外疡之初，有但觉酸楚而不痛者，大率皆劳力伤经，及寒邪深入。或体质薄弱，血气俱
衰。或骤丧真元，房帏不谨，阴虚受寒，皆阴证也。皆大证之发于骨节，或且伤及内藏者也
。劳力伤经者，任重致远，筋力既疲，因而气滞血凝，停顿不前，其患多发于手足大节，如
肩、肘、腕，膝、 、环跳，跨阴等部。其始则经脉不舒，或酸或掣，治之于早
络应手成功。或更循其经脉，针刺以流通之，为效尤捷。逮迁延日久，酸者作痛，肿势有加
，而为害巨矣（手腕、足踝、环跳诸部之疡，酸楚尤甚，且有肿形已巨，而仍大酸不痛者，
此
，
痛。若郁久化热，则痛多而 发矣。体弱者，真阴忒微，阳气亦馁，脏腑之盖□既□，营卫
之布□难周，或为腰疽，或为肾俞，或为虚损流痰，虽已有形而多不痛。此无他，正不胜邪
、无相争之力耳。盖疡之为痛，皆正气与邪气搏战之故。若正气既不能敌，则逆来顺受，痛
于何有。凡骨小肉脆者，多有此证。治之及早，能投滋补，或有一线之生机，否则怯瘵之始
基、疮痨之正轨也。甚且有外证未溃，而大命先倾者，复何论其溃后之成绩耶。不仅者，闺
房戕贼，欲后感寒，肾阴之根本久虚，肌表之卫阳必弱。况当百脉偾张之会，气血奔驰之时
，腠理皆疏，感受外寒，更是易易。而直入经络，深及骨髓，或为腰膝酸软，痿弱不仁，或
为环跳股阴，经制牵强。驯致经络短缩，漫肿坚凝。而皆酸楚者多，剧痛者少，亦是正不敌
邪，无力争胜之候。凡附骨、环跳、鹤膝、腰髀等证，酸在骨节间者，苟非其先天之不足，
即皆由房室之耗伤也。如其人体质犹强，而及早治疗，则温经宣络，合以滋养，亦多有效。
若素禀不坚，而复迁延渐久，邪势既张，正气更惫，则必不治。凡此皆疡患之多酸少痛者，
总之皆是重证。往往病者初不介意，不早调治，而浅者视之，又复不能洞烛病情，迁延坐误
，即其后再遇明者，亦终无法外之法，挽此沉 ，殊可慨也。
外科疾病初期，有的患者只感到酸楚而不疼痛，这大多是因为劳累损伤经络，以及寒邪深入体内。或者是体质虚弱，气血都衰退。或者是突然丧失真元之气，房事不节制，导致阴虚受寒，这些都属于阴证。这些都是严重的病症发于骨节，或者甚至伤及内脏的情况。
因劳累损伤经络的，是因为承担重任、长途跋涉，筋骨力气已经疲惫，因此气机阻滞、血液凝滞，停滞不前，这种病患多发生在手足的大关节，如肩、肘、腕、膝、髀关、环跳、跨阴等部位。起初则是经脉不畅，或酸或牵引作痛，如果在早期治疗，络脉通畅即可成功。或者顺着其经脉，用针刺来疏通它，效果尤其快捷。如果拖延日久，酸楚转为疼痛，肿胀程度加重，危害就大了（手腕、足踝、环跳等部位的疮疡，酸楚特别严重，而且即使肿胀形状已经很大，仍然只是大酸不痛，这是因为……若郁结久了化热，则疼痛多且发作了）。
体质弱的人，真阴极其微弱，阳气也衰弱，脏腑的功能既已不足，营卫之气的布散难以周全，有的表现为腰疽，有的表现为肾俞穴处的病变，有的表现为虚损流痰，虽然已经有形可见但大多不痛。这没有别的原因，是正气不能战胜邪气、没有相互抗争的力量罢了。大概疮疡之所以疼痛，都是正气与邪气搏斗的缘故。如果正气既然不能抵挡，那就逆来顺受，哪里还会有疼痛呢。凡是骨头小、肌肉脆的人，多有这种情况。治疗要及早，能给予滋补，或许还有一线生机，否则就是怯弱痨病的基础、疮痨的正途了。甚至有外证还没有溃破，而性命先已丧失的，还谈什么溃破后的疗效呢。
不仅如此，闺房生活过度伤害，欲望之后感受寒邪，肾阴的根本长久虚弱，肌表的卫阳必然薄弱。况且正当百脉奔涌、气血奔驰的时候，腠理都疏松，感受外寒，更是容易。而寒邪直入经络，深达骨髓，有的表现为腰膝酸软、痿弱麻木，有的表现为环跳股阴部位，经筋牵强拘急。逐渐导致经络短缩，漫肿坚硬凝结。而且大多只是酸楚，剧烈疼痛的很少，这也是正气不敌邪气、无力争胜的表现。凡是附骨疽、环跳疽、鹤膝风、腰髀等病症，酸楚在骨节之间的，如果不是先天不足，那就是由房室劳伤造成的。如果其人体质还强健，并且及早治疗，那么温通经络宣畅脉络，配合滋养之法，也多有效。如果素来禀赋不坚固，又加上拖延渐久，邪气势力嚣张，正气更加疲惫，那就必定无法治愈。凡此种种都是外科病患中多酸少痛的情况，总之都是重症。往往病人起初不在意，不早调理治疗，而浅薄医生看待病情，又不能洞察病情本质，拖延坐视错误，即使后来遇到高明的医生，也没有办法之外的方法，挽回这种沉疴，实在令人感慨。
At the initial stage of external sores, some patients only feel soreness and discomfort without pain. This is generally due to meridian injury from overexertion and deep penetration of cold pathogenic factors. It may also result from weak constitution with decline in both blood and qi, or sudden loss of true yuan qi due to immoderate sexual activity, leading to yin deficiency with cold invasion; all these belong to yin syndromes. These are severe conditions manifesting in bone joints or even affecting internal organs.
For those injured by overexertion, carrying heavy loads or traveling long distances exhausts sinews and muscles, causing qi stagnation and blood coagulation, leading to stasis. Such ailments often occur at major joints of the hands and feet, such as the shoulder, elbow, wrist, knee, Bitong (Bilateral Groin), Huantiao (GB30), and Kua-Yin regions. Initially, meridians are unsmooth, presenting with either soreness or pulling pain. If treated early, smoothing the collaterals can achieve success. Alternatively, needling along the affected meridians to promote circulation yields even quicker results. However, if delayed for a long time, soreness turns into pain, swelling increases, and the harm becomes significant. (In sores at the wrist, ankle, and Huantiao areas, soreness is particularly severe. Even when swelling is massive, there may still be only intense soreness without pain [due to underlying deficiency]; if stagnation transforms into heat over time, then pain becomes prominent and frequent.)
Individuals with weak constitutions have extremely deficient true yin and feeble yang qi. The covering functions of zang-fu organs are compromised, and the distribution of Ying (Nutritive) and Wei (Defensive) qi is incomplete. Conditions may include lumbar carbuncle (Yao Ju), lesions at Shenshu (BL23), or phlegm-drainage resulting from deficiency (Xu Sun Liu Tan). Although deformities are visible, they are often painless. This is because righteous qi cannot overcome pathogenic factors, lacking the strength to contend. Generally, pain in sores arises from the struggle between righteous qi and pathogenic factors. If righteous qi is unable to resist, it submits passively, hence no pain occurs. This condition is common in individuals with small bones and fragile flesh. Early treatment with tonifying methods may offer a glimmer of hope; otherwise, it becomes the foundation for consumptive diseases (Qie Zhai) or progresses inevitably toward chronic ulcerative wasting (Chuang Lao). In severe cases, death may occur before the external sore even ulcerates, let alone considering recovery after ulceration.
Furthermore, excessive sexual activity damages the body, and subsequent cold invasion further depletes kidney yin, the root. Consequently, defensive yang on the muscle surface becomes weak. Especially during periods when all vessels are active and blood and qi are surging, pores are open, making external cold invasion easy. Cold may penetrate directly into meridians and reach deep into bone marrow, causing soreness and weakness of the waist and knees, flaccidity, and numbness, or stiffness and tension in the Huantiao and thigh-groin regions. Gradually, meridians shorten, and diffuse swelling becomes hard and consolidated. Soreness is predominant, while severe pain is rare, indicating that righteous qi fails to overcome pathogens and lacks the strength to compete. For conditions such as Gu Su Ju (Bone-Attached Carbuncle), Huantiao Ju, He Xi Feng (Crane Knee Wind), and Yao Bi, where soreness is located in the joints, unless it is due to congenital insufficiency, it is invariably caused by sexual exhaustion. If the patient’s constitution is still strong and treatment begins early, warming meridians, unblocking collaterals, combined with nourishing therapies, can be effective. However, if the innate constitution is weak and the condition persists, allowing pathogenic factors to flourish and righteous qi to deteriorate, the disease becomes incurable. All these cases of external sores characterized by more soreness than pain are essentially severe conditions. Patients often neglect them initially and fail to seek timely regulation and treatment. Superficial physicians may fail to discern the nature of the illness, leading to delay and error. Even if a skilled physician is consulted later, there may be no method beyond standard treatments to rescue such critical conditions, which is truly lamentable.