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[Classic Discourse]
When cold qi invades outside the vessels, the vessels become cold; when vessels are cold, they contract and curl; when contracted and curled, the vessels become taut and urgent; when taut and urgent, they externally pull on small collaterals, thus causing sudden pain. Upon receiving warmth (Jiong), pain stops immediately. If re-inflicted by cold, pain persists for a long time. ○ When cold qi invades within the main vessels and contends with warm qi, the vessels become full; when full, there is pain that cannot be pressed. If cold qi lingers and warm qi rises from above, the vessels become distended and large, and blood and qi become chaotic, thus causing severe pain that cannot be pressed. ○ When cold qi invades between the intestines and stomach, below the membrane sources, blood cannot disperse, small collaterals become tense and pull, thus causing pain; pressing causes blood and qi to disperse, thus pain stops upon pressing. ○ When cold qi invades the vessels flanking the spine, the depth is profound, pressing cannot reach it, thus pressing is of no benefit. ○ When cold qi invades the Chong vessel, which originates at Guanyuan (CV4) and ascends straight up along the abdomen. When cold qi invades, the vessel becomes obstructed; when obstructed, qi follows suit, thus pulsation can be felt at the hand during respiration. ○ When cold qi invades the Back-Shu vessels, blood flow stagnates; when blood flow stagnates, blood deficiency occurs; when blood is deficient, pain arises. The Shu points connect to the Heart, thus mutual pulling causes pain. Pressing brings heat; when heat arrives, pain stops. ○ When cold qi invades the Jueyin vessels. The Jueyin vessels connect to the genitalia and attach to the Liver. When cold qi invades within the vessels, blood stagnates and vessels become tense, thus mutual pulling causes pain in the hypochondrium and lower abdomen. ○ Jueqi invades the medial thigh, cold qi ascends to the lower abdomen, blood stagnates, upper and lower mutually pull, thus abdominal pain radiates to the medial thigh. ○ When cold qi invades between the membrane sources of the small intestine and within the collateral blood, blood stagnates and cannot pour into the main vessels, blood and qi stagnate and cannot circulate, thus masses form after some time. ○ When cold qi invades the Zang organs, Jue reversal causes upward leakage, Yin qi is exhausted, Yang qi has not entered, thus sudden pain leads to death-like unconsciousness; if Qi returns, life is preserved. ○ When cold qi invades the intestines and stomach, Jue reversal causes upward emission, thus pain accompanied by vomiting. ○ When cold qi invades the small intestine, the small intestine cannot complete its gathering function, thus diarrhea and abdominal pain occur. ○ When hot qi remains in the small intestine, intestinal pain occurs, intense heat causes dryness and thirst, leading to hard, dry stool that cannot pass, thus pain and obstruction occur. (From *Suwen*)

[Philosophical Statements]
Xiaochang Qi pain: pain moving around the umbilicus. Pangguang Qi pain: swelling and pain in the lower abdomen with inability to urinate. Gan Qi pain: pain in the lower abdomen radiating to both hypochondria. Shan Qi pain: pain in the lower abdomen radiating to the testicles. Shen Qi pain: Qi rushing from the lower abdomen to the heart region causing pain; if tangible, it is Ben Tun (Rushing Pig). (From *Yi Jie Bian Zheng*)

Pain is categorized as Deficiency or Excess. In cases of Sanjiao pain, most are due to Food Stagnation, Cold Stagnation, or Qi Stagnation. Those caused by parasites, Fire, Phlegm, or Blood stasis can also cause pain. Generally, acute pain is mostly due to the first three conditions, while chronic pain is mostly due to the latter four. However, parasite pain and phlegm pain are mostly in the Middle Jiao; fire pain can occur in all three Jiaos; blood pain is mostly in the Lower Jiao, common in women but rare in men. Only when observing signs of stagnation and rebellion should it be considered an Excess pattern; otherwise, it should not be treated as Excess. ○ Pain has Cold and Heat distinctions; misidentification causes significant harm. Approximately 80-90% of pains are due to Cold, while only 10-20% are due to Heat. This can be understood from the *Neijing*’s discussions on pain. Cold causes stagnation; stagnation causes Qi rebellion; Qi rebellion causes pain and distension. Heat promotes circulation, so this is less common. Although heat patterns often have pain, clear differentiation is necessary. As stated in the Classics: intestinal pain, thirst, intense heat scorching the hypochondria, hard dry stool unable to pass, and obstruction—this is due to dryness and heat closure, but must be accompanied by symptoms like irritability and heat, which are easily seen. If one merely sees heart or abdominal pain and, regardless of cold or heat signs, claims it belongs to Fire and uses many cooling herbs, such presumption is too severe! ○ Pain patterns should be differentiated as Tangible or Intangible. Intangible pain is in the Qi level. Qi pain manifests as distending pain, alternating between distension and relief, with no fixed location; when Qi gathers, pain appears; when Qi disperses, it calms without trace. This is intangible pain; soothing the Qi allows pain to heal naturally. Tangible pain is in the Blood level, or due to food accumulation. Blood stasis and food accumulation always have fixed pain locations and unrelenting distension; this is tangible pain. Whether food or blood, identifying the cause and removing it is what needs differentiation. ○ Pain patterns have Deficiency and Excess, and treatments have Tonification and Purging; these must be examined in detail. Pain with distension and obstruction is mostly Excess; without distension or obstruction is mostly Deficiency. Refusal to press indicates Excess; ability to press indicates Deficiency. Preference for cold suggests Excess; preference for warmth suggests Deficiency. Worsening after eating suggests Excess; worsening on an empty stomach suggests Deficiency. Excess pulse and coarse breath suggest Excess; Deficient pulse and timid breath suggest Defusion. Recent onset and strong constitution suggest Excess; worsening with aggressive treatment suggests Defusion. Pain in the meridians usually presents with wiry and large pulses; pain in the Zang organs usually presents with deep and faint pulses. One must examine pulse and symptoms together to clarify Deficiency and Excess. Can Excess be treated with purging? Can Deficiency be treated with purging? Using purging when inappropriate causes significant harm. For exterior Deficiency pain, Yang is insufficient; warming the meridians is essential. For interior Deficiency pain, Yin is insufficient; nourishing Ying (Nutritive) Qi is essential. For upper Deficiency pain, Heart and Spleen are injured; tonifying the Center is essential. For lower Deficiency pain, collapse and Yin loss occur; saving the Spleen and Stomach and warming the Mingmen (Gate of Vitality) is essential. How can someone as enlightened as Zhu Danxi say "All pains should not be tonified"? Such limited opinion is hardly a good method. (Zhang Jingyue)

When Chong Qi attacks causing pain, ascending from the back relates to the Du Mai (Governor Vessel) pathology, treated via Shaoyin. Ascending from the abdomen relates to Chong Mai (Penetrating Vessel) and Ren Mai (Conception Vessel) pathology, treated via Jueyin. ○ Regarding various pain patterns, 70-80% are due to Cold, 20-30% due to Heat. To differentiate Cold and Heat, examine the pain site: does the patient prefer cold and dislike heat, or prefer heat and dislike cold? This reveals the nature. Regarding treatment for Qi/Blood Deficiency/Excess, ancients generally established principles based on the character "Tong" (Unblocking/Patency). However, do not mistakenly interpret "Tong" as only purgative or draining methods. It means unblocking Qi and Blood so pain ceases. One must distinguish between Qi level and Blood level: for Qi level, simply move Qi; do not use heavy drugs to disturb Blood unnecessarily. For Blood level, must treat Qi simultaneously, as "when Qi moves, Blood follows." For Excess patterns where Qi stagnates and Blood coagulates, unblock Qi and dissipate Blood to cure. For Deficiency patterns where Qi energy fails to circulate and Blood decline fails to nourish, treatment should tonify Qi and Blood, incorporating unblocking within tonification. This is a general outline. However, pain patterns are complex. Internal injuries from Seven Emotions first damage Zang-Fu then reach muscles/skin; external injuries from Six Evils first affect muscles/skin then enter Zang-Fu. For the pathways of the Twelve Meridians, prescriptions must include guiding herbs and combine with external therapies like acupuncture, cupping, application, moxibustion, massage, or Qigong for better efficacy. Additionally, differentiate traumas, sprains, yin abscesses, internal carbuncles, accumulations, masses, roundworms, pinworms, hernias, bi-syndromes, sand-swelling, and evil invasion pains. Do not mix treatments. The general principle is Tonification, Purging, Cold, and Warmth, using acrid-moistening and diffusing-unblocking methods, avoiding sour-astringent and consolidating methods. The unique brilliance lies especially in treating Collaterals. Chronic pain inevitably enters collaterals; any slight pathogenic retention in the collaterals' Qi/Blood Deficiency/Excess/Cold/Heat can cause pain. This was not mentioned by ancients. (From *Lin Zheng Zhi Nan*)

All pains are Excess; pain decreases with "Li" (benefit/unblocking). Secular people interpret "Li" as "Xia" (Purgation). Suppose pain is in the Exterior, it is Excess; in the Interior, it is Excess; in Qi/Blood, it is Excess. Therefore, exterior pain cures with sweating; interior pain cures with purging; Qi/Blood pain cures with dispersing and promoting movement. How can "Li" be interpreted as "Xia"? It should be interpreted as "Tong" (Unblocking). (From *Ci Shi Nan Zhi*)

Qi and Blood throughout the body must be patent. Thus, ancients used needles to unblock externally, from outside to inside, to harmonize Qi and Blood. Used medicine to unblock internally, from inside to outside, to harmonize Qi and Blood. The principle is the same. "Patency prevents pain, pain indicates blockage" refers to situations that were originally patent but are now blocked. Whether internal or external, once patent, pain ceases. One should unblock according to the specific locations of the Twelve Meridians, Collaterals, and Zang-Fu organs. If one unblocks other areas, the pain site remains unknown, and other areas may be pulled/disturbed instead. (From *Wu Yi Hui Jiang*)