《素问》曰∶夫痈气之息者，宜以针开除去之，夫气盛血聚者，宜石而泻之，此
所谓同病异治也。
《通评虚实论》曰∶所谓少针石者，非痈疽之谓也。痈疽不得顷时回。
《灵枢》曰∶铍针者，末如剑锋，以取大脓。
李东垣曰∶夫上古制砭石大小者，随病所宜也。《内经》谓针石、砭石、 针，
其实一也。今时用镰者，从《圣济总录》丹毒论曰∶法用镰割出血，明不可缓也。合
扁鹊云∶病在血脉者，治之以砭石。此举《素问》血实宜决之。又《气血形志论》曰∶
形乐志乐，病生于内，治之以砭石。盖砭石者，亦东方来，为其东方之民，其病多
疮疡，其法宜砭石。砭石之用，自有证候，非止丹瘤也。但见肿起色赤，游走不定，宜
急镰之，先以生油涂赤上，以镰镰之，要在决泄其毒。然而此法不可轻用，忌其太
深。《内经》所刺皮无伤肉，以其九针之用，而各有所宜也。砭镰之法，虽治疮疽、不
可轻用也。（砭镰论）
周文采曰∶如针砭伤其经络，白脓赤
汁逗流不止，宜服内托黄 圆∶生黄 去芦焙锉八两，当归洗焙三两，木香、沉香、
肉桂去粗皮，不见火，乳香别研，各一两。诸香忌见火，共为细末，用绿豆粉四两，生
姜自然汁煮糊为丸，桐子大。不拘时温汤送下，四五十丸。（《集验》）
又曰∶古人用砭石、 针、刀镰，乃决疮毒之器械也。所谓疮毒之宜出血，可
急去之意，不可延缓，恐毒势变走。《内经》云∶病在血脉；决之于针石也。岐伯
五治论云∶砭针，乃磁石锋芒利快，决毒甚便，乃东方之民，善于此，用于疮疖、丹
瘤，涂生油于赤肿之上，砭之出血。妙在合宜，亦不可过之耳。
薛立斋曰∶若元气虚弱，误服克伐，患处不痛，或肉将死，急温补脾胃，亦有生
者，后须纯补之药，庶可收敛。若妄用刀针，刺肉出血，则气无所根据附，气血愈虚，
元气愈伤矣。何以生肌收敛乎！
陈实功曰∶凡疮十日以后，自当腐溃为脓，如期不作脓腐，仍然坚硬者，此属
阴阳相半之证，疮根必多深固，若不将针当头点入寸许，开窍发泄，使毒瓦斯无门而
出，必致内攻也。倘内有脓又便易出，此为开户逐贼之意。如十日外疮虽不腐溃，形
尚红活， 热肿痛，此虽脓迟，后必有出，此又不必针之。盖由元气不能充足，或失
用补托药，又误用寒凉，或盖覆未暖，多致脓迟。有此证者，宜用补中健脾，大托
补药，以得脓为效。又以十五日至二十一日为期，过此外者纵有稀脓，但元气被毒
相拒日久，必致耗散，诚难归结也。（《正宗》）
又曰∶如疮半月后，仍不腐溃，不作脓者，毒必内陷，急用铍针品字样，当原
顶寸许点开三孔，随疮之深浅，一寸、二寸，皆可入之，入之不痛，再深入不妨，随
将药筒预先煮热，对孔窍合之。良久，候温取下，如拔出之物，血要红而微紫，脓
要黄而带鲜，此为血气营运活疮；如拔出瘀血紫黑，色败气秽，稀水无脓者，此为
气血内败死疮。
程山龄曰∶凡毒有胀痛紧急，脓已成熟，无暇待灼艾火照者，即宜用刀法开之。
但刀法须在的确脓熟之时，又须要深浅合度，以左手按肿处，先看脓之成否，如按
下软而不痛，随手起者，脓已成也；按下硬而痛，或凹陷不起者，脓未成也。已成
脓者宜刺，未成脓者宜姑待之。若脾虚气弱者，宜托补之。又须看其脓之深浅，以
手指按下软肉深者，其脓必深；软肉浅者，其脓必浅。若脓浅刀深，恐伤好肉；脓深
刀浅，恐毒不出而内败，最宜斟酌。更有伏骨之疽，脓腐于内，皮色不变，宜以刀
刺入深处，放出瘀脓，或灸开大口放出之，不得姑息因循，俾毒瓦斯越烂越深也。其下
刀须利刃，勿令病者见，恐惊彼耳。砭法施于头面及耳之前后，因其漫肿无头，急
用此法，以泻其毒。取上细磁锋，用竹箸夹定紧扎，放出锋约半分许，对患处，另
以箸敲之，偏刺肿处，俾紫血多出者为善。刺毕以精肉贴片时，再用鸡蛋清调乳香末
润之。盖此地不宜成脓，因头内中空，耳前后更多曲折，提脓拔毒，恒多未便，故
砭法断宜早施。（《十法》）
薛立斋曰∶若患于背髀之间，凡人背近脊处，并髀皮里有筋一层，患此处者，外
皮虽破，其筋难溃，以致内脓不出，令人胀痛苦楚，气血转虚，变证百出，若待自
溃多致不救。必须开之引之，兼以托里，常治此证，以利刀剪之，尚不能去，似此坚
物，待其自溃，不反甚乎！此非气血壮实者，未见其能自溃也。
又曰∶疮疡脓成，而及时针之，不数日即愈矣。常见患者，皆畏针痛而不肯用，
又有恐伤肉而不肯用。殊不知疮虽发于肉薄之所，若其脓成，必肿高寸余，疮皮又
浓分许，用针深不过二分。若发于背，必肿高二三寸，入针止寸许，况患处肉既已
坏，何痛之有，何伤之虑？凡怯弱之人，或患附骨等疽，待脓自通，以致大溃不能收
敛，气血沥尽而已者，多矣。
又曰∶凡疮既成脓，皮肤不得疏泄，昧者待其自穿，殊不知少壮而充实者，或能
自解，若老弱之人，气血枯槁，或兼攻伐太过，不行针刺，脓毒乘虚内攻，穿肠腐
膜，鲜不误事。若毒结四肢，砭刺少缓，则腐溃深大，亦难收敛。毒结颊、项、胸、腹
紧要之处，不问壮弱，急宜针刺，否则难治。大抵疮疡之证，感有轻重，发有深浅。
浅者肿高而软，发于血脉；深者肿下而坚，发于筋骨。然又有发于骨髓者，则皮肉不
变，故古人制法，浅宜砭而深宜刺，使瘀血去于毒聚之始，则易消。若脓成之时，气
血壮实者自出，怯弱者，不行针刺，鲜有不误。凡疮疡透膜，十无一生，虽以大补
药治之，亦不能救，此可为待脓自出之戒也。
《心法》曰∶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。其疮疡一科，用针为贵。用针之际，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
者可不慎哉！至于附骨疽、气毒流注及有经久不消，内溃不痛者，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，则重者减，轻者消。如洪氏室患腹痈，脓胀闷瞀，以卧针刺出脓即苏。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，或畏针而
不用，医者又徇患者之意而不针，遂至脓已成而不得溃，或得溃而所伤已深矣。卒
之夭亡者，十常八九，亦可悲矣。
张景岳曰∶经云∶天温日明，则人血淖溢，而卫气浮，故血易泻，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，或热盐、热衣类先熨其处，
务令血脉温和而后刺之，则血泻气行，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。
薛立斋曰∶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，
使阳随阴散，是速其危也。
孙真人曰∶针灸血出不止，用人屎烧灰，敷上立止。
《素问》说：凡是痈疽之气壅滞的，适宜用针具切开排脓；凡是气盛血聚的，适宜用砭石来泻邪。这就是所说的“同病异治”。
《通评虚实论》说：所谓“少用针石”，指的不是治疗痈疽的情况。因为痈疽发病急迫，不能片刻延误。
《灵枢》说：铍针，其末端像剑锋一样，用来排出大量脓液。
李东垣说：上古时期制作砭石的大小，是根据病情适宜的程度来决定的。《内经》认为针、石、砭石，本质上是一样的。现在人们使用镰刀割治，是依据《圣济总录·丹毒论》的说法：“法度是用镰刀割破出血，说明不可迟缓。”结合扁鹊的观点：“病在血脉的，用砭石治疗。”这是引用《素问》中“血实宜决之”的理论。另外，《气血形志论》说：“形体安逸、精神愉悦的人，病生于内部，用砭石治疗。”大概砭石起源于东方，因为东方百姓多患疮疡，所以治疗方法适宜用砭石。砭石的运用自有其证候指征，不仅仅是治疗丹瘤。只要见到红肿突起、颜色发红、游走不定的症状，就应当紧急用镰刀割治，先在患处涂上生油，然后用镰刀割破，关键在于泄出毒邪。然而这种方法不可轻易使用，忌讳刺得太深。《内经》指出针刺皮肤不要伤及肌肉，这是因为九针各有其适宜的用途。砭镰之法，虽然可以治疗疮疽，但也不可轻率使用。（出自《砭镰论》）
周文采说：如果针砭损伤了经络，导致白脓和赤汁淋漓不止，适宜服用内托黄芪丸：生黄芪（去芦头，焙干锉碎）八两，当归（洗净焙干）三两，木香、沉香、肉桂（去粗皮，忌见火），乳香（另研细末），各一两。各种香药都忌讳见火，共同研成细末，用绿豆粉四两，生姜自然汁煮糊作为粘合剂制成丸药，大小如梧桐子。不拘时候，用温开水送服，每次四五十丸。（出自《集验方》）
又说：古人使用砭石、针、刀镰，是决断疮毒的器械。所谓疮毒适宜出血，意思是应当迅速去除，不可延缓，恐怕毒势蔓延变化。《内经》说：“病在血脉，用针石决断。”岐伯的五治论说：砭针是用磁石磨制的，锋利快速，决断毒邪非常方便，这是东方百姓擅长此法，用于疮疖、丹瘤时，在红肿处涂上生油，用砭石刺破出血。妙处在于合乎适宜，也不可不加节制。
薛立斋说：如果元气虚弱，误服攻伐药物，患处不痛，或者肌肉即将坏死，应当紧急温补脾胃，也有能救活的，之后必须用纯补的药物，才可能收敛愈合。如果妄用刀针，刺破肌肉出血，那么气就无所依附，气血更加虚弱，元气更加受损，怎么能促进生肌收敛呢！
陈实功说：凡是疮疡十天以后，自然会腐烂化脓，如果到了期限还不化脓腐溃，仍然坚硬的，这属于阴阳相半的证候，疮根必然深固，如果不将针尖垂直点入一寸左右，开窍发泄，使毒邪没有出路而外排，必定会导致毒邪内攻。如果里面有脓就容易排出，这是“开户逐贼”的意思。如果十天外面疮虽未腐溃，形状还红活，发热肿痛，这虽然化脓迟，但后来必定会出脓，这种情况就不必用针。大概是因为元气不足，或者失于使用补托药，又误用寒凉药，或者保暖不够，多导致化脓延迟。有此证候者，适宜用补中健脾、大剂量托补的药物，以得脓为见效。又以十五天到二十一天为期限，超过这个期限即使有稀脓，但因为元气被毒邪抗拒日久，必定耗散，确实很难收口愈合了。（出自《外科正宗》）
又说：如果疮疡半个月后，仍然不腐溃、不化脓，毒邪必定内陷，紧急用铍针呈品字形，在疮顶正中点入一寸左右开三个孔，根据疮的深浅，一寸、二寸都可以刺入，刺入时不痛，再深入也无妨，随即预先煮热的药筒，对准孔窍吸附在上面。过一会儿，等温度降低取下，看拔出的东西，血液要红而微紫，脓液要黄而带鲜色，这是气血运行活跃的好疮；如果拔出的是瘀血紫黑，色泽败坏气味秽臭，只有稀水没有脓的，这是气血内败的死疮。
程山龄说：凡是毒邪有胀痛紧急感，脓已成熟，无暇等待艾灸火照确认的，就应当用刀法切开。但刀法必须在确知脓熟之时，并且深浅要合度。用左手按住肿胀处，先看脓是否形成，如果按下柔软且不痛，手松开后迅速回弹的，脓已成；如果按下坚硬且痛，或者凹陷不起的，脓未成。已成脓的适宜刺破，未成脓的适宜姑且等待。如果脾虚气弱，适宜用托补法。还要看脓的深浅，用手指按下软肉深的，脓必深；软肉浅的，脓必浅。如果脓浅刀深，恐怕伤及好肉；脓深刀浅，恐怕毒出不来而内败，最需谨慎斟酌。更有伏骨疽，脓腐在里面，皮色不变，适宜用刀刺入深处，放出瘀脓，或者灸开大口放出，不得姑息拖延，让毒邪越烂越深。下刀须用利刃，不要让病人看见，恐怕惊吓到他。砭法施用于头面及耳前后，因为这些部位漫肿无头，紧急时用此法以泻毒。取上好的细磁锋，用竹筷夹定紧扎，露出锋尖约半分许，对准患处，另用筷子敲击，偏刺肿处，使紫血多出为好。刺完后用精肉片贴敷，再用鸡蛋清调乳香末润湿。大概这里不宜成脓，因为头部中空，耳前后更多曲折，提脓拔毒往往不便，所以砭法应当尽早施行。（出自《十法》）
薛立斋说：如果患病在背髀之间，凡人背部靠近脊柱处，以及髀皮里有筋一层，患此处者，外皮虽然破了，里面的筋难溃破，导致内脓不出，令人胀痛苦楚，气血转虚，变证百出，如果等待自溃，多致无法救治。必须切开引流，兼以托里，经常治疗此证，用利刀剪除，尚且不能去除，像这样坚硬的物体，等待它自溃，不是更严重吗！这不是气血壮实的人，没见他能够自溃的。
又说：疮疡脓成，及时用针刺破，不几天就痊愈了。常见患者，都畏惧针痛而不肯用，又有害怕伤肉而不肯用的。殊不知疮虽然发于肉薄的地方，但如果脓成，必定肿胀高起一寸多，疮皮又厚一分多，用针深度不超过二分。如果发于背部，必定肿胀高二三寸，入针只有一寸左右，况且患处肉已经坏死，有什么疼痛可言，有什么可担心的？凡是怯弱的人，或者患附骨疽等，等待脓自行通畅，导致大溃而不能收敛，气血沥尽而死的，太多了。
又说：凡是疮既成脓，皮肤不得疏泄，愚昧之人等待它自己穿破，殊不知身体强壮充实的人，或许能自行解开，如果是老弱之人，气血枯槁，或者兼攻伐太过，不行针刺，脓毒乘虚内攻，穿肠腐膜，很少有不误事的。如果毒结在四肢，砭刺稍微迟缓，则腐溃深大，也难收敛。毒结在颊、项、胸、腹紧要之处，不问壮弱，紧急适宜针刺，否则难治。大抵疮疡之证，感受有轻重，发作有深浅。浅的肿胀高而软，发于血脉；深的肿胀低而硬，发于筋骨。然而又有发于骨髓的，则皮肉不变，所以古人制法，浅的适宜砭刺而深的适宜针刺，使瘀血在毒聚之初就去掉，则容易消散。如果脓成之时，气血壮实的自行排出，怯弱的，不行针刺，很少有不误事的。凡是疮疡透膜的，十无一活，即使以大补药治疗，也不能救，这可以作为等待脓自出的警戒。
《心法》说：上古有砭石的制度。《内经》有九针的区别，制度虽然不同，但去病的意思是一样的。其疮疡一科，用针最为珍贵。用针的时候，虽然说要根据溃破的深浅，尤其应当根据肉的厚薄，如果皮薄针深，反而伤及良肉，增加溃烂；肉厚针浅，则脓毒不出，反而增加疼痛，用针的人能不谨慎吗！至于附骨疽、气毒流注以及经久不消、内溃不痛的，适宜用燔针（烧红的针）开之；如果治疗咽喉的病患，应当用三棱针；如果丹瘤及痈毒，四周红赤，疼痛如火灼，适宜用砭石放血，以泄其毒，则重的减轻，轻的消除。比如洪氏的妻子患腹痈，脓胀闷乱昏迷，用卧针刺出脓后立即苏醒。一人患囊痈，脓熟肿胀，小便不利，几乎死亡。紧急针刺，脓水大泄，气通而愈。大抵用针的方法，迎而夺之，顺而取之，所谓“不治已成，治未成”，正是这个意思。现在的患者，有的畏惧针而不用，医生又顺从患者的意愿而不针刺，遂至脓已成而不能溃破，或者溃破了但伤害已经很深了。最终夭亡的，十常八九，也可悲啊。
张景岳说：经书说：天气温暖日光明亮，则人血淖溢，卫气浮越，所以血易泻，气易行；天气寒冷日阴暗，则人血凝涩，卫气沉潜，因此要因天时来调理血脉。所以凡是遇到天寒水冰，或阴气凝滞的时候，想要进行针刺，则先应当温衣覆盖，或者用艾叶炒热，或用热盐、热衣之类先熨烫患处，务必令血脉温和而后针刺，则血泻气行，病立即痊愈。如果血寒脉涩，仓促用针，则邪毒不泻，徒然伤及良肉，反而加重病情。
The *Suwen* (Basic Questions) states: For carbuncles and sores where qi is stagnant, it is appropriate to use needles to open and drain them; for conditions where qi is excessive and blood accumulates, it is appropriate to use bian stones (stone scalpels) to purge. This is what is referred to as "treating the same disease with different methods."
The *Tongping Xuushi Lun* (Discussion on Excess and Deficiency in Tongping) states: The phrase "rarely using needles and stones" does not refer to the treatment of carbuncles and sores. Carbuncles and sores cannot be delayed for even a moment.
The *Lingxu* (Spiritual Pivot) states: The Pi needle (Bian needle), whose tip resembles the edge of a sword, is used to extract large amounts of pus.
Li Dongyuan stated: In ancient times, the size of bian stones was made according to the suitability for the disease. The *Neijing* (Inner Canon) considers needles, stones, and bian stones to be essentially the same. Nowadays, people use sickles for cutting, following the *Shengji Zonglu* (General Records of Sage Medicine) on Erysipelas: "The method is to cut with a sickle to release blood, indicating that delay is not permissible." Combining this with Bian Que's view: "For diseases in the blood vessels, treat with bian stones." This cites the *Suwen*'s principle: "When blood is excessive, it should be drained." Additionally, the *Qixue Xingzhi Lun* (Discussion on Qi, Blood, Form, and Will) states: "For those whose physical life is comfortable and mental life is joyful, diseases arise internally, treated with bian stones." Generally, bian stones originated from the East, because the people of the East often suffered from skin sores, so the method suitable for them was bian stone therapy. The use of bian stones has its own indications, not limited to erysipelas. Whenever swelling rises, color turns red, and moves unpredictably, urgent cutting with a sickle is indicated. First apply raw oil to the redness, then cut with the sickle; the key is to vent the toxin. However, this method should not be used lightly, and one must avoid puncturing too deeply. The *Neijing* advises that when needling the skin, do not injure the flesh, because each of the nine needles has its specific indication. Although the bian-sickle method can treat sores and carbuncles, it should not be used rashly. (From *Bianlian Lun*)
Zhou Wencai said: If needling or bian stone therapy damages the meridians, causing white pus and red fluid to flow continuously, it is appropriate to take Neituo Huangqi Wan (Internal Supportive Astragalus Pill): Sheng Huangqi (Astragali Radix, remove rhizome, bake and slice) 8 liang, Danggui (Angelicae Sinensis Radix, wash and bake) 3 liang, Muxiang (Aucklandiae Radix), Chenxiang (Aquilariae Lignum Resinatum), Rougui (Cinnamomi Cortex, remove rough bark, avoid fire), Xurong (Olibanum, separately ground), each 1 liang. All aromatic herbs should avoid fire. Grind all into fine powder, mix with 4 liang of Moutari Semen (Mung Bean Starch) paste boiled in fresh juice of Zingiberis Rhizoma Recens (Fresh Ginger Juice) to form pills the size of paulownia seeds. Take at any time with warm water, 40-50 pills per dose. (From *Jiyan Fang*)
He also said: In ancient times, bian stones, needles, and sickles were instruments to decide and drain sore toxins. The idea that sore toxins should bleed means they should be removed urgently without delay, lest the toxin spread and change. The *Neijing* says: "Disease in the blood vessels is decided by needles and stones." Qibo's Five Treatments Theory states: Bian needles are made from magnetite, sharp and quick, very convenient for draining toxins. This was a skill of the Eastern people, used for boils, furuncles, and erysipelas; applying raw oil to the red swelling and piercing with bian stones to release blood. The subtlety lies in appropriateness, but one must not overdo it.
Xue Lizhai said: If the Yuanqi (Original Qi) is weak and astringent drugs are mistakenly taken, the affected area may not hurt, or the flesh may be about to die. Urgently warm and tonify the Spleen and Stomach; there are cases of survival. Afterwards, pure tonic medicines are necessary to achieve healing. If knives and needles are recklessly used, piercing flesh and bleeding, the Qi will have no foundation, and both Qi and Blood will become more deficient, further injuring the Yuanqi. How can muscle regeneration and healing occur?
Chen Shigong said: Generally, after ten days of a sore, it should naturally rot and suppurate. If it does not suppurate or rot by the expected time and remains hard, this belongs to a syndrome of equal Yin and Yang. The root of the sore is likely deep and solid. If one does not insert a needle vertically into the center for about one cun to open an orifice and vent the toxin, allowing the pathogenic factor to exit, it will inevitably attack inward. If pus is present inside, it will be easy to discharge, which is the meaning of "opening the door to drive out the thief." If after ten days the sore has not rotted but appears red and lively, with heat, swelling, and pain, although suppuration is delayed, it will eventually appear, and needling is unnecessary here. This is usually due to insufficient Yuanqi, failure to use supportive tonics, misuse of cold-cooling herbs, or inadequate warmth covering. For such syndromes, use Zhongjian Buzhong (Middle-Jiao Tonifying) and strong supporting tonics, aiming for suppuration as the sign of efficacy. Set the deadline at fifteen to twenty-one days. Beyond this period, even if there is thin pus, because the Yuanqi has been resisting the toxin for a long time, it will surely dissipate, making healing difficult. (From *Waike Zhengzong*)
He also said: If after half a month the sore still does not rot or suppurate, the toxin must have sunk inward. Urgently use a Pi needle to make three holes in a 'pin' character pattern on the top of the sore, inserting one to two cuns depending on depth. Insertion should be painless; deeper insertion is acceptable. Immediately apply a pre-heated medicinal jar over the holes. After some time, when cool, remove it. Observe the extracted material: if the blood is red with a slight purple tint and the pus is yellow with a fresh hue, this indicates active circulation of Qi and Blood and a viable sore; if the extracted blood is dark purple-black, the color is dull, the odor is foul, and there is only thin fluid without pus, this indicates internal failure of Qi and Blood and a dead sore.
Cheng Shanling said: Whenever there is toxin with urgent distending pain and mature pus, leaving no time to wait for moxibustion confirmation, one should use the knife method to open it. However, the knife method must be used only when pus is definitely mature, and the depth must be appropriate. Press the swollen area with the left hand to check for pus formation: if it feels soft and painless upon pressure and rebounds quickly upon release, the pus is mature; if it feels hard and painful, or sinks and does not rebound, the pus is immature. Mature pus should be pierced; immature pus should be waited for. If the Spleen is deficient and Qi is weak, use supporting tonification. Also observe the depth of the pus: if pressing with fingers reveals deep soft tissue, the pus is deep; if shallow, the pus is shallow. If the pus is shallow but the knife goes deep, good flesh may be injured; if the pus is deep but the knife is shallow, the toxin may not exit and cause internal failure. Careful consideration is essential. There is also Guju (Bone-abscessing carbuncle), where pus rots internally but the skin color does not change. It is appropriate to pierce deeply with a knife to release stasis and pus, or burn a large opening with moxa to drain it. Do not hesitate or delay, allowing the toxin to rot deeper. Use a sharp blade for incision, and do not let the patient see it, to avoid startling them. Bian therapy is applied to the head, face, and around the ears because these areas have diffuse swelling without a head; use this method urgently to vent the toxin. Take a fine magnetic tip, clamp it tightly with bamboo chopsticks, exposing about half a cun of the tip. Aim at the affected area and tap with another chopstick to pierce the swelling obliquely; releasing much purple blood is desirable. After piercing, apply a slice of lean meat and moisten with Frankincense powder mixed with Egg White. Generally, suppuration is not suitable here because the head is hollow and the areas around the ears are complex, making drainage inconvenient; therefore, bian therapy should be applied early. (From *Shifa*)
Xue Lizhai said: If the lesion is between the back and thighs, specifically near the spine where there is a layer of tendon under the skin, and in the thigh region, even if the outer skin breaks, the tendon is difficult to rupture, preventing internal pus from draining. This causes distension, pain, deficiency of Qi and Blood, and various complications. Waiting for spontaneous rupture often leads to untreatable conditions. One must incise and drain, combined with interior support. Often treating this condition, even using a sharp knife to cut may not remove the hardness. Waiting for such hard objects to rupture spontaneously is worse! Those without robust Qi and Blood are unlikely to rupture spontaneously.
He also said: When a sore has formed pus, timely needling leads to recovery in a few days. Commonly, patients fear the pain of needling and refuse it, or fear damaging flesh and refuse it. They do not realize that although sores may arise in thin-fleshed areas, once pus forms, the swelling rises more than one cun, and the skin thickens by more than one fen. Needling depth should not exceed two fen. If on the back, swelling may rise two to three cuns, and needle insertion stops at about one cun. Moreover, since the flesh at the site is already necrotic, where is the pain? Where is the concern for damage? Many frail people suffering from Guju (bone-abscessing carbuncle) wait for pus to drain spontaneously, leading to massive ulceration that cannot heal, resulting in the exhaustion of Qi and Blood and death.
He also said: Once a sore has formed pus, if the skin does not vent, ignorant people wait for it to burst spontaneously. Strong and robust individuals might resolve it themselves, but for the old and weak, with exhausted Qi and Blood, or those who have undergone excessive purging, failing to use needling allows pus and toxin to attack inward through weakness, perforating intestines and rotting membranes, rarely avoiding disaster. If toxin is bound in the limbs, delaying bian/needling leads to deep, large ulcers that are hard to heal. If toxin binds in critical areas like the cheeks, neck, chest, or abdomen, regardless of strength, urgent needling is required, otherwise it is difficult to treat. Generally, sores vary in severity and depth. Superficial ones are high-swollen and soft, arising in the blood vessels; deep ones are low-swollen and hard, arising in the muscles and bones. Some arise in the bone marrow, where skin and flesh do not change. Thus, ancient methods dictated superficial sores be treated with bian and deep ones with needling, removing stasis at the onset of toxin accumulation to facilitate resolution. When pus is formed, robust individuals expel it naturally; the frail, without needling, rarely escape mishap. Sores penetrating membranes are almost always fatal; even with strong tonics, rescue is impossible. This serves as a warning against waiting for pus to drain spontaneously.
*Xinfa* (Core Principles) states: In ancient times, there was the system of bian stones. The *Neijing* distinguishes nine types of needles. Although the systems differ, the intent to cure disease is the same. In the specialty of sores and ulcers, the use of needles is highly valued. When using needles, although one measures the depth of ulceration, one must especially consider the thickness of the flesh. If the skin is thin and the needle is deep, it injures healthy flesh and worsens ulceration; if the flesh is thick and the needle is shallow, pus and toxin do not exit, increasing pain. Can practitioners of needling afford to be careless? For Guju, Liuzhu (Flowing Abscess), and chronic non-resolving cases with internal ulceration and no pain, burning needles (hot needling) should be used to open them. For throat ailments, a Three-Edge Needle should be used. For erysipelas and carbuncles with red borders and burning pain, bian stones should be used to bleed and vent the toxin, reducing severe cases and resolving mild ones. For example, Mrs. Hong suffered from an abdominal abscess with distension, fullness, and confusion; pricking her while lying down released pus, and she revived immediately. Another patient had a scrotal abscess with mature pus, swelling, and dysuria, nearly dying. Urgent needling released large amounts of pus and fluid, restoring Qi flow and health. Generally, the method of needling involves attacking from the front and taking advantage of the situation, meaning "treat before completion rather than after," which is the true intent. Today, patients often fear needling and refuse it, and doctors sometimes yield to patients' wishes and do not needle, leading to situations where pus forms but cannot rupture, or ruptures with excessive damage. Ultimately, eight or nine out of ten die prematurely, which is truly tragic.
Zhang Jingyue said: The classics state: When the weather is warm and sunny, human blood flows freely, and Wei Qi floats, so blood is easily discharged and Qi moves easily; when the weather is cold and cloudy, human blood becomes stagnant and Wei Qi sinks. Therefore, one should adjust the blood vessels according to the seasons. Thus, whenever encountering cold weather, frozen water, or stagnant Yin Qi, if one intends to perform needling, one should first cover the patient with warm clothing, or stir-fry mugwort leaves until hot, or use hot salt or hot clothes to warm the area first. Only when the blood vessels are warm should one needle, so that blood discharges and Qi moves, and the illness is immediately cured. If blood is cold and pulses are stagnant, and one rashly uses needles, the pathogenic toxin will not discharge, merely injuring healthy flesh and worsening the disease.
Xue Lizhai said: For those with weak Yuanqi, one must tonify the Spleen and Stomach and strictly forbid the use of knives and needles. Reckless use removes flesh and blood, causing Yang to scatter with Yin, accelerating danger.
Sun Simiao said: If acupuncture causes continuous bleeding, burn human feces to ash and apply it to the wound to stop bleeding immediately.