Library

The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: The lower abdomen pulls on the testicles, radiating to the lumbar spine and sacrum, with qi rushing upward to the heart and chest, accompanied by vomiting of clear fluids, hiccups (e), and belching. In severe cases, the pathogen invades the heart, leading to forgetfulness and sadness. The *Jiayi Jing* (Essential Classic of the Mysterious Monograph) states: When pathogenic factors invade the Small Intestine...

When disease occurs in the Small Intestine, there is pain in the lower abdomen radiating to the lumbar spine, penetrating through the Liver and Lung regions. If the meridians are deficient and insufficient, Wind-Cold will enter during intervals of vulnerability. Once the pathogen enters, cold manifestations rush upward to the Liver and Lungs; cold pathogens scatter in the chest, knot at the umbilicus, pull on the testicles causing them to ascend without descending, with pain entering the abdomen. In severe cases, it rushes to the heart and chest, due to the interconnection of the meridians. Qixuanzi (Wang Bing) annotates: "Kong" means pulling or dragging; "Gao" refers to the testicles.

Respectfully noting: Cold pathogens initially lodge in the Small Intestine. Because the meridians connect and merge with the Jueyin (Liver) channel, the lower part pulls on the testicles causing pain. Although this resembles Shan (hernia/testicular swelling), it was historically referred to as "Small Intestine Qi." Thus, ancient treatment methods were often similar, though the accompanying symptoms differed.

The *Yuanbing Shi* (Treatise on the Origins of Disease) states: Shan involves the lower abdomen pulling on the scrotum, causing swelling, urgency, and colicky pain. This is because Cold governs contraction. When Cold reaches its extreme, Earth (Spleen) attempts to restrain it, resulting in swelling and fullness. The classics mention "Daifu Shan," referring to acute pain connecting the genital organs to the lower abdomen. Therefore, it is said that swelling in the lower abdomen of women is a disorder of the Foot Jueyin Liver Meridian. Classical annotations state: Accumulation of Cold Qi forms Shan. Furthermore, the classics state that all five Zang organs can be associated with Shan, characterized by a tight pulse. Annotations explain that a tight pulse is a sign of Cold. However, Cold typically presents with a short, small, and slow pulse. The "tightness" mentioned here does not refer to rapidity or surging volume but rather to the Jin (tight) pulse which governs pain; "tight" indicates severe pain. Although the disease is caused by Cold, the pulse may appear tight yet remains fundamentally short and small. Thus, pain accompanied by a tight pulse occurs because the pulse is nourished by the Heart. When any of the Six Qi causes pain, the Heart Spirit becomes unsettled, leading to tension and inability to relax; consequently, the pulse reflects this tension. To determine which pathogen is responsible, one must observe the characteristics accompanying the tightness. For instance, if the pulse is tight, surging, and rapid, it belongs to the category of Heat-pain. Additionally, the classics state: When Spleen disease transmits to the Kidney, it is named Shanxia, characterized by vexation, oppression, and pain in the lower abdomen, with discharge of white fluid. Gu Zhu annotation explains: Pain in the lower abdomen with discharge of white urine. Another interpretation suggests: Internal accumulation of exogenous Heat consumes flesh and fat like a parasite, hence called Baigu (White Parasite). However, since the classics also mention Heat causing Shanxia, one cannot attribute it solely to Cold; differentiation must be made based on pulse and symptoms.

Zhu Danxi stated: Severe Shan pain involves the testicles connected to the lower abdomen with acute pain. It may present with form or without form, with sound or without sound. Since the *Suwen*, it has been considered Cold, because meridians contract and stagnate when exposed to Cold, causing pain. Yet, some people suffer from Cold exposure without developing Shan; there must be an explanation for this. I have frequently kicked ice and waded through water without illness, because I naturally lack internal Heat. Reflecting on this, I believe this disease originates from Damp-Heat stagnating in the meridians for a long time, compounded by external Cold. The Damp-Heat is constrained by the Cold, leading to pain. If one only considers it as Cold, the analysis is incomplete. Someone asked: This syndrome mostly affects the Jueyin channel; how is the accumulation of Damp-Heat formed? I replied: Labor generates Fire in the sinews; drunkenness and overeating generate Fire in the Stomach; sexual excess generates Fire in the Kidneys; extreme anger generates Fire in the respective meridian. After Fire stagnates for a long time, Dampness becomes abundant. Turbid fluids condense and enter the blood vessels, flowing into the Jueyin Liver channel. The Liver belongs to Wood and is swift and urgent in nature; Fire is violent. Constrained by Cold, the pain becomes severe and sudden. My view is that ancient prescriptions used Aconite (Fuzi) and Gardenia (Zhizi) in equal parts as a decoction, which yielded rapid results. Later, I modified this formula according to specific syndromes, achieving consistent efficacy. However, treatment must distinguish between the degrees of Dampness and Heat. Prominent swelling usually indicates Dampness; however, swelling can also result from Water-Qi or occur in deficiency patterns. In such deficiency cases, Ginseng (Renshen) and Atractylodes Macrocephala (Baizhu) should be the sovereign herbs, assisted by draining and guiding agents. If the pulse is deep, tight, yet hollow and large, it indicates this pattern. Without using tonifying formulas and instead employing drastic purgative methods, disaster will follow immediately.