The idiom Tongxin Jishou 痛心疾首 is composed of two words：Tongxin 痛心and Jishou 疾首. “Jishou 疾首” could also be “Shouji 首疾” in oracle bone inscriptions. The character “Ji 疾” first appeared in Shang 商 dynasty，while the character “Tong 痛” did not emerge until the Warring States period. In the unearthed manusripts of this period，“Ji 疾” refers to illness more serious than “Tong 痛”，contrary to the record of

Shuowen

Jiezi

说文解字. Both Ji 疾 and Bing 病 were non-accusative verbs and could be shifted to “N1+N2+V” in the sentence pattern “N1+V+N2”， where N1 and N2 had a subordinate relationship. Tong 痛 and Teng 疼 are typical intransitive verbs that can be followed by an object. Therefore，Tongxin 痛心 and Tengxin 疼心 do not conform to the grammatical rules. They come from Jixin 疾心. Both Jishou 疾首 and Jixin 疾心 originally referred to the physical pain. At the end of the Spring and Autumn Period，they extended to the mental pain or hatred. To emphasize an extreme pain and hatred，a four-character idiom was created. To avoid repetition，Jixin was changed to Tongxin，thus forming the idiom Tongxin Jishou. The word Tongxin 痛心 was not popular only after the Han dynasty，evolving from the idiom Tongxin Jishou.