bubble_chart Concept

Scrofula refers to tuberculosis that occurs on the side of the head behind the ear, under the skin and outside the membrane, appearing like a string of beads. Larger ones are called "luo," while smaller ones are called "li," commonly known as "li zi jin." In the late stage [third stage], it often extends to areas such as the jaw, supraclavicular fossa, and armpit.

The term "scrofula" was first seen 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 nodules like mung beans or ginkgo seeds appear on the front and sides of the neck, it is called scrofula." Depending on the condition, it may be referred to as "horse knife li" or "horse bell li." It can also be classified based on the cause and pathology of scrofula formation, such as "phlegm nodule," "qi li," or "tendon li." When it repeatedly heals and breaks out, it is called "rat fistula" or "rat sore."

bubble_chart Common Symptoms and Signs

1. Phlegm coagulation and qi stagnation scrofula: Initially appears behind the ear or on the side of the neck, with nodules the size of beans or fingers, ranging from one to several, with unchanged skin color, hard to the touch, movable, and without fever or chills. Over time, the nodules gradually enlarge, spread, adhere to each other, become immovable, and cause pain. The pulse is wiry, and the tongue coating is white.
2. Liver-kidney yin deficiency scrofula: Nodules adhere to each other, become immovable, and after ulceration, they do not heal for a long time, with thin, clear pus. Symptoms include afternoon fever, irritability, poor appetite, fatigue, or accompanied by cough, night sweating, tinnitus, and in women, scanty menstruation. The pulse is thin and rapid, and the tongue is red.

1. Phlegm coagulation and qi stagnation scrofula: As the ancients said, "No phlegm, no nodules." However, the formation of phlegm nodules is often due to stagnation. The side of the neck is governed by the Shaoyang meridian, which has more blood and less qi. If emotions are not regulated, liver depression and spleen damage can lead to dampness and phlegm, blocking the meridians and forming nodules. Key diagnostic features: unchanged skin color, mild pain, movable nodules, and absence of fever or chills. Treatment should focus on regulating qi and resolving phlegm. The formula used is Nei Xiao Scrofula Pill (from "Complete Works of Sores and Wounds"). If the skin is red, hot, and painful, with fever and chills, and a wiry, rapid pulse, it indicates internal invasion of wind-heat toxin. Treatment should focus on dispersing wind and clearing heat to purge fire. The formula used is Minor Bupleurum Decoction with additions like Lonicera and Forsythia.
2. Liver-kidney yin deficiency scrofula: Often caused by insufficient kidney water, deficiency of essence and blood, water failing to nourish wood, leading to internal movement of deficient fire, which burns fluids into phlegm, resulting in phlegm-fire accumulation. Although this condition and phlegm coagulation and qi stagnation scrofula both originate from "phlegm," the former is due to phlegm coagulation and qi stagnation, belonging to an excess pattern, often accompanied by qi aspect symptoms of internal wind-heat toxin invasion. 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. Treatment should focus on nourishing the kidney and strengthening the spleen. The formula used is Yangyin Decoction (empirical formula).