Scrofula refers to subcutaneous nodes that occur on the side of the head behind the ears, beneath the skin, resembling a string of beads. Larger ones are called "luo," while smaller ones are called "li," commonly known as "lizi tendon." In the late stage [third stage], it often extends to areas such as under the jaw, the supraclavicular fossa, and the armpit.

The term "scrofula" was first mentioned in Lingshu, in the chapter on Cold and Heat: "Cold and heat scrofula is located in the neck and armpits." Yixue Rumen further clarifies: "When it appears in the front and sides of the neck, the subcutaneous nodes are like mung beans or ginkgo nuts, it is called scrofula." Depending on the condition, it may be referred to as "horse knife li" or "horse bell." It can also be classified based on the disease cause or pathology, such as "phlegm nodule," "qi li," or "tendon li." When it heals in one place but breaks out in another after ulceration, it is called "rat fistula" or "rat sore."

bubble_chart Pattern Analysis

1. Phlegm Coagulation with Qi Stagnation︰Initially, it appears behind the ears or on the sides of the neck, with subcutaneous nodes the size of beans or fingertips, numbering one or three to five, with unchanged skin color, firm to the touch, movable upon pushing, and no fever or chills. Over time, they gradually enlarge, spread, and adhere to each other, becoming immovable upon pushing and causing pain, with a wiry pulse and white tongue coating. The ancients said, "No phlegm, no nodules." However, the formation of subcutaneous nodules is mostly due to stagnation. The sides of the neck are governed by the Shaoyang meridian, where qi is abundant but blood is scarce. If emotions are suppressed, liver depression and spleen impairment occur, leading to dampness and phlegm accumulation, obstructing the sinews and vessels, resulting in subcutaneous nodes. The diagnostic features are unchanged skin color, mild pain, easy mobility upon pushing, and absence of fever or chills. Treatment should focus on regulating qi and resolving phlegm. The formula used is Internal Scrofula-Resolving Pill (from the *Complete Collection of Sores and Wounds*). If the skin appears red, hot, and painful, with fever and chills, and a wiry and rapid pulse, it indicates invasion of wind-heat toxin. Treatment should aim to disperse wind and clear heat to drain fire. The formula used is Minor Bupleurum Decoction with additions such as Lonicera and Forsythia.
2. Liver-kidney Yin Deficiency︰The subcutaneous nodules adhere to each other and are immovable when pushed. After ulceration, they do not heal for a long time, with profuse, thin, and clear pus. There is afternoon fever, irritability, poor appetite, fatigue, or accompanied by cough, night sweats, tinnitus, and scanty menstruation in women. The pulse is thin and rapid, and the tongue texture is red. This condition is often caused by insufficient kidney water, deficiency of essence and blood, water failing to nourish wood, internal stirring of deficient fire, which scorches fluids into phlegm, leading to the accumulation of phlegm-fire. Although this syndrome and scrofula due to phlegm stagnation and qi stagnation both originate from "phlegm," the former is due to phlegm stagnation and qi stagnation, belonging to an excess pattern, often accompanied by qi-aspect symptoms of internal invasion of wind-heat toxin. The latter is due to liver-kidney yin deficiency, belonging to a deficiency pattern, often accompanied by blood-aspect symptoms of steaming bone fever and consumptive heat. The treatment should focus on nourishing the kidneys and strengthening the spleen, using the formula Yangyin Decoction (empirical formula).