疽之发也。所患者惟内攻与外溃耳。盖毒不能外发。势必内攻。急宜护膜以托里。不能中出。势必旁溃。
必外兼针灸等法以提其毒。此外科之首务也。
夫用针者。譬之救火。火在屋下。必穴其顶。不尔则延亵尽焚之矣。故曰。毒瓦斯中隔。内外不通。不行针灸。
药无全功。又曰。血实者决之。先诊其脉。紧而数者。其脓未成。紧去但数者。其脓已成。若脓未成而用针。
气血已泻。脓反难成。脓已成而不针。溃坏愈深。疮口难敛。次、轻按热痛者。脓浅而稠。重按微痛者。脓深
而稀。按之不痛俱硬者。瘀血也。俱软者。湿水也。再、按之陷而不起者。脓未成。按之软随手而起者。脓已
成。按之四畔俱软者。脓大成矣。
手法 针锋宜随经络之横竖。不则难于收口。部位宜下取。便于出脓。肿高而软者。在肌肉。针四五分。
肿下而坚者。在筋脉。针六七分。肿平肉色不变者。附于骨也。针寸许。毒生背腹肋胁等处。宜扁针斜入。
以防透膜之害。入针在好肉之处。则磁实而难进。针至脓溃之处。则虚软而无阻。针既透脓。即视针口。
必有脓意如珠。斯时也。欲大开口。则将针斜出。欲小其口。则将针直出。所谓迎而夺之。顺而取之也。随
以绵纸捻蘸玄珠膏度之。使脓会齐。三二时取出捻。则脓水速干矣。疮口贴呼脓膏。四围敷溃脓散。元
气虚者。必先补而后针。脓一出则诸症悉退。若脓出反痛。肿仍不消。或烦躁呕逆者。胃气虚也。治宜大
补之。
神妙拔根法 凡背疽、脑疽。阴症者。初起不肿高。不 热。灸之不疼者。必致坏人。于十日以前。用铍针
当头插入。至知痛方止。出其恶血。通其疮窍。随用蟾酥条插入。直至孔底。服蟾酥丸、绀珠丹、发其大汗。
如元气虚者。随以内托之药大补之。每日插二条。以膏盖之。三日后加添插药。其根高肿作痛。外用神
灯照法、桑根灸法。助阴为阳。插换七日。其疮裂缝流脓。至十三日。其根自脱。如日多根深蒂固不能脱
者。铍针取之。玉红膏搽之。不脱者自脱。不敛者自敛。如半月后不作脓腐者。用铍针品字样三孔开之。
不问深浅。以知痛为住。随用药筒拔法拔之。视其脓血鲜明。谓气血交粘。用药可痊。若紫黑气秽。谓气
败血衰。神仙难医。若拔后大脓当出而反少。必内有顽膜。宜取去寸余。虽微痛血出无妨。随用两手轻
重得宜。从疮根 处渐渐捺至中间。剪去脓管。聚脓自然涌出。以黄浓为吉。其脓日渐多者为轻。反此
则为虑矣。
又有不宜针者。如疽生于筋脉。及骨节脐门。并瘿瘤。再结核推之不动者。俱不宜针。冬月闭藏。水冰地
折。只宜用药托里而少针石者。盖谓善行水者不能注冰。善穿地者不能凿冻。善用针者亦不能取四
厥也。所为寒致腠理。以苦发之。以辛散之。如托里温中汤之类也。
蜞针一法。为开门放毒之快捷方式。然恐竭于外。不能及于内。即皮肤之疾。恐血去而气不能独居也。禁之。
针委中穴法 治痈疽发背红肿疼痛。及脚膝风湿疼痛。即柱杖跛足者。针之有功。又中风痰厥。牙关
紧急不知人事者。针之立效。其法。令患者双手倚壁上。双脚挺直。用三角铍针。将纸扎只露半米粒
许尖头。针时以中指抵住针头。看委中穴有细青紫脉。皆是湿毒恶血。看准于紫脉上刺之。凡青脉俱
刺。任出黑血无妨。看血出淡黄色。方以纸轻手按片时。以小膏药贴之。三四日不可洗浴。放血后。令人
将圆棍于手足腰背腿上。如辕刮面。即弃杖而行。百发百中。针家不宜出血。惟肿偏宜出血也。
针少商穴法 治喉风、喉痹、 额、（ 、音容。大头也。）悬痈、乳蛾等症。危急者刺之立验。穴
在大指端内侧。去爪甲角一韭叶许白肉际间。用三棱针刺出紫血。立瘥。此穴能泄诸脏之热。但不宜灸。
内托黄 丸 治误伤经络。白脓赤汁。逗流不止者。
黄 （生八两） 当归（三两） 肉桂 木香 沉香 乳香（各一两）
为末。用绿豆粉四两。生姜自然汁煮。糊丸桐子大。每服四五十丸。白汤下。
疽病发作时，危害主要在于毒邪内攻脏腑或向外溃破。因为毒邪如果不能从外部发散，势必向内攻陷；此时急需保护膜原（人体组织间的间隙），采用托里法以扶助正气，使毒邪不能向中间深入。如果毒邪不能从中间排出，势必向旁边溃烂，必须结合针灸等方法来提引毒邪外出。这是外科治疗的首要任务。
使用针具，好比救火。火在屋内，必须凿开屋顶透气，否则火势蔓延，房屋将全部烧毁。所以说，毒气在中焦阻隔，内外不通，如果不进行针灸疏通，药物就无法发挥全部功效。又说：血气壅实者，应当决破泄之。首先要诊察脉象，脉紧而数，说明脓尚未形成；紧象消失仅见数象，说明脓已经形成。如果脓未成而用针刺，气血已经耗散，反而难以成脓；脓已成而不针刺，溃烂会加深，疮口难以愈合。其次，轻按患处感到热痛，说明脓浅且稠厚；重按微痛，说明脓深且稀薄；按压不痛且整体坚硬，是瘀血；整体柔软，是湿水积聚。再次，按压后凹陷不起的，脓未形成；按压后柔软且随手弹起的，脓已形成；按压四周都柔软的，脓已成熟壮大。
手法方面：针锋走向应顺应经络的横竖方向，否则难以收口。进针部位宜从下方选取，便于脓液排出。肿胀高突且质地柔软的，病变在肌肉层，进针四五分；肿胀低平且坚硬的，病变在筋脉层，进针六七分；肿胀平坦、肤色不变的，病变附着于骨骼，进针约一寸。毒邪生于背部、腹部、肋骨、胁肋等处，宜用扁针斜向刺入，以防穿透膜原造成危害。在健康皮肤处进针，则坚实难进；针至脓溃之处，则虚软无阻。针既透脓，立即观察针口，必有脓液如珠状涌出。此时，若要扩大开口，则将针斜向拔出；若要缩小开口，则将针垂直拔出。这就是所谓的“迎而夺之，顺而取之”。随即用绵纸捻蘸取玄珠膏插入，使脓液汇聚整齐，两三小时后取出纸捻，脓水即可迅速干燥。疮口贴敷呼脓膏，四周敷溃脓散。元气虚弱者，必须先补益而后针刺。脓液一出，各种症状都会消退。如果脓出后反而疼痛，肿胀仍不消退，或出现烦躁、呕吐逆气，这是胃气虚弱所致，治疗宜大补元气。
神妙拔根法：凡是背疽、脑疽属于阴证者，初起不肿高、不发热、灸之不疼的，必然导致病情恶化危及生命。在发病十日以前，用铍针当头直插入，直到患者感到疼痛为止，放出恶血，通畅疮窍。随即插入蟾酥条，直至孔底，服用蟾酥丸、绀珠丹，使其大汗淋漓。如果元气虚弱，随即以内托药大补元气。每天插两条蟾酥条，用膏药覆盖。三天后添加替换插药。待疮根高肿作痛，外用神灯照法、桑根灸法，助阴转阳。交替插换七日，疮口裂缝流脓，到第十三日，疮根自然脱落。如果日子久了，根深蒂固不能脱落的，用铍针切除，涂抹玉红膏，不脱落的自然会脱落，不愈合的自然会愈合。如果半个月后仍不化脓腐坏，用铍针切成“品”字形开三个孔，不问深浅，以患者感到疼痛为度。随即用药筒拔法拔除。观察其脓血鲜明，称为气血交粘，用药可以痊愈。如果脓血紫黑且气味臭秽，称为气败血衰，神仙也难医治。如果拔后本该大量排脓却反而很少，必定内有顽膜，宜去除寸余，虽然轻微疼痛出血无妨。随即用双手轻重适宜，从疮根处渐渐捺至中间，剪去脓管，聚积的脓液自然会涌出。以黄浓为吉兆，脓液日渐增多者为轻症，反之则为忧虑。
又有不宜针刺的情况：如疽生于筋脉、骨节、脐门，以及瘿瘤，还有结核推之不动的，都不宜针刺。冬季闭藏，水结冰地冻裂，只宜用药托里，少用针石。这是因为善于行水的人不能注入冰中，善于穿地的人不能凿开冻土，善于用针的人也不能治疗四肢厥冷。所谓寒邪导致腠理闭塞，应用苦味药发汗，辛味药散寒，如托里温中汤之类。
蜞针（蚂蟥吸血）一法，是开门放毒的快捷方式，但恐怕耗竭于外，不能顾及于内，即使是皮肤疾病，也恐血去而气不能独存。故禁止使用。
针委中穴法：治疗痈疽发背红肿疼痛，以及脚膝风湿疼痛，甚至拄拐跛足者，针刺此穴有效。又治中风痰厥，牙关紧急不知人事者，针刺立效。方法：令患者双手倚靠墙壁，双脚挺直，用三角铍针，用纸包裹只露出半米粒许的尖头。针刺时用中指抵住针头，观察委中穴是否有细青紫色的脉络，这些都是湿毒恶血。看准在紫脉上刺之。凡有青脉的都刺，任其流出黑血无妨。看到血液变为淡黄色，才用纸张轻轻按压片刻，贴上小膏药。三四天内不可洗浴。放血后，让人拿着圆棍在手足腰背腿上滚动，如同辕刮面一样，之后即可弃杖行走，百发百中。一般针家不宜出血，唯独肿胀适宜出血。
针少商穴法：治疗喉风、喉痹、大头瘟、悬痈、乳蛾等症，危急者刺之立即见效。穴位在大拇指端内侧，距离指甲角约一片韭菜叶宽的白肉际间。用三棱针刺出紫血，立即痊愈。此穴能泄诸脏之热，但不宜艾灸。
内托黄芪丸：治疗误伤经络，白脓赤汁，淋漓不止者。
黄芪（生用八两）、当归（三两）、肉桂、木香、沉香、乳香（各一两）。
研为末，用绿豆粉四两，生姜自然汁煮，制成糊丸，大小如梧桐子。每次服用四五十丸，白开水送下。
When a deep abscess (Ju, 疽) erupts, the dangers lie solely in internal invasion or external ulceration. Since the toxin cannot be expelled externally, it will inevitably attack internally; urgent measures should be taken to protect the membranes and employ the "Supporting the Interior" method (Tuoli, 托里) to support healthy Qi, preventing the toxin from penetrating inward. If the toxin cannot exit from the center, it will inevitably ulcerate laterally. Acupuncture and other methods must be combined to draw out the toxin. This is the primary task in surgery.
Using needles is like fighting a fire. If fire is inside a house, one must pierce the roof; otherwise, the flames will spread, burning everything down. Thus it is said: When toxic vapors are blocked in the middle, causing obstruction between the interior and exterior, without acupuncture and moxibustion, medicinal efficacy will be incomplete. It is also said: For excess blood conditions, one should lacerate and drain. First, diagnose the pulse. A tight and rapid pulse indicates pus has not yet formed; if the tightness disappears but the rapidity remains, pus has formed. If needling is performed before pus formation, Qi and Blood are depleted, making pus formation difficult. If needling is delayed after pus formation, the ulceration deepens, and the wound becomes difficult to heal. Secondly, light pressure causing heat and pain indicates shallow and thick pus; heavy pressure causing slight pain indicates deep and thin pus. Pressure causing no pain with overall hardness indicates stasis of blood; overall softness indicates accumulation of damp fluid. Thirdly, depression upon pressure that does not rebound indicates pus has not formed; softness with immediate rebound indicates pus has formed; softness on all sides indicates mature and abundant pus.
Technique: The needle tip should follow the horizontal or vertical orientation of the meridians; otherwise, healing will be difficult. The entry point should be chosen from below to facilitate pus drainage. Swelling that is high and soft involves the muscle layer; needle 4-5 fen. Swelling that is low and hard involves the sinews and vessels; needle 6-7 fen. Swelling that is flat with unchanged skin color adheres to the bone; needle approximately 1 cun. Toxins arising on the back, abdomen, ribs, or hypochondrium should be treated with a flat needle inserted obliquely to prevent perforating the membranes. Inserting the needle into healthy flesh feels firm and resistant; inserting it into the area of pus rupture feels soft and unobstructed. Once the needle penetrates the pus, observe the puncture site; pus should emerge like beads. At this moment, to enlarge the opening, withdraw the needle obliquely; to narrow the opening, withdraw the needle vertically. This is referred to as "meeting and seizing" (Ying Er Duo Zhi) and "following and taking" (Shun Er Qu Zhi). Immediately insert a cotton paper twist dipped in Xuanzhu Ointment (Xuanzhu Gao) to align the pus flow. Remove the twist after two to three hours, and the pus will dry quickly. Apply Hunong Ointment (Hunong Gao) to the wound and apply Kuinong Powder (Kuinong San) around the periphery. For patients with deficient Yuan Qi, tonification must precede needling. Once pus drains, symptoms subside. If pain persists after drainage, swelling remains, or irritability and vomiting occur, this indicates deficiency of Stomach Qi; treatment requires strong tonification.
Divine Root Extraction Method: For back carbuncles or brain carbuncles presenting as Yin syndromes—initially non-elevated, non-hot, and painless upon moxibustion—the condition will likely worsen and become fatal. Before the tenth day, insert a Pi needle (Bizen, 铍针) straight into the head until pain is felt, draining evil blood and opening the orifice. Immediately insert a Chan Su strip (Toad Venom Strip) to the bottom of the hole, administer Chan Su Pills (Chansu Wan) or Gan Zhu Dan (Ganzhu Dan) to induce profuse sweating. If Yuan Qi is deficient, simultaneously administer internal supporting tonics. Insert two strips daily, covered with ointment. Add fresh strips every three days. When the root becomes elevated, swollen, and painful, apply Shen Deng Illumination Method (Shendeng Zhao Fa) and Mul Root Moxibustion (Sanggen Jiufa) to transform Yin into Yang. Alternate insertion for seven days until the wound cracks and drains pus. By the thirteenth day, the root should detach naturally. If the root remains firmly attached due to prolonged duration, excise it with a Pi needle and apply Yuhong Ointment (Yuhong Gao); detached roots will heal spontaneously. If after half a month there is no suppuration or necrosis, use a Pi needle to create three holes in a "pin" shape, stopping when pain is felt. Follow with Yao Tong Ba Fa (Medicated Cylinder Suction). Observe the pus and blood: if bright, it indicates Qi and Blood are adherent, and medication can cure. If purple-black and foul-smelling, it indicates Qi failure and Blood decline, which is incurable even by immortals. If suction yields little pus despite expectation, there is likely a stubborn membrane; remove about one cun. Mild pain and bleeding are acceptable. Then, using hands with appropriate pressure, press gently from the root toward the center, cutting the pus tube so accumulated pus surges forth. Yellow and thick pus is auspicious; increasing pus volume indicates a mild case; the opposite is concerning.
There are conditions unsuitable for needling: abscesses arising in sinews/vessels, joints, umbilicus, goiters, nodules that do not move upon pushing, etc. In winter, when water freezes and earth cracks, only medicinal internal support should be used, avoiding needles and stones. This is because those skilled at moving water cannot pour it into ice, and those skilled at digging cannot drill frozen ground; similarly, skilled acupuncturists cannot treat four extremities cold (Si Jue). Cold causes closure of interstices; bitter herbs should induce sweating, and pungent herbs should disperse cold, such as Tuoli Wenzhong Tang (Supporting Interior and Warming Middle Decoction).
Leech therapy (Qi Zhen, 蜞针) is a quick way to open the gate and release toxins, but it risks exhausting the exterior without addressing the interior. Even for skin diseases, losing blood may leave Qi unsupported. Therefore, it is prohibited.
Needling Weizhong (BL40): Treats redness, swelling, and pain from carbuncles/back infections, wind-damp pain in legs/knees, and lameness requiring crutches. It is effective. It also treats stroke with phlegm syncope, locked jaw, and unconsciousness. Method: Have the patient lean hands against a wall with legs straight. Use a triangular Pi needle wrapped in paper, exposing only half a grain-sized tip. Hold the needle head with the middle finger. Observe for fine blue-purple veins at Weizhong (BL40), indicating damp-toxin and evil blood. Pierce the purple vein. All blue veins should be pierced; black blood drainage is acceptable. Stop when blood turns pale yellow. Press lightly with paper for a moment, then apply a small plaster. Avoid bathing for three to four days. After bloodletting, have someone roll a round stick along the limbs, waist, back, and legs (like scraping a wheel rim); the patient can then walk without crutches. Highly effective. Generally, acupuncture avoids bleeding, but swelling benefits from it.
Needling Shaoshang (LU11): Treats throat wind, throat bi, big head plague (Da Tou Wen, 大头瘟), hanging abscess (Xuan Yong, 悬痈), and tonsillitis (Ru E, 乳蛾). Critical cases respond immediately. Location: Inner side of the thumb tip, about the width of a leek leaf from the nail corner, in the white flesh area. Prick with a three-edged needle to release purple blood; recovery is immediate. This point clears heat from all organs but is contraindicated for moxibustion.
Neituo Huangqi Wan (Internal Supporting Astragalus Pill): Treats injury to meridians resulting in continuous discharge of white pus and red serum.
Ingredients: Sheng Huangqi (Raw Radix Astragali, 8 liang), Danggui (Radix Angelicae Sinensis, 3 liang), Rougui (Cortex Cinnamomi), Muxiang (Radix Aucklandiae), Chenxiang (Lignum Aquilariae Resinatum), Ruxiang (Resina Draconis, each 1 liang).
Process: Grind to powder. Mix with 4 liang of Mung Bean Flour (Moutou Fen) and natural juice of fresh ginger. Cook into a paste and form pills the size of tung tree seeds. Dosage: 40-50 pills per dose, taken with warm water.