腹痛不一，有食、有气、有火、有冷、有虫、有积，俱似痧非痧，不可无辨。食者，失饥伤饱，聚中脘作痛，其症
遇食即疼，胸膈饱闷，似痧者一，然按脉气口必然有力可辨。若因冷食入胃，食与寒气相搏于中，则心脾郁结，胸胁满
闷，中脘作痛，似痧者二，然按脉气口必然无力，但有嘈杂冲胸，嗳气吞酸可辨。气者因怒气所伤，不得发越，胸膈气
塞冲激心脾，呕逆恶心，吐不能出，其疼手不可按，坐卧不定，奔走叫呼，似痧者三，然按脉两关必然洪大，余部俱必
应指，及刮之无痧，痧筋不现，可辨。火者，因热作痛，胃火上逆，呕吐酸水，必然口渴欲饮，饮入即吐，其症手足温
暖，面带阳色，似痧者四，然按脉六部洪数，又与痧类，难以细分，必看痧筋，兼用刮法可辨。冷者，人属虚寒，沉寒
作痛，其脉必然平软，似痧者五，但饮热则安，饮冷痛发可辨。虫者，胃脘疼痛有如刀触，痛极按心搔爬难定。兼之脉
息无伦，徐疾不一，似痧者六，然虫必有因，各有所喜，如茶虫喜食茶叶，糖虫喜食糖物，或泥或絮，或酒或盐，其为
虫也，必有一好，食之便安，若遇槟榔、五灵脂杀虫等药，或药性力薄，不能驱逐而出，势必咬齿翻动肠胃，更加疼痛，
可辨。积者，旧有宿积，聚结肠胃，忽因行动，作痛作疼，似痧者七，然痧筋罕现，刮痧无影，可辨。如是辨之的确，
方知痧痛详明，治之得法。然此诸痛，又有兼痧者，将论脉阅筋而加察焉，鲜有不得其理矣。
腹痛的原因多种多样，有因饮食、气滞、火邪、寒冷、虫积、食积引起的，这些症状都看似痧症而非真正的痧症，因此必须加以辨别。
饮食所伤，是由于饥饱失常，食物停滞在中脘部位引起疼痛，其症状是进食后立刻疼痛，胸膈部饱闷胀满，这是与痧症相似的第一种情况，然而按压脉象时，气口脉必然有力，据此可以辨别。
如果是因冷食进入胃部，食物与寒气在体内相互搏结，导致心脾郁结阻滞，胸胁部满闷胀满，中脘部位作痛，这是与痧症相似的第二种情况，然而按压脉象时，气口脉必然无力，但伴有胃中嘈杂感冲激心胸，嗳气并吞酸水，据此可以辨别。
气滞是因为愤怒情绪所伤，气机不得疏泄发散，胸膈部气机堵塞冲激心脾，出现呕吐逆气、恶心，想吐却吐不出来，其疼痛程度剧烈到不可触碰，坐卧不安，奔走呼叫，这是与痧症相似的第三种情况，然而按压脉象时，左右关脉必然洪大，其余部位的脉象也都应指明显，且刮痧后无痧点显现，痧筋不现，据此可以辨别。
火邪所致疼痛，是因热邪引起，胃火上逆，呕吐酸水，必然口渴想要饮水，但饮水后立即吐出，其症状表现为手足温暖，面色呈现阳热之色，这是与痧症相似的第四种情况，然而按压脉象时，六部脉象均洪大而数，这与痧症类似，难以细致区分，必须观察是否有痧筋，并结合使用刮痧法来辨别。
寒冷所致疼痛，是人体属于虚寒体质，沉寒痼冷引起疼痛，其脉象必然平软无力，这是与痧症相似的第五种情况，但饮用热水则疼痛缓解，饮用冷水则疼痛发作，据此可以辨别。
虫积所致疼痛，胃脘部疼痛如同刀刺，疼痛极度剧烈，按之心腹搔爬难安。兼见脉息杂乱无章，快慢不一，这是与痧症相似的第六种情况，然而虫积必有成因，每种虫各有喜好，如茶虫喜欢茶叶，糖虫喜欢糖类食物，有的喜欢泥土或棉絮，有的喜欢酒或盐，既然是虫，必然有一种嗜好，吃了喜欢的东西就会感到舒适；如果遇到槟榔、五灵脂等杀虫药物，或者药力薄弱，不能将虫驱逐出去，虫子势必会咬齿翻动肠胃，使疼痛加剧，据此可以辨别。
食积所致疼痛，是指旧有的宿食积滞，聚结在肠胃之中，忽然因为行动劳累，引发疼痛，这是与痧症相似的第七种情况，然而痧筋很少显现，刮痧也没有反应，据此可以辨别。
这样确切地辨别之后，才知道痧痛的详细机理，治疗才能得当。然而这些种类的疼痛，又有兼夹痧症的情况，需要结合诊察脉象和观察痧筋来进行更细致的检查，很少有不掌握其中道理的。
Abdominal pain arises from various causes, including food stagnation (Food), Qi stagnation (Qi), Fire pathogen (Fire), Cold pathogen (Cold), intestinal parasites (Worms), and accumulated food retention (Accumulation). These conditions all resemble Sha syndrome (Sha Syndrome, a condition characterized by heat-toxin accumulation and blood stasis) but are not true Sha, thus requiring differentiation.
Food injury results from irregular eating habits, causing food to accumulate in the Zhongwan area (CV12, Conception Vessel 12) and cause pain. The symptoms include immediate pain upon eating and fullness/stuffiness in the chest and diaphragm. This is the first case resembling Sha. However, palpation of the Qi Kou pulse (Radial Artery at the wrist, specifically the distal segment often used for diagnosis) will reveal forceful pulses, allowing for differentiation.
If cold food enters the stomach, the food and cold pathogen contend within the middle jiao, leading to depression and knotting in the Heart and Spleen. Symptoms include fullness and stuffiness in the chest and hypochondrium, and pain in the Zhongwan area. This is the second case resembling Sha. However, palpation of the Qi Kou pulse will reveal weak pulses, accompanied by gastric discomfort rushing to the chest, belching, and acid regurgitation, allowing for differentiation.
Qi stagnation results from emotional injury due to anger, preventing the free flow and dispersal of Qi. Qi blocks and rushes against the Heart and Spleen in the chest and diaphragm, causing vomiting, nausea, and an inability to expel vomitus. The pain is so severe that it cannot be touched, leading to restlessness in sitting or lying down, running about, and shouting. This is the third case resembling Sha. However, palpation reveals surging (Hong) pulses at both Guan positions (middle position on the radial artery, corresponding to Liver/Gallbladder and Spleen/Stomach), while other pulse positions are also distinct. Furthermore, scraping therapy yields no Sha spots, and Sha veins (distended superficial veins) do not appear, allowing for differentiation.
Pain caused by Fire results from heat, with Stomach Fire reversing upward, causing vomiting of sour fluid. There is必然 thirst and desire to drink, but drinking leads to immediate vomiting. Symptoms include warm hands and feet and a facial complexion reflecting Yang heat. This is the fourth case resembling Sha. However, palpation reveals surging and rapid pulses in all six pulse positions. Since this resembles Sha closely, fine differentiation is difficult; one must observe for Sha veins and employ scraping therapy for differentiation.
Pain caused by Cold occurs in individuals with deficiency-cold constitutions, where deep-seated cold causes pain. The pulse is necessarily flat and soft. This is the fifth case resembling Sha. However, drinking hot water brings relief, while drinking cold water triggers pain, allowing for differentiation.
Pain caused by worms involves epigastric pain feeling like a knife touch, extremely severe, causing the patient to scratch the heart and abdomen in distress. The pulse is chaotic and irregular in speed. This is the sixth case resembling Sha. However, worm infestation has specific causes; each type of worm has preferences. For example, "tea worms" prefer tea leaves, and "sugar worms" prefer sweets. Some prefer mud, cotton, wine, or salt. Being worms, they have a preference; consuming their preferred item brings comfort. If treated with vermifuges such as Areca Seed (Arecae Semen) or Trogopterus Dung (Excrementa Trogopterori), or if the medicinal potency is too weak to expel them, the worms may bite and churn the intestines and stomach, exacerbating the pain, allowing for differentiation.
Pain caused by Accumulation refers to old food retention gathering in the intestines and stomach. Sudden movement or exertion triggers pain. This is the seventh case resembling Sha. However, Sha veins rarely appear, and scraping yields no reaction, allowing for differentiation.
By differentiating accurately in this manner, one understands the detailed mechanisms of Sha pain and can apply appropriate treatments. However, these various pains may also coexist with true Sha. Therefore, one must examine the pulse and inspect the Sha veins for further observation. It is rare for one who does so to fail to grasp the underlying principles.