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。
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.