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Invention states: The *Classic of Internal Difficulty* (Neijing) says, "Diseases of the Three Yang channels manifest as chills and fever, lower body obstruction and swelling, as well as flaccidity and coldness of the extremities; their transmission leads to dryness and scaling of the skin, or their transmission leads to hernia." When heat is external and cold is internal, the scrotum hangs down; this corresponds to the Qi of summer. When cold is external and heat is internal, the testicles retract; this corresponds to the Qi of winter. The channel of Foot-Taiyang Bladder ascends against the flow, meeting the channel of Hand-Taiyang Small Intestine which descends to the foot. The channel of Foot-Jueyin Liver cannot extend freely. The Ren Mai (Conception Vessel) and the Jueyin channels become disordered, like a great river in flood, causing Yang Qi to sink downward. This is due to Wind-Cold-Damp-Heat pathogens descending into the scrotum, causing swelling of both testes, termed "Hernia" (Shan). If the condition is severe, the channel of Foot-Jueyin Liver converges with the Cold-Water channels of Large Intestine and Bladder at the end of the anterior yin region. Specialists in Cold Damage (Shanghan) state that when the Foot-Jueyin Liver channel is diseased, manifesting as irritability, fullness, and retraction of the scrotum, one should purge urgently, suitable for using Dachengqi Tang (Major Order the Qi Decoction) to drain intense Heat. The *Lingshu* (Spiritual Pivot) states: "The sinews of the Foot-Jueyin Liver channel, if struck by Cold, cause sinew contraction and testicular retraction; this is extreme Cold." The previous view held that testicular retraction indicates intense Heat, while this view considers it Extreme Cold. This view also associates testicular retraction, hanging scrotum, and Hongxiangjiao (Hongxiangjiao, foot-qi/beriberi) with excessive Cold-Damp-Wind, where hanging scrotum indicates Cold, differing from the aforementioned two views.

Commentary explains: Considering a healthy person without disease, during the peak heat of summer, the scrotum hangs loose; during the severe cold of winter, the scrotum contracts tightly. This differs from the previous three views. Are they contradictory or not? The answer is: Specialists in Cold Damage argue that testicular retraction is due to intense Heat inside, requiring urgent purging with Chengqi Tang. This aligns with the *Lingshu* view of testicular retraction due to Cold outside, yet fundamentally involves Heat inside, consistent with the Cold Damage perspective. Thus, citing healthy individuals serves as verification: In winter, Yang Qi resides inside and Yin Qi outside; humans mirror this, so external Cold causes skin tension, leading to testicular retraction. In summer, Yin Qi resides inside and Yang Qi outside; humans mirror this, so external Heat causes skin relaxation, leading to scrotal hanging. These are manifestations of Hernia. The three explanations share the same underlying principle. Practitioners must examine carefully. Therefore, each of the above three theories has its specific focus; combining these examinations makes the differences in pulse-symptoms, Yin-Yang, Cold-Heat, and Deficiency-Excess clearly distinguishable.

Chen Wuyue said: The *Classic* mentions "Seven Hernias" and "Various Hernias," but does not provide specific names or symptom descriptions, only mentioning Han-Shan (Cold Hernia) and Shan-Qi (Hernia Qi). Only the *Taiqi Lun* lists Five Hernias based on the pulses of the Five Zang organs (see previous text). Generally, Blood stagnating due to Cold forms Jia masses; Qi gathering due to Cold forms Shan hernias. However, the pulse principles of the Five Zang differ and must be distinguished. The Kidney pulse is naturally deep; the Heart pulse is naturally slippery. Upon contracting Cold, the pulse becomes tight. Logically, this refers to the Liver pulse being naturally wiry, and the Lung pulse being naturally choppy, yet collectively calling them "deep" fails to clarify the meaning. Furthermore, the Spleen pulse omits its natural characteristic, stating only that a tight pulse indicates Hernia, which is a textual omission. Any mention of "tight" implies a Tight Pulse (Jin Mai), which indicates Cold, allowing for analogical reasoning. Additionally, pathogenic Wind entering the abdomen causes Hernia; exposure to Summer-Heat and walking in Dampness can also cause Hernia. One must adapt to the Four Seasons' Qi: Wind diseases present with Floating-Wiry pulses; Summer-Heat diseases with Surging-Rapid pulses; Dampness diseases with Slow-Fine pulses. This clarifies the principles. It must be known that although Hernias involve Zang Qi, they are primarily caused by external factors. Cold coagulation, Wind dispersion, Summer-Heat depression, and Dampness twisting cause stabbing pain and impact, with no fixed location. In sudden onset, the pain is unbearable. Laypeople call these Heng-Xian (Horizontal String), Shu-Xian (Vertical String), Bladder and Small Intestine Qi, Pathogenic Wind Entering Abdomen, etc. Although the names differ, the symptoms are identical.

Commentary: The differentiation of pulse and symptoms here is quite detailed, but formulas for warming Cold, dispersing Wind, draining Summer-Heat, and drying Dampness are not fully compiled. However, Chen's intent seems to encourage learners to expand upon these principles themselves.