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Both Jie pulse (Knotted Pulse) and Dai pulse (Intermittent Pulse) belong to pulses with intermittent pauses. The Jie pulse features irregular pauses, which still belongs to disharmony of Qi and Blood, occurring occasionally; the Dai pulse features regular pauses, indicating a defect in Zang Qi that has become habitual. Thus, when Dai pulse arises with Jie pulse, there is a clear distinction between them. However, even speaking from the perspective of Internal Medicine, since the Qi and Blood of the elderly have declined and circulation is insufficient, the appearance of a Dai pulse does not necessarily signify an immediate death omen. If nourished and cared for properly, life can be prolonged. Nevertheless, it remains a sign of deficiency, like a candle in the wind, perilous at any moment.

Regarding surgical diseases (Yang conditions), although swelling ulcers are all characterized by obstruction and blockage, being merely diseases of skin, flesh, and meridians, unless they are severe cases, they should certainly not present with Jie or Dai pulses. However, in cases of internal abscesses that are solidified, or when pain is extremely intense, such pulses may occasionally be seen. At this time, one must resolve the stagnation and alleviate pain to restore the pulse and ensure safety. If Jie or Dai pulses persist for a long time, it is definitely a bad omen. After the ulcer has suppurated and drained, the blocked passages are open, and the stagnant flow is cleared; the pulse channels should circulate freely without obstruction. If Jie or Dai pulses are still present, it indicates that the True Yuan (Original Qi) cannot continue, and recovery will likely be difficult.

When Qi and Fire in the Upper Jiao boil vigorously, the pulse must respond by overflowing upwards; in severe cases, it becomes wiry and extends beyond the Cun position, reaching directly to the Yuji area. This occurs in individuals with excessive Yang of the Heart and Liver. Symptoms include dizziness, headache extending to the vertex, or even impact on the brain meridians, leading to coma and loss of consciousness. Surgeons also encounter this pulse pattern in excess Heat syndromes, such as Ding toxic sores on the head and face, which are frequently observed. When the Ministerial Fire in the Lower Yuan fails to remain hidden, the pulse responds by becoming excessive downwards; in severe cases, it sinks into the Chi position, beating strongly and powerfully. This occurs in individuals with blazing Fire of the Liver and Kidney. In internal medicine, this manifests as abnormal erections, painful protrusion of the vagina or anus, and sweaty, itchy genitalia, all caused by the uncontrolled rampant nature of Dragon Fire and Ministerial Fire. In surgery, this also governs various toxic fire conditions of the two yin openings (anterior and posterior), such as acute orchitis, damp-heat external hemorrhoids, and bubo abscesses. When the intensity of carbuncles is at its peak, such long and forceful pulses are common. Additionally, ding sores on the feet, characterized by extreme Yang toxicity that rapidly turns to pus and rot, also occasionally present this way.

Surgical prescriptions must be adjusted according to the patient's cold/heat, deficiency/excess, Seven Emotions, Six Evils, and various syndromes involving Qi, Blood, Phlegm, and Dampness. Therefore, in clinical prescription-making, regardless of external appearances, one must prioritize internal syndromes. This represents the highest level of surgical practice. If one masters internal medicine treatment and applies this knowledge to surgical sores, even severe cases often yield prompt results. Observing contemporary famous internal medicine physicians who are not specialists in surgery but occasionally treat surgical sores with miraculous effects confirms this fact, which is both empirically verifiable and logically sound, and recognized by virtuous physicians worldwide. However, surgical diseases are extremely complex. Even the changes in external manifestations are endless, and their progression and sequence must not be disordered. Without dedicated study and research, even if one excels in internal medicine with profound theories and methods, applying them to surgery may result in general competence but lack precision in details. Consequently, practical application may fail to proceed step-by-step with exactitude. Although the general principle of treating surgery relies on internal syndromes as a benchmark, for external symptoms such as detoxification, pain relief, removing necrotic tissue, and promoting new growth, specific herbs are needed as guides to balance internal and external treatments. Otherwise, lacking relevance, how can one expect immediate efficacy? Moreover, each affected site has its specific meridian distribution; treating according to meridians requires avoiding vagueness and superficiality. Yet, popular surgical texts often contain "universal formulas" for hundreds of diseases, creating confusion akin to a dark hell. For instance, widely circulated formulas like Xianfang Huoming Yin (Immortal Formula for Saving Life) and Shenshou Weisheng Tang (Divinely Granted Health-Preserving Decoction) are listed first in surgical manuals, claiming to treat all carbuncles and sores, eliminating toxins, and relieving pain with divine efficacy. Examining their actual effects reveals chaos without legal principles, making efficacy unlikely. While every disease has specific effective herbs, the same disease varies in warmth/cold, deficiency/excess, and stage (early vs. late transmission), meaning no single pre-set formula can universally treat it. Claiming ancient universal formulas can treat all carbuncles regardless of size, location, or yin/yang nature, causing resolution before suppuration and drainage after suppuration, is fundamentally flawed. Adding miscellaneous ingredients arbitrarily to match symptoms is futile. Boasting names like "Immortal Formula" dazzles the public but only highlights absurdity. Consider Xianfang Huoming Yin: it contains Ruxiang (Olibanum), Moyao (Myrrha), Chishao (Red Peony Root), Gancao Jie (Licorice Knot), Guiwei (Cinnamon Twig/Cassia Twig tail - *Note: Context implies Danggui Wei/Tail of Angelica Sinensis*), Chuanshanjia (Pangolin Scales), Zaocisus (Gleditsia Spine), Yinhua (Honeysuckle Flower), Baizhi (Angelica Dahurica), Chenpi (Tangerine Peel), Huafen (Trichosanthes Root), Beimu (Fritillaria Bulb), Fangfeng (Saposhnikovia Root). Ruxiang and Moyao are commonly used for pain relief; their sticky nature helps seal wounds externally for hemostasis and analgesia, and they promote granulation tissue externally. Internally, their aromatic nature soothes Liver and Stomach Qi, potentially helping with hidden pain. However, being tree gums, they become viscous and foul-tasting in decoctions, causing nausea or vomiting. Ancient texts record them only in pills or powders, never in decoctions. Modern vulgar doctors misuse them in decoctions under the guise of pain relief, harming the stomach unnecessarily. Licorice (Gancao) treats surgical toxins because sweetness corresponds to Earth, transforming toxins. However, sweetness is cloying; in damp-phlegm cases, it causes distension and vomiting. Ancient formulas used it sparingly for harmonizing; modern usage is reduced due to these drawbacks. In surgical cases, damp-phlegm is prevalent, and patients often have thick, greasy tongue coatings, making sweet herbs contraindicated, especially potent ones like Guolao (Licorice). The claim that "Licorice Knots" specifically treat sores is baseless; Li Shizhen's Compendium mentions tips and heads but not knots, suggesting this myth arose later. Pharmacopoeia specimens show uniform stems without distinct knots. Prescribing "Licorice Knots" blindly perpetuates error. Chishao and Guiwei break and invigorate blood, suitable only for blood stasis. Using them prematurely in deep tissue infections causes unnecessary pain; they are used reluctantly to draw infection outward for incision, avoiding internal spread. If pus is not yet formed, using them promotes premature suppuration, worsening minor illnesses and endangering major ones. Chenpi and Beimu suit upper jiao heat-phlegm like parotid mumps. Baizhi disperses wind in the head and face; Fangfeng disperses cold wind but is unsuitable for wind-heat or damp-heat, acting as poison in such contexts. Yinhua and Huafen are cooling, suitable for heat but contraindicated in cold. Combining warming and cooling agents in one formula to claim universal efficacy for all carbuncles is erroneous. Other popular formulas like Xiao Jin Dan and Xingxiao Wan from Wang Shi Quan Sheng Ji also lack universal applicability. Recent "Liushen Wan" (Six Spirit Pill), containing Pearl, Coptis, Musk, Toad Venom, Realgar, and Yellow Ochre, is expensive and revered despite lacking proven efficacy for surgical sores, exploiting patients financially. Following my master's teachings and personal experience, I believe each disease requires specific formulas tailored to individual constitutions, not rigid universal prescriptions. Categorizing syndromes provides a methodological path. Though my summary here is fragmentary, clarifying principles allows flexible application, superior to blind adherence to ancient formulas. External treatments covering detoxification, warming/cooling dispersion, toxin extraction, pain/hemorrhage control, drying dampness, and tissue regeneration complement internal decoctions. Ancient texts offer thousands of formulas, but few are practical; following them blindly causes harm. Clinical practice should not be a testing ground for unverified drugs. I have compiled my master's techniques and half a lifetime of experience into a separate chapter to ensure each formula has specific efficacy, aiding students in flexible treatment to benefit humanity. Regarding internal decoctions for differentiated treatment, I have collected surgical case studies for critical analysis, ensuring comprehensive mastery of surgical arts.