疝气者，小腹坠痛，控引睾丸，见症于肝，而原于任脉。故经谓∶任脉为病，男子内结七疝，女子带下
瘕聚。任起中极之下，上毛际，循腹里，上关元，故疝为任病，瘕聚即妇人之疝也。经言七疝∶冲、狐、厥、
、瘕、 、癃也。经云∶从少腹上冲心而痛，不得前后，为冲疝。言气上冲心，二便不通，能上而不能
下。木香散。又云∶肝所生病，为狐疝。言卧则入腹，立则入囊。仲景用蜘蛛散后人用二香丸。又云∶黄脉
土脉之至也，大而虚，积气在腹中，有厥气，名曰厥疝。言脾受肝克，气逆上升。《宝鉴》当归四逆汤、
苦楝散。又云∶三阳为病发寒热，其传为 疝。言小肠膀胱之邪，传为 疝，囊丸肿大如栲栳，顽痹不仁。
三层
茴香丸、荔枝散。又云∶脾传之肾，病名疝瘕。少腹冤热而痛，出白。言脾失运化，而传于所胜，则瘕聚成形，
痛出白淫。乌头栀子汤加橘核、桃仁、吴萸。又云∶足阳明之筋病 疝，腹筋急。又云∶肝脉滑甚为 疝，
言肝木乘胃，或至溃脓下血，荔枝橘核汤、橘核散。又云∶肾脉滑甚为 癃。又云∶厥阴之阴盛，脉胀不通，
为癃疝。言内里脓血，外小便闭。加味通心散。此《内经》所谓七疝也。《金匮》论疝者主寒。至巢氏分厥
厥逆心痛、症气积如臂、寒食冷腹痛、气乍满乍减、盘脐旁作痛、腑脐下有积、野狼腹痛引阴大便难七疝。张子
和非之，别列寒、水、筋、血、气、狐、 七种。谓诸疝不离乎肝，以肝脉络阴器故也。其曰∶寒疝囊冷如石，
阴茎不举，《宝鉴》当归四逆汤。水疝囊如水晶，湿痒出水，加味五苓散去术，或肾气丸。筋疝茎痛筋急，
或挺纵不收，龙胆泻肝汤。血疝状如黄瓜，在小腹两旁，复元通气散。气疝上连肾，下及囊，因怒气胀，
气疝饮。狐疝、 疝，治同前。丹溪云∶自《素问》而下，皆以疝为经络有寒，收引则痛，不知始由湿热壅
遏在经，又感外寒，湿热被郁，不得疏散，故痛。盖醉饱则火起于胃，房劳则火起于肾，大怒则火起于肝，大
劳则火起于筋，火郁湿生，浊液凝聚，进入血隧，流于厥阴。肝性急速，为寒所束，宜其痛矣。宜枳实、桃仁、
山栀、吴萸、山楂、生姜。若湿胜成 疝，加荔枝核。痛甚，加盐炒大茴香。痛处可按，加桂。士材论寒则多
痛，热则多纵，湿则肿坠，虚亦肿坠。在血分者不移，在气分者多动，皆足补前人所未备。今按疝症初起，必
由虚寒劳力致之，积久腑络阻痹，遂聚湿热。用药不离辛泄苦降，以肝司疏泻也。其触寒骤痛，兼犯生冷，
用荔香散。若火注阴分而为热痛，必有热症热脉，或便闭渴烦，宜大厘清饮。若食积疝痛，近脐必有块梗起，
立效散。瘀血疝痛，在腹必有形不移，金铃子散加桃仁、五灵脂。因怒动肝胁胀，必坠入腹，宜木香、青皮、
山栀、香附、归须、青葱管。举重伤力气虚，必下穿囊，举元煎加法。火腑留邪，内行苦泄，胃苓汤加枳壳、
山栀、黄柏。肾囊流湿，外用汤熏，以蛇床子、川椒、熟矾煎汤熏洗，再用灶心土炒热，加川椒、小茴末拌匀，
绢袋盛，安肾囊下，冷则易之。气
聚络虚，理须疏导，宜延胡、山甲、木香、归须、小茴、芦巴、橘核等。胃虚浊逆，法在温通，宜干姜、吴萸、
茯苓、木通、草豆蔻。房劳疝发，温摄下元，宜杞子、沙苑子、菟丝子、茯苓、鹿角胶、苁蓉、当归。筋结疝
，治同木肾，宜穿山甲、全蝎、
木瓜、萆 、茯苓、归尾、乳香、白芷、酒糊丸，盐汤下。少腹偏坠，散结为先，香橘散加穿山甲，或穿山甲、
茴香研末。酒调下。阴丸肿大，逐湿可效，荔枝核十枚， 研，火酒调如糊服，效。别有小肠气，名曰气 。
痛引腰脐，天台乌药散。膀胱气，名曰水 。不得小便，加味五苓散。又如奔豚响疝，是气水冲突下焦。丹
溪用理中汤去术，加桂心、茯苓。或一捏金散。或木通、川楝各一钱，茴香五分。飞盐酒调服。丹溪云∶桂
能泄奔豚，茯苓能伐肾邪，苦白术则助土克水，燥肾闭气，故宜去之。凡 儿疝，睾丸偏肿。由啼哭动伤阴器。
导气汤，或用全蝎一钱、核桃肉一两。蜜丸弹子大，日一丸。大约疝气上攻者，宜吴萸、桂心、枳壳、茴香、
茯苓等。下坠者，宜川楝子、香附、橘核、木香、葫芦巴等。按之大痛者为实，宜楂肉、延胡、青皮、枳实、
桃仁、牛膝等。不痛者为虚，宜参、苓、归、杞、韭子、核桃等。痛处寒者必寒积，宜川乌、胡椒、官桂、
沉香、小茴、乳香等。痛处热者必湿热，宜山栀、川楝、木通、茯苓、橘核、苍术、浓朴、黄柏等。茎缩者
宗筋受寒，宜虎潜丸去知、柏。或鹿茸、沙苑子、苁蓉、补骨脂、韭子等。肾疝者客邪在肾，酒煮当归丸。
卵大小上下不常者，属气分，聚香饮去肉桂。囊肿胀坚顽不移者，属血分，橘核丸，若结硬者加朴硝。盖疝
之上攻者冲病，下注者任病；偏坠者小肠病，闭癃者膀胱病；卵 出白者肾病，余则筋急囊肿，瘕聚浊逆，
肝胃病为多。日久沉痼虚滑，正气陷，邪气留，行立穿囊，顽不知痛。下焦路远，药力难到，遂成宿 ，迄
乎无子。丹溪云∶不痛断房事及浓味，不可治，信夫。
Shan Qi (Hernia/Scrotal swelling) manifests as a dragging pain in the lower abdomen, radiating to the testicles. The symptoms appear in the Liver channel (Liver Meridian), but the root lies in the Ren Mai (Conception Vessel). Thus, the Classics state: "When the Ren Mai is diseased, men develop seven types of Shan (hernias), and women suffer from leukorrhea and Jia Ju (abdominal masses)." The Ren Mai originates below the Zhongji point, ascends through the pubic hair region, follows the interior of the abdomen, and reaches the Guanyuan point. Therefore, Shan is a disease of the Ren Mai, and Jia Ju in women is equivalent to Shan.
The Classics mention seven types of Shan: Chong Shan (Pulsation Hernia), Hu Shan (Fox Hernia), Jue Shan (Reversal Hernia), [Missing Character], Jia Shan (Mass Hernia), [Missing Character], Long Shan (Urinary Obstruction Hernia).
The Classics say: "Qi rushes from the lower abdomen up to the heart causing pain, with inability to pass stool or urine; this is called Chong Shan." This means Qi rushes upward to the chest and heart, blocking both bowels and bladder, able to ascend but not descend. Muxiang San (Costus Powder) may be used.
It also states: "Among diseases generated by the Liver, there is Hu Shan (Fox Hernia)." This refers to a condition where the testicle retracts into the abdomen when lying down and descends into the scrotum when standing. Zhang Zhongjing used Zhizhu San (Spider Powder), and later physicians used Erxiang Wan (Two Fragrances Pill).
It further says: "When the Huang Mai (Yellow Pulse) and Tu Mai (Earth Pulse) arrive, large and empty, with accumulated Qi in the abdomen and Jue Qi (reversal Qi), it is named Jue Shan." This implies the Spleen is overacted upon by Liver Wood, causing Qi to reverse and ascend. Danggui Sixun Tang (Angelica Decoction for Cold Extremities) from *Baojian* or Kulian San (Melia Powder) may be used.
It says: "Diseases of the Three Yang channels manifest with chills and fever; transmission leads to [Missing Character] Shan." This implies pathogenic factors from the Small Intestine and Bladder transmit to cause [Missing Character] Shan, characterized by scrotal swelling as large as a basket, hard and numb. Sanceng Huixiang Wan (Three-Layer Fennel Pill) or Lizhi San (Lychee Powder) may be used.
It says: "Spleen disease transmitting to the Kidney is named Shan Jia." This involves heat and pain in the lower abdomen due to grievance, with discharge of white fluid. This means Spleen fails in transformation and transportation, transmitting to its conquered organ (Kidney), forming Jia Ju masses, causing pain and discharge of Bai Yin (white turbid discharge). Wutou Zhizi Tang (Aconite and Gardenia Decoction) with Juhe (Tangerine Seed), Taoren (Peach Kernel), and Wuyu (Evodia Fruit) may be used.
It says: "Diseases of the tendons of the Foot-Yangming Stomach channel cause [Missing Character] Shan, with abdominal tendon tension."
It also says: "A slippery and excessive Liver pulse indicates [Missing Character] Shan," implying Liver Wood overacting on Stomach Earth, potentially leading to ulceration, pus, or bloody stools. Lizhi Juzhe Tang (Lychee and Tangerine Seed Decoction) or Juzhe San (Tangerine Seed Powder) may be used.
It says: "A slippery and excessive Kidney pulse indicates Long Shan (Urinary Obstruction Hernia)."
It also says: "Excess Yin in the Jueyin channel causes vessel distension and blockage, known as Long Shan." This implies internal pus and blood externally accompanied by urinary retention. Jiawei Tongxin San (Modified Heart-Unblocking Powder) may be used. These are the seven Shans mentioned in the *Neijing*.
The *Jingui Yaolue* discusses Shan primarily as caused by Cold. Later, Chao Yuanfang in *Zhubing Yuanhou Lun* divided Shan into seven types: Jue Xin Tong (Reversal Heartache), Zheng Qi Ji Ru Bi (Mass like an arm), Hanshi Leng Fu Tong (Cold Food Abdominal Pain), Qi Zha Man Zha Jian (Intermittent Fullness), Pan Qi Pang Zuo Tong (Periumbilical Pain), Fu Qi Xia You Ji (Sub-umbilical Mass), Yelang Fu Tong Yin Yin Da Bian Nan (Wolf-like Abdominal Pain Radiating to Genitals with Difficult Defecation). Zhang Hezi disagreed, listing seven types instead: Han (Cold), Shui (Water), Jin (Tendon), Xue (Blood), Qi (Qi), Hu (Fox), and [Missing Character]. He stated that all Shans involve the Liver because the Liver meridian connects to the genitalia.
He said: "Han Shan (Cold Shan) presents with cold scrotum like stone and impotence; Danggui Sixun Tang from *Baojian* is used. Shui Shan (Water Shan) presents with crystal-clear scrotal swelling, dampness, itching, and weeping; Jiawei Wuling San (Modified Five-Agents Powder) without Atractylodes, or Shenqi Wan (Kidney Qi Pill) is used. Jin Shan (Tendon Shan) presents with penile pain and tendon tension, or protrusion without retraction; Longdan Xiegan Tang (Gentian Liver-Draining Decoction) is used. Xue Shan (Blood Shan) looks like a cucumber, located on both sides of the lower abdomen; Fuyuan Tongqi San (Restoring Origin and Unblocking Qi Powder) is used. Qi Shan (Qi Shan) connects to the Kidney above and the scrotum below, swelling due to anger; Qishan Yin (Shan Qi Drink) is used. Hu Shan and [Missing Character] Shan are treated as previously described."
Zhu Danxi said: "Since the *Suwen*, it has been believed that Shan is caused by cold in the meridians, where contraction causes pain. They did not realize it initially stems from Damp-Heat stagnating in the meridians, compounded by external Cold. The Damp-Heat is constrained and cannot disperse, hence the pain. Generally, drunkenness generates Fire in the Stomach, sexual exhaustion generates Fire in the Kidney, great anger generates Fire in the Liver, and great labor generates Fire in the tendons. Fire constriction generates Dampness, turbid fluids condense, enter the blood vessels, and flow into the Jueyin channel. The Liver nature is swift; constrained by Cold, pain inevitably occurs. Use Zhishi (Immature Bitter Orange), Taoren (Peach Kernel), Shanzhi (Gardenia), Wuyu (Evodia), Shanzha (Hawthorn), and Shengjiang (Fresh Ginger). If Dampness predominates forming [Missing Character] Shan, add Lizhihe (Lychee Seed). For severe pain, add Yan Chao Dachui Xiang (Salt-fried Big Anise). If the painful area can be pressed, add Guizhi (Cinnamon Twig)."
Shitai (Li Zhongzi) discussed: "Cold often causes pain, Heat often causes flaccidity, Dampness often causes swelling and prolapse, and Deficiency also causes swelling and prolapse. Diseases in the Blood level are fixed; diseases in the Qi level move frequently. These supplement what predecessors omitted."
My analysis: Initial Shan usually arises from Deficiency-Cold and physical strain. Over time, fu-organ collaterals become obstructed, accumulating Damp-Heat. Medications should not depart from Acrid-dispersing/Bitter-draining methods, as the Liver governs free flow.
If sudden pain triggered by Cold and raw/cold food, use Lixiang San (Lychee and Costus Powder). If Fire injects into the Yin level causing Heat-pain, with Heat signs/pulse, constipation, thirst, and irritability, use Dali Qingyin (Great Clearing Drink). If caused by Food Stagnation, with a mass near the umbilicus, use Lixiao San (Instant Effect Powder). If caused by Blood Stasis, with a fixed abdominal mass, use Jinlingzi San (Meliosma Powder) plus Taoren (Peach Kernel) and Wulingzhi (Trogopterus Dung). If triggered by anger causing hypochondriac distension and descent into the abdomen, use Muxiang (Costus), Qingpi (Green Tangerine Peel), Shanzhi (Gardenia), Xiangfu (Cyperus), Guixu (Twig of Angelica), and Qingcongguan (Green Onion Tube). If caused by lifting injury with Qi Deficiency and scrotal penetration, use Juyuan Jian (Lifting Origin Decoction) with modifications. If Fire organs retain pathogens, using Bitter-draining internally, use Weiling Tang (Stomach and Five-Agents Decoction) plus Zhike (Aurantium), Shanzhi (Gardenia), and Huangbai (Phellodendron). For dampness flowing from the scrotum, fumigate/wash externally with Shechuangzi (Cnidium), Chuanjiao (Sichuan Pepper), and Shufan (Alum). Then, mix hot scorched earth with Chuanjiao and Xiaohui (Small Fennel), place in a silk bag, and apply to the scrotum; replace when cool.
For Qi accumulation and collateral deficiency, dredging is required: Yanhusuo (Corydalis), Shanjia (Pangolin Scale), Muxiang (Costus), Guixu (Angelica Twig), Xiaohui (Small Fennel), Lubu (Fenugreek), Juzhe (Tangerine Seed), etc. For Stomach Deficiency with turbid reversal, warming and unblocking is needed: Ganjiang (Dried Ginger), Wuyu (Evodia), Fuling (Poria), Mutong (Akebia), Caodoukou (Black Cardamom). For sexual exhaustion-induced Shan, warming and securing the Lower Yuan: Gouqi (Goji), Shayuanzi (Astragalus Complanatus), Tusizi (Dodder), Fuling (Poria), Lujiaojiao (Deer Antler Glue), Rongrong (Cistanche), Danggui (Angelica). For Tendon Knot Shan, treat like Mu Shen (Wood Scrotum): Shanjia (Pangolin Scale), Quanxie (Scorpion), Mugua (Chaenomeles), Bibo (Dioscorea Hypoglauca), Fuling (Poria), Guiwei (Angelica Tail), Rushi (Frankincense), Baizhi (Angelica Dahurica), pill with wine paste, taken with salt water. For unilateral lower abdominal dragging, prioritize resolving knots: Xiangju San (Fragrant Orange Powder) plus Shanjia (Pangolin Scale), or powder of Shanjia and Huixiang (Fennel), taken with wine. For enlarged testicles, dispelling Dampness is effective: 10 Lizhihe (Lychee Seeds), powdered, mixed with Huojiu (Fire Wine) into a paste.
There is also Xiao Chang Qi (Small Intestine Qi), named Qi [Missing Character]. Pain radiating to waist and umbilicus: Tiantai Wuyao San (Tiantai Meisinkweed Powder). Bladder Qi, named Shui [Missing Character]: Urinary retention: Jiawei Wuling San (Modified Five-Agents Powder).
Also, Ben Tun Xiang Shan (Running Piglet Resonant Shan) is Qi and Water conflicting in the Lower Jiao. Danxi used Lizhong Tang (Regulate the Middle Decoction) minus Atractylodes, plus Guixin (Cinnamon Bark) and Fuling (Poria). Or Yi Niejin San (One Pinch Gold Powder). Or Mutong (Akebia) and Chuanlian (Melia) 1 qian each, Huixiang (Fennel) 5 fen, taken with flying salt and wine. Danxi said: Cinnamon drains Running Piglet; Poria attacks Kidney evil; Bitter Atractylodes aids Earth to control Water but dries the Kidney and closes Qi, so it should be removed.
For children's Shan with unilateral testicular swelling, caused by crying injuring the genitalia: Daoqi Tang (Guiding Qi Decoction), or Quanxie (Scorpion) 1 qian and Hetaorou (Walnut Meat) 1 liang, honey pills, one daily.
Generally, Shan attacking upward: Wuyu (Evodia), Guixin (Cinnamon Bark), Zhike (Aurantium), Huixiang (Fennel), Fuling (Poria). Downward dragging: Chuanlianzi (Melia), Xiangfu (Cyperus), Juzhe (Tangerine Seed), Muxiang (Costus), Huluba (Fenugreek). Severe pain on pressure indicates Excess: Sharou (Hawthorn Flesh), Yanhu (Corydalis), Qingpi (Green Tangerine Peel), Zhishi (Immature Bitter Orange), Taoren (Peach Kernel), Niuxi (Achyranthes). No pain indicates Deficiency: Renshen (Ginseng), Ling (Poria), Danggui (Angelica), Gouqi (Goji), Jiu Zi (Leek Seed), Hetao (Walnut). Cold painful areas indicate Cold accumulation: Chuanwu (Chuanwu), Hujiao (Pepper), Guangen (Official Cinnamon), Chenxiang (Agarwood), Xiaohui (Small Fennel), Rushi (Frankincense). Hot painful areas indicate Damp-Heat: Shanzhi (Gardenia), Chuanlian (Melia), Mutong (Akebia), Fuling (Poria), Juzhe (Tangerine Seed), Cangzhu (Atractylodes), Houpo (Magnolia Bark), Huangbai (Phellodendron). Penile retraction indicates Zongjin (Convergent Tendons) Cold: Huyian Wan (Tiger Secret Pill) minus Zimu and Huangbai. Or Lurong (Deer Horn), Shayuanzi (Astragalus Complanatus), Rongrong (Cistanche), Buguzhi (Psoralea), Jiu Zi (Leek Seed). Kidney Shan is guest pathogen in the Kidney: Jiuzhu Danggui Wan (Wine-boiled Angelica Pill). Testicles varying in size/position belong to Qi level: Juxiang Yin (Gathering Fragrance Drink) minus Rougui. Hard, fixed cystic swelling belongs to Blood level: Juzhe Wan (Tangerine Seed Pill); if hard, add Pomiao (Mirabilite).
Generally, Shan attacking upward is Chong Mai disease; downward pouring is Ren Mai disease; unilateral dragging is Small Intestine disease; retention is Bladder disease; testicular discharge of white fluid is Kidney disease; others are mostly Tendon tension, cystic swelling, Jia Ju, and turbid reversal, involving Liver and Stomach diseases. Long-standing chronic cases with Deficiency-Slipperiness, sinking of Righteous Qi, lingering Pathogenic Qi, walking/standing with scrotal penetration, and stubborn numbness. The Lower Jiao is distant, drug power difficult to reach, becoming chronic illness, ultimately leading to infertility. Danxi said: "Without abstaining from sex and rich flavors, it cannot be cured." This is true.