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Damp-heat (Shi Re), Cold Stagnation (Han Yu), Phlegm-Fluids (Tan Yin), Dead Blood (Si Xue).

The so-called Shan (疝, Hernia/Inguinal Disorder) refers to painful conditions arising from Cold-Dampness Qi. The three Yin meridians of the foot—Taiyin Spleen Meridian (Taiyin Pi Jing), Shaoyin Kidney Meridian (Shaoyin Shen Jing), and Jueyin Liver Meridian (Jueyin Gan Jing)—are all affected. These are the Yin meridians of the foot. Why? Because the feet constantly tread on the ground, and Cold-Dampness Qi rises from below. The *Neijing* states: "When the Ren Mai (Conception Vessel) is diseased, patients suffer internal knotted distress; in men, this manifests as seven types of Shan." These are: Jue Shan, Jia Shan, Han Shan, Pan Shan, Qi Shan, Fu Shan, and Hu Shan.

These symptoms can be verified upon onset. Although there are seven distinct names, they share similarities with minor differences. Commonly referred to as Bladder Qi (Pang Guang Qi), Small Intestine Qi (Xiao Chang Qi), Ben Tun Qi (Rushing Pig Qi), Pan Chang (Coiled Intestine), Pian Zhui (Lateral Drooping), and Mu Shen (Woodish Kidney), all originate from disorders of the Ren Mai. While their names differ, generally speaking, in individuals with Kidney Deficiency, Cold-Dampness Qi invades the Ren Mai. When internal and external Qi attack the Kidneys, it results in an enlarged but non-painful Kidney condition known as "Mu Shen" (Woodish Kidney); if one side is larger, it is called "Pian Zhui" (Lateral Drooping); if Qi flows into the Bladder, it becomes "Bladder Qi"; if it enters the Small Intestine, it becomes "Small Intestine Qi". The Qi of the Kidney and Bladder communicates; when these two meridians combine and their Qi attacks each other, pain ensues. Furthermore, if turbid Dampness flows into the external kidneys and fails to dissipate over time, it transforms into Damp-Heat and turbid pus, becoming a "Scrotal Carbuncle" (Nang Yong). At the time of illness, careful examination is indispensable.

The *Neijing* states: "When the Ren Mai is diseased, men suffer from seven types of Shan," namely Han, Shui, Jin, Xue, Qi, Hu, and Jia.

Zhang Zihe stated: In Cold Shan, the scrotum is cold, hard like stone, the penis does not erect, or the testicles are painful. This arises from sitting or lying on wet ground, wading in cold months, encountering rain or snow, sitting on bricks or stones, or engaging in sexual intercourse in windy/cold places for a long time leading to infertility.

In Water Shan, the condition presents as swelling and pain in the kidney/scrotum region, sweating from the yin area, or the scrotum appearing crystal-clear, or the scrotum itching with yellow fluid exuding upon scratching, or water accumulation in the abdomen producing a splashing sound upon pressure. This results from drinking alcohol or engaging in sexual activity after heavy meals, excessive fatigue, sweating followed by exposure to Wind-Cold, causing Cold-Water to accumulate in the scrotum, leading to sudden onset of Shan.

In Sinew Shan, the penis swells, or ulcerates into pus, accompanied by tenesmus, sinew contraction, pain in the urethra, extreme pain leading to itching, flaccidity without retraction, or discharge of white substance resembling marrow. This is caused by sexual exhaustion and the influence of evil arts.

In Blood Shan, the condition resembles a cucumber, located laterally in the lower abdomen within the transverse crease near the pubic bone, commonly known as Bian Yong (Urethral Abscess). This results from contracting heat during spring and summer while engaging in sexual activity, causing Qi and Blood to overflow, seep into the scrotum, remain stagnant, and form an abscess with little pus and much blood.

In Qi Shan, the condition extends upward to the Kidney and downward to the scrotum. It arises from crying or anger. Crying causes Qi stagnation and distension; anger causes Qi dispersion. Children may also exhibit this condition, commonly known as Pian Zhui, resulting from the father's impotence and weak essence, engaging in forceful intercourse, thereby transmitting congenital defects to the offspring.

In Fox Shan, the condition resembles an inverted tile; when lying down, it retreats into the lower abdomen; when standing or walking, it protrudes from the abdomen into the scrotum. Like a fox that exits its burrow to urinate during the day and returns at night without urinating, this Shan moves up and down similarly to a fox. It is largely similar to Qi Shan.

Another type of Shan presents with a scrotum enlarged like a measuring vessel, without itching or pain. This arises from low-lying damp environments, hence common among people in the Jianghuai region.

These are the morphological signs of the seven Shans. The *Lingshu Jing* discusses the seven Shans: 1. Jue Shan: characterized by rebellious heart pain, cold feet, vomiting of food, and inability to swallow. 2. Jia Shan: characterized by abdominal fullness, epigastric pain, and Qi accumulation feeling like splitting. 3. Han Shan: characterized by pain in the hypochondrium and abdomen due to drinking cold liquids and food stagnation. 4. Pan Shan: characterized by abdominal Qi pain coiling around the umbilicus. 5. Qi Shan: characterized by intermittent abdominal fullness and reduction with pain. 6. Fu Shan: characterized by masses below the umbilicus in the abdomen. 7. Hu Shan: characterized by pain connecting the lower abdomen and genitals, with difficulty in defecation. These are the morphological signs of the seven Shans.

It is further stated: In women, this manifests as Jia Ju (Masses), characterized by protrusion of the vaginal opening, hardness, and pain in the lower abdomen. Although related to this category, it is due to Heat failing to secure and contain, and should not be mistaken for Deficient-Cold prolapse treated with warming and tonifying herbs.