夫疝者痛也。重坠如山。故名曰疝。皆厥阴肝经之病。与肾经绝无干涉。自素问而下。皆以为寒。东垣丹溪以为先
有湿热。又被风寒外束。所以作痛。然疝有多端。不可以湿热尽也。即以湿热言之。初起睾丸肿大。恶寒发热。
脉来弦数。不时举发者。奔走劳碌。饮食郁结。水谷之气。陷于至阴。即为湿热。非水谷之外。又有湿热也。诸书泛言
湿热。而水谷之气。毫未言及。所以治之不应。予从金匮论中。见其言疝言香港脚。以及腿缝生核。 肿不消。皆
言水谷之气下注。则疝气之由食积明矣。其寒热脉数。全是劳倦伤脾。气道错乱。失其营运常度。郁生寒热诸症。
岂尽感于风寒乎。予用柴葛二妙汤。散其劳倦之火。继以柴胡化滞汤。消其食积。不但目前立愈。并疝气之
根永除不复作矣。此古人隐而不发之义。经予一言道破。治疝之法。了无疑义也。又有微寒微热。脉虽洪弦。按之无力
者。气虚下陷。与前症迥不相同。宜用橘练补中汤。其肿自消。以上二症。卵皮虽肿。其色如故。若红肿大
痛者。谓之囊痈。热多湿少。血热下注。日久血化为脓。最难调治。初用清肝渗湿汤。七八日后。肿而不溃者。宜用滋
阴内托散。已溃之后。全要睾丸悬挂。毒从外散。可保无虞。若囊皮脱落。连及睾丸。法在不治。此皆疝家常见
之症。而亦有不恒见者。条分于左。以备采用。
疝，就是疼痛的意思。那种沉重下坠的感觉如同背负大山，所以称之为“疝”。这都属于厥阴肝经的病变，与肾经完全没有关系。自从《素问》以来，大家都认为这是寒邪所致。李东垣和朱丹溪则认为先是体内有湿热，又被风寒从外部束缚，所以才产生疼痛。然而疝的种类繁多，不能一概归结为湿热。
就以湿热为例，初起时睾丸肿大，伴有恶寒发热，脉象弦而数，且不时发作。这是由于奔走劳碌、饮食积滞郁结，导致水谷的精微之气陷入至阴部位，从而形成湿热，并非在水谷之外另有湿热。各种医书泛泛地谈论湿热，却对水谷之气的因素毫未提及，所以治疗效果不佳。我从《金匮要略》中看到，书中论述疝气、香港脚（足部肿痛），以及腿缝间生核、肿胀不消等情况，都提到是水谷之气下注所致，那么疝气由食积引起的道理就明确了。那些寒热往来、脉象数的症状，完全是因为劳倦损伤了脾气，导致气道错乱，失去了正常的运行规律，郁结而生出寒热等各种症状，哪里全是感受风寒呢？
我使用柴葛二妙汤，来疏散因劳倦产生的火邪；接着使用柴胡化滞汤，来消除食积。这样不仅眼前能立即痊愈，而且疝气的病根也能永远去除，不再复发。这是古人隐含而未阐发的深意，被我这一句话点破了。治疗疝气的方法，从此就没有什么可怀疑的了。
又有另一种情况，表现为轻微的恶寒发热，脉象虽然洪大或弦，但按下去无力，这是气虚下陷，与前一种症状截然不同。适宜使用橘练补中汤，其肿胀自然会消退。以上两种病症，虽然阴囊皮肤肿胀，但颜色如常。如果是红肿且剧烈疼痛的，称为“囊痈”，这是热多湿少，血热下注，日久血液化为脓液，最难调理治疗。初期使用清肝渗湿汤；七八天后，如果肿胀但不溃破的，适宜使用滋阴内托散。已经溃破之后，一定要让睾丸悬挂起来，使毒邪从外部散发，这样可以保证没有危险。如果囊皮脱落，并连及睾丸，治疗方法上属于不治之症。这些都是患疝气的人常见的症状，也有不常出现的，现分条列于左侧，以备参考采用。
Shan (Hernia) refers to pain. The sensation is heavy and dragging, as if bearing a mountain, hence the name "Shan". These conditions all belong to diseases of the Jueyin Liver Meridian (Jueyin Gan Jing: The liver meridian of foot-jueyin) and have absolutely no connection with the Kidney Meridian (Shen Jing: The kidney meridian of foot-shaoyin). Since the *Suwen* (Plain Questions), it has been generally believed to be caused by Cold (Han: Pathogenic cold). Li Dongyuan and Zhu Danxi considered that there was initially Damp-Heat (Shi Re: Accumulation of dampness and heat pathogens), which was then constrained externally by Wind-Cold (Feng Han: Pathogenic wind and cold), thus causing pain. However, Shan manifests in various forms and cannot be entirely attributed to Damp-Heat.
Taking Damp-Heat as an example, at the onset, the testicles swell, accompanied by aversion to cold and fever, with a wiry and rapid pulse (Xian Shu Mai: Wiry and rapid pulse indicating heat and constraint), and attacks occur intermittently. This results from running about, overwork, and dietary stagnation and constraint, where the Qi of water and grain sinks into the lowest Yin region, thereby generating Damp-Heat; it is not that there is Damp-Heat separate from the water and grain. Various medical texts vaguely discuss Damp-Heat but fail to mention the Qi of water and grain at all, which is why treatments often fail. In the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), I observed discussions on Shan, Hong Kong Foot (Xiang Gang Jiao: A condition characterized by swelling and pain in the feet/legs, often translated as beriberi or similar lower limb edema/pain syndromes), and nodules forming in the thigh clefts that do not subside, all attributing these to the downward pouring of the Qi of water and grain. Thus, it is clear that Shan can arise from food stagnation (Shi Ji: Food retention/stagnation). The symptoms of alternating chills and fever with a rapid pulse are entirely due to fatigue damaging the Spleen (Pi: The spleen, responsible for transformation and transportation), causing disorder in the Qi mechanism and loss of its normal operational rhythm, leading to the accumulation and generation of various symptoms like chills and fever. How could these be solely due to contracting Wind-Cold?
I employ Chai Ge Er Miao Tang (Bupleurum and Kudzu Two Marvels Decoction) to dissipate the fire generated by fatigue, followed by Chai Hu Hua Zhi Tang (Bupleurum Transforming Stagnation Decoction) to eliminate food stagnation. Not only does this bring immediate relief, but it also permanently eradicates the root of the Shan, preventing recurrence. This profound meaning, hidden by the ancients, has been revealed by my words. There is no longer any doubt regarding the methods for treating Shan.
There is another presentation characterized by slight chills and fever, where the pulse may appear surging or wiry but is forceless upon deep pressure; this indicates Qi Deficiency with sinking (Qi Xu Xia Xian: Sinking of Qi due to deficiency), which is completely different from the previous syndrome. One should use Ju Lian Bu Zhong Tang (Citrus Peel and Pericarpium Citri Reticulatae Tonifying the Middle Decoction), after which the swelling will naturally subside. In the above two syndromes, although the scrotal skin swells, its color remains unchanged. If there is redness, swelling, and severe pain, it is called Nang Yong (Scrotal Carbuncle/Abscess). This involves more Heat than Dampness, with Blood-Heat pouring downward; over time, the blood transforms into pus, making it extremely difficult to treat. Initially, use Qing Gan Shen Shi Tang (Clear Liver and Drain Dampness Decoction). After seven to eight days, if the swelling persists without ulceration, use Zi Yin Nei Tuo San (Nourish Yin and Support Internally Powder). After ulceration, it is essential to suspend the testicles to allow the toxin to disperse externally, ensuring safety. If the scrotal skin sloughs off involving the testicles, the condition is deemed untreatable. These are common symptoms among Shan patients, though some are less frequent. They are listed item by item on the left for reference.