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All versions of the text lack the character "Pian" (Chapter). Ma Yun stated: Whenever individuals suffer from *luoli* (scrofula, a disease characterized by swollen lymph nodes in the neck), their condition must be accompanied by alternating chills and fever; hence, this chapter is named "Chills and Fever."

Chills and fever associated with persistent *luoli* refer to those cases that do not resolve. Ma Yun explained: *Luoli* is the name for a type of ulcer, also known as *shulou* (rat fistula), which occurs between the meridians of the neck and axilla, belonging to the Yangming and Shaoyang meridians. This is because the cold-heat toxic qi inherent in rats remains lodged in the human meridians without dissipating. Folklore claims: When rats drool on food or drink, humans who inadvertently use it may contract *luoli* due to toxic infection. Observing that rats often have lumps in their necks and axillae resembling *luoli*, later generations used cat-based medicinal formulas to counteract this toxicity. The main principle is also discussed in the subsequent chapter "Diagnosing Diseases by Inspecting the Forearm." Zhang Jingyue stated: The appearance of *luoli* is clustered and continuous, extending up and down. Thus, it can occur in the neck and axilla. Because its shape resembles rat holes—blocking one only to pierce another—it is also called *shulou*. Generally, the toxic heat-cold lingering in the meridians causes this continuous connection. Another term is *jiesu* (tubercle); continuous clusters are called *luoli*, while elongated shapes like clams are called *madao* (horse knife). It is also said that lesions under the ribs are called *madao*.

Jian An (Commentary): Chao Yuanfang's *Zhubing Yuanhou Lun* (Source Book of All Categories of Diseases) states under the section on *luoli*: This arises from wind-pathogenic toxic qi lodging in the muscles, settling where deficiency exists to form *luoli*. They may resemble plums, dates, or jujube pits, varying in size, with two or three connected, located between the skin and flesh, occasionally triggering chills and fever. Over time, they suppurate and ulcerate into fistulas. Additionally, the *Waitai Miyao* collects nine types of fistulas; the second is *shulou*. Initially appearing in the neck without distinct head or tail, like a small mouse nodule, moving up and down, causing chills, fever, and emaciation. This results from residual toxic qi from consuming large rats, with the root in the Stomach, treated primarily with fox bone. From this, we deduce that *luoli* refers to the pre-ulcerative stage, while *shulou* refers to the post-ulcerative stage. (*Shuowen Jiezi* defines *ying* as neck swelling.) The term *shulou* is used because the morphology resembles a shrew burrowing under the skin. The *Huainanzi* states: Fox heads cure *shulou*. Wang Chong's *Lunheng* notes: Humans suffering from rat-disease can heal themselves by consuming fox meat. Subsequent dictionaries thus wrote the character as *lou* (fistula). *Luo* implies leakage, referring to unceasing discharge, hence the name *shulou*. The claims regarding the toxicity of eating large rats or their saliva are absurd. Zhu Zhenheng stated: *Luoli* without chills and fever indicates a survivable prognosis; if it progresses to tidal fever after a short period, the prognosis is critical. This statement is credible.

Jie An noted: Small nodules are called *luo*, large ones *li*. There are many names and colors. For instance, anterior neck lesions are called phlegm-*luo*; posterior neck lesions are damp-*luo*; soft masses on both sides that swell upon anger are Qi-*luo*; hard, contracted tendon-like masses are tendon-*luo*. Continuous, bead-like strings are *luoli*. As for *shulou*, its shape resembles a rat, also named rat-abscess. Even if the wound closes, side openings may persist with continuous pus discharge. Some cases start in the neck and reappear at the soles of the feet, colloquially known as "rats drilling holes," representing an especially perilous syndrome.

Toxic Qi (Du Wa Si): Jian An commented: The character "Du" was originally written as "𦬆". *Shuowen Jiezi* explains: "𦬆" means intense/potent; it is a harmful herb that grows densely. It comprises the radicals for grass and poison. *Zhou Li* states: Gather poisonous drugs and attack diseases with five poisons. *Book of Documents* says: You bring disaster upon yourself through your own poison. *Book of Rites* says: Petty men harm the upright. These all borrow the meaning of harm. Here, "toxic qi" refers to evil or pathogenic air. Later terms like cold-toxin or wind-toxin derive from this usage.

The root of *shulou* is easy to eliminate: Zhang Jingyue stated: *Luoli* originates in the Shaoyang meridian, then spreads to the Yangming meridians, transmitting between interior and exterior, eventually reaching Jueyin and Taiyang. Pathogenesis generally stems from accumulated stagnant Qi, rich dietary flavors, or wind-heat toxic qi condensing. Thus, the root cause lies within the Zang organs, while the branch manifestations appear in the neck and axilla. If the toxin is mild, manifesting only in the pulse without solidifying in muscles to form pus and blood, removal is relatively easy. Once pus and blood are formed, treatment becomes more difficult.

Seek its root... three punctures suffice: Lou Shi stated: Select the root of the Zang-Fu via these meridians to treat the branch symptoms of *luoli*. Zhang Jingyue explained: By eliminating the root cause, the external branch symptoms will naturally recede. I administer acupuncture. Examine and follow the meridian pathways, i.e., trace the route of pulse Qi. Slow insertion and slow withdrawal constitute tonification and sedation methods. "Slow entry, fast exit" tonifies (makes full); "fast entry, slow exit" sedates (empties). Early-stage lesions are wheat-grain-sized; thus, one puncture shows effect, and three punctures cure the disease. Treatment should be early; do not neglect small lesions.

Reverse gaze... treatable: Zhang Jingyue stated: The eyes are the convergence point of numerous meridians. The pupil represents the essence of bone. Red vessels penetrating downward through the pupil indicate that evil-toxic fire has deeply invaded the Yin aspect, signaling death. However, if two or three red vessels are visible, the pathogenic Qi is scattered and slow; if condensed into one vessel, the toxin is sharp and focused. This determines the timing of death. Similarly, the chapter "Diagnosing Diseases by Inspecting the Forearm" applies this method for diagnosing chills and fever. Jian An commented: Chen Yan's *San Yin Fang* notes: Although such theories exist, clinical verification rarely confirms this specific sign, making it hard to substantiate. This usually occurs when Three-Yang meridians transmit to Yin meridians. Primary organ pathology may not present this way. Students should know this is an empirically verified theory, worthy of trust.