黄帝问于岐伯曰。寒热瘰 。在于颈腋者。皆何气使生。岐伯曰。此皆鼠痿寒热之毒瓦斯也。留于
脉而不去者也。
此承上章之义。而论足少阴之水火焉。寒热者。先天水火之气。水火者。精气也。以上数章。论
后天所成之身
形。及水谷所生之血气。有盛有虚。为痈为积。上章论少阴所生之气。上出于会厌而发于音声。所藏
之精。上通于任脉以濡空窍。然有正气。则有邪淫。如寒热之毒瓦斯。下藏于脏。上通于颈腋之间。留
于脉而不去。则为瘰 者。此肾藏先天之水毒也。天开于子。天一生水。其毒在外。故名曰鼠。夫颈
腋之脉。少阳之脉也。少阳乃初阳之气。生于先天之水中。少阳与肾脏经气相通。故本经曰少阳属肾。
愚按、本经凡论刺论疾。其中暗合天地阴阳之道。及血气之生始出入。盖欲使学人知邪病之所由生。
则知正气之所出入。若能触类旁通。斯得圣人之微义。
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。黄帝曰。去之奈何。岐伯曰。谓从其本引其末。可使衰去。而绝其
寒热。审按其道以予之。徐往徐来以去之。其小如麦者。一刺知。三刺而已。
此言阴脏之毒瓦斯。传于腑阳。而外出于末者。可刺而易已也。夫脏为本。脉为末。其毒在脏。而上
出于颈腋之间。其浮于脉中而外为脓血者。此毒瓦斯出于末而从脉溃。故易已也。未内着于肌肉者。未
转及于阳明也。故从其本。引其末。可使衰去。而绝其寒热之毒。审按其所出之道路以予夺之。徐往徐
来。以引去之。其小如麦者。毒之轻微者。可一刺知。三刺而已。此章与素问集注第六十篇之骨空论
合参。其大义晓然矣。徐振公曰。手厥阴少阳。皆与肾合。阴脏之毒。出于腑阳。故为易治。若传于
厥阴之脏。故为不治之死证矣。
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。赤脉不下贯瞳子。可治也。
夫肾藏天一之水。地二之火。此先天始分之两仪也。少阳厥阴之气。皆出于肾。厥阴之气。上舍
于心下之包络。而为有形之一脏。包络主脉。而代君行其血焉。少阳之气。游行于上中下。出入于
肌腠。归于中焦之部署。而为有形之一腑。与心主包络之相合也。是厥阴少阳之形脏。在于心下中焦
之部分。而二气皆本于肾脏之所生。瞳子者。水脏之骨睛也。赤脉从上而下贯瞳子者。水脏之毒瓦斯。
上交于包络之火脏。火脏之毒瓦斯。复下交于水脏之骨睛。此为阴阳交者死不治。盖毒瓦斯在于阴阳之脏
内往来。不能出于末而从脉溃。故为不治之恶疾也。夫天一地二。合而为三。一脉一岁死者。水脏之
毒甚也。二脉二岁死者。水脏之毒。传之于火脏也。三脉三岁死者。毒瓦斯分于二岁之间也。盖毒之专
者重。故死之速。分者死之迟也。一脉半者。一二之间也。二脉半者。二三之间也。夫人秉先天之水火
而成此形。有感于正气。必协于邪淫。是以痘毒发原在肾。先天之火毒也。瘰 者。先天之水毒也。盖
火有毒而水亦有毒。但火毒多而水毒少也。仇汝霖曰。心包络为阳脏。阴传于阳。而不复下交于阴者。
尤为可治。故复曰赤脉不下贯瞳子者可治也。圣人救民之心甚切。医者可轻忽而待其死焉。
黄帝向岐伯问道：颈部和腋下出现的寒热瘰疬（淋巴结结核），是由什么气引起的？
岐伯回答说：这些都是鼠瘿（一种以颈腋部肿块、寒热为特征的疾病）的毒气，滞留于经脉中而不消散。
这段文字承接上一章的含义，论述足少阴肾经的水火关系。所谓“寒热”，是指先天水火之气；所谓“水火”，即精气。以上几章论述了后天形成的身体形态，以及由水谷化生的血气，有盛有虚，从而形成痈疽或积聚。上一章论述了少阴所生之气，向上出于会厌而发出声音，所藏的精髓向上通达任脉以滋润空窍。然而，如果有正气存在，就会有邪气淫溢，比如寒热的毒气，向下藏于脏腑，向上通达于颈腋之间，滞留于经脉中不离去，就形成了瘰疬。这是肾脏藏有的先天水毒。天开于子时，天一生水，这种毒气在外，所以名叫“鼠”。颈腋部的经脉，属于少阳经脉。少阳是初生的阳气，产生于先天的水中。少阳与肾脏的经气相通，所以《本经》说少阳属肾。
我按语：本经凡是论述针刺和治疗疾病的章节，其中暗合天地阴阳的道理，以及血气的生成、起始、出入规律。大概是希望学习者知道邪病产生的原因，从而了解正气的出入途径。如果能触类旁通，就能领悟圣人的微言大义。
黄帝问：如何去除它？
岐伯说：鼠瘿的根本在于脏腑，其末梢向上出于颈腋之间。如果毒气浮在脉中，尚未深入附着于肌肉，而在外部化为脓血的，容易去除。
黄帝问：如何去除它？
岐伯说：要顺着它的根本引导其末梢，可以使毒气衰退而去，断绝寒热。仔细审察其循行道路来进行治疗，进针缓慢，出针也缓慢，以祛除病邪。如果肿块小如麦粒，刺一次见效，刺三次即可痊愈。
这段文字讲述阴脏的毒气传于腑阳，并从外部末梢发出的，可以针刺且容易治愈。脏腑为本，经脉为末。毒气在脏腑，向上出于颈腋之间，浮在脉中并在外部化为脓血，这是毒气从末梢通过经脉溃散出来，所以容易治愈。没有深入附着于肌肉的，说明尚未波及阳明经。因此顺着根本引导末梢，可以使毒气衰退，断绝寒热之毒。仔细审察其排出的道路来施以补泻。进针出针缓慢，以引去病邪。像麦粒那样小的，是毒气轻微的，可以刺一次见效，刺三次痊愈。这一章可以与《素问集注》第六十篇《骨空论》合参，其大意就很清楚了。徐振公说：手厥阴和手少阳都与肾相合。阴脏的毒气出于腑阳，所以容易治疗。如果传入厥阴之脏，就是无法治愈的死证了。
黄帝问：如何判断生死？
岐伯说：翻转眼睛观察，如果其中有赤色的脉络上下贯穿瞳孔，见到一条赤脉，一年死；见到一条半赤脉，一年半死；见到两条赤脉，两年死；见到两条半赤脉，两年半死；见到三条赤脉，三年死。赤色脉络不向下贯穿瞳孔的，可以治疗。
肾脏藏有天一的之水，地二之火，这是先天开始分化的两仪。少阳和厥阴的气，都出于肾。厥阴之气，向上舍入心下的包络，成为有形的一个脏器。包络主司血脉，代替君主行使血液的运行。少阳之气，游行于上中下三焦，出入于肌腠，归于中焦的部署，成为有形的一个腑，与心主包络相配合。这样，厥阴和少阳的形质脏器，位于心下中焦的部位，而这两股气都源于肾脏的生化。瞳孔是水脏的骨睛。赤色脉络从上向下贯穿瞳孔，是水脏的毒气向上交于心包络这个火脏，火脏的毒气又向下交于水脏的骨睛。这叫做阴阳交，是死证，无法治愈。因为毒气在阴阳脏腑内往来，不能从末梢通过经脉溃散出来，所以是不治的恶疾。天一与地二，合而为三。见到一条赤脉一年死的，是水脏的毒气很重。见到两条赤脉两年死的，是水脏的毒气传到了火脏。见到三条赤脉三年死的，是毒气分散在两年的时间里。一般来说，毒气专一集中的病情重，所以死得快；分散的病情轻，所以死得慢。一条半赤脉，是在一到二年之间；两条半赤脉，是在二到三年之间。人禀受先天的水火而形成形体，感受到正气，必然伴随邪气淫溢。所以痘毒发源于肾，是先天的火毒；瘰疬是先天的水毒。大概火有毒而水也有毒，只是火毒多而水毒少。仇汝霖说：心包络为阳脏，阴毒传于阳脏，如果不复向下交于阴脏的，更是可治的。所以说赤色脉络不向下贯穿瞳孔的可以治疗。圣人救民的心非常迫切，医生怎能轻视而等待病人死亡呢？
Huangdi asked Qibo: "What qi causes the cold-heat scrofula (lymph node tuberculosis) appearing in the neck and axilla?"
Qibo replied: "These are all the toxic vapors of Shuying (a disease characterized by neck and axillary masses with alternating chills and fever). They remain stagnant in the meridians without dissipating."
This passage continues the meaning of the previous chapter, discussing the water and fire of the Foot-Shaoyin Kidney Meridian. The so-called 'cold-heat' refers to the primordial water and fire qi; the so-called 'water and fire' is essence and qi. The preceding chapters discussed the postnatal physical form, as well as the blood and qi generated from grain and water, which have excess or deficiency, leading to carbuncles or accumulations. The previous chapter discussed the qi generated by Shaoyin, ascending out of the epiglottis to produce voice, and the stored essence ascending through the Ren Mai (Conception Vessel) to moisten the orifices. However, if righteous qi exists, pathogenic factors will invade excessively. For instance, the toxic vapor of cold-heat descends to hide in the zang organs and ascends to connect between the neck and axilla. If it remains stagnant in the meridians without leaving, it forms Luoli (scrofula). This is the primordial water toxicity stored in the Kidneys. Heaven opens at the Zi hour; Heaven generates Water as One. Since this toxicity manifests externally, it is named 'Rat'. The meridians of the neck and axilla belong to the Shaoyang Meridian. Shaoyang is the initial Yang qi, born from the primordial water. Shaoyang communicates with the Kidney meridian qi; thus, the *Neijing* states that Shaoyyang belongs to the Kidney.
My commentary: In this classic, whenever acupuncture and disease treatment are discussed, they implicitly align with the principles of Heaven and Earth Yin-Yang, as well as the generation, origin, entry, and exit of blood and qi. It is likely intended to enable students to understand the cause of pathological conditions, thereby knowing the pathways of righteous qi. If one can draw analogies and extend knowledge, one may grasp the subtle meanings of the Sages.
Huangdi asked: "How should it be removed?"
Qibo said: "The root of Shuyu lies within the Zang organs, while its branches emerge upward in the neck and axilla. If the pathogen floats within the vessels but has not yet adhered internally to the muscles, and instead manifests externally as pus and blood, it is easy to remove."
Huangdi asked: "How should it be removed?"
Qibo said: "Follow its root to guide its branches, allowing the pathogen to decline and dissipate, thereby cutting off the cold-heat. Carefully examine its pathway to administer treatment. Enter the needle slowly and withdraw it slowly to expel the pathogen. If the nodule is small like a wheat grain, one insertion brings improvement, and three insertions result in cure."
This section explains that toxic vapors from Yin Zang organs transmitting to Yang Fu organs and emerging externally can be treated with acupuncture and easily cured. The Zang organs are the root; the vessels are the branches. When toxicity resides in the Zang organs and emerges in the neck and axilla, floating in the vessels and manifesting externally as pus and blood, the toxin exits via the branches through vessel rupture, hence it is easy to cure. Not adhering internally to the muscles means it has not yet affected the Yangming Meridian. Therefore, following the root to guide the branches allows the toxicity to decline, cutting off the cold-heat toxins. Carefully examine the exit pathways to apply tonification or sedation. Slow insertion and withdrawal guide the pathogen out. Small nodules like wheat grains indicate mild toxicity; one insertion shows effect, three insertions achieve cure. This chapter should be cross-referenced with Chapter 60, *Gu Kong Lun* (Bone Empty Theory), in the *Suwen Jizhu*, making its main idea clear. Xu Zhen Gong stated: Both Hand-Jueyin and Hand-Shaoyang combine with the Kidney. Toxicity from Yin Zang emerging into Yang Fu is therefore easy to treat. If it transmits to the Jueyin Zang, it becomes an incurable fatal syndrome.
Huangdi asked: "How do we determine life and death?"
Qibo said: "Flip the eyes and observe. If red vessels run vertically through the pupil, seeing one red vessel indicates death in one year; one and a half vessels, death in one and a half years; two vessels, death in two years; two and a half vessels, death in two and a half years; three vessels, death in three years. If red vessels do not penetrate downward through the pupil, the condition is treatable."
The Kidneys store the Water of Tian Yi (Heaven One) and the Fire of Di Er (Earth Two), representing the primordial differentiation of Yin and Yang. The Qi of Shaoyang and Jueyin both originate from the Kidney. The Qi of Jueyin ascends to reside in the Pericardium below the heart, forming a tangible organ. The Pericardium governs the vessels and acts on behalf of the Sovereign Heart to circulate blood. The Qi of Shaoyang travels through the Upper, Middle, and Lower Jiao, entering and exiting the muscle-clefts, returning to the deployment of the Middle Jiao, forming a tangible Fu organ, harmonizing with the Pericardium of the Master Heart. Thus, the structural organs of Jueyin and Shaoyang are located in the region below the heart and in the Middle Jiao, yet both Qi sources originate from the Kidney's generation. The pupil is the bone-eye of the Water Organ. Red vessels penetrating downward through the pupil indicate that the toxic vapor of the Water Organ ascends to intersect with the Fire Organ (Pericardium), and the toxic vapor of the Fire Organ descends to intersect with the bone-eye of the Water Organ. This is called 'Yin-Yang Intersection,' which is fatal and incurable. Because the toxic vapor moves back and forth within the Yin and Yang organs and cannot exit via the branches through vessel rupture, it constitutes an incurable malignant disease. Tian Yi and Di Er combine to form Three. Death in one year with one red vessel indicates severe toxicity in the Water Organ. Death in two years with two red vessels indicates the transmission of Water Organ toxicity to the Fire Organ. Death in three years with three red vessels indicates the toxicity is dispersed over two years. Generally, concentrated toxicity is severe, leading to rapid death; dispersed toxicity is lighter, leading to slower death. One and a half vessels fall between one and two years; two and a half vessels fall between two and three years. Humans acquire their form from primordial water and fire. Upon encountering righteous qi, pathogenic factors inevitably accompany it. Thus, variola virus originates in the Kidney as primordial Fire Toxicity; Scrofula is primordial Water Toxicity. Fire has toxicity, and Water also has toxicity, though Fire toxicity is more prevalent than Water toxicity. Qiu Rulin stated: The Pericardium is a Yang Organ. If Yin toxicity transmits to Yang and does not descend again to intersect with Yin, it is even more treatable. Hence, it is stated that red vessels not penetrating downward through the pupil are treatable. The Sages' heart for saving people is extremely urgent; how can physicians neglect this and wait for death?