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
，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》所谓刺皮无伤肉，以其九针之用，而各有所
宜也。砭镰之法，虽治疮疽，不可轻用。
夫疮肿之生于外者，由热毒之气蕴结于内也，盖肿于外，有生头者，有漫肿者，有皮浓
有皮薄者，有毒瓦斯深者，有毒瓦斯浅者；有宜用温药贴 者，有宜用凉药贴 者，有可以干换
其药者，有可以湿换其药者，深浅不同，用药亦异，是以不可不辨也。若疮肿初生，似有
者，即当贴温热药，引出其热，毒火就燥之义也；于四畔赤 处，捣生寒药贴 之，折伏其
热势，驱逐其邪恶，扑火之义也。夫生寒药势，气力精全，性味雄健，或有疗者，不本物理
，皆通用药草膏之类，有势力微，欲使 瘠者，敌其勇夫，不亦难乎！又有粗工不审逆从，
便用寒药，敷贴趁逐，邪毒复入于内，归于肝心，十死八九矣。大抵敷贴之法，欲消散肿毒
，血脉疏通，寒热逆从断其去就焉，慎不可执方无权，安能散于郁结，不成脓乎！其肿皮浓
者，以故软布，或以纸花子涂药贴 之，待其药干换；肿皮薄者，即用疏纱，或薄纸涂药贴
之，其药未干，即当换之。若至脓溃之后，即贴温肌生肉膏药，要在逐臭腐，排恶汁，取
死肌，生良肉，全藉温热膏剂之力也，切勿用寒凉之药水调贴之。夫血脉喜温而恶寒，若着
冷气过理，即血滞难瘥矣。
上古时代制作砭石的大小，是根据病情适宜的程度来决定的。《内经》中说针石、砭石、针，其实是一样的。现在的时候，依据《圣济总录·丹毒论》的说法：治疗方法是用镰刀割破皮肤出血，说明病情紧急不可迟缓。扁鹊说：病在血脉的，用砭石治疗。这引用了《素问》中“血实宜决之”的观点，又引用《灵枢·九针论》（原文作“气血形志论”，实为《素问·阴阳应象大论》或相关篇章内容，此处依原文翻译）中说：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；砭石的用途，自有其适应症，并不只是治疗丹瘤。只要见到红肿突起，颜色赤红且游走不定，就应当急用镰刀割治。先在红肿处涂上生油，然后用镰刀割破，关键在于泄出其中的毒邪。然而这种方法不可轻易使用，忌讳割得太深。《内经》所谓刺皮不要伤及肌肉，是因为九针各有其适宜的用法。砭镰法虽然可以治疗疮疽，但不可轻率使用。
凡是生长在体外的疮肿，都是由体内的热毒之气蕴结所致。大概肿胀在外，有的有头，有的漫肿无头，有的皮厚，有的皮薄，有的毒气深，有的毒气浅；有的适宜用温热药贴敷，有的适宜用寒凉药贴敷，有的可以等药干了再换药，有的需要湿着换药，深浅不同，用药也不同，因此不能不辨别清楚。如果疮肿初生，似乎有脓头者，就应当贴敷温热药物，以引出热毒，这是遵循“火就燥”的道理；在四周红肿处，捣碎寒凉药物贴敷，以折伏热势，驱逐邪恶，这是扑火的道理。那些未经炮制的寒凉药物，气势强劲，性味雄健；如果有医生不懂药理，都通用草药膏之类，这些药势力微弱，想要制服猛烈的病邪，不是很难吗！又有粗劣的医生不审察病情的顺逆，便使用寒凉药物，敷贴追逐病邪，导致邪毒反而深入体内，归于肝心，十个人中有八九个会死亡。大抵敷贴的方法，旨在消散肿毒，疏通血脉，根据寒热顺逆来决定去留，千万不要固执成方而不知权变，怎么能散开郁结，使脓液形成呢！对于皮厚的肿胀，用旧的软布，或者纸花子涂药贴敷，等药干了再换；皮薄的肿胀，就用疏纱，或者薄纸涂药贴敷，药未干时就应当更换。如果到了脓溃之后，就贴敷温肌生肉的膏药，关键在于去除臭腐，排出恶汁，去除死肌，生长良肉，完全依赖温热膏剂的力量，切勿用寒凉的水调制药粉贴敷。因为血脉喜欢温暖而厌恶寒冷，如果冷气侵入过深，就会导致血液凝滞，难以痊愈。
In ancient times, the size of bian stones (bian shi, a stone tool for draining blood) was made according to the suitability for the disease. The *Neijing* (Classic of Internal Medicine) states that needles, bian stones, and lancets are essentially the same. Currently, following the *Shengji Zonglu* (General Records of Holy Relief) · "Treatise on Erysipelas": the method is to cut with a sickle to induce bleeding, indicating that the condition is urgent and cannot be delayed. Bian Que said: For diseases in the blood vessels, treat them with bian stones. This cites *Suwen* (Basic Questions): "When blood is excessive, it should be drained." It also cites the chapter on "Qi, Blood, Form, and Will" (referring to *Suwen*: "Those whose form is at ease and spirit is joyful, their diseases arise internally; treat them with bian stones"). Generally, bian stones originated from the East, because the people of the East often suffered from sores and ulcers, so the method suitable for them was bian stones; the use of bian stones has its own indications, not limited to erysipelas. Whenever swelling rises, with red color and wandering boundaries, one should urgently use a sickle to cut. First, apply raw oil on the red area, then cut with a sickle; the key lies in draining the toxin. However, this method should not be used lightly, and caution must be taken against cutting too deeply. The *Neijing* says: "Pierce the skin without injuring the flesh," because each of the nine needles has its appropriate application. Although the bian-lancing method can treat sores and carbuncles, it should not be used rashly.
Sores and swellings arising externally are caused by the accumulation and knotting of heat-toxin qi internally. Generally, external swelling may have a head or be diffuse; the skin may be thick or thin; the toxin qi may be deep or shallow. Some cases are suitable for warm medicine patches, some for cool medicine patches; some allow changing the medicine when dry, some require wet changes. Due to differences in depth, the medicines used differ, thus distinguishing them is essential. If a sore/swelling is newly formed and appears to have a head, warm medicine should be applied immediately to draw out the heat, following the principle that "fire tends to dryness"; on the surrounding red areas, crushed cool medicine should be applied to suppress the heat trend and drive away evil pathogens, akin to extinguishing fire. Raw cool medicines possess strong momentum and potent nature/flavor; if practitioners do not understand the principles of materia medica and universally use herbal pastes, which have weak efficacy, trying to subdue such vigorous pathogens would indeed be difficult! Moreover, incompetent physicians who fail to assess the favorable or unfavorable course of the disease may use cold medicines indiscriminately, applying patches to chase the pathogen, causing the evil toxin to re-enter the interior and affect the Liver and Heart, leading to death in eight or nine out of ten cases. Generally, the method of application aims to dissipate swelling and toxicity, unblock blood vessels, and determine retention or expulsion based on cold/heat and favorable/unfavorable conditions. One must not rigidly adhere to fixed formulas without flexibility; how else can one disperse stagnation and promote suppuration? For swellings with thick skin, old soft cloth or paper flowers coated with medicine can be used as patches, changed when dry; for swellings with thin skin, gauze or thin paper coated with medicine should be used, changed before the medicine dries. After pus rupture, patches promoting muscle regeneration and warming the tissues should be applied, focusing on removing foul decay, discharging bad fluids, eliminating dead tissue, and generating healthy flesh, relying entirely on the power of warm ointments. Cold water-mixed powders should never be used for application. Blood vessels prefer warmth and dislike cold; if cold qi penetrates too deeply, blood stasis will occur, making recovery difficult.