疝也，不可不下。
上疝图虽七，然寒疝即疝之总名，水疝即 疝之属，气疝即狐疝之属，血疝即痈疖之属，惟筋疝罕见之，
盖下疳疮之属也。
睾囊肿大如升如斗是也。
〔丹〕下部 气不痛之方。细思非痛断房事与浓味不可，用药惟促其寿。若苍术、神曲、白芷、山楂、
川芎、枳实、半夏皆要药，人视其药，皆鄙贱之物，以启慢心，又不能断欲，以爱护其根本，非徒无益，而反
被其害者多矣。且其药宜随时月寒湿，更按君臣佐使加减，大抵 疝属湿多。
苍术 神曲 白芷（散水） 山楂 川芎 枳实 半夏 南星
上神曲糊为丸。有热加山栀一两，坚硬加朴硝半两，秋冬加吴茱萸二钱半。
疝。
南星 山楂 苍术（各二两） 白芷 半夏 枳实 神曲（各一两） 海藻 昆布（各半两）
玄明粉 吴茱萸（各二钱）
上为末，酒糊丸。
又方 治木肾不痛。
南星 半夏 黄柏（酒洗） 苍术（盐炒） 枳实 山楂 白芷 神曲（炒） 滑石（炒） 茱萸 昆布
上为末，酒糊丸。空心盐汤下。一方加枸杞子。
〔无〕香附散治 胀。
用香附子不拘多少为末，每用酒一盏，海藻一钱，煎至半盏，先捞海藻嚼细，用所煎酒调末二钱服。
〔东〕又方 治偏坠初生，用穿山甲、茴香二味，为细末，酒送下，以干物压之。
〔丹〕木肾，以楮木叶雄者，晒干为末，酒糊为丸，空心盐酒下。（《本事方》云∶无实者雄也。）
〔洁〕海蛤丸 疝。
海蛤（醋淬三次） 当归 海金沙 腻粉 砂（各一钱） 海藻 粉霜（各五分） 水蛭（二十一条，
炒） 青黛 滑石 乳香（各一钱）
朱砂（二钱，为末） 地龙（二十一条，去头足）
上细末，盐煮面糊为丸，如小豆大，朱砂为衣。每服十丸，煎灯心汤空心服之，小便下冷脓恶物乃效。却
以黄连、紫河车、板蓝根各二钱，煎汤漱口，以固牙齿，去板蓝根加管仲。
〔世〕治偏坠大者。用干姜、桂各一两，为末，以绵一两，水大三碗，同煮二十余沸，起晒干，又煮水尽
为度。用干绵包阴丸，汗出数次，渐愈。
〔海〕地黄膏子丸 治男子妇人，脐下奔豚气块，小腹疼痛，卵痛，即控睾相似，渐成肿，阴阴痛上冲
心腹，不可忍者，宜服此药。
血竭 沉香 木香 广术（炮） 玄胡索 蛤蚧 人参 当归 川芎 川楝（麸炒） 续断 白
术全蝎 茴香（炒） 柴胡 吴茱萸 没药（以上分两不定，随症加减用之） 气多者加青皮。血多加肉桂。
上同为细末，地黄膏子丸，桐子大。空心温酒下二十丸，日加一丸，至三十丸。
〔《简》〕安息香丸 治阴气下坠痛胀，卵核肿大，坚硬如石，痛不能忍者。
玄胡索（炒） 海藻（洗） 昆布（洗） 青皮（去白） 茴香（炒） 川楝子（去核） 马蔺花（以上
各一两半） 木香（半两，不见火） 大戟（酒浸三宿，切片焙干，三钱半）
上为细末，另将 砂、真阿魏、真安息香三味，各二钱半，用酒一盏，醋一盏，将 砂、阿魏、安息香淘
去砂石，用酒醋合一盏，熬成膏子。再入麝香一钱，没药二钱半，俱各另研细，入前药一同和丸如绿豆大。每
服十丸至十五丸，空心用绵子灰调酒下。
〔《本》〕治膀胱疝气，外肾肿痛不可忍，念珠丸。
乳香 砂（各三钱，飞） 黄蜡（一两）
上乳香， 砂同研匀，溶蜡和为丸，分作一百单八丸，以线穿之，露一宿，次日用蛤粉为衣，旋取用乳香汤
下。顷年有人货疝疾药，日货数千，有一国医多金得之，用之良验。
〔丹〕郑子敬，因吃酒后，饮水与水果，偏肾大，时作蛙声，或作痛。炒枳实一两，茴香盐炒、炒栀子各
三钱，研，煎，下保和丸。
昌世官，膀胱气下坠如蛙声，臭橘子核炒十枚，桃仁二十枚，萝卜自然汁，研下保和丸七十。
兄年三十，左肾核肿痛，此饮食中湿，坠下成热，以橘核（即臭橘。）五枚，桃仁七枚，细研，顺流水一盏，
煎沸热，下保和丸。
〔《本》〕治膀胱肿硬，牵引疼痛，及治小肠气阴囊肿，毛间出水，宜服金铃丸。
金铃子肉（五两） 茴香（炒） 马蔺花（炒） 菟丝子 海蛤 破故纸 海带（各二两） 木香 丁香（各一两）
上细末，糊丸，如桐子大。每服二三十丸，温酒盐汤，空心食前服。
〔无〕大戟丸 治阴 肿胀，或小肠气痛。
大戟（去皮锉，炒黄，半两） 葫芦巴（炒，四两） 木香（一两） 附子（炮，去皮脐） 茴香 诃子（煨，
去核） 槟榔（各半两） 川楝（五两） 麝香（半两，另研）
上为末，独取川楝，以好酒二升，葱白头七枚，长三四寸，煮川楝软，去皮复选肉，和上件药杵丸如桐子
大，空心温酒下十丸，潮发疼痛，炒姜，热酒下十五丸。
抵圣丸 治阴 肿满，赤肿，大便秘，欲饮水，按之脐腹痛。
续随子 薏苡仁 郁李仁 茵芋 白牵牛（各一钱，略炒）
上为末，滴水丸如桐子大。每服五丸，用《博济方》香姜散咽下，黄昏服，五更利下恶物效。
〔子和〕汝南司候李审言，因劳役王事，饮冷水，坐湿地，乃湿气下行，流入脬囊，大肿，痛不可忍，以
金铃、川楝等药不效，求治于戴人。曰∶可服泄水丸。审言惑之。又数日，痛不可堪，竟从戴人，先以舟车丸、
浚川散，下青绿水十余行，痛止。后用茴香丸、五苓散以调之，三日而肿消，至老更不作。
〔世〕绵包取汗。（方见 疝不痛条。）
〔丹〕木肾，以枇杷叶、野紫苏叶、苍耳叶、水晶蒲卜叶，浓煎汤熏洗。
〔无〕雄黄散 治阴肿大如斗，核痛，人所不能治。
雄黄（一两，研） 矾（二两） 甘草（生，半两）
上锉散，以水五升，煎洗。
〔洁〕失笑散 治肾肿。
荆芥穗（一两） 朴硝（二两）
上为粗末，萝卜葱同煎汤，淋洗。
〔梅〕治卒外肾肿痛，大黄末，醋和涂之，干即易之。
〔焦〕治男子阴肿大如升，核痛，人所不能治者，捣马鞭草，涂之。男子阴肿大如斗，核痛，人所不能治
者，蔓菁根捣，敷之。
运气 疝有一。经云∶阳明司天，燥淫所胜，丈夫 疝，妇人小腹痛。又云∶阳明之胜，外发 疝者，
是燥邪攻肝，气虚而然。治法当补肝泻燥金也。（全文见运气类注。）
〔《素》〕厥阴所谓 疝妇人少腹肿者，厥阴者辰也，三月阳中之阴，邪在中，故曰 疝少腹肿也。所谓
癃疝肤胀者，曰阴亦盛，而脉胀不通，故曰 癃疝也。（俱脉解篇。）
三阳为病，发寒热，下为痈肿，及为痿厥 ，其传为 疝。（全文见诊病传变。王注云∶ ，酸痛也。）
〔《灵》〕黄帝曰∶刺节言去爪，夫子乃言刺关节肢络，愿卒闻之。岐伯曰∶腰脊者，身之大关节也。肢胫
者，人之管以趋翔也。茎垂者，身中之机，阴精之候，津液之道也。故饮食不节，喜怒不时，津液内溢，乃下
留于睾，血道不通，日大不休，俯仰不便，趋翔不能，此病荥然有水，不上不下，铍石所取，形不可匿，常不
得蔽，故命曰去爪。帝曰∶善。（刺节真邪篇）
《内经》刺灸 疝共四法∶
其一即此篇文，所谓铍石，取睾囊中水液者是也，其法令世人亦多能之。睾丸囊大如斗者，中藏秽液，必
有数升，信知此出古法也。（铍针如刀状。）
其二取肝。经云∶足厥阴之脉，是动则病丈夫 疝，妇人小腹肿是也，是于足厥阴肝经，视盛虚热寒陷下，
而施补泻留疾与灸也。（全文见针灸门十二经条。）
其三取肝之络。经云∶足厥阴之别，名曰蠡沟，去内踝五寸，别走少阳，其别者，径胫上睾，结于茎。其
病气逆则睾肿卒疝，取之所别是也。是于内踝上五寸贴胫骨后近肉处，蠡沟取之也。（全文见针灸门十五经条。）
其四取足阳明筋。经云∶足阳明之筋，聚于阴器上腹。其病转筋，髀前肿 疝腹筋急，治在燔针劫刺，以
知为数，以痛为输是也，是于转筋痛处，用火针刺之也。
〔桑〕治偏坠。当外肾缝，沿皮针透即消。
〔《集》〕木肾，红肿如升大，不痛∶大敦 三阴交 海底 归来（在水道下二寸，针入二寸半，灸
七壮。）木肾，红肿
阴汗偏坠∶阑门（毛际玉茎旁开二寸，针入二寸半。）三阴交
〔《甲》〕 疝，大巨及地机、中 主之。 疝，阴暴痛，中封主之。（《千金》云∶ 疝癃暴痛
痿厥，身体不仁。）气癃 疝，阴急，股枢 内廉痛，交信主之。丈夫 疝，阴跳痛，引篡中不得溺，
腹支胁下 满闭癃，阴痿后时泄，四肢不收，实则身疼痛，汗不出，目KT KT 然无所见，怒欲杀人，
暴痛引髌下节，时有热气，筋挛膝痛，不可屈伸，狂如新发衄，不食喘呼，小腹痛引噫，足厥痛，涌泉主之。
〔《撮》〕木肾，红肿疼痛∶然谷（半寸，泻之。）
〔世〕灸关元者，可愈。盖灸之早方效。
〔垣〕前阴分大寒大热囊垂缩 阴阳别论云∶三阳为病，发寒热，下为壅肿，及为痿厥 ，其传为索泽，
又传为 疝。夫热在外，寒在内，则累垂，此九夏之气也。寒在外，热在内，则卵缩，此三冬之气也。足太阳
膀胱之脉逆上迎，手太阳小肠之脉下行，至足厥阴肝之脉不得伸，其任脉并厥阴之脉，逆则如巨川之水，致阳气
下坠，是风寒湿热下出囊中，致两睾肿大，谓之曰疝，太甚则为 。足厥阴之脉，与大肠膀胱寒水之脉，同至
前阴之末。伤寒家说足厥阴肝经为病，烦满囊缩，急下之，宜大承气汤以泻大热。《灵枢经》云∶足厥阴肝经筋
中为寒，则筋挛卵缩为大寒。前说囊缩为大热，此说为大寒。此说囊缩垂睾下引 疝香港脚为大寒，风湿盛下垂
为寒，与上二说不同，何也？曰∶以平康不病患论之，夏暑大热，囊卵累垂。冬天大寒，急缩收上，于前三说
又不同，何也？是相乖耶？不相乖耶？答曰∶伤寒家囊卵缩，大热在内，宜承气汤急下之。与经筋说囊卵缩，
大寒在外，亦是热在内，与伤寒家同。故再引平康人以证之，冬天阳气在内，阴气在外，人亦应之，故寒在外
则皮急，皮急则囊缩。夏月阴气在内，阳气在外，人亦应之，故热在外则皮缓，皮缓则囊垂，此 疝之象也。
三说虽殊，皆一理也。用药者宜详而审之。以上三论，各有所主，兼此考订，则脉证阴阳寒热虚实之辨，判然矣。
疝病，不可不深入研究。
关于上部的疝图虽然有七种分类，但寒疝实际上是疝病的总称；水疝属于疝病的一类；气疝属于狐疝的一类；血疝属于痈疖（皮肤化脓性感染）的一类；只有筋疝比较罕见，它大概属于下疳疮（一种性病溃疡）的范畴。
睾丸囊肿大，像升、像斗那样大，就是这种情况。
〔朱丹溪〕下部气滞但不疼痛的方剂。仔细思考，如果不戒除房事和浓味饮食，疼痛是断不了的，用药只能延长寿命。苍术、神曲、白芷、山楂、川芎、枳实、半夏都是重要的药物，人们往往轻视这些药材，认为它们是卑贱之物，从而产生轻慢之心，又不能戒除欲望以爱护根本，结果不仅无益，反而受害的人很多。而且这些药宜根据季节气候的寒湿变化，按照君臣佐使的原则加减使用，大抵疝病多属湿邪所致。
苍术 神曲 白芷（散水湿） 山楂 川芎 枳实 半夏 天南星
以上药物用神曲糊制成丸剂。有热象加山栀一两，坚硬者加朴硝半两，秋冬季节加吴茱萸二钱半。
疝病。
天南星 山楂 苍术（各二两） 白芷 半夏 枳实 神曲（各一两） 海藻 昆布（各半两）
玄明粉 吴茱萸（各二钱）
以上药物研为细末，用酒糊制成丸剂。
又一方，治疗木肾（睾丸肿大无痛）。
天南星 半夏 黄柏（酒洗） 苍术（盐炒） 枳实 山楂 白芷 神曲（炒） 滑石（炒） 吴茱萸 昆布
以上药物研为细末，用酒糊制成丸剂。空腹时用盐汤送服。另一方的配方中加入枸杞子。
〔李东垣〕香附散治疗阴囊肿胀。
取香附子不拘多少研为细末，每次用酒一盏，海藻一钱，煎至半盏，先捞出海藻嚼碎，用煎好的酒调服香附末二钱。
〔张元素〕又一方，治疗偏坠初起，用穿山甲、小茴香两味药，研为细末，用酒送服，并用干物压迫患处。
〔朱丹溪〕木肾，用楮树叶子中雄性的，晒干研为细末，用酒糊制成丸剂，空腹时用盐酒送服。（《本事方》说：没有果实的是雄性。）
〔王好古〕海蛤丸治疗疝病。
海蛤（醋淬三次） 当归 海金沙 轻粉 砂仁（各一钱） 海藻 粉霜（各五分） 水蛭（二十一条，炒） 青黛 滑石 乳香（各一钱）
朱砂（二钱，研为细末） 地龙（二十一条，去头足）
以上药物研为细末，用盐煮面糊制成丸剂，如小豆大小，用朱砂做外衣。每次服用十丸，空腹时煎灯心草汤送服，待小便排出冷脓恶物后见效。随后用黄连、紫河车、板蓝根各二钱，煎汤漱口，以固牙齿，若不加板蓝根则加入管仲。
〔世传方〕治疗偏坠较大者。用干姜、桂枝各一两，研为细末，用绵一两，加水三大碗，同煮二十余沸，取出晒干，再煮至水尽为止。用干绵包裹阴囊，出汗数次后，逐渐痊愈。
〔王海藏〕地黄膏子丸治疗男子妇人，脐下奔豚气块，小腹疼痛，睾丸痛，就像控睾一样，逐渐形成肿胀，隐隐作痛上冲心腹，痛苦难忍，适宜服用此药。
血竭 沉香 木香 莪术（炮） 玄胡索 蛤蚧 人参 当归 川芎 川楝子（麸炒） 续断 白术 全蝎 小茴香（炒） 柴胡 吴茱萸 没药（以上分两不定，随症状加减使用） 气滞多加青皮。血瘀多加肉桂。
以上药物同为细末，用地黄膏子制成丸剂，如梧桐子大小。空腹时温酒送服二十丸，每日增加一丸，直至三十丸。
〔《简要济众方》〕安息香丸治疗阴气下坠痛胀，卵核肿大，坚硬如石，痛不能忍者。
玄胡索（炒） 海藻（洗） 昆布（洗） 青皮（去白） 小茴香（炒） 川楝子（去核） 马蔺花（以上各一两半） 木香（半两，不见火） 大戟（酒浸三宿，切片焙干，三钱半）
以上药物研为细末，另外将硇砂、真阿魏、真安息香三味药，各二钱半，用酒一盏，醋一盏，将硇砂、阿魏、安息香淘去砂石，用酒醋合一盏，熬成膏子。再加入麝香一钱，没药二钱半，都分别研细，与前药一同和丸如绿豆大小。每次服用十丸至十五丸，空腹时用绵子灰调酒送服。
〔《本草衍义》〕治疗膀胱疝气，外肾肿痛不可忍，念珠丸。
乳香 硇砂（各三钱，飞制） 黄蜡（一两）
以上乳香、硇砂同研匀，溶化黄蜡和为丸，分作一百零八丸，用线串起来，露置一夜，次日用蛤粉做外衣，随时取用乳香汤送服。近年有人贩卖疝疾药，每天卖出数千，有一位国医花费重金得到此药，使用效果很好。
〔朱丹溪〕郑子敬，因为酒后饮水与水果，导致偏侧肾脏肿大，时常发出蛙声，有时疼痛。用炒枳实一两，盐炒小茴香、炒栀子各三钱，研细，煎汤，送服保和丸。
昌世官，膀胱气下坠如蛙声，用臭橘子核炒十枚，桃仁二十枚，萝卜自然汁，研细送服保和丸七十丸。
兄长年三十岁，左侧睾丸核肿痛，这是饮食中湿气，下坠化成热，用橘核（即臭橘）五枚，桃仁七枚，研细，顺流水一盏，煎沸热，送服保和丸。
〔《本草衍义》〕治疗膀胱肿硬，牵引疼痛，以及治疗小肠气阴囊肿，毛间出水，适宜服用金铃丸。
金铃子肉（五两） 小茴香（炒） 马蔺花（炒） 菟丝子 海蛤 破故纸 海带（各二两） 木香 丁香（各一两）
以上药物研为细末，糊丸，如梧桐子大小。每次服用二三十丸，空腹食前用温酒盐汤送服。
〔李东垣〕大戟丸治疗阴囊肿胀，或小肠气痛。
大戟（去皮锉，炒黄，半两） 葫芦巴（炒，四两） 木香（一两） 附子（炮，去皮脐） 小茴香 诃子（煨，去核） 槟榔（各半两） 川楝子（五两） 麝香（半两，另研）
以上药物研为细末，单独取川楝子，用好酒二升，葱白头七枚，长三四寸，煮川楝子软，去皮复选肉，和上述药物杵丸如梧桐子大小，空腹温酒送服十丸，潮发疼痛时，用炒姜、热酒送服十五丸。
抵圣丸治疗阴囊肿满，赤肿，大便秘结，想喝水，按压脐腹痛。
续随子 薏苡仁 郁李仁 茵芋 白牵牛（各一钱，略炒）
以上药物研为细末，滴水制成丸剂如梧桐子大小。每次服用五丸，用《博济方》中的香姜散咽下，黄昏服用，五更时分泻下恶物后见效。
〔张从正〕汝南司候李审言，因为劳役王事，饮冷水，坐湿地，于是湿气下行，流入脬囊，大肿，痛不可忍，用金铃、川楝等药无效，求治于戴人（张从正）。戴人说：可以服用泄水丸。李审言对此感到困惑。又过了几天，痛不可堪，最终听从戴人的建议，先用舟车丸、浚川散，泻下青绿水十余行，疼痛停止。后用茴香丸、五苓散来调理，三日而肿消，直到老死也不再发作。
〔世传方〕绵包取汗。（方见疝不痛条。）
〔朱丹溪〕木肾，用枇杷叶、野紫苏叶、苍耳叶、水晶蒲卜叶，浓煎汤熏洗。
〔李东垣〕雄黄散治疗阴肿大如斗，核痛，人所不能治者。
雄黄（一两，研） 矾（二两） 甘草（生，半两）
以上药物锉散，用水五升，煎汤清洗。
〔王好古〕失笑散治疗肾肿。
荆芥穗（一两） 朴硝（二两）
以上药物为粗末，萝卜葱同煎汤，淋洗。
〔梅氏〕治疗突然外肾肿痛，大黄末，醋调和涂之，干了就换。
〔焦氏〕治疗男子阴肿大如升，核痛，人所不能治者，捣马鞭草，涂之。男子阴肿大如斗，核痛，人所不能治者，蔓菁根捣，敷之。
运气学说中关于疝病有一条。经书说：阳明司天，燥淫所胜，丈夫患疝病，妇人小腹痛。又说：阳明之胜，外发疝病，这是燥邪攻肝，气虚而然。治法应当补肝泻燥金。（全文见运气类注。）
〔《素问》〕厥阴所谓疝病，妇人少腹肿者，厥阴者辰也，三月阳中之阴，邪在中，故曰疝少腹肿也。所谓癃疝肤胀者，曰阴亦盛，而脉胀不通，故曰癃疝也。（俱脉解篇。）
三阳为病，发寒热，下为痈肿，及为痿厥，其传为疝。（全文见诊病传变。王冰注云：，酸痛也。）
〔《灵枢》〕黄帝说：刺节篇提到去爪法，先生您说是刺关节肢络，我想听完整的内容。岐伯说：腰脊，是人体的大关节。肢胫，是人行走的管子。茎垂，是人体中的机关，阴精的候察之处，津液的道路。所以饮食不节制，喜怒不时，津液内溢，于是下留于睾，血道不通，日益增大不休，俯仰不便，行走不能，此病荥然有水，不上不下，需用铍石治疗，形体不可隐匿，常不得遮蔽，所以命曰去爪。帝说：好。（刺节真邪篇）
《内经》中刺灸疝病共有四种方法：
其一就是本篇文字，所谓铍石，取睾囊中水液的方法，其法令世人也多能掌握。睾丸囊大如斗者，中藏秽液，必有数升，信知此出古法也。（铍针如刀状。）
其二取肝经。经书说：足厥阴之脉，是动则病丈夫疝，妇人小腹肿是也，是在足厥阴肝经，视盛虚热寒陷下，而施补泻留疾与灸也。（全文见针灸门十二经条。）
其三取肝之络脉。经书说：足厥阴之别，名曰蠡沟，去内踝五寸，别走少阳，其别者，径胫上睾，结于茎。其病气逆则睾肿卒疝，取之所别是也。是在内踝上五寸贴胫骨后近肉处，蠡沟取之也。（全文见针灸门十五经条。）
其四取足阳明筋。经书说：足阳明之筋，聚于阴器上腹。其病转筋，髀前肿疝腹筋急，治在燔针劫刺，以知为数，以痛为输是也，是在转筋痛处，用火针刺之也。
〔桑氏〕治疗偏坠。当外肾缝，沿皮针透即消。
〔《针灸集成》〕木肾，红肿如升大，不痛：大敦 三阴交 海底 归来（在水道下二寸，针入二寸半，灸七壮。）木肾，红肿
阴汗偏坠：阑门（毛际玉茎旁开二寸，针入二寸半。）三阴交
〔《针灸甲乙经》〕疝病，大巨及地机、中主之。疝病，阴暴痛，中封主之。（《千金方》说：疝癃暴痛痿厥，身体不仁。）气癃疝，阴急，股枢内廉痛，交信主之。丈夫疝，阴跳痛，引篡中不得溺，腹支胁下满闭癃，阴痿后时泄，四肢不收，实则身疼痛，汗不出，目KT KT然无所见，怒欲杀人，暴痛引髌下节，时有热气，筋挛膝痛，不可屈伸，狂如新发衄，不食喘呼，小腹痛引噫，足厥痛，涌泉主之。
〔《针灸撮要》〕木肾，红肿疼痛：然谷（半寸，泻之。）
〔世传方〕灸关元者，可愈。盖灸之早方效。
〔李杲〕前阴分大寒大热囊垂缩阴阳别论云：三阳为病，发寒热，下为壅肿，及为痿厥，其传为索泽，又传为疝。夫热在外，寒在内，则累垂，此九夏之气也。寒在外，热在内，则卵缩，此三冬之气也。足太阳膀胱之脉逆上迎，手太阳小肠之脉下行，至足厥阴肝之脉不得伸，其任脉并厥阴之脉，逆则如巨川之水，致阳气下坠，是风寒湿热下出囊中，致两睾肿大，谓之曰疝，太甚则为。足厥阴之脉，与大肠膀胱寒水之脉，同至前阴之末。伤寒家说足厥阴肝经为病，烦满囊缩，急下之，宜大承气汤以泻大热。《灵枢经》说：足厥阴肝经筋中为寒，则筋挛卵缩为大寒。前说囊缩为大热，此说为大寒。此说囊缩垂睾下引疝香港脚为大寒，风湿盛下垂为寒，与上二说不同，何也？曰：伤寒家囊卵缩，大热在内，宜承气汤急下之。与经筋说囊卵缩，大寒在外，亦是热在内，与伤寒家同。故再引平康人以证之，冬天阳气在内，阴气在外，人亦应之，故寒在外则皮急，皮急则囊缩。夏月阴气在内，阳气在外，人亦应之，故热在外则皮缓，皮缓则囊垂，此疝之象也。
三说虽殊，皆一理也。用药者宜详而审之。以上三论，各有所主，兼此考订，则脉证阴阳寒热虚实之辨，判然矣。
Scrofula (Hernia), specifically referring to diseases of the genital region, requires thorough investigation.
Although there are seven diagrams for upper hernias, Cold Hernia is actually the general term for all hernias; Water Hernia belongs to the category of hernias; Qi Hernia belongs to the category of Fox Hernia; Blood Hernia belongs to the category of Carbuncles and Furuncles (skin suppurative infections); only Sinew Hernia is rare, which probably belongs to the category of Chancre Sores (a type of sexually transmitted ulcer).
Swelling of the testicular sac as large as a Sheng or a Dou is the condition described.
[Zhu Danxi] For lower body Qi stagnation without pain: Upon careful consideration, unless one abstains from sexual intercourse and rich flavors, the pain will not cease; medication can only prolong life. Cangzhu (Atractylodis Rhizoma), Shenqu (Massa Medicata Fermentata), Baizhi (Angelicae Dahuricae Radix), Shanzha (Crataegi Fructus), Chuanxiong (Ligustici Chuanxiong Rhizoma), Zhishi (Aurantii Fructus Immaturus), and Banxia (Pinelliae Rhizoma) are all important herbs. People often despise these medicinal materials, considering them cheap and inferior, thereby developing a dismissive attitude. Furthermore, if one fails to abstain from desires to protect the root, they will not only gain no benefit but suffer harm. These medicines should be adjusted according to the cold and dampness of the seasons, following the principles of Sovereign, Minister, Assistant, and Courier. Generally, hernias are mostly caused by Dampness.
Cangzhu (Atractylodis Rhizoma) Shenqu (Massa Medicata Fermentata) Baizhi (Angelicae Dahuricae Radix) [dispels water-dampness] Shanzha (Crataegi Fructus) Chuanxiong (Ligustici Chuanxiong Rhizoma) Zhishi (Aurantii Fructus Immaturus) Banxia (Pinelliae Rhizoma) Nanting (Arisaematis Rhizoma Praeparatum)
Make pills using Shenqu paste. If there is Heat, add Zhizi (Gardeniae Fructus) 1 liang; if hard, add Poxiao (Natrii Sulfas) 0.5 liang; in autumn and winter, add Wuzhuyu (Evodiae Fructus) 2.5 qian.
For Hernia:
Nanting (Arisaematis Rhizoma Praeparatum) Shanzha (Crataegi Fructus) Cangzhu (Atractylodis Rhizoma) [each 2 liang] Baizhi (Angelicae Dahuricae Radix) Banxia (Pinelliae Rhizoma) Zhishi (Aurantii Fructus Immaturus) Shenqu (Massa Medicata Fermentata) [each 1 liang] Haizao (Sargassum Herba) Kunbu (Eckloniae Herba) [each 0.5 liang]
Xuanmingfen (Natrii Sulfas Exsiccatus) Wuzhuyu (Evodiae Fructus) [each 2 qian]
Grind into powder, make pills with wine paste.
Another prescription for treating Muren (painless testicular swelling):
Nanting (Arisaematis Rhizoma Praeparatum) Banxia (Pinelliae Rhizoma) Huangbai (Phellodendri Cortex) [wine-washed] Cangzhu (Atractylodis Rhizoma) [salt-fried] Zhishi (Aurantii Fructus Immaturus) Shanzha (Crataegi Fructus) Baizhi (Angelicae Dahuricae Radix) Shenqu (Massa Medicata Fermentata) [fried] Huashi (Talcum) [fried] Wuzhuyu (Evodiae Fructus) Kunbu (Eckloniae Herba)
Grind into powder, make pills with wine paste. Take on an empty stomach with salt water. Another formula adds Gouqi Zi (Lycii Fructus).
[Li Dongyuan] Xiangfu San treats Yin swelling.
Take Xiangfu Zi (Cyperi Rhizoma) in any amount, grind into powder. Each time, use 1 zhan of wine and 1 qian of Haizao (Sargassum Herba), decoct until half a zhan remains. First, remove the Haizao, chew it finely, then mix the powder with the decocted wine and take 2 qian.
[Zhang Yuansu] Another prescription for early-stage unilateral scrotal descent: Use Chanshanjia (Manis Squama) and Huixiang (Foeniculi Fructus), grind into fine powder, take with wine, and apply dry pressure to the area.
[Zhu Danxi] For Muren (painless testicular swelling), use male leaves of the Paper Mulberry tree (Broussonetiae Folium), dry them, grind into powder, make pills with wine paste, and take on an empty stomach with salt wine. (*Ben Shi Fang* states: those without fruit are male.)
[Wang Haogu] Hai Ge Wan treats Hernia.
Haige (Concha Meretricis et Cyclinae) [quenched three times in vinegar] Danggui (Angelicae Sinensis Radix) Haijinsha (Spora Lygodii) Qifen (Calomelas) Sharen (Amomi Fructus) [each 1 qian] Haizao (Sargassum Herba) Fenshuang (Sublimated Arsenic Trioxide) [each 5 fen] Shuizhi (Hirudo) [21 pieces, fried] Qingdai (Indigo Naturalis) Huashi (Talcum) Ruxiang (Olibanum) [each 1 qian]
Zhusha (Cinnabaris) [2 qian, ground] Dilong (Pheretima) [21 pieces, head and feet removed]
Grind into fine powder, make pills with salt-boiled wheat flour paste, size of small beans, coat with Zhusha (Cinnabaris). Take 10 pills each time, decoct Dengxincao (Junci Medulla) soup and take on an empty stomach. Effect is seen when cold pus and foul matter are discharged in urine. Afterwards, rinse mouth with decoction of Huanglian (Coptidis Rhizoma), Zihache (Placenta Hominis), and Banlangen (Isatidis Radix) [each 2 qian] to strengthen teeth; if Banlangen is omitted, add Guanzhong (Asari Radix et Rhizoma).
[Worldly Prescription] For large unilateral scrotal descent: Use Ganjiang (Zingiberis Rhizoma) and Guizhi (Cinnamomi Ramulus) [each 1 liang], grind into powder. Take 1 liang of cotton, add 3 bowls of water, boil together for more than 20 boils, remove and dry, then boil again until water is exhausted. Wrap the swollen scrotum with dry cotton; sweating several times leads to gradual recovery.
[Wang Haizang] Dihuang Gaozi Wan treats men and women with Ben Tun Qi masses below the navel, lower abdominal pain, testicular pain resembling testicular retraction, gradually forming swelling, dull pain rushing up to the heart and abdomen, unbearable suffering. This medicine is suitable.
Xuejie (Dragon's Blood) Chenxiang (Aquilariae Lignum Resinatum) Muxiang (Vladimiriae Radix) Ezhu (Curcumae Rhizoma) [processed] Yanhusuo (Corydalis Rhizoma) Gejie (Gecko) Renshen (Ginseng Radix et Rhizoma) Danggui (Angelicae Sinensis Radix) Chuanxiong (Ligustici Chuanxiong Rhizoma) Chuanlianzi (Toosendan Fructus) [bran-fried] Xuduan (Dipsaci Radix) Baizhu (Atractylodis Macrocephalae Rhizoma) Quanxie (Scorpio) Huixiang (Foeniculi Fructus) [fried] Chaihu (Bupleuri Radix) Wuzhuyu (Evodiae Fructus) Moyao (Myrrha) [dosages indefinite, adjust according to symptoms]. Add Qingpi (Citri Reticulatae Pericarpium Viride) for excess Qi. Add Rougui (Cinnamomi Cortex) for excess Blood.
Grind all into fine powder, make pills with Dihuang Gao (Rehmanniae Radix Preparata paste), size of tung seeds. Take 20 pills on an empty stomach with warm wine, increasing by one pill daily up to 30 pills.
*[Jian Yao Ji Zhong Fang]* Anxi Xiang Wan treats sinking pain and distension of Yin Qi, enlarged and stone-hard testicles, unbearable pain.
Yanhusuo (Corydalis Rhizoma) [fried] Haizao (Sargassum Herba) [washed] Kunbu (Eckloniae Herba) [washed] Qingpi (Citri Reticulatae Pericarpium Viride) [white part removed] Huixiang (Foeniculi Fructus) [fried] Chuanlianzi (Toosendan Fructus) [core removed] Malinhua (Iridis Tectorii Flos) [each 1.5 liang] Muxiang (Vladimiriae Radix) [0.5 liang, do not expose to fire] Daji (Euphorbiae Pekinensis Radix) [soaked in wine for three nights, sliced and dried, 3.5 qian]
Grind into fine powder. Separately, take Naosha (Natrii Nitras), Zhen Awei (Asafoetida), and Zhen Anxi Xiang (Benzoinum) [each 2.5 qian]. Use 1 zhan of wine and 1 zhan of vinegar. Wash away sand from Naosha, Awei, and Anxi Xiang. Combine wine and vinegar to 1 zhan, boil into a paste. Add She Xiang (Moschus) 1 qian and Moyao (Myrrha) 2.5 qian, both ground separately. Mix with previous powder, make pills size of mung beans. Take 10-15 pills on an empty stomach, mixed with ash from cotton seeds and wine.
*[Ben Cao Yan Yi]* Treats Bladder Hernia Qi, unbearable external genital swelling and pain, Nian Zhu Wan.
Ruxiang (Olibanum) Naosha (Natrii Nitras) [each 3 qian, refined] Huangla (Beeswax) [1 liang]
Grind Ruxiang and Naosha evenly, melt wax and mix to form pills, divide into 108 pills, string with thread, leave exposed overnight. Next day, coat with Gafen (Concha Tridacnae). Take as needed with Ruxiang soup. Recently, someone sold hernia medicine, selling thousands daily. A national physician bought it for a high price; it was very effective.
[Zhu Danxi] Zheng Zijing, after drinking alcohol, consumed water and fruits, leading to unilateral kidney swelling, making frog-like sounds at times, sometimes painful. Use fried Zhishi (Aurantii Fructus Immaturus) 1 liang, salt-fried Huixiang (Foeniculi Fructus) and fried Zhizi (Gardeniae Fructus) [each 3 qian], grind, decoct, and take Baohe Wan.
Chang Shiguan, bladder Qi sinking with frog-like sounds. Fry 10 stink orange seeds, 20 peach kernels, mix with radish juice, grind, and take 70 Baohe Wan pills.
Brother, age 30, left testicular kernel swelling and pain. This is dampness from diet sinking and turning into heat. Use 5 Ju He (Citri Reticulatae Semen - stink orange seed), 7 peach kernels, grind finely. Decoct in flowing water (1 zhan) until boiling hot, then take Baohe Wan.
*[Ben Cao Yan Yi]* Treats bladder hardness and pulling pain, as well as Small Intestine Qi causing scrotal swelling and weeping between hairs. Jin Ling Wan is suitable.
Jinlingzi Rou (Toosendan Fructus Flesh) [5 liang] Huixiang (Foeniculi Fructus) [fried] Malinhua (Iridis Tectorii Flos) [fried] Tusizi (Cuscutae Semen) Haige (Concha Meretricis et Cyclinae) Poguzhi (Psoraleae Fructus) Haitai (Laminariae Thallus) [each 2 liang] Muxiang (Vladimiriae Radix) Dingxiang (Caryophylli Flos) [each 1 liang]
Grind into fine powder, make pills with paste, size of tung seeds. Take 20-30 pills each time, on an empty stomach before meals with warm wine and salt water.
[Li Dongyuan] Daji Wan treats Yin swelling or Small Intestine Qi pain.
Daji (Euphorbiae Pekinensis Radix) [peeled, cut, fried yellow, 0.5 liang] Huluba (Trigonellae Semen) [fried, 4 liang] Muxiang (Vladimiriae Radix) [1 liang] Fuzi (Aconiti Lateralis Radix Praeparata) [processed, peel and navel removed] Huixiang (Foeniculi Fructus) Hezi (Terminaliae Chebulae Fructus) [baked, core removed] Binglang (Arecae Semen) [each 0.5 liang] Chuanlianzi (Toosendan Fructus) [5 liang] She Xiang (Moschus) [0.5 liang, ground separately]
Grind into powder. Take Chuanlianzi alone, boil in 2 sheng of good wine with 7 green onion whites (3-4 cun long) until soft. Peel, select flesh, and mix with other powders, pound into pills size of tung seeds. Take 10 pills on an empty stomach with warm wine. If pain flares up, take 15 pills with fried ginger and hot wine.
Di Sheng Wan treats Yin swelling and fullness, red swelling, constipation, thirst, and abdominal pain upon pressing.
Xuisui Zi (Euphorbiae Lathyridis Semen) Yiyiren (Coicis Semen) Yuliren (Pruni Semen) Yinyu (Cosmea Herb) Bai Qianniu (Pharbitidis Semen) [each 1 qian, lightly fried]
Grind into powder, make pills with drops of water, size of tung seeds. Take 5 pills each time, swallow with Xiang Jiang San from *Bo Ji Fang*. Take at dusk; effect is seen when foul matter is discharged at dawn.
[Zhang Congzheng] Li Shenyuan, Official of Runan, due to laborious royal duties, drank cold water, sat on wet ground, leading to dampness descending into the bladder sac, causing massive swelling and unbearable pain. Jinling and Chuanlianzi were ineffective. He sought treatment from Dairen (Zhang Congzheng). Dairen said: You can take Xie Shui Wan. Li was confused. A few days later, pain became unbearable, he finally followed Dairen. First, use Zhou Che Wan and Jun Chuan San, draining green-yellow water more than ten times, pain stopped. Then regulate with Huixiang Wan and Wu Ling San. Swelling subsided in three days, never recurred until old age.
[Worldly Prescription] Cotton wrap to induce sweat. (See prescription for painless hernia.)
[Zhu Danxi] For Muren, decoct Pipa Ye (Loquat Leaf), Ye Zisu Ye (Wild Perilla Leaf), Cang Er Ye (Xanthii Folium), and Shuijing Pubo Ye (Pueraria Leaf) strongly, fumigate and wash.
[Li Dongyuan] Xionghuang San treats Yin swelling as large as a Dou, kernel pain, untreatable by others.
Xionghuang (Realgar) [1 liang, ground] Fan (Alumen) [2 liang] Gancao (Glycyrrhizae Radix et Rhizoma) [raw, 0.5 liang]
Cut into pieces, decoct in 5 sheng of water, wash.
[Wang Haogu] Shixiao San treats Kidney swelling.
Jingjie Sui (Schizonepetae Spica) [1 liang] Poxiao (Natrii Sulfas) [2 liang]
Grind into coarse powder, decoct with radish and green onion, wash.
[Mei Shi] Treat sudden external genital swelling and pain. Apply Dahuang (Rhei Radix et Rhizoma) powder mixed with vinegar. Change when dry.
[Jiao Shi] Treat male Yin swelling as large as a Sheng, kernel pain, untreatable by others. Mash Bian Cao (Verbenae Herba) and apply. Male Yin swelling as large as a Dou, kernel pain, untreatable by others. Mash Man Jing Gen (Turnerae Radix) and apply.
In the theory of Six Qi transformations, there is one point on Hernia. The Classics state: When Yangming governs the year, Dryness prevails, men suffer from Hernia, women have lower abdominal pain. It also says: When Yangming wins, external Hernia erupts. This is Dryness attacking the Liver, resulting from Qi deficiency. The treatment method should tonify the Liver and drain Dryness Metal. (Full text see Theory of Six Qi annotations.)
*[Su Wen]* What Jueyin calls Hernia, and women's lower abdominal swelling: Jueyin corresponds to the third month, Yin within Yang. Pathogen in the middle, hence called Hernia and lower abdominal swelling. What is called Long Hernia and skin distension: Yin is also excessive, and meridians are swollen and blocked, hence called Long Hernia. (All from Mai Jie Chapter.)
When San Yang disease occurs, chills and fever develop, lower body suffers carbuncles and swelling, and Wei Jue (flaccidity and cold limbs), transmitting to Hernia. (Full text see Diagnosis of Disease Transmission. Wang Bing notes: , soreness and pain.)
*[Ling Shu]* Yellow Emperor said: The Ci Jie chapter mentions Qu Zhao (Removing Claws), and you mentioned piercing joints and limb collaterals. I wish to hear it fully. Qibo said: The waist and spine are the great joints of the body. The legs and calves are the tubes for walking. The penis and scrotum are the mechanisms of the body, the monitors of Yin Essence, and the pathways of fluids. Therefore, irregular diet and unregulated emotions cause fluids to overflow internally, accumulating downwards in the testes. Blood channels become blocked, enlarging daily without cessation. Bending and stretching become inconvenient, walking becomes impossible. This disease has abundant fluid, neither rising nor falling, requiring Pi Shi (scalpel) treatment. The deformity cannot be hidden, always exposed, hence named Qu Zhao. The Emperor said: Good. (Ci Jie Zhen Xie Chapter)
The *Nei Jing* describes four acupuncture/moxibustion methods for Hernia:
The first is this chapter's text, referring to Pi Shi, removing fluid from the testicular sac. This method is known to many. When the testicular sac is as large as a Dou, it contains foul fluid, likely several Sheng. This confirms its ancient origin. (Pi needle is knife-shaped.)
The second targets the Liver Meridian. The Classics state: When the Foot Jueyin Meridian moves, it causes Hernia in men and lower abdominal swelling in women. On the Foot Jueyin Liver Meridian, observe excess/deficiency, heat/cold, sinking, and apply tonification/reduction, retention/speed, and moxibustion. (Full text see Acupuncture Section, Twelve Meridians.)
The third targets the collateral of the Liver. The Classics state: The collateral of Foot Jueyin is named Ligou, five cun above the medial malleolus, diverging to Shaoyang. Its branch goes up the shin to the testes, connecting to the penis. If Qi rebels, testes swell and acute Hernia occurs. Treat the divergence point. This is Ligou, located five cun above the medial malleolus, posterior to the tibia near the flesh. (Full text see Acupuncture Section, Fifteen Collaterals.)
The fourth targets the sinews of Foot Yangming. The Classics state: The sinews of Foot Yangming gather at the genitals and upper abdomen. Symptoms include spasms, anterior thigh swelling, Hernia, and abdominal tendon tension. Treatment involves burning needles and rapid puncture, using sensation as the count and pain as the point. This means using fire needles at the site of spasms and pain.
[Sang Shi] Treat unilateral scrotal descent. Pierce along the seam of the external genitalia subcutaneously, and it will resolve.
*[Zhen Jiu Ji Cheng]* Muren, red and swollen like a Sheng, painless: Dadun, Sanyinjiao, Haidi, Guilai (2 cun below Shuidao, needle 2.5 cun, moxa 7 cones). Muren, red and swollen.
Yin sweat, unilateral scrotal descent: Lanmen (2 cun lateral to pubic hair line and penis base, needle 2.5 cun). Sanyinjiao.
*[Jia Yi Jing]* Hernia, controlled by Daju, Dizhi, Zhongzhu. Hernia, sudden Yin pain, controlled by Zhongfeng. (*Qian Jin Fang* says: Hernia, Long, sudden pain, Wei Jue, body numbness). Qi Long Hernia, Yin urgency, inner thigh pain, controlled by Jiaoxin. Men's Hernia, jumping Yin pain, drawing to perineum, inability to urinate, abdominal and hypochondriac fullness and blockage, impotence, delayed diarrhea, limbs flaccid, excess body pain, no sweat, eyes dim and unable to see, anger wanting to kill, sudden pain drawing to knee joint, occasional hot Qi, tendon spasms and knee pain, inability to flex/extend, madness like fresh epistaxis, refusal to eat, panting, lower abdominal pain drawing to belching, Foot Jueyin pain, controlled by Yongquan.
*[Zhen Jiu Cuo Yao]* Muren, red, swollen, painful: RanGu (0.5 cun, reduce).
[Worldly Prescription] Moxibustion on Guanyuan can cure. Early moxibustion is effective.
[Li Gao] Discussion on Cold/Heat and Scrotal Descent/Retraction of Anterior Genitals: The *Yin Yang Bie Lun* states: San Yang disease causes chills/fever, lower carbuncles/swelling, Wei Jue, transmitting to Su Ze, then to Hernia. Heat outside, Cold inside causes hanging scrotum (Summer Qi). Cold outside, Heat inside causes retracted testicles (Winter Qi). Foot Taiyang Bladder Meridian rebels upward, Hand Taiyang Small Intestine Meridian descends, reaching Foot Jueyin Liver Meridian which cannot extend. Ren Meridian and Jueyin Meridian rebel like a great river, causing Yang Qi to sink. Wind-Cold-Damp-Heat exits from the scrotum, causing bilateral testicular swelling, called Hernia, severe cases become something else. Foot Jueyin Meridian and Large Intestine/Bladder Cold-Water Meridians meet at the anterior genital end. Shang Han scholars say Foot Jueyin Liver Meridian disease causes irritability, fullness, and scrotal retraction, requiring urgent purgation with Da Cheng Qi Tang to drain Great Heat. *Ling Shu* says: Cold in Foot Jueyin Liver Sinew causes tendon spasm and testicular retraction, indicating Great Cold. Previous theory says retraction is Great Heat, this says Great Cold. This theory says retraction, hanging testes, Hernia, and Hong Kong Foot are Great Cold, wind-damp heaviness is Cold, differing from previous two. Why? Answer: Shang Han scholars' retraction is Great Heat inside, requiring Da Cheng Qi Tang. This matches the Sinew theory's retraction where Cold is outside but Heat is inside, same as Shang Han. Thus, citing healthy people: In Winter, Yang is inside, Yin outside; humans respond. Cold outside makes skin tight, skin tight causes retraction. In Summer, Yin is inside, Yang outside; humans respond. Heat outside makes skin loose, skin loose causes hanging scrotum. This is the sign of Hernia.
Though three theories differ, they share one principle. Prescribers should examine carefully. The above three discussions each have their focus; combining these examinations clarifies the differentiation of pulse/symptoms, Yin/Yang, Cold/Heat, and Excess/Deficiency.