Lingshu · Abscess and Flat-Abscess

The text

The Yellow Emperor said: I have heard that the intestines and stomach receive grain; the upper jiao sends out qi, so as to warm the divisions of the flesh, nourish the bone-joints, and open the interstices. The middle jiao sends out qi like dew, pours upward into the ravines and valleys, and seeps into the grandchild vessels. The fluids are in accord; they change and become red, becoming blood. When blood is in accord, the grandchild vessels first fill; overflowing, they then pour into the network vessels; when all are full, they then pour into the channel vessels. Yin and yang already stretched, they travel by the breath; the travel has its warp and mark; the circuit has its road and principle; they join with heaven and cannot rest. Press and attune them. Follow vacancy and send repletion away: drain, and there is insufficiency; go swiftly, and qi diminishes; stay, and there is before and after. Follow vacancy and send vacancy away: supplement, and there is surplus. When blood and qi are already attuned, form and qi then hold. I already know the level and the unlevel of blood and qi. I do not yet know whence abscess and flat-abscess are born, the times of completion and ruin, the dates of death and life, which are far and which near — how does one measure them? May it be heard? Qi Bo said: The channel vessels remain and travel without stopping; they share heaven's measure, and join earth's mark. Thus when heaven's lodgings lose their measure, sun and moon thin and eclipse; when earth's channels lose their mark, the water-roads overflow; grass and sprouts are not completed; the five grains do not breed; the paths do not pass; the people do not come and go; they gather in lanes and dwell in towns, then part and live apart. Blood and qi are still like this. Let me speak of the reason. Now blood vessels, ying and wei, circuit and flow without rest; above they answer the star-lodgings, below they answer the channel-numbers. When cold pathogen lodges as a guest in the channels and networks, the blood weeps; when the blood weeps it does not pass; when it does not pass, wei qi returns to it and cannot come back again — therefore there is abscess-swelling. Cold qi transforms into heat; when heat overcomes, the flesh decays; decaying flesh becomes pus; if the pus is not drained, the sinews rot; rotting sinews injure bone; injured bone, the marrow melts. If it is not at the bone-hollows, it cannot discharge and drain; the blood withers and is empty; then sinew, bone, flesh and muscle do not nourish one another; the channel vessels are ruined and leak, and fumigate the five zang. The zang injured — therefore there is death. The Yellow Emperor said: I wish to hear fully the forms of abscess and flat-abscess, and the names of the taboo days. Qi Bo said: An abscess that issues in the throat is named Fierce Flat-Abscess. If Fierce Flat-Abscess is not treated, it transforms into pus; if the pus is not drained, it blocks the gullet — death in half a day. If it has transformed into pus, drain it, then mix with hog's fat, eat it cold, and in three days it is finished. One that issues in the neck is named Early-Death Flat-Abscess. The abscess is large and red-black. If not treated swiftly, heat-qi goes down into the deep armpit, injures the conception vessel in front, and inwardly fumigates liver and lung. Fumigating liver and lung — death in ten-odd days. Yang remaining and greatly issuing, melting the brain and remaining in the nape, is named Brain-Scorch. The color is not glad; the nape hurts as if stabbed with a needle; if the heart is troubled, death, and it cannot be treated. One that issues in the shoulder and upper arm is named Blemish Abscess. Its look is red-black. Treat it swiftly. This makes a person sweat to the feet; it does not harm the five zang. When the abscess has issued four or five days, then lance it. One that issues below the armpit, red and hard, is named Rice Flat-Abscess. Treat it with the stone-awl, wanting it fine and long; awl it sparsely; smear already with hog's fat; in six days it is finished; do not wrap it. If the abscess is hard and does not break, it is horse-blade, pinched-scarf goiter; treat it swiftly. One that issues in the chest is named Well Flat-Abscess. Its look is like a great bean. It rises in three or four days; if not treated early, it goes down into the abdomen; if not treated, death in seven days. One that issues in the breast is named Sweet Flat-Abscess. The color is green; its look is like a grain-fruit, small and precious. One is often bitter with cold and heat. Treat it swiftly; send the cold and heat away. Death in ten years; after death the pus comes out. One that issues in the flank is named Ruined Blemish. Ruined Blemish is an illness of women. Moxa it; the illness is a great abscess of pus. Treat it: within there is living flesh, as large as a red small bean. File one sheng each of ji and jia-cao root; boil in one dou and six sheng of water; reduce to three sheng; then drink strongly, wear thick clothes, sit upon a cauldron and let sweat go out to the feet — finished. One that issues in the thigh and shin is named Thigh-and-Shin Flat-Abscess. Its look is not severe; it changes, and the abscess-pus beats upon the bone. If not treated swiftly, death in thirty days. One that issues in the rump is named Sharp Flat-Abscess. Its look is red, hard, and large. Treat it swiftly; if not treated, death in thirty days. One that issues in the yin of the thigh is named Red Spreading. If not treated swiftly, death in sixty days; if it is within both thighs, if not treated, death in ten days. One that issues in the knee is named Blemish Abscess. Its look is large; the abscess-color does not change; there is cold and heat; it is like hard stone. Do not stone it; those who stone it die. Wait until it is soft, then stone it — they live. All abscesses and flat-abscesses that issue at a joint and answer one another cannot be treated. Those that issue in yang: death in a hundred days. Those that issue in yin: death in thirty days. One that issues in the shin is named Hare-Bite. Its look is red to the bone. Treat it swiftly; if not treated, it harms a person. One that issues at the inner ankle is named Running-Slow. Its look is an abscess; the color does not change. Stone its transports several times, and stop the cold and heat — no death. One that issues above and below the foot is named Four Overflows. Its look is a great abscess. Treat it swiftly; death in a hundred days. One that issues beside the foot is named Harsh Abscess. Its look is not large; at first it issues like a little toe. Treat it swiftly; send away the black. If it does not melt it only increases; if not treated, death in a hundred days. One that issues in a toe of the foot is named Shedding Abscess. Its look is red-black: death, and it is not treated. If it is not red-black, no death. If it does not wane, cut it swiftly; otherwise there is death. The Yellow Emperor said: You speak of abscess and flat-abscess — how does one distinguish them? Qi Bo said: When ying and wei linger in the channel vessels, the blood weeps and does not travel; not traveling, wei qi follows it and does not pass; it is dammed and cannot travel — therefore heat. Great heat does not stop; heat overcomes, then the flesh decays; decaying flesh becomes pus. Yet it cannot sink into the marrow of the bone; it does not become scorched and withered; the five zang are not injured — therefore it is named abscess. The Yellow Emperor said: What is meant by flat-abscess? Qi Bo said: Heat-qi is richly abundant; it sinks below the flesh and skin; sinew and marrow wither; inwardly it joins the five zang; blood and qi are exhausted. Beneath that abscess, sinew, bone, and good flesh are all without remainder — therefore it is named flat-abscess. In flat-abscess the skin above is large and hard, like the skin of an ox's neck. In abscess the skin above is thin and glossy. These are their signs.

The line

The Yellow Emperor said: I have heard that the intestines and stomach receive grain; the upper jiao sends out qi, so as to warm the divisions of the flesh, nourish the bone-joints, and open the interstices.

The note

Abscess and flat-abscess are a blockage of blood and qi between the divided flesh. The upper jiao sends out qi to warm the divisions of the flesh. Blockage is the road of warmth cut. Still ask qi first, not the bursting.