结代皆歇止之脉。结为无定之止，尚是气血失调，偶然停顿；代为有定之止，竟是脏气
缺陷，习为故常。所以代生结生，显然有别。然即以内科言之，老人气血既衰，循行不及，
即见代脉，亦未必遽是死征。苟其颐养得宜，尚可绵延岁月。但终是不足之征兆，残龄风烛
刻刻可虞耳。
以言疡证，则肿疡虽皆壅塞不通，惟皮肉经络之病，苟非大证，必不当有结代之脉。而
内痈固结，及痛势极炽者，偶一见之。是当解结定痛，方能脉复即安。久见结代，必非佳兆
。若溃后则闭者已泄，滞者已通，脉道周流当无结塞。如其有之，则真元不续，恐难为力矣
上焦气火沸腾，脉必应之而上溢，甚者且弦出寸口，直上鱼际。此心肝阳盛者有之。其
证为眩晕头痛，直达顶巅，或且冲激脑经，昏瞀无识。而疡家实火证亦有此脉，头面疔毒，
时一见之。下元相火不藏，脉必应之而下盛，甚者且垂入尺中，搏劲有力。此肝肾火炽者有
之。于内证为强阳不痿，为阴挺顽痛，为阴汗湿痒，皆龙相之横逆莫制者也。于疡家亦主二
阴毒火诸恙，如急性子痈，如湿热外痔及便毒 疽之势焰方张时，恒有此垂长之脉。而足
水疔，阳发大毒，顷刻化腐者，亦时一见之。
疡家药剂，必随其人之寒热虚实，七情六淫，气血痰湿诸证而调剂之。故临证处方，无
论外形如何，要必以内证为之主。此疡医之最上乘也。苟能精明乎内科治理，而出其余绪，
以治外疡，虽有大证，亦多应手得效。试观近今内科名手，本非治外专家，而偶治外疡，亦
复时有奇效，此事实之有可考者，而亦事理之最可信者，且亦天下之良医所公认者也。惟是
疡之为病，甚繁赜矣。即其外候之变迁，亦复层出不穷，步骤次序，必不可紊。设非专心致
志，研究一番，纵使长于内科，理法深邃，而移以治疡，即能大致楚楚，然细缄密缕，必有
不逮；则按之实际，亦不能按部就班，铢两悉称。盖治疡大旨，虽无不以内证为权衡，而对
于外证，如消毒止痛，去腐生新之类，必须有二三味合宜之药，为之导引，而后内外各如其
分。否则全无关系，又安能收复杯取效之应。况乎所发部位，各有分野；分经论治，尤不可
笼统含糊，浮泛不切。而世俗所传外科各书，且有百病通治之煎方，宁不隐约模糊，长如黑
暗地狱。如通行之仙方活命饮、神授卫生汤等方，凡是疡医家言，无不列之首简，谓为能治
一切痈疽，退毒定痛，如何神效云云。试为考其实在作用，庞杂无纪，既无法律可言，又安
有效验可望。盖凡是一病，虽曰自有对病应验之药；然同此一病，而温凉寒热，虚实轻重，
始传末传，亦复各各不同，已无预定一方可以通治之理。而乃曰古有成方，且可通治上下大
小一切痈疽，未成即消，已成即溃，自治至终，无不合辙。揆之情理，其谬何如。须知见证
治证，随宜加浮芜杂，无一是处。而乃大张其名，眩人耳目，一则曰仙方，再则曰仙授，自
诩神通，适以彰其妄诞而已。今试以仙方活命饮一方论之。药用乳香、没药、赤芍、甘草节
、归尾、穿山甲、皂角刺、银花、白芷、陈皮、花粉、贝母、防风十三味。乳香、没药固世
俗所谓止痛之套药也，其性粘韧，能合金刃创口，外敷止血定痛，最有神验；又可研敷作外
疡生肌长绞肉子药。此乳没两味之第一功用也。又其气芳香，能舒肝胃之气，则内服以治肝
心隐痛，亦或有效。古人之用以止痛者如此。然其质是树胶，一入煎剂，粘稠凝腻，其臭反
恶，难于入口，即令勉强吞咽，亦必惹胃泛恶，甚者则吐。古人用此二味，皆入丸散，未见
有作汤饮者。《本草纲目》所引诸方，尚皆如此。而后之俗医，乃以止痛二字乱入煎方。姑
无论其有无效力，而令病者饮此浊胶，徒犯肠胃，亦已太酷。盖俗医只知人云亦云，并未深
明古人用药有法。若令医家亲啜一匙，吾知其亦必愁眉闭目而不能下咽。甘草能治外疡，乃
甘为土之正味，百毒入土而化，故甘草能消外科之毒。然甘者必腻，若湿病痰病得之，必满
必呕。古人成方，虽多以甘草调和诸药，而今人则用之甚少，诚有见于此中弊窦。况在外疡
，湿痰为病最多。故患疡者，舌苔多浓浊粘腻，甘味皆是禁药，况大甘大腻如国老乎。又俗
医每谓甘草节专治疡患，其说不知何本。考李氏濒湖《本草纲目》引书最博，辨药极详，于
甘草有梢有头，而独无节。可知明代尚无此谬说。今就药肆中持甘草观之，长者尺余，两端
如一，其节安在。而俗医处方，竟大书特书曰甘草节若干，岂非以盲引盲之故态。（或谓甘
草
，故专治疡。其说颇似有理，然细思之，终觉可哂。）赤芍、归尾破血活血，惟是血瘀者可
用
在肉里，早用刀针，大是痛苦，不得已而用此二物，使之向外面皮肤透达，俾得从速用针，
可免内攻化巨，亦是避重就轻之法；若内脓未成，犹可消散，而妄用之，适以助其成脓外溃
，则小病化大，而大病可危。病者何辜。与医何仇？而必令其惨痛号呼，脓血横决，何其忍
耶。陈皮、贝母惟上部热痰为患，如发颐痰核之类宜之。白芷芳香上行，可散头面之风；防
风辛温，以散寒风，为百药长，而风热已大非所宜。若在温热湿热诸病，岂非鸩毒。银花、
花粉则清凉之味，宜于温热而寒证所忌。似此温凉并进，糅杂成方，而曰治一切痈疽，无论
阴阳，宁非大谬。又《王氏全生集》有小金丹、醒消丸等方，颇为时俗所尚，然亦无通治百
病之理。而近更有所谓六神丸者，以珠黄、脑麝、蟾酥、腰黄六物为方，以百草霜为衣，价
值兼金，可为贵重。而按之药性病情，亦非外疡有效之药。乃俗人不察，群认为治疡必效之
神丹，甚至医林亦推重之，不从效力上着想，而惟以重价为佳，徒耗病家资财。庸陋之尤，
更是可笑。寿颐秉师门家法，参以生平阅历，颇觉一病有一病之方剂，尚必随其人之气体，
而相与变迁，已非板方所能必效，更安有预备数方，可以泛应曲当之理。但分证言之，亦未
尝无门径之可寻。用是撮其大旨，分门别类，列举各法，姑示涯略。虽曰东鳞西爪，必不能
曲尽精微，要之门径既清，则临时制裁，自能变化。较之从事于古方之浑漠无垠，不分虚实
，不辨温凉者，不啻指南有针，导之觉路矣。至于外治各药，退毒围毒，温散凉散，提毒消
毒，止痛止血，收湿止痒，去腐生新诸法咸备，与内服煎剂，各收效果。更不可泛泛不切，
敷衍了事。考之古书，成方千万，可供实用者，竟百不得一，甚者且贻误无穷。不能照书配
用，幸图一效。要知事倍功半，既不当以临床为练习之场。如果以药试人，且不啻借病患作
习射之鹄。爰以师门心法暨半生经验各药别为一章，并录于篇。务使一方有一方之效力，俾
同学人习此一编，而随宜施治，绰有余裕，借以利济苍生，拯其疾苦，鲰生事业，差足自豪
。若夫内服煎剂，分证治疗，则各有攸宜，不能泛然立方，仍蹈通套之陋。因别采疡科治案
，辑为平议一编。庶几是是非非，具有经纬；治疡一门，无余蕴矣。
结脉和代脉都属于脉搏间歇停跳的脉象。结脉是停跳没有固定规律，这尚且属于气血失调，偶然出现的停顿；代脉则是停跳有固定的规律，这完全是脏气缺陷，已经习以为常了。所以代脉产生时伴随结脉，两者显然有明显的区别。然而即使仅从内科疾病来说，老年人气血既然衰退，循行力量不足，出现代脉，也未必立刻就是死亡的征兆。如果调养得当，还可以延长寿命。但这终究是正气不足的征兆，如同风中之烛，随时都有危险。
谈到外科疮疡病症，那么肿疡虽然都是壅塞不通，但只是皮肉经络的疾病，如果不是重症，必然不应该出现结脉或代脉。而内痈固结，以及疼痛极其剧烈的时候，偶尔会见到这种脉象。这时应当解除结滞、安定疼痛，才能使脉象恢复从而平安。如果长期出现结脉或代脉，必定不是好兆头。如果疮疡溃破之后，闭塞的已经疏通，停滞的已经通畅，脉道周流应该没有结塞。如果此时还有结代脉，那就是真元之气接续不上，恐怕难以救治了。
上焦气火沸腾，脉象必然随之而上溢，严重的甚至弦硬地超出寸口，直上达到鱼际部位。这是心肝阳气旺盛的人会出现的情况。其症状表现为眩晕头痛，直达头顶，或者冲击脑部神经，导致昏迷无知觉。而外科医生的实火证也有这种脉象，头面部的疔毒，时常可以见到。下元相火不藏，脉象必然随之而下盛，严重的甚至下垂进入尺中，搏动强劲有力。这是肝肾火炽盛的人会出现的情况。在内科病症中表现为阳强不倒（阳痿的反面，指异常勃起），阴挺顽痛，阴部汗出湿痒，这都是龙雷之火与相火横逆无法控制所致。在外科医生看来，这也主司二阴（前后二阴）毒火诸病，如急性子痈，如湿热外痔及便毒，当疽势焰正盛时，常常有这种垂长有力的脉象。而足部的疔疮，阳发大毒，顷刻间化脓腐烂的，也时常可以见到。
外科医生的药剂，必须根据病人的寒热虚实，七情六淫，气血痰湿等各种证候来调剂。所以临证处方，无论外形如何，一定要以内证作为主导。这是外科医生的最高境界。如果能够精通内科的治疗，并运用其剩余的知识来治疗外科疮疡，即使是重症，也多能应手见效。试看近年的内科名医，本非治疗外科的专家，但偶尔治疗外科疮疡，也常有奇效，这是事实可考的，也是事理最可信的，而且是天下良医所公认的。但是，疮疡这类疾病，非常繁杂深奥。即使其外部征候的变化，也层出不穷，步骤次序，绝对不能混乱。如果不是专心致志，深入研究一番，纵使擅长内科，理法深邃，而用来治疗疮疡，虽然能大致清楚，但在细微严谨之处，必定有所不及；那么在实际情况中，也不能按部就班，精准恰当。大概治疗疮疡的大旨，虽然无不以内证为权衡，但对于外证，如消毒止痛，去腐生新之类，必须有二三味合适的药物，为之引导，然后内外各得其分。否则完全无关，又怎么能收到立竿见影的效果呢？况且发病的部位，各有分野；分经论治，尤其不能笼统含糊，浮泛不切题。而世俗所传的外科各书，甚至有百病通治的煎方，岂不是隐约模糊，像黑暗地狱一样。如通行的仙方活命饮、神授卫生汤等方剂，凡是外科医生的家言，无不列在首篇，说能治疗一切痈疽，退毒定痛，如何神效等等。试着考察其实际作用，庞杂无纪，既没有法度可言，又怎么能有疗效可期待呢？大概凡是有一种病，虽说自有对病应验的药；然而同样是这一种病，而温凉寒热，虚实轻重，初起还是已传，也各不相同，本来就没有预定一方可以通治的道理。却说古有成方，且可通治上下大小一切痈疽，未成即消，已成即溃，从治疗到结束，无不合辙。揆之情理，其谬误多么严重啊。须知见证治证，随意加上浮华杂乱的东西，没有一处是妥当的。却大肆张扬其名，眩人耳目，一说是仙方，再说是仙授，自夸神通，恰恰彰显其妄诞罢了。现在试着以仙方活命饮一方来讨论。药用乳香、没药、赤芍、甘草节、归尾、穿山甲、皂角刺、银花、白芷、陈皮、花粉、贝母、防风十三味药。乳香、没药固然是世俗所谓止痛的套药，其性质粘韧，能粘合金刃创口，外敷止血定痛，最有神验；又可以研碎外敷作为外科疮疡生肌长肉的药。这是乳香、没药这两味药的第一功用。另外它们气味芳香，能舒展肝胃之气，那么内服治疗肝心隐痛，或许有效。古人用它们来止痛就是这样。然而它们的质地是树胶，一旦入煎剂，粘稠凝腻，气味反而恶臭，难于入口，即使勉强吞咽，也必定引起胃部反恶心，严重的则呕吐。古人用这两味药，都入丸散，未见有作汤饮用的。《本草纲目》所引用的各方，也都是这样。而后来的俗医，乃是用“止痛”二字乱入煎方。姑且不论其有无效力，而让病人喝这种浊胶，徒然侵犯肠胃，也太残酷了。大概俗医只知道人云亦云，并未深明古人用药有法度。如果让医生亲自尝一匙，我知道他也必定愁眉苦脸不能咽下。甘草能治外科疮疡，是因为甘为土的正味，百毒入土而化，所以甘草能消外科之毒。然而甘味必腻，如果是湿病痰病得到它，必定胀满呕吐。古人成方，虽多以甘草调和诸药，而今人则用得很少，确实看到了其中的弊端。何况在外疡中，湿痰致病最多。所以患疮疡的人，舌苔多浓浊粘腻，甘味都是禁药，何况大甘大腻如国老（甘草别称）的呢。又俗医每谓甘草节专门治疗疮疡，这种说法不知依据什么。考李氏濒湖《本草纲目》引书最广，辨药极详，对于甘草有梢有头，而唯独没有提到节。可知明代还没有这种谬说。现在就在药店中拿甘草来看，长的有一尺多，两端都一样，它的节在哪里呢？而俗医开处方，竟大书特书曰甘草节若干，这岂不是以盲引盲的老样子吗？（有人说甘草节专治疡，这种说法颇似有理，但细思之，终觉可笑。）赤芍、归尾破血活血，只有血瘀者可用。如果在肉里，早用刀针是大痛苦，不得已才用这两物，使之向外面皮肤透达，以便尽快用针，可以避免内攻化脓巨大，这也是避重就轻的方法；如果内脓未成，还可以消散，而妄用之，恰好助其成脓外溃，那么小病变大，大病可危。病人有什么罪？与医生有什么仇？而一定要让他惨痛号呼，脓血横决，何其残忍啊。陈皮、贝母只适用于上部热痰为患，如发颐痰核之类的。白芷芳香上行，可散头面之风；防风辛温，以散寒风，为百药之长，而风热已大非所宜。如果在温热湿热诸病中，岂不是毒药。银花、花粉则是清凉之味，适宜于温热而寒证所忌。像这样温凉并进，糅杂成方，却说能治一切痈疽，无论阴阳，难道不是大谬误吗？又《王氏全生集》有小金丹、醒消丸等方，颇为时俗所崇尚，但也无通治百病的道理。而近来更有所谓的六神丸，以珠黄、脑麝、蟾酥、腰黄六物为方，以百草霜为衣，价值兼金，可谓贵重。而按之药性病情，也不是外科疮疡有效的药。乃俗人不察，群认为治疡必效的神丹，甚至医林也推重它，不从效力上着想，而只以重价为佳，徒耗病家资财。庸陋之极，更是可笑。寿颐秉承师门家法，参以生平阅历，颇觉一病有一病的方剂，还必须随其人的体质，而相互变迁，已经不是板方所能必效，更哪里有预备几方，可以泛应曲当的道理。但分证言之，也未尝没有门径可寻。于是撮取大旨，分门别类，列举各法，姑示涯略。虽然说东鳞西爪，必定不能穷尽精微，但只要门径清晰，那么临时裁制，自然能变化。比起从事于古方的浑漠无垠，不分虚实，不辨温凉的，不啻是指南针，导之觉路了。至于外治各药，退毒围毒，温散凉散，提毒消毒，止痛止血，收湿止痒，去腐生新诸法咸备，与内服煎剂，各收效果。更不可泛泛不切题，敷衍了事。考之古书，成方千万，可供实用者，竟百不得一，严重的甚至贻误无穷。不能照书配用，侥幸图一效。要知道事倍功半，既不当以临床为练习之场。如果以药试人，且不啻借病患作习射之靶。于是将师门心法暨半生经验各药别为一章，并录于篇。务使一方有一方的效力，使同学人学习这一编，而随宜施治，绰有余裕，借此利济苍生，拯其疾苦，我的事业，差足自豪。至于内服煎剂，分证治疗，则各有适宜，不能泛然立方，仍蹈通套之陋。因此另外采集疡科治案，辑为平议一编。庶几是是非非，具有经纬；治疗疡科一门，无余蕴矣。
Both Jie pulse (Knotted Pulse) and Dai pulse (Intermittent Pulse) belong to pulses with intermittent pauses. The Jie pulse features irregular pauses, which still belongs to disharmony of Qi and Blood, occurring occasionally; the Dai pulse features regular pauses, indicating a defect in Zang Qi that has become habitual. Thus, when Dai pulse arises with Jie pulse, there is a clear distinction between them. However, even speaking from the perspective of Internal Medicine, since the Qi and Blood of the elderly have declined and circulation is insufficient, the appearance of a Dai pulse does not necessarily signify an immediate death omen. If nourished and cared for properly, life can be prolonged. Nevertheless, it remains a sign of deficiency, like a candle in the wind, perilous at any moment.
Regarding surgical diseases (Yang conditions), although swelling ulcers are all characterized by obstruction and blockage, being merely diseases of skin, flesh, and meridians, unless they are severe cases, they should certainly not present with Jie or Dai pulses. However, in cases of internal abscesses that are solidified, or when pain is extremely intense, such pulses may occasionally be seen. At this time, one must resolve the stagnation and alleviate pain to restore the pulse and ensure safety. If Jie or Dai pulses persist for a long time, it is definitely a bad omen. After the ulcer has suppurated and drained, the blocked passages are open, and the stagnant flow is cleared; the pulse channels should circulate freely without obstruction. If Jie or Dai pulses are still present, it indicates that the True Yuan (Original Qi) cannot continue, and recovery will likely be difficult.
When Qi and Fire in the Upper Jiao boil vigorously, the pulse must respond by overflowing upwards; in severe cases, it becomes wiry and extends beyond the Cun position, reaching directly to the Yuji area. This occurs in individuals with excessive Yang of the Heart and Liver. Symptoms include dizziness, headache extending to the vertex, or even impact on the brain meridians, leading to coma and loss of consciousness. Surgeons also encounter this pulse pattern in excess Heat syndromes, such as Ding toxic sores on the head and face, which are frequently observed. When the Ministerial Fire in the Lower Yuan fails to remain hidden, the pulse responds by becoming excessive downwards; in severe cases, it sinks into the Chi position, beating strongly and powerfully. This occurs in individuals with blazing Fire of the Liver and Kidney. In internal medicine, this manifests as abnormal erections, painful protrusion of the vagina or anus, and sweaty, itchy genitalia, all caused by the uncontrolled rampant nature of Dragon Fire and Ministerial Fire. In surgery, this also governs various toxic fire conditions of the two yin openings (anterior and posterior), such as acute orchitis, damp-heat external hemorrhoids, and bubo abscesses. When the intensity of carbuncles is at its peak, such long and forceful pulses are common. Additionally, ding sores on the feet, characterized by extreme Yang toxicity that rapidly turns to pus and rot, also occasionally present this way.
Surgical prescriptions must be adjusted according to the patient's cold/heat, deficiency/excess, Seven Emotions, Six Evils, and various syndromes involving Qi, Blood, Phlegm, and Dampness. Therefore, in clinical prescription-making, regardless of external appearances, one must prioritize internal syndromes. This represents the highest level of surgical practice. If one masters internal medicine treatment and applies this knowledge to surgical sores, even severe cases often yield prompt results. Observing contemporary famous internal medicine physicians who are not specialists in surgery but occasionally treat surgical sores with miraculous effects confirms this fact, which is both empirically verifiable and logically sound, and recognized by virtuous physicians worldwide. However, surgical diseases are extremely complex. Even the changes in external manifestations are endless, and their progression and sequence must not be disordered. Without dedicated study and research, even if one excels in internal medicine with profound theories and methods, applying them to surgery may result in general competence but lack precision in details. Consequently, practical application may fail to proceed step-by-step with exactitude. Although the general principle of treating surgery relies on internal syndromes as a benchmark, for external symptoms such as detoxification, pain relief, removing necrotic tissue, and promoting new growth, specific herbs are needed as guides to balance internal and external treatments. Otherwise, lacking relevance, how can one expect immediate efficacy? Moreover, each affected site has its specific meridian distribution; treating according to meridians requires avoiding vagueness and superficiality. Yet, popular surgical texts often contain "universal formulas" for hundreds of diseases, creating confusion akin to a dark hell. For instance, widely circulated formulas like Xianfang Huoming Yin (Immortal Formula for Saving Life) and Shenshou Weisheng Tang (Divinely Granted Health-Preserving Decoction) are listed first in surgical manuals, claiming to treat all carbuncles and sores, eliminating toxins, and relieving pain with divine efficacy. Examining their actual effects reveals chaos without legal principles, making efficacy unlikely. While every disease has specific effective herbs, the same disease varies in warmth/cold, deficiency/excess, and stage (early vs. late transmission), meaning no single pre-set formula can universally treat it. Claiming ancient universal formulas can treat all carbuncles regardless of size, location, or yin/yang nature, causing resolution before suppuration and drainage after suppuration, is fundamentally flawed. Adding miscellaneous ingredients arbitrarily to match symptoms is futile. Boasting names like "Immortal Formula" dazzles the public but only highlights absurdity. Consider Xianfang Huoming Yin: it contains Ruxiang (Olibanum), Moyao (Myrrha), Chishao (Red Peony Root), Gancao Jie (Licorice Knot), Guiwei (Cinnamon Twig/Cassia Twig tail - *Note: Context implies Danggui Wei/Tail of Angelica Sinensis*), Chuanshanjia (Pangolin Scales), Zaocisus (Gleditsia Spine), Yinhua (Honeysuckle Flower), Baizhi (Angelica Dahurica), Chenpi (Tangerine Peel), Huafen (Trichosanthes Root), Beimu (Fritillaria Bulb), Fangfeng (Saposhnikovia Root). Ruxiang and Moyao are commonly used for pain relief; their sticky nature helps seal wounds externally for hemostasis and analgesia, and they promote granulation tissue externally. Internally, their aromatic nature soothes Liver and Stomach Qi, potentially helping with hidden pain. However, being tree gums, they become viscous and foul-tasting in decoctions, causing nausea or vomiting. Ancient texts record them only in pills or powders, never in decoctions. Modern vulgar doctors misuse them in decoctions under the guise of pain relief, harming the stomach unnecessarily. Licorice (Gancao) treats surgical toxins because sweetness corresponds to Earth, transforming toxins. However, sweetness is cloying; in damp-phlegm cases, it causes distension and vomiting. Ancient formulas used it sparingly for harmonizing; modern usage is reduced due to these drawbacks. In surgical cases, damp-phlegm is prevalent, and patients often have thick, greasy tongue coatings, making sweet herbs contraindicated, especially potent ones like Guolao (Licorice). The claim that "Licorice Knots" specifically treat sores is baseless; Li Shizhen's Compendium mentions tips and heads but not knots, suggesting this myth arose later. Pharmacopoeia specimens show uniform stems without distinct knots. Prescribing "Licorice Knots" blindly perpetuates error. Chishao and Guiwei break and invigorate blood, suitable only for blood stasis. Using them prematurely in deep tissue infections causes unnecessary pain; they are used reluctantly to draw infection outward for incision, avoiding internal spread. If pus is not yet formed, using them promotes premature suppuration, worsening minor illnesses and endangering major ones. Chenpi and Beimu suit upper jiao heat-phlegm like parotid mumps. Baizhi disperses wind in the head and face; Fangfeng disperses cold wind but is unsuitable for wind-heat or damp-heat, acting as poison in such contexts. Yinhua and Huafen are cooling, suitable for heat but contraindicated in cold. Combining warming and cooling agents in one formula to claim universal efficacy for all carbuncles is erroneous. Other popular formulas like Xiao Jin Dan and Xingxiao Wan from Wang Shi Quan Sheng Ji also lack universal applicability. Recent "Liushen Wan" (Six Spirit Pill), containing Pearl, Coptis, Musk, Toad Venom, Realgar, and Yellow Ochre, is expensive and revered despite lacking proven efficacy for surgical sores, exploiting patients financially. Following my master's teachings and personal experience, I believe each disease requires specific formulas tailored to individual constitutions, not rigid universal prescriptions. Categorizing syndromes provides a methodological path. Though my summary here is fragmentary, clarifying principles allows flexible application, superior to blind adherence to ancient formulas. External treatments covering detoxification, warming/cooling dispersion, toxin extraction, pain/hemorrhage control, drying dampness, and tissue regeneration complement internal decoctions. Ancient texts offer thousands of formulas, but few are practical; following them blindly causes harm. Clinical practice should not be a testing ground for unverified drugs. I have compiled my master's techniques and half a lifetime of experience into a separate chapter to ensure each formula has specific efficacy, aiding students in flexible treatment to benefit humanity. Regarding internal decoctions for differentiated treatment, I have collected surgical case studies for critical analysis, ensuring comprehensive mastery of surgical arts.