经云。任脉为病。男子内结七疝。女子带下瘕聚。从少腹上冲心而痛。不得前后为冲疝。邪
客厥阴之络。则卒疝。厥阴之阴盛。脉胀不通。为 癃疝。肝所生病为狐疝。肾脉大急沉。肝脉
大急沉。皆为疝。心疝。心痛引少腹。上下无定。溲便难者。取厥阴。
金匮云。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。寒
疝绕脐痛。若发则自汗出。手足厥冷。其脉沉紧者。大乌头煎主之。
寒疝绕脐痛。其脉阳弦阴紧。阳弦。故卫气不行而恶寒。阴紧。故胃中寒盛不杀谷。今寒入
营中。与卫相搏。则绕脐腹痛。自汗出。手足厥冷。阳微阴盛。其候危矣。故用乌头之温。合蜜
之甘入。胃以建其中。而缓其痛。使营中之阳旺。则卫中之邪自不能留。亦不使虚寒自下上之微旨也。
寒疝。腹中痛。及胁痛里急者。当归生姜羊肉汤主之。
寒积迫于厥阴冲脉。故用当归以通冲脉之急。生姜以散中外之寒。羊肉以补精血之虚也。
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。
腹中痛。乃少阴与任脉寒证。逆冷手足不仁。身疼痛。营卫之气亦不调矣。灸刺诸药不效者。
邪不在经而在肾与任脉也。故用乌头蜜煎以温少阴任脉之经。合桂枝以调营卫之气。方后有云。
知者如醉状。营卫得温而气行也。得吐者为中病。阳气内复。则阴邪无容息之地而上出矣。
巢氏所叙厥疝症疝。寒疝气疝。盘疝 疝野狼疝。戴人又立寒疝水疝。筋疝血疝。气疝狐疝
疝之名各七。然皆谬立多名。殊非切要。大抵疝之为证。受热则缓纵不收。受寒则牵引作痛。受
湿则肿胀累垂。虚者亦然。三者之间。分其孰多孰少。而为施治。在血分者不移。在气分者多动。
往往有左丸偏胀而移于右丸者。亦有右丸偏胀而移于左丸者。皆是气分之病。若积年痛发。不胀
大而不能动移者。方是血分之病。屡发屡更其处者。当是厥阴风木为患。肿极而不甚痛者。当是
太阴湿土为患。又上引者。宜用桂枝、吴茱萸、茴香等辛热治之。下坠者。宜用川楝、黄柏、苍
术、香附苦燥治之。又痛处热而不欲人按者。湿热也。痛处寒而喜人按摩者。寒积也。以此明辨。
万无差误矣。丹溪云。睾丸连小腹急痛。或有形。或无形。或有声。或无声。皆以为经络有寒。
收引则痛。不知始于湿热壅遏在经。又感外寒。湿热被郁。不得疏散。故作痛。若只作寒论。恐
为未备。盖大劳则火起于筋。醉饱火起于胃。房劳火起于肾。大怒火起于肝。火郁之久。湿气便
盛。浊液凝聚。并入血隧。流入厥阴。肝性急速。为寒所束。宜其痛甚。当用枳实、桃仁、山栀、
吴茱萸、山楂、
生姜。湿胜成 疝。加荔枝核。痛甚。加盐炒大茴香。痛处可按者。加桂。此亦前人未备之旨也。
古方治疝。多用温剂。丹溪独用凉剂。然更有寒热兼施者。如乌头栀子汤治疝瘕少腹缓急。痛处
按之则减。因其人素有湿热。外束寒邪。故用黑山栀、川乌头等分为末。姜汁糊丸。川乌治外束
之寒。栀子治内郁之热。殊有奇效。元气衰弱者。加人参、白术。佐以木香、砂仁。脐下撮急。
周身皆痛。小便数而清。诸脉洪缓。独肾脉弦急无力。此邪客于肾。名曰肾疝。酒煮当归丸。凡
疝气带下。皆厥阴风木之病。全蝎治风之要药。川楝、茴香皆入小肠。当归、延胡活血止痛。疝
气带下。皆寒邪积聚于小肠。总郁化为热。非附子不能开之。丁香、木香为引导也。若有瘀血结
滞作痛。又当以桃仁、赤芍导之。冲疝者。气上冲心下。二便不通。乃寒湿之邪。固结于内郁。
积为热。加以客寒触之而发。天台乌药散加铁锈水调服。甚则禹功散加炮姜、枳实、青皮下之。
冲疝岁久不除。渐成冲心疝气。证与蛊胀无异。误用攻伐。胀必转剧。惟辛温健运。庶为合宜。
然亦取效良难。至于调理。尤宜详慎。每见食填中脘。浊阴之气上逆。顷刻告变。业尝见之。此
与冲心香港脚不殊也。
狐疝者。卧则入腹。立则出腹。仲景云。阴狐疝气。偏有大小。时时上下。蜘蛛散主之。若
寒束热邪。疝瘕攻痛。酒煮当归丸。
疝者。少腹控卵。肿急绞痛。灵枢刺节篇所谓去瓜是也。睾囊肿大。如斗如栲栳。甚者与
身齐等。而不作痛。中脏秽液甚多。此湿邪也。最为难治。但觉微痛者可治。桂苓丸加苍术、浓
朴、黄柏、川乌。
水疝。肾囊肿痛。阴汗如流。囊如水晶。小腹内按之作声。得之饮酒使内。更感风寒。湿留
囊中所致。五苓散换苍术。加
楝实、柏皮。
木肾。则阴丸肿大作痛。顽痹结硬。皆嗜欲内戕。肾经虚惫。湿热凝滞其间。故顽痹结硬。
肿大作痛。二妙散加肉桂、吴茱萸、半夏、枳实、生姜。荆芥穗一两。朴硝、萝卜各二两。葱七
茎煎汤淋洗。
厥疝者。厥气上冲心腹。肝经素有火邪。加以寒气外郁。宝鉴当归四逆汤。若阴疝牵引小腹
痛。房劳痛不可忍者。此肝经素虚挟热。而外挟风寒也。乌头栀子汤。加葱白二三茎。煎成入红
酒调服。痛定。用八味丸加茴香。
瘕疝。脾传之肾。少腹冤热而痛出白。即巢氏之症疝。子和之筋疝也。丹溪所谓内郁湿热者。
与此疝相似。龙胆泻肝汤去生地。加橘核、桃仁、吴茱萸。
偏坠初起。香橘散加穿山甲。或穿山甲、茴香二味为末。酒调下。干物压之。患久药之不效。
或一核缩入少腹。痛不可忍。用手按捺。方得还旧者。木香楝子散。外用牡蛎灰、良姜等分为末。
唾津调涂肿大一边。须臾如火热。痛即安。阴虚偏坠。一味败龟板为末。茴香汤或温酒调服。不
应。风入厥阴也。加醋炒蝎梢三分。小肠气者。小肠经为病。小腹引睾丸连腰脊而痛。盖小肠虚
则风冷乘间而入。厥而上冲肝脉。控引睾丸。上而不下。痛冲心肺。病名控睾。天台乌药散。小
肠气。及肾虚腰痛者。喝起丸。若湿热内郁。小便不通。为膀胱实热。加味通心散。
膀胱气者。膀胱经为病。小腹肿痛。不得小便是也。宜五苓散加川楝子、葱白、茴香。煎成
入盐少许。热服。疝因食积为患者。必因饮食而发。痛处有块梗起。宜立效散。疝因瘀血为患者。
必因奔驰受寒而发。痛处手不可拊。按之刺痛如锥。宜酒煮当归丸去丁香加桃仁。疝因风与湿热
而发者。必连阴囊肿痛。九味蟠葱散。疝急作痛者。用黄
柏酒炒为君。醋炒青皮、延胡索、益智、桃仁为臣。苍术、香附、茴香俱盐水炒为佐。附子、甘
草为使。研末作汤。服后一痛过。更不再作。七疝痛不可忍。灸大敦穴。穴在足大拇指聚毛处。
去甲一韭叶。灸七壮。属厥阴井也。须用浓蒜瓣衬。不可贴肉。贴肉则伤指甲。一种因肺气不化。
膀胱为热邪所滞。而小便不通。小腹与睾胀痛。一味沙参。大剂煎服。肺气化而小便通。一服即
愈。但小便不闭者不可服。寒疝用茴香一斤。生姜二斤。捣绞自然汁浸一夜。收尽。入青盐二两。
炒燥为末。酒丸。空心酒或葱汤下二钱。小肠疝气。用四制香附、盐炒茴香等分为末。空心酒下
三钱。妇人阴肿坚硬。青橘皮一斤。炒燥为末。分二分。绢包焙热熨。频频易之。寒疝引急。痛
连小腹。及睾丸偏缩者。以胡椒十余粒为细末。掺黑膏上烘热。贴阴囊片时。其痛即止。若睾丸
偏缩者。贴偏小半边。盖缩即寒。而坠则热也。患疝之人。每浴时忍小便不去。入汤揉令肠中和
畅。出浴即去小便。使所郁寒湿。乘热发泄。又有疝气入汤。致逼上升者。此奔豚证也。人常有
之。而俗医不能辨耳。小儿啼哭不止。动于阴器。结聚不散。则阴核肿大而成疝。用桂枝汤加细
辛、当归、木香、蝎尾。小儿啼哭。阴囊肿大。丹方。用全蝎一分。连皮核桃肉十分。蜜丸弹子
大。日服一丸。米汤化下屡效。石顽曰。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。每致湿热郁发而为囊痈肿溃者多矣。因
为拈出。以警将来。
〔诊〕脉数而弦者。当下其寒。脉紧大而迟者。必心下坚。脉大而紧。阳中有阴也。可下之。
脉弦急搏皆疝。弦数宜清热。弦紧宜温经。兼浮宜兼汗。兼实宜兼下。弦细为寒湿。弦濡为湿热也。
《黄帝内经》说：任脉发生病变，男子会出现内结的七种疝病，女子会出现带下病和瘕聚（腹内结块）。如果感觉气从少腹部向上冲撞至心脏部位并引起疼痛，大小便不通畅，这称为冲疝。邪气侵犯厥阴经的络脉，就会突然发作疝痛。若厥阴经阴气过盛，导致经脉胀满闭塞不通，则形成癃疝。肝经所生的疾病中有一种叫狐疝。肾脉呈现大而急且沉象，肝脉也呈现大而急且沉象，这些都是疝病的脉象。心疝的症状是心痛牵引至少腹部，疼痛位置上下不定，且伴有小便困难，治疗时应取用厥阴经穴位。
《金匮要略》说：腹痛，脉象弦而紧。弦脉意味着卫气运行不畅，所以患者会恶寒；紧脉意味着不想进食。邪气与正气相互搏结，就形成了寒疝。寒疝的特点是绕脐疼痛，发作时自汗出，手脚冰冷。脉象沉紧的，用大乌头煎主治。
寒疝绕脐疼痛，脉象寸部弦、尺部紧。寸部弦，所以卫气运行不畅而恶寒；尺部紧，所以胃中寒气盛而不能消化食物。现在寒气进入营分，与卫气相搏结，导致绕脐腹痛、自汗出、手脚冰冷。这是阳气微弱、阴气偏盛的危重证候。所以使用乌头的温性，配合蜂蜜的甘味入胃，以建立中气，从而缓解疼痛，使营分中的阳气旺盛，那么卫分中的邪气自然无法停留，这也是防止虚寒之气由下往上侵袭的微妙旨意。
寒疝，腹中疼痛，以及胁肋部疼痛、里急后重的，用当归生姜羊肉汤主治。
这是因为寒气积聚压迫了厥阴冲脉，所以用当归来疏通冲脉的急迫，用生姜来散除内外的寒气，用羊肉来补益精血的亏虚。
寒疝，腹中疼痛，四肢逆冷，手足麻木不仁，如果身体疼痛，灸法、针刺和各种药物都无法治愈的，用抵当乌头桂枝汤主治。
腹中疼痛，属于少阴经和任脉的寒证；四肢逆冷、手足麻木不仁、身体疼痛，说明营卫之气也不调和。灸法和药物无效，是因为邪气不在经络而在肾与任脉。所以用乌头蜜煎来温通少阴经和任脉，配合桂枝来调和营卫之气。方后注说：服药后如有如醉酒般的反应，说明营卫得到温煦而气机通畅。如果呕吐，说明药已中病，阳气在内恢复，阴邪就没有容身之地而上出了。
巢元方叙述的厥疝、症疝、寒疝、气疝、盘疝、野狼疝，戴人又创立了寒疝、水疝、筋疝、血疝、气疝、狐疝，疝的名称各有七种。然而这些都谬立了许多名称，并不切中要害。大体上，疝病受热则松弛下垂不收，受寒则牵引作痛，受湿则肿胀累垂，虚证也是如此。在这三者之间，分辨哪方面占多数，据此施治。病在血分的，位置固定不移；病在气分的，多会移动。往往有左侧睾丸偏胀而移向右侧睾丸的，也有右侧偏胀而移向左侧的，这都是气分的病。如果是多年疼痛发作，不肿大也不能移动的，才是血分的病。屡次发作且位置不断变化的，应当是厥阴风木为患。肿胀极度严重但不怎么痛的，应当是太阴湿土为患。又有疼痛向上牵引的，宜用桂枝、吴茱萸、小茴香等辛热药物治疗；向下坠胀的，宜用川楝子、黄柏、苍术、香附等苦燥药物治疗。另外，疼痛处发热且不喜欢人按压的，是湿热；疼痛处发凉且喜欢人按摩的，是寒积。以此明确辨别，万无一失。
朱丹溪说：睾丸连带小腹急痛，或有形或无形，或有声或无声，都认为是经络有寒，收缩牵引而痛。但他不知道这始于湿热壅遏在经络，又感受外寒，湿热被郁闭，不得疏散，所以作痛。如果只当作寒证论治，恐怕不够全面。因为大劳累则火起于筋，醉饱则火起于胃，房劳则火起于肾，大怒则火起于肝。火郁久了，湿气便盛，浊液凝聚，并入血隧，流入厥阴。肝性急速，被寒邪束缚，所以疼痛剧烈。应当用枳实、桃仁、山栀、吴茱萸、山楂、生姜。湿气胜而成疝，加荔枝核。疼痛剧烈，加盐炒的大茴香。疼痛处可以按压的，加桂枝。这也是前人未阐明的旨意。
古方治疗疝病，多用温剂。丹溪独用凉剂。然而还有寒热兼用的，如乌头栀子汤治疗疝瘕引起的少腹缓急，疼痛处按压则减轻。因为患者素有湿热，外束寒邪，所以用黑山栀、川乌头等分为末，姜汁糊丸。川乌治疗外束之寒，栀子治疗内郁之热，确有奇效。元气衰弱者，加人参、白术，佐以木香、砂仁。脐下拘急，周身皆痛，小便频数而清长，诸脉洪缓，唯独肾脉弦急无力，这是邪气客于肾，名叫肾疝，用酒煮当归丸。凡是疝气带下，都是厥阴风木的病。全蝎是治风的要药，川楝子、小茴香都入小肠经，当归、延胡索活血止痛。疝气带下，都是寒邪积聚于小肠，总郁化为热，非附子不能开通，丁香、木香作为引导。如果有瘀血结滞作痛，又应当用桃仁、赤芍疏导。冲疝，是气上冲心下，二便不通，这是寒湿之邪固结于内郁，积久化热，加上客寒触动而发作，用天台乌药散加铁锈水调服。严重的，用禹功散加炮姜、枳实攻下。冲疝日久不愈，逐渐变成冲心疝气，证候与蛊胀无异。误用攻伐，胀满必然加重，只有用辛温健运之法，才比较适宜。但也很难取得良效。至于调理，尤其应该详细谨慎。常见饮食填塞中脘，浊阴之气上逆，顷刻间病情突变，我曾亲眼见过。这与冲心香港脚没有区别。
狐疝，躺下时疝气回纳腹中，站立时疝气脱出腹外。张仲景说：阴狐疝气，偏侧大小不一，时时上下移动，用蜘蛛散主治。如果是寒束热邪，疝瘕攻痛，用酒煮当归丸。
疝病，是少腹部牵引睾丸，肿胀急痛绞痛。《灵枢·刺节真邪》篇所说的“去瓜”就是这种。睾囊肿大，像斗像栲栳，严重时与身体等高，但不作痛，体内秽液很多，这是湿邪所致，最为难治。只要觉得微痛的还可以治疗，用桂苓丸加苍术、厚朴、黄柏、川乌。
水疝，肾囊肿痛，阴汗如水流淌，囊皮如水晶透明，小腹内按之作有声。这是由于饮酒后行房事，更感风寒，湿气留在囊中所致。用五苓散换掉苍术，加川楝子、黄柏。
木肾，则是阴囊睾丸肿大疼痛，顽痹结硬，都是因为嗜欲内伤，肾经虚惫，湿热凝滞其间，所以顽痹结硬，肿大作痛。用二妙散加肉桂、吴茱萸、半夏、枳实、生姜。另取荆芥穗一两，朴硝、萝卜各二两，葱七茎，煎汤淋洗。
厥疝，厥气上冲心腹，肝经素有火邪，加上寒气外郁，用宝鉴当归四逆汤。如果是阴疝牵引小腹疼痛，房事后疼痛不可忍受的，这是肝经素虚挟热，而外挟风寒，用乌头栀子汤，加葱白二三茎，煎成后入红酒调服。疼痛停止后，用八味丸加小茴香。
瘕疝，是脾传之于肾，少腹冤热而痛，流出白色分泌物，即巢元方的症疝，张子和的筋疝。丹溪所说的内郁湿热，与此疝相似。用龙胆泻肝汤去掉生地，加橘核、桃仁、吴茱萸。
偏坠初起，用香橘散加穿山甲。或者将穿山甲、小茴香两味研为末，酒调下，用干物压迫患处。患病日久药物无效的，或者一个睾丸缩入少腹，疼痛不可忍，用手按捺才能回复原状的，用木香楝子散。外用牡蛎灰、高良姜等分为末，唾津调涂肿大一边，须臾如火热，疼痛即安。阴虚偏坠，一味败龟板研为末，用茴香汤或温酒调服。如果不奏效，是风入厥阴，加醋炒蝎梢三分。
小肠气，是小肠经为病，小腹牵引睾丸连腰脊而痛。大概小肠虚则风冷乘间而入，厥而上冲肝脉，控引睾丸，上而不下，痛冲心肺，病名控睾，用天台乌药散。小肠气及肾虚腰痛者，用喝起丸。如果湿热内郁，小便不通，为膀胱实热，用加味通心散。
膀胱气，是膀胱经为病，小腹肿痛，不能小便。宜用五苓散加川楝子、葱白、小茴香，煎成后入少许盐，热服。疝因食积为患者，必因饮食而发，痛处有块梗起，宜用立效散。疝因瘀血为患者，必因奔驰受寒而发，痛处手不可触碰，按之刺痛如锥，宜用酒煮当归丸去掉丁香加桃仁。疝因风与湿热而发者，必连阴囊肿痛，用九味蟠葱散。疝急作痛者，用黄柏酒炒为君药，醋炒青皮、延胡索、益智仁、桃仁为臣药，苍术、香附、小茴香俱盐水炒为佐药，附子、甘草为使药，研末作汤剂。服后一次疼痛过后，不再发作。七疝疼痛不可忍受，灸大敦穴。穴在足大拇指聚毛处，去指甲一韭叶宽，灸七壮。属厥阴井穴。必须用浓蒜瓣衬垫，不可直接贴肉，贴肉则损伤指甲。一种情况是因肺气不化，膀胱为热邪所滞，而小便不通，小腹与睾丸胀痛，一味沙参，大剂煎服。肺气化则小便通，一服即愈。但小便不闭者不可服。寒疝用茴香一斤，生姜二斤，捣绞自然汁浸一夜，收尽，入青盐二两，炒燥为末，酒丸。空腹时酒或葱汤送服二钱。小肠疝气，用四制香附、盐炒茴香等分为末，空腹酒送服三钱。妇人阴肿坚硬，青橘皮一斤，炒燥为末，分二分，绢包焙热熨，频频更换。寒疝引急，痛连小腹及睾丸偏缩者，以胡椒十余粒为细末，掺在黑膏上烘热，贴阴囊片刻，其痛即止。若睾丸偏缩者，贴偏小半边。盖缩即是寒，而坠则是热。患疝的人，每次洗澡时忍住小便不去，进入汤水中揉令肠中和畅，出浴后即去小便，使所郁积的寒湿乘热发泄。又有疝气入汤，致使逼迫上升的，这是奔豚证。人常有此病，而俗医不能辨别罢了。小儿啼哭不止，动于阴器，结聚不散，则阴核肿大而成疝，用桂枝汤加细辛、当归、木香、蝎尾。小儿啼哭，阴囊肿大，丹方：用全蝎一分，连皮核桃肉十分，蜜丸弹子大，日服一丸，米汤化下，屡效。石顽说：疝证多用辛散苦降，以解寒热错综之邪。然而厥阴一经，内藏龙火，稍涉辛温，如乌头、桂枝、肉桂、小茴香之类，每致湿热郁发而为囊痈肿溃者多矣。因此拈出，以警将来。
〔诊〕脉数而弦的，当下其寒。脉紧大而迟的，必定心下坚满。脉大而紧，阳中有阴，可下之。脉弦急搏指的都是疝病。弦数宜清热，弦紧宜温经，兼浮宜兼汗，兼实宜兼下。弦细为寒湿，弦濡为湿热。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When the Ren Mai (Conception Vessel) is diseased, men develop seven types of internal hernias (Shi Zhen), and women develop leukorrhea and Jia Ju (abdominal masses). If Qi rushes upward from the lower abdomen to the heart causing pain, accompanied by inability to pass urine or stool, it is called Chong Shi (Rushing Hernia). When pathogenic factors invade the collaterals of the Jueyin Liver channel, sudden hernia occurs. If Yin energy of the Jueyin channel is excessive, causing distension and blockage of the meridians, it forms Long Shi (Obstructive Hernia). The diseases generated by the Liver channel include Hu Shi (Fox Hernia). A Kidney pulse that is large, rapid, and deep, or a Liver pulse that is large, rapid, and deep, both indicate hernia. Xin Shi (Heart Hernia) presents with heart pain radiating to the lower abdomen, with shifting pain locations and difficulty in urination; treatment involves selecting points on the Jueyin channel.
The *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) states: Abdominal pain with a string-taut (Xian) and tight (Jin) pulse. A Xian pulse indicates impaired circulation of Wei Qi (Defensive Qi), leading to aversion to cold; a Jin pulse indicates loss of appetite. The struggle between pathogenic factors and healthy Qi results in Han Shi (Cold Hernia). Han Shi is characterized by periumbilical pain, spontaneous sweating during attacks, and cold extremities. For cases with a deep and tight pulse, Da Wu Tou Jian (Major Aconite Decoction) is indicated.
In Han Shi with periumbilical pain, if the pulse is Xian at the superficial position (Cun) and Jin at the deep position (Chi): Xian at Cun implies impaired Wei Qi circulation and aversion to cold; Jin at Chi implies excess cold in the Stomach failing to digest food. When cold enters the Ying (Nutrient) level and struggles with Wei Qi, it causes periumbilical abdominal pain, sweating, and cold extremities. This represents a critical condition of weak Yang and excess Yin. Therefore, the warming property of Wu Tou (Aconiti Lateralis Radix Preparata) combined with the sweetness of honey enters the Stomach to strengthen Middle Qi and relieve pain, promoting Yang in the Ying level so that pathogens in the Wei level cannot remain. This also prevents deficiency-cold from rising from below.
For Han Shi with abdominal pain, hypochondriac pain, and internal urgency, Dang Gui Sheng Jiang Yang Rou Tang (Angelica Sinensis, Ginger, and Mutton Decoction) is indicated. This addresses cold accumulation pressing on the Chong Mai (Penetrating Vessel) of the Jueyin channel; Dang Gui unblocks the urgency of the Chong Mai, Sheng Jiang (Fresh Ginger Rhizome) disperses internal and external cold, and mutton tonifies essence and blood deficiency.
For Han Shi with abdominal pain, cold limbs, numbness in hands and feet, body pain, where moxibustion, acupuncture, and other drugs fail, Di Dang Wu Tou Gui Zhi Tang (Di Dang Aconite and Cinnamon Twig Decoction) is indicated. Abdominal pain indicates Cold syndrome of the Shaoyin Kidney and Ren Mai; cold limbs, numbness, and body pain indicate disharmony of Ying and Wei Qi. Ineffectiveness of previous treatments suggests the pathogen resides in the Kidney and Ren Mai rather than the meridians. Thus, Wu Tou Mi Jian (Aconite and Honey Decoction) warms the Shaoyin and Ren Mai meridians, combined with Gui Zhi (Cinnamon Twig) to harmonize Ying and Wei Qi. The post-prescription note states: feeling intoxicated indicates Ying and Wei are warmed and Qi moves; vomiting indicates the medicine has struck the disease, restoring internal Yang and expelling Yin pathogens upward.
Chao Yuanfang described Jue Shi, Zheng Shi, Han Shi, Qi Shi, Pan Shi, and Ye Lang Shi. Dai Ren added Han Shi, Shui Shi (Water Hernia), Jin Shi (Sinew Hernia), Xue Shi (Blood Hernia), Qi Shi, and Hu Shi. While there are seven names for each, these are largely superfluous. Generally, hernias caused by Heat become flaccid and prolapsed; those caused by Cold cause traction pain; those caused by Dampness swell and hang heavy. Deficiency can present similarly. Treatment depends on which factor predominates. Pathology in the Blood level remains fixed; pathology in the Qi level moves. Often, swelling shifts from left to right testicle or vice versa, indicating Qi-level disease. Chronic pain without swelling or movement indicates Blood-level disease. Frequent changes in location suggest Jueyin Wind-Wood pathology. Extreme swelling with little pain suggests Taiyin Damp-Earth pathology. Upward-pulling pain should be treated with acrid-hot herbs like Gui Zhi, Wu Zhu Yu (Evodia Fruit), and Hui Xiang (Fennel). Downward-prolapsing pain should be treated with bitter-drying herbs like Chuan Lian Zi (Sichuan Chinaberry Seed), Huang Bo (Phellodendron Bark), Cang Zhu (Atractylodes Rhizome), and Xiang Fu (Cyperus Rhizome). Painful areas that are hot and dislike pressure indicate Damp-Heat; painful areas that are cold and welcome massage indicate Cold accumulation. Clear differentiation ensures accuracy.
Zhu Danxi stated that testicular pain radiating to the lower abdomen, whether有形 (formless/formless), with or without sound, is due to Cold in the meridions causing contraction and pain. However, he overlooked that it often starts with Damp-Heat stagnation in the meridians compounded by external Cold, trapping the Damp-Heat. Treating only as Cold is insufficient. Great fatigue generates Fire in sinews; overeating/drinking generates Fire in the Stomach; sexual exhaustion generates Fire in the Kidneys; anger generates Fire in the Liver. Prolonged Fire stagnation leads to Dampness abundance, condensing turbid fluids into blood vessels and flowing into Jueyin. The Liver’s rapid nature, constrained by Cold, causes severe pain. Use Zhi Shi (Immature Bitter Orange), Tao Ren (Peach Kernel), Shan Zhi (Gardenia), Wu Zhu Yu, Shan Zha (Hawthorn), and Sheng Jiang. If Dampness prevails forming hernia, add Li Zhi He (Lychee Seed). For severe pain, add salt-fried Da Hui Xiang (Anise). If the painful area can be pressed, add Gui Zhi. This elucidates principles previously unmentioned.
Ancient formulas mostly used warm agents for hernia; Danxi used cool agents. Some combine cold and heat, such as Wu Tou Zhi Zi Tang (Aconite and Gardenia Decoction) for Shao Fu (lower abdomen) tension and pain relieved by pressure. This suits patients with internal Damp-Heat and external Cold binding. Black Zhi Zi (Gardenia) clears internal郁 (stagnant) Heat; Chuan Wu Tou (Aconite) dispels external Cold. For deficient Yuan Qi, add Ren Shen (Ginseng) and Bai Zhu (Atractylodes Macrocephala), assisted by Mu Xiang (Aucklandia) and Sha Ren (Amomum). Umbilical tightness, whole-body pain, frequent clear urination,洪缓 (surging-slow) pulses except for a 弦急无力 (string-taut-rapid-weak) Kidney pulse indicates Shen Shi (Kidney Hernia); treat with Jiu Zhu Dang Gui Wan (Wine-Boiled Angelica Pill). All Hernia Qi and leukorrhea are Jueyin Wind-Wood disorders. Quan Xie (Scorpion) treats wind; Chuan Lian Zi and Hui Xiang enter the Small Intestine; Dang Gui and Yan Hu Suo (Corydalis) invigorate blood and stop pain. Hernia Qi and leukorrhea involve Cold accumulation in the Small Intestine transforming into Heat; Fu Zi (Aconite Root) opens this, guided by Ding Xiang (Clove) and Mu Xiang. For blood stasis pain, use Tao Ren and Chi Shao (Red Peony Root). Chong Shi involves Qi rushing to the chest/epigastrium with urinary/fecal obstruction, caused by Cold-Damp stagnation transforming into Heat, triggered by exogenous Cold. Treat with Tian Tai Wu Yao San (Tiantai Magnolia Bud Powder) mixed with iron rust water. Severe cases use Yu Gong San (Yu Gong Powder) with Pao Jiang (Baked Ginger), Zhi Shi, and Qing Pi (Green Tangerine Peel) to purge downward. Chronic Chong Shi becoming Chong Xin Hernia Qi resembles Gu Zhang (蛊胀 - abdominal distension resembling gu poison); mistaken purgatives worsen distension. Only acrid-warm strengthening methods are appropriate, though efficacy is difficult. Regulation requires caution. Food stagnation in the Middle Jiao causing turbid Yin to rush upward can lead to sudden deterioration, similar to Chong Xin Hong Kong Foot (a type of gouty arthritis).
Hu Shi (Fox Hernia) retracts into the abdomen when lying down and protrudes when standing. Zhang Zhongjing said: Yin Fox Hernia Qi varies in size and moves up and down; treat with Zhi Zhu San (Spider Powder). If Cold binds Heat causing Shu (mass) pain, use Jiu Zhu Dang Gui Wan.
Hernia generally refers to lower abdomen pulling on the testicles, swelling, urgency, and colic, known as "Qu Gua" in the *Ling Shu*. Scrotal swelling like a bucket or basket, equal to the body height but painless, with much foul fluid, is Dampness, very difficult to treat. Mild pain is treatable with Gui Ling Wan (Cinnamon and Poria Pill) plus Cang Zhu, Hou Po (Magnolia Bark), Huang Bo, and Chuan Wu Tou.
Shui Shi (Water Hernia) features scrotal swelling/pain, profuse sweating, crystal-clear scrotal skin, and splashing sounds in the lower abdomen upon palpation. Caused by alcohol consumption during intercourse followed by Wind-Cold, leaving Dampness in the scrotum. Treat with Wu Ling San (Five Ingredient Powder with Poria) replacing Cang Zhu, adding Chuan Lian Zi and Huang Bo.
Mu Shen (Wood Kidney) involves swollen, painful, hard, and numb testicles due to excessive desires damaging the Kidney channel, leading to deficiency and Damp-Heat stagnation. Treat with Er Miao San (Two Marvels Powder) plus Rou Gui (Cinnamon Bark), Wu Zhu Yu, Ban Xia (Pinellia), Zhi Shi, and Sheng Jiang. External wash: Jing Jie Sui (Schizonepeta Spikes), Xiao Ming (Mirabilite), Luo Bo (Radish), and Cong Bai (Scallion White) decocted.
Jue Shi (Jue Hernia) involves Jue Qi rushing to the heart/abdomen, Liver channel having internal Fire exacerbated by external Cold. Treat with Bao Jian Dang Gui Si Ni Tang (Precious Mirror Angelica Four Reversals Decoction). If Yin Hernia pulls lower abdomen pain, unbearable after sex, indicating Liver deficiency with internal Heat and external Wind-Cold, use Wu Tou Zhi Zi Tang plus Cong Bai, taken with red wine. After pain subsides, use Ba Wei Wan (Eight Flavor Pill) plus Hui Xiang.
Jia Shi (Mass Hernia) spreads from Spleen to Kidney, causing lower abdomen burning pain and white discharge, corresponding to Chao’s Zheng Shi and Hezi’s Jin Shi. Similar to Danxi’s internal Damp-Heat stagnation. Use Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction) removing Sheng Di Huang (Rehmannia), adding Ju He (Tangerine Seed), Tao Ren, and Wu Zhu Yu.
Pian Zhui (One-sided Droop) early stage: Xiang Ju San (Citrus Powder) plus Chuan Shan Jia (Pangolin Scale). Or powder of Pangolin Scale and Hui Xiang, taken with wine, compressed with dry objects. Chronic cases ineffective with medicine, or one testicle retracting into lower abdomen with unbearable pain requiring manual reduction: Mu Xiang Liu Zi San (Costus and Chinaberry Seed Powder). External: Mu Li Hui (Oyster Shell Ash) and Liang Jiang (Galangal) powder mixed with saliva applied to the swollen side; burns like fire, relieving pain. Yin-deficiency Pian Zhui: Bai Gui Ban (Tortoise Plastron) powder taken with Hui Xiang tea or warm wine. If ineffective, Wind has entered Jueyin; add Cu Chao Xie Shao (Vinegar-fried Scorpion Tail).
Xiao Chang Qi (Small Intestine Qi) is Small Intestine channel disease, lower abdomen pulling testicles and lumbar spine pain. Small Intestine deficiency allows Wind-Cold to enter, rushing up to Liver channel, pulling testicles upward, causing pain rushing to Heart/Lungs, named Kong Gao (Pulling Testicle Hernia). Treat with Tian Tai Wu Yao San. For Xiao Chang Qi and Kidney deficiency backache: He Qi Wan. If internal Damp-Heat obstructs urination (Bladder Excess Heat): Jia Wei Tong Xin San.
Bang Guang Qi (Bladder Qi) is Bladder channel disease, lower abdomen swelling/pain with urinary retention. Treat with Wu Ling San plus Chuan Lian Zi, Cong Bai, and Hui Xiang, taken warm with a pinch of salt. Hernia due to Food Stagnation arises after eating, with palpable mass; treat with Li Xiao San. Hernia due to Blood Stasis arises after running/cold exposure, sharp stabbing pain; treat with Jiu Zhu Dang Gui Wan removing Ding Xiang, adding Tao Ren. Hernia due to Wind/Damp-Heat involves scrotal swelling/pain; treat with Jiu Wei Pan Cong San. Acute hernia pain: Huang Bo (fried in wine) as Sovereign; Qing Pi, Yan Hu Suo, Yi Zhi Ren (Alpinia Oxyphylla), Tao Ren as Ministers; Cang Zhu, Xiang Fu, Hui Xiang (salt-fried) as Assistants; Fu Zi, Gan Cao (Licorice) as Guides. Powdered soup. One dose stops recurrence. For unbearable Seven Hernias pain, moxa Da Dun (LR1) point (big toe hair line, one leek-leaf width from nail bed), 7 moxa cones. Use thick garlic slice cushion to prevent skin burn. Another case: Lung Qi failure, Bladder heat stagnation, urinary retention, lower abdomen/testicular swelling. Large dose of Sha Shen (Glehnia) alone. Once Lung Qi transforms, urination flows, cured in one dose. Do not use if urination is not blocked.
Han Shi: Hui Xiang (1 jin), Sheng Jiang (2 jin), juice soaked overnight, dried, add Qing Yan (Green Salt), fried dry, powdered, wine pills. Take 2 qian fasting with wine or scallion soup. Xiao Chang Hernia Qi: Si Zhi Xiang Fu (Four-processed Cyperus) and salt-fried Hui Xiang equal parts, powder. Take 3 qian fasting with wine. Female vulvar hardness/swelling: Qing Ju Pi (Green Tangerine Peel) 1 jin, fried dry, powder. Divide into two portions, wrap in silk, heat, apply frequently. Han Shi pulling tight, pain to lower abdomen/testicular retraction: Pepper powder (10+ grains) on black plaster, heated, applied to scrotum. For retraction, apply to smaller side (retraction=Cold, prolapse=Heat). Patients holding urine while bathing allows trapped Cold-Damp to vent via heat. Urinating in bathwater may force Qi upward (Ben Tun/Pancreatic Gas syndrome), often misdiagnosed by folk doctors. Children crying excessively moving genitalia causing swelling/hernia: Gui Zhi Tang plus Xi Xin (Asarum), Dang Gui, Mu Xiang, Xie Wei (Scorpion Tail). Child crying/scrotal swelling: Quans Xie (1 fen), Walnut meat with skin (10 fen), honey pill. One pill daily with rice gruel. Effective.
Shi Wen noted: Hernia usually uses acrid-dispersing and bitter-descending herbs to resolve complex Cold/Heat. However, Jueyin contains Dragon Fire; slight use of acrid-warm herbs (Wu Tou, Gui Zhi, Rou Gui, Hui Xiang) often causes Damp-Heat to erupt as Nang Yong (scrotal abscess/ulcer). I highlight this to warn future practitioners.
[Diagnosis] Pulse rapid and Xian: purge Cold. Pulse tight-large and slow: epigastric hardness. Pulse large and Jin: Yang containing Yin, purgable. Pulse Xian/rapid/thready all indicate Hernia. Xian-Shu (rapid) indicates clearing Heat; Xian-Jin (tight) indicates warming meridians; if floating, induce sweat; if excess, purge. Xian-Xi (fine) indicates Cold-Damp; Xian-Ru (soft) indicates Damp-Heat.