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Li Dongyuan stated: The manifestations of sores and carbuncles vary, and the methods of needling and cauterization are indeed significant. There are variations in depth (shallow or deep) and speed (fast or slow); one must carefully distinguish between what is appropriate and what is not. Generally, for carbuncles with thick skin and small openings, where swelling is extensive and pus drainage is sluggish, needling and cauterization are suitable. For boils with thin skin, only needling to drain pus and blood is required; cauterization should not be used. If before suppuration occurs, one should not rely on various medicinal pastes or soaks to treat it, waiting for spontaneous resolution. If it persists without resolving and internally suppurates, medication should be abandoned in favor of needling and cauterization. One should use a fire needle, shaped like a fire rod, ground to a sharp, round tip resembling a jujube pit. Heat it briefly over a lamp flame, dip it in warm oil several times, heat until red-hot, and cauterize near the lower part of the sore head. If one application does not penetrate, repeat until penetration is achieved. The key is to facilitate easy pus drainage without relying on pressure. In recent times, skilled physicians, in urgent situations, can generally use needles made of gold, silver, or iron rods similar in shape, which effectively drains toxic qi. Alternatively, heating charcoal until red-hot and dipping it in oil for cauterization is particularly excellent. After cauterization, for patients with excess conditions, twist hair into a thread; for deficiency conditions, twist paper into a thread. Apply medicine to the thread, cover with cloth, and apply a warm, soft, sticky plaster. Keep the area moist and avoid dryness. Once sores and carbuncles arise, toxic heat gathers and attacks, eroding the fascia and causing muscle rot. Without needling and cauterization, toxic qi has no outlet, and pus stagnation cannot be drained. If cauterization is delayed, the pathogen may attack internally, leading to internal dissolution. To hope for survival under such circumstances is impossible! Alas, while using needling and cauterization to cure this disease is reasonable, one must avoid acting too early or too late. I have seen incompetent practitioners who fail to assess the depth of the condition and recklessly apply these methods. Sometimes the sore is deep but the needle/cautery is shallow, preventing toxin discharge and causing internal ulceration. Sometimes the sore is shallow but the cautery is deep, injuring healthy flesh and causing bone and tendon rot. Sometimes pressing or rubbing exacerbates pain. Sometimes improper needling causes new sores to form elsewhere. Sometimes there is no pus initially, and only after moxibustion does it ulcerate, adding pain to pain and damaging true qi. Investigating the cause, it is due to not encountering a skilled physician. Therefore, when seeking medical treatment, one must choose carefully. Even if ordinary treatment leads to recovery, it is merely luck. (From *Ten Books*)

Jiang Shiji said: There is also a cauterization method. When pus has formed but the skin is thick and muscles deep, making spontaneous rupture difficult, if needling and cauterization are not used, the necrotic tissue carrying toxic heat will remain in the interstices for a long time, turning healthy flesh into pus and blood. This is why cauterization benefits ulcerative lesions. However, for those with shallow roots and thin skin, why resort to this method? From this perspective, for thin skin, use White Reduction Paste; for slightly thicker skin, use needling; for extremely thick skin with toxins adhering to the bone, cauterization is indispensable. The method involves identifying the largest sore head as the pus aperture. Use a five-to-six-cun long熟 iron needle. Split the lower half of the needle with a bamboo chopstick to clamp the needle inside, adjusting by intent. If inserting half a cun, expose half a cun of the needle tip outside. If inserting one cun, expose one cun of the tip. Tie tightly with thread to ensure accurate depth. Heat the needle red-hot over a sesame oil lamp. Based on the depth and location of the sore, judge the depth and deficiency/excess status, and insert one cun or up to two or three cuns. If no pus is present, temporarily insert a paper wick and remove it the next day. Yellow-white pus indicates healing; red-black pus warns of potential bleeding. Do not perform needling or cauterization randomly in deficient areas or at joints/tendon-bone interfaces. When inserting needles or cauterizing, angle slightly to avoid penetrating internal membranes. Delayed cauterization is bad, but too early also causes complications. Deep pus with shallow needling prevents internal pus drainage but causes external bleeding. Shallow sores with deep needling allow internal pus drainage but injure healthy flesh. This illustrates the difficulty of using needling and cauterization. (From *Shuo Yue*)

Shen Douyuan said: For stubborn boils, tumors, or abscesses that have not healed after six months of treatment, cauterization should be used, as it facilitates quicker healing.

Zhou Wencai said: Why do stubborn boils, tumors, or abscesses persist for half a year or a year? It is often due to men and women failing to control sexual desire. Children may also contract it through sucking milk from mothers with such conditions. Another cause is trauma, such as falling or bumping, which disrupts the pus and blood before healing is complete, resulting in a stubborn boil. When hundred medicines fail, one should use silver coins or silver spoons heated red-hot to cauterize the boil. Recovery occurs within a few days. Inform the patient beforehand. This is a truly excellent method. If silver coins are unavailable, copper coins can be substituted.

Hu Gongbi said: Fire cauterization needles should be round like chopsticks, thick like reeds, with a flat, round tip 6-7 cun long. Two identical needles are used. Dip them in sesame oil and heat red-hot in charcoal fire. Cauterize the area corresponding to the sore head's shape. Insert obliquely towards the softer area. If not penetrated, cauterize again until pus is obtained. Discharge occurring out of season (before suppuration) is fresh blood; discharge occurring in season (during suppuration) is yellow pus and necrotic tissue. No pressure is needed. Use paper wicks for drainage and prevent the wound opening from closing.

He also stated: For toxic sores arising in deficient areas or at tendon-muscle-bone-joint sites, absolutely do not perform random needling or cauterization. If these methods are used, they should be angled slightly to prevent membrane penetration.