In traditional folk medicine, Xanthoxylum plants are referred to as 'toothache trees' because their anesthetic or counter-irritant properties render them useful in the treatment of pain. Psychophysical studies have identified hydroxy-α-sanshool as the compound most responsible for the unique tingling and buzzing sensations produced by Szechuan peppercorns or other Xanthoxylum preparations. Although it is generally agreed that sanshool elicits its effects by activating somatosensory neurons, the underlying cellular and molecular mechanisms remain a matter of debate. Here we show that hydroxy-α-sanshool excites two types of sensory neurons, including small-diameter unmyelinated cells that respond to capsaicin (but not mustard oil) as well as large-diameter myelinated neurons that express the neurotrophin receptor TrkC. We found that hydroxy-α-sanshool excites neurons through a unique mechanism involving inhibition of pH-and anesthetic-sensitive two-pore potassium channels (KCNK3, KCNK9 and KCNK18), providing a framework for understanding the unique and complex psychophysical sensations associated with the Szechuan pepper experience.Somatosensation, or the sense of touch, is the process whereby we detect changes in ambient temperature or pressure. This sensory modality is mediated by subsets of primary afferent neurons that detect chemical, thermal or mechanical stimuli over a range of stimulus intensities. Generally speaking, pain-producing (noxious) stimuli are detected by neurons (referred to as nociceptors) that have small-to medium-diameter somata that correspond to unmyelinated C and lightly myelinated Aδ nerve fibers. In contrast, innocuous stimuli, such as light touch, are detected by large-diameter neurons corresponding to more heavily Reprints and permissions information is available online at