马云。首篇悉举诸痛。以为问答。故名篇。吴据新校正。改作卒痛。
必有验于人 国语楚语。楚右尹子革曰。民。天之生也。知天必知民矣。
必有厌于己 张云。厌。足也。高云。厌。弃也。弃其非。而从其是也。简按张注为是。
要数极 简按玉版论要篇云。至数之要。迫近以微。
明明也 宋本无一明字。志高根据此。简按考王注意。宋本近是。
如发蒙解惑 宋本。如。作而。简按蒙。 同。刺节真邪论。二曰发 。礼记仲尼燕居。昭然若发
矣。又东方朔七谏。幸君之发 。汉扬雄传。发 廓然。窦融传。旷若发 。（晋顾恺之作启 记。朱子有易学
启蒙。）诗毛传。有眸子而无见。曰 。王充论衡云。人未学问曰 。 者。竹木之类也。并可以证。王注未允。
稽迟 说文。稽。留止也。
缩 熊音。 。贝员反。 不伸也。
绌急 释音。绌。丁骨切。张云。绌。屈曲也。简按广韵。绌。竹律切。音 。荀子非相篇。缓急
嬴绌。注。犹言伸屈也。
炅 熊音。古惠反。烟出貌。唐椿原病集云。灵。音翎。
小热貌。内经举痛论云。寒气客于脉外。引小络而痛。得灵则痛止。注云。灵。热也。考篇韵中。炅。明也。
与热无干。查有灵。是小热貌。恐传写者。误灵为炅。未审是否。宜当考读。（考字典。炅。唐韵。古迥切。
音颖。说文。见也。广韵。光也。灵。广韵。郎丁切。音灵。字类。小热貌。正字通。俗灵字。）简按熊唐并
误。高云。炅。 同。热也。（集韵。 。俱永切。音憬。炎蒸也。字汇。居永切。）通雅云。灵素之炅。当
与热同。此说为得。
而不可按也 滑云。此当作痛甚不休也。
膜原之下 简按王注疟论云。募原。谓膈膜之原系。与此注异。
挟脊之脉 张云。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。志云。伏
冲之脉也。深者。谓邪客于挟脊之冲脉则深。在于腹之冲脉。则浮于外而浅矣。简按冲脉有浮沉之别。见于灵
五音五味篇。志注义长矣。
起于关元 马云。按骨空论云。冲脉起于气冲。今曰关元者。盖任脉当脐中而上行。冲脉挟脐两旁
而上冲。则本起于气冲。而与任脉并行。故谓之起于关元。亦可也。张云。关元。任脉穴。在脐下三寸。冲脉
起于胞中。（出五音五味篇。）即关元也。
因之 吴云。气从之也。
喘动应手 马云。发喘而动。则应手而痛也。志云。人迎气口。喘急应手也。简按王吴张并不释。
盖此指腹中筑动而言。灵百病始生篇云。其着于伏冲之脉者。揣之应手而动。是也。喘。或者与 通。 音软。
说文。动也。马志注恐非也。
按之则热气至热气至则痛止矣 滑云。以上十三字。不
知何所指。简按高本。此十三字。移于第四对。故按之痛止之下。文脉贯通。极是。
在下相引 吴作上下相引。非也。
小肠膜原之间 简按上文云。肠胃之间。膜原之下。张云。膜。筋膜也。原。肓之原也。肠胃之间。
膜原之下。皆有空虚之处。以原为肓之原。恐误。百病始生篇云。舍于肠胃之外。募原之间。又云。着于肠胃
之募原。太阴阳明论云。脾与胃以膜相连。盖脏腑之间。有膜而相遮隔。有系而相连接。此即膜原也。故王注
疟论云。膈膜之原系。马注始生篇云。肠胃之外。膜原之间者。即皮里膜外也。此说近是。
大经 志云。脏腑之大络也。简按百病始生篇云。其痛之时息。大经乃代。离合真邪论云。反乱大
经。皆其义也。
宿昔而成积矣 志云。宿昔。稽留久也。高云。匪朝伊芳夕。故痛于宿昔。汪昂云。按此即今之小肠气也。
厥逆上泄 吴云。上泄。吐涌也。涌逆既甚。阴气必竭。
阴气竭阳气未入 马云。阴经之气竭。卫气不得入。故寒气壅滞。高云。阴气竭于内。阳气虚于外。
不能即入于阴。阴气竭。阳气未入。故卒然痛。死不知人。少间则阴气竭而得复。阳气未入而得反。乍剧乍苏
则生矣。
不得成聚 张云。水谷不得停留。志云。不成积聚。而后泄腹痛也。简按王注为是。
热气留于小肠 吴云。此明腹痛而闭不通者。简按本篇。叙腹痛一十四条。属热者止一条。余皆属寒。
王氏证治准绳有说。当参考。又史载之方。举每证。附以脉候及治方。文繁不录。宜参。
固尽有部 简按吴改固作面。泥矣。
视其五色 马云。按灵枢五色篇第四节。义与此同。
飧泄 简按甲乙。太素。作食而气逆。然经脉篇。肝所主病。呕逆飧泄。未必改字。
肺布叶举 志云。肺脏布大。而肺叶上举。简按此据全注。今从之。
上焦不通荣卫不散 吴云。二不字。非也。
精却 吴云。却。却步之却。退也。
故气不行矣 新校正。不。作下。考上文。作下为是。吴亦从之。马则云。作下行者。不知经脉之行
故也。张亦引本神篇。忧愁者。气闭塞而不行。而证之。并难凭矣。
气不行 新校正引甲乙。似是。吴云。气。荣卫表气也。亦通。
外内皆越 马云。人有劳役。则气动而喘息。其汗必出于外。夫喘则内气越。汗出则外气越。故以
之而耗散也。
马云说：首篇全面列举各种疼痛，采用问答的形式，因此命名为该篇。吴崑根据《新校正》的内容，将题目改为“卒痛”（突然发生的疼痛）。
百姓（民众）必定在自身有所验证。《国语·楚语》中，楚国右尹子革说：“百姓，是上天所生的，知晓天意必定知晓民意。”
必定对自己感到满足（或厌恶/舍弃）。张景岳注解说：“厌，意为满足。”高世栻注解说：“厌，意为舍弃。舍弃错误的，而遵循正确的。”丹波元简按语认为张景岳的注解是正确的。
要数达到极致。丹波元简按语：《素问·玉版论要篇》中说：“至数的要领，迫近而精微。”
明明白白。宋本中没有“一明”二字。高世栻据此进行考证。丹波元简按语：考察王冰的注释，宋本更接近原意。
如同揭开蒙蔽、解除困惑。宋本中，“如”写作“而”。丹波元简按语：“蒙”同“朦”。《素问·刺节真邪论》中说：“二是发朦。”《礼记·仲尼燕居》中说：“昭然若发朦矣。”又见东方朔《七谏》：“幸君之发朦。”汉代扬雄传：“发朦廓然。”窦融传：“旷若发朦。”（晋代顾恺之作《启朦记》，朱熹有《易学启蒙》。）《诗经》毛亨传：“有眸子而无见，曰朦。”王充《论衡》说：“人未学问曰朦。”“朦”指竹木之类，都可以用来证明。王冰的注释不恰当。
稽留迟缓。《说文解字》：“稽，停留止息也。”
缩戾（屈曲不伸）。熊宗立注音为“熊音”，反切为“贝员反”。意为不伸展。
绌急（屈曲紧急）。释音：“绌”，丁骨切。张景岳注：“绌，屈曲也。”丹波元简按语：《广韵》中，“绌”，竹律切，音同“窘”。《荀子·非相篇》：“缓急嬴绌。”注解说：“犹言伸屈也。”
炅（热）。熊宗立注音为“古惠反”，意为烟出的样子。唐代椿《原病集》说：“灵，音翎。”小热的样子。《内经·举痛论》说：“寒气客于脉外，引小络而痛，得灵则痛止。”注解说：“灵，热也。”查考《篇韵》中，“炅”，意为明亮。与热没有直接关系。查得有“灵”，是小热的样子。恐怕是传抄者误将“灵”写成了“炅”，不知是否如此，应当考读。（查考字典：“炅”，《唐韵》古迥切，音颖。《说文》：见也。《广韵》：光也。“灵”，《广韵》郎丁切，音灵。《字类》：小热貌。《正字通》：俗“灵”字。）丹波元简按语：熊宗立和唐代均错误。高世栻说：“炅”同“灵”，意为热。（《集韵》：“灵”，俱永切，音憬，炎蒸也。《字汇》：居永切。）《通雅》说：“《灵枢》《素问》中的‘炅’，应当与‘热’相同。”这种说法比较妥当。
膜原之下。丹波元简按语：王冰注《疟论》说：“募原，谓膈膜之原系。”与此处的注释不同。
挟脊之脉。张景岳说：“挟脊者，足太阳经也。其最深者，则是伏冲、伏膂之脉，所以按压不能触及到它的位置。”高世栻说：“是伏冲之脉。”深层的意思是，邪气客居于挟脊的冲脉则位置深，而在腹部的冲脉，则浮于外表而浅。丹波元简按语：冲脉有浮沉的区别，见于《灵枢·五音五味篇》。高世栻的注解义理更长。
起于关元。马云说：按《骨空论》所说，冲脉起于气冲。现在说“起于关元”，大概是任脉当脐中而上行，冲脉挟脐两旁而上冲，那么本来起于气冲，而与任脉并行，所以说起于关元，也是可以的。张景岳说：“关元，是任脉穴位，在脐下三寸。冲脉起于胞中。”（出自《五音五味篇》）即关元穴。
因之（随之）。吴崑云：气随之而动。
喘动应手（搏动明显可触）。马云说：发喘而动，则手按之感到疼痛。高世栻说：人迎、气口脉搏，喘急应手可触。丹波元简按语：王冰、吴崑、张景岳都没有解释。大概这是指腹中筑动而言。《灵枢·百病始生篇》说：“其着于伏冲之脉者，揣之应手而动。”正是此意。“喘”或许与“輭”通假。“輭”音软，《说文》：“动也。”马云和高世栻的注释恐怕不对。
按压后热气到达，热气到达则疼痛停止。滑寿云：以上十三个字，不知道指代什么。丹波元简按语：高世栻本将这三十字移至第四对问答之后，所以在“故按之痛止”之下，文脉贯通，非常正确。
在下相互牵引。吴崑作“上下相引”，是不对的。
小肠膜原之间。丹波元简按语：上文说：“肠胃之间，膜原之下。”张景岳说：“膜，筋膜也。原，肓之原也。肠胃之间，膜原之下，皆有空虚之处。”以“原”为“肓之原”，恐怕有误。《百病始生篇》说：“舍于肠胃之外，募原之间。”又说：“着于肠胃之募原。”《太阴阳明论》说：“脾与胃以膜相连。”大概脏腑之间，有膜而相互遮隔，有系而相互连接。这就是膜原。所以王冰注《疟论》说：“膈膜之原系。”马莳注《百病始生篇》说：“肠胃之外，膜原之间者，即皮里膜外也。”这种说法接近正确。
大经。高世栻说：脏腑的大络。丹波元简按语：《百病始生篇》说：“其痛之时息，大经乃代。”《离合真邪论》说：“反乱大经。”都是这个意思。
经过一夜就形成了积聚。高世栻说：“宿昔”，稽留很久。另一说：“匪朝伊夕”，所以痛于一夜之间。汪昂说：按此即今之小肠气。
阴气竭，阳气未入。马云说：阴经之气竭，卫气不得入，所以寒气壅滞。高世栻说：阴气竭于内，阳气虚于外，不能立即进入阴分。阴气竭，阳气未入，所以突然疼痛，昏死不知人。过一会儿则阴气竭而得以恢复，阳气未入而得以返回，乍剧乍苏则能生存。
不能形成聚结。张景岳说：水谷不得停留。高世栻说：不成积聚，而后出现泄泻腹痛。丹波元简按语：王冰的注释是正确的。
热气留于小肠。吴崑说：这是说明腹痛而闭不通的情况。丹波元简按语：本篇叙述腹痛十四条，属热的只有一条，其余都属寒。王肯堂《证治准绳》中有相关论述，应当参考。又史载之方，列举每证，附以脉候及治方，文字繁杂不录，宜参看。
固尽有部（确实各有部位）。丹波元简按语：吴崑改“固”为“面”，拘泥了。
视其五色。马云说：按《灵枢·五色篇》第四节，义理与此相同。
飧泄（完谷不化的泄泻）。丹波元简按语：《甲乙经》、《太素》作“食而气逆”。然而《经脉篇》中，肝所主病有呕逆飧泄，未必改字。
肺布叶举。高世栻说：肺脏分布宽大，而肺叶上举。丹波元简按语：此据全元起注，现在遵从它。
精气退却。吴崑说：却，却是退步之却，退也。
所以气不行矣。《新校正》：“不”，作“下”。考察上文，作“下”是正确的。吴崑也遵从它。马云则说：作“下行”的人，是不懂经脉运行的缘故。张景岳也引用《本神篇》：“忧愁者，气闭塞而不行。”来证明，并不可靠。
Ma Yun states: The first chapter comprehensively lists various types of pain and adopts a question-and-answer format, hence the chapter title. Wu Kun, based on the *Xin Zheng* (New Corrections), changed the title to "Cu Tong" (Sudden Pain).
The people must have verification in themselves. In the *Guoyu · Chu Yu*, Zi Ge, the Right Yin of Chu, said: "The people are born from Heaven; knowing Heaven's will necessarily means knowing the people's will."
One must be satisfied with oneself (or reject/discard). Zhang Jingyue annotated: "Yan (厌) means satisfaction." Gao Shishi annotated: "Yan means rejection. Reject what is wrong and follow what is right." Danbo Yuanjian's commentary considers Zhang Jingyue's annotation correct.
The essential number reaches its extreme. Danbo Yuanjian's commentary: In the *Suwen · Yubai Lun Yao Pian*, it is stated: "The essence of the ultimate numbers is proximate and subtle."
Clearly and distinctly. The Song edition lacks the character "Yi Ming". Gao Shishi relied on this for his analysis. Danbo Yuanjian's commentary: Examining Wang Bing's annotations, the Song edition is closer to the original meaning.
Like removing a blindfold or resolving confusion. In the Song edition, "Ru" (like/as if) is written as "Er" (and/then). Danbo Yuanjian's commentary: "Meng" (blindfold) is identical to "Meng". In the *Suwen · Cijie Zhenxie Lun*, it states: "The second is Fa Meng (removing visual obstruction)." In the *Liji · Zhongni Yanju*, it states: "Clear as if removing a blindfold." Also seen in Dongfang Shuo's *Seven Laments*: "Hoping the ruler removes his blindfold." In the biography of Yang Xiong of the Han Dynasty: "Removing the blindfold, vast and clear." In the biography of Dou Rong: "Vast as if removing a blindfold." (In the Jin Dynasty, Gu Kaizhi wrote *Qi Meng Ji*, and Zhu Xi had *Yi Xue Qi Meng*.) In Mao Heng's commentary on the *Shijing*: "Having pupils but unable to see is called Meng." Wang Chong in *Lunheng* says: "A person who has not studied is called Meng." "Meng" refers to bamboo or wood categories, which can all serve as evidence. Wang Bing's annotation is inappropriate.
Delayed and slow. The *Shuowen Jiezi* states: "Ji (稽) means to stay and stop."
Contracted and twisted (not extending). Xiong Zongli provided phonetic readings: "Xiong sound," reverse cut "Bei Yuan fan." It means not extending.
Constricted and urgent. Phonetic explanation: "Chu (绌)," Ding Gu Qie. Zhang Jingyue annotated: "Chu means bent and curved." Danbo Yuanjian's commentary: In the *Guangyun*, "Chu," Zhu Lv Qie, sounds like "Jiong." In the *Xunzi · Feixiang Pian*: "Huanji Yingchu." The annotation states: "Still speaking of extension and contraction."
Jiong (Heat). Xiong Zongli provided phonetic reading: "Ancient Hui reverse cut," meaning the appearance of smoke emerging. Tang Chun's *Yuanbing Ji* states: "Ling (灵), sounds like Ling." A slight heat appearance. The *Neijing · Jutong Lun* states: "When cold qi lodges outside the vessels, pulling small collaterals causing pain, obtaining Ling stops the pain." The annotation states: "Ling means heat." Checking the *Pianyun*, "Jiong" means bright. It has no direct relation to heat. Checking records, there is "Ling," which is a slight heat appearance. It is likely that copyists mistakenly wrote "Jiong" instead of "Ling." Whether this is true remains to be examined and read. (Checking dictionaries: "Jiong," *Tangyun* Gu Jiong Qie, sounds like Ying. *Shuowen*: To see. *Guangyun*: Light. "Ling," *Guangyun* Lang Ding Qie, sounds like Ling. *Zilei*: Slight heat appearance. *Zhengzitong*: Colloquial form of "Ling.") Danbo Yuanjian's commentary: Both Xiong Zongli and Tang were mistaken. Gao Shishi says: "Jiong" is identical to "Ling," meaning heat. (*Jiyun*: "Ling," Ju Yong Qie, sounds like Jing, steaming heat. *Zihui*: Ju Yong Qie.) *Tongya* states: "The 'Jiong' in *Lingshu* and *Suwen* should be the same as 'heat.'" This view is appropriate.
And cannot be pressed. Hua Shou said: This should be interpreted as severe pain that does not cease.
Below the membrane source. Danbo Yuanjian's commentary: Wang Bing's annotation on *Nuelun* states: "Muyuan refers to the root system of the diaphragm membranes." This differs from the annotation here.
The vessels flanking the spine. Zhang Jingyue said: "Those flanking the spine are the Foot Taiyang Meridian. The deepest among them are the Fu Chong and Fu Lü vessels, so pressing cannot reach their location." Gao Shishi said: "It is the Fu Chong vessel." The deep aspect means that when pathogenic factors lodge in the Chong vessel flanking the spine, the location is deep; whereas in the abdominal Chong vessel, it floats on the exterior and is shallow. Danbo Yuanjian's commentary: The Chong vessel has distinctions between floating and sinking, as seen in the *Lingshu · Wuyin Wumei Pian*. Gao Shishi's annotation has superior reasoning.
Originating at Guanyuan. Ma Yun said: According to the *Gukong Lun*, the Chong vessel originates at Qichong. Now saying it "originates at Guanyuan" is likely because the Ren vessel runs upward through the center of the navel, while the Chong vessel rushes upward alongside both sides of the navel. Thus, originally originating at Qichong and running parallel with the Ren vessel, it can also be said to originate at Guanyuan. Zhang Jingyue said: "Guanyuan is an acupoint of the Ren vessel, located three cun below the navel. The Chong vessel originates in the uterus." (From the *Wuyin Wumei Pian*) which is Guanyuan.
Following it. Wu Kun said: Qi moves along with it.
Pulsating movement palpable by hand. Ma Yun said: When panting occurs with movement, pain is felt upon manual palpation. Gao Shishi said: At the Renying and Koucui points, the pulse is rapid and palpable. Danbo Yuanjian's commentary: Wang Bing, Wu Kun, and Zhang Jingyue did not explain this. It likely refers to the throbbing sensation in the abdomen. The *Lingshu · Bai Bing Shisheng Pian* states: "When it attaches to the Fu Chong vessel, palpating reveals pulsating movement." This is exactly the meaning. "Chuan" (panting) might be interchangeable with "Ruan" (soft/moving). "Ruan" sounds like "Ruan." The *Shuowen* states: "Movement." Ma Yun and Gao Shishi's annotations are likely incorrect.
Upon pressing, warm qi arrives; when warm qi arrives, pain ceases. Hua Shou said: These thirteen characters above are unclear in reference. Danbo Yuanjian's commentary: The Gao Shishi edition moved these thirteen characters to the fourth pair of questions, so under "therefore pressing stops the pain," the textual flow is coherent, which is extremely correct.
Pulling each other downwards. Wu Kun wrote "pulling each other up and down," which is incorrect.
Between the small intestine and the membrane source. Danbo Yuanjian's commentary: The text above states: "Between the intestines and stomach, below the membrane source." Zhang Jingyue said: "Membrane refers to fascia. Source refers to the origin of Huang (bladder fat). Between the intestines and stomach, below the membrane source, all are empty spaces." Interpreting "Source" as the "Origin of Huang" is likely erroneous. The *Bai Bing Shisheng Pian* states: "Settling outside the intestines and stomach, between the Muyuan." It also states: "Attaching to the Muyuan of the intestines and stomach." The *Taiyin Yangming Lun* states: "The spleen and stomach are connected by membranes." Generally, between the zang-fu organs, there are membranes that separate them and systems that connect them. This is the membrane source. Therefore, Wang Bing's annotation on *Nuelun* states: "The root system of the diaphragm membranes." Ma Shi's annotation on the *Bai Bing Shisheng Pian* states: "What is outside the intestines and stomach, between the membrane sources, is the space inside the skin and outside the membranes." This explanation is close to being correct.
Large vessels. Gao Shishi said: The large collaterals of the zang-fu organs. Danbo Yuanjian's commentary: The *Bai Bing Shisheng Pian* states: "When the pain temporarily subsides, the large vessels take over." The *Lihe Zhenyelun* states: "Disrupting the large vessels." All refer to this meaning.
Accumulations formed after one night. Gao Shishi said: "Suxi" means lingering for a long time. Another interpretation: "Not just morning but evening," thus painful overnight. Wang Ang said: According to this, it is equivalent to modern intestinal hernia (small intestine qi).
Rebellious counterflow with upper discharge. Wu Kun said: Upper discharge refers to vomiting and surging. If surging and rebellious are severe, yin qi must be exhausted.
Yin qi exhausted, yang qi has not entered. Ma Yun said: The qi of the yin meridians is exhausted, and defensive qi cannot enter, causing cold qi to stagnate. Gao Shishi said: Yin qi is exhausted internally, while yang qi is deficient externally and cannot immediately enter the yin. With yin qi exhausted and yang qi not yet entered, sudden pain and unconsciousness occur. After a short while, the exhausted yin qi recovers, and the unentered yang qi returns. Fluctuating between exacerbation and relief leads to survival.
Cannot form aggregations. Zhang Jingyue said: Food and fluids cannot remain stagnant. Gao Shishi said: Not forming accumulations, followed by diarrhea and abdominal pain. Danbo Yuanjian's commentary: Wang Bing's annotation is correct.
Warm qi remaining in the small intestine. Wu Kun said: This clarifies the condition of abdominal pain with blockage and lack of free passage. Danbo Yuanjian's commentary: This chapter narrates fourteen cases of abdominal pain; only one belongs to heat, while the rest belong to cold. Wang Ken-tang's *Zhengzhi Zhunsheng* contains relevant discussions, which should be consulted. Additionally, Shi Zaizhi's formulas list each syndrome with pulse indications and treatments; the text is too lengthy to record here, but consultation is recommended.
Indeed, each has its specific location. Danbo Yuanjian's commentary: Wu Kun changed "Gu" (indeed/solid) to "Mian" (face), which is pedantic.
Observe the five colors. Ma Yun said: According to Section 4 of the *Lingshu · Se Pai*, the principle is the same as this.
Sunxi (diarrhea with undigested food). Danbo Yuanjian's commentary: The *Jiayi Jing* and *Taisu* write it as "food and rebellious qi." However, in the *Jingmai Pian*, diseases governed by the liver include vomiting, rebellious qi, and sunxi; it is unlikely the characters were changed.
Lungs spread, leaflets elevated. Gao Shishi said: The lung organ spreads widely, and the lung leaflets elevate. Danbo Yuanjian's commentary: This follows Quan Yuanqi's annotation; we now adopt it.
Upper jiao blocked, ying and wei do not disperse. Wu Kun said: The two "bu" (not) characters are incorrect.
Essence retreats. Wu Kun said: Que means stepping back, i.e., retreating.
Therefore, qi does not move. The *Xin Zheng* correction states: "Bu" (not) should be "Xia" (down). Examining the preceding text, "Xia" is correct. Wu Kun also follows this. Ma Yun, however, said: Those who write "descending movement" do not understand the circulation of meridians. Zhang Jingyue also cited the *Benshen Pian*: "Those who worry have qi blocked and not moving," to prove this, but it is unreliable.
Qi does not move. The *Xin Zheng* cites the *Jiayi Jing*, which seems plausible. Wu Kun said: Qi refers to ying-wei surface qi. This is also acceptable.
Both interior and exterior are scattered. Ma Yun said: When humans engage in labor, qi moves and causes panting, and sweat inevitably emerges externally. Panting causes internal qi to scatter, and sweating causes external qi to scatter; therefore, using this method leads to consumption and dispersion.