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Chapter 70 of 81
黄帝内经·灵枢
Overall Paraphrase
The Yellow Emperor asked Qi Bo: The cold-heat luǒlì (swollen lymph nodes that ulcerate and suppurate) occurring in the neck and axillary region — what kind of pathogenic qi (disease-causing factors) cause them?
Qi Bo replied: These are all caused by the cold-heat toxic qi of shǔ lòu (a type of disease in which ulcerated scrofula forms fistulas, discharging fluid like water from a rat hole). This toxic pathogen lodges within the channels and vessels without dispersing, and thus the disease arises.
The Yellow Emperor asked: How can it be eliminated?
Qi Bo said: The root of shǔ lòu always lies in the five viscera. Although the root is in the internal organs, the pathogen ascends from within to emerge between the neck and axillae. If the toxic qi merely floats in the vessels (resides in relatively superficial channels), attaching internally to the muscles and transforming externally into pus and blood (pus and sanguineous fluid), it is relatively easy to eliminate.
The Yellow Emperor asked: How exactly can it be eliminated?
Qi Bo said: One should proceed from its root and guide its branch — that is, regulate from the root cause (the five viscera), while simultaneously guiding the superficial pathogen to disperse outward. In this way, the pathogenic qi can be made to subside, thereby severing its cold-heat symptoms. One must carefully examine the pathways of the channels to select the needling sites. When needling, advance slowly and withdraw slowly (insert the needle slowly and remove it slowly), in order to eliminate the pathogen. If the scrofula is as small as a grain of wheat, a single needling will show effect, and three sessions may achieve a cure.
The Yellow Emperor asked: How does one assess the prognosis of life and death for such patients?
Qi Bo said: Turn back the patient's eyelid and observe — if on the sclera (the white of the eye) there are red vessels (red blood vessels/capillaries) that penetrate from above and below through to the pupil, and one such vessel appears, then death occurs after one year; if one and a half appear, death follows after one and a half years; if two appear, death follows after two years; if two and a half appear, death follows after two and a half years; if three appear, death follows after three years. If red vessels exist but do not penetrate downward through the pupil, the condition may still be treatable.
The core medical principles of this chapter can be summarized as follows:
1. "The disease originates in the viscera; its manifestation appears externally" — The root–branch relationship under holism
Qi Bo explicitly states that although scrofula manifests in the neck and axillae, its root lies in the five viscera. This reflects the consistent Neijing principle of "what is within must manifest without": surface lesions are not isolated but are external reflections of internal organ dysfunction. The neck and axillary regions are areas traversed by the hand and foot shaoyang channels and yangming channels, and hence scrofula in these areas is closely related to disorders of visceral qi and blood.
2. "Toxic qi lodges in the vessels" — The etiological concept of pathogenic qi
The ancients attributed scrofula to cold-heat toxic qi that lodges in the channels without dispersing. In an era without concepts of microbiology, using "toxic qi" to explain a condition that is ulcerative, pus-discharging, and lingering reflects a rudimentary understanding of chronic infectious diseases.
3. "Proceed from the root, guide the branch" — The therapeutic principle of treating both root and manifestation
Treatment emphasizes the combination of "proceeding from the root" and "guiding the branch": on one hand, focusing on the root cause (the five viscera), and on the other, guiding superficial pathogenic qi to disperse outward. This approach of balancing internal and external treatment and addressing both root and branch is an important principle in Chinese medical therapeutics.
4. "Advance slowly and withdraw slowly" — The subtlety of needling technique
In needling, Qi Bo emphasizes "advancing slowly and withdrawing slowly" — inserting slowly and removing slowly. This reflects the ancients' attention to reinforcing–reducing technique: for chronic conditions where upright qi is already injured and pathogenic qi remains lodged, one should not attack with rapid insertion and rapid withdrawal; rather, one should treat with a slow, gentle approach to protect upright qi.
5. Eye diagnosis of red vessels in judging life and death — The unique application of inspection
Using observation of whether red vessels on the sclera penetrate the pupil to assess prognosis is a distinctive method of eye diagnosis. Its theoretical basis lies in: the eye is the site where the essential qi of the five viscera and six bowels gathers, with the pupil belonging to the kidney, the sclera to the lung, and the inner and outer canthi to the heart. When red vessels penetrate the pupil, it indicates that the pathogen has reached the core level of kidney essence, giving a poor prognosis. The number and depth of penetration of red vessels are used to judge the depth of the struggle between upright and pathogenic qi and the stage of disease progression.
Regarding luǒlì/shǔ lòu: Modern medicine recognizes that "luǒlì" in ancient medical texts primarily corresponds to cervical lymph node tuberculosis (caused by Mycobacterium tuberculosis), and more broadly may encompass other chronic lymphadenitis, lymph node enlargement, and even tumor metastasis. The ancients called it "shǔ lòu" because ulcerated fistulas are observed to tunnel like rat burrows — a description highly consistent with modern observations of sinus tract formation following ulceration of tuberculous lymph nodes. The ancient concept of "toxic qi" has some rudimentary correspondence with the modern concept of "pathogenic infection" in terms of directional thinking, though the ancients could not have known the specific pathogenic microorganisms involved.
Regarding eye diagnosis of red vessels in judging life and death: From a modern medical perspective, conjunctival congestion and vascular proliferation may be seen in various conditions, including anemia, malnutrition, and chronic conjunctivitis resulting from prolonged wasting diseases such as tuberculosis. Red vessels penetrating the pupil correspond to some degree with corneal neovascularization in modern medicine, which does suggest more severe local or systemic disease. However, the ancients' practice of using "one vessel = one year to death, two vessels = two years" as precise temporal predictions lacks reliable clinical basis and carries clear traces of empirical speculation and metaphysical reasoning that should not be taken literally. A more reasonable interpretation is: the more red vessels present and the deeper they penetrate, the more severe the illness and the more depleted the upright qi, and hence the worse the prognosis — this is a qualitative warning, not a quantitative prediction.
Regarding acupuncture treatment: Acupuncture for scrofula was a conventional external treatment in ancient times. In modern clinical practice, treatment for lymph node tuberculosis is primarily with anti-tuberculous drugs; acupuncture may serve as an adjunct to improve symptoms and overall status, but it is by no means a primary or stand-alone therapy.
Related concepts:
Further reading:
This content is based on classical Chinese medical texts and is provided solely for the study of traditional culture. It does not constitute any medical diagnosis, medication, or treatment advice; please seek medical attention promptly if unwell.