【方歌】轻痛肌肉皮肤浅，重痛深在骨筋间，虚痛饥甚不胀闭，
喜人揉按临时安。实痛饱甚多胀闭，畏人挨按痛难言，
寒痛喜暖色不变，热痛焮痛遇冷欢。脓痛鼓长按复起，
瘀痛隐隐溃不然，风痛气痛皆走注，风刺气刺细心看。
【注】痛由不通，然亦种种不一，有轻痛、重痛、虚痛、实痛
、寒痛、热痛、脓痛，瘀血凝结作痛、风痛、气痛之别
。轻痛者，肌肉皮肤作痛，属浅；重痛者，痛彻筋骨，
属深。虚痛者，腹肌则甚，不胀不闭，喜人揉按，临时
可安；实痛者，食饱则甚，又胀又闭，畏人挨按，痛不
可言。寒痛者，痛处定而不移，皮色不变，遇暖则喜；
热痛者，皮色焮赤，遇冷则欢。脓痛者，增寒壮热，形
势鼓长，按而复起。瘀血凝结作痛者，初起隐隐作痛，
微热微胀，将溃则色紫微痛，既溃则不疼。风痛者，走
注甚速。气痛者，流走无定，刺痛难忍。诸痛如此，不
可不详辨也。
【方歌】痈疽未成宜消托，已成当辨有无脓，按之坚硬无脓象，
不热无脓热有脓。大软应知脓已熟，半软半硬脓未成。
按之即起脓已有，不起无脓气血穷。深按速起稀黄水，
深按缓起坏污脓。实而痛甚内是血，内是气兮按不疼。
轻按即痛知脓浅，重按方疼深有脓。薄皮剥起其脓浅，
皮不高阜脓必浓。稠黄白脓宜先出，桃红红水次第行。
肥人脓多瘦人少，反此当究有变凶。稠黄气实虚稀白，
粉浆污水定难生。汗后脓秽犹可愈，脓出身热治无功。
【注】凡看痈疽疮疡，形势未成者，即用内消之法；若形势已
成，即用内托之法，当辨脓之有无浅深。以手按之坚硬
者，无脓之象。按之不热者无脓，热者有脓，按之大软
者内已熟；半软半硬者，脓未全成；按之指起即复者，
有脓；不复者无脓，其气必穷而虚甚也。深按之而速起
者，内是稀黄水；深按之而缓起，内是坏污脓。按之实
而痛甚者，内必是血；按之虚而不疼者，内必是气。轻
按即痛者，其脓浅；重按方痛者，其脓深。薄皮剥起者
，其脓必浅；皮色不变，不高阜者，其脓必稠。大抵痈
疽疮疡，先宜出黄白稠脓，次宜出桃花脓，再次宜流淡
红水。胖人宜于脓，多瘦人宜于脓少。若胖人脓少，是
肉不腐；瘦人脓多，是肉败坏，皆非吉也。又凡气实者
多稠黄脓，气虚者多稀白脓，半虚半实者多稠白脓。又
有脓出如粉浆，如污水者，谓之败浆，不治之证也，命
必难生。惟汗后脓秽者可愈，若脓已出，而身犹大热不
休者，治亦无功。盖痈疽之得脓，如伤寒之得汗，汗出
而反大热者，坏伤寒也；脓出而身犹大热者，坏痈疽也
。
【方歌】疼痛轻微者，病位在肌肉和皮肤浅层；疼痛剧烈者，病位深在骨骼和筋脉之间。虚证疼痛在饥饿时加重，腹部不胀满闭塞，喜欢被人揉按，按压后暂时缓解。实证疼痛在饱食后加重，伴有明显的胀满和闭塞感，畏惧他人触碰按压，疼痛难以言表。寒性疼痛喜欢温暖，患处皮色无变化；热性疼痛表现为红肿灼痛，遇冷则舒适。脓成之痛，局部肿胀隆起，按压后凹陷随即弹起。瘀血阻滞之痛，隐隐作痛，溃破后仍不缓解。风邪所致之痛和气滞所致之痛，疼痛部位游走不定，需仔细辨别是风刺还是气刺。
【注】疼痛的根本原因是气血不通，但表现形式多种多样，分为轻痛、重痛、虚痛、实痛、寒痛、热痛、脓痛、瘀血凝结作痛、风痛、气痛等不同类型。轻痛是指肌肉和皮肤部位的疼痛，属于病位浅；重痛是指疼痛深入筋骨，属于病位深。虚痛表现为饥饿时疼痛加剧，腹部不胀也不闭塞，喜欢被人揉按，按压后可暂时安宁；实痛表现为进食后疼痛加剧，既胀又闭，害怕别人触碰按压，疼痛无法忍受。寒痛的特点是疼痛部位固定不移，皮肤颜色没有改变，遇到温暖则感到舒适；热痛的特点是皮肤红肿发热，遇到寒冷则感到欢悦。脓痛的特点是恶寒高热，局部肿胀隆起，按压后凹陷立即回弹。瘀血凝结引起的疼痛，初起时隐隐作痛，伴有微热和微胀，即将溃破时颜色发紫且疼痛轻微，溃破后反而不疼。风痛的特点是疼痛游走迅速。气痛的特点是疼痛流窜无定处，呈刺痛状难以忍受。各种疼痛的情况如此，不可不详细辨别。
【方歌】痈疽尚未形成脓肿时，适宜采用消散或托毒的方法；一旦形成脓肿，应当辨别是否有脓液。触摸患处坚硬者，表明没有脓液；不发热者无脓，发热者有脓。患处完全变软，说明脓液已经成熟；半软半硬，说明脓液尚未完全形成。按压后凹陷立即弹起，说明有脓；按压后不起，说明无脓，这是气血极度亏虚的表现。深按后迅速弹起，流出的是稀薄的黄水；深按后缓慢弹起，流出的是败坏的污浊脓液。触诊感觉坚实且疼痛剧烈者，内部多为血液；触诊感觉空虚且不疼痛者，内部多为气滞。轻按即痛，说明脓液位置较浅；重按才痛，说明脓液位置较深。表皮薄而隆起者，脓液位置浅；表皮不高耸突起者，脓液必然浓稠。黄色、白色、稠厚的脓液应当先排出，随后依次排出桃花色的脓液和红色的水样液体。肥胖之人脓液较多，消瘦之人脓液较少，若与此相反，应当探究是否有凶险的变证。脓液稠黄表示正气充实，脓液稀白表示正气虚弱，如粉浆或污水般的脓液必定难以治愈。出汗之后排出的脓液秽浊尚可痊愈，若脓液已出而身体仍然发热，治疗就无效了。
【注】凡是诊治痈疽疮疡，在病情尚未成形（未化脓）时，立即使用内消法；若病情已经成形（已化脓），则使用内托法，此时应当辨别脓液的有无、深浅。用手触摸患处，质地坚硬的，是没有脓液的征象。触摸不热的，没有脓液；发热的，有脓液；触摸完全柔软的，说明内部脓液已熟；半软半硬的，说明脓液未完全形成；按压后手指抬起即复原的，说明有脓；按压后不复原的，说明无脓，这是因为气必虚而极度虚弱。深按后迅速回弹的，内部是稀薄的黄水；深按后缓慢回弹的，内部是败坏的污浊脓液。按压感觉坚实且疼痛剧烈的，内部必然是血；按压感觉虚软且不疼痛的，内部必然是气。轻按就痛的，脓液位置浅；重按才痛的，脓液位置深。表皮薄且隆起的，脓液必浅；皮色不变、不高耸突起的，脓液必稠厚。大抵痈疽疮疡，适宜先排出黄白色的稠脓，其次适宜排出桃花样的脓，再次适宜流出淡红色的水。胖人适宜脓多，瘦人适宜脓少。如果胖人脓少，说明肌肉没有腐化；瘦人脓多，说明肌肉败坏，这些都不是吉兆。另外，正气充实的人多排出稠黄的脓，正气虚弱的人多排出稀白的脓，虚实夹杂的人多排出稠白的脓。又有脓液排出像粉浆、像污水的，称为“败浆”，属于不治之症，性命难保。只有在出汗之后，脓液秽浊但可逐渐痊愈；如果脓液已经排出，而身体仍然持续高热不退的，治疗也无效。大概痈疽化脓，就像伤寒病出汗一样，出汗后反而高热不退的，是伤寒恶化；脓液排出后身体仍然高热的，是痈疽恶化。
[Verse] Mild pain indicates a superficial location in the muscle and skin; severe pain indicates a deep location between the bone and sinew. Pain from deficiency worsens with hunger, without abdominal distension or obstruction, and is relieved by massage temporarily. Pain from excess worsens after eating, accompanied by significant distension and obstruction, is aggravated by touch, and is unbearable. Cold-type pain prefers warmth with no change in skin color; heat-type pain presents as burning redness and feels better with cold. Pain from pus formation shows swelling that rebounds immediately upon pressure. Pain from blood stasis is dull and persists even after ulceration. Wind-type pain and Qi-type pain both feature wandering migration; careful observation is needed to distinguish wind-stabbing from Qi-stabbing.
[Annotation] Pain arises from blockage, yet manifests in various forms: mild, severe, deficiency, excess, cold, heat, pus, blood stasis, wind, and Qi types. Mild pain occurs in the muscle and skin, indicating a shallow depth. Severe pain penetrates to the bone and sinew, indicating a deep depth. Deficiency pain intensifies when hungry, without distension or closure, favors massage, and provides temporary relief. Excess pain intensifies after meals, presenting with distension and closure, fears touch, and is intolerable. Cold pain is fixed in location, with unchanged skin color, and benefits from warmth. Heat pain features burning redness of the skin and comfort with cold. Pus pain involves chills and high fever, with local swelling that rebounds upon pressure. Pain from coagulated blood stasis begins with dull pain, slight heat and distension, turns purple with mild pain before ulceration, and ceases to hurt after ulceration. Wind pain moves rapidly. Qi pain wanders without fixed location and is unbearable stabbing pain. Such are the characteristics of various pains; they must be distinguished in detail.
[Verse] For carbuncles and sores not yet formed into abscesses, resolution or support methods are appropriate; once formed, one must distinguish the presence of pus. Hardness upon palpation indicates no pus; lack of heat indicates no pus, while heat indicates pus. Complete softness indicates mature pus; half-soft and half-hard indicates incomplete pus formation. Immediate rebound upon pressure indicates pus; no rebound indicates no pus, signifying extreme exhaustion of Qi and Blood. Rapid rebound upon deep pressure indicates thin yellow fluid; slow rebound upon deep pressure indicates foul, necrotic pus. Firmness with severe pain indicates internal blood; emptiness without pain indicates internal Qi. Pain upon light pressure indicates shallow pus; pain only upon heavy pressure indicates deep pus. Thin, raised skin indicates shallow pus; non-elevated skin indicates thick pus. Thick yellow and white pus should appear first, followed sequentially by peach-blossom colored pus and red watery discharge. Obese individuals tend to have more pus, while thin individuals have less; deviations from this pattern suggest ominous changes. Thick yellow pus indicates strong Zheng Qi (Upright Qi), while thin white pus indicates deficient Zheng Qi. Pus resembling flour paste or sewage is termed "failed paste" and is incurable. Pus discharged after sweating may still be curable; if pus is discharged but fever persists, treatment is futile.
[Annotation] In diagnosing carbuncles, sores, and ulcers, if the condition has not yet formed an abscess, employ internal resolution methods; if it has formed, employ internal support methods, distinguishing the presence, depth, and nature of the pus. Hardness on palpation signifies no pus. Lack of heat signifies no pus; heat signifies pus. Complete softness signifies mature pus. Half-soft and half-hard signifies incomplete pus formation. Immediate rebound upon pressure signifies pus; no rebound signifies no pus, due to extreme Qi and Blood deficiency. Rapid rebound upon deep pressure signifies thin yellow fluid. Slow rebound upon deep pressure signifies foul, necrotic pus. Firmness with severe pain signifies internal blood. Emptiness without pain signifies internal Qi. Pain upon light pressure signifies shallow pus. Pain upon heavy pressure signifies deep pus. Thin, raised skin signifies shallow pus. Unchanged skin color and lack of elevation signify thick pus. Generally, for carbuncles and sores, thick yellow-white pus should appear first, followed by peach-blossom pus, and then pale red water. Obese individuals suitably produce more pus; thin individuals suitably produce less. If an obese person produces little pus, it means the flesh has not rotted; if a thin person produces much pus, it means the flesh is decaying. Neither is auspicious. Furthermore, those with strong Zheng Qi often produce thick yellow pus; those with weak Zheng Qi often produce thin white pus; those with mixed deficiency and excess often produce thick white pus. Pus resembling flour paste or sewage is called "failed paste," representing an incurable condition where life cannot be saved. Only if pus is discharged after sweating can recovery occur; if pus is discharged but high fever persists, treatment is ineffective. The emergence of pus in carbuncles is analogous to sweating in Shanghan (Cold Damage) disease. Just as persistent high fever after sweating indicates deterioration of Shanghan, persistent high fever after pus discharge indicates deterioration of the carbuncle.