素问·举痛论 Treatise on Pain
黄帝问曰：余闻善言天者，必有验于人；善言古者，必有合于今；善言人者，必有厌于己。如此，则道不惑而要数极，所谓明也。今余问于夫子，令言而可知，视而可见，扪而可得，令验于己而发蒙解惑，可得而闻乎。歧伯再拜稽首对曰：何道之问也。
帝曰：愿闻人之五藏卒痛，何气使然。歧伯对曰：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。
帝曰：其痛或卒然而止者，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，或脇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，有少闲复生者，或痛而呕者，或腹痛而后泄者，或痛而闭不通者，凡此诸痛，各不同形，别之柰何.
歧伯曰：寒气客于脉外，则脉寒，脉寒则缩蜷，缩蜷则脉绌急，则外引小络，故卒然而痛，得炅则痛立止，因重中于寒，则痛久矣。寒气客于经脉之中，与炅气相薄，则脉满，满则痛而不可按也。寒气稽留，炅气从上，则脉充大而血气乱，故痛甚不可按也。寒气客于肠胃之闲，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。寒气客于侠脊之脉，则深按之不能及，故按之无益也。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。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。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，故脇肋与少腹相引痛矣。厥气客于阴股，寒气上及少腹，血泣在下相引，故腹痛引阴股。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。寒气客于五藏，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。寒气客于肠胃，厥逆上出，故痛而呕也。寒气客于小肠，小肠不得成聚，故后泄腹痛矣。热气留于小肠，肠中痛，瘅热焦渴，则坚乾不得出，故痛而闭不通矣。帝曰：所谓言而可知者也。
视而可见，柰何。歧伯曰：五藏六府，固尽有部，视其五色，黄赤为热，白为寒，青黑为痛，此所谓视而可见者也。帝曰：扪而可得，柰何。歧伯曰：视其主病之脉坚而血，及陷下者，皆可扪而得也。
帝曰：善。余知百病生于气也，怒则气上，喜则气缓，悲则气消，恐则气下，寒则气收，炅则气泄，惊则气乱，劳则气耗，思则气结，九气不同，何病之生。歧伯曰：怒则气逆，甚则呕血及飱泄，故气上矣。喜则气和志达，荣卫通利，故气缓矣。悲则心系急，肺布叶举，而上焦不通，荣卫不散，热气在中，故气消矣。恐则精却，却则上焦闭，闭则气还，还则下焦胀，故气不行矣。寒则腠理闭，气不行，故气收矣。炅则腠理开，荣卫通汗大泄，故气泄。惊则心无所倚，神无所归，虑无所定，故气乱矣。劳则喘息汗出，外内皆越，故气耗矣。思则心有所存，神有所归，正气留而不行，故气结矣。
Huangdi asked: I have heard that one who speaks well of heaven must find confirmation in man; one who speaks well of antiquity must find correspondence in the present; one who speaks well of man must find application in himself. Only thus does the Way remain free of confusion and its essential principles reach their utmost — this is called illumination. Now I ask you, Master, for something that can be known through words, seen through observation, and grasped through palpation, so that it may be verified in myself, dispelling ignorance and resolving doubt. May I hear of it? Qibo bowed twice, touching his head to the ground, and replied: What is it you wish to ask concerning the Way?
Huangdi said: I wish to hear what qi brings about sudden pain in the five viscera of man. Qibo replied: The channels and vessels flow without cessation, circulating in an unending round. When cold qi enters a channel, it causes delay and stagnation; the blood congeals and does not move. When the cold lodges outside the vessel, blood becomes scant there; when it lodges within the vessel, the qi cannot pass through — hence sudden pain arises.
Huangdi said: In some cases the pain suddenly stops; in some it is severe and unceasing; in some it is so severe that pressure cannot be borne; in some pressure brings the pain to a halt; in some pressure brings no relief; in some there is a throbbing that responds to the touch of the hand; in some the pain pulls between the heart and the back; in some it pulls between the flanks and the lower abdomen; in some abdominal pain pulls toward the inner thigh; in some the pain persists for days and forms an accumulation; in some the patient suddenly collapses in pain, losing consciousness, and revives again after a short while; in some there is pain with vomiting; in some abdominal pain is followed by diarrhea; in some there is pain with blockage and no passage. All these various pains differ in form from one another — how are they to be distinguished?
Qibo said: When cold qi lodges outside the vessel, the vessel becomes cold; when the vessel is cold it contracts and shrinks, and when it contracts and shrinks it becomes taut and tight, pulling on the small collateral vessels outside — hence sudden pain arises. If warmth is obtained, the pain stops at once; but if the patient is struck by cold again, the pain persists long. When cold qi lodges within the channel vessel and clashes with warm qi, the vessel becomes full, and when full there is pain that cannot bear pressure. When cold qi lingers and warm qi rises from below, the vessel becomes engorged and enlarged and the blood and qi fall into disorder, causing severe pain that cannot bear pressure. When cold qi lodges between the intestines and stomach, beneath the membrane source, the blood cannot disperse and the small collaterals are pulled taut, causing pain; pressing on it disperses the blood and qi, so pressure brings the pain to a stop. When cold qi lodges in the vessel flanking the spine, deep pressure cannot reach it, so pressure brings no relief. When cold qi lodges in the thoroughfare vessel (chongmai), which arises at Guanyuan (CV-4) and ascends straight up along the abdomen, the cold causes the vessel to become blocked; when the vessel is blocked the qi is likewise obstructed, producing a throbbing that responds to the touch of the hand. When cold qi lodges in the vessel of the back transport points, the vessel becomes congealed; when the vessel is congealed the blood becomes deficient, and deficient blood causes pain. Since these transport points connect to the heart, the pain pulls between the two; pressing on it brings warm qi to the area, and once warm qi arrives, the pain stops. When cold qi lodges in the vessel of reverting yin — the vessel of reverting yin encircles the genitals and connects with the liver — the cold qi lodging within the vessel causes the blood to congeal and the vessel to tighten, so pain pulls between the flanks and the lower abdomen. When reversing qi lodges in the inner thigh, the cold qi rises to reach the lower abdomen, and the congealed blood below pulls upward, so abdominal pain pulls toward the inner thigh. When cold qi lodges between the small intestine and the membrane source, within the collateral blood vessels, the congealed blood cannot pour into the great channels, and blood and qi linger and cannot move — hence over time an accumulation forms. When cold qi lodges in the five viscera, causing reversal and counterflow surging upward and discharging, the yin qi becomes exhausted and the yang qi has not yet entered — hence the patient suddenly collapses in pain and loses consciousness; when the qi returns, life is restored. When cold qi lodges in the intestines and stomach, causing reversal and counterflow surging upward and out, there is pain together with vomiting. When cold qi lodges in the small intestine, the small intestine cannot form and hold its contents, so there is diarrhea following the pain. When heat qi lingers in the small intestine, there is pain within the intestines; with dan-heat and parching thirst, the stool becomes hard and dry and cannot pass, so there is pain together with blockage and no passage. Huangdi said: This is what is meant by something that can be known through words.
What of something that can be seen through observation? Qibo said: The five viscera and six bowels each indeed have their own region; observing the five colors — yellow and red indicate heat, white indicates cold, and green-blue and black indicate pain. This is what is meant by something that can be seen through observation. Huangdi asked: What of something that can be grasped through palpation? Qibo said: Observing the vessel governing the disease — if it is hard and full of blood, or if it is sunken and depressed — all these can be grasped through palpation.
Huangdi said: Good. I know that the hundred diseases arise from qi: anger makes qi rise, joy makes qi relax, grief makes qi dissipate, fear makes qi descend, cold makes qi contract, heat makes qi leak out, fright makes qi fall into disorder, overexertion makes qi become depleted, and brooding makes qi become knotted. These nine qi differ from one another — what diseases does each produce? Qibo said: Anger causes qi to counterflow, and in severe cases the patient vomits blood or suffers undigested-food diarrhea; hence qi is said to rise. Joy harmonizes the qi and allows the will to reach its aims, so that the nutritive and defensive qi flow freely; hence qi is said to relax. Grief tightens the heart's connecting vessel, causes the lung lobes to spread and lift, and blocks the upper burner so that it fails to communicate; the nutritive and defensive qi fail to disperse, and heat qi collects within; hence qi is said to dissipate. Fear causes the essence to retreat; as it retreats, the upper burner closes, and when it closes the qi turns back; as it turns back the lower burner becomes distended; hence qi is said to fail to move. Cold causes the striae and interstices to close, so the qi cannot move; hence qi is said to contract. Heat causes the striae and interstices to open, so that the nutritive and defensive qi flow freely and sweat pours out profusely; hence qi is said to leak out. Fright leaves the heart with nothing to rely upon, the spirit with nowhere to return, and thought with nothing settled; hence qi is said to fall into disorder. Overexertion causes panting breath and sweating, so that both the exterior and interior are exhausted; hence qi is said to become depleted. Brooding causes the heart to fix upon something, so that the spirit has somewhere to return, and the upright qi lingers there and does not move; hence qi is said to become knotted.