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Capítulo 70 de 81
黄帝内经·灵枢
Overall Paraphrase
The Yellow Emperor asked Qi Bo: The cold-heat luo-li (scrofula; swollen, festering lymph nodes) that occur in the neck and axilla (neck and armpits) — what kind of pathogenic qi (disease-causing factors) cause them?
Qi Bo replied: These are all caused by the cold-heat toxic qi of shu-lou (rat fistula; a disease where scrofula ulcerates to form fistulas, draining pus and fluid like rat burrows). This toxic pathogen lingers within the channels and vessels without dispersing, and thus this disease arises.
The Yellow Emperor asked: How can it be removed?
Qi Bo said: The root of rat fistula lies in the five viscera. Although its root is internal, the pathogen emerges from within upward to the region between the neck and the axilla. If the toxic pathogen merely floats in the vessels (remains in the relatively superficial channels), attaching internally between the muscles, and transforming externally into pus and blood (pus and bloody fluid), then it is relatively easy to remove.
The Yellow Emperor asked: Then how specifically can it be removed?
Qi Bo said: One should proceed from its root, and guide its branch — that is, regulate the root (the five viscera) while simultaneously guiding the superficial pathogen to disperse outward. In this way, the pathogen can be made to decline, thereby ending its cold-heat symptoms. Carefully examine the pathways of the channels and vessels to select the site of needling. When needling, go slowly in, go slowly out (insert the needle slowly, withdraw it slowly), in order to expel the pathogenic qi. If the scrofula is as small as a grain of wheat, one needling will show effect, and three will effect a cure.
The Yellow Emperor asked: How can one determine the prognosis of life and death for such patients?
Qi Bo said: Turn up the patient's eyelid and observe. If red vessels (red blood vessels) appear on the white of the eye (sclera), penetrating from above and below through to the pupil, and one such red vessel appears, then the patient dies after one year; if one and a half appear, death comes after one and a half years; if two appear, death comes after two years; if two and a half appear, death comes after two and a half years; if three appear, death comes after three years. If there are red vessels but they do not go downward through the pupil, then the condition can still be treated.
The core medical principles of this chapter can be summarized as follows:
1. "The disease is rooted in the viscera, manifesting externally" — the holistic view of root and branch
Qi Bo clearly states that although scrofula manifests in the neck and axilla, its root lies in the five viscera. This embodies the Classic's consistent "what is within must manifest without" visceral-manifestation thought: diseases of the body surface are not isolated but are external reflections of internal visceral dysfunction. The neck and axilla are regions through which the hand and foot shaoyang channels, yangming channels, and others pass, so scrofula in these areas is closely related to disorders of visceral qi and blood.
2. "Toxic qi retained in the vessels" — the concept of pathogenic qi in etiology
The ancients attributed the cause of scrofula to "cold-heat toxic qi" lingering in the channels and vessels without leaving. In an era without the concept of microbiology, using "toxic qi" to explain a lesion that ulcerates, discharges pus, and lingers stubbornly reflects an elementary understanding of chronic infectious disease.
3. "Proceed from its root, guide its branch" — the therapeutic principle of treating both root and branch
Treatment emphasizes combining "from the root" with "guiding the branch": one must focus on the root of the disease (the five viscera) while simultaneously guiding the superficial pathogen to disperse outward. This approach of treating both internal and external aspects, root and branch together, is an important principle in Chinese medical therapeutics.
4. "Go slowly in, go slowly out" — the subtlety of needling technique
In needling technique, Qi Bo emphasizes "going slowly in, going slowly out," that is, slow insertion and slow withdrawal. This reflects the ancients' careful attention to supplementation and drainage methods: for chronic diseases where righteous qi has been damaged but pathogens remain, one should not attack with rapid in-and-out draining techniques; instead, one should treat gently and regulate slowly, to protect and support righteous qi.
5. Eye diagnosis: red vessels and prognosis — distinctive use of inspection
Using observation of whether red vessels in the white of the eye penetrate through to the pupil as a prognostic sign is a distinctive eye-diagnostic method. The theoretical basis lies in the principle that the eye is where the essential qi of the five viscera and six bowels pours upward, with the pupil specifically belonging to the kidney, the white of the eye to the lung, and the inner and outer canthi to the heart. Red vessels penetrating to the pupil means the pathogen has already deeply entered the core level of kidney essence, indicating poor prognosis. The number and depth of red vessels are used to assess the depth of the struggle between righteous and pathogenic qi and the stage of disease progression.
On scrofula/rat fistula: Modern medicine believes that "scrofula" in ancient texts primarily corresponds to cervical lymph node tuberculosis (caused by Mycobacterium tuberculosis), and broadly may also encompass other chronic lymphadenitis, lymph node enlargement, and even tumor metastasis. The ancients' term "rat fistula" — describing ulcerated fistulas that burrow like rat holes — closely matches modern observations of sinus tracts formed after lymphatic tuberculosis ulceration. The ancient concept of "toxic qi," while directionally comparable in some crude sense to the modern notion of "pathogenic microbial infection," could not have identified specific microorganisms.
On eye diagnosis for prognosis: From a modern medical standpoint, conjunctival congestion and vascular proliferation can be seen in numerous conditions, including the anemia, malnutrition, and chronic conjunctivitis associated with the long-term wasting of tuberculosis. Red vessels penetrating the pupil correlate to some extent with corneal neovascularization, which indeed suggests more severe local or systemic disease. However, the ancients' precise chronological prognoses — "one vessel, death in one year; two vessels, death in two" — lack reliable clinical basis and bear clear marks of empirical extrapolation and metaphysical speculation; they should not be interpreted literally. A more reasonable reading is: the more red vessels and the deeper their penetration, the more severe the illness and the greater the decline of righteous qi — a qualitative warning approach, not a quantitative precise prediction.
On acupuncture treatment: Acupuncture for scrofula was a conventional external treatment in ancient times. In modern clinical practice, the treatment of lymphatic tuberculosis centers on anti-tuberculosis medications; acupuncture may serve as an adjunctive therapy to improve symptoms and overall bodily state, but it is by no means a first-line or primary therapy.
Related concepts:
Further reading:
This content is based on classical Chinese medicine texts and is provided solely for the study of traditional culture. It does not constitute any form of medical diagnosis, medication, or treatment recommendation. If you feel unwell, please seek medical attention promptly.