气者，盖为此也。《金匮方》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。用乌头一味，以蜜二升，煎减半去渣，以桂枝汤五合和之，令得一升后，初服二合；不
知，再服三合；又不知，复加至五合。其知者，如醉状，得吐者为中病。海藏以附子建中汤加蜜煎治
疝，即此法也。腹痛，脉弦而紧，弦则卫气不行，即恶寒，紧则不欲食，弦紧相搏，即为寒疝。寒疝
绕脐痛，若发则自汗出，手足厥冷，其脉沉弦者，大乌
头煎主之。《衍义》云∶葫芦巴，《本经》云得茴香、桃仁，治膀胱气甚效。尝合用桃仁麸炒各等分，
半酒糊丸，半为散。每服五七十丸，空心食前盐酒下。散以热米饮调下，与丸子相间，空心各一二服效。
《宝鉴》葫芦巴丸。
丹溪治内郁之湿热煎方∶枳实（九粒炒）、桃仁（十四个炒）、山栀仁（九个炒）、吴茱萸（七
粒炒）、山楂（四粒炒）、生姜（如指大），上六味，同入擂盆擂细，取顺流水一钟，入瓶内煎至微
沸，带渣服。如湿胜 疝者，加荔枝核。如痛甚者，加盐炒大茴香二钱。如痛处可按者，加薄桂少许。
丸方∶山栀（二两炒）、山楂（四两炒）、枳实（炒）、茴香（炒各二两）、柴胡、牡丹皮、八角茴
香（各一两炒）、桃仁、茱萸（炒各半两），末之，酒糊丸。空心盐汤下五六十丸。阳明受湿热，传
入大肠，发热恶寒，小腹连毛际间闷痛不可忍，用栀子仁（炒）、桃仁（炒）、枳实（炒）、山楂（各
等分），同研细，入生姜汁半合，用水一小钟，汤起煎令沸，热服之。一方加茱萸。
寒热兼施《灵枢》云∶胃中热，肠中寒，则疾饥，小腹痛胀。丹溪云∶愚见有用川乌头、栀子等
分，作汤用之，其效亦敏。后因此方随症与形加减用之，无有不效。
盖川乌头治外束之寒，栀子仁治内郁之热也。又云∶诸疝痛处，用手按之不痛者属虚，必用桂枝、炒
山栀细切、川乌头等分，为细末，生姜自然汁打糊为丸，如桐子大。每服三四十丸，空腹白汤下。罗
谦甫云∶阴疝，足厥阴之脉，环阴器，抵少腹，或痛因肾虚寒水涸竭，泻邪补肝，蒺藜汤主之。
补例 丹溪云∶疝有挟虚而发者，其脉不甚沉紧，而大豁无力者是也。然其痛亦轻，唯觉重坠牵引
耳。当以参术为君， 导药佐之。盖 导药即桃仁、山楂、枳实、栀仁、茱萸、川楝、玄胡索、丁香、
木香之类是也。海藏云∶姬提领因疾服凉剂数日，遂病脐腹下大痛，几至于死，与姜附等剂，虽稍苏，
痛不已，随本方内倍芍药服之愈。《金匮方》寒疝腹中痛，及胁痛里急者，当归生姜羊肉汤主之。《衍
义》云∶张仲景治寒疝，用生姜羊肉汤服之，无不应验。有一妇人，产当寒月，寒气入产门，腹脐以
下胀满，手不欲犯，此寒疝也。师将治之以抵当汤，谓有瘀血，非其治也。可服仲景羊肉汤，二服遂
愈。
肝气 肝足厥阴经之病，必小腹引胁而痛。经云∶厥阴之复，小腹坚满，里急暴痛，是风气助肝
盛而然，治法当泻肝也。又云∶岁金太过，民病两胁下痛，小
腹痛。又云∶岁木不及，燥乃大行，民病中清， 胁痛，少腹痛。又云∶岁土不及，风乃大行，民病
腹痛，复则胸胁暴痛，下引小腹者，是燥邪攻肝虚而然，治法当补肝泻金也。又云∶寒气客于厥阴之
脉，则血泣脉急，故胁肋与小腹相引痛。又云∶肝病者，两胁下痛引小腹，取其经厥阴、小肠。又云∶
邪客厥阴之络，令人卒疝暴痛，刺足大指爪甲上与肉交者各一 ，男子立已，女子有顷已，左取右，
右取左。泻肝，山栀、川芎、桂、芍之属。补肝，当归生姜羊肉之属。
小肠气 小肠之病，小腹引睾丸必连腰脊而痛。经云∶少阴之脉，心下热，善饥，脐下痛。又云∶
少阴之复，燠热内作，小腹绞痛者，是热助小肠盛而然，治法当泻小肠也。又太阳在泉，寒淫所胜，
与太阳之复，皆病小腹控睾，引腰脊，上冲心痛，及太阴司天，大寒且至，病小腹痛者，是寒邪攻
小肠虚而然，治法当补小肠，泻寒邪也。《宝鉴》引至真大要论云∶小腹控睾，引腰脊，上冲心，唾
出清水，及为哕噫，甚则入心，善悲善忘。《甲乙经》曰∶邪在小肠也。小肠病者，小腹痛引腰脊，
贯肝肺，其经虚不足，则风冷乘间而入，邪气既入，则厥之证上冲肝肺，客冷散于胸，结于脐，控引
睾丸，上而不下，痛而入腹，甚则冲心胸。盖其经络所属所系也。治
之方，茴香（炒）、练实（锉炒）、食茱萸、陈皮、马兰花（醋炒各一两）、芫花（醋炒五钱），上
为末，醋糊丸，如桐子大。每服十丸至二十丸，温酒送下。又方，益智仁、蓬术各半两，茴香、山茱
萸肉、牛膝、续断、川芎、葫芦巴、防风、牵牛（炒熟）、甘草，各二钱半，为细末。每服三钱，水
一盏二分，煎两三沸，空心连滓服。白汤调下二钱匕亦得。
膀胱气膀胱之病，小腹痛肿，不得小便是也。经云∶太阴在泉，病小腹痛肿，不得小便，是湿邪
攻膀胱虚而然，治法当补膀胱，泻湿土邪也。又云∶膀胱病者，小腹偏肿而痛，以手按之即欲小便而
不得，取委中央。又云∶小腹痛肿，不得小便，邪在三阳，取之足太阳大络。（即委阳穴）。许学士
云∶顷在岳城日，歙尉宋荀甫，膀胱气作疼不可忍，医者以刚剂与之痛愈甚，小便不通三日矣，脐下
虚胀心闷。予因候之，见其面赤黑，脉洪大。予曰投热药太过，阴阳痞塞，气不得通，为之奈何。宋
尚手持四神丹数粒云，医谓不止更服此。予曰若服此定毙，后无悔。渠求治予，适有五苓散一两许，
分三服，用连须葱一茎，茴香一撮，盐一钱，水一盏半，煎至七分，令接续三服，中夜下小便如墨汁
者一二升，腰下宽得睡，翌日诊之，脉已平安矣。续用 砂丸与之，数日瘥。娄全善治谢人妻，小腹
疼痛，小便不通，先艾灸三
阴交，以茴香、丁香、青皮、槟榔、桂、茱萸、玄胡索、山楂、枳实，又倍用黄柏，煎服愈。
心疝 心脉微滑为心疝。心脉搏滑急为心疝。帝曰∶诊得心脉而急，此为何病？岐伯曰∶病名心疝，
小腹当有形也。心为牡脏，小肠为之使，故曰少腹当有形也。木香散、广脏煮散。
【 疝】睾囊肿大，如升如斗是也。丹溪云∶下部 气不痛之方，细思非痛断房事与浓味不可，
用药唯促其寿。若苍术、神曲、白芷、山楂、川芎、枳实、半夏皆要药。人视其药皆鄙贱之物，已启
慢心，又不能断欲以爱护其根本，非惟无益，而反被其害者多矣。且其药宜随时月寒热，更按君臣佐
使加减。大抵 疝属湿多。苍术、神曲、白芷、（散水）山楂、川芎、枳实、半夏、南星。有热加山
栀一两。坚硬加朴硝半两。秋冬加吴茱萸二钱半，神曲糊丸。又方，南星、山楂、苍术各二两，白芷、
半夏、枳实、神曲各一两，海藻、昆布各半两，玄明粉、吴茱萸各二钱，为末，酒糊丸。又方，治木
肾不痛，南星、半夏、黄柏（酒洗）、苍术（盐炒）、枳实、山楂、白芷、神曲（炒）、滑石（炒）、
茱萸、昆布，酒糊丸。空心盐汤下。治 胀，用香附子不拘多少为末，
每用酒一盏，海藻一钱，煎至半盏，先捞海藻细嚼，用所煎酒调末二钱服。楮叶雄者，晒干为末，酒
糊丸。空心盐酒下。（无实者为雄）。洁古海蛤丸。 气痛者易治，荔核散、三层茴香丸、宣胞丸、
地黄膏子丸、安息香丸、念珠丸，随宜选用。阴囊肿胀，大小便不通，宜三白散。偏坠初生，用穿山
甲、茴香二味为末，酒调下，干物压之。外用牡蛎（ ）、良姜各等分，为细末，津唾调敷大者一边，
须臾，如火热痛即安。丹溪治一人，因饮酒后饮水与水果，偏肾大，时作蛙声，或作痛。炒枳实一两，
茴香盐炒，栀子炒，各三钱，研、煎，下保和丸。一人膀胱气下坠如蛙声，臭橘子核炒十枚，桃仁二
十枚，萝卜自然汁研，下保和丸。一人左肾核肿痛，此饮食中湿坠下成热。以橘核五枚，桃仁七枚，
细研，顺流水一盏，煎沸热，下保和丸。木肾，以枇杷叶、野紫苏叶、苍耳叶、水晶葡萄叶，浓煎汤
熏洗。雄黄一两研，矾二两，生甘草半两，水五升煎洗。荆芥穗一两，朴硝二两，为粗末，萝卜、葱
同煎汤淋洗。大黄末，醋和涂之，干即易。马鞭草捣涂。蔓菁根捣敷。经云∶阳明司天，燥淫所胜，
丈夫 疝，妇人小腹痛。又云∶阳明之胜，外发 疝，是燥邪攻肝气虚而然，治法当补肝泻燥金也。
又云∶厥阴所谓 疝，妇人少腹肿者。厥阴者辰也，三月阳中之阴，邪在中，故曰 疝少腹肿也。所
谓癃疝肤胀者，曰阴亦盛而脉胀不通，故
曰癃疝也。三阳为病，发寒热，下为痈肿，及为痿厥 ，其传为 疝。东垣曰∶阴阳别论云，三
阳为病，发寒热，下为痈肿，及为痿厥 ，其传为索泽，又传为 疝。夫热在外寒在内则累垂，此
九夏之气也。寒在外热在内则卵缩，此三冬之气也。足太阳膀胱之脉，逆上迎手太阳小肠之脉，下行
至足厥阴，肝之脉不得伸，其任脉并厥阴之脉，逆则如巨川之水，致阳气下坠，是风寒湿热下出囊中，
致两睾肿大，谓之曰疝，太甚则为 。足厥阴之脉与太阳膀胱寒水之脉，同至前阴之末。伤寒家说，
足厥阴肝经为病，烦满囊缩，急下之，宜大承气汤以泻大热。《灵枢经》云∶足厥阴肝经，筋中为寒
则筋挛，卵缩为大寒。前说囊缩为大热，此说为大寒，此说囊缩垂睾下引 疝、香港脚为大寒，风湿盛
下垂为寒，与上二说不同何也？曰∶以平康不病患论之，夏暑大热，囊卵累垂，冬天大寒，急缩收上，
与前三说又不同何也？是相乖耶，不相乖耶。答曰∶伤寒家囊卵缩，大热在内，宜承气汤急下之，与
经筋说囊卵缩，大寒在外，亦是热在内，与伤寒家同。故再引平康人以证之，冬
天阳气在内，阴气在外，人亦应之，故寒在外则皮急，皮急则囊缩。夏月阴气在内，阳气在外，人亦
应之，故热在外则皮缓，皮缓则囊垂，此 疝之象也。三说虽殊，其理一也。用药者宜详审之。以上
三论，各有所主，兼此考订，则脉证阴阳寒热虚实之辨判然矣。《内经》刺灸 疝有四法∶其一铍石
取睾囊中水液。经云∶腰脊者，身之大关节也。肢胫者，人之管以趋翔也。茎垂者，身中之机，阴精
之候，津液之道也。故饮食不节，喜怒不时，津液内溢，乃下流于睾，血道不通，日久不休，俯仰不
便，趋翔不能。此病荥然有水，不上不下。铍石所取，形不可匿，常不得蔽，命曰去爪。其法今世人
亦多能之。睾丸囊大如斗者，中脏秽液必有数升，信知此出古法也。其二取肝。经云∶足厥阴之脉，
是动则病，丈夫 疝，妇人小腹肿是也。是于足厥阴肝经，视盛、虚、热、寒、陷下，而施补、泻、
留、疾与灸也。其三取肝之络。经云∶足厥阴之别，名曰蠡沟，去内踝五寸，别走少阳，
其别者，循胫上睾，结于茎。其病气逆则睾肿卒疝，取之所别是也。是于内踝上五寸，贴胫骨后近肉
处，蠡沟取之也。其四取足阳明筋。经云∶足阳明之筋，聚于阴器，上腹。其病转筋，髀前肿， 疝，
腹筋急。治在燔针劫刺，以知为数，以痛为输是也。是于转筋痛处用火针刺之也。
【狐疝】卧则入腹，立则出腹，偏入囊中者是也。仲景方，阴狐疝气有大小，时时上下者，蜘蛛
散主之。《内经》刺灸狐疝，但取足厥阴一经。经云∶肝足厥阴之脉，所生病者，狐疝是也。随其经
盛、虚、寒、热、陷下取之也。耳后陷者肾下，肾下则腰尻痛，不可俯仰，为狐疝。
通治不问何证，皆可用生料五积散，每服一两，入盐炒吴茱萸、茴香各一钱，生姜三片，葱白五
寸煎，空心热服。服药未效，大痛攻刺不已，阴缩，手足厥冷，宜香附子，仍炒盐乘热，用绢裹熨脐
下。若大小腑不甚通者，五苓散加桂，下青木香丸。初发或头疼身热，或憎寒壮热，并宜参苏饮加木
香。有逆上攻，心下不觉痛，而见心疼者，宜以生韭捣取自然汁，和五苓散为丸，茴香汤下。有肾气
才动，心气亦发，上下俱疼者，宜异功散吞茱萸内消丸。或且专治下，下痛定则上痛定矣。神
方治疝气上冲，如有物筑塞心胸欲死，手足冷者，二三服除根。硫黄火中熔化，即投水中去毒，研细，
荔核切片炒黄，陈皮各等分，上为末，饭丸桐子大。每服十四五丸，温酒下，其疼立止。患人自觉疼
甚，不能支持，止与六丸，不可多也。食积与瘀血作痛者，导积行血则愈。（于伤食、蓄血二门求之。）
【诊】寸口弦紧为寒疝，弦则卫气不行，气不行则恶寒，紧则不欲食。寸口迟缓，迟为寒，缓
为气，气寒相搏，转绞而痛。沉紧豁大为虚。弦急搏皆疝，视在何部而知其脏，心脉微滑为心疝，肝
脉滑为 疝，肾脉滑为癃 ，大急沉为肾疝，肝脉大急沉为肝疝，心脉搏急为心疝，肺脉沉搏为肺疝，
脾脉紧为脾疝。寸弦而紧，弦紧相搏为寒疝。趺阳虚迟为寒疝。肝脉滑甚为 疝，肾肝滑甚为癃 。
气，大概是由这种情况引起的。《金匮方》记载：寒疝导致腹中疼痛，四肢逆冷，手足麻木不仁，如果伴有身体疼痛，用灸法、针刺和各种药物都无法治愈，应当用抵当乌头桂枝汤主治。取乌头一味，用蜂蜜二升，煎煮至减半后去渣，将桂枝汤五合与之混合，最终得到一升药液。初次服用二合；若无反应，再服三合；仍无反应，继续加量至五合。服药后若出现感觉，如同醉酒状，能呕吐的即为药已中病。海藏（张元素）用附子建中汤加蜜煎治疝，就是这种方法的运用。腹痛，脉象弦而紧，弦脉说明卫气运行不畅，因此恶寒；紧脉说明不欲饮食，弦紧两脉相搏结，就形成了寒疝。寒疝表现为绕脐疼痛，发作时自汗出，手足厥冷，脉象沉弦的，用大乌头煎主治。《衍义》说：葫芦巴，《本经》记载其与茴香、桃仁配合使用，治疗膀胱气非常有效。我曾将桃仁麸炒与葫芦巴等分合用，一半制成酒糊丸，一半制成散剂。每次服用五七十丸，空腹食前用盐酒送服。散剂用热米汤调下，与丸子交替服用，空腹各服一二服即见效。《宝鉴》中有葫芦巴丸。
丹溪治疗内郁湿热煎剂的方子：枳实（九粒炒）、桃仁（十四个炒）、山栀仁（九个炒）、吴茱萸（七粒炒）、山楂（四粒炒）、生姜（如手指大小），以上六味药，一同放入擂盆中研细，取顺流水一钟，装入瓶内煎至微沸，带渣服用。如果是湿气偏胜导致的疝气，加荔枝核。如果疼痛剧烈，加盐炒大茴香二钱。如果疼痛部位可以按压，加少许薄桂。
丸方：山栀（二两炒）、山楂（四两炒）、枳实（炒）、茴香（炒各二两）、柴胡、牡丹皮、八角茴香（各一两炒）、桃仁、茱萸（炒各半两），研为末，用酒糊制丸。空腹用盐汤送服五六十丸。阳明经受湿热，传入大肠，出现发热恶寒，小腹连及阴毛际间闷痛难忍，用栀子仁（炒）、桃仁（炒）、枳实（炒）、山楂（各等分），一同研细，加入生姜汁半合，用水一小钟，煮沸后趁热服用。另一方案加茱萸。
寒热兼施：《灵枢》说：胃中有热，肠中有寒，则容易饥饿，小腹胀痛。丹溪说：我的见解是用川乌头、栀子等分，作汤剂服用，效果也很迅速。后来根据这个方子随症状和体质加减使用，没有不有效的。
大概是川乌头治疗外束之寒，栀子仁治疗内郁之热。又说：所有疝气疼痛处，用手按压不痛的属于虚证，必须用桂枝、炒山栀细切、川乌头等分，研为细末，用生姜自然汁打糊为丸，如梧桐子大。每次服用三四十丸，空腹用白开水送下。罗谦甫说：阴疝，足厥阴肝经环绕阴器，抵达少腹，有时疼痛是因为肾虚寒水枯竭，治疗应泻邪补肝，用蒺藜汤主治。
补益案例：丹溪说：疝气有夹杂虚证而发作的，其脉象不甚沉紧，而是大而豁无力。然而其疼痛也较轻，只感觉重坠牵引而已。应当以人参、白术为君药，导药佐之。所谓导药即桃仁、山楂、枳实、栀仁、茱萸、川楝、玄胡索、丁香、木香之类。海藏说：姬提领因病服用凉剂数日，于是出现脐腹部剧烈疼痛，几乎致死，给予姜附等药剂，虽然稍苏醒，但疼痛不止，随后在原方内加倍芍药服用而痊愈。《金匮方》记载：寒疝腹中痛，以及胁痛里急的，用当归生姜羊肉汤主治。《衍义》说：张仲景治疗寒疝，用生姜羊肉汤服用，没有不应验的。有一位妇人，在寒冷的月份生产，寒气侵入产门，腹脐以下胀满，手不愿触碰，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。可以服用仲景的羊肉汤，服两剂便痊愈了。
肝气：足厥阴肝经的病，必然从小腹牵引胁部疼痛。经文说：厥阴之气复返，小腹坚硬胀满，里急暴痛，这是风气助长肝气盛所致，治法应当泻肝。又说：岁金太过，百姓患两胁下痛，小腹痛。又说：岁木不及，燥气大行，百姓患中焦清冷，胁痛，少腹痛。又说：岁土不及，风气大行，百姓患腹痛，复气则胸胁暴痛，向下牵引小腹，这是燥邪攻击肝虚所致，治法应当补肝泻金。又说：寒气客居于厥阴之脉，则血液凝涩脉管拘急，所以胁肋与小腹相互牵引疼痛。又说：肝病者，两胁下痛牵引小腹，取足厥阴经、小肠经穴位。又说：邪气客居厥阴之络，使人突然发生疝气暴痛，刺足大指爪甲上与肉交接处各一针，男子立即见效，女子片刻见效，左病取右，右病取左。泻肝，用山栀、川芎、桂、芍之类。补肝，用当归生姜羊肉之类。
小肠气：小肠的病，小腹牵引睾丸必连腰脊而痛。经文说：少阴之脉，心下热，善饥，脐下痛。又说：少阴之气复返，燠热内生，小腹绞痛，这是热助小肠盛所致，治法应当泻小肠。又说：太阳在泉，寒邪盛行，与太阳之复，都病小腹控睾，牵引腰脊，上冲心痛，以及太阴司天，大寒且至，病小腹痛，这是寒邪攻击小肠虚所致，治法应当补小肠，泻寒邪。《宝鉴》引用《至真要大论》说：小腹控睾，牵引腰脊，上冲心，吐出清水，以及发生呃逆嗳气，严重时入心，悲伤健忘。《甲乙经》说：邪在小肠。小肠病者，小腹痛引腰脊，贯穿肝肺，其经络虚弱不足，则风冷乘虚而入，邪气既入，则厥逆之证上冲肝肺，客冷散于胸，结于脐，控引睾丸，上而不降，痛而入腹，甚则冲心胸。盖因其经络所属所系。治疗的方子，茴香（炒）、练实（锉炒）、食茱萸、陈皮、马兰花（醋炒各一两）、芫花（醋炒五钱），以上为末，醋糊丸，如梧桐子大。每次服用十丸至二十丸，温酒送下。另一方案，益智仁、蓬术各半两，茴香、山茱萸肉、牛膝、续断、川芎、葫芦巴、防风、牵牛（炒熟）、甘草，各二钱半，为细末。每次服用三钱，水一盏二分，煎两三沸，空腹连渣服用。白汤调下二钱匕也可以。
膀胱气：膀胱的病，小腹痛肿，小便不通利。经文说：太阴在泉，病小腹痛肿，不得小便，是湿邪攻击膀胱虚所致，治法应当补膀胱，泻湿土邪。又说：膀胱病者，小腹偏肿而痛，用手按之即想小便而不得，取委中央穴。又说：小腹痛肿，不得小便，邪在三阳，取足太阳大络。（即委阳穴）。许学士说：以前在岳城时，歙县尉宋荀甫，膀胱气作疼不可忍受，医生用刚烈药剂给他，疼痛更甚，小便不通三日，脐下虚胀心闷。我观察他，见他面赤黑，脉洪大。我说投热药太过，阴阳痞塞，气不得通，怎么办。宋尚手持四神丹几粒说，医生说不止于此还服此药。我说如果服此定死，后悔莫及。他求治于我，恰好有五苓散一两许，分三服，用连须葱一茎，茴香一撮，盐一钱，水一盏半，煎至七分，令连续服完三服，半夜排出如墨汁般的小便一二升，腰部以下宽松得以入睡，第二天诊脉，脉已平安。接着用砂丸给他，数日痊愈。娄全善治疗谢人的妻子，小腹疼痛，小便不通，先艾灸三阴交，用茴香、丁香、青皮、槟榔、桂、茱萸、玄胡索、山楂、枳实，又倍用黄柏，煎服而愈。
心疝：心脉微滑为心疝。心脉搏滑急为心疝。黄帝问：诊得心脉而急，这是什么病？岐伯说：病名心疝，小腹应当有形。心为牡脏，小肠为之使，所以说少腹应当有形。木香散、广脏煮散。
【疝】：睾丸囊肿大，如升如斗。丹溪说：下部气不痛的方子，仔细思考，如果不是断绝房事与浓味不可，用药只是促进寿命。如果苍术、神曲、白芷、山楂、川芎、枳实、半夏都是要药。人们看这些药都是卑贱之物，已经轻视，又不能断欲以爱护根本，不仅无益，反而受害的人很多。而且这些药宜随时月寒热，再按君臣佐使加减。大抵疝属湿多。苍术、神曲、白芷、（散水）山楂、川芎、枳实、半夏、南星。有热加山栀一两。坚硬加朴硝半两。秋冬加吴茱萸二钱半，神曲糊丸。另一方案，南星、山楂、苍术各二两，白芷、半夏、枳实、神曲各一两，海藻、昆布各半两，玄明粉、吴茱萸各二钱，为末，酒糊丸。又一方案，治木肾不痛，南星、半夏、黄柏（酒洗）、苍术（盐炒）、枳实、山楂、白芷、神曲（炒）、滑石（炒）、茱萸、昆布，酒糊丸。空腹盐汤下。治胀，用香附子不拘多少为末，每用酒一盏，海藻一钱，煎至半盏，先捞海藻细嚼，用所煎酒调末二钱服。楮叶雄者，晒干为末，酒糊丸。空腹盐酒下。（无实者为雄）。洁古海蛤丸。气痛者易治，荔核散、三层茴香丸、宣胞丸、地黄膏子丸、安息香丸、念珠丸，随宜选用。阴囊肿胀，大小便不通，宜三白散。偏坠初生，用穿山甲、茴香二味为末，酒调下，干物压之。外用牡蛎（煅）、良姜各等分，为细末，津唾调敷大者一边，须臾，如火热痛即安。丹溪治一人，因饮酒后饮水与水果，偏肾大，时作蛙声，或作痛。炒枳实一两，茴香盐炒，栀子炒，各三钱，研、煎，下保和丸。一人膀胱气下坠如蛙声，臭橘子核炒十枚，桃仁二十枚，萝卜自然汁研，下保和丸。一人左肾核肿痛，此饮食中湿坠下成热。以橘核五枚，桃仁七枚，细研，顺流水一盏，煎沸热，下保和丸。木肾，以枇杷叶、野紫苏叶、苍耳叶、水晶葡萄叶，浓煎汤熏洗。雄黄一两研，矾二两，生甘草半两，水五升煎洗。荆芥穗一两，朴硝二两，为粗末，萝卜、葱同煎汤淋洗。大黄末，醋和涂之，干即易。马鞭草捣涂。蔓菁根捣敷。经文说：阳明司天，燥淫所胜，丈夫疝，妇人小腹痛。又说：阳明之胜，外发疝，是燥邪攻肝气虚所致，治法应当补肝泻燥金。又说：厥阴所谓疝，妇人少腹肿者。厥阴者辰也，三月阳中之阴，邪在中，故曰疝少腹肿也。所谓癃疝肤胀者，曰阴亦盛而脉胀不通，故曰癃疝也。三阳为病，发寒热，下为痈肿，及为痿厥，其传为疝。东垣说：阴阳别论云，三阳为病，发寒热，下为痈肿，及为痿厥，其传为索泽，又传为疝。夫热在外寒在内则累垂，此九夏之气也。寒在外热在内则卵缩，此三冬之气也。足太阳膀胱之脉，逆上迎手太阳小肠之脉，下行至足厥阴，肝之脉不得伸，其任脉并厥阴之脉，逆则如巨川之水，致阳气下坠，是风寒湿热下出囊中，致两睾肿大，谓之曰疝，太甚则为。足厥阴之脉与太阳膀胱寒水之脉，同至前阴之末。伤寒家说，足厥阴肝经为病，烦满囊缩，急下之，宜大承气汤以泻大热。《灵枢经》说：足厥阴肝经，筋中为寒则筋挛，卵缩为大寒。前说囊缩为大热，此说为大寒，此说囊缩垂睾下引疝、香港脚为大寒，风湿盛下垂为寒，与上二说不同何也？曰：以平康不病患论之，夏暑大热，囊卵累垂，冬天大寒，急缩收上，与前三说又不同何也？是相乖耶，不相乖耶。答曰：伤寒家囊卵缩，大热在内，宜承气汤急下之，与经筋说囊卵缩，大寒在外，亦是热在内，与伤寒家同。故再引平康人以证之，冬天阳气在内，阴气在外，人亦应之，故寒在外则皮急，皮急则囊缩。夏月阴气在内，阳气在外，人亦应之，故热在外则皮缓，皮缓则囊垂，此疝之象也。三说虽殊，其理一也。用药者宜详审之。以上三论，各有所主，兼此考订，则脉证阴阳寒热虚实之辨判然矣。《内经》刺灸疝有四法：其一铍石取睾囊中水液。经文说：腰脊者，身之大关节也。肢胫者，人之管以趋翔也。茎垂者，身中之机，阴精之候，津液之道也。故饮食不节，喜怒不时，津液内溢，乃下流于睾，血道不通，日久不休，俯仰不便，趋翔不能。此病荥然有水，不上不下。铍石所取，形不可匿，常不得蔽，命曰去爪。其法今世人亦多能之。睾丸囊大如斗者，中脏秽液必有数升，信知此出古法也。其二取肝。经文说：足厥阴之脉，是动则病，丈夫疝，妇人小腹肿是也。是于足厥阴肝经，视盛、虚、热、寒、陷下，而施补、泻、留、疾与灸也。其三取肝之络。经文说：足厥阴之别，名曰蠡沟，去内踝五寸，别走少阳，其别者，循胫上睾，结于茎。其病气逆则睾肿卒疝，取之所别是也。是于内踝上五寸，贴胫骨后近肉处，蠡沟取之也。其四取足阳明筋。经文说：足阳明之筋，聚于阴器，上腹。其病转筋，髀前肿，疝，腹筋急。治在燔针劫刺，以知为数，以痛为输是也。是于转筋痛处用火针刺之也。
【狐疝】：卧则入腹，立则出腹，偏入囊中。仲景方，阴狐疝气有大小，时时上下者，蜘蛛散主治。《内经》刺灸狐疝，但取足厥阴一经。经文说：肝足厥阴之脉，所生病者，狐疝是也。随其经盛、虚、寒、热、陷下取之也。耳后陷者肾下，肾下则腰尻痛，不可俯仰，为狐疝。
通治：不问何证，皆可用生料五积散，每服一两，入盐炒吴茱萸、茴香各一钱，生姜三片，葱白五寸煎，空心热服。服药未效，大痛攻刺不已，阴缩，手足厥冷，宜香附子，仍炒盐乘热，用绢裹熨脐下。若大小腑不甚通者，五苓散加桂，下青木香丸。初发或头疼身热，或憎寒壮热，并宜参苏饮加木香。有逆上攻，心下不觉痛，而见心疼者，宜以生韭捣取自然汁，和五苓散为丸，茴香汤下。有肾气才动，心气亦发，上下俱疼者，宜异功散吞茱萸内消丸。或且专治下，下痛定则上痛定矣。神方治疝气上冲，如有物筑塞心胸欲死，手足冷者，二三服除根。硫黄火中熔化，即投水中去毒，研细，荔核切片炒黄，陈皮各等分，上为末，饭丸桐子大。每服十四五丸，温酒下，其疼立止。患人自觉疼甚，不能支持，止与六丸，不可多也。食积与瘀血作痛者，导积行血则愈。（于伤食、蓄血二门求之。）
【诊】：寸口弦紧为寒疝，弦则卫气不行，气不行则恶寒，紧则不欲食。寸口迟缓，迟为寒，缓为气，气寒相搏，转绞而痛。沉紧豁大为虚。弦急搏皆疝，视在何部而知其脏，心脉微滑为心疝，肝脉滑为疝，肾脉滑为癃，大急沉为肾疝，肝脉大急沉为肝疝，心脉搏急为心疝，肺脉沉搏为肺疝，脾脉紧为脾疝。寸弦而紧，弦紧相搏为寒疝。趺阳虚迟为寒疝。肝脉滑甚为疝，肾肝滑甚为癃。
Qi is, generally speaking, caused by this condition. The *Jingui Fang* records: Cold hernia causing abdominal pain, cold limbs, and numbness in the hands and feet; if accompanied by body pain, and unresponsive to moxibustion, acupuncture, and various medications, it should be treated with Didang Wutou Guizhi Tang (Cinnamon Twig and Aconite Decoction). Take one portion of Wutou (Aconiti Radix), decoct it with two sheng of honey until reduced by half, remove the dregs, mix with five he of Guizhi Tang (Cinnamon Twig Decoction) to obtain one sheng of liquid. Initially administer two he; if no effect, administer three he; if still no effect, increase to five he. If the patient feels a sensation, resembling drunkenness, and vomits, it indicates the medicine has struck the disease. Haicang (Zhang Yuansu) used Fuzi Jianzhong Tang (Aconite Decoction to Establish the Middle) added with honey to treat hernia, which is an application of this method. Abdominal pain with a wiry and tight pulse: wiry indicates obstructed Wei Qi (Defensive Qi), leading to aversion to cold; tight indicates loss of appetite. The interplay of wiry and tight pulses constitutes cold hernia. Cold hernia manifests as periumbilical pain; upon onset, spontaneous sweating and cold extremities occur, with a deep and wiry pulse, treated with Da Wutou Jian (Great Aconite Decoction). *Yanyi* states: Halobaba (Trigonellae Semen) is very effective for Bladder Qi when combined with Huixiang (Foeniculi Fructus) and Taoren (Persicae Semen), as recorded in *Benjing*. I once combined equal parts of Taoren (wheat bran-fried) and Halobaba, making half into wine-paste pills and half into powder. Each dose was 50-70 pills, taken on an empty stomach before meals with salted liquor. The powder was mixed with hot rice water, alternating with pills, taking 1-2 doses on an empty stomach for efficacy. *Baojian* contains Halobaba Wan (Pill).
Danxi's formula for internal stagnation of damp-heat decoction: Zhishi (Immature Bitter Orange, fried 9 grains), Taoren (Peach Kernel, fried 14 grains), Shanzhiren (Gardeniae Semen, fried 9 grains), Wu Zhu Yu (Evodiae Fructus, fried 7 grains), Shanzha (Crataegi Fructus, fried 4 grains), Shengjiang (Fresh Ginger, finger-sized). These six ingredients are ground finely in a mortar. Take one zhong of flowing water, put in a bottle, and decoct until slightly boiling. Drink with the dregs. For hernia dominated by dampness, add Litchi He (Litchi Seed). For severe pain, add Yan Chao Dachuan Xiang (Salt-fried Anise Fruit) 2 qian. For tender pain points, add a small amount of Bo Gui (Thin Cinnamon Twig).
Pill Formula: Shanzhi (Gardeniae Fructus, 2 liang fried), Shanzha (Crataegi Fructus, 4 liang fried), Zhishi (Immature Bitter Orange, fried), Huixiang (Foeniculi Fructus, 2 liang fried), Chaihu (Bupleuri Radix), Mudanpi (Moutan Cortex), Bajiao Huixiang (Star Anise, 1 liang fried), Taoren (Peach Kernel, fried), Zhuyu (Evodiae Fructus, 0.5 liang fried). Grind into powder, make pills with wine paste. Take 50-60 pills on an empty stomach with salt water. When Damp-Heat affects the Yangming channel and transmits to the Large Intestine, causing fever, aversion to cold, and unbearable stifling pain in the lower abdomen extending to the pubic region, use Fried Gardeniae Semen, Fried Peach Kernels, Fried Immature Bitter Orange, and Crataegi Fructus in equal parts. Grind finely, add 0.5 he of fresh ginger juice, decoct with one zhong of water until boiling, and take hot. Another prescription adds Evodiae Fructus.
Combining Cold and Heat Treatments: *Ling Shu* states: Heat in the Stomach and Cold in the Intestines cause rapid hunger and lower abdominal distending pain. Danxi says: My view is that using equal parts of Chuan Wutou (Chuanwu) and Shanzhiren (Gardeniae Semen) as a decoction yields rapid results. Later, I modified this formula according to symptoms and constitution, achieving consistent efficacy.
Essentially, Chuan Wutou treats external constriction of Cold, while Shanzhiren treats internal stagnation of Heat. It is also stated: For all hernia pain sites, if pressing does not elicit pain, it belongs to Deficiency. Use equal parts of Guizhi (Cinnamomi Ramulus), fried Shanzhi (Gardeniae Fructus), and Chuan Wutou (Aconiti Radix Preparata), grind into fine powder, make pills with fresh ginger juice, size of paulownia seeds. Take 30-40 pills on an empty stomach with plain water. Luo Qianfu states: Yin Hernia involves the Foot Jueyin Liver Channel, which circles the genitalia and reaches the lower abdomen. Pain may arise from Kidney Deficiency with depletion of Cold Water; treatment should drain pathogenic factors and tonify the Liver, using Jili Tang (Tribuli Decoction).
Tonification Case: Danxi states: Hernia can occur with concurrent deficiency, characterized by a pulse that is not deeply wiry and tight, but rather large, hollow, and weak. The pain is mild, felt only as heaviness and traction. Treatment should prioritize Renshen (Ginseng Radix) and Baizhu (Atractylodis Macrocephalae Rhizoma) as sovereign drugs, assisted by Dao Drugs (Guiding Medicines). Dao Drugs refer to substances like Taoren (Peach Kernel), Shanzha (Crataegi Fructus), Zhishi (Immature Bitter Orange), Shanzhiren (Gardeniae Semen), Zhuyu (Evodiae Fructus), Chuanlian (Meliosma Fructus), Yuanhuxsuo (Corydalis Rhizoma), Dingxiang (Caryophylli Flos), and Muxiang (Aucklandiae Radix). Haicang states: Ji Tiling took cooling agents for several days due to illness, resulting in severe pain in the umbilical and lower abdomen, nearly fatal. Given Jiang Fu (Ginger and Aconite) agents, he revived slightly but pain persisted. Increasing Shaoyao (Paeoniae Radix) in the original formula cured him. *Jingui Fang* records: For cold hernia with abdominal pain, or hypochondriac pain with interior tension, Danggui Shengjiang Yangrou Tang (Angelica Sinensis, Fresh Ginger, and Mutton Decoction) is indicated. *Yanyi* notes: Zhang Zhongjing treated cold hernia with Fresh Ginger and Mutton Decoction, with universal success. A woman gave birth in a cold month; cold qi entered the birth canal, causing fullness below the navel, intolerable to touch—this is cold hernia. The physician intended to use Didang Tang (Ephedra, Persica, Cornus, and Asarum Decoction) assuming blood stasis, which was incorrect. She was given Zhongjing's Mutton Decoction and recovered after two doses.
Liver Qi: Disease of the Foot Jueyin Liver Channel necessarily causes pain radiating from the lower abdomen to the hypochondrium. The Classics state: Return of Jueyin Qi causes hardness and fullness in the lower abdomen, interior urgency, and sudden pain, driven by Wind assisting excessive Liver Qi. Treatment should drain the Liver. Also: Excess Metal leads to people suffering hypochondriac and lower abdominal pain. Insufficiency of Wood leads to excessive Dryness, causing middle jiao cold, hypochondriac pain, and lower abdominal pain. Insufficiency of Earth leads to excessive Wind, causing abdominal pain; return Qi causes sudden chest/hypochondriac pain radiating to the lower abdomen, due to Dryness attacking deficient Liver. Treatment should tonify Liver and drain Metal. Also: Cold invading Jueyin channels causes blood stasis and vessel tension, leading to radiating pain between hypochondrium and lower abdomen. Liver disease causes hypochondriac pain radiating to the lower abdomen; treat via Foot Jueyin and Small Intestine channels. Evil invading Jueyin collaterals causes sudden hernia and acute pain; needle the junction of nail and flesh on the big toe (one point each side); men recover immediately, women shortly; treat left for right, right for left. To drain Liver, use Shanzhi (Gardeniae Fructus), Chuanxiong (Ligustici Rhizoma et Radix), Gui (Cinnamomi Ramulus), Shaoyao (Paeoniae Radix). To tonify Liver, use Danggui (Angelicae Sinensis Radix), Shengjiang (Fresh Ginger), Yangrou (Mutton).
Small Intestine Qi: Small Intestine disease causes lower abdominal pain radiating to the testicles and connecting to the lumbar spine. The Classics state: Shaoyin channel heat below the heart causes frequent hunger and pain below the navel. Return of Shaoyin Qi causes internal warmth and lower abdominal cramping pain, due to Heat assisting Small Intestine excess. Treatment should drain the Small Intestine. Taiyang in the Lower Heaven with prevailing Cold, or Taiyang Return, both cause lower abdominal pain radiating to testicles, connecting to lumbar spine, and rushing up to the heart. Taicin ruling Heaven with severe Cold causes lower abdominal pain, due to Cold attacking deficient Small Intestine. Treatment should tonify Small Intestine and drain Cold. *Baojian* quotes *Zhizhen Dayao Lun*: Lower abdominal pain radiating to testicles, connecting to lumbar spine, rushing to heart, vomiting clear fluid, hiccups/belching, progressing to heart involvement with sadness and forgetfulness. *Jiayi Jing* states: Evil in the Small Intestine. Small Intestine disease causes lower abdominal pain radiating to lumbar spine, penetrating Liver/Lungs. When meridians are deficient, Wind-Cold enters. Pathogen rushes up to Liver/Lungs, cold disperses in chest, knots at navel, controls testicles, rises but does not descend, enters abdomen, and rushes to heart/chest due to meridian connections. Prescription: Fried Huixiang (Foeniculi Fructus), Lianshi (Loti Semen), Shizhuyu (Zanthoxyli Fructus), Chenpi (Citri Reticulatae Pericarpium), Malanhua (Iris Tectorii Flos, vinegar-fried, 1 liang each), Yuanhua (Genkwa Flos, vinegar-fried, 5 qian). Grind to powder, make pills with vinegar paste, size of paulownia seeds. Take 10-20 pills with warm wine. Another prescription: Yizhiren (Alpiniae Oxyphyllae Fructus), Pengzhu (Curcumae Rhizoma), 0.5 liang each; Huixiang, Shanzhuyu (Corni Fructus), Niuxi (Achyranthis Bidentatae Radix), Xuduan (Dipsaci Radix), Chuanxiong, Halobaba, Fangfeng (Saposhnikoviae Radix), Qianniu (Pharbitidis Semen, roasted), Gancao (Licorice Root), 2.5 qian each. Grind to powder. Take 3 qian, decoct with 1.2 zhong of water for 2-3 boils, take hot with dregs on empty stomach. Alternatively, mix with plain water (2 qian bi).
Bladder Qi: Bladder disease presents as lower abdominal swelling/pain and urinary retention. The Classics state: Taicin in the Lower Heaven causes lower abdominal swelling/pain and urinary retention, due to Dampness attacking deficient Bladder. Treatment should tonify Bladder and drain Damp-Earth evil. Also: Bladder disease causes unilateral lower abdominal swelling/pain; pressure induces urge to urinate without result; treat Weizhong (BL-40). Also: Lower abdominal swelling/pain with urinary retention, evil in Three Yang, treat Foot Taiyang major collateral (Weiyang BL-34). Xu Xueshi states: In Yuecheng, Song Xunfu, Magistrate of She, suffered unbearable Bladder Qi pain. Harsh medicines worsened it; urinary retention for three days, lower abdominal distension, chest oppression. His face was dark red/black, pulse large and forceful. I said excessive hot medicines caused Yin-Yang blockage and Qi obstruction. He held Sishen Dan (Four Spirit Pill) saying doctors advised continuing it. I warned death would follow. I prescribed Wuling San (Five-Ingredient Powder with Poria) divided into three doses, with scallion stalks, Huixiang, and salt, decocted in water. After three doses, he passed dark urine at midnight, waist relaxed, slept well. Pulse normalized next day. Continued with Sha Wan (Sand Pill) for recovery. Lou Quanshan treated Wife of Xie: lower abdominal pain, urinary retention. First moxa Sanyinjiao (SP-6). Then decoct Huixiang, Dingxiang, Qingpi, Binglang, Gui, Zhuyu, Yuanhuxsuo, Shanzha, Zhishi, with doubled Huangbai (Phellodendri Cortex), administered orally for cure.
Heart Hernia: Heart pulse slightly slippery indicates Heart Hernia. Heart pulse slippery and urgent indicates Heart Hernia. Emperor asked: Heart pulse is urgent, what disease? Qibo answered: Heart Hernia; there should be a palpable mass in the lower abdomen. Heart is a Yang organ, Small Intestine is its envoy, hence lower abdominal mass. Muxiang San (Wood-Aromatic Powder), Guang Zang Zhu San (Internal Organ Decoction).
[Hernia]: Testicular swelling, large as a measuring cup or bowl. Danxi states: For lower body Qi painless conditions, abstinence from sex and rich food is essential; medication merely prolongs life. Cangzhu (Atractylodis Rhizoma), Shenqu (Medicated Leaven), Baizhu (Atractylodis Rhizoma - *Note: Text likely implies Baizhi Angelicae Dahuricae Radix based on context of "Baizhu" typo or distinct herb*), Shanzha, Chuanxiong, Zhishi, Banxia (Pinelliae Rhizoma) are key herbs. People despise these cheap herbs, neglect abstinence, harming themselves. Herbs must be adjusted by season and Five Elements principles. Generally, Hernia is mostly Dampness. Cangzhu, Shenqu, Baizhi, Shanzha, Chuanxiong, Zhishi, Banxia, Nanxing (Arisaematis Rhizoma). Add Shanzhi (Gardeniae Fructus) 1 liang for Heat. Add Pomiao (Mirabilitum) 0.5 liang for hardness. Autumn/Winter add Wuzhuyu 2.5 qian, Shenqu paste pills. Another formula: Nanxing, Shanzha, Cangzhu 2 liang each; Baizhi, Banxia, Zhishi, Shenqu 1 liang each; Haizao (Sargassum), Kunbu (Laminariae Thallus) 0.5 liang each; Xuanmingfen (Natrii Sulfas), Wuzhuyu 2 qian each. Powder, wine paste pills. Another formula for Mu Shen (Wood Kidney/Painless Hernia): Nanxing, Banxia, Huangbai (Phellodendri Cortex, wine-washed), Cangzhu (salt-fried), Zhishi, Shanzha, Baizhi, Shenqu (fried), Huashi (Kaolinitum, fried), Zhuyu, Kunbu. Wine paste pills, salt water on empty stomach. For distension, use Xiangfu (Cyperi Rhizoma) powder, decoct with seaweed in wine, chew seaweed, drink wine with powder. Chu Ye (Broussonetiae Folium, male/dry) powder, wine paste pills, salt liquor on empty stomach. Jiegu Gege Haiwan (Shell Pill). Qi pain is easy to treat: Lihex San, Sansheng Huixiang Wan, Xianbao Wan, Dihuang Gaozi Wan, Anshixiang Wan, Nianzhu Wan. Select as appropriate. Scrotal swelling with bowel/bladder obstruction: Sanbai San. Early unilateral descent: Chanshunjia (Manis Squama) and Huixiang powder, wine wash, dry compress externally. External: Mudli (Ostreae Concha, calcined), Liangjiang (Alpinae Rhizoma) equal parts, saliva paste applied to larger side; burning pain subsides quickly. Danxi treated a man: post-drinking water/fruit, unilateral kidney enlarged, croaking sound/pain. Fried Zhishi 1 liang, salt-fried Huixiang, fried Shanzhi, 3 qian each, grind/decoct, take Baohe Wan. Another case: Bladder Qi sinking with croaking sound, roasted orange seeds 10, peach kernels 20, radish juice, take Baohe Wan. Left testicular swelling/pain from dietary damp-heat transforming to heat: Tangerine seeds 5, peach kernels 7, grind, decoct in flowing water, take Baohe Wan. Mu Shen (Wood Kidney): Steam/wash with Loquat leaf, Wild Perilla leaf, Xiancao (Acanthopanacis Senticosi Caulis/Radix - *Text says Cang'er Ye Xanthocarpium Leaf*), Grape leaf strong decoction. Realgar 1 liang, Alum 2 liang, Raw Licorice 0.5 liang, water 5 sheng, boil and wash. Jingjie (Schizonepetae Spica) 1 liang, Pomiao 2 liang, coarse powder, radish/scallion decoction pour over. Rhubarb powder mixed with vinegar, apply, change when dry. Verbena crushed and applied. Turnip root crushed and applied. Classics: Yangming ruling Heaven, Dryness prevails, men have hernia, women lower abdominal pain. Yangming Victory, external hernia, Dryness attacks deficient Liver. Treatment: Tonify Liver, drain Dryness-Metal. Jueyin Hernia, women lower abdominal swelling. Jueyin corresponds to Chen month (3rd lunar month), Yin within Yang. Evil in middle causes hernia/lower abdominal swelling. Long Hernia (Urinary retention) skin distension: Yin excess, vessel obstruction. Three Yang disease: chills/fever, lower abscesses, flaccidity/cold limbs, transmitting to Hernia. Dongyuan cites *Yinyang Bielun*: Three Yang disease... transmits to Hernia. Heat outside/Cold inside causes pendulous scrotum (Summer). Cold outside/Heat inside causes retracted testicles (Winter). Foot Taiyang Bladder channel meets Hand Taiyang Small Intestine, descends to Foot Jueyin Liver. Liver channel cannot extend; Ren Mai joins Jueyin. Reversal like a great river causes Yang Qi to sink, Wind-Cold-Damp-Heat exit scrotum, causing bilateral testicular swelling (Hernia), extreme cases become [Severe Hernia]. Jueyin and Taiyang Cold Water channels meet at genitals. Shanghan scholars say Jueyin disease causes irritability and retraction, treat urgently with Dachengqi Tang (Major Order the Qi Decoction) to drain Heat. *Ling Shu* says Jueyin channel cold causes tendon contraction and retraction (Cold). Previous theory said retraction is Heat; this says Cold. This theory says retraction/descending hernia/Hong Kong foot is Cold, Wind-Damp descending is Cold. How differs from previous? Answer: Healthy person: Summer heat causes pendulous scrotum; Winter cold causes retraction. This differs from previous three theories. Are they contradictory? Answer: Shanghan retraction is Internal Heat, treat with Dachengqi Tang. Tendon theory retraction is External Cold but Internal Heat (same as Shanghan). Thus, healthy person proof: Winter Yang inside/Yin outside -> Cold outside makes skin tight -> retraction. Summer Yin inside/Yang outside -> Heat outside makes skin loose -> pendulous. This is Hernia sign. Three theories differ in logic but share principle. Physicians must examine carefully. These three theories have specific focuses; combining them clarifies Pulse/Symptom Yin-Yang/Cold-Heat/Deficiency-Excess differentiation. *Neijing* has four acupuncture/moxa methods for Hernia: 1. Pip Shi (Knife stone) to drain fluid from scrotum. Classics: Waist/spine are major joints; legs are tubes for movement; penis/scrotum are mechanisms of essence/fluid. Irregular diet/emotions cause fluid overflow to testicles, blood flow blocked, long-term immobility. Fluid accumulates, neither rising nor falling. Knife stone removes it; shape cannot be hidden, named "Qu Zhao" (Remove Claws). Modern people still know this. Large scrotum holds liters of turbid fluid, proving ancient origin. 2. Treat Liver. Classics: Foot Jueyin moving disease causes men's hernia, women's lower abdominal swelling. On Foot Jueyin Liver channel, assess Excess/Deficiency/Heat/Cold/Collapse, apply tonify/draining/retention/speed/moxa. 3. Treat Liver Collateral. Classics: Foot Jueyin branch named Ligou (蠡沟), 5 cun above medial malleolus, branches to Shaoyang, ascends to testicle, knots at penis. Qi reversal causes testicular swelling/sudden hernia; treat the branch. Needle Ligou (LR-5) 5 cun above medial malleolus, posterior to tibia near flesh. 4. Treat Foot Yangming Tendon. Classics: Foot Yangming tendons gather at genitalia, ascend to abdomen. Disease: tendon twitching, thigh anterior swelling, hernia, abdominal tendon tension. Treat with burning needle (fire needle) puncture, repeat until sensation changes, pain point as acupoint. Needle twitching/pain site with fire needle.
[Fox Hernia]: Enters abdomen when lying, exits abdomen when standing, deviates into scrotum. Zhongjing formula: Yin Fox Hernia Qi varying in size, moving up and down, treated with Zhizhu San (Spider Powder). *Neijing* acupuncture/moxa for Fox Hernia treats only Foot Jueyin channel. Classics: Liver Foot Jueyin channel diseases include Fox Hernia. Treat based on channel Excess/Deficiency/Heat/Cold/Collapse. Ear depression indicates Kidney descent; Kidney descent causes lumbar/sacral pain, inability to bend/extend, constituting Fox Hernia.
General Treatment: Regardless of syndrome, use Shengliao Wuji San (Raw Five Accumulations Powder), 1 liang per dose, add Salt-fried Wuzhuyu, Huixiang 1 qian each, Shengjiang 3 slices, Congbai (Scallion White) 5 cun. Decoct, take hot on empty stomach. If ineffective, severe stabbing pain, retraction, cold limbs: use Xiangfu (Cyperi Rhizoma), salt fried hot, wrap in silk, moxa lower abdomen. If bowels not open: Wuling San + Gui (Cinnamon Twig), take Qingmuxiang Wan (Green Wood-Aromatic Pill). Initial onset headache/fever or chills/high fever: Can Su Yin (Ginseng and Perilla Decoction) + Muxiang. Upward counterflow, heart discomfort/pain: Fresh garlic juice mixed with Wuling San pills, Huixiang decoction wash. Kidney Qi moves, Heart Qi activates, upper/lower pain: Yigong San swallow Zhuyu Neixiao Wan (Evodia Internal Dissolving Pill). Or treat lower first; lower pain settles, upper pain settles. Divine Formula for Hernia Qi rushing up, blocking chest/heart, feeling like dying, cold limbs: 2-3 doses cure root. Sulfur melted in fire, dropped in water to detoxify, ground fine; Litchi seed sliced fried yellow, Chenpi (Citri Reticulatae Pericarpium) equal parts. Powder, rice pills, paulownia seed size. Take 14-15 pills with warm wine, pain stops immediately. If patient cannot bear pain, give only 6 pills, do not exceed. Food accumulation and Blood Stasis pain: Guide accumulation, move blood to cure. (Refer to Food Injury and Blood Stasis chapters.)
Diagnosis: Cun Kou wiry/tight indicates Cold Hernia. Wiry means Wei Qi obstruction, leading to aversion to cold. Tight means loss of appetite. Cun Kou slow/relaxed: Slow is Cold, Relaxed is Qi. Cold-Qi interplay causes twisting pain. Deep/Tight/Hollow/Large indicates Deficiency. Wiry/Urgent/Pulsating all indicate Hernia; location determines affected Zang organ. Heart pulse slightly slippery = Heart Hernia. Liver pulse slippery = [Hernia]. Kidney pulse slippery = Long Hernia (Urinary retention). Large/Urgent/Deep = Kidney Hernia. Liver pulse Large/Urgent/Deep = Liver Hernia. Heart pulse Slippery/Urgent = Heart Hernia. Lung pulse Deep/Pulsating = Lung Hernia. Spleen pulse Tight = Spleen Hernia. Cun wiry/tight, interplay = Cold Hernia. Zu Yang (Dorsalis Pedis) Empty/Slow = Cold Hernia. Liver pulse very slippery = [Hernia]. Kidney/Liver pulse very slippery = Long Hernia.