人之五脏卒痛者，经脉流行不止，环周不休，寒气入经而稽迟，泣而不行，客于脉外则血少，客于
脉中则气不通，故卒然而痛。其痛或有卒然而止者，或痛甚不休者，或痛甚不可按者，或按之而痛止者，
或按之无益者，或喘动应手者，或心与背相引而痛者，或胁肋与少腹相引而痛者，或腹痛引阴股者，或痛
宿昔而成积者，或卒然痛死不知人、少间复生者，或痛而呕者，或腹痛而后泄者，或痛而闭不通者，
凡此诸痛，皆当别之。寒气客于脉外，则脉寒，脉寒则缩蜷，缩蜷则脉绌急，绌急则外引小络，故卒然而痛，
得炅则痛立止。（蜷，不申也，绌，屈曲也。炅，热也。寒气客于脉外者，邪不甚深，卫气不得流通，
则外引小络而卒然为痛，故但得炅暖之气，其痛则立止也。蜷，音拳。绌，音屈。）因重中于寒，则痛久矣。
（重中于寒则不易解散也。）寒气客于经脉之中，与炅气相薄，则脉满，满则痛而不可按也。（阳气行于脉
中而寒袭之，则寒热相薄，留而不行，则邪实于经，故脉满而痛不可按也。）寒气稽留，炅气从上，则脉充
大而血气乱，故痛甚不可按也。（炅气从上，阳主升也。寒邪遏之，则脉充于内而血气乱，故其痛必甚。）
寒气客于肠胃之间，膜原之下，血不得散，小络急引故痛。按之则血气散，故按之痛止。（膜，筋膜也。原，
肓之原也，义详下章。肠胃之间，膜原之下，皆有空虚之处，血不散而小络满，则急引而痛。按之则寒气可散，
小络可缓，故其痛止，非若经脉之无罅隙者，按之则愈实而愈痛也。其着于肠胃之募原也，饱食则安，饥
而痛。）寒气客于挟脊之脉，则深按之不能及，故按之无益也。（挟脊者，足太阳经也。其最深者则伏冲、伏
膂之脉，故按之不能及其处。）寒气客于冲脉，冲脉起于关元，随
腹直上，寒气客则脉不通，脉不通则气因之，故喘动应手矣。（关元，任脉穴，在脐下三寸。冲脉起于胞中，
即关元也。其脉并足少阴肾经挟脐上行，会于咽喉，而肾脉上连于肺，若寒气客之，则脉不通，
脉不通则气亦逆，故喘动应手也。）寒气客于背俞之脉，则脉泣，脉泣则血虚，血虚则痛，其俞注于心，
故相引而痛。按之则热气至，热气至则痛止矣。（背俞，五脏俞也，皆足太阳经穴。太阳之脉，循膂，当心
入散，上出于项，故寒气客之则脉涩血虚，为背与心相引而痛，因其俞注于心也。按之热至而痛止者，正以
血虚故耳。）寒气客于厥阴之脉，厥阴之脉者，络阴器系于肝，寒气客于脉中，则血泣脉急，故胁肋与少腹相
引痛矣。（肝经之脉，循阴股，入髦中，抵少腹，布胁肋也。）厥气客于阴股，寒气上及少腹，血泣在
下相引，故腹痛引阴股。（厥气，寒逆之气也，少腹阴股之间，乃足三阴冲脉之所中行也，寒气之犯，
皆相引而痛。）寒气客于小肠膜原之间，络血之中，血泣不得注于大经，血气稽留不得行，故
宿昔而成积矣。（小肠为受盛之府，化物所出。若寒气客于膜原、络血之间，则血涩不行，故不得注于大经。
稽留渐久，因成积也。）寒气客于五脏，厥逆上泄，阴气竭，阳气未入，故卒然痛死不知人，气复反则生矣。（
寒伤脏气，则气不得降而厥逆上泄，乃致真阴暴竭，阳气未能遽入，故卒然痛死，必待脏气复返则生矣。）
寒气客于肠胃，厥逆上出。故痛而呕也。（肠胃，亦言腑也，水谷之在六腑，必自上而下，乃其顺也。若寒
气客之，则逆而上出，故为痛为呕。）寒气客于小肠，小肠不得成聚，故后泄腹痛矣。（小肠为丙火之府，
而寒邪胜之，则阳气不化，水谷不得停留，故病为后泄腹痛矣。）热气留于小肠，肠中痛，瘅热焦渴，
则坚干不得出，故痛而闭不通矣。（热留小肠，是阳脏阳病也。故为瘅热、焦竭、坚干、痛闭之疾。治痛
之法，有曰痛无补法者，有曰通则不痛、痛则不通者，有曰痛随利灭者，人相传
诵，皆以此为不易之法。凡是痛症无不执而用之，不知“痛随利灭”，“利”字训作“通”字，非下也。
假令在表者实，汗而利之，在里者实，下而利之，在气血者实，散之、行之而利之，则得治实之法也。然痛症
亦有虚、实，治法亦有补、泻。其辨之之法，不可不详。凡痛而胀闭者多实，不胀不闭者多虚；痛而拒按
者为实，可按者为虚；喜寒者多实，爱热者多虚；饱而甚者多实，饥而甚者多虚；脉实气粗者多实，脉虚
气少者多虚；新病壮年者多实，愈攻愈剧者多虚。痛在经者脉多弦大，痛在脏者脉多沉微。必兼脉症而察之，
则虚实自有明辨。实者可利，虚者亦可利乎？不当利而利之，则为害不浅。故凡治表虚而痛者，阳不足也，
非温经不可；里虚而痛者，阴不足也，非养荣不可；上虚而痛者，心脾受伤也，非补中不可；
下虚而痛者，脱泄亡阴也，非速救脾肾、温补命门不可。夫以温补而治痛者，古人非不多也，惟近代薛立
斋尤得之，奈何明似丹溪而亦曰“诸痛不可补气”，局人意见如此。）
人的五脏发生突然疼痛，是因为经脉中的气血运行不止，循环周身没有休止。当寒气侵入经脉，导致气血运行迟缓、凝滞而不通畅；如果寒气停留在脉外，就会导致血液亏少；如果寒气客居于脉中，就会导致气机阻滞不通，所以会突然产生疼痛。这种疼痛有的突然停止，有的剧烈疼痛不止，有的疼痛剧烈且不能按压，有的按压后疼痛缓解，有的按压后毫无益处，有的能感觉到脉搏跳动应手，有的心口与背部相互牵引而痛，有的胁肋部与小腹部相互牵引而痛，有的腹痛牵引至大腿内侧，有的疼痛经过一夜形成积聚，有的突然剧痛昏死不知人事，片刻后又苏醒，有的疼痛伴有呕吐，有的腹痛随后腹泻，有的疼痛伴有大便闭塞不通。以上各种疼痛，都应当加以辨别。
寒气客居在脉外，会使经脉受寒，经脉受寒就会收缩卷曲，收缩卷曲则经脉拘急，经脉拘急就会向外牵引细小的络脉，所以突然产生疼痛，遇到温热疼痛立刻停止。（蜷，是不舒展的意思；绌，是屈曲的意思；炅，是热的意思。寒气客居在脉外，邪气不深，卫气不能流通，从而向外牵引小络而突然疼痛，所以只要得到温热的空气，疼痛就会立刻停止。蜷，读音同“拳”；绌，读音同“屈”。）如果再次受到寒邪侵袭，疼痛就会持久。（再次中寒就不容易解散。）
寒气客居在经脉之中，与体内的热气相互搏击，就会导致脉道充盈胀满，脉道充盈胀满就会疼痛且不可按压。（阳气行于脉中而寒气袭击它，寒热相互搏击，停留而不能运行，邪气实于经脉，所以脉道充盈而疼痛不可按压。）寒气稽留不去，热气从上而来，就会导致脉道充大而血气紊乱，所以疼痛剧烈且不可按压。（热气从上而来，因为阳主升发。寒邪遏制它，脉道在内部充盈而血气紊乱，所以疼痛必然剧烈。）
寒气客居在肠胃之间、膜原之下，血液不能散行，细小络脉紧急牵引所以疼痛。按压时血气散开，所以按压后疼痛停止。（膜，指筋膜；原，指肓之原，含义详见下一章。肠胃之间、膜原之下，都是空虚之处，血液不散而小络充盈，就会紧急牵引而痛。按压则寒气可散，小络可舒缓，所以疼痛停止，不像经脉那样没有缝隙，按压后会更加坚实而更痛。那些附着在肠胃募原的疼痛，吃饱了则安宁，饥饿时则疼痛。）
寒气客居在夹脊的经脉（足太阳膀胱经），深层按压不能触及，所以按压没有益处。（夹脊处，是足太阳经所在。其最深处的则是伏冲、伏膂之脉，所以按压不能到达那些部位。）
寒气客居在冲脉，冲脉起于关元穴，沿腹壁直上，寒气客居则脉道不通，脉道不通则气随之逆乱，所以能感觉到脉搏喘动应手。（关元，是任脉穴位，在脐下三寸。冲脉起于胞中，即关元处。其脉伴随足少阴肾经夹脐上行，交会于咽喉，而肾脉向上连接于肺，若寒气客居其中，则脉道不通，脉道不通则气也逆乱，所以喘动应手。）
寒气客居在背俞脉（五脏俞穴，均属足太阳膀胱经），则血脉凝涩，血脉凝涩则血虚，血虚则疼痛，这些俞穴的气注于心，所以心背相互牵引而痛。按压则热气到来，热气到来则疼痛停止。（背俞，是五脏的俞穴，都属于足太阳经穴。太阳经的脉，循行于脊柱，当心入内散布，向上出于项部，所以寒气客居其中则脉涩血虚，造成背与心相互牵引而痛，这是因为其俞穴注于心。按压后热气至而痛止，正是因为血虚的缘故。）
寒气客居在厥阴肝经，厥阴肝经联络阴器并系于肝脏，寒气客居在脉中，则血液凝涩、经脉拘急，所以胁肋与小腹部相互牵引而痛。（肝经的脉，循行于阴股，进入毛际，抵达小腹，布散于胁肋。）
厥逆之气客居在阴股，寒气上行波及小腹，血液凝涩在下部相互牵引，所以腹痛牵引至大腿内侧。（厥气，指寒逆之气，小腹阴股之间，是足三阴经和冲脉所经过的地方，寒气侵犯这里，都会相互牵引而痛。）
寒气客居在小肠膜原之间、络脉血液中，血液凝涩不能注入大经脉，血气稽留不能运行，所以经过一夜就形成了积聚。（小肠是受盛之腑，是化物之所出。若寒气客居在膜原、络血之间，则血涩不行，所以不能注入大经脉。稽留时间渐久，因而形成积聚。）
寒气客居在五脏，导致厥逆之气上泄，阴气竭绝，阳气未能入内，所以突然剧痛昏死不知人事，气机恢复则生。（寒邪损伤脏气，则气不得下降而厥逆上泄，致使真阴暴竭，阳气未能随即入内，所以突然剧痛昏死，必须等待脏气恢复才能生还。）
寒气客居在肠胃，导致厥逆之气上出。所以疼痛并伴有呕吐。（肠胃，也是指六腑，水谷在六腑中，必须自上而下运行，这才是顺行。若寒气客居其中，则逆而上出，所以表现为疼痛和呕吐。）
寒气客居在小肠，小肠不能正常聚化水谷，所以出现腹泻和腹痛。（小肠是丙火之腑，若寒邪战胜它，则阳气不化，水谷不能停留，所以病为腹泻和腹痛。）
热气留在于小肠，肠中疼痛，湿热焦渴，导致大便坚硬干燥无法排出，所以疼痛且大便闭塞不通。（热留小肠，这是阳脏阳病。所以表现为湿热、焦竭、坚干、痛闭的疾病。治疗疼痛的方法，有说“痛无补法”的，有说“通则不痛、痛则不通”的，有说“痛随利灭”的，人们互相传诵，都认为这是不可改变的方法。凡是疼痛病症无不执着于此法使用，不知道“痛随利灭”中的“利”字解释为“通”，并非指泻下。假如在表的实证，用汗法使其通利；在里的实证，用下法使其通利；在气血的实证，用消散、行气的方法使其通利，这就得到了治疗实证的方法。然而疼痛病症也有虚、实之分，治疗方法也有补、泻之别。辨别它们的方法，不可不详细考察。凡是疼痛且胀满闭塞的多为实证，不胀不闭的多为虚证；疼痛且拒绝按压的为实证，可以按压的为虚证；喜欢寒冷的多为实证，喜爱温暖的多为虚证；饱食后加重的多为实证，饥饿时加重的多为虚证；脉实气粗的多为实证，脉虚气少的多为虚证；新病且壮年的多为实证，越攻伐病情越严重的多为虚证。疼痛在经络的，脉象多弦大；疼痛在脏腑的，脉象多沉微。必须结合脉象和症状来观察，则虚实自然有明确的辨别。实证可以用通利法，虚证也可以用通利法吗？不应当通利而通利，那么危害就不浅了。所以凡是治疗表虚而痛的，是阳气不足，不用温经之法不行；里虚而痛的，是阴血不足，不用养血荣营之法不行；上虚而痛的，是心脾受伤，不用补中之法不行；下虚而痛的，是脱泄亡阴，不用速救脾肾、温补命门之法不行。用温补法治疼痛的，古人不是不多，只有近代的薛立斋尤为得法，为何明明像朱丹溪却还说“诸痛不可补气”，局促之人的见解如此。）
Sudden pain in the five Zang organs of humans occurs because the flow of Qi and blood in the meridians is ceaseless, circulating around without rest. When cold pathogen enters the meridians, it causes stagnation and delay, making the flow sluggish and obstructed; if the cold lodges outside the vessels, blood becomes deficient; if it resides within the vessels, Qi movement becomes blocked. Therefore, sudden pain arises. This pain may stop suddenly, or persist severely without ceasing, or be so severe that it cannot be pressed, or be relieved by pressing, or remain unaffected by pressing, or exhibit a pulsating sensation under the hand, or involve mutual牵引 (traction) between the heart/chest and the back, or between the hypochondrium/flank and the lower abdomen, or abdominal pain radiating to the groin, or pain lasting overnight leading to accumulation, or sudden severe pain causing unconsciousness with recovery after a short while, or pain accompanied by vomiting, or abdominal pain followed by diarrhea, or pain with constipation. All these various pains must be differentiated.
When cold lodges outside the vessels, the vessels become cold; cold vessels contract and curl; contraction leads to tension and cramping; tension pulls on the small collateral vessels, resulting in sudden pain. Applying heat stops the pain immediately. (*Juan* means not extending; *Chu* means bending/curling; *Jiong* means heat. Cold lodging outside the vessels is not deeply seated; Wei Qi cannot circulate freely, pulling on the small collaterals to cause sudden pain. Thus, only warmth can stop it instantly. *Juan* sounds like "quan"; *Chu* sounds like "qu".) If struck repeatedly by cold, the pain persists for a long time. (Repeated cold invasion is difficult to resolve.)
When cold lodges within the meridians and clashes with warm Qi, the vessels become full/distended, causing pain that cannot be pressed. (Yang Qi moves within the vessels but is attacked by cold; cold and heat clash, stagnate, and fail to move, making the pathogen excess in the meridians, thus vessels are full and painful to touch.) When cold lingers and warm Qi rises from above, the vessels become enlarged and Qi/blood become chaotic, causing severe pain unyielding to pressure. (Warm Qi rising reflects Yang's ascending nature. Cold suppresses it, causing internal vessel distension and chaotic Qi/blood, hence severe pain.)
When cold lodges between the stomach/intestines and below the membrane source (Moyuan), blood cannot disperse, and small collaterals tighten and pull, causing pain. Pressing disperses Qi/blood, relieving pain. (*Mo* refers to fascia; *Yuan* refers to the origin of Huang [pericardium/epigastrium], detailed in the next chapter. The space between stomach/intestines and below Moyuan is empty. If blood does not disperse and small collaterals fill, they tighten and pull, causing pain. Pressing dissipates cold and relaxes collaterals, stopping pain. Unlike solid meridians where pressing increases hardness and pain, here it helps. Pain fixed at the stomach/intestine Moyuan is relieved by eating and worsens with hunger.)
When cold lodges in the meridians flanking the spine (Foot-Taiyang Bladder Meridian), deep pressing cannot reach them, so pressing is ineffective. (The area flanking the spine belongs to the Foot-Taiyang meridian. Its deepest parts are the Fu-Chong and Fu-Lü meridians, inaccessible to palpation.)
When cold lodges in the Chong Mai (Penetrating Vessel), which originates at Guanyuan (CV4, 3 cun below the umbilicus) and ascends straight up the abdomen, the cold blocks the vessel. Blockage causes Qi to rebel, resulting in a pulsating sensation felt by the hand. (The Chong Mai originates in the uterus/Guanyuan. It runs alongside the Foot-Shaoyin Kidney Meridian up the navel, meeting at the throat, connecting to the Lung. Cold blockage causes Qi rebellion and palpable pulsation.)
When cold lodges in the Back-Shu points (Zang organ Shu points on the Foot-Taiyang meridian), blood flow becomes sluggish, leading to blood deficiency and pain. Since these Shu points connect to the Heart, pain radiates between the back and chest. Pressing brings heat, relieving pain. (The Taiyang meridian runs along the spine, enters near the heart, and emerges at the neck. Cold causes sluggish blood and deficiency, leading to referred pain due to the connection with the Heart. Pressing generates heat to relieve deficiency-related pain.)
When cold lodges in the Jueyin (Liver) meridian, which connects to the genitalia and anchors in the Liver, cold in the vessels causes blood stasis and vessel tension, leading to referred pain between the hypochondrium and lower abdomen. (The Liver meridian runs through the thigh, into the pubic region, to the lower abdomen, and spreads over the hypochondrium.)
If Jue Qi (cold-rebellious Qi) lodges in the inner thigh, and cold ascends to the lower abdomen, blood stasis below causes referred pain from the abdomen to the groin. (The lower abdomen and groin are pathways for the Three Yin meridians and Chong Mai. Cold invasion here causes mutual traction and pain.)
When cold lodges in the membranes and collaterals of the Small Intestine, blood stagnates and cannot enter the major meridians. Qi/blood stagnation over time forms an accumulation. (The Small Intestine receives and transforms food. Cold in the membranes/collaterals causes blood stasis, preventing entry into major meridians. Prolonged stagnation creates masses.)
When cold lodges in the Five Zang organs, causing rebellious Qi to escape upward, Yin essence is exhausted, and Yang fails to enter. This causes sudden death-like pain and unconsciousness; life returns when Qi recovers. (Cold damages Zang Qi, preventing descent, causing true Yin depletion and Yang failure to enter. Recovery depends on Zang Qi restoration.)
When cold lodges in the stomach/intestines, causing rebellious Qi to exit upward, pain and vomiting occur. (Food/water in Fu organs should descend. Cold causes upward rebellion, leading to pain and vomiting.)
When cold lodges in the Small Intestine, impairing its function of gathering and transforming, diarrhea and abdominal pain result. (The Small Intestine is the Fire Fu organ. Cold overwhelms it, failing to transform fluids/food, causing diarrhea and pain.)
When hot pathogen remains in the Small Intestine, intestinal pain, intense heat, thirst, and dry hard stools occur, leading to pain and constipation. (Heat in the Small Intestine is a Yang organ/Yang disease, causing heat, dehydration, dryness, and obstruction.)
Regarding pain treatment: Some say "no tonification for pain," others "free flow means no pain, pain means blockage," and "pain vanishes with discharge." These are widely accepted as immutable rules. However, "Li" (discharge/freeing) means "Tong" (unblocking), not necessarily purgation. For exterior excess, use sweating to unblock; for interior excess, use purgation to unblock; for Qi/blood excess, use dispersing/moving methods to unblock. Yet, pain has deficiency and excess types, requiring tonifying and reducing methods respectively. Differentiation is crucial: Distension/obstruction suggests excess; lack thereof suggests deficiency. Rejection of pressure suggests excess; acceptance suggests deficiency. Preference for cold suggests excess; preference for warmth suggests deficiency. Worsening after eating suggests excess; worsening on an empty stomach suggests deficiency. Excess pulse/rough breath suggests excess; deficient pulse/faint breath suggests deficiency. New onset in young adults suggests excess; worsening with attack suggests deficiency. Meridian pain often shows wiry/large pulses; Zang pain shows deep/faint pulses. Pulse and symptoms must be combined for accurate differentiation. Can deficiency pain be treated with draining? Incorrect draining causes harm. Exterior deficiency pain requires warming the meridians (Yang insufficiency). Interior deficiency pain requires nourishing Ying blood (Yin insufficiency). Upper deficiency pain (Heart/Spleen injury) requires middle-tonification. Lower deficiency pain (fluid loss/Yin exhaustion) requires urgent Spleen/Kidney rescue and Mingmen warming. Ancient masters used warming/tonifying methods for pain; Xue Lizhai excelled in this. Why did Zhu Danxi claim "all pains should not be tonified"? Such limited views are misguided.