《巢氏病源论》∶疝者痛也。其名曰厥,曰症,曰寒,曰盘,曰气,曰附,曰野狼,此七
者疝之名也。其厥逆心痛足寒,诸饮食吐不下,曰厥疝;腹中气乍满,心下尽痛,气积如臂
,曰症疝;因寒饮食,即胁下腹中尽痛,曰寒疝;腹中乍满乍减而痛,曰气疝,腹中痛在脐
旁,曰盘疝,腹中脐下有积聚,曰附疝;小腹与阴相引而痛,大便难,曰野狼疝。其证发则可
验。又有石疝,血疝,阴疝,妒疝,气疝,此五者有名而无形也。外有心疝,寒疝,饥疝,
疝癖数者,其名不同,病则大同小异。世俗呼为小肠气,膀胱气,奔豚气,蟠肠气,横弦竖
弦,偏坠木肾,肾余阴肿,由疝之为病,其名别也。至于张子和论七疝,曰寒疝,水疝,筋
疝,血疝,狐疝,气疝, 疝,名与诸论不同。且如 疝者,外肾坚肿也。痛者为阴肿,不
痛者为木肾,一边坠下者为偏坠。疝名诸论立,虽多且异。《灵枢经》云∶邪在小肠连睾系
属肾,贯肝络肺,系心气盛,厥气上冲也。《内经》又云∶任脉为病,男子内结七疝,女子
带下瘕聚,冲脉逆为气里急,然则任脉虽称病,有七疝之名,而无七疝之状,而任脉者是疝
病之本源,各经是病疝之支流也。又云∶厥阴脉滑为狐疝,小肠脉滑为肝风疝,太阴脉滑为
脾风疝,少阴脉滑为心风疝,太阳脉滑为肾风疝,阳明脉滑为肺风疝。此风非外入之风,乃
肝木阳脉气动之风也。此六疝者,应乎六经,在于五藏。何谓疝病?皆属肝病。生于阴,起
于下。阴者内之太阴肝,厥阴肝,少阴肾,皆足之阴经也。下者地之寒气也,足常履地,盖
天之风寒皆入于地,人之风湿皆从足起。或因经虚,聚于胞囊小腹,两阴相并,二气相搏,
则为疼痛矣。或冷冻饮料过情,水流归肾,或坐卧处湿,寒搏留阴,以寒攻阴,则为疝痛。经曰
∶痛者通也。疝气作痛,宜通不宜塞,宜温不宜寒。通谓温其实,不泻其虚,寒谓补其虚,
不补其实。虚者邪气也,实者正气也。若正气盛极则先温而后泻,若邪气盛极则先泻然后补
。温者必兼于气,虚者必因于寒。寒则入于肝,而正其邪,温则疏其气,养其正也。大凡内
外之气交入于肾者,为肾气入于膀胱者,为膀胱气入于小肠者,为小肠气,肾与膀胱为沟渠
,其气相通,连为外肾,系于睾丸。此三经,乃相连相会者也。其脉当以弦紧,弦则为寒,
紧则为痛,从寒则痛,从湿则肿,疝而不愈,邪气留滞,结成积聚,而为疼痛。或胁左右如
杯,或脐上下如臂,或腹大如盘,令人羸瘦少气,洒淅寒热嗜卧,饮食不为肌肤,腹满呕吐
。医者当临期审察,若因七情而得者,当调其气,安五脏;外邪相干者,散湿祛寒为先,去
邪之实,补肝之虚,则亦愈矣。
《巢氏病源论》说:疝,就是疼痛的意思。它的名称有厥、症、寒、盘、气、附、野狼这七种,这些都是疝的名称。其中出现厥逆、心痛、足部发冷,各种饮食无法吞咽下咽的,称为厥疝;腹部气机突然胀满,心下部完全疼痛,气积聚得像手臂一样粗大的,称为症疝;因为吃了寒凉饮食,导致胁下和腹中全部疼痛的,称为寒疝;腹部突然胀满又突然减轻并且疼痛的,称为气疝;腹部疼痛位于肚脐旁边的,称为盘疝;腹部肚脐下方有积块的,称为附疝;小腹部与阴部相互牵引而疼痛,大便困难的,称为野狼疝。这些证候发作时就可以验证。另外还有石疝、血疝、阴疝、妒疝、气疝,这五种是有名称而没有固定形态的。此外还有心疝、寒疝、饥疝、疝癖等几种,它们的名称不同,但病情大同小异。世俗人称之为小肠气、膀胱气、奔豚气、蟠肠气、横弦竖弦、偏坠木肾、肾余阴肿,这都是因为疝这种疾病的名称各异。至于张子和论述七疝,说是寒疝、水疝、筋疝、血疝、狐疝、气疝、㿉疝,其名称与其他论述不同。比如㿉疝,是指外肾坚硬肿胀。疼痛的称为阴肿,不痛的称为木肾,一边下垂的称为偏坠。关于疝的名称,各派论述创立的标准虽然多且差异很大,《灵枢经》说:邪气在小肠,连接睾丸系带归属肾脏,贯穿肝脏联络肺脏,如果心气盛,厥气上冲就会发病。《内经》又说:任脉发生病变,男子内部结聚成七疝,女子白带过多及瘕聚,冲脉之气上逆则导致气里急迫。既然如此,任脉虽然被称为有病,有七疝的名称,却没有七疝的具体症状表现,而任脉是疝病的本源,其他各经则是疝病的支流。又说:厥阴脉滑表现为狐疝,小肠脉滑表现为肝风疝,太阴脉滑表现为脾风疝,少阴脉滑表现为心风疝,太阳脉滑表现为肾风疝,阳明脉滑表现为肺风疝。这里的“风”不是外入的风邪,而是肝木阳脉气动产生的内风。这六种疝对应六经,位于五脏。什么是疝病?都归属于肝病。生于阴分,起于下部。阴分指的是内部的太阴肝、厥阴肝、少阴肾,都是足部的阴经。下部指的是大地的寒气,脚经常踩在地上,大概天上的风寒都进入地下,人的风湿也都从脚底发起。或者因为经脉虚弱,邪气聚集在胞囊小腹,两阴相并,二气相搏,就会产生疼痛。或者因过量饮用冷冻饮料,水流归并于肾,或者坐卧之处潮湿,寒邪搏结停留在阴部,以寒攻阴,就会导致疝痛。经书说:痛是因为不通。疝气发作疼痛,宜通不宜塞,宜温不宜寒。所谓“通”是指温补其实质,而不泻其虚损;所谓“寒”(此处指误用寒法或寒邪致病机理的反面推导,原文意指治疗原则中的对立统一,结合上下文“温者必兼于气...寒则入于肝”,此处翻译需贴合原意:若言寒治,则是补其虚,不补其实——注:原文逻辑较为晦涩,通常理解为“通”即温通,“塞”即寒凝。原文“寒谓补其虚,不补其实”可能存在传抄错误或特定语境,按字面直译并保留中医术语):这里依据原文字面意思,若涉及寒性治疗或病机,则是补其虚,不补其实。虚指的是邪气,实指的是正气。如果正气极盛,则先温后泻;如果邪气极盛,则先泻后补。温法必然兼顺气机,虚证必然因于寒邪。寒邪则侵入肝脏,从而纠正邪气;温法则疏利气机,养护正气。大凡内外之气交并入肾的,称为肾气;入于膀胱的,称为膀胱气;入于小肠的,称为小肠气。肾与膀胱如同沟渠,气机相通,连接形成外肾,系属于睾丸。这三条经脉,是相连相会的。其脉象应当呈现弦紧之象,弦主寒,紧主痛,受寒则痛,受湿则肿。疝病如果不愈,邪气留滞,结成积块,从而产生疼痛。或者胁肋左右像杯子一样硬块,或者肚脐上下像手臂一样肿块,或者腹部大如盘子,使人消瘦气短,恶寒发热想睡觉,饮食不能转化为肌肤营养,腹部胀满呕吐。医生应当根据当时情况仔细审察,如果是因七情所致的,应当调畅气机,安养五脏;如果是外邪干扰的,则以散湿祛寒为先,去除邪气的实证,补益肝脏的虚证,病也就痊愈了。
*Chao Shi Bing Yuan Lun* (Source of Diseases by Chao Yuanfang) states: "Shan" (Hernia/Colic) refers to pain. Its names include Jue, Zheng, Han, Pan, Qi, Fu, and Yelang; these seven are the names of Shan. Among them, if there is Jue-ni (reversal cold), heart pain, cold feet, and inability to swallow any food or drink, it is called Jue-Shan; if there is sudden abdominal distension, complete pain in the epigastrium, and qi accumulation as large as an arm, it is called Zheng-Shan; if eating cold food and drink causes pain throughout the hypochondrium and abdomen, it is called Han-Shan (Cold Hernia); if the abdomen is suddenly distended and then relieved with pain, it is called Qi-Shan; if the abdominal pain is located beside the umbilicus, it is called Pan-Shan; if there is a mass below the umbilicus in the abdomen, it is called Fu-Shan; if there is pulling pain between the lower abdomen and the yin region, accompanied by difficulty in defecation, it is called Yelang-Shan. These manifestations can be verified when they occur. Additionally, there are Shi-Shan (Stone Hernia), Xue-Shan (Blood Hernia), Yin-Shan, Du-Shan, and Qi-Shan; these five have names but no fixed form. Furthermore, there are Xin-Shan (Heart Hernia), Han-Shan, Ji-Shan (Hunger Hernia), and Shan-Pi; although their names differ, their diseases are largely similar with minor differences. The common people call them Xiao-Chang-Qi (Small Intestine Qi), Pang-Guang-Qi (Bladder Qi), Ben-Tun-Qi (Rushing Pig Qi), Pan-Chang-Qi, Heng-Xian Shu-Xian, Pian-Zhui Mu-Shen (Unilateral Drooping Wooden Kidney), and Shen-Yu Yin-Zhong. This is because the disease of Shan has various distinct names. As for Zhang Zihe's discussion on the Seven Shans, he listed Han-Shan, Shui-Shan (Water Hernia), Jin-Shan (Sinew Hernia), Xue-Shan, Hu-Shan (Fox Hernia), Qi-Shan, and Bi-Shan; his nomenclature differs from other theories. For instance, Bi-Shan refers to hardness and swelling of the external kidneys. If painful, it is called Yin-Zhong; if painless, it is called Mu-Shen; if drooping on one side, it is called Pian-Zhui. Although the establishment of Shan names varies greatly among different theories, *Ling Shu Jing* (Spiritual Pivot) states: "Evil qi in the small intestine connects to the testicular cords which belong to the kidney, passes through the liver and connects to the lung. If Heart Qi is excessive and Jue Qi rushes upward, disease occurs." *Nei Jing* (Inner Canon) also states: "Disease of the Ren Mai (Conception Vessel) results in internal formation of the Seven Shans in men, and leukorrhea and Jia-Ju (masses) in women; reversal of Chong Mai (Penetrating Vessel) Qi leads to urgency in the interior." Thus, although the Ren Mai is said to be diseased with the name of Seven Shans, it lacks the specific symptoms of the Seven Shans; the Ren Mai is the root source of Shan disease, while the other meridians are its tributaries. It further states: "Slippery pulse at Jueyin indicates Hu-Shan; slippery pulse at Small Intestine indicates Gan-Feng-Shan (Liver Wind Hernia); slippery pulse at Taiyin indicates Pi-Feng-Shan (Spleen Wind Hernia); slippery pulse at Shaoyin indicates Xin-Feng-Shan (Heart Wind Hernia); slippery pulse at Taiyang indicates Shen-Feng-Shan (Kidney Wind Hernia); slippery pulse at Yangming indicates Fei-Feng-Shan (Lung Wind Hernia)." This "wind" is not external wind entering the body, but rather the wind generated by the movement of Qi in the Liver Wood and Yang meridians. These six Shans correspond to the Six Meridians and reside within the Five Zang Organs. What is Shan disease? It all belongs to Liver disease. It arises from Yin and starts from the lower part. Yin refers to the internal Taiyin Liver, Jueyin Liver, and Shaoyin Kidney, which are all the Yin meridians of the foot. Lower refers to the cold qi of the earth. Since feet constantly tread on the ground, heaven's wind and cold enter the earth, and human dampness and wind all arise from the feet. Due to deficiency in the meridians, evil gathers in the Bao-Nang (uterus/scrotum area) and lower abdomen. When two Yins merge and two Qis contend, pain ensues. Or, due to excessive consumption of frozen drinks, water flows into the Kidney; or due to sitting/lying in damp places, cold contends and remains in the Yin region. Attacking Yin with Cold results in Shan pain. The Classics state: "Pain implies obstruction." For pain caused by Shan Qi, unblocking is preferred over blocking, and warming is preferred over cooling. "Unblocking" means warming the substance without draining deficiency; "Cooling" (referring to the pathological mechanism or incorrect treatment principle discussed in context) means tonifying deficiency without tonifying excess. Deficiency here refers to Evil Qi, and Excess refers to Healthy Qi. If Healthy Qi is extremely abundant, one should first warm and then drain; if Evil Qi is extremely abundant, one should first drain and then tonify. Warming must involve regulating Qi, and deficiency is necessarily due to Cold. Cold enters the Liver to correct the evil; warming disperses Qi and nourishes the healthy aspect. Generally, internal and external Qi interacting and entering the Kidney is called Kidney Qi; entering the Bladder is called Bladder Qi; entering the Small Intestine is called Small Intestine Qi. The Kidney and Bladder act like channels, with Qi communicating freely, connecting to form the external Kidney, attached to the testes. These three meridians are interconnected and convergent. Their pulse should be Xian (Wiry) and Jin (Tight). Xian indicates Cold, Jin indicates Pain. Following Cold leads to pain; following Dampness leads to swelling. If Shan does not heal, evil qi stagnates, forming accumulations and causing pain. There may be masses like cups on either side of the hypochondrium, masses like arms above and below the umbilicus, or an abdomen large as a plate, causing emaciation, shortness of breath, chills and fever, desire to lie down, poor nutrition from diet, abdominal fullness, and vomiting. Physicians must carefully examine the situation at the time. If caused by the Seven Emotions, one should regulate Qi and calm the Five Zang Organs; if interfered with by external evils, dispelling dampness and expelling cold should come first. Removing the excess of evil and tonifying the deficiency of the Liver will lead to recovery.