外疡之患，最普通者，惟肿与痛二者而已。顾肿之情势，即各不同。而痛之源流，亦非
一致。故泛言之，则外疡之发，无非气血之壅滞，古人所谓痛则不通，通则不痛，其大要也
。而细辨之，则种种色色，各有原由。故有先肿而后痛者，有先痛而后肿者；有但痛而不肿
者，有但肿而不痛者；有肿渐坚巨而渐觉痛者，有肿常绵软而不甚痛者；有内欲酿脓而始作
痛者，有内已成脓而竟不痛者；有痛发数处，同时并作者；有走痛无定，莫可指认者；有痛
在肌肉之间者，有痛在筋骨之里者；有痛势大剧，片刻不休者；有痛势和缓，时而间甚者，
有隐隐作痛，手掌抚摩，而自觉愉快者，有频频作痛，手指按之，而竟如刀刺者；有肿已蔓
延甚巨，而其痛仅在一处者；有肿渐散漫广阔，而肿处无不大痛者；有形块日久，不甚高突
，而坚硬不移，按之酸痛，尚不大痛者；有坚块既久，初不膨胀，而忽然 发，有时抽
掣，
缓者；有溃后脓流不畅而痛不减者；有腐肉未脱而痛不休者；有脓血太多而痛转盛者；有腐
烂甚巨而始终不大痛者，有腐烂渐久，而先痛忽不痛者。情状固万有不齐，证势即因之大异
。或为顺，或为逆，或则渐臻佳境，或则陷入危途。或貌视之虽属可危，而其实易疗；或观
其状似无大害，而其实难瘳。所以有痛势大炽而应手成功者，亦有痛势和平而卒归不治者。
盖病源有深浅，形证有险夷。或病本剧也，而治之如法，尚可转败为功；或病似轻也，而根
蒂已深，究竟百无一效。苟非识之既确，辨之能详，所见既多，阅历有素，奚以见微知着，
洞察源流，而先事预防，死机立断乎？
试就肿痛之各有不同者而分析言之。要皆有理可求，有源可溯，非臆说也。凡先肿后痛
者，其病浅。外疡之常态，而亦外疡之轻恙也。先痛而后肿者，其病深。非附骨着节之大证
（穿骨、穿踝、骨槽，如附骨疽，环跳疽，皆是，）即流痰流注内痈之属也（痈、肚痈、肠痈
等皆
但
内脓
疡之正。肉腐成脓，理无不痛也。内已成脓，而竟不痛者，疡之变。神经已死，多难挽救也
。痛发数处，同时并起，或先后相继，更迭递传者，时邪之流注也；痛常走窜，忽彼忽此，
或竟无定处，莫能指认者，风胜之行痹也。痛在肌肉之间者，其病必浅，虽有大证，当无大
变；痛在筋骨之里者，其患已深，治之不早，必多幻象。痛势大剧，片刻不休，其脓已成也
。痛势和缓，有时间甚，脓犹未聚也。其隐隐作痛而喜抚摩者，病虽未剧，脓虽未成，然病
发于阴，深藏不露，断非轻恙不可忽视；其频频作痛，无时或休，而不可手按者，内已成脓
，是宜针之使溃也。凡肿势漫延而痛在一处者，脓毒有定，其形虽巨，可以冀其聚而不散；
若肿势散漫而无处不痛者，毒邪四散，其势方张，苟非治疗得宜，鲜不毒延四窜矣。形块日
久，不甚高突，坚硬不移，酸而不痛者，瘰 结痰痞积之流，蒂固根深，非可猝拔。若坚块
既久，初不 发，而忽然膨胀时觉掣痛者，乳岩石疽失荣之证；郁之日深，势且迸裂矣
。若
吉，不痛则凶。此性命呼吸之机也。而昧者反以不痛为苟安，则谬矣。肿势既束而痛反剧者
，毒已成熟，由深而浅，此内脓已聚之征也。而俗人或以大痛为可骇，则惑矣。溃后脓泄而
痛随缓者，疡之常，毒已达，势已衰，浪静波平，安澜之朕兆也。溃后脓泄而痛不减者，疡
之变，非手术不精、脓流不畅，即余毒尚炽、死灰复燃也。溃后毒未尽而痛不衰者，恶毒不
脱，新肌不生。
毒重者，化毒为先。正衰者，补正宜亟。溃后脓过多而痛转盛者，攻孔既巨，调复需时
，余毒未消，则宜清理。正气若馁，端赖扶持矣。腐烂既巨而始终不甚痛者，惟湿疡为然。
皮肤之病，湿重热轻，如 疮之类有之，则宜清燥。而脑背疽之元气式微者，亦间有之，则
非温补托毒，鲜不败矣。腐烂渐大，而先痛后不痛者，如其调治得宜，恶腐渐净，是邪之退
，正之充，庶几顺境。抑或腐未去，新未生，而忽然顽木痛痒不知，则为内陷，危殆近矣。
痛，虽若相安无事，而盘踞要害，痼疾难疗。乳岩石疽 疡之属（其尤厉者），而附骨流痰之
伦
之不当，即手术之粗疏，或外治之药，不合机宜。此皆医师之不良，有以贻害。而自然之坏
证，尚是无多。操司命之权者，尚其明辨笃行而弗致遗人夭殃，绝人长命，则庶几矣。
外科疮疡的病患，最普遍的表现，只有肿胀和疼痛这两者罢了。然而肿胀的情势，各自不同。而疼痛的来源与演变，也不一致。所以泛泛而言，外科疮疡的发生，无非是气血的壅滞不通，古人所说的“痛则不通，通则不痛”，就是其中的大要旨。但如果仔细辨别，则各种情况各有原因。所以有先肿胀而后疼痛的，有先疼痛而后肿胀的；有只疼痛而不肿胀的，有只肿胀而不疼痛的；有肿胀逐渐变得坚硬巨大而渐渐感到疼痛的，有肿胀始终绵软而不怎么疼痛的；有内部将要化脓才开始疼痛的，有内部已经化脓却竟然不疼痛的；有疼痛发作在多处，同时并发的；有游走性疼痛没有定处，无法指认的；有疼痛位于肌肉之间的，有疼痛位于筋骨深处的；有疼痛剧烈，片刻不停的；有疼痛和缓，时而间歇加重的；有隐隐作痛，用手掌抚摸而感到舒服的，有频繁作痛，手指按压时竟如刀刺般的；有肿胀已经蔓延很大，但疼痛仅局限在一处的；有肿胀逐渐散漫广阔，而肿胀处无不剧烈疼痛的；有形块日久，不太高突，坚硬不移，按压时酸痛，尚且不怎么疼痛的；有坚硬的肿块存在已久，起初不膨胀，而忽然发作，有时出现抽掣感，缓解后仍有疼痛的；有溃破后脓液流出不畅而疼痛不减的；有腐肉未脱落而疼痛不休的；有脓血太多而疼痛反而加剧的；有腐烂极其严重却始终不怎么疼痛的，有腐烂时间渐久，而突然从疼痛转为不疼痛的。病情状况固然万有不齐，证候趋势也就因此大不相同。有的属于顺证，有的属于逆证，有的逐渐趋向好转，有的陷入危险境地。有的表面上看虽然似乎危急，但实际上容易治疗；有的观察其状似乎没有大害，但实际上难以痊愈。所以有疼痛势头猛烈而随手治愈成功的，也有疼痛势头平和最终却未能治愈的。大概病因有深浅之分，形证有险易之别。有的病根本来严重，但治疗得当，还可以转败为胜；有的病看似轻微，但病根深蒂固，终究百无一效。如果不是认识准确，辨析详尽，所见既多，阅历丰富，怎么能见微知著，洞察源流，而在事前预防，对死机果断判断呢？
试着就肿痛各自不同的情况进行分析论述。其中都有理可求，有源可溯，并非臆说。凡是先肿后痛的，病位浅。这是外科疮疡的常态，也是外科疮疡的轻症。先痛而后肿的，病位深。不是附骨着节的大证（如穿骨、穿踝、骨槽疽，像附骨疽、环跳疽等都是），就是流痰、流注或内痈之类的疾病（痈、肚痈、肠痈等都属于此类）。肉腐成脓，按理没有不痛的。内部已经化脓却竟然不痛的，是疮疡的变证。神经已死，大多难以挽救。疼痛发作在数处，同时并起，或先后相继，更迭传递的，是时邪的流注；疼痛常走窜，忽此忽彼，或者竟无定处，不能指认的，是风胜的行痹。疼痛在肌肉之间的，病必浅，即使是大证，应当不会有大的变故；疼痛在筋骨之里的，患已深，治疗如果不早，必然会出现很多变幻的症象。疼痛剧烈，片刻不停，说明脓已成。疼痛和缓，有时间歇加重，说明脓尚未聚拢。隐隐作痛而喜欢抚摸的，病虽不剧烈，脓虽未成，但病发于阴，深藏不露，断然不是轻症可以忽视的；频繁作痛，无时休止，而不能手按的，说明内已成脓，适宜针刺使其溃破。凡是肿势漫延而疼痛局限在一处的，说明脓毒有定所，其形虽大，可以期望其聚而不散；如果肿势散漫而无处不痛的，说明毒邪四散，其势正盛，如果不是治疗得当，很少有不导致毒邪四处窜散的。形块日久，不太高突，坚硬不移，酸而不痛的，是瘰疬、结痰、痞积之类的，根深蒂固，不可猝然拔除。如果坚硬的肿块存在已久，起初不发作，而忽然膨胀并时常觉得抽掣疼痛的，是乳岩、石疽、失荣这类病症；郁结日久，势将迸裂了。如果溃破后脓出而痛减，是吉兆；不痛则凶。这是性命攸关的关键时刻。而无知的人反而认为不痛是苟安，那就错了。肿势已经局限而疼痛反而加剧的，说明毒已成熟，由深变浅，这是内脓已聚的征象。而俗人往往以为剧痛可怕，那就迷惑了。溃破后脓液泄出而疼痛随之缓和的，是疮疡的常理，毒气已达，势已衰，浪静波平，是平安的预兆。溃破后脓液泄出而疼痛不减的，是疮疡的变证，不是手术不精、脓流不畅，就是余毒尚炽、死灰复燃。溃破后毒未尽而疼痛不衰的，是恶毒未脱，新肌不生。
毒重者，以解毒为先。正气衰者，补益正气宜急。溃破后脓过多而疼痛反而加剧的，是因为攻孔既大，调理恢复需要时间，余毒未消，则宜清理。正气若虚弱，完全依赖扶持了。腐烂极大而始终不怎么疼痛的，只有湿疡是这样。皮肤之病，湿重热轻，像浸淫疮之类有的，则宜清燥。而脑背疽元气式微的，也间或有之，则非温补托毒，很少有不失败的。腐烂渐大，而先痛后不痛的，如果调治得当，恶腐渐净，这是邪气退去，正气充盛，算是顺境。或者腐肉未去，新肉未生，而突然麻木不知痛痒，则是内陷，危殆近了。疼痛，虽然看似相安无事，但盘踞要害，是痼疾难疗。乳岩、石疽属于疮疡中特别厉害的，以及附骨流痰之类的，如果不及时诊治，即手术粗疏，或外治药物不合机宜。这些都是医师的不良表现，从而贻害患者。而自然的坏证，尚且不多。掌握生命大权的人，尚且应该明辨笃行，不致遗留给人夭折的灾殃，断绝人的长寿，那就差不多了。
The afflictions of external sores are most commonly manifested by swelling and pain. However, the conditions of swelling vary, and the origins and developments of pain are not uniform. Therefore, in general terms, the occurrence of external sores is nothing but the stagnation of Qi and Blood; the ancient saying "pain indicates obstruction, freedom from pain indicates flow" captures the main principle. But upon detailed differentiation, various situations have their own causes. Thus, there are cases where swelling precedes pain, and cases where pain precedes swelling; cases with only pain but no swelling, and cases with only swelling but no pain; cases where swelling gradually becomes hard and large while pain gradually appears, and cases where swelling remains soft with little pain; cases where pain begins as pus forms internally, and cases where pus has already formed internally yet there is no pain; cases where pain erupts in multiple places simultaneously, and cases of wandering pain without a fixed location that cannot be pinpointed; cases where pain is located between muscles, and cases where pain is deep within sinews and bones; cases of severe pain that does not cease for a moment, and cases of mild pain that intensifies intermittently; cases of dull pain that feels pleasant when rubbed with the palm, and cases of frequent pain that feels like knife stabbing when pressed by fingers; cases where swelling has spread extensively but pain is localized to one spot, and cases where swelling is diffuse and widespread with severe pain throughout the swollen area; cases of long-standing lumps that are not very prominent, hard and immobile, sore to touch but not severely painful, and cases of long-standing hard lumps that initially do not swell but suddenly flare up with occasional pulling pain that persists even after easing; cases where pain does not decrease despite poor drainage of pus after ulceration, and cases where pain continues unabated while necrotic flesh has not yet detached; cases where pain intensifies due to excessive discharge of pus and blood, and cases of severe ulceration that never causes significant pain; cases where ulceration progresses over time and pain suddenly ceases. The clinical manifestations are indeed diverse, leading to vastly different prognoses. Some are favorable (Shun), some are unfavorable (Ni); some gradually improve, while others fall into danger. Some appear critical superficially but are actually easy to treat; some seem harmless but are actually difficult to cure. Hence, there are cases where intense pain is successfully treated promptly, and cases where mild pain ultimately proves incurable. This is because disease sources vary in depth, and clinical presentations differ in severity. A fundamentally severe disease may still be turned around if treated correctly; conversely, a seemingly mild disease with a deep root may prove completely unresponsive. Unless one has accurate understanding, detailed differentiation skills, extensive experience, and profound practical knowledge, how can one perceive the subtle signs, comprehend the origin and evolution, prevent issues beforehand, and decisively judge fatal outcomes?
Let us analyze the different manifestations of swelling and pain. All have logical basis and traceable origins, not mere speculation. Cases of swelling preceding pain indicate shallow disease. This is the normal state of external sores and represents a mild condition. Pain preceding swelling indicates deep disease. It is either a major syndrome attached to bone and joints (such as penetrating bone, penetrating ankle, or alveolar osteitis, including Osteomyelitis [Fugu Ju] and Hip Joint Abscess [Huantiao Ju]), or it belongs to categories like Wandering Phlegm [Liutan], Flowing Injection [Liuzhu], or internal carbuncles (such as abdominal abscess or intestinal abscess). Flesh rotting into pus naturally causes pain. Internal pus formation without pain is an atypical variation of sores; nerve death makes rescue difficult. Pain erupting in several places simultaneously, or succeeding each other in succession, indicates the spreading of seasonal pathogens [Shixie]; wandering pain that shifts locations unpredictably indicates Wind-dominant Bi-syndrome [Xingbi]. Pain located between muscles indicates shallow disease; even if severe, major changes are unlikely. Pain located deep within sinews and bones indicates deep affliction; delayed treatment will likely lead to many complications. Severe, unremitting pain indicates that pus has formed. Mild, intermittent pain indicates that pus has not yet gathered. Dull pain relieved by rubbing indicates that although the disease is not severe and pus is not formed, the pathology originates from Yin, is deeply concealed, and certainly should not be ignored as a minor ailment. Frequent, unceasing pain intolerable to touch indicates internal pus formation, suitable for puncture to induce ulceration. When swelling spreads widely but pain is localized, the pus-toxin is contained; although the shape is large, aggregation without dispersion can be expected. If swelling is diffuse and painful everywhere, the toxin is dispersing in all directions with strong momentum; unless treatment is appropriate, toxic spreading is inevitable. Long-standing lumps that are not prominent, hard, immobile, and sore but not painful belong to scrofula [Luoli], phlegm nodules, or stagnant accumulations; they have deep roots and cannot be abruptly eliminated. If a hard lump, existing for a long time, suddenly swells and experiences pulling pain, it indicates conditions like Breast Cancer [Ruyan], Stone Carbuncle [Shiju], or Loss of Prosperity [Shirong]; prolonged stagnation threatens rupture. If pain decreases after ulceration and pus discharge, it is auspicious; absence of pain is ominous. This is the critical juncture of life and death. Ignorant people mistakenly consider absence of pain as safety, which is erroneous. When swelling localizes but pain intensifies, the toxin has matured and moved from deep to shallow, signaling gathered internal pus. Laypeople often fear severe pain, which is a misconception. After ulceration, if pain eases with pus discharge, it is the normal course: toxin has reached its peak and waned, indicating calmness and recovery. If pain persists after ulceration and pus discharge, it is a variation: either surgical technique was imprecise causing poor drainage, or residual toxin is vigorous, reigniting inflammation. If pain does not subside after ulceration while toxin remains, it means evil toxin has not detached and new tissue is not growing.
For heavy toxins, detoxification is prioritized. For deficient Zheng-Qi (Upright Qi), tonification is urgent. If pain intensifies after excessive pus discharge post-ulceration, it is because the wound is large and recovery takes time; if residual toxin remains, clearing it is necessary. If Zheng-Qi is weak, support is essential. Ulcerations that are extensive but cause little pain are characteristic of Damp Sores [Shiyang]. Skin diseases with heavy dampness and light heat, such as Oozing Sores [Jinyin Chuang], should be treated with drying and clearing. In cases of Brain and Back Carbuncles [Naobei Ju] with declining Yuan-Qi (Primal Qi), warm tonification and pushing out toxin are required, otherwise failure is likely. If ulceration enlarges and pain stops after initially being present, proper management leads to cleaning of necrotic tissue, indicating retreat of pathogenic factors and replenishment of Zheng-Qi, a favorable trend. However, if necrotic tissue remains, new tissue has not grown, and sudden numbness/loss of pain sensation occurs, it indicates internal sinking of the pathogen, approaching danger. Pain that seems harmless but resides in vital areas constitutes stubborn diseases difficult to cure. Breast Cancer [Ruyan] and Stone Carbuncle [Shiju] are among the most severe sores, along with Osteomyelitis [Fugu] and Wandering Phlegm [Liutan]. Improper timing, rough surgery, or inappropriate topical medications constitute physician negligence causing harm. Natural bad outcomes are relatively few. Those wielding the power of life and death must distinguish clearly and act firmly to avoid causing premature death or cutting short longevity.