六十难曰∶头心之病，有厥痛，有真痛，何谓也？
然∶手三阳之脉受风寒，伏留而不去者，则
名厥头痛。
厥，逆也，言气逆而痛也。厥痛，厥头痛，厥心痛也。真痛，真头痛，真心痛也。手三阳之
脉，为风寒留滞而不行，则壅逆而冲于头，故名厥头痛也。足三阳之脉，风寒留滞，亦作头痛，
今不言者，省文也。
入连在脑者，名真头痛。
真头痛不在经，而入连于脑，故痛甚，脑尽痛，手足寒至节，死不治。盖脑为髓海，真气之
所聚，卒不受邪，受邪则死矣。
按∶《素问·奇病论》帝曰∶人有病头痛，以数岁不已，此安得之，名为何病？岐伯曰∶当
有所犯大寒，内至骨髓，髓者，以脑为主，脑逆，故令头痛，齿亦痛，病名曰厥逆。此因寒邪
入髓，则上入头脑而为痛，其邪入深，故数岁不已也。若《灵枢·厥病篇》所载厥头痛，面若
肿起而烦心者，阳明之气，上逆而为痛也。又头脉痛，心悲善泣者，厥阴之气，上逆而为痛也。
又贞贞头重而痛者，少阴之气，上逆而为痛也。又项先痛，腰脊为应者，太阳之气，上逆而为
痛也。又头痛甚，耳前后脉涌有热者，少阳之气，上逆而为痛也。又真头痛，头痛甚，脑尽痛，
手足寒至节，死不治。此非六气之厥，乃客邪犯脑，故头痛甚，脑尽痛。盖头为诸阳之首，脑
为精水之海，手足寒至节，此真气为邪所伤，故死不治也。更有击堕而为痛者，大痹而为痛者，
寒气伤营而为偏痛者，是经论头痛者如此，不独手三阳为病也。
其五脏气相干，名厥心痛。
诸经络皆属于心，盖心主百脉，其营血由心而通于十二经络也，若一经有病，其脉逆行，逆
则乘心，乘心则心痛，故曰厥心痛。是五脏气冲逆致痛，非心家自病也。
其痛甚，但在心，手足青者，即名真心痛。其真心痛者，旦发夕死，夕发旦死。
心为脏腑之大主，精神之所舍，其脏坚固，邪不能客，客之则伤心，心伤则神去，神去则死
矣。真心痛，其痛甚，但在心而无别脏相干也。手足青者，寒邪犯君火之位，血色变也。旦发
夕死，夕发旦死者，心不受邪也，真头痛亦然。盖脑为人身之主宰，亦不受邪，故滑氏言其真
心痛者，真字下欠一头字是矣。
按∶《灵枢·厥病篇》曰∶厥心痛与背相控，善螈，如从后触其心，伛偻者，肾心痛
也。又
腹胀胸满，心尤痛甚者，胃心痛也。又痛如以锥针刺其心，心痛甚者，脾心痛也。又色苍苍如
死状，终日不得太息者，肝心痛也。又卧若徒居，心痛间动作痛益甚，色不变者，肺心痛也。
此别脏腑相干之痛也。又真心痛，手足青至节，心痛甚，旦发夕死，夕发旦死，此伤其脏真，而
为真心痛也。
第六十难问道：头部和心脏部位的疼痛，有厥痛和真痛之分，这是什么意思呢？
回答说：手三阳经脉受到风寒侵袭，邪气潜伏停留而不消散的，就称为厥头痛。
“厥”，就是逆乱的意思，指气机逆乱而导致的疼痛。厥痛包括厥头痛和厥心痛。真痛则包括真头痛和真心痛。手三阳经脉被风寒邪气留滞，导致气血运行不畅，从而壅塞逆乱并冲激头部，所以称为厥头痛。足三阳经脉如果也受风寒留滞，同样会引起头痛，这里之所以没有提及，是省略了文字（因为原理相同）。
真头痛的病位不在经络，而是直接连及脑部，所以疼痛非常剧烈，整个头脑都感到疼痛，并且手脚发冷直到关节，这种病症死亡且无法治疗。这是因为脑为髓海，是真气汇聚的地方，突然之间不能承受邪气，一旦受邪就会导致死亡。
按语：《素问·奇病论》中黄帝问道：有人患头痛病，多年不愈，这是怎么得的？叫什么病？岐伯回答说：这一定是遭受了大寒之邪，寒气内入骨髓。髓以脑为主，寒气上逆于脑，所以引起头痛，牙齿也会痛，这种病名叫厥逆。这是因为寒邪侵入髓海，向上进入头脑而引发疼痛，由于邪气深入，所以多年不愈。如果像《灵枢·厥病篇》所记载的厥头痛，面部浮肿且心烦意乱的，是阳明经气上逆引起的疼痛。还有头侧脉痛、心中悲伤爱哭泣的，是厥阴经气上逆引起的疼痛。还有头部沉重且疼痛的，是少阴经气上逆引起的疼痛。还有先项部疼痛，随后腰脊随之反应的，是太阳经气上逆引起的疼痛。还有头痛剧烈，耳前后脉搏跳动且有热感的，是少阳经气上逆引起的疼痛。至于真头痛，头痛剧烈，整个头脑都痛，手脚冷至关节，死亡且无法治疗。这些情况并非六气之厥，而是客邪侵犯脑部，所以头痛剧烈，全脑皆痛。因为头为诸阳之首，脑为精水之海，手脚冷至关节，说明真气已被邪气损伤，所以死亡且无法治疗。此外，还有因跌打撞击引起的疼痛，因严重痹症引起的疼痛，因寒气损伤营血引起的偏侧疼痛等，这些都是经典中论述的头痛原因，并不只是手三阳经发病。
如果是五脏之气相互干犯引起的，称为厥心痛。
所有经络都归属于心，因为心主司全身血脉，营血由心通达十二经络。如果某一经发生病变，其脉气逆行，逆气就会乘袭心脏，乘袭心脏就会导致心痛，所以称为厥心痛。这是五脏之气冲逆导致的疼痛，并非心脏本身的疾病。
如果疼痛非常剧烈，仅局限于心脏部位，且手脚呈现青紫色，就称为真心痛。真心痛的患者，早晨发病晚上死亡，晚上发病第二天早上死亡。
心是脏腑中的大主，是精神寄居的地方，其脏体坚固，邪气不能入侵；如果邪气入侵则伤及心脏，心脏受伤则神气离去，神气离去就会死亡。真心痛的疼痛非常剧烈，仅限于心脏而没有其他脏腑的气机干扰。手脚发青，是因为寒邪侵犯了君火之位，导致血色改变。早晨发病晚上死，晚上发病早上死的，是因为心脏不受邪气侵扰（此处指非外感常规邪气，而是直中真元），真头痛也是同样的道理。因为脑是人身的最高主宰，也不受邪气侵扰，所以滑寿先生认为在“真”字下面缺少一个“头”字才是正确的（意指真头痛与真心痛同理，皆属危重症）。
按语：《灵枢·厥病篇》说：厥心痛与背部牵引相连，容易抽搐，感觉像从背后触碰心脏，身体弯曲驼背的，是肾心痛。又有腹部胀满、胸部憋闷，心脏特别疼痛剧烈的，是胃心痛。又有疼痛像用锥子针刺心脏，心痛剧烈的，是脾心痛。又有面色苍白发暗如同死状，整天不能深呼吸叹息的，是肝心痛。又有躺卧或静坐时心痛暂时缓解，活动后疼痛加剧，面色不变的，是肺心痛。这是区分不同脏腑相互干犯引起的疼痛。另外，真心痛表现为手脚青紫直到关节，心痛剧烈，早晨发病晚上死，晚上发病早上死，这是损伤了脏器的真元，从而成为真心痛。
Difficulty 60 states: Regarding diseases of the head and heart, there are Jue pain (Jue Tong) and Zhen pain (Zhen Tong). What does this mean?
The response is: When the meridians of the Hand Three Yang (Hand Taiyang, Hand Yangming, Hand Shaoyang) are affected by Wind-Cold, and the pathogenic factor lingers and remains without dissipating, it is named Jue Headache.
"Jue" means reversal or counterflow, referring to pain caused by Qi counterflow. Jue pain includes Jue Headache and Jue Heartache. Zhen pain includes Zhen Headache and Zhen Heartache. When the meridians of the Hand Three Yang are stagnated by Wind-Cold, causing Qi to become obstructed and reverse, rushing upwards to the head, it is therefore called Jue Headache. If the meridians of the Foot Three Yang (Foot Taiyang, Foot Yangming, Foot Shaoyang) are also stagnated by Wind-Cold, they too can cause headaches; the reason this is not mentioned here is due to textual omission (as the principle is similar).
If the pathogen penetrates deeply and connects with the brain, it is named Zhen Headache.
Zhen Headache does not reside in the meridians but penetrates into the brain; therefore, the pain is severe, involving the entire brain, accompanied by coldness of the hands and feet extending to the joints. This condition is fatal and untreatable. This is because the brain is the Sea of Marrow, the gathering place of True Qi. It cannot suddenly withstand pathogens; once invaded, death ensues.
Commentary: In *Su Wen: Chapter on Rare Diseases*, the Yellow Emperor asks: "There are people suffering from headache that persists for years. How did they acquire it, and what is the name of this disease?" Qibo replies: "This must be due to exposure to severe Cold, which penetrated inward to the bone marrow. Since the brain is the master of marrow, the Cold causes Qi to reverse upward to the brain, resulting in headache and toothache. This disease is named Jue Ni (Counterflow Reversal)." This occurs because Cold pathogen enters the marrow, ascending to the head and brain to cause pain. Since the pathogen is deep-seated, the condition persists for years. For example, as recorded in *Ling Shu: Chapter on Jue Diseases*, if Jue Headache presents with facial swelling and irritability, it is caused by the counterflow of Yangming Qi. If there is pain along the temporal vessels, sadness, and a tendency to weep, it is caused by the counterflow of Jueyin Qi. If there is a heavy sensation and pain in the head, it is caused by the counterflow of Shaoyin Qi. If neck pain precedes, followed by corresponding pain in the lower back and spine, it is caused by the counterflow of Taiyang Qi. If the headache is severe, with pulsating vessels around the ears and heat, it is caused by the counterflow of Shaoyang Qi. As for Zhen Headache, the headache is severe, the entire brain hurts, and the hands and feet are cold up to the joints, leading to death and being untreatable. These cases are not due to the counterflow of the Six Qi, but rather an external pathogen invading the brain, hence the severe headache and whole-brain pain. The head is the summit of all Yang meridians, and the brain is the sea of Essence and Water. When the hands and feet are cold up to the joints, it indicates that True Qi has been damaged by the pathogen, making it fatal and untreatable. Furthermore, there are pains caused by blows or falls, by severe Bi syndrome, or by Cold damaging Ying Blood causing unilateral pain. These are the various causes of headache discussed in the classics, not limited to diseases of the Hand Three Yang meridians.
When the Qi of the Five Zang organs interferes with each other, it is named Jue Heartache.
All meridians connect to the Heart. The Heart governs all blood vessels, and Ying Blood flows from the Heart through the Twelve Meridians. If a disease occurs in any one meridian, its Qi may reverse. Reversed Qi will attack the Heart; attacking the Heart results in Heartache, hence it is called Jue Heartache. This is pain caused by the counterflow of Qi from the Five Zang organs, not a primary disease of the Heart itself.
If the pain is extremely severe, localized solely in the Heart region, and the hands and feet turn cyanotic (blue/green), it is named Zhen Heartache. Patients with Zhen Heartache who develop symptoms in the morning will die by evening, and those who develop symptoms in the evening will die by morning.
The Heart is the great master of the Zang-Fu organs and the residence of Spirit (Shen). Its organ structure is solid, and pathogens cannot easily invade. If pathogens do invade, they damage the Heart; if the Heart is damaged, the Spirit departs; if the Spirit departs, death occurs. Zhen Heartache involves severe pain localized only in the Heart without interference from other Zang organs. The cyanosis of the hands and feet occurs because Cold pathogen invades the position of Ministerial Fire (Jun Huo), altering the color of the blood. The mortality pattern (morning onset/evening death, or vice versa) reflects the fact that the Heart generally does not accept pathogens in this manner; similarly, the Brain does not accept pathogens. Therefore, Master Hua (Huashi) suggested that the character 'Zhen' (True) in Zhen Heartache should ideally have a 'Head' (Tou) component below it, implying that Zhen Heartache and Zhen Headache share the same critical nature of direct invasion of the vital essence.
Commentary: *Ling Shu: Chapter on Jue Diseases* states: "Jue Heartache that radiates to the back, accompanied by spasms, feeling as if touched from behind, with the patient stooping, is Kidney Heartache." "Abdominal distension, chest fullness, and particularly severe Heartache is Stomach Heartache." "Heartache feeling like being pierced by an awl or needle, with severe pain, is Spleen Heartache." "Pale, ashen complexion resembling death, unable to take a deep sigh all day, is Liver Heartache." "Heartache that alleviates when lying down or resting at home, but worsens with movement, with unchanged complexion, is Lung Heartache." These differentiate pains caused by the interference of various Zang organs. Additionally, Zhen Heartache presents with cyanosis of the hands and feet extending to the joints, severe Heartache, and early death (morning onset/evening death, or evening onset/morning death). This indicates damage to the True Essence of the Zang organs, constituting Zhen Heartache.