张三锡曰∶疝属肝经湿热，为外寒所郁，气不得通，则痛甚，是固然也。乃或肾气惫甚，酒色无节，渗
利不及，浊气流入下部厥阴之分，或劳碌，或遇寒则发，发作有时。或有形，结于小腹，不能顿消。乃湿热
为标、肾虚为主。丹溪法用参术，佐心疏导是也。张子和以寒、水、筋、血、气、孤、 名七疝，其治一以
攻下为主，恐非确。
大抵七疝为病，若非劳役过度，即是远行辛苦，涉水履冰，热血得寒，而凝滞于小肠、膀胱之分；
或湿乘虚而流入于足厥阴之经。古方一以为寒，而纯用乌、附。我丹溪先生
独断为湿热也，发前人所未发也。火郁于中，而寒束于外，宜有非常之痛，故治法宜驱逐本经之湿热，
消导下焦之瘀血。而寒因热用，则邪易伏。稍安即加培养，更慎酒色、浓味为佳。
其症有有声者，有无声者，或有形如瓜，或有声如蛙，有小腹痛连睾丸者，有痛在下部一边者。
然湿热又须分多少而治。湿者肿多， 疝是也。其有挟虚而发者，肺沉紧大豁无力，其痛亦轻，惟觉
重坠牵引耳，当补而兼疏导。
寒疝，其状囊冷结硬如石，阴茎不举，或控睾丸而痛。得之坐卧湿地，寒月涉水，或冒雨雪，或劳碌
热极，坐卧砖石。
水疝，其状肾茎肿痛，阴汗时出，或囊肿状如水晶，或囊痒而搔出黄水，或小腹按之作水声。得之饮水醉
酒使内，过劳汗出，寒湿乘虚袭入下部而然。
筋疝，其状阴囊肿胀，或溃或痛，而里急筋缩；或茎中痛，痛极则痒；或挺纵不收；或白物随溺而下，
得之房劳及邪术。
血疝，其状如王瓜，在小腹傍核骨两端，俗云便痈。得之醉饱劳碌入房，气血流入脬囊，结成痈肿，
后复生梅疮。
气疝，其状上连肾区，下及肾囊。或因号哭忿怒，则气郁而胀，胀罢则气散是也。小儿有此，俗名偏气。
惟灸筑宾穴可消。
狐疝，其状如瓦，卧则入小腹，行立则出小腹，入囊中。狐则昼出穴而溺，夜入穴而不溺，此疝
出入往来，正与狐相类，今人带钩钳是也。
疝，其状阴囊肿缒，如升如斗，不痒不痛是也。得之地气卑湿所生。
女子前阴突出，后阴痔核，皆疝类。但不谓之疝，谓之瘕。
张三锡说：疝气属于肝经湿热，被外寒所郁闭，导致气机不通畅，因此疼痛剧烈，这确实是这样的。然而，也有因为肾气极度疲惫，饮酒和房事没有节制，渗利功能不足，浊气流入下部厥阴经的部位；或者因为劳累过度，或者遇到寒冷就发作，发作有一定的时间。有的有形状，结在小腹部，不能立刻消除。这是以湿热为标证、肾虚为主证。丹溪的方法是用人参、白术，辅以心疏导（此处指疏泄心火或调理心神以助气化），就是这个道理。张子和用寒、水、筋、血、气、孤、疝来命名七种疝病，他的治疗一概以攻下法为主，恐怕不够确切。
大体上来说，七种疝病的发生，如果不是劳役过度，就是远行辛苦，涉水踩冰，热血遇到寒气，从而凝滞在小肠、膀胱的部位；或者是湿气趁着虚弱流入足厥阴肝经。古方一律认为是寒邪，而纯粹使用乌头、附子。我的丹溪先生独自判断为湿热，这是发现了前人未曾发现的问题。火郁结在体内，而寒束缚在体表，应当有非常剧烈的疼痛，所以治疗方法应该驱逐本经的湿热，消导下焦的瘀血。如果寒邪因热邪的使用而被伏藏，那么邪气就容易潜伏。稍微缓解后就增加补益培养，更加谨慎对待酒色和浓味食物是较好的做法。
其症状有发出声音的，有不出声的，或者有形状像瓜的，或者有声音像青蛙叫的，有小腹疼痛牵连睾丸的，有疼痛在下部一边的。然而湿热又需要区分多少来治疗。湿重的肿胀多，这就是“湿疝”。那些夹杂虚证而发作的，脉象肺沉紧大豁无力，疼痛也较轻，只感觉沉重坠胀牵引，应当采用补益兼疏导的方法。
寒疝，其状态是阴囊冷硬结块如石头，阴茎不能勃起，或者牵引睾丸疼痛。这是由于坐卧湿地，寒冬腊月涉水，或者冒雨雪，或者劳累至极发热后，坐卧砖石所致。
水疝，其状态是阴茎根部肿痛，阴汗时常流出，或者阴囊肿胀像水晶一样透明，或者阴囊瘙痒抓挠后流出黄水，或者小腹部按压时有水声。这是由于饮水过量、醉酒后进行房事，过度劳累出汗，寒湿趁虚侵袭下部所致。
筋疝，其状态是阴囊肿胀，或者溃烂或者疼痛，并且里急后重、筋脉拘缩；或者尿道中疼痛，痛到极致则发痒；或者阴茎挺纵不收；或者白色分泌物随小便排出，这是由于房劳过度及邪术所致。
血疝，其状态像王瓜，位于小腹旁边髂骨两端，俗称便痈。这是由于醉饱之后劳累并进入房事，气血流入膀胱囊袋，结成痈肿，后来又生梅疮（梅毒）所致。
气疝，其状态向上连及肾区，向下到达阴囊。或者因为号哭愤怒，导致气机郁结而胀满，胀满过后气机消散就是这样。小儿有此病，俗名叫偏气。只有灸筑宾穴可以消除。
狐疝，其状态像瓦片，躺下时进入小腹，行走站立时从小腹出来，进入阴囊。狐狸白天出洞排尿，晚上入洞不排尿，这种疝气的出入往来，正与狐狸相似，现在人佩戴钩钳治疗的即是此病。
癫疝，其状态是阴囊肿大下垂，像升斗一样，不痒不痛。这是由于地气卑湿所产生。
女子前阴突出，后阴痔核，都属于疝类疾病。只是不称之为疝，而称之为瘕。
Zhang Sanxi stated: Shan (hernia) belongs to damp-heat in the Liver meridian, constrained by external cold, leading to qi stagnation and severe pain; this is indeed the case. However, there are instances where Kidney qi is extremely exhausted due to excessive alcohol consumption and sexual indulgence, resulting in insufficient diuresis, allowing turbid qi to flow into the lower Jueyin region. It may also be triggered by overwork or exposure to cold, occurring at specific times. Some present with a palpable mass in the lower abdomen that cannot dissipate instantly. Here, damp-heat is the branch manifestation, while Kidney deficiency is the root. Danxi’s method involves using Renshen (Ginseng Root) and Baizhu (Atractylodes Rhizome), assisted by methods to guide heart fire downward, which is correct. Zhang Hezi named seven types of Shan as Cold, Water, Sinew, Blood, Qi, Orphan, and Shan, treating them all primarily with purgative methods, which is likely inaccurate.
Generally, the seven types of Shan arise either from excessive labor or from arduous travel, wading through water, or stepping on ice, causing hot blood to coagulate upon contact with cold in the Small Intestine and Bladder regions; or dampness invading the Foot Jueyin Liver meridian due to deficiency. Ancient formulas uniformly attributed this to cold, using only Wutou (Aconite Lateral Root) and Fuzi (Aconite Prepared Root). My teacher Mr. Danxi uniquely identified it as damp-heat, revealing insights previously overlooked. With fire郁 (stagnant heat) internally and cold externally, extreme pain should occur. Therefore, treatment should expel damp-heat from the affected meridian and resolve blood stasis in the Lower Jiao. If cold is treated via heat, pathogens may become latent. Once symptoms slightly subside, tonification should be added, and caution regarding alcohol, sex, and rich foods is advisable.
Symptoms vary: some produce sounds, others do not; some present with masses resembling melons, others with sounds like croaking frogs; some have lower abdominal pain radiating to the testicles, others have pain on one side of the lower region. Damp-heat must be differentiated by degree. When dampness predominates, swelling is prominent, known as Shi Shan (Damp Hernia). Cases complicated by deficiency present with a deep, tight, large, and forceless pulse in the Lung position; pain is mild, characterized mainly by heaviness, dragging, and traction. Treatment requires tonification combined with regulation.
Han Shan (Cold Hernia): The scrotum is cold, hard, and stone-like; the penis does not erect; or pain radiates to the testicles. Etiology includes sitting or lying on damp ground, wading in winter months, exposure to rain/snow, or extreme fatigue/heat followed by sitting on bricks/stone.
Shui Shan (Water Hernia): Swelling and pain at the root of the penis; profuse sweating in the genital area; scrotal edema resembling crystal; itching with yellow discharge upon scratching; or fluid sound upon palpation of the lower abdomen. Etiology includes excessive drinking, sexual activity after intoxication/fullness, overexertion with sweating, allowing cold-dampness to invade the lower region due to deficiency.
Jin Shan (Sinew Hernia): Scrotal swelling, ulceration, or pain with tenesmus and sinew retraction; pain in the urethra, intense pain leading to itching; priapism; or white discharge with urine. Etiology includes sexual exhaustion and evil arts.
Xue Shan (Blood Hernia): Resembles Trichosanthes fruit, located at the ends of the iliac bones on either side of the lower abdomen, commonly called Bian Yong (Perineal Abscess). Etiology includes sexual activity after intoxication and fullness, causing qi and blood to flow into the bladder sac, forming an abscess, later complicated by Mei Chuang (Chancre/Syphilis).
Qi Shan (Qi Hernia): Extends upward to the kidney region and downward to the scrotum. Caused by crying or anger leading to qi stagnation and distension, which dissipates after the episode. In children, it is commonly called Pian Qi (Unilateral Hernia). Moxibustion at Zhubin (KI9) can eliminate it.
Hu Shan (Fox Hernia): Resembles a tile; reduces into the lower abdomen when lying down, but protrudes into the scrotum when standing or walking. Like foxes emerging by day to urinate and retreating by night without urinating, this hernia moves in and out, resembling a fox. Historically treated with hooks or clamps.
Dian Shan (Epileptic/Large Hernia): Scrotal swelling and pendulous enlargement, like a measuring vessel, without itching or pain. Caused by low-lying damp earth conditions.
In women, prolapse of the anterior yin and hemorrhoidal nodes at the posterior yin are classified as Shan-type disorders but are termed Jia (masses) rather than Shan.