(《灵枢·寒热篇》全)
黄帝问于岐伯曰∶寒热瘰 在于颈腋者,皆何气使生?岐伯曰∶此皆鼠 ,寒热之毒瓦斯也,留于脉而不去者也。(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 ,形长如蚬哈者为马刀。又曰胁肋下者为马刀。瘰,裸、垒
二音。 音历。 音漏。)黄帝曰∶去之奈何?岐伯曰∶鼠 之本皆在于脏,其末上出于颈腋之间,其浮于脉中,而未内
着于肌肉而外为脓血者,易去也。(瘰 必起于少阳,而后延及阳明,二经表里相传,乃至厥阴、太阴俱能为病。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。)黄帝曰∶去之奈何?岐伯曰;请从其本,
引其末,可使衰去而绝其寒热。(谓去其致之之本,则外见之末,自可引而衰也。)审按其道以予之,徐往徐来以去之。(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。)其小如麦者,一
刺知,三刺而已。(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。)黄帝曰∶
决其生死奈何?岐伯曰∶反其目视之,其中有赤脉,上下贯瞳子,见一脉一岁死,见一脉半一岁半死,见二脉二岁死,
见二脉半二岁半死,见三脉三岁而死,见赤脉不下贯瞳子可治也。(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,详脉色类三十二。)
(《灵枢·寒热篇》全文)
黄帝向岐伯问道:颈部和腋部出现的瘰疬(颈部淋巴结结核,状如串珠),都是由什么气引起的?岐伯回答说:这些都是鼠瘘(一种因寒热毒邪滞留经脉而形成的颈部肿块),是寒热之毒气停留在脉中未能消散所致。(注:瘰疬的形状累累相连,上下贯穿,所以在颈腋之间都可能发生。因为其形状像老鼠打洞一样,堵塞了一个洞口,又在别处穿通另一个洞口,所以又被称为鼠瘘。这是由于寒热毒邪留在经脉中,导致病灶相互牵连不止。另一种说法认为,结核连续不断的称为瘰疬,形状长如蛤蜊的称为马刀。还有一种说法认为,发生在胁肋下的称为马刀。“瘰”音同“裸”或“垒”,“疬”音同“历”,“瘘”音同“漏”。)
黄帝问:如何去除它?岐伯说:鼠瘘的根本原因都在于内脏,其表现却向上反映在颈腋之间。如果病邪浮现在脉中,尚未深入肌肉内部转化为脓血,那么就容易去除。(注:瘰疬必定起始于少阳经,随后蔓延波及阳明经,这两条经络表里相传,甚至厥阴、太阴经也能引发此病。大抵是因为郁结之气积聚、饮食口味浓厚,或者风热毒邪结聚而成,所以其致病根本皆出于内脏,而标症则表现在颈腋之间。如果毒邪尚不严重,只是浮现在脉中,尚未附着于肌肉化为脓血,去除它还比较容易;如果脓血已经形成,治疗起来就比较困难了。)
黄帝问:如何去除它?岐伯说:请从疾病的根本入手,引导其末梢症状,可以使病情衰退并断绝寒热的发作。(意思是去除了致病的根本,外在表现的末梢症状自然可以引导其衰退。)仔细审察经脉气血运行的道路来进行针刺,缓慢进针、缓慢出针以祛除病邪。(“予”,指给予针刺。审按其道,即审察脉气所经过的道路。徐往徐来,就是补泻的手法,所谓“慢进快出为补,快进慢出为泻”。)如果肿块小得像麦粒一样,刺一次就能见效,刺三次就可以痊愈。(小如麦粒,说明是初起阶段,所以刺一次就知道效果,刺三次病可治愈,因此治疗应当宜早不宜迟,不能因为肿块小而忽视它。)
黄帝问:如何判断它的生死预后?岐伯说:观察患者的眼睛,如果眼中有赤色血脉上下贯穿瞳孔,见到一条赤脉预示一年死,见到一条半赤脉预示一年半死,见到两条赤脉预示两年死,见到两条半赤脉预示两年半死,见到三条赤脉预示三年死,如果见到赤脉但不向下贯穿瞳孔,则是可治的。(眼睛是众多经脉汇聚的地方。瞳孔是肾精的外在表现。赤脉向下贯穿瞳孔,是因为邪毒之火深入侵害阴分,这是死亡的征兆。然而,脉象分散呈现两三条的,说明正气散漫且病势缓和;脉象聚集为一的,说明毒邪锐利且专一,这也是死亡期限有快慢不同的原因。另外,《论疾诊尺篇》中论述诊断寒热病的方法也与此相同,详见《脉色类》第三十二部分。)
(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.)