灵枢经·痈疽 Welling-Abscess and Flat-Abscess
黄帝曰：余闻肠胃受谷，上焦出气，以温分肉，而养骨节，通腠理。中焦出气如露，上注溪谷，而渗孙脉，津液和调，变化而赤为血。血和则孙脉先满溢，乃注于络脉，皆盈，乃注于经脉，阴阳已张，因息乃行。行有经纪，周有道理，与天合同，不得休止。切而调之，从虚去实，写则不足，疾则气减，留则先后。从实去虚，补则有馀，血气已调，形气乃持。余已知血气之平与不平，未知痈疽之所从生，成败之时，死生之期，有远近，何以度之，可得闻乎？
歧伯曰：经脉留行不止，与天同度，与地合纪。故天宿失度，日月薄蚀；地经失纪，水道流溢，草萓不成，五谷不殖；径路不通，民不往来，巷聚邑居，则别离异处。血气犹然，请言其故。夫血脉营卫，周流不休，上应星宿，下应经数。寒邪客于经络之中，则血泣，血泣则不通，不通则卫气归之，不得复反，故痈肿。寒气化为热，热胜则腐肉，肉腐则为脓。脓不写则烂筋，筋烂则伤骨，骨伤则髓消，不当骨空，不得泄写，血枯空虚，则筋骨肌肉不相荣，经脉败漏，熏于五藏，藏伤故死矣。
黄帝曰：愿尽闻痈疽之形，与忌曰名。歧伯曰：痈发于嗌中，名曰猛疽。猛疽不治，化为脓，脓不写，塞咽，半日死。其化为脓者，写则合豕膏，冷食，三日而已。
发于颈，名曰夭疽。其痈大以赤黑，不急治，则热气下入渊腋，前伤任脉，内熏肝肺。熏肝肺，十馀日而死矣。
阳留大发，消脑留项，名曰脑烁。其色不乐，项痛而如刺以针。烦心者，死不可治。
发于肩及臑，名曰疵痈。其状赤黑，急治之，此令人汗出至足，不害五藏。痈发四五日，逞焫之。
发于腋下赤坚者，名曰米疽。治之以砭石，欲细而长，疏砭之，涂以豕膏，六日已，勿裹之。其痈坚而不溃者，为马刀挟瘿，急治之。
发于胸，名曰井疽。其状如大豆，三四日起，不早治，下入腹，不治，七日死矣。
发于膺，名曰甘疽。色青，其状如谷实𦸈𧁾，常苦寒热，急治之，去其寒热，十岁死，死后出脓。
发于胁，名曰败疵。败疵者，女子之病也，灸之，其病大痈脓，治之，其中乃有生肉，大如赤小豆，坐陵翘草根各一升，以水一斗六升煮之，竭为取三升，则强饮厚衣，坐于釜上，令汗出至足已。
发于股胫，名曰股胫疽。其状不甚变，而痈脓搏骨，不急治，三十日死矣。
发于尻，名曰锐疽。其状赤坚大，急治之，不治，三十日死矣。
发于股阴，名曰赤施。不急治，六十日死。在两股之内，不治，十日而当死。
发于膝，名曰疵痈。其状大，痈色不变，寒热，如坚石，勿石，石之者死，须其柔，乃石之者，生。
诸痈疽之发于节而相应者，不可治也。发于阳者，百日死；发于阴者，三十日死。
发于胫，名曰兔啮，其状赤至骨，急治之，不治害人也。
发于内踝，名曰走缓。其状痈也，色不变，数石其输，而止其寒热，不死。
发于足上下，名曰四淫。其状大痈，急治之，百日死。
发于足傍，名曰厉痈。其状不大，初如小指，发，急治之，去其黑者；不消辄益，不治，百日死。
发于足趾，名脱痈。其状赤黑，死不治；不赤黑，不死。不衰，急斩之，不则死矣。
黄帝曰：夫子言痈疽，何以别之？歧伯曰：营卫稽留于经脉之中，则血泣而不行，不行则卫气从之而不通，壅遏而不得行，故热。大热不止，热胜，则肉腐，肉腐则为脓。然不能陷，骨髓不为燋枯，五藏不为伤，故命曰痈。
黄帝曰：何谓疽？歧伯曰：热气淳盛，下陷肌肤，筋髓枯，内连五藏，血气竭，当其痈下，筋骨良肉皆无馀，故命曰疽。疽者，上之皮夭以坚，上如牛领之皮。痈者，其皮上薄以泽。此其候也。
Huangdi said: 'I have heard that when the intestines and stomach receive grain, the upper burner sends forth qi to warm the interstitial flesh, nourish the bones and joints, and open the interstices of the skin. The middle burner sends forth qi like dew, which ascends to pour into the valleys and ravines of the flesh and seeps into the grandchild vessels (sunmai); there the fluids and humors become harmonized, and are transformed, turning red to become blood. When the blood is harmonious, the grandchild vessels first become full to overflowing, and then pour into the network vessels; when these too are full, they pour into the channel vessels. Once yin and yang have thus become fully extended, the blood moves in step with the breath. Its movement follows a set order, its circuit follows a fixed course, corresponding with Heaven itself, and it never comes to rest. When one palpates the vessels in order to regulate them: proceeding from deficiency, one removes excess — yet if one drains what is already deficient, insufficiency only deepens; if this is done too hastily, the qi is diminished; and if the needle is retained, the effects unfold in their proper sequence, first one thing and then another. Proceeding from excess, one removes deficiency — yet if one supplements what is already in excess, a surplus results. Once the blood and qi have been regulated in this way, the body's form and qi are thereby sustained. I have already learned of the balance and imbalance of blood and qi, but I do not yet know from what welling-abscess (yong) and flat-abscess (ju) arise, the timing of their formation and resolution, nor the term allotted for death or survival, whether near or distant. How is this to be gauged? May I hear of it?'
Qibo said: 'The channel vessels flow without cease, in step with Heaven's own measure and in accord with Earth's own order. Thus when the lodges of Heaven lose their proper measure, the sun and moon become eclipsed and dimmed; when the pathways of Earth lose their proper order, the waterways overflow their banks, the grasses and weeds fail to mature, and the five grains fail to grow; when roads become impassable, the people cease to travel between one another, and those gathered in lanes and settled in towns become cut off and separated from one another. The blood and qi are just the same — allow me to explain the reason. Now the blood vessels, together with the nutritive and defensive qi, circulate ceaselessly, corresponding above to the stars and constellations, and below to the fixed measure of the channels. When cold evil lodges within the channels and network vessels, the blood congeals; when the blood congeals it fails to flow freely; and when it fails to flow freely, the defensive qi converges there and is unable to return along its course — hence welling-abscess and swelling result. The cold qi transforms into heat; when the heat prevails it putrefies the flesh, and when the flesh putrefies it becomes pus. If the pus is not drained away it will rot the sinews; when the sinews rot, the bone is injured; when the bone is injured, the marrow is consumed. If this does not open into a hollow of the bone through which it might drain, and cannot be released and discharged, the blood dries up and the area becomes hollow and empty, so that the sinews, bones, and flesh no longer nourish one another; the channel vessels decay and leak, and the noxious vapor steams upward into the five viscera — once the viscera are injured, death follows.'
Huangdi said: 'I should like to hear in full the various forms that welling-abscess and flat-abscess take, together with the names by which each is known and the dangers to be guarded against.' Qibo said: 'When an abscess breaks out within the throat, it is called mengju, the fierce ju. If fierce ju is not treated, it turns to pus; if the pus is not drained it will block the throat, and the patient dies within half a day. Once it has turned to pus, drain it, apply pig's fat, and have the patient eat cold food; within three days it will be resolved.'
When it breaks out on the neck, it is called yaoju, the fatal ju. The swelling is large and reddish-black; if not treated promptly, the heat qi will descend to Yuanye, the hollow of the armpit, injuring the Conception Vessel in front and steaming the liver and lung within. Once it steams the liver and lung, the patient dies within ten-odd days.
When yang heat lingers and erupts greatly, consuming the brain and lodging in the nape, it is called naoshuo, brain-scorching. Its color is dull and lusterless, and the nape aches as though pierced by a needle. If the patient becomes vexed at heart, death follows and the condition cannot be treated.
When it breaks out on the shoulder or upper arm, it is called ciyong, the blemish welling-abscess. Its appearance is reddish-black; treat it promptly. This will cause the patient to sweat down to the very feet, but it does not harm the five viscera. Once the abscess has been present for four or five days, proceed to cauterize it.
When it breaks out below the armpit, red and hard, it is called miju, the rice-grain ju. Treat it with the stone needle (bianshi); the stone should be fine and long, and the puncturing sparse. Apply pig's fat, and within six days it will heal; do not bind or wrap it. If the swelling is hard and does not rupture into pus, this is what is called saber-scrofula with goiter (madao xieying), a hard chain of swellings like beads along a saber hilt, accompanied by goiter, and it must be treated promptly.
When it breaks out on the chest, it is called jingju, the well ju. Its shape resembles a large bean, and it rises up over three or four days. If not treated early it will sink down into the abdomen; left untreated, the patient dies within seven days.
When it breaks out on the front of the chest, over the breastbone, it is called ganju, the sweet ju. Its color is greenish, and its shape resembles the fruit of a gourd. The patient constantly suffers from chills and fever; treat it promptly to eliminate the chills and fever. Left untreated, the patient dies within ten years, and pus emerges only after death.
When it breaks out on the rib-side, it is called baici, the rotting blemish. The rotting blemish is a disorder that afflicts women; moxibust it. As the disorder progresses it becomes a large welling-abscess full of pus; in treating it, once granulation flesh the size of a small red bean appears within, take one sheng each of zuoling root and qiaocao root, boil them in one dou six sheng of water, and reduce this down to three sheng. Have the patient drink it forcibly, then dress warmly and sit atop the cauldron to receive its warmth, so as to induce sweating down to the very feet; once this is achieved, the patient will recover.
When it breaks out on the thigh or shin, it is called gujingju, the thigh-shin ju. Its outward appearance shows little change, yet the abscess and its pus press against the bone. If not treated promptly, the patient dies within thirty days.
When it breaks out on the buttocks, it is called ruiju, the sharp ju. Its appearance is red, hard, and large; treat it promptly. Left untreated, the patient dies within thirty days.
When it breaks out on the inner thigh, it is called chishi, red-spreading. If not treated promptly, the patient dies within sixty days. Should it appear between the two thighs and go untreated, death should occur within ten days.
When it breaks out on the knee, it is called ciyong, the blemish welling-abscess. Its form is large, but the color of the swelling does not change; the patient suffers chills and fever, and the mass is hard as stone. Do not lance it with the stone needle — one who lances it while it is still hard will die. Only once it has softened should it be lanced; then the patient will live.
In all cases where welling-abscess or flat-abscess breaks out at a joint and its effects correspond straight through to the far side, it cannot be treated. If it breaks out on a yang aspect of the body, the patient dies within a hundred days; if on a yin aspect, within thirty days.
When it breaks out on the shin, it is called tunie, rabbit-bite. Its appearance is red down to the bone; treat it promptly. Left untreated, it will endanger the patient's life.
When it breaks out on the inner ankle, it is called zouhuan, sluggish walking. Its appearance is that of a welling-abscess, and its color does not change. Repeatedly lance its transport point with the stone needle to halt the chills and fever, and the patient will not die.
When it breaks out on the upper or lower foot, it is called siyin, the four excesses. Its form is a large welling-abscess; treat it promptly, for if untreated the patient dies within a hundred days.
When it breaks out at the side of the foot, it is called liyong, the dread welling-abscess. Its form is not large, at first no bigger than the little finger when it erupts; treat it promptly, removing whatever has turned black. If it fails to resolve and instead keeps enlarging, and is left untreated, the patient dies within a hundred days.
When it breaks out on the toe, it is called tuoyong, the sloughing welling-abscess. If its appearance is reddish-black it is fatal and cannot be treated; if it is not reddish-black, it is not fatal. If it fails to subside, amputate it promptly — otherwise the patient will die.
Huangdi said: 'Master, you have spoken of welling-abscess and flat-abscess — how are they to be distinguished from one another?' Qibo said: 'When the nutritive and defensive qi become detained within the channel vessels, the blood congeals and fails to move; when it fails to move, the defensive qi that follows it likewise becomes obstructed and impassable, and being blocked and dammed up, cannot flow — hence heat arises. When the great heat does not cease and the heat prevails, the flesh putrefies, and when the flesh putrefies it becomes pus. Yet in this case the disorder cannot sink in deeply: the bone and marrow are not scorched and withered, and the five viscera are not injured — hence this is termed a welling-abscess (yong).'
Huangdi said: 'What is meant by a flat-abscess (ju)?' Qibo said: 'When the heat qi is thick and exuberant, it sinks down deeply into the flesh and skin; the sinews and marrow wither, and the disorder connects inwardly to the five viscera, exhausting the blood and qi. Beneath the site of the swelling, the sinews, bones, and healthy flesh are all consumed without remainder — hence this is termed a flat-abscess (ju). In a flat-abscess, the skin above is lusterless and hard, thick like the skin of an ox's neck. In a welling-abscess, the skin above is thin and glossy. These are the signs by which the two are distinguished.'