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Shan (Hernia) refers to pain. The sensation is heavy and dragging, as if bearing a mountain, hence the name "Shan". These conditions all belong to diseases of the Jueyin Liver Meridian (Jueyin Gan Jing: The liver meridian of foot-jueyin) and have absolutely no connection with the Kidney Meridian (Shen Jing: The kidney meridian of foot-shaoyin). Since the *Suwen* (Plain Questions), it has been generally believed to be caused by Cold (Han: Pathogenic cold). Li Dongyuan and Zhu Danxi considered that there was initially Damp-Heat (Shi Re: Accumulation of dampness and heat pathogens), which was then constrained externally by Wind-Cold (Feng Han: Pathogenic wind and cold), thus causing pain. However, Shan manifests in various forms and cannot be entirely attributed to Damp-Heat.

Taking Damp-Heat as an example, at the onset, the testicles swell, accompanied by aversion to cold and fever, with a wiry and rapid pulse (Xian Shu Mai: Wiry and rapid pulse indicating heat and constraint), and attacks occur intermittently. This results from running about, overwork, and dietary stagnation and constraint, where the Qi of water and grain sinks into the lowest Yin region, thereby generating Damp-Heat; it is not that there is Damp-Heat separate from the water and grain. Various medical texts vaguely discuss Damp-Heat but fail to mention the Qi of water and grain at all, which is why treatments often fail. In the *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet), I observed discussions on Shan, Hong Kong Foot (Xiang Gang Jiao: A condition characterized by swelling and pain in the feet/legs, often translated as beriberi or similar lower limb edema/pain syndromes), and nodules forming in the thigh clefts that do not subside, all attributing these to the downward pouring of the Qi of water and grain. Thus, it is clear that Shan can arise from food stagnation (Shi Ji: Food retention/stagnation). The symptoms of alternating chills and fever with a rapid pulse are entirely due to fatigue damaging the Spleen (Pi: The spleen, responsible for transformation and transportation), causing disorder in the Qi mechanism and loss of its normal operational rhythm, leading to the accumulation and generation of various symptoms like chills and fever. How could these be solely due to contracting Wind-Cold?

I employ Chai Ge Er Miao Tang (Bupleurum and Kudzu Two Marvels Decoction) to dissipate the fire generated by fatigue, followed by Chai Hu Hua Zhi Tang (Bupleurum Transforming Stagnation Decoction) to eliminate food stagnation. Not only does this bring immediate relief, but it also permanently eradicates the root of the Shan, preventing recurrence. This profound meaning, hidden by the ancients, has been revealed by my words. There is no longer any doubt regarding the methods for treating Shan.

There is another presentation characterized by slight chills and fever, where the pulse may appear surging or wiry but is forceless upon deep pressure; this indicates Qi Deficiency with sinking (Qi Xu Xia Xian: Sinking of Qi due to deficiency), which is completely different from the previous syndrome. One should use Ju Lian Bu Zhong Tang (Citrus Peel and Pericarpium Citri Reticulatae Tonifying the Middle Decoction), after which the swelling will naturally subside. In the above two syndromes, although the scrotal skin swells, its color remains unchanged. If there is redness, swelling, and severe pain, it is called Nang Yong (Scrotal Carbuncle/Abscess). This involves more Heat than Dampness, with Blood-Heat pouring downward; over time, the blood transforms into pus, making it extremely difficult to treat. Initially, use Qing Gan Shen Shi Tang (Clear Liver and Drain Dampness Decoction). After seven to eight days, if the swelling persists without ulceration, use Zi Yin Nei Tuo San (Nourish Yin and Support Internally Powder). After ulceration, it is essential to suspend the testicles to allow the toxin to disperse externally, ensuring safety. If the scrotal skin sloughs off involving the testicles, the condition is deemed untreatable. These are common symptoms among Shan patients, though some are less frequent. They are listed item by item on the left for reference.