痈疽为患，痛者其常，不痛者其偶。如皮肤之病，暑热之疡，间有不痛者，则本非大证
，无害其不作痛也。若夫肿势猖狂，非不坚巨，而反觉顽木不仁，不痛不痒，则苟非大毒，
可以劫制神经，使失知觉，何以致此。所以顽肿木肿之证，其为害必较之大痛者倍而有余。
如疔疮之猛厉者，始发黍米之粒，而坚肿随之，顷刻四溢。患者但觉肌肤之呆滞不灵，而无
所谓痛也。此帷头、面、额、颅、耳前、唇、颌诸疔有之。迁延不治，曾不崇朝而毒已内攻
，胸满恶心，神思昏愦。若非急急大剂清解，势多不救。此顽木不痛之属于急证者一也。又
有顽痼之病，初发坚块，附筋着骨，并不痛痒，为日虽多，而情势如故，其在外之肌肉皮色
亦如故，甚至有经年累月而不改其常者。在病者且毫不介意，以为相安已久，不复为患。然
偶有感触，而形块乃巨，于是有始作一抽之痛者，则大证已成，变动乃速。此惟石疽乳岩，
有此奇变，而证已不可为矣。此顽木不痛之属于缓证者又其一也。此外有皮肤之疡，腐溃日
久，时而稍稍收敛，时而渐渐化开，反复频仍，几更寒暑，流水不彻，痛痒俱忘。此则久烂
之余，其肌肉之神经已死，而皮肤之颜色黯然，津液干枯，有如槁木，则亦顽梗无知，搔爬
不觉，虽似习惯自然，不为大患，然而脂膏已耗，痊愈无期。此惟久溃疮疡，失于调治，致
成坏证。在贫劳劳力之人，往往有之。又梅疮、结毒治不得法，亦必如此。此皆久腐之余，
调理失宜，迁延岁月，气血不流，每令四围未腐，肌肤渐为顽木。则其后虽或治之合宜，幸
得收敛，而其肌肉亦必痛痒不关，如非己有；抑且皮色斑驳，按之木强。此即局部神经失其
功用，不能恢复使然。要皆久败之疮疡，非寻常之轨范已。
痈疽这类疾病，疼痛是常见现象，不痛则是偶发情况。像皮肤表面的病症，或是暑热引起的疮疡，偶尔有不痛的，但这本来就不是严重的病证，不痛也没什么害处。如果肿胀之势猖狂，肿块既坚硬又巨大，反而感觉麻木不仁，既不痛也不痒，那么如果不是因为使用了大毒药物，能够抑制神经功能使其失去知觉，怎么会导致这种情况呢？所以，这种顽固肿胀、麻木的病症，其危害程度必然比剧烈疼痛的病证加倍有余。
例如猛厉的疔疮，刚开始只像黍米大小的颗粒，随之出现坚硬肿胀，顷刻间向四周扩散。患者只感觉肌肤呆滞不灵活，而并不觉得疼痛。这种情况多见于眉棱骨、面部、额头、头颅、耳前、嘴唇、下颌等部位的疔疮。如果拖延不治，不到半天时间，毒邪就会内攻入里，出现胸部胀满、恶心、神志昏沉迷糊等症状。如果不紧急使用大剂量的清热解毒方药，病情大多无法挽救。这是顽木不痛属于急症的一种情况。
又有顽固难愈的疾病，初起时形成坚硬的块状物，附着于筋脉骨骼之上，既不痛也不痒。虽然病程很长，但病情态势没有变化，体表的肌肉和肤色也保持原样，甚至有经年累月都不改变常态的。患病者对此毫不在意，认为已经相安无事很久，不再构成威胁。然而一旦偶然受到触动，肿块就会变得巨大，此时突然产生一阵抽掣样的疼痛，说明大病已成，病情变化迅速。这只有石疽、乳岩（乳腺癌）等疾病才有这种奇特的变化，且此时病情已经不可救治了。这是顽木不痛属于缓症的另一一种情况。
此外，还有皮肤上的疮疡，腐烂溃破日久，有时稍微收敛，有时渐渐扩大，反复频繁，历经寒暑更替，脓水淋漓不尽，痛感和痒感都消失了。这是因为长期溃烂之后，肌肉的神经已经坏死，皮肤颜色暗淡无光，津液干枯，如同枯死的树木一样，因此变得顽固僵硬、无知觉，搔抓也不觉得疼。虽然看似习惯自然，不构成大患，但是体内的脂膏（精血）已经耗损，痊愈遥遥无期。这只有那些久溃不愈的疮疡，因失于调理治疗，最终导致成为坏证的情况才会发生。在贫穷劳累的体力劳动者中，往往有这样的病例。另外梅毒疮、结毒如果治疗方法不当，也必定会如此。这些都是长期腐败溃烂之后，调理不当，拖延岁月，导致气血运行不畅，常常使得周围未腐烂的肌肤逐渐变得麻木僵硬。这样即使后来治疗得当，侥幸得以收敛，但其肌肉也会痛痒无关，仿佛不是自己身体的一部分；而且皮肤颜色斑驳，按压时感觉木质般强硬。这就是局部神经失去功能，无法恢复所致。总之，这些都是久败的疮疡，不符合常规的治疗规范了。
Carbuncles and sores typically present with pain, while the absence of pain is an occasional occurrence. In cases of superficial skin diseases or sores caused by summer-heat, there are instances without pain; however, these are not serious conditions, and the lack of pain poses no harm. Conversely, if swelling is rampant, with masses that are both hard and large, yet accompanied by a sensation of numbness and insensitivity—neither painful nor itchy—one must ask: unless potent toxic substances have been used to suppress neural function and cause anesthesia, how could such a state arise? Therefore, conditions characterized by stubborn swelling and numbness are invariably more harmful than those presenting with severe pain.
For instance, in aggressive ding sores (hard boils), the lesion initially appears as small as a millet grain, followed immediately by induration and swelling, spreading rapidly within moments. The patient may only perceive a dullness and lack of agility in the skin, without experiencing any pain. This presentation is common in ding sores located on the supraorbital ridge, face, forehead, skull, preauricular area, lips, and mandible. If left untreated for even a short period (less than half a day), the pathogenic toxin may penetrate inward, leading to chest fullness, nausea, and mental confusion. Without urgent administration of large doses of clearing and resolving formulas, the prognosis is often fatal. This constitutes one category of emergency conditions characterized by numbness and lack of pain.
Another category involves chronic, stubborn diseases. Initially, hard nodules form, adhering to tendons and bones, without pain or itching. Although the duration is long, the clinical picture remains unchanged, and the overlying muscle and skin color remain normal. Some cases persist for years without alteration. Patients often disregard these symptoms, assuming they have coexisted peacefully for a long time and pose no threat. However, upon accidental stimulation, the mass may enlarge significantly, suddenly triggering a pulling pain. At this stage, a major disease has developed, and changes occur rapidly. Such peculiar transformations are characteristic of shi ju (stone abscesses) and ru yan (breast cancer), but at this point, the condition is incurable. This represents another category of chronic conditions characterized by numbness and lack of pain.
Furthermore, there are cutaneous sores that have ulcerated for a prolonged period. These lesions may occasionally contract slightly or gradually expand, recurring frequently across seasons. Discharge persists indefinitely, and both pain and itching sensations disappear. This occurs because prolonged ulceration leads to necrosis of the muscular nerves, resulting in darkened skin pigmentation and dryness of body fluids, resembling dead wood. Consequently, the area becomes rigid and insensitive; scratching elicits no response. While this may appear to be a habitual state without immediate danger, the essence and blood (body fluids and nutrients) have been depleted, and recovery is delayed indefinitely. This scenario is typical of chronic ulcers that have failed to heal due to inadequate management, leading to complicated conditions. It is frequently observed among poor individuals engaged in strenuous labor. Additionally, improper treatment of syphilitic chancres or condylomata can lead to similar outcomes. In all these cases, prolonged decay and inappropriate conditioning result in stagnation of Qi and Blood, causing the surrounding non-ulcerated skin to become numb and stiff. Even if subsequent treatment is appropriate and healing is achieved, the muscles may lose sensitivity to pain and itch, feeling alien to the patient. Moreover, the skin may exhibit mottled discoloration and feel woody-hard upon palpation. This is due to the irreversible loss of local neural function. Ultimately, these represent chronic, deteriorating ulcers that deviate from standard therapeutic norms.