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The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: When the Ren Mai (Conception Vessel) is diseased, men suffer from seven types of internal hernia (Shan), and women suffer from leukorrhea and Jia Ju (abdominal masses); when the Chong Mai (Penetrating Vessel) is diseased, it causes Qi rebellion and abdominal urgency. It further states: A slippery pulse at Shaoyin indicates Lung Wind Shan; a slippery pulse at Taiyin indicates Spleen Wind Shan; [a slippery pulse at] Yangming indicates Heart Wind Shan; [a slippery pulse at] Taiyang indicates Kidney Wind Shan; a slippery pulse at Shaoyang indicates Liver Wind Shan. This is because external pathogens enter the Wood organ (Liver, which corresponds to Wood and is a Yang organ), stirring up Wind, hence a slippery pulse signifies Wind. However, the repeated mention of "Shan" likely exists because the Kidney and Liver both reside in the Lower Jiao, and the Foot-Jueyin Liver Meridian assists the Ren Mai in generating and transforming Qi. Indeed, it is the simultaneous rebellion of Kidney and Liver Qi that manifests as Shan due to Kidney Yin Qi and Feng (Wind) due to Liver Yang Qi. Furthermore, the penis and scrotum are the mechanism of the body, indicators of Yin and Yang, and pathways for fluids. If diet is irregular, or emotions like joy and anger are untimely, fluids overflow internally and flow downward to the testicles. If the blood channels are blocked, mobility such as bending, stretching, walking, and flying becomes inconvenient. This is the view of Chao Yuanfang et al.

However, Zhang Congzheng (courtesy name Dairen) refutes this, stating: These are erroneous names established by mediocre physicians. The area surrounding the genitalia, extending upward to the lower abdomen, belongs to the Foot-Jueyin Liver Meridian; this is where the disease resides. It may be that Cold Water Qi overcomes Wood Qi, causing spasms and constriction in this meridian; or Dryness Metal Qi overcomes Wood Qi, causing depression in this meridian; or anger and sorrow cause Qi stagnation and frustration; or external astringent treatments cause closure and retention of essence, blocking this meridian. It has nothing to do with the Bladder, Kidney, or Small Intestine. Moreover, Shan disease involves either the Liver Wood being invaded by pathogens or the Liver Wood becoming excessive itself. Therefore, he established seven names within Yin Shan: Han Shan (Cold Shan), Shui Shan (Water Shan), Jin Shan (Sinew Shan), Xue Shan (Blood Shan), Qi Shan (Qi Shan), Hu Shan (Fox Shan), and Pi Shan (Flaccid Shan).

Han Shan (Cold Shan): The scrotum is cold, hard, and contracted like stone; the penis does not erect; pain may radiate to the testicles. It results from sitting/lying on wet ground or bricks, wading in winter, exposure to rain/snow/wind-cold, or excessive sexual exertion. Treatment requires warming and purgative formulas; otherwise, infertility may result.

Shui Shan (Water Shan): Swelling and pain of the scrotal sac; intermittent sweating from the yin region; the scrotum swells like a water-filled bag; itching may yield yellow fluid; pressing the lower abdomen produces a water sound. It results from drinking alcohol/water excessively, sexual exhaustion, sweating followed by exposure to cold water, leading to dampness accumulation in the scrotum. Excess water can cause sudden Shan. Treatment requires diuretic and purgative formulas.

Jin Shan (Sinew Shan): Swelling of the penis, ulceration, pus formation, pain with internal tension and sinew contraction, penile pain that becomes itchy when severe, priapism, or white discharge resembling semen during urination. It results from sexual exhaustion or malicious arts. Treatment requires formulas that descend Heart Fire.

Xue Shan (Blood Shan): Shape resembles a cucumber, located between the two ends of the Henggu acupoint in the lower abdomen, commonly called Bian Yong (urinary abscess). It results from exposure to extreme heat in spring/summer combined with sexual exhaustion, causing Qi and Blood to overflow into the bladder and scrotum, forming an abscess with little pus and much blood. Treatment requires blood-nourishing and regulating formulas.

Qi Shan (Qi Shan): Extends from the kidney region to the scrotum. It arises from weeping or anger, causing Qi stagnation and distension; the distension resolves when the emotional outburst ceases and Qi disperses. Treatment requires Qi-dispersing formulas. Children also suffer from this,俗称 Pian Qi (Lateral Qi), often due to an aged father, or a young father who was frequently ill, impotent, or weak in essence, engaging in forced intercourse. This is a congenital defect and is difficult to cure.

Hu Shan (Fox Shan): Resembles a ball; retracts into the abdomen when lying down, and protrudes from the lower abdomen into the scrotum when standing or walking. Like a fox that exits its burrow to urinate by day and returns without urinating by night, this Shan moves up and down, similar to Fox behavior, and is closely related to Qi Shan. It corresponds to conditions treated with hooks or supports today. Treatment requires formulas that expel Qi and unblock meridians.

Pi Shan (Flaccid Shan): The scrotum hangs heavily like a measuring vessel, without itching or pain. It results from low-lying, damp environments, common in the Jianghuai region. Treatment requires damp-draining formulas. After using purgatives for these conditions, one should regulate or tonify according to the condition, avoiding rigid adherence to folk methods. The Classics state that Yin excess causing abdominal distension and blockage is Long Shan (Urine Retention Shan), which must be purged.

Although Zhang Dairen cited the *Lingshu* chapter of the *Neijing* and the *Mingtang*, focusing solely on the Foot-Jueyin division and neglecting the Ren Mai, it was because he strongly argued that the genitalia belong to the Jueyin domain. His treatment method, applying purgatives indiscriminately regardless of deficiency or excess due to the lower location of the disease, lacked thoroughness. Zhu Danxi often discussed pain connecting the testicles and lower abdomen, whether palpable or not, audible or silent. People attribute this to Cold contracting the meridians, but fail to realize the pain originates from long-standing Damp-Heat stagnation exacerbated by external Cold. The initial cause of Damp-Heat is: fatigue generates Fire in the sinews; drunkenness/full meals generate Fire in the Stomach; sexual excess generates Fire in the Kidneys; great anger generates Fire in the Lungs. Prolonged Fire stagnation leads to abundant Dampness; turbid fluids condense and enter the blood vessels, flowing into the Jueyin channel. Since Liver Wood is swift and Fire is fierce, constrained by Cold, the disease becomes severe and acute. This elaborates on Zhang Dairen's omissions. Furthermore, Pi Shan involves Wind, Cold, and Dampness: Heat causes flaccidity, Cold causes pain, Dampness causes swelling. One must distinguish their proportions. While both testicles can be affected, unilateral involvement is also common. The Kidneys are paired, left and right. The Left belongs to Water, which generates Liver Wood, which generates Heart Fire; all three govern Blood, and the Liver manages the Blood on the left. The Right belongs to Fire, which generates Spleen Earth, which generates Lung Metal; all three govern Qi, and the Lung manages the Qi on the right. Thus, Cold causing contraction leads to blood stasis, so Cold-Blood follows the Liver and descends to the left testicle. Qi stagnation leads to Dampness accumulation, so Qi-Dampness follows the Lung and descends to the right testicle. Moreover, the tendons connecting the testicles are not exclusively Jueyin; Taiyang and Yangming tendons also connect. Often, left-sided lesions present with more pain and less swelling, while right-sided lesions present with less pain and more swelling, which serves as verification.

A patient suffered severe pain in the left testicle after drinking water post-illness. Da Dun (LR1) was moxibusted, and Yao Gao (Waist Rubbing Paste) was applied to the scrotum up to Henggu (ST30), covered with warm cloth. Pain ceased immediately, and swelling subsided overnight. I previously had a chronic accumulation from citrus fruits. Once, while hiking and starving, I ate oranges and taro. The oranges disturbed the old accumulation, and the taro stagnated Qi, causing immediate chills and fever, and swelling of the right testicle. I first took one or two doses of Tiao Wei (Regulate the Stomach) formula. The next morning, I used Yishi (Mind Instruction) to guide Qi to the Lower Jiao. Feeling the accumulation move, I experienced retching and vomiting repeatedly. Finally, harmonizing the Stomach Qi and unblocking the meridians led to recovery.