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To extract pus and remove necrotic tissue, use the Pipian (Bīzhēn, a flat, sword-shaped needle for incision). The lightness, heaviness, speed, and slowness of insertion depend entirely on the practitioner's judgment. If the skin is thin and the needle is inserted too deeply, healthy flesh will be damaged; if the flesh is thick and the needle is inserted too shallowly, the pathogenic toxin will remain retained.

For swellings that are high and soft, insert the needle to a depth of four or five fen. For hard and swollen areas, a depth of six or seven fen is appropriate. For flat swellings with no change in skin color, this condition requires insertion to a depth of approximately one cun.

When toxic lesions occur on the back, abdomen, ribs, or hypochondrium, use a flat needle inserted obliquely to preserve internal integrity. To create a larger opening, withdraw the needle obliquely; to maintain a smaller opening, withdraw it vertically. This method must be strictly observed.

In cases of Qi deficiency, tonification should be performed first, followed by needling. When pus is discharged, symptoms recede with miraculous efficacy. Treatment is typically employed ten days to half a month after onset, aiming to expel toxins outward without harming the body's healthy Qi.

There are also contraindications for needling, such as goiter (Yingliu, neck masses), during the winter season of storage, and near bones and tendons.

[Note] The Classic states: "Where the Qi of carbuncles and sores stagnates, it should be opened and removed with a needle." It further states: "The Pipian is not as sharp as the Fengzhen (sharp needle); it is used to extract large amounts of pus." Hence, it is said, "To extract pus and remove necrosis, use the Pipian." The variations in pressure and speed have their own regulations, relying on the practitioner's mental assessment and application, and must not be applied arbitrarily. Generally speaking, deep insertion in thin skin damages healthy tissue; shallow insertion in thick flesh fails to expel toxins. Broadly, high and soft swellings reside in the muscle layer, requiring four to five fen depth; low and hard swellings reside in the sinew layer, requiring six to seven fen depth; flat swellings with unchanged skin color adhere to the bone, requiring approximately one cun depth. If toxins arise in areas like the back, abdomen, ribs, or hypochondrium, oblique insertion with a flat needle is suitable to prevent penetrating the body cavity membrane. Once the needle penetrates the pus, observe the wound opening where pus may emerge like pearls. At this time, to enlarge the opening, withdraw the needle obliquely; to keep it small, withdraw it vertically. This is referred to as "opposing the trend to seize it, following the logic to take it." Subsequently, apply cotton paper wicks dipped in Yuanzhu Ointment for drainage, ensuring complete pus evacuation. Remove the wicks after two to three shichen (4-6 hours). Apply Taiyi Paste to the wound and Wulong Ointment around the periphery. In cases of deficient Yuan Qi, tonification must precede needling; once pus is discharged, all symptoms subside. Furthermore, there is a proper timing for needling; it should not be too early nor too late. Within ten days, if the sore remains hard, use the Pipian to puncture the apex. After half a month, if suppuration and necrosis do not occur, use the Pipian to make three punctures in a triangular ("pin") pattern. Depth is irrelevant; stop when pain is felt. Follow this with the Yao Tong Ba Fa (Medicated Cylinder Extraction Method) to draw out toxins. Contraindications include goiters, tubercles, areas near the umbilicus, joints, and tendons, as well as the winter season of closure.