注云∶腹中虽硬，而忽聚忽散，无有常准。经曰∶血不流而寒薄，故血内凝（不
流）而成瘕也。一云∶腹内积病也。又曰∶小肠移热于大肠，为伏瘕，为沉。
〔注〕曰∶小肠热以传入大肠，两热相搏，则血溢而为〔 〕瘕也。血涩不利，
则月事沉滞而不行，故云为〔 假〕、为沉〔 〕。乃或阳气郁结，〔怫热壅
滞〕而坚硬不消者，非寒瘕也，宜以脉〔证〕别之。瘕〔一为〕疝，传写之误。
注云∶小腹连卵肿急绞痛也，寒主拘缩故也。寒极而土化制之，故肿满也。经云
丈夫 疝，谓阴器连小腹急痛也。经〔注〕曰∶寒气聚而为疝也。脉急者，寒之象
也。然，寒则脉当短小而迟，今言急者，非急数而洪也，由紧脉主痛，急为病甚也。病
寒缩急，亦短小也。所以有痛而脉紧急者，脉为心所养也。凡气为痛，则心神不宁
而紧急，不得舒缓，故脉亦（从）之而见也。欲知何气为其痛〔者〕，诊其紧急相兼
之脉可知矣。如紧急洪数，则为热痛之类也。
注云∶寒主拘缩，故急痛也。寒极则血脉凝冱，而反兼土化制之，故坚痞而腹
痛也。或热郁于内，而腹满坚结痛〔者〕，不可言为寒也，当以脉别之。
注云∶寒则清净明白故也。
注云∶胃热则消谷善饥，故病寒〔则〕食虽已而不饥也。胃〔膈〕润泽，而无燥
热故也。或邪热不杀谷，而腹热胀满，虽数日而不食，亦不饥者，不可言为寒也。由阳
热太甚而郁结，传化失常，故虽不食。亦不饥也。二证以脉别之自见。
注释说：腹部虽然坚硬，但肿块忽聚忽散，没有固定的形态。《内经》说：血液运行不畅且寒气侵袭，导致血液在体内凝结而形成瘕（腹内结块）。另一种说法是：这是腹内的积滞病证。又说：小肠的热邪移注于大肠，形成伏瘕和沉疝。〔注〕解说：小肠的热邪传入大肠，两热相互搏结，则血液外溢而成为瘕。血液涩滞不通，则月经停滞而不行，所以称为瘕、称为沉。如果是阳气郁结，热气壅滞而导致坚硬不消的，就不是寒性瘕，应当通过脉象来辨别。瘕字有时误写为疝，这是传抄的错误。
注释说：小腹部连同睾丸肿胀、拘急、绞痛，这是因为寒性收引的缘故。寒气极盛时，土气（脾土）试图制约它，所以出现肿胀满闷。《内经》说：男子患疝气，是指阴器连接小腹部的急痛。经文的〔注〕解说：寒气聚集而形成疝。脉象紧急，是寒气的征象。然而，寒证脉象应当短小且迟缓，现在所说的“急”，不是指急促、数大或洪大的脉象，而是因为紧脉主痛，急脉表示病情严重。病属寒邪则经脉收缩紧急，也表现为短小。之所以有疼痛且脉象紧急的情况，是因为脉由心所滋养。凡是气机阻滞引起疼痛，心神就会不安而紧张，无法舒缓，所以脉象也随之呈现紧急之象。想要知道是什么气引起的疼痛，诊察其紧急兼见的脉象就可以知道了。如果脉象紧急且洪数，就属于热痛之类。
注释说：寒性收引，所以引起急痛。寒气极盛则血脉凝滞冻结，反而兼有土气（脾土）的制约作用，所以出现坚硬痞块和腹痛。或者是热邪郁结在内部，导致腹部胀满、坚硬结聚而疼痛的，不能说是寒证，应当通过脉象来辨别。
注释说：因为寒性使身体保持清净、安静的状态。
注释说：胃中有热则消化食物快且容易饥饿，所以患寒证时，即使吃过东西也不觉得饿。这是因为胃脘部滋润润泽，没有燥热的缘故。或者是邪热不能腐熟水谷，导致腹部发热胀满，即使几天不吃东西，也不觉得饿的，不能说是寒证。这是由于阳热太盛而郁结，传导化生功能失常，所以虽然不吃东西，也不觉得饿。这两种证候通过脉象辨别自然就能清楚。
The commentary states: Although the abdomen feels hard, the masses gather and disperse intermittently without a fixed standard. The Classics state: When blood flow is stagnant and cold is thin (invading), blood coagulates internally to form *jia* (abdominal mass). Another view holds: It is an accumulation disease within the abdomen. It is also said: Heat from the Small Intestine transfers to the Large Intestine, resulting in latent *jia* (*fu jia*) and sinking conditions (*chen*). [Commentary] explains: Heat from the Small Intestine transmits into the Large Intestine; when the two heats contend, blood overflows and forms *jia*. When blood is astringent and unsmooth, menstruation stagnates and fails to proceed, hence it is called *jia* and *chen*. If Yang Qi is constrained and heat is obstructed, leading to hardness that does not dissipate, this is not a cold *jia*; one must distinguish it by pulse and signs. *Jia* is sometimes erroneously written as *shan* (hernia) due to transcription errors.
The commentary states: Swelling, urgency, and severe colic pain in the lower abdomen extending to the testicles occur because cold causes contraction. When cold reaches its extreme, Earth transformation (Spleen Earth) attempts to control it, resulting in swelling and fullness. The Classics state regarding men's *shan*: It refers to urgent pain connecting the genital organs and the lower abdomen. The [commentary on the] Classics states: Cold Qi gathers to form *shan*. A tight pulse is a sign of cold. However, while cold typically presents with a short, small, and slow pulse, the "urgency" mentioned here does not refer to rapid, large, or surging pulses. Instead, because a tight pulse governs pain, an urgent pulse indicates severe disease. Cold diseases cause contraction and urgency, which can also appear short and small. The reason for pain accompanied by an urgent pulse is that the pulse is nourished by the Heart. Whenever Qi causes pain, the Heart Spirit becomes restless and tense, unable to relax; thus, the pulse also reflects this tension. To know what Qi is causing the pain, one can determine it by diagnosing the combined urgent pulse characteristics. For instance, if the pulse is urgent, surging, and rapid, it belongs to the category of heat pain.
The commentary states: Cold causes contraction, hence urgent pain. When cold is extreme, blood vessels congeal and freeze, yet they are counteracted by Earth transformation, resulting in hard痞 (masses) and abdominal pain. Alternatively, if heat is depressed internally, causing abdominal fullness, hardness, consolidation, and pain, it cannot be described as cold; it must be distinguished by the pulse.
The commentary states: This is because cold maintains clarity and stillness.
The commentary states: Stomach heat leads to the digestion of food and easy hunger; therefore, in a cold disease, even after eating, there is no sensation of hunger. This is because the Stomach and Diaphragm are moistened and lubricated, lacking dryness and heat. Conversely, if pathogenic heat fails to cook grain, leading to abdominal heat, fullness, and distension, where one does not eat for several days yet feels no hunger, this cannot be classified as cold. This arises because Yang-heat is excessive and constrained, disrupting transmission and transformation; thus, even without eating, there is no hunger. These two conditions can be distinguished by observing the pulse.