诸本无篇字。马云。凡有瘰 者。其病必发寒热。故名篇。
寒热瘰 （止）不去者也 马云。瘰 者疮名。一名鼠 疮。生于颈腋两脉间。乃阳明少阳两经
之所属也。正以鼠 有寒热之毒瓦斯。留于其脉而不去耳。俗云鼠用饮食流涎于其中人误用之所以毒瓦斯感而生
瘰今鼠之颈腋多块其状犹瘰 然后世有用猫制药方者亦所以胜其毒耳大义又见后论疾诊尺篇中张云。瘰 者。
其状累然。而历贯上下也。故于颈腋之间。皆能有之。因其形如鼠穴。塞其一复穿其一。故又名为鼠 。盖以
寒热之毒。留于经脉。所以联系不止。一曰结核。连续者为瘰 。形长如蚬蛤者为马刀。又曰胁肋下者为马刀。
简案、巢源瘰 候云。此由风邪毒瓦斯。客于肌肉。随虚处而停结为瘰 。或如梅李枣核等。大小两三相连。
在皮间而时发寒热是也。久则变脓溃成 也。又外台集验九种 。其二曰鼠 。始发于颈。无头尾。如鼷鼠
核。时上时下。使人寒热脱肉。此得之由食大鼠余毒不去。其根在胃。狸骨主之。由此考之。瘰 者未溃之称。
鼠者已溃之名。（说文 颈肿也）其谓之鼠者。如鼷鼠 于皮下状也。淮南说山训。狸头愈鼠。王充论衡。
人有鼠病。吞狸自愈。后世字书遂作 是也。瘰、漏也。漏泄不止之谓。故名曰鼠 。其言食大鼠及鼠涎之毒
者诞也。朱震亨云。瘰 不作寒热者可生。稍久转为潮热者危。此言信然。
介按、小者为瘰。大者为 。名色甚多。如项前为痰瘰。
项后为湿瘰。左右两侧形软。遇怒即肿为气 。坚硬筋缩为筋 。若连绵如贯珠者为瘰 。至于鼠 。其形如
鼠。又名鼠疮。甚至疮口已合。旁边有眼。出脓不止。又有颈项生之不已。复从脚底而生。俗称老鼠打洞。其
症尤为险恶。
毒瓦斯 简案、毒本作HT 。说文云。HT 、浓也。害人之草。往往而生。从草从毒。周礼云。聚毒药又
以五毒攻之是也。书盘庚云。惟汝自生毒。礼。缁衣。小人毒其正。皆假以恶害之义。此云毒瓦斯。亦以邪恶之
气为言。后世寒毒风毒之类。毒字皆本此。
鼠 之本（止）易去也 张云。瘰 必起于少阳。而后延及阳明二经。表里相传。乃至厥阴太阳。但
能为病。大抵因郁气之积。食味之浓。或风热之毒。结聚而成。故其所致之本。皆出于脏。而标则见乎颈腋之
间也。若其毒之未甚。则但浮见脉中。尚未着于肌肉以化脓血者。去之犹易。若其脓血既成。则为力较难也。
请从其本（止）三刺而已 楼氏云。从此经脉取脏腑之本。以治瘰 之末也。张云。谓去其致之之本。
则外见之末。自可引而衰也。予、与之针也。审按其道。审脉气所由之道也。徐往徐来。即补泻之法。所谓徐
而疾则实。疾而徐则虚也。小如麦者。其初起也。故一刺即知其效。三刺其病可已。所以治在宜早。不可因小
而忽之。
反其目（止）可治也 张云。目者。宗脉之所聚也。瞳子者。骨之精也。赤脉下贯瞳子。以邪毒之焰。
深贼阴分而然。死之征也。然脉见二三者。其气散而缓。脉聚为一者。其毒锐而专。此又死期迟速之有异也。
又论疾诊尺篇。言诊寒热者亦同此法。简案、陈言三因方云。虽有此说。验之病者。少有此证。亦难考据。此
往往是三阳传诸阴经方有之。若本脏发。未必有此。学人知之。是实验之说。殆可信据焉。
各版本原文中均无“篇”字。马云说：凡是患有瘰疬的人，其病症必定伴随寒热发作，因此以“寒热”命名此篇。
寒热瘰疬是指那些经久不愈的瘰疬病证。马云说：瘰疬是一种疮疡的名称，又名鼠瘘，生长在颈部和腋下的经脉之间，属于阳明经和少阳经所主。这是因为鼠类体内含有寒热性质的毒气，停留在人的经脉中而不消散所致。民间传说：老鼠在饮食时流涎液其中，人若误用这些唾液，就会因毒气感染而生出瘰疬。如今观察老鼠的颈部和腋下多有肿块，形状就像瘰疬一样，所以后世有用猫来制药的方子，也是用来克制这种毒气的道理。这一大义也见于后文《论疾诊尺》篇中。张景岳说：瘰疬的形状是累累相连，上下贯穿的。所以在颈部和腋下之间都能发生。因为它的形状像鼠洞，堵塞了一个又穿通另一个，所以又叫做鼠瘘。大概是因为寒热的毒气停留在经脉中，所以连绵不断。另一种说法叫结核，连续成串的叫瘰疬，形状长如蛤蜊的叫马刀。又说胁肋下部的叫马刀。
简案：巢元方《诸病源候论·瘰疬候》中说：这是由于风邪毒气，客居于肌肉之中，随着身体虚弱的地方停留结聚而成瘰疬。有的像梅、李、枣核等大小，两三颗连在一起，位于皮肉之间，时常发作寒热。时间久了则化脓溃烂形成瘘管。另外《外台秘要》收录的九种瘘中，第二种叫鼠瘘。开始时发生在颈部，没有头尾，像小老鼠的硬结，时而向上时而向下，使人出现寒热、消瘦脱肉。这得自于食用大鼠残留的毒气未去，病根在胃，用狸骨主治。由此考证，瘰疬是未溃破时的称呼，鼠瘘是已溃破后的名称。（《说文解字》解释：瘿，指颈肿。）之所以称为鼠瘘，是因为其形态像鼷鼠钻在皮下一样。《淮南子·说山训》说：狸头能治愈鼠瘘。王充《论衡》说：人患鼠病，吞食狸肉就能自愈。后世的字书于是写作“瘘”字。瘰，即漏，指漏泄不止的意思，所以名叫鼠瘘。书中说的吃大鼠及鼠涎有毒的说法是荒诞的。朱震亨说：瘰疬如果不产生寒热症状的可以存活，如果稍久转为潮热的就危险了。这话确实可信。
介按：小的叫瘰，大的叫疬，名称颜色非常多。比如项前部的叫痰瘰，项后部的叫湿瘰，左右两侧质地柔软，发怒时就肿起的是气瘰，坚硬筋脉收缩的是筋瘰。如果连绵像串珠一样的叫瘰疬。至于鼠瘘，其形状像老鼠，又名鼠疮，甚至疮口已经愈合，旁边又有孔眼，流出脓液不止。又有在颈项生长不止，又从脚底生出的，俗称老鼠打洞，这种病症尤为险恶。
毒瓦斯：简案，“毒”字原作“𦬆”。《说文解字》说：“𦬆”，浓烈之意，是害人的草，往往丛生。从草从毒。《周礼》说：聚集毒药，并用五毒来攻治它。《尚书·盘庚》说：只因为你自招灾毒。《礼记·缁衣》说：小人毒害正直之人。都是借用有害之义。这里说的“毒瓦斯”，也是指邪恶之气而言。后世所说的寒毒、风毒之类，“毒”字都源于此。
鼠瘘之本（止）易去也：张景岳说：瘰疬必定起始于少阳经，然后延及阳明二经，表里相传，乃至厥阴、太阳经。但凡是能引起疾病的，大抵都是因为郁积的气机、浓厚的饮食口味，或者风热毒气，结聚而成。所以导致疾病的根本原因都出于脏腑，而标症则表现在颈部和腋下之间。如果毒气还不严重，只是浮现在脉象中，尚未附着在肌肉中化为脓血，那么去除它还比较容易。如果脓血已经形成，那么治疗就比较困难了。
请从其本（止）三刺而已：楼氏说：从此处经脉选取脏腑的根本，来治疗瘰疬的末梢症状。张景岳说：意思是去除致病的根本，那么外在显现的末梢症状，自然可以引导其衰退。我给予您针刺疗法。审察并顺着经络之道，即审察脉气运行的道路。缓慢进针，缓慢出针，这就是补泻的方法。所谓“徐而疾则实”（慢进快出为补法），“疾而徐则虚”（快进慢出为泻法）。初起时如麦粒大小，所以一刺就能见效，针刺三次病就可以痊愈。所以治疗应当宜早，不可因为病灶小而忽视它。
反其目（止）可治也：张景岳说：眼睛，是众多经脉汇聚的地方。瞳仁，是骨骼的精气所在。赤色的血脉向下贯穿瞳仁，是因为邪毒的火势，深深侵害阴分所致，这是死亡的征兆。然而，如果脉象显示有二三条赤脉，说明邪气散漫且缓和；如果脉象聚集成一条，说明毒气锐利且专一。这也是死亡期限迟速不同的原因。另外《论疾诊尺》篇中，诊断寒热病的方法也与这个相同。简案：陈言《三因极一病证方论》说：虽然有这种说法，但在患者身上验证，很少见到这种证候，也难以考证依据。这往往是三阳经传入诸阴经时才有的情况。如果是本脏自发，未必会有这种情况。学医的人要知道，这是经过实验验证的说法，大概可以信赖依据。
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.