He is chastened also with pain upon his bed, and the multitude of his bones with strong pain:

He rebuketh also by sorrow in the bed, and he maketh all his bones to wither.

He is chastened also with pain upon his bed, and with constant strife in his bones;

And he hath been reproved With pain on his bed, And the strife of his bones is enduring.

Pain is sent on him as a punishment, while he is on his bed; there is no end to the trouble in his bones;

He is chastened also with pain upon his bed, And all his bones grow stiff;

Likewise, he rebukes by sorrow in bed, and he causes all of his bones to become weak.

He is chastened also with pain - As another means of checking and restraining him from the commission of sin. When the warnings of the night fail, and when he is bent on a life of sin, then God lays him on a bed of pain, and he is brought to reflection there. There he has an opportunity to think of his life, and of all the consequences which must follow from a career of iniquity. This involves the main inquiry before the disputants. It was, why people were afflicted. The three friends of Job had said that it was a full proof of wickedness, and that when the professedly pious were afflicted it was demonstrative of insincerity and hypocrisy. Job had called this position in question, and proved that it could not be so, but still was at a loss why it was. Elihu now says, that affliction is a part of a disciplinary government; that it is one of the means which God adopts, when warnings are ineffectual, to restrain people and to bring them to reflection and repentance. This appears to have been a view which was almost entirely new to them.
And the multitude of his bones with strong pain - The bones, as has before been remarked, it was supposed might be the seat of the acutest pain; see the notes at Job 30:17; compare Job 20:11; Job 7:15; Job 30:30. The meaning here is, that the frame was racked with intense suffering in order to admonish men of sin, to save them from plunging into deeper transgression, and to bring them to repentance.

IV. By Afflictions
He is chastened also with pain upon his bed, etc. - Afflictions are a fourth means which God makes use of to awaken and convert sinners. In the hand of God these were the cause of the salvation of David, as himself testifies: Before I was afflicted, I went astray, Psalm 119:67, Psalm 119:71, Psalm 119:75.
The multitude of his bones - By such diseases, especially those of a rheumatic kind, when to the patient's apprehension every bone is diseased, broken, or out of joint.
Some render the passage, When the multitude of his bones is yet strong; meaning those sudden afflictions which fall upon men when in a state of great firmness and vigor. The original, ורוב עצמיו אתן verob atsamaiv ethan, may be translated, And the strong multitude of his bones. Even the strong multitude of his bones is chastened with pain upon his bed; the place of rest and ease affording him no peace, quiet, or comfort.
The bones may be well termed multitudinous, as there are no less than 10 in the cranium, or skull; upper jaw, 13; lower jaw, 1; teeth, 32; tongue, 1; vertebrae, or back-bone, 24; ribs, 24; sternum, or breast-bone, 3; os innominatum, 1; scapula, or shoulder-blades, 2; arms, 6; hands, 54; thigh-bones, 2; knee-bones, 2; legs, 4; feet, 54: in all, not less than 233 bones, without reckoning the ossa sethamoides; because, though often numerous, they are found only in hard laborers, or elderly persons.

He is chastened also with pain upon his bed,.... This seems to be another way, in which God, according to his eternal purposes, speaks unto men, as the word "also" intimates; namely, by afflictions, and sometimes painful ones; which have a voice in them, and men of wisdom will hearken to it, Micah 6:9. Pain here signifies not pain of the mind, or a wounded spirit, which is very afflicting, distressing, and intolerable; but pain of the body, as the next clause shows; and this endured on the bed, it being so great as to confine a man to his bed, or is what he felt there, where he might hope for ease and rest; see Job 7:13;
and the multitude of his bones with strong pain; not with a slight one, but a very strong one, such as those felt who gnawed their tongues for pain, Revelation 16:10. Jarchi interprets it, the multitude of his bones, which are strong; though they are hardy and strong, yet filled with exquisite pain; and not one, or a few of them, but a multitude of them, as there are a multitude of them in a man's body; even all of them, as Hezekiah complains, which must be very excruciating indeed, Isaiah 38:13; and which was Job's case; not only his flesh was in pain, through the sores and ulcers upon him, but his bones were pierced in him, and his sinews had no rest, and he was full of tossings to and fro, Job 7:3; and in this way he was, as other good men are, reproved and chastened by the Lord; and in which way he had spoke to him, as he does to others, and which should be attended to; and since such painful afflictions are but fatherly chastisements, they should be patiently endured, and the voice of God in them listened to, and before long there will be no more pain: the "Cetib", or textual writing, is, "the contention of his bones is strong"; through pain, or with which God contends with men; we follow the marginal reading.

Job complained of his diseases, and judged by them that God was angry with him; his friends did so too: but Elihu shows that God often afflicts the body for good to the soul. This thought will be of great use for our getting good from sickness, in and by which God speaks to men. Pain is the fruit of sin; yet, by the grace of God, the pain of the body is often made a means of good to the soul. When afflictions have done their work, they shall be removed. A ransom or propitiation is found. Jesus Christ is the Messenger and the Ransom, so Elihu calls him, as Job had called him his Redeemer, for he is both the Purchaser and the Price, the Priest and the sacrifice. So high was the value of souls, that nothing less would redeem them; and so great the hurt done by sin, that nothing less would atone for it, than the blood of the Son of God, who gave his life a ransom for many. A blessed change follows. Recovery from sickness is a mercy indeed, when it proceeds from the remission of sin. All that truly repent of their sins, shall find mercy with God. The works of darkness are unfruitful works; all the gains of sin will come far short of the damage. We must, with a broken and contrite heart, confess our sins to God, 1-John 1:9. We must confess the fact of sin; and not try to justify or excuse ourselves. We must confess the fault of sin; I have perverted that which was right. We must confess the folly of sin; So foolish have I been and ignorant. Is there not good reason why we should make such a confession?

When man does not heed warnings of the night, he is chastened, &c. The new thought suggested by Elihu is that affliction is disciplinary (Job 36:10); for the good of the godly.
multitude--so the Margin, Hebrew (Keri). Better with the text (Chetib), "And with the perpetual (strong) contest of his bones"; the never-resting fever in his bones (Psalm 38:3) [UMBREIT].

19 He is chastened also with pain upon his bed,
And with the unceasing conflict of his limbs;
20 And his life causeth him to loathe bread,
And his soul dainty meat.
21 His flesh consumeth away to uncomeliness,
And his deranged limbs are scarcely to be seen.
22 Then his soul draweth near to the grave,
And his life to the destroyers.
Another and severer lesson which God teaches man is by painful sickness: he is chastened with pain (בּ of the means) on his bed, he and the vigorous number of his limbs, i.e., he with this hitherto vigorous (Raschi), or: while the multitude of his limbs is still vigorous (Ew). Thus is the Keri ורב to be understood, for the interpretation: and the multitude of his limbs with unceasing pain (Arnh. after Aben-Ezra), is unnatural. But the Chethib is far more commendable: and with a constant tumult of his limbs (Hirz. and others). Job 33:19 might also be taken as a substantival clause: and the tumult of his limbs is unceasing (Umbr., Welte); but that taking over of בּ from במכאוב is simpler and more pleasing. ריב (opposite of שׁלום, e.g., Psalm 38:4) is an excellent description of disease which consists in a disturbance of the equilibrium of the powers, in the dissolution of their harmony, in the excitement of one against another (Psychol. S. 287). אתן for איתן belongs to the many defective forms of writing of this section. In Job 33:20 we again meet a Hebraeo-Arabic hapaxlegomenon. זהם from זהם. In Arab. zahuma signifies to stink, like the Aram. זהם (whence זוּהם, dirt and stench), zahama to thrust back, restrain, after which Abu Suleiman Dad Alfsi, in his Arabic Lexicon of the Hebrew, interprets: "his soul thrusts back (תזהם נפסה) food and every means of life,"
(Note: Vid., Pinsker's Likkute Kadmoniot, p. קמג.)
beside which the suff. of וזהמתּוּ is taken as an anticipation of the following object (vid., on Job 29:3): his life feels disgust at it, at bread, and his soul at dainty meat. The Piel has then only the intensive signification of Kal (synon. תּעב, Psalm 107:18), according to which it is translated by Hahn with many before him. But if the poet had wished to be so understood, he would have made use of a less ambiguous arrangement of the words, וזהמתו לחם חיתו. We take זהם with Ew. 122, b, as causative of Kal, in which signification the Piel, it is true, occurs but rarely, yet it does sometimes, instead of Hiph.; but without translating, with Hirz., חיה by hunger and נפשׁ by appetite, which gives a confused thought. Schlottm. appropriately remarks: "It is very clearly expressed, as the proper vital power, the proper ψυχή, when it is inwardly consumed by disease, gives one a loathing for that which it otherwise likes as being a necessary condition of its own existence." Thus it is: health produces an appetite, sickness causes nausea; the soul that is in an uninjured normal state longs for food, that which is severely weakened by sickness turns the desire for dainties into loathing and aversion.

Pain - The second way whereby God instructs men and excites them to repentance.