Lingshu: Chapter 81 — Ulcers and Deep Abscesses (Yong-Ju)

Overall Paraphrased Translation

The original text of this chapter contains numerous textual errors and omissions from transmission. The following is a coherent paraphrase based on contextual clues and standard collations such as the Taisu (Grand Simplicity).

The Yellow Emperor asked: I have heard that after the stomach and intestines receive water and grain, the Upper Burner outputs Defensive Qi (yang qi that warms and protects the body surface), used to warm the interstices of flesh, nourish the bones and joints, and keep the striae and interstices (cou li) open and permeable. The Middle Burner outputs dew-like essential subtle substances, which flow upward into the valleys of the body (muscle interspaces), seep into the minute collateral vessels (sun mai, the finest blood vessels). Fluids and humors harmonize and transform into red blood. When blood is harmonized, the minute collateral vessels fill first, then spill into the collateral vessels (luo mai); when the collaterals are full, blood then pours into the primary channels (jing mai). Both yin and yang channels are replete with qi and blood, moving in accordance with breathing, regulated by rules and regulations, cycling endlessly, in harmony with the movements of heaven and earth without cease. In treatment, one palpates the pulse and regulates qi, supplementing or draining according to deficiency or excess: improper draining causes disuse of healthy qi; rapid needling makes qi easily decline; retention of needle requires distinction of order; improper supplementing causes excess of qi and blood. When qi and blood are harmonized, the physical appearance and qi become stable. I already understand the principle of whether qi and blood are in balance or not, but still wish to understand from what ulcers and deep abscesses (yong-ju) arise, and how to judge their success or failure, and the proximity or distance of death or survival?

Qi Bo said: The channels and vessels move without stopping, in concert with celestial phenomena, in harmony with terrestrial patterns. Therefore if heavenly mansions lose their proper degrees, the sun and moon will experience eclipses; if earthly channels lose their order, waterways will flood, grass and trees will not grow, the five grains will not propagate, roads will be impassable, and the people cannot come and go, their settlements severed and isolated. So it is with qi and blood. Let me explain the reasons.

Blood vessels, Nutritive Qi (ying qi), and Defensive Qi (wei qi) circulate without rest, above corresponding to the star mansions, below corresponding to the numerological patterns of the earth. When cold pathogens invade the channels and collaterals, blood circulation becomes coagulated and sluggish; when blood is sluggish and blocked, defensive qi will converge at that site, unable to return normally, thus forming swelling and abscesses. When cold pathogen stagnates over time, it transforms into heat; when heat flourishes, it rots the flesh; when flesh rots, it becomes pus. If pus is not drained, it decays the sinews; when sinews decay, it injures the bones; when bones are injured, the marrow dissolves; if it is not drained through the bone cavities, then blood becomes depleted and vacuous, sinews, bones, and flesh lose nourishment, the channels and vessels become damaged and leak, heat toxin fumigates the five viscera, and when the five viscera are injured, death results.

Individual Discussion of Ulcers and Deep Abscesses

• Arising at the throat: Called Fierce Abscess (meng ju). If not treated promptly, it will transform into pus; if pus is not drained, it blocks the throat and death occurs within half a day. If pus has already formed, the ancients believed one could drain the pus, then hold an ointment of lard in the mouth and eat cold foods, recovering in three days.
• Arising at the neck: Called Heavenly Abscess (tian ju). When the abscess is large and dark red in color, if not treated urgently, heat qi descends to the axillary region (yuan ye), injuring the Conception Vessel (ren mai) in front, internally fumigating the liver and lungs with death occurring in about ten days or more.
• Arising at the nape of the neck: Called Cranial Burning (nao shuo). The facial expression is unhappy, neck pain is like needle pricks; if vexation and restlessness appear, death is certain and untreatable.
• Arising at the shoulder and arm: Called Speckled Abscess (ci yong). Dark red in color — treat urgently. One may cause sweating that reaches the feet, and the five viscera will not be injured.
• Arising beneath the armpit: Dark red and firm — called Rice Abscess (mi ju). The ancients used fine elongated bian stones to drain it sparsely, then applied lard ointment; recovery in six days, no need to bandage. If the abscess is firm and does not ulcerate, it is called Horse-Sword Lymphatic Nodes (ma dao jia ying) — urgent treatment required.
• Arising at the chest: Called Well Abscess (jing ju). Shaped like a soybean, arising within three or four days; if not treated early, it descends into the abdomen; without treatment, death occurs in seven days.
• Arising at the breast region: Called Sweet Abscess (gan ju). Bluish in color, shaped like grain kernels or snake-gourd fruit, often with alternating chills and fever. Urgent treatment should be applied to eliminate the chills and fever; the original text says "death in ten years, pus exits after death" — this passage contains textual variants and is suspected to be erroneous.
• Arising at the flank region: Called Defeated Anthrax (bai chi). Defeated Anthrax occurs more often in women and may be treated with moxibustion. If a large abscess with pus has formed, fleshy growths like red bean kernels may emerge within. The ancients recorded boiling herb roots in water for oral administration, requiring the patient to wear heavy clothing and sit over the pot of boiling medicine, causing sweat to reach the feet.
• Arising at the buttocks: Called Pointed Abscess (rui ju). Red, firm, and large — treat urgently. Without treatment, death in thirty days.
• Arising at the medial thigh: Called Red Spreading (chi shi). If not treated urgently, death in sixty days. If arising on both inner thighs simultaneously, without treatment death in ten days.
• Arising at the knee: Called Speckled Abscess (ci yong). The swelling is large and painful, the skin color unchanged, accompanied by chills and fever, hard as stone. Do not cut it open with bian stones; using them erroneously will cause death. The area must be waited for to soften before incising with knife or bian stone; then survival is possible.
• Arising at joints with involvement of both interior and exterior correspondence: Untreatable. Those arising on the yang aspect die in a hundred days; those arising on the yin aspect die in thirty days.
• Arising at the calf: Called Rabbit Gnaw (tu nie). Dark red in color, reaching deep into the bone — treat urgently. Without treatment, it will injure a person.
• Arising at the medial malleolus: Called Slow Running (zou huan). Externally resembling an abscess, the skin color is unchanged; needle the associated transport points repeatedly to stop chills and fever — the prognosis may be survival.
• Arising above and below the foot: Called Four Exuberances (si yin). Large abscess — treat urgently. Without treatment, death in one hundred days.
• Arising at the side of the foot: Called Harsh Abscess (li yong). Initial onset is not large, like a little finger tip. Urgently treat, removing black necrotic tissue. If instead of subsiding it grows larger, without treatment, death in one hundred days.
• Arising on the toes: Called Detached Abscess (tuo yong). If reddish-black in color, the prognosis is poor; if not dark red, the prognosis is better. If the disease does not abate, the ancients believed one should urgently amputate the affected digit; otherwise, death ensues.

Differentiation Between Yong (Superficial Abscess) and Ju (Deep Abscess)

The Yellow Emperor asked: How do yong and ju differ?

Qi Bo said: When Nutritive Qi (ying qi) and Defensive Qi (wei qi) stagnate within the channels and vessels, blood becomes coagulated which arrests movement. When blood fails to move, defensive qi follows suit and becomes blocked, congestion and restraint prevents passage — thus heat is generated. When great heat does not cease, exuberant heat rots the flesh; rotted flesh becomes pus. However, yong does not penetrate deeply, the bone marrow is not thereby scorched, and the five viscera are not injured — hence it is called yong.

The Yellow Emperor asked: What then is ju?

Qi Bo said: When heat qi is fierce, it penetrates deeply into the skin and flesh. The sinews and marrow dry up; it connects to the five viscera internally; qi and blood become exhausted, and the sinews, bones, flesh — all are destroyed beneath. Hence it is called ju. The characteristic of ju is skin that is darkened and firm, like the skin of a bull's neck, while the characteristic of yong is skin that is thin and glossy. These are the distinguishing manifestations of the two conditions.

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🧠 Deep Understanding

Core Principles 💡

The central medical philosophy of this chapter is established upon the holistic view that "qi and blood circulate unceasingly, internal and external correspond":

1. Abnormal qi and blood circulation is the source of ulcers and deep abscesses
   The qi and blood of the channels circulate without rest, corresponding to the movements of heaven and earth. Once cold pathogens invade the channels and collaterals, blood congeals and fails to move; when defensive qi becomes congested, local swelling and abscesses form. This continues the line of thought from the Lingshu: "When nutrient qi does not follow its proper path, rebelling within the interstices of flesh, ulcers and swellings are born."

2. Transformation of cold into heat, and blazing fire rotting the flesh
   First, cold congelation; later, heat transformation through stagnation. Blazing heat decays flesh to produce pus. This pathological chain of "cold → stasis → heat → decay → pus" constitutes the fundamental model by which traditional Chinese medicine surgery understood infectious swellings.

3. Yong is superficial, ju is deeply positioned, with different prognoses
   Yong is superficial — not damaging bone marrow or the five viscera. Ju is deep — injuring sinews and marrow, connecting to the viscera, exhausting qi and blood, with critical prognosis. Skin that is "thin and glossy" identifies yong, while "featureless skin firm like a bull's neck" identifies ju — this became an essential differential touchstone for later generations.

4. Emphasis on anatomical location and early management
   The chapter enumerates sites systematically — from throat through neck, chest, flanks, joints, and toes — stressing the urgent need for treatment and warning of fatal outcomes if untreated, revealing that the ancients already recognized the relationship between anatomical location and the degree of infection-related danger.

Contemporary Understanding 🌟

• Rough Correspondences in Pathophysiology
  The progression from "cold pathogen invading collaterals → blood stasis impedes movement → defensive qi aggregates → transforms heat → rots flesh forming pus" is broadly comparable to the sequence of local circulatory disturbance, congestion, exudation, suppuration, and necrosis seen in modern inflammatory responses. Deep infections, osteomyelitis, necrotizing fasciitis, and gangrene parallel the descriptions of ju as deeply penetrating bone and viscera injuries.

• Early Value of Classification Systems
  This chapter represents one of the few surgical monographs within the Huangdi Neijing. Its systematic prognosis based on location, depth, the color of the skin, chill and fever, and degree of firmness reflects the systematic observational power of classical empirical medicine.

• Historical Limitations Call for Independent Evaluation
  Statements throughout this text, including citations of "death in N days," "untreatable," and "cannot be cured," represent summations drawn from the natural clinical course of grave modern-day-detected infections under early medical conditions; they should not be directly applied in contemporary settings. Bian stones, moxibustion, digit amputation, and the drinking of herbal decoctions constitute ancient therapeutic normative approaches, which are discussed here for scholarly purposes only and not as any modern clinical recommendation.

Wellness Insights ⚡

• Safeguard healthy qi — vigilantly expel lingering cold: Keep warm, avoid long-term exposure to cold and damp environments, and promptly wipe away sweat after exercise.
• Qi and blood require smooth flow: Exercise moderately and avoid prolonged sitting or reclining, which helps qi and blood circulate freely and reduces local stagnation.
• Clean promptly even minor wounds or skin blemishes: Do not manually squeeze red, swollen, hardened lumps — especially on the face, joints, and feet.
• Maintain emotional moderation and dietary restraint: Keep the bowels regular and sleep fully healthy to promote overall harmonization of qi and blood.
• Seek prompt medical care for continuing redness, swelling, and heat with unrelenting fever: Do not imitate ancient texts' localized superficial procedures independently.

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📚 Related Material

• Related Concepts
  Defensive Qi (wei qi), Nutritive Qi (ying qi), Primary Vessels (jing mai) and Collateral Vessels (luo mai), Sun (minute) collaterals, Cold-Heat Transformation, Bone Cavities (gu kong), The Five Viscera, Bian Stone (stone needles), Moxibustion, Yong, Ju, Tuo Yong (approximate: gangrene)

• Further Reading

  • Suwen, Chapter 3, "Writings on the Sanctity of Vitality" (Sheng Qi Tong Tian Lun): "When nutrient qi does not follow, rebelling within the interstices of flesh, ulcers and swellings come forth."
  • Lingshu, Chapter 17, "Doctrine of the Crossing Points of the Vessels" (Mai Du): study of vapor-blood momentum interpenetrations among channels(^*now given to one in need)—historical context; providing title basis.
  • Lingshu, Chapter 1, "The Nine Needles, Origins of Nine Numbers" (Jiu Zhen Shi Er Yuan): foundational features of supplementing-elimated use of needles in relevant pathways are classically aligned techniques in guiding spirit the needling correspondence to those transmissions has known reference point relations to body micro alignment always matters
  • Lingshu, Chapter 81, entire text: This final Lingshu dispatch thematisates systemic categorisation that governs this class materials set orthopedics-forward across texture and biohumor synthesis mapping reading matrix medical institution coheres chained conclusions with assessment details per site enumerated.

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