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Pain that is mild indicates the pathology is superficial, located in the muscles and skin; pain that is severe indicates the pathology is deep, located between the bones and sinews. Deficiency-type pain worsens with hunger, without abdominal distension or obstruction, and is relieved by massage, providing temporary comfort upon pressure. Excess-type pain worsens after eating, accompanied by distension and obstruction, and is aggravated by touch, making the pain unbearable to describe. Cold-type pain prefers warmth and relief, with no change in skin color; heat-type pain finds comfort in cold applications. Pain from abscess formation presents as swelling and elevation, where depression rebounds immediately upon release; pain from blood stasis presents as dull pain, which persists even after ulceration. Wind-type pain and Qi-type pain both manifest as wandering pain, requiring careful differentiation between wind-piercing and Qi-piercing sensations.

[Note] Pain arises from blockage of flow, yet causes vary greatly, categorized into mild, severe, deficiency, excess, cold, heat, abscess, blood-stasis coagulation, wind, and Qi pains. Mild pain refers to pain in the muscles and skin, indicating a shallow location; severe pain penetrates to the bones and sinews, indicating a deep location. Deficiency pain intensifies when the abdomen is empty, without distension or closure, favors massage, and can be temporarily alleviated by pressure; excess pain intensifies after full meals, presenting with both distension and closure, fears touch, and involves pain too severe to articulate. Cold pain is fixed in location, with unchanged skin color, and feels pleasant with warmth/relief; heat pain presents with red skin and feels pleasant with cold. Abscess pain presents with aversion to cold and high fever, with a swollen and elevated condition, rebounding immediately upon pressure. Pain from blood-stasis coagulation initially presents as dull pain with slight heat and distension; just before ulceration, the color turns purple with slight pain; after ulceration, there is no pain. Wind pain moves rapidly. Qi pain flows without a fixed location, presenting as unbearable stabbing pain. Such are the various pains; they must not be distinguished in detail.

For carbuncles and sores (Yongju, 痈疽) that have not yet formed an abscess, resolution (Xiao, 消) methods should be used; once formed, one must distinguish the presence or absence of pus. If palpated as hard with no fluctuation, there is no pus; if not hot, there is no pus; if hot, there is pus. If very soft upon pressure, the pus is ripe; if half-soft and half-hard, the pus is not fully formed. If the skin rebounds immediately after pressing, pus is present; if it does not rebound, there is no pus, indicating exhaustion of Qi and Blood. Deep pressure causing rapid rebound yielding thin yellow fluid indicates thin yellow water; deep pressure causing slow rebound yielding foul liquid indicates corrupt pus. Firmness with severe pain upon palpation indicates blood inside; emptiness with no pain upon pressure indicates Qi inside. Pain upon light pressure indicates shallow pus; pain only upon heavy pressure indicates deep pus. Thin skin peeling up indicates shallow pus; skin that is not elevated indicates thick pus. Thick yellow-white pus should be discharged first, followed sequentially by peach-red pus and then pale red fluid. Fat individuals tend to have more pus, while thin individuals have less; deviations from this suggest ominous changes. Thick yellow pus indicates excess Qi, while thin white pus indicates deficient Qi; pus resembling flour paste or sewage is difficult to cure. Pus discharged after sweating can still be cured; however, if pus is discharged but body heat persists, treatment is futile.

[Note] In treating carbuncles, sores, and ulcers, if the condition has not yet formed an abscess, internal resolution methods are applied; if the condition has formed, internal support (Tuo, 托) methods are used, and one must distinguish the presence, depth, and quantity of pus. Hardness upon manual palpation indicates no pus. Lack of heat indicates no pus; presence of heat indicates pus. Extreme softness indicates ripe pus; half-soft/half-hard indicates incomplete pus formation. Immediate rebound after pressing indicates pus; lack of rebound indicates no pus, implying extreme deficiency and exhaustion of Qi and Blood. Rapid rebound upon deep pressure indicates thin yellow fluid; slow rebound upon deep pressure indicates corrupt pus. Firmness with severe pain indicates blood accumulation; emptiness with no pain indicates Qi accumulation. Light pressure causing pain indicates shallow pus; heavy pressure causing pain indicates deep pus. Peeling thin skin indicates shallow pus; unchanged skin color without elevation indicates thick pus. Generally, for carbuncles and sores, thick yellow-white pus should be discharged first, followed by "peach blossom" pus, and finally pale red fluid. Abundant pus is favorable for fat individuals, while scant pus is favorable for thin individuals. Scant pus in fat individuals suggests non-decaying flesh; abundant pus in thin individuals suggests decaying flesh; neither is auspicious. Furthermore, excess Qi typically yields thick yellow pus, while deficient Qi yields thin white pus; mixed excess-deficiency yields thick white pus. Pus resembling flour paste or sewage is termed "decayed paste," a hopeless condition with fatal prognosis. Only pus discharged after sweating can be cured; if pus is out but high fever persists, treatment is ineffective. The emergence of pus in carbuncles is analogous to sweating in Shanghan (Cold Damage); persistent high fever after sweating indicates deteriorating Shanghan, just as persistent high fever after pus discharge indicates deteriorating carbuncle.