入乳香、没药、阿魏末,搅匀,油纸摊贴。
十香膏 治五发、恶疮、结核、瘰 、疳 、疽痔。
沉香 麝香(各一钱) 木香 丁香 乳香 甘松 白芷 安息香 藿香 零陵香(各五
钱,为细末) 当归 川芎 黄 木通 芍药 细辛 升麻 白蔹 独活 川椒 本
菖蒲 浓朴 商陆根 木鳖子 官桂(各二钱,锉) 桃仁 柏子仁 松子仁 杏仁(各五钱)
槐枝 桑枝 柳枝 松枝(各二两,锉) 没药 轻粉 雄黄 朱砂 云母石 生犀角 乱发
灰白矾灰(各二两,另研如粉) 真酥 羊肾脂 猪脂(各二两) 黄丹(一斤) 清芝麻油(三斤)
上先用木炭火炼油香熟,下一十六味锉碎药,并四枝、四仁,熬至紫黑色,出火滤
去渣;入酥脂煎十余沸,再以新绵滤过,油澄清,拭铛令净;再入火上煎油沸,下丹,用
湿柳枝作篦子,不住搅熬一日,滴在水中成珠不散则成也,离火入十味药末搅匀,再上
火,入云母等粉八味,轻煎令沸,出火不住搅一食时,于瓷盒内密封收。每用量疮口大
小,绯帛上摊贴之,肠胃痈疽可作丸,如梧桐子大。每服七丸,空心温酒送下。
又方 治瘰 已破,核不腐,致疮口不敛。或贴琥珀膏,不应,用时效针头散敷之
以去腐肉,以如神散敷之,更服益气养荣汤。若气血虚者,先服益气养荣汤,待气血稍充,
方用针头散,仍服前汤。
〔丸〕
治瘰 上先于疮上灸三壮,然后用药溃作疮口。用新活鳝鱼截长一指大,批开,就
掩在疮口上。少时,觉疮内痒,急揭起鱼,觑鱼上有细虫如马尾一节,虫出如卷。三五次
取尽虫子后,用敛疮口药。
龙脑 乳香(各一字) 麝香 粉霜 雄黄 轻粉(各半钱)
上为细末,水糊为丸,如小麦大。每用一丸两丸, 在疮口内,觉肿痛是效。
洗方拔毒汤 治瘰 ,百杂疮肿,悉能内消。
防风 荆芥 羌活 独活 细辛 本 川芎 白芷 大黄 苦参 当归 赤芍药 威灵仙 玄参
何首乌 黄柏 甘草 蜂房 甘松 藿香 苍术 石菖蒲 零陵香 枸杞子
上葱白、川椒煎水热洗,又用绵布二帖,煮热蒸熨。
针灸法
《灵枢·寒热篇》黄帝曰∶寒热瘰 ,在于颈腋者,皆何气使然?岐伯曰∶此皆鼠
寒热之毒瓦斯也,留于脉而不去者也。鼠 之本,皆在于藏,其末上出于颈腋之间,其浮
于脉中而未内着于肌肉,而外为脓血者,易去也。黄帝曰∶去之奈何?岐伯曰∶请从其
本引其末,可使衰去而绝其寒热。审按其道以予之,徐往徐来以去之,其小如麦者,一
刺知,三刺而已。
上经一章,皆从经脉取脏腑之本,以治瘰 之本也。其末出于耳下,或耳后下颈至
肩上,或入缺盆中者,当于手足少阳经取之,或针、或灸如后穴。
〔扁〕 瘰 ∶天井 肩井
〔撮〕 瘰 ∶天井(半寸,灸七壮泻之)
〔东〕 腋下肿,马刀挟瘿,善自啮舌颊,天牖中肿,寒热∶临泣 丘墟(各一分,灸五壮)
太冲(一分,灸三壮) 腋下颈项肿∶天池(顺皮三分,灸七壮) 如颔肿,加后溪(二分,灸五壮) 腋
下肿马刀、挟瘿,喉痹∶阳辅(五分,灸二七壮) 申脉(一分,灸三壮,立愈)
〔甲〕 胸中满,腋下肿马刀、 ,善自啮舌颊,天牖中肿,淫烁胫酸,头眩,枕骨
颔腮痛,目涩身痹,洒淅振寒,季肋肢满寒热,胁腰腹膝外 痛,临泣主之。马刀肿 ,
渊腋、章门、支沟主之。出于颏下,或至颊车者,当于手足阳明经取之,或针、或灸如
后穴。三里(足阳明) 合谷(手阳明)
〔丹〕 捣生商陆根作饼子,置于瘰 上,艾柱灸饼子上,干即易之,灸三四饼。
〔世〕 当 上贴肉灸十四壮,神效。
〔东〕 瘰 、马刀,将先出一疮,用四楞铁环定住,不令出移,破作口子。以油纸
捻之,勿令合了,以绝其疮之源,其效至速。如疮不破,或病患不肯破,更以药涂之,
三日一易之,以龙泉散主之。(方见前。)
此穴治瘰 之秘法。盖瘰 属肝胆二经,故患在耳前后、项腋之间,男子多因恚怒,亏
损肝经之血,阴火内作,或不慎起居,耗损
肾水不能生肝血。妇女多因恚怒,伤肝火,动血燥,或郁结伤脾,火动血耗。或患于胸乳
间,亦属前经。此证若因恚怒伤肝,气血壅遏而不愈者,宜灸此穴,疏通经络。若因久
郁怒,元气亏损而不愈,当推其所属而调补化源。如取其穴,当以指甲掏两肘、两肩四
所,患处觉酸麻方是其穴。
又方 灸瘰 未成脓者,用大蒜切片,如三钱浓安患处,用艾壮于蒜上灸之,至三五壮
换蒜,每日灸十数蒜片,以拔郁毒。如破久不合,内有核,或瘀肉,此因血气不足,不能腐
烂,以铜钱挺轻轻连衣膜取去,纵取重亦不痛,不必畏惧。更用江西豆豉为末,唾津和为饼,
如前灸之,以助阳气。内服补药,外贴琥珀膏,或太乙膏,疮口自合。
\r肩尖肘尖二穴图\ps96a4.bmp\r
《灵枢》黄帝曰∶决其生死奈何?岐伯曰∶反其目视之,其中有赤脉,上下贯瞳子。见
一脉一岁死,见一脉半一岁半死,见二脉二岁死,见二脉半二岁半死,见三脉三岁而死。
见赤脉不下贯瞳子,可治也。肺脉微涩为鼠 ,在颈、肢腋之间下,不胜其上,其应善
酸。
十香膏 治疗五发(多种痈疽发背)、恶疮、结核(淋巴结结核等肿块)、瘰疬(颈部淋巴结核)、疳积(小儿慢性消耗性疾病)、疽痔。
沉香、麝香(各一钱),木香、丁香、乳香、甘松、白芷、安息香、藿香、零陵香(各五钱,研为细末);当归、川芎、黄芪、木通、芍药、细辛、升麻、白蔹、独活、川椒、本(藁本)、菖蒲、浓朴、商陆根、木鳖子、官桂(各二钱,切碎);桃仁、柏子仁、松子仁、杏仁(各五钱);槐枝、桑枝、柳枝、松枝(各二两,切碎);没药、轻粉、雄黄、朱砂、云母石、生犀角、乱发灰、白矾灰(各二两,另研成粉状);真酥、羊肾脂、猪脂(各二两);黄丹(一斤);清芝麻油(三斤)。
以上药物先用木炭火炼油至香气熟透,加入上述十六味切碎的药物,以及四枝、四仁,熬煮至紫黑色,离火过滤去除药渣;加入酥和油脂煎煮十余沸,再用新棉布过滤,使油澄清,擦拭锅具使其干净;再次上火将油煮沸,加入黄丹,用湿柳枝做成刮板,不停地搅拌熬煮一天,滴入水中能成珠不散即为成功;离火后加入十味药末搅拌均匀,再次上火,加入云母等八味粉剂,轻微煎煮令其沸腾,离火后不停搅拌一顿饭的时间,在瓷盒内密封收藏。每次使用时根据疮口大小,在绯帛上摊开贴敷,若为肠胃痈疽可制成丸剂,如梧桐子大。每次服用七丸,空腹用温酒送服。
又一方 治疗瘰疬已经破溃,但硬结不腐烂,导致疮口不能愈合。或者贴琥珀膏,无效时,用时效针头散敷之以去除腐肉,再用如神散敷之,同时服用益气养荣汤。如果气血虚弱者,先服用益气养荣汤,待气血稍充盛后,才使用针头散,并继续服用前面的汤药。
〔丸剂〕
治疗瘰疬:先在疮上灸三壮,然后用药使疮溃破形成疮口。取新活的鳝鱼截成一指长,剖开,直接覆盖在疮口上。过了一会儿,感觉疮内发痒,急忙揭起鱼,看鱼身上有像马尾一节那样的细虫,虫子出来时呈卷曲状。重复三五次取尽虫子后,使用收敛疮口的药物。
龙脑、乳香(各一字),麝香、粉霜、雄黄、轻粉(各半钱)。
以上研为细末,用水糊制作成丸,如小麦粒大。每次用一到两丸,塞入疮口内,感觉肿痛即是有效。
洗方拔毒汤 治疗瘰疬,各种杂症疮肿,都能从内部消散。
防风、荆芥、羌活、独活、细辛、本(藁本)、川芎、白芷、大黄、苦参、当归、赤芍药、威灵仙、玄参、何首乌、黄柏、甘草、蜂房、甘松、藿香、苍术、石菖蒲、零陵香、枸杞子。
以上加葱白、川椒煎水热洗,再用两块棉布,煮热后蒸熨患处。
针灸法
《灵枢·寒热篇》黄帝说:寒热瘰疬,发生在颈腋部位的,是什么气导致的?岐伯说:这都是鼠瘰寒热的毒气,停留在脉中而不散去。鼠瘰的根本,都在脏腑,其表现向上出于颈腋之间,那些浮在脉中而未深入肌肉,外部化为脓血的,容易去除。黄帝说:如何去除?岐伯说:请顺着病本引导病末,可以使病势衰退而断绝寒热。仔细按压其经脉之道来施治,缓慢进针缓慢出针以祛除病邪,小的如麦粒大小的,刺一次见效,刺三次痊愈。
上面这一章经文,都是从经脉选取脏腑的根本,来治疗瘰疬的根本。其表现末端出于耳下,或耳后下颈至肩上,或进入缺盆中的,应当在手足少阳经取穴,或针刺、或艾灸如下穴位。
〔扁鹊〕 瘰疬:天井、肩井。
〔撮〕 瘰疬:天井(深半寸,灸七壮泻法)。
〔东垣〕 腋下肿,马刀挟瘿(腋下及颈部肿块),喜欢自己咬舌颊,天牖中肿,寒热:临泣、丘墟(各一分,灸五壮);太冲(一分,灸三壮);腋下颈项肿:天池(顺皮三分,灸七壮);如果下巴肿,加后溪(二分,灸五壮);腋下肿马刀、挟瘿,喉痹:阳辅(五分,灸十四壮);申脉(一分,灸三壮,立即痊愈)。
〔甲乙经〕 胸中满,腋下肿马刀、瘰疬,喜欢自己咬舌颊,天牖中肿,淫烁胫酸(小腿酸痛),头眩,枕骨颔腮痛,目涩身痹,洒淅振寒(怕冷发抖),季肋肢满寒热,胁腰腹膝外侧痛,临泣主治。马刀肿、瘰疬,渊腋、章门、支沟主治。出于下巴下,或至颊车者的,应当在手足阳明经取穴,或针刺、或艾灸如下穴位。三里(足阳明)、合谷(手阳明)。
〔丹〕 捣碎生商陆根做成饼子,置于瘰疬上,在饼子上艾柱灸,干了就更换,灸三四张饼。
〔世〕 当在瘰疬上贴肉灸十四壮,神效。
〔东垣〕 瘰疬、马刀,将要先出一个疮,用四楞铁环固定住,不让它移动,破作口子。用油纸捻条填塞,不要让它闭合,以绝其疮之源,效果极快。如果疮不破,或者病人不肯破,再用药涂之,三天更换一次,以龙泉散为主。(方剂见前文。)
这些穴位是治疗瘰疬的秘法。大概瘰疬属于肝胆二经,所以患病在耳前后、项腋之间,男子多因愤怒,亏损肝经之血,阴火内生,或者起居不慎,耗损肾水不能滋养肝血。妇女多因愤怒,伤肝火,动血燥,或者郁结伤脾,火动血耗。或者患于胸乳间,也属于前经。此证如果因愤怒伤肝,气血壅遏而不愈者,宜灸这些穴位,疏通经络。如果因久郁怒,元气亏损而不愈,应当推究其所属而调补化源。如果要寻找穴位,应当用指甲掐按两肘、两肩四处,患处感觉酸麻才是正确的穴位。
又一方 灸未成脓的瘰疬,用大蒜切片,约三钱厚安放在患处,用艾壮在蒜上灸之,到三五壮换一片蒜,每天灸十几片蒜,以拔出郁毒。如果破溃很久不合,里面有核,或者有瘀肉,这是因为气血不足,不能腐烂,用铜钱挺轻轻连同衣膜取去,即使取重也不痛,不必畏惧。更用江西豆豉研为末,用唾液调和成饼,像前面那样灸之,以助阳气。内服补药,外贴琥珀膏,或太乙膏,疮口自然愈合。
《灵枢》黄帝说:判断生死如何?岐伯说:翻转眼睛看它,其中有赤脉,上下贯穿瞳孔。见到一脉一年死,见到一脉半一年半死,见到二脉二年死,见到二脉半二年半死,见到三脉三年而死。见到赤脉不下贯瞳孔,可以治疗。肺脉微涩为鼠瘰,在颈、肢腋之间下方,不胜其上,其反应善于酸痛。
Add *Ruxiang* (Frankincense), *Moyao* (Myrrh), and *Awei* (Asafoetida) powder, stir evenly, spread on oil paper, and apply as a plaster.
Shixiang Gao (Ten-Fragrance Plaster) treats Wufa (various types of carbuncles and sores), Echuang (malignant ulcers), Hejie (tuberculous lymphadenitis), Luoli (scrofula), Ganji (infantile malnutrition with accumulation), Ju (deep-seated abscesses), and Zhizhong (hemorrhoids).
Chenxiang (Aquilaria Wood), Shexiang (Musk) (each 1 qian); Muxiang (Costus Root), Dingxiang (Clove), Ruxiang (Frankincense), Gansong (Nardostachys Root), Baizhi (Angelica Dahurica), Anshixiang (Benzoin), Huoxiang (Patchouli), Linglingxiang (Lingnan Fragrant Herb) (each 5 qian, ground into fine powder); Danggui (Angelica Sinensis), Chuanxiong (Sichuan Lovage Rhizome), Huangqi (Astragalus Root), Mutong (Akebia Stem), Shaoyao (Peony Root), Xixin (Asarum), Shengma (Cimicifuga Rhizome), Bailian (Belamcanda Rhizome), Duhuo (Angelica Pubescens), Chuanjiao (Sichuan Pepper), Ben (Ligusticum Root), Changpu (Acorus Tatarinowii), Houpo (Magnolia Bark), Shanglugen (Phytolacca Root), Muguezi (Momordica Seed), Guangui (Cinnamon Bark) (each 2 qian, chopped); Taoren (Peach Kernel), Baiziren (Biota Seed), Songziren (Pine Nut), Xingren (Apricot Seed) (each 5 qian); Huaizhi (Locust Twig), Sangzhi (Mulberry Twig), Liuzhi (Willow Twig), Songzhi (Pine Twig) (each 2 liang, chopped); Moyao (Myrrh), Qingfen (Calomel), Xionghuang (Realgar), Zhusha (Cinnabar), Yunmushi (Mica), Sheng Xijiao (Fresh Rhinoceros Horn), Luanfa Hui (Ash of Human Hair), Baifan Hui (Ash of Alum) (each 2 liang, separately ground into powder); Zhen Su (Butter/Ghee), Yangshenzhi (Sheep Kidney Fat), Zhuzhi (Pig Fat) (each 2 liang); Huangdan (Lead Monoxide) (1 jin); Qing Zhima You (Pure Sesame Oil) (3 jin).
First, use charcoal fire to heat the oil until fragrant. Add the sixteen chopped medicinal ingredients, along with the four twigs and four kernels. Boil until the mixture turns purple-black. Remove from fire and filter to remove dregs. Add butter and fats, boil for about ten cycles, then filter through new cotton cloth until the oil is clear. Wipe the pot clean. Return to fire, boil the oil, add Huangdan (Lead Monoxide). Use a wet willow twig as a spatula, stirring constantly for one day. When a drop forms a bead that does not disperse in water, it is ready. Remove from fire, add the ten powdered medicines, stir evenly. Return to fire, add the eight powders including Yunmushi (Mica), boil gently. Remove from fire, stir continuously for the duration of a meal. Seal tightly in a porcelain jar. For each use, spread on crimson silk according to the size of the wound. For intestinal or gastric abscesses, form into pills the size of a paulownia seed. Take seven pills per dose, swallowed with warm wine on an empty stomach.
Another prescription: Treats Luoli (scrofula) that has already ulcerated, but the nodules do not necrose, causing the wound to fail to heal. If applying Hupo Gao (Amber Plaster) is ineffective, use Shixiao Zhentou San (Time-Efficient Needle-Head Powder) to debride necrotic tissue, then apply Rushen San (Miraculous Efficacy Powder), and concurrently administer Yiqi Yangrong Tang (Qi-Nourishing and Blood-Supplementing Decoction). If Qi and Blood are deficient, first administer Yiqi Yangrong Tang. Wait until Qi and Blood are slightly replenished before using Zhentou San, while continuing the previous decoction.
[Pills]
To treat Luoli (scrofula): First moxa three cones on the lesion, then use medicine to induce ulceration. Take a fresh live eel, cut to the length of one finger, split open, and apply directly over the wound. After a short time, when itching is felt inside the wound, quickly remove the eel. Inspect the eel for fine worms resembling segments of a horse's tail, which emerge curled. Repeat this three to five times until all worms are removed. Then apply wound-healing medication.
Naobor (Borneol), Ruxiang (Frankincense) (each 1 zi); Shexiang (Musk), Fenshuang (White Arsenic Oxide), Xionghuang (Realgar), Qingfen (Calomel) (each 0.5 qian).
Grind all into fine powder, mix with water paste to form pills the size of wheat grains. Insert one or two pills into the wound; feeling pain and swelling indicates efficacy.
Wash Formula: Baidu Tang (Detoxification-Extracting Decoction) treats Luoli (scrofula) and various miscellaneous swollen sores, resolving them internally.
Fangfeng (Saposhnikovia Root), Jingjie (Schizonepeta Spike), Qianghuo (Notopterygium Rhizome), Duhuo (Angelica Pubescens), Xixin (Asarum), Ben (Ligusticum Root), Chuanxiong (Sichuan Lovage Rhizome), Baizhi (Angelica Dahurica), Dahuang (Rhubarb Root), Kushen (Sophora Root), Danggui (Angelica Sinensis), Chishao (Red Peony Root), Weilingxian (Clematis Root), Xuanshen (Scrophularia Root), Heshouwu (Polygonum Multiflorum Root), Huangbai (Phellodendron Bark), Gancao (Licorice Root), Fengfang (Honeycomb), Gansong (Nardostachys Root), Huoxiang (Patchouli), Cangzhu (Atractylodes Rhizome), Shichangpu (Acorus Tatarinowii), Linglingxiang (Lingnan Fragrant Herb), Gouqizi (Goji Berry).
Decoct with Congbai (Green Onion White) and Chuanjiao (Sichuan Pepper) in water for hot washing. Also, boil two pieces of cotton cloth and apply hot compresses.
Acupuncture and Moxibustion Method
*Ling Shu · Han Re Pian*: The Yellow Emperor asked: What causes cold-heat Luoli (scrofula) located in the neck and axilla? Qibo replied: These are toxic vapors of cold-heat shu lu (rat scrofula) remaining in the vessels. The root of shu lu lies within the zang organs, manifesting upwards between the neck and axilla. Those floating in the vessels without penetrating the muscles, externally turning into pus and blood, are easy to remove. The Yellow Emperor asked: How to remove them? Qibo replied: Guide from the root to the branch, allowing the pathogenic factor to decline and the cold-heat to cease. Carefully press the meridian pathways to treat, inserting and withdrawing needles slowly to expel the pathogen. For small lesions like millet seeds, one insertion brings improvement, three insertions cure.
The above chapter discusses treating the root of Luoli by selecting points based on the meridian origins of the zang organs. If the manifestation extends below the ear, behind the ear down to the neck and shoulder, or enters the clavicular fossa, select points from the Hand and Foot Shaoyang meridians, using acupuncture or moxibustion at the following points.
[Qian] Luoli: Tianjing (SJ10), Jianjing (GB21).
[Cuo] Luoli: Tianjing (SJ10) (depth 0.5 cun, moxa 7 cones, reducing method).
[Dong Yuan] Swelling in axilla, Madao Jia Ying (axillary and cervical masses), frequent self-biting of tongue and cheeks, swelling at Tianyou (SI16), cold and heat: Linqi (GB15), Qiuxu (GB40) (each 0.1 cun, moxa 5 cones); Taichong (LR3) (0.1 cun, moxa 3 cones); Swelling in axilla, neck, and throat: Tianchi (PC1) (parallel insertion 0.3 cun, moxa 7 cones); If chin is swollen, add Houxi (SI3) (0.2 cun, moxa 5 cones); Axillary swelling, Madao, Jia Ying, throat obstruction: Yangfu (GB38) (0.5 cun, moxa 14 cones); Shenmai (BL62) (0.1 cun, moxa 3 cones, immediate cure).
*[Jia Yi Jing]* Chest fullness, axillary swelling, Madao, Luoli, frequent self-biting of tongue and cheeks, swelling at Tianyou (SI16), soreness in calves, dizziness, pain at occiput, jaw, and cheek, dry eyes, body numbness, chills, hypochondriac fullness with cold and heat, pain in lateral sides of ribs, waist, abdomen, and knees: Linqi (GB15) governs. Madao swelling, Luoli: Yuanye (GB22), Zhangmen (LR13), Zhigou (SJ6) govern. Manifesting below the chin or reaching Jiache (ST6): Select points from Hand and Foot Yangming meridians, using acupuncture or moxibustion at the following points: Zusanli (ST36) (Foot Yangming), Hegu (LI4) (Hand Yangming).
[Dan] Pound fresh Shanglu Root (Phytolacca Root) into a cake, place on Luoli, moxa on the cake. Replace when dry. Moxa 3-4 cakes.
[Shi] Apply moxa directly on the skin over Luoli for 14 cones. Divine efficacy.
[Dong Yuan] For Luoli and Madao, if a sore is about to appear, fix it with a square iron ring to prevent movement, make an incision. Pack with oiled paper twist, keeping it open to cut off the source of the sore. Effect is very rapid. If the sore does not break, or the patient refuses, apply medicine instead. Change every three days. Main formula: Longquan San (Dragon Spring Powder). (Formula see earlier.)
These points are secret methods for treating Luoli. Luoli belongs to the Liver and Gallbladder meridians, hence occurring around ears, back of neck, and axillae. Men often suffer from anger damaging Liver Blood, causing internal Yin Fire, or improper lifestyle consuming Kidney Water, failing to nourish Liver Blood. Women often suffer from anger injuring Liver Fire, disturbing Blood Dryness, or depression injuring Spleen, causing Fire to consume Blood. Lesions on chest/breasts also belong to these meridians. If due to anger damaging Liver, causing Qi and Blood stagnation, moxa these points to unblock meridians. If due to long-term depression damaging Yuan Qi, investigate the affected organ and tonify the source. To locate points, press with fingernails at both elbows and shoulders; soreness and numbness indicate the correct point.
Another prescription: For Luoli not yet suppurating, slice garlic, place thickly on the lesion, moxa on the garlic. Change garlic after 3-5 cones. Moxa dozens of slices daily to extract stagnant toxin. If ulcerated long-term without healing, with nodules or necrotic flesh due to insufficient Qi and Blood, gently remove necrotic tissue with a copper coin probe without fear of pain. Grind Jiangxi Dou Chi (Fermented Soybean) into powder, mix with saliva to form a cake, moxa as before to assist Yang Qi. Internally take tonics, externally apply Hupo Gao (Amber Plaster) or Taiyi Gao (Supreme One Plaster). The wound will heal naturally.
*Ling Shu*: The Yellow Emperor asked: How to determine life and death? Qibo replied: Observe the eyes. If red vessels penetrate the pupil vertically: One vessel indicates death in one year; one and a half vessels in one and a half years; two vessels in two years; two and a half vessels in two and a half years; three vessels in three years. If red vessels do not penetrate the pupil, it is treatable. Lung pulse micro-choppy indicates Shu Lu (Rat Scrofula) in neck, limbs, and axillae. It cannot overcome the upper part, presenting with soreness.