Inguinal Hernia

WESTERN MEDICINE: Hernia of inguen in Chinese medicine includes the following in western medicine: 

Hydrocele is the most common intrinsic scrotal mass, resulting from excessive accumulation of normal fluid within the tunica vaginalis, a consequence of overproduction (inflammation of the testis and its appendages) or diminished resorption (lymphatic or venous obstruction in the cord or retroperitoneal space). Congenital hydrocele communicates with the abdominal cavity through a patent processus vaginalis, a potential hernia space, but may resolve spontaneously following neonatal obliteration of the communication.

Hematocele is an accumulation of blood within the tunica vaginalis; unlike hydrocele, it is usually not transilluminable. 

Inguinal hernia, direct or indirect, may extend into the scrotal compartment. Surgical repair of inguinal hernia is recommended in virtually every instance because of the probabilities of progression and the possibilities of incarceration and strangulation. 

Spermatocele (spermatic cyst) occurs in the epididymis and contains sperm, while epididymal cysts contain clear fluid. Either may be difficult to differentiate from hydrocele, since all will transilluminate and are cystic and painless in character. 

SYMPTOMS AND SIGNS: lnguinalhemia in Chinese medicine means the scrotal masses, or the enlargement of the testicle, or with the radiated pain to lower abdomen. Chinese medicine considers that hernias have the closest relationship with the liver and Ren (receptive) channels, so the symptoms and signs of liver and Ren channels mostly show up as hernias. 

ETIOLOGY AND PATHOLOGY: The name of "Shuan" (hernia) shows up in the earliest Chinese medical book Huang Di Nei Jing (The Yellow
Emperor's Inner Classic). It mostly is considered as the accumulation of Qi, coldness, water (or fluids), dampness, heat and blood. Its etiological factors include the exogenous factors, excessive sexual activities, strong and prolonged unhealthy emotions, over - working (exhaustion) and congenital factors. Its pathological changes are those of stagnation of cold-dampness; or damp-heat, liver Qi stagnation, deficient dropping Qi, or the stagnation of phlegm and blood. So traditionally, hernias have been categorized as Han Shuan (the hernia due to coldness), Sui Shuan (the hernia due to water or fluids), Qi Shuan (hernia due to Qi), Fu Shuan (moving hernia) and Tu Shuan (hernia due to damp - phlegm or heat - phlegm).

DIFFERENTIATIONS: 

1. Han Shuan (Hernia due to the Coldness):

(1). Hernia due to the Excessive Coldness: 

Indications: The feeling of scrotal mass is cold and hard, pain at local area, likes hot press and dislikes coldness. White tongue coating, deep and wiry pulse. 

Treatment & Formula: Warm the channels and dispel the coldness, harmonize the liver and promote the circulation of Qi and blood. 

Products:

    • Xiao Chai Hu Tang (Minor Bupleurum Combination, Item No. 2029) plus Gui Zhi (Cinnamon twig, Item No. 1145), Wu Zhu Yu (Evodia Fructus, Item No. 1099), Xiao Hui Xiang (Fennel, Item No. 1023), or Rou Gui (Cinnamomum Cortex, Item No. 1079).

(2). Hernia due to the Deficient Coldness: 

Indications: Soft scrotal mass, extended and cold feelings, or pain at local area, or radiated to lower abdomen and testicles, cold limps and body, or numbness of the four limbs. Pale tongue body, white coating, deep and thready or slow pulse. 

Treatment & Formula: Dispel the coldness and promote the circulation of Qi and tonify the blood.

Products:

    • Nuan Gan Jian (Tang - kuei and Lycium Fruit Decoction): Its ingredients are as follows: 

2. Sui Shuan (Hernia due to the Water or Fluid Retention):

(1). Hernia due to the Cold - Dampness: 

Indications: Scrotal mass like glass with heavy, full and extended feelings or pain, sweating at local area, gurgling sound when pressed, scanty urine, thin and greasy tongue coating, wiry pulse. 

Treatment & Formula: Eliminate the cold-dampness by promoting the normal Qi Hua (Qi movements). 

Products:

    • Wu Ling San (Hoelen Five Herb Formula, Item No. 2043): This eliminates the dampness by its promoting functions of spleen and kidney. The following two herbs may be added to strengthen the function of Qi movements: Ju He (orange seed, Item No. 1240) and Mu Xiang (Saussurea Radix, Item No. 1032). 

(2). Hernia due to the Heat - Dampness: 

Indications: Scrotal mass, red or swollen at local area with itching and pain, yellowish fluids come out when skin is broken, scanty urine, red tongue, yellow and greasy coating, wiry and rapid pulse. 

Treatment & Formulas: Eliminate the dampness and clear the interior heat. 

Products:

    • Yin Chen Hao Tang (Capillaris Combination, Item No. 2142): This clears the interior heat and eliminates the damp factor at the liver channel. 
    • Yin Chen Wu Ling San (Capillaris and Hoelen Five Combination, Item No. 2143): This is good to use when there is more dampness than heat. 
    • Ba Zheng San (Dianthus Formula, Item No. 2008): It clears the damp heat at lower burner.
    • Xiao Cheng Qi Tang (Minor Rhubarb Combination, Item No. 2028): This is used for the patient with strong interior heat and constipation by its purgative function. 

3. Qi Shuan (Hernia due to Qi):

(1). Hernia due to the Qi Stagnation: 

Indications: Sometimes feeling of full and extended scrotal mass, sometimes the feeling of pain of scrotal mass, uncomfortable feeling at lower abdomen, moving pain, mostly the feeling of fullness, moody emotions, cries easily, thin tongue coating, wiry pulse. 

Treatment & Formulas: Regulate the Qi movement and harmonize the liver. 

Products:

(2). Hernia due to the Qi Deficiency: 

Indications: Scrotal mass, heavy and full feeling, recurs easily when feeling tired or over-worked, heavy and dropping feeling at lower abdomen, difficulty urinating, pale tongue, or with teeth margins, thin coating, weak and forceless pulse. 

Treatment & Formula: Tonify and ascend the dropping Qi.

Products:

    • Bu Zhong Yi Qi Tang (Ginseng and Astragalus Combination, Item No. 2225): This is atypical Qi tonic and ascending formula. 

4. Fu Shuan (Moving Hernia):

Indications: Moving and changing scrotal mass, small or large, up and down occasionally, with full and painful sensations, disappears when lying down, appears when standing up. 

Treatment & Formula: Regulate the stagnated Qi and harmonize the liver. 

Products:

    • Dao Qi Tang plus: The ingredients are as follows:
    • The following herbs may be added: 
      • Wu Yao (Lindera Radix, Item No. 1150) 
      • Yuan Hu (Corydalis Rhizoma, Item No. 1028) 
      • Qing Pi (Blue Citrus, Item No. 1106)
      • Ju He (Orange Seed, Item No. 1240)
      • The dosage for the above herbs depend on the patient's situation. 

5. Tu Shuan (Hernia due to Damp- Phlegm or Heat - Phlegm):

(1). Hernia due to Damp - Phlegm: 

Indications: Scrotal mass, heavy and numb feeling at local area or the four limbs, dark and purplish tongue, white and greasy coating, slippery or deep and wiry pulse. 

Treatment & Formulas: Eliminate the damp- phlegm and soften the hardness. 

Products:

    • Ju He Wan (Tangerine Seed Formula, Item No. 2255): This is a very popular formula used for hernias due to the stagnation of dampness, phlegm and Qi together.
      If the stagnation has been chronic, and the scrotal mass is big and hard, the following two herbs may be added for better results of dissolving the hardness. 
    • San Leng (Sparganium Rhizoma, Item No. 1012)
    • E Zhu (Zedoariae Rhizoma, Item No. 1170) If there is more damp - phlegm symptoms, the following herbs may be added:
      • Cang Zhu (Atractylodes Lancea Rhizoma, Item No. 1218) 
      • Fu Ling (Hoelen, Item No. 1133) 
      • Ban Xia (Pinellia Tuber, Item No. 1068)
      • Bei Mu (Fritillaria Bulbus, Item No: 1295)

(2). Hernia due to the Phlegm - Heat: 

Indications: Scrotal mass, heavy and dropping and burning sensation at local area, swollen and hard in quality, red or purplish tongue, yellow and greasy coating, slippery and rapid or wiry and rapid pulse. 

Treatment & Formulas: Clear heat, resolve the phlegm, and soften the hardness. 

Products:

    • Long Dan Xie Gan Tang (Gentiana Combination, Item No. 2267) combines with Ju He Wan (Tangerine Seed Formula, Item No. 2255): This combination is very good for the hernia due to the interior liver damp - heat and stagnation of damp - phlegm. 

COMMENTS:

  1. The methods of acupuncture and moxibustion: The use of moxa is very beneficial for the hernia due to coldness and fluid (or water retention). Acupuncture is good for the hernia due to the Qi, blood, dampness, or phlegm. The acupuncture points are mostly chosen from the channels of Ren and liver.
  2. The method of pressing: Cook 1 or 2 pounds of salt to warm or hot, wrap it in cloth, and press at lower abdomen, which can help alleviate the localized pain. This method is suitable for the hernia due to coldness.
  3. Try to stay in a clean and dry environment; a happy mood is very important as welt.
  4. Patients who hernias are due to coldness should avoid cold food and drinks; others due to the interior heat or combined with damp or phlegm factors should avoid fried, spicy and hot foods.

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