Also mouse sores. From Plain Questions (素问 sù wèn). Lumps beneath the skin down the side of the neck and under the armpits. These are often referred to in older books as saber and pearl-string lumps because of the saberlike formation they can make below the armpit, and the necklace-like formation they make on the neck. Scrofula arises in liver-kidney yīn vacuity and enduring liver qì depression when vacuity fire scorches the fluids and turns them into phlegm, when then gathers in the neck, armpits, or groin. In some cases, wind-fire evil toxin is also a factor. Scrofula starts as bean-like lumps, associated with neither pain nor heat. Subsequently the lumps expand and assume a stringlike formation, merge, and even bunch up into heaps. They are hard and do not move under pressure. In the latter stages, they may become slightly painful. They can rupture to exude a thin pus and sometimes contain matter that resembles bean curd dregs (residue of ground soybeans in the production of soybean milk and tofu). They can take a long time to heal, old ones healing while new ones arise. In some cases, fistulas may form.
Biomedical correspondence: tuberculosis of lymph node; lymphadenitis.
Medicinal therapy: Course the liver and resolve depression; soften hardness and transform phlegm. Use Free Wanderer Powder (逍遥散xiāo yáo sǎn) combined with Two Matured Ingredients Decoction (二陈汤èr chén tāng). In advanced stages, base treatment on enriching the lung and supplementing the kidney, using Six-Ingredient Rehmannia Pill (六味地黄丸liù wèi dì huáng wán) plus adenophora/glehnia (Adenophorae seu Glehniae Radix, 沙参shā shēn) and ophiopogon (Ophiopogonis Radix, 麦门冬mài mén dōng).
Acumoxatherapy: Use principally local points and points selected according to the affected channel. Main points: ouch points (阿是穴ā shì xué) (i.e., the nodes themselves), Hundred Taxations (百劳bǎi láo) and Tip of the Elbow (肘尖zhǒu jiān). Apply treatment in the following way: Prior to rupture, fire-needle the center of each node once every 2–3 days. After rupture, for wounds that fail to heal, pole the affected areas or apply 3–5 cones of moxa on garlic or aconite cake every 3–5 days; complement acupuncture treatment with medicinal therapy and dressings. At Hundred Taxations (百劳bǎi láo) and Tip of the Elbow (肘尖zhǒu jiān), apply moxa pole or 5–7 cones directly or on ginger, repeating the treatment every other day. These points may also be needled with supplementation, retaining the needles for 15–30 minutes.
Point selection according to affected area: For scrofula on the nape, add TB-17 (Wind Screen, 翳风 yì fēng), TB-6 (Branch Ditch, 支沟 zhī gōu), and TB-10 (Celestial Well, 天井 tiān jǐng), and moxa GB-41 (Foot Overlooking Tears, 足临泣 zú lín qì). For the neck, add LI-14 (Upper Arm, 臂臑 bì nào) and ST-5 (Great Reception, 大迎 dà yíng), and moxa LI-10 (Arm Three Lǐ, 手三里 shǒu sān lǐ). For the armpit, add GB-21 (Shoulder Well, 肩井 jiān jǐng), HT-3 (Lesser Sea, 少海 shào hǎi), and GB-38 (Yáng Assistance, 阳辅 yáng fǔ). Needle with drainage.
Point selection according to the progression of the disease: For initial-stage scrofula, needle with drainage at BL-18 (Liver Transport, 肝俞 gān shù), LR-3 (Supreme Surge, 太冲 tài chōng), ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ), and ST-40 (Bountiful Bulge, 丰隆 fēng lóng) to course the liver and resolve depression, soften hardness and transform phlegm. For pronounced phlegm-fire, further add LI-4 (Union Valley, 合谷 hé gǔ), ST-44 (Inner Court, 内庭 nèi tíng), and SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo). For advanced stages, needle with supplementation at BL-23 (Kidney Transport, 肾俞 shèn shù), BL-13 (Lung Transport, 肺俞 fèi shù), BL-43 (Gāo-Huāng Transport, 膏肓俞 gāo huāng shù), LU-9 (Great Abyss, 太渊 tài yuān), KI-3 (Great Ravine, 太溪 tài xī), and ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ) to enrich the lung and supplement the kidney. For binding wind-heat toxin, needle with drainage at GV-20 (Hundred Convergences, 百会 bǎi huì), GB-20 (Wind Pool, 风池 fēng chí), TB-5 (Outer Pass, 外关 wài guān), GV-14 (Great Hammer, 大椎 dà zhuī), LI-4 (Union Valley, 合谷 hé gǔ), and ST-40 (Bountiful Bulge, 丰隆 fēng lóng), and prick LU-11 (Lesser Shang, 少商 shào shāng) to bleed.
Caution: Modern medicine observes that malign tumors of the nose, mouth, throat, and breast can spread to the lymph nodes of the neck and armpits. It is important to be able to differentiate these forms of metastasis from scrofula.