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Diseases of the surgical department (Yangke) invariably present with swelling and pain. The reason is none other than the stagnation and obstruction of Qi and Blood, leading to blockage. Therefore, to reduce swelling and relieve pain, promoting Blood circulation (Xingxue) and moving Qi (Xingqi) are essential methods. However, promoting Blood circulation should not be too aggressive. Substances that break Blood and drive out stasis (Poxue Zhuyu) should not be administered lightly or indiscriminately, as this may only exacerbate adverse effects. In contrast, Qi-moving herbs can be used safely without harm. Moreover, Blood stagnation arises from Qi stagnation; if the Great Qi is set in motion, then as Qi moves, Blood also moves, achieving two benefits with one action. This explains why ancient practitioners of surgical diseases emphasized the Qi aspect, which indeed grasped the key essence. In Song Dynasty's *Li Shi Ji Yan*, formulas for back carbuncles include Wuxiang Lianqiao Decoction (Five-Aromatic Forsythia Decoction) and Neibu Shixuan Powder (Internal-Nourishing Ten-Point Dispersion). *Dou Shi Chuangyang Jingyan* contains many Liúqì Infusions (Flowing-Qi Decoctions). Although these formulas may seem somewhat complex, their frequent use of Qi-regulating substances aligns best with the orthodox approach of ancient surgical treatments. Shouyi posits that Qi is the commander of Blood, and Blood follows Qi. In the vastness of heaven and earth, all things are generated and transformed through the operation of air. Humans exist within the intersection of Qi; every movement and action is driven by the circulation of this Great Qi. Thus, in treating various diseases, incorporating Qi-regulating substances is necessary so that, through their gentle stimulation and operation, efficacy becomes miraculous.

Among ancient formulas for nourishing Blood, Sìwù Decoction (Four-Substance Decoction) is paramount. Dihuang (Rehmanniae Radix) is thick and cloying; without the acrid-warm and mobilizing power of Danggui (Angelicae Sinensis Radix) and Chuanxiong (Chuanxiong Rhizoma), it remains stagnant, causing more harm than good. The refined essence of formula preparation lies in utilizing Qi-moving herbs. Yet laypeople fail to understand this, mistakenly believing that Danggui and Chuanxiong alone constitute blood-nourishing agents, failing to grasp the true intent of ancient medicinal usage—is this not strange? Furthermore, in surgical conditions, the pathology is clearly due to Qi stagnation and failure of movement. If the Qi mechanism is not invigorated, how can there be any benefit? This is undoubtedly a shortcut relied upon throughout by those treating surgical diseases, and all methods for unblocking meridians and collaterals fall under the umbrella of "moving Qi."

Phlegm (Tan) is not originally a substance that should exist in the human body. However, observing contemporary cases, syndromes involving Phlegm are numerous. Is it truly because, as Danxi stated, the low and damp terrain of the southeast generates Heat from Dampness, and Phlegm from Damp-Heat, resulting from thin soil and shallow water beyond human control? Or is it rather that individuals have inherently weak constitutions, with Spleen transport and transformation failing, lacking the authority of Great Qi rotation, and having poor digestion of food and fluids. Consequently, the essence of grain and water fails to transform into Body Fluids (Jinye) to moisten the Five Zang organs and harmonize the Six Fu organs, instead brewing stubborn Phlegm and turbid fluid retention, thereby aiding the pathogenic factors. Ancient texts often state that the Lung is the source of Phlegm production and the Stomach is the vessel storing Phlegm. This is because the Lung serves as the pathway for respiration; when Qi mechanism is unfavorable, Qi transforms into Water, leading to fluid retention. The Stomach is the reservoir of food and drink; when transportation and transformation are inefficient, food generates Phlegm, and turbid saliva accumulates. This latent growth of Phlegm-fluid in the Lung and Stomach is particularly shallow and easy to know, obvious and verifiable. As for Phlegm diseases in the meridians and muscles, these are not Phlegm from the Lung and Stomach circulating with Qi and Blood into the meridians. Rather, it is due to poor physiological operation, where the Zhouliu (circulation) of Ying and Wei occasionally stagnates. This causes the inherent fluids in the collaterals to remain stagnant unknowingly. Like a spring source, originally clear but blocked downstream, accumulating filth; or like a mountain path, initially a shortcut for pedestrians, but unused and overgrown with weeds. This is the origin of retained Phlegm and accumulated fluid in the skin, membranes, and limbs. External carbuncles and sores often involve Phlegm syndromes. Should those treating surgical diseases not pay attention to this? However, while Phlegm can lead to sores, its foundation lies in Qi mechanism obstruction, and its manifestation has other triggering causes. Some are triggered by external Wind and seasonal Heat agitating the Phlegm; since Wind nature is ascending and rapid, symptoms often appear on the neck, cheeks, and jaw, such as Fāyí (Mumps-like disease), cheek abscesses, and submandibular abscesses. These originate from condensed Phlegm, activated by external Wind, and formed by Blood-Heat. Treatment requires resolving Phlegm while clearing Heat and dispersing Wind. Others are caused by internal Heat of the Liver and Gallbladder refining the Phlegm; when Minister Fire is depressed and obstructed, entering collaterals and connecting, symptoms often appear behind the ears and on the sides of the neck, such as Luǒlì (Scrofula/Lymphatic Tuberculosis) forming chains. These originate from Wood-Fire burning Blood, leading to hardening. Treatment requires resolving Phlegm while soothing the Liver and clearing Fire. Phlegm condensing in the Stomach collaterals manifests as breast nodules, requiring simultaneous purging of Stomach excess. If Qi and Fluids have been deficient for a long time, and Phlegm travels through meridians, manifesting late as Liútán (Tuberculous Abscess/Bone TB), tonification is required for efficacy. For long-depressed Phlegm becoming chronic diseases, such as Shíjū (Hard Carbuncle) or Rǔyán (Breast Cancer), the root is deep and solid; moreover, the patient is full of resentment, which cannot be resolved by medication alone. How can "resolving Phlegm" alone hope to achieve even partial success? Although these are all Phlegm diseases, their depth and severity differ greatly. If one can distinguish the source and flow, and treat according to the specific situation, eight or nine out of ten recoveries can be expected.

Furthermore, for surgical patients with Phlegm, there are specific locations to rely on, and treatment must be differentiated based on manifestations. Symptoms around the sides of the neck and in front/behind the ears often involve Wind-Fire and Liver-Fire, requiring differentiation of internal and external causes. Symptoms in the hypochondrium may involve Excess Fire or Deficient Fire, requiring careful weighing of severity. If Phlegm occurs in the chest, abdomen, shoulders, and back, in the limbs, Phlegm typically occurs only in the arms, not below the thighs. Students must not mistake sores on the thighs and shins as Phlegm-involved syndromes, lest they be laughed at by experts.