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When a deep abscess (Ju, 疽) erupts, the dangers lie solely in internal invasion or external ulceration. Since the toxin cannot be expelled externally, it will inevitably attack internally; urgent measures should be taken to protect the membranes and employ the "Supporting the Interior" method (Tuoli, 托里) to support healthy Qi, preventing the toxin from penetrating inward. If the toxin cannot exit from the center, it will inevitably ulcerate laterally. Acupuncture and other methods must be combined to draw out the toxin. This is the primary task in surgery.

Using needles is like fighting a fire. If fire is inside a house, one must pierce the roof; otherwise, the flames will spread, burning everything down. Thus it is said: When toxic vapors are blocked in the middle, causing obstruction between the interior and exterior, without acupuncture and moxibustion, medicinal efficacy will be incomplete. It is also said: For excess blood conditions, one should lacerate and drain. First, diagnose the pulse. A tight and rapid pulse indicates pus has not yet formed; if the tightness disappears but the rapidity remains, pus has formed. If needling is performed before pus formation, Qi and Blood are depleted, making pus formation difficult. If needling is delayed after pus formation, the ulceration deepens, and the wound becomes difficult to heal. Secondly, light pressure causing heat and pain indicates shallow and thick pus; heavy pressure causing slight pain indicates deep and thin pus. Pressure causing no pain with overall hardness indicates stasis of blood; overall softness indicates accumulation of damp fluid. Thirdly, depression upon pressure that does not rebound indicates pus has not formed; softness with immediate rebound indicates pus has formed; softness on all sides indicates mature and abundant pus.

Technique: The needle tip should follow the horizontal or vertical orientation of the meridians; otherwise, healing will be difficult. The entry point should be chosen from below to facilitate pus drainage. Swelling that is high and soft involves the muscle layer; needle 4-5 fen. Swelling that is low and hard involves the sinews and vessels; needle 6-7 fen. Swelling that is flat with unchanged skin color adheres to the bone; needle approximately 1 cun. Toxins arising on the back, abdomen, ribs, or hypochondrium should be treated with a flat needle inserted obliquely to prevent perforating the membranes. Inserting the needle into healthy flesh feels firm and resistant; inserting it into the area of pus rupture feels soft and unobstructed. Once the needle penetrates the pus, observe the puncture site; pus should emerge like beads. At this moment, to enlarge the opening, withdraw the needle obliquely; to narrow the opening, withdraw the needle vertically. This is referred to as "meeting and seizing" (Ying Er Duo Zhi) and "following and taking" (Shun Er Qu Zhi). Immediately insert a cotton paper twist dipped in Xuanzhu Ointment (Xuanzhu Gao) to align the pus flow. Remove the twist after two to three hours, and the pus will dry quickly. Apply Hunong Ointment (Hunong Gao) to the wound and apply Kuinong Powder (Kuinong San) around the periphery. For patients with deficient Yuan Qi, tonification must precede needling. Once pus drains, symptoms subside. If pain persists after drainage, swelling remains, or irritability and vomiting occur, this indicates deficiency of Stomach Qi; treatment requires strong tonification.

Divine Root Extraction Method: For back carbuncles or brain carbuncles presenting as Yin syndromes—initially non-elevated, non-hot, and painless upon moxibustion—the condition will likely worsen and become fatal. Before the tenth day, insert a Pi needle (Bizen, 铍针) straight into the head until pain is felt, draining evil blood and opening the orifice. Immediately insert a Chan Su strip (Toad Venom Strip) to the bottom of the hole, administer Chan Su Pills (Chansu Wan) or Gan Zhu Dan (Ganzhu Dan) to induce profuse sweating. If Yuan Qi is deficient, simultaneously administer internal supporting tonics. Insert two strips daily, covered with ointment. Add fresh strips every three days. When the root becomes elevated, swollen, and painful, apply Shen Deng Illumination Method (Shendeng Zhao Fa) and Mul Root Moxibustion (Sanggen Jiufa) to transform Yin into Yang. Alternate insertion for seven days until the wound cracks and drains pus. By the thirteenth day, the root should detach naturally. If the root remains firmly attached due to prolonged duration, excise it with a Pi needle and apply Yuhong Ointment (Yuhong Gao); detached roots will heal spontaneously. If after half a month there is no suppuration or necrosis, use a Pi needle to create three holes in a "pin" shape, stopping when pain is felt. Follow with Yao Tong Ba Fa (Medicated Cylinder Suction). Observe the pus and blood: if bright, it indicates Qi and Blood are adherent, and medication can cure. If purple-black and foul-smelling, it indicates Qi failure and Blood decline, which is incurable even by immortals. If suction yields little pus despite expectation, there is likely a stubborn membrane; remove about one cun. Mild pain and bleeding are acceptable. Then, using hands with appropriate pressure, press gently from the root toward the center, cutting the pus tube so accumulated pus surges forth. Yellow and thick pus is auspicious; increasing pus volume indicates a mild case; the opposite is concerning.

There are conditions unsuitable for needling: abscesses arising in sinews/vessels, joints, umbilicus, goiters, nodules that do not move upon pushing, etc. In winter, when water freezes and earth cracks, only medicinal internal support should be used, avoiding needles and stones. This is because those skilled at moving water cannot pour it into ice, and those skilled at digging cannot drill frozen ground; similarly, skilled acupuncturists cannot treat four extremities cold (Si Jue). Cold causes closure of interstices; bitter herbs should induce sweating, and pungent herbs should disperse cold, such as Tuoli Wenzhong Tang (Supporting Interior and Warming Middle Decoction).

Leech therapy (Qi Zhen, 蜞针) is a quick way to open the gate and release toxins, but it risks exhausting the exterior without addressing the interior. Even for skin diseases, losing blood may leave Qi unsupported. Therefore, it is prohibited.

Needling Weizhong (BL40): Treats redness, swelling, and pain from carbuncles/back infections, wind-damp pain in legs/knees, and lameness requiring crutches. It is effective. It also treats stroke with phlegm syncope, locked jaw, and unconsciousness. Method: Have the patient lean hands against a wall with legs straight. Use a triangular Pi needle wrapped in paper, exposing only half a grain-sized tip. Hold the needle head with the middle finger. Observe for fine blue-purple veins at Weizhong (BL40), indicating damp-toxin and evil blood. Pierce the purple vein. All blue veins should be pierced; black blood drainage is acceptable. Stop when blood turns pale yellow. Press lightly with paper for a moment, then apply a small plaster. Avoid bathing for three to four days. After bloodletting, have someone roll a round stick along the limbs, waist, back, and legs (like scraping a wheel rim); the patient can then walk without crutches. Highly effective. Generally, acupuncture avoids bleeding, but swelling benefits from it.

Needling Shaoshang (LU11): Treats throat wind, throat bi, big head plague (Da Tou Wen, 大头瘟), hanging abscess (Xuan Yong, 悬痈), and tonsillitis (Ru E, 乳蛾). Critical cases respond immediately. Location: Inner side of the thumb tip, about the width of a leek leaf from the nail corner, in the white flesh area. Prick with a three-edged needle to release purple blood; recovery is immediate. This point clears heat from all organs but is contraindicated for moxibustion.

Neituo Huangqi Wan (Internal Supporting Astragalus Pill): Treats injury to meridians resulting in continuous discharge of white pus and red serum.
Ingredients: Sheng Huangqi (Raw Radix Astragali, 8 liang), Danggui (Radix Angelicae Sinensis, 3 liang), Rougui (Cortex Cinnamomi), Muxiang (Radix Aucklandiae), Chenxiang (Lignum Aquilariae Resinatum), Ruxiang (Resina Draconis, each 1 liang).
Process: Grind to powder. Mix with 4 liang of Mung Bean Flour (Moutou Fen) and natural juice of fresh ginger. Cook into a paste and form pills the size of tung tree seeds. Dosage: 40-50 pills per dose, taken with warm water.