外科用针，因痈疽脓成不得外泄，毒瓦斯壅遏，疮肿，肌肤内渍，故用针决之，俾脓泄气
通而
肉之浓薄，如皮薄针深则反伤好肉，转增其溃。肉浓针浅，则毒脓不出，反益其痛，用针可
不慎哉。大抵用针以斜锋偏锋为善。其法从旁刺入，以防透膜。欲大开口，则将针斜出，欲
小开口，则将针直出。所谓顺而导之也。然用针自有其时。果其脓熟不能自溃则用之，若未
成脓，不必用针。在膏粱怯弱之人，及肚脐骨节近筋之处，自有代刀散、咬头膏等药备用，
不必用针也。
凡赤游、丹毒、疔疮、红丝走散，或时毒、瘀血壅实等证，皆宜行砭法。然不可太深。
《内
线缚定，两手指轻撮箸尾，令瓷锋正对患处，约悬寸许，再用重箸一根频击箸头，令毒血遇
刺即出，毒瓦斯自退。若毒瓦斯入腹膨胀者难治。
经云∶荣卫稽留于经脉之中则血瘀不行，不行则卫不通故热。大热不止则肉腐为脓。盖
痈疽
白塌木肿本属阴寒，得灸之力，回阳温腠，实为尽善，若一切阳毒红肿 痛，概用灸法，
虽云宣壅散结，恐火攻反致逼毒入里，大痛大肿、神昏痰涌、吁吁作喘奈何？既不敢以人试
药，又不忍糊混相传，故特辨明此条，以待高明校定。阅诸灸法，有用隔蒜灸者，用蛴螬
灸者，用附子饼、豆豉饼、木香饼、香附饼灸者，其法不一，总以通壅积、畅荣卫而已。至于
灸壮之大小，则量疮势定也。
隔蒜灸法（按阴疽流注及麻木痹、寒湿痹痛等证以此灸之。疔疮生下部偏僻之处
，或可用。）
大蒜头去皮切片，约至三个钱浓，安患顶上，用艾壮于蒜上灸之三壮，即换蒜片再灸。
每日
附子饼（按溃疽血气虚寒不能收敛，以此灸之。）
炮附子去皮脐研末，以津唾和为饼，约三个钱浓，置患口上，以艾壮灸之。每日灸数
壮，但令知热勿令痛。如饼干，再易饼灸之，以患口红活为度。
豆豉饼 按顽疮恶癣以此灸之。
江西淡豆豉为末，量患大小，唾津和作饼或黄酒和亦可，约三个钱浓，置疮上，艾壮灸
之。
，令疮孔出汗瘥。
木香饼（按扑损闪肭，血瘀气滞，以此灸之。）
以木香五钱为末，生地黄一两杵膏和匀，量患处大小作饼，置肿上，以艾灸之。
香附饼（按瘰 痰毒或风寒袭于经络结肿，以此灸之。）
生香附为末，生姜自然汁和，量患大小作饼复患处，以艾灸之。
蛴螬灸法（按疳、 、恶疮诸药不效者，以此灸之。）
取蛴螬剪去两头安疮口上，以艾灸之，七壮一易，不过七枚，无不效者。
凡艾灸火疮不收口，用瓦松阴干为末，先以槐枝、葱白煎汤洗过，然后以末搽之即收。
外科使用针具，是因为痈疽脓液形成后无法向外排泄，毒邪壅滞阻塞，导致疮肿，肌肤内部被浸渍腐蚀，所以用针来刺破排脓，使脓液排出、气机通畅。如果肌肉丰厚而针刺过深，反而会损伤好肉，加重溃烂；如果肌肉薄弱而针刺过浅，则毒脓排不出，反而增加疼痛，使用针具能不谨慎吗？大抵使用针具以斜锋、偏锋为佳。其方法是旁侧刺入，以防穿透膜壁。想要开口大些，就将针斜着拔出；想要开口小些，就将针直着拔出。这就是所谓的“顺其势而导引它”。然而使用针自有其时机。确实脓已成熟不能自行溃破时才使用，若尚未成脓，不必用针。对于饮食肥甘厚味体质虚弱的人，以及肚脐、骨节近筋之处，自有代刀散、咬头膏等药物备用，不必用针。
凡是赤游丹、丹毒、疔疮、红丝走黄（红丝蔓延扩散），或时行毒气、瘀血壅实等证候，都适宜施行砭法。但不可刺得太深。《内经》说：“营卫稽留在经脉之中，则血液瘀滞不行，不行则卫气不通故生热。”大热不止则肌肉腐败化为脓。大概痈疽白塌木肿本属阴寒之证，得到灸法的助力，可以回阳温煦腠理，实在是非常完善。若对一切阳毒红肿疼痛，一概使用灸法，虽然说是宣通壅滞、消散结块，恐怕火攻反而逼迫毒邪深入体内，出现大痛大肿、神志昏迷、痰涌气喘等情况怎么办？既然不敢拿人试药，又不忍心糊里糊涂地相传，所以特别辨明这一条，等待高明之士校订确定。查阅各种灸法，有用隔蒜灸的，有用蛴螬灸的，有用附子饼、豆豉饼、木香饼、香附饼灸的，方法不一，总之以通利壅积、畅通营卫为目的。至于灸壮的大小，则是根据疮势来决定的。
隔蒜灸法：按阴疽流注及麻木痹症、寒湿痹痛等证以此灸之。疔疮生于下部偏僻之处，或许也可用。大蒜头去皮切片，厚度约三个钱硬币那么厚，放在患处顶上，用艾炷在蒜片上灸三壮，即换蒜片再灸。每日……
附子饼：按溃疽血气虚寒不能收敛，以此灸之。炮制过的附子去皮去脐研末，用唾液调和做成饼，厚度约三个钱硬币那么厚，放置在疮口上，用艾炷灸之。每日灸数壮，只要感到热而不痛即可。如果饼干了，再更换饼灸，以患处呈现红活颜色为度。
豆豉饼：按顽疮恶癣以此灸之。江西淡豆豉研为末，根据患处大小，用唾液调和做成饼，或用黄酒调和也可以，厚度约三个钱硬币那么厚，放置在疮上，用艾炷灸之，令疮孔出汗而痊愈。
木香饼：按跌扑损伤闪挫，血瘀气滞，以此灸之。取木香五钱研为末，生地黄一两捣成膏混合均匀，根据患处大小做成饼，放置在肿胀处，用艾灸之。
香附饼：按瘰疬痰毒或风寒侵袭经络结肿，以此灸之。生香附研为末，用生姜自然汁调和，根据患处大小做成饼覆盖在患处，用艾灸之。
蛴螬灸法：按疳积、恶疮诸药不效者，以此灸之。取蛴螬剪去两头安放在疮口上，用艾灸之，七壮更换一次，不超过七枚，没有不有效的。
In surgery, needles are used because when an abscess or carbuncle has formed pus that cannot drain externally, toxic pathogens become stagnant and obstructed, causing swelling and internal erosion of the skin and flesh. Therefore, a needle is used to puncture it, allowing the pus to drain and the qi to circulate freely. If the flesh is thick and the needle penetrates too deeply, it will damage healthy tissue and worsen the ulceration; if the flesh is thin and the needle is not deep enough, the toxic pus will not exit,反而 increasing pain. Can one be too cautious when using needles? Generally, using the oblique edge or side edge of the needle is preferable. The method involves inserting from the side to prevent penetrating membranes. To create a larger opening, withdraw the needle at an angle; to create a smaller opening, withdraw the needle straight out. This is what is meant by "guiding along the natural course." However, there is a proper time for using needles. They should only be used when the pus is mature and cannot rupture spontaneously; if pus has not yet formed, needles are unnecessary. For individuals with weak constitutions due to rich diets, and in areas near the umbilicus, bones, joints, and tendons, alternative medicines such as Daigao San (Knife-Replacement Powder) and Yaotou Gao (Head-Biting Ointment) are available for backup, so needles need not be used.
For conditions such as Chiyou Dan (Red Roaming Erysipelas), Danshu (Erysipelas), Dingchuang (Carbuncle/Boil with red thread spreading), Shiduo (Seasonal Toxicity), and Yuxue Yongshi (Stagnant Blood Obstruction), Bianfa (Bian Therapy/Stone Needle Therapy) is appropriate. However, the depth should not be excessive. The *Neijing* states: "When Ying (Nutritive) and Wei (Defensive) Qi stagnate in the meridians, blood stasis occurs. When blood does not flow, Wei Qi cannot circulate, generating heat. Unchecked high heat causes flesh to rot and transform into pus." Generally, Bai Ta Mu Zhong (White Collapse and Wood-like Swelling) of abscesses belongs to Yin-Cold patterns. Receiving the power of Moxibustion helps restore Yang and warm the Couli (interstices), which is truly excellent. However, applying moxibustion indiscriminately to all Yang-Toxic redness, swelling, and pain, although claiming to vent obstruction and dissipate nodules, risks forcing toxic pathogens inward via fire attack, leading to severe pain, massive swelling, coma, phlegm surging, and wheezing. Since we dare not test medicines on people, nor tolerate careless transmission, this point is clarified for review by experts. Various moxibustion methods exist: Garlic-Separated Moxibustion, Larva Moxibustion, and moxibustion using Fuzi Bing (Aconite Cake), Douchi Bing (Fermented Soybean Cake), Muxiang Bing (Costus Cake), and Xiangfu Bing (Cyperus Cake). Methods vary but aim to unblock accumulation and smooth Ying and Wei Qi. The size of the moxa cone depends on the severity of the lesion.
Garlic-Separated Moxibustion: Indicated for Yin-abscesses with flowing metastasis, numbness, Bi-syndrome, and Cold-Damp Bi-pain. May also be used for Dingchuang occurring in lower or remote areas. Peel garlic cloves and slice them to a thickness equivalent to three Qian coins. Place the slice on the affected area. Apply a moxa cone on the garlic and burn three Zhu (moxa cones). Replace the garlic slice and continue burning daily...
Aconite Cake: Indicated for ulcerative abscesses where Qi and Blood deficiency and Cold prevent healing. Take processed Fuzi (Aconiti Lateralis Radix Praeparata), remove skin and navel, grind into powder, mix with saliva to form a cake, approximately three Qian coins thick. Place on the wound and apply moxibustion. Burn several Zhu daily, ensuring warmth without pain. When the cake dries, replace it. Continue until the lesion appears red and vibrant.
Fermented Soybean Cake: Indicated for stubborn ulcers and malignant tinea. Grind Jiangxi Dan Douchi (Pericarpium Sojae Fermentatum) into powder. Mix with saliva or yellow wine to form a cake according to the lesion size, approx. three Qian coins thick. Place on the sore and apply moxibustion until sweat emerges from the pore, indicating recovery.
Costus Cake: Indicated for traumatic injuries, sprains, blood stasis, and Qi stagnation. Grind five Qian of Muxiang (Radix Aucklandiae) into powder. Mix with one Liang of Sheng Dihuang (Radix Rehmanniae Recens) paste. Form a cake to fit the swollen area. Apply moxibustion.
Cyperus Cake: Indicated for Luoli (Scrofula), Phlegm-toxicity, or wind-cold invading meridians causing nodular swelling. Grind raw Xiangfu (Rhizoma Cyperi Rotundi) into powder. Mix with fresh ginger juice. Form a cake to cover the lesion. Apply moxibustion.
Larva Moxibustion: Indicated for Gan-accumulation and malignant ulcers unresponsive to other medicines. Take Quqiāo (Mylabris/Cantharis), cut off both ends, and place on the wound. Apply moxibustion. Change every seven Zhu, using no more than seven insects total. This is invariably effective.
For fire-blisters or burns treated with moxibustion that fail to close, use Wasong (Parmelia/Vascular Lichen) dried in shade and powdered. First wash the area with decoction of Huai Zhi (Cortex Sophorae Tomentosae Ramulus) and Congbai (Sclerophyll Allii Fistulosi). Then apply the powder to promote closure.