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Treatment for male impotence (Yang Wei, 阳痿) involves using two sheng of un-mated silkworm moths (Yuan Can E, 原蚕蛾), removing the head, feet, and wings, stir-frying them, grinding into a fine powder, making pills with honey the size of paulownia seeds, taking one pill nightly with wine.

Another method: Use one to two qian of fine ginseng powder (Renshen, 人参), taken before evening meals, mixed with good wine or distilled liquor.

There are many external prescriptions, but six or seven have little effect and deep harm, generally consisting only of pungent, hot, aromatic, penetrating, astringent, and binding drugs. Only these two formulas are mild and harmonious, or properly controlled. If the tonifying medicine is effective, yang strength will eventually return; there is no need to rely on such external treatments. Treating the branch rather than the root ultimately yields no benefit.

Ginseng (Renshen, 人参) (1 liang), Angelica sinensis body (Danggui Shen, 当归身) (1.2 liang), Atractylodes macrocephala (Baizhu, 白术) (1.5 liang), Goji berry (Gouqizi, 枸杞子) (1 liang), Large Aconite (Da Fuzi, 大附子) (half piece), Sichuan pepper (Chuanjiao, 川椒) (3 qian).
Decoct in water until concentrated into an ointment, add 2 fen of musk (Shexiang, 麝香), store in a tin box, dissolve in saliva for external use during intercourse.

This is a secret formula from Zhang Huhou of Danghu. It contains the heat of Cinnamon Twig (Guizhi, 桂枝), Aconite (Fuzi, 附子), and native sulfur (Woliu, 倭硫), balanced by the bitter cold of Phellodendron bark (Huangbai, 黄柏); it includes the toxicity of Toad venom (Chansu, 蟾酥), countered by the detoxifying property of Realgar (Xionghuang, 雄黄); and Sushe oil (Suheyous, 苏合油) is added to counteract dryness and provide moisture. The ancients' comprehensiveness in formulating was extreme. For scholars suffering from impotence who insist on external treatment, only these two formulas pose minimal risk.

Sichuan Aconite (Chuan Fuzi, 川附子) (1 piece), Grass Aconite (Caowu, 草乌) (1 liang), Sichuan Aconite (Chuanwu, 川乌) (1 liang), Mother Clove (Mudingxiang, 母丁香) (1 liang), Zixiaohua (Zixiaohua, 紫梢花) (1 liang), Official Cinnamon (Guangui, 官桂) (1 liang), Realgar (Xionghuang, 雄黄) (5 qian), Toad venom (Chansu, 蟾酥) (1 liang), Galangal (Liangjiang, 良姜) (5 qian), Chinese gallnut (Wubeizi, 五倍子) (5 qian), Native sulfur (Woliu, 倭硫) (7.5 qian), Phellodendron bark (Huangbai, 黄柏) (1 liang), Oyster shell (Muli, 牡蛎) (1 liang), Cnidium fruit (Chuanshangzi, 蛇床子) (2 liang), Storax oil (Suheyous, 苏合油) (1 liang). Process the above ingredients into powder, dissolve in Atractylodes macrocephala (Baizhu, 白术) decoction paste, form Toad venom (Chansu, 蟾酥) into pellets. For nocturnal emission, grind with cold water and apply to the navel; for seed-enriching purposes, grind with seed wine for morning use, wash off before intercourse.

The *Classic* states: When the Ren Mai (Conception Vessel, 任脉) is diseased, men develop seven types of hernia (Shan Zheng, 疝症), and women experience leukorrhea and masses (Jia Ju, 瘕聚). (The Ren Mai originates below Zhongji (CV3), ascends to the pubic region, follows the interior of the abdomen to Guanyuan (CV4), gathering all yin meridians; thus, all hernias originate from the Ren Mai, with other meridians as branches.) Qi rushing from the lower abdomen to the heart causing pain, with inability to pass urine or stool, is called Chong Shan (Pulsating Hernia, 冲疝). (It rushes up to the heart yet cannot pass stool or urine, moving up but not down.) Diseases generated by the Liver include Hu Shan (Fox Hernia, 狐疝). (When lying down, the testis retracts into the abdomen; when standing, it protrudes into the scrotum, resembling a fox that urinates outside its burrow by day and not at night, hence the name. The area surrounding the genitalia and reaching the lower abdomen belongs to the Liver meridian, which is where hernias occur. All hernias result either from pathogenic invasion of Liver Wood or intrinsic Liver disease; this Fox Hernia represents intrinsic Liver meridian disease.) Diseases of the Three Yang meridians manifest with chills and fever, transmitting to become Dian Shan (Epileptic Hernia, 癫疝). (Three Yang refers to Hand-Taiyang Small Intestine, Foot-Taiyang Bladder, and Foot-Shaoyang Gallbladder. Small Intestine and Bladder are located inferiorly; Gallbladder is paired with Liver, and its collateral branches emerge at Qichuang, encircling the pubic region; thus, all Three Yang meridians can cause hernias.) [Missing character, likely 'Tui'] Shan refers to numbness and induration, with testes swollen like a measuring cup or bowl. When the Yellow Pulse appears, large and empty, with accumulated qi in the abdomen and rebellious qi, it is named Jue Shan (Rebellious Hernia, 厥疝). (Yellow pulse is Earth pulse. Liver Wood overacting on Spleen makes it large and empty. Jue means rebellion, referring to upward rebellious qi. Liver corresponds to Spring and Wood, both governing ascent; anger causes qi to rise, hence Rebellious Hernia.) When Spleen disease transmits to Kidney, the condition is named Shan Jia (Hernia Mass, 疝瘕), with burning pain in the lower abdomen and discharge of white fluid. (Spleen receives pathogenic factors from its unconquered element and transmits to its conquered element, losing its normal transformation function. Meeting the Cold Water Kidney, the pathogen stagnates forming a tangible mass; Jia is described in medical texts as cucumber-shaped. Yuan denotes trapped qi; qi accumulation causes pain and spontaneous white discharge. The *Classic* says: Cun Kou pulse sinking and weak indicates Shan Jia lower abdominal pain. Also: Rapid pulse indicates Shan Jia lower abdominal pain.) Diseases of the Foot-Yangming tendon manifest as [missing character, likely 'Tui'] Shan and abdominal tendon tension; also: Excessively slippery Liver pulse indicates [missing character, likely 'Tui'] Shan. (Since Foot-Yangming causes [Tui] Shan and slippery Liver pulse causes [Tui] Shan, this indicates Liver Wood overacting on Stomach. [Tui] implies severe internal pus and blood, leading to purulent bloody discharge.) Micro-large Spleen pulse indicates Shan Qi (Hernia Qi, 疝气); excessively slippery indicates Long Bi (Strangury, 癃闭); also: Excessively slippery Kidney pulse indicates Long Bi. (Internal pus and blood, external urinary obstruction, named Long Shan Strangury, resulting from Spleen pathogen transmitting to Kidney.)

Zhang Zihe said: Enuresis, strangury, impotence, bladder bi, spermatorrhea, and leukorrhea are all male hernias. Blood depletion with amenorrhea, dry throat and legs, strangury, lower abdominal masses, anterior prolapse, posterior hemorrhoids are all female hernias. However, females do not call it Shan but Jia.
Shan occurs when yin qi accumulates internally and is attacked by cold, so the *Suwen* attributes hernias to cold. However, it cannot be attributed solely to cold. Although caused by cold stagnation, it also arises from excessive drinking and eating, generating internal damp-heat, phlegm accumulating in Jueyin Liver, and the rapid nature of Liver wood being constrained by cold, causing severe pain. Though symptoms appear in Kidney disease, the root lies in the Liver, as Jueyin Liver meridian connects to the genitalia. Thus, internal damp-heat stagnation in the middle, external cold constraint, along with phlegm, food retention, and stagnant blood, indicate the disease primarily involves the Liver meridian, having nothing to do with the Kidney. Symptoms include testicular traction pain in the lower abdomen, sometimes formless and soundless, sometimes shaped like a melon, sounding like a frog, with throbbing pain without fixed location, unbearable. There are seven types: Han (Cold), Shui (Water), [Tui], Xue (Blood), Qi (Qi), Hu (Fox), Jin (Tendon). Han Shan (Cold Hernia) results from cold in Jueyin meridian, causing tendon spasm and testicular retraction, with a cold, hard scrotum and flaccid penis, or testicular pain, usually from sitting long on wet ground, allowing cold to stagnate externally. Shui Shan (Water Hernia) presents with painful, crystal-like scrotal swelling, sweating from the genitals, yellow fluid upon scratching, and water sounds upon pressing the lower abdomen, usually from drunkenness and sexual excess, sweating followed by wind exposure, allowing damp-heat to flow into the scrotum, causing urinary and fecal obstruction. [Tui] Shan presents with scrotal swelling like a cup or bowl, without itching or pain, due to dampness causing qi knotting in the genitalia, sometimes with [Tui] pain. Xue Shan (Blood Hernia) resembles a cucumber, located on both sides of the lower abdomen near the horizontal bone ends, commonly called "piss abscess," caused by heavy exertion in hot seasons, causing qi and blood to overflow into the bladder sac, forming an abscess. Qi Shan (Qi Hernia) extends from the kidney region to the scrotum, often triggered by crying or anger, causing qi stagnation and distending pain, usually a congenital defect from paternal weakness and forced intercourse during conception. Hu Shan (Fox Hernia) resembles a tile, retracting into the abdomen when lying down and protruding when walking. Jin Shan (Tendon Hernia) involves penile swelling, ulceration with pus and pain, tenesmus and tendon shortening, penile pain, intense itching, or non-retractile prepuce with white fluid resembling semen during urination, caused by sexual excess or sorcery. Mu Shen (Wood Kidney/Indurated Testis) occurs when Heart fire descends and Kidney water warms, true yang descends and Kidney qi harmonizes; if warm and harmonious, why would there be persistent erection? This results from desire injuring Kidney deficiency, causing disconnection between yin and yang/water and fire, leading to cold-induced swelling, hardness, and pain. However, all five zang organs have hernias: Large-rapid-sinking Kidney pulse indicates Kidney Shan; Large-rapid-sinking Liver pulse indicates Liver Shan; Wiry-slipping-rapid Heart pulse indicates Heart Shan; Deep-pounding Lung pulse indicates Lung Shan; Rapid Three Yang indicates Jia; Rapid Three Yin indicates Spleen Shan. Three Yang refers to Foot-Taiyang Bladder; Three Yin refers to Foot-Taiyin Spleen. Taiyang cold causes blood coagulation into Jia; Taiyin cold causes qi aggregation into Shan. Thus, blood forms Jia, qi forms Shan, though they can combine, showing each zang has its own hernia. In children, it often results from prolonged crying and anger moving yin qi downward, knotting and not dispersing, or from maternal excessive weeping affecting the fetus, causing small intestine qi closure after birth. Red tiger-mouth lines indicate fetal Shan; green lines indicate crying-induced Shan. Scrotal swelling occurs due to Shaoyin meridian insufficiency allowing wind-cold invasion; Shaoyin connects to the genitals, and wind-cold clashes with qi and blood, causing swelling. Prolonged crying and anger close qi downward, combined with external dampness, also causes swelling. Red, transparent scrotal swelling or female vulvar swelling and pain result from Heart fire transferring heat to the Bladder; clear swelling without dryness or pain indicates Liver deficiency failing to soothe. Unilateral testicular swelling, knotting on one side, extremely large and painful, is called Pian Zhui (Unilateral Descent, 偏坠), caused by anger injuring Liver, cold constraining internal heat, or summer-heat invading and transmitting to Bladder, attacking external kidneys. This disease primarily involves the Liver meridian; treatment disperses wind, warms cold, resolves summer-heat, leaches dampness, regulates Heart qi for fright/anger, promotes urination for qi-water clash. Internal qi knotting and external cold-dampness are essential factors; widening Small Intestine qi, warming, dispersing wind, and leaching dampness are necessary.

The *Classic* states Ren Mai disease causes seven hernias, summarizing the origin. Chong, Hu, [Tui], Jue, Jia, Long describe specific conditions. Chao Yuanfang divided them into Jue, [Tui], Han, Qi, Pan, Ye Lang seven types; Zhang Zihe criticized this as layman's error. Arguing only Liver meridian is involved, unrelated to Small Intestine, Bladder, or Kidney, and dividing into Han, Shui, Jin, Xue, Qi, Hu seven names, this error matches Chao's. The *Neijing* defines seven hernias with Ren Mai as the source; hernias are tendon diseases involving Liver pathogen. Claiming only Jueyin is involved contradicts the Classic. Scholars should follow the *Neijing*. Generally, cold causes pain, heat causes flaccidity, dampness causes swelling/descent, deficiency mimics this; blood involvement is stationary, qi involvement is mobile. Two testes: Left belongs to Water, generating Liver Wood, generating Heart Fire; all three govern blood, Liver controls left blood. Right belongs to Fire, generating Spleen Earth, generating Lung Metal; all three govern qi, Lung controls right qi. Thus, cold contraction causes blood stasis returning to Liver, descending to left testis; qi stagnation causes dampness gathering in Lung, descending to right testis. Tendons connecting testes are not solely Jueyin; Taiyin and Yangming tendons also connect. Hence, left testis issues have more pain, less swelling; right testis issues have less pain, more swelling. Danxi attributed hernia onset to damp-heat: Great labor ignites fire in tendons, drunkenness/eating ignites fire in Stomach, sexual excess ignites fire in Kidney, great anger ignites fire in Liver. Prolonged fire stagnation increases dampness, turbid fluids condense, enter blood team, flow to Jueyin. Liver's rapid nature constrained by cold causes severe pain, supplementing previous theories. Common in Southeast Asia, but not a universal rule. Fever with sudden mumps behind ears, red/swollen/painful, resolving rib pain but sudden testicular swelling (one large, one small, seeming unilateral but not), occurs because ear region is Shaoyang Gallbladder, paired with Liver; Shaoyang wind-heat transmits to Liver. Large scrotum with retracted penis, dribbling urine, difficulty walking, is Bladder qi issue. Kidney and Bladder are exterior-interior; Kidney fails to store, pathogen resides in Bladder, urine leaks into kidney sac; promote diuresis. Complete penile retraction with smooth, painless scrotal swelling indicates Liver qi deficiency failing to extend; tonify and warm. Children's unilateral descent often from food retention, Spleen dampness flowing to Liver. Women's lower abdominal pain near genitals, subcutaneous goose-egg-sized lump, is cold qi aggregating in Jueyin; lower abdominal cold triggers it, called Yin Shan. Female anterior prolapse and posterior hemorrhoids are hernia types, called Jia. Though hernias arise from deficiency, do not tonify abruptly; stagnation creates excess. First drain accumulated pathogens, then tonify, or combine tonification with warming to prevent stagnation. Ancients used Wu Ling San adding qi-moving herbs: Polyporus and Alisma regulate yin/yang, harmonize Heart/Small Intestine; Atractylodes leaches dampness/blood stasis in waist/navel, boosts middle qi to aid transport; Poria leaches Bladder water; Cinnamon attacks Liver pathogen, warms/disperses; Fennel treats Small Intestine qi; Golden Bell Fruit and Tangerine Seed remove Bladder stagnation; Areca nut directs qi downward; slight Akebia guides Small Intestine fire. The prescription is stable. Hernias always involve internal deficiency and external invasion; first vent qi ("unblocked, no pain"); abrupt tonification can cause critical cardiac/abdominal symptoms.

Hernia belongs to Liver meridian damp-heat constrained by external cold, blocking qi and causing severe pain. The *Classic* says: Strong people recover as qi moves; weak people develop disease. Actually, severe Kidney qi exhaustion, excessive alcohol/sex, insufficient diuresis, cause turbid qi to flow to Jueyin. Cold or劳累 triggers pain. Sometimes damp-heat is branch, Kidney deficiency is root, hence Danxi uses Ginseng/Atractylodes tonification. Generally, hernias cannot be cured without abstaining from sex and rich foods/alcohol. Hernias start with damp-heat in meridians, prolonged stagnation, external cold/damp-heat constraint causing pain; treating only as cold is incomplete. Ancient formula: Equal parts Aconite and Gardenia, boiled with salt/wine, named Zhi Fu Tang, acts quickly. Later modifications based on symptoms are effective; treat according to damp-heat ratio. Danxi said: Aconite treats external cold, Gardenia treats internal heat, clarifying internal heat/external cold logic. Both are lower jiao drugs; Gardenia guided by Aconite acts rapidly downwards, not lingering in Stomach. If pressure stops pain, it is deficiency-cold; add Cinnamon, take as Ginger juice pills. For quick pain relief, use Walnut kernel, Hawthorn kernel, Lychee kernel, Sichuan Chinaberry, Evodia, stir-fried to powder, taken with warm water.

Heart/Lung are upper yang; Kidney/Liver are lower yin. Kidney is Liver mother; Liver is Kidney child. Kidney/Liver share disease, Yi/Gui share source. Thus, Liver meridian diseases must trace back to Kidney source. Hernia is Foot-Jueyin Liver disease; pulse circles genitals, reaches lower abdomen, controls testicular pain, all belonging to Liver. Yet *Suwen* says: Kidney pulse disease, qi rushing from lower abdomen to heart, unable to pass urine/stool is Chong Shan. Why does it originate in Kidney meridian? Danxi said: Hernia belongs to Liver, unrelated to Kidney. Kidney is Water organ; Bladder is its fu, formed from cold water. Hernia originates from cold-damp invasion; cold attracts cold, pathogen is fast; Kidney/Bladder are exterior-interior. *Classic* says: All cold contractions belong to Kidney. Thus, hernia spasms and rushing to heart/stomach are indeed Kidney pathogen disease. Modern hernia patients flare after sexual activity, so *Shengji Lu* says: Desire/labor injure, Kidney water dries up, failing to nourish, Liver qi stagnates internally, causing Yin Shan. Thus, hernias often stem from Kidney deficiency. If arguing Kidney is unrelated and treating only by draining Liver, disease worsens. Minor lower body cold triggers it, as Yu Jiayan called "Earth qi attacking upwards." Large doses of Ginseng, Atractylodes, Ginger, Cinnamon bring peace; this is turbid yin qi aggregating in lower abdomen, extreme yin excess. Do not combine with Si Wu Tang (Four Substances Decoction) to tonify yin, as it worsens disease.