Liver is Wood, swift; Fire is violent; constrained by cold, pain is severe and sudden. This theory clarifies Dai-ren's omissions regarding Jueyin pathology, benefiting future students. Hernia involves these three evils: Heat causes flaccidity, Cold causes pain, Dampness causes swelling. Treat according to predominance.
Regarding unilateral testicular involvement: Left Kidney belongs to Water, generating Liver Wood (Blood). Right Kidney belongs to Fire, generating Spleen Earth/Lung Metal (Qi). Cold contracts blood, so cold-blood flows to Liver/left testicle. Qi stagnation gathers dampness, so Qi-damp flows to Lung/right testicle. Testicular tendons involve Taiyin/Yangming too. Left-sided cases often have more pain, less swelling; right-sided have less pain, more swelling.
Case 1: In youth, ate too many citrus fruits, developing fluid retention in right hypochondrium. After mountain trekking, hunger/thirst, ate oranges/taro. Oranges stirred old retention, taro trapped Qi. Right testicle swelled immediately with chills/fever. Spleen/Lung govern right side. Fluid/Qi sank, damaging Taiyin/Yangming tendons, evil entered scrotum. Dai-ren said treat upper/lower separately; Wood depression Hernia in lower part shouldn't be vomited but drained downward. However, hunger/labor injured Spleen, causing Qi sinking. Must lift it. Purging would worsen sinking. Treated with stomach-regulating herbs, then induced vomiting next morning to move Qi upward from lower to middle jiao. Swelling halved. Repeated vomiting cleared Qi, unblocked meridians. Cured in 2-3 days. Effective for alcohol/water-induced right testicular swelling.
Case 2: Patient drank water after illness, severe left testicular pain. Moxibustion at Dadun (LR1), applied Yao Gao (Waist Rubbing Paste) containing Wu (Aconite), Fu (Prepared Aconite), Ding (Clove), She (Musk) to scrotum up to Henggu. Covered with warm cloth. Pain stopped, swelling resolved overnight.
Historically, Hernia was treated mainly for external cold. *Bencao Faming* states: Severe male Hernia and female leukorrhea/masses are governed by Ren Mai (Yin Meridian). Liver/Kidney pathology shares treatment: Ding Xiang Lian Shi Wan. Hernia/leukorrhea relate to Wind; Quan Xie (Scorpion) is the holy medicine for Wind. Chuan Lian Zi (Szechwan Chinaberry) and Hui Xiang (Fennel) enter Small Intestine Meridian. Dang Gui (Angelica) and Xuan Hu Suo (Corydalis) invigorate blood and stop pain. Accumulated cold evil in Small Intestine requires Fu Zi (Aconite) support. Ding Xiang and Mu Xiang guide the herbs.
Luo Qianfu treated Hu'erchi Niulin for chronic Hernia exacerbated by July hunger/labor and excessive warm milk. Symptoms: blue-yellow complexion, paroxysmal abdominal pain, unbearable cramping, bent waist, relieved by heat, fine/rapid pulse. *Nanjing* states Ren Mai pathology causes Seven Hernias from cold in Small Intestine. Requires strong hot herbs. Prescribed Chen Xiang Gui Fu Wan. For lower abdominal cramping/pain radiating around umbilicus, frequent clear urination, six pulses urgent/huge/slow/choppy/deep but empty except Kidney pulse (not urgent, empty/weak), named Kidney Shan. Prescribed Ding Xiang Shan Qi Wan. Male/Female Hernia with cold lower abdominal pain radiating to waist/hips: Dang Gui Si Ni Tang. *Faming* Tiantai Wu Yao San, Chuan Ku Lian San, *Jianyi* Mu Xiang Lian Zi San all use Radix Crotonis (Ba Dou) fried with herbs. Xu Xueshi noted: This disease arises from deficiency; do not tonify deficiency abruptly. Where evil gathers, Qi is deficient; if lingering, disease becomes excess. Must cleanse accumulated heat/evil before tonifying. Hence, many drugs use Ba Dou.