凡用针烙，先察痈疽之浅深，及脓未成已成。高阜而软者，发于血脉；肿平而坚者，
发于筋脉；皮色不相辨者，发于骨髓。高阜而浅者，用铍针开之。疽始生白粒，便可消
退，渐长如蜂窠者，寻初起白粒上烙，及四围烙四五处，如牛项之皮者，疽顶平而浅者，
皆宜用火针烙之。其针用圆针，如箸，如纬铤大，头圆平，长六七寸，一样二枚，蘸香
油于炭火中烧红，于疮头近下烙之，宜斜入，向软处一烙，不透再烙，必得脓也。疮口烙
者，名曰熟疮，脓水常流下，不假按抑，用 药使疮口不合，旧用纸捻，及新取牛膝根，
如疮口大小，略刮去皮，一头系线 之。不如用翠青、搜脓等锭子，临用以糯米饭，和
成软条子，看浅深 之，外用拔毒膏贴之。疮毒末成，烙之可散；溃而末破，针之可消，但
要用得其宜耳。若当用针烙而不用，则毒无从而泄脓，瘀蚀其膏膜，烂筋坏骨，难乎免
矣。若毒深针浅，脓不得出，毒浅烙深，损伤良肉，不当其所，他处作头，此皆不能愈
疾，反增痛耳。或瘰 溃久不愈，漏疮经年，或通或闭，痈疽疮口不收，皆因冷滞不能收
敛，亦宜疮口内外，四畔烙之。痈疽正发，及脓见后红肿 开，用铁针烧赤，四围刺之，则
红肿随缩矣。薛新甫曰∶毒瓦斯已成者，宜用托里以速其脓。脓成者，当验其生熟、深浅
而针之。脓生而用针，气血既泄，脓反难成；若脓熟而不针，腐溃益深，疮口难敛。若疮
深而针浅，内脓不出，外血反泄；若疮浅而针深，内脓虽出，良肉受伤。若元气虚弱，必
先补而后针，其脓一出诸证自退；若脓出而反痛，或烦躁呕逆，皆由胃气亏损，宜急补
之。若背疮热毒炽盛，中央肉黯，内用托里壮其脾胃，外用乌金膏，涂于黯处，其赤处
渐高，黯处渐低，至六七日间，赤黯分界，自有裂纹如刀划，然黯肉渐溃矣。当用 针、利
剪，徐徐去之，须使不知疼痛，不见鲜血为妙。虽有裂纹，脓未流利，及脓水虽出而仍
痛者，皆未通于内，并用针于纹中引之，患于背胛之间，肉腐脓出，肿痛仍作，此内有
毒筋间隔，脓未通耳，尤宜引之。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，去肉出血，则气无所根据附，
气血愈虚，元气愈伤矣，何以生肌收敛乎。又曰∶针灸之法，有太乙、人神，周身血忌、逐
年尻神，逐日人神，而其穴有禁针、禁灸之论，犯之者其病难瘳，理固然也。但疮疡气
血已伤，肌肉已坏，宜迎而夺之，顺而取之，非平人针灸之比，何忌之有？《外科精义》云∶
疮疡之证，毒瓦斯无从而解，脓瘀无从而泄，反攻于内，内既消败，欲望其生，岂可得乎。危
恶之发于致命之所，祸在反掌，腹痈、囊痈，二便不通，胸腹胀闷，唇疔、喉痹咽喉肿塞，
其祸尤速，患者审之。蜞针法∶治痈疽初作，先以笔管一个，人蚂蜞一条，以管口对疮头，
使蜞吮疮脓血，其毒即散，如疮大须换三四条，若吮正穴，蜞必死矣，累试累效。若血
不止，以藕节上泥涂之。若疮头未明，以井边泥涂上，先干处即是。按此法，可施于血
实毒浅之证，若积毒在脏腑者，徒竭其血于外无益也。一人脑后患疮， 发肿盛，用此
而愈。一小儿赤疹，取七八大蜞吮其血，疹消三日，大热而死。
凡使用针烙疗法，首先要观察痈疽的深浅程度，以及脓液是否已经形成。肿势高起且质地柔软者，病邪发于血脉；肿势平坦且质地坚硬者，病邪发于筋脉；皮肤颜色无明显变化难以辨别者，病邪发于骨髓。肿势高起且位置表浅的，用铍针（一种形如剑刃的针具）切开排脓。疽疮初生时若仅见白色小颗粒，尚可消退；若逐渐增大如蜂巢状，则应在初起白粒处进行烙治，并在四周选择四五处进行烙治；若肿势如牛颈之皮般厚重，或疽顶平坦且表浅的，都适宜用火针烙治。所用的针具为圆针，形状像筷子，粗细如同纬线用的铁条，针头圆润平整，长度六七寸，需准备两枚相同的。将针蘸取香油后在炭火中烧红，在疮口近下方进行烙治，宜斜向插入，向柔软处烙一次，若不穿透再烙，必须使脓液排出。对于已溃破的疮口进行烙治，称为“熟疮”，此时脓水常向下流淌，无需按压挤压，需用药物使疮口保持开放不愈合。旧法使用纸捻，新法取牛膝根（Achyranthis Bidentatae Radix），大小与疮口相仿，略刮去外皮，一头系上丝线。不如使用翠青锭、搜脓锭等药锭，临用时用糯米饭调和成软条状，根据疮口深浅填入，外用拔毒膏贴敷。疮毒尚未化脓时，烙治可使其消散；已溃烂但未破溃时，针刺可使其消除，关键在于运用得当。如果应当使用针烙而不用，则毒邪无法通过脓液排出，瘀滞腐蚀膏膜，导致筋烂骨坏，难以避免严重后果。如果毒邪深重而针刺过浅，脓液无法排出；毒邪表浅而烙治过深，会损伤健康肌肉；位置不当，会在其他部位引发新的病灶，这些都不能治愈疾病，反而增加痛苦。或者瘰疬（颈部淋巴结结核）溃烂日久不愈，漏疮经年累月，或通或闭，痈疽疮口不能收敛，都是因为寒凝气滞不能收敛，也适宜在疮口内外及四周进行烙治。痈疽正在发作，以及脓液出现后红肿扩散，可用铁针烧红，在四周刺之，则红肿随即消退。薛新甫说：毒邪已成脓者，适宜用托里法以加速脓液成熟。脓液已形成者，应当检验其生熟、深浅而后针刺。脓未成熟而用针，气血既已泄出，脓液反而难以形成；若脓液成熟而不针刺，腐溃加深，疮口难以收敛。若疮深而针刺过浅，内部脓液不出，外部血液反被泄出；若疮浅而针刺过深，内部脓液虽出，但健康肌肉受伤。若元气虚弱，必须先补益而后针刺，脓液一出，各种症状自然消退；若脓液排出后反而疼痛，或烦躁呕逆，这都是由于胃气亏损，应当紧急补益。若背疮热毒炽盛，中央肌肉色暗，内服托里壮脾胃的药物，外用乌金膏涂于色暗处，红色部分逐渐隆起，暗色部分逐渐降低，到六七日间，红暗分界处自然出现如刀划般的裂纹，此时暗色肌肉逐渐溃烂。当用针、利剪，慢慢去除，须使患者不知疼痛、不见鲜血为妙。虽然有裂纹，但脓液未流利，以及脓水虽出但仍疼痛的，都是内部脓液未通畅，应用针在裂纹中引导，患处在背胛之间，肉腐脓出，肿痛仍作，这是内部有毒筋间隔，脓液未通畅，尤其适宜引导。若元气虚弱，误服攻伐药物，患处不痛，或肌肉将死，急温补脾胃，也有痊愈的，之后须用纯补益的药物，才可以收敛，若妄用刀针，去肉出血，则气无所依附，气血更虚，元气更伤，何以生肌收敛呢。又说：针灸之法，有太乙神针、人神禁忌，周身血忌、逐年尻神、逐日人神，而其穴位有禁针、禁灸的说法，触犯者病情难愈，道理固然如此。但疮疡气血已伤，肌肉已坏，适宜迎而夺之，顺而取之，这与普通人针灸不同，有什么忌讳呢？《外科精义》说：疮疡之证，毒邪无从而解，脓瘀无从而泄，反而攻于体内，体内正气既已消败，希望其生存，怎么可能呢？危重恶症发于致命之处，祸患在顷刻之间，腹痈、囊痈，二便不通，胸腹胀闷，唇疔、喉痹咽喉肿塞，其祸尤其迅速，患者务必审慎。蜞针法：治疗痈疽初起，先用一个笔管，放入蚂蟥一条，以管口对准疮头，使蚂蟥吮吸疮脓血，其毒即散，如疮大须换三四条，若吮吸正穴，蚂蟥必死，多次尝试多次有效。若血不止，用藕节上的泥涂抹。若疮头不明显，用井边的泥涂上，先干处即是疮头。按此法，可施用于血实毒浅之证，若积毒在脏腑者，徒然在外耗竭血液无益。一人脑后患疮，肿势盛大，用此法而愈。一小儿赤疹，取七八条大蚂蟥吮其血，疹消三日，因大热而死。
Whenever using the needle cauterization method, one must first observe the depth of the carbuncle and ulcer (Yong Ju), as well as whether pus has formed. If the swelling is elevated and soft, the pathology originates in the blood vessels; if the swelling is flat and hard, it originates in the tendons and vessels; if the skin color is indistinguishable, it originates in the bone marrow. For those that are elevated and superficial, use a Pi Zhen (Bian Needle) to incise them. When an ulcer first appears as white granules, it can be resolved; if it gradually grows like a honeycomb, cauterize at the initial white granule site and select four or five spots around the periphery for cauterization. For cases resembling the thick skin of an ox's neck, or where the ulcer apex is flat and shallow, fire needle cauterization is appropriate. The needles used should be round needles, shaped like chopsticks, with a thickness similar to a weft shuttle pin, having a round and flat head, approximately six or seven cun in length, with two identical needles prepared. Dip the needles in sesame oil and heat them red over charcoal fire. Cauterize near the lower part of the wound head, inserting obliquely towards the softer area. Cauterize once; if penetration is not achieved, cauterize again until pus is discharged. Cauterizing an already ulcerated wound is called "Shu Chuang" (Mature Wound), where pus and fluid often flow downward without need for pressing. Medications should be used to keep the wound open and unhealed. Old methods used paper twists; new methods take Achyranthis Bidentatae Radix (Niu Xi), sized to match the wound, slightly scraping off the skin, and tying a thread to one end. Alternatively, use Cu Qing Ding or Sou Nong Ding medicated plasters, mixed with glutinous rice paste into soft strips according to depth, and apply external Du Du Gao (Detoxifying Ointment). If toxin has not yet formed pus, cauterization can disperse it; if ulcerated but not broken, needling can resolve it, provided the technique is applied appropriately. If needle cauterization is indicated but not used, toxins cannot drain via pus, leading to stagnation, erosion of fascia, rotting of tendons, and destruction of bones, making severe outcomes difficult to avoid. If toxins are deep but needling is shallow, pus cannot exit; if toxins are shallow but cauterization is deep, healthy flesh is damaged; improper placement may cause new lesions elsewhere. These failures do not cure the disease but increase pain. For chronic non-healing ulcers from scrofula (Luo Li) or fistulas lasting years, or open/closed states where wounds fail to close due to cold stagnation preventing contraction, cauterization on the inside, outside, and periphery of the wound is also suitable. During active inflammation of carbuncles/ulcers or after pus appearance with spreading redness and swelling, red-hot iron needles can be used to prick the periphery, causing immediate reduction of redness and swelling. Xue Xinpu stated: For established toxins ready to suppurate, employ Tuo Li (Supporting the Interior) methods to accelerate pus formation. Once pus has formed, assess its maturity and depth before needling. Needling immature pus depletes Qi and Blood, hindering further pus formation; failing to needle mature pus leads to deeper corruption and difficulty in healing. Deep wounds needled shallowly retain internal pus while bleeding externally; shallow wounds needled deeply discharge internal pus but damage healthy tissue. In cases of weak Yuan Qi (Original Qi), tonification must precede needling; once pus drains, symptoms naturally subside. Persistent pain, irritability, or vomiting after drainage indicates Stomach Qi deficiency, requiring urgent tonification. For severe back carbuncles with intense heat toxicity and dark central flesh, internally use Tuo Li to strengthen Spleen and Stomach, and externally apply Wu Jin Gao (Black Gold Ointment) to the dark areas. The red areas will gradually elevate, and dark areas recede. By the sixth or seventh day, a boundary forms between red and dark areas, appearing like knife cuts, with dark flesh gradually necrosing. Use needles and sharp scissors to slowly remove necrotic tissue, ensuring the patient feels no pain and sees no fresh blood. If cracks appear but pus does not flow freely, or if pain persists despite drainage, internal blockage remains; use needles to guide drainage through the cracks. For lesions on the upper back where rotting flesh releases pus but swelling and pain persist, internal toxic tendons may be blocking flow, necessitating guidance. If Yuan Qi is weak and purgatives were mistakenly taken, resulting in lack of pain or impending tissue death, urgently warm and tonify the Spleen and Stomach; recovery is possible, followed by pure tonics to promote healing. Reckless use of knives or needles causing bleeding leaves Qi without foundation, worsening Qi and Blood deficiency and damaging Yuan Qi, making tissue regeneration impossible. Furthermore, acupuncture and moxibustion involve taboos such as Tai Yi Shen Zhen, Ren Shen, Xue Ji, Kao Shen, and daily person spirits. Certain acupoints have contraindications for needling or moxa; violating these makes curing difficult, which is theoretically sound. However, in sores and ulcers where Qi and Blood are injured and muscles damaged, one should intercept and drain顺势 (following the trend), unlike standard acupuncture for healthy individuals, so what taboos exist? *Waike Jingyi* states: In sores and ulcers, if toxins cannot resolve and pus/stasis cannot drain, attacking internally causes collapse of Zheng Qi (Upright Qi); survival is unlikely. Critical eruptions at vital sites pose immediate danger. Abdominal abscesses, scrotal abscesses with urinary/fecal retention, chest/abdominal distension, lip carbuncles, and throat bi (obstruction) with swollen airways carry rapid fatal risks; patients must exercise caution. Leech Therapy: For early-stage carbuncles/ulcers, place a leech inside a pen tube, align the tube mouth with the wound head, allowing the leech to suck pus and blood, dispersing toxicity. For larger wounds, replace 3-4 leeches. If a leech sucks a major acupoint, it will die; this method has proven effective repeatedly. To stop bleeding, apply mud from lotus rhizomes. To locate unclear wound heads, apply well-side mud; the first dry spot indicates the head. This method applies only to excess blood and shallow toxins; deep visceral toxins cannot be resolved by external bloodletting. A case involved a large posterior neck carbuncle cured by this method. Another case involved a child with erysipelas; after sucking blood with seven or eight large leeches, the rash subsided, but the child died three days later from high fever.