经曰。冬则闭脏。用药多而少针石。少针石者。非谓痈疽也。痈疽不得顷时回。回者远
（远顷时而不写。则烂筋骨穿脏腑矣。）又曰。痈疽之生。脓血之成。积微之所生也。故圣人
自治于未有形。愚者遭其已成也。已成脓者。唯砭石铍锋之所取也。
疮疡一科。用针为贵。用之之际。须视其溃之浅深。审其肉之浓薄。若皮薄针深。反伤
。益增其溃。肉浓针浅。脓毒不出。反益其痛。至于附骨疽、气毒、流注。及有经久不消。
内溃不痛。宜燔针开之。若治咽喉。当用三棱针。若丹瘤及痈疽。四畔赤 。疼痛如灼。宜
砭石砭之。去血以泄其毒。重者减。轻者消。
一妇患腹痈。脓胀闷瞀。卧针。脓出即苏。
一人囊痈脓熟肿胀。小便不利。几殆。急针。脓水大泄。气通而愈。
大抵用针迎而夺之。顺而取之。所谓不治已病。治未病。不治已成。治未成。正此意也
之患者。或畏针而不用。医者又徇患者之意而不针。遂或脓成而不得溃。或得溃而所伤已深
矣。卒之夭枉。十常八九。悲夫。
精要谓痈如椒眼十数头。或如蜂窠连房。脓血不出者。用针横直裂之。如无椒眼之类。
只消直入取脓。不必裂之。（一法）当椒眼上各各灸之。亦佳。不必裂也。
小儿疮疖。先当温衣覆盖。令其凝泣壅滞。血脉温和。则出血立已。不如此。血脉凝便
针。则邪毒不泄。反伤良肉。又益其疮势也。
精要曰。痈者皮薄肿高。多有椒眼十数粒。疽者皮肤顽硬。状如牛颈之皮。○痈成脓则
。针宜用马衔铁为之。形如薤叶样。两面皆利。可以横直裂开五六分许。攻去毒血。须先灸
而后裂。○疽成脓则宜烙。可用银篦。大二寸。长六寸。火上烧令赤。急于毒上熨烙。得脓
利为效。
又曰。一妇病痈在背之左。高硕而熟。未破。医云可烙。傍有老成者曰。凡背之上。五
穴之所系。膈膜之所近。烙不得法。必致伤人。医曰。但宜浅而不宜深。宜横而不宜直入。
（恐伤膈膜。）宜下而不宜上。（恐贮脓血。）
谓此诀尽无妨也。于是烧铁箸烙之。肉破脓出。自此而愈。当时直惊人非刽子手者。不
又曰。方其已熟未溃之时。用铁箸一烙。极是快意。方扇火欲着时。诚是惊人。予尝用
临时犹且颤悸。况未曾经历者乎。烙后脓水流通。百无所忌。名曰熟疮。其疮突者。针口宜
向下。然须是熟于用烙者。识浅深。知穴道。审生熟。非其时则所出皆生血。当其时则出黄
脓瘀肉。用尖针烙者不得法。尖针头细。其口易合。惟用平员头者为妙。盖要孔穴通透。
或恐疮口再合。用细牛膝根。如疮口之大小。略割去粗皮。插入疮口。外留半寸许。即用嫩
橘树叶、地锦草各一握。研成膏敷之。牛膝能使恶肉常流。二草温凉止痛。随干随换。此十
全之功也。
火烙针。其针圆如箸。大如纬挺。头员平。长六七寸。一样二枚。捻蘸香油。于炭火中
。于疮头近下烙之。宜斜入向软处。一烙不透再烙。必得脓。疮口烙者。名曰熟疮。脓水常
流。不假按抑。仍须 之。勿令口合。
《内经》说：冬季应当闭藏脏腑，用药多而少用针石。所谓“少用针石”，并不是指痈疽（体表化脓性感染）。痈疽的病势危急，一刻也不能延误。所谓“不延误”，是指如果拖延片刻不处理，就会导致筋骨腐烂、穿破脏腑。（如果不及时写出治疗原则，就会造成筋骨烂坏、脏腑穿孔的后果。）又说：痈疽的产生，脓血的形成，都是由于病邪由微小逐渐积累而成的。所以圣人（高明的医生）在疾病尚未形成时就加以防治，愚者则等到疾病已经形成后才遭受其害。脓已经形成的，只有依靠砭石和铍锋（一种古代外科刀具）来切开排脓。
疮疡科中，使用针法最为珍贵。在使用时，必须观察溃口的深浅，审察肌肉的厚薄。如果皮肤薄而针刺过深，反而会损伤正常组织，增加溃烂程度；如果肌肉厚而针刺过浅，脓毒排不出来，反而会增加疼痛。至于附骨疽（生于骨骼深处的脓肿）、气毒、流注（游走性深部脓肿），以及经久不消、内部溃烂但不痛的病症，适宜用燔针（烧红的针）刺开。如果是治疗咽喉部位的疾病，应当使用三棱针。如果是丹瘤及痈疽，四周发红，疼痛如火灼，适宜用砭石刺破皮肤，放出血液以泄出毒邪。病情重的减轻，病情轻的消散。
有一位妇女患腹部痈肿，因脓液胀满而感到胸闷头晕，采用卧位针刺，脓液流出后立刻苏醒。
另有一人患阴囊痈肿，脓已成熟且肿胀，小便不通利，几乎危及生命，紧急施针，大量脓水排出，气机通畅而痊愈。
大抵使用针法，要迎着病势夺取其实邪，顺着病势引导其外出。这就是所谓的“不治已病，治未病；不治已成，治未成”的意思。那些患病的人，有的畏惧针法而不愿使用，医生又顺从患者的意愿而不进行针刺，于是导致脓已形成却无法溃破，或者虽然溃破但损伤已经很深。最终因此夭折或致残的，十有八九，真是可悲啊。
《精要》中说：痈肿像椒眼一样有十几个头，或者像蜂巢一样连房相连，脓血排不出来的，用针横竖切开裂开。如果没有椒眼之类的情况，只需直接刺入取脓，不必切开裂开。（另一种方法）应当在每个椒眼上分别施灸，也很好，不必切开。
小儿患疮疖，首先应当用温衣覆盖，使局部气血凝涩壅滞的状态解除，血脉温和，那么出血就能立即停止。如果不这样做，血脉凝涩时强行针刺，邪毒不能泄出，反而损伤好肉，更加助长疮势。
《精要》说：痈的特点是皮薄肿高，多有十几个像椒眼一样的颗粒；疽的特点是皮肤顽硬，形状像牛颈部的皮。○痈成脓后，针宜用马衔铁制成，形状像薤叶样，两面都锋利，可以横竖裂开五六分许，攻去毒血。必须先施灸然后裂开。○疽成脓后适宜用火烙。可用银篦，宽二寸，长六寸，在火上烧得通红，急于毒处熨烙，能顺利排出脓液即为有效。
又说：一位妇女背部左侧患痈，高突硕大且已成熟，未破溃。医生说可以火烙。旁边有位老成持重的人说：凡是背部上方，是五脏俞穴所系之处，接近膈膜，火烙不得法，必定会伤人。医生说：只宜浅不宜深，宜横不宜直入。（担心伤及膈膜。）宜下不宜上。（担心积聚脓血。）
当时认为这些诀窍都没有妨碍。于是烧红铁箸进行火烙，肌肉破裂，脓液流出，从此痊愈。当时的人惊叹不已，如果不是刽子手手法娴熟，真让人害怕。
又说：当痈肿已经成熟但未溃破时，用铁箸一烙，极其痛快。刚扇火准备接触皮肤时，确实令人惊心。我曾经用过这种方法，临时尚且颤抖恐惧，何况没有经历过的人呢？火烙之后，脓水流通，百无禁忌，称为“熟疮”。对于突起明显的疮口，针口宜向下。但这必须是对火烙技术熟练的人，能够识别深浅，知晓穴位，审察生熟。如果不是时候（即未成熟时），排出的都是生血；到了时候（成熟时），排出的是黄脓和瘀肉。使用尖头针火烙的方法不得法，因为尖针头细，创口容易闭合。只有使用平圆头的工具才为妙，关键在于要使孔穴通透。
或者担心疮口再次闭合，可用细牛膝根，大小与疮口相仿，略割去粗皮，插入疮口中，外部留出半寸左右，随即用嫩橘树叶、地锦草各一把，研成膏敷在上面。牛膝能使恶肉常流，这两种草药能温凉止痛，干了就随时更换，这是十全的功效。
火烙针，其针身圆如筷子，粗细如纬挺，针头平圆，长六七寸，同样规格两枚。捻蘸香油，在炭火中加热，在疮头近下方火烙。宜斜向软处刺入，一次烙不透再烙，必须排出脓液。疮口经过火烙的，称为“熟疮”，脓水常流，不需要按压抑制，仍须保持开放，不要让疮口闭合。
The *Neijing* states: In winter, one should conserve the internal organs; use more medicine and fewer needles and stone lancets. The phrase "fewer needles and stone lancets" does not refer to carbuncles and sores (superficial purulent infections). Carbuncles and sores are critical conditions that cannot be delayed for a moment. "Not delaying" means that if treatment is postponed even briefly, it will lead to the rotting of muscles and bones and perforation of the viscera. (If the principle of timely treatment is not written down, it results in the destruction of muscles, bones, and viscera.) It also states: The emergence of carbuncles and sores, and the formation of pus and blood, arise from the gradual accumulation of pathogens from minute beginnings. Therefore, sages (wise physicians) treat diseases before they take shape, while fools suffer after the disease has already formed. For those with formed pus, only bi shi (stone lancets) and pi feng (a type of ancient surgical knife) can be used to incise and drain.
In the department of sores and ulcers, the use of needles is most valued. When using them, one must observe the depth of the ulceration and examine the thickness of the flesh. If the skin is thin and the needle penetrates too deeply, it will instead damage healthy tissue and increase the extent of ulceration; if the flesh is thick and the needle penetration is too shallow, pus and toxins will not discharge, thereby increasing pain. As for deep bone abscesses (abscesses originating in the bone), qi toxicity, flowing deposits (deep migratory abscesses), and conditions that persist without resolving, or internally ulcerate without pain, it is appropriate to use burning needles (red-hot needles) to open them. For treating throat diseases, three-edged needles should be used. For erysipelas tumors and carbuncles and sores where the four sides are red and pain feels like burning, it is appropriate to use bi shi (stone lancets) to prick the skin and release blood to vent the toxin. Severe cases will see reduction; mild cases will resolve.
A woman suffered from an abdominal carbuncle, experiencing chest tightness and dizziness due to distension by pus. She was needled in a supine position; upon the discharge of pus, she immediately regained consciousness.
Another man suffered from a scrotal carbuncle with mature pus and swelling, accompanied by difficulty urinating, nearly leading to death. Emergency needling resulted in the massive discharge of pus and fluid, the restoration of qi circulation, and recovery.
Generally, the use of needles involves seizing the pathogenic factor against its flow and guiding it out along its flow. This embodies the principle of "treating disease before it arises, treating the unformed before it becomes formed." Patients who fear needles and refuse treatment, combined with physicians who indulge these fears and do not needle, often result in situations where pus forms but fails to rupture, or ruptures with excessive damage. Ultimately, death or disability occurs in eight or nine out of ten cases, which is truly sorrowful.
The *Jingyao* states: Carbuncles may resemble pepper eyes with dozens of heads, or connect like honeycombs, where pus and blood do not discharge. In such cases, use a needle to split them horizontally and vertically. If there are no such pepper-eye-like structures, simply insert the needle directly to extract pus without splitting. (Another method) involves moxibustion on each pepper eye, which is also excellent and avoids splitting.
For children suffering from boils and furuncles, first cover them with warm clothing to resolve the stagnation and coagulation of local qi and blood. Once the blood vessels are warm, bleeding will stop immediately. If this is not done, and needling is performed while the blood vessels are congealed, the pathogenic toxins will not be discharged, instead damaging healthy flesh and exacerbating the condition.
The *Jingyao* states: Carbuncles are characterized by thin skin and high swelling, often having dozens of pepper-eye-like granules; sores (ju) are characterized by hard, waxy skin, resembling the hide of an ox's neck. ○ When a carbuncle matures into pus, the needle should be made of horse-bit iron, shaped like a leek leaf, sharp on both edges, capable of splitting horizontally and vertically by about five to six fen, to attack and remove toxic blood. Moxibustion should be applied first, followed by splitting. ○ When a sore (ju) matures into pus, cauterization is appropriate. A silver comb, two cun wide and six cun long, heated red-hot over fire, should be quickly pressed onto the lesion for cauterization. Successful drainage of pus indicates efficacy.
It is further stated: A woman had a carbuncle on the left side of her back, large, prominent, and mature but unruptured. The physician suggested cauterization. An experienced observer nearby remarked: The upper back is the site of the five Shu points and is close to the diaphragm. Improper cauterization will surely harm the patient. The physician replied: It should be shallow rather than deep, horizontal rather than vertical insertion. (To avoid injuring the diaphragm.) It should be lower rather than upper. (To prevent accumulation of pus and blood.)
At that time, it was deemed that these precautions were sufficient. Thus, a hot iron stick was used for cauterization. The flesh broke, pus flowed out, and she recovered thereafter. People at the time were shocked, remarking that unless one were an executioner skilled in such techniques, it would be terrifying.
It is also said: When a carbuncle is mature but unruptured, a single application of a hot iron stick is extremely relieving. The moment the fan is blown and heat approaches, it is indeed startling. I have used this method myself and still trembled with fear at the time, let alone those inexperienced. After cauterization, pus flows freely, with no taboos, termed a "ripe sore" (shu chuang). For protruding sores, the needle opening should face downward. However, this requires proficiency in cauterization, knowing depth, identifying acupoints, and assessing maturity. If not timed correctly (immature stage), only fresh blood is discharged; when timed correctly (mature stage), yellow pus and necrotic tissue are discharged. Using a pointed needle for cauterization is improper because the fine tip causes the wound to close easily. Only flat, round-headed tools are ideal, as they ensure patent openings.
To prevent the wound from closing again, fine Achyranthes root (Niuxi Gen), sized to fit the wound, with the rough bark slightly removed, can be inserted into the wound, leaving half a cun exposed externally. Then, apply a paste made from fresh citrus leaves and Euphorbia humifusa (Dijin Cao), one handful of each. Achyranthes promotes the continuous discharge of foul tissue, while the two herbs provide warming and cooling effects to relieve pain. Replace as needed when dry. This achieves perfect efficacy.
Cauterizing needles are round like chopsticks, thick like weft rods, with flat round heads, six to seven cun long, two identical pieces. Dip them in sesame oil and heat them in charcoal fire. Cauterize near the base of the sore head. Insert obliquely towards softer areas. If one cauterization is insufficient, repeat until pus discharges. Sores treated by cauterization are called "ripe sores," with constant pus flow, requiring no pressing or suppression, but keeping the opening patent to prevent closure.