陈左 厥阴之脉，循阴器而络睾丸。厥阴者，肝也。肝失疏泄，湿热下注，膀胱宣化失司，小溲夹浊，偏
疝坠胀疼痛，苔腻，脉濡数。经云∶诸液混浊，皆属于热。又云∶肝病善痛。是无形之厥气，与有形之湿
热，互相为患也。当宜疏泄厥气，淡渗湿热。
柴胡梢（七分） 延胡索（一钱） 路路通（二钱） 炒赤芍（一钱五分） 块滑石（三钱） 赤茯苓（三钱）
车前子（三钱） 荸荠梗（一钱五分） 金铃子（二钱） 陈橘核（一钱五分） 粉萆 （三钱） 黑山栀（一钱五分）
细木通（八分） 枸橘（打，一枚）
李左 湿火挟厥气下注，劳动过度，偏疝坠胀疼痛，口干内热，小溲混浊，纳谷不香，胸脘闷胀，脉弦数，
苔腻而黄。脾胃清气不能上升，小肠膀胱浊气不得下
降，肝气失于疏泄，脾虚生湿，湿郁生痰，痰火瘀凝，清不升而浊不降，然皆素体气虚之所致也。姑拟健脾胃，
清湿火，俾清气自升，浊气得降。
炒白术（二钱） 赤茯苓（三钱） 陈广皮（一钱） 陈橘核（一钱五分） 炒知母（二钱） 炒黄 （三钱）
粉萆 （三钱） 荔枝核（三钱） 软柴胡（五分） 酒炒黄柏（一钱） 小茴香（五分） 清炙草（五分）
又诊 前进健脾胃，清湿火，偏疝略收，疼痛渐止，胸闷不舒，清气有上升之象，浊气有下降之势。拟原方
更进一筹。
原方去柴胡，加金铃子（一钱五分）、延胡索（五分）。
莫左 疝气坠胀，腹痛筋急，泛泛作恶，甚则脘痛呕吐，脉弦细，苔薄腻。中阳衰弱，厥气失于疏泄。姑
拟大建中汤治之。
炒潞党参（二钱） 淡吴萸（八分） 金铃子（一钱五分） 熟附片（二钱） 川花椒（五分） 延胡索（八分）
炮姜炭（八分） 姜半夏（三钱） 路路通（一钱五分） 丝瓜络（一钱五分） 酒炒桑枝（三钱）
江左 高年气虚，疝气屡发，坠胀作痛，小溲短赤，睡则略安。治宜补中气，疏厥气，以丸代煎，缓图功效。
补中益气丸（一两） 橘核丸（二两）
每早晚各服二钱，开水送下。
黄左 劳倦奔走，元气下陷，睾丸坠胀，不能行动，胸脘不舒。肝主筋，睾丸为筋之所聚。先建其中气，俾
得元气上升，睾丸自能不坠。
炙黄 （三钱） 炙升麻（一钱） 小茴香（五分） 炒潞党（三钱） 柴胡梢（五分） 陈广皮（一钱五分）
炒白术（三钱） 清炙草（五分） 广木香（五分） 橘核丸（吞服，三钱）
又诊 坠痛已止，举动亦便。前进补中益气汤，甚为合度，仍守原法治之。
炙黄 （三钱） 云苓（三钱） 炙升麻（六分） 炒潞党（三钱） 细青皮（一钱五分） 金铃子（一钱五分）
清炙草（五分） 荔枝核（三钱） 延胡索（五分） 佛手柑（八分）
费左 偏疝坠胀作痛，头内眩晕，泛泛作恶，厥气失于疏泄，肝气肝阳易于上升，治宜清肝理气。
金铃子（一钱五分） 云苓（三钱） 荔枝核（三钱） 延胡索（五分） 姜半夏（三钱） 橘核丸（吞服，三钱）
石决（二钱） 细青皮（一钱五分） 小茴香（五分） 白蒺藜（三钱） 酒炒桑枝（三钱）
陈左：厥阴经的经脉，循行经过外生殖器并联络睾丸。厥阴，指的是肝脏。肝脏疏泄功能失常，湿热之邪向下注滞，导致膀胱的气化功能失调，小便浑浊，患侧疝气坠胀疼痛，舌苔腻，脉象濡数。《内经》说：“各种体液浑浊，都归属于热证。”又说：“肝病容易引发疼痛。”这是无形的厥逆之气与有形的湿热互相为患。治疗应当疏泄厥逆之气，淡渗利湿清热。
柴胡梢（七分） 延胡索（一钱） 路路通（二钱） 炒赤芍（一钱五分） 块滑石（三钱） 赤茯苓（三钱）
车前子（三钱） 荸荠梗（一钱五分） 金铃子（二钱） 陈橘核（一钱五分） 粉萆薢（三钱） 黑山栀（一钱五分）
细木通（八分） 枸橘（捣碎，一枚）
李左：湿火夹杂厥逆之气下注，因过度劳累，导致偏侧疝气坠胀疼痛，口干内热，小便浑浊，食欲不佳，胸脘部闷胀，脉象弦数，舌苔腻而黄。脾胃的清气不能上升，小肠和膀胱的浊气不得下降，肝气失去疏泄，脾虚生湿，湿郁久生痰，痰火瘀结凝滞，清阳不升而浊阴不降，但这都是由于素体气虚所导致的。暂且拟定健运脾胃、清利湿火的方药，使清气自然上升，浊气得以下降。
炒白术（二钱） 赤茯苓（三钱） 陈广皮（一钱） 陈橘核（一钱五分） 炒知母（二钱） 炒黄芩（三钱）
粉萆薢（三钱） 荔枝核（三钱） 软柴胡（五分） 酒炒黄柏（一钱） 小茴香（五分） 清炙甘草（五分）
复诊：前方健脾胃、清湿火后，偏侧疝气症状略有收敛，疼痛逐渐停止，胸闷不适感减轻，显示清气有上升的迹象，浊气有下降的趋势。拟在原方基础上进一步调整。
莫左：疝气坠胀，腹部疼痛伴筋脉拘急，恶心欲吐，严重时胃脘疼痛呕吐，脉象弦细，舌苔薄腻。中焦阳气衰弱，厥逆之气失于疏泄。暂且拟定大建中汤来治疗。
炒潞党参（二钱） 淡吴茱萸（八分） 金铃子（一钱五分） 熟附片（二钱） 川花椒（五分） 延胡索（八分）
炮姜炭（八分） 姜半夏（三钱） 路路通（一钱五分） 丝瓜络（一钱五分） 酒炒桑枝（三钱）
江左：年高体弱气虚，疝气反复发作，坠胀作痛，小便短少色赤，睡眠时稍安。治疗应当补益中气，疏泄厥逆之气，以丸剂代替煎剂，缓慢图取功效。
黄左：劳倦奔走，元气下陷，睾丸坠胀，无法行动，胸脘部不适。肝主筋，睾丸是筋脉汇聚之处。先建立中气，使得元气能够上升，睾丸自然就不会下坠。
炙黄芪（三钱） 炙升麻（一钱） 小茴香（五分） 炒潞党参（三钱） 柴胡梢（五分） 陈广皮（一钱五分）
炒白术（三钱） 清炙甘草（五分） 广木香（五分） 橘核丸（吞服，三钱）
复诊：坠痛已止，活动也便利了。前方使用补中益气汤非常恰当，仍守原法治疗。
炙黄芪（三钱） 云苓（三钱） 炙升麻（六分） 炒潞党参（三钱） 细青皮（一钱五分） 金铃子（一钱五分）
清炙甘草（五分） 荔枝核（三钱） 延胡索（五分） 佛手柑（八分）
费左：偏侧疝气坠胀作痛，头部眩晕，恶心欲吐，厥逆之气失于疏泄，肝气和肝阳易于上亢，治疗应当清肝理气。
金铃子（一钱五分） 云苓（三钱） 荔枝核（三钱） 延胡索（五分） 姜半夏（三钱） 橘核丸（吞服，三钱）
石决明（二钱） 细青皮（一钱五分） 小茴香（五分） 白蒺藜（三钱） 酒炒桑枝（三钱）
Mr. Chen: The Jueyin meridian (Jueyin Jing) courses through the external genitalia and connects with the testicles. Jueyin refers to the Liver. When the Liver fails in its function of free flow (Shu Xie), damp-heat (Shi Re) sinks downward, impairing the transformation and transportation functions of the Bladder (Pang Guang). This results in turbid urine, distending pain and heaviness in the hernia on one side, a greasy tongue coating, and a soggy-rapid pulse. The Classics state: "All turbid fluids belong to heat." It also states: "Liver diseases are prone to pain." Thus, formless rebellious Qi (Jue Qi) and tangible damp-heat interact to cause disease. Treatment should focus on soothing the rebellious Qi and using bland leaching herbs to drain damp-heat.
Chai Hu Shao (Bupleurum Tip, 0.7 qian), Yan Hu Suo (Corydalis Rhizome, 1 qian), Lu Lu Tong (Liquidambar Fructus, 2 qian), Chao Chi Shao (Fried Red Peony Root, 1.5 qian), Kuai Hua Shi (Talcum, 3 qian), Chi Fu Ling (Red Poria, 3 qian), Che Qian Zi (Plantago Seed, 3 qian), Bi Qi Geng (Dioscorea Hypoglauca Stem, 1.5 qian), Jin Ling Zi (Melia Fruit, 2 qian), Chen Ju He (Aged Tangerine Seed, 1.5 qian), Fen Bi Xie (Dioscorea Septemloba Rhizome, 3 qian), Hei Shan Zhi (Gardeniae Fructus, 1.5 qian), Xi Mu Tong (Akebia Caulis, 0.8 fen), Gou Ju (Crataegus Fruit, pounded, 1 piece).
Mr. Li: Damp-fire combined with rebellious Qi sinks downward due to excessive physical labor, causing distending pain and heaviness in the unilateral hernia, dry mouth with internal heat, turbid urine, poor appetite, chest and epigastric stuffiness, a wiry-rapid pulse, and a greasy yellow tongue coating. The clear Qi of the Spleen and Stomach fails to ascend, while the turbid Qi of the Small Intestine and Bladder fails to descend. The Liver Qi loses its free flow; Spleen deficiency generates dampness, which stagnates to produce phlegm; phlegm, fire, and blood stasis congeal. Clear Qi does not ascend, and turbid Yin does not descend, all resulting from a constitutional Qi deficiency. Tentatively prescribe herbs to strengthen the Spleen and Stomach and clear damp-fire, so that Clear Qi ascends naturally and Turbid Qi descends.
Chao Bai Zhu (Atractylodes Macrocephala Rhizome, fried, 2 qian), Chi Fu Ling (Red Poria, 3 qian), Chen Guang Pi (Aged Tangerine Peel, 1 qian), Chen Ju He (Aged Tangerine Seed, 1.5 qian), Chao Zhi Mu (Anemarrhenae Rhizoma, fried, 2 qian), Chao Huang Qin (Scutellariae Radix, fried, 3 qian), Fen Bi Xie (Dioscorea Septemloba Rhizome, 3 qian), Li Zhi He (Litchi Seed, 3 qian), Ruan Chai Hu (Bupleuri Radix, soft, 0.5 qian), Jiu Chao Huang Bo (Phellodendri Cortex, wine-fried, 1 qian), Xiao Hui Xiang (Foeniculum Fructus, 0.5 qian), Qing Zhi Gan Cao (Licorice Root, prepared with honey, 0.5 qian).
Second visit: After the previous prescription strengthened the Spleen/Stomach and cleared damp-fire, the unilateral hernia symptoms slightly subsided, and pain gradually ceased. Chest stuffiness improved, indicating signs of ascending Clear Qi and descending Turbid Qi. The original formula is modified for further advancement.
Remove Chai Hu from the original formula, add Jin Ling Zi (Melia Fruit, 1.5 qian) and Yan Hu Suo (Corydalis Rhizome, 0.5 qian).
Mr. Mo: Hernia with distension and heaviness, abdominal pain with tendon tension, nausea, and severe epigastric pain with vomiting. Pulse is wiry-thin, tongue coating is thin-greasy. Middle Yang is weak, and rebellious Qi fails in free flow. Tentatively prescribe Da Jian Zhong Tang (Greatly Building the Middle Decoction) for treatment.
Chao Lu Dang Shen (Codonopsis Radix, fried, 2 qian), Dan Wu Zhu Yu (Evodiae Fructus, mild, 0.8 fen), Jin Ling Zi (Melia Fruit, 1.5 qian), Shu Fu Pian (Prepared Aconite Lateralis Radix, 2 qian), Chuan Hua Jiao (Zanthoxyli Pericarpium, 0.5 qian), Yan Hu Suo (Corydalis Rhizome, 0.8 fen), Pao Jiang Tan (Zingiberis Rhizoma Carbonized, 0.8 fen), Jiang Ban Xia (Pinelliae Tuber, ginger-processed, 3 qian), Lu Lu Tong (Liquidambar Fructus, 1.5 qian), Si Gua Luo (Luffae Fructus Retinervus, 1.5 qian), Jiu Chao Sang Zhi (Mori Ramulus, wine-fried, 3 qian).
Mr. Jiang: Advanced age with Qi deficiency, recurrent hernias, distending pain, short red urine, slight relief during sleep. Treatment should tonify Middle Qi and soothe rebellious Qi. Use pills instead of decoctions for slow but steady efficacy.
Bu Zhong Yi Qi Wan (Tonify the Middle and Augment the Qi Pill, 1 liang), Ju He Wan (Citrus Seed Pill, 2 liang).
Take 2 qian each morning and evening, washed down with boiled water.
Mr. Huang: Labor and fatigue with running caused Yuan Qi to sink. Testicular distension and heaviness prevent movement; chest and epigastrium feel uncomfortable. The Liver governs tendons, and the testicles are where tendons gather. First establish Middle Qi so that Yuan Qi can ascend, preventing testicular prolapse.
Zhi Huang Qi (Astragali Radix, honey-fried, 3 qian), Zhi Sheng Ma ( Cimicifugae Rhizoma, honey-fried, 1 qian), Xiao Hui Xiang (Foeniculum Fructus, 0.5 qian), Chao Lu Dang Shen (Codonopsis Radix, fried, 3 qian), Chai Hu Shao (Bupleurum Tip, 0.5 qian), Chen Guang Pi (Aged Tangerine Peel, 1.5 qian), Chao Bai Zhu (Atractylodes Macrocephala Rhizome, fried, 3 qian), Qing Zhi Gan Cao (Licorice Root, prepared with honey, 0.5 qian), Guang Mu Xiang ( Aucklandiae Radix, 0.5 qian), Ju He Wan (Citrus Seed Pill, swallowed, 3 qian).
Second visit: Distending pain has stopped, and movement is convenient. The previous use of Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) was highly appropriate. Continue with the original method.
Zhi Huang Qi (Astragali Radix, honey-fried, 3 qian), Yun Ling (Poria, 3 qian), Zhi Sheng Ma (Cimicifugae Rhizoma, honey-fried, 0.6 fen), Chao Lu Dang Shen (Codonopsis Radix, fried, 3 qian), Xi Qing Pi (Citri Reticulatae Pericarpium Viride, fine, 1.5 qian), Jin Ling Zi (Melia Fruit, 1.5 qian), Qing Zhi Gan Cao (Licorice Root, prepared with honey, 0.5 qian), Li Zhi He (Litchi Seed, 3 qian), Yan Hu Suo (Corydalis Rhizome, 0.5 qian), Fo Shou Gan (Citri Sarcodactylis Fructus, 0.8 fen).
Mr. Fei: Unilateral hernia with distending pain, dizziness in the head, nausea. Rebellious Qi fails in free flow; Liver Qi and Liver Yang are prone to rising. Treatment should clear the Liver and regulate Qi.
Jin Ling Zi (Melia Fruit, 1.5 qian), Yun Ling (Poria, 3 qian), Li Zhi He (Litchi Seed, 3 qian), Yan Hu Suo (Corydalis Rhizome, 0.5 qian), Jiang Ban Xia (Pinelliae Tuber, ginger-processed, 3 qian), Ju He Wan (Citrus Seed Pill, swallowed, 3 qian), Shi Jue Ming (Haliotidis Concha, 2 qian), Xi Qing Pi (Citri Reticulatae Pericarpium Viride, fine, 1.5 qian), Xiao Hui Xiang (Foeniculum Fructus, 0.5 qian), Bai Ji Li (Tribuli Fructus, 3 qian), Jiu Chao Sang Zhi (Mori Ramulus, wine-fried, 3 qian).