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(Full text from *Ling Shu: Han Re Pian* [Needling and Moxibustion: Cold-Heat Chapter])

The Yellow Emperor asked Qibo, "What qi causes scrofula (scrofula, tuberculous lymphadenitis of the neck) appearing in the neck and axilla?" Qibo replied, "These are all rat-fistula (rat-fistula, a type of neck mass caused by cold-heat toxic pathogens lingering in the meridians), which are cold-heat toxic vapors remaining in the vessels and not dispersing." (Note: Scrofula presents as lumps connected in a chain, extending up and down, thus occurring in both the neck and axilla. Because its shape resembles mouse burrows—plugging one hole only to find another pierced elsewhere—it is also called rat-fistula. This is due to cold-heat toxic pathogens lingering in the meridians, causing continuous connection of lesions. Another view states that continuously connected nodules are called scrofula, while those long like clams are called 'Ma Dao' [knife-horse]. Yet another view states that those occurring under the ribs are called 'Ma Dao'. The pronunciation of 'Luo' is similar to 'Luo' or 'Lei', 'Li' is pronounced 'Li', and 'Lou' is pronounced 'Lou'.)

The Yellow Emperor asked, "How should it be treated?" Qibo said, "The root of rat-fistula lies within the Zang organs, while its branches manifest upward in the neck and axilla. If the pathogen floats in the vessels but has not yet penetrated into the muscles to form pus and blood, it is easy to remove." (Note: Scrofula invariably originates in the Shaoyang [Lesser Yang] channel and subsequently spreads to the Yangming [Yang Brightness] channel. These two channels, exterior-interior paired, transmit disease to each other, and can even involve the Jueyin [Terminal Yin] and Taiyin [Greater Yin] channels. Generally, it arises from accumulated stagnant Qi, rich dietary flavors, or condensation of wind-heat toxic pathogens. Thus, the root cause stems from the Zang organs, while the branch symptoms appear in the neck and axilla. If the toxin is not severe, merely floating in the vessels without adhering to muscles to transform into pus and blood, removal is still relatively easy; however, if pus and blood have already formed, treatment becomes more difficult.)

The Yellow Emperor asked, "How should it be treated?" Qibo said, "Please address the root and guide the branch, so that the condition may decline and the cold-heat episodes cease." (This means that by removing the root cause, the external branch symptoms can naturally be guided to subside.) Carefully examine the pathways of the meridians to apply needle therapy, advancing and withdrawing slowly to dispel the pathogen." ('Yu' refers to the application of needles. Examining the pathway means examining the route through which meridian Qi flows. Advancing and withdrawing slowly refers to tonifying and sedating techniques: 'slow insertion and rapid withdrawal tonifies; rapid insertion and slow withdrawal sedates'.) If the nodule is small like a wheat grain, one needling session will show effect, and three sessions will cure it." (Small like a wheat grain indicates early onset, so one needling reveals efficacy, and three sessions can cure the disease. Therefore, treatment should be early; do not neglect it because it is small.)

The Yellow Emperor asked, "How can one determine life and death prognosis?" Qibo said, "Observe their eyes. If red vessels are seen penetrating vertically through the pupil, seeing one vessel predicts death in one year; seeing one and a half vessels predicts death in one and a half years; seeing two vessels predicts death in two years; seeing two and a half vessels predicts death in two and a half years; seeing three vessels predicts death in three years. If red vessels are seen but do not penetrate downward through the pupil, the condition is treatable." (The eyes are the gathering point of numerous meridians. The pupil represents the essence of the bones [Kidney]. Red vessels penetrating downward through the pupil occur because evil fire deeply invades the Yin aspect, which is a sign of death. However, when vessels appear scattered as two or three lines, the Qi is dispersed and the condition is sluggish; when vessels gather into one line, the toxin is sharp and focused. This explains the variation in the speed of death. Additionally, the *Lun Ji Zhen Chi Pian* [Chapter on Discussing Diseases and Diagnosing the Forearm] states that diagnosing cold-heat conditions uses this same method. See detailed analysis in *Mai Se Lei* [Meridian and Color Classification], Part 32.)