人身经脉流行，气机环转，上下内外，无有已时，寒气客之，稽迟不行则痛，诸痛各不同形，百病皆
生于气，帝举以问，伯一一以对，是为举痛论也。
黄帝问曰∶余闻善言天者，必有验于人；善言古者，必有合于今，善言人者，必有厌于己。
如此则道不惑而要数极，所谓明也。今余问于夫子，令言而可知，视而可见，扪而可得，令验于
己，如发蒙解惑，可得而闻乎？
厌，弃也，弃其非而从其是也。言天必验于人，言古必合于今，言人必弃于己，不惑于道而知要
数之极，所谓至明也。今人不能，故以为问，言而可知，问而知之也，视而可见，望而知之也，
扪而可得，脉而知之也，或言或视或扪，皆今有验于己，如蒙昧未明者发之，疑惑未决者解之，其道可得而闻乎？
岐伯再拜稽首对曰∶何道之问也？
言而可知，视而可见，扪而可得，是何道之问也。
帝曰∶愿闻人之五脏卒痛，何气使然？
卒，音促，下同。痛者，脏腑之气不通也，故愿闻五脏卒痛，何气使然。
岐伯对曰∶经脉流行不止，环周不休，寒气入经而稽迟，泣而
不行，客于脉外则血少，客于脉中，则气不通，故卒然而痛。
泣，作涩，下同。人身十二经脉，乃血气出入之道，流行不
止，环周不休，若寒气入经，而正气稽迟，则血凝涩而不行，气行
脉外，血亦随之，今寒客于脉外则血少，血行脉中，气亦随之，今
寒客于脉中则气不通，寒客经脉，气血不能流行环转，故卒然而痛。
帝曰∶其痛或卒然而止者，或痛甚不休者。
痛有止不止之不同。
或痛甚不可按者，或按之而痛止者，或按之无益者。
痛者宜按不宜按之不同。
或喘动应乎者，或心与背相引而痛者，或胁肋与少腹相引而痛者，或腹痛引阴股者。
痛有上下相应相引之不同。
或痛宿昔而成积者，或卒然痛死不知人，少间复生者。
间，去声。痛有久暂之不同。
或痛而呕者，或腹痛而后泄者，或痛而闭不通者。
痛有通闭之不同。
凡此诸痛，各不同形，别之奈何？
别，音逼。诸痛不同，其形亦异，故举以问。
岐伯曰∶寒气客于脉外，则脉寒，脉寒则缩蜷，缩蜷则脉 急， 急则外引小络，故卒然
而痛，得炅则痛立止，因重中于寒，则痛久矣。
，音屈。炅 同，音景，下炅及余篇皆仿此。重，平声。中，去声。 ，犹屈也。炅，犹热也。其
痛或卒然而止，或痛甚不休者，始因寒气客于脉外，则脉寒，脉寒则凝涩而缩蜷。缩蜷则脉
而急，脉 急则外引小络，小络，孙络也。脉与孙络，寒气客之，故卒然而痛，得阳热之气，复于络
脉则痛立止。所以其痛或卒然而止也，始因寒空客于脉外，继因重中于寒，则痛久矣，所以或痛甚不休也。
寒气客于经脉之中，与炅气相薄则脉满，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，按之则热气至，热气至则痛止矣。寒气客于侠背之脉
则深，按之不能及，故按之无益也。
旧本，按之则热气至十三字在下段，故相引而痛之下，今改正于此。或痛甚不可按者，乃寒气客于
经脉之中，与阳热之炅气相薄，阴阳寒热相薄则脉满，脉满则壅滞而痛，壅滞而痛故不可按也。所
以然者，寒气客于经脉之中则寒气稽留与炅气相薄，则炅气从上。脉满则脉充大，致血气乱而为痛，血
气既乱故痛甚不可按也。或按之痛止者乃寒气客于肠胃之间，膜原之下。膜原内通脾土，外化肌
腠，寒气客之则脾络之血不得从经隧而散于肌腠之小络，致小络急引，急引故痛，按之则血气得以散于
小络，故按之痛止，所以然者，按之则血气散，散则热气至，热气甚故痛止矣，或按之无益
者，乃寒气客于侠脊之脉，侠脊之脉，五脏之俞也，故客之则深，按之不能及于五内，故按之无益也。
寒气客于冲脉，冲脉起于关元，随腹直上，寒气容则脉不通，脉不通则气因之，故喘动应乎矣。
寒气客于背俞之脉，则脉泣，脉泣则血虚，血虚则痛，其俞注于心，故相引而痛。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，故胁肋与少腹相引痛矣。厥
气客于阴股，寒气上及少腹，血泣在下相引，故腹痛引阴股。
或喘动应乎者，乃寒气客于冲脉。夫冲脉起于关元，随腹直上，会于咽喉，散于通体，寒气客则冲脉
不能直上，故脉不通，脉不通则气因之而逆。冲脉不通而痛，故喘动应乎矣。或心与背相引
而痛者，乃寒气客于背俞之脉则脉涩，脉涩则血虚，血虚则痛，心主血脉，其俞在背，是其背俞注于心，
注于心故优与背相引而痛也，或胁肋与少腹相引而痛者，乃寒气客于厥阴之脉。夫厥阴之脉
者，络阴器，系于肝，寒气客于厥阴之脉中，则肝血涩，而阴器脉急，故胁肋与少腹相引痛矣，或腹痛引阴
股者，亦寒气客于厥阴之脉也。厥阴之脉，循阴股，抵小腹，厥阴受寒则厥气客于阴股，寒
气上及少腹，肝血凝涩，不能循脉而上，则在下相引，在下相引故
少腹痛而引阴股也。
寒气客于小肠膜原之间，络血之中，血泣不得注于大经，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。
或痛宿昔而成积者，乃寒气客于小肠，小肠受寒则内而膜原之间，外而络血之中，血气不相通贯，
故血涩不得注于大经，而成有形之血积。血涩则气稽留，血气稽留不得行，则积之成也，匪朝伊芳
夕，故痛于宿昔，久而成积矣。或卒然痛死不知人，少间复生者，乃寒气客于五脏，客于五脏则脏寒，脏
寒则厥逆之气上泄，阴气竭于内，阳气虚于外，不能即入于阴，阴气竭，阳气未入，故卒然痛
死不知人，少间则阴气竭而得复，阳气未入而得反，乍刻乍苏则生矣。
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。
热气留于小肠，肠中痛，瘅热焦渴则坚干不得出，故痛而闭不通矣。
或痛而呕者，乃寒气客于肠胃，厥逆之气欲从上出，故痛而呕也。或腹痛而后泄者，乃寒气客于小
肠，小肠不得成聚而传化，故后泄而腹痛矣。或痛而闭不通者，乃小肠之邪不得后泄，闭而则
热，热气留于小肠，则肠中痛，热气留则瘅热焦渴，瘅热焦渴则小肠受盛之物，坚干不得出，故痛而
闭不通矣。以上皆言寒气，至终则言热气，以明始因于寒，后乃化热，而寒热之气，皆能致痛也。
帝曰∶所谓言而可知者也，视而可见，奈何？
诸痛各不同形，必言其痛之所在而后知之，此所谓言而可知者也。医者不问，病者不言，视而可见奈何。
岐伯曰∶五脏六腑，固尽有部，视其五色，黄赤为热，白为
寒，青黑为痛，此所谓视而可见者也。
五脏为阴，六腑为阳，固尽有所属之部，视其面之五色，而知
病之所在，如面色红赤，则知脏腑之有热，面色白则知脏腑之有寒，面色青黑则知脏腑之有痛，望面色
而知其病，所谓视而可见者
此也。
帝曰∶扪而可得奈何？
上文云，言而可知，视而可见，扪而可得，故复问扪而可得。
岐伯曰∶视其主病之脉，坚而血，及陷下者，皆可扪而得也。
视其主病之脉，如寸脉主心肺之病，关脉主肝脾之病者是也。坚而血，是知脉体有余，邪气实也，及陷
下者，是知脉体不足，正气虚也。邪实正虚，皆可扪而得也。此一节，言诸痛各不同形，皆
言而可知，视而可见，扪而可得也。
帝曰∶善。余知百病生于气也，怒则气上，喜则气缓，悲则气消，恐则气下，寒则气收，炅
则气泄，惊则气乱，劳则气耗，思则气结，九气不同，何病之生。
经脉流行不止，环周不休，气有所述，则病生焉，故知百病之
生于气也。七情动于内，寒炅发于外，则气因之而痛，然九气不同，何病之生。
岐伯曰∶怒则气逆，甚则呕血及飧泄，故气上矣。
怒则肝气内逆，肝主冲任之血，故逆甚则呕血，木王土衰，故及为飧泄，怒则气上，以此故也。
喜则气和志达，荣卫通利，故气缓矣。
喜则心气和而心志达，和于内而达于外，则荣卫通利，喜则气缓，以此故也。
悲则心系急，肺布叶举，而上焦不通，荣卫不散，热气在中，则气消矣。
悲则心气并于肺，故心系急，心系上连于肺，故肺布叶举，肺位房上，主行荣卫阴阳之气，今肺布
叶举，而致上焦不通，荣卫不散，上焦不通，荣卫不散，则气郁于中，而致热气在中，悲则气消，以此故也。
恐则精却，却则上焦闭，闭则气还，还则下焦胀，故气不行矣。
恐则肾伤而精却。却，退却也。精却则生阳之气不能上升，故
却则上焦闭，闭则在上之气还归于下，故闭则气还，上而复还，不
能环转，故还则下焦胀，恐伤肾而上下不交，故气不行，不行者不行于上也，恐则气下，以此故也。
寒则腠理闭，气不行，故气收矣。
寒则肌腠之文理，闭而不开，闭则三焦之气，不能通会于肌腠，故气不行，寒则气收，以此故也。
炅则腠理开，荣卫通，汗大泄，故气泄矣。
炅则阳热气盛，故腠理开，开则荣卫通，腠理开而荣卫通，则汗大泄，炅则气泄，以此故也。
惊则心无所倚，神无所归，虑无所定，故气乱矣。
惊则心气动而无所倚，神气越而无所归，思虑惑而无所定，惊则气乱，以此故也。
劳则喘息，汗出，外内皆越，故气耗矣。
劳则气血皆伤，气虚而喘息于内，血虚而汗出于外，外内皆越，气血耗竭，劳则气耗，以此故也。
思则心有所存，神有所归，正气留而不行，故气结矣。
思则心有所存，不能肆应，神有所归，不能周遍，心存神归，则正气寿而不行，思则气结，以此
故也。此一节，因诸痛各不同形之意，而言百病皆生于气，以明九气之不同也。
【背景信息】
书名：黄帝素问直解 作者：高士宗 朝代：清 章节：举痛论第三十九篇 类别：内经
人体经脉之气循环流动，气机环转不息，上下内外，没有停止的时候。寒气侵入人体，导致气血运行迟缓停滞，从而产生疼痛。各种疼痛的表现形式各不相同，但百病皆由气机失调引起。黄帝提出这个问题来询问，岐伯逐一进行解答，这就是《举痛论》篇的由来。
黄帝问道：我听说善于谈论天道的人，一定能在人体上得到验证；善于谈论古代之事的人，其言论一定符合当今实际；善于谈论他人者，一定能以自身为鉴（摒弃错误，遵循正确）。如果能做到这样，就不会对医道感到困惑，并能掌握事物的关键规律，这就叫做“明”。现在我向您请教，希望能通过言语询问而得知病情，通过观察面色而看见病证，通过触摸脉象而获得诊断依据，使这些方法都能在我身上得到验证，就像启发蒙昧、解除疑惑一样，您能讲给我听吗？
“厌”意为弃除，即弃除错误的认知而遵循正确的道理。谈论天道必须要在人体生理病理上得到验证，谈论古代必须与当今实际情况相吻合，谈论他人必须以自身经验为参照（去伪存真），这样就不会被医道所迷惑，并能知晓关键规律的极致，这就称为“至明”。现在人们往往做不到这一点，所以以此发问。“言而可知”，是指通过问诊而知晓病情；“视而可见”，是指通过望诊而观察病色；“扪而可得”，是指通过切诊（摸脉）而了解脉象。无论是问、是看还是摸，都要在当下于自身或患者身上得到验证，如同启发未开之蒙昧，解开未决之疑惑，这样的医道可以讲给我听吗？
岐伯拜了两拜，低头至地行礼后回答说：您问的是哪方面的道理呢？
所谓通过言语询问可知晓，通过观察面色可见知，通过触摸脉象可获得，这究竟是在问什么道理呢？
黄帝说：我希望听听关于人五脏突然发生疼痛的情况，是什么气机变化导致的呢？
“卒”通“猝”，读音同“促”，下文相同。疼痛的本质是脏腑之气不通畅，所以我希望了解五脏突然疼痛，是由何种气机原因造成的。
岐伯回答说：经脉中的气血流行不止，环周运转不停息。如果寒气侵入经脉，导致正气运行迟缓，血液凝涩而不流通。寒气客居在脉外，则会导致血少；寒气客居在脉中，则会导致气机不通，因此会突然发生疼痛。
“泣”通“涩”，读音同“涩”，下文相同。人身十二经脉，是气血出入通行的道路，流行不止，环周不休。如果寒气侵入经脉，正气运行就会迟缓，导致血液凝涩而不能通行。气行于脉外，血也随气而行；如今寒气客居在脉外，则血脉收缩而显得血少；血行于脉中，气也随血而行；如今寒气客居在脉中，则气机阻滞不通。寒气客居于经脉，使得气血不能正常流行环转，所以突然发生疼痛。
黄帝说：这种疼痛有的突然停止，有的剧烈疼痛持续不止。
疼痛有停止和不停止的不同情况。
有的疼痛剧烈且不可按压，有的按压后疼痛停止，有的按压后毫无益处。
疼痛对于按压的反应有宜按和不宜按的不同。
有的疼痛伴有呼吸喘动，有的心部与背部相互牵引作痛，有的胁肋部与小腹部相互牵引作痛，有的腹痛牵引至大腿内侧。
疼痛有上下部位相应、相互牵引的不同表现。
有的疼痛经过长时间形成积块，有的突然剧痛昏死不知人事，过一会儿又苏醒过来。
“间”读音同“涧”。疼痛有持久和短暂的不同。
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。
疼痛有通畅和闭塞的不同。
以上这些疼痛，表现形式各不相同，该如何辨别呢？
“别”读音同“逼”。各种疼痛不同，其形态表现也各异，所以我列举出来询问。
岐伯说：寒气客居在脉外，会导致经脉寒冷；经脉寒冷则会发生收缩卷曲；经脉收缩卷曲则变得拘急；经脉拘急则会向外牵引细小的络脉，因此突然发生疼痛。遇到温热之气，疼痛立即停止。如果再次受到寒邪侵袭，疼痛就会长久持续。
“蜷”读音同“屈”。“炅”同“炯”，读音同“景”，下文的“炅”及后续篇章都仿照此例。“重”读平声，“中”读去声。“蜷”，就是弯曲的意思。“炅”，就是热的意思。疼痛有时突然停止，有时剧烈疼痛持续不止，起初是因为寒气客居在脉外，导致经脉寒冷，经脉寒冷则凝涩而收缩卷曲。收缩卷曲导致经脉拘急，经脉拘急则向外牵引孙络（小络）。脉与孙络都被寒气客居，所以突然发生疼痛。如果遇到阳热之气，复归于络脉，疼痛就会立即停止。这就是为什么疼痛有时会突然停止的原因。起初是因为寒气客居在脉外，后来因为再次遭受寒邪侵袭，所以疼痛长久持续，这就是为什么有时疼痛剧烈且持续不止的原因。
寒气客居在经脉之中，与体内的热气相互搏结，导致经脉充盈胀满；胀满则疼痛且不可按压。寒气停留不去，热气从上而来，则经脉充大，血气紊乱，所以疼痛剧烈且不可按压。寒气客居在肠胃之间、膜原之下，血液不能散行，细小络脉拘急牵引，所以发生疼痛。按压时，血气得以疏散，所以按压后疼痛停止。按压时热气到达，热气到达则疼痛停止。寒气客居在夹脊两侧的经脉中，位置较深，按压不能触及，所以按压无效。
旧版书中，“按之则热气至”十三字位于下一段“故相引而痛”之后，现在此处改正。所谓疼痛剧烈且不可按压，是因为寒气客居在经脉之中，与阳热之气相互搏结，阴阳寒热相互搏结导致经脉胀满，经脉胀满则壅滞而痛，因壅滞而痛，所以不可按压。之所以如此，是因为寒气客居在经脉之中，寒气停留与热气相互搏结，热气随之上升。经脉胀满则脉体充大，导致血气紊乱而产生疼痛，血气既然紊乱，所以疼痛剧烈且不可按压。所谓按压后疼痛停止，是因为寒气客居在肠胃之间、膜原之下。膜原内通脾土，外连肌腠，寒气客居于此，则脾络之血不能从经隧散行至肌腠的小络，导致小络拘急牵引，因拘急牵引而痛。按压时，血气得以疏散到小络，所以按压后疼痛停止。之所以如此，是因为按压使血气疏散，疏散后热气到达，热气旺盛所以疼痛停止。所谓按压无效的，是因为寒气客居在夹脊的经脉中。夹脊的经脉，即是五脏的背俞穴所在，寒气客居于此则位置深在，按压不能触及五脏内部，所以按压无效。
寒气客居在冲脉，冲脉起于关元穴，沿腹部直上。寒气容纳其中则脉道不通，脉道不通则气机随之逆乱，所以出现呼吸喘动应指的现象。
寒气客居在背俞之脉，则脉道涩滞，脉道涩滞则血虚，血虚则痛。背俞之气注于心，所以心与背部相互牵引作痛。寒气客居在厥阴脉，厥阴脉联络阴器，系属于肝。寒气客居在脉中，则血液涩滞、经脉拘急，所以胁肋与小腹部相互牵引作痛。厥逆之气客居在大腿内侧，寒气上行波及小腹，血液在下部涩滞并相互牵引，所以腹痛牵引至大腿内侧。
所谓疼痛伴有呼吸喘动的，是因为寒气客居在冲脉。冲脉起于关元，沿腹部直上，会合于咽喉，散布于全身。寒气客居则冲脉不能直上，所以脉道不通。脉道不通则气机随之逆乱。冲脉不通而疼痛，所以出现呼吸喘动应指的现象。所谓心与背部相互牵引作痛的，是因为寒气客居在背俞之脉，导致脉道涩滞。脉道涩滞则血虚，血虚则痛。心主血脉，其背俞穴在背部，背俞之气注于心，注于心故与背部相互牵引作痛。所谓胁肋与小腹部相互牵引作痛的，是因为寒气客居在厥阴脉。厥阴脉联络阴器，系属于肝。寒气客居在厥阴脉中，则肝血涩滞，阴器脉络拘急，所以胁肋与小腹部相互牵引作痛。所谓腹痛牵引大腿内侧的，也是寒气客居在厥阴脉。厥阴脉循行于大腿内侧，抵达小腹。厥阴受寒，则厥逆之气客居在大腿内侧，寒气上行波及小腹，肝血凝涩，不能循脉上行，则在下方相互牵引，因下方相互牵引，所以少腹疼痛并牵引至大腿内侧。
寒气客居在小肠的膜原之间、络脉之中，血液涩滞不能注入大经脉，血气停留不能通行，所以经过长时间形成积块。寒气客居在五脏，导致厥逆之气上泄，阴气竭绝，阳气未能入阴，所以突然剧痛昏死不知人事，若气机恢复则能生还。
所谓疼痛经过长时间形成积块的，是因为寒气客居在小肠。小肠受寒，则内而在膜原之间，外而在络脉之中，血气不相贯通，所以血液涩滞不能注入大经脉，形成有形的血积。血涩则气机停留，血气停留不能通行，积块就形成了，不是早晨就是傍晚（形容时间久），所以在过去的时间里疼痛，久而久之形成积块。所谓突然剧痛昏死不知人事，过一会儿又苏醒的，是因为寒气客居在五脏。寒气客居在五脏则脏寒，脏寒则厥逆之气上泄，阴气在内竭绝，阳气在外虚弱，不能立即入阴。阴气竭绝，阳气未入，所以突然剧痛昏死不知人事。过一会儿，阴气竭绝后得以恢复，阳气未入后得以返回，乍苏乍醒就能生还。
寒气客居在肠胃，厥逆之气向上溢出，所以疼痛并伴有呕吐。寒气客居在小肠，小肠不能正常聚化传变，所以随后腹泻并腹痛。热气留滞在肠道，肠中疼痛，湿热焦渴则大便坚硬干燥无法排出，所以疼痛且闭塞不通。
所谓疼痛并伴有呕吐的，是因为寒气客居在肠胃，厥逆之气想要从上而出，所以疼痛并呕吐。所谓腹痛随后腹泻的，是因为寒气客居在小肠，小肠不能正常聚化传变，所以随后腹泻并腹痛。所谓疼痛且闭塞不通的，是小肠的病邪不能向下排泄，闭塞而生热。热气留滞在肠道，则肠中疼痛。热气滞留则产生湿热焦渴，湿热焦渴则小肠受盛的食物变得坚硬干燥无法排出，所以疼痛且闭塞不通。以上都是讲述寒气致病，到最后才提到热气，以说明起初因于寒，后来转化为热，而寒气和热气都能导致疼痛。
黄帝说：所谓的“通过言语询问可知晓”，具体是怎样的呢？
各种疼痛表现形式各不相同，必须说出疼痛的具体部位才能知晓，这就是所谓的“通过言语询问可知晓”。如果医生不问，病人不说，那么“通过观察面色可见知”又是怎样的呢？
岐伯说：五脏六腑，本来都有所属的面部区域。观察面部的五色，黄色和红色代表热证，白色代表寒证，青色和黑色代表痛证。这就是所谓的“通过观察面色可见知”。
五脏属阴，六腑属阳，本来都有所属的面部区域。观察面部的五色，就可以知道病变的部位。例如面色红赤，就知道脏腑有热；面色白，就知道脏腑有寒；面色青黑，就知道脏腑有痛。通过望面色来知晓病情，这就是所谓的“通过观察面色可见知”。
黄帝说：“通过触摸脉象可获得”，具体是怎样的呢？
上文提到“通过言语询问可知晓，通过观察面色可见知，通过触摸脉象可获得”，所以再次询问“通过触摸脉象可获得”是什么意思。
岐伯说：观察主治疾病的脉象，如果脉象坚实而有瘀血，以及脉象陷下的，都可以通过触摸脉象来获得诊断。
观察主治疾病的脉象，例如寸脉主要反映心肺的疾病，关脉主要反映肝脾的疾病等。脉象坚实而有瘀血，是知道脉体有余，邪气实盛；脉象陷下，是知道脉体不足，正气虚弱。邪实正虚，都可以通过触摸脉象来获得诊断。这一节内容，讲述了各种疼痛表现形式各不相同，都可以通过言语询问知晓，通过观察面色看见，通过触摸脉象获得。
黄帝说：好。我知道百病皆由气机失调引起。愤怒会使气机上逆，喜悦会使气机舒缓，悲伤会使气机消散，恐惧会使气机下陷，寒冷会使气机收敛，炎热会使气机外泄，惊骇会使气机紊乱，劳倦会使气机耗损，思虑会使气机郁结。这九种气机变化不同，会产生什么样的疾病呢？
经脉气血流行不止，环周运转不停息，气机有所述求（异常），疾病就会产生，所以知道百病皆由气机引起。七情在体内发动，寒热在体外引发，气机因此产生疼痛。然而这九种气机变化不同，会产生什么样的疾病呢？
岐伯说：愤怒会使气机上逆，严重时会导致呕血和完谷不化的腹泻，所以说是气机上逆。
愤怒会使肝气内逆，肝主司冲任之血，所以气逆严重时会导致呕血。木旺土衰，所以会导致完谷不化的腹泻。愤怒导致气机上逆，就是这个原因。
喜悦会使气机和顺、意志通达，营卫之气通畅流利，所以说是气机舒缓。
喜悦会使心气和顺、心志通达，和顺于内而通达于外，则营卫之气通畅流利。喜悦导致气机舒缓，就是这个原因。
悲伤会使心脉拘急，肺叶张举，导致上焦不通畅，营卫之气不能布散，热气郁结在中焦，所以说是气机消散。
悲伤会使心气合并于肺，所以心脉拘急。心脉上连于肺，所以肺叶张举。肺位在上，主司行营卫阴阳之气。如今肺叶张举，导致上焦不通畅，营卫之气不能布散。上焦不通畅，营卫之气不能布散，则气郁结于中，导致热气郁结在中焦。悲伤导致气机消散，就是这个原因。
恐惧会使肾精退却，精退则上焦闭塞，闭塞则气还归下部，还归下部则下焦胀满，所以说是气机下陷。
恐惧会损伤肾脏导致精气退却。“却”，是退却的意思。精气退却则生发之阳气不能上升，所以精退则上焦闭塞。上焦闭塞则在上之气还归于下，所以闭塞则气还归下部。上部之气还归下部，不能环转上升，所以还归下部则下焦胀满。恐惧损伤肾脏，导致上下不交，所以气机下陷（不行于上）。恐惧导致气机下陷，就是这个原因。
寒冷会使腠理闭塞，气机运行不畅，所以说是气机收敛。
寒冷会使肌肤腠理的纹理闭合不开，闭合则三焦之气不能通会于肌腠，所以气机运行不畅。寒冷导致气机收敛，就是这个原因。
炎热会使腠理开放，营卫通畅，汗液大量外泄，所以说是气机外泄。
炎热则阳热之气盛大，所以腠理开放。腠理开放则营卫通畅。腠理开放且营卫通畅，则汗液大量外泄。炎热导致气机外泄，就是这个原因。
惊骇会使心神无所依托，神气无所归依，思虑无所定夺，所以说是气机紊乱。
惊骇会使心气动荡而无所依托，神气越散而无所归依，思虑惑乱而无所定夺。惊骇导致气机紊乱，就是这个原因。
劳倦会导致喘息、出汗，内外之气皆越出，所以说是气机耗损。
劳倦会损伤气血，气虚则在内喘息，血虚则在外出汗。内外之气皆越出，气血耗竭。劳倦导致气机耗损，就是这个原因。
思虑会使心神有所存守，神气有所归依，正气停留而不能运行，所以说是气机郁结。
思虑会使心神有所存守，不能随意应对；神气有所归依，不能周遍全身。心神存守、神气归依，则正气停留而不能运行。思虑导致气机郁结，就是这个原因。这一节内容，承接前文诸痛各不同形之意，阐述百病皆由气机引起，以阐明九种气机变化的不同。
[Background Information]
Book: Huangdi Suwen Zhijie (Direct Explanation of the Yellow Emperor's Plain Questions)
Author: Gao Shizong
Dynasty: Qing Dynasty
Chapter: Ju Tong Lun (Discussion on Various Painful Conditions), Chapter 39
Category: Neijing (Inner Canon)
The meridians and vessels of the human body circulate continuously, and the mechanism of Qi rotates without cease. There is no end to its movement in the upper, lower, interior, and exterior. When Cold Evil invades, it causes stagnation and obstruction, leading to pain. The manifestations of various pains differ, yet all diseases arise from disturbances in Qi. The Yellow Emperor raised this question for inquiry, and Bo Qiu answered point by point. This constitutes the chapter *Ju Tong Lun*.
The Yellow Emperor asked: I have heard that those who speak well of Heaven must find verification in humanity; those who speak well of antiquity must align with the present; and those who speak well of others must find reflection in themselves. If one can achieve this, the Dao will not be confused, and the essential principles will be fully understood, which is called "Clarity." Now I ask you, Master, so that through speech I may know, through observation I may see, and through palpation I may obtain knowledge. May these methods be verified in myself, like dispelling ignorance or resolving confusion? Can you explain them to me?
"Yan" (satiety/abundance) here implies discarding the incorrect and adhering to the correct. Speaking of Heaven requires verification in the human body; speaking of antiquity must conform to the present; speaking of others must be discarded/refined through self-examination. One should not be confused by the Dao but rather understand the ultimate limits of its essential numbers, which is called "Supreme Clarity." Since people today often fail to do this, they raise this question. "Knowing through speech" refers to knowing through inquiry; "Seeing through observation" refers to knowing through inspection; "Obtaining through palpation" refers to knowing through pulse diagnosis. Whether through speech, observation, or palpation, all must yield verification in the present moment, like enlightening the ignorant or resolving doubts. Can such a Dao be explained to me?
Bo Qiu bowed twice and replied with his head to the ground: What aspect of the Dao are you asking about?
You ask what Dao is known through speech, seen through observation, and obtained through palpation.
The Yellow Emperor said: I wish to hear about sudden pain in the five Zang organs. What Qi causes this?
"Cu" (sudden) sounds like "Cu" (urgent), as used below. Pain arises from the obstruction of Qi in the Zang and Fu organs. Therefore, I wish to understand the cause of sudden pain in the five Zang organs.
Bo Qiu replied: The circulation of Qi and Blood in the meridians never stops, rotating endlessly. When Cold Evil enters the meridians, it causes stagnation and obstruction, making the blood viscous and immobile. If Cold resides outside the vessels, blood becomes deficient; if Cold resides inside the vessels, Qi becomes obstructed. Thus, sudden pain occurs.
"Qi" (stagnant/stiff) is pronounced like "Se" (viscous/astringent), as used below. The twelve meridians of the human body are the pathways for the entry and exit of Qi and Blood, circulating endlessly. If Cold Evil enters the meridians, the healthy Qi stagnates, causing blood to coagulate and become viscous, unable to flow. Qi moves outside the vessels, and blood follows; when Cold resides outside the vessels, the vessels constrict, appearing blood-deficient. Blood moves within the vessels, and Qi follows; when Cold resides within the vessels, Qi becomes obstructed. When Cold Evil lodges in the meridians, preventing the normal circulation and rotation of Qi and Blood, sudden pain ensues.
The Yellow Emperor said: Sometimes the pain stops suddenly; sometimes it is severe and unceasing.
Pain varies in whether it ceases or persists.
Sometimes the pain is severe and cannot be pressed; sometimes pressing stops the pain; sometimes pressing yields no benefit.
Pain varies in whether it is suitable for pressure or not.
Sometimes the pain is accompanied by panting movements; sometimes the heart and back pull each other in pain; sometimes the hypochondrium and flanks pull into the lower abdomen; sometimes abdominal pain radiates to the inner thighs.
Pain varies in its corresponding and pulling sensations between upper and lower regions.
Sometimes pain persists for a long time and forms an accumulation; sometimes there is sudden severe pain leading to unconsciousness, followed by recovery after a short while.
"Jian" (interval) is pronounced like "Jian" (gap). Pain varies in duration, being either long-lasting or brief.
Sometimes pain is accompanied by vomiting; sometimes abdominal pain is followed by diarrhea; sometimes pain is accompanied by constipation and blockage.
Pain varies in whether it involves openness or blockage.
All these pains have different forms. How should they be distinguished?
"Bie" (distinguish) is pronounced like "Bi". Since various pains differ, their forms also vary, hence I raise this question.
Bo Qiu said: When Cold Evil lodges outside the vessels, the vessels become cold. Cold vessels contract and curl up. Contraction leads to tension. Tension pulls on the collateral vessels externally, causing sudden pain. Upon exposure to warmth (Jiong), the pain stops immediately. However, if subjected to repeated Cold invasion, the pain persists for a long time.
"Quan" (curl) is pronounced like "Qu" (bend). "Jiong" is the same as "Jiong" (hot), pronounced like "Jing"; subsequent uses of "Jiong" follow this pattern. "Chong" (heavy/repeated) is read with a level tone; "Zhong" (strike/injure) is read with a departing tone. "Quan" means bending. "Jiong" means heat. The pain may stop suddenly or persist severely. Initially, because Cold lodges outside the vessels, the vessels become cold, leading to coagulation, viscosity, contraction, and curling. Curling causes vessel tension, which pulls on the Sun Luo (fine collaterals). Both the main vessels and fine collaterals are invaded by Cold, causing sudden pain. Upon receiving Yang-heat Qi, returning to the collateral vessels, the pain stops immediately. This explains why pain sometimes stops suddenly. Initially, Cold lodged outside the vessels; subsequently, repeated Cold invasion caused the pain to persist, explaining why it sometimes remains severe and unceasing.
When Cold Evil lodges within the meridians, it contends with Warmth (Jiong) Qi, causing vessel fullness. Fullness leads to pain that cannot be pressed. Cold Evil lingers, and Warmth Qi rises, causing vessels to swell and Qi and Blood to become chaotic, resulting in severe pain that cannot be pressed. When Cold Evil lodges between the stomach and intestines, beneath the Mo Yuan (membrane source), blood cannot disperse, and small collaterals contract and pull, causing pain. Pressing disperses the Qi and Blood, so pain stops upon pressing. Pressing brings Heat Qi to the area; once Heat Qi arrives, pain stops. When Cold Evil lodges in the Mai Xue (vessels alongside the spine), the location is deep, beyond the reach of palpation, so pressing is ineffective.
In older editions, the phrase "pressing brings Heat Qi to the area" appeared later under "thus pulling each other in pain," but this has been corrected here. Severe pain that cannot be pressed occurs when Cold lodges in the meridians and contends with Yang-heat Qi. The contention of Yin-Cold and Yang-Heat causes vessel fullness. Vessel fullness leads to stagnation and pain, making it untouchable. Specifically, when Cold lodges in the meridians, it lingers and contends with Heat Qi, causing Heat to rise. Vessel fullness swells the vessels, disrupting Qi and Blood, causing pain. Since Qi and Blood are disrupted, the pain is severe and untouchable. Pain that stops upon pressing occurs when Cold lodges between the stomach and intestines, beneath the Mo Yuan. The Mo Yuan connects internally to Spleen Earth and externally to the muscle layers. When Cold lodges there, Spleen collateral blood cannot disperse from the main channels to the small collaterals of the muscle layers, causing small collaterals to contract and pull, resulting in pain. Pressing allows Qi and Blood to disperse into the small collaterals, stopping the pain. Specifically, pressing disperses Qi and Blood; dispersion brings Heat Qi; abundant Heat Qi stops the pain. Pain unaffected by pressing occurs when Cold lodges in the vessels alongside the spine. These vessels house the Back-Shu points of the five Zang organs. Cold lodging here is deep, beyond the reach of palpation affecting the internal organs, so pressing is useless.
When Cold Evil lodges in the Chong Mai (Penetrating Vessel), which originates at Guan Yuan (CV4) and ascends straight up the abdomen, Cold containment blocks the vessel. Blockage causes Qi to rebel, leading to panting movements felt upon palpation.
When Cold Evil lodges in the Bei Shu Mai (Back-Shu Vessels), the vessels become viscous, leading to blood deficiency. Blood deficiency causes pain. The Shu points connect to the Heart, causing mutual pulling pain between the heart and back. When Cold Evil lodges in the Jue Yin Mai (Jueyin Vessel), which connects to the genitalia and ties to the Liver, Cold in the vessels causes blood stasis and vessel tension, leading to pulling pain between the hypochondrium/flanks and the lower abdomen. Jue Qi (Rebellious Qi) lodges in the inner thighs, and Cold Qi ascends to the lower abdomen. Blood stasis in the lower region causes mutual pulling, so abdominal pain radiates to the inner thighs.
Pain accompanied by panting occurs because Cold lodges in the Chong Mai. The Chong Mai originates at Guan Yuan, ascends straight up, meets at the throat, and scatters throughout the body. Cold lodging prevents upward ascent, blocking the vessel. Blockage causes Qi to rebel. Chong Mai blockage causes pain, manifesting as panting movements.
Heart and back pulling pain occurs because Cold lodges in the Back-Shu Vessels, causing vessel viscosity. Viscosity leads to blood deficiency and pain. The Heart governs blood vessels, and its Back-Shu point is on the back. Connection to the Heart causes mutual pulling pain with the back.
Hypochondrium and lower abdomen pulling pain occurs because Cold lodges in the Jue Yin Mai. The Jue Yin Mai connects to the genitalia and ties to the Liver. Cold in the Jue Yin Mai causes Liver blood stasis and genital vessel tension, leading to pulling pain between the hypochondrium and lower abdomen.
Abdominal pain radiating to the inner thighs also results from Cold lodging in the Jue Yin Mai. The Jue Yin Mai follows the inner thigh to the lower abdomen. Jueyin Cold causes Jue Qi to lodge in the inner thighs, and Cold ascends to the lower abdomen. Liver blood coagulates and fails to ascend, causing mutual pulling in the lower region, thus lower abdominal pain radiating to the inner thighs.
Cold Evil lodging between the membrane source and collateral vessels of the Small Intestine causes blood stasis, preventing injection into the large meridians. Stagnant Qi and Blood fail to move, forming accumulations over time. When Cold Evil lodges in the five Zang organs, Jue Qi rebels and leaks upward. Yin Qi exhausts, and Yang Qi fails to enter, causing sudden severe pain, unconsciousness, and death-like state. Recovery occurs if Qi returns.
Accumulations forming over time result from Cold lodging in the Small Intestine. Cold in the Small Intestine affects the membrane source internally and collateral vessels externally. Qi and Blood fail to interpenetrate. Blood stasis prevents injection into large meridians, forming tangible blood accumulations. Blood stasis causes Qi stagnation. Persistent stagnation forms accumulations, not overnight but over time ("Su Xi"), leading to long-term accumulation.
Sudden severe pain with unconsciousness followed by recovery occurs when Cold lodges in the five Zang organs. Cold in the Zang causes Zang Cold, leading to rebellious Jue Qi leaking upward. Yin Qi exhausts internally, and Yang Qi is weak externally, failing to enter Yin quickly. Exhausted Yin and unentered Yang cause sudden severe pain and unconsciousness. After a short while, exhausted Yin recovers, and unreturned Yang returns. Fluctuating consciousness leads to survival.
Pain with vomiting occurs because Cold lodges in the stomach and intestines, causing rebellious Qi to attempt upward expulsion.
Abdominal pain followed by diarrhea occurs because Cold lodges in the Small Intestine, preventing proper gathering and transformation, leading to posterior discharge and abdominal pain.
Heat lingering in the Small Intestine causes intestinal pain. Damp-heat and dryness/thirst lead to hard, dry stool that cannot pass, causing pain and blockage.
Pain with vomiting results from Cold in the stomach/intestines and rebellious Qi seeking upward exit.
Abdominal pain with diarrhea results from Cold in the Small Intestine impairing gathering/transformation, leading to posterior discharge.
Pain with blockage results from Small Intestine pathogens failing to discharge downward, causing blockage and heat generation. Lingering Heat in the Small Intestine causes pain. Damp-heat and dryness/thirst make ingested matter hard and dry, preventing passage, causing pain and blockage. The above discusses Cold pathogenesis, ending with Heat to show that initial Cold may transform into Heat, and both Cold and Heat can cause pain.
The Yellow Emperor said: You mentioned "knowing through speech." How does "seeing through observation" work?
Various pains have different forms; one must inquire about the location of pain to know it. This is "knowing through speech." If the doctor does not ask and the patient does not speak, how does "seeing through observation" work?
Bo Qiu said: The five Zang and six Fu organs have specific facial areas. Observing the five colors: yellow and red indicate Heat; white indicates Cold; blue/green and black indicate Pain. This is "seeing through observation."
The five Zang are Yin, the six Fu are Yang, each having specific facial areas. Observing the five facial colors reveals disease location. Reddish face indicates organ Heat; white face indicates organ Cold; blue/black face indicates organ Pain. Inspecting facial color to know disease is "seeing through observation."
The Yellow Emperor said: How does "obtaining through palpation" work?
As previously stated, "knowing through speech, seeing through observation, obtaining through palpation," I ask again about "obtaining through palpation."
Bo Qiu said: Observe the pulse governing the disease. A firm pulse indicates blood stasis; a sunken pulse indicates deficiency. Both can be obtained through palpation.
Observing the disease-governing pulse: Cun pulse governs Heart/Lung diseases; Guan pulse governs Liver/Spleen diseases. A firm pulse indicates excess pathogen; a sunken pulse indicates deficient healthy Qi. Both excess and deficiency can be diagnosed via palpation. This section summarizes that various pains can be known through speech, seen through observation, and obtained through palpation.
The Yellow Emperor said: Good. I know all diseases arise from Qi. Anger causes Qi to rise; Joy causes Qi to slacken; Grief causes Qi to consume; Fear causes Qi to sink; Cold causes Qi to gather; Heat causes Qi to leak; Fright causes Qi to become chaotic; Labor causes Qi to dissipate; Pensive thought causes Qi to knot. These nine Qi changes differ. What diseases do they produce?
Meridian Qi and Blood circulate endlessly. Disturbances in Qi generate disease, hence all diseases arise from Qi. Seven Emotions stir internally; Cold/Heat emerge externally, causing Qi pain. Yet these nine Qi changes differ; what diseases do they produce?
Bo Qiu said: Anger causes Qi to rebel. Severely, it causes hematemesis and undigested diarrhea. Thus, Qi rises.
Anger causes Liver Qi to rebel internally. The Liver governs the Chong and Ren vessels' blood. Severe rebellion causes hematemesis. Wood excess weakens Earth, causing undigested diarrhea. Anger raises Qi for this reason.
Joy harmonizes Qi and extends the Will, allowing Ying and Wei to flow freely. Thus, Qi slackens.
Joy harmonizes Heart Qi and extends Heart Will, inwardly harmonious and outwardly extended, allowing Ying and Wei to flow. Joy slackens Qi for this reason.
Grief tightens the Heart Tie (connective tissue), lifts Lung leaves, obstructs Upper Jiao, and prevents Ying/Wei dispersion. Heat lingers in the center, consuming Qi. Thus, Qi consumes.
Grief merges Heart Qi into the Lung, tightening the Heart Tie. The Heart Tie connects to the Lung, lifting Lung leaves. The Lung, located high, governs Ying/Wei/Yin/Yang. Lifted Lung leaves obstruct Upper Jiao, preventing Ying/Wei dispersion. Obstruction causes Qi stagnation and central Heat. Grief consumes Qi for this reason.
Fear retreats Essence. Retreat causes Upper Jiao closure. Closure causes Qi to return. Return causes Lower Jiao distension. Thus, Qi sinks (fails to ascend).
Fear injures Kidney, retreating Essence. "Que" means retreat. Retreated Essence prevents rising Yang Qi, closing Upper Jiao. Closed Upper Jiao forces Qi to return downward. Returning Qi fails to rotate, distending Lower Jiao. Kidney injury disrupts upper-lower interaction, sinking Qi (failing to ascend). Fear sinks Qi for this reason.
Cold closes Cou Li (pores/skin texture), obstructing Qi flow. Thus, Qi gathers.
Cold closes skin texture, preventing San Jiao Qi from reaching muscles. Qi flow obstructs. Cold gathers Qi for this reason.
Heat opens Cou Li, allowing Ying/Wei flow and profuse sweating. Thus, Qi leaks.
Heat increases Yang-heat, opening Cou Li. Open Cou Li allows Ying/Wei flow. Flowing Ying/Wei causes profuse sweat. Heat leaks Qi for this reason.
Fright leaves the Heart without support, Spirit without return, and thoughts without certainty. Thus, Qi becomes chaotic.
Fright agitates Heart Qi without support, scatters Spirit without return, and confuses thoughts without certainty. Fright chaotizes Qi for this reason.
Labor causes panting and sweating, with external and internal Qi escaping. Thus, Qi dissipates.
Labor injures Qi and Blood. Qi deficiency causes internal panting; Blood deficiency causes external sweating. Internal/external escape depletes Qi and Blood. Labor dissipates Qi for this reason.
Pensive thought stores the Heart Mind and returns the Spirit. Healthy Qi stays and fails to move. Thus, Qi knots.
Pensive thought stores Heart Mind, unable to respond freely; returns Spirit, unable to circulate widely. Stored mind and returned Spirit keep Healthy Qi stagnant. Pensive thought knots Qi for this reason. This section, following the theme of varied pains, explains that all diseases arise from Qi, clarifying the differences among the nine Qi changes.