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The *Neijing* states: In winter, one should conserve the internal organs; use more medicine and fewer needles and stone lancets. The phrase "fewer needles and stone lancets" does not refer to carbuncles and sores (superficial purulent infections). Carbuncles and sores are critical conditions that cannot be delayed for a moment. "Not delaying" means that if treatment is postponed even briefly, it will lead to the rotting of muscles and bones and perforation of the viscera. (If the principle of timely treatment is not written down, it results in the destruction of muscles, bones, and viscera.) It also states: The emergence of carbuncles and sores, and the formation of pus and blood, arise from the gradual accumulation of pathogens from minute beginnings. Therefore, sages (wise physicians) treat diseases before they take shape, while fools suffer after the disease has already formed. For those with formed pus, only bi shi (stone lancets) and pi feng (a type of ancient surgical knife) can be used to incise and drain.

In the department of sores and ulcers, the use of needles is most valued. When using them, one must observe the depth of the ulceration and examine the thickness of the flesh. If the skin is thin and the needle penetrates too deeply, it will instead damage healthy tissue and increase the extent of ulceration; if the flesh is thick and the needle penetration is too shallow, pus and toxins will not discharge, thereby increasing pain. As for deep bone abscesses (abscesses originating in the bone), qi toxicity, flowing deposits (deep migratory abscesses), and conditions that persist without resolving, or internally ulcerate without pain, it is appropriate to use burning needles (red-hot needles) to open them. For treating throat diseases, three-edged needles should be used. For erysipelas tumors and carbuncles and sores where the four sides are red and pain feels like burning, it is appropriate to use bi shi (stone lancets) to prick the skin and release blood to vent the toxin. Severe cases will see reduction; mild cases will resolve.

A woman suffered from an abdominal carbuncle, experiencing chest tightness and dizziness due to distension by pus. She was needled in a supine position; upon the discharge of pus, she immediately regained consciousness.
Another man suffered from a scrotal carbuncle with mature pus and swelling, accompanied by difficulty urinating, nearly leading to death. Emergency needling resulted in the massive discharge of pus and fluid, the restoration of qi circulation, and recovery.
Generally, the use of needles involves seizing the pathogenic factor against its flow and guiding it out along its flow. This embodies the principle of "treating disease before it arises, treating the unformed before it becomes formed." Patients who fear needles and refuse treatment, combined with physicians who indulge these fears and do not needle, often result in situations where pus forms but fails to rupture, or ruptures with excessive damage. Ultimately, death or disability occurs in eight or nine out of ten cases, which is truly sorrowful.

The *Jingyao* states: Carbuncles may resemble pepper eyes with dozens of heads, or connect like honeycombs, where pus and blood do not discharge. In such cases, use a needle to split them horizontally and vertically. If there are no such pepper-eye-like structures, simply insert the needle directly to extract pus without splitting. (Another method) involves moxibustion on each pepper eye, which is also excellent and avoids splitting.

For children suffering from boils and furuncles, first cover them with warm clothing to resolve the stagnation and coagulation of local qi and blood. Once the blood vessels are warm, bleeding will stop immediately. If this is not done, and needling is performed while the blood vessels are congealed, the pathogenic toxins will not be discharged, instead damaging healthy flesh and exacerbating the condition.

The *Jingyao* states: Carbuncles are characterized by thin skin and high swelling, often having dozens of pepper-eye-like granules; sores (ju) are characterized by hard, waxy skin, resembling the hide of an ox's neck. ○ When a carbuncle matures into pus, the needle should be made of horse-bit iron, shaped like a leek leaf, sharp on both edges, capable of splitting horizontally and vertically by about five to six fen, to attack and remove toxic blood. Moxibustion should be applied first, followed by splitting. ○ When a sore (ju) matures into pus, cauterization is appropriate. A silver comb, two cun wide and six cun long, heated red-hot over fire, should be quickly pressed onto the lesion for cauterization. Successful drainage of pus indicates efficacy.

It is further stated: A woman had a carbuncle on the left side of her back, large, prominent, and mature but unruptured. The physician suggested cauterization. An experienced observer nearby remarked: The upper back is the site of the five Shu points and is close to the diaphragm. Improper cauterization will surely harm the patient. The physician replied: It should be shallow rather than deep, horizontal rather than vertical insertion. (To avoid injuring the diaphragm.) It should be lower rather than upper. (To prevent accumulation of pus and blood.)

At that time, it was deemed that these precautions were sufficient. Thus, a hot iron stick was used for cauterization. The flesh broke, pus flowed out, and she recovered thereafter. People at the time were shocked, remarking that unless one were an executioner skilled in such techniques, it would be terrifying.

It is also said: When a carbuncle is mature but unruptured, a single application of a hot iron stick is extremely relieving. The moment the fan is blown and heat approaches, it is indeed startling. I have used this method myself and still trembled with fear at the time, let alone those inexperienced. After cauterization, pus flows freely, with no taboos, termed a "ripe sore" (shu chuang). For protruding sores, the needle opening should face downward. However, this requires proficiency in cauterization, knowing depth, identifying acupoints, and assessing maturity. If not timed correctly (immature stage), only fresh blood is discharged; when timed correctly (mature stage), yellow pus and necrotic tissue are discharged. Using a pointed needle for cauterization is improper because the fine tip causes the wound to close easily. Only flat, round-headed tools are ideal, as they ensure patent openings.

To prevent the wound from closing again, fine Achyranthes root (Niuxi Gen), sized to fit the wound, with the rough bark slightly removed, can be inserted into the wound, leaving half a cun exposed externally. Then, apply a paste made from fresh citrus leaves and Euphorbia humifusa (Dijin Cao), one handful of each. Achyranthes promotes the continuous discharge of foul tissue, while the two herbs provide warming and cooling effects to relieve pain. Replace as needed when dry. This achieves perfect efficacy.

Cauterizing needles are round like chopsticks, thick like weft rods, with flat round heads, six to seven cun long, two identical pieces. Dip them in sesame oil and heat them in charcoal fire. Cauterize near the base of the sore head. Insert obliquely towards softer areas. If one cauterization is insufficient, repeat until pus discharges. Sores treated by cauterization are called "ripe sores," with constant pus flow, requiring no pressing or suppression, but keeping the opening patent to prevent closure.