脓出而反痛者，虚也，宜补之；脉数虚而痛者，属虚火，宜滋阴。脉数实而痛者，邪气
实
一男子患毒，溃后作痛，肢体倦怠，疮口不合，饮食不甘。以六君子汤加黄 、川芎、
当归，四剂而愈。更以托里散月余而敛。
一男子溃后作痛，脉数而无力。以托里散加生地黄、黄柏，二剂而止。更以托里散数剂
而安。
一男子溃后发热，左手脉数而有力。以人参败毒散，一剂而止。更以托里散而瘥。
一男子溃后发热， 痛不止，烦躁便秘，右手脉沉实。以清凉饮，一剂而止。更以托里
消毒散，四剂而瘳。
一男子溃后作痛而脉涩。以定痛托里散饮之，敷乳香定痛散而止。更以托里散数剂而愈
。
一男子溃而作痛，脉浮紧。以内补黄 汤，四剂而止。又二十余剂而愈。
一男子项患毒，溃而作痛。以参、 、地黄、芎、归补之而止。更以八珍汤加黄 、桔
梗，三十余剂而愈。
一男子患痈，溃而作痛，脉软而涩。余谓气血虚，欲补之。彼不信，乃服攻伐之剂，反
发寒
。脓溃之后，肿退肌宽，痛必渐减，若反痛，乃虚也。丹溪云∶脓出而反痛，此为虚也，宜
以补之。亦有秽气所触者，和解之。风寒所逼者，温散之。齐氏云（名德之元太医令∶疮疽
之证，有脏腑气血上下，真邪虚实不同也，不可不辨。如肿起坚硬脓稠者，疮疽之实也。
肿下软漫脓稀者，疮疽之虚也。泻痢肠鸣，饮食不入，呕吐无时，手足并冷，脉弱皮寒，小
便自利，或小便时难，大便滑利，声音不出，精神不爽者，悉脏腑之虚也。大便硬，小便涩
，饮食如故，肠满膨胀，胸膈痞闷，肢节疼痛，口苦咽干，烦躁多渴，身热脉大，精神昏塞
者，悉脏腑之实也。凡诸疮疽，脓水清稀，疮口不合，聚肿不赤，肌寒肉冷，自汗色脱者，
气
塞，目赤心惊，咽喉不利，口舌生疮，烦渴饮冷，睡语切牙者，上实也。精滑不禁，大便自
利，脚腰沉重，睡卧不宁者，下虚也。肩项不便，四肢沉重，目视不正，睛不了了，食不知
味，音嘶色败，四肢浮肿者，真气虚也。肿 尤甚，痛不可近，多日不溃，寒热往来，大便秘
涩，小便如淋，心神烦闷，恍惚不宁者，邪气之实也。又曰∶真气夺则虚，邪气胜则实。又曰
∶诸痛，为痒为虚也。又曰∶诊其脉洪大而数者，实也。细微而软者，虚也。虚则补之，和其
气托里也。实则泻之，疏利而导其气。《内经》
附方
人参败毒散（方见溃疡发热门）
清凉饮（方见发背门）
定痛托里散 治疮疡血虚疼痛之圣药也。
粟壳（去蒂炒，二钱） 当归（酒拌） 白芍药（炒） 川芎（各钱半） 乳香 没药 桂（各
一钱） 作一剂，水二钟，煎八分服。
乳香定痛散 治疮疡疼痛不可忍。
乳香 没药（各二钱） 寒水石（ ） 滑石（各四钱） 冰片（一分） 为细末，搽患处，痛
即止。甚妙。此方乳没性温，佐以寒剂制之。故寒热之痛，皆有效也。
六君子汤（方见作呕门）
托里散
托里消毒散（方见肿疡门）
内补黄 汤 治溃疡作痛，倦怠少食，无睡自汗，口干或发热，久不愈。
黄 （盐水拌炒） 麦门冬（去心） 熟地黄（酒拌） 人参 茯苓（各一钱） 甘草（炙炒，
三分
片，枣一枚。煎八分，食远服。
八珍汤（方见溃疡发热门。）
If pain persists or worsens after the discharge of pus, it indicates a deficiency syndrome and should be treated with tonification. If the pulse is rapid and weak accompanied by pain, it belongs to deficient fire and should be treated with yin-nourishing methods. If the pulse is rapid and forceful accompanied by pain, it indicates an excess pathogenic factor.
A male patient suffered from a toxic sore; after ulceration, he experienced pain, general fatigue, non-healing wound, and loss of appetite. He was prescribed Liu Jun Zi Tang (Six Gentlemen Decoction) supplemented with Huang Qi (Astragali Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), and Dang Gui (Angelicae Sinensis Radix). After four doses, he recovered. Subsequently, he took Tuo Li San (Support the Interior Powder) for over a month until the wound healed.
Another male patient experienced pain after ulceration with a rapid but weak pulse. He was treated with Tuo Li San (Support the Interior Powder) added with Sheng Di Huang (Rehmanniae Radix) and Huang Bo (Phellodendri Cortex). The pain ceased after two doses. He then took several more doses of Tuo Li San (Support the Interior Powder) to stabilize his condition.
Yet another male patient had fever after ulceration with a rapid and forceful pulse on the left hand. He was given Ren Shen Bai Du San (Ginseng Detoxifying Powder), which stopped the fever after one dose. He subsequently recovered after taking Tuo Li San (Support the Interior Powder).
Another male patient presented with fever, unceasing pain, irritability, and constipation after ulceration, with a deep and forceful pulse on the right hand. Qing Liang Yin (Cooling Drink) was administered, stopping the pain after one dose. He then recovered after four doses of Tuo Li Xiao Du San (Support the Interior and Disinfectant Powder).
A male patient experienced pain after ulceration with a choppy pulse. Ding Tong Tuo Li San (Pain-Relieving Support-the-Interior Powder) was ingested, and Ru Xiang Ding Tong San (Frankincense Pain-Relieving Powder) was applied externally, stopping the pain. He subsequently recovered after several doses of Tuo Li San (Support the Interior Powder).
A male patient had pain after ulceration with a floating and tight pulse. Nei Bu Huang Qi Tang (Internal Tonifying Astragalus Decoction) was used, stopping the pain after four doses. He fully recovered after more than twenty additional doses.
A male patient suffered from a toxic sore on the neck; after ulceration, he experienced pain. He was treated with Ren Shen (Ginseng), Huang Qi (Astragali Radix), Di Huang (Rehmanniae Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), and Dang Gui (Angelicae Sinensis Radix) to tonify qi and blood, which stopped the pain. He subsequently recovered after more than thirty doses of Ba Zhen Tang (Eight Treasures Decoction) supplemented with Huang Qi (Astragali Radix) and Jie Geng (Platycodi Radix).
A male patient suffered from a carbuncle; after ulceration, he experienced pain with a soft and choppy pulse. I diagnosed this as qi and blood deficiency and proposed tonification. However, he did not believe me and instead took purgative drugs, which aggravated his condition and induced chills.
After pus discharges and swelling subsides, the skin becomes loose, and pain should gradually diminish. If pain persists or worsens, it indicates deficiency. Dan Xi stated: "Pain persisting after pus discharge indicates deficiency; it should be treated with tonification." In cases caused by foul pathogens, harmonizing methods are used. In cases caused by wind-cold invasion, warming and dispersing methods are employed. Qi Shi (Qi Dezhi, Imperial Physician of the Yuan Dynasty) stated: "In sores and carbuncles, the involvement of zang-fu organs, qi and blood, upper and lower regions, and the distinction between true/empty and evil/excess must be carefully differentiated. For instance, if the swelling is raised, hard, and the pus is thick, it is an excess syndrome of sores/carbuncles. If the swelling is depressed, soft, and the pus is thin, it is a deficiency syndrome. Symptoms such as diarrhea, dysentery, borborygmus, inability to eat, frequent vomiting, cold extremities, weak pulse, cold skin, free urination or difficulty in urination, loose stools, hoarseness, and poor mental state indicate deficiency of the zang-fu organs. Symptoms such as hard stool, scanty urine, normal appetite, abdominal distension, chest oppression, limb pain, bitter taste, dry throat, irritability, excessive thirst, fever, large pulse, and mental confusion indicate excess of the zang-fu organs. Regarding all sores and carbuncles, if the pus and water are clear and thin, the wound does not heal, the swelling is aggregated but not red, the flesh is cold, there is spontaneous sweating, and the complexion is pale, it indicates qi deficiency. Symptoms such as chest fullness and qi stagnation, red eyes, palpitations, pharyngeal obstruction, mouth and tongue ulcers, irritability and thirst for cold drinks, somnolence with teeth grinding, indicate upper excess. Symptoms such as seminal emission, spontaneous diarrhea, heavy sensation in feet and waist, and restless sleep indicate lower deficiency. Symptoms such as stiffness in shoulders and neck, heaviness in limbs, abnormal vision, dull eyes, loss of taste, hoarse voice, deteriorated complexion, and edema in limbs indicate deficiency of true qi. If the swelling is severe, pain is intolerable, the sore does not ulcerate for many days, there is alternating chills and fever, constipation, dysuria, mental restlessness, and agitation, it indicates excess of pathogenic factors. It is also said: 'Depletion of true qi constitutes deficiency; dominance of pathogenic factors constitutes excess.' It is further stated: 'Various pains manifesting as itching are due to deficiency.' Also: 'A pulse that is large and rapid indicates excess; a pulse that is fine and soft indicates deficiency.' Deficiency is treated with tonification to harmonize qi and support the interior; excess is treated with purgation to dredge and guide qi. The *Nei Jing*..."
Attached Formulas:
Ren Shen Bai Du San (See "Fever in Ulceration" section)
Qing Liang Yin (See "Carbuncle on Back" section)
Ding Tong Tuo Li San: A divine medicine for treating pain due to blood deficiency in sores and carbuncles.
Ingredients: Su Ke (Caco Fructus, removed pedicel and stir-fried, 2 qian), Dang Gui (Angelicae Sinensis Radix, wine-soaked), Bai Shao Yao (Paeoniae Radix Alba, stir-fried), Chuan Xiong (Ligustici Chuanxiong Rhizoma, each 1.5 qian), Ru Xiang (Olibanum), Mo Yao (Myrrha), Gui (Cinnamomi Ramulus, each 1 qian). Prepare as one dose, decoct with 2 zhong of water until 0.8 zhong remains, and take orally.
Ru Xiang Ding Tong San: Treats unbearable pain in sores and carbuncles.
Ingredients: Ru Xiang (Olibanum), Mo Yao (Myrrha, each 2 qian), Han Shui Shi (Halloysitum Rubrum, calcined), Hua Shi (Talcum, each 4 qian), Bing Pian (Borneolum Syntheticum, 1 fen). Grind into fine powder and apply to the affected area. Pain stops immediately. This is excellent. Since Ru Xiang and Mo Yao are warm in nature, they are counteracted by cold herbs. Thus, it is effective for both cold and heat-related pain.
Liu Jun Zi Tang (See "Vomiting" section)
Tuo Li San
Tuo Li Xiao Du San (See "Ulceration before Pus Formation" section)
Nei Bu Huang Qi Tang: Treats pain in ulceration, fatigue, poor appetite, insomnia with spontaneous sweating, dry mouth or fever, and chronic non-healing wounds.
Ingredients: Huang Qi (Astragali Radix, stir-fried with salt water), Mai Men Dong (Ophiopogonis Radix, heart removed), Shu Di Huang (Rehmanniae Radix Praeparata, wine-soaked), Ren Shen (Ginseng), Fu Ling (Poria, each 1 qian), Gan Cao (Licorice Root, honey-fried, 3 fen), Sheng Jiang (Zingiberis Rhizoma Recens, 3 slices), Da Zao (Jujubae Fructus, 1 piece). Decoct with water until 0.8 zhong remains, and take after meals.
Ba Zhen Tang (See "Fever in Ulceration" section)