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Whenever encountering such conditions, if the patient maintains mental tranquility and places trust in the physician, and the physician thoroughly grasps the therapeutic principles with appropriate methods, achieving harmony between internal and external treatments, success is often achieved. Among these cases, there are those who can be saved, perhaps one or two out of ten.

Given the differing opinions among acupuncturists and surgeons, how could there be no detailed records of medicinal therapies?

When sores and toxins have formed pus, it is necessary to support the expulsion of pus; once the pus has matured, it should be drained with a needle. This is a universally accepted standard practice. One must verify the state of the pus and puncture according to its depth, superficiality, and location. For instance, if the swelling is high and soft, indicating involvement of the muscle layer, when the pus matures, the needle should only penetrate four to five fen (approx. 1.3-1.6 cm). If the swelling is low and hard, indicating involvement of the joints and meridians, when the pus matures, the needle should penetrate six to seven fen (approx. 2.0-2.3 cm). If the swelling is flat with unchanged skin color, indicating the toxin adheres to the bone, when the pus matures, the needle must penetrate deeply, about one cun (approx. 3.3 cm), to reveal the pus. Furthermore, if light pressure causes significant heat and pain, it indicates the presence of pus that is shallow and thick. If heavy pressure causes slight heat and delayed pain, it indicates the presence of pus that is deep and thin. If pressing leaves an indentation that does not rebound immediately, the pus has not yet formed. If pressing results in softness and immediate rebound, the pus has formed. If the area is uniformly hard and painless upon pressing, it is neither pus nor blood stasis, but likely dampness or edema. The principle is that if there is pus, it should be punctured, and the incision should follow gravity downwards. If punctured before pus formation, Qi and Blood will leak, making pus formation difficult. If mature pus is not punctured, rot and ulceration will deepen, making wound closure difficult. If the pus is deep but the needle insertion is shallow, internal pus will not drain, while external blood may leak. If the pus is shallow but the needle insertion is deep, although internal pus drains, healthy flesh will be damaged. In patients with deficient Yuan Qi (Original Vital Energy), tonification must precede puncturing, allowing symptoms to recede as pus drains. Regarding Qi Ying (Qi Goiter), characterized by soft, painless swelling; Blood Ying (Blood Goiter), characterized by internal nodular masses; stubborn toxins accumulated over time, presenting with necrotic skin, purple flesh, hard roots, and surrounding red streaks; and tuberculous conditions that gradually enlarge, become painful, and ulcerate—these four types of conditions must never be lightly incised with needles or knives. Reckless use will inevitably lead to uncontrollable hemorrhage and imminent danger. However, the skill of needling lies in the smooth flow of pus upon needle withdrawal, leaving the patient unaware and painless. As for goiters, scrofula (Lymphatic Tuberculosis), various hemorrhoids, fistulas, Ding Du (Carbuncles), hard stubborn ulcers, and other such conditions, without the efficacy of thread medicines (caustic agents for debridement), rapid results cannot be expected. There are several types of thread medicines, which are too numerous to list here; they should be applied flexibly according to the specific condition.

Decoctions, powders, pills, and elixirs are effective only when their actions (such as inducing sweating or purging) precisely target the pathology. The concepts of Shen (Divine), Sheng (Sage), Gong (Skillful), and Qiao (Clever) represent the essential keys for students of medicine.

A physician skilled in prescribing formulas is like a general skilled in commanding troops. Those adept at water travel can navigate seas and break waves; those adept at land travel can cross mountains and climb vines. Using unorthodox tactics inspires momentum, while using direct paths allows for penetration and drilling. Weak forces can defend, strong forces can engage. This is the great method of military command. Physicians should emulate this principle: knowing the strength or weakness of the patient, identifying the interior or exterior nature of the disease, investigating the depth of the pathology, and observing the favorable or unfavorable timing of the season. Then, one decides whether to induce sweating, purge, vomit, or drain, or whether to harmonize or tonify. One must know which decoction excels at sweating, which powder excels at purging, which pill excels at harmonizing, and which elixir excels at tonifying. By matching the formula to the disease, like an arrow released from a trigger, the treatment will hit the mark, ensure victory, and cure the illness. This is the great method of using formulas. Similarly, the Four Diagnostic Methods (Inspection, Auscultation/Olfaction, Inquiry, Palpation) embody divine wisdom and skill. Inspecting the form reveals the spirit; listening to the voice clarifies the sage-like understanding; asking about the cause obtains skillful insight; palpating the pulse continues the clever technique. These four aspects are indeed the compass and square (standards) for beginners.

As for thousands of myriad conditions, it is difficult to exhaustively discuss their nuances.

Formulas are not numerous; spiritual efficacy comes from mental resonance. Conditions are not difficult; clarity comes from intuitive comprehension. If the formula does not resonate with the mind, and the condition is not comprehended intuitively, it is like a distant acquaintance or a rarely visited place. If the nature of the drug and the pathogenic factors do not align, how can one expect to support the expulsion of pathogens? Therefore, if the medicine does not match the disease, and the disease does not respond to the medicine, this is the evidence.

Treatment relies on flexible methods, valuing careful examination.

The dynamics of worldly affairs differ, and the mechanisms of rest and labor vary. In ancient times, diseases often originated externally; nowadays, diseases often originate internally. Anciently, people tended toward excess syndromes, so formulas were suitable for dispersing and venting; nowadays, people tend toward deficiency syndromes, so treatments should favor moistening and tonifying. If a physician fails to understand the differences between ancient and modern contexts and applies treatments indiscriminately, it will inevitably lead to premature death. Medications must be used appropriately; only then can a physician be called excellent.