bubble_chart Concept

Testicular swelling and pain have been considered by medical practitioners throughout history to fall within the scope of the narrow definition of hernia. The content of hernia is quite broad. In terms of disease cause, Wang Bing noted in the Suwen.Daqi Lun annotation: "Hernia is caused by the coagulation of cold qi." In terms of symptom manifestation, Zhubing Yuanhou Lun states: "Hernia is pain." In terms of the location of the pathological change, Leijing says: "Hernia is a disease of the external genitalia and lower abdomen, and both men and women have five zang-organs." That is to say, regardless of gender, pain in the lower abdomen and external genitalia caused by the coagulation of cold qi is collectively referred to as hernia. Yan Yong-he's Jisheng Fang clearly distinguishes diseases of the scrotum and testicles from hernia, calling them "yin tui." There are four types of yin tui, among which testicular distending pain is called "luan zhang." Danxi Xinfa states: "Hernia is the acute pain of the testicles connected to the lower abdomen." "Yixue Xinyu" also states: "Hernia is lower abdominal pain that radiates to the testicles."

From the records of medical practitioners throughout history, hernia can be divided into broad and narrow definitions. If regardless of gender, pain in the lower abdomen and external genitalia caused by the coagulation of cold qi is called broad hernia; if testicular pain or swelling is caused by "heat," "cold," or "dampness" pathogens (Yizong Bidu), it can be called narrow hernia. "Shenshi Zunsheng Shu. zang-fu organs section" states: "In summary, when internal and external pathogens attack the zang-fu organs, it results in abdominal hernia; when they gather at the genitalia, it results in testicular hernia." Therefore, narrow hernia refers specifically to testicular distending pain. If one testicle has distending pain, it is commonly called "pian zhui"; if the testicle is significantly swollen and numb, it is called "tui hernia" or "wooden kidney"; if the testicle retracts into the abdomen when lying down and descends into the scrotum when standing, it is called inguinal hernia; if the testicle and scrotum ulcerate and discharge pus, it is called "tui hernia."

bubble_chart Pattern Analysis

1. Yin Cold︰The testicular pain is severe, or radiates to the lower abdomen, with mild swelling, worsens with cold, and alleviates with warmth. It is often a distending pain on one side of the testicle, or the testicle retracts into the abdomen when lying down and descends into the scrotum when standing or walking. The tongue and pulse may appear normal, but a tight pulse may be observed during severe pain. This condition is primarily caused by excessive internal pudendal coldness combined with exposure to cold pathogens, leading to intense testicular pain with mild swelling. The pain often worsens when exposed to cold or during walking or standing, as the testicle retracts into the abdomen, and alleviates with warmth or when lying down, as the testicle returns to the scrotum. This phenomenon is described as "heat causes relaxation, cold causes contraction." It commonly affects one testicle, with severe pain radiating to the lower abdomen, and a tight pulse may be observed during intense pain. Medications such as flower spiders and common fenugreek seed (from "The Application of Insect Drugs") or formulas like Spider Powder, Aconite Mother RootCinnamon Twig Decoction, or Angelica Cold-Extremities Decoction{|104|} with modifications can be used to dispel deep-seated cold and resolve hernia. If
2. Cold-dampness︰The testicles are swollen, the scrotum is cold and hard, with or without pain. If there is no pain but the testicles are swollen, even to the size of a "sheng" or "dou," it is called "tui shan" or "wooden kidney." The tongue coating is white and greasy or moist, and the pulse is deep or slow. This is due to the patient's inherent excess of phlegm-dampness, compounded by prolonged exposure to damp and low-lying environments. Because of the excessive dampness, the pain is mild or absent, with only a heavy, dragging sensation, but the testicles are abnormally swollen, even to the size of a "sheng" or "dou," and the scrotal skin is thick or numb—this is the so-called "excessive dampness causes swelling." For the treatment of these two conditions, since both are cold patterns, "cold is treated with heat." Using warm and hot herbs to dispel cold pathogens is the common approach. It is necessary to warm and disperse cold-dampness, using prescriptions such as Juan Tong Wan with added Poria and Atractylodes Rhizome.
3. Dampness-heat︰Testicular swelling and pain, scrotal dampness and itching or discharge, dark urine, severe constipation, yellow or thick tongue coating, wiry or rapid pulse. This is due to the patient's sudden anger damaging the liver, leading to liver stagnation and heat; or indulgence in rich and greasy foods and excessive alcohol consumption, resulting in internal accumulation of dampness-heat, compounded by external contraction of cold-dampness, which causes dampness-heat to stagnate in the liver meridian and descend, leading to testicular distending pain. Because dampness-heat is stagnating in the liver meridian, it must also manifest symptoms of dampness-heat in the liver meridian (scrotal dampness and itching, reddish urine, yellow or greasy tongue coating, wiry pulse, etc.). Treatment should focus on clearing and draining dampness-heat in the liver meridian, using formulas such as Gentian Liver-Draining Decoction combined with Bupleurum and Poria Decoction, with modifications as needed.
4. Toxic Heat︰Testicular swelling and redness, fever, severe pain, hardness, or scrotal edema, mostly occurring on one side. High fever, sore throat, thirst, dark urine, red tongue with yellow coating, slippery and rapid strong pulse. Due to external contraction of heat toxin, symptoms of intense toxic fire and heat must be present (testicular swelling, redness, heat, and pain; severe pain; high fever, thirst, sore throat, dark urine, red tongue with yellow coating, rapid pulse), often a complication of "mumps" patients. Treatment should focus on clearing heat and removing toxin, using the formula Universal Relief Decoction for Eliminating Toxin with modifications.
5. Qi Stagnation︰Often, there is unilateral testicular distending pain that radiates to the lower abdomen or both flanks, accompanied by chest tightness, abdominal distension and fullness, a bitter taste in the mouth, a yellow tongue coating, and a wiry, thin pulse. This condition arises from damage caused by the seven emotions, such as sudden anger or prolonged frustration, leading to qi stagnation in the liver meridian and impaired flow of meridian qi. Clinically, it commonly presents as unilateral testicular distending pain with minimal swelling, primarily characterized by a dragging sensation of distension, along with symptoms of liver qi stagnation (bitter taste in the mouth, chest distension and tightness, hypochondriac pain, wiry pulse, etc.). Treatment should focus on soothing the liver and relieving stagnation, moving qi to alleviate pain. Prescriptions such as Juxiang Yinzi, Aucklandia Root and Chinaberry Fruit Powder, and Litchi Powder can be modified for use.

Testicular distending pain has been regarded by medical practitioners throughout history as a type of hernia, which can be referred to as a narrow definition of hernia. Neijing, Jingui Yaolue, Zhubing Yuanhou Lun, and other texts propose that hernia is a cold-induced painful disease. The "Shen's Zunsheng Shu, zang-fu organs section" states: "Danxi said, this disease begins with dampness-heat in the meridians. Stagnation over time, combined with external cold, causes pain. If only cold is considered, it may not be comprehensive." In clinical practice, testicular distending pain can manifest as cold pattern, heat pattern, dampness pattern, qi stagnation pattern, etc., with varying clinical presentations. Therefore, Yizong Bidu·hernia states: "Cold often causes pain, heat often causes relaxation, dampness causes swelling and sagging, deficiency also causes swelling and sagging. In the blood aspect, it is immobile; in the qi aspect, it is often mobile." However, regardless of the syndrome, the mechanism of disease is related to the liver meridian. "Yilin Shengmo" states: "The testicles are produced by the kidneys but belong to the liver, not the kidneys." Clinically, testicular distending pain is often seen as an excess pattern, or a combination of deficiency and excess, with deficiency pattern being rare. Therefore, Puji Benshi Fang·hernia states: "Generally, this disease arises from deficiency, but one should not hastily use tonics. The classics say that the invasion of pathogens must be due to the deficiency of essential qi. If pathogens remain and do not leave, the disease becomes excess. Therefore, one must first eliminate the accumulated pathogens, and then tonify."

bubble_chart Documentation

1. Lingshu-Jingmai: "The Foot Jueyin... when the disease is rebellious, it causes sudden swelling and pain in the testicles."
2. Lingshu．pathogenic qi zang-fu organs Disease Manifestations: "In cases of small intestine disease, there is small abdominal pain, and pain in the lower back and spine that controls the testicles."
3. Yilin Shengmo．Hernia Pain: "If discussing nocturnal emission and spermatorrhea, this is a kidney disease; if there is red or white urine, this is a bladder disease; if there is pain and blockage in the urethra, this is a small intestine disease. Whenever encountering diseases of the testicles, treatment should focus on the liver; diseases of the penis should also focus on the liver; diseases of the scrotum should focus on the spleen, and diseases of the seminal tract should focus on the kidney."
4. Zhizhi Fang: "The main principle of treatment is to promote circulation and facilitate discharge first, do not say that kidney deficiency causes the disease and dare not to discharge. Because the kidney is affected by pathogenic qi, if the root of the disease is not removed, how can the disease be cured."
5. Danxi Xinfa．Supplementary Fang Guang said: "Ancient prescriptions use pungent and warm to disperse, which treats the symptoms. Danxi believes that phlegm-fluid retention, food accumulation, and dead blood multiple abscesses belong to the liver meridian, using pungent and neutral to resolve phlegm, eliminate accumulation and remove stasis, which treats the root. Hernia, pain has a fixed location, is a tangible accumulation, how can it not be the gathering of phlegm, food, and blood."
6. Yizong Bidu．hernia: "Those suffering from the left testicle, have more pain and less swelling; those suffering from the right testicle, have less pain and more swelling."