腹痛不一，有食、有气、有火、有冷、有虫、有积，俱似痧非痧，不可无辨。食者，失饥伤饱，聚中脘作痛，其症
遇食即疼，胸膈饱闷，似痧者一，然按脉气口必然有力可辨。若因冷食入胃，食与寒气相搏于中，则心脾郁结，胸胁满
闷，中脘作痛，似痧者二，然按脉气口必然无力，但有嘈杂冲胸，嗳气吞酸可辨。气者因怒气所伤，不得发越，胸膈气
塞冲激心脾，呕逆恶心，吐不能出，其疼手不可按，坐卧不定，奔走叫呼，似痧者三，然按脉两关必然洪大，余部俱必
应指，及刮之无痧，痧筋不现，可辨。火者，因热作痛，胃火上逆，呕吐酸水，必然口渴欲饮，饮入即吐，其症手足温
暖，面带阳色，似痧者四，然按脉六部洪数，又与痧类，难以细分，必看痧筋，兼用刮法可辨。冷者，人属虚寒，沉寒
作痛，其脉必然平软，似痧者五，但饮热则安，饮冷痛发可辨。虫者，胃脘疼痛有如刀触，痛极按心搔爬难定。兼之脉
息无伦，徐疾不一，似痧者六，然虫必有因，各有所喜，如茶虫喜食茶叶，糖虫喜食糖物，或泥或絮，或酒或盐，其为
虫也，必有一好，食之便安，若遇槟榔、五灵脂杀虫等药，或药性力薄，不能驱逐而出，势必咬齿翻动肠胃，更加疼痛，
可辨。积者，旧有宿积，聚结肠胃，忽因行动，作痛作疼，似痧者七，然痧筋罕现，刮痧无影，可辨。如是辨之的确，
方知痧痛详明，治之得法。然此诸痛，又有兼痧者，将论脉阅筋而加察焉，鲜有不得其理矣。
Abdominal pain arises from various causes, including food stagnation (Food), Qi stagnation (Qi), Fire pathogen (Fire), Cold pathogen (Cold), intestinal parasites (Worms), and accumulated food retention (Accumulation). These conditions all resemble Sha syndrome (Sha Syndrome, a condition characterized by heat-toxin accumulation and blood stasis) but are not true Sha, thus requiring differentiation.
Food injury results from irregular eating habits, causing food to accumulate in the Zhongwan area (CV12, Conception Vessel 12) and cause pain. The symptoms include immediate pain upon eating and fullness/stuffiness in the chest and diaphragm. This is the first case resembling Sha. However, palpation of the Qi Kou pulse (Radial Artery at the wrist, specifically the distal segment often used for diagnosis) will reveal forceful pulses, allowing for differentiation.
If cold food enters the stomach, the food and cold pathogen contend within the middle jiao, leading to depression and knotting in the Heart and Spleen. Symptoms include fullness and stuffiness in the chest and hypochondrium, and pain in the Zhongwan area. This is the second case resembling Sha. However, palpation of the Qi Kou pulse will reveal weak pulses, accompanied by gastric discomfort rushing to the chest, belching, and acid regurgitation, allowing for differentiation.
Qi stagnation results from emotional injury due to anger, preventing the free flow and dispersal of Qi. Qi blocks and rushes against the Heart and Spleen in the chest and diaphragm, causing vomiting, nausea, and an inability to expel vomitus. The pain is so severe that it cannot be touched, leading to restlessness in sitting or lying down, running about, and shouting. This is the third case resembling Sha. However, palpation reveals surging (Hong) pulses at both Guan positions (middle position on the radial artery, corresponding to Liver/Gallbladder and Spleen/Stomach), while other pulse positions are also distinct. Furthermore, scraping therapy yields no Sha spots, and Sha veins (distended superficial veins) do not appear, allowing for differentiation.
Pain caused by Fire results from heat, with Stomach Fire reversing upward, causing vomiting of sour fluid. There is必然 thirst and desire to drink, but drinking leads to immediate vomiting. Symptoms include warm hands and feet and a facial complexion reflecting Yang heat. This is the fourth case resembling Sha. However, palpation reveals surging and rapid pulses in all six pulse positions. Since this resembles Sha closely, fine differentiation is difficult; one must observe for Sha veins and employ scraping therapy for differentiation.
Pain caused by Cold occurs in individuals with deficiency-cold constitutions, where deep-seated cold causes pain. The pulse is necessarily flat and soft. This is the fifth case resembling Sha. However, drinking hot water brings relief, while drinking cold water triggers pain, allowing for differentiation.
Pain caused by worms involves epigastric pain feeling like a knife touch, extremely severe, causing the patient to scratch the heart and abdomen in distress. The pulse is chaotic and irregular in speed. This is the sixth case resembling Sha. However, worm infestation has specific causes; each type of worm has preferences. For example, "tea worms" prefer tea leaves, and "sugar worms" prefer sweets. Some prefer mud, cotton, wine, or salt. Being worms, they have a preference; consuming their preferred item brings comfort. If treated with vermifuges such as Areca Seed (Arecae Semen) or Trogopterus Dung (Excrementa Trogopterori), or if the medicinal potency is too weak to expel them, the worms may bite and churn the intestines and stomach, exacerbating the pain, allowing for differentiation.
Pain caused by Accumulation refers to old food retention gathering in the intestines and stomach. Sudden movement or exertion triggers pain. This is the seventh case resembling Sha. However, Sha veins rarely appear, and scraping yields no reaction, allowing for differentiation.
By differentiating accurately in this manner, one understands the detailed mechanisms of Sha pain and can apply appropriate treatments. However, these various pains may also coexist with true Sha. Therefore, one must examine the pulse and inspect the Sha veins for further observation. It is rare for one who does so to fail to grasp the underlying principles.