经曰∶诸痛痒疮疡者，皆属心火。火之为物，能消烁万物，残败百端故也。盖
人之肌肤附近火灼则为疮，若肉近火则痛，微远则痒，此火之用也。或有痒痛如针尖
轻刺者，犹飞迸火星灼之然也。然疮疡时炙之以火，渍之以汤，而痒转甚者，是微
热助之所使也。有因而不痒者，是热令皮肤舒缓，腠理开通，阳气得泄，热气易散
矣，故不痒也。有痒用冷水沃之，临时少退，良久复大痒者，乃寒主收敛，阳气郁
结，不得散越，沸热内作，故复痒转甚也。又痒得抓而解者，抓主动，动为阳，阳属
火化，故轻轻抓而能痒，亦火之微也。重重抓则痒去者，是皮肤抓得辛辣，而属金
化，辛能散，故金化见火力而解，故不痒也。经曰∶痛者为实，痒者为虚，非为虚
寒之虚，乃火热微甚之意也。又有疮疡麻木而不知痛痒者，是气虚而不运，又兼疮
毒壅塞，经络不通，致令麻木，而不知有无也，亦分轻重耳。盖麻者，木之轻，木
者，麻之重也。假如人坐久之，腿膝木而不知有无，少顷舒伸，良久复疏，则麻乃
壅之少，气通血复行之意也。大抵未溃之先，有麻木者，毒塞轻重之分也。已溃之
后，而有麻木者，乃肌肉腐烂，血气已亏，是虚之轻重也。
张景岳曰∶凡痈毒 肿，赤痛之甚者，虽内治之法，已具于前，然煎剂功缓，而
痛急难当者，必须外用敷药，既欲其止痛，必欲其败毒，则无如降痈散之神妙也。又
曰∶脓出反痛者，虚也。
李东垣曰∶夫疮疽之证候不同，寒热虚实，皆能为痛，止痛之法，殊非一端，世
人皆谓乳没珍宝之药，可住痛疼，殊不知临病制宜，自有方法。盖热毒之痛者，以
寒凉之剂折其热，则痛自止也；寒邪之痛，以温热之药熨其寒，则痛自除矣。因风而
有痛者，除其风；因湿而痛者，导其湿；燥而痛者，润之；塞而痛者，通之；虚而痛
者，补之；实而痛者，泻之；因脓郁而闭者，开之；恶肉侵溃者，引之；阴阳不和
者，调之；经络秘涩者，利之。临机应变，方为上医，不可执方而无权也。（《十书》）
澄曰∶痈疽疼痛有五种，初起者，气凝血聚也，宜活血行气。已成跳痛者，此
肉腐作脓也，宜内托排脓。将溃误敷凉药痛者，宜用芳香之药淋 之；已溃脓出反
痛者，虚也，宜补气血；溃后秽气所触而痛者，宜乳没解之，其痛自止。
《黄帝内经》说：各种疼痛、瘙痒、疮疡，都归属于心火。火这种物质，能够烧灼消蚀万物，造成各种残败破坏的缘故。大概人的肌肤靠近火烤就会生疮，如果肌肉靠近火则感到疼痛，距离稍远则感到瘙痒，这是火的作用。有的瘙痒疼痛像针尖轻轻刺扎一样，就像飞迸的火星灼烧皮肤那样。然而疮疡时常被火灸、被热水浸泡，而瘙痒反而加重的，这是微热助长邪气所导致的。有的因此就不痒了，这是因为热使皮肤舒缓，腠理（皮肤纹理及汗孔）开通，阳气得以宣泄，热气容易散发，所以不痒。有的用冷水浇洗瘙痒处，暂时稍微缓解，过很久又剧烈瘙痒的，是因为寒性主收敛，导致阳气郁结，不能发散，体内沸腾的热气作祟，所以又痒得厉害。还有抓挠后瘙痒缓解的，因为抓动属于“动”，动属阳，阳归属于火的化生，所以轻轻抓挠能止痒，也是火性微弱的表现。重重抓挠则痒消失的，是因为皮肤被抓破产生辛辣感，这归属于金的化生，辛味能发散，所以金的化生见到火的力量就能解除，所以不痒了。《内经》说：痛是实证，痒是虚证，这里的虚不是指虚寒的虚，而是指火热之气的微弱或强盛的意思。又有疮疡麻木而不知道疼痛和瘙痒的，这是气虚弱而不能运行，再加上疮毒壅塞，经络不通，导致麻木，不知道有无感觉，这也分轻重程度。大概麻，是木的感觉较轻；木，是麻的感觉较重。比如人坐久了，腿膝发木而不知有无感觉，过了一会儿舒展伸展，过了很久又疏通，那么麻就是壅滞较少，气通血复行的意思。大致在疮疡未溃破之前，有麻木现象的，是毒邪壅塞轻重的区别。在疮疡溃破之后，还有麻木现象的，是肌肉腐烂，气血已经亏损，这是虚损轻重的区别。
张景岳说：凡是痈毒肿胀，红赤疼痛严重的，虽然内治的方法在前面已经具备，但是汤药作用缓慢，而疼痛紧急难以忍受的，必须外用敷药，既然想要止痛，又想解毒，没有比降痈散更神妙的了。又说：脓液流出后反而疼痛的，是虚证。
李东垣说：疮疽的证候不同，寒热虚实，都能引起疼痛，止痛的方法，绝非只有一种，世人都认为乳香、没药等珍宝药物可以停止疼痛，却不知道临病制宜，自有方法。大概热毒引起的疼痛，用寒凉的药物折服其热，疼痛自然停止；寒邪引起的疼痛，用温热的药物熨烫驱散其寒，疼痛自然消除。因风邪而有疼痛的，祛除风邪；因湿邪而痛的，疏导湿邪；因燥而痛的，滋润它；因闭塞而痛的，疏通它；因虚而痛的，补益它；因实而痛的，泻除它；因脓液郁闭而痛的，开泄它；因恶肉侵蚀溃烂的，引流它；阴阳不和的，调和它；经络秘涩的，通利它。随机应变，才是上等的医生，不可拘泥于成方而没有变通。（出自《十书》）
顾澄说：痈疽疼痛有五种情况，初起时，是气凝血聚，宜用活血行气的方法。已经形成跳痛的，这是肌肉腐烂化脓，宜用内托排脓的方法。将溃破时误敷凉药而疼痛的，宜用芳香的药物淋洗；已溃破脓出后反而疼痛的，是虚证，宜补益气血；溃破后因秽气触碰而疼痛的，宜用乳香、没药解除，疼痛自然停止。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: All pain, itching, sores, and ulcers belong to Heart Fire. Fire, as a substance, has the capacity to scorch and consume all things, causing various forms of destruction and decay. Generally speaking, when human skin or flesh is near fire, it causes burns; if the muscle is close to the fire, it causes pain; if slightly farther away, it causes itching. This is the function of fire. Some cases present with itching and pain like light pricks from needle tips, similar to flying sparks burning the skin. However, when sores and ulcers are frequently moxibusted or soaked in hot water, yet the itching intensifies, this is caused by mild heat assisting the pathogenic factor. In other cases, there is no itching because the heat relaxes the skin, opens the Couli (skin texture and pores), allows Yang Qi to dissipate, and facilitates the easy dispersion of heat, thus resulting in no itching. If cold water is poured on an itchy area, providing temporary relief followed by severe itching after some time, it is because coldness governs contraction, leading to the stagnation of Yang Qi which cannot disperse, while boiling heat arises internally, causing the itching to worsen again. When scratching relieves itching, it is because movement belongs to Yang, and Yang is associated with the transformation of Fire. Thus, gentle scratching can relieve itching due to the mild nature of Fire. Heavy scratching eliminates itching because the broken skin produces a pungent sensation, associated with the transformation of Metal. Pungency can disperse, so when the Metal transformation encounters the power of Fire, it resolves, and itching ceases. The *Neijing* states: Pain indicates Excess, while itching indicates Deficiency. Here, "Deficiency" does not refer to Cold-Deficiency, but rather signifies the degree of intensity of Heat-Fire. There are also cases of numbness in sores and ulcers where one feels neither pain nor itching. This is due to Qi deficiency failing to circulate, compounded by the obstruction of sore toxins and blockage of meridians, leading to numbness and loss of sensation, which varies in severity. "Ma" (numbness/tingling) is a lighter form of wood-like sensation, while "Mu" (woodiness/stiffness) is heavier. For example, sitting for a long time may cause legs and knees to feel stiff and numb; after stretching and waiting, circulation restores, indicating that "Ma" represents slight stagnation where Qi flows and Blood resumes circulation. Generally, before ulceration, numbness indicates the severity of toxin obstruction. After ulceration, numbness indicates muscle rot and depletion of Qi and Blood, reflecting the severity of Deficiency.
Zhang Jingyue stated: Regarding any carbuncle or toxic swelling with severe redness and pain, although internal treatment methods were previously outlined, decoctions act slowly. For urgent and unbearable pain, external applications are necessary. To achieve both pain relief and toxin resolution, nothing is more miraculous than Jiangyong San (Carbuncle-Reducing Powder). He also stated: Pain returning after pus discharge indicates Deficiency.
Li Dongyuan stated: The manifestations of sores and ulcers vary; Cold, Heat, Excess, and Deficiency can all cause pain. Methods for relieving pain are numerous. People generally believe that precious herbs like Ru Xiang (Olibanum) and Mo Yao (Myrrha) can stop pain, failing to realize that treatment must be adapted to the specific condition. For pain caused by Heat-Toxin, using cold-natured drugs to subdue the heat will naturally stop the pain. For pain caused by Cold-Evil, using warm-natured drugs to dispel the cold will naturally eliminate the pain. For pain due to Wind, remove the Wind; for pain due to Dampness, drain the Dampness; for pain due to Dryness, moisten it; for pain due to Obstruction, unblock it; for pain due to Deficiency, tonify it; for pain due to Excess, purge it; for pain due to pus retention, open it; for pain due to foul tissue erosion, guide it out; for disharmony of Yin and Yang, harmonize it; for blocked and stagnant meridians, promote flow. Adapting to changes according to circumstances makes one a superior physician; one must not rigidly adhere to formulas without flexibility. (From *Shi Shu*)
Gu Cheng stated: There are five types of pain in carbuncles and ulcers. At the initial stage, it is due to Qi stagnation and Blood coagulation, requiring methods to invigorate Blood and move Qi. When throbbing pain develops, it indicates muscle rot and pus formation, requiring internal support and pus drainage. If pain occurs before ulceration due to the mistaken application of cold medicines, aromatic drugs should be used for washing. If pain returns after ulceration and pus discharge, it is due to Deficiency, requiring tonification of Qi and Blood. If pain occurs after ulceration due to contact with foul odors, Ru Xiang (Olibanum) and Mo Yao (Myrrha) should be used to resolve it, and the pain will cease naturally.