经云。东方实。西方虚。泻南方。补北方。此言治法也。而余取以治瘰 。尤不易之法也。
东方者。木也。足厥阴肝足少阳胆属之。阴不足。则阳有余。肝胆主节。筋无血养。则火自甚而
金不能平。木反侮之。于是喉之两傍。厥阴少阳经筋之所过。则郁给成核。始则一二。继则三五。
或左或右。累累如贯珠。久则溃烂。脓血淋沥。以致月消而败矣。南方者。火也。实则泻其子也。
如夏枯草、连翘、黄芩、贝母、玄参之属。清火消痰。使火不得以乘金。而金得以平木。将少阳
之火。不复炽矣。而厥阴之血。从何养乎。则补北方是也。北方者。水也。水乃生木。乙癸同源。
肝气不宜助而肝血宜滋。况肾水既旺。而不盗金之气。西方不虚。东方独得实乎。故泻南方者。
治瘰 之始。补北方者。救瘰 之终。余因是而悟古人立法之巧。非后人所几及。类如斯。
一瘰 女子多见之。男子间有。有血虚内热所致。有郁怒伤肝而作。或感大行暑热。或啖煎
炙醇酒。热生痰。痰成核。初则泻火消痰。开郁解毒。溃则补中益气。滋养肾水。庶成者可消。
而溃者可敛也。
夏枯草汤
夏枯草（三钱） 玄参 黄芩 土贝母 金银花 连翘 天花粉 薄荷 桔梗（各一钱） 甘草节（三分）
灯芯一握。水煎。郁怒。加香附、柴胡、钩藤、远志。血虚。加当归、白芍药。血热。加生
地、牡丹皮。气虚者。加味归脾汤入夏枯草。或逍遥散加贝母、夏枯草。饮食不入者。四君子汤
加广陈皮、香附、陈神曲。饮酒太过者。前方内加葛根、泽泻、青皮。去香附。肾阴不足者。六
味地黄丸。
The *Neijing* (Classic of Internal Medicine) states: "When the East is excess and the West is deficient, drain the South and tonify the North." This discusses treatment principles. I apply this method to treat Scrofula (Luo Li, cervical lymphadenitis), which is a highly sophisticated and difficult therapeutic approach.
"East" corresponds to Wood, specifically the Foot Jueyin Liver Meridian and the Foot Shaoyang Gallbladder Meridian. When Yin fluid is insufficient, Yang qi becomes excessive. The Liver and Gallbladder govern joints and sinews; if sinews lack blood nourishment, Fire pathogenic factors intensify, preventing Metal (West/Lung) from controlling Wood, leading to Wood insulting Metal instead. Consequently, at the sides of the throat where the Jueyin and Shaoyyang meridians pass, Qi stagnation forms nodules. Initially there are one or two, later three to five, appearing on either left or right, linked like beads. Over time, they ulcerate, discharging pus and blood continuously, leading to emaciation and exhaustion.
"South" corresponds to Fire. For excess patterns, one drains the "child" organ (clearing Heart Fire and Liver Fire). Herbs such as Prunellae Spica (Xiakucao, 夏枯草), Forsythiae Fructus (Lianqiao, 连翘), Scutellariae Radix (Huangqin, 黄芩), Fritillariae Bulbus (Beimu, 贝母), and Scrophulariae Radix (Xuanshen, 玄参) are used. These clear Heat and resolve Phlegm, preventing Fire from attacking Lung Metal, thereby allowing Metal to subdue Wood, so that Shaoyang Fire no longer blazes. Then, how is the blood of the Jueyin Liver meridian nourished? This is achieved by "tonifying the North."
"North" corresponds to Water. Water generates Wood; the Liver and Kidney share the same source (Yi-Gui Tong Yuan). Liver Qi should not be excessively assisted in its ascending nature, but Liver Blood should be nourished via Kidney Water. Moreover, if Kidney Water is abundant, it will not steal Qi from Lung Metal, ensuring the West (Metal) is not deficient, thus preventing the East (Wood) from being solely in an excess state. Therefore, "draining the South" is the initial stage of treating Scrofula, while "tonifying the North" is the final stage of saving the patient. Through this, I realized the ingenuity of ancient medical legislation, which is beyond the reach of later generations, generally speaking.
Scrofula is more common in women, with occasional cases in men. It may be caused by Blood deficiency with internal Heat, or by emotional depression and anger injuring the Liver. It can also result from contracting summer-heat pathogens or consuming fried, roasted foods, and strong alcohol, generating Heat and Phlegm that coagulate into nodules. In the early stage, one should drain Fire, resolve Phlegm, open stagnation, and detoxify. After ulceration, one should tonify Middle Qi and nourish Kidney Water, so that un-ulcerated nodules may dissipate and ulcerated ones may heal.
Prunellae Decoction (Xiakucao Tang)
Prunellae Spica (Xiakucao, 夏枯草) (3 qian), Scrophulariae Radix (Xuanshen, 玄参), Scutellariae Radix (Huangqin, 黄芩), Fritillariae Thunbergii Bulbus (Tuber Beimu, 土贝母), Lonicerae Japonicae Flos (Jinyinhua, 金银花), Forsythiae Fructus (Lianqiao, 连翘), Trichosanthis Radix (Tianghuafen, 天花粉), Menthae Haplocalycis Herba (Bohe, 薄荷), Platycodonis Radix (Jiegeng, 桔梗) (each 1 qian), Glycyrrhizae Radix et Rhizoma cum Melle (Gancao Jie, 甘草节) (0.3 qian), and a handful of Junci Medulla (Dengxin, 灯芯). Decoct in water. If symptoms of depression/anger are present, add Cyperi Rhizoma (Xiangfu, 香附), Bupleuri Radix (Chaihu, 柴胡), Uncariae Ramulus cum Uncis (Gouteng, 钩藤), and Polygalae Radix (Yuanzhi, 远志). If Blood is deficient, add Angelicae Sinensis Radix (Danggui, 当归) and Paeoniae Radix Alba (Baishaoyao, 白芍药). If Blood is hot, add Rehmanniae Radix Recens (Shengdihuang, 生地) and Moutan Cortex (Mudanpi, 牡丹皮). If Qi is deficient, use Modified Guipi Decoction (Jiawei Guipi Tang, 加味归脾汤) with added Prunellae Spica, or Xiaoyao Powder (Xiaoyao San, 逍遥散) with added Fritillariae Bulbus and Prunellae Spica. If food intake is poor, use Sijunzi Decoction (Sijunzi Tang, 四君子汤) with added Tangerine Peel (Guang Chenpi, 广陈皮), Cyperi Rhizoma, and Fermented Medicinal Leaven (Chen Shenqu, 陈神曲). If excessive alcohol consumption has occurred, add Puerariae Lobatae Radix (Gegen, 葛根), Alismatis Rhizoma (Zexie, 泽泻), and Citri Reticulatae Pericarpium Viride (Qingpi, 青皮) to the previous formula, removing Cyperi Rhizoma. If Kidney Yin is insufficient, administer Liuwei Dihuang Pill (Liujun Dihuang Wan, 六味地黄丸).