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The methods of Surgery (Yang Ke, diseases of sores and ulcers) rely entirely on external treatments, and the manual techniques must be transmitted through apprenticeship. In all cases, distinguishing the shape and observing the color to ascertain auspicious or ominous outcomes, as well as administering treatment in a specific sequence, follow established protocols.

One must combine scholarly study with clinical practice, ensuring both aspects are mastered, before avoiding errors. Techniques such as promoting ascending or descending Qi, encircling and puncturing lesions, removing necrotic tissue, generating new muscle, expelling pus, stopping bleeding, and applying ointments, washing, and moxibustion/fomentation therapies must be pure, balanced, and repeatedly proven effective to ensure immediate recovery. Regarding internal prescriptions used to protect the heart, expel toxins, promote suppuration, and regenerate flesh, there is also authentic transmission; ordinary classical formulas cannot achieve these effects. Only when decocting herbal medicine must one adjust dosages based on the patient's physical strength and Yin-Yang balance, requiring proficiency in Internal Medicine principles and a solid foundation of learning. However, surgery differs from internal medicine. Although the principles of decoction are similar, the selection of herbs follows strict correspondences where specific toxic herbs treat specific conditions, and specific syndromes require specific formulas, which are ineffective otherwise; this too has its own specialized transmission. Therefore, surgery primarily relies on apprenticeship; relying solely on broad erudition is of no benefit. With proper transmission, surgery is easier than internal medicine. It is only when surgical conditions involve internal symptoms, or the patient has pre-existing chronic diseases, or contracts other pathogenic factors during the surgical illness, or suffers severe internal organ damage due to extreme severity of external lesions, that internal medicine methods must be employed concurrently. This requires prior study of internal medicine principles to ensure comprehensive and error-free treatment. If internal symptoms cannot be treated, external lesions also become incurable, which depends entirely on profound and extensive learning. If a surgeon cannot handle concurrent internal issues, they should invite a renowned internal medicine specialist to prescribe medication, while the surgeon advises to ensure the herbs do not harm the external condition, then carefully administers treatment, thereby benefiting both aspects. If the internal symptoms arise directly from the external condition—for example, fainting due to extreme pain, chills and fever when pus is about to form, or distension due to toxin sinking inward—these internal symptoms are generated by the external lesion. Treating the external lesion alone will cure the internal symptoms, but consultation with an internal medicine specialist is still necessary. The principles involved are subtle, and the number of formulas is vast, beyond the comprehension of those with shallow learning. Thus, superficially speaking, knowing a few decoction formulas and several types of plaster and encircling medicines suffices for a practitioner to establish their own school; however, deeply speaking, one must fully understand the principles of meridians, zang-fu organs, Qi, blood, bones, and vessels, as well as recognize all bizarre diseases and their myriad manifestations. Their formularies cover all conditions, and they possess even rare and precious herbs. Even when encountering extremely strange and dangerous conditions, they remain clear and doubtless. This makes surgery more difficult than internal medicine. Consequently, the hierarchy within surgery varies greatly, and few can discern these differences.