上古有砭石之制，《内经》有九针之别，制虽不同，而去病之意则一也。且疮疡一科，
用针为贵。用之之际，虽云量其溃之浅深，尤当随其肉之浓薄。若皮薄针深，则反伤良肉，
益增其溃。肉浓针浅，则脓毒不出，反益其痛。用针者，不可不慎哉。至于附骨疽，气毒流
注，及有经久不消，肉溃不痛者，宜燔针开之。若治咽喉之患，当用三棱针。若丹瘤及痈
毒四畔 赤疼痛如灼，宜用砭石去血，以泄其毒，则重者轻，轻者消。如洪氏室患腹痈，脓
胀闷瞀，以卧针刺脓出即苏。一人患囊痈，脓熟肿胀，小便不利，几殆，急针之，脓水大泄
，气通而愈。大抵用针之法，迎而夺之，顺而取之，所谓不治已成，治未成，正此意也。今
之患者，畏针而不用，医者又徇患者之意而不针，遂至脓已成而不得溃，或得溃而伤已深矣
，卒之夭枉者十常八九，亦可悲矣。见《外科心法》
经曰∶天温日明，则人血淖溢，而卫气浮，故血易泄，气易行。天寒日阴，则人血凝涩
，而卫气沉。是以因天时而调血脉也。故凡遇天寒水冰，或阴气凝滞之时，欲行针刺，则先
当温衣覆盖，或以艾叶炒热，或热盥热衣类，先熨其处，务令血脉温和，而后刺之，则血泄
气行，其病立已。若血寒脉涩，遽尔用针，则邪毒不泻，徒伤良肉，反以益其病也。
立斋曰∶凡元气虚弱者，必当补助脾胃，禁用刀针，若妄用之，而去肉去血，便阳随阴
散，是速其危也。
薛按曰∶四明有屠寿卿者，当门齿，忽如所击，痛不可忍，脉洪大而弦。余曰，弦洪相
搏，将发疮毒也。先用清胃散加白芷、银花、连翘一剂，痛即止。至晚鼻上发一疮，面肿黯
痛，用前药加犀角一剂，肿至两额，口出秽气，脉益洪大，恶寒内热。此毒炽血瘀，药力不
能敌也。乃数砭患处，出紫血，服犀角解毒之药。异日肿痛尤甚。又砭患处与唇上，并刺口
内赤脉，各出毒血，再服前药，至数剂而愈。
上古时期有砭石的制作，《内经》中记载了九种不同的针具，虽然制式不同，但祛除病邪的目的是一致的。而且疮疡这一科，使用针法最为珍贵。在使用时，虽然说要衡量溃烂的深浅，更应当根据肌肉的厚薄来决定。如果皮肤薄而针刺深，反而会损伤健康的肌肉，增加溃烂的程度；如果肌肉厚而针刺浅，脓毒排不出来，反而会增加疼痛。使用针法的人，不可不谨慎啊。至于附骨疽、气毒流注，以及经久不消、肌肉溃烂但不痛的病症，适宜用燔针（烧红的针）来刺开。如果治疗咽喉部位的疾患，应当使用三棱针。如果是丹瘤及痈毒四周红肿疼痛如火灼，适宜用砭石放血，以泄出毒邪，那么重症就会减轻，轻症就会消散。比如洪氏的妻子患腹痈，脓胀闷乱昏厥，用卧针（平刺或浅刺）刺破排脓后立刻苏醒。有一人患囊痈，脓熟肿胀，小便不通利，几乎丧命，紧急针刺后，脓水大量流出，气机通畅而痊愈。大抵使用针法的原则，是迎着病势夺取邪气，顺着病势引导正气，所说的“不治已成之脓，治未成之脓”，正是这个意思。现在的患者，害怕针法而不使用，医生又顺从患者的意愿而不施针，导致脓已形成却无法溃破，或者虽然溃破但损伤已经很深，最终夭折的十有八九，也可以说是可悲了。见于《外科心法》
经文说：天气温暖日照明亮时，人的血液运行滑利充盛，卫气浮越于表，所以血液容易泄出，气机容易运行。天气寒冷日照阴暗时，人的血液凝滞涩少，卫气沉伏于里。因此要根据天时来调理血脉。所以凡是遇到天寒水冰，或阴气凝滞的时候，想要进行针刺，应当先让病人穿暖覆盖好，或者用炒热的艾叶，或用热水洗手穿衣之类的方法，先在患处熨烫，务必使血脉温和，然后再针刺，这样血液泄出、气机运行，疾病立刻就好。如果血液寒凝脉道涩滞，仓促使用针法，那么邪毒不能排出，白白损伤健康肌肉，反而加重病情。
立斋（薛己）说：凡是元气虚弱的人，必须补助脾胃，禁用刀针，如果胡乱使用，去肉伤血，就会导致阳气随着阴血散失，这是加速其死亡危险。
薛己按语说：四明有个叫屠寿卿的人，门牙突然像被击打一样，痛不可忍，脉象洪大而弦。我说，弦脉与洪脉相搏结，将要发生疮毒。先用清胃散加白芷、金银花、连翘一剂，疼痛立即停止。到了晚上鼻子上发一个疮，面部肿胀色暗疼痛，用前面的药方加犀角一剂，肿胀蔓延到两额，口出秽气，脉象更加洪大，恶寒内热。这是毒邪炽盛血瘀，药力不能抵挡。于是多次在患处砭刺，放出紫黑色的血，服用犀角解毒的药物。第二天肿痛更加严重。又在患处和嘴唇上砭刺，并刺破口腔内的赤色脉络，各放出毒血，再服用前面的药物，经过几剂后痊愈。
In ancient times, there was the system of Bian stones (Bian Shi, 砭石 - stone knives for surgical incision), and in the *Neijing* (Inner Canon), there are distinctions among the Nine Needles (Jiu Zhen, 九针 - nine types of acupuncture needles). Although their forms differ, the intent to eliminate disease is the same. Moreover, in the specialty of sores and ulcers (Chuang Yang, 疮疡), the use of needles is highly valued. When using them, although one must measure the depth of ulceration, it is even more important to follow the thickness of the flesh. If the skin is thin and the needle insertion is deep, it will instead damage healthy tissue and exacerbate ulceration. If the flesh is thick and the needle insertion is shallow, pus and toxins will not be discharged, increasing pain instead. Those who use needles must be extremely cautious. As for Gujiju (Attaching-Bone Abscess, 附骨疽), Qi-toxin flowing deposits, and conditions that persist without resolving where flesh ulcerates but does not hurt, it is appropriate to use Fan Zhen (Fired Needle, 燔针 - a red-hot needle) to open them. For treating throat ailments, a Three-Edge Needle (San Leng Zhen, 三棱针) should be used. For Danliu (Erysipema-like Tumors, 丹瘤) and carbuncle toxins with surrounding redness and burning pain, Bian stones should be used to bleed, thereby draining the toxin; severe cases will become mild, and mild cases will resolve. For instance, the wife of Mr. Hong suffered from an abdominal carbuncle with distension, fullness, and fainting due to pus accumulation; she revived immediately after being needled (Wu Zhen, 卧针 - flat/oblique insertion) to drain the pus. Another patient suffered from scrotal carbuncle with ripened pus and swelling, causing difficulty in urination and nearly fatal condition; urgent needling led to massive drainage of pus and fluid, restoration of Qi flow, and recovery. Generally, the method of using needles involves attacking against the pathogen to deprive it (Ying Er Duo Zhi, 迎而夺之) and following the pathogen to extract it (Shun Er Qu Zhi, 顺而取之). This refers to the principle of "treating before the abscess fully matures," which is exactly this meaning. Today's patients fear needles and refuse treatment, while doctors, complying with patients' wishes, do not needle. Consequently, pus forms but cannot rupture, or if it ruptures, the damage is already deep. Ultimately, eight or nine out of ten die prematurely, which is truly lamentable. See *Waike Xinfa* (New Methods in Surgery).
The Classic states: When the weather is warm and sunny, human blood flows freely and abundantly, and Wei Qi (Defensive Qi, 卫气) floats on the surface; thus, blood is easily released, and Qi moves readily. When the weather is cold and cloudy, human blood becomes congealed and sluggish, and Wei Qi sinks inward. Therefore, one must adjust the blood vessels according to the seasons. Hence, whenever encountering cold weather, frozen water, or times when Yin Qi is stagnant, and one intends to perform acupuncture, one should first keep the patient warm with clothing or coverings, or use heated mugwort leaves, or hot water for washing hands and warming clothes, to moxa-warm or heat the area first. It is essential to ensure the blood vessels are warm before needling; then, as blood releases and Qi moves, the illness will be cured immediately. If blood is cold and pulses are sluggish, and needles are used hastily, the pathogenic toxins will not be drained, only healthy tissue will be injured, and the illness will worsen.
Lizhai (Xue Ji) stated: For those with deficient Yuan Qi (Original Qi, 元气), it is necessary to tonify the Spleen and Stomach, and knife-and-needle procedures are strictly prohibited. If used recklessly, damaging flesh and blood, Yang will dissipate along with Yin, accelerating danger.
Xue Ji noted: There was a butcher named Tu Shouqing in Siming. Suddenly, his front teeth felt as if struck, with unbearable pain. The pulse was surging (Hong, 洪) and wiry (Xian, 弦). I said, the combination of wiry and surging pulses indicates that sores and toxins are about to erupt. I first prescribed Qingwei San (Stomach-Clearing Powder, 清胃散) plus Bai Zhi (Angelicae Dahuricae Radix, 白芷), Yin Hua (Honeysuckle Flower, 银花), and Lian Qiao (Forsythiae Fructus, 连翘) for one dose, and the pain stopped immediately. By evening, a sore erupted on the nose, with dark, swollen, and painful face. Using the previous prescription plus Xi Jiao (Rhinoceros Horn, 犀角), the swelling spread to both temples, foul breath emanated, the pulse became more surging, and there was aversion to cold with internal heat. This indicated blazing toxin and blood stasis, beyond the power of medicine alone. I bled the affected area multiple times with Bian stones, releasing purple blood, and administered detoxifying medicines with Xi Jiao. The next day, swelling and pain were even worse. I again bled the affected area and the upper lip, and pricked the red vessels inside the mouth, draining toxic blood each time. After administering the previous medicine for several doses, he recovered.