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A question was raised regarding hernia (Shan disease). Ancient prescriptions considered it either as Small Intestine Qi disorder or Bladder Qi disorder. Only Liu Wansu (courtesy name Shouzhen, pseudonym Hezi) and Zhu Zhenheng (courtesy name Yanxiu, pseudonym Danxi) exclusively focused on the Liver Meridian in their discussions. Their theories differ; how can they be distinguished? The answer is: Small Intestine Qi disorder is a pathology of the Small Intestine; Bladder Qi disorder is a pathology of the Bladder; Hernia (Shan Qi) is a pathology of the Liver Meridian. These three are inherently distinct. It was erroneous for ancients to classify Small Intestine and Bladder Qi disorders as Hernia. Little did they know that the Foot Jueyin Liver Meridian circles the external genitalia and reaches the lower abdomen. When people suffer from this disease, attacks manifest as swelling and pain in the testicles radiating to the lower abdomen, indicating that Hernia is associated with the Liver Meridian. Small Intestine Qi disorder, commonly known as horizontal or vertical string-like pain, involves wandering pain around the umbilicus and stabbing pain in the lower abdomen. In contrast, Bladder Qi disorder causes pain above the pubic symphysis and in the lower abdomen, which differs from Hernia characterized by tangible masses like melons, sounds like frogs, or masses moving up to the abdomen or down into the scrotum. However, because the meridians of the Small Intestine and Bladder merge with the Foot Jueyin Liver Meridian, diseases in these organs can affect the Liver, causing downward traction pain in the testicles. Nevertheless, these remain pathologies of those two meridians and should not be classified as Hernia. Zhao Yi-de stated: This section was originally named for testicular symptoms. However, *Huangdi Neijing* states that "Shan" means pain, encompassing abdominal organ pains all named under "Shan," hence included here. The abdominal five-organ Shan can be examined through this.

Regarding testicular pain, *Huangdi Neijing* states that Ren Mai (Conception Vessel) pathology causes seven types of internal Hernia in men and leukorrhea with mass accumulation in women. Chong Mai (Penetrating Vessel) pathology causes rebellious Qi and internal urgency. Although Ren Mai has names for seven Hernias, specific morphological descriptions are lacking. Reviewing various chapters, double-character named Hernias include "Xuan Shan," attributed to Three Yang Meridians pathology, presenting with chills and fever, flaccidity and cold extremities, transmitting to Xuan Shan. Also, when Yangming governs the year and interacts with its overcoming qi, Liver Jing movement disorders, and Foot Yangming tendon disorders are all called Xuan Shan. "Jue Shan" presents with yellow complexion, pulse large and empty, accumulated Qi in the abdomen, and rebellious Qi. "Shan Xia" occurs when Spleen disease transmits to Kidney, causing heat and pain in the lower abdomen with white discharge, also called Gu. "Chong Shan" arises from Chong, Ren, and Du vessel pathology, with Qi rushing upward causing heart pain and inability to pass stool or urine. "Cu Shan" results from evil invading Jueyin collaterals, causing sudden severe pain, similar to rebellious Qi in the Luigou point affecting the testicles. "Long Shan" involves excessive Yin in Jueyin leading to vascular distension and obstruction. "Hu Shan" is a disease generated by the Liver. Perhaps these double-character names exist because Ren Mai intersects with various meridians, giving rise to the Seven Hernias. Additionally, single-character Hernias include those from Taiyin governing the earth with cold overcoming Yang, causing Hernia; Taiyang governing the earth causing lower abdomen pulling testicle pain up to the heart; lower abdomen pain preventing urination/defecation due to cold; Foot Taiyin tendon disease causing twisting pain in genitals radiating to the umbilicus; Heart Shan with urgent pulse where Small Intestine acts as the envoy, showing form in lower abdomen; Kidney pulse large, urgent, and deep indicating Shan. Heart pulse slippery and urgent indicates Heart Shan. Lung pulse deep and pounding indicates Lung Shan. Three Yin pulses urgent indicate Shan. *Lingshu* states slight slipperiness in Heart pulse indicates Heart Shan. Very slippery Liver pulse indicates Xuan Shan. Slightly large Spleen pulse indicates Shan Qi with pus and blood in intestines. Very slippery indicates Long. Very slippery Kidney pulse indicates Long. Slippery pulses indicate excessive Yang Qi and slight heat. Such cases constitute the Seven Hernias, distinguishing cold and heat evils. *Huangdi Neijing* further states: Slippery Shaoyang pulse indicates Lung Wind Shan; Slippery Taiyin pulse indicates Spleen Wind Shan; Slippery Yangming pulse indicates Heart Wind Shan; Slippery Taiyang pulse indicates Kidney Wind Shan; Slippery Shaoyang pulse indicates Liver Wind Shan. The "Wind" mentioned is not external wind but wind generated by the Liver Wood (Yang Organ). Thus, "Slippery pulse is Wind." The combination of Wind and Shan exists because Liver and Kidney reside in the Lower Jiao, and Foot Jueyin assists Ren Mai's transformation. With rebellious Qi in Liver and Kidney, Ren Yin manifests as Shan, while Liver Yang manifests as Wind, hence "Wind-Shan." Li Dongyuan argued that slippery pulses represent Bing-Ding Fire, heat sinking below, unable to overcome Ren-Gui Water, transforming into cold water, thus generating Xuan Shan, treated with hot herbs. *Huangdi Neijing* initially did not mention this in the Chi (Cun-Kun-Guan positions, specifically Chi) region. Could it be due to external cold suppressing internal heat, making fire transform from cold? This reasoning seems flawed. Furthermore, the scripture mentions the penis and scrotum as bodily mechanisms, indicators of Yin-Yang, and pathways for fluids. Irregular diet and emotions cause fluids to overflow downward to the testicles, blocking blood channels. Over time, movement becomes difficult. This condition, with fluid stagnation neither rising nor falling, is also a type of Xuan Shan. Zhang Zhongjing stated that Hernia is caused by cold evil, consistent with *Neijing*, suggesting warming and dispersing methods. Some ask: If *Neijing* attributes Hernia to various meridians, why do you attribute it entirely to Ren Mai? I reply: Ren Mai is the root of Hernia disease, while other meridians are branches. Why? Kidneys, viewed spatially, belong to Cold Water in Five Elements. Located inferiorly, they belong to Earth's Yin. Yin is paired, hence two kidneys establish Earth's rigidity and flexibility. The uterus lies between them, managing Kidney essence and blood, executing Kun Earth transformation to generate the body. Growth and development rely on Tian Gui and Kidney strength. Kun Earth does not act alone; Chong and Ren vessels, originating in the uterus, execute this transformation. Thus, all viscera and bowels receive Qi from these vessels, termed "Sea." These vessels must flow freely and avoid blockage. Flow allows Heaven's Yang to descend and interact, enabling transformation. Blockage cuts off Heaven's Yang, causing Earth's Yin to knot and diseases to arise. Hernia is one such disease. Imbalances in Ren Mai, whether from internal rigidity/flexibility conflicts or external/internal evils, disrupt Yin-Yang. Excess Yin brings cold冲击; excess Yang brings heat inward. Even if evil originates elsewhere, it must invade Ren Mai. How? Through meridian transmission, non-sequential overcoming, intersection at Ren Mai passages, or Six Meridians carrying evil into the Sea. This moves Ren Mai's stagnant Yin, striking viscera (abdominal Hernia) or descending to Jueyin/genitals (testicular Hernia). Hernia is uniquely governed by Ren Mai, arising from Earth's Yin striking violently. If other meridians are affected without involving Ren Mai, it is not called Hernia. Otherwise, why do *Ju Tong Pian* and *Bai Bing Shi Sheng Pian* describe abdominal pains without naming any as Hernia? Thus, Ren Mai is the root; other meridians' Hernias are merely branches.

Chao Yuanfang described Seven Hernias: Jue Shan, Xuan Shan, Han Shan, Qi Shan, Pan Shan, Xia Shan, Ye Lang Shan. Jue Shan involves rebellious heart pain and vomiting. Xuan Shan involves abdominal fullness and heart pain with Qi accumulation like an arm. Han Shan involves pain after cold food/drink. Qi Shan involves fluctuating abdominal fullness/pain. Pan Shan involves pain near the umbilicus. Xia Shan involves lower abdominal masses. Ye Lang Shan involves lower abdomen-genital牵引 pain and constipation. Chao attributed all Hernias to Yin accumulation, cold addition, disharmony of Ying-Wei, and weak Qi/Blood allowing wind-cold to enter. Pediatric Hernia involves scrotal swelling from crying, moving Yin Qi and causing knotting. Observing these, five involve heart/abdominal pain. Only Xuan Shan is specified for children. Later scholars added *Neijing*'s "Spleen Wind transmitting to Kidney... called Gu Disease" and established Yin Shan (Xia Shan) to complete the count of seven. Treatments for the five heart/abdominal pains suggest regulating Qi for emotional injury and warming/dispersing for external evil. Improper treatment leads to Qi entering Kidney (Kidney Qi), Bladder (Bladder Qi), or Small Intestine (Small Intestine Qi). Kidney/Bladder connect to external genitals; Small Intestine connects to testicles via ligaments. Yin Shan/Xia Shan has four subtypes: Chang Tan (Intestinal Mass), Qi Xia (Qi Mass), Luan Zhang (Testicular Swelling), Shui Shan (Water Hernia). Cold/warm evil connecting to Small Intestine causes lower abdomen-pulling testicle pain (Chang Tan). Cold evil in tendons/Jueyin causes testicular knotting (Luan Zhang). Kidney deficiency with dietary/emotional irregularity causes fluid knotting (Shui Shan). Zhang Congzheng (Dai-ren) criticized these as vulgar errors. He argued the area circling genitals to lower abdomen belongs to Foot Jueyin Liver Meridian. Causes include cold/water contraction, dryness/wood depression, anger/sorrow knotting, or medication/sexual retention blocking the meridian. It has nothing to do with Bladder, Kidney, or Small Intestine. All Hernia involves Liver Wood being invaded or becoming excessive. He established Seven Hernias within Yin Shan: Han Shan, Shui Shan, Jin Shan, Xue Shan, Qi Shan, Hu Shan, Xia Shan.
Han Shan: Scrotum cold, hard as stone, impotence, testicular pain. Caused by damp/cold exposure or sexual exertion in cold. Treated with warming purgatives. May cause infertility.
Shui Shan: Scrotal swelling/pain, sweating, crystal-like cysts, itching with yellow fluid, water sound in abdomen. Caused by drinking/alcohol/sexual exertion followed by wind-cold. Treated with water-draining purgatives.
Jin Shan: Penile swelling, ulceration, pus, pain, tight tendons, urethral pain/itching, prolapse, white discharge. Caused by sexual exhaustion or sorcery. Treated with Heart-Fire-descending purgatives.
Xue Shan: Melon-shaped mass in lower abdomen sides (near Henggu). Commonly called "soft chancre." Caused by summer heat and sexual exertion causing Qi/Blood overflow into bladder/scrotum, forming abscesses with more blood than pus. Treated with blood-nourishing purgatives.
Qi Shan: Extends from kidney region to scrotum. Distension from crying/anger, resolving when calm. Treated with Qi-scattering purgatives. Pediatric version ("Pian Qi") may result from parental age/weakness. Untreatable.
Hu Shan: Tile-shaped, enters abdomen when lying, exits to scrotum when standing/walking. Resembles fox behavior. Similar to Qi Shan but requires hook support. Treated with Qi-flow purgatives.
Xia Shan: Scrotum hangs large like a bucket, no itch/pain. Caused by damp-earth environments (Jianghuai region). Treated with damp-dispelling purgatives. After purging, adjust or tonify based on condition. *Jing* states "Yin excess with abdominal distension/blockage is Long Shan," requiring purging.

Why did Dai-ren use *Neijing/Lingshu/Mingtang* to trace Hernia origins yet omit Ren Mai pathology? Because he strongly argued genitals are unrelated to Small Intestine/Kidney/Bladder, focusing solely on Jueyin origin. However, he mentioned Ren Mai three times: 1. Acupoints for Hernia intersect with Ren Mai. 2. Chong/Ren/Du intersect with Jueyin at Qugu, circling genitals. 3. Men's sperm leakage/white discharge is Hernia; Women's amenorrhea/lower abdominal mass is "Xia" (Ren Mai internal knotting). Dai-ren's arguments were rigid, ignoring other aspects. If Bladder/Small Intestine symptoms exist, they must be addressed. *Lingshu* describes Small Intestine disease as lower abdominal pain radiating to testicles. Treatment logic applies: treat lower lesions first. However, purging weak patients without regard to timing is dangerous. Can life be saved by tonifying only after purging? Dai-ren's book is clear and enlightening, a masterpiece, but lacks nuance. Yin-Yang changes and treatments are infinite; one cannot master all. Use what is clear and supplement what is missing.

Danxi discussed testicular/lower abdominal pain (tangible/intangible, audible/inaudible). People attribute it to cold contracting meridians. Actually, it starts with Damp-Heat, suppressed long-term, then exposed to external cold, causing pain. Causes of Damp-Heat: Labor generates fire in tendons; overeating/drinking generates fire in Stomach; sexual excess generates fire in Kidney; anger generates fire in Liver. Suppressed fire leads to dampness, turbid fluids condense, enter blood channels, flow to Jueyin. Liver is Wood, swift; Fire is violent; constrained by cold, pain is severe and sudden. This theory clarifies Dai-ren's omissions regarding Jueyin pathology, benefiting future students. Hernia involves these three evils: Heat causes flaccidity, Cold causes pain, Dampness causes swelling. Treat according to predominance.

Regarding unilateral testicular involvement: Left Kidney belongs to Water, generating Liver Wood (Blood). Right Kidney belongs to Fire, generating Spleen Earth/Lung Metal (Qi). Cold contracts blood, so cold-blood flows to Liver/left testicle. Qi stagnation gathers dampness, so Qi-damp flows to Lung/right testicle. Testicular tendons involve Taiyin/Yangming too. Left-sided cases often have more pain, less swelling; right-sided have less pain, more swelling.

Case 1: In youth, ate too many citrus fruits, developing fluid retention in right hypochondrium. After mountain trekking, hunger/thirst, ate oranges/taro. Oranges stirred old retention, taro trapped Qi. Right testicle swelled immediately with chills/fever. Spleen/Lung govern right side. Fluid/Qi sank, damaging Taiyin/Yangming tendons, evil entered scrotum. Dai-ren said treat upper/lower separately; Wood depression Hernia in lower part shouldn't be vomited but drained downward. However, hunger/labor injured Spleen, causing Qi sinking. Must lift it. Purging would worsen sinking. Treated with stomach-regulating herbs, then induced vomiting next morning to move Qi upward from lower to middle jiao. Swelling halved. Repeated vomiting cleared Qi, unblocked meridians. Cured in 2-3 days. Effective for alcohol/water-induced right testicular swelling.

Case 2: Patient drank water after illness, severe left testicular pain. Moxibustion at Dadun (LR1), applied Yao Gao (Waist Rubbing Paste) containing Wu (Aconite), Fu (Prepared Aconite), Ding (Clove), She (Musk) to scrotum up to Henggu. Covered with warm cloth. Pain stopped, swelling resolved overnight.

Historically, Hernia was treated mainly for external cold. *Bencao Faming* states: Severe male Hernia and female leukorrhea/masses are governed by Ren Mai (Yin Meridian). Liver/Kidney pathology shares treatment: Ding Xiang Lian Shi Wan. Hernia/leukorrhea relate to Wind; Quan Xie (Scorpion) is the holy medicine for Wind. Chuan Lian Zi (Szechwan Chinaberry) and Hui Xiang (Fennel) enter Small Intestine Meridian. Dang Gui (Angelica) and Xuan Hu Suo (Corydalis) invigorate blood and stop pain. Accumulated cold evil in Small Intestine requires Fu Zi (Aconite) support. Ding Xiang and Mu Xiang guide the herbs.

Luo Qianfu treated Hu'erchi Niulin for chronic Hernia exacerbated by July hunger/labor and excessive warm milk. Symptoms: blue-yellow complexion, paroxysmal abdominal pain, unbearable cramping, bent waist, relieved by heat, fine/rapid pulse. *Nanjing* states Ren Mai pathology causes Seven Hernias from cold in Small Intestine. Requires strong hot herbs. Prescribed Chen Xiang Gui Fu Wan. For lower abdominal cramping/pain radiating around umbilicus, frequent clear urination, six pulses urgent/huge/slow/choppy/deep but empty except Kidney pulse (not urgent, empty/weak), named Kidney Shan. Prescribed Ding Xiang Shan Qi Wan. Male/Female Hernia with cold lower abdominal pain radiating to waist/hips: Dang Gui Si Ni Tang. *Faming* Tiantai Wu Yao San, Chuan Ku Lian San, *Jianyi* Mu Xiang Lian Zi San all use Radix Crotonis (Ba Dou) fried with herbs. Xu Xueshi noted: This disease arises from deficiency; do not tonify deficiency abruptly. Where evil gathers, Qi is deficient; if lingering, disease becomes excess. Must cleanse accumulated heat/evil before tonifying. Hence, many drugs use Ba Dou.