疝气俗名小肠气。其实非小肠也。其所属者厥阴肝经也。人之一身。惟两胁与小腹。以
至阴
囊睾丸。皆统于肝。肝主筋。而脉循阴器。阴器者。筋之宗也。人因醉饱劳后。房欲忿怒等
动火。火郁之久。湿气生焉。使浊液凝聚。并入血队。流于肝经。肝火急速。又暴为外寒所
来。是以作痛。甚至有上升入腹者焉。若寒作寒论。恐为未备。大要热者。遇热则发。二便
赤涩。小腹肛门俱热。外肾累垂。玉茎挺急。六脉洪数。寒者遇寒则发二便皆利胁腹清冷。
外肾紧缩。六脉沉细。又有冷热不调者。外肾小腹。或冷或热。二便或闭或利。又其痛走注
无形者。属气痛。有常处。有形者。乃湿痰食积瘀血。下聚而成也。按之不痛者。属虚也。
又有胁傍动气。或时胀起。横入阴处。响如蛙声。而下坠者。亦寒疝也。至于感湿而成者。
一丸渐大。一丸渐小。而小者或至于消尽。皆并于大者。而成独丸焉。其冷如冰。其硬如石
。至大如鹅卵沉沉而痛上连小腹。筋脉牵引坐卧不得安。乃肝木得湿。畅茂条达。如树得地
气
。易于长成。此为湿疝也。又有身体发热。阴囊胀大皮破水流。痛不可忍者。乃得之于房劳
。因妇人不洁秽水侵淫。热气蒸染所致。此为劳疝也。又有身体发热。耳后忽生 腮。红肿
胀痛。 腮将退。而睾丸忽胀。一丸极大。一丸极小。有似乎偏坠。而非偏坠也。盖耳傍乃
少阳胆经之分。与厥阴肝经相为表里。少阳感受风热。故 腮忽生。后又遗发于肝经。故
腮既减。而睾丸即大此亦热疝也。又有阴囊大如斗。阴茎反缩于内。小便淋漓。不能通快。
行履滞碍。不能轻健者。非疝也。乃膀胱气也。盖肾与膀胱为表里。肾主水。而不能藏。故
膀胱受之。气化则能出矣。惟肾虚为邪所客。遗病于膀胱。膀胱受邪气闭而下坠。小便渗入
阴囊。日积月累。故胀大如斗也。治此病者。以伐肾邪为主。若夫小儿偏坠。当以食积治。
盖食积不消。脾湿下行。流入肝部。故成此症。岂以大人之疝治之。至于妇人小腹两边。逼
近阴处。忽然并结胀痛。或皮内顶起如鹅子大者。乃寒气聚于厥阴所致。小腹受寒气。其病
即发矣。是之谓阴疝。熟谓妇人无疝乎。大法以热治寒。以燥治湿。以活血治劳。有食积则
散之。有邪则伐之。有寒则祛之。斯得之矣。
疝气在民间俗称“小肠气”。但实际上并非小肠的病变。其所属经络是厥阴肝经。人体全身之中，只有两胁部、小腹部以及阴囊睾丸，都统属于肝脏管辖。肝主司筋脉，而经脉循行经过阴器（外生殖器）。阴器，是筋脉的宗主所在。人如果因为醉酒饱食、劳累之后，或者因房事过度、愤怒等情绪导致体内动火，火热郁结日久，湿气便随之产生。这使得浊液凝聚，并入血分，流注于肝经。由于肝火急迫，又突然遭受外寒侵袭，因此发生疼痛，甚至有的疼痛会向上窜入腹部。如果仅仅将寒证当作寒证来论述，恐怕不够全面。大抵而言，热证疝气，遇热则发作，表现为小便和大便赤红涩痛，小腹部和肛门都感觉发热，外肾（睾丸）松弛下垂，阴茎勃起坚硬，六脉洪大而数；寒证疝气，遇寒则发作，大小便通畅，胁腹部位清冷，外肾紧缩，六脉沉细。又有冷热不调的情况，外肾和小腹部位，有时冷有时热，二便有时闭塞有时通畅。另外，那种疼痛游走不定、没有固定形体的，属于气痛；有固定位置、有实体的，乃是湿痰、食积、瘀血在下部聚集而成的。按压时不痛的，属于虚证。还有胁肋旁有气动感，有时胀起，横向进入阴部，发出像蛙叫一样的声音，并且向下坠落的，也属于寒疝。至于因感受湿气而形成的，一侧睾丸逐渐变大，另一侧逐渐变小，而小的那侧甚至可能完全消退，最终都合并到大的那一侧，形成单个巨大的睾丸。其触感冷如冰，硬如石头，大到像鹅卵一样，沉重且疼痛，上连小腹，筋脉牵引，坐卧不安，这是肝木受湿邪影响，虽然原本应条达舒畅，但如同树木得到地气滋养易于长成一样，此处指湿气积聚，此为湿疝。又有身体发热，阴囊肿大破皮流水，疼痛难以忍受的，这是因房劳过度，因妇女不洁秽水侵入浸淫，热气蒸染所致，这叫劳疝。又有身体发热，耳后忽然生痄腮（流行性腮腺炎），红肿胀痛，当痄腮将要消退时，睾丸忽然肿胀，一侧极大，一侧极小，看起来像偏坠，但其实不是真正的偏坠。因为耳旁是少阳胆经的分野，与厥阴肝经互为表里。少阳经受风热侵袭，所以忽然生痄腮；后来病邪遗留在肝经，所以痄腮减退后，睾丸就肿大了，这也是热疝。又有阴囊肿大如斗，阴茎反而缩在里面，小便淋漓不尽，不能通利畅快，行走困难，不能轻健的，这不是疝气，而是膀胱气病。因为肾与膀胱互为表里，肾主水液代谢但不能单独储藏，故由膀胱承受，气化功能正常才能排出尿液。只有肾虚被邪气客居，遗留病邪给膀胱，膀胱受邪气闭阻而下坠，小便渗入阴囊，日积月累，所以胀大如斗。治疗这种病，以祛除肾中邪气为主。至于小儿偏坠，应当按食积治疗。因为食积不消，脾湿下行，流入肝部，所以形成此症。怎能用大人的疝气方法来治疗呢？至于妇人小腹两侧，靠近阴处，忽然并结胀痛，或者皮内顶起如鹅蛋大小的，乃是寒气聚积于厥阴肝经所致。小腹受到寒气，病症就会发作，这叫做阴疝。谁说妇人没有疝气呢？大法则是：用清热法治疗寒证，用燥湿法治疗湿证，用活血法治疗劳损证。有食积则消散它，有邪气则攻伐它，有寒邪则驱除它，这样就对了。
Shan Qi (Hernia) is commonly known in folk medicine as "Small Intestine Qi" (Xiao Chang Qi). However, it is actually not a disease of the Small Intestine. Its associated meridian is the Jueyin Liver Meridian (Jueyin Gan Jing). Among all parts of the human body, only the two hypochondriac regions, the lower abdomen, and the scrotum with testicles are collectively governed by the Liver. The Liver governs the sinews (Jin), and its meridians circulate through the genital organs (Yin Qi). The genital organs are the masters of the sinews. When people engage in excessive drinking or overeating, physical exhaustion, sexual indulgence, or anger, internal fire is stirred. If this fire remains郁 (stagnant) for a long time, dampness (Shi) arises. This causes turbid fluids to coagulate, merge into the blood team (blood level), and flow into the Liver Meridian. Due to the rapid nature of Liver Fire, combined with a sudden invasion of external Cold, pain occurs. In some cases, the pain may ascend into the abdomen. If one were to discuss cold patterns solely as cold, it would be incomplete. Generally speaking, Heat-pattern Shan Qi manifests upon exposure to heat, presenting with red and scanty urine and stool, heat sensation in the lower abdomen and anus, flaccid hanging of the external kidneys (testicles), rigid erection of the penis, and a洪数 (surging and rapid) pulse in all six positions. Cold-pattern Shan Qi manifests upon exposure to cold, presenting with free urination and defecation, cold sensation in the hypochondrium and abdomen, tight retraction of the external kidneys, and a沉细 (deep and fine) pulse. There are also mixed cold-heat patterns where the external kidneys and lower abdomen feel alternately cold or hot, and urination/defecation alternate between obstruction and freedom. Furthermore, pain that wanders without a fixed form belongs to Qi Pain (Qi Tong). Pain with a fixed location and palpable mass is caused by the accumulation of Damp-Phlegm, Food Stagnation, or Blood Stasis in the lower region. Tenderness absent upon pressure indicates a Deficiency pattern. Additionally, if there is a sensation of Qi movement beside the hypochondrium, sometimes swelling and extending horizontally into the yin region with sounds like frog croaking, accompanied by a bearing-down sensation, this is also considered Cold Shan Qi. Regarding cases caused by Dampness: one testicle gradually enlarges while the other shrinks, and the smaller one may eventually disappear, merging into the larger one to form a single large testicle. It feels cold as ice, hard as stone, as large as a goose egg, heavy and painful, radiating up to the lower abdomen, with tendon and vessel traction causing restlessness in sitting and lying down. This occurs when Liver Wood is affected by Dampness; although Liver Wood naturally desires to flourish and spread freely, like a tree benefiting from earth qi to grow easily, here it refers to the accumulation of Dampness, constituting Damp Shan Qi (Shi Shan). Another type involves bodily fever, scrotal enlargement with skin rupture and fluid leakage, and unbearable pain. This results from sexual fatigue, where unclean vaginal fluids invade and moisten, causing steaming heat infection, known as Labor Shan Qi (Lao Shan). Another type presents with bodily fever, sudden onset of mumps (Zhou Che, swelling behind the ears) with redness, swelling, and pain. As the mumps subside, the testicles suddenly swell, one extremely large and the other extremely small, resembling unilateral herniation but not being true herniation. The area beside the ear belongs to the Shaoyang Gallbladder Meridian (Shaoyang Dan Jing), which is exterior-interiorly related to the Jueyin Liver Meridian. When the Shaoyang channel contracts Wind-Heat, mumps appear suddenly. Later, the pathogen lingers in the Liver Meridian, so as the mumps decrease, the testicles enlarge. This is also a Heat Shan Qi. Another condition features a scrotum swollen as large as a bucket, the penis retracting inward, dribbling urine unable to pass smoothly, difficulty walking, and lack of agility. This is not Shan Qi but Bladder Qi Disease (Pang Guang Qi). The Kidney and Bladder are exterior-interiorly related. The Kidney governs water metabolism but cannot store alone, thus the Bladder receives it; only through Qi transformation can urine be excreted. Only when Kidney Deficiency allows pathogens to lodge, transmitting illness to the Bladder, does the Bladder receive pathogenic Qi, leading to obstruction and bearing-down, allowing urine to seep into the scrotum. Over months and years, it swells as large as a bucket. Treatment focuses on eliminating Kidney pathogens. For children with unilateral scrotal swelling, treatment should address Food Stagnation. Because undigested food leads to Spleen Dampness descending into the Liver region, causing this condition. One cannot treat it using adult hernia protocols. In women, sudden binding, swelling, and pain in both sides of the lower abdomen near the yin region, or subcutaneous nodules the size of a goose egg, result from Cold Qi accumulating in the Jueyin Liver Meridian. Once the lower abdomen is invaded by Cold Qi, the disease manifests. This is called Yin Shan Qi. Who says women do not suffer from hernias? The general principles are: use Heat-clearing methods for Cold patterns, Dryness-promoting methods for Dampness patterns, and Blood-invigorating methods for Fatigue/Labor patterns. Disperse Food Stagnation if present, attack Pathogens if present, dispel Cold if present. Thus, the treatment will be successful.