经义
三阳为病发寒热，其传为 疝。○脾传之肾，名曰疝瘕。○任脉为病，男子内结七疝。○督脉生病，从少
腹上冲心而痛，不得前后，为冲疝。○邪客于足厥阴之络，令人卒疝暴痛。（《素问》）
小肠病者，少腹痛，腰脊控睾而痛，时窘之后。○肝所生病为狐疝。○足阳明之筋病， 疝，腹筋急。○足
太阴之筋病，阴器纽痛。○足厥阴肝病，丈夫 疝，妇人少腹肿。（《灵枢》）
哲言
疝必睾丸先痛，次连小腹，次攻胸胁。小肠气者，脐旁钓痛，连及腰脊；膀胱气者，肿胀溺涩，手按有
声；肾气胀者，脐下绕
阴撮急引痛，或连胯内。三证之发，必从腹而下及睾丸，有自上而下之象；偏坠木肾，惟睾丸为病，而无攻冲
诸证。○大抵疝疾外遇寒邪，必兼头疼寒热；内郁湿热，必带阴囊红肿；劳伤肝脾，必下血黄瘦；劳伤肝肾，
必腰酸遗溺。上攻而痛者，多邪气之冲逆；下坠而痛者，多元气之下陷。○凡疝久则成积，盘附脐之上下左右
为瘕，作痛不已，或变 癖，或发奔豚。（《证治汇补》）
或问∶疝病，古方有以为小肠气者，有以为膀胱气者，惟子和、丹溪专主肝言，其说不同，何以辨之？
曰∶小肠气，小肠之病；膀胱气，膀胱之病；疝气，肝经之病。三者自是不一。昔人以小肠、膀胱气为疝者误
也。殊不知足厥阴经环阴器，抵少腹，故病此者。其发必睾丸胀痛，连及少腹，则疝气之系于肝经可知矣。小
肠气俗谓之横弦、竖弦，绕脐走注，少腹攻刺，而膀胱气则在毛际之上，小腹之分作痛，与疝气之有形如瓜，
有声如蛙，或上于腹，或下于囊者不同也。但小肠、膀胱因经络并于厥阴之经，所以受病连及于肝，则亦下控
引睾丸为痛，然止是二经之病，不可以为疝也。（《医学统旨》）
按∶统旨此论，不足以尽《经》义。《素问》六经皆有疝，故后之言疝者，或名小肠气，或名膀胱气，或
名肾冷气；张戴人、朱丹溪乃独属之肝经，要之各有所本，而肝肾居多耳。按∶《灵枢经》云∶邪在小肠，连
睾系，属脊，贯肝肺，络心系，气盛则厥逆上冲。大凡邪气袭于人之经也，随各经而名之。袭于肾为肾气，袭
于膀胱为膀胱气，袭于小肠为小肠气。肾与膀胱相为表里，其气通于外肾，系于睾丸，此三经与厥阴互相联系，
而又俱在下部，与冲、任、督诸脉会也。戴人亦曰∶肾之穴十，而言疝者五。丹溪乃言与肾绝无相干。绝之一
字，未细考耳。（《赤水玄珠》）
《经》曰∶任脉为病，男子内结七疝，女子带下瘕聚。七疝者，狐、冲、 、厥、瘕、 、癃是也。凡内
外之邪所感，皆能使阴阳不和，阴偏胜则寒气冲击，阳偏胜则热气内壅，以致任脉
为病。肝则佐任脉以生化者，故疝病原于任而必及于肝。若专主肝而不及任，背经旨固非也；专主任而不及肝，
昧乎病之源流，亦非也。盖疝病在中极之下，少腹之间，总诸阴之会而上于关元，无不由任脉为之，以任总诸
阴之所聚也。其证或由热，或由寒，或由劳，或由虚，而犯阴伤筋则同，故其病皆在阴，其伤皆在筋，其动为
风，其聚如山，所以有疝之名也。（沈金鳌）
《内经》以任脉为病，内结七疝，总言病之原也。所云冲、狐、 、厥、瘕、 、癃，分言疝之状也。
巢氏强分厥、症、寒、气、盘、 、野狼之七种，子和非之，及其立论，但辨阴器专属肝病，与小肠、膀胱、肾
绝不相干，又分寒、水、筋、血、气、狐、 之七名，此其谬与巢氏无异矣。不知《内经》自有七疝，而任脉
为七疝之原，若言疝为筋病，皆挟肝邪则可，若言止在厥阴，不几与《经》文相反耶？大抵寒则多痛，热则多
纵，湿则肿坠，虚者亦然，在血分者不移，在气分者多动。盖睾丸有两，左丸属水司血，统纳左之血者，肝也；
右丸属火司气，统纳右之气者，肺也。故诸寒收引，则血泣而归肝，下注于左丸；诸气 郁，则湿聚而归肺，
下注于右丸。且睾丸所络之筋，非尽由厥阴，而太阴、阳明之筋亦入络也。丹溪以疝始于湿热郁久，湿盛浊凝，
并入血隧，流于厥阴，肝性急速，宜其痛甚，此可补前人之未备，未可守为规则也。（《医宗必读》）
疝气病者，凡小腹睾丸为肿为痛，止作无时者，皆是也。但疝证不一，如《内经》所谓狐疝者，以其出入
不常也；有言 疝者，以其顽肿不仁也；有冲疝者，以其自少腹上冲而痛也；有厥疝者，以结气在阴而气逆为
病也；有疝瘕者，以少腹冤热而痛，出白，一名曰蛊也；有六经风疝者，如《四时刺逆从论》所言者是也；有
小肠疝者，如《邪气脏府病形》篇所言者是也。凡此七者，总皆疝之为义。然疝病不独男子有之，而妇人亦有
之。《经》曰∶有积气在腹中，有厥气，名曰厥疝，女子同法，又曰∶厥阴
所谓 疝，妇人少腹肿者是也。至冲疝、疝瘕之属，亦皆男、妇之所同病；惟睾丸之病独在男子，今人但言男子
之疝，而不知妇人之疝，殊失之矣。（张景岳）
有恶风发热，耳后红肿胀痛，名曰 腮。肿痛将退，睾丸忽胀，似乎偏坠而实非。盖耳旁乃少阳胆经部位，
肝胆相为表里，少阳感受风热，邪遗于肝经也。（《冯氏锦囊》）
补编
腹痛，脉弦而紧，弦则卫气不行，即恶寒；紧则不欲食，邪正相搏，即为寒疝，绕脐痛。若发则白汗出，
手足厥冷，其脉沉紧者，大乌头煎主之。○寒疝，腹中痛，及胁痛里急者，当归生姜羊肉汤主之。○寒疝，腹中
痛，逆冷，手足不仁。若身疼痛，灸、刺、诸药不能治，抵当乌头桂枝汤主之。（《金匮》）
按∶此条脉重出，下条有证无脉。其脉沉紧者之五字，当在下条里急之下。然脉弦而紧，是劲急之甚，当
属寒疝之重者。其白汗之白字，当是自字。下条其脉沉紧，是里痛之脉，当属寒疝之轻者，必是传写之伪。
○按∶抵当二字，衍文也。（《医宗金鉴》）
治疝之法，当察所由，此虽以受寒受湿因而成疝，然或以色欲，或以劳损，或以郁怒，或以饮食酒酪之后，
不知戒慎，致受寒邪，则以阴求阴，流结于冲、任血气之海，而下归阴分，遂成诸疝。故其为病，则有遇寒而
发者；有郁久成热，遇热而发者；有郁则气逆，遇郁怒而发者；有湿因寒滞，遇湿而发者；有疲极伤筋，遇劳
苦而发者；有虚邪在少阴、厥阴，遇色欲而发者；有饮食之湿在阳明、太阴，遇酒酪而发者。至其久也，则正
气陷而不举，邪气留而不去，而为 为木，难于愈矣。必当求其所因，辨而治之。○治疝当先治气，故病名曰
疝气，非无谓也。但寒有寒气；热有热气，湿有湿气，逆有逆气。气在阳分，则有气中之气；气在阴分，则有
血中之气。凡气实者，必须破气；气虚者，必须补气。故治疝者，于诸证中但当兼用气药。（张景岳）
古人治疝，每用五苓散加行气药多效。盖猪苓、泽泻，分理阴阳，和心与小肠之气；白术渗腰间湿与死血，
又助中气以运药力；茯苓淡渗而行膀胱之水；肉桂伐肝邪而温散通行；茴香治小肠之气；金铃、橘核去膀胱之
滞；槟榔下气开导；少加木通以导小肠之火。疝证未有不因内虚外袭，然须先疏其气，所谓通则不痛。若骤用
补，必致攻腹生变。（冯楚瞻）
诸疝皆属于肝。肝欲散，急食辛以散之。此疾虽因虚而得，然不可骤补。所谓邪之所凑，其气必虚；留而
不去，其病为实。故必先涤去所蓄之邪，然后议补。（《本事方》）
按∶疝证虽始为因虚而得，然必邪实迫痛而未下者，故当先泻而后补也。至有虚甚迫痛，或上为呕逆，或
下有遗精者，此邪实正虚之甚矣，而欲不补可乎？但恐补之则无益，泻之则正气转陷，幸而获生者鲜矣。（刘宗浓）
疝证，由肝肾虚而致者居多，肝乃肾之子，前阴肾之窍，欲补其肝，能无顾其母乎？世执肝无补法之论，
每逢疝证，辄谓肝实，过用克伐，死者多矣。丹溪云∶疝有挟虚而发者，当以参、术为君，疏导药佐之，何尝
无补法哉？仲景治寒疝，腹痛里急，主以当归生姜羊肉汤，岂非补肝之一效乎？予每治疝，痛甚，气上冲心危
急者，以八味丸投之立应，又补肾之一验也。（《医论》）
疝证，多用辛散苦降，以解寒热错综之邪。然厥阴一经，内藏龙火，稍涉辛温，如乌头、桂枝、肉桂、茴
香之类，每致湿热郁遏，而为囊痈肿溃者多矣。（张路玉）
疝病之本，不离乎肝，又不越乎寒，以肝脉络于阴器，为至阴之脏；足太阳之脉属肾络膀胱，为寒水之经。
故仲景所云∶寒疝，腹中痛，逆冷，手足不仁，腹满，脉弦而紧，恶寒不欲食，绕脐痛，及胁痛里急。是内外
皆寒气作主，无复界限。其乌头二方，专以破邪治标；其当归羊肉一方，专以补虚固本。子和所云∶疝不离乎
肝者，以疝病有阴囊肿胀，或痛而里急筋缩，或茎中作痛
牵引睾丸，或少腹攻冲作痛，或由号笑忿怒而致，此皆肝经脉络之见证。其金铃子散一法，泄肝散逆，以肝主
疏泄故也；其虎潜丸一法，柔缓导引，是治肝而顾及于肾也。先生治疝之法，其旨以暴疝多寒，久疝多热，为
病之大纲。其余随证施治，如气坠下结者，以鹿茸、鹿角升阳；其胀结有形，痛甚于下者，宗丹溪通阳泄浊为
治；其火腑湿热郁结不通者，用柔苦制热，反佐辛热以开血中郁痹；其寒湿下坠，膀胱之气不和，二便不通利
者，用五苓散加减，以通太阳膀胱；如湿热久聚，气坠少腹阴囊者，用控涎丹、浚川丸等，逐痹通腑分消；如
下焦阴阳两虚者，用有情温通，以培生气。（《临证指南》）
木肾者，心火下降，则肾水不患乎不温；真阳下行，则肾水不患乎不和，安有所谓木肾者哉？夫惟嗜欲内
戕，肾家虚惫，故阴阳不相交，水火不相济，而沉寒痼冷凝滞胀大作痛，顽痹结硬。不可纯用燥热，当温散、
温利以逐其邪，邪气内消，营卫周流，譬如寒谷春回，盖有不疾而速，不行而至之妙矣。（戴复庵）
脉候
黄脉之至也，有积气在腹中，有厥气，名曰厥疝。○肾脉大急沉，肝脉大急沉，皆为疝。心脉搏滑急为心
疝，肺脉沉搏为肺疝。三阳急为瘕，三阴急为疝。（《素问》）
选案
《衍义》云∶仲景治寒疝，用当归生姜羊肉汤，无不应验。一妇，产当冬月，寒入产门，腹脐以下胀满，
手不欲犯，此寒疝也。医将治以抵当汤，谓有瘀血。非其治也。服羊肉汤二剂遂愈。（《证治准绳》）
【经文释义】
三阳经受邪发病，出现恶寒发热，其病邪传变可形成疝病。○脾脏的病邪传变至肾脏，称为疝瘕。○任脉发生病变，男子体内结聚成七种疝气。○督脉发生病变，气从少腹向上冲撞心脏并引起疼痛，大小便不通畅，称为冲疝。○邪气侵袭足厥阴肝经的络脉，使人突然患疝病且剧烈疼痛。（出自《素问》）
小肠发生病变，表现为少腹疼痛，腰部脊柱牵引睾丸疼痛，时常伴有排便窘迫感。○肝脏所生的疾病包括狐疝。○足阳明胃经的筋脉发生病变，会出现疝气，腹部筋脉拘急。○足太阴脾经的筋脉发生病变，生殖器扭转疼痛。○足厥阴肝经发生病变，男子患疝气，女子少腹部肿胀。（出自《灵枢》）
【名家论述】
疝气必定是睾丸先痛，然后牵连到小腹，再攻冲胸胁部位。所谓小肠气，表现为脐旁像被钓引一样的疼痛，连及腰脊；膀胱气，表现为肿胀、小便涩滞，用手按压有声响；肾气胀，表现为脐下环绕阴部撮急牵引作痛，或者连及胯内侧。这三种病症发作时，必定是从腹部向下波及睾丸，呈现出自上而下的趋势；而偏坠和木肾，仅仅是睾丸本身的病变，没有上述攻冲的症状。○大抵疝疾如果外感寒邪，必定兼有头痛、恶寒发热；如果内郁湿热，必定带有阴囊红肿；如果劳损伤及肝脾，必定出现便血、面色萎黄消瘦；如果劳损伤及肝肾，必定出现腰酸、遗尿。疼痛向上攻冲的，多是邪气冲逆所致；疼痛向下坠的，多是元气下陷所致。○凡是疝病日久就会形成积块，盘踞在脐部的上下左右称为瘕，疼痛不止，或者转变为癖积，或者引发奔豚病。（出自《证治汇补》）
有人问道：疝病，古方有的认为是小肠气，有的认为是膀胱气，只有张子和、朱丹溪专门从肝脏来论述，说法不同，如何辨别呢？
回答说：小肠气，是小肠的疾病；膀胱气，是膀胱的疾病；疝气，是肝经的疾病。这三者本来就不一样。过去的人把小肠、膀胱气当作疝气是错误的。殊不知足厥阴肝经环绕阴器，抵达少腹，所以患这种病的人，发作时必定睾丸胀痛，连及少腹，由此可知疝气与肝经的关系密切。小肠气俗称横弦、竖弦，绕着脐部游走刺痛，少腹攻刺作痛；而膀胱气则在毛际之上，小腹部分作痛，这与疝气有形如瓜、有声如蛙鸣，或者气上攻于腹、下注于阴囊的情况是不同的。但是小肠、膀胱因为经络并与厥阴经相连，所以受病时会连及肝脏，从而向下牵引睾丸疼痛，但这只是这两条经脉的病，不能称之为疝。（出自《医学统旨》）
按语：《医学统旨》的这个论述，不足以完全阐明《内经》的义理。《素问》指出六经都有疝病，所以后世谈论疝病的人，有的名叫小肠气，有的名叫膀胱气，有的名叫肾冷气；张戴人、朱丹溪却唯独归属于肝经，总之各有所依据，但多与肝肾有关。按语：《灵枢经》说：邪气在小肠，连及睾丸系带，属于脊柱，贯穿肝肺，联络心系，气盛则厥逆上冲。大凡邪气侵袭人的经脉，就随着各条经脉来命名。侵袭肾脏叫肾气，侵袭膀胱叫膀胱气，侵袭小肠叫小肠气。肾与膀胱互为表里，其气通于外肾，系于睾丸，这三条经与厥阴经互相联系，而且都在下部，与冲脉、任脉、督脉等经脉交会。戴人也说：肾的穴位有十个，其中提到疝的有五个。丹溪却说与肾绝对无关。“绝”这个字，是没有仔细考证的缘故。（出自《赤水玄珠》）
《内经》说：任脉发生病变，男子体内结聚成七种疝气，女子带下瘕聚。所谓的七疝，就是狐疝、冲疝、㿉疝、厥疝、瘕疝、瘛疝、癃疝。凡是内外邪气所感，都能导致阴阳不和，阴偏胜则寒气冲击，阳偏胜则热气内壅，从而导致任脉生病。肝则是辅助任脉进行生化作用的，所以疝病的根源在于任脉，但必然涉及肝脏。如果专门强调肝脏而不涉及任脉，违背了经旨固然不对；如果专门强调任脉而不涉及肝脏，不明白疾病的源流，也是不对的。大概疝病位于中极穴之下，少腹之间，汇聚诸阴经之气而上至关元穴，无不是由任脉主导，因为任脉总领诸阴经的汇聚。其症状或由热引起，或由寒引起，或由劳累引起，或由虚损引起，但侵犯阴分、损伤筋脉是一样的，所以病都在阴分，伤都在筋脉，动则为风，聚积如山，所以有“疝”这个名字。（沈金鳌）
《内经》以任脉生病，体内结聚七种疝气，是总述疾病的本源。所说的冲、狐、㿉、厥、瘕、瘛、癃，是分述疝病的形态。巢元方强行将疝分为厥、症、寒、气、盘、㿉、野狼七种，张子和批评他，等到他自己立论时，只辨明阴器专属肝病，与小肠、膀胱、肾绝对无关，又分为寒、水、筋、血、气、狐、㿉七种名称，他的谬误与巢元方没有两样。不知道《内经》自有七疝，而任脉是七疝的本源，如果说疝是筋脉的病，都挟带肝邪是可以的，如果说仅仅在厥阴经，岂不是与《内经》原文相反吗？大抵寒邪多致疼痛，热邪多致弛纵，湿邪多致肿胀下坠，虚证也是如此，在血分的病位固定不移，在气分的病位多动。大概睾丸有两个，左丸属水主管血，统纳左边血的，是肝脏；右丸属火主管气，统纳右边气的，是肺脏。所以各种寒邪收引，则血液凝涩而归聚于肝，下注于左丸；各种气机郁结，则湿气聚积而归聚于肺，下注于右丸。而且睾丸所络属的筋脉，并不全由厥阴经而来，太阴、阳明经的筋脉也进入络属。丹溪认为疝始于湿热郁久，湿盛浊凝，并入血隧，流注于厥阴，肝性急速，所以疼痛剧烈，这可以补充前人的不足，但不能固守为规则。（出自《医宗必读》）
疝气病，凡是小腹和睾丸肿胀或疼痛，发作和停止没有定时的，都属于此类。但是疝证有多种，如《内经》所说的狐疝，是因为它出入无常；有的说是㿉疝，是因为它顽肿麻木不仁；有的说是冲疝，是因为它从少腹向上冲撞疼痛；有的说是厥疝，是因为气结在阴部且气逆致病；有的说是疝瘕，是因为少腹冤热疼痛，流出白色分泌物，一名叫做蛊；有的说是六经风疝，如《四时刺逆从论》所说的那样；有的说是小肠疝，如《邪气脏腑病形》篇所说的那样。以上七种，总括起来都是疝的含义。然而疝病不只是男子有，妇人也有。《内经》说：腹中有积气，有厥气，名叫厥疝，女子治疗方法相同；又说：厥阴经所说的㿉疝，女子少腹部肿胀的就是。至于冲疝、疝瘕之类，也都是男女共同患的病；只有睾丸的病独见于男子，现在的人只说男子的疝，而不知道妇人的疝，这就大错特错了。（张景岳）
有恶风发热，耳后红肿胀痛，名叫痄腮。肿痛将要消退时，睾丸忽然肿胀，看似偏坠其实并非如此。盖耳旁是少阳胆经的部位，肝胆互为表里，少阳感受风热，邪气遗留于肝经所致。（出自《冯氏锦囊》）
【补编】
腹痛，脉象弦而紧，弦则卫气运行不畅，即感到恶寒；紧则不想进食，邪正相搏结，就形成寒疝，绕脐疼痛。如果发作时出冷汗，手足冰冷，脉象沉紧的，用大乌头煎主治。○寒疝，腹中疼痛，以及胁痛里急的，用当归生姜羊肉汤主治。○寒疝，腹中疼痛，四肢逆冷，手足麻木不仁。如果身体疼痛，灸法、针刺、各种药物都不能治愈的，用抵当乌头桂枝汤主治。（出自《金匮要略》）
按语：这一条脉象重复出现，下一条有症状无脉象。其中“其脉沉紧者”这五个字，应当在下一条“里急”之后。然而脉象弦而紧，是劲急得很，应当属于寒疝的重症。那个“白汗”的“白”字，应当是“自”字。下一条“其脉沉紧”，是里痛的脉象，应当属于寒疝的轻症，肯定是传抄的错误。○按语：“抵当”二字，是衍文（多余的字）。（出自《医宗金鉴》）
治疗疝病的方法，应当考察其成因，这虽然是因为受寒受湿因而成疝，然而有的人因为色欲，有的人因为劳损，有的人因为郁怒，有的人因为饮食酒酪之后，不知道戒慎，导致受寒邪，则以阴求阴，流结于冲脉、任脉血气之海，而下归阴分，遂成各种疝病。所以它的发病，有遇寒而发的；有郁久化热，遇热而发的；有气机郁逆，遇郁怒而发的；有湿因寒滞，遇湿而发的；有疲极伤筋，遇劳苦而发的；有虚邪在少阴、厥阴，遇色欲而发的；有饮食之湿在阳明、太阴，遇酒酪而发的。到了日久，正气下陷而不能提升，邪气停留而不能去除，而形成㿉核或木肾，难以痊愈了。必须探求其成因，辨证治疗。○治疗疝病应当先治气，所以病名叫疝气，不是没有道理的。但寒有寒气；热有热气，湿有湿气，逆有逆气。气在阳分，则有气中之气；气在阴分，则有血中之气。凡是气实的，必须破气；气虚的，必须补气。所以治疗疝病，在各种证候中应当兼用理气药。（张景岳）
古人治疗疝病，常用五苓散加入行气药，大多有效。因为猪苓、泽泻，分理阴阳，调和心与小肠的气；白术渗利腰间的湿气和死血，又助中气以运化药力；茯苓淡渗而行膀胱之水；肉桂伐除肝邪而温散通行；小茴香治疗小肠的气；金铃子、橘核去除膀胱的滞涩；槟榔下气开导；稍加木通以引导小肠的火。疝证没有不是因为内虚外袭引起的，然而必须先疏通其气，所谓通则不痛。如果骤然使用补益药，必定导致攻冲腹部产生变故。（冯楚瞻）
各种疝病都归属于肝。肝喜疏散，急需食用辛味药以发散它。此病虽然因虚而得，但不能骤然进补。所谓邪气聚集的地方，正气必然虚弱；邪气停留不去，病势就转为实证。所以必须先涤除积聚的邪气，然后议论补益。（《本事方》）
按语：疝证虽然开始是因虚而得，但必须是邪实逼迫疼痛且未下泄的，所以应当先泻后补。至于有虚甚逼迫疼痛，或者向上呕吐逆气，或者向下遗精的，这是邪实正虚得很厉害，想要不补可以吗？只是担心补益则无益，泻法则正气更加下陷，侥幸获救的很少了。（刘宗浓）
疝证，由肝肾虚损导致的居多，肝是肾的子脏，前阴是肾的窍道，如果要补肝，能不兼顾其母脏（肾）吗？世人执着于“肝无补法”的言论，每逢疝证，就说肝实，过度使用克伐药物，死者很多了。丹溪说：疝有挟虚而发的，应当以人参、白术为君药，疏导药为辅佐，何尝没有补法呢？仲景治疗寒疝，腹痛里急，主用当归生姜羊肉汤，难道不是补肝的一个效验吗？我每次治疗疝病，疼痛剧烈，气上冲心胸危急的，投用八味丸立刻见效，又是补肾的一个验证。（《医论》）
疝证，多用辛散苦降的药物，以解除寒热错杂的邪气。然而厥阴一经，内藏龙火，稍微涉及辛温药物，如乌头、桂枝、肉桂、茴香之类，常常导致湿热郁遏，而发生囊痈肿溃烂的很多。（张路玉）
疝病的根本，离不开肝，也不超出寒邪的范围，因为肝脉络于阴器，是为至阴之脏；足太阳膀胱经属肾络膀胱，是寒水之经。所以仲景所说的：寒疝，腹中疼痛，四肢逆冷，手足麻木不仁，腹部胀满，脉象弦而紧，恶寒不想进食，绕脐疼痛，以及胁痛里急。这是内外皆由寒气作主，没有界限。其中的乌头两个方子，专门用来破除邪气治标；当归羊肉一方，专门用来补虚固本。张子和所说：疝不离乎肝，是因为疝病有阴囊肿胀，或者疼痛且里急筋缩，或者茎中疼痛牵引睾丸，或者少腹攻冲作痛，或者由号笑忿怒而导致，这些都是肝经脉络的见证。其中的金铃子散一法，泄肝散逆，因为肝主疏泄的缘故；虎潜丸一法，柔缓导引，是治肝而顾及于肾。先生治疗疝病的方法，其主旨是以暴发性疝多寒，长久性疝多热，作为疾病的大纲。其余随证施治，如气坠下结的，用鹿茸、鹿角升阳；其胀结有形，疼痛甚于下方的，遵循丹溪通阳泄浊为治；其火腑湿热郁结不通的，用柔苦制热，反佐辛热以开通血中郁痹；其寒湿下坠，膀胱之气不和，二便不通利的，用五苓散加减，以通太阳膀胱；如湿热久聚，气坠少腹阴囊的，用控涎丹、浚川丸等，逐痹通腑分消；如下焦阴阳两虚的，用有情温通，以培补生气。（《临证指南》）
木肾，如果心火下降，则肾水不担心不温暖；真阳下行，则肾水不担心不和顺，哪里有所谓木肾的呢？只是因为嗜欲内伤，肾家虚惫，所以阴阳不相交，水火不相济，而沉寒痼冷凝滞胀大作痛，顽痹结硬。不可纯用燥热药，应当温散、温利以驱逐邪气，邪气在内消散，营卫周流，譬如寒谷春回，就有不待催促而迅速，不待行走而到达的妙处。（戴复庵）
【脉候】
脉象洪大至，腹中有积气，有厥气，名叫厥疝。○肾脉大急沉，肝脉大急沉，都称为疝。心脉搏滑急为心疝，肺脉沉搏为肺疝。三阳脉急为瘕，三阴脉急为疝。（出自《素问》）
【选案】
《衍义》说：仲景治疗寒疝，用当归生姜羊肉汤，没有不应验的。有一位妇女，生产在冬天，寒气侵入产门，腹脐以下胀满，手不愿意触碰，这是寒疝。医生准备用抵当汤治疗，认为有瘀血。这不是正确的治法。服用羊肉汤两剂就痊愈了。（出自《证治准绳》）
[Scriptural Interpretation]
Diseases of the three Yang meridians manifest with aversion to cold and fever; their pathogenic transmission can result in hernia (Shan). ○ The pathological transmission from the Spleen to the Kidney is named Shan-Jia (Hernia Mass). ○ When the Ren Mai (Conception Vessel) is diseased, men develop seven types of internal hernia. ○ When the Du Mai (Governing Vessel) is diseased, Qi rushes upward from the lower abdomen to the heart causing pain, accompanied by inability to pass stool and urine, known as Chong-Shan (Rushing Hernia). ○ When pathogenic factors invade the collaterals of the Foot Jueyin (Liver) meridian, it causes sudden onset of hernia and severe pain. (From *Su Wen*)
Diseases of the Small Intestine manifest as pain in the lower abdomen, pain radiating from the lumbar spine to the testicles, and occasional urgency in defecation. ○ Diseases generated by the Liver include Hu-Shan (Fox Hernia). ○ Diseases of the sinews of the Foot Yangming (Stomach) meridian involve hernia and spasm of the abdominal sinews. ○ Diseases of the sinews of the Foot Taiyin (Spleen) meridian involve twisting pain in the genitalia. ○ Diseases of the Foot Jueyin (Liver) meridian cause hernia in men and swelling of the lower abdomen in women. (From *Ling Shu*)
[Masters' Discourse]
Hernia invariably begins with pain in the testicles, which then extends to the lower abdomen, and subsequently attacks the chest and hypochondrium. "Small Intestine Qi" is characterized by a drawing pain beside the umbilicus extending to the lumbar spine; "Bladder Qi" presents with distension and dysuria, with audible sounds upon palpation; "Kidney Qi Distension" presents with cramping and pulling pain around the yin region below the umbilicus, or extending to the inner thigh. The onset of these three conditions always proceeds from the abdomen downward to the testicles, showing a trend from top to bottom. In contrast, Pian-Zhui (Unilateral Drooping) and Mu-Shen (Wooden Kidney/Hard Hernia) are solely diseases of the testicles without the aforementioned rushing symptoms. ○ Generally, if hernia is caused by external cold pathogens, it is accompanied by headache, aversion to cold, and fever; if caused by internal stagnation of damp-heat, it is accompanied by redness and swelling of the scrotum; if caused by labor injury to the Liver and Spleen, it involves bloody stool, sallow complexion, and emaciation; if caused by labor injury to the Liver and Kidney, it involves soreness of the waist and enuresis. Pain rushing upward indicates rebellious pathogenic Qi; pain dropping downward indicates sinking of Yuan Qi (Primal Qi). ○ If hernia persists for a long time, it forms accumulations; when coiled around the upper and lower left and right of the umbilicus, it is called Jia (Mass); if pain is unceasing, it may transform into Pi (Accumulation) or trigger Ben-Tun (Running Piglet Qi). (From *Zheng Zhi Hui Bu*)
Question: Regarding hernia, ancient formulas attribute it to Small Intestine Qi or Bladder Qi, whereas Zhang Hezi and Zhu Danxi exclusively attribute it to the Liver. Their theories differ; how should they be distinguished?
Answer: Small Intestine Qi is a disease of the Small Intestine; Bladder Qi is a disease of the Bladder; Hernia Qi is a disease of the Liver Meridian. These three are inherently distinct. It was erroneous for past physicians to classify Small Intestine and Bladder Qi as Hernia. One must realize that the Foot Jueyin (Liver) Meridian circles the genitalia and reaches the lower abdomen; therefore, patients with this condition invariably experience distending pain in the testicles extending to the lower abdomen, indicating the close association of Hernia Qi with the Liver Meridian. Small Intestine Qi, commonly called Heng-Xian or Shu-Xian, features wandering stabbing pain around the umbilicus and attacking pain in the lower abdomen. Bladder Qi causes pain above the pubic hair line and in the lower abdomen. This differs from Hernia Qi, which has a tangible shape like a melon, produces sounds like a frog, and may rush upward to the abdomen or downward to the scrotum. However, because the meridians of the Small Intestine and Bladder connect with the Jueyin Meridian, pathology in them can affect the Liver, causing downward traction and testicular pain. Nevertheless, these remain diseases of those two meridians and should not be classified as Hernia. (From *Yi Xue Tong Zhi*)
Commentary: The argument in *Yi Xue Tong Zhi* does not fully elucidate the meaning of the Classics. *Su Wen* states that all six meridians can have hernia; hence, later discussions on hernia name some as Small Intestine Qi, some as Bladder Qi, and some as Cold-Kidney Qi. Zhang Dairen and Zhu Danxi attributed it solely to the Liver Meridian. Essentially, each has its basis, but most involve the Liver and Kidney. Commentary: *Ling Shu Jing* states: "Pathogens in the Small Intestine connect to the spermatic cord, belong to the spine, penetrate the Liver and Lungs, and link to the Heart System; when Qi is excessive, it rebels and rushes upward." Generally, when pathogens invade the meridians, they are named according to the affected meridian. Invasion of the Kidney is Kidney Qi; invasion of the Bladder is Bladder Qi; invasion of the Small Intestine is Small Intestine Qi. The Kidney and Bladder are exterior-interior pairs, their Qi connects to the external kidneys and is tied to the testicles. These three meridians are interconnected with Jueyin and are located in the lower part, converging with the Chong, Ren, and Du vessels. Dairen also stated: "There are ten acupoints of the Kidney, five of which relate to hernia." Danxi claimed it has absolutely nothing to do with the Kidney. The word "absolutely" lacks careful examination. (From *Chi Shui Xuan Zhu*)
The Classics state: "When the Ren Mai is diseased, men develop seven types of internal hernia, and women develop leukorrhea and masses." The seven hernias are: Hu-Shan (Fox), Chong-Shan (Rushing), Bi-Shan (Flaccid), Jue-Shan (Rebellious), Jia-Shan (Mass), Chi-Shan (Spasmodic), and Long-Shan (Obstructive). Any internal or external pathogenic factor can cause Yin-Yang disharmony; excess Yin leads to cold Qi impact, while excess Yang leads to internal heat congestion, resulting in Ren Mai disease. The Liver assists the Ren Mai in generation and transformation; thus, the root of hernia lies in the Ren Mai but necessarily involves the Liver. Focusing solely on the Liver while ignoring the Ren Mai contradicts the scriptural intent; focusing solely on the Ren Mai while ignoring the Liver ignores the source and flow of the disease. Hernia occurs below the Zhongji point, in the lower abdomen, where all Yin meridians converge and ascend to Guanyuan. This is governed by the Ren Mai, which collects all Yin Qi. Symptoms may arise from heat, cold, fatigue, or deficiency, but the invasion of the Yin aspect and damage to the sinews are consistent. Thus, the disease is in the Yin, the injury is to the sinews, movement generates Wind, and accumulation is like a mountain, hence the name "Hernia." (Shen Jin'ao)
*Nei Jing* states that Ren Mai disease causes internal clustering of seven hernias, summarizing the origin of the disease. The mention of Chong, Hu, Bi, Jue, Jia, Chi, and Long describes the manifestations. Chao Yuanfang arbitrarily divided hernia into seven types: Jue, Zheng, Han, Qi, Pan, Bi, and Ye-Lang. Zhang Hezi criticized him, yet his own theory only distinguished that the genitalia belong to the Liver, having no relation to the Small Intestine, Bladder, or Kidney, and he further divided them into seven names: Han, Shui, Jin, Xue, Qi, Hu, and Bi. His error is no different from Chao's. One must understand that *Nei Jing* has its own seven hernias, and the Ren Mai is the origin of the seven hernias. Saying hernia is a sinus disease involving Liver pathogens is acceptable, but saying it is exclusively in the Jueyin Meridian contradicts the Classic text. Generally, cold causes pain, heat causes flaccidity, dampness causes swelling and drooping, and deficiency is similar. Blood-level diseases are fixed; Qi-level diseases move. There are two testicles; the left belongs to Water and governs Blood, controlled by the Liver; the right belongs to Fire and governs Qi, controlled by the Lungs. Thus, cold contraction causes blood stasis to return to the Liver and descend to the left testicle; Qi stagnation causes dampness to gather in the Lungs and descend to the right testicle. Moreover, the sinews connecting the testicles are not solely from Jueyin; Taiyin and Yangming sinews also connect. Danxi argued that hernia starts from long-term damp-heat stagnation, where dampness and turbidity condense, enter the blood channels, flow to Jueyin, and due to the Liver's rapid nature, cause severe pain. This supplements previous deficiencies but should not be held as a rigid rule. (From *Yi Zong Bi Du*)
Hernia Qi disease refers to any case where the lower abdomen and testicles swell or hurt, with irregular onset and cessation. However, hernia syndromes vary: Hu-Shan (Fox Hernia) is so named because it enters and exits irregularly; Bi-Shan is so named because it is hard-swollen and insensible; Chong-Shan is so named because it rushes upward from the lower abdomen with pain; Jue-Shan is so named because Qi knots in the Yin area and rebels; Shi-Han-Jia (Hernia Mass) is so named because of burning pain in the lower abdomen and discharge of white fluid, also called Gu; Liu-Jing Feng-Shan (Six Meridian Wind Hernia) refers to what is described in *Si Shi Ci Ni Cong Lun*; Xiao-Chang-Shan (Small Intestine Hernia) refers to what is described in *Xie Qi Zang Fu Bing Xing*. These seven types collectively define hernia. However, hernia is not exclusive to men; women also suffer from it. The Classics state: "Accumulated Qi in the abdomen with rebellious Qi is named Jue-Shan; women follow the same pattern." Also: "Jueyin Bi-Shan, where women have lower abdominal swelling." Chong-Shan and Hernia-Mass are common to both sexes; only testicular disease is unique to men. Today, people only speak of men's hernia and ignore women's hernia, which is a significant error. (Zhang Jingyue)
Aversion to wind, fever, redness, swelling, and pain behind the ears is named Ma-Sai (Mumps). As the swelling and pain subside, the testicles suddenly swell, appearing as unilateral drooping but actually being something else. The side of the ear is the site of the Shaoyang Gallbladder Meridian; the Liver and Gallbladder are exterior-interior pairs. Shaoyang contracting wind-heat allows pathogens to linger in the Liver Meridian. (From *Feng Shi Jin Nang*)
[Supplement]
Abdominal pain with a string-tight pulse (Xian) and tight pulse (Jin): Xian indicates Wei Qi stagnation, leading to aversion to cold; Jin indicates loss of appetite. Struggle between pathogen and righteous Qi results in Cold Hernia, with periumbilical pain. If attacks cause spontaneous sweating, cold hands and feet, and a deep-tight pulse, Da Wu Tou Jian (Major Aconite Decoction) is indicated. ○ For Cold Hernia with abdominal pain and hypochondriac pain with interior tension, Dang Gui Sheng Yang Rou Tang (Angelica Ginger Mutton Soup) is indicated. ○ For Cold Hernia with abdominal pain, cold limbs, and numbness in hands and feet, where moxibustion, acupuncture, and other drugs fail, Di Dang Wu Tou Gui Zhi Tang (Di Dang Aconite Cinnamon Twig Decoction) is indicated. (From *Jin Gui Yao Lue*)
Commentary: The pulse description repeats here, while the next clause has symptoms but no pulse. The phrase "its pulse is deep and tight" likely belongs after "interior tension" in the next clause. However, a string-tight pulse indicates extreme tension, belonging to severe Cold Hernia. The character "Bai" (white) in "Bai Han" (White Sweat) should be "Zi" (Self/Auto). The "deep and tight pulse" in the next clause indicates interior pain, belonging to mild Cold Hernia; this is likely a transcription error. ○ Commentary: The characters "Di Dang" are superfluous. (From *Yi Zong Jin Jian*)
The method for treating hernia requires investigating the cause. Although often caused by cold and damp, it can result from sexual indulgence, overwork, anger, or improper diet after consuming alcohol and rich foods, leading to cold invasion. Pathogens seek Yin, accumulating in the Chong and Ren seas of Blood and Qi, descending to the Yin aspect, forming various hernias. Thus, onset may be triggered by cold, heat (from long-term stagnation), anger (Qi rebellion), dampness (cold stagnation), fatigue (sinew injury), sexual activity (deficiency pathogens in Shaoyin/Jueyin), or diet (dampness in Yangming/Taiyin). Over time, righteous Qi sinks and fails to lift, while pathogens remain, forming hard masses difficult to cure. One must identify the cause and treat accordingly. ○ Treating hernia requires regulating Qi first, hence the name "Hernia Qi." Cold has Cold Qi; Heat has Heat Qi; Dampness has Damp Qi; Rebellion has Rebellious Qi. Qi in the Yang aspect is Qi within Qi; Qi in the Yin aspect is Qi within Blood. Excess Qi requires breaking Qi; Deficient Qi requires tonifying Qi. Therefore, treating hernia involves using Qi-regulating herbs alongside other treatments. (Zhang Jingyue)
Ancients often treated hernia with Wu Ling San (Five-Ingredient Powder with Poria) plus Qi-moving herbs with good results. Zhu Ling and Ze Xie regulate Yin-Yang and harmonize Heart-Small Intestine Qi; Bai Zhu drains dampness and dead blood from the waist, aiding Middle Qi to transport medicine; Fu Ling leaches out Bladder water; Rou Gui suppresses Liver pathogens and warms/disperses; Xiao Hui Xiang treats Small Intestine Qi; Jin Ling Zi and Ju He remove Bladder stagnation; Bing Lang directs Qi downward; slight Mu Tong guides Small Intestine fire. Hernia arises from internal deficiency and external attack, but one must first vent Qi ("Unblocked means no pain"). Sudden tonification will cause abdominal turmoil. (Feng Chu Zhan)
All hernias belong to the Liver. The Liver desires dispersion; urgently consume pungent herbs to disperse it. Although this disease stems from deficiency, sudden tonification is inadvisable. Where pathogens gather, Qi is deficient; if they remain, the condition becomes excess. Thus, one must first cleanse accumulated pathogens before considering tonification. (From *Ben Shi Fang*)
Commentary: Although hernia starts from deficiency, if there is severe pain from excess pathogens that have not been expelled, purgation should precede tonification. However, if deficiency is severe with pain, vomiting, or seminal emission, this is extreme excess-pathogen and deficiency-righteous-Qi. Is it possible not to tonify? Fearful that tonification is useless and purgation causes further sinking of righteous Qi, few survive. (Liu Zong Nong)
Most hernias result from Liver-Kidney deficiency. The Liver is the Child of the Kidney; the anterior yin is the aperture of the Kidney. To tonify the Liver, one must consider the Mother (Kidney). People clinging to the theory "Liver has no tonification method" often declare Liver Excess in hernia cases, overusing draining methods, leading to many deaths. Danxi said: Hernia can occur with deficiency; use Ren Shen and Bai Zhu as sovereigns with guiding herbs. Where is there no tonification method? Zhongjing treated Cold Hernia with abdominal pain and interior tension using Dang Gui Sheng Yang Rou Tang, which is a form of Liver tonification. I often treat hernia with severe pain and Qi rushing to the heart using Ba Wei Wan (Eight-Ingredient Pill), which instantly works, verifying Kidney tonification. (From *Yi Lun*)
Hernia often uses pungent-dispersing and bitter-descending herbs to resolve mixed cold-heat pathogens. However, the Jueyin Meridian contains Dragon Fire; slightly pungent-warm herbs like Wu Tou, Gui Zhi, Rou Gui, and Hui Xiang often cause damp-heat stagnation, leading to numerous cases of scrotal abscesses and ulceration. (Zhang Lu Yu)
The root of hernia lies in the Liver and is not beyond Cold, as the Liver meridian connects to the genitalia (extreme Yin organ); the Foot Taiyang Bladder Meridian belongs to the Kidney and connects to the Bladder (Cold-Water meridian). Thus, Zhongjing's description: Cold Hernia with abdominal pain, cold limbs, numbness, abdominal fullness, string-tight pulse, aversion to cold, anorexia, periumbilical pain, and hypochondriac interior tension. This indicates internal and external Cold Qi dominance without boundary. The two Wu Tou formulas specifically break pathogens to treat the branch; Dang Gui Mutton Soup specifically tonifies deficiency to secure the root. Zhang Hezi said hernia relates to the Liver because symptoms include scrotal swelling, pain with interior tension/sinew contraction, penile pain radiating to testicles, lower abdominal attacking pain, or pain induced by laughter/anger—all Liver meridian signs. Jin Ling Zi San drains Liver and disperses rebellion (Liver governs free flow); Hu Qian Wan softens and guides (treating Liver while considering Kidney). The Master's approach to hernia emphasizes acute hernia is mostly cold, chronic hernia is mostly heat. Other treatments include: for Qi sinking/knotting, use Lu Rong/Lu Jiao to raise Yang; for tangible distension/pain below, follow Danxi's method of venting Yang and draining turbidity; for Fire-Fu damp-heat stagnation, use bitter-cold to control heat, counter-assisted by pungent-warm to open blood stasis; for cold-damp drooping with Bladder Qi disharmony and urinary/fecal obstruction, modify Wu Ling San to vent Taiyang Bladder; for long-term damp-heat accumulation with Qi sinking to lower abdomen/scrotum, use Kong Yan Dan/Xun Chuan Wan to drain bi and vent bowels; for lower Jiao Yin-Yang dual deficiency, use animal-derived warm-patent herbs to nurture Sheng Qi. (From *Lin Zheng Zhi Nan*)
Mu Shen (Wooden Kidney): If Heart Fire descends, Kidney Water is warmed; if True Yang descends, Kidney Water is harmonized. Where is Mu Shen? Only due to internal damage from lust, Kidney deficiency, Yin-Yang non-interaction, and Water-Fire non-balance, causing deep cold and stubborn stagnation, swelling, pain, and hardness. Do not use purely drying-hot herbs; use warm-dispersing and warm-draining to expel pathogens. Once pathogens dissipate internally, Ying and Wei circulate, like spring returning to a cold valley—subtle effects achieved without haste. (Dai Fu An)
[Pulse Diagnosis]
Pulse arriving with accumulation: Accumulated Qi in abdomen with rebellious Qi is named Jue-Shan. ○ Kidney pulse large, urgent, deep; Liver pulse large, urgent, deep: both indicate Hernia. Heart pulse slippery, urgent: Heart Hernia. Lung pulse deep, firm: Lung Hernia. Three Yang pulses urgent: Jia (Mass). Three Yin pulses urgent: Hernia. (From *Su Wen*)
[Selected Cases]
*Yan Yi* states: Zhongjing treated Cold Hernia with Dang Gui Sheng Yang Rou Tang with universal success. A woman gave birth in winter; cold entered the birth canal, causing fullness below the umbilicus, intolerant to touch. This was Cold Hernia. The physician intended to treat with Di Dang Tang (assuming blood stasis). This was incorrect treatment. Two doses of Mutton Soup cured her. (From *Zheng Zhi Zhun Sheng*)