昔人论疝，有专主厥阴经者，有专主任脉者，有兼言五脏者。主厥阴者，谓肝之脉环阴
器，
抵少腹，是厥阴之分，乃受疝之处也。主任脉者，谓《内经》任脉为病，男子内结七疝，故
任之脉，为疝之源也。兼五脏者，谓《内经》心脉搏急为心疝，肺脉沉搏为肺疝，又太阴脉
滑为脾风疝，太阳脉滑为肾风疝，少阳脉滑为肝风疝之类是也。以愚观之，则疝病未有不本
于肝者，盖任为阴脉之海，其脉同足厥阴并行腹里，而五脏之疝，其脉曰搏急，曰滑。夫搏
急是肝脉，滑则为病风，气通于肝，故任脉诸脏，虽皆有疝，莫不连合肝经。所谓有形如瓜
，有声如蛙，或上于腹，或下于囊者，方可谓之疝病。其不与肝相干者，则不得谓之疝矣。
至论疝病之因，有主寒者，有主湿热者，有火从寒化者。要之，疝病不离寒湿热三者之邪，
寒则急，热则纵，湿则肿，而尤必以寒气为之主。其有热者，寒邪郁热于内，非热能病疝，
亦非热能变寒也，故曰热为寒郁则可，热从寒化则不可。又疝者痛也，不特睾丸肿痛为疝，
即腹中攻击作痛，控引上下者，亦得名疝。所以昔贤有腹中之疝与睾丸之疝之说。戴人且谓
妇人亦有疝。凡血涸不月，少腹有块等症皆是，要不离乎肝经为病，盖肝者藏血主筋而其气
暴，且善攻冲也。
诸疝名状，巢氏、戴人言之最详。巢氏辨列七疝，曰厥，曰 ，曰寒，曰气，曰盘，曰
曰野狼。其厥热心痛，吐食不下者，名曰厥疝。腹中气乍满，心下尽痛，气积如臂者，曰 疝
。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 疝。小腹与阴相引而痛，大便难，曰野狼疝。此皆痛在心腹之疝也。
戴人亦分七疝，曰寒，曰水，曰筋，曰血，曰气，曰狐，曰 。寒疝，其状囊气冷，结硬如
石，阴茎不举，连控睾丸而痛，得之坐卧湿地及砖石，或冬月涉水，或风冷处使内过劳，宜
以温剂下之，久而无子。水疝，其状肾囊肿痛，阴汗时出，或囊肿状如水晶，或囊痒搔出黄
水，或小腹按之作水声，得之饮水，或醉酒使内过劳，汗出而遇风寒湿之气聚于囊中，故水
多令人为卒疝，宜以逐水之剂下之。筋疝，其状阴茎肿痛，或溃或脓，或里急筋缩，或茎中
痛，痛极则痒，或挺纵不收，或白物如精，随溲而下，得之房室劳伤及邪术所使，宜以降心
火之药下之。血疝，其状如黄瓜，在小腹两旁，横骨两端约中，俗云便痈，得之春夏重感大
燠，劳于使内，气血流溢，渗入脬囊，留而不去，结成痈肿，脓少血多，宜以和血之剂下之
。气疝，其状上连肾区，下及阴囊，或因号哭忿怒，则郁久而胀，号哭怒罢，则气散者是也
，宜以散气之剂下之。狐疝，其状如瓦，卧则入小腹，行立则出腹入囊中，狐昼出穴而溺，
夜入穴而不溺，此疝出入上下往来，正与狐相类，亦与气疝大同小异也。宜以逐气流经之药
下之。 疝，其状阴囊肿缒，如升如斗，不痒不
痛，得之地气卑湿所生，故江淮之间，湫溏之处，多感此疾，宜以去湿之药下之，此皆痛在
睾丸之疝也。
古人论述疝病，有专门主张从厥阴经论治的，有专门主张从任脉论治的，也有兼谈五脏关系的。主张厥阴经的人认为，足厥阴肝经的脉络环绕生殖器，抵达少腹部，因此厥阴经所主的部位，就是受疝邪侵袭的地方。主张任脉的人认为，《黄帝内经》记载任脉发病时，男子会出现内结七种疝病，所以任脉是疝病的根源。兼谈五脏的人认为，《黄帝内经》中提到：心脉搏动急促为心疝，肺脉沉而搏指为肺疝，太阴脉滑利为脾风疝，太阳脉滑利为肾风疝，少阳脉滑利为肝风疝等情形。
依我看来，疝病没有不根源于肝脏的。因为任脉是阴脉之海，其经脉与足厥阴肝经并行于腹里；而五脏发生疝病时，其脉象表现为“搏急”或“滑”。其中，“搏急”是肝脉的特征，“滑”则主风邪，风气通应于肝。因此，虽然任脉和各脏腑都可能有疝病，但无不牵连到肝经。所谓形态像瓜、声音像蛙叫，或者向上攻至腹部、向下垂坠于阴囊的病症，才可以称为疝病。那些不与肝脏相关的，就不能称为疝病。
至于论述疝病的成因，有主张寒邪为主的，有主张湿热为主的，还有火邪由寒邪转化而来的。总之，疝病离不开寒、湿、热三种邪气。寒邪导致筋脉拘急，热邪导致弛缓，湿邪导致肿胀，而尤其必须以寒气为主导。那些伴有热象的，是因为寒邪郁结化热于体内，并非热能直接致病疝，也不是热能转化为寒，所以说“热被寒邪郁结”是可以的，说“热从寒化”则是不对的。另外，“疝”字本身含有疼痛的意思，不仅睾丸肿痛称为疝，即使是腹部攻击性作痛、牵引上下部位的疼痛，也得名疝。所以古代贤人有“腹中疝”和“睾丸疝”的说法。戴人甚至认为妇女也有疝病。凡是血液枯竭导致闭经、少腹部有肿块等症状都属于此类，但不离乎肝经病变，因为肝藏血、主筋，且肝气暴烈，善于攻冲。
关于各种疝病的名称和症状，巢元方、张子和说得最详细。巢元方辨析列举了七种疝：厥疝、瘕疝、寒疝、气疝、盘疝、[原文缺字，据上下文推测为癥疝或类似]、野狼疝。其中厥疝的症状是厥冷、心痛、呕吐食物不能下咽。瘕疝的症状是腹中气机突然胀满，心下部完全疼痛，气积聚如手臂大小。寒疝的症状是进食寒凉饮食后，胁下和腹中全部疼痛。气疝的症状是腹中时而胀满时而减轻并伴有疼痛。盘疝的症状是腹痛位于脐旁。[原文缺字]疝的症状是腹中脐下有积聚物。野狼疝的症状是小腹与阴部相互牵引疼痛，大便困难。这些都是发生在心腹部位的疝病。
张子和也将疝分为七种：寒疝、水疝、筋疝、血疝、气疝、狐疝、[原文缺字，通常指㿗疝或湿疝]。寒疝的症状是阴囊气冷，结硬如石头，阴茎不能勃起，连及睾丸疼痛，这是由于坐卧湿地砖石，或冬季涉水，或在风寒处行房过劳所致，宜用温剂攻下治疗，久治不愈会导致无子。水疝的症状是肾囊肿痛，阴汗时常流出，或者囊肿状如水泡，或者瘙痒抓挠流出黄水，或者小腹按压有水声，这是由于饮水过多，或醉酒后面色红润时行房过劳，出汗后遭遇风寒湿气聚积在阴囊中，故水多导致突发疝病，宜用逐水剂攻下治疗。筋疝的症状是阴茎肿痛，或者溃烂流脓，或者里急后重筋脉收缩，或者尿道疼痛，痛极则痒，或者阴茎挺纵不收，或者有白色分泌物像精液一样随小便排出，这是由于房劳损伤及邪术所致，宜用清降心火的药物攻下治疗。血疝的症状形状像黄瓜，位于小腹两旁，横骨两端中间位置，俗称便痈，这是由于春夏季节感受大热，行房过劳，气血流溢，渗入膀胱和阴囊，停留不去，结成痈肿，脓少血多，宜用调和气血的药剂攻下治疗。气疝的症状是上连肾区，下及阴囊，有时因号哭愤怒，则郁结久而胀大，号哭愤怒停止后，则气散缓解，宜用理气散气的药剂攻下治疗。狐疝的症状形状像瓦片，躺下时进入小腹，站立行走时出来进入阴囊，狐狸白天出穴排尿，晚上入穴不排尿，这种疝气出入上下往来，正与狐狸相似，也与气疝大同小异，宜用逐气流经的药物攻下治疗。[原文缺字]疝的症状是阴囊肿大下垂，像升斗一样，不痒不痛，这是由于地气卑湿所生，所以江淮之间低洼潮湿的地方，多感染此疾，宜用祛湿的药物攻下治疗。这些都是发生在睾丸部位的疝病。
Ancient scholars discussed hernia (Shan disease), with some focusing exclusively on the Jueyin meridian, others solely on the Ren vessel, and still others discussing all five Zang organs. Those who focused on the Jueyin meridian argued that the Foot-Jueyin Liver meridian circles the genitalia and reaches the lower abdomen; thus, the area governed by the Jueyin meridian is where hernias are contracted. Those who focused on the Ren vessel cited the *Neijing* (Classic of Internal Medicine), which states that disease of the Ren vessel causes seven types of internal hernias in men; hence, the Ren vessel is the source of hernias. Those who discussed all five Zang organs referred to the *Neijing*: a rapid and tense Heart pulse indicates Heart hernia; a deep and pounding Lung pulse indicates Lung hernia; a slippery Taiyin pulse indicates Spleen wind hernia; a slippery Taiyang pulse indicates Kidney wind hernia; and a slippery Shaoyang pulse indicates Liver wind hernia, among others.
In my opinion, hernia disease invariably originates from the Liver. The Ren vessel is the sea of Yin vessels, running parallel with the Foot-Jueyin Liver meridian within the abdomen. Regarding hernias of the five Zang organs, their pulses are described as "rapid/tense" (Boji) or "slippery" (Hua). A "rapid/tense" pulse is characteristic of the Liver, while a "slippery" pulse indicates Wind pathogen, and Wind Qi connects to the Liver. Therefore, although the Ren vessel and various Zang organs may present with hernias, they are all connected to the Liver meridian. Only conditions manifesting as solid masses like melons, sounds like frogs, or moving upward to the abdomen or downward into the scrotum can be truly called hernia disease. Conditions not involving the Liver cannot be classified as hernias.
Regarding the etiology of hernia, some attribute it primarily to Cold, others to Damp-Heat, and some to Fire transforming from Cold. In essence, hernia involves pathogens of Cold, Dampness, and Heat. Cold causes tension/spasm, Heat causes flaccidity, and Dampness causes swelling, but Cold is particularly dominant. Cases with Heat symptoms arise because Cold pathogens stagnate and transform into Heat internally; it is not that Heat directly causes hernia, nor that Heat transforms into Cold. Thus, it is correct to say "Heat is constrained by Cold," but incorrect to say "Heat transforms from Cold." Furthermore, "Shan" implies pain. It is not only testicular swelling and pain that constitutes hernia; abdominal attacks of pain radiating up and down also qualify as hernia. Hence, ancient sages distinguished between abdominal hernia and testicular hernia. Dai Ren even stated that women can suffer from hernia. Symptoms such as blood depletion leading to amenorrhea or masses in the lower abdomen fall under this category, yet they do not deviate from Liver meridian pathology, because the Liver stores Blood, governs tendons, and its Qi is violent and prone to attacking and rushing.
Regarding the names and manifestations of various hernias, Chao Yuanfang and Dai Ren provided the most detailed accounts. Chao Yuanfang identified seven types: Jue, [Missing Character], Han, Qi, Pan, [Missing Character], and Yelang.
1. **Jue Hernia**: Characterized by cold extremities, heart pain, and inability to keep food down.
2. **[Missing Character] Hernia** (likely Zha): Characterized by sudden abdominal fullness, complete pain in the epigastrium, and Qi accumulation resembling the size of an arm.
3. **Han (Cold) Hernia**: Pain throughout the hypochondrium and abdomen after consuming cold food/drink.
4. **Qi (Gas) Hernia**: Abdominal pain alternating with periods of fullness and relief.
5. **Pan (Coiled) Hernia**: Abdominal pain located beside the umbilicus.
6. **[Missing Character] Hernia**: Accumulations below the umbilicus in the abdomen.
7. **Yelang (Wild Wolf) Hernia**: Pain radiating between the lower abdomen and genitals, accompanied by difficult defecation.
These are all hernias affecting the heart and abdomen.
Dai Ren also categorized seven types: Han, Shui, Jin, Xue, Qi, Hu, and [Missing Character].
1. **Han (Cold) Hernia**: Scrotal Qi feels cold, hardening like stone; penis fails to erect; pain radiates to testes. Caused by sitting/lying on wet ground or bricks, wading in winter, or excessive sexual activity in cold/windy places. Treatment: Warm purgatives. Prognosis: Infertility if chronic.
2. **Shui (Water) Hernia**: Swollen and painful kidney/scrotum; frequent sweating of Yin; cysts may look like crystals or itch with yellow discharge; water sound upon pressing lower abdomen. Caused by excessive drinking, sexual activity after intoxication, sweating followed by exposure to Wind-Cold-Dampness accumulating in the scrotum. Excess water leads to sudden hernia. Treatment: Water-draining purgatives.
3. **Jin (Tendon) Hernia**: Swollen and painful penis; ulceration or suppuration; tenesmus with tendon contraction; penile pain so severe it causes itching; priapism or inability to retract; white discharge resembling semen during urination. Caused by sexual exhaustion or evil arts. Treatment: Herbs to descend Heart Fire.
4. **Xue (Blood) Hernia**: Shape like a cucumber, located on both sides of the lower abdomen at the midpoint of the transverse bones (pubic symphysis area); commonly called "Bian Yong" (genital abscess). Caused by heavy heat exposure in spring/summer combined with sexual exertion, causing Qi and Blood to overflow into the bladder and scrotum, forming an abscess with more blood than pus. Treatment: Blood-regulating purgatives.
5. **Qi (Gas) Hernia**: Extends from the Kidney region to the scrotum. Swells due to prolonged stagnation from crying or anger; resolves when Qi disperses after the emotion subsides. Treatment: Qi-scattering purgatives.
6. **Hu (Fox) Hernia**: Shape like a tile. Enters the lower abdomen when lying down; exits into the scrotum when standing or walking. Like a fox entering/exiting its burrow, this hernia moves up and down, similar to Fox behavior, and closely resembles Qi hernia. Treatment: Purging agents to move Qi through meridians.
7. **[Missing Character] Hernia** (likely Shi/Dampness Hernia): Scrotum swells and hangs heavily like a measuring cup; no itching or pain. Caused by low-lying damp Earth Qi. Common in Jianghuai regions' marshy areas. Treatment: Dampness-dispelling purgatives.
These are all hernias affecting the testicles.