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Huangdi asked: I wish to hear about the sudden pain in the five Zang organs of humans. What Qi causes this? Qibo replied: The flow of Qi and Blood in the meridians never ceases, circulating endlessly around the body. When Cold pathogen enters the meridians, its flow becomes sluggish, stagnating and failing to move. If it lodges outside the vessels, there is a deficiency of Blood; if it lodges inside the vessels, the flow of Qi becomes obstructed. Therefore, sudden pain occurs.

Huangdi asked: The shapes of these pains are different from each other. How can they be distinguished?

Qibo said: When Cold lodges outside the vessels, the vessels become cold. Vessels that are cold contract and shorten. Contracted and shortened vessels become taut and cramped. Taut and cramped vessels pull on the small collateral vessels, causing sudden pain. Upon receiving heat (Jiong), the pain stops immediately. However, if struck by Cold again while already affected, the pain will persist for a long time.

When Cold lodges within the main meridians and contends with Heat Qi, the vessels become full and distended. Distension leads to pain that cannot be pressed upon. If Cold remains stagnant and Heat rises from above, the vessels become enlarged and congested, causing chaotic Qi and Blood flow. Thus, the pain is severe and unyielding to pressure.

When Cold lodges between the intestines and stomach, beneath the membrane sources (Mo Yuan), the Blood cannot disperse, and the small collerals become tense and pulling, causing pain. Pressing on the area disperses the Qi and Blood, so the pain ceases upon pressure.

When Cold lodges in the meridians flanking the spine, deep pressing cannot reach the site, so pressing yields no benefit.

When Cold lodges in the Chong Mai (Penetrating Vessel), which originates at Guanyuan (CV4) and ascends straight up the abdomen, the Cold causes obstruction in the vessel. Obstruction in the vessel leads to turbulent Qi movement, which can be felt as pulsation under the hand upon palpation.

When Cold lodges in the Back-Shu points' meridians, the blood vessels become sluggish, leading to Blood deficiency. Deficiency of Blood causes pain. Since the Shu points connect to the Heart, there is mutual pulling pain between the back and the heart region. Applying heat via pressing brings warmth to the area, and when warmth arrives, the pain stops.

When Cold lodges in the Jueyin Meridian, which connects to the genitalia and is tied to the Liver, the Cold causes Blood stagnation and vessel tension within the channel. This results in mutual pulling pain between the hypochondrium/ribs and the lower abdomen.

When Jue Qi lodges in the inner thigh (Yin Gu), and Cold ascends to involve the lower abdomen, Blood stagnates. The downward pulling sensation causes abdominal pain radiating to the inner thighs.

When Cold lodges in the membrane sources between the small intestine and the collateral vessels, Blood stagnates and fails to enter the larger meridians. The stagnation of Qi and Blood prevents normal circulation, eventually forming accumulations over time.

When Cold lodges in the five Zang organs, it causes rebellious upward leakage of organ Qi. Yin Qi is exhausted, and Yang Qi fails to enter Yin. This results in sudden severe pain, death-like state, and unconsciousness. If Qi returns to its proper course, life is restored.

When Cold lodges in the stomach and intestines, it causes rebellious upward emission of Qi, resulting in pain accompanied by vomiting.

When Cold lodges in the intestines, the Small Intestine fails to properly gather and transform fluids and food, leading to diarrhea and abdominal pain.

If Heat lingers in the Small Intestine, it causes intestinal pain. Severe heat and dryness lead to thirst and parched conditions, resulting in hard, dry stool that cannot be expelled. This causes pain due to blockage and inability to pass stool.

Ying Qi (Nutritive Qi) circulates within the vessels, while Wei Qi (Defensive Qi) circulates outside the vessels. The area outside the vessels refers to the network where Wei Qi distributes. Qi and Blood flow continuously in cycles. If Cold lodges here, its congealing nature causes meridian flow to slow down, preventing normal circulation.

The reason why Cold lodging outside the vessels leads to Blood deficiency is the lack of Yang Qi's transformative power. When Cold lodges inside the vessels, Ying Qi becomes blocked and obstructed, causing sudden pain.

Cold lodging outside the vessels causes contraction and cramping of the vessels, pulling on small collaterals, leading to sudden pain. Receiving heat dissipates the Cold, stopping the pain immediately. If re-struck by Cold, the pain persists difficultly.

Cold lodging within the meridians presses against Yang Qi, causing blood stasis and distension in the vessels, making pain intolerable to pressure. Due to lingering Cold and ascending Yang Qi, the vessels become enlarged and Qi/Blood chaotic, causing severe pain unyielding to pressure.

Cold lodging beneath the membrane sources of the stomach and intestines is not in the main meridians; thus, pressing disperses Qi and Blood, stopping the pain.

Cold lodging in the meridians flanking the spine is deeper than the level of Ying and Wei Qi, so pressing cannot reach it, and the pain does not change with pressure.

Qi of the Chong Mai ascends from the lower abdomen to the chest. When Cold lodges here, Qi closes and vessels obstruct, causing palpable pulsation upon pressure.

Cold lodging in the Back-Shu meridians makes blood vessels sluggish and causes Blood deficiency. Since these Shu points connect to the Heart, there is mutual pulling pain with the Heart. As Back-Shu points also relate to collateral networks, applying heat via pressing brings warmth, stopping the pain.

The Jueyin Meridian runs through the hypochondrium and lower abdomen. Cold lodging here causes sluggish Blood and tense vessels, leading to pain radiating from the hypochondrium to the lower abdomen.

Cold lodging in the inner thigh ascends to the lower abdomen, causing sluggish Blood. This results in abdominal pain radiating to the inner thighs.

Cold lodging in the membrane sources of the small intestine causes sluggish Blood in collaterals, preventing entry into major meridians. Stagnation leads to accumulation, and the pain is self-evident.

Cold lodging in the five Zang organs causes rebellious upward leakage of organ Qi and exhaustion of Yin. Yang cannot enter Yin to harmonize, causing sudden severe pain, coma, and apparent death. If rebellious Qi reverses and Yin-Yang harmonizes, recovery occurs.

Cold lodging in the stomach and intestines causes turbid obstruction in the Fu organs. Rebellious Qi rushes upward, causing pain and vomiting.

Cold lodging in the Small Intestine impairs its function as the "Official of Reception and Transformation," preventing the gathering and distribution of water and grain, leading to diarrhea and abdominal pain. All the above describe Cold-induced pain. Only one case describes Heat lingering in the Small Intestine, characterized by severe heat, thirst, parched condition, and hard, dry stool unable to pass. This pain is due to Heat-induced blockage and should be differentiated accordingly.

Huangdi asked: How can diagnosis be made through palpation?

Qibo replied: Observe the pulse associated with the primary disease. If the pulse is firm, shows signs of blood exposure, or is sunken/depressed, all these can be detected through palpation.

This passage discusses acupuncture treatment methods. Based on the symptoms described above, one identifies which meridian or collateral is diseased, identifying it as the primary disease pulse. By observing and palpating the pulse, if it feels firm with visible blood stasis or appears sunken, these indicate the location of the pathogen. These findings allow for appropriate treatment.