凡泻痢腹痛，有实热者，有虚寒者。实热者，或因食积，或因火邪。但食积之痛，必多
胀满坚硬，或痛而拒按，此必有所停滞，微者宜行其滞，甚者宜泻而逐之。火邪之痛，
必有内热等证，方宜清之利之。然邪实于中者，必多气逆，故凡治痛之法，无论是火是食，
皆当以行气为先，但宜察药性之寒热，择而用之可也。虚寒之痛，尤所当辨，盖凡泻痢之痛
，多由寒气之在脏也。经曰∶痛者，寒气多也，有寒故痛也。又曰∶病痛者，阴也。故凡人
有过食生冷，或外受寒气，即能腹痛，此可知也。寒在中者，治宜温脾，寒在下者，治宜温
肾也。再若虚寒刮痛之义，则人多不知，盖元气不足于内，则虽无外受寒邪，而中气不暖，
即寒证也。所以泻痢不能止，饮食不能化，而病有不能愈，正以阳虚多寒也。且泻痢不止，
胃气既伤，膏血切肤，安能不痛？此其为痛，乃因剥及肠脏而然。是以痢因于痛，痛因于痢
，故凡以寒侵腑脏及脉络受伤，血动气滞者，皆能为痛。但察其不实不坚，或喜揉按，或喜
暖熨，或胸腹如饥而不欲食，或胃脘作呕而多吞酸，但无实热等证，则总属虚寒，安得谓痛
必因积，积皆实证耶？
凡治虚寒之痛者，速宜温养脏气，不得再加消伐，致令动者愈动，滑者愈滑，必至危矣
。若谓诸痛不宜补，必待痛定然后可用，则元气日去，终无定期。尝见一医云∶痢疾须过七
日，方可用补。而不知六日已死，执迷不悟，愚亦甚矣！但其痛之甚者，当于温补药中稍加
木香以顺其气，或多加当归以和其血，俟痛稍减，则当去此二味，盖又恐木香之耗气，当归
之滑肠也。若寒在下焦而作痛者，必加吴茱萸，其或痛不至甚，则但以温补脾肾为主，使脾
肾渐安，则痛当自止，此不必治其痛也。
凡是出现腹泻、痢疾并伴有腹痛的情况，有属于实热证的，也有属于虚寒证的。实热证，可能是因为饮食积滞，也可能是因为火邪作祟。如果是饮食积滞引起的疼痛，必然伴随腹部胀满坚硬，或者疼痛且拒绝按压，这必定是有病理产物停滞体内，病情轻的应当行气导滞，病情重的应当泻下攻逐。如果是火邪引起的疼痛，必然伴有内热等症状，这才适合用清热利湿的方法治疗。然而，邪气实于中焦，往往会导致气机逆乱，所以凡是治疗疼痛的方法，无论是火邪还是食积，都应当以行气为首要原则，但适宜考察药物的寒热属性，选择使用即可。
虚寒证的疼痛，尤其需要仔细辨别，大概腹泻和痢疾的疼痛，多是由寒气在脏腑所致。《内经》说：“疼痛，是因为寒气多，因为有寒所以痛。”又说：“病痛的性质，属于阴。”所以人如果吃了过多的生冷食物，或者外感寒气，就会导致腹痛，这是显而易见的。寒气在中焦的，治疗宜温补脾阳；寒气在下焦的，治疗宜温补肾阳。
另外关于“虚寒刮痛”的含义，人们大多不了解。这是因为元气内部不足，虽然没有外来的寒邪侵袭，但中气不温暖，这也属于寒证。所以腹泻痢疾不能停止，饮食不能消化，疾病不能痊愈，正是因为阳气虚弱导致多寒。而且腹泻痢疾不止，胃气已经受损，膏脂精血紧贴肠壁（意指肠道黏膜受损），怎么能不痛？这种疼痛，是由于损耗波及到肠脏而造成的。因此痢疾因为疼痛而加重，疼痛因为痢疾而产生，所以凡是寒气侵犯腑脏以及脉络受伤，导致血行妄动、气机阻滞的，都能引起疼痛。只要观察其腹部不实不硬，或者喜欢揉按，或者喜欢热敷，或者胸腹感觉像饥饿但不想吃东西，或者胃脘部呕吐且多吞酸水，只要没有实热等症状，就总属于虚寒证，怎么能说疼痛一定因为积滞，积滞都是实证呢？
凡是治疗虚寒引起的疼痛，应当迅速温养脏腑之气，不得再使用消伐（攻伐）的药物，否则会导致气血动荡者更加动荡，滑泄者更加滑泄，必然导致危重局面。如果说各种疼痛不宜进补，一定要等到疼痛停止后才能用药，那么元气就会一天天消耗，最终没有定期恢复的时候。我曾经见到一位医生说：“痢疾必须过七天，才可以使用补药。”却不知道病人第六天就已经死了，固执迷惑不知醒悟，真是愚蠢至极！但是如果疼痛严重的，应当在温补药中稍微加入木香来顺气，或者多加当归来调和血液，等到疼痛稍减，就去掉这两味药，大概是担心木香耗气、当归滑肠的缘故。如果寒气在下焦引起疼痛的，必须加入吴茱萸；如果疼痛不至于严重，就以温补脾肾为主，使脾肾逐渐安定，那么疼痛自然停止，这就叫做不必专门治疗疼痛（而是治本）。
In cases of diarrhea and dysentery accompanied by abdominal pain, there are patterns of excess-heat and deficiency-cold. Excess-heat may arise from food stagnation or fire pathogenic factors. Pain due to food stagnation is invariably associated with abdominal distension, fullness, and hardness, or pain that refuses pressure; this indicates the presence of retained pathogenic material. In mild cases, promoting qi movement to resolve stagnation is appropriate; in severe cases, purging to drive out the retention is indicated. Pain caused by fire pathogenic factors must present with signs of internal heat, warranting clearing and draining methods. However, when pathogens are excessive in the middle jiao, qi rebellion often occurs. Therefore, regardless of whether the cause is fire or food, treating pain should prioritize regulating qi. One must observe the cold or hot nature of the medicinal properties and select accordingly.
Pain due to deficiency-cold requires particular differentiation. Generally, pain in diarrhea and dysentery stems from cold pathogens residing in the zang-fu organs. The *Classic of Difficult Issues* states: "Pain is due to an abundance of cold; because there is cold, there is pain." It also states: "Painful conditions belong to yin." Thus, if one consumes excessive raw or cold foods, or contracts external cold, abdominal pain ensues, which is evident. When cold resides in the middle jiao, treatment should warm the spleen; when cold resides in the lower jiao, treatment should warm the kidney.
Furthermore, the concept of "scraping pain due to deficiency-cold" is often misunderstood. This occurs because internal yuan qi (original qi) is insufficient. Even without external cold invasion, if the middle qi lacks warmth, it constitutes a cold pattern. Consequently, diarrhea and dysentery cannot cease, food cannot be transformed, and the disease cannot resolve, primarily due to yang deficiency generating internal cold. Moreover, persistent diarrhea and dysentery damage stomach qi, causing the essence and blood to adhere closely to the intestinal walls; how can there be no pain? This type of pain arises from depletion affecting the intestines and viscera. Thus, dysentery exacerbates pain, and pain generates dysentery. Any condition where cold invades the fu organs, meridians are injured, blood moves recklessly, and qi stagnates can cause pain. If the abdomen is not firm or hard, or if the patient prefers rubbing/massage, warming compresses, feels hungry but has no appetite, or experiences epigastric vomiting with acid regurgitation, provided there are no signs of excess-heat, it belongs entirely to deficiency-cold. How can one claim that pain is always due to accumulation and that all accumulations are excess patterns?
When treating pain due to deficiency-cold, one must quickly warm and nourish the zang-fu qi. One must not add dispersing or attacking herbs, lest they cause moving qi to move further and sliding bowels to slide more, leading to critical danger. Some argue that tonification is contraindicated for all pains until the pain subsides; however, this leads to daily depletion of yuan qi with no fixed time for recovery. I have seen physicians claim that for dysentery, tonification should only be used after seven days, unaware that the patient may die on the sixth day. Such obstinate ignorance is foolish. However, if pain is severe, a small amount of *Aucklandiae Radix* (Muxiang) may be added to the warming and tonifying formula to smooth qi, or *Angelicae Sinensis Radix* (Danggui) may be increased to harmonize blood. Once pain subsides slightly, these two herbs should be removed, as *Aucklandiae Radix* may consume qi and *Angelicae Sinensis Radix* may cause loose stools. If pain arises from cold in the lower jiao, *Evodiae Fructus* (Wuzhuyu) must be added. If pain is not severe, the primary approach should be warming and tonifying the spleen and kidney. As the spleen and kidney gradually stabilize, the pain will cease naturally; this is known as treating the root rather than the symptom directly.