《集验》云∶脉紧而数，为脓未成，紧去但数，为脓已成。以手按上，热者为有脓，不
热者为无脓。按之牢硬，未有脓也；按之半软半 ，已有脓也，大软方是脓成也。大按
之痛者，脓深也，按之不甚痛者，未成脓也。按之即复者，为有脓也；不复者，无脓也。小
按便痛，薄皮剥起者，脓浅也；按之四痛，皮色不变，不高阜者，脓深也，浅者宜药点破，
高突者宜铍针，深者宜烙，更详虚实何如。肿处软而不痛者，血瘤也；发肿日渐增长而不
大热，时时牵痛者，气瘤也；虚肿而黄者水也，气结微肿，久而不消，后亦成脓，此是
寒热所为也，留积经久，积阴生阳，寒化为热。以此溃必成 ，宜早服内塞药以排之。诸
瘿瘤、疣赘等，至年衰皆自内溃不一，于补养而妄行攻蚀，必有性命之忧。至于瘰 结
核，寒热发渴，经久不消，其人面色萎黄，被热上蒸，已成脓也，（治见本条。）手足指梢，及
乳上，宜脓熟大溃，方可开之。麻豆后，肢节上痈，稍觉有脓，便须决破，迟则成挛曲
之疾。
凡疮肿，以手指从疮旁按至四畔上赤黑
者，按之色不变，脓已结成，又按之随手赤色，此亦有脓。按之白，良久方赤，游毒已
息，可就赤白色尽处灸断，疮肉平实，久而方消。夫痈则皮薄肿高，疽则皮浓肿坚，初
发并宜灼艾，惟痈脓成则宜针，疽脓成则宜烙。切宜熟视详审，候其溃熟，脓透于外，其
势盈盈欲出，只用替针丸自疮头咬开，不半日许其脓自出，切不可用针刀也。（丹溪云∶《精
要》论戒用针刀，业外科者，当拳拳服膺。）
替针丸 治痈疽已溃未破，或破后脓出不快者。
白丁香（一字） 砂（一字以上） 没药 乳香（各一字）
上灰饼药内，种糯米十四粒。其法∶用锻石五升，炉灰三升，以水五升，淋取清汁，
入大锅内熬浓汁，至三二升，用瓦器盛贮。临用时，以小青盏，盛取半盏浓汁，却用皮纸，
贴盏中浓汁面上安定，然后取糯米十四粒，种在皮纸面上，一宿即是。
上为细末，糯米饭丸，如麦粒大。每用一粒，未破，用津贴疮头薄处即破，脓滞不
快，则用一粒纳疮口内，使脓不滞好肉易生。
又方
雄雀粪（二十粒） 砂 陈仓米 没药（各一字）
上研匀，以米饭丸，如粟大。每用一粒，贴疮口眼中，即溃脓出。
替针丁香丸
草乌（尖） 砂 白丁香（坚者）
上为末，酸醋调点，将破者令速溃。若
急则无如刀快。蜞针一法亦妙，见后。
〔梅〕 治诸痈不消，已成脓，惧针不得破，令速决。取雄雀粪涂头上，干即易之，雀
粪中坚者为雄。
〔本事〕 治痈疽已有疮眼，未出脓，痛不可忍，用此药 即脓出。巴豆一枚，去皮
膜，不去心、油。盐鼓十四粒，口中含去皮，令软，同研烂，真麝香少许，如难丸，入少
稀糊，捏作饼子，如鼠粪大。大小临时看疮口 之，只以纸捻子送入药，须臾必痛，忍
之良久，脓遂出。
〔丹〕 出一切疮口，用出蛾茧壳，烧存性，无灰酒调下，每服一枚，服下一个时辰，
便有疮口一个，若服两枚，出疮口两个。
〔精〕 痈成脓宜针，其铁用马衔铁为之。形如韭叶，两面皆利，可以横直裂开，五六
分许，取其毒血，如觉病轻，须先灸而后裂。
〔娄〕 按∶痈如椒眼数十粒，或如蜂窠莲房而脓出痛不除，宜用针者，以针横直裂
之，则毒血挟脓出而愈，如无椒眼之类，只消直入取脓，不必裂之也。又法∶当椒眼上，
各各灸之亦佳，不必裂也。
〔灵〕 铍针者，末如剑锋，以取大脓。
〔素〕 夫痈气之息者，宜以针开除去之。（病疑篇，王注云∶息∶ 也，死肉也。今世用刀割去
死肉者是也。）
治腐肿者，刺腐上，视痈大小深浅刺，刺大者多血，小者深之，必端内针为故正。（长刺
节论，大者多血，小者深之八字，衍文也。大小深浅刺七字，取脓之法，尽矣备矣。）
〔精〕 疽成脓宜烙，可用银篦大二分，长六寸，火上烧令赤，急手熨烙毒上，得脓
为效。《鬼遗》凡痈觉在虚处，及眼不见处，皆是恶症。如发高肿，紫赤皮薄光泽，觉里
有脓毒，诸药贴 不破者，宜用熟铜针，于油火上燎透，先用墨笔点定，却当头以针浅
刺入，随针出脓者顺也，有不随针脓出，当用白纸作 ， 入针孔，引出脓毒，当时肿
退可及三分，如肿不退是一逆也。肿不退，疼不除，但脓出二逆也。脓疼不退，患人不觉
疮轻三逆也，虽用针破出脓，亦无所济，须急用引脓托里汤药，以助其势力可也。更有
痈生实处，不问浅深，如有脓即用针烙无害，稍缓即恐伤筋骨内疼，凡近筋脉骨节处，不
得乱行针烙，反致他病也。患疽初生赤硬，或在虚处毒瓦斯浅，或在实处毒瓦斯深，切须仔细
辨认，仍问患人疼痛，觉深觉浅，其患处疮头，不拘多少，其间须有一个最大者，即是
大脓窍，当用熟铁大针头如KT 脚者，于麻油灯上烧令热透，以大头处按定，插入一寸或
至二寸脓当下，恐未有脓毒出，却用白纸作 子 入，候次日取出，其脓即随 下矣。脓
色黄白即好，若赤黑色，防后有鲜血出，即患人寒战不禁，其有虚处，不得妄行针烙。凡
患发背，觉似有脓成，便用大熟铁针烙，当正头上烙之，其烙并用麻油灯上烧令通红，烙
入可二寸许，初人肉即须横插入，不得正入，恐烙透膜也，如已有破处，皮烂溃熟，更不
得用针烙，如是横长赤引开阔，当须两头下火针，令脓毒随针引出，肥人脓汁多，瘦人
脓汁少，如肥人却少，瘦人却多，多是肉败坏成脓，少是肉不腐烂，受气实也，尤宜详
审，不可造次便行针烙。亦看患人气脉匀和，荣卫气不节滞，血脉不致凝涩，即行针烙无
畏，切须仔细，患人气虚，脉气大者，亦不可乱行针烙；针烙之法，不可容易，先看皮
纹紧慢浓薄，紫赤色大光泽者，即可用针烙，如皮肉未变，不可用针，针亦无济。大抵用
针，只欲引脓，如针刺无脓，是气伏也，不可用针烙。
〔丹〕 或问烙法如何？曰∶脓或汪洋欲出，奈何皮浓肉深难穴者，既前无内托之药，
先致力于内。后又不用烙以开窍，脉脓何由出。脓本肉腐所成，皆挟毒热之气，若久留
肉腠间，则毒瓦斯浸淫，好肉亦化为脓腐，此所以烙法有功于溃疡也，彼根浅而皮薄者，何
必假此以卖弄假法，恐吓而胁取利也。
《集验》记载：脉象紧而数，说明脓液尚未形成；紧象消失仅见数脉，说明脓液已经形成。用手按压患处，感觉发热的表示有脓，不发热的表示无脓。按压时质地坚硬牢固的，还没有脓；按压时半软半硬（注：原文“半软半 ”缺字，据中医外科常识补为“硬”）的，已有脓液；完全变软的才是脓液成熟。用力按压感到疼痛的，说明脓位较深；按压时疼痛不明显的，说明脓液尚未形成。按压后凹陷立即回弹的，是有脓的表现；按压后凹陷不复原的，是无脓。轻微按压就痛，且表皮薄处隆起如剥皮状的，说明脓位浅表；按压四周都痛，但皮肤颜色不变、没有高突肿块的，说明脓位较深。浅表的脓适宜用药点破，高突的脓适宜用铍针切开，深的脓适宜用火烙法，此外还需详细辨别虚实情况。肿胀处柔软且不痛的，是血瘤；肿胀逐渐增大但热度不高，时常牵引作痛的，是气瘤；虚肿且呈黄色的，是水湿停滞；气机郁结导致微肿，久不消散，后来也会化脓，这是寒热邪气所致，邪气留积日久，阴积聚而生阳，寒邪转化为热邪。此时溃烂必然形成溃疡，应尽早服用内托排脓的药物以排出脓毒。各种瘿瘤、疣赘等，到了年老体衰时都会自行从内部溃烂，如果在补养的同时妄加攻伐腐蚀，必定会有生命危险。至于瘰疬结核，伴有寒热口渴，经久不消，患者面色萎黄，被热邪上蒸，说明已经成脓。（治疗方法见本条相关章节。）手足指梢及乳房部位，宜待脓液成熟大溃之后，方可切开引流。麻豆病（天花或麻疹类疾病）后，肢体关节上的痈肿，稍觉有脓，就必须决破，拖延则会形成肢体拘挛弯曲的残疾。
凡是疮肿，用手指从疮旁按至四周边缘，如果按处呈现赤黑色，说明脓已结成；又若按压后随即出现赤色，这也表示有脓。按压处发白，很久才变红，说明游走的毒邪已经平息，可以在赤白色尽头的地方施灸以截断毒势，待疮肉平实，久而久之即可消退。一般来说，痈的特点是皮薄肿高，疽的特点是皮厚肿坚。初发时都适宜灼艾，只有痈脓成时适宜用针切开，疽脓成时适宜用火烙。务必仔细审视详审，等待其溃烂成熟，脓液透达外部，势头充盈欲出之时，只用替针丸从疮头咬开，不到半天脓液自然流出，切不可使用针刀。（朱丹溪说：《精要》论述中告诫不要使用针刀，从事外科的人应当诚心信奉。）
替针丸：治疗痈疽已经溃烂但未破口，或破口后脓液排出不畅的情况。
配方：白丁香（一钱）、硇砂（一钱以上）、没药、乳香（各一钱）。
制法：将上述药物放入灰饼药内，种植糯米十四粒。具体方法：用锻石五升，炉灰三升，加水五升，淋取清汁，倒入大锅内熬制成浓汁，浓缩至二三升，用瓦器盛装储存。临用时，用小青盏盛取半盏浓汁，然后用皮纸贴在盏中浓汁面上固定，接着取糯米十四粒，种在皮纸面上，过夜即成。
用法：将上述药物研为细末，用糯米饭做丸，如麦粒大小。每次用一粒，未破口的，贴于疮头薄弱处即可破口；若脓液滞留排出不快，则将一粒纳入疮口内，使脓液通畅，好肉容易生长。
又一方：
雄雀粪（二十粒）、硇砂、陈仓米、没药（各一钱）。
制法：研匀，用米饭做丸，如粟米大小。每次用一粒，贴于疮口眼中，脓液即刻溃出。
替针丁香丸：
草乌（尖部）、硇砂、白丁香（质地坚硬的）。
制法：研为细末，用酸醋调匀点涂，促使即将破溃的尽快破溃。如果病情紧急，则没有比刀割更快的了。蜞针疗法也很妙，详见后文。
〔梅〕：治疗各种痈肿不消散，已经成脓，害怕针刺不能破溃，令其迅速决破。取雄雀粪涂在疮头上，干了就更换，雀粪中坚硬的是雄性的。
〔本事方〕：治疗痈疽已有疮眼，但脓未出，疼痛难忍，用此药片刻脓即出。巴豆一枚，去皮膜，不去心、油。盐豉十四粒，口中含去皮的盐豉，使其变软，与巴豆同研烂，加入少许真麝香，如果难以做成丸剂，加入少量稀糊，捏成饼子，如鼠粪大小。根据疮口大小临时决定用量，只需用纸捻子送入药，须臾之间必感疼痛，忍耐良久，脓液遂出。
〔丹溪〕：引出一切疮口脓液，用蚕蛾茧壳，烧存性，用无灰酒调服，每服一枚，服药一个时辰后，便会有一个疮口出脓；若服两枚，则有两个疮口出脓。
〔精要〕：痈成脓适宜用针，铁针应用马衔铁制成。形状像韭菜叶，两面锋利，可以横向或纵向裂开，约五六分许，以取出毒血。如果觉得病情较轻，必须先施灸然后裂开。
〔娄〕：按语：痈如椒眼数十粒，或如蜂窠莲房状而脓出后疼痛不除，适宜用针者，将针横向或纵向裂开，则毒血挟带脓液排出而痊愈。如果没有椒眼之类的情况，只需直入取脓，不必裂开。又一种方法：在椒眼上各施灸也不错，不必裂开。
〔素问〕：痈气停滞的地方，适宜用针开刀除去。（《病疑篇》，王冰注云：息，指息肉，死肉。现在世医用刀割去死肉的就是这种方法。）
治腐肿者，刺腐坏之处，视痈的大小深浅进行针刺，刺大的多出血，刺小的深入，必须端正地进针为标准。（《长刺节论》，其中“大者多血，小者深之”八字为衍文。“大小深浅刺”七字，概括了取脓的方法，详尽完备。）
〔精要〕：疽成脓适宜火烙，可用银篦宽二分，长六寸，在火上烧得通红，迅速用手熨烙毒处，见到脓液排出即为有效。《鬼遗科》凡痈发生在虚处，以及肉眼看不见的地方，都是恶症。如发生高肿，皮薄紫赤光泽，感觉里面有脓毒，诸药贴敷不破的，宜用熟铜针，在油火上燎透，先用墨笔点定位置，然后当头以针浅刺入，随针出脓的为顺证；有不随针出脓的，当用白纸做成捻子，插入针孔，引出脓毒，当时肿胀消退可达三分，如果肿不退是一逆；肿不退，疼不除，只是脓出，是二逆；脓疼不退，患者不觉疮情减轻，是三逆。虽然用针破出脓，也无济于事，必须急用引脓托里汤药，以助其势力。更有痈生在实处，不问深浅，如有脓即用针烙无害，稍缓恐怕伤及筋骨引起内疼。凡靠近筋脉骨节处，不得乱行针烙，反而会导致其他疾病。患疽初生时赤硬，或在虚处毒瓦斯浅，或在实处毒瓦斯深，切须仔细辨认，仍询问患者疼痛感，觉深还是觉浅。其患处疮头，不管多少，其中必有一个最大的，就是大脓窍，当用熟铁大针头如牛蹄脚者，在麻油灯上烧令热透，以大头处按定，插入一寸或至二寸，脓当下出。恐未有脓毒出，却用白纸做成捻子插入，候次日取出，其脓即随捻子下矣。脓色黄白即好，若赤黑色，防备后面有鲜血流出，即患者寒战不禁。其有虚处，不得妄行针烙。凡患发背，感觉似有脓成，便用大熟铁针烙，应当在正头上烙之，其烙并用麻油灯上烧令通红，烙入可二寸许，初入肉时须横插入，不得正入，恐怕烙透筋膜。如已有破处，皮烂溃熟，更不得用针烙。如是横长赤引开阔，应当两头下火针，令脓毒随针引出。肥人脓汁多，瘦人脓汁少，如肥人却少，瘦人却多，多是肉败坏成脓，少是肉不腐烂，受气实也，尤其宜详细审慎，不可草率便行针烙。也要看患者的气脉是否匀和，营卫气是否不节滞，血脉是否不凝涩，即行针烙无畏惧。切须仔细，患者气虚，脉气大者，也不可乱行针烙；针烙之法，不可轻视，先看皮纹紧慢浓薄，紫赤色大光泽者，即可用针烙，如皮肉未变，不可用针，针亦无济。大抵用针，只欲引脓，如针刺无脓，是气伏也，不可用针烙。
〔丹溪〕：有人问烙法如何？回答说：脓液汪洋欲出，奈何皮厚肉深难以穴位的，既然前面没有内托的药，先致力于内治。后来又不用烙法来开窍，脉脓从哪里出来呢？脓本是肉腐所成，都挟带毒热之气，若久留肉腠间，则毒瓦斯浸淫，好肉也化为脓腐，这就是烙法对溃疡的功效。那些根浅而皮薄的，何必假借这种方法来卖弄虚假的法术，恐吓而胁取利益呢。
According to *Ji Yan* (Collection of Proven Experiences): A pulse that is tight and rapid indicates that pus has not yet formed; if the tightness disappears and only rapidness remains, it indicates that pus has already formed. Pressing the affected area with hand: if it feels hot, there is pus; if not hot, there is no pus. If pressing feels firm and hard, there is no pus; if it feels half-soft and half-hard, pus has formed; if it becomes completely soft, the pus is mature. Pain upon deep pressure indicates deep-seated pus; slight pain upon pressure indicates pus has not yet formed. If the depression rebounds immediately after pressing, there is pus; if it does not rebound, there is no pus. Pain upon slight pressure with thin skin lifting like peeled bark indicates superficial pus; pain upon pressing all four sides with unchanged skin color and no elevation indicates deep-seated pus. Superficial pus is suitable for chemical cauterization with medicine; elevated pus is suitable for incision with a Pi needle (Bī Zhēn); deep pus is suitable for moxibustion/cautery. Additionally, one must carefully distinguish between deficiency and excess. Soft swelling without pain indicates a Blood Tumor (Xuè Liú); swelling that gradually increases but is not very hot, with occasional pulling pain, indicates an Qi Tumor (Qì Liú); hollow yellowish swelling indicates Water retention; slight swelling due to Qi stagnation that persists for a long time and later turns into pus is caused by Cold and Heat pathogens. Long-standing accumulation leads to Yin accumulating and generating Yang, transforming Cold into Heat. Once ulcerated, it will form a sore; early administration of internal medicines to support the interior and expel pus is advisable. Various Ying tumors (Yǐng Liú) and warts will spontaneously ulcerate internally in old age. Blindly using attacking and corrosive treatments while nourishing tonifying will surely endanger life. Regarding Scrofula (Luǒ Lí) nodules, accompanied by alternating cold and fever, thirst, persistence over time, sallow complexion, and steaming heat from above, pus has already formed. (Treatment see relevant section.) For abscesses on finger/toe tips and breasts, incision should only be performed when pus is ripe and fully developed. After smallpox/measles, abscesses on limbs and joints must be drained as soon as pus is suspected; delay may lead to contracture deformities.
For any carbuncle or swelling, press from the side towards the edges with fingers. If the pressed area turns dark red/black, pus has formed. If it turns red immediately after pressing, this also indicates pus. If it turns white and takes a long time to turn red, wandering toxic heat has subsided; moxibustion can be applied at the boundary of red and white colors to block the toxin. When the tissue becomes flat and solid, it will eventually resolve. Generally, Carbuncles (Yōng) have thin skin and high swelling, while Ulcers/Gangrene (Jū) have thick skin and firm swelling. Early stage treatment for both favors moxibustion. Only when pus forms in Carbuncles is needle incision appropriate; when pus forms in Jū, cautery is appropriate. One must examine carefully, waiting for maturity until the pus is ready to burst out. At this point, use "Ti Zhen Wan" (Substitute Needle Pill) to bite open the head of the sore; pus will flow naturally within half a day. Do not use needles or knives. (Zhu Danxi said: The *Jing Yao* warns against using needles and knives; surgeons should hold this in high regard.)
**Ti Zhen Wan**: Treats carbuncles/ulcers that are ulcerated but unbroken, or where pus drainage is slow.
Ingredients: Bai Ding Xiang (White Sparrow Droppings), Nao Sha (Nuo Sha/Rock Salt derivative), Moyao (Myrrh), Ruxiang (Frankincense).
Preparation: Plant 14 grains of glutinous rice inside ash cakes made from these herbs. Method: Use 5 sheng of calcined stone powder and 3 sheng of furnace ash, add 5 sheng of water, leach to obtain clear juice, boil in a large pot until concentrated to 2-3 sheng, store in a pottery vessel. To use, take half a cup of concentrated juice in a small cup, place parchment paper on top to stabilize, then plant 14 glutinous rice grains on the paper overnight.
Usage: Grind ingredients into fine powder, mix with glutinous rice paste to make pills the size of wheat grains. Apply one pill to the thinnest part of the unbroken sore head to induce rupture. If pus is stagnant, insert one pill into the opening to facilitate drainage and promote healthy tissue growth.
Another Formula:
Xiong Que Fen (Male Sparrow Droppings), Nao Sha, Chen Cang Mi (Aged Rice), Moyao.
Grind evenly, make pills the size of millet seeds with rice paste. Apply one pill to the center of the sore opening to induce pus discharge.
**Ti Zhen Ding Xiang Wan**:
Cao Wu (Aconite root tip), Nao Sha, Bai Ding Xiang (Hard variety).
Grind into powder, mix with vinegar for topical application to accelerate rupture of impending sores. If urgent, knife incision is faster. The Leech Needle method is also excellent (see later).
[Mei]: Treats various carbuncles that do not subside and have formed pus, fearing needle failure to drain. Apply male sparrow droppings to the sore head; replace when dry. Harder droppings are male.
[Benshi Fang]: Treats carbuncles/ulcers with an opening but no pus, causing unbearable pain. Apply this medicine for immediate drainage. One Baidu bean (peeled, heart/oil retained), 14 salted soybeans (peeled and softened in mouth). Grind together with a little real Shexiang (Musk). If difficult to pill, add thin paste to form pellets the size of mouse feces. Insert via paper twist into the sore according to size. Pain will occur shortly; endure it, and pus will drain.
[Danxi]: To drain all sore openings, burn silkworm pupal cocoons to retain charred nature, administer with non-grain wine. One pellet per dose. Within one hour, one new opening will appear. Two pellets yield two openings.
[Jingyao]: Carbuncles with formed pus require needle incision. Iron needles should be made from horse bit iron. Shape like leek leaves, sharp on both sides, capable of horizontal or vertical splitting (approx. 5-6 fen) to drain toxic blood. If condition is mild, moxibustion first, then split.
[Lou]: Commentary: If carbuncles resemble pepper eyes or honeycombs/lily pads with persistent pain after pus drainage, needle splitting is indicated to release toxic blood and pus. If no such features exist, simple vertical insertion suffices. Alternatively, moxibustion on each "pepper eye" is also effective without splitting.
*LLing Shu*: Pi Needle (Bī Zhēn) has a tip like a sword edge, used to extract large amounts of pus.
*Sù Wèn*: Areas where Qi stagnates in carbuncles should be opened and removed with needles. (Wang Bing notes: Xi refers to polyps/necrotic flesh. This corresponds to modern surgical removal of necrotic tissue.)
Treating necrotic swelling: Pierce the necrotic area. Depth depends on the size and depth of the carbuncle. Larger ones bleed more; smaller ones require deeper penetration. Ensure the needle is inserted straight. ("Large bleed, small deep" is considered interpolational text; "Size and depth determine needling" summarizes the method perfectly.)
[Jingyao]: Jū (deep ulcers/gangrene) with formed pus requires cautery. Use a silver comb-like tool (2 fen wide, 6 cun long), heat red-hot in fire, and quickly apply to the toxic area. Pus discharge indicates efficacy. *Gui Yi Ke*: Carbuncles in "empty" (weak) areas or hidden places are malignant. High swelling with thin, purple-red, shiny skin suggests internal pus/toxin resistant to external plasters. Use a heated copper needle, mark with ink, prick shallowly. Smooth pus drainage is favorable. If pus does not follow the needle, insert a white paper twist to draw out toxin. Swelling should reduce by 3 fen. Failure to reduce swelling is the first adverse sign; failure to relieve pain is the second; lack of patient relief despite pus drainage is the third. In such cases, urgently use decoctions to guide pus and support the interior. For carbuncles in "solid" (strong) areas, cautery is safe regardless of depth if pus exists; delay risks damaging tendons/bones. Avoid cautery near tendons/joints to prevent complications. Initial Jū presents as red/hard. Toxicity is shallow in weak areas, deep in strong areas. Identify the largest pore as the main drainage point. Use a large heated iron needle (like ox hoof) in sesame oil lamp, insert 1-2 cun. If no pus, insert paper twist overnight to draw pus. Yellow-white pus is good; red-black suggests fresh bleeding risk and chills. Do not cauterize in weak areas. For Back Carbuncles (Fā Bèi), if pus seems formed, cauterize the center with a large heated iron needle (approx. 2 cun deep). Insert horizontally initially to avoid piercing fascia. If already ruptured/thin, do not cauterize. For elongated red areas, cauterize both ends. Fat people produce more pus; thin people less. Reverse patterns suggest tissue decay vs. strong Qi. Carefully assess pulse harmony and Ying-Wei flow before cautery. Weak Qi with large pulse contraindicates blind cautery. Assess skin texture/color (purple-red/shiny indicates suitability). Needling aims to drain pus; if no pus comes, Qi is trapped, do not cauterize.
[Danxi]: Question: How is cautery performed? Answer: If pus is abundant but skin is thick/deep making access difficult, and internal support meds were insufficient, cautery opens the pathway. Pus results from rotting flesh carrying toxic heat. Prolonged retention causes toxins to invade healthy flesh, turning it to pus. Thus, cautery benefits ulcerative conditions. Those with shallow roots and thin skin do not need this complex method to deceive or profit.