夫疝者，是阴气积于内，复为寒气所袭而发，故《素问》以下论疝，皆以为寒，
然不可单论曰寒。盖虽为寒郁而作，亦由醉饱无度，内蒸湿热，痰积流于厥阴，木
性急速，又为寒束，是以痛甚。症虽见于肾，病实本乎肝，厥阴肝脉络于阴器耳，可
见内积湿热郁于中，外被寒邪郁束于外，且有痰饮、食积、死血郁结为病，故谓专主
肝经而与肾绝无相干也，其候睾丸牵引少腹，或无形无声，或有形如瓜，有声如蛙，
激搏而痛，无有定处，不堪忍也。其证有七∶寒、水、狐、血、气、狐、筋是也。（《冯氏锦囊》）
寒疝者，厥阴经中受寒，故筋挛卵缩，其状囊冷结硬如石，阴茎不举，或控睾丸
而痛，此必得之于久坐湿地 寒气郁于外也。水疝者，囊肿痛而状如水晶，阴汗时
出，痒瘙而出黄水，小腹按之而作水声，此必得之于醉酒房劳，汗出遇风，湿热乘虚
流结囊中，二便胀秘不通也。 疝者，阴
囊肿大如斗升，不痒不痛，此因感受湿气，是以阴核气结，亦有灼痛者。血疝者，状
如黄瓜，在于小腹两旁，横骨两端，俗名便痈。此乃得之重感，春夏大燠劳动，使
内气血流溢，渗入脬囊，结成痈肿也。气疝者，上连肾区，下及阴囊是，或号哭忿
怒，气郁急迫而胀痛，此必因父精怯，阴痿强力入房成胎，乃胎病也。狐疝者，其
状如瓦，卧则入腹，行则乃出腹，入囊似狐之昼出穴而溺，夜入穴而不溺，故名狐
疝也。盖环阴器上抵少腹者，乃肝经之部分，是受疝之处也。一切疝气，非肝木受
邪，即肝木自病，此乃肝经自病也。筋疝者，阴茎肿胀，或溃脓而痛，里急筋缩，或
茎中痛，痛极作痒或阴不收，白物如精而随溺出，此得于房劳，或邪术所致也。
更有木肾者，盖心火下行，肾水自温，真阳下降，肾气自和，既温且和焉。有木
强者哉。此因嗜欲内戕，肾虚以致阴阳水火不接，乃沉寒胀大而痛硬也。
睾丸所络之筋非尽由厥阴，而太阴阳明之筋亦入络也。故患左丸者痛多肿少，患
右丸者痛少肿多也。
又有身体发热，耳后忽生 腮，红肿胀痛，腮肿将退，而睾丸忽胀，一丸极大，
一丸极小，似乎偏坠而实非，盖耳旁乃少阳胆经之分，与肝经相为表里，少阳感受
风热而遗发于肝经也。
妇人小腹旁逼近阴处并结胀痛，或皮里顶起如鹅子大，乃寒气聚于厥阴所致。小
腹受寒，其病即发，是谓阴疝。女子血涸不月，足 嗌干，癃秘小腹有块，前阴突
出，后阴痔核，皆女子之疝也。但女子不名疝，而名瘕。
古方以乌头栀子等分加盐酒煎服之，名栀附汤，其效亦速，后因此方随症加减，
无有不应，须分湿热多少而治之。丹溪曰∶乌头治外束之寒，栀子治内郁之热，则内
热外寒之理昭然矣。况二物皆下集之药，栀子为乌头所引，则势下急速，不容少缓于
胃中矣。若按之痛止者，尤属虚寒，须加肉桂以姜汁丸服，若速欲定痛，用枳核、山
楂核、荔枝核、川楝子、吴茱萸各炒为末，白汤调服。
小儿偏坠，多因食积不消，脾湿下行，流入肝部。
又有阴茎全缩不见，而阴囊光肿不痛，此因肝气虚损而不能舒达也，宜温补之。
陈实功曰∶水疝，肾囊皮色光亮，无热无红，肿痛有时，内有聚水，宜用针从
便处引出水气自安。如肿痛日久，内脓已成，胀痛者可即针之，内服十全大补汤加
山萸肉、丹皮、泽泻。（《正宗》）
林慕莪曰∶或问气以疝称，其义何居？答曰∶积土成山，积气成疝，疝者山也，其
气日积月累，聚而不散而成疝，犹之积土成山，自小至大，由卑至高之义。但气本
无形，因虚而凝聚不散，随其所聚之处为痛，故五脏遂皆有疝，盖即五脏之元气，失
其温养生发之性，营运转输之常，虚则滞，寒则凝，自无而有，自微而着，自闭塞以至于不通而痛矣。（《活人书》。
又曰∶或问既由无形之气，积久成疝为痛，自应痛无已时，缘何亦有不痛之日，
以为散而不痛，则能散似无成疝之法，以为不散，则疝从何归，可以不痛，或有时
止时发，甚至终身不愈者，亦由此气时聚时散之所致耶？抑此气临时隐伏耶？答曰∶
若气能散能聚，何由成疝？惟其积而不散，遂成为痛为硬之势，但元气之虚，有轻重
不同，为病亦有新久深浅之异，大约痛之缓急止发，亦存乎其人之气血虚实，而五脏有病有不病也。
又曰∶或问今之所为疝者，必责之寒湿之气，但寒本足太阳膀胱寒水受病，湿
乃足太阴脾经湿土用事，缘何又言足厥阴肝家之病，既曰肝病，则当责之湿热，复
与寒湿无干矣。宁无说乎？答曰∶五脏有疝，出于《内经》，何得独系之肝，况寒湿二气，郁久皆能化热，大凡五行六气，
传
变自有不同，学人当扩充其义焉。
又曰∶或问男子固有睾丸大小，及小肠膀胱昆仑诸气为疝者矣，据云五脏皆疝，
则妇人亦当病疝，疝将何法以验之，而愈之耶？答曰∶男妇一体，五脏俱各有疝，外
肾虽无，而少阴厥阴之络脉毕具，治法必根据五脏，男妇岂有别乎？但碍于俗，不敢直言耳。
又曰∶或问疝为积气所成，五脏概有积气所成为病，何独此积又以疝称也哉？答
曰∶聚而不散之为积，积久而成高硕之形为疝，前后似是而实非。盖五积由乎本经
之气，各因七情六郁而成积，而此证不独本经因虚自病，且有感触而发，虚实传变
而盛者也。若正言疝已具七种之名，已见《医统》、《准绳》、《指掌》诸书，可以不赘。
今以五脏之疝详列于后，以诏后学。肺疝者，或为风寒深入肺俞，冷冻饮料寒气直达肺
窍，本经元气素亏，复为寒邪所袭，初由聚而不散，渐至积而成疝。盖肺证有三∶一
曰∶肺痹，痹者闭也，闭而不通，似喘非喘，咽嗌不利者，痹也，非疝也。二曰∶息
贲，乃肺气 满，不能下降，日久月深，胸中似有物碍气道不利，语言因之塞涩者，息
贲也，非疝也。三曰∶肺疝，疝则较前二证不同，鼻息粗暴，呼吸短促，胸膈与云
门、中府之间梗塞为痛者，疝也。其名有三，为病亦不相远，惟气口脉弦急有力者，
当以疝治。心疝者，心气久郁不舒，积而成疝，正气日衰，结聚日盛，稍有感触，窘
迫而痛如割如裂，痛则四肢厥冷，汗出如浴。左寸关沉而弦急者，虚寒之疝也。弦
涩而数，心烦嘈杂而痛者，阴虚内热而气郁，复兼火化也。脾疝者，其浊气自下逆
上，连嗳不宽，胀满作痛，痛则呕吐清水，或苦水痰涎之类，其脉两关弦急者为实，沉
滑者为虚。肝疝者，阴囊赤肿坚硬而痛，痛连两胯小腹之间，以厥阴之络，络于阴器
也。右关尺弦急而数，兼有寒热，外证此湿热之气，无由疏泄，传为囊痈也。若妇
人则有小腹胀痛，两胯间大筋偏坠，及痛连腰胯者，其有肝气下陷，户中阴挺突出
为痛者，湿热下陷，传为阴户 肿发痒，甚则生虫臊臭，凡此皆肝家积气所化，犹男
子之疝者也。其脉左关尺亦有沉弦而数，或弦急而数者。肾疝者，大多纵欲房劳之人，
里气先亏，寒湿之气行以乘之，积久成疝，其痛自腰肾下连阴茎，小便兼之淋浊艰涩，
其脉微而涩，或沉细而濡软。肺疝，以辛散之，以苦顺之，所为厘清也。心疝，寒
者治以温散之剂，热者兼补兼清。脾疝，专于温散，若湿热甚者，必先化湿理痰。肝
疝，必须升清利浊，分消湿热之气。肾疝，当于温补之中，佐以分消之药。更当以古
人之七疝，参酌为治，犹为详尽无疑。
又曰∶或问《丹溪纂要》一书，为世首推，独云疝主肝病，与肾无涉。况肝无
补法，故前人之治疝者，多用苦辛之味以破气散坚为主，今子主以参、术、归、苓
治疝，已为背谬，而又立肾疝一门，岂不与丹溪故为矛盾耶？答曰∶肝肾之有疝，不
独本于《内经》，即今之患者，了然有二。盖厥阴肝经之络，循环乎阴器，上连小腹
左右之旁，以至乎胁，下系外肾二子之根，故肝疝有子胀偏坠痛连小腹之证。若肾者
开窍于前阴，络脉于两腰，其疝则痛自阴茎，上连腰肾者是也。然而肝为肾之子，子
能令母虚，故肝病无有不补肾者，母能令子实，肾实则肝病无有不愈者，况世之患
疝由肾虚而致者尤多，故治肝必兼顾肾，治肾必兼顾肝，又治疝之捷要，不可不知也。
余所以治肝疝之有余者，原不出乎疏泄温散，以肝家之客邪有余，不得不由疏导而
去之耳。若病久肝家之正气自虚，或有挟虚而发，其脉不甚沉急，甚则空豁无力，面
青肢厥者，苟非参术补益，而兼用桂附温补，岂能获效，此正所谓补其母，而子自
实之义也。世俗苦执肝无补法之说，但逢疝症，不分肝肾，不论虚实，过用克伐，岂
知肝虚复盗母气以自益，而肾气亦因之亏
损，故有肝病未已，而肾家虚寒之气，上冲心胃而危急者也，此正所谓子能令母虚
也。昔仲景治寒疝腹中痛，及胁痛里急者，用当归生姜羊肉汤无不愈者，岂非补肝之
验。而王肯堂、缪仲醇治疝气上攻，心腹窘迫者，用八味地黄丸投之立应者，又非
补肾之一证乎？甚有疝证大便不通者，当利大便，如许叔微、罗谦甫皆用芫花是已。
小便不通者，当利小便，如许叔微治宋荀甫以五苓散是已。若据《纂要》于肾经无
涉，则五苓不当用，又言疝无下法，则芫花不当用，所列之药及诸书所用七疝之方，
无非辛苦破气，寒热杂收，既不能补肝肾之真阴，又不能通利二窍，使邪有所泄，而
徒耗其气于冥冥之中，岂不悖哉！昔有久疝不愈，只于每日空心以淡飞盐滚汤漱口，
咽下无遗，不半年而愈，永久不发。盖齿乃骨之余，夜卧口闭，精气聚于齿间而成垢，
以垢补肾，正补之以属也，又补肾之一征也。
《医论选要》曰∶夫疝气者，睾丸连小腹急痛也。有七疝∶一曰厥疝，谓厥逆心
痛足寒，饮食吐逆不下。二曰征疝，腹中气乍满，心下尽痛，气积如臂。三曰寒疝，
因寒饮食积，胁下腹中尽痛。四曰盘疝，腹中气痛，盘结脐傍。五曰气疝，腹中乍满
乍减而痛。六曰附疝，腹中脐下有积聚。七曰野狼疝，小腹与阴相引而痛，大便难。此
七疝之形证也。又有所谓心疝、饥疝、疝癖、小肠气、膀胱气、奔豚气、横弦、竖
弦、偏坠、木肾、肾余、阴肿，其名不同，皆疝之类也。原其所由，未有不因七情四
气之所干也。夫任脉为病，男子内结七疝，女子带下症聚，河间以为聚寒，丹溪以为
湿热，无择以为有寒有热，子和以为专属厥阴肝经，观《内经》所论，则五脏皆有
疝，而太阳小肠膀胱与厥阴肝经为疝之主，其气相通连，而外肾系于睾丸，此三经乃
相连相会者也。盖肝者筋之合也，聚于阴器，凡疝之发其部分，故曰疝本肝经，治
法当以疏导为主，或温之，或散之，要在随其各经之证施治，则无不愈矣。
古人用五苓散内加行气之药，盖猪苓、泽泻分理阴阳，以和心与小肠之气，白术
既渗腰脐间湿与死血，又助中气以佐营运药力，茯苓淡渗而利膀胱水，桂能伐肝邪
而温散通行，茴香治小肠之气，金铃子、橘核去膀胱之滞，槟榔下气开导，少加木通
以导小肠之火，立方之工稳极矣。盖疝证未有不因内虚外袭，然必先疏泄其气，所
谓通则不痛，若骤加补益，攻心入腹，变成危证。
凡阴囊大而阴茎反缩于内，小便淋漓，行履滞碍，乃膀胱气也。盖肾与膀胱为表
里，肾不能藏，为邪所客，遗于膀胱，小便渗入肾囊耳，宜渗利之。有阴茎全缩不
见，而阴囊光肿不痛，此因肝气虚损不能舒达也，宜温补之。
回回俗善何养者无他法，惟护外肾，使不着寒，见南人着夏布裤，甚以为非，恐
凉伤外肾也。又云∶夜卧当以手握之令暖，谓此乃生人性命之根本，不可以不保护也。（《觚不觚录》）
疝气，是由于阴寒之气积聚于体内，又受到外部寒邪侵袭而发作的。因此，《素问》中论述疝病，都认为是由寒邪引起的，然而不能仅仅将其归结为寒证。虽然这是由于寒邪郁结所致，但也往往因为饮酒饱食无度，导致体内湿热蒸腾，痰饮流注到厥阴肝经。肝木之性急迫迅速，再加上被寒邪束缚，所以疼痛剧烈。症状虽然表现在肾脏区域，但病根实际上在于肝脏，因为厥阴肝经的脉络连接着外生殖器。由此可见，内部有湿热郁结在中焦，外部被寒邪束缚，并且还有痰饮、食积、瘀血等郁结致病，所以说疝气主要与肝经有关，而与肾没有绝对无关的关系。其表现为睾丸牵引少腹疼痛，有时无形无声，有时有形如瓜状，有时有声如蛙鸣，激荡搏动而痛，疼痛没有固定位置，难以忍受。
疝气的证候有七种：寒疝、水疝、狐疝、血疝、气疝、筋疝。（出自《冯氏锦囊》）
寒疝，是厥阴经感受寒邪，导致筋脉拘挛，睾丸收缩。症状表现为阴囊冰冷、坚硬如石，阴茎不能勃起，或者牵引睾丸疼痛，这一定是因为久坐湿地，寒气郁结于外部所致。
水疝，表现为阴囊肿痛，形状像水晶一样透明，阴部出汗，瘙痒并流出黄水，按压小腹有水声，这一定是因为醉酒房劳过度，出汗后受风，湿热乘虚流注结聚在阴囊中，导致大小便胀满闭塞不通。
湿疝（原文“疝者”前缺字，据语境及后文“感受湿气”推断为湿疝），阴囊肿大如斗升，不痒不痛，这是因为感受湿气，导致阴核气机结滞，也有出现灼痛的情况。
血疝，形状像黄瓜，位于小腹两旁，横骨两端，俗称便痈。这是因为再次感邪，在春夏酷热时劳动，使内里气血流溢，渗入膀胱和阴囊，结成痈肿。
气疝，上连肾区，下及阴囊，如果号哭或愤怒，气机郁结紧迫而导致胀痛，这一定是因为父亲精气虚弱，在阳痿状态下强行行房受孕，属于胎病。
狐疝，形状像瓦片，躺下时进入腹腔，行走时则从腹腔滑出进入阴囊，就像狐狸白天出穴排尿，晚上入穴不排尿一样，所以叫狐疝。大概环绕外生殖器上抵少腹的部位，是肝经所主的区域，也是受疝的地方。所有的疝气，如果不是肝木受邪，就是肝木自病，这是肝经自病的表现。
筋疝，表现为阴茎肿胀，或者溃烂流脓而痛，里急筋缩，或者尿道中疼痛，痛极时发痒，或者阴器不收，白色分泌物像精液一样随小便排出，这得之于房劳过度，或者邪术所致。
更有木肾这一说法。盖因心火下行，肾水自然温暖，真阳下降，肾气自然调和，既温暖又调和，怎么会有木强（僵硬肿大）的情况呢？这是因为嗜欲内伤，肾虚导致阴阳水火不相接，从而形成沉寒胀大而痛硬的症状。
睾丸所络属的筋脉并不全由厥阴肝经主管，太阴脾经和阳明胃经的筋脉也进入络属。所以患左侧睾丸的，疼痛多而肿胀少；患右侧睾丸的，疼痛少而肿胀多。
又有身体发热，耳后突然生腮（痄腮），红肿胀痛，腮肿将要消退时，睾丸突然肿胀，一个极大，一个极小，看似偏坠但实际上不是典型的偏坠，因为耳旁是少阳胆经的分野，与肝经互为表里，少阳感受风热而波及肝经所致。
妇人小腹旁边靠近阴处结块胀痛，或者皮下顶起如鹅蛋大小，这是寒气聚于厥阴肝经所致。小腹受寒，病即发作，这叫阴疝。女子血枯闭经，足胫咽喉干燥，小便淋漓不畅，小腹有肿块，前阴突出，后阴痔核，这些都是女子的疝病。只是女子不称疝，而称为瘕。
古方用乌头、栀子各等分，加盐酒煎服，名叫栀附汤，效果也很迅速，后来根据这个方子随症加减，没有不应验的，必须分辨湿热多少来治疗。朱丹溪说：乌头治疗外束的寒邪，栀子治疗内郁的热邪，那么内热外寒的道理就清楚了。况且这两味药都是下行聚集的药物，栀子被乌头引导，则药势下行急速，不容许在胃中稍作停留。如果按压后疼痛停止的，尤其属于虚寒，必须加肉桂，用姜汁制丸服用。如果想快速止痛，可用枳实核、山楂核、荔枝核、川楝子、吴茱萸各炒成粉末，用白开水调服。
又有阴茎完全缩回不见，而阴囊光亮肿胀但不痛，这是因为肝气虚损而不能舒展通达，宜用温补法。
陈实功说：水疝，肾囊皮色光亮，无热无红，肿痛有时，内有积水，宜用针从隐秘处引出积水即可安宁。如果肿痛日久，内部脓液已成，胀痛者可立即针刺，内服十全大补汤加山萸肉、丹皮、泽泻。（出自《外科正宗》）
林慕莪说：有人问气以疝命名，其中的含义是什么？回答说：积土成山，积气成疝，疝就是山的意思，其气日积月累，聚而不散而成疝，就像积土成山，从小变大，由低变高的道理。但是气本来是无形的，因为虚而凝聚不散，随着它聚集的地方产生疼痛，所以五脏都有疝，这其实就是五脏的元气，失去了温养生发的本性，营运转输的常态，虚则停滞，寒则凝结，从无到有，从微到著，从闭塞以至于不通而疼痛了。（出自《活人书》）
又说：有人问既然由无形之气，积久成疝而痛，按理应该疼痛不止，为什么也有不痛的时候？如果说散了就不痛，那能散似乎就没有成疝的方法；如果说没散，疝从何归，可以不痛，或者是有时停止有时发作，甚至终身不愈的，也是因为这种气时聚时散所导致的吗？还是说此气临时隐伏呢？回答说：如果气能散能聚，怎么能成疝？只有它积而不散，才成为痛和硬的态势，但元气的虚损有轻重不同，发病也有新久深浅的差异，大概疼痛的缓急止发，也取决于人的气血虚实，以及五脏有病或无病的情况。
又说：有人问现在的所谓疝病，一定归咎于寒湿之气，但寒本是足太阳膀胱寒水受病，湿乃是足太阴脾经湿土当令，为什么又说这是足厥阴肝家的病？既然说是肝病，就应当归责于湿热，又与寒湿无关了。难道没有解释吗？回答说：五脏有疝，出于《内经》，怎么能单独系于肝？况且寒湿二气，郁久都能化热，大凡五行六气，传变自有不同，学医之人应当扩充其义理。
又说：有人问男子固有睾丸大小，以及小肠、膀胱、昆仑等气为疝的情况，据说是五脏皆疝，那么妇人也应该病疝，疝将用什么方法验证和治疗呢？回答说：男女一体，五脏都各有疝，外肾虽然没有，但少阴、厥阴的络脉具备，治法必须根据五脏，男女哪里有区别呢？只是碍于世俗观念，不敢直言罢了。
又说：有人问疝是由积气所成，五脏概有积气所成的病，为什么唯独这个积气又以疝称呼呢？回答说：聚而不散叫做积，积久而成高耸的形状叫做疝，前后看起来相似其实不同。五积由于本经之气，各自因七情六郁而成积，而这个证候不仅本经因虚自病，而且有感触而发，虚实传变而盛行的情况。如果正言疝已经具备七种名称，已在《医统》、《准绳》、《指掌》诸书中见到，可以不赘述。现在将五脏之疝详细列在后面，以告知后学。
肺疝，可能是因为风寒深入肺俞，冷冻饮料寒气直达肺窍，本经元气素来亏虚，又被寒邪侵袭，起初由聚而不散，逐渐积而成疝。肺证有三种：一曰肺痹，痹者闭也，闭而不通，似喘非喘，咽喉不利的，是痹，不是疝。二曰息贲，是肺气充满，不能下降，日久月深，胸中似有物阻碍气道不利，语言因此塞涩的，是息贲，不是疝。三曰肺疝，疝则与前两证不同，鼻息粗暴，呼吸短促，胸膈与云门、中府之间梗塞疼痛的，是疝。其名有三，为病也不相远，只有气口脉弦急有力的，才当作疝来治。
心疝，心气久郁不舒，积而成疝，正气日渐衰弱，结聚日渐盛大，稍有感触，窘迫而痛如割如裂，痛时四肢厥冷，汗出如浴。左寸关脉沉而弦急的，是虚寒之疝。脉弦涩而数，心烦嘈杂而痛的，是阴虚内热而气郁，兼有火化的表现。
脾疝，浊气自下逆上，连着打嗝不宽舒，胀满作痛，痛时呕吐清水，或者苦水痰涎之类，脉两关弦急的是实证，沉滑的是虚证。
肝疝，阴囊赤肿坚硬而痛，痛连两胯小腹之间，因为厥阴之络，络于阴器。右关尺脉弦急而数，兼有寒热，外证是湿热之气，无由疏泄，传变为囊痈。如果是妇人，则有腹胀痛，两胯间大筋偏坠，以及痛连腰胯的，如果有肝气下陷，阴道阴挺突出为痛的，湿热下陷，传为阴户肿胀发痒，甚则生虫臊臭，凡此皆是肝家积气所化，犹如男子的疝病。其脉左关尺也有沉弦而数，或弦急而数的。
肾疝，大多是纵欲房劳之人，里气先亏，寒湿之气乘机侵袭，积久成疝，其痛自腰肾下连阴茎，小便兼之淋浊艰涩，其脉微而涩，或沉细而濡软。
肺疝，用辛散之法，用苦顺之法，所谓厘清。心疝，寒的用温散剂，热的兼补兼清。脾疝，专于温散，若湿热甚重的，必须先化湿理痰。肝疝，必须升清利浊，分消湿热之气。肾疝，应当在温补之中，佐以分消之药。更应当参考古人的七疝，斟酌治疗，这样更为详尽无疑。
又说：有人问《丹溪纂要》一书，为世人首推，唯独说疝主肝病，与肾无关。况且肝无补法，所以前人治疝者，多用苦辛之味以破气散坚为主，现在您主张用参、术、归、苓治疝，已经违背谬误，而又立肾疝一门，岂不是与丹溪故意矛盾吗？回答说：肝肾有疝，不仅基于《内经》，即使现在的患者，也明显有两种。盖厥阴肝经之络，循环乎外生殖器，上连小腹左右之旁，以至胁部，下系外肾两个睾丸之根，所以肝疝有睾丸肿胀偏坠痛连小腹的证候。至于肾，开窍于前阴，络脉于两腰，其疝则是痛自阴茎，上连腰肾的。然而肝为肾之子，子能令母虚，所以肝病无不补肾的，母能令子实，肾实则肝病无不痊愈的，何况世上患疝由肾虚而致的尤其多，所以治肝必兼顾肾，治肾必兼顾肝，这也是治疝的捷要，不可不知。
我所以治肝疝有余者，原本不出乎疏泄温散，因为肝家之客邪有余，不得不由疏导而去之。如果病久肝家之正气自虚，或者有挟虚而发，其脉不甚沉急，甚则空豁无力，面青肢冷的，如果不是人参、白术补益，而兼用肉桂、附子温补，怎么能获效，这正是补其母，而子自实的意义。世俗苦执肝无补法之说，只要逢疝症，不分肝肾，不论虚实，过用克伐，岂知肝虚会盗取母气以自益，而肾气也因此亏损，所以有肝病未已，而肾家虚寒之气，上冲心胃而危急的情况，这正是子能令母虚。昔年张仲景治寒疝腹中痛，及胁痛里急者，用当归生姜羊肉汤无不愈者，难道不是补肝的验证。而王肯堂、缪仲醇治疝气上攻，心腹窘迫者，用八味地黄丸投之立应者，又不是补肾的一个证明吗？甚至有疝证大便不通的，当利大便，如许叔微、罗谦甫都用芫花是已。小便不通的，当利小便，如许叔微治宋荀甫用五苓散是已。如果依据《纂要》认为与肾经无关，则五苓散不当用，又说疝无下法，则芫花不当用，所列之药及诸书所用七疝之方，无非辛苦破气，寒热杂收，既不能补肝肾之真阴，又不能通利二窍，使邪有所泄，而徒耗其气于冥冥之中，岂不悖谬！昔有久疝不愈，只于每日空腹以淡飞盐滚汤漱口，咽下无遗，不到半年而愈，永久不发。盖齿乃骨之余，夜卧口闭，精气聚于齿间而成垢，以垢补肾，正是补之以属类，又是补肾的一个征象。
《医论选要》说：夫疝气者，睾丸连小腹急痛也。有七疝：一曰厥疝，谓厥逆心痛足寒，饮食吐逆不下。二曰征疝，腹中气乍满，心下尽痛，气积如臂。三曰寒疝，因寒饮食积，胁下腹中尽痛。四曰盘疝，腹中气痛，盘结脐傍。五曰气疝，腹中乍满乍减而痛。六曰附疝，腹中脐下有积聚。七曰野狼疝，小腹与阴相引而痛，大便难。此七疝的形证。又有所谓心疝、饥疝、疝癖、小肠气、膀胱气、奔豚气、横弦、竖弦、偏坠、木肾、肾余、阴肿，其名不同，皆疝之类也。推究其由来，没有不是因为七情四气所干扰的。夫任脉为病，男子内结七疝，女子带下症聚，河间认为是聚寒，丹溪认为是湿热，无择认为有寒有热，子和认为专属厥阴肝经，观《内经》所论，则五脏皆有疝，而太阳小肠膀胱与厥阴肝经为疝之主，其气相通连，而外肾系于睾丸，这三经乃是相连相会的。盖肝者筋之合也，聚于阴器，凡疝之发其部分，故曰疝本肝经，治法当以疏导为主，或温之，或散之，要在随其各经之证施治，则无不愈矣。
古人用五苓散内加行气之药，盖猪苓、泽泻分理阴阳，以和心与小肠之气，白术既渗腰脐间湿与死血，又助中气以佐营运药力，茯苓淡渗而利膀胱水，桂能伐肝邪而温散通行，茴香治小肠之气，金铃子、橘核去膀胱之滞，槟榔下气开导，少加木通以导小肠之火，立方之工稳极矣。盖疝证未有不因内虚外袭，然必先疏泄其气，所谓通则不痛，若骤加补益，攻心入腹，变成危证。
凡阴囊大而阴茎反缩于内，小便淋漓，行履滞碍，乃膀胱气也。盖肾与膀胱为表里，肾不能藏，为邪所客，遗于膀胱，小便渗入肾囊耳，宜渗利之。有阴茎全缩不见，而阴囊光肿不痛，此因肝气虚损不能舒达也，宜温补之。
回回俗善何养者无他法，惟护外肾，使不着寒，见南人着夏布裤，甚以为非，恐凉伤外肾也。又说：夜卧当以手握之令暖，谓此乃生人性命之根本，不可以不保护也。（出自《觚不觚录》）
Hernia (Shan) is caused by the accumulation of Yin-cold Qi internally, compounded by external cold pathogenic invasion. Therefore, in *Su Wen* (Plain Questions), hernias are all attributed to cold; however, they cannot be solely discussed as cold syndromes. Although arising from cold stagnation, it is also due to excessive drinking and overeating, leading to internal steaming and damp-heat, with phlegm-fluids flowing into the Jueyin Liver Meridian. The nature of Wood (Liver) is rapid and urgent; constrained by cold, severe pain ensues. Although symptoms manifest in the Kidney region, the root lies in the Liver, as the Jueyin Liver Meridian connects to the external genitalia. Thus, internal damp-heat stagnates in the middle, while external cold binds the exterior. Additionally, phlegm-fluids, food retention, and static blood may stagnate and cause disease. Hence, it is said that hernia primarily involves the Liver Meridian and is not entirely unrelated to the Kidney. Manifestations include testicular traction pain in the lower abdomen; sometimes formless and soundless, sometimes shaped like a melon, sometimes sounding like a frog; throbbing and painful without fixed location, unbearable.
There are seven types of hernia syndromes: Cold Hernia, Water Hernia, Fox Hernia, Blood Hernia, Qi Hernia, Sinew Hernia. (From *Feng Shi Jin Nang*)
Cold Hernia: Cold invades the Jueyin Meridian, causing sinew spasm and testicular retraction. Symptoms include a cold, hard scrotum like stone, impotence, or testicular traction pain. This results from sitting long on damp ground, allowing cold to stagnate externally.
Water Hernia: Scrotal swelling and pain, transparent like crystal, sweating from the yin area, itching with yellow discharge, water sound upon pressing the lower abdomen. This results from drunkenness and sexual excess, sweating followed by wind exposure, allowing damp-heat to flow into the scrotum when deficiency exists, causing distension and constipation of urine and stool.
Damp Hernia (implied): Scrotal enlargement like a bucket, neither itchy nor painful, caused by dampness pathogen condensing Qi in the yin core; burning pain may also occur.
Blood Hernia: Shaped like a cucumber, located on both sides of the lower abdomen at the ends of the transverse bone, commonly called "piss abscess" (Bian Yong). Caused by repeated pathogenic invasion during hot labor in spring/summer, causing Qi and Blood to overflow and seep into the bladder and scrotum, forming an abscess.
Qi Hernia: Connects upward to the Kidney area and downward to the scrotum. Crying or anger causes Qi stagnation and urgency, leading to distending pain. This is often a congenital condition due to paternal essence deficiency and forced intercourse during impotence.
Fox Hernia: Shape like a tile; enters the abdomen when lying down, exits into the scrotum when walking, resembling a fox urinating when out of the den by day and not at night. The area surrounding the external genitalia up to the lower abdomen is governed by the Liver Meridian, the site of hernia. All hernias involve either Liver Wood pathogen invasion or self-disease of Liver Wood.
Sinew Hernia: Penile swelling, ulceration with pus and pain, tenesmus and sinew contraction, urethral pain, extreme pain causing itching, or non-retractile yin with white fluid resembling semen discharging with urine. Caused by sexual excess or sorcery.
Wood Kidney (Mu Shen): Normally, Heart Fire descends, warming Kidney Water; True Yang descends, harmonizing Kidney Qi. Hardness/swelling occurs when desire injures internally, causing Kidney deficiency and disconnecting Yin/Yang and Water/Fire, resulting in deep cold, distension, hardness, and pain.
The sinews connecting the testes are not solely governed by Jueyin; Taiyin Spleen and Yangming Stomach sinews also connect. Left testicle issues often present more pain than swelling; right testicle issues more swelling than pain.
Another presentation: Fever, sudden mumps behind the ear (Zha Sai) with red swelling and pain. As the cheek swelling subsides, the testicles suddenly swell, one large, one small, appearing as hernia but distinct. The ear side belongs to Shaoyang Gallbladder Meridian, interior-exterior related to Liver; Shaoyang Wind-Heat affects the Liver Meridian.
In women, swelling and pain near the yin in the lower abdomen, or subcutaneous lumps like goose eggs, result from Cold Qi gathering in Jueyin. Lower abdominal cold triggers this, called Yin Hernia. Women with blood depletion amenorrhea, dry throat/legs, strangury, lower abdominal masses, prolapse of anterior yin, and posterior hemorrhoids suffer from female hernias. However, these are named Zha (masses) rather than Shan.
Ancient formula: Equal parts Aconite (Wutou) and Gardenia (Zhizi) decocted with salt wine, named Zhifu Tang, acts quickly. Modifications based on this formula are effective; treatment must distinguish damp-heat ratios. Zhu Danxi stated: Aconite treats external cold constraint; Gardenia treats internal heat stagnation, clarifying internal heat/external cold dynamics. Both herbs descend rapidly; Gardenia guided by Aconite moves fast through the stomach. If pressure relieves pain, it indicates deficiency-cold; add Cinnamon Bark (Rougui) taken as ginger-pill. For rapid pain relief, use processed seeds of Bitter Orange (Zhihe), Hawthorn (Shanzhahé), Lychee (Lizhihe), Sichuan Chinaberry (Chuanlianzi), and Evodia (Wuzhuyu) powdered and taken with warm water.
Pediatric unilateral scrotal swelling often stems from undigested food retention, Spleen dampness descending into the Liver sector.
Penile retraction with shiny, swollen, painless scrotum indicates Liver Qi deficiency failing to unblock; treat with warming tonification.
Chen Shigong stated: Water Hernia presents with shiny scrotal skin, no heat/redness, intermittent swelling/pain, internal water accumulation. Prick to drain water via discreet areas. If chronic with pus formation and pain, prick immediately; internally administer Shiquan Dabu Decoction plus Cornus (Shanyurou), Moutan (Danpi), Alisma (Zexie). (From *Waike Zhengzong*)
Lin Mu'e asked: Why is Qi termed Hernia? Answer: Accumulated earth forms mountains; accumulated Qi forms hernia. Qi accumulates month after month, gathering不散 (not dispersing) to form hernia, like earth piling up. Qi is formless; due to deficiency, it condenses and causes pain where it gathers. Thus, all five Zang organs can have hernias, representing Yuan Qi losing its warming/nourishing nature and transport function. Deficiency leads to stagnation; cold leads to coagulation. From nothing to something, subtle to obvious, blocking until obstruction and pain.
Further query: If formed by accumulating formless Qi causing pain, why is there no pain sometimes? If dispersed, how does it form hernia? If not dispersed, where does it go? Is it temporary dispersion or latent Qi? Answer: If Qi could disperse, it wouldn't form hernia. It becomes painful/hard only because it accumulates without dispersing. Severity depends on Yuan Qi deficiency depth and disease duration. Pain patterns depend on individual Qi/Blood deficiency/excess and Zang organ involvement.
Query: Hernia blamed on Cold-Damp. Cold belongs to Taiyang Bladder (Water); Damp to Taiyin Spleen (Earth). Why attribute to Jueyin Liver? If Liver, shouldn't it be Damp-Heat, unrelated to Cold-Damp? Answer: Five-Zang Hernia originates from *Nei Jing*; cannot limit to Liver. Cold-Damp stagnating long transforms into Heat. Five Elements/Six Qi transformations vary; students must expand understanding.
Query: Men have testicular size variations and Small Intestine/Bladder/Kunlun Qi hernias. If Five Zang have hernia, do women too? How to diagnose/treat? Answer: Male/female share unity; all Zang have hernia potential. Though external kidneys differ, Shaoyin/Jueyin meridians exist. Treatment follows Five Zang principles; gender distinction in pathology is minimal, though social norms obscure this.
Query: If all Zang have Qi accumulation diseases, why specifically call this "Hernia"? Answer: Accumulation不散 (not dispersing) is Ji (mass); accumulated high/protruding shape is Shan (hernia). Five Acculations stem from meridian Qi affected by Seven Emotions/Six Depressions. This condition involves not just meridian deficiency but also external contact and transmission between deficiency/excess. Seven Hernia names appear in *YiTong*, *Zhunshe*, *Zhangzhi*. Below details Five Zang Hernias for learners.
Lung Hernia: Deep Wind-Cold entering Lung Shu points, cold drinks reaching Lung orifices, inherent Yuan Qi deficiency compounded by Cold. Initially stagnant, then accumulates. Three Lung conditions: 1. Lung Bi (closure), breathing difficulty, throat obstruction—not Hernia. 2. Xi Ben (breath surging), Lung Qi full unable to descend, chest obstruction, speech difficulty—not Hernia. 3. Lung Hernia: Rough nasal breathing, shortness of breath, blockage/pain between Xige, Yunmen, Zhongfu—this is Hernia. Pulse at Qikou stringy-tight-forceful indicates treat as Hernia.
Heart Hernia: Long-term Heart Qi stagnation accumulates into Hernia; Righteous Qi declines, accumulation grows. Minor triggers cause cutting/sharp pain, cold limbs, profuse sweating. Left Cun/Guan pulse sunken-stringy-tight indicates Deficiency-Cold Hernia. Stringy-choppy-rapid pulse with vexation/irritability indicates Yin Deficiency/Internal Heat with Qi Stagnation transforming into Fire.
Spleen Hernia: Turbid Qi rises from below, belching, distension/pain, vomiting clear/bitter fluid/phlegm. Guan pulses stringy-tight indicate Excess; sunken-slippery indicate Deficiency.
Liver Hernia: Red/swollen/hard painful scrotum, pain radiating to hips/lower abdomen due to Jueyin connection to yin. Right Guan/Cun pulses stringy-tight-rapid with chills/fever indicate Damp-Heat unable to vent, transmitting to Scrotal Abscess. In women: lower abdominal pain, hip sinew drooping, waist/hip pain, Liver Qi sinking causing vaginal prolapse/pain, Damp-Heat sinking causing vulvar swelling/itching/worms/foul odor—all Liver Qi accumulation akin to male hernia. Left Guan/Cun pulses sunken-stringy-rapid or stringy-tight-rapid.
Kidney Hernia: Common in those with sexual excess; internal deficiency allows Cold-Damp invasion, accumulating into Hernia. Pain from kidney down to penis, strangury/cloudy urine. Pulse micro-choppy or sunken-thin-soft.
Treatment: Lung Hernia – Pungent-dispersing, Bitter-smoothing. Heart Hernia – Cold: Warm-dispersing; Heat: Tonify + Clear. Spleen Hernia – Warm-dispersing; if severe Damp-Heat, resolve Damp first. Liver Hernia – Raise Clear, drain Turbid, separate Damp-Heat. Kidney Hernia – Warm-tonify with draining aids. Reference ancient Seven Hernias for comprehensive treatment.
Query: *Danxi Zuanyao* claims Hernia is Liver-only, unrelated to Kidney, citing "Liver has no tonification method," using bitter-pungent breaking herbs. You use Ginseng/Atractylodes/Angelica/Poria and create Kidney Hernia category, contradicting Danxi? Answer: Liver/Kidney Hernia based on *Nei Jing* and clinical observation. Jueyin Liver Meridian loops around yin, connects to lower abdomen/flanks, ties to testicular roots; Liver Hernia features testicular swelling/drooping/lower abdominal pain. Kidney opens to anterior yin, meridians to loins; Kidney Hernia pain starts at penis, ascends to loins/kidneys. Liver is Child of Kidney; Child deficiency makes Mother weak; Mother strength makes Child solid. Since many hernias stem from Kidney deficiency, treating Liver must consider Kidney, and vice versa.
My treatment of Liver Hernia Excess uses dispersing/warming to expel pathogen. Chronic Liver Hernia with Righteous Qi deficiency (pulse not deeply tight, or empty/weak, blue face/cold limbs) requires Ginseng/Atractylodes tonification plus Cinnamon/Aconite warming. This embodies "Tonify Mother, Child becomes solid." Secular adherence to "Liver no tonification" leads to overusing attacking herbs regardless of Liver/Kidney or Deficiency/Excess, damaging Liver which steals Mother Qi, depleting Kidney. This causes Liver disease to trigger Kidney Cold rushing to Heart/Stomurgency. This is "Child making Mother weak." Zhang Zhongjing used Dang Gui Ginger Lamb Soup for Cold Hernia abdominal/flank pain—proof of Liver tonification. Wang Kentang/Miao Zhongchun used Eight Flavor Rehmannia Pill for Hernia Qi attacking heart/abdomen—proof of Kidney tonification. For constipation in hernia, Xu Shumi/Luo Qianfu used Genkwa (Yuanhua) to purge bowels. For strangury, Xu Shumi used Wuling San for Song Xunfu. If *Zuanyao* were correct (no Kidney link), Wuling San and Yuanhua would be invalid. Most formulas use bitter-pungent Qi-breaking, mixed hot/cold, failing to tonify Liver/Kidney Yin or open orifices to drain pathogens, merely wasting Qi. An old cure for chronic hernia involved rinsing mouth with salt water daily and swallowing; cured within half-year, preventing recurrence. Teeth are bone surplus; saliva/garlic forms from concentrated essence; using this to tonify Kidney is appropriate, another proof of Kidney tonification.
*Yi Lun Xuan Yao* states: Hernia is testicular/lower abdominal acute pain. Seven Hernias: 1. Jue Hernia: Reversal, heart pain, cold feet, vomiting. 2. Zheng Hernia: Abdominal distension, epigastric pain, mass like arm. 3. Han Hernia: Cold food accumulation, hypochondriac/abdominal pain. 4. Pan Hernia: Abdominal pain, coiled around umbilicus. 5. Qi Hernia: Fluctuating abdominal distension/pain. 6. Fu Hernia: Mass below umbilicus. 7. Yelang Hernia: Lower abdomen/yin牵引 pain, difficult defecation. Other terms: Xin Hernia, Ji Hernia, Shan Pi, Small Intestine Qi, Bladder Qi, Ben Tun Qi, Heng Xian, Shu Xian, Unilateral Droop, Mu Shen, Kidney Remainder, Yin Swelling—all types of Hernia. Originates from Seven Emotions/Four Qi disturbances. Ren Mai disease: Men internal Seven Hernias; Women leukorrhea/masses. He Jian: Cold accumulation. Danxi: Damp-Heat. Wu Ze: Cold/Heat. He Zi: Jueyin Liver exclusive. *Nei Jing*: All Zang have Hernia; Taiyang Small Intestine/Bladder and Jueyin Liver are primary, interconnected, with external kidneys tied to testes. Liver governs sinews, gathering at yin; thus Hernia roots in Liver Meridian. Treatment: Guiding/Unblocking primary, or Warming/Dispersing according to meridian syndrome.
Ancients used Wuling San with Qi-moving herbs: Polyporus/Alisma regulate Yin/Yang, harmonize Heart/Small Intestine; Atractylodes drains damp/stasis in waist/umbilicus, boosts Middle Qi to aid transport; Poria drains Bladder water; Cinnamon attacks Liver pathogen, warms/unblocks; Fennel treats Small Intestine Qi; Golden Bell Fruit (Jinlingzi)/Tangerine Seed remove Bladder stagnation; Areca Nut directs Qi downward; slight Akebia (Mutong) guides Small Intestine fire. Formula is stable. Hernia stems from internal deficiency/external attack; must first unblock Qi ("Unblocked means no pain"). Sudden tonification attacking heart/abdomen creates critical conditions.
Large scrotum with retracted penis, dribbling urine, gait obstruction indicates Bladder Qi. Kidney/Bladder interior-exterior; Kidney fails to store, pathogen resides, urine leaks into scrotum. Treat with draining/promoting. Penile retraction with shiny swollen painless scrotum indicates Liver Qi deficiency; treat with warming tonification.
Hui people health practices: Protect external kidneys from cold; dislike southern summer linen pants fearing cool injury. Sleep holding genitals warm, as this is life's root requiring protection. (From *Gu Bu Gu Lu*)