疝气弦急，积聚在里。牢急者生，弱急者死。
疝气者，气聚而大，外仍敛束，故脉则见弦急而证则多腹痛也。字下从山，亦
是聚而大之之义，皆从寒湿积郁于里得之。间有曰风、曰热者，亦不过寒风、湿热
耳。其发也，多恶寒寒热，呕逆不食，状类伤寒。但兼腹痛，或小腹痛胀，或只绕
脐痛，或上冲心胸痛，或旁引胁肋痛，或脐下硬急，或气走肠鸣，或控引睾丸，痛
胀急坠，或气归囊袋，收纵不时，甚或囊外或冷、或湿、或热、或红，亦有出水及
久久成痈者。此皆里有故积，复感风寒水湿，或加奔走焦劳，以致触动积邪，气聚
而发。或一二日，或延多日，得温暖及出汗，俱能气散而解也。其脉弦急者，弦急
乃厥阴肝脉，疝多发于肝故也。又弦敛急直，气不鼓畅，主诸痛胀，疝则未有不痛
不胀者。若弦急而牢，见积聚之有根，亦征元本之壮实，脉证两宜，故曰生；若但
急而弱，急则邪盛，弱则正衰，更非积聚在里者之所宜，故曰死。所云多发于肝者，
《素问》五藏生成篇、平人气象论、长刺节论、缪刺论，及《灵枢》经脉篇之言也。
而《素问·骨空论》又云∶有发于任脉、督脉者。《素问》阴阳别论、五藏生成篇、
脉要精微论、玉机真藏论、大奇论、四时刺逆从论，及《灵枢》邪气脏腑病形篇、
经筋篇又皆云有发于别脏别腑者。骨空论言任脉有内结七疝之名，而未有七疝之状。
巢氏因叙七疝曰厥疝、曰 疝、曰寒疝、曰气疝、曰盘疝、曰 疝、曰野狼疝。而张
子和复立七疝之名，曰寒疝、曰水疝、曰筋疝、曰血疝、曰气疝、曰狐疝、曰 疝。
外复有小儿 疝及膀胱、小肠等气，亦指称为疝者。聚讼纷纷，迄无定论。近惟张
景岳一辩，最为详悉得理。兹录于下，不敢再赘。
景岳曰∶愚按本经诸篇，所言疝证不一。有云狐疝者，以其出入不常也。有 疝者，
以其顽肿不仁也。有冲疝者，以其自少腹上冲心而痛也。有厥疝者，以积气在腹中，
而气逆为疝也。有瘕疝者，以少腹冤热而痛出白，一名蛊也。有六经风疝者，如四
时刺逆从论之所云也。有小肠疝者，如邪气脏腑病形篇曰∶小肠病者，小腹痛，腰
脊控睾而痛，时窘之后者，亦疝之属也。是皆诸疝之义。按骨空论曰∶任脉为病，
男子内结七疝，女子带下瘕聚。盖任脉者，起于中极之下，以上毛际，循腹里，上
关元，总诸阴之会。故诸疝之在小腹者，无不由任脉为之原，而诸经为之派耳。云
七疝者，乃总诸疝为言，如四时刺逆从论所言者六也，邪气脏腑病形篇所言者一也。
盖以诸经之疝，所属有七，故云七疝。若狐、 、冲、厥之类，亦不过为七疝之别
名耳。后世如巢氏所叙七疝，则曰厥、 、寒、气、盘、 、野狼。至张子和非之曰∶
此俗工所立谬名也。盖环阴器上抵少腹者，乃属足厥阴肝经之部分，是受疝之处也。
又曰∶凡疝者，非肝木受邪，则肝木自甚，皆属肝经。于是亦立七疝之名，曰寒、
水、筋、血、气、狐、 。治多用下。继自丹溪以来，皆宗其说。然以愚观之，亦
未为得。夫前阴、小腹之间，乃足三阴、阳明、任、冲、督脉之所聚，岂得独以厥
阴经为言。但如四时刺逆从论所云，六疝皆兼风言者，本非外入之风。盖风属肝，
肝主筋。故凡病各经之疝者，谓其病多在筋，而皆挟肝邪则可；若谓必在厥阴，则
不可也。后世议论徒多，又安能出《内经》之范围哉，学人当以经旨为正。至于治
之之法，大都此证寒则多痛、热则多纵、湿则多肿坠，虚者亦然。若重在血分者不
移，在气分者多动。分察六者于诸经，各因其多少虚实兼治之，自无不效也。
疝气的脉象表现为弦而急，病机为邪气积聚在体内。若脉象牢而急，预后良好；若脉象弱而急，预后不良。
所谓疝气，是指气机聚结而胀大，但外部仍受约束，因此脉象多见弦急，症状多为腹痛。“疝”字下部从“山”，也有聚结而大的含义，这些病症大多是因为寒湿积郁于体内所致。偶尔有称为风疝、热疝的，也不过是寒风或湿热罢了。其发作时，多伴有恶寒、寒热往来、呕吐逆气、不能进食，症状类似伤寒。但兼有腹痛，或小腹部胀痛，或仅绕脐疼痛，或气上冲心胸疼痛，或向胁肋部牵引疼痛，或脐下硬满急迫，或气走肠鸣，或牵引睾丸，疼痛肿胀且急坠，或气归囊袋，收纵无常，甚至阴囊外部或冷、或湿、或热、或发红，也有出水及久治不愈成痈的情况。这些都是因为体内原有积滞，又感受风寒水湿，或者加上奔走劳累，以致触动积邪，气机聚结而发病。病程或一两天，或拖延多日，得到温暖及出汗，都能使气散而缓解。其脉象弦急，是因为弦急乃厥阴肝经之脉，疝气多发于肝脏的缘故。另外，脉象弦敛急直，说明气机不畅，主各种疼痛和胀满，疝气没有不痛不胀的。如果脉象弦急而牢，显示出积聚有根，也征验了元气根本的壮实，脉证相宜，所以说预后良好；如果仅仅急而弱，急则邪气盛，弱则正气衰，这更不适合体内有积聚的情况，所以说预后不良。所说的多发于肝，出自《素问》的五藏生成篇、平人气象论、长刺节论、缪刺论，以及《灵枢》的经脉篇。而《素问·骨空论》又说：有发于任脉、督脉的。《素问》的阴阳别论、五藏生成篇、脉要精微论、玉机真藏论、大奇论、四时刺逆从论，以及《灵枢》的邪气脏腑病形篇、经筋篇又说都有发于其他脏腑的。《骨空论》说任脉有内结七疝的名称，但没有描述七疝的具体形态。巢元方因此叙述七疝为：厥疝、㿉疝、寒疝、气疝、盘疝、瘕疝、野狼疝。而张子和又设立七疝之名，为：寒疝、水疝、筋疝、血疝、气疝、狐疝、㿉疝。此外还有小儿㿉疝及膀胱、小肠等气，也指称为疝。议论纷纷，始终没有定论。近来只有张景岳的一番辩驳，最为详细合理。兹录于下，不敢再赘述。
张景岳说：我考察本经各篇，所言疝证不一。有称狐疝的，因为它出入无常。有称㿉疝的，因为它顽肿麻木不仁。有称冲疝的，因为它从小腹上冲心脏而痛。有称厥疝的，因为积气在腹中，气逆而为疝。有称瘕疝的，因为少腹冤热而痛，流出白物，一名蛊。有六经风疝的，如《四时刺逆从论》所说的那样。有小肠疝的，如《邪气脏腑病形篇》说：小肠病者，小腹痛，腰脊牵引睾丸而痛，时常窘迫后重，这也属于疝。这些都是诸疝的含义。按《骨空论》说：任脉为病，男子内结七疝，女子带下瘕聚。任脉起于中极之下，向上至毛际，循行腹里，上至关元，总汇诸阴经之气。所以诸疝在小腹部的，无不以任脉为源头，而各经为分支。说七疝，是总括诸疝而言，如《四时刺逆从论》所说的六种，《邪气脏腑病形篇》所说的一种。大概因为诸经之疝，所属有七种，所以说七疝。像狐、㿉、冲、厥之类，也不过是七疝的别名罢了。后世如巢元方所叙七疝，则是厥、㿉、寒、气、盘、瘕、野狼。到了张子和批评道：这是庸医设立的谬名。因为环绕阴器上抵小腹的地方，属于足厥阴肝经的部分，是受疝的部位。他又说：凡是疝，不是肝木受邪，就是肝木自甚，都属于肝经。于是也设立七疝之名，叫寒、水、筋、血、气、狐、㿉。治疗多用攻下法。自从朱丹溪以来，都宗奉他的说法。然而在我看来，也不为得法。前阴和小腹之间，是足三阴经、阳明经、任脉、冲脉、督脉汇聚之处，怎么能只谈厥阴经呢？就像《四时刺逆从论》所说，六种疝都兼言风，本来并非外入之风。因为风属肝，肝主筋。所以凡病各经之疝的，说病多在筋，且都挟带肝邪是可以的；如果说必定在厥阴经，就不对了。后世的议论徒然繁多，又怎能超出《内经》的范围呢？学人应当以经典旨意为正。至于治疗方法，大体上此证寒则多痛、热则多纵弛、湿则多肿胀下坠，虚证也是如此。如果重在血分的，病位不移；在气分的，病位多动。分别察辨六者在诸经的情况，各根据其虚实多少兼治，自然没有不有效的。
The pulse of hernia (Shan Qi) is wiry and rapid, with pathogenic factors accumulating internally. If the pulse is firm and rapid, survival is indicated; if it is weak and rapid, death is indicated.
Hernia refers to the accumulation of Qi causing distension, yet externally constrained, hence the pulse appears wiry and rapid, and symptoms often include abdominal pain. The character "Shan" contains "mountain" at the bottom, implying accumulation and enlargement. These conditions generally arise from cold-dampness stagnating internally. Occasionally referred to as wind-hermia or heat-hermia, they are merely due to cold-wind or damp-heat. Upon onset, patients often experience aversion to cold, alternating chills and fever, vomiting, inability to eat, resembling Taiyang disease (Sun Yang Bing). However, this is accompanied by abdominal pain, lower abdominal distension and pain, periumbilical pain, upward rushing pain to the chest and heart, radiating pain to the hypochondrium, hardness and tension below the umbilicus, intestinal borborygmus, traction pain in the testicles with swelling and heaviness, or Qi gathering in the scrotum with irregular contraction and relaxation. In severe cases, the external scrotum may be cold, damp, hot, or red, with discharge or chronic abscess formation. These result from pre-existing internal accumulations triggered by exposure to wind-cold-water-dampness or physical exertion, causing Qi to accumulate and manifest. The course may last one to two days or longer. Warmth and sweating can disperse the Qi and resolve the condition. The wiry and rapid pulse corresponds to the Jueyin Liver meridian, as hernias frequently involve the Liver. A wiry, tight, and straight pulse indicates stagnant Qi, governing various pains and distensions; hernias invariably present with pain and distension. If the pulse is wiry, rapid, and firm, it indicates rooted accumulation and robust constitutional strength, suggesting a favorable prognosis ("survival"). If the pulse is merely rapid but weak, it indicates excess pathogen and deficient healthy Qi, which is unfavorable for internal accumulation, suggesting an unfavorable prognosis ("death"). The statement that hernias primarily involve the Liver is supported by chapters such as *Wu Zang Sheng Cheng*, *Ping Ren Qi Xiang*, *Chang Ci Jie*, *Miu Ci* in *Su Wen*, and *Jing Mai* in *Ling Shu*. Additionally, *Gu Kong Lun* mentions involvement of the Ren and Du meridians. Other chapters like *Yin Yang Bie*, *Mai Yao Jing Wei*, *Yu Ji Zhen Zang*, *Da Qi*, *Si Shi Ni Cong Lun* in *Su Wen*, and *Xie Qi Zang Fu Bing Xing*, *Jing Jin* in *Ling Shu* mention involvement of other Zang-Fu organs. *Gu Kong Lun* names "internal knotted seven hernias" on the Ren meridian but does not describe their forms. Chao Yuanfang described seven hernias: Jue Hernia, Pi Hernia, Cold Hernia, Qi Hernia, Pan Hernia, Jia Hernia, and Ye Lang Hernia. Zhang Hezi established another set of seven: Cold Hernia, Water Hernia, Sinew Hernia, Blood Hernia, Qi Hernia, Fox Hernia, and Pi Hernia. Pediatric Pi Hernia and Qi disorders of the Bladder and Small Intestine are also termed hernias. Debates have been endless without consensus. Recently, Zhang Jingyue's refutation has been the most detailed and logical. It is recorded here without further addition.
Zhang Jingyue states: Examining the classics, hernia syndromes vary. "Fox Hernia" is so named for its irregular protrusion and retraction. "Pi Hernia" refers to hard, swollen, insensate masses. "Chong Hernia" involves upward rushing pain from the lower abdomen to the heart. "Jue Hernia" involves Qi accumulation in the abdomen with rebellious Qi. "Jia Hernia" involves heat and pain in the lower abdomen with white discharge, also called Gu. "Six Meridian Wind Hernias" are mentioned in *Si Shi Ni Cong Lun*. "Small Intestine Hernia" is described in *Xie Qi Zang Fu Bing Xing*: pain in the lower abdomen, lumbar spine radiating to the testicles, and frequent tenesmus belong to hernia. These constitute the meanings of various hernias. According to *Gu Kong Lun*: Disease of the Ren meridian causes seven internal hernias in men and leukorrhea with masses in women. The Ren meridian originates below Zhongji, ascends to the pubic hairline, runs along the interior of the abdomen to Guanyuan, converging all Yin meridians. Thus, hernias in the lower abdomen originate from the Ren meridian, with other meridians as branches. "Seven Hernias" is a general term, comprising six types from *Si Shi Ni Cong Lun* and one from *Xie Qi Zang Fu Bing Xing*. Since hernias belong to seven meridians, they are called seven hernias. Fox, Pi, Chong, and Jue hernias are merely aliases. Later, Chao Yuanfang listed Jue, Pi, Cold, Qi, Pan, Jia, and Ye Lang. Zhang Hezi criticized these as erroneous names created by mediocre physicians. He argued that the area surrounding the genitals and upper lower abdomen belongs to the Foot Jueyin Liver meridian, the site of hernias. He stated that all hernias involve either pathogenic invasion of Liver Wood or hyperactivity of Liver Wood, thus belonging to the Liver meridian. He established seven types: Cold, Water, Sinew, Blood, Qi, Fox, and Pi, treating them mostly with purgatives. Zhu Danxi and later scholars followed this view. However, I find this incomplete. The anterior genitalia and lower abdomen are convergence points of the Foot Three Yin, Yangming, Ren, Chong, and Du meridians; one cannot attribute them solely to the Jueyin meridian. As noted in *Si Shi Ni Cong Lun*, the six hernias involving "wind" do not refer to exogenous wind. Wind belongs to the Liver, which governs sinews. Therefore, while hernias of various meridians often involve sinews and Liver pathogenic factors, asserting they must be exclusively Jueyin is incorrect. Later discussions exceed the scope of the *Nei Jing*; students should adhere to classical principles. Regarding treatment, cold hernias typically present with pain, heat with flaccidity, dampness with swelling and prolapse, and deficiency similarly. Blood-involved hernias tend to be fixed, while Qi-involved hernias tend to move. By differentiating the six types across meridians and treating according to excess/deficiency and severity, efficacy is assured.