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Scrofula (Lump disease) manifesting as cold and heat in the neck and axilla are all caused by the toxic qi of scrofula (a condition characterized by cold and heat symptoms due to toxin accumulation) lingering in the meridians without dispersing. (Scrofula, also known as rat abscess, occurs between the neck and axilla, belonging to the Yangming and Shaoyang meridians.) The root of scrofula lies within the Zang organs, while its manifestations emerge superiorly in the neck and axilla. If it floats within the vessels but has not yet penetrated into the muscles and externally presents as pus and blood, it is easy to remove. Treatment should address the root and guide towards the branch. (This refers to the treatment method: eliminating the root cause allows the external branch symptoms to naturally subside.) Carefully examine the pathways of the meridians and apply acupuncture. (Administer needle therapy.) Enter and withdraw the needle slowly to dispel the pathogen; if the lump is small like a pulse beat. (Indicating the initial stage.) One insertion brings relief, three insertions cure the disease. (The *Gu Kong Lun* states: puncture the Cold Palace acupoint.)

How should one determine when to hold the needle and when to release or withhold it? ("Zong" implies a leisurely and gentle approach, "She" implies withholding use.) One must first clearly understand the origins and endings of the twelve primary meridians, the cold and heat of the skin, and the fullness, emptiness, slippery, and choppy qualities of the pulse. A slippery and full pulse indicates the disease is progressing daily; a deficient and thin pulse indicates a chronic, prolonged course; a large and choppy pulse indicates painful obstruction (Tong Bi). (This describes conditions where pathogenic qi is exuberant or Yuan Qi is deficient, both of which resist rapid cure and require gradual, slow treatment.) When Yin and Yang appear identical, the disease is difficult to treat. (When exterior and interior are both damaged, and Qi and Blood are both exhausted, this is called Yin and Yang being identical; needling will likely exacerbate the condition, so one should withhold needling.) If the root (organs) and branches (meridians) still exhibit heat, the disease persists. (The chest and abdomen/organs are the root, the limbs/meridians are the branches; remaining heat indicates residual pathogens remain, requiring slow treatment.) If the heat has subsided, the illness is departing. (Needling may be withheld.) Hold the skin of the forearm (Chichi) to observe the firmness or fragility, size, smoothness or roughness of the flesh. (Referring to pulse shape.) Cold, warmth, dryness, and dampness. (Referring to constitutional qi.) Observe the five colors of the eyes to discern the state of the Zang organs and determine prognosis regarding life and death. (The eyes are the essence of the six Fu and five Zang organs.) Observe their blood vessels. (Check for sinking or depression.) Inspect their color. (Inspect the five colors of the blood vessels.) Thereby knowing the nature of cold, heat, and painful obstruction (Thus, one can apply the methods of holding and releasing the needle.) The principle of holding the needle requires uprightness and correctness, stability and tranquility. First ascertain deficiency and excess, then decide on rapid or slow manipulation. The left hand fixes the bone, the right hand follows the pathway, avoiding entanglement with the muscle tissue. (The needle must accurately enter the acupoint, thus avoiding entanglement with muscle.) For reducing methods, maintain uprightness and correctness; for tonifying methods, close the skin aperture. Use an auxiliary needle to guide the Qi, allowing pathogenic Qi to dissipate and True Qi to reside securely. (This is the way of holding and releasing the needle.)

When the Lung or Heart has pathogenic Qi, its flow accumulates in the two elbows. (In the Lung, at Shiquan [LU5]; in the Heart, near Shaohai [HT3]. ○ "Liu" here means "flow," consistent with subsequent usage.) When the Liver has pathogenic Qi, its flow accumulates in the two axillae. (Near Qimen [LR14] and Yuanye [GB24].) When the Spleen has pathogenic Qi, its flow accumulates in the two thighs/groin areas. (The Spleen and Stomach are exterior-interior pairs; their meridians ascend from the lower legs and thighs, emerging between Chongmen [SP12] and Qichong [ST30]. Thus, pathogenic Qi lingering in the thigh/groin region indicates a Spleen meridian disorder.) When the Kidney has pathogenic Qi, its flow accumulates in the two popliteal fossae. (The Kidney and Bladder are exterior-interior pairs; their meridians emerge between Yinval [BL39] and Weizhong [BL40] behind the knees. Thus, pathogenic Qi lingering in the popliteal fossae indicates a Kidney meridian disorder.) These eight voids (Ba Xu) are all sites of joint mechanisms, passages of True Qi, and遊游 (wandering paths) of blood collaterals. Pathogenic Qi and evil blood cannot normally reside here; if they do, they damage the meridians, bones, joints, and mechanisms, leading to inability to flex and extend, resulting in spasms or contractures. (The two elbows, two axillae, two thighs, and two popliteal fossae are gaps between sinews and bones, where Qi and Blood flow and circulate, hence called the Eight Voids. When righteous Qi resides there, it functions properly; when pathogenic Qi resides there, it damages meridians and mechanisms, causing limited movement. These eight voids can be used to diagnose the Five Zang organs. Ji refers to pivot/mechanism; Guan refers to critical junctions; Shi refers to chambers/houses.)