【方歌】取脓除瘜用铍针,轻重疾徐在一心,皮薄针深伤好肉,
肉厚针浅毒犹存。肿高且软针四五,坚肿宜针六七分,
肿平肉色全不变,此证当针寸许深。背腹肋胁生毒患,
扁针斜入始全身,欲大开口针斜出,小开直出法须遵。
气虚先补针宜后,脓出证退效如神,用在十日半月后,
使毒外出不伤人。又有不宜用针处,瘿瘤冬月与骨筋。
【注】经云痈气之瘜者,当以针开除去之。又云:铍针末如锋
锐,以取大脓。故曰取脓除瘜用铍针也。其轻重疾徐,
自有一定,在人心度量用之,不可乱施。盖皮薄针深,
反伤好肉,肉厚针浅,毒又难出。大抵肿高而软者在肌
肉,针四五分;肿下而坚者在筋脉,针六七分;肿平肉
色不变者,附于骨也,宜针寸许;若毒生背腹肋胁等处
,宜偏针斜入,以防透膜。针既透脓,视疮口必有脓意
如珠,斯时欲大开口,则将针斜出;欲小开口,则将针
直出。所谓逆而夺之,顺而取之也。随以棉纸捻蘸元珠
膏度之,使脓会齐,二、三时将拈取出,疮口贴太乙膏
,四围敷乌龙骨。元气虚者,必先补而后针,脓一出则
诸证悉退。再者,用针自有其时,不可太早,亦不可太
迟,如十日之间,疮尚坚硬,用铍针当项点破。半月后
不作脓腐者,用铍针品字样,三孔开之,不问深浅,以
知痛为住,随用药筒拔法拔之。又有不宜针者,如瘿瘤
、结核之类,肚脐骨节近筋之处,及冬月闭藏之时,皆
在所禁也。
【方歌】使用铍针来排脓并切除赘肉,进针的轻重、快慢全凭医者用心把握。皮肤薄的地方如果针刺过深会损伤健康组织,肌肉厚的地方如果针刺过浅则毒邪难以排出。肿胀高起且质地柔软的脓肿,针刺深度为四五分;坚硬肿胀的脓肿,适宜针刺六七分;肿胀平坦且肤色完全不变的,此证应当针刺约一寸深。在背部、腹部、肋骨及胁部生毒患时,应使扁针斜向进入才能保全身体(避免伤及内脏)。想要扩大创口则让针斜着退出,想要缩小创口则让针直着退出,这种方法必须遵守。气虚的患者应先进行补益治疗,然后再施针,这样脓液排出后症状消退,效果如神。使用时机应在发病十日或半月之后,目的是使毒邪向外排出而不伤害人体内部。又有不适宜用针的情况,如瘿瘤、冬季以及筋骨部位。
【注】《内经》说:“痈气形成的赘肉,应当用针切开除去。”又说:“铍针的末端像刀锋一样锐利,用来取出大量脓液。”所以说取脓除赘肉要用铍针。其轻重疾徐的操作,自有定法,在于医者心中衡量运用,不可乱施。大概皮肤薄而针刺过深,反而损伤好肉;肌肉厚而针刺过浅,毒邪又难排出。大抵而言,肿高而软的位于肌肉层,针刺四五分;肿下而坚硬的位于筋脉层,针刺六七分;肿平且肤色不变的,病位附着于骨,适宜针刺约一寸;若毒邪生在背腹肋胁等处,宜偏针斜入,以防穿透体膜。针既透脓,观察疮口必有脓意,如珠状冒出,此时若想扩大开口,则将针斜出;若想缩小开口,则将针直出。这就是所谓的“逆而夺之,顺而取之”。随即用棉纸捻蘸取元珠膏涂抹引导,使脓液汇聚整齐,两三个时辰后将纸捻取出,疮口贴上太乙膏,四周敷上乌龙骨粉。元气虚弱的人,必须先补益而后施针,脓液一出则各种症状全部消退。再者,用针自有其时机,不可太早,也不可太迟。如在十日之内,疮疡尚坚硬,用铍针在项部点破。半月后若不化脓溃腐的,用铍针呈“品”字形刺三孔打开,不问深浅,以患者感到疼痛为度,随后用药筒拔法拔毒。又有不适宜用针的情况,如瘿瘤、结核之类,肚脐、骨节近筋之处,以及冬季闭藏之时,都在禁忌之列。
[Prescription Song] Use the Pi needle (Pi Zhen, a flat double-edged surgical knife) to drain pus and remove polyps; the lightness, heaviness, speed, and slowness of insertion depend entirely on the practitioner's mind. If the skin is thin and the needle is inserted too deeply, healthy flesh will be injured; if the flesh is thick and the needle is inserted too shallowly, the pathogenic toxin will remain. For swellings that are high and soft, insert the needle 4-5 fen deep; for hard and swollen areas, insert 6-7 fen deep. For swellings that are flat with no change in skin color, this condition requires insertion to a depth of approximately 1 cun. When toxic lesions occur on the back, abdomen, ribs, or hypochondrium, insert the flat needle obliquely to preserve the body [and avoid damaging internal organs]. To create a large opening, withdraw the needle obliquely; to create a small opening, withdraw it straight out; this method must be followed. In cases of Qi deficiency, tonification should be performed first, followed by needling; once pus is discharged and symptoms recede, the effect is miraculous. It should be used after ten days or half a month, so that the toxin is expelled outward without harming the person. There are also situations where needling is not suitable, such as goiters, winter months, and areas involving bones and tendons.
[Annotation] The Classics state: "Polyps formed by Qi stagnation in carbuncles should be opened and removed with a needle." It also states: "The tip of the Pi needle is sharp like a blade, used to extract large amounts of pus." Hence, Pi needles are used to drain pus and remove polyps. The techniques of lightness, heaviness, speed, and slowness have their own fixed principles, relying on the practitioner's judgment and application, and must not be applied randomly. Generally, inserting too deeply into thin skin damages healthy tissue, while inserting too shallowly into thick flesh prevents the toxin from exiting. Broadly speaking, high and soft swellings are located in the muscle layer, requiring insertion of 4-5 fen; low and hard swellings are located in the tendon and vessel layer, requiring insertion of 6-7 fen; flat swellings with unchanged skin color are attached to the bone, requiring insertion of approximately 1 cun. If toxins arise in areas such as the back, abdomen, ribs, and hypochondrium, oblique insertion is appropriate to prevent penetrating the body membrane. Once the needle penetrates the pus, observe the wound opening where the pus may appear like beads. At this time, to enlarge the opening, withdraw the needle obliquely; to narrow the opening, withdraw it straight out. This is referred to as "counteracting to seize it, following to take it." Subsequently, use a cotton-paper wick dipped in Yuanzhu Ointment to guide the drainage, ensuring the pus gathers evenly. Remove the wick after two to three shi hours. Apply Taiyi Plaster to the wound opening and spread Wulong Bone powder around the periphery. For those with deficient Yuan Qi, tonification must precede needling; once pus is discharged, all symptoms will subside. Furthermore, there is a specific timing for needling; it should not be too early nor too late. Within ten days, if the sore is still hard, use the Pi needle to puncture at the neck area. After half a month, if there is no suppuration or putrefaction, use the Pi needle to puncture three holes in a "pin" character pattern. Do not concern yourself with depth; stop when pain is felt. Then, use the Medicinal Cylinder Extraction Method to draw out the toxin. There are also contraindications for needling, such as goiters, tubercles, areas near tendons at the umbilicus and joints, and during the winter season of storage, all of which are prohibited.