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The *Suwen* (Basic Questions) states: For carbuncles and sores where qi is stagnant, it is appropriate to use needles to open and drain them; for conditions where qi is excessive and blood accumulates, it is appropriate to use bian stones (stone scalpels) to purge. This is what is referred to as "treating the same disease with different methods."

The *Tongping Xuushi Lun* (Discussion on Excess and Deficiency in Tongping) states: The phrase "rarely using needles and stones" does not refer to the treatment of carbuncles and sores. Carbuncles and sores cannot be delayed for even a moment.

The *Lingxu* (Spiritual Pivot) states: The Pi needle (Bian needle), whose tip resembles the edge of a sword, is used to extract large amounts of pus.

Li Dongyuan stated: In ancient times, the size of bian stones was made according to the suitability for the disease. The *Neijing* (Inner Canon) considers needles, stones, and bian stones to be essentially the same. Nowadays, people use sickles for cutting, following the *Shengji Zonglu* (General Records of Sage Medicine) on Erysipelas: "The method is to cut with a sickle to release blood, indicating that delay is not permissible." Combining this with Bian Que's view: "For diseases in the blood vessels, treat with bian stones." This cites the *Suwen*'s principle: "When blood is excessive, it should be drained." Additionally, the *Qixue Xingzhi Lun* (Discussion on Qi, Blood, Form, and Will) states: "For those whose physical life is comfortable and mental life is joyful, diseases arise internally, treated with bian stones." Generally, bian stones originated from the East, because the people of the East often suffered from skin sores, so the method suitable for them was bian stone therapy. The use of bian stones has its own indications, not limited to erysipelas. Whenever swelling rises, color turns red, and moves unpredictably, urgent cutting with a sickle is indicated. First apply raw oil to the redness, then cut with the sickle; the key is to vent the toxin. However, this method should not be used lightly, and one must avoid puncturing too deeply. The *Neijing* advises that when needling the skin, do not injure the flesh, because each of the nine needles has its specific indication. Although the bian-sickle method can treat sores and carbuncles, it should not be used rashly. (From *Bianlian Lun*)

Zhou Wencai said: If needling or bian stone therapy damages the meridians, causing white pus and red fluid to flow continuously, it is appropriate to take Neituo Huangqi Wan (Internal Supportive Astragalus Pill): Sheng Huangqi (Astragali Radix, remove rhizome, bake and slice) 8 liang, Danggui (Angelicae Sinensis Radix, wash and bake) 3 liang, Muxiang (Aucklandiae Radix), Chenxiang (Aquilariae Lignum Resinatum), Rougui (Cinnamomi Cortex, remove rough bark, avoid fire), Xurong (Olibanum, separately ground), each 1 liang. All aromatic herbs should avoid fire. Grind all into fine powder, mix with 4 liang of Moutari Semen (Mung Bean Starch) paste boiled in fresh juice of Zingiberis Rhizoma Recens (Fresh Ginger Juice) to form pills the size of paulownia seeds. Take at any time with warm water, 40-50 pills per dose. (From *Jiyan Fang*)

He also said: In ancient times, bian stones, needles, and sickles were instruments to decide and drain sore toxins. The idea that sore toxins should bleed means they should be removed urgently without delay, lest the toxin spread and change. The *Neijing* says: "Disease in the blood vessels is decided by needles and stones." Qibo's Five Treatments Theory states: Bian needles are made from magnetite, sharp and quick, very convenient for draining toxins. This was a skill of the Eastern people, used for boils, furuncles, and erysipelas; applying raw oil to the red swelling and piercing with bian stones to release blood. The subtlety lies in appropriateness, but one must not overdo it.

Xue Lizhai said: If the Yuanqi (Original Qi) is weak and astringent drugs are mistakenly taken, the affected area may not hurt, or the flesh may be about to die. Urgently warm and tonify the Spleen and Stomach; there are cases of survival. Afterwards, pure tonic medicines are necessary to achieve healing. If knives and needles are recklessly used, piercing flesh and bleeding, the Qi will have no foundation, and both Qi and Blood will become more deficient, further injuring the Yuanqi. How can muscle regeneration and healing occur?

Chen Shigong said: Generally, after ten days of a sore, it should naturally rot and suppurate. If it does not suppurate or rot by the expected time and remains hard, this belongs to a syndrome of equal Yin and Yang. The root of the sore is likely deep and solid. If one does not insert a needle vertically into the center for about one cun to open an orifice and vent the toxin, allowing the pathogenic factor to exit, it will inevitably attack inward. If pus is present inside, it will be easy to discharge, which is the meaning of "opening the door to drive out the thief." If after ten days the sore has not rotted but appears red and lively, with heat, swelling, and pain, although suppuration is delayed, it will eventually appear, and needling is unnecessary here. This is usually due to insufficient Yuanqi, failure to use supportive tonics, misuse of cold-cooling herbs, or inadequate warmth covering. For such syndromes, use Zhongjian Buzhong (Middle-Jiao Tonifying) and strong supporting tonics, aiming for suppuration as the sign of efficacy. Set the deadline at fifteen to twenty-one days. Beyond this period, even if there is thin pus, because the Yuanqi has been resisting the toxin for a long time, it will surely dissipate, making healing difficult. (From *Waike Zhengzong*)

He also said: If after half a month the sore still does not rot or suppurate, the toxin must have sunk inward. Urgently use a Pi needle to make three holes in a 'pin' character pattern on the top of the sore, inserting one to two cuns depending on depth. Insertion should be painless; deeper insertion is acceptable. Immediately apply a pre-heated medicinal jar over the holes. After some time, when cool, remove it. Observe the extracted material: if the blood is red with a slight purple tint and the pus is yellow with a fresh hue, this indicates active circulation of Qi and Blood and a viable sore; if the extracted blood is dark purple-black, the color is dull, the odor is foul, and there is only thin fluid without pus, this indicates internal failure of Qi and Blood and a dead sore.

Cheng Shanling said: Whenever there is toxin with urgent distending pain and mature pus, leaving no time to wait for moxibustion confirmation, one should use the knife method to open it. However, the knife method must be used only when pus is definitely mature, and the depth must be appropriate. Press the swollen area with the left hand to check for pus formation: if it feels soft and painless upon pressure and rebounds quickly upon release, the pus is mature; if it feels hard and painful, or sinks and does not rebound, the pus is immature. Mature pus should be pierced; immature pus should be waited for. If the Spleen is deficient and Qi is weak, use supporting tonification. Also observe the depth of the pus: if pressing with fingers reveals deep soft tissue, the pus is deep; if shallow, the pus is shallow. If the pus is shallow but the knife goes deep, good flesh may be injured; if the pus is deep but the knife is shallow, the toxin may not exit and cause internal failure. Careful consideration is essential. There is also Guju (Bone-abscessing carbuncle), where pus rots internally but the skin color does not change. It is appropriate to pierce deeply with a knife to release stasis and pus, or burn a large opening with moxa to drain it. Do not hesitate or delay, allowing the toxin to rot deeper. Use a sharp blade for incision, and do not let the patient see it, to avoid startling them. Bian therapy is applied to the head, face, and around the ears because these areas have diffuse swelling without a head; use this method urgently to vent the toxin. Take a fine magnetic tip, clamp it tightly with bamboo chopsticks, exposing about half a cun of the tip. Aim at the affected area and tap with another chopstick to pierce the swelling obliquely; releasing much purple blood is desirable. After piercing, apply a slice of lean meat and moisten with Frankincense powder mixed with Egg White. Generally, suppuration is not suitable here because the head is hollow and the areas around the ears are complex, making drainage inconvenient; therefore, bian therapy should be applied early. (From *Shifa*)

Xue Lizhai said: If the lesion is between the back and thighs, specifically near the spine where there is a layer of tendon under the skin, and in the thigh region, even if the outer skin breaks, the tendon is difficult to rupture, preventing internal pus from draining. This causes distension, pain, deficiency of Qi and Blood, and various complications. Waiting for spontaneous rupture often leads to untreatable conditions. One must incise and drain, combined with interior support. Often treating this condition, even using a sharp knife to cut may not remove the hardness. Waiting for such hard objects to rupture spontaneously is worse! Those without robust Qi and Blood are unlikely to rupture spontaneously.

He also said: When a sore has formed pus, timely needling leads to recovery in a few days. Commonly, patients fear the pain of needling and refuse it, or fear damaging flesh and refuse it. They do not realize that although sores may arise in thin-fleshed areas, once pus forms, the swelling rises more than one cun, and the skin thickens by more than one fen. Needling depth should not exceed two fen. If on the back, swelling may rise two to three cuns, and needle insertion stops at about one cun. Moreover, since the flesh at the site is already necrotic, where is the pain? Where is the concern for damage? Many frail people suffering from Guju (bone-abscessing carbuncle) wait for pus to drain spontaneously, leading to massive ulceration that cannot heal, resulting in the exhaustion of Qi and Blood and death.

He also said: Once a sore has formed pus, if the skin does not vent, ignorant people wait for it to burst spontaneously. Strong and robust individuals might resolve it themselves, but for the old and weak, with exhausted Qi and Blood, or those who have undergone excessive purging, failing to use needling allows pus and toxin to attack inward through weakness, perforating intestines and rotting membranes, rarely avoiding disaster. If toxin is bound in the limbs, delaying bian/needling leads to deep, large ulcers that are hard to heal. If toxin binds in critical areas like the cheeks, neck, chest, or abdomen, regardless of strength, urgent needling is required, otherwise it is difficult to treat. Generally, sores vary in severity and depth. Superficial ones are high-swollen and soft, arising in the blood vessels; deep ones are low-swollen and hard, arising in the muscles and bones. Some arise in the bone marrow, where skin and flesh do not change. Thus, ancient methods dictated superficial sores be treated with bian and deep ones with needling, removing stasis at the onset of toxin accumulation to facilitate resolution. When pus is formed, robust individuals expel it naturally; the frail, without needling, rarely escape mishap. Sores penetrating membranes are almost always fatal; even with strong tonics, rescue is impossible. This serves as a warning against waiting for pus to drain spontaneously.

*Xinfa* (Core Principles) states: In ancient times, there was the system of bian stones. The *Neijing* distinguishes nine types of needles. Although the systems differ, the intent to cure disease is the same. In the specialty of sores and ulcers, the use of needles is highly valued. When using needles, although one measures the depth of ulceration, one must especially consider the thickness of the flesh. If the skin is thin and the needle is deep, it injures healthy flesh and worsens ulceration; if the flesh is thick and the needle is shallow, pus and toxin do not exit, increasing pain. Can practitioners of needling afford to be careless? For Guju, Liuzhu (Flowing Abscess), and chronic non-resolving cases with internal ulceration and no pain, burning needles (hot needling) should be used to open them. For throat ailments, a Three-Edge Needle should be used. For erysipelas and carbuncles with red borders and burning pain, bian stones should be used to bleed and vent the toxin, reducing severe cases and resolving mild ones. For example, Mrs. Hong suffered from an abdominal abscess with distension, fullness, and confusion; pricking her while lying down released pus, and she revived immediately. Another patient had a scrotal abscess with mature pus, swelling, and dysuria, nearly dying. Urgent needling released large amounts of pus and fluid, restoring Qi flow and health. Generally, the method of needling involves attacking from the front and taking advantage of the situation, meaning "treat before completion rather than after," which is the true intent. Today, patients often fear needling and refuse it, and doctors sometimes yield to patients' wishes and do not needle, leading to situations where pus forms but cannot rupture, or ruptures with excessive damage. Ultimately, eight or nine out of ten die prematurely, which is truly tragic.

Zhang Jingyue said: The classics state: When the weather is warm and sunny, human blood flows freely, and Wei Qi floats, so blood is easily discharged and Qi moves easily; when the weather is cold and cloudy, human blood becomes stagnant and Wei Qi sinks. Therefore, one should adjust the blood vessels according to the seasons. Thus, whenever encountering cold weather, frozen water, or stagnant Yin Qi, if one intends to perform needling, one should first cover the patient with warm clothing, or stir-fry mugwort leaves until hot, or use hot salt or hot clothes to warm the area first. Only when the blood vessels are warm should one needle, so that blood discharges and Qi moves, and the illness is immediately cured. If blood is cold and pulses are stagnant, and one rashly uses needles, the pathogenic toxin will not discharge, merely injuring healthy flesh and worsening the disease.

Xue Lizhai said: For those with weak Yuanqi, one must tonify the Spleen and Stomach and strictly forbid the use of knives and needles. Reckless use removes flesh and blood, causing Yang to scatter with Yin, accelerating danger.

Sun Simiao said: If acupuncture causes continuous bleeding, burn human feces to ash and apply it to the wound to stop bleeding immediately.