（一名伤寒夹疝气）
【因】素有疝气。时发时止。复伤寒湿。直入太阳之里。膀胱气化失利。则诸状发矣。疝名有七。其
始皆因于气。故曰疝气。然有内外之别。或发时诸状复现。发过全无形迹。或素有定所。发则心腹胀痛绞切。
冲逆攻突。发过则罢。而腹部仍有瘕聚者。均名内疝。或睾丸肿坠掣痛。牵引小腹。或外肾肿溃。脓水淋
溢。二便滞涩。阴络不利者。皆名外疝。考之古训。多责之肝。其实内外诸气散列。而病踞阴部。皆足以致之。
【证】发热头疼。脘腹满痛。阴囊肿硬。茎肿溺涩。大便燥结。此为寒湿直入太阳之里。气化不利之
一例。其余七疝。不克备载。
【脉】疝脉弦急搏指。凡弦数有热。弦紧有寒。弦细亦为寒湿。弦濡而数为湿热。牢急者生。弱急者死。
【治】伤寒寒湿。直入太阳之里。膀胱化气不利。引动素因疝气者。宜五苓散加独活、防己。其他疝证。别有
治法。惟仲景独以寒疝为名。所立三方。亦以温散祛寒、调营补虚为主。而子和治法。又以辛香疏气为主。
谓肝得疏泄。而病愈矣。用金铃子散。虎潜丸等法。可谓发前人所未发。且治疝之方。必加治气之药。
【秀按】疝气之病。虽多责之于肝。实与诸经亦多有关系。《内经》云。任脉为病。男子内结七疝。女子带下瘕
聚。又云。督脉生病。从小腹上冲心而痛。不得前后为冲疝。又曰。脾传之肾。病名疝瘕。又曰。三阳为病发
寒热。其传为 疝。又曰。邪客于足厥阴之络。令人卒疝暴痛。此《素问》言诸经之疝也。《经脉篇》云。足
阳明之经病。 疝腹筋急。足太阴之经病。阴器纽痛。下引脐。两胁痛。足厥阴之经病。阴器不用。此《灵枢》言
诸经之疝也。《难经》云。五藏谓之疝。六府谓之瘕。又云。男子谓之疝。女子谓之瘕。《病源论》云。阴
气积于内。复为寒气所加。故使营卫不调。血气虚弱。故风冷入于腹内而成疝也。疝者痛也。或小腹痛。不得
大小便。或手足厥冷。绕脐痛。自汗出。或冷气逆上抢心腹。令人心痛。或里急而肠痛。此诸候非一。故云诸
疝也。《病源论》又云。七疝者。厥逆心痛。足寒。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。腹中痛在脐左旁。名曰
盘疝。腹痛在右脐下有积聚。名曰 疝。腹与阴相引而痛。大便难。名曰野狼疝。皆由血气虚弱。饮食寒温不调
之所生也。《录验方》七疝丸。治前七疝证。方用（人参、桔梗、黄芩、细辛、干姜、蜀椒、当归、芍药、浓朴、
乌头各五分。）凡十物。治下筛和。以白蜜丸。如梧子大。食先服四丸。日三。不知稍增。禁生鱼猪肉。按
《僧深方》有八物。（桔梗、细辛、桂心、芍药、浓朴、黄芩各一两半、蜀椒二两半、乌喙二合。）服三丸。
日三。范汪方有十二物。（蜀椒五分、干姜、浓朴、黄芩、细辛、芍药各四分、桔梗二分、乌喙、茈胡、
茯苓、丹皮各一分、桂心二分。）先 食。以酒服七丸。日三。张子和因有筋、水、狐、 、气、血、寒、
七疝之名。与《病源论》以
厥、 、寒、气、盘、 、野狼、为七疝。其病名与证候多不相同。特将张氏七疝病状及疗法。汇录于下。以备
参考。
筋疝者。即《经》之疝瘕。《病源》谓之 疝。有因房劳及服壮阳邪方得之。其证阴囊肿胀。或溃或痛。
而里急筋缩。或茎中痛。甚则兼痒。或挺纵不收。小腹热痛。出白物如精。随溺而下。宜治肝经湿热。以龙胆
泻肝汤加减。丹溪谓内郁湿热之证。用乌头栀子汤。（乌头末、山栀子。）
水疝者。即《经》之 疝。得
之酒醉使内。过劳汗出而遇风。寒湿之气。聚于囊中。其证囊肿而痛。阴汗时出。或囊肿如水晶。或囊痒搔之
出黄水。或小腹按之有水声。由寒湿乘虚下注。故内宜逐水之剂下之。如禹功散。（黑丑、茴香、为末。）加
肉桂末。或加生姜汁木香汁调服一二钱。或用胃苓汤。外宜用漏针去水法。
狐疝者。（狐则昼出穴溺、夜入穴
不溺、此疝出入与狐相类、故名。）《经》云。肝所生病为狐疝。其状如仰瓦。卧则入小腹。行立则出小腹入囊中。
如狐之上下出入无定也。与气疝同。宜逐气温经之药。如《金匮》蜘蛛散。（蜘蛛十四枚微炒、桂心五分、共
为末、白汤调服。）或酒煮当归丸。（当归、附子、茴香、川楝子、丁香、木香、玄胡、全蝎为末、酒和丸酒
下。）治之。
疝者。得之地气卑湿所生。其证阴囊肿而如斗。不痒不痛。甚则溃流脓水。二便涩滞。宜辛香
燥利之方。如荔枝散。（荔枝核、沉香、大茴香、小茴香、木香、川楝子、青盐、共为末。）三层茴香丸。
（大茴香、川楝子、沙参、木香各一两、为末、饭糊丸、每服三钱、空心盐汤下、此第一层服完、照前方加
荜茇一两、槟榔五钱、丸法服法如前、此第二层再不愈、服第三层、即前二方、加入茯苓四两、附子一两、丸
法服法如前、此方虽数十年之久、囊肿如升如斗、皆可除根。）或香附散。（香附、青皮、二味为末。）或越
鞠丸。加茯苓皮、海藻、昆布、白术、泽泻等治之。
气疝者。其证上连肾俞。下及阴囊。偏坠而痛或不痛。此得之忿怒号哭。气郁而胀。悒郁不泄故也。内服辛香
利气。如气疝饮。（吴萸、炒川连、人参、白术、白芍、陈皮、甘草、生姜。）聚香饮子。（乳香、沉香、
檀香、藿香、木香、丁香、广郁金、乌药、桔梗、延胡、肉桂、甘草、姜、枣。）外治以微针出气。而愈更速。
婴儿患此者。名胎疝。因父阴痿。强力入房。或父素有疝疾。或母怀孕。悒郁不伸。皆能致此。惟灸筑宾穴
（穴在内踝上 分中阴维之 。）可消。大抵睾丸偏坠。有大小左右之不同。在左因怒气伤肝。外寒内郁。在
右因肾气亏损。湿痰食滞。皆使真气不升。客邪下陷故也。又有阴虚偏坠一证。用一味龟板为末。茴香煎汤送
下。如不应。乃入厥阴也。加醋炒蝎尾三分更效。
血疝者。得之盛暑入房。气血失道。渗入脬囊。留而不去。或情欲太浓。当泄不泄而成。其状如黄瓜。
在小腹两傍。横骨两端约纹中。结成痈肿。脓少血多。俗名便痈。宜调气通瘀为治。如当归尾、赤芍、牛膝
梢、延胡、木香、五灵脂、鼠粪、乳香、没药、人中白、郁李仁肉等味治之。寒疝者。得之坐卧湿地。及寒月
涉水。或坐卧砖石。或当风凉处使内过劳。其证阴囊冷。结硬如石。阴茎不举。如控睾丸而痛。久不愈。则
无子。宜辛热散寒。以吴茱萸加附子汤。（吴茱萸、附子、人参、姜枣。）《短剧方》。治寒疝心痛如刺。绕
脐绞痛。用蜀椒、附子、干姜、半夏、粳米、大枣、甘草等治之。若疝气在小腹左右。久不愈。而聚坠者。
高丽昆布一斤。米泔浸去咸味。切细煮烂。和以盐醋、生姜、橘皮、花椒、粉、作 服。
小肠气。奔豚偏坠。及小腹有形如卵。上下走痛不可忍。大人小儿均宜用（胡芦巴八钱、小茴香六钱、巴
戟肉炮乌头各二钱、川楝子四钱、淡吴萸五钱。并炒为末、酒糊丸、如梧子大、每服钱许、淡盐汤下、日三服。）
凡外疝掣引肿冷。用大荔枝核十枚。炒焦黑存性。小茴香二钱。炮川乌一钱。研细酒调。空腹温服。凡小肠疝
气。阴囊偏坠或肿大。得热称快。小便清白。内无渴热者。用生姜切薄片。铺凑板上。上堆蕲艾一尖丛。
点火烧之。候将完。即连姜并艾。捣极烂。盛生菜叶内。随手兜托于肾囊。更护以棉絮。令其坐定。
初时其冷如冰。须臾便热。直至有汗自愈。此法甚验。弗轻视之。
【廉勘】疝气虽有因虚而得者。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。
故必先涤蓄邪。然后补之。至有虚甚迫痛。上为呕逆。或下有遗精者。此邪实正虚之甚。恐补之无益。
泻之则正气愈虚。幸而获生者鲜矣。总之内外邪气所感。攻于脏腑。则为腹中之疝。会于阴器。则为睾丸
之疝。李士材云。疝之为病。受热则挺纵不收。受寒则腹中牵引作痛。因湿则胀满重坠。因虚则其痛必轻。
在血分不移。在气分多动。患左丸者。痛多肿少。患右丸者。痛少肿多。其论甚确。王肯堂云。疝与小
肠气、膀胱气不同。小肠气。小肠之病。膀胱气。膀胱之病。疝气。肝经之病。疝必睾丸先痛。次连小
腹。次攻胸胁。有自下而上之象。小肠气者。脐傍钓痛。连及腰脊。或绕脐走注。少腹攻刺。若膀胱气。
在毛际之上。则小腹之分肿痛。不得小便是也。又有肾气。脐下绕身撮急。周身皆痛。便数而清。诸脉洪
缓。惟肾脉弦急。宜肾气丸。及酒煮当归丸治之。三证之发。必从腹而下及睾丸。有自上而下之可辨也。
因小肠膀胱。并于厥阴之经。所以受病连及于肝。亦控引睾丸而痛。然只是二经之病。不可以为疝也。
又有木肾一症。外肾则坚硬顽痹。不痛不痒。阴茎不垂。常如麻木。便溺之时。闷胀不顺。此因肾虚。
而沉寒痼冷凝滞其间。先当温散温利。以泄其邪。如二妙丸、加肉桂、吴萸、半夏、茯苓之类。亦有囊痒
不已。甚则疙瘩顽麻。破流脂水。谓之肾囊风证。是由肝经风湿。宜敷药。或薰洗以治之。宜蛇床子、
绣球花。或大叶杨柳。煎汤。乘热薰洗。再以蚯蚓焙为末。掺之即愈。如无脂水。以井水调敷。或吴萸
煎汤薰洗。若但阴囊开花。以枸橘七枚。煎汤薰洗。三日可愈。
【炳章按】疝气初病在气分之间。聚则塞痛。高突攻冲。散则鸣响。上嗳气。下泄气而休。宜青木香散。
（青木香、槟榔各二钱、川楝子三钱、淡吴萸、炮川乌、小茴香各一钱、乌药、橘核、木通各钱半、
降香八分、公丁香四分、食盐少许、生研为末、以酒水各半、葱白五枚、煎汤调送之、少顷再进、一日三
服）最效。若 疝水疝。因败精恶血结气凝湿。伏风积在阴囊所致。延及胀大、麻木、钓痛、奔突等候。
宜七制金铃子丸。（大川楝子四十九个、分七处、每处七个。各以酒浸胀取起、俟干、秤小茴香五钱、
阿魏三钱、破故纸三钱、黑丑三钱、槟榔三钱、巴豆肉十四粒去衣、斑蝥十四个去头足各以炒川楝子
七个、炒至焦黑为度、惟巴豆斑蝥、炒后拣去不用、余药与川楝子共研末、再加肉桂、广木香、香附各
三钱、合为细末、酒面糊为丸、梧子大、空心每服三十丸、青盐汤送下、日一服。）二方皆屡经效验。
故附录之。亦有因春温风温时毒喉痧。先发热自汗。曾经发颐。误用凉遏。余毒由少阳循经。传入厥
阴。下流睾丸。亦偏坠肿痛。形似疝气。宜疏通血络。以鲜生地五钱、捣豆豉二钱。黑山栀、延胡索
各二钱。土贝母二钱。川楝子三个。蝉衣钱半。苏木、红花各八分、赤芍钱半、丹皮二钱。桃仁十四粒。
水煎服。此证甚多。是方亦验。古今方书多未载。特附志之。
【病因】患者平素患有疝气，症状时发时止。又感受了伤寒湿邪，病邪直接侵入太阳经的里层，导致膀胱气化功能失常，于是各种症状发作。疝的名称有七种，起初都因气机阻滞引起，所以称为疝气。然而有内疝和外疝的区别。有的发病时各种症状重现，发作过后完全没有任何痕迹；有的平时部位固定，发作时心腹胀痛、绞痛剧烈，气冲逆上、攻突疼痛，发作停止后腹痛虽止，但腹部仍有积块聚结的，都称为内疝。有的睾丸肿胀下坠、牵拉疼痛，牵引小腹；或者外肾（阴茎及阴囊）肿胀溃烂，脓水淋漓溢出，大小便滞涩不畅，阴络不通利的，都称为外疝。考证古代医训，多将疝气归咎于肝脏，其实内外各种气机失调，且病变位于阴部，都能导致此病。
【证候】发热头痛，胃脘及腹部胀满疼痛，阴囊肿硬，阴茎肿胀、小便涩痛，大便干燥结硬。这是寒湿之邪直接侵入太阳经里，导致气化不利的一个例子。其余七种疝气的情况，无法全部记载。
【脉象】疝气的脉象弦急有力，搏指明显。凡是弦而数的脉象主热，弦紧的脉象主寒，弦细的脉象也是寒湿，弦濡而数的脉象主湿热。脉象牢急者预后良好（生），脉象弱急者预后不良（死）。
【治法】伤寒寒湿之邪，直接侵入太阳经里，导致膀胱气化不利，引动素日患有的疝气，适宜用五苓散加独活、防己。其他类型的疝证，另有治疗方法。只有张仲景专门以“寒疝”命名，所设立的三个方剂，也以温散祛寒、调和营血、补益虚损为主。而金元四大家之一的张子和的治疗方法，又以辛香行气疏肝为主，认为肝脏得到疏泄，病就能痊愈。使用金铃子散、虎潜丸等方法，可以说是发挥了前人未曾阐发的见解。而且治疗疝气的方剂，必须加入调理气机的药物。
【秀按】疝气这种病，虽然多归责于肝脏，但实际上与多条经络也多有关系。《黄帝内经》说：任脉发生病变，男子体内结成七疝，女子带下瘕聚。又说：督脉生病，气从小腹向上冲至心脏并疼痛，大小便不通，称为冲疝。又说：脾脏的病传变到肾脏，病名叫做疝瘕。又说：三阳经发病，出现恶寒发热，其传变可成为疝。又说：邪气客居在足厥阴肝经的络脉，使人突然患疝气并剧烈疼痛。这是《素问》中论述各条经络引起的疝气。《灵枢·经脉篇》说：足阳明胃经发病，会出现疝气、腹部筋脉拘急。足太阴脾经发病，会出现生殖器扭转疼痛，向下牵引脐部，两侧胁肋疼痛。足厥阴肝经发病，会出现生殖器功能丧失。这是《灵枢》中论述各条经络引起的疝气。《难经》说：五脏的病叫做疝，六腑的病叫做瘕。又说：男子的病叫做疝，女子的病叫做瘕。《诸病源候论》说：阴气积聚在内，又受到寒气侵袭，致使营卫不调，血气虚弱，所以风冷进入腹内而成疝气。疝，就是痛的意思。有的小腹痛，不能大小便；有的手足冰冷，绕脐疼痛，自汗出；有的冷气逆上冲击心腹，令人心痛；有的里急后重且肠痛。这些症状不一，所以称为诸疝。《诸病源候论》又说：七疝中，厥逆心痛，脚冷，饮食吐出不下的，名叫厥疝。腹中气突然胀满，心下完全疼痛，气积聚如手臂粗的，名叫盘疝（原文此处可能有缺字或通假，通常指厥疝或类似，依上下文推测为特定疝名，此处保留原文逻辑）。寒饮导致胁下腹中完全疼痛的，名叫寒疝。腹中突然胀满又减轻且疼痛的，名叫气疝。腹中疼痛在脐左侧的，名叫盘疝。腹痛在右侧脐下有积块的，名叫[缺字]疝（原文此处可能有缺字，通常指瘕疝或类似）。腹部与阴部相互牵引疼痛，大便困难的，名叫野狼疝。这些都是由血气虚弱、饮食寒温不调所产生的。《录验方》中的七疝丸，治疗前述七种疝证。方用人参、桔梗、黄芩、细辛、干姜、蜀椒、当归、芍药、厚朴、乌头各五分。共十味药，捣碎过筛混合，用白蜜做成梧桐子大小的丸药。饭前服四丸，每日三次，效果不明显可稍增加剂量。禁止吃生鱼和猪肉。按照《僧深方》有八味药：桔梗、细辛、桂心、芍药、厚朴、黄芩各一两半，蜀椒二两半，乌喙二合。服三丸，每日三次。范汪方有十二味药：蜀椒五分，干姜、厚朴、黄芩、细辛、芍药各四分，桔梗二分，乌喙、柴胡、茯苓、丹皮各一分，桂心二分。空腹时，用酒送服七丸，每日三次。张子和因此有筋、水、狐、[缺字]、气、血、寒、[缺字]七疝的名称，与《诸病源候论》中以厥、[缺字]、寒、气、盘、[缺字]、野狼为七疝不同，其病名与证候大多不相同。特将张氏七疝的病状及疗法，汇总记录如下，以备参考。
筋疝，即《内经》所说的疝瘕，《诸病源候论》称之为[缺字]疝。有因房劳过度及服用壮阳邪方导致的。其症状是阴囊肿胀，或者溃烂或者疼痛，并且里急筋缩，或者阴茎中疼痛，严重时兼有瘙痒，或者阴茎挺纵不收，小腹热痛，流出白色物质像精液一样，随小便排出。适宜治疗肝经湿热，用龙胆泻肝汤加减。朱丹溪认为内郁湿热的证候，用乌头栀子汤（乌头末、山栀子）。
水疝，即《内经》中的[缺字]疝。得之于酒醉后行房，过度劳累出汗后受风，寒湿之气聚集在阴囊中。其症状是阴囊肿胀而痛，阴汗时常流出，或者阴囊肿得像水晶一样透明，或者阴囊瘙痒抓挠后流出黄水，或者按压小腹有水声。由于寒湿乘虚下注，所以内部适宜用逐水剂攻下，如禹功散（黑丑、茴香，研为末），加肉桂末，或者加生姜汁、木香汁调服一二钱。或者用胃苓汤。外部适宜用漏针去水法。
狐疝。（狐狸白天出洞排尿，晚上回洞不排尿，此疝出入无常与狐狸相似，所以得名。）《内经》说：肝脏所生的病叫狐疝。其形状像仰放的瓦片，躺下时疝内容物退回小腹，站立行走时疝内容物从腹腔进入阴囊，像狐狸上下出入没有定处一样。与气疝相同，适宜用逐气温经的药物，如《金匮要略》蜘蛛散（蜘蛛十四枚微炒，桂心五分，共研为末，白开水调服）。或者酒煮当归丸（当归、附子、茴香、川楝子、丁香、木香、玄胡索、全蝎，研为末，酒和丸，酒送下）。以此治疗。
[缺字]疝（原文此处可能有缺字，结合下文荔枝散等，通常指卵疝或类似），得之于地气卑湿所生。其症状是阴囊肿大如斗，不痒不痛，严重时溃烂流脓水，大小便涩滞。适宜用辛香燥利的方法，如荔枝散（荔枝核、沉香、大茴香、小茴香、木香、川楝子、青盐，共研为末）。三层茴香丸（大茴香、川楝子、沙参、木香各一两，研为末，饭糊为丸，每服三钱，空心盐汤下。此第一层服完，照前方加荜茇一两、槟榔五钱，丸法服法如前。此第二层再不愈，服第三层，即前二方，加入茯苓四两、附子一两，丸法服法如前。此方即使患病数十年之久，囊肿如升如斗，皆可除根）。或者香附散（香附、青皮，二味研为末）。或者越鞠丸，加茯苓皮、海藻、昆布、白术、泽泻等治疗。
气疝，其症状向上连至肾俞，向下波及阴囊，偏坠而痛或不痛。这得之于愤怒号哭，气机郁结而胀，忧郁不得发泄所致。内服辛香利气的药物，如气疝饮（吴茱萸、炒川连、人参、白术、白芍、陈皮、甘草、生姜）。聚香饮子（乳香、沉香、檀香、藿香、木香、丁香、广郁金、乌药、桔梗、延胡索、肉桂、甘草、姜、枣）。外部治疗用微针刺出气，痊愈更快。婴儿患此病，名叫胎疝。因父亲阳痿，强力入房，或者父亲平素有疝疾，或者母亲怀孕时忧郁不得伸展，都能导致此病。只有灸筑宾穴（穴在内踝上[缺字]分中阴维之[缺字]）可以消除。大抵睾丸偏坠，有大小左右的不同。在左边是因为怒气伤肝，外寒内郁；在右边是因为肾气亏损，湿痰食滞。都使真气不升，客邪下陷所致。又有阴虚偏坠一证，用一味龟板研为末，茴香煎汤送下。如果无效，说明病入厥阴经，加醋炒蝎尾三分效果更好。
血疝，得之于盛暑时节行房，气血失道，渗入膀胱阴囊，停留不去。或者情欲太浓，该泄而不泄而成。其形状像黄瓜，在小腹两旁，横骨两端约纹中，结成痈肿，脓少血多，俗名叫便痈。适宜调气通瘀治疗，如当归尾、赤芍、牛膝梢、延胡索、木香、五灵脂、鼠粪、乳香、没药、人中白、郁李仁肉等药物治疗。
寒疝，得之于坐卧湿地，以及寒冷月份涉水，或者坐卧砖石，或者当风凉处行房过劳。其症状是阴囊冷，结硬如石，阴茎不举，像被控引睾丸而痛。久不愈，则无子嗣。适宜辛热散寒，用吴茱萸加附子汤（吴茱萸、附子、人参、姜枣）。《短剧方》治疗寒疝心痛如刺，绕脐绞痛，用蜀椒、附子、干姜、半夏、粳米、大枣、甘草等治疗。如果疝气在小腹左右，久不愈且聚坠的，用高丽昆布一斤，米泔水浸泡去除咸味，切细煮烂，和以盐醋、生姜、橘皮、花椒、粉，作[缺字]服。
小肠气，奔豚，偏坠，以及小腹有形如卵，上下走痛不可忍受，大人小儿均适宜用（胡芦巴八钱，小茴香六钱，巴戟天肉炮乌头各二钱，川楝子四钱，淡吴茱萸五钱。并炒为末，酒糊丸，如梧桐子大，每服钱许，淡盐汤下，每日三次）。凡外疝掣引肿冷，用大荔枝核十枚，炒焦黑存性，小茴香二钱，炮川乌一钱，研细酒调，空腹温服。凡小肠疝气，阴囊偏坠或肿大，得热感觉舒适，小便清白，内部无渴热的，用生姜切薄片，铺凑板上，上面堆蕲艾一尖丛，点火烧之。等到快烧完，立即连同姜和艾一起捣极烂，盛在生菜叶内，随手兜托于肾囊，再用棉絮护住，令其坐定。初时感觉冷如冰，一会儿便热，直至出汗自愈。此法非常有效，不要轻视它。
【廉勘】疝气虽然有因虚而得的，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。停留不去，病邪则转为实邪。所以必须先清除蓄积的邪气，然后才能补益。至于有虚甚迫痛，上为呕逆，或有遗精的，这是邪实正虚到了极点，恐怕补益无益，泻下则正气更虚，侥幸获生的很少了。总之，内外邪气所感，攻于脏腑，就成为腹中之疝；会聚于阴器，就成为睾丸之疝。李士材说：疝这种病，受热则阴茎挺纵不收，受寒则腹中牵引作痛，因湿则胀满重坠，因虚则疼痛必轻。在血分的病位不移，在气分的病多动。患左侧睾丸的，痛多肿少；患右侧睾丸的，痛少肿多。他的论述很确切。王肯堂说：疝与小肠气、膀胱气不同。小肠气是小肠的病，膀胱气是膀胱的病，疝气是肝经的病。疝必定睾丸先痛，其次连及小腹，其次攻冲胸胁，有自下而上的现象。小肠气，是脐旁牵引痛，连及腰脊，或者绕脐走注，少腹攻刺。如果是膀胱气，在毛际之上，则是小腹部分肿痛，小便不通。又有肾气病，脐下绕身撮急，周身皆痛，尿频而清，诸脉洪缓，只有肾脉弦急，适宜用肾气丸，及酒煮当归丸治疗。这三种证的发作，必定从腹部向下波及睾丸，有自上而下的特点可以辨别。因为小肠膀胱，并与厥阴经相连，所以受病连及肝脏，也控引睾丸而痛。但这只是二经的病，不可以认为是疝。又有木肾一症，外肾坚硬顽痹，不痛不痒，阴茎不垂，常如麻木，大小便时闷胀不顺。这是因为肾虚，而沉寒痼冷凝滞其间。应当先温散温利，以泄其邪，如二妙丸，加肉桂、吴茱萸、半夏、茯苓之类。也有阴囊瘙痒不已，甚至疙瘩顽麻，破流脂水，叫做肾囊风证。这是由肝经风湿引起，适宜敷药，或者薰洗治疗。适宜用蛇床子、绣球花，或者大叶杨柳，煎汤，趁热薰洗。再以蚯蚓焙为末，掺之即愈。如果没有脂水，用井水调敷，或者吴茱萸煎汤薰洗。如果仅是阴囊开花，用枸橘七枚，煎汤薰洗，三日可愈。
【炳章按】疝气初病在气分之间，聚结则堵塞疼痛，高突攻冲，消散则鸣响，上嗳气，下排气而休止。适宜用青木香散（青木香、槟榔各二钱，川楝子三钱，淡吴茱萸、炮川乌、小茴香各一钱，乌药、橘核、木通各钱半，降香八分，公丁香四分，食盐少许，生研为末，以酒水各半，葱白五枚，煎汤调送之，少顷再进，一日三服）最效。如果是[缺字]疝、水疝，因败精恶血结气凝湿，伏风积在阴囊所致，延及胀大、麻木、钓痛、奔突等症状。适宜用七制金铃子丸（大川楝子四十九个，分七处，每处七个。各以酒浸胀取起，俟干，秤小茴香五钱，阿魏三钱，破故纸三钱，黑丑三钱，槟榔三钱，巴豆肉十四粒去衣，斑蝥十四个去头足。各以炒川楝子七个，炒至焦黑为度。惟巴豆斑蝥，炒后拣去不用。余药与川楝子共研末，再加肉桂、广木香、香附各三钱，合为细末，酒面糊为丸，梧桐子大，空心每服三十丸，青盐汤送下，日一服）。这两个方子都屡经验证有效，所以附录于此。也有因春温、风温、时毒、喉痧，先发热自汗，曾经发颐，误用凉遏，余毒由少阳循经，传入厥阴，下流睾丸，也出现偏坠肿痛，形似疝气。适宜疏通血络，用鲜生地五钱，捣豆豉二钱，黑山栀、延胡索各二钱，土贝母二钱，川楝子三个，蝉衣钱半，苏木、红花各八分，赤芍钱半，丹皮二钱，桃仁十四粒，水煎服。此证很多，此方也有效。古今方书多未记载，特附志于此。
(Also known as Taiyang Syndrome complicated with Hernia)
[Etiology] The patient has a history of hernia, which manifests intermittently. Upon contracting Cold-Dampness from Wind-Cold, the pathogen directly invades the interior of the Taiyang (Greater Yang) channel. This impairs the Qi transformation function of the Bladder, leading to the onset of various symptoms. There are seven types of hernia, all originating initially from Qi stagnation, hence termed "Qi Hernia" (Hernia due to Qi). However, there is a distinction between internal and external hernias. Some present with full symptom recurrence during attacks and leave no trace afterward; others have a fixed location, but upon attack, cause severe distending and cramping pain in the heart and abdomen, with Qi rushing upward and protruding. After the attack subsides, the pain ceases, but abdominal masses remain. These are all termed Internal Hernia (Nei Shan). Others present with swelling, heaviness, and pulling pain of the testicles, radiating to the lower abdomen; or swelling and ulceration of the external genitalia with oozing pus, obstructed urination and defecation, and impaired circulation of the Yin collaterals. These are termed External Hernia (Wai Shan). Ancient texts often attribute hernia to the Liver. In reality, dysfunction of Qi in both interior and exterior, combined with pathology located in the Yin region, can all cause this disease.
[Symptoms] Fever, headache, distending and painful epigastrium and abdomen, swollen and indurated scrotum, swollen penis with dysuria, and dry, constipated stool. This is an example of Cold-Dampness directly invading the interior of the Taiyang channel, impairing Qi transformation. The manifestations of the other seven types of hernia cannot be fully recorded here.
[Pulse] The pulse for hernia is wiry (Xian), rapid, and forceful against the finger. A wiry and rapid pulse indicates Heat; a wiry and tight pulse indicates Cold; a wiry and fine pulse also indicates Cold-Dampness; a wiry, soggy, and rapid pulse indicates Damp-Heat. A firm and urgent pulse suggests a favorable prognosis (life); a weak and urgent pulse suggests an unfavorable prognosis (death).
[Treatment] For Wind-Cold and Cold-Dampness directly invading the interior of the Taiyang channel, impairing Bladder Qi transformation, and triggering pre-existing hernia, Wu Ling San (Five-Ling Powder) added with Du Huo (Angelicae Pubescentis Radix) and Fang Ji (Stephaniae Tetrandrae Rhizoma) is appropriate. Other types of hernia have different treatments. Only Zhang Zhongjing specifically named "Cold Hernia" (Han Shan) and established three formulas, primarily focusing on warming and dispersing Cold, harmonizing Ying and Blood, and tonifying deficiency. Zhang Hezi’s treatment method focuses mainly on acrid-aromatic herbs to soothe Qi, believing that once Liver Qi is freely flowing, the disease resolves. Methods such as Jin Ling Zi San (Meliae Toosendan Flos Decoction) and Hu Qian Wan (Tiger's Knee Pill) were innovative contributions. Furthermore, formulas for treating hernia must include herbs that regulate Qi.
[Xiu's Commentary] Although hernia is often attributed to the Liver, it is closely related to various meridians. *Nei Jing* states: Disease of the Ren Mai (Conception Vessel) causes seven types of hernia in men and leukorrhea with abdominal masses in women. It also states: Disease of the Du Mai (Governing Vessel) causes Qi to rush from the lower abdomen up to the heart with pain, accompanied by inability to pass urine or stool, termed Chong Shan (Rushing Hernia). It further states: Transmission of disease from Spleen to Kidney results in Shan Xia (Hernia and Mass). It states: Disease of the Three Yang channels presents with chills and fever, which may transmit into Hernia. It states: Pathogenic factors lodging in the Luo (Collateral) vessels of Foot Jueyin (Liver) cause sudden hernia and acute pain. These are the discussions on hernia from various meridians in *Su Wen*. *Jing Mai Pian* (Meridian Chapter) of *Ling Shu* states: Disease of Foot Yangming channel causes hernia and abdominal tendon tension; disease of Foot Taiyin channel causes twisting pain in the genitals radiating to the umbilicus and hypochondriac pain; disease of Foot Jueyin channel causes genital dysfunction. These are the discussions on hernia from various meridians in *Ling Shu*. *Nan Jing* states: Five Zang diseases are called Hernia, Six Fu diseases are called Xia (Mass). It also states: Male hernia is called Shan, female mass is called Xia. *Bing Yuan Lun* (Treatise on the Causes and Manifestations of Diseases) states: Yin Qi accumulates internally and is aggravated by Cold, causing disharmony of Ying and Wei, and deficiency of Blood and Qi, allowing Wind-Cold to enter the abdomen and form hernia. "Shan" means pain. Symptoms may include lower abdominal pain with inability to urinate or defecate; cold limbs; periumbilical pain with spontaneous sweating; Cold Qi rushing up to strike the heart and abdomen causing heart pain; tenesmus and intestinal pain. Since these symptoms vary, they are collectively called Various Hernias. *Bing Yuan Lun* further details the Seven Hernias: Jue Shan (Reversal Hernia) involves reversal pain, cold feet, and inability to keep food down; [Missing Character] Shan involves sudden abdominal distension and complete pain below the heart, with Qi accumulation like an arm; Han Shan (Cold Hernia) involves pain throughout the hypochondrium and abdomen due to cold fluid; Qi Shan (Qi Hernia) involves intermittent distension and pain; Pan Shan (Plate Hernia) involves pain to the left of the umbilicus; [Missing Character] Shan involves masses below the right umbilicus; Ye Lang Shan (Wild Wolf Hernia) involves pain radiating from abdomen to genitals and difficult defecation. All arise from Blood and Qi deficiency and improper diet temperature. *Lu Yan Fang*’s Seven Hernia Pill treats these seven types, using Ginseng, Platycodon, Scutellaria, Asarum, Dried Ginger, Sichuan Pepper, Angelica Sinensis, Peony, Magnolia Bark, and Aconite. Ten ingredients are powdered, mixed with honey, and formed into pills the size of mulberry seeds. Take four pills before meals, three times daily, increasing dosage if necessary. Avoid raw fish and pork. *Seng Shen Fang* has an eight-ingredient formula: Platycodon, Asarum, Cinnamon Twig, Peony, Magnolia Bark, Scutellaria (each 1.5 liang), Sichuan Pepper (2.5 liang), and Aconite Rootlet (2 he). Take three pills, three times daily. Fan Wang’s Formula has twelve ingredients: Sichuan Pepper (0.5 fen), Dried Ginger, Magnolia Bark, Scutellaria, Asarum, Peony (each 4 fen), Platycodon (2 fen), Aconite Rootlet, Bupleurum, Poria, Cortex Moutan (each 1 fen), Cinnamon Twig (2 fen). Take seven pills before meals with wine, three times daily. Zhang Hezi identified Jin, Shui, Hu, [Missing], Qi, Xue, Han, [Missing] Seven Hernias, differing from *Bing Yuan Lun*’s Jue, [Missing], Han, Qi, Pan, [Missing], Ye Lang. Their names and symptoms differ significantly. Zhang’s Seven Hernia conditions and therapies are summarized below for reference.
Jin Shan (Sinew Hernia) corresponds to Shan Xia in *Jing* and [Missing] Shan in *Bing Yuan*. It results from sexual exhaustion or use of aphrodisiacs. Symptoms include swollen scrotum, ulceration or pain, tenesmus with sinew contraction, penile pain, itching, flaccid or inverted penis, hot painful lower abdomen, and discharge of white fluid resembling semen with urine. Treat Liver Channel Damp-Heat with Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction) modified. Zhu Danxi recommends Wu Tou Zhi Zi Tang (Aconite and Gardenia Decoction) for internal Damp-Heat stagnation.
Shui Shan (Water Hernia) corresponds to [Missing] Shan in *Jing*. It results from intercourse after drunkenness, excessive labor with sweating followed by wind exposure, causing Cold-Dampness to accumulate in the scrotum. Symptoms include swollen painful scrotum, frequent sweating from genitals, crystal-like swelling, itching with yellow exudate upon scratching, or water sounds upon pressing the lower abdomen. Due to Cold-Damp sinking due to deficiency, internal treatment requires diuretics to drain water, such as Yu Gong San (Black Bean and Fennel Powder) added with Cinnamon Bark powder, or mixed with Ginger Juice and Costus Root Juice. Or use Wei Ling Tang (Stomach-Ling Decoction). External treatment uses needle drainage to remove fluid.
Hu Shan (Fox Hernia) gets its name because the hernia sac protrudes and retracts like a fox entering and exiting its burrow. *Jing* states: Liver diseases include Fox Hernia. It resembles an inverted tile; it retracts into the lower abdomen when lying down and protrudes into the scrotum when standing or walking. Similar to Qi Hernia, treat with herbs that expel cold and warm meridians, such as Spider San (Spider and Cinnamon Twig Powder) from *Jin Gui Yao Lue*, or Jiu Zhu Dang Gui Wan (Wine-Boiled Angelica Pill).
[Missing Character] Shan (likely Dian/Tui Hernia) results from dampness of low-lying areas. Symptoms include scrotal swelling like a bucket, without itching or pain, potentially ulcerating with pus, and obstructed urination/defecation. Use acrid-aromatic drying and promoting-drainage formulas, such as Li Zhi San (Lychee Seed Powder) or Three-Tier Hui Xiang Wan (Fennel Pill). The Three-Tier Fennel Pill starts with Fennel, Melia, Adenophora, and Costus; if ineffective, adds Bi Ba and Areca Nut; if still ineffective, adds Poria and Aconite. It claims to cure even decades-long cases. Alternatively, Xiang Fu San (Cyperus Powder) or Yue Ju Wan (Six-Substance Pill) added with Poria Skin, Sargassum, Kelp, Atractylodes, and Alisma.
Qi Shan (Qi Hernia) extends from Shenshu downward to the scrotum, causing unilateral swelling and pain or non-pain. It results from anger or crying, causing Qi stagnation and distension. Internal treatment uses acrid-aromatic Qi-moving herbs like Qi Shan Yin (Hernia-Drinking Decoction) or Ju Xiang Yin Zi (Aggregated Fragrance Decoction). External treatment uses micro-needling to release Qi for faster recovery. Infants suffer from Tai Shan (Fetal Hernia) due to paternal impotence with forced intercourse, paternal history of hernia, or maternal depression during pregnancy. Moxibustion at Zubin (KI9) can resolve it. Unilateral testicular descent differs by side: left is due to Liver injury from anger with external Cold and internal stagnation; right is due to Kidney deficiency with Damp-Phlegm and food stagnation, preventing ascending True Qi and allowing pathogenic sinking. Yin Deficiency unilateral descent is treated with Tortoise Shell powder taken with Fennel decoction. If ineffective, indicating Jueyin involvement, add Vinegar-fried Scorpion Tail.
Xue Shan (Blood Hernia) results from intercourse during intense heat, disrupting Qi and Blood flow, causing them to seep into the bladder/scrotum, or from suppressed sexual desire. It presents as cucumber-shaped swellings in the lower abdomen near the pubic symphysis, forming abscesses with little pus and much blood, commonly called "Urethral Abscess." Treat by regulating Qi and unblocking stasis with Dang Gui Wei, Red Peony, Achyranthes, Corydalis, Costus, Trogopterus Dung, Frankincense, Myrrh, Naringin, and Prunus Seed.
Han Shan (Cold Hernia) results from sitting/lying on wet ground, wading in cold months, sitting on bricks, or intercourse in cool drafts. Symptoms include cold, stone-hard scrotum, impotence, and pain radiating from the testicles. Chronic cases lead to infertility. Treat with acrid-hot herbs to disperse Cold, such as Wu Zhu Yu plus Aconite Decoction. *Duan Ju Fang* treats Cold Hernia heart pain with Sichuan Pepper, Aconite, Dried Ginger, Pinellia, Rice, Jujube, and Licorice. For chronic hernia masses in the lower abdomen, use Korean Kelp soaked in rice water, boiled with salt, vinegar, ginger, tangerine peel, and peppercorns.
Xiao Chang Qi (Small Intestine Qi), Ben Tun (Rushing Pig), unilateral descent, and egg-shaped masses moving up and down with unbearable pain are treated in adults and children with Hu Lu Ba, Xiao Hui Xiang, Morinda, Aconite, and Evodia pills. For external hernia with pulling, swelling, and cold, use roasted Lychee Seeds, Fennel, and Processed Aconite mixed with wine. For Small Intestine Hernia with scrotal swelling relieved by heat, clear urine, and no internal thirst, apply moxibustion with Ginger slices and Mugwort on the scrotum until sweating occurs.
[Lian's Verification] Although some hernia arises from deficiency, do not tonify abruptly. *Jing* states: Where pathogenic factors gather, Qi is deficient. If they linger, the condition becomes excess. Thus, one must first eliminate accumulated pathogens before tonifying. In cases of extreme deficiency with severe pain, vomiting, or seminal emission, the pathogen is excess and Zheng Qi is severely deficient. Tonification is useless, and purging worsens deficiency; survival is rare. In summary, internal/external pathogens attacking Zang-Fu cause abdominal hernia; affecting the genitals causes testicular hernia. Li Shicai notes: Heat causes flaccidity; Cold causes pulling pain; Dampness causes distension/heaviness; Deficiency causes mild pain. Blood-type hernias are stationary; Qi-type hernias move. Left-side hernia has more pain than swelling; right-side has more swelling than pain. Wang Kentang distinguishes Hernia from Small Intestine Qi and Bladder Qi. Hernia is a Liver Channel disease, starting with testicular pain, moving to lower abdomen, then chest/hypochondrium (bottom-up). Small Intestine Qi causes periumbilical drawing pain radiating to waist/spine. Bladder Qi causes suprapubic swelling/pain and urinary retention. Kidney Qi causes periumbilical tightening and whole-body pain with frequent clear urination; treat with Shen Qi Wan or Wine-Boiled Angelica Pill. These three descend from abdomen to testicles (top-down), whereas Hernia ascends. Since Small Intestine and Bladder connect to Jueyin, pathology affects Liver and testicles, but these are merely Meridian diseases, not true Hernia.
Mu Shen (Wood Kidney) presents as hard, numb, painless, and itchless external genitalia with non-hanging penis and difficulty urinating. Caused by Kidney deficiency with deep-seated Cold stagnation. Treat with warming/dispersing methods like Er Miao Wan added with Cinnamon, Evodia, Pinellia, and Poria. Scrotal eczema (Shen Nang Feng) caused by Liver Wind-Damp is treated with topical applications or fumigation/washing using Cnidium, Hydrangea, or Willow bark. Earthworm powder can be applied. If no exudate, use well water or Evodia wash. For scrotal cracking, use Citrus medica wash.
[Bingzhang's Note] Early-stage hernia involves Qi stagnation, causing blockage pain and protrusion; when dispersed, it makes noises, belching, or flatulence. Qing Mu Xiang San (Blue Sandalwood Powder) is highly effective. [Missing] Shan and Water Shan result from retained essence/blood, Qi stagnation, Dampness, and latent Wind in the scrotum, causing swelling, numbness, drawing pain, and rushing sensations. Qi Zhi Jin Ling Zi Wan (Seven-Processed Melia Pill) is effective. Also, Spring Warmth/Wind Warmth toxins causing fever/sweating, mismanaged with cooling herbs, may allow residual toxin to travel from Shaoyang to Jueyin, descending to testicles, causing swelling mimicking hernia. Treat by unblocking blood collaterals with Fresh Rehmannia, Fermented Soybean, Gardenia, Corydalis, Fritillaria, Melia, Cicada Slough, Sappanwood, Safflower, Red Peony, Moutan, and Peach Kernel. This prescription is effective though rarely recorded.