脉经曰脉细小紧急病速进退在中腹中刺痛○阴弦则腹痛弦急小腹痛○尺脉紧脐下痛○尺
脉伏
小腹痛瘕疝○脉实小腹痛当刺之○心腹痛痛不得息脉细小迟者生坚实大者死○腹痛脉反大而
长者死
内经举痛论云五脏卒然而痛者何气使然岐伯曰经脉流行不止环周不休寒气入经则稽迟涩
而不
行客于脉外而血少客于肺中则气不通故卒然而痛帝曰其痛或卒然而止者或痛不休者或痛甚不
可按者或按之痛止或按之无益者或喘动应手者或心与背相引而痛者或胁肋与小腹相引而痛者
或腹痛引阴股者或卒然痛死不知人少间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奈何岐伯曰寒气客于脉外则脉寒脉寒则缩蜷缩蜷则脉绌急绌急则外引小
络故卒然而痛立止因重中于寒则痛久矣寒气客于经脉之中与炅气相搏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间膜原之下血不得散
小络急引故痛按之则血气散故按之痛止寒气客于夹脊之脉则深按之不能及故按之无益也寒气
客于冲脉波脉起关元随复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（云云见心痛门）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胁
肋
与小腹相引痛矣厥气客于阴股寒气上及小腹血泣在下相引故腹痛引阴股寒气客于小肠膜原之
下络血之中血泣不注于大经血气稽留不得行故宿昔而成积矣寒气客于五脏厥逆上泄阴气竭阳
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流于小肠肠中痛秘热焦渴则坚干不得出故痛而闭不通矣
《脉经》说：脉象细小而紧急，病情迅速变化，疼痛位于中腹部，呈刺痛感。○ 阴部脉弦，则出现腹痛，伴有弦急和小腹疼痛。○ 尺脉紧，脐下疼痛。○ 尺脉伏，小腹痛，有瘕疝（腹内结块或疝气）。○ 脉实，小腹痛，应当针刺治疗。○ 心腹痛，疼痛剧烈导致呼吸不畅，脉象细小迟缓的预后良好，脉象坚实大的预后不良。○ 腹痛，脉象反而大而长的，预后不良。
《内经·举痛论》说：五脏突然发生疼痛，是什么气导致的呢？岐伯说：经脉气血流行不止，环周运行不休。寒气侵入经脉，则运行迟缓、涩滞而不通。寒气客于脉外，则血液减少；客于肺中，则气机不通，所以突然发生疼痛。黄帝问：这种疼痛，有的突然停止，有的疼痛不止，有的疼痛剧烈不能按压，有的按压后疼痛停止，有的按压后无益，有的疼痛处跳动应手，有的心和背相互牵引疼痛，有的胁肋和小腹相互牵引疼痛，有的腹痛牵引至大腿内侧，有的突然剧痛昏死过去，过了一会儿又苏醒，有的疼痛伴随呕吐，有的腹痛随后腹泻，有的疼痛伴有大便闭塞不通。这些不同的疼痛，形态各异，如何辨别呢？岐伯说：寒气客于脉外，则经脉受寒，经脉受寒则收缩卷曲，收缩卷曲则脉络拘急，脉络拘急则向外牵引细小的络脉，所以突然发生疼痛，很快停止。如果再次受到寒邪侵袭，则疼痛持久。寒气客于经脉之中，与热气相搏，则脉道满盛，满盛则疼痛且不能按压。寒气停留，热气从上而来，则脉道充大，血气紊乱，所以疼痛剧烈不能按压。寒气客于肠胃之间、膜原之下，血液不能散行，小络脉紧急牵引，所以疼痛，按压后血气散行，所以按压后疼痛停止。寒气客于夹脊的经脉，位置深在，重按达不到病所，所以按压无益。寒气客于冲脉，冲脉起于关元穴，随直脉上行，寒气客于此处则脉道不通，脉道不通则气机随之受阻，所以跳动应手。寒气客于背俞之脉（详见心痛门）。寒气客于厥阴之脉，厥阴之脉联络阴器，系属于肝，寒气客于脉中，则血液凝涩，脉道拘急，所以胁肋与小腹相互牵引疼痛。厥逆之气客于大腿内侧，寒气上及小腹，血液凝涩在下部相互牵引，所以腹痛牵引至大腿内侧。寒气客于小肠膜原之下、络血之中，血液凝涩不注于大经脉，血气停留不得运行，所以经过一段时间形成积块。寒气客于五脏，导致厥逆之气上泄，阴气竭绝，阳气未入，所以突然剧痛昏死过去，人气回复则生还。寒气客于肠胃，导致厥逆之气上出，所以疼痛伴随呕吐。寒气客于小肠，小肠不能正常聚化食物，所以随后腹泻并腹痛。热气流于小肠，肠中疼痛秘结，热盛焦渴，则大便坚硬干燥不得排出，所以疼痛伴有大便闭塞不通。
The *Mai Jing* (Pulse Classic) states: When the pulse is fine, small, and tight, the disease progresses rapidly; pain in the middle abdomen is stabbing. ○ If the Yin pulse is wiry, abdominal pain occurs, characterized by tension and lower abdominal pain. ○ A tight Chi pulse indicates pain below the umbilicus. ○ A hidden Chi pulse indicates lower abdominal pain with mass or hernia (Jia Shan). ○ An excess pulse with lower abdominal pain indicates that acupuncture should be applied. ○ For heart and abdominal pain where breathing is obstructed due to pain, a fine, small, and slow pulse indicates survival, whereas a firm and large pulse indicates death. ○ For abdominal pain, if the pulse is unexpectedly large and long, it indicates death.
The *Nei Jing* (Inner Canon), in the chapter "Discourse on Pain" (Ju Tong Lun), asks: What causes sudden pain in the five zang organs? Qibo replies: The flow of qi and blood in the meridians never ceases, circulating endlessly. When cold pathogen enters the meridians, its flow becomes sluggish, stagnant, and obstructed. If it lodges outside the vessels, blood volume decreases; if it lodges in the lungs, qi mechanism is blocked, resulting in sudden pain. The Yellow Emperor asks: Regarding this pain, some stops suddenly, some persists, some is so severe it cannot be pressed, some stops when pressed, some is unaffected by pressure, some pulsates under the hand, some involves mutual pulling pain between the heart and back, some between the hypochondrium and lower abdomen, some radiating from the abdomen to the medial thigh, some causing sudden syncope with recovery after a short time, some accompanied by vomiting, some followed by diarrhea, and some accompanied by constipation. How can these different pains be distinguished? Qibo says: When cold lodges outside the vessels, the vessels become cold, contract, and curl; contraction leads to tension and cramping of the vessels, which pulls on the collateral vessels, causing sudden pain that stops quickly. If re-exposed to cold, the pain becomes chronic. When cold lodges within the vessels and combats with heat, the vessels become full, causing pain that cannot be pressed. If cold lingers and heat rises, the vessels become distended, and qi and blood become chaotic, causing severe pain unresponsive to pressure. When cold lodges between the intestines and stomach, beneath the membrane origins, the blood cannot disperse, and small collaterals are pulled tightly, causing pain; pressing disperses the qi and blood, relieving the pain. When cold lodges in the meridians alongside the spine, deep pressure cannot reach the site, so pressing is ineffective. When cold lodges in the Chong Mai (Penetrating Vessel), which originates at Guanyuan (CV4) and ascends vertically, obstruction of the vessel blocks qi flow, causing pulsation felt under the hand. Cold lodging in the Back-Shu meridians (see Heart Pain section). Cold lodging in the Jueyin Meridian of Foot-Shaoyin, which connects to the genitalia and attaches to the Liver, causes blood stagnation and vessel tension, leading to mutual pulling pain between the hypochondrium and lower abdomen. Rebellious qi lodging in the medial thigh allows cold to ascend to the lower abdomen; blood stagnation below causes mutual pulling, resulting in abdominal pain radiating to the thigh. Cold lodging beneath the membrane origins of the Small Intestine and among the collateral blood causes blood stagnation without flowing into the major vessels; qi and blood stagnate, eventually forming masses over time. Cold lodging in the five zang organs causes rebellious qi to escape upward, depleting yin qi while yang qi fails to enter, causing sudden severe pain and syncope; recovery of vital qi leads to survival. Cold lodging in the intestines and stomach causes rebellious qi to move upward, resulting in pain with vomiting. Cold lodging in the Small Intestine prevents proper digestion and accumulation, leading to subsequent diarrhea and abdominal pain. Heat flowing into the Small Intestine causes intestinal pain and constipation; intense heat and dryness cause hard, dry stool that cannot be expelled, resulting in pain with obstinate constipation.