夫疮疡之证候不同，寒热虚实皆能为痛。止痛之法，殊非一端，世人皆谓乳、没可以
止痛，殊不知因病制宜，自有活法。故因热而痛者，以寒凉之剂折其热，则痛自止也。因
寒而痛者，以温热之药熨其寒，则痛自除也。因风而痛者，除其风。因湿而痛者，除其湿。
燥而痛者，润之。塞而痛者，通之。虚而痛者，补之。实而痛者，泻之。脓郁而闭者，开
之。恶肉侵溃者，引之。阴阳不和者，调之。经络滞涩者，利之。忧愁者，远志酒饮之。虚
寒而痛者，乳香、没药止之。大抵痈疽不可不痛，不可大痛，若大痛闷乱者危。薛新甫
云∶疮疡之作，由六淫七情所伤，其痛也，因气血凝滞所致。假如热毒在内，便秘而作痛
者，内疏黄连汤导之。热毒炽盛， 肿而作痛者，黄连解毒散治之。不应，仙方活命饮
解之。瘀血凝滞而作痛者，乳香定痛散和之。作脓而痛者，托里消毒散排之。脓胀而痛者，
针之。脓溃而痛者，补之。若因气虚而痛，四君加归 。血虚而痛，四物加参 。肾虚而
痛，六味地黄丸。口干作渴，小便频数者，加减八味丸。此皆止痛之法也。
托里消毒散加减法 若高肿 痛，热毒也，加黄连。漫肿微痛，气虚也，去金银花、
连翘，加参术。肿赤作痛，血凝滞也，加乳香、没药。如不应，暂用仙方活命饮。脓出
反痛，气血虚也，去金银花、连翘、白芷，加参 、归也。漫肿不痛或肉死不溃，脾气虚
也，去三味，加人参、白术。如不应，加姜桂。更不应，急加附子。
痈疽脓血大泄，败臭痛甚，宜用黄 人参汤。
黄 人参汤
人参 苍术（米泔浸，炒） 陈皮（炒） 麦门冬（去心） 当归（酒拌） 神曲（炒） 甘草（炙）
五味子（杵，各一钱） 黄 （炙，二钱） 黄柏（炒） 升麻（各四分）
作一剂。水二盅，姜三片，枣二枚，煎八分，食远服。
〔薛〕 按∶前证七恶中之二恶也，宜此方治之。亦有溃后虚而发热，或作痛少寐尤
效。若痛少止，大便不实，黄柏、麦门冬可不用，盖恐寒中也。凡疮脓溃之后，若脉洪
大则难治，自利者不治。
痈疽大痛不止，宜用加味解毒汤。
加味解毒汤
黄 （盐水拌，炒） 黄连（炒） 黄芩（炒） 黄柏（炒） 连翘 当归（酒拌，各七分） 甘草（炙）
白芍药 栀子仁（炒，各一钱）
作一剂。水二盅，煎八分服之，药下痛即止。
按∶此方若脉洪大按之有力者，用此解之，其功甚捷。亦有便秘脉实而痛者。宜用
内疏黄连汤下之。若溃而反痛者，宜用内补黄 汤补之。
内补黄 汤
黄 （盐水拌炒，二钱） 熟地黄（酒拌） 人参 茯苓 甘草（炙，各五分） 芍药（炒） 川芎 官
桂远志（去心，炒） 当归（酒拌，各八分） 麦门冬（去心，五分）
作一剂。水一盅半，姜三片，枣二枚，煎六分，食远服。
当归和血散 治疮疡未发出，内痛不可忍，及治妇人产前产后腹痛。
当归（二钱） 乳香（半钱） 没药（一钱半） 白芍药（三钱）
上为细末。每服一钱，水一中盏，煎七分，和滓温服，日二。妇人酒煎。疮既发不
须用。疮痒者，加人参、木香。妇人服之，加赤芍药。
回疮金银花散 治疮疡痛甚，色变紫黑者。
金银花（连枝叶俱用，锉研，二两） 黄 （四两） 甘草（一两）
上 咀。用酒一升，用入壶瓶内闭口，重汤煮三两时辰，取出去滓，顿服之。一方无
黄。
郭氏定痛托里散 治一切疮肿疼痛不可忍。如少壮气充实，先用疏利，后服此药。
粟壳（去蒂，炒，二两） 当归 白芍药 川芎（各半两） 乳香 没药 桂（各三钱）
上 咀。每服五钱，水煎。
乳香止痛散 治一切疮肿，疼痛不止。
粟壳（六两，制） 白芷（三两） 甘草（炙） 陈皮（各一两半） 乳香 没药（各一两）
丁香（半两）
上 咀。每服三钱，水一盏半煎。
乳香黄 散 治一切恶疮、痈疽、发背、疔疮，疼痛不可忍者。或未成者速散，已成
者速溃败脓，不假刀砭，其恶肉自下，及治打扑伤损，筋骨疼痛。
黄 （去芦） 当归（酒洗） 川芎 麻黄（去根、节） 甘草（生用） 芍药 人参（去芦）
粟壳（各一两，蜜炒） 乳香（另研） 没药（各五钱，另研） 陈皮（一两）
上为细末。每服三钱，水一盏，煎至七分，去渣，温服。如疮在上食后，在下食前
服之。
人参内托散 治疮疡溃脓而作痛者。
人参 黄 当归 川芎 浓朴 防风 桔梗 白芷 官桂 紫草 木香 甘草
上入糯米一撮，水煎服。
乳香丸 治发背及一切疽疮，溃烂痛不可忍。
乳香（别研） 没药（别研） 羌活 五灵脂 独活（各三钱） 川芎 当归 真绿豆粉 交
桂川白芷 白胶香（各半两）
上为细末，炼蜜和丸，如弹子大。每服一丸，细嚼，薄荷汤送下。手足损痛不能起
者，加草乌，用木瓜盐汤送下。
乳香定痛散 治一切疮疡，溃烂疼痛。
乳香 没药（各五钱） 滑石 寒水石（各一两） 冰片（一钱）
上为细末。擦患处，痛即止。敷药中加南星、半夏能止痛，更加蓖麻仁，尤佳。
豆豉饼 治疮疡肿痛，硬而不溃，及溃而不敛，并一切顽疮、恶疮。用江西豆豉饼
为末，唾津和作饼子如钱大，浓如三文，置患处。以艾壮于饼上灸之，干则易之。如背
疮，用漱口水调作饼，覆患处，以艾铺饼上灸之。如未成者即消，已成者亦杀其大毒，如
有不效，气血虚败也。
乳香膏 治诸疮痛久不瘥。
乳香（一两，别研） 食盐 松脂 杏仁（去皮尖，研，各一两半） 生地黄（取汁，三合） 白羊肾
脂（半斤） 黄蜡（三两）
上先熬脂令沸。下杏仁、地黄汁，蜡煎，候蜡熔尽，入香、盐、松脂煎，以柳箅搅，令
匀，稀稠得所，瓷盒盛。疮上日三二度。
又乳香膏
木鳖子（去壳，细锉） 当归（各一两） 柳枝（二八寸，寸锉，同以清油四两，煎令黑色，次用后）
乳香 没药（各半两） 白胶香（明净者四两，同研细，入油煎化，用绵子滤之）
上炼药铁铫，令极净。再倾前药油蜡在内，候温，入黄丹一两半，以两柳枝搅极得
所，再上火煎，不住手搅，候油沸起住搅，注在水中，成珠不散为度。秋冬欲软，春夏欲
坚。倾在水中，出火毒，搜成剂收之。
戴院使云∶有不敷药时大痛，敷即不痛；有不敷药不痛，敷之则痛。盖寒热风湿，并
忧怒等气积而内攻，则痛不禁，药拔出之，故不痛也。死血阴毒在中，愈伏愈深，愈不觉
痛，药发之于外，故反痛也。
The manifestations of sores and ulcers vary, and pain can be caused by cold, heat, deficiency, or excess. The methods for relieving pain are not limited to one approach. People generally believe that *Ruxiang* (Frankincense) and *Moyao* (Myrrh) can relieve pain, but they fail to realize that treatment must be tailored to the specific condition, employing flexible methods. Therefore, for pain caused by heat, using cold-natured medications to subdue the heat will naturally stop the pain. For pain caused by cold, using warm-natured medications to dispel the cold will naturally eliminate the pain. For pain caused by wind, remove the wind. For pain caused by dampness, remove the dampness. For pain caused by dryness, moisten it. For pain caused by obstruction, unblock it. For pain caused by deficiency, tonify it. For pain caused by excess, purge it. For pain due to pus accumulation and blockage, open and drain it. For pain due to foul tissue erosion and ulceration, guide and drain it. For pain due to disharmony of Yin and Yang, harmonize them. For pain due to stagnation and涩 (obstruction) of meridians, promote circulation. For pain caused by sorrow, treat with *Yuanzhi* wine. For pain caused by deficiency-cold, use *Ruxiang* (Frankincense) and *Moyao* (Myrrh) to stop it. Generally, carbuncles and sores cannot be without pain, but severe pain is dangerous; if the pain is extreme and causes mental confusion, the prognosis is critical. Xue Xinpu stated: The occurrence of sores and ulcers results from damage by the Six Evils (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) and Seven Emotions (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright). The pain arises from the stagnation of Qi and Blood. For instance, if internal heat-toxin causes constipation and pain, use *Neishu Huanglian Tang* (Internal Purging Coptis Decoction) to guide it out. If heat-toxin is flourishing, causing swelling and pain, treat with *Huanglian Jiedu San* (Coptis Detoxification Powder). If ineffective, resolve it with *Xianfang Huoming Yin* (Immortal Formula for Preserving Life Decoction). For pain caused by blood stasis and stagnation, harmonize with *Ruxiang Dingtong San* (Frankincense Pain-Stopping Powder). For pain during suppuration, drain pus with *Tuoli Xiaodu San* (Supporting Interior and Eliminating Toxin Powder). For pain due to pus distension, puncture with a needle. For pain after pus rupture, tonify. If pain is due to Qi deficiency, use *Sijunzi Tang* (Four Gentlemen Decoction) plus *Danggui* (Angelica Sinensis). If pain is due to Blood deficiency, use *Siwu Tang* (Four Substances Decoction) plus *Renshen* (Ginseng). If pain is due to Kidney deficiency, use *Liujun Dihuang Wan* (Six-Ingredient Rehmannia Pill). For dry mouth with thirst and frequent urination, use *Jiaban Bawei Wan* (Modified Eight-Ingredient Pill). These are all methods for relieving pain.
Modifications to *Tuoli Xiaodu San*: If there is high swelling and pain, it is heat-toxin; add *Huanglian* (Coptis). If there is diffuse swelling and slight pain, it is Qi deficiency; remove *Jinyinhua* (Honeysuckle) and *Lianqiao* (Forsythia), add *Renshen* (Ginseng) and *Baizhu* (Atractylodes Macrocephala). If redness and swelling cause pain, it is blood stagnation; add *Ruxiang* (Frankincense) and *Moyao* (Myrrh). If still ineffective, temporarily use *Xianfang Huoming Yin* (Immortal Formula for Preserving Life Decoction). If pain occurs after pus discharge, it is Qi and Blood deficiency; remove *Jinyinhua* (Honeysuckle), *Lianqiao* (Forsythia), and *Baizhi* (Angelica Dahurica), add *Renshen* (Ginseng) and *Danggui* (Angelica Sinensis). If diffuse swelling without pain or necrotic tissue fails to ulcerate, it is Spleen Qi deficiency; remove these three herbs, add *Renshen* (Ginseng) and *Baizhu* (Atractylodes Macrocephala). If still ineffective, add *Shengjiang* (Fresh Ginger) and *Guirou* (Cinnamon Bark). If still ineffective, urgently add *Fuzi* (Prepared Aconite Root).
For carbuncles and sores with massive loss of pus and blood, severe putrid odor, and intense pain, use *Huangqi Renshen Tang* (Astragalus and Ginseng Decoction).
**Huangqi Renshen Tang (Astragalus and Ginseng Decoction)**
*Renshen* (Ginseng), *Cangzhu* (Atractylodes Lancea) (soaked in rice water, fried), *Chenpi* (Tangerine Peel) (fried), *Mendong* (Ophiopogon Tuber) (heart removed), *Danggui* (Angelica Sinensis) (mixed with wine), *Shenqu* (Medicated Leaven) (fried), *Gancao* (Licorice Root) (roasted), *Wuweizi* (Schisandra Berry) (pounded, each 1 qian), *Huangqi* (Astragalus Root) (roasted, 2 qian), *Huangbai* (Phellodendron Bark) (fried), *Shengma* (Cimicifuga Rhizome) (each 4 fen).
Prepare as one dose. Add two cups of water, three slices of ginger, and two jujubes. Decoct until eight-tenths remain. Take far from meals.
[Xue Ji] Commentary: The aforementioned conditions belong to two of the "Seven Evil" signs. This formula is appropriate. It is also effective for post-ulceration deficiency with fever, or pain with insomnia. If pain subsides slightly and stool is loose, *Huangbai* (Phellodendron Bark) and *Mendong* (Ophiopogon Tuber) should be omitted to avoid injuring the Middle Jiao with cold. After pus rupture, if the pulse is flooding and large, the condition is difficult to treat; spontaneous diarrhea is untreatable.
For carbuncles and sores with unremitting severe pain, use *Jiawei Jiedu Tang* (Modified Detoxification Decoction).
**Jiawei Jiedu Tang (Modified Detoxification Decoction)**
*Huangqi* (Astragalus Root) (mixed with salt water, fried), *Huanglian* (Coptis Rhizome) (fried), *Huangqin* (Scutellaria Root) (fried), *Huangbai* (Phellodendron Bark) (fried), *Lianqiao* (Forsythia Fruit), *Danggui* (Angelica Sinensis) (mixed with wine, each 7 fen), *Gancao* (Licorice Root) (roasted), *Baishao* (White Peony Root), *Zhizi Ren* (Gardenia Seed) (fried, each 1 qian).
Prepare as one dose. Add two cups of water. Decoct until eight-tenths remain. Take orally; pain ceases immediately upon ingestion.
Commentary: Use this formula if the pulse is flooding and large and firm to resolve the pathogen, yielding rapid results. For constipation, solid pulse, and pain, use *Neishu Huanglian Tang* (Internal Purging Coptis Decoction) to purge. If pain recurs after ulceration, use *Neibu Huangqi Tang* (Interior-Nourishing Astragalus Decoction) to tonify.
**Neibu Huangqi Tang (Interior-Nourishing Astragalus Decoction)**
*Huangqi* (Astragalus Root) (mixed with salt water and fried, 2 qian), *Shudihuang* (Prepared Rehmannia Root) (mixed with wine), *Renshen* (Ginseng), *Fuling* (Poria), *Gancao* (Licorice Root) (roasted, each 5 fen), *Shaoyao* (Peony Root) (fried), *Chuanxiong* (Sichuan Lovage Rhizome), *Guangui* (Cinnamon Twig), *Yuanzhi* (Polygala Root) (heart removed, fried), *Danggui* (Angelica Sinensis) (mixed with wine, each 8 fen), *Mendong* (Ophiopogon Tuber) (heart removed, 5 fen).
Prepare as one dose. Add one and a half cups of water, three slices of ginger, and two jujubes. Decoct until six-tenths remain. Take far from meals.
**Danggui Hexue San (Angelica Harmonizing Blood Powder)**
Treats unbearable internal pain before sores erupt, and abdominal pain in women before and after childbirth.
*Danggui* (Angelica Sinensis) (2 qian), *Ruxiang* (Frankincense) (0.5 qian), *Moyao* (Myrrh) (1.5 qian), *Baishao* (White Peony Root) (3 qian).
Grind into fine powder. Take 1 qian per dose, decoct with one cup of water until seven-tenths remain. Take warm with dregs, twice daily. Women should decoct with wine. Not needed once the sore has erupted. For itching, add *Renshen* (Ginseng) and *Muxiang* (Aucklandia Root). For women, add *Chishao* (Red Peony Root).
**Hui Chuang Jinyinhua San (Returning Sore Honeysuckle Powder)**
Treats severe pain in sores where the color turns purple-black.
*Jinyinhua* (Honeysuckle Flower) (use stems and leaves, chopped and ground, 2 liang), *Huangqi* (Astragalus Root) (4 liang), *Gancao* (Licorice Root) (1 liang).
Chop coarsely. Use one sheng of wine, seal in a pot, and steam-boil for three double-hours (6 hours). Remove, strain, and take in one dose. Another version omits *Huangqi* (Astragalus Root).
**Guoshi Dingtong Tuoli San (Guo's Pain-Stopping Interior-Supporting Powder)**
Treats unbearable pain in all swellings. For young and robust individuals with strong Qi, first use purgative/dispersing methods, then take this medicine.
*Suke* (Poppy Shell) (remove stem, fried, 2 liang), *Danggui* (Angelica Sinensis), *Baishao* (White Peony Root), *Chuanxiong* (Sichuan Lovage Rhizome) (each 0.5 liang), *Ruxiang* (Frankincense), *Moyao* (Myrrh), *Guirou* (Cinnamon Bark) (each 3 qian).
Chop coarsely. Take 5 qian per dose, decoct with water.
**Ruxiang Zhitong San (Frankincense Pain-Stopping Powder)**
Treats all swellings with unremitting pain.
*Suke* (Poppy Shell) (6 liang, processed), *Baizhi* (Angelica Dahurica) (3 liang), *Gancao* (Licorice Root) (roasted), *Chenpi* (Tangerine Peel) (each 1.5 liang), *Ruxiang* (Frankincense), *Moyao* (Myrrh) (each 1 liang), *Dingxiang* (Clove) (0.5 liang).
Chop coarsely. Take 3 qian per dose, decoct with one and a half cups of water.
**Ruxiang Huangqi San (Frankincense and Astragalus Powder)**
Treats malignant sores, carbuncles, back carbuncles, and hard carbuncles with unbearable pain. Rapidly dissipates unformed lesions; rapidly promotes suppuration and drainage of formed lesions without surgical incision, allowing foul tissue to fall off naturally. Also treats traumatic injuries and bone/joint pain.
*Huangqi* (Astragalus Root) (remove rhizome), *Danggui* (Angelica Sinensis) (wash with wine), *Chuanxiong* (Sichuan Lovage Rhizome), *Mahuang* (Ephedra Stem) (remove roots and nodes), *Gancao* (Licorice Root) (raw), *Shaoyao* (Peony Root), *Renshen* (Ginseng) (remove rhizome), *Suke* (Poppy Shell) (each 1 liang, honey-fried), *Ruxiang* (Frankincense) (separately ground), *Moyao* (Myrrh) (each 5 qian, separately ground), *Chenpi* (Tangerine Peel) (1 liang).
Grind into fine powder. Take 3 qian per dose, decoct with one cup of water until seven-tenths remain. Strain and take warm. Take after meals for lesions above the waist, before meals for lesions below the waist.
**Renshen Neituo San (Ginseng Internal-Piercing Powder)**
Treats pain following pus discharge in sores.
*Renshen* (Ginseng), *Huangqi* (Astragalus Root), *Danggui* (Angelica Sinensis), *Chuanxiong* (Sichuan Lovage Rhizome), *Houpo* (Magnolia Bark), *Fangfeng* (Saposhnikovia Root), Jiegeng (Platycodon Root), *Baizhi* (Angelica Dahurica), *Guangui* (Cinnamon Twig), *Zicao* (Arnebia Root), *Muxiang* (Aucklandia Root), *Gancao* (Licorice Root).
Add a pinch of glutinous rice. Decoct with water and take.
**Ruxiang Wan (Frankincense Pill)**
Treats back carbuncles and all yu sores with unbearable pain from ulceration.
*Ruxiang* (Frankincense) (separately ground), *Moyao* (Myrrh) (separately ground), *Qianghuo* (Notopterygium Rhizome), *Wulingzhi* (Trogopterus Dung), *Duhuo* (Angelica Pubescens Root) (each 3 qian), *Chuanxiong* (Sichuan Lovage Rhizome), *Danggui* (Angelica Sinensis), True Mung Bean Starch, *Guirou* (Cinnamon Twig), *Baizhi* (Angelica Dahurica), *Biaojiaoxiang* (Elemi Resin) (each 0.5 liang).
Grind into fine powder, mix with refined honey to make pills the size of quail eggs. Take one pill per dose, chew thoroughly, and swallow with mint tea. For limb injuries with pain preventing movement, add *Caowu* (Aconitum Carmichaelii Lateral Root) and swallow with Quappa salt water.
**Ruxiang Dingtong San (Frankincense Pain-Stopping Powder)**
Treats all sores with unbearable pain from ulceration.
*Ruxiang* (Frankincense), *Moyao* (Myrrh) (each 5 qian), *Huashi* (Talcum), *Hanshuishi* (Calcium Carbonatum) (each 1 liang), *Bingpian* (Borneol) (1 qian).
Grind into fine powder. Apply to the affected area; pain stops immediately. Adding *Nanxing* (Arisaema Cum Bile) and *Banxia* (Pinellia Tuber) to the poultice enhances pain relief; adding *Bimaren* (Castor Seed) is especially good.
**Douchi Bing (Fermented Soybean Cake)**
Treats swollen and painful sores that are hard and non-suppurating, or suppurating but non-healing, as well as stubborn and malignant sores. Grind Jiangxi fermented soybean cakes into powder, mix with saliva to form cakes the size of coins, thickness of three cash coins. Place on the lesion. Moxibustion on the cake; replace when dry. For back sores, mix with mouthwash to form a cake, cover the lesion, place moxa on top, and moxibustion. Unformed lesions will dissipate; formed lesions will reduce toxicity. If ineffective, it indicates Qi and Blood exhaustion.
**Ruxiang Gao (Frankincense Ointment)**
Treats chronic sores with persistent pain.
*Ruxiang* (Frankincense) (1 liang, separately ground), Salt, Songzhi (Pine Rosin), Xingren (Apricot Seed) (skin and tip removed, ground, each 1.5 liang), Shengdihuang Juice (Raw Rehmannia Juice) (3 he), Baiyangshenzhi (White Goat Kidney Fat) (0.5 jin), Huangla (Yellow Beeswax) (3 liang).
First boil the fat until bubbling. Add apricot seeds and raw rehmannia juice, melt the wax. When wax is fully melted, add frankincense, salt, and pine rosin. Stir with a willow whisk until uniform and proper consistency. Store in porcelain jars. Apply to sores 2-3 times daily.
**Another Ruxiang Gao (Frankincense Ointment)**
*Miebaozi* (Momordica Cochinchinensis Seed) (shell removed, finely chopped), *Danggui* (Angelica Sinensis) (each 1 liang), Willow Branches (2-8 cun, chopped per cun). Simmer in four liang of clear oil until black. Then use the following:
*Ruxiang* (Frankincense), *Moyao* (Myrrh) (each 0.5 liang), *Biaojiaoxiang* (Elemi Resin) (pure, 4 liang, ground fine, added to oil and melted, filtered through cotton).
Clean an iron cauldron thoroughly. Pour the prepared oil and wax into it. When warm, add 1.5 liang of *Huangdan* (Lead Monoxide). Stir vigorously with two willow branches. Reheat, stirring constantly. When oil boils, stop stirring. Pour into water until it forms beads that do not disperse. In autumn/winter, make it soft; in spring/summer, make it firm. Pour into water to remove fire toxicity, knead into a paste, and store.
Director Dai stated: Some cases have severe pain before applying medication, which ceases after application. Others have no pain before application, but pain ensues after application. The former is due to the accumulation of cold, heat, wind, dampness, and emotional factors (worry/anger) attacking internally; the medication draws the pathogen out, thus stopping pain. The latter is due to dead blood and yin toxins hiding deep within; the medication brings the pathology to the surface, thus causing pain.