凡值此症，若患者方寸不杂，托信于医，而医者又得机关透彻，治法得宜，内外融和，每
每中节，其中亦有可生者，十中一二矣。
既有针工之异说，岂无线药之品详。
凡疮毒既成，当托其脓；脓既成，当用针通，此举世自然之良规也。必当验其生，熟
浅深上下而针之。假如肿高而软者，发于肌肉，脓熟用针，只针四五分；肿下而坚者，发
于节脉，脓熟用针，只在六七分；肿平肉色不变者，毒瓦斯附于骨也，脓熟用针，必须深
入寸许，方得见脓。又轻按热甚便痛者，有脓且浅且稠。重按微热方痛者，有脓且深且
稀。按之陷而不起者，脓未成。按之软而复起者，脓已成。按之都硬不痛者，非脓即瘀
血也，或湿水也。所谓有脓即当针，脓孔宜顺下。若脓生而用针，气血反泄，脓反难成。
若脓熟而不针，腐溃益深，疮口难敛。若脓深而针浅，内脓不出，外血反泄。脓浅而针
深，内脓虽出，良肉受伤。元气虚者，必先补而后针，症随脓退。又有气瘿肿而绵软不
痛者，血瘿肿而内叠成块者，顽毒结之日久，皮腐肉紫，根硬四边红丝缠绕者，以及结核
之症，渐大渐痛渐腐者，以上四症，俱不可轻用针刀掘破。若妄用之，定然出血不止者
立危。但用针之法，妙在脓随针出，而寂然无所知觉也。至于瘿瘤瘰 诸痔诸漏，疔毒
坚硬顽疮，此等症者，若非线药之功，亦不能刻期取效。夫线药乃有五六种，难以概说，
与其各病相应者，亦随症而善用之。
汤散丸丹，要在发而必中，神圣工巧，诚为学人机关。
医善用方，如将善用兵。善于水者，涉海潜波，渡津破浪；善于陆者，穿山越岭，附
葛攀藤；奇偶者鼓舞飞扬，蹊径者浮沉钻凿，弱者可守，强者当敌，此为将用兵之大法。凡
为医者，理皆仿此，其要在知人之强弱，识病之内外，究病之浅深，察时之顺逆，然后
可汗可攻，或吐或下，或宜和解，或宜补益，又知某汤善汗，某散善攻，某丸善和，某丹
善补，因其病而用其方，如矢发机，投之必中，中之必胜，胜之则病无不愈之理，此为
用方之大法也。又如望闻问切，神圣智巧，亦可兼之。所谓望其形而通其神，闻其声而明
其圣，问其由而得其工，切其脉而续其巧。此四者，诚为初学之绳墨也。
至于千万百症，难将说尽短长。
方不在多，心契则灵。症不在难，意会则明。方不心契，症不意会，如疏淡之交，寡
游之地。性情情势不切，何以便托用哉！故药不应病，病不应药，即此据也。
治在活法，贵在审详。
动静世务不同，劳逸机关亦异。昔之受病，从外而来，今之受病，从内而发。又古
者多实，设方宜散宜宣，今者多虚，治法宜滋宜补。若医者不识古知今，一概施与，必
多致其夭亡者也。用之必得其当，医斯可以称良。
凡是遇到这类病症，如果患者内心平静不乱，信任医生，而医生又透彻掌握治疗的关键，治疗方法得当，内外配合和谐，往往能切中病机，其中也有能够治愈的，十个人中能救活一两个。
既然有针灸工匠的不同说法，难道就没有药物疗法的详细记载吗？
凡是疮毒已经形成脓液时，应当托毒排脓；脓液既已成熟，应当用针切开引流，这是举世公认的良好规范。必须验证脓液的生成情况，根据深浅、上下位置进行针刺。假如肿胀高起且质地柔软，说明病变在肌肉层，脓液成熟时用针，只需刺入四五分深；假如肿胀低平且质地坚硬，说明病变在筋骨脉络间，脓液成熟时用针，只需刺入六七分深；假如肿胀平坦、肤色不变，说明毒气附着在骨骼上，脓液成熟时用针，必须深入一寸左右，才能见到脓液。另外，轻按时感觉热甚且疼痛明显的，说明有脓且位置浅、脓液稠厚；重按时微热且才感到疼痛的，说明有脓且位置深、脓液稀薄。按压后凹陷不能立即回弹的，说明脓未形成；按压后柔软并能迅速回弹的，说明脓已形成；按压整体坚硬且不痛的，不是脓就是瘀血，或者是湿水（水肿）。所谓有脓就应当针刺，脓孔宜顺应重力向下。如果在脓液尚未生成时就针刺，气血反而外泄，脓液更难形成；如果脓液成熟却不针刺，腐烂溃破会更加深入，疮口难以愈合；如果脓液位置深而针刺浅，内部脓液排不出，外部血液反而外泄；如果脓液位置浅而针刺深，内部脓液虽然排出，但健康的肌肉组织会受到损伤。元气虚弱的人，必须先补益正气然后再针刺，症状会随着脓液的排出而消退。又有气瘿（甲状腺肿大等），肿胀绵软不痛的；血瘿，肿胀内部叠结成块的；顽固毒邪结聚日久，皮肤腐败肌肉紫暗，根部坚硬四周红丝缠绕的；以及结核类病症，逐渐增大、逐渐疼痛、逐渐溃烂的，以上四种病症，都不可轻易用针刀掘破。如果妄加使用，必然导致出血不止，立刻陷入危险境地。但是用针的方法，妙处在于脓液随针流出，而病人寂静毫无知觉。至于瘿瘤、瘰疬（淋巴结结核）、各种痔疮、各种漏管，疔毒、坚硬顽疮，这些病症，如果不是线药（腐蚀去腐药物）的功效，也不能期望在短时间内见效。线药有好几种，难以一概而论，应当根据各种病症相应地，灵活善于使用它。
汤剂、散剂、丸剂、丹剂，关键在于发汗或攻邪时必须切中病机，“神、圣、工、巧”四法，确实是学习中医的关键所在。
医生善于运用方剂，就像将领善于指挥军队。善于涉水的人，能涉海潜波，渡津破浪；善于行陆的人，能穿山越岭，攀藤附葛；奇正相生则鼓舞飞扬，蹊径突进则浮沉钻凿；弱者可以防守，强者应当迎敌，这是将领用兵的大法。凡是做医生的，道理也都仿照这个，关键在于了解人的体质强弱，识别疾病的表里，探究病情的深浅，观察时令的顺逆，然后决定是否可以发汗、是否可以攻下，或者催吐、或者泻下，或者适宜和解，或者适宜补益。又要知道哪种汤剂善于发汗，哪种散剂善于攻邪，哪种丸剂善于调和，哪种丹剂善于补益，根据病情使用相应的方剂，就像箭从机关射出，投掷必中，命中必胜，胜利了则没有治不好的病，这是运用方剂的大法。又如望、闻、问、切四诊，具备神圣智巧，也可以兼用。所谓观察外形以通晓神气，听声音以明了圣意，询问病因以获得工巧，切脉象以延续技巧。这四点，确实是初学者的准则。
至于成千上百种病症，很难一一说完长短优劣。
方剂不在于多，心意契合则灵验；病症不在于难，意念领会则明白。方剂若不与心意契合，病症若不靠意念领会，就像疏淡的交情，少有人游历的地方。性情与病势如果不切合，怎么能轻易托毒用药呢！所以药物不对应病情，病情也不对应药物，这就是证据。
治疗在于灵活变通，贵在审慎详察。
动静世俗事务不同，劳逸的关键机制也各异。过去患病，多从外部而来；现在患病，多从内部发生。古代人多实证，设立方剂适宜发散宣通；现代人多虚证，治疗方法适宜滋润补益。如果医生不懂得古今差异，一概施治，必定会导致许多人夭亡。用药必须得当，这样的医生才可以称为良医。
Whenever encountering such conditions, if the patient maintains mental tranquility and places trust in the physician, and the physician thoroughly grasps the therapeutic principles with appropriate methods, achieving harmony between internal and external treatments, success is often achieved. Among these cases, there are those who can be saved, perhaps one or two out of ten.
Given the differing opinions among acupuncturists and surgeons, how could there be no detailed records of medicinal therapies?
When sores and toxins have formed pus, it is necessary to support the expulsion of pus; once the pus has matured, it should be drained with a needle. This is a universally accepted standard practice. One must verify the state of the pus and puncture according to its depth, superficiality, and location. For instance, if the swelling is high and soft, indicating involvement of the muscle layer, when the pus matures, the needle should only penetrate four to five fen (approx. 1.3-1.6 cm). If the swelling is low and hard, indicating involvement of the joints and meridians, when the pus matures, the needle should penetrate six to seven fen (approx. 2.0-2.3 cm). If the swelling is flat with unchanged skin color, indicating the toxin adheres to the bone, when the pus matures, the needle must penetrate deeply, about one cun (approx. 3.3 cm), to reveal the pus. Furthermore, if light pressure causes significant heat and pain, it indicates the presence of pus that is shallow and thick. If heavy pressure causes slight heat and delayed pain, it indicates the presence of pus that is deep and thin. If pressing leaves an indentation that does not rebound immediately, the pus has not yet formed. If pressing results in softness and immediate rebound, the pus has formed. If the area is uniformly hard and painless upon pressing, it is neither pus nor blood stasis, but likely dampness or edema. The principle is that if there is pus, it should be punctured, and the incision should follow gravity downwards. If punctured before pus formation, Qi and Blood will leak, making pus formation difficult. If mature pus is not punctured, rot and ulceration will deepen, making wound closure difficult. If the pus is deep but the needle insertion is shallow, internal pus will not drain, while external blood may leak. If the pus is shallow but the needle insertion is deep, although internal pus drains, healthy flesh will be damaged. In patients with deficient Yuan Qi (Original Vital Energy), tonification must precede puncturing, allowing symptoms to recede as pus drains. Regarding Qi Ying (Qi Goiter), characterized by soft, painless swelling; Blood Ying (Blood Goiter), characterized by internal nodular masses; stubborn toxins accumulated over time, presenting with necrotic skin, purple flesh, hard roots, and surrounding red streaks; and tuberculous conditions that gradually enlarge, become painful, and ulcerate—these four types of conditions must never be lightly incised with needles or knives. Reckless use will inevitably lead to uncontrollable hemorrhage and imminent danger. However, the skill of needling lies in the smooth flow of pus upon needle withdrawal, leaving the patient unaware and painless. As for goiters, scrofula (Lymphatic Tuberculosis), various hemorrhoids, fistulas, Ding Du (Carbuncles), hard stubborn ulcers, and other such conditions, without the efficacy of thread medicines (caustic agents for debridement), rapid results cannot be expected. There are several types of thread medicines, which are too numerous to list here; they should be applied flexibly according to the specific condition.
Decoctions, powders, pills, and elixirs are effective only when their actions (such as inducing sweating or purging) precisely target the pathology. The concepts of Shen (Divine), Sheng (Sage), Gong (Skillful), and Qiao (Clever) represent the essential keys for students of medicine.
A physician skilled in prescribing formulas is like a general skilled in commanding troops. Those adept at water travel can navigate seas and break waves; those adept at land travel can cross mountains and climb vines. Using unorthodox tactics inspires momentum, while using direct paths allows for penetration and drilling. Weak forces can defend, strong forces can engage. This is the great method of military command. Physicians should emulate this principle: knowing the strength or weakness of the patient, identifying the interior or exterior nature of the disease, investigating the depth of the pathology, and observing the favorable or unfavorable timing of the season. Then, one decides whether to induce sweating, purge, vomit, or drain, or whether to harmonize or tonify. One must know which decoction excels at sweating, which powder excels at purging, which pill excels at harmonizing, and which elixir excels at tonifying. By matching the formula to the disease, like an arrow released from a trigger, the treatment will hit the mark, ensure victory, and cure the illness. This is the great method of using formulas. Similarly, the Four Diagnostic Methods (Inspection, Auscultation/Olfaction, Inquiry, Palpation) embody divine wisdom and skill. Inspecting the form reveals the spirit; listening to the voice clarifies the sage-like understanding; asking about the cause obtains skillful insight; palpating the pulse continues the clever technique. These four aspects are indeed the compass and square (standards) for beginners.
As for thousands of myriad conditions, it is difficult to exhaustively discuss their nuances.
Formulas are not numerous; spiritual efficacy comes from mental resonance. Conditions are not difficult; clarity comes from intuitive comprehension. If the formula does not resonate with the mind, and the condition is not comprehended intuitively, it is like a distant acquaintance or a rarely visited place. If the nature of the drug and the pathogenic factors do not align, how can one expect to support the expulsion of pathogens? Therefore, if the medicine does not match the disease, and the disease does not respond to the medicine, this is the evidence.
Treatment relies on flexible methods, valuing careful examination.
The dynamics of worldly affairs differ, and the mechanisms of rest and labor vary. In ancient times, diseases often originated externally; nowadays, diseases often originate internally. Anciently, people tended toward excess syndromes, so formulas were suitable for dispersing and venting; nowadays, people tend toward deficiency syndromes, so treatments should favor moistening and tonifying. If a physician fails to understand the differences between ancient and modern contexts and applies treatments indiscriminately, it will inevitably lead to premature death. Medications must be used appropriately; only then can a physician be called excellent.