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Zhang Sanxi stated: Shan (hernia) belongs to damp-heat in the Liver meridian, constrained by external cold, leading to qi stagnation and severe pain; this is indeed the case. However, there are instances where Kidney qi is extremely exhausted due to excessive alcohol consumption and sexual indulgence, resulting in insufficient diuresis, allowing turbid qi to flow into the lower Jueyin region. It may also be triggered by overwork or exposure to cold, occurring at specific times. Some present with a palpable mass in the lower abdomen that cannot dissipate instantly. Here, damp-heat is the branch manifestation, while Kidney deficiency is the root. Danxi’s method involves using Renshen (Ginseng Root) and Baizhu (Atractylodes Rhizome), assisted by methods to guide heart fire downward, which is correct. Zhang Hezi named seven types of Shan as Cold, Water, Sinew, Blood, Qi, Orphan, and Shan, treating them all primarily with purgative methods, which is likely inaccurate.

Generally, the seven types of Shan arise either from excessive labor or from arduous travel, wading through water, or stepping on ice, causing hot blood to coagulate upon contact with cold in the Small Intestine and Bladder regions; or dampness invading the Foot Jueyin Liver meridian due to deficiency. Ancient formulas uniformly attributed this to cold, using only Wutou (Aconite Lateral Root) and Fuzi (Aconite Prepared Root). My teacher Mr. Danxi uniquely identified it as damp-heat, revealing insights previously overlooked. With fire郁 (stagnant heat) internally and cold externally, extreme pain should occur. Therefore, treatment should expel damp-heat from the affected meridian and resolve blood stasis in the Lower Jiao. If cold is treated via heat, pathogens may become latent. Once symptoms slightly subside, tonification should be added, and caution regarding alcohol, sex, and rich foods is advisable.

Symptoms vary: some produce sounds, others do not; some present with masses resembling melons, others with sounds like croaking frogs; some have lower abdominal pain radiating to the testicles, others have pain on one side of the lower region. Damp-heat must be differentiated by degree. When dampness predominates, swelling is prominent, known as Shi Shan (Damp Hernia). Cases complicated by deficiency present with a deep, tight, large, and forceless pulse in the Lung position; pain is mild, characterized mainly by heaviness, dragging, and traction. Treatment requires tonification combined with regulation.

Han Shan (Cold Hernia): The scrotum is cold, hard, and stone-like; the penis does not erect; or pain radiates to the testicles. Etiology includes sitting or lying on damp ground, wading in winter months, exposure to rain/snow, or extreme fatigue/heat followed by sitting on bricks/stone.

Shui Shan (Water Hernia): Swelling and pain at the root of the penis; profuse sweating in the genital area; scrotal edema resembling crystal; itching with yellow discharge upon scratching; or fluid sound upon palpation of the lower abdomen. Etiology includes excessive drinking, sexual activity after intoxication/fullness, overexertion with sweating, allowing cold-dampness to invade the lower region due to deficiency.

Jin Shan (Sinew Hernia): Scrotal swelling, ulceration, or pain with tenesmus and sinew retraction; pain in the urethra, intense pain leading to itching; priapism; or white discharge with urine. Etiology includes sexual exhaustion and evil arts.

Xue Shan (Blood Hernia): Resembles Trichosanthes fruit, located at the ends of the iliac bones on either side of the lower abdomen, commonly called Bian Yong (Perineal Abscess). Etiology includes sexual activity after intoxication and fullness, causing qi and blood to flow into the bladder sac, forming an abscess, later complicated by Mei Chuang (Chancre/Syphilis).

Qi Shan (Qi Hernia): Extends upward to the kidney region and downward to the scrotum. Caused by crying or anger leading to qi stagnation and distension, which dissipates after the episode. In children, it is commonly called Pian Qi (Unilateral Hernia). Moxibustion at Zhubin (KI9) can eliminate it.

Hu Shan (Fox Hernia): Resembles a tile; reduces into the lower abdomen when lying down, but protrudes into the scrotum when standing or walking. Like foxes emerging by day to urinate and retreating by night without urinating, this hernia moves in and out, resembling a fox. Historically treated with hooks or clamps.

Dian Shan (Epileptic/Large Hernia): Scrotal swelling and pendulous enlargement, like a measuring vessel, without itching or pain. Caused by low-lying damp earth conditions.

In women, prolapse of the anterior yin and hemorrhoidal nodes at the posterior yin are classified as Shan-type disorders but are termed Jia (masses) rather than Shan.