注云∶腹中虽硬，而忽聚忽散，无有常准。经曰∶血不流而寒薄，故血内凝（不
流）而成瘕也。一云∶腹内积病也。又曰∶小肠移热于大肠，为伏瘕，为沉。
〔注〕曰∶小肠热以传入大肠，两热相搏，则血溢而为〔 〕瘕也。血涩不利，
则月事沉滞而不行，故云为〔 假〕、为沉〔 〕。乃或阳气郁结，〔怫热壅
滞〕而坚硬不消者，非寒瘕也，宜以脉〔证〕别之。瘕〔一为〕疝，传写之误。
注云∶小腹连卵肿急绞痛也，寒主拘缩故也。寒极而土化制之，故肿满也。经云
丈夫 疝，谓阴器连小腹急痛也。经〔注〕曰∶寒气聚而为疝也。脉急者，寒之象
也。然，寒则脉当短小而迟，今言急者，非急数而洪也，由紧脉主痛，急为病甚也。病
寒缩急，亦短小也。所以有痛而脉紧急者，脉为心所养也。凡气为痛，则心神不宁
而紧急，不得舒缓，故脉亦（从）之而见也。欲知何气为其痛〔者〕，诊其紧急相兼
之脉可知矣。如紧急洪数，则为热痛之类也。
注云∶寒主拘缩，故急痛也。寒极则血脉凝冱，而反兼土化制之，故坚痞而腹
痛也。或热郁于内，而腹满坚结痛〔者〕，不可言为寒也，当以脉别之。
注云∶寒则清净明白故也。
注云∶胃热则消谷善饥，故病寒〔则〕食虽已而不饥也。胃〔膈〕润泽，而无燥
热故也。或邪热不杀谷，而腹热胀满，虽数日而不食，亦不饥者，不可言为寒也。由阳
热太甚而郁结，传化失常，故虽不食。亦不饥也。二证以脉别之自见。
The commentary states: Although the abdomen feels hard, the masses gather and disperse intermittently without a fixed standard. The Classics state: When blood flow is stagnant and cold is thin (invading), blood coagulates internally to form *jia* (abdominal mass). Another view holds: It is an accumulation disease within the abdomen. It is also said: Heat from the Small Intestine transfers to the Large Intestine, resulting in latent *jia* (*fu jia*) and sinking conditions (*chen*). [Commentary] explains: Heat from the Small Intestine transmits into the Large Intestine; when the two heats contend, blood overflows and forms *jia*. When blood is astringent and unsmooth, menstruation stagnates and fails to proceed, hence it is called *jia* and *chen*. If Yang Qi is constrained and heat is obstructed, leading to hardness that does not dissipate, this is not a cold *jia*; one must distinguish it by pulse and signs. *Jia* is sometimes erroneously written as *shan* (hernia) due to transcription errors.
The commentary states: Swelling, urgency, and severe colic pain in the lower abdomen extending to the testicles occur because cold causes contraction. When cold reaches its extreme, Earth transformation (Spleen Earth) attempts to control it, resulting in swelling and fullness. The Classics state regarding men's *shan*: It refers to urgent pain connecting the genital organs and the lower abdomen. The [commentary on the] Classics states: Cold Qi gathers to form *shan*. A tight pulse is a sign of cold. However, while cold typically presents with a short, small, and slow pulse, the "urgency" mentioned here does not refer to rapid, large, or surging pulses. Instead, because a tight pulse governs pain, an urgent pulse indicates severe disease. Cold diseases cause contraction and urgency, which can also appear short and small. The reason for pain accompanied by an urgent pulse is that the pulse is nourished by the Heart. Whenever Qi causes pain, the Heart Spirit becomes restless and tense, unable to relax; thus, the pulse also reflects this tension. To know what Qi is causing the pain, one can determine it by diagnosing the combined urgent pulse characteristics. For instance, if the pulse is urgent, surging, and rapid, it belongs to the category of heat pain.
The commentary states: Cold causes contraction, hence urgent pain. When cold is extreme, blood vessels congeal and freeze, yet they are counteracted by Earth transformation, resulting in hard痞 (masses) and abdominal pain. Alternatively, if heat is depressed internally, causing abdominal fullness, hardness, consolidation, and pain, it cannot be described as cold; it must be distinguished by the pulse.
The commentary states: This is because cold maintains clarity and stillness.
The commentary states: Stomach heat leads to the digestion of food and easy hunger; therefore, in a cold disease, even after eating, there is no sensation of hunger. This is because the Stomach and Diaphragm are moistened and lubricated, lacking dryness and heat. Conversely, if pathogenic heat fails to cook grain, leading to abdominal heat, fullness, and distension, where one does not eat for several days yet feels no hunger, this cannot be classified as cold. This arises because Yang-heat is excessive and constrained, disrupting transmission and transformation; thus, even without eating, there is no hunger. These two conditions can be distinguished by observing the pulse.