举痛论云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
卒然
而止者或痛甚不可按或按之痛止或按之无益或喘动应手者或胁肋与少腹相引而痛者或腹痛引
阴股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各不同形
按本论具以上病形异候皆寒气所因甚详宜玩本文唯痛而闭不通为热气留于小肠肠中痛瘅
热焦渴则坚干不得出为热痛此述病机寒热皆能为痛也盖寒痛者多热痛者少
脉经曰脉细小紧急病速进在中腹中刺痛 阴弦则腹痛 弦急小腹痛 尺脉紧脐下痛 尺
脉伏
小腹痛症疝 尺脉实小腹痛当利之 心腹痛痛不得息脉细小迟者生坚大疾者死 腹痛脉反浮
大而长者死伤寒论曰伤寒脉阳涩阴弦腹中急痛里有虚寒
成无己云阴寒为邪者则腹满而吐食不下自利益甚腹自痛太阴证也发汗不解医反下之因而
腹满时痛者属太阳也桂枝加芍药汤主之大实痛者桂枝加大黄汤主之
东垣曰腹中诸痛皆因劳役过甚饮食失节中气不足寒邪乘虚而入客之故卒然而作大痛经言
得炅则止炅者热也以热治寒治之正也然腹痛有部分脏位有高下治之者宜分之
按以上脉证言诸虚痛矣然邪传入里热结下焦实满血结硬痛皆实痛也脉经云腹满按之不痛
为虚痛者为实此述病机虚实之异又兼部分高下言也
《举痛论》说：寒气侵入经脉，运行迟缓凝涩而不通畅。如果寒气客于脉外，则血液亏少；如果寒气客于脉中，则气机不通畅，所以突然发生疼痛。这种疼痛有的突然停止，有的疼痛剧烈不能按压，有的按压后疼痛缓解，有的按压后无益，有的疼痛跳动应手，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，有的突然剧痛昏厥不省人事，过一会儿又苏醒，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。各种疼痛形态各不相同。根据本篇论述，上述这些不同的病状和表现，都是由于寒气引起的，记载得非常详细，应当仔细研读本文。只有“疼痛伴有大便闭塞不通”这一种情况，是热气留滞于小肠，肠中热毒炽盛，灼伤津液导致焦渴，粪便坚硬干燥无法排出，这属于热痛。这里阐述了寒热两种病因都能引起疼痛的道理。大概寒性疼痛较多，热性疼痛较少。
《脉经》说：脉象细小紧急，病情迅速进展，病位在中腹，表现为刺痛。脉象阴弦则腹痛，脉象弦急则小腹痛。尺脉紧，脐下疼痛；尺脉伏，小腹痛，症见疝气；尺脉实，小腹痛，应当通利大便。心腹疼痛，呼吸受阻，脉象细小迟的预后良好（生），脉象坚大疾速的预后不良（死）。腹痛脉象反而浮大而长的，预后不良（死）。
《伤寒论》说：伤寒病，脉象阳涩阴弦，腹中拘急疼痛，这是里有虚寒。
成无己说：如果是阴寒之邪致病，就会出现腹部胀满、呕吐、饮食不下、自发性腹泻且日益加重、腹部自然疼痛，这是太阴证的表现。如果发汗后病不解，医生反而使用攻下法，导致腹部胀满、时发疼痛的，属于太阳病兼证，用桂枝加芍药汤主治；如果疼痛严重且属实证的，用桂枝加大黄汤主治。
李东垣说：腹中各种疼痛，都是因为过度劳累、饮食失节，导致中气不足，寒邪乘虚而入侵袭人体，所以突然发作。大抵痛经言说遇到温热就会停止，“炅”就是热的意思，用温热的方法治疗寒证，是正确的治法。然而腹痛有具体的部位，脏腑位置有高下之分，治疗时应当加以区分。
按语：以上脉证言说了各种虚性疼痛。然而邪气传入体内，热结于下焦，出现实证胀满、血结硬痛等，都属于实痛。《脉经》说：腹部胀满但按压不痛的为虚证，按压疼痛的为实证。这里阐述了虚实性质的差异，同时也涉及了病变部位高下的区别。
The *Ju Tong Lun* (Treatise on Pain) states: When cold qi enters the meridians, its movement becomes sluggish and congealed, failing to flow smoothly. If cold lodges outside the vessels, blood volume decreases; if it lodges inside the vessels, qi circulation is obstructed, resulting in sudden pain. This pain may cease suddenly, or be so severe that it cannot be pressed upon; pressing may relieve the pain, or have no effect; the pain may pulsate and be felt under the hand; there may be pulling pain between the hypochondrium and the lower abdomen; abdominal pain may radiate to the medial thigh; sudden severe pain may cause fainting and loss of consciousness, with recovery after a short while; pain may be accompanied by vomiting; abdominal pain may be followed by diarrhea; or pain may be accompanied by constipation. The forms of these pains vary greatly. According to this treatise, all the aforementioned pathological manifestations and symptoms are caused by cold qi, recorded in considerable detail, and the original text should be studied carefully. Only the case of "pain accompanied by constipation" is due to heat qi lingering in the small intestine, where intestinal heat toxicity is flourishing, scorching fluids causing dryness and thirst, leading to hard, dry feces that cannot be expelled; this is classified as heat pain. This describes the pathogenesis that both cold and heat can cause pain. Generally, cold-induced pains are more common, while heat-induced pains are less frequent.
The *Mai Jing* (Pulse Classic) states: A pulse that is fine, small, and urgent indicates rapid disease progression, with the pathology located in the middle abdomen, presenting as stabbing pain. A yin-chord-like pulse indicates abdominal pain; a string-taut and urgent pulse indicates lower abdominal pain. A tight chi pulse indicates pain below the umbilicus; a hidden chi pulse indicates lower abdominal pain and hernia syndromes; a solid chi pulse indicates lower abdominal pain, which should be treated by promoting bowel movements. For heart and abdominal pain with difficulty breathing, a fine, small, and slow pulse indicates a favorable prognosis (life), whereas a firm, large, and rapid pulse indicates an unfavorable prognosis (death). Abdominal pain with a pulse that is unexpectedly floating, large, and long indicates an unfavorable prognosis (death).
The *Shang Han Lun* (Treatise on Cold Damage Disorders) states: In cold damage diseases, a pulse that is superficially choppy and internally string-taut, accompanied by acute abdominal pain, indicates deficiency-cold within.
Cheng Wuji stated: When yin-cold acts as the pathogenic factor, it causes abdominal fullness, vomiting, inability to eat, spontaneous diarrhea that worsens, and spontaneous abdominal pain; this is a Taiyin syndrome. If sweating fails to resolve the condition and the physician erroneously applies purgation, resulting in abdominal fullness and intermittent pain, it belongs to the Taiyang stage complications, and Guizhi Jia Shaoyao Tang (Cinnamon Twig Decoction plus Peony Root) should be used as the primary treatment. For cases of severe pain indicating excess, Guizhi Jia Dahuang Tang (Cinnamon Twig Decoction plus Rhubarb) should be used.
Li Dongyuan stated: Various types of abdominal pain arise from excessive labor and improper diet, leading to insufficiency of Middle Qi, allowing cold pathogens to invade due to deficiency, thus causing sudden onset. Generally, as mentioned in the Da Jing, pain relieved by warmth ("Jiong," meaning heat) confirms that treating cold with heat is the correct approach. However, abdominal pain has specific locations, and the zang-fu organs are situated at different heights; therefore, treatment must distinguish between them.
Commentary: The aforementioned pulse discussions describe various deficiency-type pains. However, when pathogens transmit inward, heat binds in the lower jiao, presenting with excess fullness, blood stasis causing hard pain, etc., these are all excess pains. The *Mai Jing* states: Abdominal fullness without pain upon palpation indicates deficiency; pain upon palpation indicates excess. This elucidates the difference between excess and deficiency pathologies, while also addressing the high and low positions of the affected areas.